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19 May 1999 : Column 1186

European Communities

    That the draft Social Security and Child Support (Decisions and Appeals) (Amendment) Regulations 1999, which were laid before this House on 4th May, be approved.

    That the draft Social Security Commissioners (Procedure) Regulations 1999, which were laid before this House on 21st April, be approved.

    Local Government Finance

    That the Local Government Finance (England) Special Grant Report (No. 47) on rural bus subsidy grants for 1999-2000 (HC 407), which was laid before this House on 27th April, be approved.


    That the draft International Headquarters and Defence Organisations (Designation and Privileges) (Amendment) Order 1999, which was laid before this House on 15th April, be approved.

    That the draft Visiting Forces and International Headquarters (Application of Law) Order 1999, which was laid before this House on 15th April, be approved.--[Mr. Betts.]

Question agreed to.


Bicycle Bells

10.57 pm

Dr. Nick Palmer (Broxtowe): Some 2,487 residents of Broxtowe and neighbouring constituencies

To lie upon the Table.

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Health Service (Forest of Dean)

Motion made, and Question proposed, That this House do now adjourn.--[Mr. Betts.]

10.58 pm

Mrs. Diana Organ (Forest of Dean): Patients in the Forest of Dean are facing cuts to community health services because of the funding position of Gloucestershire health authority, whose allocation of only a 3.8 per cent. increase--the second lowest in the country--and the pressure created by not having the pay award fully funded have resulted in it facing a deficit of £5.4 million.

If the health authority had received the English average growth allocation, it would have another £2 million and the Forest of Dean would not be facing cuts to its health services. The underlying national policy objective of securing fairness in the distribution across England is supported by the health authority and understood by the public, but makes the transition areas such as the Forest of Dean face cuts, so that budgets can be balanced. There are strong arguments why the area should not suffer in that way.

The Forest of Dean is a rural and industrial area with scattered centres of population. It suffers from low pay, faces rising unemployment and has some poor housing stock and poor transport. Access to any service is difficult. The area has pockets of real deprivation.

The population profile is skewed towards the elderly, with nearly 10 per cent. of the population over 75, and 18 per cent. over 65. The area has markedly poor public health, and, unlike other parts of Gloucestershire, it is not wealthy and healthy, a fact that health authority funding does not reflect. The Forest of Dean has the highest percentage of people with disabilities in the county, excluding those of pensionable age. In comparison with national averages, death rates are higher in certain areas, especially for women. So are rates for heart disease, respiratory diseases, cancer and even tuberculosis, a disease usually associated with inner city deprivation.

Ill health is an issue in the Forest of Dean. The report of the director of public health recommended that the poor health status of residents of Gloucester and the Forest of Dean should be acknowledged and taken into consideration by agencies when they allocate resources. Our rates of ill health are not reflected in our allocation of health service money.

I welcome the Government's determination to improve the public health of the nation and to close widening inequalities in health. We must recognise that public health is affected by many factors. The appointment of my right hon. Friend the Minister for Public Health shows our determination, which was also set out clearly in the White Paper "Our Healthier Nation" and in the programmes of health improvement that are being put in place as a priority. That is real progress.

Set against that progress, we are able to spend only £600 per head in the Forest of Dean while the UK average is £750. The area has higher-than-average need and, as a rural area, has greater costs of health care delivery. Those difficulties of delivery are not recognised in the funding formula. Although we have sparsity problems, access problems and poor public health indicators, we have no health action zone, no sure start programme and no

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NHS Direct. The extra investment that those wonderful initiatives would bring would enhance the health service, improving access and tackling the problems of deprivation and public health. Instead, some patients face cuts to services, and those cuts will hit some of the most vulnerable--the elderly and the poor.

The proposed cuts are all to community health care services. Cuts in areas such as emergency services, cancer services, mental health, improvement to dentistry, improvement in coronary heart disease and reduction in waiting list times are unacceptable, particularly in the context of the Government's national strategy. To meet the deficit, we are beginning to dismantle our community services piece by piece. In the great scheme of things, that will save relatively little money, but it has a devastating impact on patients in rural areas. Rightly, it is highly unpopular.

