Health Inequalities: Office for Health Improvement and Disparities

[Derek Twigg in the Chair]

Before we begin, I remind hon. Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with the current Government guidance and that of the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test before coming on to the parliamentary estate. Please also give each other and members of staff space when seated and when entering and leaving the room.

I beg to move,

That this House has considered the Office for Health Improvement and Disparities and health inequalities.

It is a real pleasure to be here under your stewardship this afternoon, Mr Twigg. I thank all those who have come along—all on the Labour side of the House—to debate this important issue, which affects so many of our constituents. I thank the organisations that have provided me with information to help me articulate my points, including the Royal College of Physicians, the Inequalities in Health Alliance, the British Heart Foundation, Cancer Research UK, Maternity Action, the Royal College of Paediatrics and Child Health, the NHS Federation, the UK Vaping Industry Association, Kidney Research UK, the Health Foundation, the Terrence Higgins Trust, Global Blood Therapeutics, the Local Government Association, the Institute of Alcohol Studies, the Children’s Alliance and, as ever, the House of Commons Library, which brings much of this together. I do not believe I have missed any organisation out. If I have, I apologise.

Each organisation made helpful and constructive comments about the matter we are debating today. The extent of health inequalities is remarkably wide—in fact, I felt I understood the extent of such inequalities, but the information from those organisations has widened my knowledge significantly. Each of the organisations had the decency to send me information, so I will read out comments from each of them, if I may.

Alongside its key ask for a cross-governmental strategy to reduce health inequalities, the Inequalities in Health Alliance also asks the Government to

“commence the socio-economic duty, section 1 of the Equality Act 2010”

and to

“adopt a ‘child health in all policies’ approach.”

The Health Foundation notes:

My hon. Friend is making an excellent speech. On that point, I want to ask him about gender inequality in terms of health. As a member of the all-party parliamentary group on osteoporosis and bone health, he will know that fracture liaison services are key to prompt and timely diagnosis of osteoporosis, but only 51% of NHS trusts in England have an FLS and only 41% of all NHS trusts have permanent and sustainable funding in place for their FLS. That means that every year an estimated 900,000 people miss out on the medication they need to prevent avoidable fractures. Does he agree that this health inequality, or postcode lottery, needs to end?

My hon. Friend is completely right and she has been a real champion of osteoporosis services, pushing them in her own area and as chair of the APPG. One figure shows that half of women over the age of 50 suffer a broken bone due to osteoporosis. That is the kind of stark figure that we have to face. I thank my hon. Friend for that intervention.

The NHS Confederation has made comments similar to those I have mentioned:

“The number of people waiting for planned NHS care in England has grown to record levels, with more than 5.6 million people currently on the waiting list and over 7 million ‘missing patients’ anticipated to come forward... Inequalities are now becoming evident in the backlog, with evidence suggesting that waiting lists have grown more rapidly in more deprived areas during the pandemic.”

Maternity Action says:

“Vulnerable migrant women face charges of £7,000 or more for… maternity care. Charges are levied on women with insecure immigration status, including destitute asylum seekers whose claim has been refused and who are not in receipt of Home Office support, women whose relationship has broken down and who were dependent on their partner for their immigration status, women on fiancee visas and women who have been unable to afford to renew their visas. This policy disproportionately impacts on minority ethnic women, who make up 85% of women using Maternity Action's Maternity Care Access Advice Service, which advises women”

on such matters.

The British Heart Foundation said:

“The prevalence of heart failure, stroke, and mini stroke in adults with learning disabilities in England is higher than the general population, and circulatory diseases are one of the main causes of death in people with learning disabilities. For the most part, this can be attributed to differences in the social determinants of health.”

My hon. Friend is making an excellent speech. Does he agree that, given that the largest number of covid-related deaths have been experienced by ethnic minority communities, it is imperative that the Minister provides clarity on whether the Office for Health Improvement and Disparities and the Health Promotion Taskforce will be given a remit outside the Department for Health and Social Care?

I am pleased that my hon. Friend asked that question, because it is one that has been asked many times, and I am sure the Minister will cover it—it is one of the questions I have as well.

The UK vaping industry said:

“It is absolutely critical that the new Office for Health Improvement and Disparities continues the pragmatic approach of Public Health England in recognising the role of vaping in tackling inequalities. It is essential that the institutional knowledge of PHE is not lost in the establishment of the OHID”

It is important that that is factored into these debates.

