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Mr. Barry Sheerman (Huddersfield): It is a great pleasure to introduce a debate on a topic close to my heart, and to have it presided over by you, Mr. Illsley, a fellow Yorkshire Member of Parliament. I want to make general points before coming to the specifics of Huddersfield. Huddersfield is a typical place when considering health inequalities because it is close to the national averageso, when we talk of the place, we talk about the United Kingdom.
When we celebrated the 50th birthday of the national health service, not long ago, it was a time for reflection. An interesting part of that reflection was that when the NHS was founded, there was a tremendous confidence in the fact that health inequalities would be tackled. Some who were euphoric believed and wrote that by and large the NHS would eventually disappear, as all ill health would be cleared up, problems of health inequalities would be solved and there would no longer be a need for a health system. We have learned a few lessons since then.
I want to point out the important fact that after some initial success in delivering health care to a broader audience, and in involving more people in high-quality health care, something significant happened. When we became the Government in 1997 and looked back over the previous 20 years, we found that, astonishingly, health inequalities had widened. For two generations, the gap had widened between the two extremes of those who had good health and were enjoying longer, healthier lives in social class 1, and those in social class 5. That is worrying for someone who represents an average constituency such as Huddersfield. So, why did it occur?
First, I will give some chilling figures. In the early 70s, the mortality rate among men of working age was almost twice as high for those in social class 5 as it was for those in social class 1. By the early 90s, it was almost three times as high. Those are unacceptable figures. Between 1970 and 1972, the mortality rate per 100,000 men aged between 20 and 64 was 500 in social class 1 and 897 in social class 5. By 1991-93, the number had fallen to 280 in social class 1, but was 806 in social class 5. That is not to suggest that there had not been a general improvement across the piece, but the gap was widening substantially.
Interestingly, Professor Richard Peters, who was responsible for a clinical trials study in Oxford, believes that smoking was a relevant explanation for up to 30 per cent. of that disparityanother chilling figure. We know that such disparity in Huddersfield and the average constituency such as yours, Mr. Illsley, or the Minister's, is centred around income. To paraphrase President Clinton, "It's income, stupid"how much disposable income is necessary to promote a healthy life.
Income is not the only important issue because factors such as family, smoking, alcohol, drugs, poor diet and a lack of good exercise are also relevant. Those on lower incomes with lower education are prone to a range of diseases. I have spent my lifetime in Parliament campaigning for public health measures such as seatbelts, and I was interested to learn that social classes 4 and 5 are most likely to die in accidents.
The answers lie in education, and poverty alleviation through the income tax system and other benefit systems to address poor incomes. Employment is important because there is a clear relationship between having a job, feeling good about oneself and having good health. One great thing that the Government have achieved during the past five years is a record level of employment. The disparity between social classes 1 and 5 becomes more worrying when one realises that the statistics leave out unemployed and disabled people. That is the nature of the statistics, but many that look pretty darn awful are in fact even worse because they only take into account people in work.
Given your constituency, Mr. Illsley, you know about accidents, the mining industry and the health of miners, and you know what that environment did to the health of both your constituents and mine. The chemical industry had a heavy presence in both the Minister's constituency of Pontefract and Castleford and mine, and it caused diseases, especially in the dyestuff industry in Huddersfield, which are a serious indictment of former industrial practices.
Wearing another hat, I am Chairman of the Select Committee on Education and Skills. On becoming Chairman, one of the first inquiries that we conducted concerned school meals, which are important for children from deprived backgrounds. For many years, especially under the previous Administration, there was a move away from a balanced and healthy school meal regime. The Committee visited schools where there was a broad choice from salads to what I call "proper food", but sadly many children were eating burgers, chips and other unhealthy stuff. Worryingly, a recent survey asked school children to identify a range of fruits and vegetables, but they did not know what they were. There are worrying trends in our diets.
In Huddersfield, we have just reached the stage at which we no longer see old men with bandy legs who had worked in textile mills and whose children must have suffered from rickets, because that generation has died out. There is, however, a new generation with symptoms of obesity, who we can predict will die early of coronary heart disease or other diseases because of their diet and lifestyle. Couch-potato syndrome is a problem because people are not getting enough exercise. There is too much watching sport on television and not enough participation in it.
What can we do about these matters in Huddersfield, and what can we do about them nationally? I have been involved with the launch of the new health forum and the new parliamentary group on health. Until now, we have been unable to identify the statistics on health that influence our constituencies because most data have been collected on a regional and sub-regional level, which is too broad and unfocused. The Dr. Foster organisation enables us to identify, in some focus and detail, health statistics in our own constituencies. The service is accessed by using a private pin number. You could use it, Mr. Illsley, to access the health statistics in your Barnsley constituency. It could be of great benefit to Members of Parliament, and I hope that they will use it. The House of Commons Library can provide marvellous statistics on employmentunemployment rates, length of employment, male, female and youth unemployment, the shift between manufacturing and service jobs, and so onbut health statistics remain vague.
