House of Commons
Wednesday 25 February 1998
The House met at half-past Nine o'clock
PRAYERS
[Madam Speaker in the Chair]
Health Inequality
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Jamieson.]
9.34 am
Ms Joan Walley (Stoke-on-Trent, North): I am grateful for this Adjournment debate because never has it been more important for the House to debate inequalities in health. After 18 long years when the divide between those in good health and those in bad health got worse than ever, for the first time we now have positive action from the new Labour Government and a commitment from the Minister for Public Health, my hon. Friend the Member for Dulwich and West Norwood (Ms Jowell), whom I am pleased to see in her place this morning, to do something about health inequality.
I have spent 11 years representing North Staffordshire, so it is not surprising that, along with my colleagues from the area, I want us to address the issue of health inequality. I want the Government's actions to mean something and to make a real difference to my constituents' lives. That is why I asked for this debate.
It is also fitting that, 150 years after the first public health Act and 50 years after the birth of the national health service, we now have a public health Green Paper, "Our Healthier Nation". We have until 30 April 1998 to submit our comments, so we need a countrywide debate on public health. That would be a first step towards improving the nation's health, and I hope that this morning's debate will stimulate that debate.
I want people in both the urban and rural areas of my constituency to discuss public health, and I want the debate to take place at local level: at work; in schools; in youth clubs; in voluntary organisations--I have received many representations from voluntary organisations about the importance of this morning's debate; in the community; in councils and in parish councils in rural areas; in sports halls, churches, halls, clubs, pubs and working men's clubs; in doctors' surgeries and clinics while people wait for treatment; and wherever people get together.
I welcome the four main categories set out in the Green Paper: heart disease and strokes; accidents; cancer; and mental health. It is important to debate the targets for those categories. I spent many years as president of the West Midlands Home Safety Council, which, along with many other organisations, such as the Royal Society for the Prevention of Accidents, has long pressed for more to be done by local authorities to prevent accidents in the home. Obviously, more also needs to be done to prevent road traffic accidents, and accidents and disease at work.
I welcome the targets to reduce heart disease and strokes by a third, cancer deaths by a fifth and suicides by a sixth. I doubt whether anyone would challenge or question those laudable objectives and I hope that they will be discussed at length as the debate about public health takes place throughout the country.
I am concerned that, while the Government get on with changing the structure and framework of the NHS through the new NHS White Paper, I do not want them to lose sight of the important, all-embracing, over-arching concept of sustainable development, which recognises that the principles behind public health are part and parcel of all aspects of public policy. I welcome the White Paper, as it lays the foundation for beginning the process of modernisation and especially accountability, so that we can deliver uniformly high standards of health care. It consults, and puts a clinical focus on the four main targets.
This is a challenge for us all, and we must support our Minister for Public Health, no matter which side of the House we are on. We must help her in her co-ordinating role to ensure that the comprehensive spending reviews that are taking place across all Departments recognise the importance of public health policies. The Advisory Committee on Resource Allocation must tackle real needs, and the new health improvement programmes, which identify and meet local needs, must have the resources to do what is necessary.
I shall mention some of the consultation documents that are being discussed across the country. The Department of the Environment, Transport and the Regions has produced a White Paper, "Building Partnerships for Prosperity"; a review of planning guidance and of planning for the communities of the future. The housing conditions survey is important, as housing is crucial to health. A consultation document on contaminated land is due shortly, and a review of water charging is currently out for consultation.
The DETR has also produced a document on opportunities for change and a new strategy for a sustainable future. There are reviews of the crucial matter of national air quality and of regulation strategy, which are being undertaken by the Department of Trade and Industry, and new lottery legislation will bring in many bids across the country. All are integral to the promotion of an enhanced quality of life and improved public health.
The public health Green Paper makes many healthy references to the need for local authorities to work in public health partnerships with NHS trusts. A duty on local government and health trusts to work together to produce local health improvements is proposed. However, we must not fragment public health provision by leaving councils with insufficient means to close the huge health gap between the rich and the poor.
Health inequality is tied up with domestic metering of water and disconnections; energy efficiency in the home; the fact that the worst sewers are often in the oldest parts of urban areas; poverty wages, low-income households and the condition of people's homes; and a lack of sports facilities. Many schools in my constituency lack proper sports facilities: how can people take up healthy, active life styles without them?
Health inequality is also tied up with poor diet; unsound agricultural practices, such as the use of untreated abattoir waste as fertiliser for crops and the risk of that getting into the food chain; polluted air; stress; and low educational
achievement--we know all about that in North Staffordshire. Unemployment also has an effect, and, in parts of my constituency, people are on a four-day working week. We must also urgently address the failing child support system.
I speak as the vice-president of the Institute of Environmental Health Officers. Environmental health officers often do not get the recognition that they deserve: they come a poor third in health authority partnerships. Indeed, a MORI survey for the Anchor Housing Trust showed that only 56 per cent. of health authorities consulted environmental health departments when putting together plans for 1998-99.
