Austerity: Life Expectancy 4.30 pm Louise Haigh
(Sheffield, Heeley) (Lab) I beg to move, That this
House has considered austerity and changes in life expectancy.
It is a pleasure to serve under your chairmanship, Mr
Paisley. Life expectancy is the statistical analysis of that most
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Austerity: Life Expectancy
4.30 pm
-
(Sheffield, Heeley)
(Lab)
I beg to move,
That this House has considered austerity and changes in
life expectancy.
It is a pleasure to serve under your chairmanship, Mr
Paisley. Life expectancy is the statistical analysis of
that most basic feature of health, life itself. Through
these linear annals, since the early years of Queen
Victoria’s reign, the health and wellbeing of this nation
have been catalogued. Life expectancy serves as the
statistical testimony of the social history of our country.
Through it are revealed the national crises and epidemics,
the giant leaps forward in public health and the great
workplace, environmental and social reforms that have
marked the last two centuries of change.
In the first collection, published in 1841, the English
life table gave female life expectancy as 41 years and male
as 40. The changes that followed in the subsequent 180
years have seen those doubled. The turn of the 20th century
saw a dramatic drop in infant and childhood mortality as
sanitation and living standards improved. Improvements in
the treatment of infectious disease, the creation of the
NHS, the Clean Air Act 1956 and improvements in maternity
care, living standards and incomes followed, and with them
rises in life expectancy that were sustained for almost a
century. Neither wars nor global convulsions could stem the
inexorable upward rise.
That was the great era of a remarkable revolution in public
health. By 2011, women’s life expectancy had reached 83 and
men’s 79. With three months added with each passing year, a
little girl born in Sheffield in 2011 had every right to
expect to live to be 100 years old. Those assumptions were
not based on any great improvements or medical discoveries,
but simply on the fact that our health was improving and
would continue to do so.
However, since 2011, something unusual and, in modern
British history, unprecedented has happened to life
expectancy: it has flatlined. For the first time in well
over a century, the health of the people of this nation has
stopped improving. It is of course axiomatic that life
expectancy cannot increase forever, and that a slowdown in
growth would eventually occur, but it is the sudden and
sustained rise in mortality rates that has so concerned
public health professionals and should concern us as
parliamentarians.
The period from July 2014 to June 2015 saw an additional
39,074 deaths in England and Wales, compared with the same
period the previous year. While mortality rates fluctuate
year on year, that was the largest rise for nearly 50
years, and the higher rate of mortality was maintained
throughout 2016 and into 2017. Provisional figures on the
number of weekly deaths indicate that winter mortality was
higher than usual in early 2015, 2017 and 2018.
Those recent trends contrast starkly with the long-term
decline in age-specific mortality rates throughout the 20th
and 21st centuries. Now, research published in The BMJ has
revealed the shocking fact that 10,000 more people died in
the first seven weeks of 2018 than in the same period in
2017. The study finds no external factor that might have
caused the 11% rise: no unusual cold snap, natural disaster
or flu outbreak outside normal expectations. The Office for
National Statistics has gone so far as to revise down its
official life expectancy projections by almost a whole
year, compared with the projections of just two years ago.
That means 1 million further earlier deaths are now
projected over the next 40 years.
The Financial Times has reported that the deceleration of
previous rises in life expectancy has cut £310 billion from
future British pension fund liabilities. As Professor Danny
Dorling of the University of Oxford has noted, what is
happening with life expectancy,
“is no longer being treated as a temporary decline; it is
the new norm.”
Dorling and Dr Hiam have looked at other extraneous factors
to explain those projections. A rise in birth rates?
No—birth rates are falling. More migration? The ONS now
projects less inward migration over the next 40 years.
How then to explain an increase of 40,000 deaths on what
was projected for this year, and an extra 25,000 deaths for
next year? We can only conclude that there has been a sharp
deterioration in the collective health of this country.
Dominic Harrison, Director of Public Health for Blackburn
and Darwen, and an adviser to Public Health England, has
said that the figures are a “strong and flashing” amber
light that,
“something is making the population more vulnerable to
avoidable death.
We know that in some areas the picture is even more
concerning, with higher death rates and life expectancy
falling. Research has pinpointed 29 areas where we see
falling life expectancy for women; chief among them are
seaside towns and post-industrial areas.
-
(Barnsley East)
(Lab)
I congratulate my hon. Friend on securing this important
debate. Barnsley, the area I represent, has one of the
lowest life expectancies in the country. Does she agree
that post-industrial towns such as Barnsley need more
funding and resources to tackle the inequality between
north and south?
-
I could not agree more with my hon. Friend. She makes an
important point, because it is exactly those
post-industrial towns and regions that were invested in so
heavily under the last Labour Government and have seen a
fall in life expectancy over the last seven years.
Regional and class inequalities in health, as we know, are
nothing new, but there is a more distinct change now taking
place. In my city of Sheffield, the healthy life expectancy
for women of 57.5 years has dropped by four years since
2009, while healthy life expectancy across the country has
basically held steady. There are already too many areas in
our country where healthy life expectancy is unacceptably
low. The average baby girl born in Manchester between 2014
and 2016 will live to be 79, but only until age 54 will she
be healthy. That is almost one third of her life spent
grappling with health issues that will not affect the
average woman born on Orkney until she is 71 years old.
