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Caroline Flint: I am involved in a great deal of work with organisations such as the Men's Health Forum to consider how we can encourage men to think about their health, and we are also considering innovative ways to use pharmacies and others to reach hard-to-reach
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groups whose members often do not come into GP surgeries. I understand that men are particularly guilty of that.

We are looking at other venues where it might be possible to get men to think about their health. For example, we have done some fantastic work with the Football Association and some good work is going on in football clubs up and down the country to engage men. Although men exclusively do not go to football, that is one way we can reach them.

I would like to say something further on the issue around gender, so I will come back to the hon. Member for Torridge and West Devon later. While we obviously need to look clearly at gender differences, there is some concern among women—we might be seeing some trends, as more women seem to be drinking more alcohol and smoking rates among women are also considerably high—that we need to address health issues arising from the change over the past 20 or 30 years in terms of taboos that existed for my grandmother and for my mother over women's lifestyles. I am not saying that that was all right or that it was rather judgmental, but there are consequences. We are seeing, because of that, some evidence that issues that were often seen as male health problems are starting to emerge among women as well. We must consider how best to deal with that too.

Mr. Geoffrey Cox (Torridge and West Devon) (Con): On the point relating to rural areas, does the Minister agree that the national weighted capitation strategy is plainly inherently biased towards urban areas? Its assessment of additional need adopts indices that are clearly not applicable to poverty in rural areas, to which the hon. Member for Stroud (Mr. Drew) referred. If it is inherently biased, and if the best method of capturing need in rural areas is being systematically missed, there will be increasing health inequality in rural communities. Is not that something that the Government should deal with urgently, and what is the Minister going to do about it?

Caroline Flint: The basis of funding to primary care trusts is determined on levels of need and issues around population are taken into account, but this is an area that we keep under review. To give an example from my constituency, which is semi-rural as it contains mining villages, we have benefited from money we got through the rural bus grant to have bus services provided for some of our outlying villages. That has given many people an opportunity to reach some of the services in Doncaster. That provision has helped and it is a good example as it involves health in terms not only of rural areas, but of how other Departments and those agencies closer to where people live—whether the local authority or the strategic transport executives—take these issues into account. The regional development agencies also have a role to play in looking at supporting infrastructure in our rural communities.

Mr. Lansley: This is an interesting point. Does the Minister agree that using ward-based data in relation to deprivation in rural areas such as her constituency might indicate high levels of deprivation there, while in many other rural areas such data do not do so because smaller numbers of relatively poor people are hidden by larger
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numbers of relatively wealthy people? One method of dealing with that is for the national health service in particular, given that it is building up through GPs an enormous database of morbidity—knowing how many asthmatics there are, knowing how many diabetics and the like—to transfer from assumed to real data.

Caroline Flint: Data are important for planning and commissioning. I have had interesting discussions about how some GPs are breaking down their practice areas, not just on a ward basis but street by street, to target services on those who are most in need, rather than getting in touch with everyone. Some exciting work has been done in rural and urban areas. For example, particular ethnic minorities have been targeted, because of certain health needs, to good effect. One of the Department's challenges is how to enable those who commission and plan services to use social intelligence better to construct services and gain better value for money through more precise targeting.

I am sure that the hon. Member for South Cambridgeshire (Mr. Lansley) would agree that, having given record funding to the NHS, our challenge is to demonstrate that best value for money is being achieved. My right hon. Friend the Secretary of State visited Dudley the other week where better-quality services are having much greater impact and better outcomes, from less money, than the old services used to provide. I visited a sexual health clinic off the Tottenham Court road only last week, which provided good examples of changing the way in which services are provided to improve access and save money. There is a 48-hour waiting time target for those services, which is challenging but which some providers are meeting. It is an exciting area, and those who are planning and want to provide services need to think about how to reach people in a more targeted way. If they do, we will have a much greater opportunity to close the health inequalities gap.

Mr. Blunt: Does the Minister agree that the gist of what she is saying is that the best way to address health inequalities, particularly those produced by social deprivation, is through first-class primary care services and community care hospitals, whereas the elderly population are more likely to need access to good critical care services? Does she accept that that is a reasonable definition?

Caroline Flint: In tackling health inequalities, it is critical to be clear which are the most vulnerable groups in the local community when it comes to suffering ill health. It is then a question of identifying the core components leading to those poor health outcomes. As to whether that is partly about changing what happens in the acute sector, there is probably room for improvement in hospitals. Provision in community hospitals is also part of the debate. But there are two other aspects. First, prevention can stop people getting ill in the first place or reduce illness. Secondly, people are living longer because technology has moved on and drugs are better, which is welcome—more people are surviving heart attacks and cancers. The question of provision for more long-term management of illnesses follows from that. Whether it should be done in hospital or in the community is open to debate. It is extremely
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important, however, that we consider outcomes, focus on what we are attempting to deliver and show clearly that what we are doing works. We need to be as robust in arguing for the activities that we encourage and support, especially in the context of public health, as are those in the clinical sector when it comes to operations and medicines.

Siobhain McDonagh (Mitcham and Morden) (Lab): Does my hon. Friend agree that although the average 65-year-old has more health needs than a younger person, some over-65s are very healthy? Average life expectancy in East Elmbridge and Mid Surrey is over 81, nearly 10 years higher than the average life expectancy for men in Cricket Green in my constituency. If we want to reduce health inequalities, should health services be concentrated where there are healthy 70-year-olds or where there are people 10 years younger whose health needs are far greater?

Caroline Flint: My hon. Friend is right. As I have said, life expectancy is much lower in some parts of the country and in some parts of communities than it is elsewhere. I am pleased that many people are taking action to improve their health, and that should be encouraged. We should do as much as we can through the NHS to help people to help themselves and to make the right choices. We must also bear down on health inequalities, however, and recognise that they are not a case of "One size fits all". We need a much more targeted and focused way of addressing health inequalities among those who are most in need. We must direct services to their communities, so that they can be taken up easily. That will enable such people to change their lives in the same way as other, healthier people elsewhere.

We have recently added health inequality targets to our other health targets and incorporated them in the business of the NHS. As a number of Members have pointed out, the issue of health inequalities cannot just be tagged on to the work of the NHS; it must underpin that work. Our targets on heart disease, cancer and smoking now automatically include elements to reduce the health gap. I am pleased to say that we have already seen a 24.7 per cent. reduction in the heart disease gap, and a 9.4 per cent. reduction in the cancer gap.

Local action is the key to delivering our national programmes throughout England. That means engaging with local delivery partners such as local government, the local health service, the voluntary sector and community groups. Through improved NHS funding and the measures specified in "Choosing Health", the most disadvantaged areas, covering 28 per cent. of the population of England, received extra support and money to help them to tackle health inequalities. Those steps must be supported by measures that identify and reward performance and by other incentives that encourage action in both health and local government services.

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