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10.2 am
Mr. Jonathan Sayeed (Mid-Bedfordshire): I congratulate the hon. Member for Stoke-on-Trent, North (Ms Walley) on securing a debate on a thoroughly important topic that affects the lives of many people. The publication of the White Paper on the national health service and the Green Paper on public health, both of which build on the considerable achievements of the previous Administration, means that the debate is timely.
The hon. Lady spoke about a range of inequalities in health care. I hope that she will understand when I say that I shall speak on only one--cancer care provision in the United Kingdom. Cancer remains our greatest medical problem. One in three people suffer from some form of cancer; one in four will die of it, and demographic changes mean that, by 2020, one person in two will get some form of cancer.
It is essential for the Government to support the previous Government's recognition that cancer is one of the main challenges facing our health service. The previous Government commissioned a report on a strategic plan for cancer services. It was published in 1995 and became known as the Calman-Hine report. It is one of the best reports that I have read in the past 20 years. It was practical and focused, and it has already led to considerable achievements in the provision of cancer care. However, there is still much to do.
The aim of the Calman-Hine report was to ensure that all patients
Perhaps I may be allowed a short commercial. For some years, I have worked with the Cancer Macmillan Fund, which is a superbly run charity. It does not waste money, but does what it is meant to do, which is to help people. It does that in a number of ways, one of which is by working with the NHS and with Government. It does not spend its time complaining but gets on with the job. My commercial is that those who are thinking of giving money to charity should put the Cancer Macmillan Fund on their list.
That charity has made it clear to me that there are significant variations in the availability and quality of services--the so-called cancer lottery. I congratulate the charity on its work with the NHS, which has benefited many patients. Much of its pump-priming work will be known to the House. It is the only charity that works with the NHS and others to provide cancer patients with expert nursing and medical care. It also provides a service that is often lacking in the NHS because it offers emotional and practical support from the point of diagnosis onwards, so that patients and their families may continue with productive working lives.
There are many examples of health care inequalities in tackling cancer, but I shall give just a few, because I know that other hon. Members wish to speak. Fewer than 50 per cent. of cancer patients are referred to a specialist for treatment, and only a fraction have access to clinical nurse specialists such as Macmillan. There is considerable evidence that some black and ethnic groups and older people are less well served than other members of the community. For instance, there is a low uptake among the Asian population for screening and palliative care, and there is a chronic shortage of information in languages other than English.
People in rural areas also have limited access to specialist services. I have not even touched on the widely differing arrangements for different types of cancer. For example, lung cancer patients often receive what is coyly called sub-optimal treatment whereas breast cancer patients rightly have a fast-track diagnosis.
One fundamental element links all those issues, and it is the lack of appropriate patient information on the types of services that are available, on the nature and course of the disease and, most importantly, what patients have the right to expect from those who are caring for them. Such information is not expensive to produce, but it is critical if we are to deal with what is already a scourge and will get even worse. Patients can demand better services only if they have access to the most basic information on their condition. Too often, that information is lacking.
The Government have made some welcome commitments in their recent White Paper and Green Paper, which I hope will end those forms of health inequality. However, fine words have to be supported by action and backed by resources. There is--to give one specific example--a considerable shortage of clinical and medical cancer specialists. The Government have given a pledge: to ensure that everyone with suspected cancer will be referred to a specialist within two weeks of their general practitioner recommending that course. That will be achieved only if action is taken now to recruit and train new postholders--otherwise, it will not happen.
Mr. Gareth R. Thomas (Harrow, West):
I congratulate my hon. Friend the Member for Stoke-on-Trent, North (Ms Walley) on introducing this debate on health inequalities--an issue that Ministers in the previous Government completely failed to address properly. One of the most disappointing features of the debate following the Green Paper's launch by my right hon. Friend the Secretary of State for Health was the continuing inability of Opposition Front Benchers to recognise the clear links between ill health and poverty, ill health and unemployment, and ill health and poor housing.
The London Research Centre--one of many research bodies working in the subject--has published many excellent reports, which have consistently highlighted the link between ill health and deprivation. Mortality rates in London are consistently worse in areas of deprivation. In the most deprived inner-London boroughs, mortality rates are up to twice as high as in some outer-London boroughs.
Therefore, one of the most positive aspects of the recent Green Paper on public health is the Government's commitment to improving health for the worst-off in our society and to narrowing the obvious health gap. Other positive features of the Green Paper are explicit recognition of the link between childhood injuries and social deprivation; of higher mortality rates for coronary heart disease and cancer among men of working age in the bottom social classes; and of rising incidence of poor mental health, particularly among the socially disadvantaged.
It is frustrating that it has taken so long for Government health policy to address health inequalities. As far back as 1980, the Black report concluded:
The failure to acknowledge and address the socio-economic factors affecting health was the most serious omission of the 1992 document "The Health of the Nation". The document's only reference to those socio-economic factors was made in section F of the appendix, which mentioned
As the Green Paper clearly states, poverty and unemployment can result in problems in keeping the home warm, may inhibit healthier life styles and increase the likelihood of accidents. The Government's welfare-to-work programme to tackle unemployment by offering a new deal to young people, the long-term unemployed and lone parents will be crucial--with the introduction of a national minimum wage--in beginning to tackle immediately those two key causes of inequality: low incomes and lack of employment opportunities.
Establishment of the Prime Minister's social exclusion unit--focusing on the needs of those on low incomes, who face a combination of social problems--will generate welcome longer-term initiatives to tackle health inequalities.
