HEALTH INEQUALITIES IN CORNWALL

Closing the gap is a disturbing but unexpected report from the Care Quality Commission (CQC) about inequalities in health and access to health services in England.

The CQC report looks at smoking and cardiovascular disease; let me focus on the latter. Two quotations sum it all up.

There is an inequality in diagnosis and getting treatment: “The more deprived an area is, the less likely it is that GPs record CVD [cardiovascular disease], resulting in poorer access to treatment” (Closing the gap page 4).

There is a consequent basic inequality in final outcome: “Deaths from coronary heart disease are three times higher among unskilled men than among professionals, and around fifty percent higher in South Asian communities than in the general population” (page 9).

The chair of the CQC, Barbara Young, says robustly, “We cannot rest while health inequalities exist on the scale they do.” That is a positive approach and the commission makes practical recommendations for primary care trusts to improve their health services.

Cornwall as a whole is not among the most deprived parts of England but there are several deprived communities in the county. The CQC findings and recommendations presumably apply there. Some of the health inequalities associated with deprivation will be the result of the lifestyle and economic aspects of people’s lives and they can be difficult to change. However, it should be a priority in healthcare in Cornwall to tackle these inequalities, to bring everyone and everywhere up to much nearer the best. The primary care trust has a positive strategic aim of reducing inequalities but deprivation does not appear explicitly to be acknowledged.

Everyone who cares about people and life here should be ensuring that we “cannot rest” until we are doing very much better.

AFFORDABLE HOUSING IN CORNWALL

I have already looked at Labour’s failure on child poverty. Now another important and dismal failure: housing waiting lists. On 1 April 1997 there were 8 124 households on the public housing waiting lists for housing in Cornwall. In 2008 there were 17 728. The figures are here and the explanatory notes should be read, especially note 1.

This increase is not unique to Cornwall; there are increases across England. It isn’t down to second homes, or empty houses, or the increase in household formation, or any of the litany of excuses: it is at bottom a failure to build enough houses for rent and purchase that local people can afford, a failure by a government in effect indifferent to such housing and lacking the resolve to push for it, and councils timid about nimby ire. Public housing has been neglected by the Labour government. The numbers being built are pitiful. There has been a lack of will, a failure of determination, much talk and few houses. Is housing and child poverty the “failure that topples all our success”?

Finance for affordable housing is difficult and there has been a notable lack of imagination in realising new schemes for making land acquisition and building and rent and purchase feasible. There has been insufficient will. The government should think of letting councils keep the housing receipts to finance the building of new houses.

Why does it matter?

People need houses to rent and to buy at a price they can afford. Put aside for the moment notions of fair play and social justice and even interdependency, it’s in our own interests to ensure people have a roof over their heads. People more easily believe they have a stake in their community and are less alienated from society and more socially minded if they have decent place to live. It pays us to ensure people are housed well. Children, the people who will work tomorrow and create the wealth and pay the taxes for our pensions and health service and roads, deserve better than third rate, insecure accommodation. They have the best chance of flourishing and growing up straight in a loving and stable home with a sense of being important to their family and their society. A decent, permanent house is part of that. It pays us to ensure children have a decent house to grow up in.

A decent place to live is also necessary ground for an autonomous life, a resource and right of positive freedom. People do not become independent, rational, self-realisers without the means to education and health and housing. For most of us society makes possible the circumstances wherein we might live with independence and dignity.

Affordable houses and child and adult poverty: key matters where Labour has let us down and where Conservatives are unlikely to seriously try to succeed.

We mustn’t give up in Cornwall or anywhere on building much more affordable housing. In Cornwall we should explore whether the new council should seek to build and own some housing; who provides isn’t a question of dogmatism but of what mix delivers best for people in need of a home. We mustn’t abandon those local people struggling to get a house. There has to be more determination and imaginative intelligence and I hope that the government even at this late time and the new unitary council will have those in spades, though the latter has set a cautious and unchallenging target.
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“a failure that topples all our success”: John Steinbeck The grapes of wrath

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KICKING PEOPLE WHEN THEY’RE DOWN

Andrew George, the Libdem MP for St Ives, has signed Early Day Motion (EDM) 1576 of 2 June 2009 in support of the report Hung up — the cost of calling government from a mobile phone from Leeds Citizens Advice Bureau (CAB).

I congratulate Leeds CAB on their report, direct and concrete, detailing the problems, showing solutions. I warmly commend Andrew George for signing the supportive EDM. This is an issue which also affects people in Cornwall.

The report is a sorry tale of government ineptitude and failure to adapt to changed circumstances rather than government raw callousness. It is a problem that can be readily solved.

The costs of ringing government help lines from a mobile phone are high; at present free and cheap government department numbers are not available for mobiles. Yet mobiles are the only phones that many vulnerable and poor people have.

