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SP: A plan for tackling health inequality
[Image: kathy-bates.jpg?w=1200]

The Shadow Secretary of State for Health spoke to the King's Fund about health inequality with the press in attendance. Afterwards, she ate a lot of biscuits and pretended she was enjoying herself. 

"It’s good to be here.

For almost a hundred years, the King’s Fund has been at the centre of the debate on how we can keep Britons happy, healthy and thriving. It’s a pleasure to be here outlining how the Labour Party will approach the big issues of the day.

And this government and the next has plenty of issues it will have to tackle. It’s crucial as we approach the millennium that we have an NHS that remains true to its principles and is able to apply them to the modern era. An ageing population, the cost of new technologies and the complete overhaul in how we live and work brings new and unprecedented challenges to our Health Service. The British people deserve to know that they have a government up to the task in delivering that NHS that is fit for purpose.

Unfortunately, the debate on all sides has been lacking. It initially centred on funding and means tests in the post war era, and in the past decade the battle has shifted between the role of the state and the role of the market in our NHS. I’m not here to say what side of that debate that I fall on, though I’m sure you can make an educated guess.

But as crucial as these debates are, we must shift our thinking. It is time for both the state and the individual to change our approach on how we best keep Britain healthy, and it’s time for both the state and the individual to be more proactive in how we respond to that challenge. As a HIV-AIDS crisis rages, obesity increases and our population ages, discussing whether NHS ambulance services should be supplied by businessman or bureaucrat feels increasingly redundant. We are twiddling our thumbs which our health service creaks under the weight of threats it alone cannot solve.

It is Labour’s initiative as the opposition to change the terms of that debate. Yes, we will still make the case for a free at the point of use health service operated by and for the people. But we must make it clear that we must make our National Health Service a health service, not a sickness service. If it continues as a sickness service, not proactively rooting out the causes of ill health from its very roots, there will be huge costs both morally and financially – ones that Britain cannot afford.

And we need to think innovatively about the burdens that increase those costs. We know that alcohol, drugs, obesity, cancer, diabetes and other preventable illnesses are putting strain on our health service. But we must also think about the deeper causes of all of these social ills. Only then can we be proactive.

We know that health inequality is one of those deep ills. I do not need to make the case about the moral case for stamping out inequality. It shocks us all knowing that a child born in my neighbouring town of Kensington, Liverpool could live up to a decade shorter than a child in Kensington, London: and in the years that child will live they are more likely to experience a variety of illnesses, from heart disease to drug addiction. But we do not think of the consequences of lost decade after lost decade – it creates a less productive, less dynamic economy and burdens our National Health Service. It is crucial we respond to the scale of this fight with the time, resources and innovation it warrants. If not, we let our fellow citizens down, taxpayers down and our Health Service down.

Initially, governments of past seemed willing to accept this problem and put up this fight. As signatories to the World Health Organisation’s Health For All Strategy we pledged to commit to reducing health inequality by 25% by the year 2000. Subsequently, the Black Report was commissioned so we understood the scale of the crisis and response needed.

Because if there is any case that we all are responsible for one another, it is our health. Even if you are well off, your neighbour being sick does you no favours. It increases wait lists for that crucial operation you may need, strains your wallet and leaves us all the worse as a consequence. 

The Black Report found what we all know in our heart of hearts: that health inequality exists, and it is fuelled not by problems in the health service, but by economic inequality. It called on government to be proactive in preventing this and made clear if government refused to do so, we would see health inequality widen. It made it clear that responding with adequate funding would in the long term reduce the burden for both taxpayers and the National Health Service.

The Thatcher government responded by rejecting the report, throwing our international, moral and financial commitments into the long grass. And yet in doing this they vindicated its findings, with its worst predictions coming true.

Yes, on the surface, it appears as if lifespans across Britain are increasing. But when we dig into the statistics, we know that is because the lifespans of only the very richest are increasing exponentially. Amongst the lower classes, lifespans are decreasing, and health inequality is widening as a result. It’s clear that we need to respond now and that we need to up our game if we are to tackle this issue head on.

