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9 Oct 2007 : Column 27WH—continued

11.17 am

Dr. Ian Gibson (Norwich, North) (Lab): I shall be brief, to allow others to speak. I congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this timely debate. I also congratulate the Secretary of State; it gladdened my heart that he gave a speech to the Socialist Health Association at Toynbee hall. Inequality was mentioned all through that speech, which should be bedtime reading for every chair of every PCT and every chief executive officer who thinks that they know something about health.

I want to speak briefly about my role as chair of the powerful all-party group on cancer. We have very much played our part in developing a programme with the Government. The first cancer reform strategy, cancer plan one, has come out and we are now looking at a cancer plan two—although we call it our cancer reform strategy—with patient groups and others. I hope that money will be put into that strategy. It is partly about addressing inequalities related to gender, race and sexuality, but other issues also need to be addressed. I am told that many homeless people do not get health service support, such as the identification and diagnosis of early-stage diseases such as cancer in their environment. The St. Mungo’s Trust in London, which looks after the homeless, has really accentuated that point.

People who have rarer and less-talked about cancers do not get the same kind of support as those who have breast cancer and prostate cancer. Incidentally, there is not as much support for prostate cancer, as for breast cancer, but identification levels are on their way up. People with ovarian, pancreatic, liver and brain cancers do not get the same support, which is necessary to repair their lives and cure those cancers.

The lack of information does not help and inequality exists, particularly in black and minority ethnic communities. My PCT in Norfolk—I am glad to see my hon. Friend the Member for Great Yarmouth (Mr. Wright) here—has suddenly decided that it is worth putting out some
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documents in different languages. It has suddenly decided that Portuguese migrant workers, Lithuanian policemen and others deserve to have something written in their languages. It has taken it 10 years to see that, but it has a long way to go. I hope that the PCT is embarrassed, and that that fact is reported if anybody is listening. The problem is growing. Minority groups exist and do not get the whack of support from the health services that they need.

There was a report in The Lancet Oncology this summer about inequalities on another level—between us in the UK and other European countries. The report dealt particularly with two children’s cancers: a rare brain cancer called neuroblastoma and Wilms tumour, which is a kidney tumour. On looking at the survival rates, we see that we are lagging behind. There are many arguments about early identification and so on, but the situation has gone on a long time and we should be worried about it. Our first cancer plan is at an early stage of development and perhaps the data will improve as time goes by, but we should not sit back and expect that to happen. We have much more to do.

The answer is not always just to shovel money into the system willy-nilly; it is about directing money to the right places. I was on the Science and Technology Committee when the first cancer plan was set up. We investigated where the extra £640 million had gone, but it was difficult to find out from the PCTs at that time—a few years ago—what they had done with the money. Was it ring-fenced for cancer or did it go elsewhere? Was it used for car parks, and so on? We did not get to the bottom of that, but our questions precipitated a further investigation by the Department of Health. Funding for cancer research, treatments and cures was meant to be spread across the country, but it was unequal.

Cancer has been the doyenne of the health service, given what we have achieved in the past 10 years. It is a paradigm for many other illnesses such as diabetes, mental ill health and so on. Patient support groups have worked together and with the Government to improve services. Stimulating charities to join together is important.

I mentioned children earlier, but we must also think about the carers in the process. In some places in this country, carers are respected and given support. For example, if a child has to get treatment at the local hospital or clinic, a parent must go with them. If the parent works, they have to get time off work and lose pay. Things are not fair in this country—some people are not allowed time off. A managing director or football club manager, for example, presumably can take time off—unless they are managing Norwich City, when they need as much time as possible to achieve anything. However, I am sure that Members will take my point that it is easier for some people to get time off work. We must consider whether funding has been fairly adjusted in this country. Many young people are not getting that kind of support from their carers.

More men die of cancer than do women, particularly older men. I have mentioned ethnic minorities, particularly the women in them. The all-party group on cancer runs the Britain Against Cancer conference. Last year’s conference was attended by more than 300 people, with a waiting list just as long. Patient groups and other information groups speak about the issues and inspire us to do things. Some young women spoke about outreach
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projects that they were involved with in parts of London and elsewhere in the country, through which small groups of people address the big cultural differences in understanding the treatments that can be applied in various situations. Their problem—a real problem that I hope the Government will address—is that they set up a project that achieves greatness in year one and more greatness in year two, but then the money falls. When voluntary groups do such things, we must ensure that they are able to continue in office and to support the people out there.