-
Mr (Coventry South)
(Lab)
One of the factors, if not the sole factor, is that when we
look at the past recession, most of the burden has been
inflicted on women generally. We all know that. That is an
anxiety factor, and there are good examples of it. One good
example is the women of the Women Against State Pension
Inequality Campaign. A lot of them were due to retire and
had plans; those plans have gone now, because they will not
get their entitlement. There are a number of factors that
affect women more than men, particularly during a
recession.
-
My hon. Friend is absolutely right. It has particularly hit
older women, and I will come on to that disproportionate
impact shortly.
Something is adversely affecting the health of our
population, and as my hon. Friend has just said, none of it
is happening in a vacuum. The observation is unavoidable
that these patterns coincide with the era of austerity. It
is simply inconceivable that the state of our public realm,
welfare system, housing, fuel poverty, child poverty and
our NHS have nothing at all to do with it. The number of
NHS trusts with budget deficits has increased sharply since
2015, as have waiting periods for elective surgery and
waits for urgent care. Hospitals are now warning of an
“eternal winter”, as records show the number of patients
receiving urgent care within four hours fell to a record
low in March 2018. Almost half a million patients waited
longer than 18 weeks for planned care.
This week, the Royal College of Physicians raised the
alarm, writing to hon. Members to tell us that hospitals
are “underfunded, underdoctored, overstretched”. That will
not be news to anybody who has been anywhere close to the
NHS in recent years. However, the shortage of doctors and
consultants revealed by the RCP is systematic and shocking;
43% of advertised consultant posts last year in Yorkshire
and the Humber were not appointed to. In acute medicine,
only five out of 26 posts were successfully appointed to.
The RCP concludes that these workforce shortages have
direct implications for patient safety. Although our
hospitals still provide expert care, relentlessly drawing
on the good will of staff—who cannot possibly provide the
best possible care when under such pressure—is
unsustainable.
Issues within the NHS are being compounded by problems with
the provision of adult social care. According to the King’s
Fund, in 2016-17 there were 380,000 cases of a delayed
transfer of care due to patients’ awaiting a hospital
assessment. A similar number were waiting for a place in a
nursing home. It is little surprise that the sorry state of
our social care system should be linked to a fall in the
life expectancy of older women living in the poorest parts
of the UK, because that cohort has seen a disproportionate
fall in their life expectancy. For the first time, health
inequality is rising because the most deprived are
suffering with poorer health.
I have often heard it said that the elderly have been
protected from the worst ravages of austerity, but the
elderly who live in deprived communities have been hit many
times over. Relevant to this debate, they have been hit
first by the cut in pension credit for lower-income groups
and then through the funding pressures on adult social
care. Of course, it is in the local authorities serving the
most deprived areas that these effects have been felt the
most.
-
Mr (Slough)
(Lab)
My hon. Friend is making an excellent speech, especially on
the impact on the elderly. However, does she agree that
more and more children are now being impacted by austerity?
Slough Foodbank has noticed an increase in the number of
families attending its food bank, saying:
“When we checked the vouchers, we discovered that there had
been an increase of 16% in the number of children we helped
in 2017 compared to 2016.”
Does my hon. Friend agree that it is important that child
poverty is addressed now? There are lifelong implications
for those who grow up in poverty, such as poorer academic
results, employment prospects and life expectancy.
-
I am glad that my hon. Friend raises that important point,
because I am not able to address all the factors behind
declining life expectancy. The British Medical Association
raised that point this week, saying it is very concerned
about the 5 million children growing up in poverty and the
implications that that will have in the future on life
expectancy.
-
(Delyn) (Lab)
I do not want to divert my hon. Friend from the main course
of her speech, but she knows that, over the past 30 years,
infant mortality has fallen by 60%, yet from 2015 onwards
it has risen in England and Wales each year. Holywell
Central and Flint Castle wards in my constituency have
child poverty rates of 43% and 42%. We have seen an
increase of 100 children in poverty in my constituency in
the last year. This is a long-term issue, which we need to
address.
-
My right hon. Friend is absolutely right: these are
long-term issues, which need addressing. They are all the
more heartbreaking because we have seen decades of
progress, and we all assumed that that would only go in one
direction; little did any of us imagine that we would see a
rise in infant mortality in the sixth-richest country in
the world. These figures are, quite frankly, inexcusable.
On social care, care homes in deprived communities often no
longer receive enough to cover the costs of care, which
inevitably compromises the quality that they are able to
provide. For those in such communities who cannot afford
private care homes, that reduction of quality, and in some
cases the lack of any available residential care at all,
has had a punishing effect.
All Members present will have received casework regarding
those still in their homes in the community who rely on
care packages. Their care is simply unacceptable, relying
on care workers who are paid far too little and who often
do upward of 25 care visits every single day. There is not
a chance, even by unsustainably drawing on the boundless
good will of those care workers, that visits could last for
30 minutes, as defined by official guidance. It is beyond
the realms of possibility. Those millions of hours of lost
contact time for the 470,000 vulnerable—predominantly
elderly—people who use home care will have undoubtedly
compromised their long-term care and support needs and the
management of multiple conditions.
