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12 Nov 2009 : Column 156WH—continued
Gillian Merron: The hon. Gentleman has previously secured a useful Adjournment debate on that issue, to which I responded. Of course, there are differences in responses to prostate cancer, but that issue is not simply about the inequalities that we are talking about today. There is a whole range of factors to consider, but I am sure that you would say, Mr. Bayley, that they would be better discussed in a relevant Adjournment debate.
I should like to return to the targets we have been discussing. By setting the 2010 national health inequalities target and by learning from experience, we have increasingly been able to show what works and have been able to develop evidence-based resources for local planners of public services. That is something that the Select Committee has been very keen on. In the June 2008 document, "Health Inequalities: Progress and Next Steps", we reconfirmed our commitment to setting out new and enhanced programmes for health inequalities and to ensuring that we have in place the structures and systems needed to support sustainable improvements in health inequalities.
Mr. Bone: Once again, we have heard the Government say that we have the national capitation formula that is based on the needs of particular areas, but they are not meeting those figures because they are overfunding elsewhere. If I had a pound for every time a Minister has told me, "We are closing this gap," I would be a very rich man, but there is no evidence that they are closing the gap. If it is closing and if we are going to get to the point at which we have the fair formula, will the Minister tell me the date on which that will happen?
Gillian Merron: I have already outlined the progress that has been made on that, and I assure the hon. Gentleman, as my colleague Ministers have, that we will continue to make progress.
Comments have been made about the bleak outlook before us, and I have expressed my concerns about the picture that the hon. Member for North Norfolk painted of the situation. The latest life expectancy data for 2006 to 2008 showed an average increase in life expectancy in spearhead areas of 3.1 years for males and 2.1 years for females. The same figures showed an average increase across England of 3.3 years for males and 2.3 years for females, compared with 1995 to 1997 baseline figures. As I have said, infant mortality is at an historically low level. We should acknowledge where there have been achievements.
Let me turn specifically to the Committee's report. I welcome the report and its call for more work on health inequalities, not least by proposing a 10-year extension to the life of the national target. I am glad that colleagues feel the target is useful, because it makes a difference. I also agree with the Committee about the need to do more to address inequalities. The report will help us sharpen our efforts on framing policy, delivering change and ultimately narrowing the inequality gap.
It might help hon. Members if I briefly outline some of the Government's actions on health inequalities. In 1997, the Government set up an inquiry, which was run by the former chief medical officer Sir Donald Acheson. The inquiry pulled together evidence on health inequalities, which showed a marked widening of the gap over the previous 20 years and made clear the link between health and wealth. Since then, we have established the first ever national health inequalities targets on infant
mortality and life expectancy, we have developed an ambitious national health inequalities strategy, which is backed by 12 Departments, and we have incorporated the health inequalities message across public services to make it part of everybody's business. I think that those are stretching targets and demands. We are building on that work and developing a post-2010 cross-Government health inequalities strategy.
As we have heard today, the Government also have a strong record on taking action to address the causes of ill health, including on smoking, which is a real driver of inequality. I hope that all right hon. and hon. Members present will join me in welcoming the measures on tobacco control in the Health Bill, which prohibit the sale of tobacco from vending machines and will bring an end to the display of tobacco. Those measures will help to protect children from being new recruits to smoking and will help people to quit.
Norman Lamb: The Minister has mentioned the Acheson inquiry and its recognition of the link between health and wealth, as she put it. Work on precisely that issue has been done by Richard Wilkinson, who I understand is soon to present a seminar to the Cabinet-a little late, sadly. Does she accept his case that if we are to make real progress we must address inequality within society?
Gillian Merron: That is the theme that I have been trying to develop. It is true that inequality remains a challenge, but it is not true that no progress has been made. That is the only point to which I draw the hon. Gentleman's attention.
We know that it will not be easy to reverse the trend of widening health inequalities and to improve the health of all. There is no single formula or blueprint for tackling this matter, so the Government have had to blaze our own trail. We have built on the evidence in the Acheson report and have negotiated new directions in the business of government to give us the flexibility to meet the needs of individuals, communities and families. I repeat that by setting a target and learning from experience, we have been able to show what works and have been better able to develop evidence-based resources for local planners of public services.
Mike Penning: The Minister has talked about the measures in the Health Bill banning the sale of tobacco from vending machines-I understand that the Bill might already have received Royal Assent. I have nothing but admiration for the Chair of the Select Committee, who has for years advocated such a ban and has been involved in that argument time and again. However, at no time during the Bill's passage through the Committee and Report stages, during which time all the evidence was there, did the relevant Ministers say that the Government wanted to ban the sale of cigarettes from vending machines.
Mike Penning: I have not finished. At the last minute, Ministers tore up their proposals and accepted proposals from Labour Back Benchers that have caused problems for the Bill, but those problems have now been addressed. What made Ministers suddenly change their minds after the Bill had gone through Second Reading, Committee and Report? Why did they suddenly think, "Ah, we'll ban it today"?
