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Danny Alexander: Does the Minister accept that all the things that he has just described depend fundamentally on pensioners and benefit recipients being able to access those benefits in the first place? Does he agree that the Government's decision on the card account will severely undermine people's ability to access the benefits that are being uprated? Will the Government consider reversing that decision to enable full access to benefits for all the people who currently access them through their local post office?

Mr. Plaskitt: The hon. Gentleman again seeks to assert that there has been a recent decision or change of policy, but there has not. I repeat the commitment that we have given many times before that if pensioners and benefit recipients choose to collect their income from the post office we want to ensure they are able to do so.

We need to do more to meet the demographic, social and economic challenges that we face today. The Pensions Commission was clear that there is not a pensions crisis, but it identified about 9 million people who were not saving enough for their retirement. That,
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together with the demographic challenge of increasing life expectancy, would lead to a crisis in 20 or 30 years' time if we failed to make appropriate responses now. That is why we established the Pensions Commission to provide a reliable, independent review of the UK pension system and to make recommendations for change.

We are expanding the national pensions debate and talking to people of all ages across the country to listen to their views. We want to involve citizens and stakeholders in developing a lasting settlement on pensions. We will hold a number of events that will culminate in national pensions day on 18 March. The findings will help us to develop a consensus-based package for reform. I believe that building such a consensus is crucial. We want to ensure that the decisions that people make in the next few years about savings for retirement will still be sensible choices in 20, 30 or even 40 years' time.

The Government have undertaken their own rigorous analysis of the commission's proposals. The package of reforms that we will introduce in a White Paper in the spring will satisfy the five tests that my right hon. Friend the Secretary of State has set out to promote personal responsibility, and be fair, affordable, straightforward and sustainable.

In conclusion, the uprating order further delivers on our promises to help the people who need it most, supporting families and tackling the poverty suffered by pensioners and children wherever it occurs. We are supporting more people who can work into work, including people on incapacity benefit and lone parents. We are helping older people who want to return to, or remain in, the work force to extend their working lives. We are ensuring dignity and security for pensioners, as well as an end to abject poverty in retirement. For those reasons, I commend the orders to the House.

Question put and agreed to.




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Tackling Health Inequalities

Motion made, and Question proposed, That this House do now adjourn.—[Caroline Flint.]

2.44 pm

The Parliamentary Under-Secretary of State for Health (Caroline Flint): It gives me great pleasure to open the debate on inequalities in health. Over the past 50 years we have seen impressive social, economic and health improvements in the United Kingdom. People from every class and every region are healthier and are living longer than ever before. The differences over time are striking. For instance, data for 1972–76 show that male life expectancy in the lowest social group was 66.4 years. That compares to a life expectancy of 71 years by 1997–2001. That is an indication that public health policies are having an effect on people's lives, as are treatment and new drugs.

However, the Government are not complacent. We need to do more about inequalities. We know how to improve life expectancy, but we need to ensure that all parts of society are benefiting. We know that families in poorer neighbourhoods are at greater risk of infant mortality, still die at a younger age and are likely to spend more of their lives in ill health. A man living in Manchester is likely to die nine years earlier than one living on the south coast of England. We know, too, that a man working as a manual worker in a factory is a third more likely to report a long-standing illness, compared with a man in a professional group, such as a doctor or a lawyer.

Social injustices like those are what brought me and many of my colleagues into politics, and are one of the reasons why we have given health inequalities a high priority now that we are in government. From the beginning, we were keen to set the record straight. One of the first things we did was to commission a comprehensive inquiry into the evidence on health inequalities. We invited a former chief medical officer to chair the inquiry. The result was the Acheson report, published in 1998. Acheson showed a significant widening of health inequalities between the 1970s and 1990s. The differential had increased two to three times between the highest and lowest social classes. It could be addressed only by focusing on the wide range of determinants—social, economic and environmental—that have an impact on health.

Acheson focused on programmes and priorities, but targets are important to focus attention on the problem, to stimulate action and to engage key players. In 2001, we set a national health inequalities target for England that called for a 10 per cent. reduction in the health gap for life expectancy and infant mortality. We extended this approach by including health inequalities as part of our key targets on heart disease, cancer and smoking. We have used the adoption of national targets as a way of influencing and shaping policy across the Department of Health, the health service and, importantly, other Government Departments, too.