It perhaps should not be a surprise that the rise in
mortality and the fall in life expectancy came from
precisely that cohort—older women living alone in poorer
areas. In many senses, they were the early-warning sign of
the deeply troubling trend in increasing mortality. This
cohort, more reliant than any other on a functioning,
effective, compassionate state providing quality support,
have been badly let down in recent years. It should be a
source of national shame that elderly women in some of the
most deprived areas of our country are living in isolation,
not properly cared for, and are losing their lives because
the state has not supported them. However, it is not just
that cohort of women. Some 7% of the extra deaths in
2016-17 were of people aged between 20 and 60. Almost 2,000
more younger men and 1,000 more younger women have died
than would have if progress had not stalled.
I am sure that the Minister cannot look at the evidence
presented here today, or at the research undertaken over
the past two years, and not want to take steps to tackle
those shocking statistics and to prevent those lives from
being cut short. It is therefore critical that Ministers
and the Government take seriously the fall in life
expectancy and the evidence behind the growth in mortality.
Up to now, Public Health England has regrettably tried to
attribute it to the greater prevalence of flu. However, as
Loopstra noted in her report:
“If Public Health England’s attribution of rising mortality
to cold weather and flu is correct, then it should lead to
an elevation of mortality in regional swathes across the
nation. However…trends have varied considerably across
local authorities, with no apparent geographic patterning
consistent with regional outbreaks.”
The rise in unexpected mortality and the concurrent fall in
life expectancy represents a significant moment in the
history of public health in this country, yet the
Department of Health has so far rejected the call from
public health professionals for an inquiry into the sharp
rise in deaths. I repeat that call today, and ask the
Minister to look very seriously at the evidence presented
on the link between life expectancy and austerity.
I will end on the words of Danny Dorling and Stuart
Gietel-Basten, who have undertaken so much of the research
in this area:
“demography is not destiny. Projections are not
predictions. There is no preordained inevitability that a
million years of life need be lost…but only through
politics comes the power to make the changes that are now
so urgently needed.”
The Minister has that power in her hands, and there can be
no more pressing question for her than to ask why the
citizens of our country are dying sooner than they should.
I hope she leaves no stone unturned in pursuit of that
answer.
-
(in the Chair)
I do not intend to put a formal time limit on speeches.
However, there are two Opposition spokespersons as well as
the Minister, and I would like to start calling the
Opposition spokespersons just after the hour, so if Members
could speak for about five minutes each, that would be
helpful.
4.47 pm
-
(South West
Bedfordshire) (Con)
I pay tribute to the hon. Member for Sheffield, Heeley
(Louise Haigh) for bringing this important matter before
the House.
I will start with the economics, because the debate relates
to austerity and life expectancy. Government Members would
probably talk about living within our means and would put
to the hon. Lady the argument that the consequences for the
poor and the vulnerable of a country continuing to live
beyond its means are very grave. Economic history tells us
that when countries lose control of their finances, it is
not the well-to-do or the comfortable who suffer, but the
poor and the vulnerable. That needs to be put very firmly
on the record.
It is also worth noting that the Commonwealth Fund, which
is an independent body, last year pointed out that our NHS
was the best health system of the 11 different health
systems it looked at. If we look at our outcomes on
strokes, heart attacks and cancer, we see that they are
getting better—there are 7,000 people alive today who would
not be alive had we not seen that improvement in cancer
outcomes.
Looking at the data across Europe, we see that what is
happening in the UK is part of a trend, because life
expectancy is also falling in Italy, Spain, France and
Germany. Some of those countries spend quite a lot more on
health than we do. France and Germany spend one percentage
point of GDP more on health than we do, yet they have also
seen that downward trend.
-
Dr (Central Ayrshire)
(SNP)
Will the hon. Gentleman give way?
-
I will in a moment. There has been no austerity in Germany,
because the Germans live within their means and run a big
budget surplus. They have a trade surplus with China.
However, life expectancy is falling in Germany as well. We
need to look at these wider factors and at the European
context. I will now of course give way, with great
pleasure, to my former colleague on the Health Committee.
-
Dr Whitford
Does the hon. Gentleman also recognise from the data that
there is not a similar fall in life expectancy in the
Scandinavian countries and that it is wrong to look
narrowly at health services, because the biggest driver in
relation to life expectancy is poverty?
-
I will come on to those very important public health issues
and what we need to do about them, because I care
passionately about them, as probably everyone in the
Chamber does. As the hon. Lady is from Scotland, it is also
worth looking at what is happening there, because Scotland
offers free adult social care and spends a higher amount on
healthcare per head than England, yet still has a lower
life expectancy than England. We need to get those issues
firmly—
-
(Vale of Clwyd)
(Lab)
Will the hon. Gentleman give way?
-
If the hon. Gentleman will forgive me, I am going to make a
bit of progress, because I am mindful of your admonition,
Mr Paisley, not to take too long and I want all the
Opposition Members to have their say as well.
What do we need to do about this situation? We have 25%
more nurses coming into the system—that training has
started—and 25% more doctors coming into the system. We
will get the social care Green Paper in July; we cannot get
it a second too soon. I for one, as a Conservative Member
on the Government side of the House, put up my hand: I want
to see increased spending on health and social care,
probably through a hypothecated tax. I think that is
necessary. If we want quality, we have to pay for it.
