Below is the full text of Jon Ashworth’s speech today at the Fabian summer conference.
Good morning and thank you. As a member of the Fabian Society since I was 16, an avid reader of your pamphlets and your journals, it is a real pleasure and indeed honour to have been asked to offer a few reflections this morning.
The Fabian Society has always stood in the finest Labour traditions of intellectual endeavour to improve the common good. Today you remain at the forefront of the debate about what a socialist transformative programme encompasses for the next Labour government.
At a time when society feels more fractious, more divided than ever before and when political debate seems more polarised and disagreements protracted with hitherto solid certainties melting into the air, the left needs the calm, considered wisdom of the Fabian Society more than ever.
Of course we are still grappling with the shockwaves of Brexit and we still don’t know if we are on the cusp of fundamental realignment in political preferences in response. Like Saturn devouring his children, Brexit has already finished off two Tory Prime Ministers, I’m not convinced a third will fare any better.
I don’t intend to focus my remarks today on Brexit in detail suffice to say that in my opinion deeply entrenched inequalities, often concentrated geographically, coupled with the collective failure of policy makers to address and confront those inequalities drove that referendum result.
But ironically Brexit is essentially a neoliberal pro-austerity project, it’s Nigel Farage’s and Boris Johnson’s great swindle on working people. It will only entrench those inequalities, not alleviate them. I commend Jeremy Corbyn for his efforts in trying to win support for a deal – an entirely honourable attempt in my mind – to bring both sides together and mitigate the very worst excesses of that neoliberal project.
Now, though, we face the very real prospect of a so called no deal Brexit. A Brexit that will smash our manufacturing base, that risks the smooth import of 37 million packs of medicines every month, that puts our NHS up for sale in a trade deal with the US forcing us to buy expensive drugs at higher prices and hand over patient data, the so called ‘new oil’ to US tech firms. This is not the future I want for our society, certainly not the future I want for my children.
A general election must be our priority, but it’s time people were given a public vote on the Brexit outcome. I would campaign for Remain. But whatever happens with the debate in the Labour Party over Brexit, it doesn’t resolve the question of how we tackle the entrenched inequality that blights so many communities. This is where I want to focus my observations this morning.
Inequality is fundamentally about life and death. The creation of the National Health Service 71 years ago surely stands as our proudest achievement and the most effective engine for social justice the United Kingdom has ever seen.
Richard Titmus described it as the “most unsordid act of British social policy in the 20th century” that “allowed and encouraged sentiments of altruism, reciprocity and social duty to express themselves”.
The idea of an NHS free at the point of use, universal and comprehensive in scope where care is delivered on the basis of need as a moral right for all rather than purchased as a commodity by the privileged few is woven into the fabric of our society, and quite rightly so.
But our NHS has been under attack like never before. Nine years of austerity have left us with waiting lists at over four million and 580,000 waiting beyond 18 weeks for treatment. Over 260,000 wait beyond 4 hours in busy overcrowded A&E departments.
100,000 children are denied mental health treatment each year because their problems aren’t ‘serious’ enough. For problems deemed serious, 500 children wait beyond a year for specialist mental health treatment. Our NHS struggles with shortages of 100,000 staff including 40,000 nurses, 3,500 midwives and almost 10,000 doctors.
Adult Social Care often delivered by private providers seeking to squeeze our profits to the detriment of quality has been savaged by £7bn of cuts. 400,000 vulnerable and elderly people denied the care support they otherwise would have got.
The constant competitive tendering of contracts brought in by the Health and Social Care Act has led to £8.8bn being spent on private health providers. When a private provider fails to win a contract, like Virgin Care, they can sue the NHS.
Years of austerity has seen local health commissioners ration more treatments and deny patients procedures all together. Last week, a hospital invited patients to pay for hip and knee replacements for £18,000 each on NHS wards – treatments that were previously available on the NHS.
Our Labour response is to drive up standards, provide the best quality of care and start recruiting the staff our NHS needs for the future. Austerity in our NHS will end. Cuts to Adult Social Care will end. To start recruiting the nurses, midwives and allied health professionals we need we will bring back a training bursary, we will invest in fair pay and rather than cutting professional development budgets will restore them.
We will bring an end to privatisation too. So that means we will sweep away the Health and Social Care Act and bring forward legislation to reinstate a publicly provided, administered universal National Health Service. Our commitment to reverse the Health and Social Care Act is motivated by more than our desire to rebuild a public NHS after years of damaging austerity and marketisation. It’s also because the current structures have left our NHS ill equipped for the challenges ahead.
