Health

– in the House of Commons at 3:55 pm on 14th May 2019.

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Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health 3:55 pm, 14th May 2019

I beg to move,

That an humble Address be presented to Her Majesty, that she will be graciously pleased to give directions that the following papers be laid before Parliament: any briefing papers or analysis provided to the Secretary of State for Health and Social Care or his Ministers since 9 July 2018 including impact assessments of public health spending reductions and any assessments made on falling life expectancy and the minutes of all discussions between the Department of Health and Social Care and NHS England on funding pay risks for Agenda for Change staff working on public health services commissioned by local authorities.

A child born at this very moment in the very poorest of communities—whether in inner cities like Manchester or my own city, Leicester, or in towns such as Blackpool or Burnley—will have a life expectancy that is around nine years lower than that of a child born at this very moment in some of the wealthiest communities, such as Chelsea, Westminster or east Dorset, and they will enjoy 18 fewer healthy years of life. Two babies born today could have years of difference in life expectancy and years of difference in healthy living, due entirely to the circumstances into which they are born. The child born in the very poorest of areas is more likely to leave school obese and almost 70% more likely to be admitted to A&E. That child is less likely to receive measles, mumps and rubella vaccinations, more likely to take up smoking as a teenager, and more likely to need the help of specialist mental health services at some point.

Of course, health inequalities have always existed, throughout the 71-year history of the national health service, but nine years of desperate, grinding austerity have brought us record food bank usage and in-work poverty, and seen child poverty increase to 4 million, with 123,000 children today growing up homeless in temporary accommodation—a 70% increase since 2010. Some 4,700 of our fellow citizens sleep rough on our streets, an increase of 15%, and, tragically, nearly 600 of them die on our streets. There have also been savage cuts to public services, including social care, which have left 600,000 elderly and vulnerable people without support. We have seen nine years of all that, and we should be shocked, because the advances in life expectancy that we all take for granted and that have steadily improved for 100 years are grinding to a halt.

Photo of Diana R. Johnson Diana R. Johnson Labour, Kingston upon Hull North

My hon. Friend is setting out clearly why the Opposition called for this important debate. Does he agree that the fact that for the first time since Victorian times we are seeing life expectancy falling for the poorest women in the most disadvantaged communities in our country, where the cuts have been heaviest, is a sad indictment of nine years of Conservative rule?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

Absolutely. Not only are there indications that advances in life expectancy are going backwards, particularly for women, but the Institute for Fiscal Studies has been quite clear today in launching its Deaton review:

In 2001, women born in the 10% most affluent areas could expect to live 6.1 years longer than women born in the 10% most deprived areas;
by 2016, the gap stood at 7.9 years.”

That is why we secured this debate.

Photo of Adrian Bailey Adrian Bailey Labour/Co-operative, West Bromwich West

My hon. Friend is making an excellent case. In my local authority, Sandwell, life expectancy is in the bottom 15% nationally and the childhood obesity rate is more than three times that of the best local authorities, yet although nationally the Government boast that they are investing money in the health service, public health spending seems to be left out. Does my hon. Friend agree that it is essential that there is a big boost to public health spending, so that local area health budgets do not have devastating long-term obligations in future?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

My hon. Friend is absolutely right and, typically, anticipates the argument I am going to make.

Advances in life expectancy look as though they are going backwards for some of the poorest in our communities, particularly women. Let me take as an example our infant mortality rates, which reflect the survival rates for the very sickest of small babies. Those mortality rates have risen again, for the second year in a row.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

Two or three weeks ago I visited a food bank, one of the biggest in the west midlands, and what amazed me was that it had to provide clothing for babies, which struck me as very profound. In other words, at least 20,000 people in Coventry are using food banks, and that tells us the consequences on people’s health. When they have to go to these centres for clothing and cots, does that not say something about austerity under this Government?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

It most certainly does. We are seeing a huge rise in the number of children living in poverty and an explosion not just in food bank use but in so-called baby banks, where parents arrive to pick up toys, nappies, and so on—even milk. It really is quite shameful.

We are also seeing an increase in the prevalence of mental health conditions among the poorest. Children and adults in the poorest areas are three times more likely to suffer mental health problems. We are also now seeing an increase in so-called “deaths of despair” for those in middle age, that is, deaths from suicide, drug and alcohol overdose, and alcohol liver disease. They are rising—[Interruption.] The Secretary of State says that that is not true, but it is in the report from the Institute for Fiscal Studies today.

Rates of premature mortality, including deaths linked to heart disease, lung cancers, and chronic obstructive pulmonary disease, are two times higher in the most deprived areas of England compared with the most affluent. Growing up and living in poverty means people get sick quicker and die sooner. It is shameful.

Photo of Matt Rodda Matt Rodda Shadow Minister (Transport) (Buses)

I find the picture that my hon. Friend paints deeply disturbing. In my area in Reading, there is exactly the position that has been described by other colleagues; there is a 10-year gap in life expectancy in one town in the south of England between areas that are only two or three miles apart. Does he agree that it is now time for the Government to listen and take urgent action to address these serious problems that are linked to their own policies?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

Absolutely. Everybody accepts that advances in life expectancy cannot continue indefinitely, but we need urgent investigation into what is happening here in the United Kingdom. As Michael Marmot, the authority on these matters, says:

“Since 2010, this rate of increase has halved. Indeed, the increase has more or less ground to a halt.”

He goes on to say:

The first thing to say is that we have not reached peak life expectancy. A levelling off is not inevitable. In the Nordic countries, in Japan, in Hong Kong, life expectancy is greater than ours and continues to increase.”

We need to understand what is happening in the United Kingdom. Surely it can be no coincidence that this halt in life expectancy advances has come after nine years of desperate austerity in our society.

Many of us are puzzled by the fact that, although we know that growing up in poverty means that people get sick quicker and die sooner, and we all accept that it is shameful—the Prime Minister accepts that it is shameful and talked on the steps of Downing Street about wanting to tackle these burning injustices—the Government continue to cut public health services by £700 million, including cuts of £85 million in the current financial year.

The stark reality is that these inequalities are costing the NHS £4.8 billion a year, and we are seeing a growing burden of chronic ill health in society. The NHS long-term plan, with its many laudable goals and ambitions, is simply undeliverable without investment in local public health services and a reversal of these deep, swingeing cuts.

Photo of Mary Glindon Mary Glindon Shadow Minister (Environment, Food and Rural Affairs) (Farming and Rural Communities)

Does my hon. Friend agree that it is disgraceful that while we are talking about all those cuts to the health service the Government have provided more than £4 billion in tax giveaways to alcohol companies, which is the equivalent of the salaries of 160,000 nurses?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

As my hon. Friend indicates, government is about choices. The Government have chosen to give big tax cuts to some of the richest and most privileged people in society while cutting the public health services on which the most vulnerable rely. That tells us all we need to know about the Tory approach to the national health service.

Photo of Geraint Davies Geraint Davies Labour/Co-operative, Swansea West

My hon. Friend has eloquently linked poverty and life expectancy. Does he agree that when we look at statistics such as the 64,000 people who die prematurely as a result of air pollution, that is focused on poorer people who live near busy roads? When we look at people who die from diabetes who have been force-fed processed foods, there is another correlation. The common theme is partly the support that the Government give to manufacturers of sugar, diesel and so on. That disproportionately hits poorer areas and ends up killing more people.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

The House has no greater champion of clean air than my hon. Friend. He is quite right—we have to tackle the wider social determinants of ill health, including pollution. We would introduce a clean air Bill. I am disappointed that the Government do not seem to agree that that is necessary.

I shall run through—[Interruption.] The Secretary of State is chuntering. He will have a chance to respond to the points that I have made. We all accept that smoking is a No. 1 cause of ill health and early death, causing about 115,000 deaths a year. Some 480,000 hospital admissions are attributable to smoking, which is an increase of 6% since 2013. That costs the NHS £2.5 billion a year—it costs primary care £1 billion and social care £760 million—but because of public health cuts, smoking cessation services in communities have faced cuts of £3 million. Over half of local authorities have been forced to cut services. Some local authorities have had to decommission smoking cessation services altogether, and 100,000 smokers no longer have access to any local authority-commissioned support. The number of people using smoking cessation services to help them quit has decreased by 11%—the sixth year in a row that the figure has fallen.

That means that smoking cessation services are, in the words of The BMJ,

“withering on the vine as councils are forced to redeploy funding to other areas”

Those cuts will lead to the risk of more people developing cancer and to higher costs for the NHS. It is a similar story with drug and alcohol services, which have seen cuts of £162 million, with more cuts to come this year.

Photo of Gloria De Piero Gloria De Piero Shadow Minister (Justice)

A family came to see me to tell me about their alcoholic son who, in the past year, had been taken to hospital by ambulance 35 times, and had spent four weeks over that year in hospital. All that they wanted was support services to help him get his addiction under control. The urgent care was there, but that was not good enough for them. It is devastating for him, but it makes no financial sense for the NHS.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

My hon. Friend makes an eloquent and powerful point. She is absolutely right. It makes absolutely no sense to cut alcohol addiction services, as that fails a number of vulnerable people in society and only increases pressures on the wider NHS.

The NHS recognises the pressures on alcohol services. It announced in its long-term plan that it wanted to roll out alcohol care teams in hospitals—a proposal that I made at the Labour party conference last year. At the same time, public health budgets are cutting alcohol addiction services in our communities. Years of investment under the Labour Government in drug and alcohol treatment and recovery centres helped to reduce HIV, hepatitis and drug-related deaths, and also helped to reduce drug-related crime and wider social harms. Yet the number of those receiving treatment and in recovery for alcohol problems has fallen by 17% since 2013. When alcohol misuse costs wider society £18 billion a year in crime and lost productivity, and when drug misuse is also a factor in so much crime, surely these cuts represent the very worst type of short-term thinking—cutting proven preventive services for a short-term saving but ignoring the bigger and longer-term human and financial cost.

What about weight management programmes? The Government pride themselves on their obesity strategy, but when the NHS spends £5 billion on obesity, when there are 617,000 hospital admissions because of obesity, when 18% of hospital beds are occupied by a person with diabetes, when 25% of care home residents have diabetes, and when we have one of the worst childhood obesity rates in western Europe, why are weight management programmes being cut in communities? One GP told Pulse magazine:

“This is crazy. It makes conversations between GPs and patients very difficult. They say, “you tell me that I need to lose weight, but the only help you can give me is advice and a diet sheet printed off Google.”

Another GP told Pulse:

“You try to refer someone for bariatric surgery but they can only have it if they’ve undergone 12 months of a weight management programme—but there isn’t one.”

Photo of Nick Smith Nick Smith Opposition Whip (Commons)

My hon. Friend is doing very well. Does he agree that movement is medicine and we need far more physical activity strategies in our NHS? For instance, if we had more ParkRun activities, particularly in working class neighbourhoods, that would help a lot in improving health inequalities in many parts of the country.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

Absolutely. I hazard a guess that when the Secretary of State stands up, he will talk about the support for social prescribing that he has given to general practice so that GPs can send people for more of this activity. But, at the same time, public health budgets are cutting these very types of activities. One hand does not know what the other hand is doing.

Photo of Alex Sobel Alex Sobel Labour/Co-operative, Leeds North West

I met Professor Paul Gately of Leeds Beckett University, who set up the applied obesity research centre. He also established Europe’s longest-running weight loss camp for young people, although only the better off families can now afford it. He asked me to ask my hon. Friend and the Secretary of State why the sugar tax cannot be used to fund some of that work.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

That is an entirely sensible proposal, and I look forward to the Secretary of State’s thoughts on it. The sugar tax is supposed to be funding more physical activities for young people across the country.

At a time of rising demand, we have also seen £55 million cut from sexual health services. That has meant that half of councils have reduced the number of sites commissioning contraceptive services, with the result that 6 million women of reproductive age live in an area where one or more services have been closed. Prescriptions of long-acting reversible contraceptives—the most effective form of contraception—have decreased by 8% at the same time as abortion rates for women over 30 have been steadily increasing. We have seen an increase in sexually transmitted infections such as syphilis and gonorrhoea while, because of cuts, the number of sexual health checks has dropped by 245,000. I was particularly shocked to hear the evidence given recently at the Health and Social Care Committee by Dr Olwen Williams from the British Association for Sexual Health and HIV, who said:

“We are seeing neonatal syphilis for the first time in decades and neonatal deaths due to syphilis in the UK…We are seeing an increase in women who are presenting with infectious syphilis in pregnancy, and that has dire outcomes.”

That was the evidence presented to the Committee about the impact of these cuts on sexual health services in communities.

What about the cuts to health visitor numbers? Last week, we heard concerns across the House about falling vaccination rates, which fell for the fourth time in a row. Vaccinations are one of the most important public health interventions we can make, and our health visitor workforce is vital to ensuring their take-up. Yet public health cuts and wider local authority cuts have meant that we have lost 25% of our health visitors. Every 12 hours since October 2015, we have lost one health visitor, and there are no proposals to reverse those cuts in the long-term plan. School nurse numbers have gone down, and the caseloads of health visitors and school nurses are increasing. As a consequence, parents and small children are missing out. According to the Government’s own figures, 14.5% of children are not receiving a six to eight-week review on time, and 24% are not receiving a 12-month review on time. With high caseloads, there are increased risks of abuse or poor health of babies not being picked up, of maternal mental health issues not being picked up and of domestic violence and trauma not being picked up.

We need investment in the wider public health workforce and we need to expand training opportunities. The Government should honour their commitment to pay the public health workforce properly, and especially those on “Agenda for Change” terms and conditions. Last year, when the Government announced a pay increase for staff, they said they would honour that for all public health staff working for local authorities or in the voluntary sector. We are now told that the Government and the NHS are refusing to honour a pay rise this year. I hope the Secretary of State will tell us whether all public health staff employed on “Agenda for Change” terms and conditions will get a pay rise this year.

We are pleased that the Secretary of State has joined us today from the leadership campaign trail. We look forward to his response but, whenever he is asked about public health cuts, he says, “Well, prevention is better than cure.” Who would disagree with that? He never tells us that he is going to stand up to the Chancellor and demand that these cuts be reversed. He simply says that individuals’ attitudes have to change. But it is not just about individuals; it is about the services that are available in local communities. He gives the impression that he just wants people to look after themselves. For example, he said that those who present at hospital with ailments related to alcohol abuse will be targeted for a “stern talking to”—that is his answer. He needs to take it up with The Sunday Times if that was not what he said.

We know that the Secretary of State loves an app, and one of his solutions is more targeted advertising on Facebook. Whenever there is a problem in the NHS, he says that we are going to have more apps; that is the solution to everything. I am told that he and his old friend George Osborne are now part of a WhatsApp group called “Make Matt Hancock Great Again”—there are some problems that even an app cannot fix.

