Public Health: County Durham

I beg to move,

That this House has considered public health in County Durham.

It is a pleasure to serve under your chairmanship, Mr Owen. I am pleased to have secured this debate, but it is unfortunate that we have to have a debate on public health to highlight the effects that the Government’s cuts have on one of the poorest counties in our nation. I thank the men and women of the NHS, those who work in public health for the county council, and the voluntary and community sectors, which are part of the matrix of support for delivering in County Durham not only general healthcare, but, importantly public health.

In recent years, there has been debate about Government funding not just in health, but in local government and other areas. That debate starts from the premise that everywhere is the same, so a fair funding formula spreads the jam evenly around the country, but I am sorry—that is just not the case. Deprivation and need are factors that must be taken into consideration. In local government funding, fire service funding and police funding, need and poverty have been removed as determinants.

County Durham is a large rural county of 525,000 people. It faces some unique issues on health, partly because of the legacy of the county’s industrial past of coalmining and heavy industry, which means a high incidence of diseases associated with those industries, such as respiratory diseases, which put particular demands on the health service.

We also have a legacy of rapid deindustrialisation in the 1980s, when the hearts of many of the coalmining and steel communities across County Durham were ripped out by the policies of the Thatcher Government. That legacy remains in terms of hopelessness, drug and alcohol abuse, obesity and smoking, as well as the poverty that goes with all that. Previously, I have described County Durham as a rural county with urban problems, but those urban problems are sometimes ignored because of County Durham’s rurality.

We also have a growing elderly population. In the period to 2035, the number of people aged 65-plus will rise by 31%, and the number of people aged 85-plus will rise by 82%. That puts particular demand on the health service at all levels, in both the community and the acute sectors. Life expectancy in Durham is 78.3 years for men and 81.4 years for women. I will mention two other counties, and allude to the reasons for doing that later in my remarks: in Surrey, life expectancy is 81.5 years for men and 84.8 years for women, while in Hertfordshire, it is 81 years for men and 84.2 years for women.

The figures for healthy life expectancy, which indicates the age at which people develop serious health concerns, are even worse. In County Durham, they are 58.9 years for men and 58.7 years for women, whereas in Surrey, they are 68.3 years for men and 68.7 years for women, and in Hertfordshire, 64.9 years for men and 65.9 years for women. People in County Durham who get long-term health issues get them sooner than people in more affluent areas, which leads to demand on our health service. We are always told by the Government that we need to stop people using the health service to reduce the demand placed on it, but unless we tackle some of the underlying causes of the problem that pressure will continue.

Responsibility for public health funding was transferred from the Department of Health and Social Care to local government in 2013-14. I supported that move because public health is best delivered locally. The budget devolved to County Durham in 2013-14 was £40.5 million, based on the assessment of health needs by the primary care trust, which was abolished under the same legislation that introduced the transfer of responsibilities. To give credit to County Durham, it has used that money effectively, with services commissioned both directly by the county council and externally by private and third-sector organisations.

As with many things, however, devolution of responsibility for public health came with a sting in 2016, when the budget was reduced by 12.8%. That was part of George Osborne’s strategy, in a host of areas, to devolve money locally and tell the local authority to decide where the cuts would come. He could then stand back and say, “That decision has to be made locally.” But that misses the point. By sleight of hand, he sought to give the idea that somehow he had no responsibility for the cuts when he had top-sliced the budgets.

To be fair to County Durham, its public health priorities were the right ones to tackle. The funding was directed towards the control of tobacco and cessation of smoking, teenage pregnancies, obesity and weight reduction, mental health—an issue close to my heart—and improved dental services. I do not know whether the Minister is aware of this, but when I was first elected in 2001, certain areas of my constituency had no access to dental services at all. That has changed—not since 2010, I hasten to add, but certainly under the last Labour Government.

County Durham also targeted drug and alcohol addiction. I give it credit for the work that it has done on that. In the light of the recent confessions of the Conservative party leadership contenders, I think that they could take note of the available drug and alcohol services. However, unlike those middle-class people who have confessed to drug use, the young people we are talking about will not go on to glittering careers in the media or elsewhere. They will be pushed into a cycle of poverty and desperation at local level, and will add to our shared tax burden, because their demand on health, police and other services will increase. I always look at public health as an investment in our local communities to ensure not only that we have good public health outcomes, but that we reduce demand elsewhere in the system.

Before my right hon. Friend moves on to the next section of his speech, I want to congratulate him on securing this important debate. What shocks me is the fact that in Woodhouse Close in my constituency, the healthy life expectancy is 10 years lower than that in Barnard Castle, yet those two places are only 10 miles apart. The notion of cutting public health funding seems grotesque.

My hon. Friend is correct. She highlights that example in County Durham, but there are many more between the more affluent areas and the pockets of poverty. They have been there since the 1980s and they need to be addressed. I am passionate about this issue; the idea that where someone lives should determine how long they live, in a wealthy country such as ours, is wrong. We should be able to tackle that in this day and age.