In our target on smoking—the biggest cause of avoidable deaths—and our work to reduce smoking levels, we recognise that we cannot achieve our overall goal to reduce smoking levels without focusing on the hard-core group of poor smokers. Clearly, the decision
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of the House to ban smoking in all public places apart from a few exemptions, which was supported by Members from all parties, will make a huge contribution to tackling the problem, and took account of the concerns about health inequalities caused by partial restrictions on smoking in public places, particularly licensed premises.

Mr. Crispin Blunt (Reigate) (Con): The hon. Lady ought to concede that it was the view of the House on a free vote that overrode the policy of her Department that was presented to the House on Second Reading—a policy that would have promoted health inequalities resulting from smoking.

Caroline Flint: As I said in the debate, the opportunity that we had to vote came about because Labour decided that we should legislate on the matter. I am pleased that there was a debate. It was healthy for democracy. It is a Labour Government who are doing more than any Government before to tackle the problems of smoking and the effects on others who do not smoke.

Mr. Andrew Lansley (South Cambridgeshire) (Con): I get the impression that the hon. Lady might be moving away from telling the House in simple terms what has been the result thus far of the two national targets relating to life expectancy and infant mortality.

Caroline Flint: I intend to cover those issues, which are very complex. [Interruption.] Well, they are complex. The reality is that everybody from every social group is making progress in terms of their life expectancy. Our problem, which I am certainly not afraid to face up to, is how we deal with a situation whereby although everybody is living longer and improving their health, people who are better off and more educated take up the challenges of improving their health more quickly than those who are less well off and less educated. That is one of the reasons why we have to deal with the gap, of which I am fully aware.

Mr. Graham Stuart (Beverley and Holderness) (Con) rose—

Ann Winterton (Congleton) (Con) rose—

Caroline Flint: I should like to make a little progress in the hope that I will deal with some of the points that the hon. Gentleman and the hon. Lady may make, but I will be happy to take interventions if I do not.

Following the adoption of the national target, health inequalities was chosen as the subject for a cross-Government review led by the Treasury. That review was designed to influence spending decisions across Government as part of a wider programme to address child poverty and promote social justice. Jointly chaired by the Department of Health and the Treasury, it brought together 18 Departments—from Department for Work and Pensions to the Department for Transport—and Government units and agencies. Together, they assessed progress and agreed priorities for action. For us, the role
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of the Treasury provided the catalyst for this cross-Government work and a new national health inequalities strategy.

That strategy—the programme for action launched in 2003—sets out four themes to tackle health inequalities: supporting mothers, families and children; engaging with mothers, families and children; preventing illness and providing effective treatment and care; and, importantly, addressing the underlying determinants of health. Those four related themes set out a programme to address health inequalities on a broad front, directed to the whole population and designed to ensure that responsibility for tackling health inequalities lies at the heart of all public services. That includes work on urban and neighbourhood renewal and on giving children from poorer families a fairer start in life through Sure Start. As well as focusing on the 2010 national target, the strategy seeks to address some of the underlying causes and determinants of health such as employment, education, crime, transport, early years support and homelessness. Our aim is to improve everyone's health, but to improve the health of the poorest fastest.

People living in disadvantaged areas usually have much lower expectations of the health care system and of their own health. On a recent visit, we met a 49-year-old man who, despite breathlessness, did not think that he was unwell. He said, "I'm not ill—I'm just getting old". Yet he was not even 50. Here we are in Westminster, where a man will most likely live until 76. If we travelled east on the Jubilee line to Canning Town, eight stops away, we would find that on average men live until 69—a seven-year difference. A shorter life expectancy means that families are robbed of parents and grandparents. Between 2002 and 2004, there were 13,700 additional deaths among 30 to 59-year-olds in the most deprived local authorities compared with the rest of England.

The status report on the programme for action published last August showed encouraging signs of progress on health inequalities, but recognised that a significant challenge remained. Following that report, we decided to commission a review of health inequalities, which was undertaken in conjunction with the Treasury. The review signalled a conscious decision to improve our performance and to ensure that we use the available evidence base to meet our targets. We have developed a model to deliver real improvements in public health in the short term that concentrates on averting early death. The model identifies the age groups we need to focus on—the 40 to 60-year- olds—the most common causes of early death, and the most effective treatments and interventions we can apply to prolong life.

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