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Speech by Rt Hon John Reid MP, Secretary of State for Health, 28th November 2003: Central Liverpool PCT

  • Last modified date:
    8 February 2007

Since June I have commented on health inequalities in almost every speech I have made, but today I want to outline a more general political approach to the issue.

Over the last 50 years, there has been enormous social, economic and health improvement in this country.  People from every class and region are a lot healthier than they were. However because of the way in which the general population's health has improved, serious health inequalities remain.  Politicians often refer to such issues as a 'challenge' but let us be clear, in a city such as Liverpool this is much more than a challenge - it consists of too many people having ill health and too many people dying before their time. It's not just a challenge. It's a disgrace.

This is clear for everyone to see when we look at the life expectancy in this country for children born today.  A boy born today in Rutland can expect to live seven years longer than a boy born in Liverpool, while a girl born today in Kensington and Chelsea can expect to live just over seven years longer than a girl born in Liverpool.  It means that in some parts of the country we have the same death rates as the national average for the 1950s. For them, the progress of the last 50 years that the rest of us have experienced, when it comes to, for example, mortality rates, simply has not happened. This is characterised by cancer, where the incidence of cancer in the 1990's for men in the city was over a third higher than the national average, and the incidence for women was just under a third higher.

This situation is unacceptable.  It is wasteful in terms of the potential of individuals and communities.  It offends against fairness and social justice. And it flies in the face of the intentions of the NHS when it was founded over 50 years ago. One of the proudest things I can say as Secretary of State for Health is that the founding value of the NHS, namely that there should be equal access to free health care for everybody at the point of delivery - that value is still our guiding light. But if we believe in it we have to recognise not just when its followed but also when its not being followed, and we must commit ourselves to change and improvement to bring this about so that all of us end up with an outcome that is equitable. And today I am doing that.

Now we have already started that process, setting out the first-ever national health inequalities target which looks to narrow the gap in life expectancy and infant mortality by 2010. It is why in July, the whole government committed itself to act on this.  But let me make this clear we are not committed to tackling health inequalities because we have a target. We are committed to tackling health inequalities because it is the right thing to do.

So, in the next few years, as the better off get healthier we must improve the health of the poorest faster - and this means action in places where differentiated health outcomes are large, like Liverpool.

As I said the founding value of the NHS is to provide equal access to health care. Of course I recognise that these inequalities are caused by issues well beyond the control of the NHS, but I think the general public who believe in equity in the NHS would be shocked by the inequity of outcome demonstrated by the mortality rates that I outlined earlier.

The kernal of the problem in my view, is that for decades it has been felt that in order to meet the health service needs of masses of people we would need to mass-produce a health service.

You see it was believed that delivering everyone the same sort of service, would ensure that everyone would be treated fairly. The idea seemed to be that all of the British people were all the same, and therefore if we were treated all the same it would create fairness.

Of course this is not the case. The mass production of any service ultimately fails to meet the individual needs of each service user in that mass production is uniform in its delivery. Since the 1970s we know that uniform services have failed to meet the needs of women, people from ethnic minorities and others in the population who are without sufficient confidence and resources.

So, we need a service which is comprehensive, fair to all, and personal to each.

We have been busily addressing issues of quality and capacity of NHS services.  And my announcement today about the massive expansion of facilities at the Royal Liverpool and Broadgreen Hospital and the Cardiothoracic Centre, supported by £84 million of public funding, shows how we are seeking to improve mainstream services in disadvantaged areas.

In cash terms Central Liverpool will receive a total increase of £103m or 40.3% for the three years from 2003/04 to 2005/06. This is the largest increase in cash terms awarded to any PCT in England, which is in recognition of some of the problems you face.

This year social services funding increased by 10.4% in Liverpool and overall local government funding increased by 7.4%.

Recent studies show that inequalities in access to a wide range of NHS services persist.  And there is strong evidence that lower socio-economic groups use these services less in relation to need than higher socio-economic groups. This means that as well as building a bigger and better NHS, these services need to be more flexible and responsive if the needs of the different populations they serve are to be met.  This means reaching out to communities so that these barriers can be overcome. 

So whereas in the past we believed, or appeared to believe, that if we provided everyone with the same service it would create equality. Now we recognise that everyone has different needs and therefore will need different services. So that will need a determined effort to adopt new ways of working within and across the NHS as well as other public services. If I might make a political point it demonstrates that we need a radical new Labour approach to a long term old Labour problem of inequality and the solutions that derive from it.

