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9 Oct 2007 : Column 40WH—continued
12.9 pm
Mr. Stephen O'Brien (Eddisbury) (Con): I congratulate the hon. Member for Wigan (Mr. Turner) on bringing forward this vital debate. He has long campaigned for those of his constituents who have been adversely affected by health inequalities under the present Government. I note also his work chairing the special interest group of municipal authorities within the Local Government Association, particularly with reference to its report of last month, “Caring for All: balancing fairness and stability in the funding of local services”. He slightly spoilt his introduction by, of course, attempting some party political point scoring. Perhaps I can help him. I do not know where he has been in the past few days, but recent events suggest that he may need to catch up—that in fact the Prime Minister has bottled it and ignominiously retreated from facing the electorate, having marched him and all his colleagues up the hill.
David Taylor (in the Chair): Order. The debate is on the impact of health funding.
Mr. O'Brien: I am grateful. I am sure that the hon. Member for Wigan will agree with me that the fact that this debate is being held 10 years into the rule of a party that pledged from the outset to stand against such inequalities says something about the impact that his party has had—or rather has not had—on the country. I represent a constituency in the north-west, which is particularly well represented in the debate this morning, and that fact is important.
I also want to thank the hon. Gentleman, who is a well-known Wigan rugby league club supporter, for ceding Jason Robinson into union, without whom England might not have succeeded so well at the weekend.
Under the present Government, the relative gap in life expectancy for men has increased by nearly 2 per cent, and for women it has increased by 5 per cent. The latest figures on infant mortality confirm the previously reported trend. Despite overall improvements, the relative gap between the routine and manual groups and the
population as a whole has widened over recent years, since the target baseline; and the number of sexually transmitted infections has doubled over recent years.
Kelvin Hopkins: Will the hon. Gentleman give way?
Mr. O'Brien: I will not, because we are very short of time, and the hon. Gentleman had his own chance.
We have had a wide-ranging debate in which many good points were covered. Many effectively amounted to bids, which I am sure the Minister will deal with individually when she replies.
The hon. Member for Wigan may remember a supplementary question on health inequalities that he put to the then Health Secretary, the right hon. Member for Darlington (Mr. Milburn), in 2002. The response was
“we are now in the process of reviewing the whole way in which NHS cash is distributed to local communities.”—[Official Report, 26 March 2002; Vol. 382, c. 688.]
Sadly, the current Administration, particularly as regards health policy, has rarely moved beyond the review as a piece of ongoing politicking. Last week brought us Lord Darzi’s interim report. Its release just before the end of the recess served not only to deepen the electoral chasm left by the Prime Minister’s fear of the electorate, but also to avoid Lord Darzi’s having to come to the other place. Notwithstanding the claim with which he opens his report—
“I’m a doctor not a politician”—
can the Minister tell us when the noble Lord—whose main job now, whether he likes it or not, is as an accountable politician and a Minister, and who is paid by the electorate and who accepted the job—will make his maiden speech in the House of Lords?
In his interim report, the noble Lord twice made the point that
“the Secretary of State has announced a comprehensive strategy for reducing health inequalities”.
It is true that in his statement to the House on 4 July, the Secretary of State for Health said that the matter of health inequalities is “crucial to the Government” and, referring to the Darzi review, that it was
“too important for us to wait for that review”.
He gave an assurance that the Government would
“crack on with that as an absolute priority.” —[Official Report, 4 July 2007; Vol. 462, c. 969.]
However, the Secretary of State seems to have made the announcement neither to the House nor, even more surprisingly, to the press. True, the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo) announced a web-based health inequalities intervention tool on 23 August. As far as I can see, all it does is tell spearhead primary care trusts whether to focus on smoking cessation, reducing infant deaths or preventive prescribing for cardiovascular disease. Undeniably that is of some use, but it is a far cry from a strategy. Indeed, the biggest claim that the Government made of it was that it could
“be used as part of a comprehensive local strategy to reduce health inequalities.”
Will the Minister tell us when the Secretary of State will make good on his promise of a comprehensive strategy for health inequalities?
Another review that the hon. Gentleman will be familiar with is that relating to the market forces factor, to which his constituency neighbour, the then Health Minister, and now Chief Secretary to the Treasury, the right hon. Member for Leigh (Andy Burnham) made reference in a Westminster Hall debate secured by the hon. Gentleman on 6 June. The hon. Gentleman may be interested to know that his comments in that debate were well reported by the Revolutionary Communist Party of Britain (Marxist-Leninist) on its website.
