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Health Inequalities

I, too, congratulate the hon. Member for Wigan (Mr. Turner) on securing this important debate. Although at times it has seemed like a competition to decide which of the many eloquent speakers has the worst life expectancies or funding in their constituencies, I recognise the passion with which all who have spoken put their case. The title of the debate on the Order Paper is ““Impact of health funding on health inequalities””. Although there is a geographical aspect to such inequalities—not, as others have demonstrated, a north-south divide—I should like to talk about gender and race inequalities. The hon. Member for Wigan said that there is no doubt that a person's life expectancy and health outcomes are affected by their social class at birth and by where they live, and a powerful case has been made for increased funding for areas that have the greatest need. I acknowledge that money has been spent, but we must ask whether it has been spent in the most effective way, because much of the extra Government funding has been diverted to secondary care. If we are to tackle inequality problems in the long term, we must ensure that more money is spent on the preventive health agenda and that more people have good access to primary care. The Government recognised the inequality problem and announced that there would be 88 spearhead PCTs in 70 of the local authorities with the poorest health outcomes according to many of the indicators. The aim, which we might all agree was a worthy one, was to tackle inequalities in the long term, focus on improving life expectancy and reduce more quickly rates of premature deaths from cancer and heart disease. We might have expected to see those PCTs increase spending on public health if they were truly to address their aim, but the Liberal Democrats have analysed the public health spend in all PCTs, and unfortunately, we found absolutely no correlation between spending and the extent of need. For example, in 2005 Lewisham was designated to receive proportionately more Government money than other PCTs to compensate for its position in the one fifth of areas with the worst health and the largest gaps between rich and poor. In fact, there was a drop in public health spending by that PCT far in excess of any other trust—14 per cent. of total PCT spending used to go on public health but the figure has dropped in recent years to 1.7 per cent. We must ask ourselves why there was such a dramatic reduction and whether it was to do with other financial pressures. Why was Lewisham PCT allowed to take its eye off the important goal of reducing health inequalities in the long term? We also discovered that a quarter of all spearhead PCTs spent less on public health in 2005-06 compared to 2003-04, and that 26 received an increase in public health spending of less than £1,000. Will the Minister explain why that happened and why it was allowed to happen, and say something about whether we can stop it happening in future? The hon. Member for Norwich, North (Dr. Gibson) spoke about directing money toward different budgets, and that needs to be looked at closely, because there are huge variations between trusts. The King's Fund has analysed the national programme budget project—the NPBP—and the Government have collected data since 2003 on 21 different disease areas. There are now sufficient data to allow comparison between PCTs and to enable us to ask questions about whether they are putting funds to their best available use. Analysis shows that the three largest shares of increase in overall PCT spend have gone to mental health, heart disease and cancer. That reflects Government priorities and no one should have a problem with it. However, the analysis also shows that there are large variations in the amounts and proportions of total budgets spent on individual disease areas by PCTs. For example, Islington PCT spends £406 per head on mental health compared to the £56 per head spent by Bracknell Forest PCT. We can argue all we like about whether people who live in Islington are any saner than people who live in Bracknell Forest, but there is also a fourfold difference in spending on cancer, a threefold difference on circulatory system diseases and an eightfold difference on musculoskeletal problems. It might be argued that the differences can be accounted for by relative needs, and there may be an evidence base for them. However, even when we adjust for those factors, we can see that the sevenfold spending gap between Islington and Bracknell Forest reduces only to a fourfold gap, which is still a huge difference in the amount spent. The same pattern occurs around the country in relation to spending on cancer. After taking into account known population differences, the proportion of budget spent on cancer ranges from 3 to 10 per cent. of a trust's overall budget. Local decision making cannot account for such a wide discrepancy. In-depth research ought to be undertaken so that we can compare amounts spent to outcomes, to see where money is most effectively spent, and to learn lessons from that. I shall briefly talk about gender. On average, women live five years longer, but there is a wider gap in the most deprived areas. The situation is even worse than that suggests, because general health outcomes are worse for men. For example, women contract skin cancer much more frequently, but men have a higher death rate from the disease. We are not serving men well if we allow such things to happen. Again, bettering men's health is not necessarily down to spend; it is down to taking different approaches to tackling their problems. Men between the ages of 16 and 34 consult a GP half as frequently as women, and the outcomes are there for all to see. Asian men have a high rate of diabetes, but funding formulae do not account for ethnic mixes. Finally, I shall comment on the Institute for Public Policy Research report that was published yesterday. It claimed that focus on choice has helped the better-off, but that to help the poorest, public services need to be personalised. Research has shown that the more affluent and better educated a person, the greater the health benefits they receive from the NHS. Care for such people is planned, but the less affluent tend to present themselves as emergencies. People in poorer areas have 20 per cent. fewer GPs per 100,000 people than in the most affluent areas in the country. Cancer death rates are 29 per cent. higher in the poorest fifth of the population. In summary, money is important, but some of my examples show that we perhaps need to aim at other targets. We need to look at access to health services in the most deprived areas. People will not access a GP if they cannot get to one via a good travel network, and they may not be able to afford a car. All such things are relevant. Furthermore, do we have enough health visitors going into deprived areas to try to encourage families to adopt healthy living styles from the outset? I have a final query: the Darzi review recommended polyclinics. If we centralise our health services, will that mean that in the poorest areas the poorest people, who are least likely to access existing services, will be even less likely to access them in future? There is much food for thought in what is happening, but much potential for improvement as well.