HC Deb 03 November 1999 vol 337 cc260-7

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Mr. Bob Blizzard (Waveney)

I shall start with a rather grisly fact. If one lives in certain parts of Lowestoft one has a 60 to 80 per cent. greater chance of dying before the age of 75 than the average individual living in Suffolk. That fact is contained in the 1999 report of Suffolk's director of public health. That is a shocking statistic for those who live in the two wards concerned as well as for the whole town of Lowestoft, the county of Suffolk and anyone who cares about health inequality. It reveals what is meant by the term "health inequality".

The director has made it clear in his report that there is a strong association between high death rates and deprivation. The two wards, together with a ward in central Ipswich, have the highest standard mortality ratios in Suffolk. They also have the highest levels of deprivation and the highest number of people on income support—about 25 per cent. The director's report tells us that Lowestoft as a whole has the highest premature death rate of any town in Suffolk and that it is significantly above the Suffolk average. All the information and statistics in the report are based on research from the years 1995–98.

Unfortunately, this is nothing new. In the director's 1997 report, which was based on statistics from the years 1987–95, the same three wards were at the top of Suffolk's standard mortality ratio. The report begins: Overall, Suffolk people are amongst the most fortunate residents of this country when it comes to health—or at least to death! In any one year a Suffolk resident of any age has, on average, an 8 per cent. lower chance of dying than the average individual of the same age living in England and Wales. However, the report goes on to say: This encouraging overall picture for Suffolk does, however, conceal some marked variations in death rates within the county…The three most deprived wards in Suffolk…have deprivation levels akin to those found in many inner city areas of the UK's big cities. They also have the most significantly high SMRs in Suffolk and the highest levels of unemployment…If you are amongst the 10 per cent. of the population living in the wards in Suffolk with the highest death rates you are almost twice as likely as the 10 per cent. living in the best wards, to die before age 75. The director was so concerned that he called the report, "Time for action".

Sadly, and unacceptably, as I have pointed out, the 1999 report reveals that things have not improved and that, if anything, they have got worse. I spoke to the director this week and he is concerned that things my have got worse. The SMR for the Kirkley ward was 143 in 1997 and it is now 184. The SMR for the Harbour ward was 138 in 1997 and is now 164.

I have looked at other figures from the Office for National Statistics, which allows primary care groups to compare their death rates. It uses a measure known as the death, age, sex standardisation rate. Those figures show the Lowestoft PCG area substantially higher than all other Suffolk PCGs.

We see the same inequalities in mental health. The director's 1999 report shows that Lowestoft's standard admission rate for psychiatric specialties is 131. The next highest is Ipswich with 109 and the lowest rate in the county is 77. Again, the director confirms the link with deprivation.

Health inequalities such as these are immoral and unacceptable, even more so when one lives in a community that is at the wrong end of the statistical table. I am pleased that this Government are the first Government to make one of their two overall priorities the reduction of health inequalities to narrow the health gap. Few communities will appreciate that more than Lowestoft. However, if it was time for action in 1997, people want to know why things have not improved in 1999. What has happened?

I have looked at Suffolk's health improvement programme. The first programme is just a catalogue of what has been happening, but we must recognise that it will take time for health authorities to develop their programmes. As they are developed in the future, they will need to be more focused on specific priorities for addressing health inequalities, with a clear strategic direction.

It is clear that we need a two-pronged approach. First, we must tackle the causes of ill health. The Kirkley area of Lowestoft has been designated a single regeneration budget area. That funding is being used for a healthy Kirkley initiative, drawing together public bodies carrying out community based work. There is improvement in housing conditions and enhancement of the physical environment. A training centre is up and running to help youngsters back to work. That partnership has put in a bid to the new opportunities fund for a healthy living centre. If it is not against protocol, I hope that the Under-Secretary of State for Health, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), will support the bid.

