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9 Oct 2007 : Column 33WH—continued
The continued inequalities experienced by my constituents are exemplified by the infant mortality rate, which in Newham fell by 4 per cent. between 1998-2000 and 2003-05, although it fell by more than 10 per cent. in London as a whole. Obviously, all improvements in health are welcome, but the worrying growth in inequality simply cannot be ignored. There are clear inequalities in outcomes, but also great disparities in inputs, such as funding per person. North-east London contains several deprived boroughs with some of the lowest life expectancies in England. In 2004-05, the average expenditure per weighted head of the population was £1,090, compared with the north-west London figure of £1,311. Indeed, according to the Government’s own weighted capitation calculations, and as my hon. Friend kindly stated, Newham Primary Care Trust currently receives £15 million less than it should each year. Such underfunding in an area such as mine is frankly immoral.
Last year, I was forced to have a meeting with the then Secretary of State for Health to express my deep concern at the requirement made by NHS London that Newham PCT contribute 3 per cent. of its 2006-07 budget to a financial risk pool for London. The risk pool was required to ensure that the NHS in London as a whole was in financial balance. Although I understand that requirement from the wider perspective of getting the NHS on budget, it is hard to stomach given the local circumstances. Newham PCT has a consistent record of hitting its financial targets. The deficit in London had been run up by other PCTs, many of which have been, and continue to be, overfunded according to weighted capitation targets. My hon. Friend referred to that too. Along with other demands, such as that for a 15 per cent. saving on management and administration costs by 2008 as a consequence of commissioning a patient-led NHS, the requirements mean that the PCT is facing significant financial pressures while attempting to make real progress towards narrowing health inequalities.
I am confident that this Labour Government are facing up to the enormous challenge of inequalities in health care—something that the previous Government failed to do. However, while there is much to praise, good intentions will be carried through only if constituencies such as West Ham and the other constituencies mentioned here this morning receive better and more appropriate funding and health care—health care designed around the needs and realities of living in a borough such as my own.
11.45 am
Ian Stewart (Eccles) (Lab): It is incumbent on each of us to thank my hon. and good Friend the Member for Wigan (Mr. Turner) for securing such an important debate. Each of my Labour colleagues who has spoken previously has covered the general issues adequately, so I shall keep my comments specific to my own city of Salford and to the north-west.
For Salford, health inequalities are not just about quality of life, important though that is; they are about the actual lengths of people’s lives. They are important to the SIGOMA organisation, which was mentioned earlier, because Salford is an active member of that group. As to the more general comments made by my hon. Friends, let me just say that if we are to deliver the joined-up services for which we strive, and improve the health of our citizens and successfully tackle social
problems in our neighbourhoods, the Government need to move swiftly towards full implementation of their own funding targets.
In Salford, the evidence is stark. Despite huge improvements in the general health, housing, employment, income and education of Salford residents, the relative inequalities in health in parts of the city remain as great as they were 100 years ago, if not greater. In parts of Salford, male life expectancy based on 2003-05 figures is 73.8 years, compared with 76.9 years for England as a whole. The equivalent figures for women are 78.4 years in Salford, compared with 81.1 years elsewhere. That means that male life expectancy in Salford is the sixth lowest in England, and female life expectancy is the fifth lowest. Life expectancy in Salford has improved in recent years, year on year, but the gap for male life expectancy between Salford and England as a whole—3.1 years—is the same now as it was eight years ago. For women, it has widened from 2.3 years to 2.7 years.
The death rate from smoking in Salford is higher than the north-west and England averages and is the fifth highest in England. Smoking accounts for 505 deaths in Salford every year—deaths that are avoidable. The early death rate from heart disease and strokes is higher than the north-west and England averages and is the fifth highest in England.
The number of people claiming sickness benefit in Salford because of mental health problems is higher than the north-west and England averages and is the sixth highest in England. The rate of hospital admissions for alcohol-specific conditions is also above the north-west and England averages and is the tenth highest in England. Reducing health inequalities and improving well-being therefore remains one of the key challenges across agencies in Salford and requires an active and co-ordinated approach.