The need to adjust quickly means that savings or cuts must be made not against a considered strategy but to balance the budget. We could face a process of expensive reviews and consultations about threatened cuts, which will raise anxiety among the population, but which, either on health grounds or for political reasons, will never be implemented. That would waste money that should be spent on delivery of front-line services.

The list of proposed cuts is extensive, and includes the axing of non-emergency patient transport, cuts to the chiropody service, axing a day hospital in a market town, cuts to health visitor services, cuts in GP prescription budgets and cuts to newly set up primary care groups.

Mr. David Drew (Stroud): Would my hon. Friend comment further on the first item on her list of proposed cuts, which affects my constituents in the neighbouring constituency? Reducing services in more rural parts of Gloucestershire while also cutting transport means that people face a double dilemma--fewer services but an inability to reach the nearest hospital or health care centre.

Mrs. Organ: My hon. Friend is absolutely correct. The cut to transport in a rural area is a double whammy.

Mr. Alan Duncan (Rutland and Melton): That's a Labour Government for you.

Mr. Deputy Speaker (Mr. Michael J. Martin): Order. I must tell the hon. Member for Rutland and Melton (Mr. Duncan) that Adjournment debates allow Back-Bench Members to put their case to Ministers. Front-Bench spokesman should not interrupt them.

Mrs. Organ: Cuts will also be proposed to the joint finance funding available to voluntary organisations to fund local mental illness schemes. We recognise that mental health services are always underfunded.

There may be reductions in the number of GPs in the area as GPs who retire are not replaced. Yet hard-working GPs offer skills and real expertise to the local community hospitals. Thus, the services available to the local population in the community hospitals will be reduced. All those proposals are up for consideration, but some are in place, as my hon. Friend the Member for Stroud (Mr. Drew) has mentioned. One is in the transport service, a much-needed service predominantly for elderly people, for whom access to services is difficult and

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mobility a problem. The service is crucial to take patients to clinics as out-patients either to the district hospital in Gloucester or to the two local community hospitals--Lydney and district hospital and Dilke Memorial hospital. There is not an alternative public bus service. Distances are great and car ownership or access to a car among the elderly is low. The proposals will make access to health services even more difficult.

In addition, patients are on a limited and low income, so there will be a burdensome extra cost as the free service goes. The Forest Voluntary Action Forum is trying to cope and to meet the newly arisen need, but its volunteer driving scheme must make a charge of 15p a mile and sometimes the round trips are as much as 50 miles. The services were needed; 3,500 journeys were previously made within the forest. The cuts affect many people.

Emergency transport, of course, is protected, as is that for the mentally ill, the disabled and cancer patients, although that does not always seem to be the case, as the Forest Voluntary Action Forum has received numerous requests for transport from oncology patients. A relatively small saving with a massive impact on a vulnerable group is now going ahead.

Another proposed cut is to the chiropody service--both the clinics and the domiciliary service. Again, it is a service much used by the elderly and those with mobility difficulties or a disability. It really makes a difference. It helps to keep people mobile. There are waiting lists for it. It needs to be delivered in local clinics or people's homes, especially in a rural area with transport problems. At present, it is an excellent service. Why cut it, when it is so good? We should be extending it.

We recognise that the Forest of Dean is getting massive investment in other areas of health care and we welcome it. There is a £25 million project for a new building for accident and emergency services in the general district hospital in Gloucester, although it is certain that there will be cuts for some wards. Money has been provided to bring down waiting lists. We have an excellent record on waiting lists in Gloucestershire. We have some of the shortest times in the south-west, and rightly so. No one waits longer than the Government guidelines permit.

My right hon. Friend the Secretary of State has permitted flexibility in using £1 million of the modernisation fund money to meet some of the most pressing service needs. Will Ministers consider whether further moneys from the fund could be released in the same way to stop the cuts to the community health services in the forest? Or, in order that the health authority can manage the transition from the current pattern of expenditure and services to something that can be planned strategically and is sustainable in the long term, will they consider the allocation of a short-term funding package similar to those recently granted to Cornwall of £2 million and to Worcestershire of £4.5 million? In that way, the public health of the forest could be improved and the elderly would not suffer the brunt of the cuts. We shall continue to improve, as we are determined to do, equitable access to health care for people in rural areas such as the Forest of Dean and other areas of Gloucestershire.

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