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Mr. John Baron (Billericay) (Con): We have had a short but useful debate this afternoon, in which hon. Members on both sides of the House have highlighted the extent to which the Government have failed to address the issue of health inequalities.
The hon. Member for Mitcham and Morden (Siobhain McDonagh) understandably talked about local health issues, but failed to explain why health inequalities had actually widened under this Government. The hon. Member for Bristol, West (Stephen Williams) explained how health outcomes were not simply a matter of choice. In referring to differing GP availability rates, he correctly observed that access was also important.
The hon. Member for Kingston upon Hull, North (Ms Johnson) said that life expectancy rates in Hull were poor compared with those in the rest of the country. She also talked about the need for better financial management by her local trusts. My hon. Friend the Member for Reigate (Mr. Blunt) passionately and rightly expressed his concern about the Secretary of State's intervention for political reasons in important health matters such as the siting of a new hospital, and about the adverse effect that that could have on his constituents.
The hon. Member for Denton and Reddish (Andrew Gwynne) reminded us that the Conservatives Clean Air Act 1956 had contributed to better health outcomes, and I thank him for that. My hon. Friend the Member for Torridge and West Devon (Mr. Cox) powerfully pointed out that the cuts in health services were closing community beds and minor injuries units to the
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detriment of his constituents. He talked about the need for the resource allocation system to be re-examined because of its apparent inbuilt bias against rural health needs. He said that his constituents were suffering accordingly, that the real needs of rural people were not being recognised, and that that situation needed to be corrected now.
Finally, my hon. Friend the Member for South-West Surrey (Mr. Hunt) rightly pointed out that the NHS funding formula punishes poor families in rich areas and that a high percentage of carers in the families of those with long-term medical conditions are unable to get respite care. The need, therefore, is to address access to services as well as outcomes.
A good number of those and many other contributions made outside this place have made it clear that strategies to reduce health inequalities are not having the impact that we all want. Indeed, the Government's own figures, as was mentioned earlier, confirm that progress has not been made. The Department of Health's public service agreement target aims at reducing inequalities in health outcomes by 10 per cent. by 2010, as we have heard, using 1998 as a start date, as measured by infant mortality and life expectancy at birthyet, as we have also heard this afternoon, a progress report made in August last year confirmed that those inequalities have widened since 1998.
The Government's figures are not the only statistics that highlight Labour's failure to tackle inequalities in health outcomes. According to a joint study by the universities of Bristol and Sheffield last year, there is a 10-year difference in life expectancy between the most affluent and the most deprived areas of the United Kingdom. There are many other such reports.
Clearly, those depressing statistics reflect patterns of poverty and social deprivation across the country. There is, of course, a link between poor health and povertysomething that was questioned by an hon. Member who is no longer in his place. I should perhaps say at this point that some of what the Minister has said risks creating the impression that she believes that only on her side of the House are there Members with a social conscience. Among those on the Conservative Benches, too, the wish to help the most vulnerable and disadvantaged in society is the reason we came into politics, but we sit on these Benches because we do not believe that big government and socialist dogma are the way to achieve that goalquite the opposite.
Having said that, we should be careful of overstating the causal link between poverty and ill health. Unhealthy lifestyle is the more direct and relevant causal factor. The Government have still not done enough to persuade people in areas with the highest deprivation levels to adopt lifestyle changes that would do most to improve health outcomes. Smoking provides one worrying example. According to the Library, 17 per cent. of those in managerial and professional occupations smoke. The figure rises to 29 per cent. among those employed in the routine and manual sector.
Such simple facts powerfully argue for a much more ambitious public health and awareness campaign. Conservative Members pledged to put those themes at the heart of our policies if elected last year. The
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Government should now do the same. However, their public health record is poor. Indeed, it was described by the British Medical Association as "dilatory and disgracefully complacent" and a "calamity". Only recently, Ministers produced an unworkable smoking policy before being forced into a total ban by their own Back Benchers. Meanwhile, Labour has presided over accelerating obesity and sexually transmitted infection rates.