There is some public disquiet about the rate of progress, but we must recognise that multi-agency work takes time. The new deal is making an impact in Lowestoft, as is the minimum wage legislation, and we fully expect the working families tax credit to help. We had excellent news this summer when the Government awarded Lowestoft assisted area status and designated it as a European objective 2 area from 1 January. All those initiatives will be a huge boost to the employment prospects, economic recovery and future prosperity of the people of Lowestoft. However, it will take some time for them to have an effect, so we must look at the second prong.

Like crime and the causes of crime, while we are dealing with the causes of ill health, we must ensure that the resources are available to treat the existing high levels of ill health. People in Lowestoft have asked whether the director's reports have influenced the spending patterns and distribution of resources in Suffolk. The answer seems to be not at all. The current allocation of resources within the county does not match or relate to the health inequalities. That is a sore point in my constituency. The director reveals that clearly with regard to mental health services in this year's report.

Government policy could not be clearer. The document entitled, "The New NHS modern and dependable" states: The healthcare needs of the population, including the impact of deprivation, will be the driving force in determining where cash goes. There will be a national formula to set fair shares for the new PCGs as there is now for health authorities. It will be for health authorities to determine the pace of change at which individual PCGs within their area should move towards their fair share. So far in Suffolk I have seen no such movement.

Suffolk health authority has said that the budgets are tight and difficult. It is not easy to take resources from one part of the county to give to another. Let us be clear. Suffolk health authority has had above inflation rises in Government cash awards. In 1998–99, it was 4.14 per cent. and in 1999–2000, it is 5.5 per cent. It had extra money for the winter difficulties in 1997. It has had extra money for waiting lists and a good share of the modernisation fund. However, it has had only the basic rise in its annual revenue allocation from Government. It has not had any discretionary rise because, as a whole, Suffolk is relatively healthy in national terms. The Suffolk average SMR is 7 to 8 per cent. better than the national average. The Suffolk average for deprivation is quite low.

Government policy is to give greater uplift in resources to the more deprived health authorities to narrow the inequalities between them. The problem faced by Lowestoft is that it is an area of high deprivation suffering huge health inequalities in an otherwise better-off county. How will the Government ensure that their philosophy of addressing health inequalities through differential funding is replicated within a health authority? Is there an allowance for Lowestoft's deprivation currently included in Suffolk health authority's settlement? If so, how much is it? Is there monitoring to see whether that money is directed towards Lowestoft? The authority appears to use an historic roll-over budget rather than redirecting resources. I know that the Secretary of State for Health, my right hon. Friend the Member for Darlington (Mr. Milburn), when he was the Minister of State, wrote to Suffolk health authority about the issue in February 1998.

Before coming to the debate today, I consulted a number of health professionals in Lowestoft. The commonly held view is that the gap has got worse rather than better. Resources were directed towards an acute hospital in another part of the county that had particular problems.

In my discussions, I discovered that there are mounting problems with mental health services. There is restricted access to cognitive behaviour therapy for patients with ME and chronic pain, restricted access for victims of sexual abuse and young people to support and advice services, and, alarmingly, reduced access to the Waveney alcohol and drugs service. That is worrying, as there is a drugs problem in the area to which I have referred.

The plan to develop the locally available renal dialysis service at the local hospital has been abandoned. As a result, some people will have to make the 60-mile return journey to Norwich three times a week for dialysis. That is uncomfortable for any patient, and transport is a particular problem for those suffering deprivation. If my hon. Friend the Minister has not been to East Anglia, I can tell her that 60 miles on East Anglian roads is far worse than 60 miles in other parts of the country. The abandonment of the plan to develop local renal services poses a great problem for my constituents.

Mr. Anthony D. Wright (Great Yarmouth)

Is my hon. Friend aware that Norfolk and Suffolk health authorities planned to improve the renal unit at the James Paget hospital, the benefit of which is enjoyed by both our areas? The inability of Suffolk health authority to raise that revenue has scuppered that plan, whereas Norfolk health authority has introduced proposals that benefit the people who use the renal service in Norwich and at the James Paget hospital.

