Part of the debate – in the House of Commons at 5:55 pm on 14th May 2019.

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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.