After taking weighting factors into account, Salford PCT’s GPs have more patients to care for than the national average. The PCT estimates that we would need an additional 17 full-time GPs over and above the current 132 GP full-time equivalents to bring the average weighted GP list size down to the national average. Extra doctors would result in greater specialisation, and most practices could, for example, have GPs specialising in areas such as diabetes and heart disease. That, in turn, could lead to reduced mortality rates.
On the plus side, I should say that the number of road injuries and road deaths in Salford is relatively low and that significantly more older people are helped to live at home than the national average.
If you have not visited Salford, Mr. Illsley, you might be surprised to hear, given what I have said, that a recent Royal Bank of Scotland survey, which developed an index of lifestyle indicators and how much they cost, found that Salford is one of the best places in Britain to live—in fact, it is No. 5. Given that Salford has such good facilities, I want residents to be around and in good health for as long as possible to enjoy them and I want them to have better-than-average life expectancies.
The problem before us is complex, and we need action on a number of fronts. For example, economic and regeneration policies have a role to play, as my colleagues have said. I applaud the north-west food and
health action plan, which was published at the beginning of the year. It looks at how regional agriculture and food industries can help local people to make food choices for healthier lifestyles. I was also pleased to see a recent report from NHS North West and others, which championed the role that local parks can play in improving our physical fitness and general well-being. It does not help, however, that we will lose our excellent maternity services, and we will continue campaigning to retain those services so that mothers can continue having their babies safely in Salford.
Today’s debate is more focused on health funding, however, and it is clearly about not only quality of life, but length of life. I therefore urge the Government to deliver health funding based on need, and the same goes for local authority social services. Our public and voluntary authorities will continue to work together to deliver the best for local people. If we in Salford are given additional resources, we will use them wisely and effectively. We now need to ensure that the tremendous social, environmental and economic progress that has been made in Salford is matched by progress in the health of Salford people.
11.53 am
Mr. Edward O'Hara (Knowsley, South) (Lab): I, too, congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this important debate and enabling me to draw attention to health inequalities and health needs in Knowsley, which I represent.
Of the 26 indicators in Knowsley’s health profile, 18 are worse than the national average and one is better—it happens to relate to deaths in road accidents, although that might be connected to the low incidence of car ownership, which in turn might be connected to the fact that 29 per cent. of residents are dependent on health-related benefits, against a national average of 13 per cent. Knowsley’s figures for smoking are above the national and north-west averages. According to the statistics, we also have the worst record in England for the number of adults who eat healthily. Our male life expectancy is seventh lowest in the country and female life expectancy is fifth lowest. The main reasons for that gap in life expectancy are coronary heart disease and cancer, although we have had a proud record in that respect over the past decade, given that deaths from coronary heart disease have fallen by 19 per cent. and those from cancer have fallen by 5 per cent.
As regards the provision of funding to meet Knowsley’s health needs, I must acknowledge that the Government have recognised the problem and provided significant uplifts in funding over the past three years, and we are grateful for that. That money has been spent wisely, with sound budgeting, efficient organisation and proactive health improvement measures. Generally, our record has been good. For example, Knowsley PCT has managed the implementation of the new GP and dental contracts better than many other PCTs, and I have had little problem solving my constituents’ difficulties in that respect with the PCT’s help.
However, Knowsley is still 3 per cent. off the expected target for an area with its health profile, and that amounts to £9 million per annum. The financial strategy for the next two years assumes that we will have a 6 per cent. uplift, given Knowsley’s under-target position. If
that turns out to be over-optimistic, planned investments to make a real difference to the health inequalities suffered by the people of Knowsley might have to be reduced or delayed.
Much of Knowsley PCT’s undoubted success in managing its resources is due to the synergy of its working arrangements with those of the local council. The two bodies pioneered the joint appointment of the PCT’s chief executive and the council’s director of health and social care. That has allowed for an integrated approach to health and social care and joint working to address the health inequalities agenda. That has been made possible through section 31 arrangements with the local authority, the pooling of budgets, the sweating of assets and, generally, by working together to achieve efficiencies across a wide range of services.