Mr. Blizzard

My hon. Friend is right. The James Paget hospital has an admirable policy of providing services for both counties. It wants to treat the two counties equitably, but the failure or inability of Suffolk health authority to fund the renal service means that people in both our constituencies are suffering.

We now have a worse problem. Suffolk health authority is undertaking a planning exercise to prepare for a 2 per cent. budget cut across the board to deal with its deficit and in anticipation of its expected settlement for 2000–01. How can we have a 2 per cent. cut and record levels of expenditure through the £21 billion extra money that the Government are putting into the health service? The two are incompatible. Someone will have to explain to people in Suffolk how that can he. Will the Minister look into this matter?

Will the basic increase that Suffolk health authority is expecting be inadequate to cope with unavoidable, rising costs, bearing in mind that it is expecting only the basic uplift? Or is the projected deficit the result of stored-up, longer-standing budgetary problems that pre-date this Government? Whatever it is, people in my area will be dismayed if we suffer a 2 per cent. cut. I ask the Minister to look into how that problem can be overcome and consider a financial remedy.

Even if there has to be a 2 per cent. reduction, it should not be across the board, because then the inequalities in Suffolk would be perpetuated. Government policy requires health authorities to narrow the gap, so how can a reduction be imposed on hard-pressed general practitioners and on the primary and secondary services in Lowestoft that deal with the highest levels of ill health in Suffolk? The policy demands a re-routing of resources in Suffolk to deal with the findings of the director of public health in successive reports. Even with the tightest budget, there must not be an across-the-board response.

Government policy on reducing health inequalities is just what we need in Lowestoft, and it is vital that it is implemented. The new Health Act 1999 gives the Secretary of State new powers to ensure that it is. Will the Minister look into the issues that I have raised, and help Lowestoft to receive its fair share of resources: the share that the appalling statistics and Government policy determine that it should have?

1.14 pm
The Parliamentary Under-Secretary of State for Health (Yvette Cooper)

I congratulate my hon. Friend the Member for Waveney (Mr. Blizzard) on securing this debate and on raising the issue of health inequalities, which is a matter of great concern to the Government. He is a powerful advocate for his constituency, and has drawn attention to the problems faced by his constituents in Lowestoft.

The Government are strongly committed to tackling health inequalities. Under the previous Government, health inequalities were barely mentioned, never mind tackled, and the idea that they might be linked to poverty, unemployment or the wider inequalities in society was anathema to them. The result was that, when we came to office, we inherited a society in which the health gap between rich and poor had continually grown. My hon. Friend makes that case powerfully when he talks about his constituents.

One of the first actions that the Government took was to commission an independent inquiry into health inequalities. Sir Donald Acheson reported that, although average mortality had fallen over the past 50 years, unacceptable health inequalities persisted, and many measures of health showed that inequalities had either stayed the same or had grown and widened in recent decades.

Health is too much of a local lottery. Surrey man can expect to live on average 11 years longer than Manchester man. For women, the difference is nine years. The problem is not just about where people live, but about who they are. Their chances of dying young are significantly higher if they are working class than if they are middle class. The unemployed are twice as likely to suffer from depression as those in work. High blood pressure, smoking and obesity are more prevalent among the low skilled. People in substandard housing are at greater risk of cold and damp. Death rates from coronary heart disease among people living here but who were born in south Asia are 46 per cent. higher for men and 51 per cent. higher for women than the rates for England and Wales as a whole.

People on low incomes are not only more likely to get ill, but are less likely to get the treatment that they need. The highest numbers of heart operations are not in the areas with the highest rates of coronary disease. People in poorer areas are less likely to survive cancer than those in more affluent areas.

In Lowestoft, the pattern is similar. Kirkley and Harbour wards have higher than average unemployment and crime rates. They also have the highest premature death rate, and Kirkley has the highest out-patient referral rate in Suffolk. Those wards also have a 29 per cent. higher rate of emergency admissions than the average for Suffolk. Lower job opportunities, lower incomes, higher rates of drug and alcohol abuse, social exclusion and poverty all take their toll compared with other parts of Suffolk.