The only way of contacting many government services is by phone.

This results in some people with mobiles not claiming benefits they are entitled to. The folly of the present arrangements is best seen in that it costs desperate people dearly to ring the government’s crisis loan help number. This is kicking people when they are down. This is making life more difficult for people in difficulties.

There is a solution through the government negotiating with the mobile phone companies to make 0800 numbers for selected government services, such as the crisis loans service, free on mobiles, if necessary through the Telephone Helpline Association scheme (0800 numbers are free on landlines but not usually on mobile phones).

Here is a problem. Here are vulnerable people needing help. Here is a solution. Here is a government…Ah, how will that sentence end?

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EDM 1576 is here.

There is an article about this in the Observer for 14 June 2009.

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SHAMEFUL FAILURE

The Labour government has failed on child poverty. It will not meet its target of halving it by next year and the target to abolish it by 2020 will sink. The numbers of children in poverty actually went up in 2007/08, the last year for which figures are available.

Some good work has been done, especially before 2005, as Labour half-heartedly tackled the leftover misery of an uncivilised version of Toryism which doubled the number of children in poverty after 1979. Labour had to balance on one hand the need to encourage enterprise and justly enable the reward of achievement and on the other hand the need to redistribute wealth to help those with life’s short straw. That takes skill and resolve and the disagreeable truth is that the Labour government lacked them. It also lacked the courage to challenge the self-absorbed to see beyond themselves and see a society; and it did not understand, for all the chatter of a moral compass and religion, the difference between rewarding success and indulging greed.

It didn’t have to be like this. There has been enough money since 1997 to achieve the noble ambition. Yes, it might well be impossible to persuade most of the wealthy that the children of the poor deserve a break. It takes political and moral skill and determination to persuade middling workers, who are the vast majority and who often struggle themselves, that children in poverty should be a major priority, that there is a bill that must be paid. It takes courage to make them a priority. A supine Labour government wasn’t up to the task.

At the same time we learn that income inequality, different from but related to poverty, is at its highest since the 1960s; yes, higher than when the Thatcher Tory government deregulated and encouraged me-now greed and set Britain on the course to the present financial miasma. The Gini coefficient is at its highest since records began. Three terms of Labour are ending like this with only the minimum wage and perhaps Sure Start as lights in the dark, though the latest increase in the wage is derisory.

This government was supposed to be about the many not the few, about opening up the possibilities of life for everyone, about helping the vulnerable. However, overshadowing the good and hard work of the party and its councillors and candidates in Cornwall and locally elsewhere, Labour 1997-2009/10 will be remembered for timidity, failures, and a bathplug. I am vastly disappointed.

Note on the mandatory minimum wage

From October the mandatory national minimum wage will be £5.80 an hour for people aged twenty two and over, an increase of 7p an hour over the October 2008 rate. This is the smallest money increase since the wage began in 1999 and is a 1.2 percent increase. For people aged 18-22 it will be £4.83, an increase of 6p an hour, and for people aged 16-17 it will be £3.57, an increase of 4p an hour. The recommendation of the Low Pay Commission that people over twenty one (rather than twenty two) should be entitled to the full wage will be implemented from October 2010, after the next general election. See Hansard 12 May 2009 column 40WS.

Related post: Work for peanuts in Cornwall . The second reading of the Tory bill is due 12 June 2009.
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POVERTY AND SCHOOL ACHIEVEMENT IN CORNWALL

See the addenda of 16 October and 30 October 2009 at the end for further information

Data for educational achievement in Cornwall show, I think, the adverse effects of poverty.

A paper (DEP2009-0918) of 19 March 2009 in the parliamentary library gives the numbers and percentages of (a) all pupils and of (b) only pupils eligible for free school meals in Cornwall (and all 152 local authorities in England) who did not gain any GCSEs above grade D for each year from 2003 to 2008.

Here are the percentages for 2008 for Cornwall:
All pupils 19.8 percent
Pupils eligible for free school meals 39.9 percent.

For all Cornwall pupils there is a modest improvement over the years since 2003; for free-school-meals Cornwall pupils the improvements are more marked.

Of course these GCSE results are general figures and there are admirable exceptions to them. However, free school meals are seen by many as a proxy measurement for poverty. The data revealed in the library paper is an issue that should exercise all those concerned about young people in Cornwall, including local and parliamentary politicians and educationists. It isn’t new; it has been known – or at least the knowledge about it has been available – for a long time. Why is the gap still so scandalously large? What can we do, economically, socially, and educationally, to narrow it further? How can we, indeed, reduce the general proportion achieving so little? As far as I can see not a single party in Cornwall is engaged with this though it is an important issue about the lives, schooling, and futures of teenagers in Cornwall; it is about their their achievement and self-esteem and sense of themselves. This issue is part of the real, everyday pro-Cornish agenda; recognising the needs of people in Cornwall and trying to help them to meet those needs.

