§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Goodlad.]
10.44 pm§ Mr. David Evennett (Erith and Crayford)I am grateful for this opportunity to draw to the attention of the House the difficulties that are facing Lakeside health centre, which is located in my constituency. So often in Adjournment debates on health centres, the focus is on hospital facilities, and there is a tendency for the important role that is played by general practitioners to be taken for granted. I am pleased, therefore, to be able to draw attention to the valuable work that is being done by Lakeside health centre, which provides a comprehensive range of primary care services to those of my constituency who live in Thamesmead, a 1970s development which includes many system-built high-rise properties. Thamesmead has suffered from the misguided housing policies of successive Greater London council administrations and has more than its share of problems.
The practice is housed in system-built accommodation which was designed to be a health centre for 6,000 patients. Lakeside now has 12,000 registered patients. As the practice was designed to deal with half that number, an additional burden has been placed upon those who work at the centre.
Despite the difficulties, Lakeside is a good example of how a health centre should operate and it provides an extremely comprehensive range of services to the local community. The six-partner general practice based there offers the full range of additional services which general practitioners are being encouraged to provide, such as ante-natal care, minor surgery and diabetes and well woman clinics. In addition, district services such as dentistry, chiropody and speech therapy are provided at the clinic, as well as out-patient clinics held by consultants in a wide range of specialties.
The senior partner of the practice when it first opened in 1969 until his retirement in 1988 was Professor Peter Higgins, professor of general practice at Guy's hospital. He has now retired, but he continues to take a keen interest in the work of Lakeside health centre and of other groups in Thamesmead, and I should like to place on record my gratitude for all that he has done in the area and continues to do.
Peter Higgins forged a strong link between the centre and the education and training of general practitioners, and that link continues. Currently, all six partners hold part-time teaching posts with the united medical schools —Guy's and St. Thomas's—and medical students, both undergraduate and postgraduate, are regularly in attendance at the centre.
The link with professional education also has an influence on the way that services are provided at Lakeside health centre. As one would expect of doctors who are involved in the education of general practitioners, the practice at Lakeside is already pursuing policies which other practices are now being encouraged by the Government to adopt.
The doctors at Lakeside have worked hard to educate their patients and make them aware that good clinical practice does not require patients to be given a prescription every time they visit the doctor. As a consequence, the practice's prescribing costs are some 20 1313 per cent. less than the average for other practices within the Greenwich and Bexley family practitioner committee area and about 25 per cent. less than the national average. Similarly, over 50 per cent. of prescribing is of generic alternatives to brand name drugs.
The practice has also embraced the use of information technology for a wide range of applications, and has appointed a practice manager to ensure efficient delivery of patient care.
The partners at Lakeside are committed to putting the needs of the patient first and their success in doing so is borne out by the comments of my constituents. I often hear the doctors and other staff at Lakeside praised by constituents, and I have never yet received a single complaint about the quality of health care which the centre provides.
In 1987, my right hon. Friend the Secretary of State for Social Security, who was then Minister for Health, visited Lakeside health centre as part of a visit to Bexley health district. His comment at the time was that Lakeside
was an inner-city practice serving an inner-city population but in an outer London borough.His view was, and still is, entirely correct and neatly sums up the situation in Thamesmead.A large number of Thamesmead residents are from the inner city, having been decanted from areas of south London, designated for slum clearance and compulsory purchase, to Thamesmead in the early 1970s. In addition, a number of local authorities took advantage of the opportunity which Thamesmead offered and moved some of their tenants with social difficulties to Thamesmead.
Because the practice has all the problems associated with an inner-city practice, the work load of each doctor is high. With 12,000 registered patients, each doctor has a list of around 2,000. That is not particularly large for many practices, but it would be difficult for the doctors at Lakeside to expand their lists beyond that number without reducing the quality of the health care that they provide given that the consultation rate per patient at Lakeside is around 30 per cent. higher than average. A measure of the effect that that high consultation rate has is that the practice can expect to see over 90 per cent. of all female patients at least once a year.