The new funding formula, ironically called the fair funding formula—trades description comes to mind—is based on the premise, pushed mainly by a lot of Conservative Members, that somehow the needs of individuals in health and other areas are the same across the nation. That is just not the case. The methodology put forward by the Ministry of Housing, Communities and Local Government means that County Durham will lose 38% of its existing budget—that is £18 million a year. It is the worst loser in this process, because the dedicated, ring-fenced public health budget is being abolished. It is being pushed in terms of the business rate retention scheme, which concerns me because it means that there will be areas where councils—I will refer to two in a minute—that get a budget increase will have no duty at all to ring fence that money and put it into public health. That is a retrograde step.

County Durham has achieved a lot: smoking is 22% down and teenage pregnancy is down to a level that is no longer statistically different from national averages. That certainly was not the case when I was first elected in 2001. We have made great strides getting cardiac mortality down from 31 deaths per 100,000 in 2001 to 5.7 deaths per 100,000 by 2015. A lot of effort has gone into addressing suicide rates, particularly among men. That is a credit to multi-agency work, including the police, the voluntary community sector and others. We have a good-news story in the sense that we have a good partnership-working approach in County Durham, yet the Government want to take that budget away.

It is a pleasure to serve under your chairmanship, Mr Owen. I congratulate my hon. Friend—

Right honourable.

He is my right hon. Friend, as he reminds me. I congratulate my right hon. Friend the Member for North Durham (Mr Jones) on securing this timely debate. He has been a real campaigner on this issue in County Durham for many years, and I know he takes a real interest in the public health issues we face in Durham.

The backdrop to the debate is this: we face cuts to public health provision in the north-east of England, primarily in County Durham, at the same time as we see a parade of candidates to be leader of the Conservative party, virtually all of whom want to cut taxes by billions of pounds. I am beginning to wonder where exactly the money will come from for any kind of public sector provision. Those claims of future tax cuts will probably end up being unfunded after Brexit, considering that the pot of tax money for the public sector will be reduced anyway.

As my right hon. Friend said, we may face cuts to public health services of around £18 million in Durham. I reiterate what he said about Surrey and Hertfordshire: under the new formula, there will be a £14.4 million increase for Surrey and a £12.6 million increase for Hertfordshire. That cannot be right when we consider the problems we have with health and healthcare provision in Durham. Sedgefield grew up, as a community, on coal. The number of men who worked down the collieries and are still alive today but have ailments related to that industry, such as lung disease and arthritis, just goes to prove that there is a requirement not to cut funding but to increase it.

If we look at random at some areas of health, we see that the figures for Sedgefield are worse than the national average in all of them. It has higher than the national average cases of dementia, patients on antidepressant drugs, patients on painkillers, asthma sufferers, people with high blood pressure, people with depression—the list goes on and on. We are talking about a formula devised by algorithm rather than by listening to what healthcare professionals say the county needs. People in Durham can expect to live a decent life in good health for seven years less than people in Surrey and nine years less than people in Hertfordshire.

Does my hon. Friend agree that, especially in mental health, the outcomes for an individual are better if we intervene early, at a young age, rather than leaving problems untreated for many years?

That is absolutely right, and that is an issue that the mental health trust raised. If those issues are picked up in the early years or when someone is still at school, they can be resolved. Leaving them just puts extra strain on the mental health trusts in the area.

I want to end on a positive note. I had some schoolchildren in Parliament yesterday from the primary schools in Ferryhill and Chilton. Cleves Cross Primary School in Ferryhill has a whole host of initiatives around mental health, eating properly and so on. Around the village, it is setting up edible walkways: instead of flower beds, it is planting vegetables, which people can pick when they mature. It is great that schools are coming up with those great initiatives, but if the same thing is to happen in schools across Country Durham, there needs to be central provision from public health services.

For wellbeing, there are initiatives to make sure that children have meals together with their families, and to ensure that if there are problems, other children and friends from school are invited along to share those meals. Such initiatives for those aged seven to 10 bode well for the future, and the public health service in Durham needs to look at them, but they must be funded.

We also need to think about how we develop best practice, so that we see such initiatives not just in Ferryhill and Chilton but in Consett, Barnard Castle, Durham city, Esh Winning and Easington—all over County Durham. There needs to be some strategy. As my right hon. Friend said, we need some kind of audit or impact assessment of what cuts to public health mean to areas like ours. What is the reasoning behind making cuts in Durham, where services are needed, and increasing funding in places such as Surrey and Hertfordshire, where they will not be?

Order. Before I call Dr Roberta Blackman-Woods, I remind Members that this an hour-long debate. I will call the Front-Bench speakers at 5.25 pm, with five minutes for the Opposition and 10 minutes for the Minister, allowing Mr Jones a couple of minutes to finish the debate.

May I say what a pleasure it is to serve under your chairmanship, Mr Owen? I thank my right hon. Friend the Member for North Durham (Mr Jones) for bringing forward this important debate. In 2013, there was a general welcome for the transfer of public health funding to local government, because it meant that public health and addressing public health issues could be integrated into the council’s service delivery objectives to better promote public health objectives.