Just as Edwin Chadwick--an engineer, not a doctor--inspired medical officers of health and developments in public health, we must, as the millennium approaches, recognise the importance of public health to all areas of policy if we are to reduce ill health and health inequality. Ordinary people, just as much as doctors and clinicians, can contribute to improving public health.
That over-arching framework is as relevant to Europe as to the United Kingdom. I urge the Minister to press urgently for wider European Union public health competence through an extension of article 129 of the treaty of Rome when she chairs the European Union Health Council. The Institute of Environmental Health Officers would welcome the opportunity to work with the Government to achieve that.
The truth is that the previous Government failed to recognise the effects of their blatant cumulative under-resourcing of local authorities through the standard spending assessment formula and the abandonment of the resource allocation working party, which did much to redress the balance. Those of us who have been around for a while know that RAWP attempted to iron out the health inequalities that left people in many parts of the country suffering appalling ill health. Such people lived in rundown inner-city areas which traditionally depended on heavy manufacturing industry, but there were pockets of deprivation in rural areas, too.
Ill health reduces daily living to a remorseless and painful struggle for survival. Month by month, our national health services are merely firefighting. Hospital waiting lists are unacceptably long; efficiency savings to pay for treatments have to be made despite our injection of extra money; and litigation costs have to be paid because underfunding has meant that services cannot be provided.
We could start to improve the service if we were able to prevent ill health. The Green Paper will help, but the reality, at least for many of my constituents, is a world apart. That brings me to the second part of my speech--why I want the House to discuss these issues.
Health, good or ill, depends largely on where people live and on their circumstances. I do not think that it should. We in North Staffordshire consider ourselves fortunate. We are a proud community, and we look after one another as best we can. The performance of the Staffordshire ambulance service trust is such that an ambulance arrives at life-threatening emergencies after an average wait of six minutes 11 seconds. The average in all other cases is seven minutes nine seconds. That performance is not bettered anywhere in the United Kingdom; I doubt whether it is bettered in Europe.
In this financial year, the Staffordshire ambulance service trust has responded to 90.28 per cent. of life-threatening emergencies in eight minutes, 97 per cent. in 14 minutes, and 99.36 per cent. in 19 minutes. That is excellent, but there the good news ends. The bad news is that, in an area of 1,000 square miles, the trust had responded to 48,285 emergencies by 20 February this year.
We must learn the lessons of best practice from the trust, and recognise its experience and the improvements that it has made. That must be fed into the review. But the downside is the high death rate from chronic heart disease, which must be treated in the short term, and prevented in the long term.
In my constituency from 1981-92, the odds of people dying before their 65th birthday were 25 per cent. higher than the British average for someone of their age and sex. Furthermore, those odds were more than 75 per cent. higher than in Esher and Walton and in South Cambridgeshire, the constituencies with the lowest rates of premature mortality.
Hon. Members know that people can use statistics to show whatever they want. Whatever figures I consult, however, I receive the message that North Staffordshire, and Stoke-on-Trent in particular, rank highly in terms of relative deprivation. The public health common data set figures show that, in regard to most causes, Stoke has a standard mortality rate of more than 100. In the case of heart disease in men, the rate is 123, 23 per cent. above the average. That makes us 30th out of the 358 local authorities in England. In terms of accidents among women, we rank 23rd.
As for premature and infant mortality, in 1996 there were 5,597 perinatal deaths in England and Wales; there were 689 in the west midlands, and 57 in North Staffordshire. Since 1983, our rate has been consistently higher than the average, and consistently higher than the west midlands rate and the west midlands rate trend, never falling below 10 per 1,000.
Contributory factors include poor nutrition, social deprivation, teenage pregnancy--there is a high risk of teenage pregnancy in North Staffordshire--smoking and drinking alcohol during pregnancy, and inadequate standards of obstetric and paediatric care. Such inadequate standards have been identified as causes of some deaths in confidential inquiries throughout the United Kingdom, and North Staffordshire is clearly no exception.
It is not just infants who start off with reduced life expectancy. The Association of Retired Persons over 50 campaigns for the rights of older people. I am sure that many of us who are present today, if we have not quite reached 50, are not all that far from it.
The North Staffordshire pensioners convention and North Staffordshire Healthwatch campaign for improved services for older people, believing that discrimination on the basis of age rather than need leads to the delivery of inappropriate treatment and, in some instances, the complete absence of effective care. They are worried about the widening gulf between the treatment of older people and the treatment of those under retirement age. I do not want that to happen in my constituency.
Screening for breast cancer in women over 60 is a matter of special concern. I know that the House has discussed the issue before, but I want to flag it up briefly today. There is also a lack of adequate preventive
treatment for osteoporosis and prostate cancer. I am especially concerned about health issues affecting women, because I think that women's health care is very important.
