| Previous Section | Index | Home Page |
12 Nov 2009 : Column 138WH—continued
Mr. Peter Bone (Wellingborough) (Con): Does the hon. Gentleman agree that one of the problems of the Sure Start system is that it is not getting to the hard-to-reach cases? That is what the Sure Start centre in my constituency tells me. It is working well, but it is not getting to the very difficult and hard-to-reach groups.
Dr. Taylor: I am coming on to that in a moment, because that is one of my concerns, too. The Sure Start centre that I mentioned is at the heart of a deprived community and is doing marvellously. Last week, I opened a children's centre in Kidderminster, which has absolutely superb facilities. Its catchment area is supposed to tackle some 988 children, and the children come from extremely mixed areas. The centre provides stay-and-play facilities, dads' groups, which are crucial, and support and advice on a wide range of topics. It has links with nurseries, childminders and schools and, most importantly, it has outreach workers who aim to visit all 988 children.
The place was packed when I opened it, so I could not do an assessment of where all the children came from. There must be a huge temptation for the better-off families to use the centres because they have such super facilities. However, it is the silent voices that we so often try to find that must be tackled and made to feel involved in the children's centres because they are the people who really need them.
I had a briefing from the Royal College of Physicians for this debate. It desperately wants movement on a range of issues, including a reduction in obesity, the prevention of smoking and a reduction in alcohol consumption. Many of its examples of what is needed to promote healthy lifestyles for children are covered by PSHE and by what is provided by the children's centres. So we have the right aims and right tools in place. We must ensure that they are taken up by the people who need them.
I am not sure whether hon. Members realise, but there are proverbs that were written before the birth of Christ. One states:
"Train up a child in the way he should go: and when he is old, he will not depart from it."
We have just come round to realising the importance of what happens in childhood.
2.55 pm
Dr. Howard Stoate (Dartford) (Lab): It is a pleasure to take part in this debate. I am a practising GP and take a great deal of interest in issues around the health of my constituents as well as my patients.
In recent years, the debate on health inequalities has focused almost exclusively on what we eat, drink and do-or, more specifically, what we do not do in terms of physical activity. Hardly any attention has been paid to the physical environment in which we live. It is as if we have collectively decided that with the advent of modern domestic plumbing, central heating, cavity wall insulation and so on we no longer need to spend time worrying about the environment in which we live.
Even though the dragons of poor sanitation and slum housing may largely have been slain in this country, it would be wrong of us to ignore the environment as an important issue. Unquestionably, people's housing conditions have improved, but the condition of their
neighbourhoods leaves a lot to be desired and has not improved to the same extent. Living in badly maintained and badly planned neighbourhoods with inadequate infrastructure and amenities not only restricts people's ability to live healthy lives, but causes untold damage to their health and mental well-being.
A study published last year in Preventive Medicine found that areas perceived to be safer and more aesthetically pleasing can enhance mental health, while adverse effects were associated with road congestion and urban noise. Rates of psychiatric illness are also greatest in the most deprived areas, and the rates for psychoses map closely those for deprivation. Poorly maintained environments are also a cause of increased levels of stress and a greater susceptibility to heart disease, stroke, cancer and long-term chronic conditions.
Sustrans has reviewed the evidence of links between physical activity, health and social inequality and found that obesity, diabetes and cancer all affect people from deprived communities disproportionately. The link has primarily been made to the environment in which they live.
The recent Royal Commission on Environmental Pollution has also found plenty of evidence to show that living in deprived urban areas increases the risk of poor health outcomes, even after controlling for individual circumstances. So, a bad situation is made to seem much worse by the inevitable contrasts that people in poor neighbourhoods make between their own living conditions and those of richer people living down the road in much better provided and much better maintained areas.
There is plenty of evidence to back up such a view. My particular favourite is the example of Roseto, a blue-collar Italian-American community in Pennsylvania. Puzzled as to why Roseto's health outcomes were consistently better on average than those of neighbouring towns-despite the fact that Roseto was no wealthier than they-a team of researchers decided to take a closer look. What they found was a town that was different in character and appearance from anything else they had seen in Pennsylvania. Its residents did the same kinds of jobs as those in neighbouring towns; they ate the same diets; they took the same risks with their health; they even had the same disparities in income as the towns nearby. The difference was that it was almost impossible to detect income disparities by looking at the places in which people lived. The houses were the same size, the cars were the same and the clothes that the people wore were similar. It was virtually impossible to distinguish people's social position just by the appearance of either themselves or their houses. The report states:
"It was difficult to distinguish, on the basis of dress and behaviour, the wealthy from the impecunious in Roseto. Living arrangements-houses and cars-were simple and strikingly similar."
The researchers attributed that to a strong egalitarian sense of community among Roseto's residents that precluded ostentatious displays of wealth and frowned on any behaviour that might cause embarrassment or shame to the community's least affluent members. Clearly, when people's houses, cars and clothes are uniform across society, it has a beneficial effect on their health outcomes despite the disparities in income.