Many of our parliamentary colleagues are remiss in their approach to local health problems. In Huddersfield and elsewhere, the regime should be much more focused on making MPs pro-active leadersknowing about community health issues and assuming a leadership role. To do that, they need the relevant statistics. Now that they are available, I hope that Members will use them.
For too many MPs, their only contact with the health sector comes from sitting in their advice surgeries hearing complaints about the health service. One always hears a lot about the people who complain"You never did anything for me, Mr. Sheerman"but not much about the contented people whom one has helped. Sometimes they write a letter, but more often one meets them in the street and they say, "All those years ago, you helped me." Many people are happy with the good service that they receive from the NHS, but those cases do not come to prominence and the Leader of the Opposition does not drag them into Question Time.
MPs should be more pro-active. I do not want their relationship with the health service to be limited to involvement only when a ward or a cottage hospital is closing down and they rush in like the fire brigade attending a fire. MPs are always invited to and are good at attending ceremonies at which a Minister unveils a plaque for a new hospital extension, but the prescription for changing health understanding in this place is to make Members commit themselves to spending seven daysa whole weekin a hospital talking to patients, doctors, nurses and ancillary and care staff to find out what is really going on. Too many of us talk about health without any real focus.
In Huddersfield, the town centre has more deprived wards than less deprived wards. In other words, more people from the lower socioeconomic classes live in the centre. We are surrounded by higher-income and more affluent areas, especially in our valleys. Data from the Library shows a clear difference between the centre and the wealthier periphery. I am sure that the same applies in your constituency, Mr. Illsley.
I applaud the Government for taking two brilliant steps. First, they have introduced a 10-year national strategy for the health service. Secondly, they have set targets for tackling health inequalities over that period of time. Even better, statistics are emerging that show that since 1997 the gap between social class 1 and social class 5 has started to close, not to widen further. As with education, the resources that the Government are putting into health care seem to be paying off, although it is early days.
Primary care trusts are part of the answer. The Government's ambition for the not-too-distant future is for 75 per cent. of health spend to be in the hands of the primary care trusts. There has recently been consultation on whether there should be one or two primary care trusts in the Huddersfield area. Until now, one trust, Huddersfield Central, has covered most of the deprived wards in my Huddersfield constituency and the neighbouring one, Colne Valley, and another trust, South Huddersfield, has covered more affluent areas.
After a long deliberation, Huddersfield health authority came down firmly in favour of one primary care trust for the area. Huddersfield is one community. It does not contain a more deprived community and a more affluent one, it is one community. I would have thought that, to tackle health care inequalities, one primary care trust would have been the answer.
The Minister might be going to tell me that there is a reason why the Government overturned the health authority's recommendation, ignored it and said that we will have two trustsone for the affluent and one for the less affluent area. Those trusts go across constituency boundaries. Will she tell me the rationale for that decision ? I think that people in this House know that I am a reasonable Member of Parliament and that I can accept a reasoned argument, but I have not heard the rationale and logic for that move. Pontefract or Barnsley, for example, do not have one primary care trust for the more deprived part and another for the more affluent, but the Government have decided that my town and my community should. If the Minister can give me a rationale, and assure me that the reason for the decision is that money will be poured into Huddersfield Central, and that it will be given an enormous amount of resources per head compared with South Huddersfield, which is more affluent and does not need so many resources, I shall be content and we can resume our normal good relations.
I hope that the debate has put in context why I, as a Member of Parliament, feel strongly about health inequalities. The Government have done some good things and are on the road to tackling inequalities, but I am part of the coalition that wants faster change. I want to know why, in the Huddersfield area, it is deemed right to have two primary care trusts, one for the more affluent area and one for the less affluent area.
The Parliamentary Under-Secretary of State for Health (Yvette Cooper) : I congratulate my hon. Friend the Member for Huddersfield (Mr. Sheerman) on securing the debate and on raising the important issue of health inequalities in his constituency. He made some general points and some specific ones about his area, particularly about the primary care trusts. I shall attempt to address those in turn.
I concur with my hon. Friend's points about the scars that health inequalities leave right across the country. It is fundamentally unfair that people on higher incomes on average live longer than those on lower incomes, and that people in some parts of the country live significantly longer than those in other areas purely on the basis of region and background. That is unfair, and we must address such inequalities in our broad programmes to tackle the causes of ill health and in more local structures and health service programmes.
The scale of health inequalities is stark. For example, a baby boy born in Calderdale and Kirklees health authority can expect to live three years less than a baby boy born in Barnetat the end of the 20th century.
The provisional findings of the Centre for Health Economics in York suggest that the majority of people are shocked when they become aware of such health inequalities and believe that action should be taken to narrow the gap. The Government are right not just in investing to improve and reform our health service, but in investing to improve and narrow health inequalities.
