Part of the debate – in the House of Commons at 6:37 pm on 14th May 2019.

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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.