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Health Inequalities

It is a great pleasure to be under your eagle eye today, Mr. Illsley, while we discuss this important issue. It is well recognised that inequalities exist in all advanced countries, but it is equally sure that where the extremes are closer, the societies are better. The issue is not just a moral one but one of self-interest for everybody in the country. The Labour party exists to lessen such inequalities. That was why it was formed, and it is why many Labour Members joined it. Inequalities in health are stark. The life expectancy gap between those in the poorest and richest parts of the country is often 10 years or even more. Morbidity—the way that people feel about their health—follows the same path. Labour recognised that in our 2001 manifesto, in which we stated:"““There has been a growing health gap between rich and poor. Beyond other commitments to combat child poverty and poor housing, we will tackle the long-standing causes of ill-health and health inequality””." In our 2005 manifesto, we stated:"““By 2010…we plan to reduce the health inequalities that exist between rich and poor.””" That aim was exemplified in the policy document that went to all Labour candidates for that election, in which we stated:"““It is simply unacceptable to us that the opportunity for a long and healthy life today is still linked to social circumstances, childhood poverty, where you live, how much your parents earned, how much you earn yourself, your race and your gender…Though health inequalities remain, we are determined to use a third term in office to reduce them further.””" That is clearly recognised. Indeed, in his first speech on taking office, the new Secretary of State concentrated on health inequalities. There is no difference between ourselves and the Government on what we want to achieve. I shall not take any lectures or strictures from the Conservative party on the issue. In all the time that it was in office, it refused to allow it to be discussed. The recent Joseph Rowntree Foundation report indicated clearly that, in the years between the 1980s and 2000, health and social inequalities widened dramatically. Rather than any strictures, an apology would be in order. To tackle health inequalities, we must first identify them. Two headline figure indicators have been identified: infant mortality and life expectancy. In November 2004, spearhead authorities were identified to tackle health inequalities. They were classified as those in the worst 20 per cent. of authorities in England in three of the following five areas: cardiovascular mortality; cancer mortality; life expectancy at birth for both males and females, and the index of multiple deprivation. Wigan is in the worst 20 per cent. in all five categories. Health inequalities are recognised as an issue and identified as a geographical problem. So what about the means and resources of tackling them? The Government have a formula whereby they distribute 75 per cent. of their health budget to primary care trusts. That formula measures health needs by taking account of age, sex, mortality, morbidity, the cost of living and economic deprivation, and it produces a target for each PCT. I should emphasise that it is a Department of Health formula—it is the Department's assessment of the health needs of each area. However, the actual funding does not follow the targets set by that formula. It is guided by them, but does not follow them. The guidance is not particularly well followed, as I shall show shortly. Prior to the 2005-08 comprehensive spending review round, a group of Members pushed the then Secretary of State, the right hon. Member for Airdrie and Shotts (John Reid), to speed up the pace of change and the rate at which PCTs get closer to their targets. I wish to pay tribute to him, because we were reasonably successful, particularly in the areas that were seriously below their target funding allocations. For instance, in 2005 Easington PCT was £25.5 million below its target funding. It is now £6.5 million below—a shift from 16.2 per cent. to 3.5 per cent. below. That was replicated in many other areas that were seriously below target in 2005, and we should pay tribute to the then Secretary of State for making those massive improvements, which laid a firm foundation upon which we can build for our next comprehensive spending review round. This debate is essentially about making further progress on that. Despite the efforts of the then Secretary of State in the 2005-08 round, primary care trusts still do not receive the share of funding that the Department says they need to tackle the health needs of their populations. The differences are stark, and many of them are inexplicable, especially when set against the Government's stated aim of reducing health inequalities. Ashton Leigh and Wigan PCT is £11 million—2.4 per cent.—below its funding target. Westminster PCT is £41 million, or 11.6 per cent., over its target. Newham is £15 million, or 3.2 per cent., below; Richmond is £28 million, or 13 per cent., above. Bradford is £20 million, or 3.5 per cent., below; Brent is £20 million, or 4.8 per cent., above. Liverpool is £25 million, or 3.2 per cent., below; Lambeth is £56 million, or 12.6 per cent., over its target. Incidentally, that last example shows a totally inexplicable increase, because in three years Lambeth has moved from being £25 million over target—6.4 per cent.—to being £56 million, or 12.6 per cent., over. Rather than moving in the right direction, some PCTs are moving in totally the wrong direction. I emphasise that the issue is not one of north versus south. It is about deprived areas throughout the country, and deprived boroughs in London are as underfunded as many of the areas in the north and the midlands. Newham is £15 million below its target, Barking and Dagenham £10 million below, Tower Hamlets £14 million below and Hackney £15 million below. The matter is not north versus south, it is about health inequalities, deprivation, health need and funding PCTs to address their health needs and reduce inequalities.