This is not leadership. Real leadership would be reversing the cuts to public health services and intervening to stop the health inequalities and the rolling back of life expectancy advances. Only Labour is offering that leadership on health inequalities. We will fully fund public health services. We will not cut public health services. We will adopt a health in all policies approach; this Government will not. We will invest in the health and wellbeing of every child and meet our ambition to have the healthiest children in the world. Longer, healthier, happier lives will be our mission. I commend our motion to the House.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care 4:18 pm, 14th May 2019

It is a great pleasure to respond to this Opposition day debate on health. It is worth saying at the start that, for all we have heard from Jonathan Ashworth, today’s debate gives the House the chance to discuss the record £33.9 billion of extra funding that we are putting into health services in the UK, how we are going to spend that money and what we will do to improve the nation’s health.

I will respond to the many points that the hon. Gentleman made and explain why it is important to look at the facts when debating these things, but let me start by being crystal clear about what he is trying to do. This debate should start from a point of welcoming the record investment that is going into the NHS. Instead, all we get is Opposition Members talking down the NHS. I will get on to the details but, before I do, let us remember why we can put £33.9 billion extra into the NHS. It is because we have a strong economy, with record employment, not through increasing the tax that people pay, but by having more people in work paying income tax. [Interruption.] I hear those on the Opposition Front Bench say “No”, but just this morning we have seen record numbers of jobs—yet again, record numbers of women in work and record numbers across the board—which means that we can have this money.

It was Gordon Brown who said, “When you lose control of the public finances, it’s the most vulnerable who pay the price”. It is certainly true that we have had to do a big job of fixing the public finances, but now we are able to put in this record investment to be able to make sure that the NHS is always there in the future.

Photo of Anna Soubry Anna Soubry Independent, Broxtowe

I am grateful that the right hon. Gentleman has confirmed that this investment in the NHS, which we should all welcome, is as a result of an improvement in our economy and has absolutely nothing to do with what was written on the side of a bus. In other words, whether or not we leave the European Union, does he agree that this money is guaranteed to go to the NHS and it has nothing to do with Brexit?

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

Yes. We can only fund a stronger health service and we can only fund strong public services if we have a strong economy and that would be put at risk by the recklessness of the Labour party. Let us talk about the details of how we are going to improve healthcare in this country, but let us say first and foremost that we can fund public services only if we can ensure that the economy is run well.

Photo of Debbie Abrahams Debbie Abrahams Labour, Oldham East and Saddleworth

Would the Secretary of State like to address the issues that my hon. Friend Jonathan Ashworth raised? We are seeing a flatlining of life expectancy, with the infant mortality rate having increased for the first time in 100 years. Will he address that in his response, please?

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

As I have said, I will come on to the details because there is undoubtedly work to do. Normally, we work on these issues in a fairly non-partisan way across the aisle. If we take tackling the problems of children of alcoholics, the hon. Member for Leicester South and I have worked together on that, and I pay tribute to the work he has done. In fact, he normally comes to this Chamber—as he did yesterday, for instance—in a spirit of discussion and objectivity to try to improve the health of our constituents. He is normally an extremely reasonable man. He is a very nice man. I know that he agrees far more with me than he does with his own party leader. Generally, he takes the approach of being constructive. I accept, and we accept, that improvements need to be made and we on this side of the House are determined to make those improvements, but we have to start from a basis of objective fact.

Photo of Rebecca Pow Rebecca Pow Conservative, Taunton Deane

The Secretary of State is making a really powerful case. On mortality, I would say that, far from the age going down in Somerset, it is going up. This is a good thing, but the conditions from which people are suffering are getting more complex. This is something we have to address. Indeed, I know the Government are seriously looking at it with many of the models they are bringing in.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

I will give way in a moment, if I may just make a bit of progress.

Of course extending healthy life expectancies is a central goal of the Government, and we will move heaven and earth to make it happen. Yes, that does involve ensuring that the entire budget of the NHS—not just the public health budget, important though it is, but the entire budget of the NHS—and all those who work in it are focused more on preventing ill health. The entire long-term plan of the NHS, which sets out how we are going to spend all the extra taxpayers’ money that is going in, is about focusing the entire NHS more on prevention than on cure. To choose just to look at the public health grant—it is important, but it is smaller by far than the entire budget of the NHS—is entirely to miss the point.

Photo of Clive Efford Clive Efford Labour, Eltham

The right hon. Gentleman must accept that it is not acceptable that, in the fifth richest economy in the world, life expectancy has flatlined across the country and in some areas has actually gone backwards. Is that not an indication that wider policy approaches by this Government than just those on health are not working?

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

It is true that across the western world the incredible rise in life expectancy is continuing but the rate of improvement has slowed. Our task here is to ensure that we extend healthy life expectancies.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

I have taken the hon. Gentleman’s point. That is the purpose of the entire prevention agenda: to help people to stay healthy in the first place.

Let me give a few examples. The hon. Member for Leicester South talked about deaths of despair, and each one of those suicides is a preventable tragedy, but he did not mention that the suicide rate in this country is the lowest it has been in seven years. We should be celebrating that while also resolving to drive it down further. Similarly, he talked about some of the sexually transmitted infections that are rising around the world, including in America, France and Belgium, but he did not mention that STIs overall are down. Indeed, HIV is down very significantly, and the UK is one of the leading countries in tackling HIV. It is important to look at the objective facts and not just pick out some. Of course there are STIs that we must tackle, and we will, but we must look at the overall picture. I will give one more objective fact: the number of attendances at sexual health clinics has gone up. That is one of the reasons why STIs overall are down.

Photo of Neil Coyle Neil Coyle Labour, Bermondsey and Old Southwark

When will the Secretary of State meet his commitment to expand the PrEP—pre-exposure prophylaxis—impact trial? He made that commitment some time ago but it has still not been delivered.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

Yes, I have made that commitment and we have made that available. The NHS is doing its part but some local authorities have not yet chosen to make that available and, because sexual health services are delivered through local authorities, I cannot direct that to happen. What I can do is ensure that I play my part, and I have.

Photo of Neil Coyle Neil Coyle Labour, Bermondsey and Old Southwark

I thank the Secretary of State for giving way again; he is being generous. The bottom line here is that there are men who have contracted HIV as a direct result of PrEP not being available. He must get a grip on the situation because he cannot keep passing the buck to local councils. He does have the resources and it is his commitment.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

We have made those resources available. The resources from the NHS to make PrEP available have been put forward. I find it deeply frustrating that in many areas that has not yet been delivered by local councils. We are working with local councils and urging them to take up the offer that is already available from the NHS. I totally understand and share the hon. Gentleman’s frustration. We are working to push local authorities to do this, but responsibility for public and sexual health services was transferred to local councils, as a result of a decision taken by this House. I am doing my part. I would love to work with him to ensure that it can actually be delivered on the ground because he is absolutely right that it is the right thing to do and the right direction to go in.

Photo of Rushanara Ali Rushanara Ali Labour, Bethnal Green and Bow

The objective fact is that the public health grant has gone down by £700 million between 2014-15 and 2019-20. If a person gets on the tube at Westminster station and travels to Whitechapel station in my constituency, average life expectancy drops by six months at every stop. That is the reality in constituencies such as mine. My appeal to the Secretary of State, if he is serious about tackling health inequalities, is to back local authorities with the resources they need.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

The public health grant is of course an important part of this, but it is only one part. The overall funding of the NHS is rising by £33.9 billion, the first £6.2 billion of which came on stream last month. I understand the hon. Lady’s point. That is on the money. On the health inequalities, I entirely agree with her that they should be tackled. Doing so is at the heart of the NHS long-term plan. It is a vital task that we do not shirk. Indeed, we embrace it and are addressing it.

Let me turn to the details of the motion. While I care deeply about making sure that we have the best possible health in this nation and the strongest possible NHS—and we are prepared to put the resources in to see that happen—I also care about good governance of the nation. The way that we are run is one of the reasons this country has been strong over generations, and I believe that using the Humble Address to undermine the ability of experts, clinicians, and civil servants to give me the benefit of their frank and wise advice not only undermines me as Secretary of State, but makes it harder to make good decisions. I know the shadow Secretary of State sits on the Front Bench with revolutionaries, but I thought he was a grown-up. I do not know what his mentor, Lord Mandelson, would make of his posturing today. Of course, we will object to the motion and, if he searched the depths of his heart, he would too.

The hon. Gentleman has obviously had a missive from the Leader of the Opposition’s office—LOTO, as it is called—telling him to present the Humble Address, but it is not his style. I hope that we can get back to debating these issues on a proper motion in the future. I respect and like the hon. Gentleman: he is a really nice guy. If he had asked for the information directly—perhaps he could have sent me a message on the app—

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

Now that is an insult! There are only two types of people in the world—the people who are on the Matt Hancock app and the people who are not on the Matt Hancock app yet. I can see that the hon. Gentleman falls into the latter category. I digress.

If the hon. Gentleman had asked for the information directly, I would have been more than happy to provide it. To show willingness, I am happy to provide the House with the information requested in the motion. We will republish the impact assessments on the public health grant. They have already been published, but I am happy to do that. We will republish the Office for National Statistics stats and the Public Health England report on life expectancy. We will publish a statement on the “Agenda for Change” decision that he mentioned. It had been released already this week, as it happens, before we saw the motion.

If the hon. Gentleman wants to know about the “Agenda for Change” pay rises, I am delighted to keep talking about them. Perhaps he should ask the 1 million NHS staff who last month received a pay rise of up to 29%, including £2,000 extra a year for new full-time nurses. That came into force at the start of last month. I will debate with him the “Agenda for Change” pay rises any day of the week. Because the Government are running a strong economy, we can afford to put the money in to make sure that under “Agenda for Change” nurses get the pay rise they deserve.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I am delighted that the Secretary of State wants me to join his Make Matt Hancock Great Again WhatsApp group. Please add me to it. Perhaps in the group I can get some style tips from him, because he looked rather Alan Partridge-esque in the photos on Friday. I digress.

On Agenda for Change, it was reported in the Health Service Journal that the Government will not honour the pay rise for public health staff such as health visitors, sexual health staff and school nurses—all the sort of staff we have been talking about this afternoon—and that there was a dispute between NHS England and the sector about who will fund that £50 million pay rise. Is he telling us today that the Government will honour that pay rise for public health staff working in public health services?

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

We are honouring the pay rise proposed—of course we are. I love the HSJ, which is an absolutely terrific journal, but it was wide of the mark on that. We are putting in record funding.

Photo of John Redwood John Redwood Conservative, Wokingham

The Secretary of State has done well in getting the extra money that the NHS needs. Will he briefly summarise what extra service and capacity we will get for that money? It is important to spend it wisely.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

My right hon. Friend anticipates my very next point. It is important to get value for the extra taxpayers’ money we put in. I always try to refer to it as taxpayers’ money, because there is no Government money or NHS money. Every single penny we put into the NHS—rightly, in my view—comes from the taxes that people pay, and it should be treated with the respect that that deserves.

Photo of Geraint Davies Geraint Davies Labour/Co-operative, Swansea West

The thesis of a strong NHS is based on a strong economy, yet will he accept that under this Government since 2010 overall debt has gone from 45% of GDP to nearly 90% of GDP? It is not about tax; it is just borrowed money from a failing economy.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

No. I agree with the hon. Gentleman about the importance of clean air, but I gently point out that dealing with the deficit—the annual amount by which the Government was overspending—is, and must be, the precursor to getting the debt down. Now, thankfully, the debt is falling relative to the economy, but there has been an awful lot of hard work to get us there.

Let us look at some of the things the NHS is delivering. The entire population now has access to evening and weekend GP appointments. More than a million GP appointments a month are now booked online, and consultation increasingly takes place online. More than three million repeat prescriptions are done online. There are more than 2 million more operations a year than in 2010, and we see 11.5 million more out-patient appointments than in 2010. Since last year, more than 500 extra beds a day have been freed up in hospitals.

When it comes to the future, only yesterday we announced that a new treatment aid for brain cancer can be rolled out across the country, benefiting up to 2,000 patients, all because of the extra money we are putting in. My right hon. Friend John Redwood is quite right that in return for the extra taxpayers’ money we are putting in, we must get extra out, too.

Photo of Paul Williams Paul Williams Labour, Stockton South

Extra investment in the NHS is welcome, but when will the Secretary of State start talking about health visitors, school nurses, drug treatment services and other services funded out of the public health grant—the topic of the debate?

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

The public health grant is settled in the spending review. The NHS settlement has come before the spending review, and the public health grant is only one part of the approach to public health. In 2015, this House agreed, with broad acceptance across parties—I know the hon. Gentleman was not in the House then—that local authorities should take responsibilities for public health, to ensure that the entirety of local authority activity could be focused on better public health.

Public health is not just what happens in the NHS, with councils or in GP surgeries or hospitals. For instance, the Government have taken a global lead in getting social media companies to remove suicide and self-harm content online because of the danger that poses to people’s mental health, and in particular that of children and young people. That is a public health issue. Likewise, the efforts we are making to reduce air pollution in the environment Bill—a broader piece of legislation than just a clean air Act—are about a public health matter. It is not in the public health grant, but it is a public health matter.

Photo of Anna Soubry Anna Soubry Independent, Broxtowe

As a former Minister for Public Health, I understand the huge remit of what we call public health. The Secretary of State is right that we should invest more in prevention, particularly with regard to certain diseases and conditions, but the real concern about the Government’s plan is that, while that is happening, all the other important services not in the “prevention is better than cure” envelope, such as sexual health and the treatment of alcohol and smoking, delivered at a local level, will be cut in real terms.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

I respect the right hon. Lady’s work as Public Health Minister—she was excellent in that role—and I was going to turn to this point. It is very important that we understand the base we are starting from, but we also have the spending review, in which these budgets will be settled, and that is clearly an important cross-Government question that we will be addressing in the coming months.

Smoking cessation services have been mentioned. Now, the smoking rate has fallen since 2010 from 20.1% of the population to 14.9%, which is excellent, although it is part of a fall over a generation, not just the last 10 years. Likewise, the drug use rate has fallen from over 10% to 8.5%. We have to provide the services for those we still need to get off smoking and to support people to stop using drugs, but the number of people smoking and using drugs has fallen too.

On clean air, the World Health Organisation has called the clean air strategy we published an example for the rest of the world to follow, so I think in this area the necessary action we are taking should be being welcomed across this Chamber.

Photo of Geraint Davies Geraint Davies Labour/Co-operative, Swansea West

I know the Secretary of State accepts that the environment Bill is the vehicle to deliver cleaner air, but is he aware that, as it stands, it does not include indoor air quality? Given that we spend 90% of our time inside and that the medical research now shows a cocktail effect of outdoor dirty air conflating with indoor air that has poisons in it—from sprays, cleaning products, chemicals in furniture and all the rest—if we are to properly tackle the problem of dirty air causing 64,000 deaths a year, indoor air quality has to be included in the environment Bill. Will he press the Secretary of State for the Environment, Food and Rural Affairs to ensure that it is?

