Health Inequalities

Part of the debate – in the House of Lords at 8:26 pm on 27 October 2003.

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Photo of Lord Warner Lord Warner Parliamentary Under-Secretary, Department of Health, Parliamentary Under-Secretary (Department of Health) 8:26, 27 October 2003

My Lords, I am sure that we are all grateful to the noble Lord, Lord Chan, for putting the subject down for debate this evening. I assure him that the Government share his concerns, which he outlined so cogently. I shall try to outline what we are doing in the North West more generally and answer his questions along the way.

We shall continue to publicise public health initiatives and developments and hope that a more balanced presentation can be provided in the media. I cannot always guarantee that we shall be able to compete with the latest medical technology in column inches, but we shall do our best. I reassure the noble Lord, Lord McColl, that I run regularly, although probably not as fast as my noble friend Lord Bassam.

Effective action to tackle health inequalities is particularly important in north-west England, given its relatively poor health, as several noble Lords have mentioned. The legacy of the Industrial Revolution is a region with a concentration of population in older, urban areas with high levels of poverty and deprivation—however one measures poverty—and a relatively poor environment, infrastructure, and housing stock. Given the constraints on time, I shall concentrate on the North West, but much of what I say has a wider application.

Male life expectancy at birth in Manchester is just under 70 years, the lowest of any local authority in England. Blackpool and Liverpool, with a life expectancy of 72, have the second lowest rates nationally. Unless substantial progress is made in tackling health inequalities in the North West, it will be difficult to meet national health inequality targets for the country as a whole.

Investment for Health, A Plan for North West England 2003, was launched in July 2003, and is the jointly owned strategy of the Northwest Development Agency, the North West Regional Assembly, the Government Office for the North West and the three strategic health authorities. I mention that because it is now common property across those different elements of government. The production of the strategy was co-ordinated by the regional director of public health for the North West, whose contribution has been recognised by several noble Lords.

The north west plan has its foundation in the Government's national strategy, Tackling Health Inequalities: A Programme for Action. The plan emphasises the need for more effective action across a range of sectors and agencies, to produce a positive impact on health outcomes by focusing on four priority areas.

First, there is tackling the wider determinants of health, such as housing, education and transport, and associated lifestyle and risk factors such as smoking, poor diet, and a lack of exercise. An example of that is the Food Development Network in North Cumbria, which was established to promote a healthy diet and local trade. The project connects farmers and communities and food is priced at a level that is attractive to both parties. The network supplies locally sourced fruit, vegetables, meat and fish through local food distribution networks. I hope that reassures the noble Lord, Lord McColl, that we are tackling dietary issues in some of these initiatives. The network is a partnership between the health action zone, Allerdale Borough Council, the Countryside Alliance, and local providers. It was established in February 2000. Outcomes to date include: 37 food co-operatives using local producers and reaching 6,000 people; fruit and sports initiatives in 42 schools and cooking on a budget courses reaching over 1,000 people. The network has improved access to affordable, healthy food in disadvantaged areas. I mention that as a concrete example of the kind of initiatives that are taking place.

To eliminate cold and damp housing conditions for people over 60, Merseyside health action zone has completed a project in Liverpool and St. Helens, Making People Feel Safe and Warm at Home. With elderly people it is not just a matter of feeling warm, but often of feeling safe as well. A package of home improvement measures was carried out on all properties to increase energy efficiency. Evaluation showed that residents felt warmer and more secure and had reduced heating costs. In addition, there were reduced demands on GP services from those involved in the project. The mainstreaming of the project is currently being reviewed.

The second priority area is ensuring that the NHS develops its role as a good corporate citizen by using its enormous social, economic, and environmental weight to support wider regeneration and sustainability objectives. I shall say a little more about that later.

The third priority area is mainstreaming measures to reduce inequalities in access to health and social care services and their quality and outcomes for underserved areas and groups. We have become very good at initiatives; what we need to do is to get those initiatives into the mainstream services.

The fourth priority is strengthening primary care services, and particularly staffing and infrastructure in deprived and underserved areas. Primary care trusts have a vital role not just in providing and commissioning services but in improving health and reducing inequalities within wider local partnerships. I hope that reassures the noble Lord, Lord Chan, on the priorities we are giving to primary care and the role of PCTs.

The key now is to take and integrate action in accordance with the north west plan, first, by making health improvement a cross-cutting theme in regional strategies such as the Regional Economic Strategy (RES) and, secondly, by ensuring that area-based policies address the need to reduce health inequalities. Primary care trusts are now required to produce local delivery plans to set out their programmes, and to agree health priorities with local authorities and other partners. Targeted area-based policies are particularly important in reducing health inequalities. For example, of the 88 local authorities in England eligible for neighbourhood renewal fund, 21 are in the north west region; that is virtually a quarter of the neighbourhood renewal fund initiatives.

An example of an initiative within a priority area is the Netherton Feelgood Factory in Liverpool. This uses a community development approach to enable people in a deprived area to improve their health. A shop in central Netherton acts as a base for a jobs and training service, a welfare rights service and a credit union. People are able to make appointments to see specialist advisers on the pensions service or lone parent issues.

A third form of integrated action comprises programmes for four specific priority groups: children and young people, older people, black and minority ethnic groups, and disabled people. The North West Regional Assembly has been running a major consultation exercise on disability and social inclusion over the past two years to take forward some of those issues.

A fourth area of integrated approach concerns tackling inequalities through programmes in everyday settings, particularly schools, workplaces and prisons. Schools provide a significant opportunity to deliver reductions in health inequalities. The National Healthy Schools Standard supports schools to invest in the education, health and well-being of the whole school community. Recent Ofsted research identifies schools in the Healthy Schools Programme, particularly those in disadvantaged areas, to be improving faster than similar schools not in the programme. I am cantering through as I know that noble Lords want to get on to the next business.

The noble Earl, Lord Listowel, raised the important issue of mental health and looked-after children. He knows my commitment in that area. He will be reassured to know that I have not resiled from anything I said in the Choosing with Care report. It is important, however, to know that we are making progress in reducing inequalities. There will be a review in an annual report to be published from 2004 showing what progress has been made. The noble Baroness, Lady Massey, rightly talked about the importance of partnerships. Evaluating partnerships locally is an important part of the new work.

I want to spend my last minute saying a few words about what the NHS itself is doing as a good corporate citizen. The Northwest Development Agency has taken action to improve health and reduce inequalities by making the NHS an investment for economic development, recruiting, employing and training more people from deprived areas to work in the NHS, using NHS purchasing and procurement to support the local economy, and ensuring that major capital schemes are assessed to identify opportunities for improving social, economic and environmental conditions in more deprived areas. Examples in North Huyton and Oldham show how those initiatives can be made to work.

In conclusion, well before my 12th minute, this has been a very thoughtful debate with some interesting perspectives. The Wanless report concluded that there should be more emphasis on prevention and public health measures, and on supporting the development of a population that was better informed and more able to manage its own health. I hope that I have shown that we are adopting that approach. Good work is going on in the North West to tackle such difficult issues, and it is very much a cross-cutting, joined-up government approach that works across the agencies and does not rely only on healthcare.