Let me explain. In 1948 life expectancy was 66 for men and 71 for women. Today it is 86.9 years for men and 89.2 years for women. We have become used to thinking of our live spans in terms of the Biblical three score years and ten, yet as Lynda Gratton and Andrew Scott argue in ‘The 100 Year Life’, we are in the midst of a transition few of us are prepared for as much much longer lives face us.
By the time the NHS celebrates its 100th birthday, the numbers of over 60s are projected to have increased by 6.6 million; overs 85s by two million and the numbers over 100 by 63,000. It’s obvious that the need for a sustainable solution for the provision of adult social care becomes more pressing by the day and my colleague Barbara Keeley is working on detailed plans.
But it’s not just that we are living longer. The burden of ill health as we live longer is changing too. In 1948, the medical challenge was infectious disease. In 2019, we are worlds away from the days when 30,000 hospital beds were set aside for the treatment of tuberculosis, or when wards were filled with row after row of iron lungs to treat those suffering from polio.
Today we face a growing population of people with multiple health needs whether that’s for example COPD, diabetes, hypertension, heart disease. 12 years ago, one in 10 patients admitted to hospital as an emergency had five plus conditions, today that figure has increased to one in three.
The prevalence of mental health conditions, whether depression or anxiety, is growing. It’s estimated one in six people meet the criteria for a common mental disorder. Over the next 20 years, the numbers of people in England with four plus conditions is expected to have doubled compared to 2015.
In the face of ever more complex health challenges we need a system not based on fragmentation and market forces but one based on local planning, publicly provided and administered integrating health and social care properly, better coordinating across boundaries.
But I think there is something even more fundamental we need confront too. After creating the NHS, Bevan described it as a “real piece of socialism”. Its creation was essentially about equality, social justice and the recognition that health is a human right.
Yet 71 years health inequalities are widening. Today a baby girl born in Liverpool can expect to live 13 fewer years in good health than a baby girl born in Richmond. Men from the most deprived backgrounds can expect 52 years of healthy living, despite the retirement being 67, 15 years later.
And after nine years of Tory austerity, advances in life expectancy, which had steadily increased for 100 years, have now ground to halt, and even gone backwards in some of the poorest areas. Shamefully, infant mortality rates – children dying before their first birthday – have risen three years in a row for the first time since the Second World War.
Rates of premature deaths – including deaths linked to heart disease, lung cancers, COPD – are two times higher in the most deprived areas of England compared to the most affluent. Children and adults living in the poverty are up to three times more likely to develop mental health problems compared to those living in the highest income brackets.
We see a higher rate of suicide in the most deprived areas, a higher rate of addictions and shockingly higher rates of drug overdose deaths too. It’s a toxic cocktail. The result is death rates in middle age, so called ‘deaths of despair’ are rising after decades of virtually continuous improvement.
Sir Michael Marmot says: “The higher your income, the longer you live.” And as Richard Wilkinson and Kate Pickett have shown in the Spirit Level, societies with greater inequality have worse health outcomes, lower life expectancy, higher rates of infant mortality, mental illness and obesity.
Inequality, poverty and deprivation mean people get ill quicker and die sooner. As socialists we should never settle for this; as Health Secretary I won’t. For me, it’s so heart-breaking that while poverty is not self-correcting, it need not be inevitable.
Yet much of the growing burden of ill health is driven by that inequality and poverty. And it is preventable. For example, Tony Blair and Gordon Brown lifted a million children out of poverty, rolled out Sure Start centres in communities, which the IFS has shown helped prevent thousands of hospital admission for children every year.
We shifted more NHS funding to poorer areas and by 2010 for the first time we actually had more GPs per person in deprived areas than in more affluent areas. That Labour government made a dent in health inequalities. But today, GP numbers are actually falling fastest in the most deprived areas. Sadly Tudor Hart’s warnings of the inverse care law, where the communities that need the most care provision get the least, has emerged once again.
In response, the next Labour government will adopt a comprehensive, cross government national strategy to tackle health inequalities, attacking the wider determinants of ill health and putting prevention first. That means action to improve the homes we live in, the childhood experiences we are exposed to, the neighbourhoods we grow up in, the schools we are nurtured in, the condition of the work we do especially in today’s gig economy, the food we eat, the quality of air we breathe and the support we rely on in our older years.
As a start, we will fully fund public health services – sexual health services, smoking cessation services, drug and alcohol treatment services, which have been hammered with £700m of cuts. Investing in children must be the rock upon which a health inequalities strategy is built. I’ve said our ambition should be for our children to become in the healthiest in the world.
We know the first 1,001 days of a child’s life, from conception to age two, are the most crucial for a baby’s development. The evidence shows that children who suffer abuse, neglect and trauma – so called Adverse Childhood Experiences – are more likely to suffer mental health problems and other physical problems later in life.
