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Mr. Lansley: Will the Minister give way?

Caroline Flint: I have already accepted a number of interventions, but if I make enough progress I may give way to the hon. Gentleman later.
 
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Health inequalities exist everywhere, but we continue to emphasise the importance of making faster progress among the most deprived groups. We have therefore identified the 70 local authority areas with the worst health and deprivation indicators—the spearhead group. That epitomises our targeted approach and allows the creation of innovative public health programmes, such as the healthy schools programme and the provision of health trainers. Services are being tailored to the needs of local communities, and barriers to healthy living are being removed.

Local government is a key partner. We have agreed with local government a shared priority for healthier communities and reduced health inequalities. For the first time local authorities will be assessed, as part of the comprehensive performance assessment, on the action that they are taking to reduce health inequalities. The ongoing local area agreement process has enabled local authorities to embrace the agenda in their areas with enthusiasm. The White Paper offered the opportunity for more joint appointments of public health directors and for joint commissioning. We have recently made dealing with health inequalities the first of six top priorities for the NHS and have signalled our commitment to performance-managing the NHS more closely. We are also sharing best practice in areas that are delivering with those that are under-performing.

Government programmes to tackle child poverty and bring about neighbourhood renewal form an integral part of our strategy, but we also need to empower individuals to seize responsibility for their own health by improving socio-economic factors, thus giving them a reason to live and helping them to change their lifestyles. In the "Choosing Health" White Paper, we introduced health trainers—a new type of personal health support. They will be visible and accessible to local people, living and working in the communities they serve and providing "support from next door". We have engaged with nearly half the NHS to deliver, from April 2006, NHS health trainers in the areas of highest need. Having listened to people's concerns, we responded by announcing in the recent White Paper—"Our Health, Our Care, Our Say"—our intention to introduce NHS "life checks" at different points in people's lives.

Mr. Lansley: I am grateful to the Minister for giving way, because this is precisely the issue on which I wanted to come in earlier. She is right to say that interventions must be rigorously examined in the same way as clinical procedures, which is one reason why the National Institute for Health and Clinical Excellence has taken over responsibility for such matters from the Health Development Agency. She will of course be able to quote the evidence that points directly to the need to appoint health trainers and to provide the life checks outlined in the recent White Paper.

Caroline Flint: The work on health trainers was developed by talking to those on the ground about how we can engage people who are not presenting themselves to services in the traditional way. We have asked—[Interruption.] I shall finish my sentence, if the hon. Member for South Cambridgeshire will allow me. We have asked different areas of the country to provide information on such services, and we will evaluate their impact. [Interruption.] Both the life check and health
 
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trainer initiatives emerged from the White Paper consultation process. We will establish an expert stakeholder group, which will examine how the initiatives will work.

This is not about adding more checks—there are already opportunities for different checks—or adopting a one-size-fits-all approach; nor is it just about sickness: it is about health and finding a practical, non-burdensome way of engaging with people at different points in their life and getting them to think about their health. [Interruption.] For some people, relatively little action will be required. Many will be able to carry out a self-assessment and will need nothing more. But for others, a health check might be the spur for health providers to think about the services that they should provide, and for the individual to consider how their lifestyle is affecting their future health.

David Taylor: Is it not a bit much to have a constant stream of chuntering from Conservative Members while the Minister describes these initiatives? When they were in government, they denied the link between poverty and ill health. They suggested that elderly people should respond to fuel poverty simply by putting on an extra cardigan, and that people in northern constituencies such as hers should respond to an increase in the incidence of heart disease and other such illnesses by eating fewer chips. That is a very constructive and helpful public health policy, is it not?

Caroline Flint: No, it is not. In fact, under previous Conservative Administrations the term "health inequalities" was not used; instead, the Department was expected to use the phrase "variations in health".

Mr. Neil Turner (Wigan) (Lab): My constituency has a four-star authority, a three-star primary care trust and a three-star hospital trust. However, social services are seriously underfunded and the PCT is £10 million below its target figure. I realise that you recognise the problem of health inequalities, but can you indicate—

Mr. Deputy Speaker (Sir Michael Lord): Order. I gently remind the hon. Gentleman that he must use the correct parliamentary language when addressing a fellow Member.

Mr. Turner: I apologise, Mr. Deputy Speaker. What action will the Minister take to ensure that the funding inequalities experienced by the PCT itself and in its work with the local authority are addressed?

Caroline Flint: In areas where there is deprivation and various problems associated with a sizeable older population, the funding provided to local authorities and PCTs has taken such factors into account. However, there are opportunities for PCTs and local authorities to work more closely, and that needs to happen. We must also look at where resources are being directed, and decide whether they could be used differently to achieve better results. There are various good examples around the country of money being used better and achieving better outcomes. We do not micromanage the NHS from the centre, thank goodness, but we can give an oversight and provide access to the best information about what works. People
 
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like my hon. Friend and other colleagues will be able to use that information to ask their PCTs and local authorities why a system that produces results in other parts of the country is not being used to meet the challenges elsewhere.

I absolutely believe that it is very important not to underestimate the challenge posed by health inequalities. Our life expectancy target is deliberately challenging. We faced two problems when we set it—halting and then reversing a long-term trend. There is still a huge amount of work to be done, but I believe that the target is achievable, and am pleased to say that there are signs of positive change.

For example, 60 per cent. of the spearhead areas are making progress towards meeting the target and narrowing health inequalities. Of the 70 local authorities, 29 are on track to meet either the male or female elements of the target, and a further 13 are on track to meet both.

However, health inequalities are stubborn, persistent and difficult to change. Change will take time, but in our health and equality strategy we have identified a range of headline early-warning indicators, and other indicators. The most recent assessment of progress is set out in our status report published last August. Our latest robust data are for 2003, although of course work has been done since then. The figures show that health inequalities in respect of infant mortality and life expectancy were still widening, in line with the long-term trend. However, there are encouraging early signs of progress in key areas, such as reducing child poverty, improving housing quality and reducing inequalities in circulatory diseases.

As I said earlier, death rates from heart disease and strokes are falling. Importantly, the absolute gap between disadvantaged areas and the country as a whole has fallen by more than a fifth—22 per cent.—in the past six years. For example, a more targeted approach to tackling health inequalities among South Asian groups in Sheffield achieved a faster decline in heart disease mortality in deprived areas than in the rest of the city. The figures were 23 per cent. and 16 per cent., respectively.

We recognise that black and minority ethnic people experience inequality in health outcomes and in other social determinants of ill health. Therefore, we must also look at what is happening in our black and ethnic minority communities to make sure that the service is sensitive to the needs of the people who live there, irrespective of gender or ethnicity.

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