We also need to consider issues such as obesity, exercise,
air quality and housing quality. If we look at the obesity
epidemic in our country, we see that it is now the poor who
are much more obese than other social groups, and we know
what a massive impact obesity has on health through
diabetes and so on. We have to do better there. Why are
only 2% of journeys in London made by bicycle? In
Amsterdam, it is 30%. The children there cycle, there is
much less childhood obesity, and that feeds into better
health outcomes and better life expectancy. I chaired the
Health Committee’s Sub-Committee that looked into air
quality. We need to do a lot better on air quality, and we
need there to be good- quality housing.
I salute the intentions of the hon. Member for Sheffield,
Heeley. She is right to bring this issue before the House.
But I would tell her to think of the broader economics and
to look at the European comparisons and those important
drivers of public health as well.
4.52 pm
-
(Vale of Clwyd)
(Lab)
I congratulate my hon. Friend the Member for Sheffield,
Heeley (Louise Haigh) on securing the debate. The issue of
stalling life expectancy, and indeed of falling life
expectancy in some areas, is very serious. The hon. Member
for South West Bedfordshire (Andrew Selous) talked about
living within our means, but people in my constituency are
dying early without their means.
We must reach out across the party political divide on this
issue, because the constituencies affected are in poorer
areas of the country, as has been mentioned, but they are
not anomalies; many different parts of the country are
affected. I will give an example. Life expectancy for
females at age 65-plus has fallen over the past five years
by 0.8 years in Stevenage and by 0.6 years in Cheltenham.
Life expectancy for males at birth has fallen in my county
of Denbighshire by 0.6 years and by 0.9 years in
Bromsgrove. This issue affects a great many of our
constituents, across the political divide and across the
country. There must be the political will for us to
understand the root causes of what has resulted in this
debate.
-
(Hove) (Lab)
Does my hon. Friend agree that what is responsible for this
situation is not just the restraint in spending, but the
way in which spending restraint and austerity have played
out on the frontline? The issue is the withdrawal of mental
health services for people living at home. It is the
teaching assistants who have all but been removed. In
particular, it is the impact on services that help people
to stay at home and manage conditions and the cuts to
frontline policing that have led to the evisceration of not
just life chances, but life expectancy itself.
-
I agree. All those issues are part of the mix as to why we
are seeing a decrease in life expectancy. It is a complex
issue that needs further inquiry.
-
(Blaenau Gwent) (Lab)
Will my hon. Friend give way?
-
I am afraid that I must move on, because I have been
getting eyes from the Chair and I do not want to upset Mr
Paisley.
The Government have said that the situation is a blip
because of flu or the cold weather. The Department of
Health has seemed to downplay fears about life expectancy,
pointing out that smoking rates have gone down and cancer
rates have gone down, but that is all the more reason to be
worried. If those indicators are going down and life
expectancy is going down, what is causing that? Those are
good indicators, but there are some bad outcomes for
certain people in certain areas.
A report by Professor Martin McKee, whom I had the pleasure
of meeting yesterday, notes that the most recent period
“has seen one of the greatest slowdowns in the rate of
improvement”
in life expectancy
“for both sexes since the 1890s”.
The relative data on life expectancy today is comparable to
a time before workers’ rights, advancements in medicine and
technology, and the welfare state. That slowdown, as
reported by the Office for National Statistics last July,
shows that the increases in the previous period, before
2010, meant that for every five years that a woman was
living, she could expect to live one year extra. Now it is
the case that for every 10 years that a woman is living,
she can expect to live one year extra. The rate has been
halved.
Let me add to those figures some of my own, which I
received through parliamentary questions that I tabled in
January. Between 2009-11 and 2014-16, 19.8% and 20.3% of
local authorities reported a decline for females at birth
and at 65-plus respectively. There are certain areas of the
country, certain demographics and certain genders—women—who
are feeling this the most. That is no surprise, because 80%
of the austerity cuts made since 2010 have fallen on the
shoulders of women. The link between life expectancy and
cuts to social care budgets has already been highlighted.
The hon. Member for South West Bedfordshire mentioned
Scotland. I do not want to stick up for the Scots: they can
do a good job themselves, especially the hon. Member for
Central Ayrshire (Dr Whitford), with her medical
background. However, there are national and regional
variations within the United Kingdom. If we look at local
authorities in England, we see that 22% of them have seen a
decrease in life expectancy.
-
(in the Chair)
Order. Could the hon. Gentleman draw his remarks to a
conclusion?
-
In Wales and Northern Ireland the figure is 18%. In
Scotland it is only 6.2%. In the north-east of England, 27%
of local authorities have seen a decrease in life
expectancy. There are regional differences. What we can
draw from that is that where there has been devolution and
kinder, gentler Administrations, there has been a less
sharp decline.
Hope is a powerful motivator in the way we make decisions.
Messages of hope won historic victories for my party in
1945 and 1997 and denied the current Government their
majority last year. What the Conservatives proposed at the
last election, after seven years of austerity, was another
10 years of austerity. There is learned helplessness out
there. People are sick and tired, and they are dying
because there is no hope. They have lost income—£2,000 for
most people and £5,000 for teachers. Austerity is biting,
not just in medicine but in social care, and affecting
mental health and physical health. In the short time I have
left, Mr Paisley, it is worth noting—
-
(in the Chair)
Very little time.