So rather than cutting Health Visitors as the Tories are, we will expand their numbers and introduce mandatory visit and as Angela Rayner is developing prioritise an expansion of early years services. We must become braver in intervening to challenge the commercial determinants of ill health too.
The smoking ban was one of the most effective public health interventions of recent years. I’ve called for mandatory labelling of alcohol, we need action on minimum unit pricing and when more people die from drug misuse than in car accidents every year it’s clear the status quo on drugs isn’t working either, we need a clear public health approach instead.
Or take the air we breathe. The UK has the highest asthma death rates in most of Europe for 10-24 years olds. It’s estimated that air pollution kills 40,000 people every year. It’s time, as our shadow Defra Secretary has called for, a Clean Air Act. But when we know the NHS is responsible for 6% of greenhouse gas emissions, it’s also time the NHS took its responsibilities to climate change seriously as well. A Labour government will make sure it does.
We know obesity carries life-threatening health risks and that obesity in children leads to serious health outcomes in adulthood and ultimately premature death. Our child obesity rates are amongst the worst in Europe, with rates highest in the most deprived groups.
The government is failing to act, so a Labour government will. We will restrict the advertising of junk food, with Tom Watson has launched a Diabetes Commission to understand how our food industry is failing to provide the nutritious food we need.
And whereas the Tories are cutting Health Start funding that helps families access healthy food, today I can announce that Labour in government will commit £26m to the ‘Healthy Start’ programme. To ensure no child in the poorest parts of our country is deprived of fresh fruit and vegetables – the equivalent of an extra 42.4 million pints of milk, and 33 million more apples for the very poorest children.
We know that loneliness and isolation is a growing social problem that allows mental health problems and harmful behaviours to fester. As John Steinbeck wrote: “A sad soul can kill you quicker than any germ”.
Government talks of parity of esteem while only 1.6% of the public health budget is allocated to mental health. A strategy to tackle preventable illness and inequality must integrate mental health into the prevention and public health agenda too. The World Health Organisation defines health not just as the absence of disease but as “a state of complete physical, mental and social wellbeing”. Yet too often a focus on wellbeing has been absent from our debates.
I believe a plain, clear, simple commitment to improving happiness and wellbeing as Richard Layard has proposed would force significant change and force policy makers to think through the long term implications of decisions, not just the pounds and pence of GDP.
Welsh Labour led the way with a Wellbeing Act built upon clear principles requiring public bodies to improve overall wellbeing and meet the sustainable development goals. In New Zealand, the Labour government recently introduced a wellbeing budget. Their minister of finance Grant Robertson explained it’s about helping people live “lives of purpose, balance and meaning” and giving people the capabilities to do so.
Like Wales and New Zealand, I want to put wellbeing central to our framework for tackling health inequalities in society. So a Labour government will introduce a Future Generations Wellbeing Act.
Fundamentally, such an Act will commit the next Labour government to a ‘health in all policies’ approach with ‘health equality audits’ of all government decisions; it will enshrine our commitments in legislation to ensuring life expectancy match the best of our international peers and that children enjoy the best health and wellbeing outcomes possible; and it will place a new duty on both local health services and national leadership to reduce health inequalities.
Our NHS is not just a national driver of prosperity, employing over 1.5 million staff UK wide, but also communities acts as a local ‘economic anchor’ institution. Provision of services, levels of NHS employment, pay and conditions impacts local economies and therefore wider local health outcomes too.
So a Future Generations Wellbeing Act will also ensure the NHS maximises the social value of its local spending decisions to improve the wellbeing of local communities. So a wellbeing framework could have radical, far-reaching consequences indeed.
And it’s fully in the tradition of the left as a theme running through so much of our heritage. Our movement always sought to improve the ‘social wage’. Marx spoke of society where one could hunt in the morning and criticise after dinner. Tony Crosland famously sought the aesthetic life for all exemplified by open air cafes.
Perhaps it was the great liberal US Democrat Bobby Kennedy who put it most eloquently, reminding us that “the gross national product does not allow for the health of our children, the quality of their education or the joy of their play”. Prioritising wellbeing and tackling inequality for me is about the kind of society we want to leave for those who follow us.
It was the wellbeing economist Katherine Trebeck who suggested: “Why not get countries to measure the number of girls who bicycle to school? What clearer yardstick could convey so much about progress in women’s education, green transport, health and poverty alleviation in a single number?”
I agree. That’s the kind of world I want. We can achieve it. And it will be one where people live longer, healthier, happier lives. That’s something worth fighting for.