Acheson Report: Inequalities in Health (Hansard, 12 January 1999)

§ Baroness Hayman
My Lords, the whole Government are firmly committed to reducing health inequalities. A range of initiatives is already helping to carry forward Sir Donald Acheson's recommendations. My right honourable friend the Secretary of State for Health made clear when Sir Donald was appointed that his findings would contribute to the development of a new health strategy. We shall be publishing a White Paper on that strategy shortly.

§ Baroness Castle of Blackburn
Does not Sir Donald's report demonstrate statistically that many of the health 82 inequalities today are due to the previous government's deliberate policy of widening the gap between the rich and the poor, not least by lavishing on the richest 5 per cent. of this country generous tax reliefs at the expense of the rest of us? While I appreciate that this Government cannot be expected to remedy these inequalities at a stroke, perhaps I may urge upon them the need to launch without delay an educational campaign to ensure that the people of this country recognise the case for a fairer distribution of income, and the need to repudiate the absurd disclaimer that they are not in favour of a policy of tax and spend. How can a government spend unless they raise taxes? For example, how do the Government expect to improve the status and income of nurses, which are so essential to the health service, unless they spend money? Can my noble friend the Minister say how they will raise that money?

§ Baroness Hayman
My Lords, I have to point out to my noble friend that we are certainly spending money on the health service. Like many of my noble friends and others, I know that my noble friend welcomes the massive injection of funds that we are putting into the NHS. However, to respond to my noble friend's points about the Acheson report, I can say that it certainly illustrates the growing divide in health status between the rich and the poor. Indeed, I would not quarrel with her that poverty is a principal source of ill health. That is why we clearly set ourselves targets both as regards reducing inequalities and improving access to health services for those who are most disadvantaged. It is also important to recognise that we are taking action across a broad range of government areas, not simply in terms of health but in terms of the environment and social security, by way of a whole series of measures which contribute to reducing health inequalities and social exclusion.

§ Lord Clement-Jones
My Lords, in the light of the Minister's reply to the noble Baroness, Lady Castle, can she confirm whether or not the Government are actively considering the whole question of adopting Sir Donald's principal recommendation about health impact assessments? In particular, can the Minister say whether or not she believes that a prime candidate in that respect would be social security disentitlement?

§ Baroness Hayman
My Lords, the noble Lord makes an important point. If we are to make sure that we look at the effect of government policies in the round, we cannot put on departmental blinkers in any assessment of the effects of one area of policy on another area of policy. Across Whitehall we are working to ensure that all departments whose work and policies impact on health are assessed to ensure that the implications are taken into account when policies are drawn up. Of course, social security is a prime candidate in that respect.

§ Baroness Gardner of Parkes
My Lords, is the Minister aware that one of the greatest health inequalities is dental health? Indeed, in the city of Blackburn, which is where the noble Baroness who tabled the Question comes from, over 100 children a week have to have teeth extracted. Can the Minister say 83 when the Government will consider putting fluoride into the water system which would do so much to help the really poor children who receive no dental treatment?

§ Baroness Hayman
My Lords, the noble Baroness is absolutely right to point out the health inequalities in dental health. I believe that the House had an opportunity to debate at length the issues surrounding fluoridation only recently. Indeed, this raises great passions on both sides of the debate and answers will be forthcoming in the White Paper to which I referred earlier.

§ Lord Rea
My Lords, although I recognise the Government's efforts in removing people from benefit and putting them into the employment sector, does my noble friend the Minister not recognise that many people will still be on benefit, among whom will be the poorest people, and that that will include a disproportionate number of families with children? Will the Government implement recommendation 3.2 of Sir Donald's report, which says: We recommend uprating of benefits and pensions according to principles which … improve the standard of living of those who depend on them and which narrow the gap between their standard of living and average living standards"?

§ Baroness Hayman
My Lords, it is absolutely right that we focus our attention on improving the living standards of the poorest households. The best way for many people to get out of poverty is by helping them into work and giving them the opportunity to improve their incomes and lifestyle. There will be others who, for various reasons, do not have those opportunities. In particular, as my noble friend pointed out, the children of such families need support. The Sure Start programme is particularly important and I am sure that my noble friend acknowledges that the allowances for children in income-related benefits that were increased in November 1998—for example, that for the eldest child of £2.95 a week—are a reflection of the need to provide targeted help for some families.

§ Lord Hooson
My Lords, as to the remarks of the noble Baroness, Lady Castle, about inequality of incomes at present, is it not correct that old Labour had the right goal in wanting less inequality of income but the wrong means, whereas the present Government give the impression that they have abandoned the goal? How do the Government intend to restore the goal of less inequality of income in this country?

§ Baroness Hayman
My Lords, it is clear that we are looking closely at what we need to do to improve the income and general support available for those people who are suffering from the effects of poverty. I believe that there is an understanding that issues surrounding deprivation go far wider than income levels. That is reflected in our debate on health and the issue of income. Health inequalities and deprivation are very much linked, for example, to poor educational attainment, which in turn leads to a poor income later in life. The poor environment in which many children are being brought up on some of our worst estates, with 84 the highest levels of crime, also reflects on people's opportunities. The Government are trying to take a broad and cohesive approach to those problems, and not look at them in separate boxes.

Earl Howe
My Lords, recommendation 38.4 is that the Government should establish a review of the relationship of private practice to the NHS. Will the Government do that?

§ Baroness Hayman
My Lords, we shall be looking in detail at all the recommendations that Sir Donald Acheson made to see which of them we need to take forward. It is particularly important to focus on those areas that he highlighted and on which we can take action in terms of a public health strategy. That is why the report was such a valuable document in terms of forming the White Paper that will soon be published.

§ The Earl of Listowel
My Lords, bearing in mind that the report recommends policies that promote the sexual health of young people, will the Government undertake to do everything possible to speed up the work of charities that help to get homeless young people off the streets before they slip into prostitution, with all the dangers of venereal disease and HIV infection that that brings with it?

§ Baroness Hayman
My Lords, the health of young people and adolescents is an important area on which to focus. As the noble Earl pointed out, voluntary organisations play a particular part in driving health education that is focused and which will be received well by those groups. Sometimes it is more appropriate for that work to be done more effectively by voluntary organisations than by the Government. In the past, we have certainly provided support for such organisations and I shall be surprised if we do not continue doing so.