Examination of Witnesses (Questions 10400
- 10419)
10400. My name is Jeff Safir. I am senior partner
at the Spitalfields practice in Old Montague Street. We have 7.2
doctors, seven full-time and one one-day-a-week doctor and three
full-time nurses. We are the nearest practice to the proposed
site and an awful number of patients of mine will be represented
in the discussions we are dealing with today, so I welcome the
opportunity to give what I consider to be a non-biased factual
report to the Committee. I hasten to say I am not a resident of
Spitalfields, I have no vested interest in the properties, I am
not against Crossrail in concept, I am not an expert witness on
pollution, and if you want that I can call on people who are,
but I will tell you that pollution in very deprived areas has
a much greater effect than pollution in not so deprived areas.
Also, my practice is three streets away, so directly I will not
be affected by the drilling or the vibrations or whatever. So
I am trying today to give a factual report on what the health
and social environment of Spitalfields is.
10401. I would like the Committee to understand
that Spitalfields is unique, it is not a normal inner city area.
We are one of the most deprived areas in the whole of the UK and
under my old GP contract there was a thing called the Jarman Index
which listed deprivation on social, medical, health, housing,
unemployed, et cetera, et cetera, and under the old Jarman Report
which was done away with under the new contract, and I will not
go into that, Spitalfields was joint top in the whole of the UK,
so you are dealing with an exceptionally deprived population,
top of the pops.
10402. I have been working in Spitalfields for
33 years, I was supposed to stay for six months but something
went wrong and I am still here, so I really feel there is nobody
better than me to present information to the Committee on what
my population is like.
10403. Our practice has 12,500 patients. 75
per cent call themselves Asian, we have a sprinkling of so many
other, South Asian, Somali, AfroCaribbean, and an increasing amount
of people coming from the new European Union. We have an enormous
amount of unemployment, an enormous amount of housing problems
which I will touch on, an enormous amount of illiteracy, and I
hear today learned counsel saying about all the documents that
have come through and they are bilingual and everything, but we
have an enormous amount of Bengali people who are illiterate in
their own language.
10404. They are also, not wishing to be racist
or rude in anyway, totally unaware of concepts of health, housing,
of major impacts on social undertakings that would have perhaps
influenced different populations. I imagine an awful lot of my
population would have no idea what Crossrail is about. I will
reiterate Mr Akker's concept that I think it is very poorly publicised.
I do not remember seeing any leaflets coming through my door,
and I think an awful lot of my population, especially the Bengali
population, will not have understood concepts even if due consultation
as described by Crossrail has gone ahead.
10405. I would like to touch on the health issues
and the social issues by just saying that Spitalfields is a medical
disaster area. I called the health authority in six months ago
to point out our problems of disease entities and prevalence of
diseases and they were absolutely amazed, so not even our health
authority have really understood the problems we are facing, the
deprivation in Spitalfields. We have an enormous birth rate which
adds to overcrowding in housing. We have 3-4 new births a week
which is probably double what it should be; every single disease
entity under the chronic disease register, I have brought figures
which I will not bore you with, that GPs are supposed to look
at are massive for Spitalfields. This is compounded by the ignorance,
the non-compliance, the difficulty in understanding concepts,
the difficulty with language even though we have interpreters
in our surgery—we are dealing with a very unique population
who really are not on the same wavelength as all the people in
this room, and that has to be taken into account when we are talking
about impact on population. We are dealing with a very poor illiterate
people who do not understand loads of concepts, who have not got
computers, who have no idea about internets or whatever. I have
people living in the country for 20/30 years who do not speak
a word of English, and people who would have no idea who the Queen
of England is or the Prime Minister. We are one mile from Tower
Bridge and I often ask people: "Have you ever been to Tower
Bridge?", and the answer is invariably "No", because
they live in their little community a few blocks square. That
is where they live, that is where they survive, and that is their
life. And what is going to happen with the Hanbury Street project
is it is going to have a major impact on the Spitalfields community,
far more than any other community of similar population.
10406. What is going to happen with the Hanbury
Street project, it is going to have a major, major, major, major
impact on the Spitalfields community, far, far more than any other
community of similar population. Just to give you an example of
non-compliance, we see three new diabetics a week in our practice
alone. Already our total population is seven per cent and countrywide
it is three per cent. We tried converting people to insulin when
all else has failed. We have a highly trained nurse-practitioner,
with interpreters, who spends ages and ages and ages showing the
people how to inject themselves with insulin. So it is not a language
problem. We have shown them how to prick their finger to test
their blood and tell them how to adjust the insulin doses according
to the blood test results. Invariably—maybe that is a bit
too strong—in the majority of cases when they are called
back a week later they have been injecting themselves with the
starting dose of insulin, they have not been taking the blood
testing meter out, and when asked why they have not bothered testing
their blood there is just a shrug of the shoulder. There is no
concept of health wellbeing in the area. As I say, every disease
entity—asthma, chronic obstructive airways, which is the
in-word for basically chronic lung disease, we have enormous amounts.