I finish on this note. One of the Ministers and I will be attending a dinner tonight, and I point out that there are people lurking in the background who want to privatise the health service. Such people are pushing the idea that they can deliver better cancer services than the NHS. We should beware of the fact that they will be waiting in the wings with their American supporters if the Government do not precipitate action through the new reform strategy.

11.24 am

Dr. Brian Iddon (Bolton, South-East) (Lab): Ever since my election to this House in 1997, health inequalities has been one of my major campaigns. I therefore congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this important debate.

Regrettably, Bolton is included in a list of the 15 per cent. most deprived boroughs in the country, with 37 per cent. of its population living in the 20 per cent. most deprived wards. Of the three Bolton parliamentary constituencies, mine demonstrates the most deprivation, followed by Bolton, North-East, then Bolton, West. The Royal Bolton hospital, which has the second busiest accident and emergency department in Greater Manchester, is situated in the heart of my constituency.

Several diverse ethnic minority communities, mainly from south-east Asia, live in Bolton, particularly in my constituency. They present special challenges to the national health service, such as different diseases, cultures and styles of living. For example, 23 different languages are spoken in one of my primary schools. Such a situation is a challenge to the NHS.

Bolton is a low-wage economy. The median pay is only £317.60 per week, compared with the England average of £369.40 and the north-west average, which stands at £344.20. Worklessness, as represented by those receiving jobseeker’s allowance, incapacity benefit or severe disablement allowance, is high at 12.9 per cent. The figure reaches 49 per cent. in the most deprived wards in Bolton.

In the past, the principal industries in the town were mining and cotton textiles, supported by heavy engineering. They have caused considerable incapacity and disablement, particularly in our older population. That is a feature of all the old industrial towns. In some Bolton wards, life expectancy today is under 67, with a 15-year gap between the rich and poor areas of the town.

In 1997, the Wigan and Bolton health authority was considerably underfunded; I believe that the figure was about £14 million at that time. I compliment the Government on introducing the pace of change policy, which has brought more money to constituencies such as mine. Unfortunately, as my hon. Friend pointed out,
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the pace of that policy has been rather slow, and in some cases we have actually gone backwards, as I shall demonstrate.

There are just not enough doctors or dentists in Bolton. That is particularly true of the most deprived areas of the town. Bolton’s primary care trust, which is coterminous with the borough boundary, is currently just over 2 per cent. away from target in the three-year allocation leading up to 2007-08. That equates to a shortfall of £8 million. Compare that with affluent Richmond and Twickenham PCT, which receives 12 per cent., or £27 million, above target. As my hon. Friend said, such discrepancies simply cannot be right.

In November 2004, the Government defined spearhead local authorities as those rated in the worst 20 per cent. in the country in three out of five categories, which my hon. Friend defined. Bolton qualifies in four of those categories. The average spearhead PCT was 1.1 per cent. or, on average, £2.6 million under target in 2006-07—Bolton is at 2 per cent.—while the non-spearhead PCTs received, on average, 0.5 per cent. or £1 million over target. The differential is reducing. Bolton PCT’s figure has reduced, but only from 2.0975 per cent. to 2.035 per cent. Not surprisingly, especially in view of Bolton’s health legacy, which I described, I would support accelerating a reduction in the health inequalities that have existed not only in my constituency but in others for far too long.

A recent analysis of cancer mortality rates in the north-west for spearhead versus non-spearhead PCTs has shown an actual worsening of the position by 4.4 per cent. for men and 19.7 per cent. for women. Instead of the 6 per cent. absolute reduction required by the Government’s public sector agreement targets to reduce health inequalities between the fifth most deprived areas and the rest by 2010, the gap has increased in the north-west. Stomach, cervical, lung, and bladder cancers are of greatest concern, especially among women.

I assure the Minister that Bolton is doing everything possible within its financial capabilities to reduce the health inequalities in our town, even by using non-health pots of money such as neighbourhood renewal funding to pump-prime interventions, but we need more help than we are currently getting. That is what this debate is about.