As well as disturbing regional variations in lifestyles and health outcomes, there are unacceptable postcode lotteries in access to services and treatments, which has been referred to on previous occasions. Cancer is one area in which the Government have claimed a great success. Indeed, there have been improvements in services and patient experience, but cancer still exemplifies inequalities of both kinds. In terms of outcomes, a recent Public Accounts Committee report highlighted persistent and unacceptable variations depending on where patients live. For example, the figure for lung cancer deaths is twice as high in the worst region compared with the best. Breast cancer death rates are 20 per cent. higher in some regions in the north than in others, which are mainly in the south. Men with prostate cancer have a 10 per cent. better chance of surviving for five years if they live in London or the south-east than in Trent and the northern and Yorkshire regions. That is on top of the inequality already suffered by men with prostate cancer, who report significantly poorer experience of care than patients with other cancers.
Uptake of drugs and technologies recommended by NICE also reflects wide variations, a fact recognised by the cancer tsar in a report back in 2004. We know that use of the breast cancer drug Herceptin one year after the NICE recommendation ranged from a staggering 90 per cent. of eligible women in Dorset to a dismal 16 per cent. in Essex. In relation to early-stage breast cancer, it is incredible that Ann Marie Rogers had to go to the High Court to clarify the Secretary of State's direction last autumn, in which she seemed to suggest that PCTs could not withhold the drug on consideration of cost alone. By not making additional resources available at the time, however, she might have done as much to exacerbate inequalities as to reduce them, particularly at a time of worsening deficits. The charity Breakthrough Breast Cancer commented:
"This drug could save the lives of 1,000 women a year and it is unfair and cruel for women like Ann Marie Rogers to know that it is money and their postcode that stands between them and this potentially life-saving treatment."
The problem of regional variations in access to drugs and technology is not restricted to cancer. Photodynamic therapy for wet age-related macular degeneration was approved for use in the NHS in September 2003. Only last autumn, however, data presented by the Macular Disease Society and the Royal National Institute of the Blind showed that 30 per cent. of people in the UK who could have benefited from PDT had not been treated.
NICE was set up to address the postcode lottery in access to drugs and treatments. However, the Government must now address the postcode lottery in implementation of NICE guidance. In particular, they
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should follow the Conservative policy of ensuring that NICE appraisals are carried out in conjunction with a full resource implementation assessment, so that national guidance is realistic, implemented and successful. More broadly, NHS bodies should be subject to a statutory duty to implement NICE guidelines on standards of care as well as drugs and technologies. In a devolved health service, it is essential that patients are given clear entitlements to treatment. That will help particularly the 17 million patients who suffer from long-term medical conditions and who are increasingly realising that in a target-driven culture, conditions that are not targeted suffer unduly.
Chiropody services for elderly people and rehabilitation services for the visually impaired are two sad examples of the type of care for long-term conditions that suffers in a devolved service when Government targets are focused on the acute sector and politically sensitive waiting times. A survey by the Conservatives showed that more than half of chiropody services had recently raised the eligibility criteria for access to treatment, with the average department undermanned by a shocking 25 per cent. Meanwhile, with regard to the nearly half a million people in the country registered as blind or partially sighted, the Guide Dogs for the Blind Association has estimated that as many as 20 per cent. of local authorities have no dedicated rehabilitation services, with nearly 80 per cent. overall admitting that services were restricted due to a shortage of suitably qualified staff.
With an estimated half of all NHS trusts going into deficit, inequalities in local services and patient care are bound to increase. Hon. Members have already highlighted cases in their constituencies where services are being cut in order to balance the books. This latest development comes from a Government who spent years bombarding the NHS with targets and bureaucracy and then destabilised trusts with bungled reforms. The Government have not tackled health inequalitiesin fact, they have widened in recent years.
By not implementing a strong public health programme and not radically improving the NHS, the Government have failed to break the link between poverty and ill health. All the evidence suggests that when unreformed state services do not perform as well as they should, the less well-off tend to be let down the most. Meanwhile, inequalities in access to services have also proliferated. As Conservative Members have argued, postcode lotteries will be ended only if NICE is given the tools and instructions to create a culture of standards and entitlements in the NHS. Until patients have those entitlements, health inequalities will continue to widen.
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