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18 Mar 2009 : Column 273WH—continued
“inverse care law—which says those who need healthcare the most are least likely to get it”
is, sadly, alive and well, so that some of the poorest parts of the country are being
“systematically underfunded to the benefit of the healthiest and wealthiest.”
I was concerned to see in that article that, in the league table of PCTs with the strongest tendency to underfund poor practices, mine in Oxfordshire was second. I know that the PCT is doing a lot locally—for example, with capital investment in new health centres—to improve primary care in some of the most deprived parts of my constituency and elsewhere in the county, but that aspect of ongoing funding to practices, and the inequalities uncovered by the Health Service Journal, must be addressed. I am sure that the Minister shares my concern, and it would be good to hear him say what he and his Department are doing about that. As my hon. Friend the Member for Wigan said, they cannot micro-manage absolutely every allocation everywhere, and one understands that, but there needs to be much greater transparency, and perhaps the Minister will tell us that his Department is already working on that.
If the formulae interact properly, we should be able to compare primary care provision in a deprived community in Oxfordshire with that in a similarly deprived community in Sunderland. If the figures are similar, those communities should have similar levels of resourcing, although I suspect that the analysis would show that the Sunderland community was better resourced, but I might be wrong. Areas might be sucked up by the regional average, or
resources might be sucked out of pockets of deprivation within regions by the historic overfunding of the most affluent areas.
Whatever the theory behind the statistical analysis, the practical politics of correcting the problem are very hard. This is not totally a zero-sum game, and budgets have been increasing quite quickly. However, if we give relatively more and relatively more extra to one area, we will be giving relatively less extra to another. If that other area has more articulate and demanding constituents, and they are kicking off about the issue, the practical politics make it very difficult to get the allocations right. The Department needs to keep a close eye on how allocations are working out in practice across the country, particularly with the introduction of practice-based commissioning. PCTs face some hard choices in the guidance on practice-based commissioning if sufficient extra resources are to get into the areas that need them most.
The second issue, on which I want to touch more briefly, is the situation of practices with a high proportion of student patients. That will not be a problem across most of the country, but it is certainly an issue in Oxford, as I expect that it is in Cambridge, Brighton and one or two other places. Changing practice funding to relate income more to long-term acute conditions and changes in the minimum income guarantee has a logic to it, and the Minister may argue that that is part of tackling the very inequalities that I have just mentioned. However, the exceptional situation of practices with an overwhelmingly high proportion of student patients could threaten their viability if their circumstances are not taken sufficiently into account.
Will the Minister confirm that he is aware of the situation of practices with a high proportion of students? Although students obviously do not have a high incidence of long-term physical conditions, they do have a high incidence of mental health conditions and sexual health issues. When looking at PCTs’ funding needs, it is important to take account of their patients’ particular needs. It is important that the good service that PCTs give students is not undermined by funding changes. I would appreciate the Minister’s assurance that the needs of such practices are being fully and properly addressed.
I will bring my remarks to a close now to let others get in, but I congratulate my hon. Friend the Member for Wigan once again on securing this vital debate. He made a powerful point when he said that the importance of health allocations is such that they should be debated on the Floor of the House in the same way as local government, police and other allocations. This is as important an issue as any that the House ever addresses in terms of its impact on our constituents’ quality of life, and it would bear a great deal more scrutiny and informed public debate. My hon. Friend’s suggestion of a debate on the Floor of the House would help.
3.14 pm
Mr. Mike Hall (Weaver Vale) (Lab):
I congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this important debate about health inequalities. I have served as a Parliamentary Private Secretary to two Secretaries of State—my right hon. Friends the Members for Darlington (Mr. Milburn) and for Airdrie and Shotts (John Reid). Both were acutely aware of the
need to reduce health inequalities, to increase life chances and to improve the care that the health service provides to people from impoverished communities.
A lot has been done to increase funding to the national health service in the past 12 years. One of the Government’s major achievements was their brave decision to increase national insurance by 1 per cent., so that we could devote the money to making massive improvements to the national health service. Although one of the primary care trusts in my area was 4.7 per cent. away from target, that spending has achieved some remarkable improvements in the health service.