Gillian Merron: We have already had that argument. I know the hon. Gentleman still resents the effort the Government have agreed to make on tobacco control, but the fact is that the Bill was always written to allow either restrictions or a ban, as he knows. We said we would test the will of the House and that is what we did. Rightly, the House spoke and the Government gave effect to that. I gently suggest that it is time he accepted not only the will of the House, but the Government's efforts to protect young people from smoking and help others to quit.
Dr. Stoate: May I say how welcome are the significant changes the Government have made since the Acheson report and the real improvements in policy? However, does the Minister share my regret that the previous Government's burial of the Black report and of the subsequent report by Margaret Whitehead in 1985 puts us at least 20 years behind the improvements that could have been made had we taken the issues more seriously earlier?
Gillian Merron: My hon. Friend always makes clear and informed points. As I said earlier, health inequalities widened over those 20 years because of inaction, and now we are in a position-[Interruption.] Opposition Members may not like it, but there has been an improvement and, more importantly, there are moves forward. I am afraid the idea that all that can be turned around overnight is totally unrealistic.
Mike Penning: Will the Minister give way?
Gillian Merron: I would like to continue, because Opposition Members have raised several points already.
My right hon. Friend the Member for Rother Valley referred to evaluation. We have audited and reviewed the results of a range of programmes, including our own work on health inequalities, to make our effort on narrowing the gap more effective. I recognise that we need to strengthen policy and programme evaluations further and can assure Members that we have encouraged programme evaluation as part of our approach to tackling health inequalities so as to learn and do better.
With regard to the role of the NHS, we emphasised in our response to the Committee's report that the NHS has a key role to play through its planning and commissioning arrangements, but there are many major NHS programmes, such as those for cancer or coronary heart disease, that have a health inequalities dimension, as do the public health prevention programmes on smoking, alcohol and obesity. In primary care, improving access for and outreach to disadvantaged groups in areas is a priority. We also fund a range of specific initiatives to support the delivery of the national health inequalities target set out in our report "Health Inequalities: Progress and Next Steps."
The hon. Member for Hemel Hempstead stressed the importance, as I do, of cross-Government action. Our response to the Committee's report states, by way of agreement, that effective cross-departmental action
"is a hallmark of the Government's approach as shown from 2002/03 onwards through the Treasury-led cross cutting review and the Programme for Action. It has also included close working with individual departments particularly the Department for Children, Schools and Families (DCSF)...The learning process is bearing fruit. Ken Judge, a leading academic, has suggested that
'Perhaps the best example of a focused strategy with a clear action plan to achieve specified reductions in inequalities can be found in England'".
I believe that that judgment reflects recent developments, particularly with regard to infant mortality.
Health inequalities are everyone's business, and I wish to emphasise that we see effective partnerships across Departments. We monitor links between Departments on our wider ambitions in order to deliver a long-term, sustainable reduction in health inequalities. We do that through our regular status reports, which look at reductions in child poverty, improvements in housing and educational attainment, and reductions in deaths from cardiac heart disease and cancer. We are also working across Government on the Equality Bill to ensure that the link between socio-economic disadvantages and the other dimensions are fully accounted for in policy making.
The hon. Member for Wyre Forest (Dr. Taylor) referred to secondary care. Perhaps I can assure him that Professor Marmot's review will look at the key health factors contributing to health inequalities in primary and secondary care. The results of that review will be taken alongside NHS policy developments such as the Darzi report to contribute to what I hope will be a comprehensive post-2010 health inequalities strategy.
I am glad that the Committee welcomes the decision to make personal, sexual and health education a statutory part of the curriculum. Members will know that my right hon. Friend the Secretary of State for Children, Schools and Families has agreed to take forward the recommendations of the Macdonald review as soon as possible, and we will work with that Department to ensure that the work is carried out as soon as possible.
The hon. Member for Wyre Forest also asked about children's services, and there was much discussion on Sure Start. Having a centre in each community means that many more disadvantaged children and their families can benefit from those services, as I see happening in my constituency in Lincoln, which will help to end child poverty and improve community cohesion. Sure Start is an example of where we have learned and further developed the programmes from their initial pilots, and they have continued to grow.
Dr. Richard Taylor: With regard to Sure Start and children's centres, is there any way that the Minister and the Department can monitor the uptake by the disadvantaged families that we are so keen to involve, rather than the better-off who do not actually need the services?
Gillian Merron: I do not think that is necessarily a helpful distinction. I know from my own experience that the fact that all families can access those services removes stigma. One of the great successes of Sure Start has been that the promotion of breast-feeding, good parenting and good nutrition, for example, is not aimed only at the most disadvantaged.
Norman Lamb: Will the Minister give way?
Gillian Merron: I will take one more intervention.
