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Mr. Cox: My hon. Friend may be aware of the report commissioned by the Department for Environment, Food and Rural Affairs in December 2004, in which the Institute of Rural Health reported on a survey of various agencies responsible for the collection of data from which funding decisions would subsequently be made. It said that the majority had no idea that they should be looking at rurality factors or collecting data against the definition of rurality, and were not gathering information that enabled anybody to distinguish between rural and urban areas and thus to make fair decisions for rural areas.

Mr. Lansley: I am grateful to my hon. Friend. I do recall that. My hon. Friend the Member for Westbury (Dr. Murrison) has published some material of his own on how we could deal with rural health problems and inequalities of access.

The principle of evaluating policies for their impact on health inequalities is established in theory, but it has to be carried out in practice—it is a rigorous process. Technically speaking, that is what the Acheson report recommended. I am not sure how well that has gone recently, given the inclusion of the Airdrie and Shotts provisions in the Health Bill at the end of last year.

Inequalities of access need to be tackled. The Government were right to point in their White Paper to the wide disparity in the availability of GPs in different parts of the country relative to their populations. I was entertained and impressed by the article from Simon Stevens, a former adviser at No. 10, who said that the language used in the White Paper exactly mirrored that used in 1920 in relation to the distribution of doctors across the country. These are intractable problems, but we have to tackle them—I make no bones about that. We have to ensure the availability of services in the
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community, notwithstanding whether GPs want to be self-employed principals in general practice in some parts of the country.

I want to close with one further thought. As I said earlier, it is always invidious to try to single out major disease groups, but the Government, right at the start of their time in office, singled out cancers and coronary heart disease. I know why they did it, and it was not a dishonourable thing to have done, as cancers and coronary heart disease were the largest and most avoidable killers. However, the time has come for there to be a wider range of clinical priorities and for their distribution to be much more determined by clinicians, practitioners and professionals than to be dictated by a narrow range of Government targets. Stroke is a classic illustration of that. The National Audit Office report identified many things that could be done today that would not only deliver substantial improvements but save more than 500 lives a year. That is the same number of lives that we set out to save in the Health Bill on Tuesday as a result of the changes to smoking. If the NHS took some of the necessary measures, such as immediate CT scans, 500 lives could be saved today. That would save the NHS money. It would not cost it any more; it would not only be value for money but would reduce the cost of treatment. The same, as I said, is true for lung disease and the availability of pulmonary rehabilitation, for example.

Such matters have to be dealt with, but for lung disease—for all that chronic obstructive pulmonary disease is a real killer—the disparities are striking. I was astonished to read that in the north and west mortality rates are 30 per cent. above the national average; in the south they are 30 per cent. below the average. Those are massive disparities. [Interruption.] Well, if the hon. Member for North Durham knows that, why is it not on the Government's priority list? Why is there no national service framework, since that is supposed to be how the Government have addressed such matters over the years? Why is the British Thoracic Society having to argue for a national service framework? Why has no national clinical director dealing with respiratory diseases been given the status of others? Why is there not pulmonary rehabilitation? Why do we not have routine spirometry in GP practices? If the hon. Gentleman wants those things to happen, why did he not intervene on the Minister to ask for them rather than intervening on me?

Mr. Kevan Jones: I will not take any lessons from the Conservative party on COPD. The Government put in place the most generous compensation package for those miners whose health was ruined while the hon. Gentleman's Government refused to settle those claims for many years. It is a bit rich if he is trying to say that now.

Mr. Lansley: The hon. Gentleman should understand that I am not asking him to take lessons from me, but from the British Thoracic Society. I am sure that even those former miners would take the view that the fact that they have been given compensation does not mean that they should not receive the highest quality health services. Of course they should, and that is what we are arguing for.
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To tackle health inequalities we require a focus on the evidence of the disease group from which those inequalities come, on the behavioural and environmental factors and on an understanding that relative inequalities will not necessarily be overcome, even if at the same time we—like countries across the world—improve aggregate health outcomes. As in the debate about Herceptin, if it is a national health service, the national part demands equitable access to services. It should not be distorted by the centre's failure to understand what clinical criteria should be applied on a consensual basis or by distorted funding from the Government to try to advantage some areas of the country. If we do all those things and improve the public health environment, I hope that in years to come a new Conservative Government will bring our reports back to the House and show that we have tackled and reduced health inequality.