-
There is very little time, so I will draw my comments to a
close by saying that Professor Martin McKee and other
academics, from Oxford and other universities, want the
Health Committee to have an inquiry on this issue. It is
complex. I have mentioned some of the causes, and other
MPs, from both sides of the Chamber, have mentioned some of
the other causes of the decline in life expectancy. It is a
complex mix of issues and deserves an inquiry by the Health
Committee.
4.59 pm
-
(Witney) (Con)
It is a pleasure to serve under your chairmanship this
afternoon, Mr Paisley. I shall keep my comments brief
because many other Members wish to speak. I also take the
opportunity to congratulate the hon. Member for Sheffield,
Heeley (Louise Haigh) on securing a debate on this
important matter.
When people think of the rolling hills of west Oxfordshire,
I appreciate that poverty is not one of the things that
immediately springs to mind, but that is to ignore some of
the very real issues present in my constituency. There are
real factors and pockets of deprivation, and rural poverty
in particular is a real concern, so the issue is very live
for those of us in the green shires, as well as for those
in urban environments. I would like the House to bear that
in mind.
The hon. Lady made some important points today, but I
suggest that it is simplistic to look at a straightforward
line between necessary control of public spending and an
impact on life expectancy. As we have heard, a whole range
of factors affect life expectancy and mortality—quality of
life, mental health, obesity, housing, air quality—and
simply to draw that straightforward causation line is to
make things far too simple, when in fact we are dealing
with a complex issue.
-
(Lewisham, Deptford)
(Lab)
The hon. Gentleman talked about it being simplistic to talk
about the cuts, austerity and so forth, but let us talk,
for example, about the cost of a pupil going to a pupil
referral unit being 10 times more expensive, or the cost of
someone in prison being £35,000 per year. If we invested
such money earlier in education, mental health support or
support for our young people, we would save money. Indeed,
he is the one coming out with the simplistic argument.
-
The hon. Lady will not be surprised to hear that I do not
agree with her. She made a number of points, but I am
simply suggesting that the issue is complex. Saying simply
that necessary control of public spending leads to an
increase in mortality, as is being suggested, is too
simplistic.
Let us look at the example of Scotland—this is a simple and
important point—where free adult social care is offered and
more is spent on healthcare per head than in England.
However, life expectancy there is still lower than in
England. That simply underlines my point, which I make in
response to the hon. Member for Sheffield, Heeley, that it
is too simplistic to say that that link between spending
and outcomes is as straightforward as she would make out.
That cannot be the case, or the situation in Scotland would
not be as it is.
For that matter, let us look at the outcomes across Europe.
The Public Health England figures are quite striking,
particularly in graph form. They show that not only do we
have a slight dip in life expectancy figures over the
course of the past year or so, but so too do Italy, Spain
and, strikingly, France—a dip almost identical to what we
have seen in the UK, despite the fact that I understand the
French spend the highest amount in Europe on healthcare. We
are clearly dealing with a much more complicated situation,
and lifestyle factors are crucial. Those are not restricted
to the UK.
I am glad that the hon. Member for Sheffield, Heeley has
accepted that life expectancy cannot be expected to
increase forever. That is of course common sense and a
point that she readily accepts, but the point bears
repeating and remembering. For a number of reasons we have
had extraordinary success in increasing healthcare over the
past few years, but we are now faced with the results of
that—an ageing and increasing population, therefore with
increased complexity of morbidity factors.
I therefore applaud the approach being taken by the
Government. We are not only investing as much as possible
within the constraints of sensible Government spending, but
ensuring that we address the lifestyle factors that can
affect life expectancy in the round. However, as I continue
to speak, I can see you looking at me with concern, Mr
Paisley, so I will confine myself to those remarks.
5.03 pm
-
Dr (Central Ayrshire)
(SNP)
The hon. Member for Sheffield, Heeley (Louise Haigh), whom
I commend for securing the debate, spoke a lot about the
impact of austerity on health and social care. To pick up
on that, I should say that austerity has a triple impact.
Spending on health and social care ends up being strangled,
as we have seen: the reduction of the annual climb in
expenditure from 3.5% to approximately 1%.
Of the two other impacts, one is the economic impact that
we have faced ever since the crash at the end of the 2000s
and which has been felt throughout Europe—I have a German
husband, and I can tell you that while Germany itself may
have a surplus, there are people there who are struggling
and have not seen the wage rises that they would have
liked. Also, in this country especially, we have seen
welfare cuts, which have removed social security from
people, creating particular areas and populations of
poverty. That has particularly hit the disabled, children
and pensioners.
There has been a lot of talk about healthcare. After 33
years as a doctor, I have to say that we can have far too
much faith in what medicine can do to change overall life
expectancy. We have some impact, but the biggest driver of
ill health and the biggest impact on life expectancy is
poverty and deprivation. That is something we have seen
increasing in this country.
For example, over the past 20 years the rate of pensioner
poverty dropped 28% to 13% by 2011-12, but it has now come
back up to 16%. Twenty years ago in England, child poverty
started out at 33%, got down at best to 27% in 2011-12, and
is now back up at 30%. In fact, Scotland has the lowest
rate in the UK: we started at a similar level, got down to
21% in 2011-12, and are still the lowest, at 24%. However,
we have seen the same uplift, and that is because of
aspects of social security and the impact of things such as
the removal of child tax credits or the cuts to all the
various social security supports. Over the past few years,
similarly, poverty in general has risen slightly in
England, Wales and Scotland, although Scotland has the
lowest poverty rate, at 19%.