Although such working arrangements have contributed to the PCT’s undoubted success in addressing the health inequality agenda, its future success is vulnerable to the outcome of the comprehensive spending review. The local government formula has less weighting for social deprivation, and the local authority fears that there will be a standstill in uplift because its population is not increasing at the same rate as elsewhere in England, where there are higher levels of immigration. Clearly, that will have an impact on health care in Knowsley, as the council will have less money to invest in initiatives to help improve the health profile of the people of Knowsley.
As in many other respects, Knowsley, which is typical of the Liverpool area, has a story to tell about its attempts to address the health inequality agenda, and it can be justly proud of it. At the heart of that success story is the close working between the PCT and Knowsley council. Like other PCTs, Knowsley PCT is therefore highly dependent on the outcome of the CSR. I therefore urge the Minister to give due and particular attention to that and to ensure that Knowsley council and Knowsley PCT can continue to address health inequalities in Knowsley as well as they have in recent times.
David Taylor (in the Chair): Order. I shall call the Front-Bench speakers at exactly 12 o’clock, but I shall give two minutes to Tony Wright.
11.58 am
Mr. Anthony Wright (Great Yarmouth) (Lab): I will be very quick, because everything has been said. Clearly, this is a major issue for Labour Members, and it is significant that the Opposition Benches are empty; either Opposition Members have no health issues to raise or their areas are well funded by the Government.
All too often, we can be critical of the health service, but there has been significant investment in my constituency in the past 10 years, which has significantly improved the health of my constituents. However, there are problems with the way in which the formula is worked out. Significantly, the formula for Great Yarmouth means that we are now 3.5 per cent. below the average, but that does not tell the complete picture. Although we are underfunded, we were on target last year, but we were penalised because money was clawed back from the SHA as a result of shortfalls in other areas. In fact, our formula works out at about 6.9 per cent. below the
average, which is a considerable amount of money—around £21 million—and it is something that we need to look at.
I am aware that the Government are looking at and will probably change how the formula is calculated. I do not think that there is anything wrong with the formula per se, but the funding is not coming. I would like an assurance from the Minister that there will not be changes to the formula that would change PCT funding procedures overnight.
12 noon
Sandra Gidley (Romsey) (LD): I, too, congratulate the hon. Member for Wigan (Mr. Turner) on securing this important debate. Although at times it has seemed like a competition to decide which of the many eloquent speakers has the worst life expectancies or funding in their constituencies, I recognise the passion with which all who have spoken put their case. The title of the debate on the Order Paper is “Impact of health funding on health inequalities”. Although there is a geographical aspect to such inequalities—not, as others have demonstrated, a north-south divide—I should like to talk about gender and race inequalities.
The hon. Member for Wigan said that there is no doubt that a person’s life expectancy and health outcomes are affected by their social class at birth and by where they live, and a powerful case has been made for increased funding for areas that have the greatest need. I acknowledge that money has been spent, but we must ask whether it has been spent in the most effective way, because much of the extra Government funding has been diverted to secondary care. If we are to tackle inequality problems in the long term, we must ensure that more money is spent on the preventive health agenda and that more people have good access to primary care.
The Government recognised the inequality problem and announced that there would be 88 spearhead PCTs in 70 of the local authorities with the poorest health outcomes according to many of the indicators. The aim, which we might all agree was a worthy one, was to tackle inequalities in the long term, focus on improving life expectancy and reduce more quickly rates of premature deaths from cancer and heart disease. We might have expected to see those PCTs increase spending on public health if they were truly to address their aim, but the Liberal Democrats have analysed the public health spend in all PCTs, and unfortunately, we found absolutely no correlation between spending and the extent of need.
