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Mr. Leigh: If it is unhelpful to road traffic safety to have certain symbols on the number plate, why have any symbol on it? It would surely be easier to exclude all symbols and have neither national nor EU symbols. What is it about the EU symbol that, alone among any other patriotic or religious symbol in the world, makes it the only one that should be allowed on our number plates? Where is the logic in that?
Mr. Hill: I remind the hon. Gentleman that it is entirely up to the individual vehicle keeper whether he or she has the symbol on the number plate. The reason for the use of the EU symbol is to permit ease of circulation in the European Community. It is also a standard symbol, not a confusing or distracting symbol. The hon. Gentleman may not have been here for the beginning of my speech, so I shall repeat that the object of the exercise is clarity. The recognition of a number plate is vital for law enforcement and it is for that purpose that the Government have decided to legislate to ensure that number plates are easy to read and free from other potentially distracting marks. The EU symbol does serve a particular purpose and is to be permitted on a voluntary basis. There is no good reason to allow other variations.
I appreciate that strong feelings over national identity have been expressed here tonight. However, I hope that the House now fully understands the intentions of the new regulations and that the Government, by making the display of the Euro flag optional, have preserved that freedom of choice which is the birthright of every self-respecting Briton.
Mr. Speaker: I think the Ayes have it.
Division deferred till Wednesday 25 April, pursuant to order [7 November 2000].
Battersea Primary Care Group
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Touhig.]
11.22 pm
Mr. Martin Linton (Battersea): I am grateful for the opportunity to raise the issue of the funding of Battersea primary care group. I make no apology if this sounds like a cry for help, because the health service is seriously underfunded in Battersea by comparison with neighbouring areas. I do not wish to drown my right hon. Friend the Minister in statistics, but he will know from his Department that Battersea is underfunded by £4 million and he will be familiar with the figures produced by the Merton, Sutton and Wandsworth health authority. Battersea primary care group has an allocation of £70 million, its target spending is £74 million, and that leaves a shortfall of just over £4 million, or roughly £43 a head.
Battersea is not even in the flush of good health. Among the six primary care groups in the health authority, Battersea is in the unenviable position of having the highest rates of heart disease and respiratory disease. Indeed, it may have the highest asthma rate in the country, but this comparison is solely with the other primary care groups in the health authority. Battersea also has the highest neonatal mortality rate; the highest mortality ratio for all ages; the highest admission rate for respiratory diseases; the highest admission rate for men and women over 65; and the highest admission rate for diabetes. I am sorry if the list is long, but it is important to establish the facts. It also has the highest admission rate for epilepsy, the highest conception rate for under-age mothers--three times the London average--and the highest conception rate for teenage mothers. It has the highest proportion of single, widowed or divorced households. Battersea also has the highest proportions of one parent families and of pensioners living alone. All those factors are indicators of medical need.
Battersea also has the highest rates of claims for income support, jobseeker's allowance, attendance allowance and many other benefits. The NHS needs index is the Department of Health's measuring tool for medical need. It shows that Battersea comes top on the indices for acute needs, for community mental health, for district nurses, for health visitors, for community maternity, and for chiropody. Battersea comes top in every single category.
The needs are high in national as well as local terms; Battersea is 26 per cent. above the national average on the community mental health index, and 19 per cent. above the national average on the mental health index. It is 10 per cent. above the national average level for the chiropody index, and 10 per cent. above that for the health visitor index.
Battersea also has the highest limiting long-term illness ratio, according to the normal standardised basis that takes account of age. It has the highest proportion of adults in-household who are recorded as unable to work because of permanent sickness. Battersea has the highest mortality rate for people over 75, and for people under 65. That is extremely worrying, because the population is very young. Of all the 659 constituencies in the country, Battersea has the highest ratio of people aged between 25 to 34.
The last census showed that Battersea had the second most mobile health authority population in the country. I am sure that the new census will show that we have reached the number one spot--certainly in the Merton, Sutton and Wandsworth health authority and probably in the entire country. The electoral register shows that Battersea has gained 37,000 new voters since the 1997 election: that is, 53 per cent. of electors in Battersea were not living at their present addresses in 1997.
When Battersea is not first in terms of medical need, it is often second after the neighbouring primary care group of Balham, Tooting and Wandsworth, part of which is in my constituency. Balham, Tooting and Wandsworth is not much better off financially, having an allocation that is nearly £4 million under target. It has the highest mortality rate from lung cancer and diabetes, with Battersea in second place in both cases.