Norman Lamb:
The Minister said that Sure Start and children's centres are an example of how the Government have learned, but the Committee's report suggests otherwise. Has there actually been an evaluation of the impact of
shifting from Sure Start to children's centres and spreading them across all communities, and was that effectively piloted? While it is fair to say that every mother needs guidance and support, surely if we are to address health inequalities we need to target that effort in the most disadvantaged communities. Is there any evidence that the policy is achieving that?
Gillian Merron: I am a little worried that hon. Members are suggesting that we should cut back on Sure Start. I know that it is the policy of the Opposition to close Sure Start centres and move the services elsewhere. I remember the pilot from way back, and I think that the Sure Start centres and services we see are extremely popular and well received.
Mike Penning: Will the Minister give way?
Gillian Merron: I will not give way because I want to allow time for my right hon. Friend the Member for Rother Valley to speak.
At the local level we do see changes. For example, the gap between women's life expectancy in Southwark and that of the rest of England has been not only narrowed, but closed completely: female life expectancy in Southwark has jumped from 78.7 years to 82.4 years, which is higher than the average life expectancy for England. In Manchester that gap for men is being closed: male life expectancy there has risen from 70.1 years to 73.8 years. Life expectancy in Hackney has increased faster than the English average for both males and females. If those areas can improve, so can others.
We remain committed to supporting local partners to tackle inequalities. There is much more to do if we are to retain and build on the progress we have made over the last few years and lay the foundations that the Committee rightly asks us to for a long-term and sustainable reduction in health inequalties in the future. That recognition has informed our decision to ask Professor Marmot to conduct the review, and he is the world's leading expert in that field. I am delighted that the Committee has welcomed that decision and emphasised the potential contribution that that work can make.
A key part of the work that Sir Michael will undertake for us in England will be to explore how to translate the evidence into promising areas for policy development, and what that will mean for delivery and implementation on the ground. It is exactly what the Select Committee is looking for. The review will provide a fresh and rich source of material that will be invaluable to the Committee and to the Government.
Health inequalities are persistent and difficult to change, but we remain committed to and focused on tackling this blight on the lives of people across the country. The learning from the past 10 years and the results of the forthcoming Marmot review will mean that we will be better placed than ever to deliver on our ambition of achieving a long-term, sustainable reduction in health inequalities.
4.20 pm
Mr. Barron: I thank hon. Members for taking part in this debate and for their kind words about the operation of the Health Committee. I thank the three members of the Committee who contributed this afternoon. I would like to run through a few things and give a view on them, as I truncated my speech earlier.
The Minister rightly says that personal, social and health education will be introduced under the national curriculum. I noticed that when that was announced in the media last week, one issue immediately came up for national debate. I would like to remind the House exactly what PSHE will mean under the national curriculum for years to come. This is in paragraph 201 of the Government's response:
"It covers a range of issues central to children and young people's lives including: drugs, alcohol and tobacco, emotional health and wellbeing, sex and relationships, nutrition and physical activity, personal finance, safety, careers and work related learning."
Many of those things are involved in health inequalities and how they operate in this country.
That takes me on to what the hon. Member for North Norfolk (Norman Lamb) said about economic inequality being the driver of health inequality. I want to question that a little. The Committee did not go into this in great detail, but if Members look at page 24 of the report, the person who is mentioned, Richard Wilkinson, did give evidence to us. It would have been my wish that Richard could have been an adviser to us throughout the inquiry, because of his eminence in this field, but he could not make it. He stated that
"health-related behaviour is all about resolutions to give up the things you do not want to give up and to do the things you do not want to do. You cannot do that, you cannot make the resolutions and stick to them, unless you are feeling on top of life."
That is not quite the same as what public health academics have been saying for many years now, which is that it is all about income inequality.
Norman Lamb: Will the right hon. Gentleman give way?
Mr. Barron: Let me finish first, please. The Committee took evidence from numerous people as eminent as Richard Wilkinson. I remember Professor Kay-Tee Khaw from the university of Cambridge saying that such issues are not necessarily about income inequality but about what people do or do not do. They are lifestyle choices. Many people who were born and brought up in my constituency are very much like I was before I came to this House. They live healthy and fulfilled lives, although one could say that they are in a risk area, being in social class IV or V. That is why I say to the hon. Member for North Norfolk that we cannot say that this is just about income. Clearly, it is not.
Norman Lamb: I said clearly that despite the clear evidence in Richard Wilkinson's analysis in "The Spirit Level", we have a duty to do everything that we can to reduce the health inequalities that exist in our society here and now. Has the right hon. Gentleman seen that analysis, or the incredibly compelling evidence from international studies which show a clear link between income inequalities and health inequalities?
Mr. Barron: Indeed, the Committee has seen it, and we visited northern Europe to look at how income inequalities were measured. Before I move on, let me refer to paragraph 48 of the Committee's report. This was not our idea, and it was not one of the recommendations, but when the hon. Gentleman spoke earlier, I was reminded of this paragraph in the report:
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