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

The Secretary of State for Environment, Food and Rural Affairs and I are working incredibly closely on this because clean air is a public health matter. The challenge is that, although measuring outdoor air quality is essentially a public matter and in public buildings it may well be a public matter, inside most people’s homes it is far harder to make a direct intervention, but I accept the premise of the hon. Gentleman’s point. It may be something we can look at in public spaces. [Interruption.] He mentions schools and hospitals. I accept the premise of that point and I think it is something we can take away. The same is true inside vehicles, but that is a wider question.

Photo of Anna Soubry Anna Soubry Independent, Broxtowe

I want to come back to the Secretary of State’s answer to my intervention. I am worried because, if I may say so, it is rather simplistic to say—I think this is what he said—that because the levels are falling we can accordingly reduce the amount of money being spent on those services. I would suggest that he listen to the experts and the evidence, because I suspect they will say that we must continue to invest to make sure those reductions continue and to take account of any eventualities. Police spending is a good example of how Government can cut too far.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

I am glad I took that intervention because that was not the intention I was trying to convey at all. We need to do more to tackle smoking, and we will, and we need to continue to tackle the abuse of drugs, and we will. My argument is that this House decided that public health was better delivered through a broad approach by local councils working with the NHS than separately. On sexual health services, I gently say that many such services—for instance, the provision of PrEP—are preventive, not just reactive. However, the boundary between what is prevention and what is cure in sexual health services is, by nature, more complicated.

Photo of Nick Smith Nick Smith Opposition Whip (Commons)

May I take up that issue of prevention? Earlier this afternoon, the Secretary of State said that he would move heaven and earth to achieve healthy outcomes. When will we see a ban on junk food advertising before the watershed?

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

We have not discussed obesity much during this debate, but the Government have a whole programme to tackle it. That includes tackling advertising and, in particular, tackling the pro-obesity environment in which too many children grow up. There is a broad range of actions on our agenda, with more to come.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

I will give way one final time, but I want to leave some time for Back-Bench speeches.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Transport)

The Secretary of State has boasted about the amount of money that is going into the NHS, but the Government have transferred public health services to local authorities, whose funding is being slashed, and as a result funding for those services is also being cut. Can the Secretary of State say how much of that NHS money will support the role of local authorities in delivering the public health agenda?

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

Local authorities and the NHS work very closely in delivering a huge number of services, and authorities often commission services back from the NHS. I can tell the hon. Lady that between 2013 and 2017, the number of attendances at sexual health centres increased by 13%. The suggestion made by many Opposition Members that there has been a cut in the number of such attendances is not supported by the facts.

We will not rest until we can solve these problems.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

We are putting money in, and we are putting commitment in. The NHS was proposed from this Dispatch Box by a Conservative Minister, under a Conservative Prime Minister, and its expansion has been overseen by Conservative Governments for most of its 71-year history.

Photo of Eleanor Laing Eleanor Laing Deputy Speaker (First Deputy Chairman of Ways and Means)

Order. The Secretary of State is not giving way, and we are running out of time.

Photo of Matthew Hancock Matthew Hancock Secretary of State for Health and Social Care

Once again, a Conservative Government are expanding the NHS and planning for the future to ensure that it will always be there for us, with a record £33.9 billion investment and a focus on preventing ill health in the first place. I believe that, from the bottom of our hearts, we all know that we need to deliver.

Several hon. Members:

rose—

Photo of Eleanor Laing Eleanor Laing Deputy Speaker (First Deputy Chairman of Ways and Means)

Order. Before I call Dr Cameron, I should give a gentle warning to colleagues. Obviously a great many people want to speak, and there is limited time, so there will be an initial speaking time limit of six minutes. I give that warning in advance so that speeches can be restructured.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health) 4:48 pm, 14th May 2019

It is an absolute pleasure to speak on behalf of the Scottish National party and to see you in your place, Madam Deputy Speaker.

As we know, public health campaigns can be extremely successful. They make health improvements in a widespread manner; individual interventions do not have the same effect. However, the work of public health campaigns and departments is not always visible. It tends to take place behind the scenes. Constituents do not often speak to their MPs about these issues. Very infrequently has anyone come to my door to ask about a cervical screening appointment, or about our campaigns and work on obesity. Public health is not the most visible area of our NHS, unlike the frontline issues of access to treatments, accident and emergency waiting lists and access to GP appointments. It does not have the profile that it ought to have, and it certainly does not feature the sensationalism on which the media often want to report. However, it is important to say that public health is fundamental to the health of the nation. Therefore, public health should not be underestimated and should certainly never be underfunded.

Since 2006-07, the annual health resource budget has increased in Scotland by £4.8 billion, and the Scottish Government have passed all consequentials on to health and care. Funding for NHS boards will increase again by £430 million—an increase of 4.2%—and the package of investments in health and social care in Scotland for integration programmes will be £700 million to the better. Health spending per head in Scotland is almost 9% higher than in England, according to Treasury analysis in 2018.

Investment in primary care is essential; our GPs are at the frontline and it is important that we increase funding for that. The Scottish Government have invested over £930 million in primary care, and £30 million will be invested to extend the free personal care individuals have in Scotland to the under-65s. Some £11.1 million will be provided to increase nursing and midwifery bursaries from £8,100 to £10,000 the following year. Again, midwives and nursing staff are on the frontline of our public health achievements.

Young families across Scotland receive the opportunity to have a baby box as soon as their baby is delivered, which is fundamentally to the good; it is about saying, “We know your baby is born; it is the most valuable thing in your life and we want every baby in Scotland to have the same start and to reduce the inequality we know impacts on people’s lives and families.”

We also need to increase our sportscotland funding, and there has been a pledge of 3%. We have discussed obesity today. I was a member of the Health and Social Care Committee when it was looking at the issue, and again this underlines the importance we must place on public health investment. Advertising and marketing campaigns overshadow the work we are able to do because of the huge investment the industry puts into encouraging people to eat and feed their children the wrong types of food and to give ourselves treats many more times than we should. I have fallen foul of that, particularly since arriving in the House of Commons; our Tea Room has far too many little treats at the counter. These are all things we grapple with as families and individuals, and that is why it is so important that public health and public health campaigns are supported.

I am pleased to learn more about the Government’s nudge unit. The UK Government has put some investment into psychological approaches to public health and to health, and I was pleased to meet a member of the nudge unit a few months ago at the all-party group on psychology, which I chair, because we must try to help people shape their behaviours and make it as easy as possible to make the right decisions moving forward. Making the right decisions is difficult anyway, but things such as having the opportunity to have a piece of chocolate at the till when we are making purchases makes it that little bit more difficult for people to make the choices we know they need to make. Public health and taking responsibility for our health is all about shaping behaviour: making those choices ourselves through our motivation, but also the Government helping to shape the society we live in and make sure that the easy choices are the healthy choices.

It is important that we raise as much awareness as possible of mental health, particularly in this week, mental health awareness week. This has often been about communities plugging gaps, however. Progress has been made across the UK, but community mental health service waiting times are still far too long, particularly for young people and adolescents awaiting access to child and adolescent mental health services. That is why there has to be a partnership between public health, health services, voluntary agencies and others in the community.

An example is the Trust Jack Foundation in my constituency, which was formed following the tragic suicide of a young person in my constituency, Jack. His mother came through that terrible trauma and created the foundation, which enables young people in Stonehouse and elsewhere in Lanarkshire to have access to mental health services while they are on the waiting list for CAMHS, and it is really making a difference by giving them the support they need and the earliest possible intervention.

On disability, we must pay cognisance to the fact that those who are disabled are much more likely to be living in poverty than those who do not have disabilities. It is important to take account of that, because people who have disability have less access to the workplace, to transport, to adapted housing and even to shops, because in some cases, Changing Places toilets are not available in our shops. They also have less access to getting about, because Changing Places toilets and facilities and accessible transport are often not available. All those factors contribute to the impact of poverty on people with disability, and we need a joined-up approach across Departments if we are to make a difference.

I want to speak briefly about homelessness. I cannot help but notice that every time I arrive here in Westminster each day, there are people sleeping at the underground station just outside the entrance to Westminster. I have also noticed that, a number of times, there have been flowers left for those who have died there. It is incumbent on us all, as MPs and as a Government, to notice what is right in front of our eyes and to act to ensure that those homeless people have opportunities and that their health and wellbeing are cared for.

I want to touch briefly on the subject of older adults. Public health campaigns will have to focus on and target older adults in the years to come. We are living longer by virtue of the good health we enjoy as a result of the interventions, treatments and technologies that are now available, but chronic illnesses will be with people for longer and affect many more people.

Photo of Theresa Villiers Theresa Villiers Conservative, Chipping Barnet

Does the hon. Lady agree with a point made to me by a number of my older constituents at an event last week, which is that we need to ensure that sports facilities are providing the right encouragement and opportunities to keep older people active for longer, given that that is crucial for public health goals?

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

Yes, that is an absolutely fantastic point. I was going to mention the fact that our local sports and leisure facility has an agreement with the NHS that GPs can prescribe sports facilities to people so that they can have an exercise regime designed specifically for them. If they can benefit from such a regime, that can maximise their health. All these things actually save money in the long term, and that is why public health is so crucial. We really are investing for the good of the nation.

From my own experience of working in addiction services many years ago, I know that we have to take on board the fact that there are huge levels of comorbidity with mental health. Often, people in addiction services have a history of trauma. They are self-medicating with alcohol or drugs, and they are not coping with life due to their underlying mental health issues. However, those very same people are often refused access to mental health services treatment until they have dealt with their addiction. That is a circular argument, and those who are struggling with mental health and addiction problems never really get the support that they need or deserve. That is why integrated services in relation to addiction are so important.

Photo of Diana R. Johnson Diana R. Johnson Labour, Kingston upon Hull North

I am interested to hear about what is happening with drug and alcohol services in Scotland, particularly the 9% budget increase that the hon. Lady mentioned. Has she had the same experience that I have had in Hull, where more and more people on the streets seem to be taking spice, which turns them in an obvious way into someone who is taking drugs and which is causing real problems on the streets? Is that happening in Scotland as well? We have seen an 18% cut in drug and alcohol services since 2013.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

This is always a difficult situation, because when people self-medicate, they tend to take the drugs that are available. They may take something that has an impact on their behaviour and personality, which may then have an impact on their life if they become involved in crime and so on. The types of drugs that are coming on to the market seem to lower people’s inhibitions, so they can get into terrible difficulties with the criminal justice system, but their difficulties—their underlying trauma and addiction—are not dealt with. That money is welcome, but we have a long way to go to ensure that we also deal with other issues.

Finally, it is important not to forget about our veterans when it comes to public health. These individuals who have served us may be invisible, silent or hidden in the background, but they need interventions and they need us to reach out. I wanted to mention the excellent Veterans First Point service in Lanarkshire for providing counselling without a waiting list to our local veterans to ensure that their needs are met.

I thank everybody who will take part in this extremely important and timely debate. The more that we can do in terms of public health, the better success we will have in years to come in dealing with inequality and the underlying issues that mean those in our society who did not get the best start do not get the chances that they deserve. We can achieve that only by working together on a cross-Government basis, with local councils and within communities, and I look forward to working with everybody in the Chamber who has an interest in moving this issue forward to ensure that progress is made.

Several hon. Members:

rose—

Photo of Eleanor Laing Eleanor Laing Deputy Speaker (First Deputy Chairman of Ways and Means)

Order. As I indicated earlier, there will be an immediate time limit of six minutes.

Photo of Suella Braverman Suella Braverman Conservative, Fareham 5:02 pm, 14th May 2019

I am pleased to speak in this debate about local public health, but the Opposition are seriously off target in calling for it in the first place. Of all Government budgets, the NHS has had record investment since 2010 and, although I am not going to do Labour Members’ work for them, there are stronger cases that could have been made about public funding in other Departments. When we look at public health outcomes since 2010, the Conservatives can point to a good record. The Labour party does not have a monopoly on our health service. There is this assumption that Labour somehow knows best and that the solution is simply more cash and more managers, but that is not true at all. I grew up as a proud Conservative and as a daughter of an NHS nurse—my mother worked for the NHS for 45 years. The NHS has been there for my family, for me and for my baby to be, which is due in July. I love the NHS, and just because I am on the Conservative side of the Chamber does not diminish my commitment to it whatsoever.

I want to speak about Fareham, where there are definite challenges when it comes to health services, such as with the mental health services provided by the Southern Health NHS Foundation Trust. I want to put on the record my gratitude to the Secretary of State for meeting me on behalf of some of the families who have been affected by Southern Health’s issues. When it comes to social care, I have met many relatives of elderly residents for whom the system has not worked well, a subject that I discussed in the Chamber some weeks ago.

Notwithstanding those challenges, I want to talk about a fantastic facility in my constituency called Fareham Community Hospital, and I am using my speech to launch a report that I have prepared about a future vision for how we can use the hospital better. When I was first elected in 2015, the No. 1 issue was how to make better use of Fareham Community Hospital. It is a relatively small, relatively new facility in the heart of the constituency, but it remains underutilised, according to several footfall surveys we have conducted. Rooms are frequently booked by various health trusts but still lie vacant, at considerable cost to the taxpayer. Complex lease arrangements render the release of space time-consuming and bureaucratic. There is no coherent public information system or public-facing management to signpost services for local people.

Random and sporadic services are offered. Most recently, phlebotomy and blood testing were removed, much to the disappointment of many residents and to Friends of Fareham Community Hospital, which plays a vital role in co-ordinating volunteers who want to support this asset. In short, the hospital is at risk of becoming a wasted opportunity and a wasted asset.

I set up a Fareham Community Hospital taskforce in 2015 to bring together many of the health providers: the local CCGs; Hampshire County Council; Solent NHS Trust; Southern Health NHS Foundation Trust; Friends of Fareham Community Hospital; Community Health Partnerships Ltd; Portsmouth Hospitals NHS Trust; and University Hospital Southampton NHS Foundation Trust. The sheer number of organisations reflects the complexity of how the hospital is run.

Last year, I ran a constituency-wide survey on how the community would like to see the hospital run better. I am grateful to the many hundreds of people and all the organisations that participated. I am pleased to launch the “Fareham Community Hospital Future Vision” report, which can be found on my website. The report compiles the survey, and it makes seven recommendations.

First, the report welcomes the new primary care same-day access scheme run by local GPs at the Jubilee, Whiteley and Highlands surgeries for the past 18 months, which is a reflection of the historic £4.5 billion commitment at national level for primary and community health. The scheme has been welcomed by the community, and it is working effectively. There is a call for it to be expanded to other GP surgeries. I put on record my thanks to Dr Tom Bertram for leading the initiative.

Secondly, the report recommends that more consideration be given to other clinical priorities. Scanning facilities and using the hospital as a diagnostic centre could be viable options for the future. Thirdly, public health functions should be considered at FCH. A public health hub could support patients with clinical obesity, depression, anxiety and other conditions. Lastly, accessibility is a key theme running through the responses. We need a bus stop at the hospital and a method to enable elderly and ill patients to get to it more easily.