The House of Commons Library referred to the debate on health inequalities versus disparities. Jabeer Butt of the Race Equalities Foundation has welcomed the institution of the OHID and the possibility of working alongside it, but he said:

“With the establishment of OHID, we can’t help but wonder why the language used by the Health and Social Care Secretary talks about ‘health disparities’, compared to Professor Chris Whitty, who describes ‘health inequalities in the Government announcement.”

This is not just about semantics. It is important that we recognise that it is about not just disparities but health inequalities as well.

I commend my hon. Friend on his speech. He touched on a really important point: that the Government talk about disparities when they should talk about inequalities. To truly tackle health inequalities, we need to look at social factors, such as housing, racism and air pollution, and socioeconomic factors. Does he agree that, to tackle all of those inequalities, the OHID will need to look in the round at all those issues and seek a cross-governmental role to deliver on the Department of Health and Social Care’s aims?

My hon. Friend is spot on. That is a key point that we want to tease out today: cross-departmental working.

As with many other health issues, the devil is in the detail. Only by looking into the granularity of the issues can a real understanding of the levels of inequality and disparity be established. I do not have time for more significant references to the organisations concerned, but it really was important for me to get down to the detail of the information that they provided. I will give the documents to the Minister for her perusal in due course.

Before the pandemic, growth in life expectancy had stalled for the most deprived in England. Between 2014 and 2019, people in the least deprived areas saw their life expectancy grow significantly, but there were no significant changes for people in the most deprived areas. For women in the most deprived areas of England, life expectancy fell between 2010 and 2019—a stark fact. The pandemic unambiguously exposed and exacerbated inequalities that have existed in our society for far too long, as many hon. Members will have seen first hand in their constituencies. The pandemic has widened gaps that were already too big to begin with, and once again it is the most vulnerable who have borne the brunt.

We know from the Sir Michael Marmot’s “Build Back Fairer” report that mortality rates for covid in the first wave mirrored mortality rates for other causes. In order words, the causes of health inequalities more widely were similar to the underlying drivers of covid-19 deaths among certain groups. It has been estimated that working-age adults in England’s poorest areas were almost four times more likely to die from covid than those in the wealthiest areas—another stark figure. Now, with the backlog, analysis of waiting list data shows that people living in the most deprived areas are nearly twice as likely to wait more than a year for treatment compared to those living in the least deprived areas. That cannot be right.

A good number of Members want to speak today. I do not intend to impose a time limit, but it would helpful if you could keep your speeches to around six minutes. That will ensure that everybody gets in. I intend to call the Front Benchers at no later than 3.40 pm.

I will keep my mask on because I have a wound, unfortunately, which I need to keep covered. It is an absolute pleasure to serve under your chairmanship, Mr Twigg. I remember that we served on the 2012 Health and Social Care Bill Committee together, so this is bringing back memories.

I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on his excellent speech, and particularly on his focus on the wider health determinants and the need for an intergovernmental strategy and co-ordination. He is absolutely right.

I sought to become an MP because of my work on health inequalities. I was at the University of Liverpool for 10 years. Prior to that, I was a jobbing public health consultant. My hon. Friend mentioned the Black report. We must not forget that Margaret Whitehead at Liverpool was the first person to identify the health divide between the north and south. I am grateful to her. I learned so much under her and my other colleagues at Liverpool.

In the time that you have made available to me, Mr Twigg, I want to make three points. First, health inequalities are not inevitable. We hear “Oh, it’s always been there; it’s never going to change”. They are not inevitable but a consequence of political choices. As my hon. Friend said, those choices relate to whether or not we want socioeconomic inequalities to continue. It is also about—and this is rarely talked about—inequalities in power. We must ensure that that is addressed and brought into the debate.

Secondly, the structural inequalities across our country have been exposed and exacerbated by covid, resulting in, as Professor Sir Michael Marmot has said,

“the high and unequal death toll from COVID-19”,

which was one of the highest in the world. Thirdly, tackling health inequalities involves every single Government Department, not just the Department of Health and Social Care.

It is a pleasure to serve under your chairship, Mr Twigg. I will keep my remarks as brief as possible. I am grateful to my hon. Friend the Member for Bootle (Peter Dowd) for securing this important debate, at a time when the NHS is under enormous strain and facing a clear and present threat of relentless cuts and privatisation under this Conservative Government.

As well as leaving our beloved health service on its knees and struggling to cope after two years of a crippling pandemic, this Government have presided over a period of austerity that has seen health inequality become even more prevalent and extreme.