Important impacts of poverty on health include housing and
fuel. People in the lowest 20th will be spending a third of
their income on housing and, in the north of Scotland,
another third on fuel. People are literally being squeezed
and are struggling to eat well, which of course impacts on
their health. We can see big differences in wealth across
the UK. There is approximately twice the wealth in
Kensington and Chelsea as in Glasgow—as well as more than
10 years’ difference in life expectancy.
As has been mentioned, the improvement in life expectancy
has halved, from three months to approximately six weeks,
although in Scandinavian countries the improvement
continues, because social support and the social fabric is
something they invest in. In Scotland the life expectancy
deprivation gap has narrowed from 13.5 years to nine. That
gap can, in the raw sense, be influenced by healthcare—we
manage to keep people alive—but we are not keeping people
healthy. They are surviving but accruing more and more
diseases. In Scotland, therefore, the healthy life
expectancy gap has increased from 22.5 years to 26 years.
People are struggling with all of that, and it results in a
much higher health spend and much more pressure on the NHS.
That is exactly what Members have been saying: there is no
sensible saving of money if it ends up being spent
somewhere else.
Infant mortality is a measure of the impact of poverty on
health that is used right across the world. For three
decades, infant mortality had been dropping; it has now
taken a small uptick. In Scotland, again, we have the
lowest infant mortality rate—0.5 per 1,000 live births
lower than in England—but it too has gone back up. Look at
the contrast between the wealthiest and poorest areas: in
the wealthiest areas, just over 2.5 babies per 1,000 live
births will die within a year; and in the poorest areas the
rate is more than double that, at 5.9 per 1,000 live
births. Read Professor Marmot, and we cannot escape what we
have known for 20 years: that the biggest impact on
survival, quality of life and outcomes is poverty—and the
biggest driver of poverty is austerity.
5.09 pm
-
Mrs (Washington and
Sunderland West) (Lab)
It is a pleasure to serve under your chairmanship, Mr
Paisley. I thank my hon. Friend the Member for Sheffield,
Heeley (Louise Haigh) for securing this important debate
and for her excellent and well-informed speech. It is of
great interest—not only to me, but to the public, who I am
sure will be listening closely to the Minister’s response
today. I also want to thank the hon. Members for South West
Bedfordshire (Andrew Selous) and for Witney (Robert
Courts), my hon. Friend the Member for Vale of Clwyd (Chris
Ruane) and the Scottish National party spokesperson, the
hon. Member for Central Ayrshire (Dr Whitford), for their
thoughtful and passionate speeches, even though I do not
necessarily agree with all the things that were said.
As we heard, life expectancy has always gradually
increased. Between 1920 and 2010, it increased from 55 to
78 years for men and from 59 to 82 years for women.
However, the improvement began to stall in 2011 when the
coalition Government came in. That cannot be just a
coincidence. Since then, for the first time in over a
century, the health of people in England and Wales has
stopped improving, and has flat-lined ever since.
I must emphasise that researchers do not believe that we
have reached peak life expectancy. The Nordic countries,
Japan and Hong Kong all have life expectancies greater than
ours and they continue to increase, so why is life
expectancy flat-lining in the UK? Why is Britain being left
behind and fast becoming the sick man of Europe? I know
that the hon. Member for South West Bedfordshire said that
that was not the case, but academic research by Danny
Dorling, published in November 2017, which I have here,
said:
“Life expectancy for women in the UK is now lower than in
Austria, Belgium, Cyprus, Finland, France, Germany, Greece,
Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Malta,
the Netherlands, Norway, Portugal, Slovenia, Spain, Sweden,
and Switzerland. Often it is much lower. Men…do little
better.”
I think the hon. Gentleman needs to check his facts.
The life expectancy gap between the richest and poorest in
this country is nothing less than shameful. According to
the Institute of Health Equity, the longest life expectancy
in the country is, not surprisingly, in the richest
borough: Kensington and Chelsea. Men in Kensington and
Chelsea can expect to live to 83 and women to 86.
Unsurprisingly, you will find the lowest life expectancy in
my part of it: the north and Scotland. In Glasgow, life
expectancy for men is 73 and in West Dunbartonshire it is
79 for women—10 years of difference for men and seven years
for women. The difference within the richest borough,
Kensington and Chelsea, is even more stark. Despite living
in the richest borough in the country, the most
disadvantaged within it can expect to live 14 years less
than their most advantaged counterparts. Does the Minister
agree that this is completely unacceptable?
The north-south divide remains as relevant as ever when we
look at healthy life expectancy—the years that people can
expect to live a healthy life. In the south-east, the
healthy life expectancy is 65.9 years for men and 66.6
years for women. However, people can expect a shorter
healthy life expectancy in the north-east, where men have a
healthy life expectancy of 59.7 years and women 59.8 years.
That is significantly lower than the England average.
Looking after those people during that unhealthy part of
life means a huge cost to the NHS. It also means that the
inequality gap in healthy life expectancy at birth between
the south-east and the north-east is 6.2 years for men and
6.8 years for women.