4.13 pm

Siobhain McDonagh (Mitcham and Morden) (Lab): I am pleased that the subject of today's debate is tackling health inequalities because I have tried to address that issue in my constituency since my election in 1997. I have had first-hand knowledge of the Government's commitment to confronting and dealing with inequalities. Last week, more than 250 people from two council wards in the south of my constituency braved a freezing February evening to attend a small reception hosted by the London borough of Merton and me to thank my right hon. Friend the Secretary of State for saving their local general hospital, St. Helier. They wanted to thank her for listening to their concerns. Many were elderly or infirm and they had suffered for years as a result of inequalities in the health service, but they wanted to celebrate because they were so delighted that the health establishment's decision about where to locate a new hospital had been overruled in order to tackle health inequalities.

Inequalities in health care had become virtually unchallengeable by the end of 18 years of Conservative Government. My constituency is one of the most disadvantaged in our strategic health authority's catchment area, with some of the greatest health needs, yet through the 1980s and 1990s, when the axe had to fall, it was my constituency that suffered the cuts. As a local councillor, I spent many years campaigning against plans to close our local community hospital, the Wilson hospital in Mitcham. I led thousands of campaigners in the fight against the local authority, but eventually the Tories won and Mitcham and Morden lost its last community hospital. Thankfully, the campaign to reopen the Wilson has carried on, and now, eight years after Labour came to power, we have learned that we are finally going to get our Wilson back. The Wilson is only one example of how the health establishment targeted Mitcham and Morden. In the past few months, we have uncovered secret local authority plans, dating back to the mid-1990s, in which the authority proposed to close our nearest general hospital, St. Helier. Thankfully, it was unable to do so before Labour came to power.

The health establishment has scorned Mitcham and Morden for many years, and even now, despite many complaints from me, there is still no one who lives in Mitcham and Morden on any of the NHS boards that
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make decisions about the lives of the people living there. So I should not have been surprised when St. Helier came under threat again more recently. It was saved only after the intervention of my right hon. Friend the Secretary of State for Health.This is a salutary tale. St. Helier is not actually in my constituency, but it serves half my constituents. It is part of the Epsom and St. Helier University Hospitals NHS Trust, which covers Merton, Sutton, Epsom and beyond, and which was created when Epsom hospital got into financial difficulties and merged with St. Helier in the 1990s. Epsom hospital had been struggling for some time, and the health authority decided to look at remodelling health care so that there would be one main hospital and several smaller community hospitals.

The health authority argued that the site of the main hospital—the critical care hospital—was not important, as the community hospitals would take most of the people who normally go to hospital. A public consultation took place to determine whether there was agreement with the proposals, and it soon became clear that the main issue would be where to put the critical care hospital, which would house the area's accident and emergency services and acute services such as maternity and obstetrics.

My view is that the people who need critical care services the most are those who are the most disadvantaged and have the worst health. There is a strong link between social disadvantage, the need for emergency services, and health problems such as low birth weight and teenage pregnancy. As the vast majority of those with the greatest health needs live near St. Helier, I felt that having the critical care hospital there would be the best way to reduce health inequalities. Initially, the health establishment agreed—in its original assessment, it gave St. Helier a 7 per cent. higher score than a Sutton hospital site in Belmont.

The public seemed to agree, following the consultation. Although fewer people from disadvantaged areas take part in public consultations, and although my own surveys were repeatedly ignored, St. Helier emerged as the top choice among the public for the location of the critical care hospital. However, last January, local NHS managers voted to overturn the views of residents and to build a new critical care hospital in Belmont, a very well-to-do suburb in Surrey. That decision meant that St. Helier would lose its accident and emergency, maternity and other critical care services. Belmont is one of the wealthiest areas in the country and people living close to it have very high life expectancy, very good access to health care and very high levels of private health care.

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