Last week, the other place started its Committee stage of the Health and Care Bill and began discussing proposed amendments about health inequality. Speaking at that Committee sitting, peers from across the House made clear that the Bill is a huge opportunity to eliminate health inequality and for the Government to demonstrate their commitment to tackling the “disease of disparity”, to quote the Secretary of State for Health and Social Care, who pledged to address the issue when he took office last year. However, in the months since, there has been little evidence that the Government are taking the bold steps required to address the crisis.

The Government cannot say that they are not aware of the issue, because research published in 2019 by the Department for Work and Pensions revealed that the highest reported rates of poor health in those under the age of 55 was overwhelmingly in the poorest percentiles, with the bottom 20% of the population having worse health outcomes by a staggering 1,100%.

Three years and a pandemic later, the situation is even bleaker. In 2020, life expectancy in England fell more dramatically than at any other point since world war two, as a result of the covid pandemic. In the poorest areas, life expectancy declined nearly twice as much as it did in the wealthy ones, while ethnic minority people died from covid at much higher rates. Sadly, those with disabilities faced a significantly higher death rate.

It is an honour to serve under your chairmanship, Mr Twigg. I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on an excellent, well-researched speech and on securing this important debate.

Before turning to the exact subject of the debate, as vice-chair of the all-party parliamentary group for vaping, I want to reflect on the role of the predecessor body of the Office for Health Improvement and Disparities. Public Health England sought to be a practical institution, with evidence and pragmatism at the heart of its approach to public life. I want to pay particular attention to its work on tobacco harm reduction, which I have witnessed not only as a member of the APPG but personally. Since 2015, across seven evidence reviews, PHE reports on the role that e-cigarettes can play in a healthier society have captured the ethos of the organisation in its entirety.

The first report was a landmark publication for the vaping industry. It concluded—I hope that everyone in this House heeds this fact when reflecting on reducing inequalities born from smoking cigarettes—that vaping is “95% less harmful” than tobacco. In its report, PHE went on to look favourably on e-cigarettes, while others have sought only to fuel misinformation, risking lives by claiming vaping and smoking to be one and the same. They are not. It is because of that evidence-based endorsement of vaping that millions of smokers across England and—dare I say it?—across the world, who have exhausted all other routes trying to quit smoking, have a fighting chance with an incredibly successful product that is helping smokers to quit.

Smoking is perhaps one of the biggest contributors to inequality in our society, causing considerable damage to private and public health, and it has a high impact on physical and mental health. It is an expensive and addictive habit, particularly for those most disadvantaged in our society, where smoking prevalence is highest. Vaping is less expensive and is an effective way to stop smoking. It is therefore critical that the Office for Health Improvement and Disparities recognises the role of vaping, picks up the torch left by Public Health England and continues to be a stalwart champion of tobacco harm reduction.

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank my hon. Friend the Member for Bootle (Peter Dowd) for having secured this important debate, and for his eloquent and detailed speech. Salford is currently the 18th most deprived local authority area out of 317 in England, yet it is a tale of two cities: more than 30% of the city’s population reside in a highly deprived area, yet we are also home to some of the wealthiest suburbs in Greater Manchester. That disparity is shown starkly by our life expectancy. It has been improving over the past few decades, but there remains a gap between Salford and the rest of England of three years for males and two years for females.

Male residents living in the most affluent areas of Salford can expect to live more than 11 years longer than those in the most deprived areas, while females in the most affluent areas can expect to live seven years longer. I think we can all agree that that is morally wrong. Sadly, we have known for decades—from the Beveridge report to the Marmot report—that poor health, discrimination, housing, employment and income are inextricably linked, yet we have seen very little action in recent years. Of course, there was a burst of radical policy development in the late 1940s, with the creation of the welfare state and the NHS, for example, and we saw policy approaches in the late 1990s and early 2000s, but since then we have lacked a comprehensive health inequality strategy. What is worse is that austerity has resulted in the unravelling of many of the positive policies put in place and the undermining of the remaining ones.

The creation in October 2021 of the new Office for Health Improvement and Disparities and the announcement of a new cross-Government agenda to track the wider determinants of health and to reduce disparities were met with cautious optimism. However, since the creation of the OHID, there has been little information on what it will actually do or what it has done so far. Will the Minister clearly set out how the Office for Health Improvement and Disparities will reduce health inequalities? Indeed, what is the new cross-Government agenda? Can she confirm that the Health Promotion Taskforce will be given a remit to act outside of the Department of Health and Social Care, to address the true socioeconomic causes of poor health? Finally, can she set out how OHID will work with the new integrated care systems, and how it will support them to address health inequalities in their area?