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9 Oct 2007 : Column 20WH—continued


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During the debate, we heard important points about the involvement of, and information for, parents. Local authorities have a clear legal duty to make available to parents information about the SEN provision in their area, including specialist speech and language resource provision or units. Local authorities must make that information available on their websites and provide a written copy on request. The statutory SEN code of practice, by which local authorities must be guided, advises authorities that they must ensure that information is available and accessible for all parents, and that they should work with the local parent partnership service to secure that outcome. The parent partnership services work to minimum standards that are also set out in the code. The standards state that partnerships should ensure that parents are provided with accurate and neutral information on their rights and on the wide range of options that are available for their children’s education, including specialist speech and language provision.

In our response to the report by the Select Committee on Education and Skills about SEN last year, we undertook to exemplify the minimum standards in the SEN code. We set clear expectations for parent partnership services in every area to increase parental confidence in their impartiality and the quality of information and advice that they provide. That work is well under way, and it will be issued later this term. That issue is about more than information, however. It is something on which I shall reflect, and I look forward to the comments in the review that the hon. Gentleman is leading, so that I can reflect a little more on the way in which we encourage better involvement, particularly from that broadest range of parents whom he described during his intervention on the hon. Member for East Worthing and Shoreham (Tim Loughton).

I accept that there is a certain amount of anxiety among parents about statementing. Parents have a right under the Education Act 1996 to request that local authorities assess their children’s special educational needs with a view to the children being given statements. If the local authority declines the request for an assessment, the parents can appeal to the SEN and disability tribunal, whose decisions are binding on local authorities; and as I have said, in each local authority, the parent partnership service should give practical, unbiased advice about special educational needs, including statementing. Local authorities cannot have blanket policies not to assess certain groups of children. The Secretary of State will investigate any complaints against authorities, and if there is evidence of such policies, he will issue directions to the authorities to remedy the situation.

The SEN regulations also set out statutory time limits for completing statements, which amount to 26 weeks from the initial request for an assessment. Figures collected by the Audit Commission show that in 2005-06, 95 per cent. of draft statements were completed in the statutory 18 weeks, when none of the allowable exemptions, such as health or social services being late with their advice, came into play; and that almost 80 per cent. were completed when they did. We are introducing a new indicator to monitor how many statements are completed within the statutory 26 weeks, and we hope that it will improve matters.

John Bercow: I do not sniff at the fact that the speed with which statements are completed is an important subject; I know that the Government have a target for
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it, and that they are pleased that there has been some progress. However, may I put it to the Minister that it is not necessarily either the only or the best target and that what is incredibly important is that, once the content of the statement is agreed, the lead-in time to its implementation should be as short as possible? Does he agree that delays of several months and more are simply unacceptable?

Jim Knight: I certainly agree that such delays are unacceptable. As soon as a statement is finalised, a local authority has a statutory duty to arrange the educational provision set out in the statement, including any speech and language therapy that is specified as necessary educational provision. In practice, there may be some delay—for example, with the local authority having to arrange speech and language provision with the health service; but in cases in which there is an unnecessary and lengthy delay in putting the educational support in place, parents can complain to the Secretary of State on the ground that the local authority is failing to carry out a statutory duty. Naturally, we would consider such situations seriously, because some delays that we hear about anecdotally are unacceptable.

I shall return to the issue of the supply of speech and language therapists. It is important that we bring services together through such measures as extended schools and children’s centres, which I have discussed. The number of qualified speech and language therapists has increased by more than one third since 1997, but we must do more. We must ensure that we match up affordable demand and supply in the NHS work force, and we must focus on strengthening front-line capacity through increases in productivity and the skill mix. I am sure that we will hear more about that from the hon. Gentleman in due course.

The hon. Gentleman also referred to concerns about unit closures. He has raised those concerns in the House, most recently at oral questions on 26 July. Since May 2006, local authorities have had to apply a statutory SEN improvement test when they plan to close a dedicated language unit or to remove resource provision. To obtain a clearer picture about the situation regarding language units, our national strategies SEN advisers have been asked to identify the number of existing units in each local authority and any plans to change the number in 2008. The review that the hon. Gentleman is leading will—I am sure—consider the merits of going further on data collection, with due regard to the need to minimise burdens on schools and local authorities. I look forward to seeing what his review suggests.

Supporting children and young people with speech, language and communication needs and their families is a key priority for the Government, but no political party can or should claim any monopoly of concern about this subject. Much is already being done to help improve services and provision, but more must be done to ensure that everyone gets the type of support that they need, when and where they need it. We are committed to improvements in the system and better collaboration between health and education.

The review that the hon. Gentleman is leading will—I am sure—cast new light on those elements that are working well and on those elements that need improvement and change. We await with interest its outcome.


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Health Inequalities

Mr. Eric Illsley (in the Chair): A large number of hon. Members wish to speak in this debate and, in order to accommodate all of them, brevity will be required on everyone’s part. It is my intention to begin the winding-up speeches at 12 o’clock.

11 am

Mr. Neil Turner (Wigan) (Lab): It is a great pleasure to be under your eagle eye today, Mr. Illsley, while we discuss this important issue.