We have the worst of the worst. I was at a recent meeting and
unfortunately they did charts of hospital admissions and the cost
to the health authority, and unfortunately on the top of the list,
my name, Dr Safir, "top of the pops", most admissions,
most expense, most everything for hospital admissions due to lung
disease. There is this thing called FEB1, which basically is a
disease which is the amount of air you can get out in the first
second, and according to the lung specialists this is the biggest
indicator of premature death—far more than cholesterol or
blood pressure and all the other things that we read about in
the papers all the time.
10407. Mr Liddell-Grainger: I think we
have what you are saying. Can I ask you what you would like from
us? I accept that you have an enormously difficult job as a doctor.
10408. Dr Safir: What I would like you
to do, in a nutshell, is accept the fact that our population is
going to be far more affected by the Crossrail project in Hanbury
Street than any other population that I know of because of all
the problems I have said, because of the non-compliance, because
of the housing problems. I would very briefly like to say that
it is not uncommon to have four families living in a four bedroom
flat—20, 30 people, including children. So although you
have already a very close-knit community with fairly close housing
together the devastating effect on the Hanbury Street project
will affect far more residents than I think people understand.
10409. Mr Liddell-Grainger: Doctor, I
think you have put forward a very eloquent case. Is there anything
else that you would like to add?
10410. Dr Safir: I would say, number
one, that it is a very highly sensitive area at the moment with
the Muslim population, and I think we need to retain race relations.
I am not aware of any detailed assessment of health issues that
have already gone through that Crossrail have asked for. I am
sure there is going to be a big impact on the health of my population.
I feel that there is a different route that can be taken that
does not involve Hanbury Street. I am not political, I do not
know the ins and outs, but there is a different route that could
be used that would totally avoid the Hanbury Street population.
10411. Mr Liddell-Grainger: So you would
prefer to see one of the other routes?
10412. Dr Safir: I would much prefer
to see the route not going through the middle of my patch, for
all the reasons that I have said.
10413. Mr Liddell-Grainger: Your point
is taken.
10414. Dr Safir: I just would really
like to say again that the impact on the community is not going
to be the same as the impact on another similar community—I
really feel that very strongly.
10415. Mr Liddell-Grainger: I think that
is a very fair comment, and I do not think you can add to that.
10416. Dr Safir: I will not add to that.
10417. Mr Liddell-Grainger: This Committee
has taken on board your concerns as the local GP for this area.
Thank you very much indeed.
10418. Mr Mould: Sir, all I want to say
in response to Dr Safir's presentation is this. The need to consider
carefully the impact of the project both during the construction
phase and during its operation upon the health of people and communities
through whom the railway will pass, both directly and indirectly,
is something that the project has very much in mind. We have carried
out a Health Impact Assessment and that has been the subject of
public consultation. It is available, as I understand it, on the
website and it is also available on application in paper copy.
We have also had carried out and are in the process of continuing
with an Equality Impact Assessment, and I emphasise that in particular
because the particular concerns that Dr Safir has identified are
in what are known in the jargon as the differential impacts of
the scheme on particular communities, particularly those who suffer
from social and economic deprivation. We are engaged in that process
and that is focused specifically upon the kind of issues in terms
of the potential for markedly greater impact upon areas of social
and economic deprivation, whether it be in relation to matters
of health, environmental impact and so on, and we are focused
specifically on that in that Equality Impact Assessment. It seems
to me that Dr Safir is very well placed to provide us with detailed
local knowledge and understanding in relation to that. That has
been the subject of public consultation already but that public
consultation round, as I understand it, is continuing, and certainly
it would be the subject of further consideration through consultation
as the detailed design of the project emerges. I would urge Dr
Safir to engage himself and to use the benefit of his local knowledge
and expertise in contributing to that process—we welcome
him doing so, frankly. And the gentleman who was giving evidence
to the Committee a few moments ago is an obvious point of contact
for him if he wishes to take advantage of that offer. That Equality
Impact Assessment has specifically focused, amongst other areas,
upon the area of Tower Hamlets and upon the area around Hanbury
Street in particular, as indeed has the Health Impact Assessment,
and I can say that to you because I was involved in the preparation
of that document and I know how much focus and attention we attached
to impacts on Tower Hamlets and Hanbury Street, precisely because
of the particular problems of social deprivation that he mentioned.
So I can assure this Committee that from this end those concerns
are not by any means new to us. So I think those are the points
I wanted to raise. I am not going to say anything about routes
because you have heard about that.
10419. Mr Liddell-Grainger: Thank you
very much.
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