The first review referred to by the then Minister was
“an overall funding formula review that will examine the make-up of the market forces factor”,
being undertaken by the independent Advisory Committee on Resource Allocation, to be published before the allocations were made. The second was a
“specific review of the technical aspects of the MFF, which is different from the general funding formula review that ACRA has undertaken.”—[Official Report, Westminster Hall, 6 June 2007; Vol. 461, c. 138WH.]
The hon. Member for Falmouth and Camborne (Julia Goldsworthy), who was also present at that debate, said that she was informed at Christmas that the latter report was on the desk of the then Minister, Lord Warner. The Minister also made reference to the departmental consultation on payment by results, confessing that the market forces factor had been left out of the public consultation, but included in the independent, but ultimately internal, review.
Resource allocation is still being decided across the country on the basis of assumed and aggregated data in respect of deprivation and age. We increasingly have data that would allow known morbidity in a community to be the basis on which NHS resources are allocated. Can the Minister tell us, first, when ACRA’s overall funding formula review will be published; secondly, when ACRA’s specific review of the technical aspects of the marked forces factor will be published—and why it has lain so long on Ministers’ desks; and, thirdly, when the results of the departmental payment by results consultation will be published? Can she also confirm that ACRA will take account of morbidity data in its review and reflect them in the funding formula? Will the funding formula be changed to reflect local pay variation as has been done with the area cost adjustment in the local government formula?
It was the Government’s intention to publish an annual status report on health inequalities, but the first report took two years. They said in July 2003 that the Department of Health would publish an annual report on health inequality indicators, related to the health inequality targets. The first was published in August 2005 just as we were in recess. Will the Minister tell us whether she plans to reinstate that? Any Government who want properly to address the issue of health inequalities will focus not on absolute reductions, but on the relative gap between the most and the least healthy, and between the richest and the poorest. I have no doubt that the Minister will tell us all the statistics on how many cancer and coronary heart disease deaths have been prevented in the last 10 years, but will she admit that they are on a trend that was pretty well established in the latter part of the 1970s for coronary heart disease and in the early 1980s for cancer? What plans do the Government have to switch to meaningful metrics?
In “The Road to Wigan Pier” George Orwell said
“a man who drinks a bottle of whisky a day does not actually intend to get cirrhosis of the liver”.
Admittedly, that was a metaphor illustrating Orwell’s luddite attack on mechanisation, but it is a moot point for today’s debate. Only last month the Department of Health announced an increase in consumption among school-aged pupils who drink. On current trends obesity will overtake smoking within three or four years as the principal cause of avoidable death in this country, bringing concomitant diseases in its wake. The story is similar with rising alcohol consumption, drug abuse and a rise in sexually transmitted infections. Yet the Government were all too happy to watch public health budgets being plundered as PCTs tried to rake in cash to pay off a deficit of the Government’s making. A Conservative Government would give PCTs dedicated public health resources. When will the Minister show that she really cares about combating health inequalities and do that?
One issue that is not often addressed under the heading of this debate is long-term care: it is right, however, that any debate on health inequalities should look at inequity across the age range. In fairness, several hon. Members, not least among whom was the hon. Gentleman, conceded that point. Today we anticipate something of a damp squib with the comprehensive spending review, with the Government failing once more to address the scandal of people selling their houses to fund their long-term care, something that was deplored by the former Prime Minister and Member for Sedgefield in 1997. I suspect another dodge by the present somewhat enfeebled Prime Minister. That could be the only thing to trump the brazenness of the Liberal Democrats, who are still running with the headline—it is on their website if anyone wants to look—about a free personal care policy, despite their health spokesman’s confession in this very Chamber that it is a dishonest policy.
I look forward to hearing what the Minister has to say. I hope that she will give firm dates for the publication of the various reviews that I mentioned and that she will use the opportunity radically to overhaul the Government’s public health strategy, to begin combating the growth in health inequality of the past 10 years.
12.20 pm
The Minister of State, Department of Health (Dawn Primarolo): I congratulate my hon. Friend the Member for Wigan (Mr. Turner) and the 10 Labour MPs who have spoken so eloquently in this debate. It is timely in the parliamentary agenda.
Since the creation of the national health service, we have seen impressive social, economic and health improvements in this country. People in all regions and from every social group are healthier and living longer than ever before, and we should celebrate that, but—it is a big “but”—despite those tremendous achievements, health inequalities remain. The Government recognise the great challenge that they pose and have established the most comprehensive programme ever seen in this country to address that deep social injustice—as opposed to the previous Tory Government, who buried the Black report and ignored it.