It is well recognised that inequalities exist in all advanced countries, but it is equally sure that where the extremes are closer, the societies are better. The issue is not just a moral one but one of self-interest for everybody in the country. The Labour party exists to lessen such inequalities. That was why it was formed, and it is why many Labour Members joined it.

Inequalities in health are stark. The life expectancy gap between those in the poorest and richest parts of the country is often 10 years or even more. Morbidity—the way that people feel about their health—follows the same path. Labour recognised that in our 2001 manifesto, in which we stated:

In our 2005 manifesto, we stated:

That aim was exemplified in the policy document that went to all Labour candidates for that election, in which we stated:

That is clearly recognised. Indeed, in his first speech on taking office, the new Secretary of State concentrated on health inequalities. There is no difference between ourselves and the Government on what we want to achieve.

I shall not take any lectures or strictures from the Conservative party on the issue. In all the time that it was in office, it refused to allow it to be discussed. The recent Joseph Rowntree Foundation report indicated clearly that, in the years between the 1980s and 2000, health and social inequalities widened dramatically. Rather than any strictures, an apology would be in order.

To tackle health inequalities, we must first identify them. Two headline figure indicators have been identified: infant mortality and life expectancy. In November 2004, spearhead authorities were identified to tackle health inequalities. They were classified as those in the worst 20 per cent. of authorities in England in three of the following five areas: cardiovascular mortality; cancer mortality; life expectancy at birth for both males and females, and the index of multiple deprivation. Wigan is in the worst 20 per cent. in all five categories.

Health inequalities are recognised as an issue and identified as a geographical problem. So what about the means and resources of tackling them? The Government
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have a formula whereby they distribute 75 per cent. of their health budget to primary care trusts. That formula measures health needs by taking account of age, sex, mortality, morbidity, the cost of living and economic deprivation, and it produces a target for each PCT. I should emphasise that it is a Department of Health formula—it is the Department’s assessment of the health needs of each area. However, the actual funding does not follow the targets set by that formula. It is guided by them, but does not follow them. The guidance is not particularly well followed, as I shall show shortly.

Prior to the 2005-08 comprehensive spending review round, a group of Members pushed the then Secretary of State, the right hon. Member for Airdrie and Shotts (John Reid), to speed up the pace of change and the rate at which PCTs get closer to their targets. I wish to pay tribute to him, because we were reasonably successful, particularly in the areas that were seriously below their target funding allocations. For instance, in 2005 Easington PCT was £25.5 million below its target funding. It is now £6.5 million below—a shift from 16.2 per cent. to 3.5 per cent. below. That was replicated in many other areas that were seriously below target in 2005, and we should pay tribute to the then Secretary of State for making those massive improvements, which laid a firm foundation upon which we can build for our next comprehensive spending review round. This debate is essentially about making further progress on that.

Despite the efforts of the then Secretary of State in the 2005-08 round, primary care trusts still do not receive the share of funding that the Department says they need to tackle the health needs of their populations. The differences are stark, and many of them are inexplicable, especially when set against the Government’s stated aim of reducing health inequalities. Ashton Leigh and Wigan PCT is £11 million—2.4 per cent.—below its funding target. Westminster PCT is £41 million, or 11.6 per cent., over its target. Newham is £15 million, or 3.2 per cent., below; Richmond is £28 million, or 13 per cent., above. Bradford is £20 million, or 3.5 per cent., below; Brent is £20 million, or 4.8 per cent., above. Liverpool is £25 million, or 3.2 per cent., below; Lambeth is £56 million, or 12.6 per cent., over its target. Incidentally, that last example shows a totally inexplicable increase, because in three years Lambeth has moved from being £25 million over target—6.4 per cent.—to being £56 million, or 12.6 per cent., over. Rather than moving in the right direction, some PCTs are moving in totally the wrong direction.

I emphasise that the issue is not one of north versus south. It is about deprived areas throughout the country, and deprived boroughs in London are as underfunded as many of the areas in the north and the midlands. Newham is £15 million below its target, Barking and Dagenham £10 million below, Tower Hamlets £14 million below and Hackney £15 million below. The matter is not north versus south, it is about health inequalities, deprivation, health need and funding PCTs to address their health needs and reduce inequalities.

Andrew George (St. Ives) (LD): I represent the poorest region of the UK, Cornwall and the Isles of Scilly, which is below its target for the funding available to the PCT. Does the hon. Gentleman agree that it is inappropriate that, in such circumstances, PCTs with appointed, not elected, members, were forced by the
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Department of Health to spend 15 per cent. of their limited resources within the acute sector in private hospitals, rather than support struggling NHS hospitals? Does the hon. Gentleman agree that such decisions should be made locally, not enforced on PCTs by the Department of Health?

Mr. Turner: I do agree, and that is an issue that we have addressed previously. Indeed, the Department has made changes to the second and third round of independent sector treatment centre procurement, and those changes will address the problem. While I understand the hon. Gentleman’s point, it is not fundamental to the issue that we are discussing, which is about overall health funding rather than how the funding is spent in particular areas. However, I take his point.

