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6 Nov 2002 : Column 403—continued



10.56 pm

Mr. David Heath (Somerton and Frome): I have pleasure in presenting a petition collected by my constituent Mrs. Rachel von Kimmelmann of 4, Thornwall Way, Wincanton. It expresses the concern of a number my constituents at the prospect of a pre-emptive war against Iraq. I have attempted to express the same view in this House.

The petition states:

6 Nov 2002 : Column 404

To lie upon the Table.


10.57 pm

Mr. Adrian Flook (Taunton): Before I present this petition, I should like to pay tribute to the Taunton Times and to Gillian Powell for working with me to raise the 1,000 signatures of constituents from Taunton and Taunton Dene. The aim is that all drugs should be made freely available to all patients on the basis of clinical need alone.

The petition states:

To lie upon the Table.

Food Supplements

10.59 pm

Mr. Alan Reid (Argyll and Bute): I wish to present a petition signed by 100 of my constituents.

The petition states:

To lie upon the Table.

NHS Funding for East London

Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]

11 pm

Mr. Brian Sedgemore (Hackney, South and Shoreditch): I am delighted to participate in this debate on behalf of the citizens of east London. I have recently had extensive discussions with the primary care trusts of Hackney, Tower Hamlets and Newham, the major local hospitals, including the Homerton, Barts and the London, the East London and the City mental health NHS trust and the north-east London health authority. Put boldly, we all agree that the way in which the NHS is funded in the United Kingdom is unjust and unfair, leading to unnecessary pain and suffering and even early deaths in east London.

For too many local people, life really is nasty, brutish and short—thanks, in large part, to an outdated and antiquated funding formula. The formula has to change, not at some distant time over the horizon but within the next few weeks, before the forthcoming three-year settlement; our people will settle for no less. Those who think otherwise must think again unless they wish to see blood on the House of Commons carpets.

The NHS in east London has suffered from years of chronic underfunding. Despite the Chancellor's announcement in March of major sustained growth in NHS funding, east London remains one of the most under-resourced health communities in England. Over the past three years, the former East London and the City health authority has been below its target share of resources. Since April 2000 alone, it has missed out on more than #90 million of funding—a staggering figure.

In the face of persistent inequities in funding and mounting demand, this divide must be closed now. East London is currently #26 million behind where it should be in funding terms, and there is absolutely no justification for that. Unless urgently tackled, the gap between the best and the worst-funded health systems will continue to grow, resulting in even greater inequalities.

The case for east London is simple but powerful. A sound, equitable and transparent system for the allocation of funding is essential, particularly now, as we move into a new era of three-year revenue allocations direct to primary care trusts. The new formula must recognise that east London is an area of exceptional ethnic and cultural diversity with some of the worst social and economic deprivation in the country. We need to get the formula right; the cost of providing existing health services rises year on year as new treatments become available and the number of the heaviest users of these services—the very young and older people—increases.

Serious flaws in the current method of funding exist in eight key areas where improvements must be made. They relate to population projections, demography, general practice work load, diversity of the population, refugee health, forensic psychiatry, staff market factors and child and maternal health. I will touch tonight on just three of those factors—population projections, general practice work load and child and maternal health.

On population projections, a major concern is that over time the census-derived estimates issued by the Government have become increasingly unreliable. For example, in April 2001, 779,915 patients were registered with GPs in east London and the City, compared with the mid-year estimate of relevant population by the Office for National Statistics of 666,725—a variance of 17 per cent., and the fourth highest in the country. The average variation for England overall is just 4 per cent. East London's population is growing rapidly and has a much larger proportion of young adults than the rest of England. That growth has been most marked among five to 14-year-olds, 15 to 24-year-olds and 25 to 44-year-olds—the least funded groups. At least 142,000 homes are planned for the area in the next 10 years, so improvements to the quality and quantity of health services are essential to cope with the resultant demands.

As for general practice work loads, a feature of east London's practice not adequately reflected in the national resource allocation formula is the high turnover of patients. Applying recent research findings to east London, we see that patient turnover generates an additional 54,000 consultations for GPs and 28,000 consultations with nurses a year. The existing formula simply does not recognise that. Fair shares for non-discretionary expenditure should reflect the work load pressures faced by primary care, and would include recognition that patient turnover is a major determinant of work load. Moreover, 25 per cent. of GPs in east London are due to retire within five years. There are eight to 12 annual GP consultations in east London per patient, compared with a national average of five. Again, the existing formula does not recognise the enormous burden that that places on heroic local GPs.

As for child and maternal health, in addition to having some of the highest infant mortality rates in the country, east London has the highest rates of teenage pregnancy. It also has high numbers of children with low birth weight, a result of premature delivery and complications during pregnancy such as gestational diabetes and hypertension. Meanwhile, maternity services in east London are operating with 50 per cent. staff vacancy rates, and their models of care need substantial updating. The existing formula does not recognise that. Poverty can damage children's esteem, affecting their future mental health and life chances. Prevalence of psychiatric disorder in children in inner London is 13 per cent., compared with 6.8 per cent. nationally. Again, the existing formula does not recognise that.

Perinatal and infant mortality rates are higher in east London than in the rest of the country. Stillbirths and deaths within the first seven days—perinatal mortality—are over a third higher than nationally. Infant mortality—deaths within the first year—is over a fifth higher. In simple terms, a baby born in Hackney is at more than double the risk of dying in the first year of life than a baby born in Bexley. A baby boy born in Newham is likely to die nearly six years earlier than a baby boy born in Westminster. That is appalling. How can the Minister justify a system that is killing us in the east end so early? What have the citizens of east London done to Ministers and civil servants at the Department of Health to warrant such early graves? The situation cannot continue.

East London also has a high fertility rate. The 2001 census showed that there were more under-one-year-olds than in any other part of the country. Newham had the highest proportion of children aged under 16 in the country. The area is increasingly densely populated; Hackney, for example, has the fourth highest population density in the country. The formula must begin to recognise that.

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