Fareham Community Hospital is a great example of how a local asset is available to a community and how local health providers can come together to make it more responsive to local needs. I am pleased to launch the “Fareham Community Hospital Future Vision” report today, and I hope it provides a starting point for future work.

Photo of Ivan Lewis Ivan Lewis Independent, Bury South 5:07 pm, 14th May 2019

The Secretary of State is right to say that the shadow Secretary of State is, indeed, a nice man, but he is far more than that. I pay tribute to Jonathan Ashworth for the tremendous work that he and Liam Byrne have done on behalf of the children of alcoholics—they are making a tremendous difference.

I will focus on the impact of cuts to mental health services. At a time when there is a welcome all-party commitment to parity of esteem between mental health and physical health, there is an alarming gap between rhetoric and reality. Headline national figures too frequently do not reflect the experiences of people at the sharp end. It is widely acknowledged that mental health services were underfunded to start with, and the perpetual cuts we have seen have made matters worse.

A lethal cocktail of cuts to health and benefits has created a shameful epidemic of rough sleeping that is so evident in the towns and cities of our country. Specific Government funding, although welcome, is inadequate and no substitute for the savage cumulative cuts to mainstream services. It is paying for the damage caused by indiscriminate, disproportionate cuts.

I put on record our support for the tremendous leadership shown by the Mayor of Greater Manchester with his “a bed every night” initiative, but that will need considerably more investment from the Government if it is to achieve its noble objectives.

My “Talking About Mental Health” campaign in Bury South has attracted a lot of support from people with mental health issues and their families. It has illustrated a simple truth: one in four people experiences mental health problems every year. The campaign is encouraging people to feel able to talk about their own experiences and is galvanising support to improve local services. Cuts have meant too often that people endure long waits for psychological therapy, and are unable to access appropriate in-patient and emergency services. Community support is scarce, and far from services being focused on prevention and early intervention, people can usually access services only in the event of a crisis. Relatives and carers are frequently left to struggle alone.

We have some excellent, innovative local voluntary services, such as the Creative Living Centre, Moodswings and The Friendship Circle, but they are underfunded and cannot be expected to meet the scale of the demand for support. A major concern is the state of child and adolescent mental health services. Although the Government’s pledge of an extra £1.4 billion to transform CAMHS in 2015 was welcome, work by YoungMinds has demonstrated that in the first year of extra funding only 36% of clinical commissioning groups that responded had increased their CAMHS spend by as much as that Government funding.

In my constituency, I am currently advocating on behalf of a number of local parents who have autistic children with mental health problems—I am sure other hon. Members have the same experience. These people are under unspeakable daily pressure, yet services consistently fail to meet their needs. In the light of it being Mental Health Awareness Week, I would like to read part of a blog written by my brave 19-year-old constituent Libby Bean, who describes the realities of living and coping with a mental health condition as follows:

“I found going to many psychologists that it just wasn’t working for me, I didn’t like the by the book exercises and help they would give me and treat my case like every other person as I believed it had to be adapted specifically for me. After several psychologists I tried this one amazing person that I had heard was great for anxiety. Me being me I said I’d try it because”— it was just an opportunity—

“to get rid of my feelings of anxiety, I thought how this will be any different to what I have been through before, well I was wrong. This changed my life. They have helped me so much and have been the best support system.”

The point that I am making and that I think Libby is making is that health and local public service cuts are making it harder for people such as Libby to receive the tailored care and support that they need. A one-size-fits-all approach is always destined to fail; an issue as varied as mental health requires personalisation.

Supporting mental wellbeing should be at the heart of any responsible Government’s approach to building a better society. It requires health and local government leadership, and a joined-up, cross-government approach. It requires us to continue the tremendous progress that has been made in recent years in tackling stigma. It also requires the full engagement of employers in the public and private sectors. Parity of esteem and a shift to prevention and early intervention are noble objectives, but disproportionate cuts to local government and underfunding of the NHS mean that the reality is very different. Not only does this make vulnerable people even more vulnerable, but it corrodes trust in politicians and this place. I hope that the Secretary of State will give serious consideration in the future to ring-fencing funding for mental health, so that people at the sharp end genuinely see the benefits of extra funding that is announced at a national level.

Several hon. Members:

rose—

Photo of Lindsay Hoyle Lindsay Hoyle Deputy Speaker and Chairman of Ways and Means, Chair, Panel of Chairs, Chair, Standing Orders Committee

May I just say that to get everybody in and give them equal time, five minutes will be the order of the day?

Photo of Theresa Villiers Theresa Villiers Conservative, Chipping Barnet 5:13 pm, 14th May 2019

Thank you, Mr Deputy Speaker. Supporting the NHS and its values, and securing the best healthcare for my constituents, has always been one of my highest priorities as a Member of this place, so I warmly welcomed the news that the NHS would get the biggest increase in funding in its history, with a £20 billion cash boost. As we have heard today, the demands on our health service are increasing as we grow older as a society, and I would like to pay a warm tribute to all NHS staff, especially those working in and around my constituency at the Barnet and Chase Farm Hospitals and in primary care. They do incredible work and we all owe them a great debt of gratitude. We need only to consider some of the statistics that the Secretary of State shared with us, such as the fact that the NHS currently sees 3.3 million more people attending at A&E than in 2010. The number of operations carried out is up dramatically, as are the number of diagnostic tests and out-patient appointments. The NHS is delivering more care than at any time in its 71-year history.

There is much that we should praise about the service but, as we have heard today, we should also acknowledge the challenges and the concern felt about waiting times, about access to new and innovative treatments, about caring for our frail elderly, about dealing with health inequalities and about action to improve outcomes for the most serious conditions, such as cancer. That is why the new funding and the new NHS plan are both so crucial. The goals set out in the NHS long-term plan will greatly improve patient care, and they should also boost productivity in the NHS to ensure that taxpayers’ money is used as effectively as possible and gets to the frontline care about which we all care so much. The key challenge now is to ensure that those goals are delivered in practice.

Photo of Liz Twist Liz Twist Labour, Blaydon

Does the right hon. Lady agree that we also need to tackle the preventive measures covered by public health programmes? It is really important that we maintain public health spending and run smoking cessation programmes and others that prevent ill health from developing in future.

Photo of Theresa Villiers Theresa Villiers Conservative, Chipping Barnet

I think there is cross-party support in the Chamber for effectively funding our NHS and public health. Both those spending areas will continue to be a priority for the Government.

I particularly welcome the Government’s commitment that primary care and GP services are at the heart of the NHS long-term plan. GPs are very much in the frontline of increasing healthcare needs, and they are feeling the pressure. I want to see the Government’s £4.5 billion commitment to primary care deliver expanded GP capacity in my Chipping Barnet constituency. The proposals for GPs to be able to call on support from teams of other professionals, such as district nurses and pharmacists, may play a helpful role in relieving the pressure on GP services.

If we are to ensure that patients can get appointments when they need them, we need to train and recruit more GPs. This need is even more intense in areas such as Whetstone in my constituency, where new homes are being built and patient rolls are getting longer. I would like to have the Minister’s assurance that the Government’s target to increase medical school places from 6,000 to 7,500 per year will be met. It is also vital to ensure that whatever reforms are introduced to our immigration system when we leave the EU, we ensure that the new system meets the needs of the NHS and ensures it can continue to bring in skilled professionals from the EU and beyond. It is also important to enable doctors to expand their buildings to improve facilities for patients, and I commend the plans to do so that GPs in High Barnet, Whetstone and elsewhere in my constituency are taking forward.

A third aspect of the NHS plan that I would warmly welcome is the improvement of digital capability, in which respect I wish to highlight an important success in my local area. In autumn last year, Chase Farm Hospital reopened in a brand new £200 million state-of-the-art building. It uses the most up-to-date digital facilities, and the new building is significantly improving patient care. It is situated just outside my constituency but used by many of my constituents and is part of the same trust as Barnet Hospital. I campaigned for many years to secure Chase Farm Hospital’s future, and I welcome the great new facilities for my constituents.

I will always be the strongest supporter of the NHS and its values. This debate is an opportunity to celebrate the incredible achievements of our national health service and its staff, but also to recognise that there is a huge amount of work to be done to ensure that the NHS can continue to meet the needs of future populations. We should never ever forget that delivering a strong economy and strong public finances is imperative if we are to continue to have a strong NHS. It is the only way to deliver the funding that the NHS needs to provide the care on which we all depend. A strong economy is vital to ensure that our constituents get the best possible healthcare in the years ahead, and I urge the Government to ensure that they continue to deliver the economic stability and prosperity on which we all depend and on which the NHS depends for a successful future.

Photo of Eleanor Smith Eleanor Smith Labour, Wolverhampton South West 5:19 pm, 14th May 2019

I thank Theresa Villiers for raising her points.

Since 2010, we have seen the Government cut health services and social care by £7 billion. Because of this, we MPs have been seeing local cuts in our individual constituencies. Last week, a constituent of mine came to visit me during my surgery about a new policy that has come into effect. The policy states that a patient will no longer be given prescriptions for over-the-counter medicines for a range of health conditions, even if they qualify for a free prescription. I would say that that is a public health matter.

There are 33 conditions that are part of that policy, from acute sore throat, excessive sweating and period pains to warts and verrucas. My constituent is 64 and has various health conditions that stop her from working. She is on universal credit, which gives her £317 a month, which is much less than she would earn under the Government’s national minimum wage if she were working part time. Because of her low income, she has had to use up all her savings and even pawn her jewellery, which holds sentimental value, to make ends meet. She recently went to her doctors for her hay fever medication and was told that she is no longer entitled to a free prescription. I feel that that is a public health matter. When she disputed the claim, she was told that under the NHS England guidelines they could no longer provide free prescriptions for mild to moderate hay fever.

As a nurse of 40 years, I am dismayed at how poorly NHS England and the Government publicised the consultation. Many people were unaware of this and it just sums up what the Government and their Departments seem to do. Backdoor and underhanded changes: these have been the steps the Government have been taking over the last nine years to move towards privatising the NHS. It brings me to tears to see the changes that NHS England is bringing in, which affect the most vulnerable. Socioeconomically deprived groups too often face the prospect of poorer access to healthcare, a public health matter.

We know that some of the conditions mentioned in the guidance are the first symptoms of more serious conditions and, if diagnosed too late, they can cause long-term complications for the patient, a public health matter. Did NHS England take into consideration single parents and those on low income who are on universal credit? How are they going to afford to pay for medication for themselves and their children under this new policy? That is a public health matter. It is unfair to them—having the right to free prescriptions was their safety net and one less problem to think about. Is this part of the Government’s NHS 10-year plan? To punish the most vulnerable individuals in society? The Government need to review this policy again. It is short-sighted and will have repercussions for their 10-year plan within the public health agenda.

Photo of Gillian Keegan Gillian Keegan Conservative, Chichester 5:22 pm, 14th May 2019

The NHS is without a doubt a much-loved and vital service. Established almost 71 years ago, it has been under the stewardship of a Conservative Government for 44 of those years, almost two thirds of its existence. The NHS treats 1.4 million patients every 24 hours. It is literally where we start our life, and a constant support and safety blanket throughout our lives. We simply could not live without it.

That is why the NHS is this Government’s No. 1 spending priority. It is beyond question that this Government have provided the biggest investment ever into our NHS in the post-war period. The scale of the commitment is mind-blowing, at £33.9 billion extra in cash terms by 2023-24. If any other Government had done it they would have been celebrating it and would have spoken of little else. By 2023, we will be spending £157 billion a year—many billions of pounds more than the Opposition proposed.

My mother-in-law, who was a frequent user of the NHS in her later years, used to say to me “You have to be able to cope to be able to care.” I find her words very poignant when talking about our magnificent NHS, because it is vital that we maintain a strong economy to fund the NHS at these record-breaking levels. The biggest danger to the NHS in my view is a dangerous experiment with socialism coupled with a £1,000 billion spending commitment. The NHS will literally be competing with railways and utility companies and goodness knows what else for a pot of money which will be much smaller due to economic failure.

As someone who has worked in the private sector for most of her life, my approach is somewhat different. The private sector has to work well if the NHS is to have the funding that it needs. There are other lessons that are relevant in my experience. It is reasonable to assume that we can increase efficiency. There are many examples across the NHS and many new ways of working: multi-disciplinary teams, primary care networks, integrated services, urgent care centres, Pharmacy First, online GP services, and much more innovation to come as part of the long-term plan.

Nowhere have I see that endeavour for excellence combined with efficiency more than in St Richard’s Hospital in Chichester. I pay tribute to our wonderful staff and the phenomenal record of the whole Western Sussex Hospitals NHS Foundation Trust, led brilliantly by Dame Marianne Griffiths. We are extremely proud that our hospital trust is rated outstanding, and was described as effective, caring and well led during its Care Quality Commission evaluation. It is not surprising that the trust has won awards. Over the past four years it has won best organisation in the health service, best education and training in patient safety, and the top hospital award. Marianne has won best chief executive two years running. We need that excellence in all our hospitals across the country.

Before I was elected to Parliament I was lucky to serve on the hospital trust board of governors, where I learned a great deal. Most importantly, I saw its can-do attitude and search for continuous improvement combined with sensible and inclusive leadership that ensured that it delivered great results. For those who doubt that the NHS can make efficiency savings year on year while maintaining top-quality services, Western Sussex Hospitals has managed a surplus every year but one since its creation in 2009, wiping out £20.5 million-worth of legacy debts.

West Sussex County Council has stepped up to the public health challenge, and only last month launched a new joint health and wellbeing strategy, “Start well, Live well, Age well”. Prevention through education is a key component of our health and wellbeing. In West Sussex, we have introduced a winter falls prevention programme, a tobacco control strategy and alcohol reduction initiatives, as well as programmes to counter loneliness, suicide and self-harm. Listening to Opposition speakers in this debate, people could believe that the system is broken. It is not, and that is certainly not the story in my constituency, where I am lucky to work with great people: doctors, nurses, porters and all the other NHS staff.

None of this is to the credit of politicians, who often use the NHS as a political football, spreading nonsense and rumours with threats of privatisation. It is down to the committed people in the NHS doing a great job with strong leadership on the ground. That is now underpinned by the right funding model for the future—the biggest cash injection in NHS history, which is something that we should all celebrate.

Photo of Tim Farron Tim Farron Liberal Democrat Lords Spokesperson (Communities and Local Government) 5:28 pm, 14th May 2019

It is an honour to follow Gillian Keegan, with whom I work closely and proudly on the all-party parliamentary group on radiotherapy.

When the NHS long-term plan was published, the emphasis on strengthening preventive care was a welcome step in the right direction. Good preventive care and public health are kinder and cheaper than the late interventions that are often caused by not addressing issues that could have been spotted earlier.

