Health Inequalities: 23rd April 2013

The Parliamentary Under-Secretary of State for Health (Anna Soubry)

It is a pleasure, Dr McCrea, to serve under your chairmanship. I congratulate the hon. Member for Ealing, Southall (Mr Sharma) on securing the debate and raising this important issue, although this is only a half-hour slot.

The hon. Gentleman said that he was keen to learn from the past. That is an admirable aim but, unfortunately and with great respect, he has rose-tinted glasses when looking back at the previous Government’s record. I will look at that record with no rose tint. The simple truth has been identified by my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay), and despite the doubtless very best intentions, health inequality under the last Government got worse, notwithstanding their claim to have made it some sort of priority and to have put more money into the NHS.

Stephen Barclay
The last Labour Government took more than 10 years to introduce even basic known measures such as smoking cessation programmes in deprived communities, although the science and evidence base was clear. Will the Minister assure the House that the Government will not say one thing and do another on health inequalities, but will follow the science?

Anna Soubry
I can say that absolutely. The hon. Member for Ealing, Southall asked whether the Government are committed to reducing health inequalities and making the sort of progress that we did not see in 13 years of the previous Government. I assure him that it is not just a question of blind intention, but an absolute fact that we have already done it.

[Interruption.] I am making a noise because I am removing the script of my speech. I am not good at following a script from my officials. They are extremely helpful, and it sometimes causes them concern that I go off script and speak off the cuff.

I am familiar with the Health and Social Care Act 2012. What the hon. Gentleman either does not know—this is not a criticism—or may have forgotten is that, for the first time ever, there is a statutory duty, not just on the Secretary of State, but throughout the NHS, to improve health inequalities. It is not a question of targets, which have not always delivered the right outcomes, and Mid-Staffordshire NHS Foundation Trust is a good example, as was identified in the Francis report. That duty is ​statutory so the Secretary of State and all those involved in the NHS must deliver, and the Secretary of State must give an annual account of how his work in leading the Department of Health and being the steward of the NHS in England has delivered a reduction in the sort of health inequalities that we all understand. That is there in law, but in 13 years in government, the hon. Gentleman’s party failed to do that.

Mr Sharma
I am not disputing the matter and, as I said at the beginning of my speech, I do not want a blame culture or to say what happened during those 13 years, but I ask the Minister to join me in my constituency on Saturday when thousands of people will march from Southall to Ealing. At the last march in September, there were more than 20,000 people, and we expect more this time. She will then know whether people believe that services have improved or got worse.

Anna Soubry
I am grateful to the hon. Gentleman but, with great respect, he does not understand that reducing health inequalities is not simply about saving an A and E department. I hope that, when the hon. Gentleman is marching on Saturday, he will remonstrate with anyone who has a banner saying “Fight the NHS cuts”. Whenever anyone looks at reconfiguration, they do so on the basis of how to make the service better.

Stephen Barclay
I am sure that the Minister is aware that, on reconfiguration, bodies such as the Royal College of Surgeons support specialised centres, because they save lives. The evidence from stroke services in London is that reconfiguration is saving around 500 lives a year.

May I draw the Minister’s attention to the fact that, at the end of the last Labour Administration, only 4% of the NHS budget was being spent on prevention? It is all very well for the hon. Gentleman to join marches, but prevention is far more helpful from a value-for-money perspective than treating things when they go wrong.
Anna Soubry
I am very grateful for that intervention. My hon. Friend makes the point more ably than I can that much of the great work to reduce health inequalities is not about whether there is an urgent care centre or an accident and emergency centre within 500 yards or 5 miles of where someone lives. Work on public health is critical, and that is why I am so proud that this Government have increased the amount of money available to local authorities, which now have responsibility for delivering public health. They had that historically and we have returned that power to local level. That is important in the delivery of improvements in public health. This Government’s view is that local authorities, as in the hon. Gentleman’s constituency, know their communities better than Whitehall does. In the delivery of key and important work on public health, it is right and proper that local authorities have that responsibility. They, too, have a statutory duty to deliver on health inequalities. That runs through all their work of looking after the public’s health, but, most importantly, addresses those very factors that cause the sort health inequalities of which we are all conscious. For example, there is a clear demographic link between smoking and diabetes.

If the hon. Gentleman goes to Leicester, he will see the work that is being done there and in Leicestershire with the clinical commissioning groups—the GPs are ​now doing the commissioning—working for the first time with the local hospital and looking at a whole new way of delivering a better pathway not just of care, but of early diagnosis and prevention, linking those up in a way that has never been done before in the NHS. If he sees those examples, far from criticising the Government or having doubt about our commitment to health inequalities, he will take the opposite view.

If the hon. Gentleman needed yet further proof of the great work that can be done under the new way of delivering public health and commissioning in the NHS, he could do no better than take a trip to Rotherham in Yorkshire. I went there to see its fantastic work in tackling obesity. Obesity is a clear issue of health inequality and Rotherham has taken a totally joined-up approach. GPs are working with dieticians, schools and planners, with the local authority at the heart. They are all coming together to deliver a considerably better strategy, with real results in tackling the problems in that area.