Today, we have had the report on the Mid Staffordshire NHS Foundation Trust and calls to scrap targets, but it would be absolute madness to scrap the two-week target for people suspected of suffering from cancer to see a consultant. It would be absolute madness to remove the 18-week maximum wait for someone to see a clinician. It would be absolute madness to say, “You have to wait as long as you must in accident and emergency.” It would also be madness to say that we do not want to prioritise reducing child mortality or deaths from heart attacks, cancer and strokes. It is right to say that we should reduce those, and that is why we have seen improvements in our health service.
I have mentioned that the Halton and St. Helen’s primary care trust is 4.7 per cent. away from target, but it still receives £530-odd million to spend each year, and some fantastic things have happened there. We have secured the future of Halton hospital under the Warrington and Halton Hospitals NHS Foundation Trust. Not so long ago, people thought that the hospital faced closure, but its business is now absolutely fantastic. The hospital is making massive improvements to day case surgery, so the people of Halton can actually be treated in the borough. There have also been massive improvements in diagnostics. The extension of endoscopy is a massive improvement in the earlier detection of illnesses that can be life threatening.
The hospital now houses the regional renal unit, which is up and running. It provides the best renal services in the north-west—apparently, that is because the water at the hospital is so pure. State-of-the-art activity is going on at the unit, and when I go there, I see people from the area being treated and booking to go back for their regular treatment, because the facilities are state of the art. Another thing that we have been able to do as a result of the current funding is to establish an independent treatment centre on the hospital site. That is fantastic for hip and knee replacements and other such surgery. Wonderful things are happening.
For the past 17 years, I have campaigned to get proper primary health care facilities on the Windmill estate in my constituency, which is the most deprived area in the borough of Halton. Even with its current funding, Halton and St. Helen’s PCT will be able to open a brand-new GP surgery on the estate this year. My first ten-minute Bill related to the fact that the single GP on the estate walked away without giving his patients any notice and without any consultation. I have been fighting ever since to make sure that the people in the most deprived part of my constituency get the service to which they are entitled.
That raises the question of how many more improvements we could make in the Halton and St. Helen’s PCT area, if the PCT had the same funding as other PCTs and if it was at target. The answer is that we could make significant improvements. There have been remarkable improvements in bringing PCTs closer to target, because the Government are committed to doing that, but as my hon. Friend the Member for Wigan has said, we really need to up the pace of change.
In another part of my constituency, I have the town of Northwich, which has the Victoria infirmary. The Brunner family donated the site to the people of Northwich for the free provision of national health facilities. The infirmary is part of the Mid Cheshire Hospitals NHS Foundation Trust, together with Leighton hospital, which provides acute care. The Victoria infirmary in the centre of Northwich is an important cottage hospital, but it was threatened with closure.
The Central and Eastern Cheshire PCT is at target, and I want it to stay at target. I am calling not for its funds to be reduced, but for the funding of Halton and St. Helen’s PCT to be brought up to the level of other PCTs. I have now secured the future of the Victoria infirmary site. In conjunction with the GPs of Northwich, we shall bring forward first-class primary care and secondary care facilities, and we shall have a 12 or 24-bed facility as an assessment centre, a step-down centre for people who need to be discharged from hospital but are not fit to go home, and an assessment centre for people with long-term disabilities, to see what needs to be done to improve their care.
The one fly in the ointment with the arrangement is that Central and Eastern Cheshire PCT has decided to impose car parking charges at the hospital. Parking was previously free, as it is in the rest of the Northwich area. People will be able to park for free at the hospital for 20 minutes, after which the charge will be £3. That is a substantial increase and a substantial amount of money for people to pay. I congratulate the Northwich Guardian, my friend Dorie Willington and the journalist Gina Bebbington, who are campaigning forcefully to get the Central and Eastern Cheshire PCT to remove the parking charges.
