---

Health Inequalities

I will not, because we are very short of time, and the hon. Gentleman had his own chance. We have had a wide-ranging debate in which many good points were covered. Many effectively amounted to bids, which I am sure the Minister will deal with individually when she replies. The hon. Member for Wigan may remember a supplementary question on health inequalities that he put to the then Health Secretary, the right hon. Member for Darlington (Mr. Milburn), in 2002. The response was"““we are now in the process of reviewing the whole way in which NHS cash is distributed to local communities.””—[Official Report, 26 March 2002; Vol. 382, c. 688.]" Sadly, the current Administration, particularly as regards health policy, has rarely moved beyond the review as a piece of ongoing politicking. Last week brought us Lord Darzi's interim report. Its release just before the end of the recess served not only to deepen the electoral chasm left by the Prime Minister's fear of the electorate, but also to avoid Lord Darzi's having to come to the other place. Notwithstanding the claim with which he opens his report—"““I'm a doctor not a politician””—" can the Minister tell us when the noble Lord—whose main job now, whether he likes it or not, is as an accountable politician and a Minister, and who is paid by the electorate and who accepted the job—will make his maiden speech in the House of Lords? In his interim report, the noble Lord twice made the point that"““the Secretary of State has announced a comprehensive strategy for reducing health inequalities””." It is true that in his statement to the House on 4 July, the Secretary of State for Health said that the matter of health inequalities is ““crucial to the Government”” and, referring to the Darzi review, that it was"““too important for us to wait for that review””." He gave an assurance that the Government would"““crack on with that as an absolute priority.”” —[Official Report, 4 July 2007; Vol. 462, c. 969.]" However, the Secretary of State seems to have made the announcement neither to the House nor, even more surprisingly, to the press. True, the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo) announced a web-based health inequalities intervention tool on 23 August. As far as I can see, all it does is tell spearhead primary care trusts whether to focus on smoking cessation, reducing infant deaths or preventive prescribing for cardiovascular disease. Undeniably that is of some use, but it is a far cry from a strategy. Indeed, the biggest claim that the Government made of it was that it could"““be used as part of a comprehensive local strategy to reduce health inequalities.””" Will the Minister tell us when the Secretary of State will make good on his promise of a comprehensive strategy for health inequalities? Another review that the hon. Gentleman will be familiar with is that relating to the market forces factor, to which his constituency neighbour, the then Health Minister, and now Chief Secretary to the Treasury, the right hon. Member for Leigh (Andy Burnham) made reference in a Westminster Hall debate secured by the hon. Gentleman on 6 June. The hon. Gentleman may be interested to know that his comments in that debate were well reported by the Revolutionary Communist Party of Britain (Marxist-Leninist) on its website. The first review referred to by the then Minister was"““an overall funding formula review that will examine the make-up of the market forces factor””," being undertaken by the independent Advisory Committee on Resource Allocation, to be published before the allocations were made. The second was a"““specific review of the technical aspects of the MFF, which is different from the general funding formula review that ACRA has undertaken.””—[Official Report, Westminster Hall, 6 June 2007; Vol. 461, c. 138WH.]" The hon. Member for Falmouth and Camborne (Julia Goldsworthy), who was also present at that debate, said that she was informed at Christmas that the latter report was on the desk of the then Minister, Lord Warner. The Minister also made reference to the departmental consultation on payment by results, confessing that the market forces factor had been left out of the public consultation, but included in the independent, but ultimately internal, review. Resource allocation is still being decided across the country on the basis of assumed and aggregated data in respect of deprivation and age. We increasingly have data that would allow known morbidity in a community to be the basis on which NHS resources are allocated. Can the Minister tell us, first, when ACRA's overall funding formula review will be published; secondly, when ACRA's specific review of the technical aspects of the marked forces factor will be published—and why it has lain so long on Ministers' desks; and, thirdly, when the results of the departmental payment by results consultation will be published? Can she also confirm that ACRA will take account of morbidity data in its review, and reflect them in the funding formula? Will the funding formula be changed to reflect local pay variation as has been done with the area cost adjustment in the local government formula? It was the Government's intention to publish an annual status report on health inequalities, but the first report took two years. They said in July 2003 that the Department of Health would publish an annual report on health inequality indicators, related to the health inequality targets. The first was published in August 2005 just as we were in recess. Will the Minister tell us whether she plans to reinstate that? Any Government who want properly to address the issue of health inequalities will focus not on absolute reductions, but on the relative gap between the most and the least healthy, and between the richest and the poorest. I have no doubt that the Minister will tell us all the statistics on how many cancer and coronary heart disease deaths have been prevented in the last 10 years, but will she admit that they are on a trend that was pretty well established in the latter part of the 1970s for coronary heart disease and in the early 1980s for cancer? What plans do the Government have to switch to meaningful metrics? In ““The Road to Wigan Pier”” George Orwell said"““a man who drinks a bottle of whisky a day does not actually intend to get cirrhosis of the liver””." Admittedly, that was a metaphor illustrating Orwell's luddite attack on mechanisation, but it is a moot point for today's debate. Only last month the Department of Health announced an increase in consumption among school-aged pupils who drink. On current trends obesity will overtake smoking within three or four years as the principal cause of avoidable death in this country, bringing concomitant diseases in its wake. The story is similar with rising alcohol consumption, drug abuse and a rise in sexually transmitted infections. Yet the Government were all too happy to watch public health budgets being plundered as PCTs tried to rake in cash to pay off a deficit of the Government's making. A Conservative Government would give PCTs dedicated public health resources. When will the Minister show that she really cares about combating health inequalities and do that? One issue that is not often addressed under the heading of this debate is long-term care: it is right, however, that any debate on health inequalities should look at inequity across the age range. In fairness, several hon. Members, not least among whom was the hon. Gentleman, conceded that point. Today we anticipate something of a damp squib with the comprehensive spending review, with the Government failing once more to address the scandal of people selling their houses to fund their long-term care, something that was deplored by the former Prime Minister and Member for Sedgefield in 1997. I suspect another dodge by the present somewhat enfeebled Prime Minister. That could be the only thing to trump the brazenness of the Liberal Democrats, who are still running with the headline—it is on their website if anyone wants to look—about a free personal care policy, despite their health spokesman's confession in this very Chamber that it is a dishonest policy. I look forward to hearing what the Minister has to say. I hope that she will give firm dates for the publication of the various reviews that I mentioned, and that she will use the opportunity radically to overhaul the Government's public health strategy in order to begin combating the growth in health inequality of the past 10 years.