The Battersea and Balham, Tooting and Wandsworth primary care groups are at the top of every relevant league table bar one. Both are at the bottom of the spending league table, at roughly £4 million below target. This is not a simple demand for more cash. I want to ask my right hon. Friend the Minister about the criteria according to which funds are allocated to primary care groups. Should the guiding principle be equity, need or demand?
If the Government believe that the guiding principle should be demand, I concede that in some respects the Battersea primary care group has low demand. We have the lowest admission rate for cancer, for instance, and for bypass operations, even though we have the highest incidence of heart disease.
That sums up the problem: Battersea has low demand in some areas, but that is not because needs are low. We have the highest emergency admission-to-hospital rate, but a low admission rate from GPs. That is a classic symptom of people on low incomes in the inner city who need the NHS more but use it less. It is not because they do not believe in it--quite the reverse: it is usually because such people lead hard, stressful and chaotic lives. It is much easier for such people to miss an appointment with a GP or a hospital. To go through the system from diagnosis of a heart problem to a bypass operation often requires a lot of tenacity.
The Government believe that the national health service should be founded on the principle of treatment on the basis not of demand of need. The health service should not simply meet the needs of the articulate or the well organised. We need a proactive health service that can find the people who need the treatment most.
The Government's system is based on measuring need, producing target figures based on need and providing more growth money to be distributed to health authorities with higher need. Primary care groups that are under target should be levelled up. Pace of change money is provided, but what happens? Health authorities have so many "must do" targets, such as reducing waiting lists, fulfilling the quota of cancer operations--all good aims in themselves--that it is easy to lose sight of the most important target of all, which is to meet medical need.
Merton, Sutton and Wandsworth health authority ended up with pace of change money of only £500,000. That may sound like a lot, but the portion that went to help Battersea PCG reach its target was only £281,000--just 0.4 per cent. of its annual budget. Wandsworth council has calculated that at that rate it would take 21 years for Battersea to catch up with its fair share of the budget.
I understand the reluctance of the Department of Health to reduce budgets. I understand why there is a principle of non-disinvestment, as it is called, and that PCGs should not have money taken away from them. It is not my aim to take money away from any of the neighbouring primary care groups, but I want the growth money to go to the primary care groups that need it most and to close the gap not in 21 years but in two or three years--the foreseeable future. That must be a "must do" target.
I remind the Minister that Battersea primary care group has been a pace setter. It was a pilot for locality commissioning schemes back in 1997-98. When my right hon. Friend the Secretary of State for Health was Minister of State, he visited Battersea primary care group when it was set up as a pilot because it was seen as a model of good practice. I pay tribute to the work done by the chairman of the primary care group, Dr. Sian Job, by Dr. David Finch, and by all the other members of the board who have set up a model PCG. It is involved in its community, it has good relationships with its general practitioners and it consults and listens to local people.
If the Government set up primary care groups, they must listen to them. If they have targets, they must make progress in meeting them. If they give more money to health authorities in deprived areas, they must ensure that the redistribution occurs not just between health authorities but within health authority areas. Wandsworth is in inner London, but in a health authority that is mainly in outer London, taking in the whole of Merton and Sutton. The danger is that this system of funding will turn into a huge disadvantage if money is allowed to drift towards demand rather than need. That argument has all-party support. The Minister will hear it from Wandsworth council as well as from me, as the Member of Parliament for Battersea.
Just as the deprivation of Wandsworth, as an inner London borough, is diluted and, to some extent, disguised by being joined with Sutton and Merton, so the deprivation of Battersea as the most inner London, deprived part of Wandsworth can be disguised by the creation of a new Wandsworth primary care trust, which would average out some of these inequities.
I do not seek to make a purely local point. The aim of this debate is to draw attention to a wider problem through the example of Battersea. Primary care groups need to become intelligent primary care organisations--the very point of setting them up in the first place. When general practitioners were purely reactive, one could not expect them to go out to discover the health needs of their areas. Battersea PCG provides a role model of a group determined to be proactive and intelligent in tackling its job, seeking out health needs and pushing preventive care programmes. It can make sure that the people who most need the health service receive the help.
I appeal to my right hon. Friend to take another look at the formulas used to determine how soon PCGs will meet their targets. While the situation that I have described has come about for the most understandable of reasons and out of the purest of motives, it would be unacceptable, having set targets, to allow it to be possible to take more than 20 years to achieve them. The Minister and his hon. Friends have set up PCGs and a system that can deliver intelligent primary care, but he must either provide the money for health authorities to make that a reality or
loosen the system so that more resources can be put towards the most important health objective of all--medical treatment in relation to need.
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