And yet the government appears unprepared to do so. When questioned on this it was clear the government has no plan to respond to rising health inequality. Despite its economic programme widening health inequalities it initially claimed its economic programme was plan enough. Then when Mr. Heseltine rightly realised the fanciful thinking of this response he claimed the government was responding appropriately by introducing ‘Family Hubs.’

Family Hubs are a strong start, but without a fully-fledged plan they are only that. You cannot treat knife wounds with plasters, and that is the government’s strategy… if you can call it a strategy.

As Shadow Health Secretary, I have made it clear that I am happy to provide the government with such a plan if they’ll accept it.

It’s one I have already run through with the thinktank, and they concede: the vast majority of the proposals I have presented will, at the very minimum, be cost neutral in the longer term. But if the Black Report and studies into tackling health equality have made it clear, we can expect these proposals to be a boost for the economy and a burden lifted from our health service. It is good for every British citizen and taxpayer.

Firstly, we will commission a new report exploring health inequalities, making clear the scale of the crisis in this country and outlining the scale of the response needed. The Black Report remains a crucial document for policymakers, but it’s clear the socioeconomic, health and demographic scenario in Britain has changed radically in the past decade. So too should our response, but I’ll also make it absolutely clear that we will commit to seeing all recommendations implemented.

But we’ll continue to act in the meantime – too many lives depend on it. We’ll put our international commitments into law and compel all layers of government and the NHS to meet a target of a 25% reduction in health inequality by the year 2000. That way, we can coordinate effectively to root this issue out at every level possible.

Thirdly, we will bring the ‘Family Hub’ scheme closer to the health service so it can coordinate more effectively with the NHS, and massively expand its scope and remit in the process. In doing this, we will ensure that the scheme covers up to half a million of the country’s poorest children, giving them access to childcare, family planning and health interventions.

But in reforming the hubs into Family Centres, we’ll ensure that children covered by the scheme remain so well into adulthood and even in old age. The focus must remain on early intervention, but we know children scarred by poverty young will continue to face more health complications later on in life, even should they be fortunate enough to move up the social ladder. By providing children covered under the scheme with a ‘Family Hub Card’ which guarantees access to nutritious food, vitamins and regular GP check-ups for life, we can continue to ensure problems are tackled at their roots. It is not enough to act early and then abandon them after a few years. Our proactive approach will continue from cradle to grave.

And we will ensure Family Hubs are geared more towards the earliest intervention possible:  pregnancy. Within the Family Hub scheme we will establish a ‘Strong Start’ scheme, ensuring pregnant women in the most deprived areas have prioritised maternal care and are given free access to healthy food, vitamins and free welfare advice.

Finally, we’ll continue to ensure that health checkups remain accessible and available for all. The Thatcher government acted against this principle and took us backwards mere years ago and introduced charges for dental and optical inspections. We’ll scrap them. By reducing this bureaucratic burden within the NHS and making inspections free to all, we can get to diagnosing problems, free at the point of use, at every level in the NHS.

I have had it verified by the Kings Fund that the proposal would cost £800 million pounds. But we expect this to be self-funding, at the very minimum the proposals would be cost neutral by establishing a stronger, more productive economy and a less burdened National Health Service.

There is one thing I will make clear, though: this plan is not a panacea. I earlier praised the government’s introduction of Family Hubs as a strong start. The plan I have presented today is a stronger start. We will need to continue this fight, implementing all recommendations from relevant reports and commissions and – should we hit the 25% reduction by 2000 target – ensuring we fight to get that even lower, so that one day every child will know their postcode will not predetermine their life chances. 

That will be a battle for future leaders, though… not an old bird like me. [Smiles].

Thank you."
A well considered and detailed speech, highlighting depth of knowledge about the area in which she shadows. This adds to the perception that Ruth is one of the more influential figures in the Shadow Cabinet and one of the leading thinkers in developing party policy.

In particular, the attendees and the press noticed how Ruth proposed to build on and reform existing government policy in a Labour government, as well as her thoughts on how the future of the NHS may be shaped.

However, attendees also noticed a sudden lack of biscuits after the speech.

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