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Mr. Webb: I am grateful to the Minister and I do not want to interrupt his flow. I hope that in the remaining four or five minutes, he will address my specific question. When will the target waiting time of 26 weeks for out-patient orthopaedic appointments be hit in Avon? Given all that the Minister has said and all the money that he told us is being put in, he must be confident that that target will be hit soon. When?
Mr. Denham: There has been a long period of poor service and underinvestment, which has led to the length of waiting lists that the hon. Gentleman described and which I acknowledged. My priority, which must also be the priority for the trusts and those working in them, is to get a grip on the problem and to make sure that waiting times are reduced. I shall set out the measures through which that must be done. We start from a position that is worse than that experienced in the NHS as a whole. People working in the health service in Avon must get a grip on that.
Various measures have been and will be taken to reduce the number of patients waiting more than 13 weeks. For example, an additional two new consultant clinics per week in general surgery have been established at Frenchay hospital, with additional clinics at Southmead hospital.
In orthopaedics, which is of particular concern to the hon. Gentleman, the North Bristol NHS trust has appointed a new consultant and will use money from the performance fund to appoint additional physiotherapists as clinical assistants. The trust has also agreed low back pain referral protocols with GPs to allow direct referral to a physiotherapist, rather than to a consultant.
In ophthalmology, another problem area, a new consultant has been appointed from October this year. A new locum consultant gynaecologist appointment is being made from January next year. It is intended to use money from the performance fund to develop plans to provide four nurse practitioner-led clinics a week doing minor procedures to release consultants to see additional out-patients. A new staff-grade doctor in ear, nose and throat is being appointed from January. New clinics are being established in plastic surgery, rheumatology, dermatology and neurology, some of which it is intended to support through the use of performance fund moneys.
The trust is examining various measures to improve the way in which out-patient services are provided and to ensure that the best use is made of out-patient clinics by reducing the number of non-attenders and by filling vacant out-patient slots. The trust is engaged in discussion with other NHS trusts identified as "beacons" for good waiting list management to ensure that the trust identifies best practice and applies it to the local situation.
The United Bristol Healthcare NHS trust intendsto increase activity in ophthalmology, dermatology, neurology, dental specialties and ENT. This activity will be targeted at long-waiters. The trust is working with local primary care groups and considering the increased use of physiotherapy screening for orthopaedic out-patients to ensure that patients are seen by the most appropriate professional. In addition, the trust is working to ensure that its management of out-patient appointments process is in accord with best practice.
Orthopaedics is the specialty with the longest wait to see a consultant. Over the past five years, the Avon health authority has invested an additional £5.1 million in improving the orthopaedic service. As I said, the health authority is conducting a wide-ranging review of orthopaedic services across the Avon area to inform its funding decisions for next year. It will be assisted in that by the national patients access team.
In conclusion, I believe that action taken by the Avon health authority and the local NHS trusts will lead to a reduction in the number of patients waiting more than 13 weeks and, more importantly, a reduction in the maximum length of time taken to see a consultant. Current times are far too long. The regional office of the NHS Executive has carried out an assessment of the action plans prepared by the health community, and is satisfied that the waiting list objectives will be met. We want patients in Avon to wait less time to see a consultant in future, and will continue to work with the local NHS to achieve that aim.
Mr. Bob Blizzard (Waveney):
I shall start with a rather grisly fact. If one lives in certain parts of Lowestoft one has a 60 to 80 per cent. greater chance of dying before the age of 75 than the average individual living in Suffolk. That fact is contained in the 1999 report of Suffolk's director of public health. That is a shocking statistic for those who live in the two wards concerned as well as for the whole town of Lowestoft, the county of Suffolk and anyone who cares about health inequality. It reveals what is meant by the term "health inequality".
The director has made it clear in his report that there is a strong association between high death rates and deprivation. The two wards, together with a ward in central Ipswich, have the highest standard mortality ratios in Suffolk. They also have the highest levels of deprivation and the highest number of people on income support--about 25 per cent. The director's report tells us that Lowestoft as a whole has the highest premature death rate of any town in Suffolk and that it is significantly above the Suffolk average. All the information and statistics in the report are based on research from the years 1995-98.
Unfortunately, this is nothing new. In the director's 1997 report, which was based on statistics from the years 1987-95, the same three wards were at the top of Suffolk's standard mortality ratio. The report begins:
Sadly, and unacceptably, as I have pointed out, the 1999 report reveals that things have not improved and that, if anything, they have got worse. I spoke to the director this week and he is concerned that things my have got worse. The SMR for the Kirkley ward was 143 in 1997 and it is now 184. The SMR for the Harbour ward was 138 in 1997 and is now 164.
I have looked at other figures from the Office for National Statistics, which allows primary care groups to compare their death rates. It uses a measure known as the death, age, sex standardisation rate. Those figures show the Lowestoft PCG area substantially higher than all other Suffolk PCGs.