The Government’s actions since then suggest that their commitment to preventive care was little more than smoke and mirrors. Having loudly proclaimed their commitment to preventive healthcare, Ministers ever so quietly, ever so slyly, just before the Christmas recess, sneaked out £85 million-worth of cuts to public health budgets. That money is used for key services, as we have heard, such as preventive mental healthcare, preventive physical healthcare, “stop smoking” clinics, sexual health clinics, and drug and alcohol misuse services. The Government may say that public health spending is the decision of local authorities, but all they have done is give them the responsibility to care for their communities while leaching away much of the resource that would enable them to do so. Councils’ public health budgets, which fund school nurses and public mental health services, have been reduced by £600 million since 2015. In Cumbria, the public health budget is set to be slashed by half a million pounds, and it is one of the 10 local authorities receiving the least money per head from the Conservative Government. Cumbria’s spending is now set to drop to just £36 per head—barely half the national average of £63 per head, and ridiculously lower than that of the City of London, which receives £241 per head.

The impact of this has of course been tangible. School nurses not only provide a host of services but are a valuable source of health education for children and young people—a place to turn to as they try to navigate the complexities of adolescence. The removal from schools of health professionals who contribute so much to children’s health education means that children are vulnerable to slipping into bad mental, dental and physical health. In 2015, the coalition Government made a commitment to spend £25 million a year on Cumbria’s public health, but cuts to spending since then mean that Cumbria gets less than £18 million a year. Pernicious, heavy cuts to the public health budget mean that Cumbria now only spends a pathetic 75p per child per year on preventive mental health care.

In the face of this, young people themselves are determined to fight for better mental health provision. In my constituency, the CAMHS crisis service was not available at the weekend or after school hours in south Cumbria until our community campaign forced local health bosses to change this. But we still have an awfully long way to go. Proper investment in public health budgets would allow us to place a mental health worker in every school. The key to young people being resilient and healthy, and to making sure that problems do not become so severe further down the line, is surely to do just that.

The Government’s failure to take prevention seriously puts at risk a range of preventive health measures—physical as well as mental. I very much welcome the Minister to her new role. She is the most senior Blackburn Rovers supporter to sit on the Front Bench since Jack Straw; I hope she does far better than he. The question that she must answer is this: when the Government verbally prioritised preventive care but then cut public health by £85 million, were they being deliberately cynical or was it mere incompetence? Either way, will she fix this matter and restore public health funding to Cumbria and elsewhere so that we can tackle mental and physical health problems before they become tragically serious?

Photo of Rebecca Pow Rebecca Pow Conservative, Taunton Deane 5:32 pm, 14th May 2019

I am very pleased to follow Tim Farron, and to talk about the Government’s commitment to public health. This Government are providing an additional £4.5 billion for primary and community health services as part of the long-term plan for the NHS. In ensuring that this plan operates properly, a renewed focus has been put on prevention. When the Prime Minister announced the £33.9 billion funding boost for the NHS, she said that the accompanying 10-year plan must have that focus on prevention. As hon. Friends have said, none of this is possible without a strong economy and without a Government who understand that tackling the debt and the deficit is really important, because we cannot have the services we want unless we do that.

One of the key parts of the plan is the importance of new screening methods. Earlier testing for bowel cancer is one of the issues that will be dealt with. I want to say a big thank you for the grant of £79 million that we got to build new theatres at Musgrove Park Hospital, which is Somerset’s main hospital but also a really big hospital providing services across the south-west. With part of that grant, it is building a whole new endoscopy service and suite. This really will help the population not just of Somerset but the whole south-west with early diagnosis, which is the way we have to go. We also have a new MRI scanner, thanks to the community, which contributed towards it. That will help a great many people by picking up diseases early.

Somerset has a wonderful record on diabetes. Diabetes is a big issue, and amputations are very costly. One amputation costs £20,000, and a person with diabetes who has a limb amputated—sadly, that is what can happen—unfortunately then has a life expectancy of only five years. Somerset has implemented a diabetes foot pathway, which cut amputations from 122 to 66 in 2017. Not only are people living better and more healthily, but that pathway is saving the NHS a huge amount of money. That is the kind of model we need to put in place.

The public health grant remains ring-fenced, which I am very pleased about, and protected exclusively for improving health, but local government spending on health is not just about the grant. It is about local authorities being able to prioritise what they think is important, and indeed they are, with a range of innovative models in Somerset.

One third of Somerset residents will be 65 or over in 10 years’ time, compared with 21% nationally, and that has to be dealt with as a matter of urgency. Somerset County Council is responsible for all adult social care, children’s services and special needs, which takes up 70% of its budget. While I welcome the Government giving another £240 million to adult social care and enabling local authorities to add adult social care to their precept, there are still pressing issues in Somerset that must be dealt with relating to the elderly population. Despite a great number of pressures, the council has done really well in sorting out its finances thanks to some tough decisions, but we have to make the resources go further. The council will be the subject of a “Panorama” documentary soon.

We must have better models. One model I want to mention is micro-providers. A list of self-employed, accredited providers can be accessed for all kinds of care and health needs across Somerset, so that people can stay at home, and providers go in to help them. We are using it at home for my family, and it really is a good model. I hope the Under-Secretary of State for Health and Social Care, Seema Kennedy, will visit us to have a look at it.

We need to do more. While 92% of our care providers in Somerset are good or outstanding, which is above the national average of 83%, the current spending review needs to acknowledge that the pressures from not only the growing costs of care but being a rural county are different from those in other places. Somerset gets £730 of Government funding per head of population, which is 11% less than the national average. Our school transport gets less money than urban areas, and our public health funding from Government is only £36 a head, compared with £56 nationally. Will the Minister

Photo of Preet Kaur Gill Preet Kaur Gill Shadow Minister (International Development) 5:37 pm, 14th May 2019

This week is Mental Health Awareness Week, and I fully support the need to break the stigma and talk about our own and others’ mental health. Public health has an integral role to play in improving young people’s mental health, but we live in a country where, because of the actions of the Conservative party, the funding and the ability to access care from trained professionals are being decimated. What happens when we realise that we need support? How long do we have to wait for help? What are we doing to provide support for people who are struggling and their families, who are left to cope without sufficient support? How do the Government expect to provide support when they have cut £700 million in cash terms of the public health grant to local government between 2015-16 and 2019-20, according to the Local Government Association, of which I am a vice-president?

Today I want to speak specifically about children and young people’s mental health. NHS figures show that one in eight people under the age of 19 in England has a mental health disorder, and half of all mental health problems start before the age of 14. I recently conducted a survey of schools in my constituency. In 10 of the 11 schools that have responded to the survey so far, the number of pupils suffering with mental health problems has increased over the last five years. One saw a 15% increase in the last 12 months alone, and all but one have seen these cases becoming more severe.

I want to place on record my thanks to my hon. Friend Chris Elmore for his chairing of the all-party parliamentary group on social media and young people’s mental health and wellbeing. The group’s recent inquiry found that 27% of children who are on social network sites for three or more hours a day have symptoms of mental ill health. That stands against 12% of children who spend no time on such sites. The Government’s Online Harms White Paper concurs with research by the Royal College of Paediatrics and Child Health, which reported that there was

“moderately-strong evidence for an association between screen time and depressive symptoms.”

The Government need to take real responsibility for the children in this country and their wellbeing. Instead, we have heard that they will support further research without saying what that will be, and that they welcome industry efforts. What parent would feel reassured by that? The industry has taken some steps to regulate itself, but it is obvious that it is not doing enough. Public health cannot be left to businesses, and with the mental health of children and young people at stake, we need to look at the various contributing factors. It is not enough simply to acknowledge the problem and not to address what is seen to be one of the growing risks to our children’s mental health and wellbeing.

Let us take the next step of the process: when a child has mental health problems, how are they identified? Teachers are often the individuals on the frontline most likely to spot this need, but they are working with larger classes and increased pressures, without teaching assistants or additional support. Schools in my constituency and many across the country are doing an amazing job in trying to make appropriate provision for their pupils to deal with mental health problems—from developing their own wellbeing support to check-in sessions and peer mentors—but this is not sustainable. Schools in my constituency have told me that immediate support is usually unavailable to vulnerable children and parents; response times from overburdened mental health agencies are poor; there are long waiting lists; and early help support is limited. Because of the fall in the ability to access core public health services, schools are forced to pick up the slack despite often not having had the appropriate training or resources to do so. A quarter of 11 to 16-year-olds with a mental health disorder have self-harmed or attempted suicide, and that figure rises to as high as 46% among teenage girls with a disorder.

The Children’s Commissioner has said:

“There is a danger that we continue to have a system that fails to help children until they are so unwell that they need specialist intervention.”

Funding pressures mean many councils are being forced to cut early intervention services that support children with low-level mental health issues and avoid more serious problems in later life, which cost far more over the coming decades. If we are to improve provision of preventive and early intervention services, it is vital that the Government adequately fund public health in the forthcoming spending review, as reducing spending on public health is short-sighted and irresponsible at the best of times.

Photo of Maria Caulfield Maria Caulfield Conservative, Lewes 5:41 pm, 14th May 2019

Like my hon. Friend Gillian Keegan, I am disappointed that in this debate we are using health once again as a political football, and that we are constantly talking down the NHS. I say that as someone who still works in the NHS, as you can see, Mr Deputy Speaker, from my entry in the Register of Members’ Financial Interests. I am still working in the NHS, and for the staff and those working day in and day out, it is depressing not to have some of the many achievements recognised.

Where is the recognition that this year, after huge investment and better co-ordination, we have seen no winter crisis? In previous years, there were urgent questions demanding answers year after year, but the Government have delivered on that. My local council in East Sussex got £2 million this winter, and despite an 11% increase in demand, there was a 33% reduction in delayed discharges. That is because social care and healthcare are working better together.

Where is the recognition of the achievements in tackling breast cancer? Mortality rates for breast cancer are down 38% since the 1970s and down 22% in the last decade, while they are predicted to fall further by 23% in the next decade. That is personal for me because I lost my mother to breast cancer when I was a teenager, and four of my aunts. If they had been diagnosed now, their chances of survival would be so much better. That is down to improved early detection and screening, improved treatments for many of the difficult-to-treat breast cancers, and improvements in follow-up and early detection. And where is the recognition for cancers overall? According to Cancer Research UK, mortality rates for most cancers are predicted to fall between now and 2035.

Where is the recognition of the progress made on HIV? According to the Terrence Higgins Trust, in relation to the overall mortality for those aged between 15 and 59 who are now diagnosed early, for the first time ever their life expectancy is equal to that of the general population.

Where is the recognition of improvements for stroke outcomes? In its “State of the nation” publication, the Stroke Association says that stroke deaths have now fallen by half since the 1990s. That is because we are reducing risk factors, detecting early risk factors early and getting treatment started within an hour of a stroke happening. The stroke call that now goes out in A&E when someone arrives, with the urgent CT and the anti-embolism treatment, means that people do not just survive a stroke, but live better lives after a stroke. That is so important, given that stroke now causes almost twice as many deaths as breast cancer. Smoking rates have fallen, as the Secretary of State explained; 14.9% of people now smoke, compared with 19.8% in 2011. TB rates have fallen by 40%, whereas under the previous Labour Government they were actually increasing.

We have much to celebrate in public health and in the NHS, but there is no doubt that we could do with more funding. I say that as a Member for an East Sussex constituency, where life expectancy is higher than the national average, because so many people retire to the south coast—we have the highest number of 85-year-olds in the country. As I mentioned in a recent debate, we would like another four-year funding settlement for social care, so that we could make better plans for our ageing population.

I will conclude with the facts that I would like to see included in the Humble Address to Her Majesty, because this is not just about complaining about what we have not got. Perhaps the Labour party would like to explain to Her Majesty why it voted against the £16 billion of public health spending between now and 2021, and also why it has not supported the £20 billion a year for the NHS, or the extra £4.5 billion for primary and community health services. As those on the Government Front Bench will know, I am often a critical friend of the Government, but I would like to stand on facts, rather than causing political mischief.

Photo of Sarah Champion Sarah Champion Labour, Rotherham 5:46 pm, 14th May 2019

I welcome the debate, as public health cuts are having a dramatic impact across the country. The Health and Social Care Act 2012 pushed responsibility for sexual and public health services from the NHS to local authorities—from national oversight to a postcode lottery. In Rotherham, we are fortunate that the contract for sexual health services was retained by the NHS. Others in south Yorkshire were not so lucky, leading to patchy provision by private providers, increasing waiting lists and services being shut.

Public health funding is vital for preventing sexual disease, but it is also important in recognising sexual harm and responding to it. When I visit Rotherham’s sexual health clinics, I am constantly struck by how, for many, they are often the first port of call for disclosing sexual abuse, sexual exploitation and modern slavery. We need to build a healthcare system that is ready to support victims of the most horrendous sexual crimes, not one that is driven by profit.

Sexual assault referral centres have a key role to play in the matrix of support for survivors, and I have been encouraged by recent investment in them. However, England has only 47 of the 71 SARCs recommended under the Istanbul convention. People are not aware that they can self-refer, and that SARCs are also for past sexual abuse, not just recent rape. The Government need to do more to promote that information.

The all-party parliamentary group on adult survivors of childhood sexual abuse, which I chair, last week published a report following a six-month investigation into support for adult survivors. Some 89% of survivors told our inquiry that their mental health had been negatively impacted by child sexual abuse, but only 16% said that NHS mental health services met their needs.

Survivors said that they want the specialist voluntary sector to provide them with counselling and support. Our research found that specialist voluntary sector agencies receive, on average, 13% of funding from local authorities and 14.5% from clinical commissioning groups. However, when I asked the Department of Health and Social Care for its assessment of the effectiveness of CCG funding of therapeutic services for survivors, I was shocked to find that it does not even collect data. Does the Minister agree that the Government need to get a grip on the effectiveness of commissioning specialist voluntary sector services and that they should start by collecting the right data?

Survivor after survivor told the APPG of disappointing interactions with NHS staff who were often poorly equipped to respond to disclosures of child sexual abuse and ill-informed about the services they could refer patients to. The Minister needs to ensure that frontline professionals, including GPs, sexual health nurses and social workers, are trained in trauma-informed practice, so that survivors receive a service that is empathetic, empowering and appreciative of the impact of trauma.

Today’s debate is rightly framed around reversing the cuts in public health spending. This is a sorry, short-sighted state to be in. The Health Foundation calculates that an additional £3.2 billion a year must be made available just to reverse the impact of Government cuts to public health services.

The APPG’s inquiry found that as our understanding of the scale of sexual violence and abuse grows, and ever more survivors come forward looking for support, the Government should meet the challenge by launching a nationwide public health campaign that raises awareness of the impact of child sexual abuse on survivors, tackles myths and stereotypes and directs survivors and professionals to information and support. Does the Minister agree that we have a moral duty to provide survivors of sexual abuse with the knowledge they need to make decisions about their own recovery, especially in the absence of knowledgeable professionals and access to public services? Will she therefore lobby the Chancellor to make a serious commitment to ring-fence funding for all sexual and public health services in the next spending review and to make sure that some of the money is dedicated to services and information for victims and survivors of sexual abuse? Any less is a dereliction of duty.