In North Staffordshire, we have a particular problem. It is no accident that we have a relatively high number of long-stay continuing-care beds. In our area, older people cannot necessarily afford private health care. Despite an extensive campaign to keep our NHS long-stay beds, 37 beds are mothballed at Stanfield hospital, and so far no progress has been made on a proposed private finance initiative bid for reprovision of beds at Westcliffe hospital, although it has already been formally agreed through consultation.
There is a good deal of fear and anxiety, because the legacy of underfunding--not just of the health service, but of social services--has left us short of resources for community care. I feel that I have a debt of honour to my elderly constituents. We must plan for the long term and the short term, and also plan transitional arrangements.
I have been inundated with briefings from a number of organisations that want to hammer home to the House just how unfair the system is to those who happen to live where services are insufficient, and whose particular illnesses are not given the priority allocated to them in other parts of the country. We have had another campaign in Stoke-on-Trent to prevent the proposed closure of the fertility unit by the health authority. Although we have had a minor victory, in that the unit has been reprovided, it has been reprovided in a private clinic. There is not enough money from the national health service to pay for treatment there. Those living elsewhere have access to fertility treatment, but there is a definite ceiling on the amount of money available in North Staffordshire.
Dental care is another problem. It is barely possible to gain access to a dentist at present. We currently have applications for extra bids to help the provision of dental care on the NHS in North Staffordshire. Our children have the worst dental health care record in the west midlands--hence our bid.
There are many indicators relating to coronary heart disease, strokes, lung cancer, schizophrenia and suicide. In every instance, the North Staffordshire rates are worse than the west midlands rates, and worse than the rates in England and Wales. I hope that the Minister will have a chance to examine the figures.
There are even worse figures. The extent of ill health in North Staffordshire is illustrated by data showing an increased use of health services in Stoke-on-Trent and North Staffordshire. In 1996-97, there were 170,230 finished consultant episodes at the two NHS trusts in North Staffordshire. That represents about 360 per 1,000 of population, compared with 230 for England as a whole.
The problems that my constituents face daily are illustrated by the fact that the average GP list size in North Staffordshire was 2,077, higher than the England average of 1,881. That average was the highest in the west midlands, and the ninth highest in England, as of 1 April 1997, according to statistics from the NHS executive.
Yesterday, I received a telephone call from a constituent aged 74, who had hardly ever had any NHS treatment. He, his wife and his son--who has had a stroke--have all been struck off by their GP, who does not have to give a reason. We have a shortage of GPs.
Not enough trained GPs are being provided, and, in an area without a medical school, we cannot train the people we need.
I do not like painting a black picture, and I do not intend to do so this morning. We all live with the position daily in North Staffordshire, and we know how urgent is the need to deal with it. Some 10 years ago, the city council published a report called "Health of the City", which remains a blueprint for action, and confirms what I know from my surgeries.
It is clear that there are pockets of extreme ill health and deprivation in North Staffordshire's health authority area that urgently need to be tackled. The key indicators of risk of poor health in certain wards have led to their being designated health action areas. We are making progress, and doing a great deal to offset the problems. The designation of health action areas is a result of joint action that Stoke-on-Trent city council and Staffordshire Moorlands district council have already taken with the health authority. In those health action areas, the Jarman score is unacceptably high, but it is clear that we are making progress.
The problem is that many people cannot wait to be treated, no matter how much we are doing to put in extra money. Many cannot easily see doctors or dentists, and many must wait too long for social work support. Many cannot easily reach clinics. I am currently doing my best to stop the closure of a clinic in Fegg Hayes. We are hoping for a joint initiative to retain clinics in areas where they are needed, to provide family planning and other services.
It is obvious that there are not enough services to meet the needs of people in North Staffordshire. That may lead the House to conclude that our trusts, councils and voluntary organisations are not doing their best, but nothing could be further from the truth: they are doing the best that they can in very difficult circumstances. I want the Minister to know that. They are working in partnership to reduce health inequality in North Staffordshire, especially in those pockets of deprivation where health is worst.
The Green Paper sets out targets relating to specific illnesses, and calls for local initiatives jointly to tackle specific local problems.
We have already started that joint work in our health action areas, but we could do much more. There is a new unitary local authority in Stoke-on-Trent, and it could also do much more. As a result of wanting to do more, it has submitted a proposal for a health action zone. I want that bid to succeed, because it shows that we have the will and the vision and that there is local co-operation to address our specific problems.
I understood that need would play a large part in determining the areas that would succeed in being designated as health action zones. We in North Staffordshire are convinced that our bid is based on need, and we want it to succeed. We are concerned that the panel that is advising Ministers seems already to have excluded our bid. Only three of the six bids from our region are being forwarded with a regional office recommendation for consideration. There will be a decision at the end of March, and I fear that North Staffordshire will not be chosen, because our bid has not been forwarded. I urge the Minister to look in detail at our needs and our bid. We should be pleased to co-operate if she wishes to arrange a meeting.
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