Whilst there are many Government Departments involved in this process as Secretary of State for Health I want to concentrate on what we are doing. Effective action by the NHS will I believe have a faster impact than most other services on the national target.

This places a special responsibility on the NHS because PCTs and hospital trusts are central to the programme I have outlined. Prevention and treatment of the biggest killers such as cancer and CHD, effective smoking prevention and cessation services, and improved antenatal care and early years support, all targeted to disadvantaged groups and areas, all will be fundamental to any real success in the reform of the national service. 
Lots of these services will be delivered through primary care.  Good access to high quality primary care services is of the utmost importance for those in disadvantaged areas. These services must be delivered to people on their own terms.  This is what we mean by choice. If people don't get good primary care, they often present later to the hospital service and in greater numbers than would otherwise be the case, either to A&E departments or as emergency patients when their problem could have been more easily and effectively tackled by primary care. Liverpool faces one of the hardest tasks of any part of the country.

But big problems don't daunt big people. Rather than creating a climate of despair, it has I believe fuelled activity characterised by energy, by enthusiasm and by commitment that marks Liverpool out as an imaginative and innovative place in tackling these challenges.  This is not new. In the 1980s the city took a leading role in the WHO Healthy Cities initiative and has a long history of working with communities on health issues.  The legacy of that engagement is a strong sense of solidarity across the city with the three PCTs working closely together with each other and with a wide range of other agencies.

But there are immense problems. Reducing smoking is central to the Government's strategy to reducing health inequalities. We have set a target to reduce smoking rates among manual groups from 32 per cent to 26 per cent by 2010. Liverpool has more than one and a half times the national death rate from lung cancer for males and over twice the rate for women. So the city-wide smoking cessation programme is evidence of an energetic response to meet this target. The programme provides flexible and targeted support through a variety of services tailored to the people's needs including one-to-one, evening and Saturday morning sessions with specialist workers, a dedicated Liverpool help-line and community pharmacy support.  Action also focuses on people at work, with over 300 companies targeted for advice this year. I know that, for example, the Central Liverpool PCT has provided support in hospitals, pharmacies and primary care settings as part of their smoking cessation services. Last year they exceeded their local 4-week quitter target by 52% and this year they are again on track to over-achieve.  

I know just how difficult it is to give up smoking. It was hard for me but we all know that reducing smoking among manual groups is one of the biggest single steps that we can take towards reducing health inequalities.

Next door in Knowsley they have also carried out some very specific work. The Knowsley Health Partnership is funding a Young People's Smoking Cessation Service through Merseyside Health Action Zone, which involves three smoking cessation advisors working on a rolling basis with Knowsley's 10 secondary schools.  The scheme is already regarded as being highly successful.

These examples demonstrate how in public health, as in all health care services, we need very specific practices. What works in terms of smoking cessation for teenagers is different for younger children and different again for pregnant mothers to be. To help people who want to give up smoking we have to specifically help them with their own experiences and difficulties and not as an average member of the general public that we keep talking about.

A critical way of tackling health inequalities of course is by empowering patients and the public to have a greater say over their own health and health services.

The Government has put in place a major programme of measures that completely overhaul the extent to which patients and the public can influence their own health services.

One driver for change will be Patient and Public Involvement Forums. Next week we are intending to have a Forum for every trust and PCT - independent patient-led organisations set up to feed the views of local people into the improvement of the NHS locally. Some Liverpool Forum members are here today.

Now it is a fact that the people who know most about health inequalities are those who experience them at first hand - we must try to make sure that it is their experiences, their needs and their preferences that, even if they cannot dictate the nature of the health service, at least informs the improvement of health and health services.

The whole Government passionately believes in social justice. Our economic policy of job creation has shown that we also believe in providing people with opportunities and many thousands of people in Liverpool have accepted and developed those employment opportunities. Our health policy has to follow the same principles - we must demonstrate clearly how our policy is firmly based on social justice. Our work to eradicate health inequalities is based on social justice.

But just as with opportunities for work. We believe that everyone must be provided with the opportunity to work BUT whether they take up that opportunity depends on the hard work of the people involved. We cannot make people take up these opportunities. It is up to them and their personal responsibility. The same is true for health. We cannot make people healthy. I know we cannot make people give up smoking. Nor can we make people get fitter. They have to want to do that themselves. Our responsibility is to provide them with every assistance to help them chose to live healthier lives. Their responsibility is to make those difficult choices.

This is the crucial partnership to reduce health inequalities. Government and individuals taking their different responsibilities. Working together, we will make an impact for all disadvantaged areas and low-income groups.  Only in this way will we narrow the health gap and meet the target.

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