This debate is a wonderful opportunity. I do not want to detain hon. Members, but I fully agree with my hon. Friend the Member for Wigan that the Government’s pace of change must improve and that we must get primary care trusts such as Halton and St. Helen’s PCT closer to target. As my hon. Friend has suggested, we need an annual debate in the House where we can air the issues, put the Minister on the spot and point out issues such as the level of funding that we think that we are entitled to in my constituency. All that we ask for is fair play, and if that comes about as a result of the debate, my hon. Friend will have done us all a great service.
3.21 pm
Christopher Fraser (South-West Norfolk) (Con):
I want to make a very quick contribution to the debate. [Interruption.] Before the hon. Member for Stockton, South (Ms Taylor) makes her point, I will make mine, which is that I was in the other Chamber, where I wanted to contribute to the debate on the economy. As we all know, hon. Members must sit through both
opening speeches to do that, and it is not my fault or anyone else’s that both debates are happening at the same time.
I congratulate the hon. Member for Wigan (Mr. Turner) on obtaining this timely debate, which I wish I had been able to attend throughout, but alas could not. I want to ask the Minister a question, after making one observation. We are currently in prostate cancer awareness month, as I am sure that the Minister knows. Health inequalities suffered by those with prostate cancer were highlighted in the 2005 National Audit Office report, which stated that prostate cancer patients
“reported a generally poorer experience of care than patients with other common cancers.”
John Neate, the chief executive of the Prostate Cancer Charity has said that prostate cancer has
“suffered from a historical legacy of neglect.”
My one question, so that the hon. Member for Stockton, South has plenty of time to speak, is this: does the Minister agree that that is unacceptable and that urgent action is needed to ensure that PCTs are given adequate funding to deal with the situation?
3.23 pm
Ms Dari Taylor (Stockton, South) (Lab): I congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing the debate. I am most grateful to the hon. Member for South-West Norfolk (Christopher Fraser) for explaining his situation. It is valuable for us to be able to understand what has happened; we all have three or four things to do at once. I am most grateful to him; I was a little shocked, but am no longer.
I was very impressed by my hon. Friend’s opening contribution. He clearly outlined the shameful situation that the national health service was in before 1997 and the staggering range of services and level of investment that there has been in the NHS, certainly in the past 10 years. It has been overwhelming, in some ways, to see, in my patch, James Cook university hospital becoming one of the national cardiac centres. It has also been valuable that the university hospital of North Tees has developed teaching capabilities as well as serious competences in many areas of the health service. Like my hon. Friend, I am keen to put on record the fact that the Government have supplied considerable investment. However, like other hon. Members, I often feel that we have an inflexible formula, which works on averages, so that the chronically deprived areas in our constituencies, which frequently experience serious health hazards, are outside that formula.
The special interest group of municipal authorities within the Local Government Association has often spoken to the Secretary of State for Health and other Ministers. The point is always pressed that fair funding must be seen to be a fact throughout the health service and throughout Great Britain. I agree, but my problem is that I do not see fair funding. I do not have any problem with research-based hospitals and teaching-based hospitals receiving phenomenal increases in their funding. I realise that they must have them. However, I believe equally that the time is long overdue for us to pay attention to areas such as, in my own patch, Mandale and Victoria ward. There, average life expectancy is 58. In Hartburn and Fairfield there are very low levels of deprivation. It is delightful that they have people with
above-average salaries, with the lifestyles that they accommodate. Those people have a life expectancy of 78. That is a serious issue, and it is long overdue to be dealt with. It has been sidelined by statisticians or by people who are trying to construct a formula that works for all people. I accept unequal spending, but not unequal treatment of people and their needs.
In wards with a high deprivation factor the characteristics are pretty universal. I am convinced that all hon. Members would say the same about them. Those characteristics are: low birth rates for children, high rates of illegitimate births to teenage girls, obesity rates that are a significant contributor to poor health, and significant incidence of cardiac problems and cancer. The issue is not just health, but much more. It is a question of poor rented private housing, long-term sickness, pools of permanent unemployment, and part-time and low-paid work. All those contribute to the situation, as does cigarette smoking. Who am I to complain about that? I do complain, as hon. Members can well imagine, and ask people not to do it, but when they are dealing with enormous stress a cigarette becomes their friend. We must move in to support and help, reassure them and get their trust, and get them off that frankly filthy habit.