Much of the work in this area stems from that of Sir Donald Acheson and his team who were commissioned soon after the 1997 election to carry out an independent inquiry into inequalities in health and the causes of those inequalities. It was the first time since the Black report some 20 years before that a major report was produced on health inequalities in this country. It examined the root causes of ill health, ranging from child poverty, unemployment and poor housing, and more immediate factors such as smoking and poor diet. As my hon. Friend said, smoking is indeed one of the greatest causes of health inequalities because the highest rates of smoking are among those on lowest incomes.
Since the 1997 general election, we have taken action to try to narrow those health inequalities. For example, the minimum wage and the working families tax credit have lifted 1 million children out of poverty. I am sure that my hon. Friend agrees that that measure alone will probably have more impact on his constituents in Huddersfield and mine in Pontefract and Castleford than almost any other measure to narrow health inequalities. Widening educational opportunities for children, initiatives such as the new deal programmes and many of the measures that he, as a member of the Select Committee on Education and Skills, has examined will also have an impact on health.
The sure start programme is one of the most important in helping to narrow health inequalities early in life by providing help and support for the under-fours and their families. Two fifth-wave sure start programmes have been approved for Huddersfield, both of which will have an impact on the population in Huddersfield Central primary care trust area. One programme is based in Deighton ward, which was identified in the neighbourhood renewal programme as among the 10 per cent. most deprived wards in England. It is being led by local trusts, with responsibility passing to Huddersfield Central primary care trust from April 2002. It is developing in parallel with other local programmes, including the Deighton Brackenhall initiative and the second sure start programme, which covers parts of the Crosland Moor and Paddock wards and is led by Kirklees social services.
We are also targeting specific help at key risk factorsfor example, nicotine-replacement therapy on prescription to help people to stop smoking, and the national school fruit scheme. I agree with my hon. Friend that the diet and nutrition of school children is particularly important, and I am a strong supporter of the national school fruit scheme, which will ensure that all infant school children are entitled to a free piece of fruit each day. That is probably the biggest programme to support children's nutrition since the introduction of free school milk after the war. The teenage pregnancy strategy is clearly also having an impact.
My hon. Friend expressed concern about PCTs and their configuration in Huddersfield. He also raised the issue with my hon. Friend the Minister of State, Department of Health, the Member for Redditch (Jacqui Smith), who took his views seriously and who has spent some considerable time weighing the arguments. My hon. Friend the Member for Huddersfield is right that the role of the PCTs is critical in tackling health inequalities, as they have so much moneythey will have 75 per cent. of the budgetsand as they commission work that can have a huge impact on health inequalities. They also provide services that can help reduce those inequalities, such as smoking cessation, statins for heart disease and managing hypertension.
PCTs can have an impact on all those things, as well as in the untapped source of working more closely in partnerships. They work more closely in some areas, but not as far as they could in others. More partnership work is needed on sure start and teenage pregnancies, and more local partnership work is needed on housing. I understand my hon. Friend's concern that PCTs are established most effectively to address health inequalities. My hon. Friend the Minister of State and the Department of Health considered those issues when they made their decision.
PCTs need to be rooted in their local communities and be endorsed by them to have the greatest effect. My hon. Friend the Member for Huddersfield will be aware that the public responses to the consultation were overwhelmingly in favour of two PCTs for the area. I recognise his concerns, but we have made it clear that the PCTs and the health economy in Huddersfield need to work closely together across the patch. If the community is not ready to embrace a single PCT with enthusiasm, it is right to establish two PCTs, but with the clear direction that they work closely together and look forward to the future. That means joint appointments, such as the director of public health and the director of finance. The director of public health is the most important appointment, as issues of health inequality need close joint working. We expect the director of public health to lead that work in a PCT.
We also expect strategic health authorities to explore greater joint working throughout the health and social care sectors. I assure my hon. Friend that we have considered those issues and that the decision was not easy to take. Nevertheless, on balance, it was the right one to take at this stage. The two PCTs can make considerable progress in narrowing health inequalities by working together and in partnership with the local community, local authorities, voluntary organisations and community groups.
As my hon. Friend made clear, we have set two national health inequalities targets and recently ran a major consultation throughout the country on how to meet those targets on life expectancy and infant mortality. A group of organisations in the Calderdale and Kirklees area responded jointly to that consultation. The group included the Calderdale primary care group, the North Kirklees PCG, the Central Huddersfield PCG, the South Huddersfield PCG, the Calderdale and Kirklees health authority and a range of community groups. Although they supported the consultation document and much of the work that is being done, they urged us to do more work to ensure that mainstream resources are devoted to action on inequality. I agree. They also said that two groups had been prioritised locally because of the changing demographics of older people and black and minority ethnic communities, to which they urged us to pay more attention. We will certainly take their remarks seriously.
I welcome the fact that such bodies worked together on the consultation on narrowing health inequalities. I urge them to continue to do so. We will consider their comments seriously and are working as part of a cross-cutting review involving all Departments on how best to address the narrowing of health inequalities. We have made considerable progress, but must recognise that fundamental injustices still scar our nation and that there is much more to do.