Inequalities in Health

There was a debate on the NHS in Essex, in Parliament today.  I made three points:

First;  inequalities in health in Harlow - the problems with high levels of obesity, drug and alcohol abuse and the need to direct resources where they are most needed.  Second; 'Prevention' is central to public health policy - with the hospital being the last - not the first resort.  Third; the importance of involving charities and voluntary groups - 'the little society', as an essential component of public health.

I also noted that Labour had made significant cuts to the NHS when they were in Government.  Yet Labour 'cuts' are never described as such -yet when Conservatives make cuts, Labour present the measures as 'unjust'.  I am glad that the NHS Budget will increase in real terms.

In fact Health Minister Ann Milton stated in the debate:

"The allocations announced on 15 December will provide PCTs with £89 billion to spend on the local front-line services that matter most—that is an overall increase of £2.6 billion, or 3%. Of that, Essex will receive £519.6 million, which is a cash increase of 3.2% above the national average. From 2013-14, the NHS commissioning board will allocate the majority of NHS resources to consortia, and funding will be arranged so that every area gets its fair allocation, based on the burden of disease and disability".


My full speech is below:

Robert Halfon (Harlow) (Con): I, too, congratulate my almost-neighbour and hon. Friend the Member for Witham (Priti Patel). She made an incredibly powerful case about the individual against the state and the powerlessness that people feel against state agencies, which is why we need to return power to the people. I thank her for securing this important debate. I am sorry that my hon. Friend the Member for Southend West (Mr Amess) has been to all the hospitals in Essex apart from Princess Alexandra hospital in Harlow. I strongly recommend it; it is a good place.

As has been mentioned, Essex is a large county, with five primary care trusts and more than 1.4 million people, which is roughly the same population as Northern Ireland’s. Some variation in such a large area is natural, but sadly, my constituency contains serious health inequalities, despite the best efforts of local staff and the Princess Alexandra hospital. Addressing them is not just about health and a stronger work force; to me, it is also about social justice.

I have three points. First, we suffer from significant health inequalities, as I said. Secondly, Harlow has a good hospital; it has its problems, but I strongly support its bid for foundation status. Thirdly, we have a history of funding problems, particularly in west Essex—I am glad to move from north Essex to west Essex—and they must be addressed.

On health inequalities, sadly, more men die from alcohol-related causes in Harlow than in any other district in Essex. The latest statistics show that there are 45 such deaths in Harlow every year, double the rate in nearby Uttlesford and about 50% more than the east of England average of 30 a year. I accept that Harlow is a major town, but families there are struggling with a particular problem, and the rate is higher than in similar towns in Essex such as Colchester and Basildon. Harlow also experiences some of the worst rates of child and adult obesity in Essex. Government statistics show that one in five 11-year-olds in Harlow is obese before leaving primary school. Some 55% of 15-year-olds in Essex drink alcohol, 19% are regular smokers and 13% use drugs, but the problem is particularly acute in Harlow. The rate of adult drug abuse in Essex is 4.8 per 1,000, but in Harlow it is nearly double, at 8.3 per 1,000.

I do not want to paint a negative picture of Harlow. I am proud of my town and constituency. There is some good news. Local faith and charitable groups are aware of the challenges and are responding to them. The organisation Open Road runs an SOS bus and does other anti-drug work, helping people access advice, information, support and more formal treatment if needed. Some other remarkable drug rehab charities do essential work behind the scenes. There are many walking groups, and I have been to a number of events organised by the Harlow Athletics Club, which is one of the most distinguished groups in the region. Projects such as Kickz work with young people, providing football, boxing and other fitness pursuits.

In that context, Princess Alexandra hospital has had problems, but hopefully it will become a foundation hospital. With a new chairman and chief executive, the hospital is making a strong bid for foundation status, which I support. I have found the chairman of the hospital, Mr Coteman, to be open, honest and straight-talking about the difficulties that we face in Harlow. He is also dedicated. On Christmas day, I visited the hospital wards with Harlow hospital radio and was astonished to see not only that the chairman was going around visiting patients, but that he had brought his whole family with him after travelling from Cambridge for the day. That shows a lot of commitment to the hospital.

It is not just Mr Coteman. I visited the cancer ward at Addison House with Robert Duncombe. The ward is very well run. We have talked a lot about waste and bureaucracy, and of course, we have those problems, but it is a completely different story at Addison House, where five staff share a small office, and when I say small, I mean really small.

The Princess Alexandra hospital is at the cutting edge of research, with its cellular pathology laboratories, for which I hope NHS support will continue. Having visited the laboratories, I know that the genius of their people and their technology is remarkable and bests anything in the private sector. However, the difficult environment means that the Princess Alexandra hospital needs the foundation status for which it has applied in order to take its work to the next level.