What will the Minister do to address the life expectancy
and healthy life expectancy gap between the rich and poor,
and the north and south? It is simply unacceptable that the
least advantaged in our society bear the brunt of this
Government’s policies—wherever they live. Austerity is not
a choice. It is a political ideology, which harms the
poorest and the most vulnerable in our communities.
-
(South Suffolk)
(Con)
Rubbish!
-
Mrs Hodgson
It is not rubbish. Professor Sir Michael Marmot warned:
“If we don’t spend appropriately on social care, if we
don’t spend appropriately on health care, the quality of
life will get worse for older people and maybe the length
of life, too”.
Sadly, we have seen this across the board. Despite the
growing pressure on our health and social care service, the
Government are responsible for spending cuts across our
NHS, social care and public health services. While demand
continues to increase, the Government have taken away vital
funding, which could close the life expectancy gap.
Since local authorities became responsible for public
health budgets in 2015, it is estimated by the King’s Fund
that, on a like-for-like basis, public health spending will
have fallen by 5.2%. That follows a £200 million in-year
cut to public health spending in 2015-16. Further real-term
cuts are to come, averaging between 3.9% each year between
2016-17 and 2020-21. On the ground, that means cuts to
spending on tackling drug misuse among adults of more than
£22 million compared with last year and smoking cessation
services cut by almost £16 million. Spending to tackle
obesity, which the hon. Member for South West Bedfordshire
mentioned as a cause of shorter life expectancy, has also
fallen by 18.5% between 2015-16 and 2016-17 and further
cuts are in the pipeline. These are vital services for
local communities and could benefit their health and
lifestyle, but sadly they continue to be cut due to lack of
funding.
How does the Minister expect to close the life expectancy
gap without investing properly in vital public health
services? An ounce of prevention is better than a pound of
cure. The Government must invest in public health and
prevention services, as that could play a significant role
in closing the life expectancy gap that we are discussing.
When the Prime Minister made her first speech on the steps
of Downing Street—the Minister is nodding, because she
knows the quote—she said:
“if you are born poor, you will die on average nine years
earlier than others.”
We were all pleased that the Prime Minister highlighted
that issue, but I have been left disappointed with her
Government’s lack of response to tackle it. We on this side
of the House are committed to ensuring that our health and
care system is properly funded, so that all children are
given the best possible start in life and older people are
treated with the respect and dignity that they deserve. I
hope that the Minister will clearly outline what the
Government will do to close the life expectancy gap.
-
(in the Chair)
Before I call the Minister, I thank all hon. Members for
complying so obediently with the timing that I requested.
5.17 pm
-
The Parliamentary Under-Secretary of State for Health
(Jackie Doyle-Price)
It is a pleasure to see you in the Chair, Mr Paisley. I
thank all hon. Members who have contributed. Clearly, we
all want the best possible outcomes for all our
constituents, and it is in that spirit that we approach
this debate. I congratulate the hon. Member for Sheffield,
Heeley (Louise Haigh) on securing the debate. I know her
constituency well. Actually, looking at hon. Members
opposite, I know the constituency of the hon. Member for
Lewisham, Deptford (Vicky Foxcroft) well, also. That really
brings into stark relief some of the issues we are talking
about, because at the heart of the issue of life expectancy
is the issue of inequality. I can speak from personal
experience in my own constituency. The hon. Member for
Washington and Sunderland West (Mrs Hodgson) talked about
the differences between north and south, and rich and poor.
Within my constituency there is a 10-year difference in
life expectancy in the two-mile trip from the north of my
constituency to the south, where it is poorest.
We are all acutely aware that inequalities lead to lower
life expectancy. It would be a poor Minister for
Health—indeed, a poor Member of Parliament or anyone
involved in public life—who did not think that was
important. It is important that we address it and we are
determined to do so. I will run through some things, which
tell a better story than the stark figures we have heard
today. I will also address some of the points made about
those figures, because I think it would be premature to
draw too many conclusions at this stage about the causes of
those and whether this is a long-term trend.
My hon. Friend the Member for South West Bedfordshire
(Andrew Selous) also made some wise points. Ultimately, we
can only spend what we collect from taxpayers. We are
having an active debate on the extent of the funding we
need to make available for health and social care. In this
70th anniversary year of the founding of the NHS, it is
appropriate to focus on that. We will continue,
notwithstanding the fiscal challenges that we face, to
prioritise spending on health.
It is important to emphasise that this dip in life
expectancy is not unique to the UK. We have seen it
elsewhere in Europe. We need to be circumspect about
drawing too much by way of conclusion.
The hon. Member for Washington and Sunderland West
mentioned the Prime Minister’s speech. I want to supply the
context of the Government’s approach against the background
of that speech. The Prime Minister made it a priority to
fight injustice and inequality. Ultimately, we know that by
focusing actions on the people, communities and localities
with the greatest needs, we will achieve the best health
outcomes. As the hon. Lady said, we will also reduce
long-term demand on the NHS and social care services, so it
is smart to focus our strategy on tackling inequality.
We need to be honest about facing up to what the sources of
inequality are. Sometimes, those will make us
uncomfortable. One of the most disadvantaged groups in our
society is those with learning disabilities. They will live
20 years less than the rest of us. For me, that is a very
uncomfortable truth to live with. Successive Governments
have tried to direct resources to help that group of
people, but it is still not working. That leads to the
realisation that this is as much about behaviour and
leadership as it is about money.