Sadly-this is the interesting part-it did not last. Once the first generations of primarily Italian-speaking residents died out and were replaced by English-speaking
children and grandchildren who had the same cultural and moral values as those in other Pennsylvanian towns, Roseto's health outcomes soon began to slip. It is a very instructive example. It reminds me of the rather whimsical essay "The Socialist's Guide to Camping" by the late Oxford philosopher, G.A. Cohen. On a camping holiday, Cohen said, "there is no hierarchy" among people. They co-operate, share, generally act in ways that promote the collective good and take great pleasure in doing so. Although some tents may be bigger and brighter than others, or some people may have shinier, more high-tech camping gear than other people, it is much harder to detect the differences in wealth and status between families that mark them out in normal everyday life. So, for a brief, happy, life-affirming and health-enhancing moment, egalitarianism rules and our social differences are forgotten.
In the real world, however, it is not quite so easy to draw a veil over our wealth differences. That is not to say that we should not be trying to do so and indeed there are examples where people have succeeded in doing so. The fact that Britain is becoming more and more segregated geographically by class, age and wealth, as Professor Danny Dorling and his team from Sheffield university have shown, indicates to me that people are trying, consciously or unconsciously, to restrict the degree to which they are exposed to wealthier and supposedly more successful sections of society in their exclusive enclaves.
One way of addressing this issue is to invest more resources in improving the quality of the built environment in our most disadvantaged communities. Over the past 12 years, we have had a number of successes in this respect, but we need to do a lot more. For instance, the new deal for communities has helped to deliver a lot of schemes that have helped to improve the fabric and appearance of many disadvantaged communities, as well as helping to cut crime and improve access to jobs, education and health services. Crucially, local residents in those communities have been closely involved at an early stage in the design and implementation of many of those initiatives. Resident "ownership" is essential if schemes are to be sustainable in the long term and not require further investment at a later stage. The skills and confidence that residents develop as a result of their involvement in those schemes is not only good for their health and well-being but often encourages them to go on and set up further projects of their own. However, we need far more resident-led, area-based initiatives of that kind if we are to reduce health inequalities.
We also need to think much more carefully about health when we are planning new developments. Ever since the public health function was taken away from local authorities back in the 1970s, very few local authorities have spent much time thinking about the health implications of their planning decisions. That has to change if we are to create developments that actively encourage people to pursue healthy lives.
New developments with safe, well-maintained and attractive walking routes, play areas and parks are vital if we are to get people out of their homes and cars, and on to the streets. As with everything in life, it is a matter of motivation. Telling people that they need to take more exercise is easy; getting them to want to take more exercise is altogether more difficult. That is why the built environment is so important. If people look out of
their windows and see a grey, badly maintained street scene, clogged with traffic, litter and dereliction, they will stay at home. On the other hand, if they look out of their windows and see trees, grass, nice paths and families out walking their dogs and their children, they will want to take part themselves, because otherwise they will feel left out of what is going on outside. That is a fundamental human condition.
In my area, which is in the Thames Gateway, the new Thames Gateway parkland initiative is a model of the approach that we should be taking. It recognises that creating attractive green spaces that are easily accessible and well integrated with the existing urban grain is a vital aspect of the area's long-term regeneration. The proposed A2 activity park, the improvements to the Darent valley path and the new Jeskyns community woodland are all good examples of this work in my area. What we need to do now is to extend that programme across other areas in the Thames Gateway. It is clear that many existing communities feel that much of the investment that has been directed at the Thames Gateway has simply passed them by. If we do not address that problem quickly, there is a grave risk that we will not achieve one of the central goals of the Thames Gateway regeneration strategy, which is to improve the quality of life and the life chances of the area's residents.
In short, if we want to improve people's sense of well-being and enhance their long-term health prospects, we can do no better than to spend time and money on improving the quality of the built environment in which they live.
3.3 pm
Mr. Peter Bone (Wellingborough) (Con): I want to start, Mr. Bayley, by saying that it is a pleasure to serve under your chairmanship. I also want to congratulate the right hon. Member for Rother Valley (Mr. Barron) on how he introduced the report that we are discussing today and on how he carried out the inquiry into this issue. As usual, he did so with great diligence, hard work and fairness.
The report brings to the Government's attention the key problem that evidence-based activity needs to be undertaken in the future. One of the things that became clear to me during the inquiry was that there was a willingness to invest money in ideas but the Government had not necessarily worked out whether those ideas were the best ideas, nor had they found any way of establishing whether they were the best ideas.
I have a question for the Minister. One of the things that I struggled with during the inquiry was the issue of targeting resources. Let us say that my primary care trust has £10 million to use up and that it could spend that money on improving people's lifestyles, so that perhaps 1,000 people could live a year longer than they might otherwise have done. Those 1,000 people are middle class, active people who want to engage with the PCT. Alternatively, there are 50 people in the hard-to-reach group who would also see their life expectancy improve by a few years if that £10 million was spent on them. What should that PCT do? Should it help the greatest number of people or help the few people in the minority? I am not sure that saying that it is always right to try to close health inequalities is always the way forward, in practical terms.