My hon. Friend is right when he says that such health inequalities are immoral and unacceptable. They are as unacceptable to the Government as they are to him. In Lowestoft and across the country, the Government are committed to tackling this unfairness.

I want to talk about the action that we are taking to tackle health inequalities, and to try to answer the points made by my hon. Friend. He is right that we need to tackle the underlying causes of ill health, whether it is poverty, unemployment, poor housing or other problems that cut right across every Department, not just the Department of Health. That is why we are raising the income of families with children through the working families tax credit, raising child benefit and the child premium for income support.

The working families tax credit provides extra help to 1.4 million families. Families with children and someone in full-time work will have a minimum income of £200 per week. The Prime Minister has said that we must end child poverty in a generation. We have a long way to go, but these are important steps along the way.

To cut unemployment, we have invested £5 billion in the new deal programmes. We are investing £450 million in sure start to help vulnerable children to make the best possible start in life. Sure start brings together early education, health services, family support and advice to families in low-income areas with children under the age of four.

The Government are also working to tackle pensioner poverty. We are providing a new minimum income guarantee for pensioners worth at least £75 per week for a single pensioner and £116 for couples this financial year, and a winter fuel payment of £100 for every pensioner household. As many pensioners on low incomes will know, sitting in a cold house because they do not have the money to turn up the heating is not good for their health. We are also investing in our poorest communities through projects such as the new deal for communities, the single regeneration budget and sure start. The most powerful way of tackling the ill health of some of our poorest communities will not just involve the health service; it will involve reducing the poverty that caused the problem in the first place. That is why the Kirkley regeneration initiative described by my hon. Friend, which has secured single-regeneration funds for the area, is so important. Its purpose is to tackle local unemployment and deprivation.

All the programmes that I have mentioned will help to tackle some of the underlying causes of ill health. My hon. Friend is right to say that it will be a long process, but we must make a start, and we must do it now. We also need direct action to tackle health inequalities, which is why the Government are currently developing initiatives such as health action zones, healthy living centres and health improvement programmes to improve the health of communities.

One of the programmes in Lowestoft is the "healthy Kirkley" initiative, a community health project which brings together the local NHS trust, the community health council, Waveney district council, Suffolk county council and the local primary care group. Together, those bodies are trying to deal with the symptoms that are so often related to deprivation: depression, isolation, low self-esteem, stress and asthma. The partnership is addressing community needs directly, organising, for instance, a Saturday morning drop-in centre for young parents and a scheme enabling unemployed people to be trained through the renovation of local housing. The initiative will obviously be strengthened by the bid for a healthy living centre, to include the wards of Kirkley and Harbour. My hon. Friend made a powerful case for that bid, and I am sure that the message will be passed on. There are further schemes to deal with the problems of older people, smoking, misuse of drugs and other substances, and domestic violence.

Let me say something about programmes in Suffolk as a whole. The alliance for health in Suffolk, financed by Suffolk county council and Suffolk health authority, has established a healthy schools project to promote a health ethos and environment in schools. The project has links with mental health, coronary heart disease and stroke prevention groups which, as part of the health alliance, aim to reduce health inequalities. All those local partnerships are examples of programmes that we must promote and make effective throughout the country if we are to have an impact on the root causes of ill health and health inequality.

We must also consider what our health services can do more directly. That applies to health authorities, trusts, primary care groups and other health partners. My hon. Friend expressed anxiety about the allocation of resources to Suffolk health authority, the distribution of resources in Suffolk and the impact on inequality. I can tell him for a start that the Government have commissioned a review of NHS resource allocation, which is now under way. A key objective is for the way in which resources are divided across the country to contribute to a reduction in avoidable health inequalities.

