---

Public Health (England)

Well, let us look not at Dickens but—the hon. Gentleman will love this—at Frederick Engels, who looked at the condition of the working classes in Manchester in the 1850s. What was the average age at which males in Manchester in the 1850s died? It was 47. The idea that statistically we can compare public health, or the health of the public, now to what was happening in Victorian times is nonsense. I say that honestly to the hon. Gentleman. Next time we have a debate on public health—I hope that the Opposition will use a bit of their time for that—we will look in greater detail at how public health and the health of the public have improved not just since 1850, but even in the past 10 years. That is well documented. The Government want and are working towards a fairer society. That has meant that there has been fairer funding in the NHS, and more funding per head has been allocated to constituencies such as mine, because of health inequalities. The disease burden is quite high. The formula bandied about by Opposition Front Benchers a few months ago would mean that we got even more money. I would be more than happy if we were to move on to a ““disease burden”” system of funding health need, but other issues need to be taken into account. Over the past 10 years, the Government have been making health services better in communities that have more health inequalities. Twelve years ago now, my constituency—or Rotherham metropolitan borough council I should say, as that was the geographical area on which this was measured—had the highest ratio of patients to general practitioners in England and Wales. We do not have that now. That is not down to doctors. The vast majority of them are private, independent business people, and although they work for the national health service they set up their own businesses according to where they want to live and raise their families. Clearly, under the system that has been in place, Rotherham has for 40 years or more been one of the places where they would not want to set up in business and raise their families. One of the reasons for that might be health inequalities—the disease burden that exists there, and therefore the high work loads in constituencies such as mine. I have nothing but praise for GPs, but those ratios have for years and years been far too high—they have been the highest in England and Wales. The national health service is an organisation that I support, but it did, or could do, nothing about that until this Government landed on the Government Front Bench. They changed the local contracts so that primary care trusts themselves could employ doctors to work in such areas—so it was not up to doctors to think that they wanted to set up in business there. Instead, the PCT could put doctors into single-handed practices; they still had high patient ratios and work loads, but it could help and assist them. Those matters should have been on the national health service agenda decades ago, but they never were. However, under this Government they are. This Government have been able to do that, and over time that will improve the situation in this country. The hon. Member for Billericay (Mr. Baron) made several interventions about what has been happening in the past few years. The White Paper ““Choosing Health: Making healthy choices easier”” clearly outlined a fundamental strategic shift towards public health, health prevention and moving care closer to people in their own communities. Other White Papers have followed it in terms of moving care and taking pressure off the acute sector by moving treatment out into the primary sector. The danger—it has always existed, and could have happily been solved—is that the new emphasis on health promotion and healthier choices leads to an increase, rather than a decrease, in health inequalities. They have not returned to the levels of Dickensian days or Victorian days, but when more choice is made available to people, the better off—the people who have always made better choices, such as the better educated—swiftly take on board messages about diet, smoking, drinking and exercise. Historically, that is what they have done; the more such choices are put into the public domain, the more of them will act on such messages, so it appears that there is a widening of health inequalities. I am not saying that the position at the bottom end is perfect. However, although inequalities might be widening—the middle classes and the better educated might nowadays be taking better decisions than they have done—that does not mean that the health of the people at the bottom is not also increasing; on the contrary, it is. Therefore, when we address the question of widening health inequalities, let us get it into perspective. There is a widening of health inequalities, but the health of the people at the bottom, who have always been disadvantaged for whatever reason, is improving. Their lifestyles are improving as well; they are not Dickensian, Victorian, Edwardian or anything else. That is an important issue, and if the Opposition have not thought it through, they ought to.