The parliamentary library and the document DEP2009-0918 are here.

Addendum 16 October 2009

Hansard 12 October 2009 column 860W gives further figures about the relationship between free school meals and achievement in school in England:
Percentage of pupils on free school meals achieveing level 3 or below in reading, writing, and maths: 33 percent
Percentage of pupils not on free school meals achieving level 3 or below in reading, writing, and maths: 66 percent.
No date is given for the information. As ever, read the footnotes to the original in Hansard.

Addendum 30 October 2009

See Hansard 29 October 2009 column 593W (questions by Nick GIbb and David Laws) for further data about free school meals and school achievement.

AGGREGATE NONSENSE

I shall not spend much time on this as I have been here several times before. There is more data about educational spending in Cornwall: Hansard for 19 January 2009, columns 1137W onwards give the per pupil spending for 2008/09. For Cornwall the figure is £4340. There are 148 authorities listed in the data; nineteen have lower percapita funding than Cornwall.

However, my general point once more is that these overall funding figures for local education authorities are meaningless and lead us down unhelpful paths. We can do better than a Cornwall-wide statistic and if we are serious about egalitarian levelling up and helping everyone, including those at the bottom, get a fair deal, we have to focus on the present inequalities within Cornwall.

The education department has produced deprivation data, based on tax credits, for education authorities and schools. In the authority table Cornwall comes in at 56 out of 150 authorities (the lower the number the worst the deprivation). However, the education department has published data for deprivation at school level though it is based on area not actual attending pupils. Look now at the school data: the deprivation indicator for the most deprived Cornish school is 80.58%, for the least deprived Cornish school 23.62%; they rank 1306 and 20 507 in the table of 21 665 schools in England (the smaller the rank number the more deprivation). These are vast differences and they cry out against the unhelpfulness of a single aggregate statistic for the whole county and grounding politics in this aggregate nonsense.

Do look at the original statistics for the explanatory details of the numbers and terms.

Additamentum 29 January 2009

Hansard 28 January 2009 columns 658W-661W give the per-pupil funding for 2007-2008 and 2008-2009.

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DEPRIVATION AND CORNWALL

I feel like Gradgrind, facts, facts, facts, and no poetry, no fables, no myths.

However, it is worth recording the unpoetic deprivation score for 2007 for the Cornwall and Isles of Scilly primary care trust (CIOS PCT) which has just been highlighted in Hansard 22 October 2008 columns 377W-380W. It is 74th out of 149 trusts in England (rank of average scores, where the higher the score the less deprivation). This is, of course, in line with the measures of poverty and deprivation for Cornwall which I have discussed several times.

Let me go through this again. The index of multiple deprivation (IMD) shows that in Cornwall, in the districts and within the districts, deprivation varies significantly, and in some places is severe and in some slight, and it is thus unhelpful to generalise about Cornwall as a whole.

As an example of the variety consider the IMD ranks for 2007, where the higher the number the less the deprivation, for the six districts: Caradon 156th, Carrick 120th, North Cornwall 96th, Restormel 89th, Kerrier 86th, Penwith 36th. These are the figures for the rank of average scores for 354 local authorities in England. However, remember, within each district the deprivation varies and you can find this fine level data here. This fine data is for the 32 482 lower layer super output areas (LSOAs) in England with an average of 1500 residents in each. There is an interactive map of the LSOAs here which will enable you to identify each of the 328 LSOAs in Cornwall. Note too that even an LSOA may contain variety and not be fine enough to identify all parcels of deprivation.

I do not expect these facts to stop nationalists and Liberal Democrats saying “Cornwall” suffers signal and Westminster-inflicted deprivation, though the projectile nonsense of the streets of London being paved with gold seems to have died off. Perhaps if I keep drawing attention to the evidence…

Okay, that’s a lot of data but the import is clear: deprivation in Cornwall varies greatly; some areas are severely deprived, some are prosperous; it is not sensible to generalise about deprivation and prosperity in Cornwall. Let me repeat what I said at the end of my post Ranking Cornwall. Looking at aggregated data for the whole county, or an entire primary care trust or council district, is not particularly helpful. What counts is the position on the ground for individuals and parcels within those areas and we can look at LSOA parcels. For people who live here Cornwall is not one place but many and the circumstances of life vary vastly, and knowing this variation empowers us to meet need effectively and efficiently.

The indices of deprivation are published by the Department of Communities and Local Government.You can access them here.

You might like to look at Poverty and deprivation in Cornwall (published 2006).