The characteristics of parts of the wards in my constituency are the same as are found in other hon. Members’ constituencies, so how is it that we still do not deal with the problems? Why does our funding formula, which may or may not be generous, not include the people in those areas? Why does it not involve asking when they went to the GP last and which clinic they visit? Those people do not trust and are not confident; they have no self-belief and do not put themselves first. They are the last in the queue. We—individuals—are persuading them to take up all sorts of opportunities, but it is the job of the national health service.
My local authority works closely with the health service. The relationship between social services and the primary care trust is a keen one. As my hon. Friend the Member for Wigan said, our Supporting People grant was 177 per cent. off what it should have been. When I have made that argument, I have received nods of sympathy and little else. Sympathy ain’t what I am here for. I want action that drives resources to people who need them. Stockton’s PCT and the local authority social services offer a model of excellence. They share knowledge and resources. They work the streets. However, it is a hard routine getting people to trust, to come on board, to hear the good news and to hear about the services that should be available to them.
The absolute statement for me is that my local PCT is 6 per cent. below where it should be. Our Supporting People budget is below where it should be. Our health budget is below where it should be. We cannot ensure that the work that needs to be done in very high deprivation pools is done if we do not have the people to work those streets and the resources to employ them. I am therefore saying to my hon. Friend the Minister that we need greater specificity in the way that deprivation is handled in all budgets, but most particularly in the health budget.
I was delighted to read some of the material from the Advisory Committee on Resource Allocation. It is clear that ACRA believes that we have to use weighted capitation. It is clear that it wants a separate health inequalities formula. It believes that if we are not specific about the
work that we ask PCTs to do, we will never give to all people that which they deserve—fairness. Good health and good living standards should be theirs as of right, not because of someone fighting for that. I would appreciate hearing what the Minister has to say about ACRA. I want to know when the Government will come on board with this. I would like to believe that he will tell us that the Mandale, Victoria, Hartburn and Fairfield distributions will be acknowledged in the future and that all people will be treated fairly under the funding formula.
3.31 pm
Dr. John Pugh (Southport) (LD): I congratulate the hon. Member for Wigan (Mr. Turner) on having started this very important debate. I shall start uncharacteristically by congratulating the Government on putting a lot of money into the health service—it is a lot of money—on registering the problem of socially differentiated outcomes in health and on endeavouring to address it. Sadly, that is where the congratulations stop, because they have not been successful hitherto. There are two possible explanations for that: one is that the Government are not particularly competent; the other is that it is a very hard problem to address.
The facts are still fairly stark. I know the story that going eastwards on the Jubilee line, each station represents a year knocked off a local person’s life expectancy. I do not know whether anyone has checked that recently, but it is an often repeated mantra. I know the story about children in the inner-city Manchester area dying far sooner than those born in Kensington. I came across a chilling statistic the other day that the Government should think hard about: babies born in poor families in 2008 had a 70 per cent. higher than average chance of dying. That figure has worsened—worsened—since 1998.
Allegations have been made about the ability of the UK to address health inequalities compared with other nations. The evidence on that is pretty mixed. I am not convinced that we are necessarily worse or better at addressing this issue than other European nations. Clearly, part of the problem is that we are dealing with an extremely difficult problem. Health inequalities are only partly an issue of NHS resources. They are also, as the right hon. Member for Oxford, East (Mr. Smith) said, an issue of housing, education, cultural factors in some areas, nutrition, smoking and drinking habits, and employment history—or lack of it. As unemployment goes up, health outcomes will undoubtedly get worse.
Obviously, the NHS alone cannot address a problem of this nature and size and it looks to alliances with other agencies and branches of government, so there is now in many areas a plethora of partnerships. By themselves, they are no substitute for political policy and will. They can be, to some extent, cosmetic: once the partnerships are in place, everyone thinks that the job is done, although in fact progress is not quite what we would expect. None the less, it is a fact—many hon. Members have harped on this—that NHS resources, as well as objectives, count, and count decisively. Clearly, we need to apply resources at the PCT end to great effect. However, the whole business of allocating resources, as has become apparent in the debate, is extraordinarily contentious.
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