The Government believe that resources for health care should go where needs are greatest. At national level, we take relative need into account when allocating money to health authorities, so that we can distribute more additional resources to the areas in greatest need. Last year, all health authorities received a minimum increase of 1.67 per cent., and additional growth funds were aimed at the health authorities in greatest need.

As my hon. Friend said, Suffolk health authority received a 5.5 per cent. increase in its budget this year, which represents a real increase 2.9 per cent. in its power to spend money on health services for people in the area. That compares with real increases of 1.35 per cent. last year, 1.9 per cent. in 1997, only 0.5 per cent. in 1996, and a mere 0.06 per cent. in 1995, under the last Government. Suffolk has received funds from the modernisation fund for waiting lists, mental health treatment, lung and colorectal cancer and information technology.

I am aware that the health authority is running a deficit this year, and is now planning how to recover its balance by 1 April 2000, which it is required to do by the regional office. How the authority allocates its resources to achieve that balance must be a matter for local discussion; nevertheless, I expect the authority, the primary care groups and all the local health partners to take account of health inequalities and deprivation during that discussion. I am very interested in what my hon. Friend said in that context, and I will pursue the matter.

I understand that the 2 per cent. mentioned by my hon. Friend is not an across-the-board cut. If he wants to discuss that further, I shall be happy to talk to him, because, as I have said, I believe that health authorities must take account of health inequalities.

Health authorities, including the Suffolk authority, are now expected to take account of such inequalities, and to draw up plans for improving the health of local populations. This is the first time that all health authorities have led the preparation of comprehensive and cross-sector health improvement programmes. My hon. Friend asked what the Department could do to ensure that the programmes included action on health inequalities and areas of deprivation. I can tell him that the Department will provide guidance on the setting of local targets to measure progress in the reduction of health inequalities, and on assisting health authorities.

I understand that the development of Suffolk's health improvement programme involved health services, social services, education and housing services, and many of the other agencies and groups involved in health issues. The plan of action for improving health in 1999–2000 has identified health inequalities as one of its five priorities, the others being coronary heart disease, cancer, accident prevention and mental health. Those are important aspects of the national health strategy, which will have a considerable impact on the health of Suffolk residents.

The primary care group in Lowestoft is concentrating on health inequalities and mental health issues. It is currently working with key stakeholders to produce a primary care investment plan, which I understand will be finalised soon. Taken together, the health improvement programmes and the primary care investment plans should deliver a comprehensive range of targeted measures to tackle health priorities both countywide and in local communities.

The Government are also taking broader action across the NHS, which should help to tackle health inequalities not just in Suffolk, but throughout the country. The decision to place cancer, heart disease and mental health problems among our top priorities also constitutes an attack on health inequalities. After all, the people who are most likely to die prematurely of cancer, or to have heart attacks under the age of 65, are those on low incomes. The death rate from coronary heart disease is three times higher among unskilled men than among professionals.

We have charged the new cancer director, Professor Mike Richards, with assessing the wide variations in cancer care and cancer survival rates across the country, and with drawing up a strategy to end the national lottery in cancer care. It simply is not fair that where a person lives, or who a person is, should affect the treatment that that person receives, as well as his or her chances of getting cancer in the first place.

My hon. Friend asked what the Government could do nationally to raise standards in every area. The national service frameworks that we are currently developing to deal with coronary heart disease, mental illness, the problems of older people and diabetes will reflect the need to tackle inequalities, and will ensure that national guidance will enable every area to improve the health of its population.

Tackling health inequalities will require determination on many fronts. For too long, the main problem has been securing official recognition of those inequalities. The NHS will be a key player, but not the only player. We shall have to work in partnership with other organisations; but the Government are absolutely committed to ensuring that everyone has a fair chance of leading a healthy life, regardless of where they live and regardless of social class, ethnicity and gender. That means tackling the causes of health inequalities, but it also means modernising our health services, so that the NHS becomes a truly national service in which patients can have fair access to consistently high quality and prompt treatment throughout the country.

We have a long way to go if we are to reduce health inequalities in Britain, but we are making plans in order to start making a difference now.