On transfer, the grant to County Durham was £44.5 million, based on an assessment of health needs in the county by professionals—albeit one heavily influenced by the Government’s austerity programme. It is therefore extremely alarming that the Government now plan to move to determining the county’s grant level not on need but according to a new formula, under the huge misnomer of the “fair funding review”—it is anything but. The public health grant to County Durham will be reduced by a massive 38% while resources are transferred to more affluent areas of the country that have much better health outcomes. That is clearly madness and cannot be right.

The public health team in County Durham has done a good job, despite facing the hugely complex health issues discussed in some detail by my right hon. Friend. The county has an industrial past of heavy industry that has left a huge legacy of negative health impacts on the local community. Despite that, and through use of the public health grant, public health professionals, to whom we all pay tribute this afternoon, have done much. They have reduced smoking prevalence and teenage conceptions, and they also provide excellent support for vulnerable families on health and wellbeing issues, including access to mental health services. Those positive changes will be very much put at risk by the massive reduction in funding. In fact, given the severity of the problems Durham faces, it should be given more funding, not less.

Under the last Labour Government, my hon. Friend, along with my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), pioneered a free school meals initiative. Is she alarmed that, as I learned yesterday, the national school breakfast programme, which costs only £12 million nationally and affects quite a few schools—primary schools in particular—in her constituency, my constituency and other parts of County Durham, has still not had its funding guaranteed for next year?

My right hon. Friend makes an important point, which I am sure my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and I will take up in the coming weeks. That is an indication of how little the Government seem to be concerned about the children growing up in poor households.

Let us look at the Durham situation. The starkest indicator is the seven-year healthy life expectancy gap between females in Durham, currently at 59, and those in Hertfordshire, where it is 66, and Surrey, where it is 68. That gives rise to the question of why the Government are transferring resources from County Durham to Surrey and Hertfordshire. I know the Minister is new to her post, but it would be helpful to get an explanation of why the Government think that is a good idea, because we have not had one so far. The appalling health inequality is compounded by overall life expectancy figures, which for women are 81 in Durham compared with 84 for Hertfordshire and Surrey. There is a similar gap for men.

Let us look at other measures. Suicide rates in County Durham were above the national average, with 20.6 deaths per 100,000 of the population for males. On mental health, the rate of young people admitted to hospital because of self-harm is significantly above the national average. On alcohol, 33.8% of people in County Durham drink more than the low-risk guidelines recommended, and 290 people died due to alcohol-related problems last year. There were also 12,500 hospital admissions and 108 road traffic accidents. That suggests a significant problem that needs to be addressed.

Furthermore, the percentage of mothers smoking at the time of delivery is above regional and national averages. As my hon. Friend the Member for Sedgefield (Phil Wilson) made clear, breastfeeding rates are low, yet we know that it provides the best nutrition that babies and young children can get. Seven out of 10 adults in County Durham are overweight or obese, significantly more than the national average, and cardiovascular mortality rates are also higher than the national average.

It is a pleasure to serve under your chairmanship this afternoon, Mr Owen. I thank my right hon. Friend the Member for North Durham (Mr Jones) for securing this important debate and for his excellent speech. I also thank my hon. Friends the Members for Sedgefield (Phil Wilson) and for City of Durham (Dr Blackman-Woods) for their insightful and powerful contributions.

As I have said many times before, under the Tory-led coalition and the current Conservative Government, public health budgets have been cut by £700 million since 2013, with no financial settlement agreed so far post-2020. As we have heard, that means that vital public health services, such as those for smoking cessation, obesity, sexual health and many more, have been stripped back to the bare minimum. That has consequences: gonorrhoea is at its highest level in 40 years and syphilis at its highest level in 70 years; rates of smoking among pregnant women have risen for the first time on record; and Victorian diseases, such as scarlet fever, whooping cough, malnutrition and gout, have seen a 52% upturn since 2010, with an increase of over 3,000 hospital admissions per year.

Life expectancies are stalling and, in some places, declining, with the north-south divide as wide as ever in terms of health and productivity. For a number of us in this Chamber, it was the north-south divide that drove us into politics; to see it as wide as ever, and not closing, drives us to come to debates such as this one. This is a welcome opportunity to highlight and discuss public health in County Durham.

Overall, health and wellbeing have improved significantly in County Durham, but it still remains worse than the England average. Although it has improved in the north, the rest of the country has also improved, so the gap remains wide. In addition, large health inequalities still remain across County Durham, especially with regard to breastfeeding, babies born to mothers who smoke, childhood obesity and premature deaths. The impact becomes obvious when we look at life expectancy. As we have heard, a child born today in the most deprived areas of County Durham can expect to live between seven and eight years less than one born in the least deprived areas.

To give time for the Minister, can the hon. Lady finish up, please?

Yes, I will. I ask the Minister: when will the Government agree a future funding settlement for public health? I am under the impression that this has been postponed now until after the leadership contest. Local authorities and public health services need to know where they stand. As my right hon. Friend the Member for North Durham said when he opened the debate, we cannot have County Durham or other local authorities being left behind any longer.