On funding, it is important for the hon. Gentleman to understand that we have increased the amount of money that is available. It is now ring-fenced, on a two- year deal, so that real security and certainty is given to those local authorities. In some areas, we have increased up to 10% the money that is available to spend on public health.

Rehman Chishti
I completely share the Minister’s opinion about an approach where local authorities know what is in their best interests—for example, in relation to obesity in Medway, which has one of the highest recordings above the national average for obesity. However, I want to raise another point with the Minister. On diabetes and organ transplants, certain parts of the community—or certain parts of minority communities—are more likely to be affected. Will there be a national strategy that covers and supplements what is going on locally, because these are national issues that affect minority communities throughout the country?

Anna Soubry
I am grateful to my hon. Friend for making that point. The subject of diabetes—type 2 in particular—and the clear link to obesity and being overweight is something about which I am beginning to have a passion, because I can see the great work that can be done. We have just done a cardiovascular strategy. It is a call for action about mortality, and we know that cardiovascular disease work sits within that, and that cardiovascular work—I am getting very worried, Dr McCrea, because I am beginning to sound almost as though I am a health professional, when I am nothing more than a simple hack criminal barrister, rather like my hon. Friend.

The point, however, is that we know that if we look at diabetes, many other boxes are ticked in improving the lot and the health of our population. Certain parts of our population, in particular, have suffered from health inequalities, and my hon. Friend makes a very good point about some of our communities—in the Asian community, there is a great prevalence of type 2 diabetes, as there is in the Afro-Caribbean population. If we look at diabetes prevention, earlier treatment and diagnosis, and then proper treatment and good outcomes, other boxes are ticked—for example, obesity and being overweight, and all the other things that often flow from diabetes, such as the link with cardiovascular disease and so on. My hon. Friend makes a very good ​point about how a local authority beginning really to drill in and target a particular illness or disease can have many beneficial spin-offs in the manner that I have described.

The Government have established a comprehensive measurement system designed to measure not only overall improvement, but, in particular, inequalities. The NHS outcomes framework—I know that these words do not trip off the tongue and that they may be lost on the majority of completely normal people, but they are important documents—forms the basis for measuring progress on delivering improved results for patients and reducing health inequalities. The NHS England business plan commits to assessing health inequalities across a range of dimensions in the NHS outcomes framework, and those important documents guide our clinicians, the commissioners, and everybody involved in ensuring that we live longer, healthier, and happier lives. That exercise may reveal important health inequalities that have not previously been evident. The public health outcomes framework includes an overarching aim to reduce differences in life expectancy and healthy life expectancy between communities, through greater improvements in more disadvantaged communities. Public Health England will regularly publish data for the indicators, including breakdowns by key equality and inequality characteristics to enable monitoring to help focus action where it is needed.

I am looking forward to the time when we begin to publish, by local authority, the outcomes in each local authority on such things as the stopping of smoking, and the work that is done on the abuse of alcohol. Invariably, we gather that information, but when we start to publish it and put it in the public domain, Members of Parliament, local councillors and members of the public will all have access to it, and they will be able to see how their local authority is performing. We will not try and trick anybody and we will not be unfair, but we will ask people to compare like with like. We make it clear to local authorities that they do not all start from a level playing field, because many of them, unfortunately, are inheriting public health policies that were not some of the best. Therefore, we will recognise that—it is one of the legacies left over from the previous Administration. However, because people, GPs, and everybody involved in the delivery of health, including councillors and Members of Parliament, will have public access to such information, I have no doubt that that will begin to drive a real desire to reduce health inequalities.

I mean no disrespect to the hon. Member for Ealing, Southall, but I know the previous job of my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) and he, like me, knows that there is no better grit in the millstone among professionals than when comparisons are made about who has a better set of results. There is always good, healthy competition between professionals. We have seen that in the past when we published—I am not going to try to pretend that I can remember what it is, and if I say what I think it is, Dr McCrea, you can bet your bottom dollar that it will be wrong, but I know that in the past we have published the outcomes of particular procedures and surgery, and that it has improved the outcomes to everybody’s benefit when there has been a bit of healthy competition between professionals. That is what we intend to do by publishing the statistics on public health outcomes by local authorities, so that everybody can see what is out there. We saw it in ​recycling rates. Publishing information did exactly what we hope it would—it upped everybody’s game, and that is one of the reasons why we will do it.

To conclude, we have created a new health system that makes tackling health inequalities core business, underpinned by new legal duties, measurement and assessment. The local autonomy that we have given to our CCGs and our health and wellbeing boards will enable them to take focused action that meets the needs and aspirations of their populations, concentrating on the groups that experience the worst health inequalities. I hope that the hon. Member for Ealing, Southall is now in no doubt about what has been done.

Tackling health inequalities is a key priority for the Government, and it supports the wider focus on fairness and social justice. I know from a radio interview that I ​gave on Friday—on the “Today” programme on the BBC—that Professor Marmot, who wrote his brilliant report on health inequalities, has already recognised how important it has been that we have made this a statutory duty. He has praised much of the work that this Government have done—I have to say, in stark contrast to the previous Government, of which the hon. Gentleman has been a firm supporter.

Our approach is to design a system that empowers those at a local level to take action on inequalities, with a strong focus on commissioning quality services and on improving the health of the poorest, fastest.

Question put and agreed to.