For example, in 2005 Lewisham was designated to receive proportionately more Government money than other PCTs to compensate for its position in the one fifth of areas with the worst health and the largest gaps between rich and poor. In fact, there was a drop in public health spending by that PCT far in excess of any other trust—14 per cent. of total PCT spending used to go on public health but the figure has dropped in recent years to 1.7 per cent. We must ask ourselves why there was such a dramatic reduction and whether it was to do with other financial pressures. Why was Lewisham PCT allowed to take its eye off the important goal of reducing health inequalities in the long term?
We also discovered that a quarter of all spearhead PCTs spent less on public health in 2005-06 compared to 2003-04, and that 26 received an increase in public health spending of less than £1,000. Will the Minister
explain why that happened and why it was allowed to happen, and say something about whether we can stop it happening in future?
The hon. Member for Norwich, North (Dr. Gibson) spoke about directing money toward different budgets, and that needs to be looked at closely, because there are huge variations between trusts. The King’s Fund has analysed the national programme budget project—the NPBP—and the Government have collected data since 2003 on 21 different disease areas. There are now sufficient data to allow comparison between PCTs and to enable us to ask questions about whether they are putting funds to their best available use.
Analysis shows that the three largest shares of increase in overall PCT spend have gone to mental health, heart disease and cancer. That reflects Government priorities and no one should have a problem with it. However, the analysis also shows that there are large variations in the amounts and proportions of total budgets spent on individual disease areas by PCTs. For example, Islington PCT spends £406 per head on mental health compared to the £56 per head spent by Bracknell Forest PCT. We can argue all we like about whether people who live in Islington are any saner than people who live in Bracknell Forest, but there is also a fourfold difference in spending on cancer, a threefold difference on circulatory system diseases and an eightfold difference on musculoskeletal problems. It might be argued that the differences can be accounted for by relative needs, and there may be an evidence base for them. However, even when we adjust for those factors, we can see that the sevenfold spending gap between Islington and Bracknell Forest reduces only to a fourfold gap, which is still a huge difference in the amount spent.
The same pattern occurs around the country in relation to spending on cancer. After taking into account known population differences, the proportion of budget spent on cancer ranges from 3 to 10 per cent. of a trust’s overall budget. Local decision making cannot account for such a wide discrepancy. In-depth research ought to be undertaken so that we can compare amounts spent to outcomes, to see where money is most effectively spent and to learn lessons from that.
I shall briefly talk about gender. On average, women live five years longer, but there is a wider gap in the most deprived areas. The situation is even worse than that suggests, because general health outcomes are worse for men. For example, women contract skin cancer much more frequently, but men have a higher death rate from the disease. We are not serving men well if we allow such things to happen. Again, bettering men’s health is not necessarily down to spend; it is down to taking different approaches to tackling their problems. Men between the ages of 16 and 34 consult a GP half as frequently as women, and the outcomes are there for all to see. Asian men have a high rate of diabetes, but funding formulae do not account for ethnic mixes.
Finally, I shall comment on the Institute for Public Policy Research report that was published yesterday. It claimed that focus on choice has helped the better-off, but that to help the poorest, public services need to be personalised. Research has shown that the more affluent and better educated a person, the greater the health benefits they receive from the NHS. Care for such
people is planned, but the less affluent tend to present themselves as emergencies. People in poorer areas have 20 per cent. fewer GPs per 100,000 people than in the most affluent areas in the country. Cancer death rates are 29 per cent. higher in the poorest fifth of the population.
In summary, money is important, but some of my examples show that we perhaps need to aim at other targets. We need to look at access to health services in the most deprived areas. People will not access a GP if they cannot get to one via a good travel network, and they may not be able to afford a car. All such things are relevant. Furthermore, do we have enough health visitors going into deprived areas to try to encourage families to adopt healthy living styles from the outset?
I have a final query: the Darzi review recommended polyclinics. If we centralise our health services, will that mean that in the poorest areas the poorest people, who are least likely to access existing services, will be even less likely to access them in future? There is much food for thought in what is happening, but much potential for improvement as well.
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