-
Putting that aside for one moment, could the Minister
explain to Members of the House why infant mortality rose
for the first time in 30 years in 2016 and 2017? If it is
not linked to the issues that my hon. Friend the Member for
Sheffield, Heeley (Louise Haigh) mentioned, what is it
linked to?
-
The right hon. Gentleman knows that we have made tackling
that a priority. It is too early to draw any conclusions.
It is the case that poverty is a big source of inequality,
but we need to do more work before drawing conclusions.
Having developed the evidence, we will act. There is a
reason that we have developed a national maternity safety
strategy. There is a reason we are focusing resource on the
perinatal phase, because we recognise it is critical. We
will also continue to spend money on the healthy living
supplements to give children a better start in life and to
tackle some of those inequalities.
-
Dr Whitford
The Minister accepts in her speech that poverty is a big
driver of these changes and talks about doing more, but we
expect that over the next few years another quarter of a
million children will be driven into child poverty. It is
not a matter of doing more. In fact, the policies at the
moment are making the situation worse.
-
I do not accept that. The real issue for us as a Government
is being able to make those interventions that address the
sources of inequality. It is about giving practical steps,
which I will come to in more detail.
The hon. Member for Sheffield, Heeley referred to the
article in The BMJ by Hiam and Dorling about the spike in
mortality and winter deaths. She was absolutely right to
highlight that. We must pay attention to emerging studies.
However, using the total number of deaths can be misleading
and needs to be put in the broader context. It does not
take account of the ageing population and the fluctuations
in population numbers. We use the age-standardised
mortality rate as the accepted measure, which looks broadly
stable. Clearly this is not something we should be
complacent about, and we should continue to keep a very
close eye on trends in those numbers.
I mentioned people with learning disabilities living for 20
years less than the rest of us. It is good that that figure
has come down since 2000. Their life expectancy has risen
by seven years since the millennium. We must encourage that
direction of travel by supporting them to live full,
healthy and independent lives. That goes to show that
having better health is not just an issue for the NHS and
health services, but is about having more support to get
people into work and to help them to live in the community.
We need to use every interface with the state to achieve
that.
If we take a lifestyle approach to securing the best
possible health outcomes and tackling inequalities, an
individual’s start in life is the beginning of that. We are
focusing on pregnancy through early years and into old age
to ensure that every child gets the best start and journey
through the rest of their life. Public Health England is
leading programmes to ensure that women are fit during
pregnancy. It is leading programmes to ensure that children
are ready to learn at two and ready for school at five. We
want to continue to support smoke-free pregnancy, which
leads to better health for children. Central to that is
local commissioning driving best-quality service and
interventions as appropriate.
We are obviously very concerned about childhood obesity. If
we do not tackle it, it will set people up for poor life
expectancy in the longer term. It is worrying to see the
number of children entering school at the age of five who
are already obese. We need to leave no stone unturned to
achieve early intervention. Broader public education about
the impact of sugar is helping, but there is much more we
can do to encourage people to adopt healthier lifestyles.
-
Could the Minister confirm what the net change in investment
in early intervention has been since the Conservatives came
to power?
-
I cannot give the hon. Lady that information now, but I will
write to her.
Alcohol is a source of poor health outcomes, so we are also
doing much to tackle that. I am in dialogue with Members on
both sides of the House about supporting the children of
alcoholic parents, recognising that they are a particular
need group. I thank those hon. Members who have been
associated with that.
-
Dr Whitford
With Scotland having been the first place to ban smoking in
public places, and now moving forward with minimum unit
pricing for alcohol, will this Government consider following
that lead for England to tackle alcohol?
-
I am grateful for that point, which consideration is being
given to in the Department. There are any number of tools
that we could use to tackle alcohol. Probably the most
important thing is to give the message that unsafe drinking
is bad for the health. It is always interesting to learn from
Scotland’s experience, and we will keep an eye on that.
Tobacco is a major cause of poor health. It is worth noting
how much progress we have made over decades to reduce the
prevalence of smoking. That should lead to better health
outcomes, but that has yet to be seen.
-
(Hartlepool) (Lab)
Rates of premature deaths in Hartlepool and the north-east
are among the highest in the country. Other issues such as
poor-quality housing, food poverty, fuel poverty and
unemployment are also factors. Does the Minister agree that
those factors also need to be taken into consideration?
-
I agree. That is exactly the point made by the hon. Member
for Central Ayrshire (Dr Whitford). Housing is probably the
single most important ingredient in good health. We often
talk in this place about there being a housing crisis and
about the need to fix the broken housing market and get more
supply. Amen. The fact that we have failed to manage the
supply of housing effectively for decades is bringing bigger
health challenges. We really need to crack that if we are to
tackle some of these issues.
I could go on, but we are running short of time. We are
seeing very good rates of improvement in health for things
such as cancer, and much better outcomes for people. The
direction of travel means that there are good things to
report. I am grateful to all hon. Members who have approached
this debate with real thought about the very serious issue of
the decline in life expectancy. I am sure that we will
revisit the issue, but my lasting message is that we see the
method of tackling this being tackling inequalities. That is
what I pledge to do.
Question put and agreed to.
Resolved,
That this House has considered austerity and changes in life
expectancy.
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