Photo of Derek Thomas Derek Thomas Conservative, St Ives 5:50 pm, 14th May 2019

We are talking about preventive health care, and I want to focus on podiatry and its workforce. This place has supported changes to the nursing bursary, and I continue to support those changes for students, but they are having an impact on mature students that I do not think was intended. We all have feet, which we need to look after, and if professionals help to take good care of our feet, it can avoid problems in the future. We all need the podiatrists and others who work to care for our feet.

Plymouth University has recently announced that because of changes in applications for its podiatry undergraduate programme, it will be unable to run the course from September, so in the south-west, especially Cornwall and Devon, no one will train in podiatry. We all know that when people train in an area, they tend to stay there.

Photo of Rebecca Pow Rebecca Pow Conservative, Taunton Deane

The diabetes foot pathway relied on opening eight podiatry clinics across Somerset. Does my hon. Friend agree that it is the podiatrists who are helping to solve the diabetes problem?

Photo of Derek Thomas Derek Thomas Conservative, St Ives

I completely agree with my hon. Friend, and I attended a conference 18 months ago at which the podiatrists and Plymouth University mentioned the risk of this happening. We are now seeing that prophecy being fulfilled. I appreciate what my hon. Friend says about what has been done to improve the pathway and reduce lower limb amputations. We must not see that good work reversed.

When it comes to caring for our feet, we are heading for a perfect storm. Fewer people are going into training because of financial barriers, and in 10 years we will see an enormous amount of podiatrists retiring from the profession. That adds up to a real challenge that we need to address quickly. I ask the Minister to look at what has happened since the nursing bursary was removed for mature students and whether we can address that.

The impact on patients is severe. Type 2 diabetes is the fastest growing health threat facing our nation, and 3 million people are living with it. That figure is set to reach 4 million by 2030. Diabetic foot care costs the NHS in England between £1.1 billion and £1.3 billion a year—£5.7 million per clinical commissioning group. It accounts for £1 in every £100 spent, more than the combined cost of three of the four most common cancers. Some 80% of the 135 lower extremity amputations each week in England are preventable through good foot care, and the Government have made a commitment in legislation and policy to provide safe care. That is just one example of how, if we do not get this right, we will fail to avoid the impact on patients of more lower limb amputations and lower life expectancy. The facts show that after a lower limb amputation, life expectancy is reduced to about five years.

There is also an impact on the NHS. I have mentioned the sheer cost of caring for lower limb problems, and it will have an impact on multidisciplinary teams if we do not keep people with the skills coming through. It will also have an impact on budgets. As well as the impact on social care and on the budgets for those delivering support in people’s homes, making changes around a home because someone has had a lower limb amputation is a costly affair that is easily avoided if we get it right and get enough podiatrists on the ground.

There is an urgent need for action. I ask the Government to look at why mature students are uniquely impacted when going to study these important professions. If a mature student is on any sort of benefit—housing benefit or other financial support—the minute they take out a student loan to study to be a podiatrist, they lose all that support. Perhaps the Department of Health and Social Care and the Department for Work and Pensions need to look at that, because that is a significant barrier to people coming into a skill we so badly need.

I ask the Minister to look at solutions to reverse the reduction of mature students going into important parts of the NHS such as podiatry so that we can save money for the future, to be used where needed, and provide a real opportunity to improve people’s lives.

Photo of Paul Williams Paul Williams Labour, Stockton South 5:55 pm, 14th May 2019

It is a pleasure to follow my colleague Derek Thomas, who serves with me on the Health and Social Care Committee. I warmly welcome the new Minister to her place, but if she thought she would learn about public health in the debate, she will be sadly disappointed. I and Opposition colleagues have sat and listened to Government Members talk about anything other than public health. It is so disappointing that Government Members do not seem to know what public health is.

I really care about public health. I care about it so much that, after spending five years training to be a doctor and another four years training to be a GP, I did a master’s degree in public health. It is so important because it is about health inequalities and the massive gap in life expectancy, which we are seeing increasing. I represent the town of Stockton-on-Tees, where the life expectancy gap between men living in the most deprived areas of town and those in the wealthiest is more than 11 years; for women, it is more than 16 years. Much of that is because of the inverse care law that tells us that the people with the highest need are those least likely to access healthcare. Those with the highest need for cervical screening are least likely to access it. Those with the highest mental health problems are less likely to access those services. Those with the highest needs for smoking cessation services are least likely to access them. Investment in public health makes economic sense, because prevention is better than cure, and it makes really good social justice sense.

Tempting as it may be to invest in another building or buy another machine that goes ping, the real difference that can be made to health inequalities and public health comes right at the beginning of life. The first 1,000 days are where most health inequalities are sown. It was a privilege recently to chair the Health and Social Care Committee’s inquiry on the first 1,000 days of life: a time when developing brains make a million new connections every single second. If we get it right then, we can build healthy minds and healthy bodies, but if we get it wrong, that can cause all kinds of problems.

The fact is that more than 8,000 children in this country live in homes with the triad of a parent with a mental health problem, a parent with substance misuse problems and domestic violence. What intervention will make the real difference? How can we help those children? That is done largely through the work of health visitors, and I am afraid that since public health funding and the responsibility for public health was transferred to local authorities, we have seen a cut of 2,000 health visitors employed by the NHS and 1,000 Sure Start centres have closed.

These are the things that make the real difference. They make a difference to breast feeding, of which our rate is one of the lowest in Europe; to child mortality, our levels of which are much higher than those in comparably rich countries; and to detecting the hidden half of women with perinatal mental health problems who say they were not detected by health services.

I hope that it has not been a deliberate strategy to disinvest from these important services. I think that it has happened by accident. Either way, we have to make a difference; the situation must be rectified. I welcome the work of the cross-departmental ministerial working group that the Leader of the House is leading, and I hope that the new Minister is lobbying the Treasury and making a passionate case for investment at the start of life.

Photo of Liz Twist Liz Twist Labour, Blaydon

My hon. Friend is making a powerful speech about the importance of public health, especially in the early years. In Blaydon, which is part of Gateshead Council, the public health budget has reduced by 15% since the transfer of health visitor services, which has led to the loss of services that make a big difference to people on the ground. Is it not a shame that we are losing vital public health services?

Photo of Paul Williams Paul Williams Labour, Stockton South

It is painful that that is happening in places such as Blaydon, where life expectancy is declining. Life expectancy in the north is declining, and there are huge life expectancy gaps between north and south. It is the very part of the country where we should be investing in public health, not making cuts. In Stockton-on-Tees, public health has been cut by £1 million in the past two years.

What do we want? It is 10 years since the Marmot review set out the evidence base for how to reduce health inequalities. We should be doubling down on investment in health inequalities. We should be investing in sexual health services. We should be investing in drug treatment services, which nationally have been cut by 16.5%. Instead, we see year-on-year funding reductions, public health is being cut to the bone, life expectancy is falling and health inequalities are rising. The Government need to show an absolute commitment not just to treatment services but to grassroots prevention services in communities up and down the country, and they must invest properly in public health services. Local authorities are the right place for them to be, but they have to be properly funded and supported.

Photo of Rachel Maclean Rachel Maclean Conservative, Redditch 6:02 pm, 14th May 2019

It is a pleasure to follow Dr Williams, but I want to put it on the record that Conservative Members understand and appreciate the importance of public health. I have heard several contributions from hon. Friends about exactly that. I am grateful that public health is at the heart of the long-term plan for the national health service and that investment is already going into it.

My constituents would not forgive me if I did not start by talking about the Alex Hospital in Redditch, which is the No. 1 concern for me and my constituents. Yes, we are having a debate about public health, but this takes its place at the heart of that. It is not just about funding—a lot of money has been invested in the Alex for wards, infrastructure and facilities thanks to all our lobbying, but that is not enough; it is about how that money is managed across the trust. Unfortunately, services were centralised in Worcester, and that is not working for my constituents. I welcome the Minister to her place, but she will definitely receive more visits and correspondence from me on this issue. I have an Adjournment debate tomorrow night, so I will not steal my own thunder, but I want to place it on the record that it is very much about leadership, making services work across a county and getting the right outcomes for patients and my constituents.

One of the causes close to my heart is the menopause. Anyone who has been watching BBC’s “Breakfast” programme this week will know it is featuring it as part of its menopause week. It is brilliant that people are brave enough to talk about their experiences. This is a taboo subject, but we are starting to talk about it in this Chamber, and I have received cross-party support, which is fantastic. This goes to the heart of what we are talking about: prevention and public health. It is about educating primary care providers and GPs to do the right thing when prescribing for women entering the perimenopause and the menopause and to understand that it is not just about having hot flushes and those other stereotypical symptoms but that there can be hundreds of different symptoms. Every woman is different. There is widespread ignorance, but when women visit their GPs, very simple treatment should be available. This does not cost money. It is just a question of ensuring that GPs are in the right place to prescribe what those women need: treatment that will make a transformative difference to their lives, and will enable them to continue to contribute at work as well as in their families and communities. I hope that the Minister will recognise the importance of this issue, because it affects not only women; it affects every man who has to work with a woman or is related to a woman. That fact is often hidden, and we need to break down the stigma to an even greater extent.

My third point concerns technology. We are talking about prevention, and technology plays an important role in that. I have been a tech entrepreneur, and I was delighted to learn about a service called GP at Hand, which was released recently. I have been using it, and it has made a massive difference to me. We are all stuck here, and I do not know about other Members, but I find it very hard to make an appointment to see my GP. However, I have an app on my phone. I need only log on, and I can secure an appointment within five or 10 minutes.

Let me add, before Members jump up and say it, that we all know that that service will not work for everyone. Of course it will not work for complex patients and vulnerable people who are not able to use technology. However, if it can work for people who are confident and comfortable with technology and can embrace it, it will make a huge difference in freeing up more resources for the patients who need more care and support in the GP’s surgery. I think that the two services can work side by side. What we need to do in the long-term plan for the future is embrace what technology can do and spread that across the country. There needs to be a real impetus behind solutions such as GP at Hand which provide more time for talking to people who need a lot of support, including mental health support. It really is a brilliant service, and it is free to use in London. I believe that it is being piloted, and I very much hope that it will extend across the country.

I commend the Government’s efforts, and their focus on public health. Let us not forget that if it were not for a Government who sorted out the economy and enabled it to grow, we would not have this multi-billion-pound investment. I believe that £157 billion of public money will have been invested in the NHS by 2023.

Photo of Debbie Abrahams Debbie Abrahams Labour, Oldham East and Saddleworth 6:07 pm, 14th May 2019

For the first time since the 1890s, we are seeing a slowdown in health improvements, including, as we have heard, a flatlining in life expectancy. However, that varies in different parts of the country. Men’s average life expectancy in Windsor and Maidenhead is 81.6 years, while in my constituency it is 77 years. As well as the data from the Office for National Statistics, we have information from the Institute and Faculty of Actuaries that falling longevity has accelerated. Last year’s analysis cut forecast life expectancy by two months, and this year it took off another six months. Since 2015, it has fallen by 13 months for men and 14 months for women. That renders the Government’s increase in the state pension age an absolute nonsense, and is rather cruel to women born in the 1950s.

Healthy life expectancy—how long we expect to live in good health—has also declined for women, by three months between 2009 and 2011. That, too, varies across local authority areas, by 21.5 years for females and 15.8 years for males. Our children have been affected as well. As the Royal College of Paediatrics and Child Health reported last year, infant mortality is on the increase for the first time in 100 years. Four out of 1,000 babies will not see their first year, which is an indictment of the fifth richest country in the world. We are also seeing increases in child mortality, linked closely to the poverty that children are experiencing.

Why is this happening? It is absolutely true that the cuts in public health spending which were described so eloquently by my hon. Friend Dr Williams have played a part, but they are not the only cause of the decrease in life expectancy and other problems. We know that investment in the NHS has been far from perfect, and it should have been at least £30 billion by 2022 instead of the £20 billion that has been promised. The coalition Government have a lot to answer for with the Health and Social Care Act 2012, which championed the outsourcing of NHS contracts to the private sector among other things. There is also strong evidence that that has contributed to not only increases in inequality in access to health care but also inequality in outcomes.

There is clear evidence, as many of us predicted, of the impact of the coalition Government’s and this Government’s wider austerity programme. It has widened the inequalities of income, wealth and power and contributed particularly to the premature deaths of many of our citizens.

I welcome the launch today of Sir Angus Deaton’s inquiry to review inequalities across our country, and I hope it builds on the evidence Kate Pickett and Richard Wilkinson produced in their totemic publication “The Spirit Level” a decade earlier. However, we also need to explore other aspects of inequalities that have been not yet been investigated, such as the inequalities in power and the rise of nationalism.

I also hope that the inequality review analyses evidence presented at a recent event I chaired. Professor Danny Dorling referred to Office for National Statistics data published the day after the EU referendum showing that there were 52,400 more deaths than the previous year. This was the seventh largest single-year increase in deaths after cholera caused an increase in 1849. The evidence showing a correlation with austerity, as people’s long-term care needs were most affected, is compelling. We now have the 10th lowest level of public spending out of 12 developed countries, and in 2018 some 1.4 million older people had unmet care needs.

Professor David Taylor-Robinson provided evidence showing that the impact of austerity is also taking its toll on our children. His report, “Due North”, provided evidence of the north-south divide and the impact on health, including child health. We now have the worst child health in western Europe and rising child mortality, which is clearly associated with child poverty.

The Government’s first duty is to protect their citizens. For our children, our old people and our disabled people, it is clear this Government have failed and I urge them to take this more seriously.

Photo of Vicky Ford Vicky Ford Conservative, Chelmsford 6:12 pm, 14th May 2019

It is a pleasure to follow Debbie Abrahams. First, I should probably declare an interest: I am the wife of a consultant oncologist, the sister of a consultant geriatrician, the daughter of a retired ophthalmologist and my late father was also a consultant geriatrician. They all dedicated their professional lives to the NHS.

The NHS is extremely precious and it is right that we should value it, and I for one was very proud to see a long-term plan for its future, taking it into the 21st century with unprecedented levels of funding and a focus on primary care, prevention, mental health and investing in staff and above all, as someone who cares deeply about science and research, a commitment to continue investing in science and innovation.

But in all large organisations there are areas that are going well and areas that need focus. In Mid Essex for many years there has been a difficulty recruiting GPs and experts in mental health, and I am delighted that this year we opened the first ever medical school in Chelmsford —the first ever in Essex, the first in a generation in the country—with 100 young students now nearly through their first year, specialising in general practice and mental health. From day one of their course they are on placements in local GP practices, becoming embedded in our primary care network. The places for next year at Anglia Ruskin medical school in Chelmsford are already 12 times oversubscribed; it is that popular.