Health inequalities are proving stubborn, persistent and resistant to change, and we are disappointed with
the progress made. We have set national targets to narrow the gap in infant mortality across socio-economic groups and in life expectancy across geographic areas, but we have not seen the narrowing that we want. We knew that it would take time; we are the first Government in a generation to recognise it as a priority and choose to highlight it. We must acknowledge that every major country in the world, with the possible exception of Sweden, is struggling to resolve this intransigent problem.
There are some early signs of progress. Some 60 per cent. of the areas with the worst health and deprivation, referred to as spearhead areas, are making progress to narrow their share of the life expectancy gap by 10 per cent. by 2010. We have already seen a 27.9 per cent. reduction in the heart disease absolute inequality gap and a 12.7 per cent. reduction in the cancer absolute inequality gap between the spearhead authorities and England, but as my hon. Friend the Member for Norwich, North (Dr. Gibson) said, we must do more. The cancer reform strategy to get individuals to GPs early and the additional help in spearhead authorities are addressing the challenges.
The number of children living in absolute poverty has been halved. The number of homeless families living in bed and breakfasts has been reduced sharply, and the number of teenage pregnancies is down. We have proved that with a concentrated effort it is possible to close the gap between the affluent and the disadvantaged. If the problem is stubborn and persistent, we as a Government must be so too. We are determined to see change on inequalities.
The Secretary of State has said that tackling health inequalities will be central to the work of the Department of Health and is his priority for the NHS. He has announced that we will publish a comprehensive strategy next year for reducing health inequalities. In his interim report, published last week, my noble Friend Lord Darzi described the aims of the comprehensive strategy: to ensure that the NHS and other health services close unjustifiable gaps in health status between individuals, whatever their background, to ensure fair access for everyone to the NHS and to treat all patients fairly with high quality and good outcomes of care for all.
Mr. Ken Purchase (Wolverhampton, North-East) (Lab/Co-op): Will my hon. Friend give way?
Dawn Primarolo: If my hon. Friend will allow me, there is so much to answer from those who have already spoken. I shall make progress, but I am happy to speak to him at the end.
My noble Friend emphasised in his report the need to help all members of our diverse population live longer, healthier lives, especially those least able to help themselves. What that will mean for areas with poor primary care provision is clear from that interim report. There is a strong correlation between underdoctored areas and deprivation: many such primary care trusts are also spearhead areas. A new package will provide 100 new GP practices, including up to 900 GPs, nurses and health assistants, in the 25 per cent. of PCTs with the poorest provision.
Mr. Purchase:
I am grateful to my hon. Friend. I exempt her from my earlier comments about no socialist being a member of our Government. The
Minister has read out a series of points, all of which are self-evident and have been so for many years, yet I understand that we are spending millions more on yet another review. I urge her to lead from the front in a good socialist way and implement it without further delay.
Dawn Primarolo: I am always grateful to my hon. Friend for his support and encouragement. I am sure that he agrees that change must be put in context. I challenge the picture that the Opposition parties wish to paint—that nothing has been done. We are the first Government to do so, and we are making progress, but more must be done.
My hon. Friend the Member for Wigan focused particularly on resource allocation. Investment in the NHS has trebled since 1997 and now stands at £90 billion of public money. To ensure that the money reaches those in most need, the PCTs’ revenue allocation fairer funding formula takes account of deprivation, need and unmet need. We are tackling health inequalities through mainstream core funding, but my hon. Friends have quite rightly questioned some of the provision. They know that we inherited a situation in which some PCTs were getting more than they should, and it takes time to adjust that.
I give credit to my hon. Friend for the pressure under which he has kept the Government, ensuring particularly that the pace of change policy closed the gap. ACRA, the independent body overseeing the development of weighted capitation, is considering a review of how that formula works and whether it delivers the outcome that we expect. I can give my hon. Friend the Member for Great Yarmouth (Mr. Wright) the reassurance he seeks. We have not yet received ACRA’s recommendations. When we do, we will consider carefully before deciding whether, when and how the formula should be changed, for the reasons that he mentioned.
Under the fair funding formula, Ashton, Leigh and Wigan PCT received an allocation of £449.1 million. During the two-year period 2006-08, it has benefited from a total resource increase of £74 million, or 19.7 per cent., which is greater than the average national increase. It has also received £4.8 million in additional funding through allocations from the £553 million. Under the pace of change process, we have continued to reduce the gap.
To follow the comments made by my hon. Friends, we as a Government have faced up to the problems of health inequalities, but we must now act. Improving the health of the nation means ensuring that those with the poorest health improve the fastest. I congratulate my hon. Friend on securing the debate. I listened carefully to the comments and representations made, and I shall take them back with me to the Department of Health.
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