---

Health Inequalities

I, too, congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this important debate and enabling me to draw attention to health inequalities and health needs in Knowsley, which I represent. Of the 26 indicators in Knowsley's health profile, 18 are worse than the national average and one is better—it happens to relate to deaths in road accidents, although that might be connected to the low incidence of car ownership, which in turn might be connected to the fact that 29 per cent. of residents are dependent on health-related benefits, against a national average of 13 per cent. Knowsley's figures for smoking are above the national and north-west averages. According to the statistics, we also have the worst record in England for the number of adults who eat healthily. Our male life expectancy is seventh lowest in the country and female life expectancy is fifth lowest. The main reasons for that gap in life expectancy are coronary heart disease and cancer, although we have had a proud record in that respect over the past decade, given that deaths from coronary heart disease have fallen by 19 per cent. and those from cancer have fallen by 5 per cent. As regards the provision of funding to meet Knowsley's health needs, I must acknowledge that the Government have recognised the problem and provided significant uplifts in funding over the past three years, and we are grateful for that. That money has been spent wisely, with sound budgeting, efficient organisation and proactive health improvement measures. Generally, our record has been good. For example, Knowsley PCT has managed the implementation of the new GP and dental contracts better than many other PCTs, and I have had little problem solving my constituents' difficulties in that respect with the PCT's help. However, Knowsley is still 3 per cent. off the expected target for an area with its health profile, and that amounts to £9 million per annum. The financial strategy for the next two years assumes that we will have a 6 per cent. uplift, given Knowsley's under-target position. If that turns out to be over-optimistic, planned investments to make a real difference to the health inequalities suffered by the people of Knowsley might have to be reduced or delayed. Much of Knowsley PCT's undoubted success in managing its resources is due to the synergy of its working arrangements with those of the local council. The two bodies pioneered the joint appointment of the PCT's chief executive and the council's director of health and social care. That has allowed for an integrated approach to health and social care and joint working to address the health inequalities agenda. That has been made possible through section 31 arrangements with the local authority, the pooling of budgets, the sweating of assets and, generally, by working together to achieve efficiencies across a wide range of services. Although such working arrangements have contributed to the PCT's undoubted success in addressing the health inequality agenda, its future success is vulnerable to the outcome of the comprehensive spending review. The local government formula has less weighting for social deprivation, and the local authority fears that there will be a standstill in uplift because its population is not increasing at the same rate as elsewhere in England, where there are higher levels of immigration. Clearly, that will have an impact on health care in Knowsley, as the council will have less money to invest in initiatives to help improve the health profile of the people of Knowsley. As in many other respects, Knowsley, which is typical of the Liverpool area, has a story to tell about its attempts to address the health inequality agenda, and it can be justly proud of it. At the heart of that success story is the close working between the PCT and Knowsley council. Like other PCTs, Knowsley PCT is therefore highly dependent on the outcome of the CSR. I therefore urge the Minister to give due and particular attention to that and to ensure that Knowsley council and Knowsley PCT can continue to address health inequalities in Knowsley as well as they have in recent times.