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In 1980, the Black report told us that the
“causes of health inequalities are so deep rooted that only a major and wide-ranging programme of public expenditure is capable of altering the pattern.”
The report was, famously, whisked out on a bank holiday. It was massively rejected by the then new Thatcher Government as being unrealistic in its expenditure levels— typically short-sighted and we have borne the cost of that since.
The findings of the report and the consequent discussions about health inequalities, I discussed when I was at university, as quite a young person at that point. My lecturer, Professor Albert Weale, taught me a lot about health inequalities, which served me to want to seek a career in the NHS to make a difference. But the NHS contributes little if anything to reducing health inequalities, and many would argue that it in fact increases them: it makes them worse, with better-off patients finding access easier and being better able to navigate the systems—the sharp elbows. The inverse care law also applies: the best services are in the better-off areas. So I am always passionate about my career in and commitment to the NHS, but I have never deified it.
Progress was made in the last 40 years. In 1997 we, as the new Government, tried to tackle the social determinants of health, with healthy living centres, such as the one in my constituency in Knowle West, the new deal for communities, a focus on early years and families, smoking cessation, teenage pregnancies and sexual health services. We made a massive difference, but in 2011 the health inequality targets were removed. It is heartbreaking for me to see in my constituency the evidence-based work that we led in that Government destroyed by this Government, the shocking waste of human potential that has resulted, the huge personal and family and community loss, and the huge financial problem that that causes the Government in lost income and increased benefit payments.
The Treasury should be deeply concerned about the Marmot findings. The figures are stark; they continue to be stark. In report after report that I have read in my 30-odd years in the NHS and as an MP, we hear much about the north, but Bristol has neighbourhoods that are among the most deprived in the country, and the 10 most deprived neighbourhoods in Bristol are all in my constituency of Bristol South. Personal independence payment claims stand at 5,500, and those for carer’s allowance and live employment and support allowance at 4,907—all the highest in Bristol. One in 10 people of working age in Bristol South are not able to work because of health and disability reasons, and the joint strategic needs assessment also tells us that it is women who are bearing the brunt of this. Women in Bristol on average live in poor health for 22 years, which is higher than the England average. The health burden and the mortality and morbidity figures are equally stark, as Professor Marmot has highlighted.
In 40 years, we have learnt a lot, and if the Government are willing to use the learning we could have much better policy, but local government is key. Public health rooted in local authorities and using independent advice ought to be far more influential in issues around prioritising and resource allocation, overcoming the vested interests that are in the NHS.
Early intervention is key. The NHS does maternity and there is then a big gap until care of the elderly; local government has the interaction with children. The NHS focuses on individuals; local authorities focus on families and communities. NHS bodies are not co-terminus with local authorities. They have no grounding in community, but local authorities do. Resource allocation in the NHS is driven by payment by results. Local authorities are much better at aligning resources with local needs. The NHS is not directly accountable to electors, which would make it better understand communities and social care. Unless the Government support local government, everything else is platitudes.