We see the same inequalities in mental health. The director's 1999 report shows that Lowestoft's standard admission rate for psychiatric specialties is 131. The next highest is Ipswich with 109 and the lowest rate in the county is 77. Again, the director confirms the link with deprivation.
Health inequalities such as these are immoral and unacceptable, even more so when one lives in a community that is at the wrong end of the statistical table. I am pleased that this Government are the first Government to make one of their two overall priorities the reduction of health inequalities to narrow the health gap. Few communities will appreciate that more than Lowestoft. However, if it was time for action in 1997, people want to know why things have not improved in 1999. What has happened?
I have looked at Suffolk's health improvement programme. The first programme is just a catalogue of what has been happening, but we must recognise that it will take time for health authorities to develop their programmes. As they are developed in the future, they will need to be more focused on specific priorities for addressing health inequalities, with a clear strategic direction.
It is clear that we need a two-pronged approach. First, we must tackle the causes of ill health. The Kirkley area of Lowestoft has been designated a single regeneration budget area. That funding is being used for a healthy Kirkley initiative, drawing together public bodies carrying out community based work. There is improvement in housing conditions and enhancement of the physical environment. A training centre is up and running to help youngsters back to work. That partnership has put in a bid to the new opportunities fund for a healthy living centre. If it is not against protocol, I hope that the Under-Secretary of State for Health, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), will support the bid.
There is some public disquiet about the rate of progress, but we must recognise that multi-agency work takes time. The new deal is making an impact in Lowestoft, as is the minimum wage legislation, and we fully expect the working families tax credit to help. We had excellent news this summer when the Government awarded Lowestoft assisted area status and designated it as a European objective 2 area from 1 January. All those initiatives will be a huge boost to the employment prospects, economic recovery and future prosperity of the people of Lowestoft. However, it will take some time for them to have an effect, so we must look at the second prong.
Like crime and the causes of crime, while we are dealing with the causes of ill health, we must ensure that the resources are available to treat the existing high levels of ill health. People in Lowestoft have asked whether the director's reports have influenced the spending patterns and distribution of resources in Suffolk. The answer seems to be not at all. The current allocation of resources within the county does not match or relate to the health inequalities. That is a sore point in my constituency. The director reveals that clearly with regard to mental health services in this year's report.
Government policy could not be clearer. The document entitled, "The New NHS modern and dependable" states:
Suffolk health authority has said that the budgets are tight and difficult. It is not easy to take resources from one part of the county to give to another. Let us be clear. Suffolk health authority has had above inflation rises in Government cash awards. In 1998-99, it was 4.14 per cent. and in 1999-2000, it is 5.5 per cent. It had extra money for the winter difficulties in 1997. It has had extra money for waiting lists and a good share of the modernisation fund. However, it has had only the basic rise in its annual revenue allocation from Government. It has not had any discretionary rise because, as a whole, Suffolk is relatively healthy in national terms. The Suffolk average SMR is 7 to 8 per cent. better than the national average. The Suffolk average for deprivation is quite low.
Government policy is to give greater uplift in resources to the more deprived health authorities to narrow the inequalities between them. The problem faced by Lowestoft is that it is an area of high deprivation suffering huge health inequalities in an otherwise better-off county. How will the Government ensure that their philosophy of addressing health inequalities through differential funding is replicated within a health authority? Is there an allowance for Lowestoft's deprivation currently included in Suffolk health authority's settlement? If so, how much is it? Is there monitoring to see whether that money is directed towards Lowestoft? The authority appears to use an historic roll-over budget rather than redirecting resources. I know that the Secretary of State for Health, my right hon. Friend the Member for Darlington (Mr. Milburn), when he was the Minister of State, wrote to Suffolk health authority about the issue in February 1998.
Before coming to the debate today, I consulted a number of health professionals in Lowestoft. The commonly held view is that the gap has got worse rather than better. Resources were directed towards an acute hospital in another part of the county that had particular problems.
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"Overall, Suffolk people are amongst the most fortunate residents of this country when it comes to health--or at least to death! In any one year a Suffolk resident of any age has, on average, an 8 per cent. lower chance of dying than the average individual of the same age living in England and Wales."
However, the report goes on to say:
"This encouraging overall picture for Suffolk does, however, conceal some marked variations in death rates within the county . . . The three most deprived wards in Suffolk . . . have deprivation levels akin to those found in many inner city areas of the UK's big cities. They also have the most significantly high SMRs in Suffolk and the highest levels of unemployment . . . If you are amongst the 10 per cent. of the population living in the wards in Suffolk with the highest death rates you are almost twice as likely as the 10 per cent. living in the best wards, to die before age 75."
The director was so concerned that he called the report, "Time for action".
"The healthcare needs of the population, including the impact of deprivation, will be the driving force in determining where cash goes. There will be a national formula to set fair shares for the new PCGs as there is now for health authorities. It will be for health authorities to determine the pace of change at which individual PCGs within their area should move towards their fair share."
So far in Suffolk I have seen no such movement.
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