WARMER AND CHEAPER IN CORNWALL?

The energy supply statement from Ofgem on 6 October sets out the facts about the differential rates for the various ways of paying for fuel and they do not tell a simple story about unfairness to the poor.

Paying by prepayment meter is about £118 a year more on average than paying by direct debit and paying quarterly by cash or cheque is about £80 a year on average dearer. For more than four million households in rural places, including villages in Cornwall, mains gas is not available and they lack the reduced rates that come with competitive dual fuel tariffs, paying about £55 a year more than if they had access to dual fuel deals. These figures depend on the level of fuel consumption which varies among households.

Of course prepayment and quarterly arrangements cost the companies more to collect and administer than direct debit payments but the differential is greater than that and although the report says the differential in prepayment charges are cost-justified I think the figures suggest a small premium is paid by customers.

It is a commonplace of concern that the poor and the fuel-poor (those who spend more than ten percent of their income on domestic fuel) are using prepayment meters and quarterly payments and are thus paying more for their fuel and energy than the well-heeled paying by direct debits. The Ofgem report is clear that this simple picture is misleading.

Not everyone who pays by the higher rate methods is poor and not everyone who has no access to mains gas is poor, but many are. Not all the poor/fuel-poor pay by the dearer methods but certainly they are concentrated in there; for example the quarterly payment method is the most common payment method among the fuel-poor and just over half of prepayment meter customers are in the bottom two social groups, D and E.

A blanket reduction of the dearer tariffs, removing the unjustified premiums, will help the poor/fuel-poor but also help others on those arrangements. A little has been done but much more is required to target fair, and even subsidised, charges on the poor/fuel-poor. Ofgem is holding a consultation until 1 December 2008 about its report and I hope people and groups in Cornwall will respond and advocate definite help for people who plainly need it: the aim should be to reduce prices for the poor.

The Ofgem report helpfully distinguishes between those who are poor/fuel-poor and vulnerable customers who also include those who are sick or disabled and who also need help in accessing the best financial deals.

These price differentials and barriers should have been tackled definitively so far as they impact upon the poor and vulnerable a long time ago. Better late than never, I suppose. If all goes well next year should be a little warmer and cheaper for many in Cornwall. The Labour government’s winter fuel payment will help people (though it is not targeted on the poor), as will, eventually, lagging; but high prices need more than revised tariffs, winter fuel payments, and lagging, and the government appears unimaginatively unable or unwilling to help.

CORNWALL BREATHES

The Association of Public Health Observatories (APHO) have published the 2008 health profiles today. You can read the report for Cornwall and for each of its six districts here .

For Cornwall as a whole the APHO report is generally good news. For example, in five of the districts there is a smaller proportion of people living in the most deprived fifth of areas of England than the average for England; and in every district men and women have a higher life expectancy at birth than the average for England.

The APHO report gives information for each district too and although here the news is generally good of course there are difficult spheres where it is less rosy compared to the averages for England. For example, look at the figures in Penwith for index-of-multiple-deprivation, child poverty, and educational achievement.

There is much here to be pleased about. Not complacent, but recognising a record of progress. Cornwall, again, isn’t at the bottom.

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Source: Association of Public Health Observatories website article Welcome to health profiles

REAL LIFE IN CORNWALL

I wondered in this post why organised Cornish nationalism was not responding to Labour’s pauperisation of the poor. The government has since helped most of those affected but pro rata there are still nearly 10 000 people in Cornwall who have been only half-helped.

Consider also:

How many people in Cornwall are in fuel poverty, households where gas and electricity cost more than ten percent of income? How many people in Cornwall with low incomes are on prepayment meters which charge more for heating and cooking fuel than direct debit payments? How many, in rural places without mains gas, are paying heavily for heating oil? Of course these questions affect people all over Britain not just Cornwall and, apart from the prepayment issue, are not easily and immediately solvable by a national government without vast subsidies.

These are real life questions which affect the everyday life of too many in Cornwall. They are not remote questions, not issues in the far past, they are current, they are about real life now for people here.

Now another small entertainment. Using your knowledge, skill, and judgement, which of these do you think best represents the present overall position:

(a) Yes, organised Cornish nationalism and the Cornish nationalist websites collectively – the Cornish nationalist movement, if you will – are aroused and publicly campaigning hard on these issues, fiery with denunciation, and gung ho with ideas for remedies

or

(b) No, they’re saying nothing, zilch, nada, sod all, not a sausage.

(Of course, individual nationalists may be engaged with these issues.)

My own view is that the government should immediately urge the companies to eradicate completely the higher differential price charged to domestic customers, mainly among the poorest in our country, for prepayment meter fuel; and if urging does not speedily work, a way should be found to outlaw it.