Healthcare Provision: Inequalities

Question

Tabled by

To ask His Majesty’s Government what assessment they have made of inequalities in the provision and experience of healthcare among different population groups; and what plans they have to address this.

My Lords, on behalf of my noble friend Lady Brown of Silvertown, and at her request, I beg leave to ask the Question standing in her name on the Order Paper.

My Lords, the report on the NHS by the noble Lord, Lord Darzi, casts light on a range of health inequalities which are both stark and unacceptable. In response, our 10-year plan for the NHS in England sets out a re-imagined service designed to tackle inequalities in access and outcomes for everyone, no matter who they are or where they live.

My noble friend Lady Brown’s supplementary is about the experience of women. Last month, the Secretary of State for Health went on record saying that women should have consistent pain relief when coils are fitted. My noble friend has campaigned for 10 years to get proper pain relief for women who are undergoing hysteroscopies. Manchester is piloting a way to deliver this, though many other hospitals are ignoring it. Can my noble friend the Minister assure the House that the Government are seriously looking at this and monitoring what Manchester is doing in this regard?

I can indeed give that assurance, and I am grateful to my noble friend Lady Brown for her voice on the matter of women’s poor hysteroscopy experiences. These are unacceptable and part of a wider issue of women’s pain being normalised. Women must be given the opportunity to discuss pain relief with a clinician before the procedure. While I am glad to say that updated guidelines from the Royal College of Obstetricians and Gynaecologists do emphasise minimising pain, it is clear that more action is needed. I assure my noble friend that we are updating the Women’s Health Strategy for England to address what I believe is a wider issue, and to improve the experiences of women across the country.

My Lords, clinical evidence has established that poor health care directly contributes to the current 22-year life expectancy gap between people with learning disabilities and the general population. Why is this unacceptable inequality simply becoming a grim statistic that the Government continue to pay millions of pounds to measure, but are reluctant to take statutory measures to end?

It is an unacceptable situation, as the noble Lord says. However, I refer him to the national approach, which will inform action in communities, including for people with a learning disability and those who are autistic. The Core20PLUS5 informs the reduction of healthcare inequalities among a range of groups; and, extremely importantly, it supports NHS organisations in identifying who might be at risk of poorer experiences, and in addressing this. I agree with the noble Lord that this must include those with a learning disability and those who are autistic.

My Lords, I support what the noble Lord just said on raising concerns about those with learning disabilities. They have a long-standing issue with access to the health service, and we saw some particularly poor treatment during the Covid pandemic. The last Government took steps to improve training for those working in the NHS in order to improve the situation. Picking up on the Minister’s answer to the noble Lord, what is her ambition in terms of timescale? When might we see some significant improvement in how those with learning disabilities can access National Health Service treatment?

In a number of ways—I refer, for example, to the Mental Health Act, which is very significant in respect of the group we are discussing. We have already taken action in that regard in a legislative form.

However, the noble Lord is right. We started in a difficult place, but I am more than hopeful about the whole approach through the 10-year plan. So while I cannot give a month-by-month answer to the noble Lord—much as I would like to—I can say that in the course of the next 10 years, the matters to which he refers will be addressed. I believe that a neighbourhood health service designed around the specific needs of local populations will be a great contributor to this.

My Lords, we have seen in debates across a wide range of medical matters such as perinatal care, dementia and cardiovascular issues that there is widespread geographical disparity within the country, often driven by different approaches taken by different NHS trusts. Can the Minister outline how she intends to use the 10-year plan as a driver for greater uniformity of services, to ensure that there is not that postcode lottery disparity for many patients?

The 10-year health plan has tackling inequalities at its very heart, and that is the big driver throughout. Health inequalities are strongly associated with deprivation, and it cannot be right that healthy life expectancy at birth for a girl born in Wokingham is 70.8 years, but 52.6 years for a girl born in Barnsley. I think we get a real sense of the challenge.

However, I would not expect every local area to approach this in exactly the same way, not least because the challenges are different. That is why the whole structure of the NHS, including funding, will allow local areas to meet the needs and the challenges, which are considerable in certain areas, in the way that will deliver the best outcome.

My Lords, will the Minister look closely at the inequalities between rural and urban areas in delivering healthcare? The Minister is aware of the work I do with dispensing doctors. Is she aware that community pharmacies and dispensing doctors in rural areas are struggling, as they are not being reimbursed for the national insurance contributions increase announced at the last election? I understand that hospitals are having these reimbursed. Will the Government look at this to ensure that rural pharmacies and GP practices have a level playing field with those in urban areas?

We have discussed national insurance contributions a number of times in your Lordships’ House, and I can only repeat the previous assurance, given not just by me but by other Ministers: that in making the decision, the Chancellor took into account not just the funding available—for example, in the Department of Health and Social Care, which was notable and welcome—but the impact.

In respect of rural areas, the national approach to inform action to improve equality in healthcare does define groups, including those in rural and coastal communities, so I can assure the noble Baroness that this issue does get the attention she seeks.

My Lords, to address inequalities we need better data. We have heard from noble Lords about granular data in some areas, but in many areas we still need to collect data and publish it in a much more granular manner, based on region, ethnicity and income, but also other measures. What are the Government doing to improve the collection of data, and particularly its granularity, so that we can address these inequalities?

I agree with the noble Lord about the importance of data. We have discussed this a number of times in respect of racial inequalities. But it is not just about data; it is also about the use of digital services. We must ensure that those in the most deprived areas are not excluded because of their inability to deal with digital aspects. As the noble Lord knows, moving from analogue to digital is another core part of what we are doing. I assure him that we are improving data collection and its availability and use.

My Lords, one of the groups most disadvantaged and, I regret to say, ignored at times, is unpaid carers—those who have taken on the care of a very disabled child or an elderly relative. Will the Minister continue her work to persuade all the services to be altogether more sensitive to carers and, most of all, to accord them the dignity and care that they need?

The noble Lord is absolutely correct, and I can give him the assurance that he seeks.