I also met our mental health network last Friday and they told me about some amazing stuff that has already been introduced since the announcement of the long-term plan. They are doing new work on perinatal mental health, identifying mums-to-be who are at risk of post-natal depression or are depressed and working with them before the babies are even born. They are introducing a 24-hour, seven-day-a-week crisis and urgent care service, which will be in place by the end of this year, along with new early intervention on psychosis and more work on dementia and on placing mental health practitioners directly into the primary care networks. These new networks will bring GPs together so that they can work with their neighbouring practices, allowing those practices to get more specialist care into the primary care networks, thus helping prevention. This will include specialists in physiotherapy and in medicines reviews, specialist district nurses and specialists in areas such as chiropody and diabetes, all of whom will be able to work locally.

I am concerned, however, that we are struggling locally with recruiting nurses, especially at hospital level, where a number of nurse places have been vacant for a long time. We have to be honest with our constituents about this: a number of the EU staff have left the UK, and we need to resolve the uncertainty over Brexit. We need to reassure the staff that we care for them. There has been a drop-off in the number of people applying to nursing college, particularly among older people, and that needs to be resolved. I am also concerned to hear from many of the senior doctors in my constituency about the impact that pensions and taxation are having on them.

On the positive side, I have heard about new treatments, especially for diabetes. My diabetic patients can now get continuous glucose monitors, which they have never been able to have before. However, other treatments are still needed. My poor constituent Cait is nine years old and she desperately needs Kuvan for her phenylketonuria. It would also prevent many other diseases. Any other country in Europe would prescribe it, but we do not.

We are the world leader in many areas of medical research—we lead the world in genomics, for example—but we must ensure that the treatments that are developed here are prescribed here, otherwise, we will lose that research. One area of research that particularly impressed me was dementia research. We were told on a recent visit that a quarter of dementia cases might be preventable, but that will involve understanding the condition much earlier—decades before the symptoms become evident. We need to be able to identify those at risk and ensure that they get the right treatment. That is why I am so pleased by the long-term plan. It is already putting those words into action to ensure that we can deliver a world-class NHS for the future.

Photo of Geraint Davies Geraint Davies Labour/Co-operative, Swansea West 6:17 pm, 14th May 2019

Air pollution—the silent, invisible killer—is now leading to 64,000 premature deaths in Britain each year. The figure was thought to be 40,000 by the Royal College of Physicians, but it has now been updated by the European Heart Journal. Pollution is now the biggest killer in the world—bigger even than smoking. We know that 8.8 million people die from air pollution, compared with 7.2 million who die from smoking. People are killed, or their lives are prematurely ended by heart attacks, heart disease, lung cancer, lung disease and strokes. Air pollution is also a massive cause of dementia. Pregnant mothers have their foetuses impacted by the particulates that they breathe in, and children in so-called clean air zones have a 10% lower lung capacity and much worse mental health issues.

I am therefore pleased that The Times is now supporting a five-point action plan to tackle air pollution. It supports the idea of a clean air Act, and I have a Clean Air Bill going forward. People have a right to clean air, and it is important that local authorities and others have the resources to deliver that. It is also important that the Government get off their seat and say that, instead of banning all new diesel and petrol cars by 2040, we should do so by 2030. After all, that ambition is now held by India, China, Ireland and others, and we really need to do much more. We need to ban traffic from idling outside schools, and we need to ensure that the 40 cities in Britain that breach the World Health Organisation standards do more to stop older vehicles entering city centres and charge them. We need to monitor local levels of air pollution through local authorities and the Environment Agency, so that people have the figures and the power to campaign to stop pollution. It is also important that we stop building new schools next to busy roads.

In addition to that, my Clean Air Bill sets out a fiscal strategy for tackling air pollution. Fuel duty on diesel has been frozen since 2010. There is no differential between that and petrol, let alone electric cars. We require electric car infrastructure across Britain, but the Government have given that responsibility to BP, which of course has a vested interest in keeping fossil fuel on the road. We also need proper testing. VW was fined in the United States following the testing scandal, but not in Britain, and 300,000 VWs still have not been called back for correction. The Government are hurtling ahead with expanding airport capacity, leading to more dirty air. We need to do more on ports, with a maritime strategy that ensures that ships coming into port are connected to electric power. We should be converting to electric trains, but Swansea, which was promised electrification, is getting diesels.

It is also important that the environment Bill considers both indoor and outdoor air. I am pleased that the Secretary of State put it on the record today that schools and hospitals should be included in the Bill, and I will certainly be holding him to his word. People inhale all sorts of dangerous chemicals when indoors through cleaning agents, which may be sprayed on people’s bodies, fire retardants in sofas and so on.

We must ensure that high standards are enforced. Members will know that ClientEarth has taken the Government to court over their failure to protect people from dirty air, and we need an assurance that if we do Brexit—I very much hope that we do not—enforceable standards will be in place to ensure that people are safe. Put simply, children and the rest of us have a right to clean air, but the Government are failing in their duty to deliver that right. They need to get on and protect our public health, protect our future and deliver clean air.

Photo of Liz McInnes Liz McInnes Shadow Minister (Foreign and Commonwealth Affairs) 6:22 pm, 14th May 2019

It is a pleasure to follow my hon. Friend Geraint Davies. I want to talk about the impact of public health grant cuts on Rochdale Borough Council, which serves both my constituency and the Rochdale constituency. Reductions in the public health grant will inevitably have an impact on a wide range of services and on the ability to plan and deliver prevention. The Rochdale borough public health team takes a broad view of health and wellbeing, seeing it as being influenced by health behaviours, wider determinants of health, such as housing and education, and relationships with others.

Local public health work is about much more than health promotion and telling people what is good and bad for them. It includes support for youth services and libraries and for victims of domestic abuse. It involves training to help to prevent suicide, support for volunteering, and reducing the impact of alcohol and drug abuse.

The work of the public health team also includes supporting people in residential homes to improve their oral health and nutrition. It includes seeking funding from grant-giving bodies to improve local health. Importantly, the work involves helping to reduce the spread of sexually transmitted diseases. However, as we have heard, cuts to sexual health services are leading to an increase in the incidence of sexually transmitted diseases. In Greater Manchester as a whole, the abortion rate is rising as access to sexual health services and contraceptive help and advice diminishes.

The work of the public health team also includes providing direct input into NHS commissioning and providing essential support for NHS services. For example, while the NHS provides cancer screening, it is work within our communities that helps to get people to attend appointments. The public health team works to increase attendance at NHS health checks and to get people tested for diabetes, which can result in lifestyle changes and real savings in treatment costs. With Heywood, Middleton and Rochdale having one of the north-west’s highest rates of type 2 diabetes, the importance of this work cannot be overemphasised. The public health team works to reduce smoking, especially in poor communities and among people with long-term conditions. When NICE looks at such prevention work, it is always shown to be highly cost-effective.

To give an idea of the health challenges facing my community, a man or woman living here in Westminster can expect to live, on average, five and a half years longer than a man or woman living in the borough of Rochdale. Such health inequalities exist here in London, too. My hon. Friend Ms Buck tells me that for every tube station from here to Queen’s Park there is a year’s reduction in life expectancy.

Yet such health inequalities are not compensated for by increased funding. In the borough of Rochdale, the public health grant is now £3 million lower than it was in 2016-17—decreasing from £19.7 million then to £16.7 million in 2018-19. For this financial year, 2019-20, the budget has been cut yet again to £16.3 million, giving cumulative cuts over the past four years of over £8 million. That has led to cuts in support to HIV charities, children’s playgroups, physical activity events, pest control, smoking cessation services and other much-needed vital services.

A reduction in the public health grant has to be considered in the context of wider council savings and the contribution of public health. As cuts to services and support have to be made due to a reduction in funding, the inevitable result is additional hardship for residents.

The choices we face are stark. Do we stop support for a necessary service such as help for domestic abuse victims, or do we not recruit much-needed staff? With the shocking news that we are seeing the return of diseases of the Victorian era—cases of whooping cough, malnutrition and scarlet fever are all increasing—this Government cannot be complacent and must take another look at their false economy of cutting public health funding.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Transport) 6:27 pm, 14th May 2019

It is always a pleasure to follow my hon. Friend Liz McInnes, who brings her health expertise to this debate.

The discord between the Government’s narrative and reality could not be more stark. The long understood centrality of public health to addressing health inequalities was ably brought to the fore by Michael Marmot’s report a decade ago that highlighted the social determiners of poor health. We therefore cannot just look at health in this debate; we have to look at the wider impact of health across our society.

Of course the Government’s 10-year plan and long-term approach are welcome, but the reality is that there are serious funding cuts to the delivery of public health by local authorities. Half a million pounds is proposed to be slashed from York’s public health spending, which will have an impact on the services to be delivered.

Public health is about the long term, and the disadvantage for local authorities is that, with their strained budgets, they are having to focus on the emergencies today. Of course, local authorities have no levers over the NHS, which ultimately picks up the tab for the failure to deliver a public health agenda. Controls over the system is not in the right place.

Of course, the advantage of moving public health back out of health and into local authorities is that it impacts on education, the environment, the economy, housing and the wider community. We are deeply worried about the ending of public health grants. To date, there is no clear vision of how public health will be funded as we move past the comprehensive spending review. The clock is ticking and plans need to be made now.

In York, the health inequality is eight years between Clifton, the poorest area of my city, and the richest area. The council has slashed long-term contraception services, which has meant a rise in the number of unwanted pregnancies. Health checks have been cut, although they are a major intervention in prevention. We have also had smoking cessation services ceased; in 2010, we had 1,948 people using the smoking cessation service, whereas last year we had just 92.

On substance misuse, I must thank my friend Councillor Michael Pavlovic, whose forensic scrutiny of drug and alcohol service funding highlighted the serious £550,000 cut over a five-year period when usage was at a crisis. Shockingly, the drug death figures for York are the worst not only in Yorkshire, but in the whole country. The Government have not been taking a public health approach to substance misuse and it is vital that that now moves into a public health arena.

We have also seen alcohol being used hazardously in York, with 7% of my constituents—15,000 people—doing so. Some 10% of accident and emergency admissions were alcohol-related in 2014, and in December last year it was found that 33% of admissions to York Teaching Hospital involved people who were using alcohol. Of course, that leads to premature death. We also see the impact it has on the criminal justice system, with 75% of arrests involving alcohol. Alcohol is the influencing factor in a third of crimes. So investing in public health saves not only NHS spend, but wider service spend. Of course alcohol has an impact on the safeguarding of young people. In York it also has an impact on domestic violence. Yet York has 799 premises that sell alcohol. We know there is cost, risk and devastation, and we know there is an impact on wider public services, families and wider society. We therefore need a more comprehensive approach and properly funded public health services.

I ask the Minister whether the Government will look again to ensure that there is a comprehensive screening programme for people across the country, so that they can check in at the key point and transition phases in their lives to ensure their mental and physical wellbeing is reinstated. Local authorities being able to cut these services is of serious detriment.

Photo of Rushanara Ali Rushanara Ali Labour, Bethnal Green and Bow 6:32 pm, 14th May 2019

The health of the population should be the Government’s and Parliament’s highest priority. From the times of the ancient civilisations, enlightened authorities have sought to prevent disease, provide clean water and sanitation, and enable citizens to live long, healthy lives. In the UK, we have a long history of interventions to improve the health of the nation, from the great sanitation projects in the Victorian era, to the Clean Air Acts, slum clearances and inoculation programmes in the 20th century, and the public smoking ban in the 21st century. Of course, all of that was accelerated with the establishment of the national health service, yet in these first decades of our new century it is clear that something is going seriously wrong.

With all our medical and scientific advances, surely we should have ended preventable disease, enabled many more years of healthy life, and witnessed ever-lengthening life expectancies. But we know that the opposite is true, as many right hon. and hon. Members have pointed out. We face an explosion of obesity and obesity-related diseases, such as type 2 diabetes and coronary heart disease. We are in the depths of a mental health crisis, with ever-growing demand for ever-diminishing mental health services. Society faces the health risks from smoking, alcohol and drug misuse, and sexually transmitted diseases.

The thing that should make us really angry is the stark difference in health and life expectancy between rich and poor. These inequalities in health are a terrible scar on our society, no matter which side of the House we are on. How can we fail to be ashamed when a person’s life expectancy depends largely on their postcode and income, and what their parents did for a living? There are many incredibly positive things in my constituency, including some of the most improved schools, which have not only improves opportunity and life chances but played a role in tackling health inequality and improving wellbeing. I pay tribute to all the health professionals and community workers in the clinical commissioning group, including its chair Sam Everington and others, who have led the way on tackling the public health challenge, but the reality is that despite all their work my constituents face massive health inequalities.

With every tube stop between Westminster station and Whitechapel station, people’s life expectancy goes down by six months. That is a scandal. Tower Hamlets has the shortest life expectancy of all London boroughs, with men living on average five years less than men in Kensington and Chelsea. We have the 12th highest prevalence of diagnosed diabetes, major challenges with obesity among children, and high levels of smoking, HIV, sexually transmitted infections and drug addiction. Even though many of my constituents abstain from alcohol, Tower Hamlets unfortunately has the seventh highest number of people with alcohol dependency.

In 2017, Sir Michael Marmot warned that the historic rises in life expectancy—the result of centuries of improvements—had ground to a halt. It is almost beyond belief that centuries of progress should end on our watch. The Institute for Fiscal Studies has warned of some of the challenges, including around suicide, drug overdose and alcohol-related liver diseases, which are affecting middle-aged men throughout England. Given the scale of the challenge and the dangers of going backwards, what are Ministers doing about this? We would think they would be investing in the kinds of programmes that help to tackle the public health emergency, but instead we see significant funding cuts, as many Members have said. In my borough, we have lost £3 million since 2015-16—in one of the areas with the highest levels of deprivation and child poverty in the country.

We need Government investment to tackle the public health challenge. Otherwise, all the Government’s investment in the national health service will be undermined, as many have pointed out, and the Government will be missing a trick. We should in this debate be unified on the need to tackle the public health challenge in all our constituencies. Ministers talk about cross-party working, so my appeal to them is that they put that to the test and put in the investment to support local agencies, local authorities and health professionals. Let us deal with this appalling challenge by working together, because it is desperately needed.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 6:37 pm, 14th May 2019

I am happy to be closing an excellent debate on public health in what is, as we have heard, Mental Health Awareness Week. I thank those who have contributed to the debate: the hon. Members for Fareham (Suella Braverman) and for Bury South (Mr Lewis); Theresa Villiers; my hon. Friend Eleanor Smith; the hon. Members for Chichester (Gillian Keegan), for Westmorland and Lonsdale (Tim Farron) and for Taunton Deane (Rebecca Pow); my hon. Friend Preet Kaur Gill; Maria Caulfield; my hon. Friend Sarah Champion; Derek Thomas; and my hon. Friend Dr Williams, whose speech was absolutely excellent and is the only one I am going to highlight—[Interruption.] Yes, there is a little bit of favouritism. I also thank Rachel Maclean, my hon. Friend Jim McMahon, Vicky Ford, and my hon. Friends the Members for Swansea West (Geraint Davies), for Heywood and Middleton (Liz McInnes), for York Central (Rachael Maskell) and for Bethnal Green and Bow (Rushanara Ali). There were a lot of excellent speeches in among all those.