In my constituency, my local authority is due to receive next year about £2.3 million under the capital receipts initiative--part of a national programme that will, over the next two years, provide almost £800 million to enable a much more ambitious programme of repairs and improvements to our housing stock than would have been possible had the previous Administration's plans been continued. The measures will help tenants in social housing--who are usually the least well-off and most vulnerable to ill health--to be able to live in healthier domestic environments, free from the twin spectres of damp and overcrowding that not only damage our lungs and our respiratory system but increase the likelihood of accidents, sleeplessness and the spread of infections.
Increased energy efficiency programmes will be deliverable by the Energy Saving Trust now that the threat of a £5.5 million funding cut has been lifted by the Deputy Prime Minister and the Chancellor has cut value added tax on energy saving materials. Those programmes and the resources provided under the capital receipts initiative will be crucial in tackling the health problems of the least well-off that are caused by living in cold homes.
The Government have begun the task of confronting the inequalities in income, housing and job opportunities that are also the causes of major health inequalities. We have to ensure that international, national, regional and local partnerships for health improvement are developed by all key stakeholders. Such partnerships must be sustained and rigorously monitored to ensure that they are appropriately targeted and successful in narrowing--and eventually eliminating--health inequalities.
The success in Europe of my hon. Friend the Minister for Public Health in securing European Union agreement on ending tobacco advertising and sponsorship is one positive example of international action to reduce the greater incidence of smoking in low-income families. If our targets are to be achieved, it is essential also that effective work across Departments--which has already started, as the Green Paper demonstrates--continues.
Focused and co-ordinated policies in delivering long-term reductions in health inequalities will be crucial also at a regional and particularly at a local level. I look forward to a London regional development agency and a Greater London strategic authority focusing on health inequalities across the London region.
Too often, public health has been the cinderella service for health authorities, to the chagrin of many of the staff working in those authorities. Public health has not been singled out for development and has often been the first service to be targeted for service cuts. I welcome the important development of primary care groups, which will rightly shift health authorities' thinking to focus much more on improving health and away from concentrating on episodes of illness.
I look forward to my own Brent and Harrow health authority developing--in tandem with the council, local voluntary groups and other statutory bodies--a health improvement programme to help achieve the Green Paper's national targets and to tackle local priorities. Health action zones are a particularly welcome initiative in the Green Paper to focus investment and to generate impetus in tackling health inequalities in areas of considerable deprivation. The zones must generate long-term and sustainable strategies to confront those health inequalities.
Despite my constituency's relatively wealthy image, it has some significant pockets of poverty and poorer health. Just as Harrow will benefit from the health authority's--I hope successful--bid for a Brent health action zone, so we must ensure that best practice in the health action zones that are established is quickly identified and disseminated to all health authorities.
The most effective initiatives to date in tackling health inequalities have been born out of partnerships between a range of agencies and groups of local people. As my hon. Friend the Member for Stoke-on-Trent, North recognised, new duties on local authorities and NHS bodies to work together to promote well-being in their areas will help to deepen and cement the effective local joint working which is crucial to the success of the Green Paper.
The desire to improve health must also be at the core of regeneration initiatives in our inner-city areas and on rundown estates and part of the Government's wider drive to make urban areas more attractive and healthier neighbourhoods in which to live.
An integrated transport policy--for example, the provision of safe cycling and walking routes--will help to ensure better air quality, improve levels of fitness and lead to fewer accidents in areas of deprivation. In many such areas, banks and shopping facilities have been withdrawn, making access to the cheapest and most nutritious foods difficult. Credit unions, food co-operatives and local exchange trading systems all have a role to play in improving access to a range of services that tackle inequalities.
As regional development agencies work to increase investment, I hope that they will focus specifically on areas of high deprivation and will have a strong public health dimension to their work.
Measures to make sport and physical activity in general more accessible are essential components of a healthy environment, whether at school, in the workplace or in the wider community. Research by the English Sports Council clearly shows the link between unemployment and a sedentary life style. I share the concern of my hon. Friend the Member for Stoke-on-Trent, North about the
lack of decent sports facilities in many areas. In my constituency, a number of key communities are a considerable distance from proper sports facilities, and this problem needs to be tackled.
I congratulate some of our major sporting governing bodies, such as the Rugby Football Union and the English Sports Council, on targeting some of their development work on areas of great deprivation. I hope that the White Paper, when it appears after the consultation period, will encourage increased partnerships between sporting clubs and their communities to tackle health inequalities. The decision to stop the sale of school playing fields is a crucial step in the development of healthier schools, where pupils take regular exercise and are encouraged to participate in sports.
"received a consistently high level of service regardless of where they lived."
It highlighted
"variations in recorded outcomes of treatment"
and advocated that
"all patients should have access to a uniformly high quality of care in the community or hospital".
Much work was carried out under the previous Administration to make that strategic plan a reality, but much remains to be done. I urge the Government to take the opportunity that is presented by the Green Paper on public health to make fair and equal access to specialist, high-quality cancer care their priority.
"much of the evidence on social inequalities in health can be adequately understood in terms of specific features of the socio-economic environment."
We should not have had to wait until 1998 before the Black report's conclusions were listened to and acted upon.
"variations in health status between different socio-economic groups".
Sadly, it went on to conclude:
"the reasons for these variations are by no means fully understood".
In cold light, such apparently wilful ignorance of the causes of health inequality is astounding. I do not believe that those who drafted "The Health of the Nation" simply did not know or understand the causes of health inequality. The previous Administration--who were responsible for great increases in poverty and inequality--simply did not dare to admit that growth in the numbers of those on low incomes might have wider social
consequences. They chose instead to focus almost entirely on individuals' own behaviour, failing completely to own up to the consequences for the nation's health of economic policies that generated increasing poverty, poorer-quality housing and higher unemployment levels.
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