11.30 am

Kelvin Hopkins (Luton, North) (Lab): We are discussing health, and I am afraid that my health is not particularly good today, so I shall not speak for long because my voice might not last. I want to speak because this debate is important, and I congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing it, and on speaking so strongly on this important subject.

I speak for Luton, which is seriously and consistently underfunded, and has been for many years. It is the most underfunded health area in the relatively prosperous eastern region, yet we have the greatest health inequalities, enormous levels of heart disease and diabetes, and serious mental health problems, which are not being addressed as they should be because we are underfunded.

I was recently called to a meeting by Amicus, which is now part of Unite, because its members include health visitors and there are not enough health visitors. Luton
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has a large young population with many children and a high birth rate, so we need health visitors and we do not have enough.

I have recently been informed that Luton has the longest waiting times for musculoskeletal treatments. Again, that is simply because of underfunding. Some non-statutory funding areas have been cut—for example, foyers for people with mental health problems—and there are funding squeezes all around. There was a health funding freeze two years ago, when Luton should have been treated rather better than some other areas, but it was treated worse and had the worst health funding cuts of any primary care trust in the region. Others in the more prosperous leafy shires and relatively middle class areas were allowed to increase their spending when we were forced to cut ours. That was gross inequity by any standard.

More recently, in the past year or so, we have had a savage cut in our walk-in centre. Walk-in centres were recently trumpeted by the Prime Minister, and the then Secretary of State for Health opened our walk-in centre with a great fanfare, but its hours were later cut to a quarter of what they had been. It was a wonderful facility that took pressure off GPs and the local accident and emergency department, and enabled people who might not have gone to their doctor to drop in. Some people with health problems, particularly middle-aged men, do not go to their doctor when they should, and walk-in centres pick up on conditions.

I do not blame the health professionals, who do their best in difficult circumstances, and I commend my local patient and public involvement forum, which has done a tremendous job in lobbying on behalf of local patients. Some months ago it called a special meeting to discuss the walk-in centre and other matters with representatives of the primary care trust and the strategic health authority. The PCT officers, to their credit, turned up at that meeting. They had a hard time, but they turned up. The SHA officer did not turn up and there was a vacant seat. I understand that a few days later, the SHA called the PCT officers to an early-morning meeting elsewhere in the region and told them to get the PPI in line. The SHA’s behaviour was outrageous. Not only did it impose unfair spending cuts; it lambasted its own officers in the PCT for not keeping local patient representatives in line.

Luton has serious problems, which must be addressed. I have written many times and at length to successive Secretaries of State for Health about our funding problems. I want Luton to be treated fairly in future, and I urge my right hon. Friend the Minister to look carefully at Luton’s funding and at other areas that are similarly poorly treated, to ensure that we have fair funding levels in future.

11.34 am

Jeff Ennis (Barnsley, East and Mexborough) (Lab): Thank you, Mr. Illsley, for giving me the opportunity to participate in this important Adjournment debate. There is no doubt that social care funding has had great difficulty in keeping pace with demand. The pressure on social care services from rising demand is well rehearsed and reflects the experience of Doncaster
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and Barnsley, which are my home authorities. People are living longer with improvements in health care from birth to old age, so more people have complex dependency needs. They have greater expectations for more and higher quality services. The situation has been compounded by recent developments in the NHS—for example, long-stay hospital closures. Treating more people more quickly with earlier discharge requires more intensive care in the community and places an extra burden on social care services.

Within social services, better assessment and early intervention, rather than reducing long-term costs, is creating pressure to offer more in the way of early, targeted support. More investment is needed for the shift from spending on intensive care services to prevention and individualised support.

The Government face a difficult scenario, but it is compounded by the inequalities in the health funding system, as all hon. Members who have spoken have said. This debate is not just about health funding inequalities; more importantly, it is about health inequalities in general.

You will be familiar with the health profile of my constituency, Mr. Illsley, where more than one in three households has at least one disabled person. It has the highest number of individual claims—more than 12,500—for chronic bronchitis and emphysema from former miners. Former miners in my constituency have received more than £100 million from the Labour Government. They would not have received that if we had had a Conservative Government, and those claims are a legacy of the mining industry.