I want to touch upon the history of the funding problems in west Essex, which are all the more serious given the health inequalities that I have described. Under the previous Government, West Essex primary care trust struggled with the 20th worst deficit in the UK, and the black hole for 2009-10 was nearly £2 million. I welcome the coalition Government’s commitment to increase health spending in each year of this Parliament, but it is a question not only of getting the right resources, but of spending the money wisely.

When I was a parliamentary candidate, I found out, via a freedom of information request, about a £700,000 cut in funds to the NHS walk-in centre in Harlow. Finances had been mismanaged, so much of the investment was wasted. There have been serious problems with health management, as well as health inequalities, which we must address under the new ways of devolving purchasing power to GPs. I particularly welcome the pledge to remove strategic health authorities, because they seem to be a complete waste of resources and an unnecessary tier of bureaucracy. That money would be much better ploughed into the work of nurses, doctors and health visitors on the front line. I think that the Health Secretary said at the Conservative conference that managers have so far been cut by 2,000 and that front-line staff have been increased by 2,700. I am sure that the Minister will want to clarify that.

On NHS fuel and petrol allowances for workers, I was astonished to discover when I visited my mental health trust that NHS mental health professionals who use their cars all day for their work—this is not just about commuting, but about visiting patients—get tiny fuel allowances, some just 12p a mile. I have tried to investigate the issue, but there seems to be a spaghetti junction of authorities that decide what the rate is. It is unfair, when petrol is at £1.35 a litre, that their fuel allowances are so low. I urge that dedicated NHS professionals who use their cars all day for their work should get a decent fuel allowance.

We must deal with the health inequalities in Harlow. To coin a phrase, we must be tough on health problems, but tough on the causes of health problems, too. Ultimately, the evidence is that we need more early intervention and preventive work, but the cause of many health problems is social deprivation. It is jobs, a stronger economy, higher employment, and opportunity for the many and not the few that will give us a healthier society, which is why I welcome the Government’s economic reform, with lower taxes for lower earners and deficit reduction. It is about not just pure utilitarianism, but social justice.

We must do more. We need more partnerships with grass-roots community groups, such as the local Harlow branch of the Alzheimer’s Society and the Harlow athletic club, which I have mentioned. Hospitals should be the first, not the last resort, which is part of the problem that we face in the NHS today. To do that, resources must be directed towards prevention, and the best people at prevention are the small community and faith groups already in our estates, working with people. When we open up NHS contracts, we must make it easier for small charities and firms to bid for them, as well as the larger, “Tesco” charities. There is fear in some parts of my constituency that our health reforms will be monopolised by vast health conglomerates. I very much hope that we see more co-operatives. I understand that the PCT in Kingston has become a co-operative. If that is the case, I hope that it will be a model that other PCTs and GP commissioning bodies can follow.

I have always said that the big society will only work if we build the little society, too. We must bring real localism to our NHS. We have to give patients meaningful choice. Harlow struggled for years with top-down cuts under the previous Government. For example, the North Essex trust, which, as has been mentioned, supplies mental health services, suffered a £5.3 million cut in 2007.

Finally, why is it that whenever the previous Labour Government cut our services in Harlow, it was presented as a fact of financial management, but whenever the coalition Government are forced to cut spending, it is seen as an ideological outrage? That double standard must be addressed. I am glad that our NHS budget is guaranteed to rise in real terms every year in this Parliament, and hope sincerely that Harlow patients and residents will get their fair share. I look forward to the Minister’s forthcoming visit to Harlow to see for herself the NHS in operation.

The Minister replied:

Ann Milton: My hon. Friend the Member for Harlow discussed inequalities, and was right to say that they are a matter of social justice. For instance, it is outrageous that in Westminster there is a 17-year difference in mortality: people born in some parts of Westminster may live 17 years less than those born elsewhere in the borough—that is truly shocking.

My hon. Friend raised the issues of alcohol-related deaths and obesity, and discussed the fantastic work done by many local organisations. Again, health and well-being boards will be an opportunity to put public health right at the heart of local authorities, which have a long and proud history of improvements in public health and bringing together all the organisations that do so much.

My hon. Friend was also right to say that there is tremendous social capital in our communities. In my travels around the country—I try to get out a lot, for fear someone might say that I do not get out enough—I have been fascinated to find in some of the most deprived areas the greatest social capital, innovation and response from local communities to do something about their problems. They want a way out of poor health outcomes and the crime in their area, and their resourcefulness is outstanding.

by Robert Halfon - www.roberthalfon.blogspot.com