We can take great pride in how successive Governments of all political persuasions have managed to develop the health service so that we all live longer. That is probably what we are looking for. We are certainly not looking to reduce the life expectancy of the well-off so that people who are much poorer live longer; clearly, that is not what we are trying to do. The aim of the debate is to increase life expectancy for everyone, while somehow also helping those people who are in the minority groups. I am not sure that our report takes us any nearer to striking that very difficult balance.
One of the things that the Government did that was very good was to introduce the national capitation formula. That is a method whereby every PCT receives a sum of money based on the criteria of its needs. In crude terms, a PCT would receive more money if it had more people with health inequalities. In my patch, for example, I have some very poor areas, where health inequalities are much worse than in other areas.
The problem, however, is that the Government have never funded to the national capitation formula. I have challenged the Government time and again on that, and the answer that I have received is, "Oh, we over-fund elsewhere". That is no answer at all to my constituents. For instance, my area does not have a hospital. However, if we had received the money that we would have got if the national capitation formula had been paid in full, we could have had a hospital, which could have helped those people who experience health inequalities.
So it seems to me that the Government were going in the right direction with the formula, but because they did not implement it-indeed, they still have not implemented it-Northamptonshire PCT is millions and millions of pounds short. For a long time, one of my arguments has been that, to get more fairness in the system, people should be funded fully in line with the national capitation formula. To use the excuse that more money is being paid to other people, as the Government have done, just does not work.
I also think that Tony Blair, when he was Prime Minister, had the right idea in wanting to bring our standard of health care up to the European average. There are still no benchmarks of quality care and outcomes, and that is a fundamental flaw that needs to be put right. However, the ex-Prime Minister got it wrong in thinking that if we just put the money into the health service, that would automatically improve it. Consequently, we have seen the funding for the health service go up to roughly £100 billion a year, which is twice as much in real terms as it was under the last Conservative Government. Unfortunately, outcomes, as measured by finished consultant episodes, have increased by only 20 per cent. So we have put 100 per cent. more money in, but got only a 20 per cent. improvement in outcomes.
That is the great criticism of the Labour Government; their hearts are in the right place, but they have failed dismally despite having had a golden opportunity to succeed. Someone, at some stage, has got to look at this massive budget and use it more effectively. We must know what the outcomes are and approach the issue evidentially, so that we can measure health inequalities. Furthermore, we must not only measure the health inequalities in this country, but compare them with those of our European colleagues.
If our European colleagues have much better success rates on strokes, we as a nation are suffering a health inequality, and we have to put that right. As the report says, we have to start with evidential measurements; we have to know what the measurements are so that we can know whether the money that we are putting in is actually working.
I want to conclude in a moment because we are short of time. I notice that the sitting on the Floor of the House has been suspended, so we might have been switched to live national television, which is only right and proper given that we are debating health inequalities and the Health Committee report. The right hon. Member for Rother Valley talked about taking local people's wants and needs into account. I have a big town in my constituency called Rushden, which funded an out-patient facility after the second world war in remembrance of those who had fallen. The hospital served by that facility was not in my constituency, but miles away in Kettering. When the Government changed the rules and gave us foundation hospitals, it became a foundation hospital.
That hospital has now closed the out-patient facility in my patch, despite the fact that the facility was funded by local people at the end of the second world war. That will increase health inequalities in my area because the facility was used by those who could walk to it-the 20 per cent. who did not have cars and who could not easily travel miles. Now that it has gone, however, they have to use taxis or get friends to transfer them to the nearest NHS facility, which is outside the constituency. That is a health inequality, and such things should be measured.
In conclusion, the report was helpful, and I hope that this Government and the next Government-whatever their political persuasion-will consider it seriously. The main point is clear: it is no good putting our finger in the air and thinking, "This is a good idea. Let's put a few million pounds behind it." We have to have the measurements to know whether initiatives are achieving anything; if they are not, we have to have the political courage to stop them and spend the money on something else.
3.12 pm
Norman Lamb (North Norfolk) (LD): I have received a text message suggesting that we might have until 5 pm, so the Minister may have well over an hour to respond to the debate. I am sure that she will appreciate that opportunity, although the message may be entirely inaccurate.
Hugh Bayley (in the Chair): Order. Let me say for the benefit of hon. Members that I am also taking what soundings I can. I do not think that the debate is likely to end imminently, but I would be surprised if it went anywhere near half-past 5. That said, I do not want to curtail what anybody wants to say, and I am sure that we all want to hear what all three Front Benchers have to say.
Norman Lamb: Of course. I am grateful to you, Mr. Bayley.
| Next Section | Index | Home Page |