The latest figures that I have for mortality rates for cancer are for 2005-06 and are based on 100,000 people of all ages. The average rate in England is 177; in Barnsley it is 204.35 and in Doncaster it is 207.68. Turning to the mortality rate for chronic heart disease, the average rate in England is 101.8; in Doncaster it is 115.8 and in Barnsley it is 145.02. That is 40 per cent. higher than the national average, and provides a snapshot of the sort of picture that we face in Barnsley and Doncaster. Yet overall Government funding bears little relationship to assessed needs, with current grant differing from some 130 per cent. over target to some 23 per cent. below target. Doncaster is 6.8 per cent. below target and Barnsley is 9.3 per cent. below target. Around 95 local authorities nationally are below target funding by some £686 million. Of those, 37 are part of the special interest group of municipal authorities outside London—SIGOMA—and are losing £239 million this year. Both Barnsley and Doncaster are members of SIGOMA.

I have a confession to make. I was one of the three founding fathers of SIGOMA when I was leader of Barnsley council. The other two gentlemen in the frame were Councillor Peter Smith from Wigan and Councillor George Gill from Gateshead. That was one of my greatest achievements as leader of the council.[Hon. Members:One of many.”] Yes, one of the many achievements. It is important that the Government revisit the issue, so that resources can be more effectively targeted at areas of greatest need.

The efficiency of local authorities has been widely acknowledged in recent weeks, and the Local Government Association lobbying of Ministers to switch 0.5 per cent. of the NHS’s expected budget of £100 billion—that
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is £500 million—to social care should be widely welcomed and supported, because there is evidence that such a switch would deliver better value for money.

In conclusion, the issue is one of fairness and equity, and I would like the Minister to answer this specific question when she responds. How can it be right that Barnsley, where the death rate from chronic heart disease is 45 per cent. higher than the average, is underfunded to the tune of 9.5 per cent. below target? The Barnsleys and Doncasters of this world do not want more than other areas. We would be more than happy with our fair share.

11.39 am

Lyn Brown (West Ham) (Lab): I thank my hon. Friend the Member for Wigan (Mr. Turner) not only for securing the debate, but for the careful way in which he put forward his arguments and also for mentioning Newham many times. I thank him too for characterising the debate not as one between north and south, but as one about health inequalities. I am really grateful to him for framing the debate in that way.

This debate is very important for my constituency, which is the eleventh poorest part of England and Wales. In the distance of the short journey on the Jubilee line from here in Westminster to my home in Newham, life expectancy for children decreases by six years. Put simply, my local authority does not have the money that it needs to deal with health inequalities. In the year 2007, the locality where people live should not determine lifespan, but the reality is that it does.

I acknowledge, as have other hon. Members, the findings of the Black and Acheson reports that health inequality has its determinants in poverty, low income, poor housing, lack of education, lack of security and high levels of stress. It is therefore clear that any redress in health inequality needs to engage more players than the NHS alone. My hon. Friend the Member for Wigan mentioned that we need a partnership with the Department for Communities and Local Government in dealing with these issues, and he is absolutely right.

There is no need to be an expert in Maslow’s hierarchy of needs to understand that living on a low income in a high-cost capital has an impact on healthy choices—food, leisure and education choices—and therefore on the stress levels of families struggling to make ends meet while living cheek by jowl with the enormous wealth of the City. It does not take a genius to understand that it is very difficult for families in temporary accommodation, living in the private sector in homes that they can barely afford, and moving every few months or years while they wait the 13 years that it takes to get a house in the public sector, to have a lifestyle that maintains good health.

Newham has a housing waiting list of 30,000 families—families that are moved from place to place while they wait, often unable to put down roots in an area, and are therefore unable to find their way on to doctors’ waiting lists. If they are successful in registering on the very full lists, they are often then subject to another move and another search for the most basic of health requirements—access to a doctor. Is it any surprise, therefore, that such families access their health care erratically, through the accident and emergency services of the local hospital, too late for there to be an impact on their health? That results in a shorter lifespan and means that such people live longer in ill health than those in better circumstances.

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