It has been a passionate debate—with good reason—and I am pleased to see so many Members who are as passionate about public health as I am. Let us be clear: it is not talking down the fabulous work that our NHS does day in, day out, or the amazing doctors, nurses, radiographers, clinicians, porters, catering staff, cleaners—indeed all NHS workers—to say that the health of our nation is at risk because of this Government’s callous and careless cuts to public health services. The public health grant is expected to see a £700 million real-terms reduction from its 2014-15 level. That includes £85 million in the current financial year, at a time when the Government are peddling the phrase “prevention is better than cure”. That phrase means nothing without adequate funding for our public health services.

I therefore ask the Minister, since prevention is a priority for this Government, whether she will commit today to reversing years of public health budget cuts. Public health spending is just a tiny proportion of the overall spend on health in England. It was just 2.8% in 2018-19, and that figure is falling year on year. Because of that, the Association of Directors of Public Health says that reductions in services are now “inevitable”— and that is a direct quote. This is at a time when services are needed more than ever, as we have heard.

Gonorrhoea and syphilis rates are on the rise, rates of smoking among pregnant women have risen the first time on record, Victorian diseases—scarlet fever, whooping cough, malnutrition and gout—have seen a 52% upturn since 2010, and there has been an increase of more than 3,000 hospital admissions per year: that is all on this Government’s watch. This Government are making our country ill. Local authorities were given the responsibility for public health in 2013, rightly so in my opinion, but without sustainable funding they have buckled under the pressure of austerity. Their ability to maintain and improve the health outcomes of local residents has been jeopardised. Last year, for the first time in over a century, increases in life expectancy stalled, and in some parts of the UK they have even decreased, as we have heard.

The life expectancy gap between women in the most deprived and least deprived areas is 7.4 years. The healthy life expectancy gap between men in the most deprived and least deprived areas is almost two decades. Yes, you heard me right, Mr Speaker—I said two decades. That is 20 years of difference in healthy life. There is a persistent north-south divide in life expectancy and healthy life expectancy, with people residing in southern regions of England on average living longer and with fewer years in poor health than those living further north. As someone from the north, as Members can probably tell, that particularly concerns me.

The Northern Health Science Alliance, or NHSA, set out why that is so important in its “Health for Wealth” report, published last year. I recommend that every Member reads it. Productivity is worse in the north, because health is worse in the north. Improving health in the north of England would therefore lead to substantial economic gains. What will the Minister do to address these regional health inequalities? Obviously, I agree with the notion that prevention is better than cure, but I do not share the Government’s belief that prevention is possible without sustainable funding. If we are to reduce the ever-growing pressure on our NHS, we should therefore be investing in our public health services to ensure that everyone has the opportunity to live a healthy life—[Interruption.] I am pleased that we have been joined by the Secretary of State, and I shall have to try to repeat some of my best lines for him.

Analysis by the British Medical Association shows a continued trend of decreased funding, despite hospital admissions in which obesity, smoking, and alcohol was a factor increasing over a similar time period.

We have an obesity crisis in this country. The UK has one of the worst childhood obesity rates in Europe, but the Government’s childhood obesity plans have failed to seriously tackle this crisis, and with consultations still ongoing we have yet to see any material action by the Government. The UK spends about £6 billion a year on the medical costs of conditions related to being overweight or obese, and a further £10 billion on diabetes, but less than £638 million on obesity prevention programmes. Will the Minister commit to correcting that funding imbalance today?

Smoking remains the No. 1 cause of death in England, yet Action on Smoking and Health, ASH, found that in England from 2014-15 to 2017-18 local authority spending on tobacco control, including stop smoking services, fell by 30%. Furthermore, an annual survey conducted by ASH, commissioned by Cancer Research UK, found that, in 2018, 30 local authorities had no budget for tobacco control activity outside of stop smoking services. Although smoking costs the NHS an estimated £2.5 billion, NICE estimates that for every £1 invested in stop smoking services, £2.37 will be saved on treating smoking-related disease and lost productivity. Will the Minister therefore justify the Government’s reasoning for not investing in stop smoking services?

Alcohol is the leading risk factor for ill health, early mortality and disability among people aged 15 to 49. Even though hospital admissions associated with alcohol have nearly doubled since 2006-07, and have risen tenfold when obesity is also a factor, the budgets for alcohol and obesity services have been cut by more than 10% over the past three years. Does the Minister agree that if there is a need funding should follow? Will she ensure that public health services are funded sufficiently?

Demands on sexual health services have also increased. At a time when sexually transmitted infections such as gonorrhoea and syphilis are on the rise, the Government have cut funding for sexual health services by £55.7 million since 2013-14. I welcome the Government’s commitment to end HIV infections in England by 2030, but that progress risks being undone by those cuts. Sexual health services are essential if we are to end new HIV transmissions in the UK, but clinics report that they have to turn people away because of cuts to services. Does the Minister agree with the assessment by the Terrence Higgins Trust? [Interruption.] If the Minister’s two colleagues will allow her to listen to what I am saying, the trust said that

“sexual health services are at crisis point”.

The Secretary of State may shake his head as much as he likes, but that is not me saying that—it is the Terrence Higgins Trust.

Finally, I would like to state my disappointment and frustration at the fact that there is no future funding settlement for the local authority public health grant after 2019-20. The Minister will know all too well that time is ticking by, so will she set out the Government’s plans for a funding settlement post 2020? We need a settlement that will ensure that people can access the public health services they need so that they can live healthier and longer lives. I hope that after this debate the Minister will see how important that is to our constituencies and local authorities, which are responsible for this area of work. That is why the Opposition are calling on the Government to publish impact assessments on public health spending cuts and stalling life expectancy. I look forward to the Minister’s response. This is only her second or third time at the Dispatch Box—it is the first time we have faced each other across the Dispatch Box—and she is still finding her feet, but she will be keen to make her mark. Now is her chance. I urge her to publish those impact assessments, then do the right thing: properly fund public health now, because people’s lives really do depend on it.

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care 6:48 pm, 14th May 2019

It is a great pleasure to respond to this important debate, which has covered a wide range of issues, showing the depth of the passion shared by hon. Members across the House for public health.

I want to address some of the points made by hon. Members. I should like to begin with the shadow Secretary of State, Jonathan Ashworth, who opened the debate and began by mentioning towns such as Burnley and Blackpool. I was born in Blackburn, as Tim Farron referred to. Like him, I am a slightly disappointed Blackburn Rovers fan, and I represent a Lancashire constituency. I share his concerns about health inequalities, which I see in my constituency. That is what motivates me in this job, and it is what motivates my right hon. Friend the Prime Minister, which is why she set the ageing society grand challenge. The Government share the commitment to prevention and public health that the debate has highlighted, because the costs, both to individual lives and to the NHS, are simply too great to ignore.

I want to address some of the points that hon. Members have raised. My hon. Friend Suella Braverman spoke about her local services. I am looking forward to reading the report and wish her well as she becomes a mother.

Mr Lewis spoke about local mental health provision and the experience of his young constituent. NHS England’s planned spend on mental health in the year ending 2019 was just over £12 billion. For children’s mental health services, it is nearly £7 billion—an increase of 5.6% on the previous year. I would like to reassure him that we are definitely not aiming for a one-size-fits-all service.[This section has been corrected on 16 May 2019, column 4MC — read correction]

I can reassure my right hon. Friend Theresa Villiers that we are absolutely committed to training more GPs. In September last year, we had the highest ever number of students in training. We are also committed to allied healthcare professionals and working to retain the GPs that we have as well as releasing them to give them more time for frontline care.

In response to Eleanor Smith, let me say that this Government are absolutely committed to the NHS remaining free at the point of delivery. I would like to put to bed the myth that there is any aim towards privatisation. On the specific constituency case that she raised, I remind her that almost 90% of prescriptions are dispensed free of charge.

My hon. Friend Gillian Keegan spoke with her usual passion. She paid tribute to Dame Marianne Griffiths, and I join her in paying tribute to everyone at Western Sussex Hospitals NHS Foundation Trust.

I can tell Tim Farron that we do take prevention extremely seriously. I know that he and I have a meeting scheduled to discuss healthcare in his constituency. We have published our vision for prevention, setting out how we will put that at the heart of the health and social care system, and later this year, we will launch a Green Paper on prevention.

My hon. Friend Rebecca Pow, who is an assiduous parliamentarian as well as constituency Member of Parliament, talked about screening for bowel cancer—something that has touched her family. The long-term plan will modernise the bowel cancer screening programme to detect more cancers by lowering the starting age from 60 to 50. Preet Kaur Gill touched on mental health. I would like to reiterate again that that is at the heart of the long-term plan.

I had never noticed my hon. Friend Maria Caulfield being critical, but she is definitely a candid friend to the Government. I thank her for her work as a cancer nurse and for highlighting the improvements in the diagnosis of breast cancer, stroke and other diseases.

Sarah Champion is a great champion for survivors of sexual abuse. I will take away the specific points that she raised and discuss them with the Under-Secretary of State for Health and Social Care, my hon. Friend Jackie Doyle-Price, who is responsible for mental health, inequalities and suicide prevention.

My hon. Friend Derek Thomas, who is also a great champion for the healthcare of his constituents—as I know from the number of letters to him that I sign—spoke about podiatry and the importance of prevention in amputations.

Dr Williams is obviously, with his background in medicine, extremely passionate about public health. Like him, the Government are committed to early years provision. He mentioned the work that my right hon. Friend the Leader of the House is doing on this. Yes, there are inequalities in life expectancy, but it is as high as it has ever been in this country.

I congratulate my hon. Friend Rachel Maclean on the work that she has done on highlighting the issue of menopause, which has not been raised in this Chamber nearly enough. I reiterate to Debbie Abrahams that reducing health inequalities remains central to our strategy for public health, and we continue to require councils to use their grant with a view to achieving that.

I agree with my hon. Friend Vicky Ford that we need to resolve the uncertainty about Brexit, and I thank her for highlighting the importance of research.

To Geraint Davies, all I will say is that the World Health Organisation said that our air quality strategy is an example for the world to follow. To Liz McInnes, let me say that we are in no way complacent, and I draw her attention to the targeted lung health checks in Manchester, which are producing excellent results.

To Rachael Maskell, let me say that public health funding for 2020 onwards, including the local authority public health grant, will be considered carefully in the next spending review, in the light of all available evidence. To Rushanara Ali, let me say that we are taking serious steps on obesity. I share the passion of Mrs Hodgson for improved health outcomes in the north; I represent a seat in the north-west, and she represents one in the north-east.

The most important thing to remember is that public health is about more than the health service and public health grant. It is about the whole of government. It is about more than a single pot of money. Even within local government, improving health is not all about the grant, because local authorities can use the whole range of their activity—including on transport, planning and the economy—to promote better health. Spending across the board in local government, central Government and the NHS can all be far more influential in improving and protecting health.

Equality issues remain central to our strategy for public health. Our overarching twin ambition is to raise healthy life expectancy while reducing the inequalities in life expectancies across different groups of the population. In its long-term plan, the NHS has already committed to strengthen action on prevention and health inequalities. All local health systems will be expected to set out in 2019 how they will reduce health inequalities. This Government’s commitment to improving public health, working with the NHS, local authorities and others, is rock solid. We will set out further steps in the Green Paper, and I urge all Members to oppose the motion.

Question put.

Division number 415 Health

Aye: 229 MPs

No: 286 MPs

Ayes: A-Z by last name

Tellers

Nos: A-Z by last name

Tellers

The House divided: Ayes 230, Noes 286.

Question accordingly negatived.

Several hon. Members:

rose—

Photo of Barbara Keeley Barbara Keeley Shadow Minister (Mental Health and Social Care)

On a point of order, Mr Speaker. I raised a point of order yesterday highlighting the fact that the annual report of the learning disabilities mortality review has not been published despite its being handed over by its authors on 1 March and being leaked in The Sunday Times this week. Now we have leaks with not only details from the report about the deaths of people with learning disabilities who had a do not resuscitate order placed on their care, but of the full recommendations of the report in the Health Service Journal.

It is a pity that the Under-Secretary of State for Health and Social Care, Seema Kennedy, has left her place before I have finished this point of order. Ministers do not seem to care about this report, which deals with the deaths of 4,300 people with learning disabilities.

Have you had notification that the Secretary of State has finally decided that this vital report is too important to have published by selective leaks, or has he indicated that he will come to the House tomorrow, as he should, to make a statement on this report?

Photo of John Bercow John Bercow Speaker of the House of Commons, Chair, Speaker's Committee on the Electoral Commission, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Commons Reference Group on Representation and Inclusion Committee

I am grateful to the hon. Lady for her point of order. The short answer is that I have received no indication from any Minister of an intention to come to the House to make an oral statement on this matter. I note what she says about leaks to the media of sections and parts, even substantial elements of the report. That is not conducive to the best public debate, it has to be said. I know not how those leaks occurred: it is not the first time and it will not be the last.

If the hon. Lady is concerned that these matters should be aired in the Chamber, there are options open to her and she will have to reflect on that. I certainly have no aversion whatever to a proper focus on that important matter, affecting very many vulnerable people indeed, in the Chamber. Knowing her as I do, I have a feeling that I will probably hear further from her.

Photo of Nicholas Dakin Nicholas Dakin Opposition Whip (Commons)

On a point of order, Mr Speaker. There has been a lot of speculation today about British Steel, which employs 4,000 people in my constituency and across the country. It is a significant business. In the light of that speculation, while I recognise the sensitivities of the situation, have the Government given any notice of an intention to update the House about what is going on?

Photo of John Bercow John Bercow Speaker of the House of Commons, Chair, Speaker's Committee on the Electoral Commission, Chair, Speaker's Committee for the Independent Parliamentary Standards Authority, Chair, Commons Reference Group on Representation and Inclusion Committee

No. I have received no recent indication. If the hon. Gentleman has in mind the Secretary of State for Business, Energy and Industrial Strategy, I should, in fairness, say that that right hon. Gentleman is a most solicitous member of the Government. From time to time, as he judges appropriate, he does come to see me to apprise me of matters of which he thinks I need to be aware, sometimes as a prelude to a ministerial statement. In this case, in recent days—that is to say, this week—I have received no such indication. The hon. Gentleman may wish to conduct his own private discussions or make inquiries about Government intentions. He may thereby be satisfied. If he is not, and on a different subject but, in the same way as Barbara Keeley, he feels the Chamber has improperly been denied a chance to air the issue, he knows there is a recourse open to him.