Rob Marris (Wolverhampton, South-West) (Lab): I shall give an example with which my hon. Friend may not be familiar, from my own area of Wolverhampton. Infant mortality improvement has completely stalled in recent years, and male life expectancy is rising at a much slower rate than national male life expectancy. That may well be related to Wolverhampton City PCT’s having been under formula for many years.

Mr. Turner: My hon. Friend is absolutely right and raises an important issue. We have not merely been underfunded for the past three years; the underfunding is historical and goes right back to 1948, when the NHS was formed. The number of GPs that our PCTs are able to employ and the number of interventions that we can make in our areas are seriously lower than in the areas that I have identified as being over target. That is not only because of the funding of the past three years, but because of the nature of the funding, historically. All that impacts on health inequalities. Whatever happens in this comprehensive spending round and whatever Ministers are able to do about the problem, the impact will not be immediate or dramatic—it will be a long haul. We must recognise that it will take a long time to reduce the health inequalities in our country, and we must make a start now.

In August 2007, guidance was given to spearhead PCTs on reducing standard mortality ratios in a range of areas. In Wigan, although cancer mortality rates are down, they are not down as much as for the country as a whole, so the gap is widening. Life expectancy in Wigan is improving, but only at the national rate—the gap is staying the same. With cardiovascular diseases such as heart attack and stroke, our standardised mortality ratios are consistently 40 per cent. higher than those for the UK, nationally. Those PCTs that have been identified as spearhead trusts have been given no extra funding to tackle those issues. Where specific funding has been given—for smoking cessation services, for example—and practice nurses have been used in GP surgeries to screen for cancers, there have been dramatic improvements. The lesson that we can learn from that is that additional resources bring improved results.

In 1997, in a reversal of the disgraceful attitude of the previous Tory Government, Labour commissioned Sir Donald Acheson, the then chief medical officer, to review health inequalities. His report made 39
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recommendations, only three of which were directly related to the NHS. Inequalities in health indicate that there is wider deprivation and have an impact on that deprivation. This is an important point. We are not just talking about inequalities of health as a result of deprivation: inequalities of health and in the way in which people are unable to contribute to the local economy help to create deprivation in those areas.

Other agencies, particularly our local authorities, will have to tackle areas of multiple deprivation. That point was recognised in the 2002 Wanless report, in which Wanless drew particular attention to personal social services. Many local authorities and PCTs, including my own in Wigan, now have joint commissioning and pool the funding for those services. But there we hit yet another difficulty—many of the local authorities covering the areas in which PCTs have below-target funding are themselves inadequately funded. Just as the Department of Health has a formula to calculate health needs and allocate funding accordingly, so does the Department for Communities and Local Government. Just as that formula is not followed by the DOH, it is not followed by the DCLG. Almost inevitably, the local authorities that are underfunded in health are also underfunded in local government. Wigan is £10 million underfunded in local government, while Westminster is £18 million overfunded. Bradford is £12.5 million under, while Brent is £21.5 million over; Newham is £15 million under and Barking and Dagenham is £14 million under, while Richmond is £13.5 million over and Wandsworth is £49 million over.

Mr. Chris Mullin (Sunderland, South) (Lab): Will my hon. Friend allow me to add the figures for Sunderland to that list? My local authority, which also represents one of the more deprived catchment areas, estimates that it was down just under £7 million in 2006-07 and £6.4 million in the current financial year.

Mr. Turner: I think that all Labour Members present could give figures for our areas and show that we are underfunded not only with our health allocation, but in local government. That is important because of the way in which they interact and affect each other. If we are to tackle health inequalities, we must also tackle other areas of deprivation.

I appreciate that it is not in the purview of the DOH to review local government funding, but, as Sir Donald Acheson made clear and as Wanless has re-emphasised, we will not reduce health inequalities through the NHS alone. The two Departments must tackle the problem jointly. To continue the double whammy of underfunding PCTs and local authorities serving the same local population will mean that those populations will continue to suffer health and social inequalities.

The debate is timely because this afternoon the Chancellor of the Exchequer will announce the comprehensive spending review for 2008-11, which will allocate health and local government resources nationally. In his 1998 report, Sir Donald Acheson said that only three of his 39 recommendations related directly to the NHS. The most important of those three was the need for a

within the NHS.


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Mr. David Drew (Stroud) (Lab/Co-op): I totally support my hon. Friend’s comments, but does he accept that there is also a problem within areas? A problem with semi-rural constituencies is that people living in the more rural areas who do not have income to support them are often very disadvantaged in health terms. It is important that we drill down—I suppose that is the in term—to look below the macro picture at what is happening on the ground. Does he agree?

Mr. Turner: I do agree. In my borough, the best ward is at around the national average, whereas six or seven wards are in the bottom 3 per cent. of deprivation in the country. Within each of our areas will be areas that are relatively well off and healthy, and areas that are significantly unhealthy and significantly worse off.

The debate is vital for all our constituents who die before their time or who suffer debilitating illnesses and grow old before their time. The size of the national health cake has been decided, and we will hear an announcement on that this afternoon. A more equitable distribution of that cake will allow PCTs such as Wigan to contribute to achieving the Government’s aim of making serious inroads into the health inequalities in this country.


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