The difficulties that the practice faces are not helped by the building in which it is located. The design of the health centre is such that effective use cannot be made of the space available. There is no proper storage facility for patients' medical records, which are simply kept on open racks behind the reception desk. The number of consulting rooms is insufficient for a large and busy practice which offers a wide range of services. Until recently, these problems were made worse by the need for some of the partners to keep buckets on their examination couches to catch the rain water coming through the roof, although I am pleased to say that the roof has now been repaired.
Because of all the problems associated with the building, the partners asked the district health authority to carry out repairs and alterations. It was agreed that a programme of work would be carried out in three phases at a total cost of £100,000. Phase 1 was the repair of the roof which, as I have already said, has been carried out. Phase 2 was internal structural alterations to make better use of the existing space by providing a proper storage facility for records and three much-needed additional consulting rooms. Phase 3 was minor general repairs and 1314 decoration. I regret to say that phases 2 and 3 have been halted by Bexley health authority because of a lack of funds for capital projects.
When the partners first brought the matter to my attention, I naturally raised it with the Brian Hord, the chairman of Bexley health authority. While he was sympathetic to the needs of Lakeside, and hoped that the district would be able to complete the work in the next financial year, he told me that there were no guarantees that the work would proceed, because Bexley health authority had not received capital resources of £300,000 which it had expected from South Thames regional health authority. As a consequence, a number of projects had been stopped, including the remaining work at Lakeside.
I am extremely concerned that the work has been abandoned because it is not simply a question of making the centre look better, although I believe that the partners, as tenants of the district health authority, are entitled to expect their landlord to keep the premises in reasonable decorative order. The delay in carrying out alterations affects the treatment which is being provided for patients, because the changes are necessary to ensure the effective delivery of service to patients. Until such time as the additional facilities are available, the pressure on existing consulting space will continue. The partners are asking not for lavish suites of room, but simply for the provision of enough consulting rooms to enable them to provide a proper service for their patients.
I have no doubt that the district and the regional health authorities have prepared their arguments as to where the money is, why it was not available and who is to blame, although from my point of view all that is unimportant. My immediate concern is that some of my constituents are not receiving health care in an appropriate manner because essential work has not been carried out. The work must be done. I ask my hon. Friend the Minister to take whatever steps he can to ensure that the work is carried out with all possible speed.
The other major issue which has caused considerable concern at Lakeside health centre applies equally to practices in other areas similar to Thamesmead. None the less, it has specific implications for Lakeside. I refer to the criteria for eligibility for deprivation payments under the new general practitioner contract. My hon. Friend will already be aware of some of my concerns from our correspondence on the issue. As I have already said, Thamesmead suffers many of the problems normally associated with inner-city areas, with possibly one exception—that there is little overcrowding because of the modern housing stock, although living in high-rise, system-built dwellings can bring problems of a different kind.
As a consequence, the electoral ward of Thamesmead, East, which is in my constituency, has a score of over 27 on the Jarman index of deprivation, the measure of deprivation used to determine eligibility for payments under the new contract. To put that score into perspective, we must remember that only 15 per cent. of the population live in areas where the Jarman score is over 20. Thamesmead, East is certainly different from the other wards in my constituency. Of the other wards, the next nearest score is 18, and the remainder are much lower, mostly in single figures. That further confirms my earlier remarks about Thamesmead.
The deprivation allowance paid since the beginning of this month is given only to practices in areas with a Jarman 1315 score of more than 30—not on a sliding scale or taper of any kind, but based on a once-and-for-all threshold of 30. The difference in the problems experienced by practices in areas that score between 29 and 31 must be negligible, yet one will receive the allowance in full while the other will receive nothing. That is illogical and unfair. As the Jarman score for Thamesmead, East is "only" 27, Lakeside does not qualify for the allowance.
That is unsatisfactory, not only because Lakeside is the kind of practice that should receive additional help but because it is likely that the Jarman score would be higher if it were based on up-to-date statistics. The current figure is based on information from the 1981 census, but Thamesmead has changed significantly since then. For example, a Vietnamese community of about 600 has moved into the area since then, and its specific problems are not reflected in the Jarman scale.
Lakeside is not the kind of practice that is able to generate additional income beyond the basic allowances. Despite the determined efforts of the centre's doctors, meeting immunisation and cervical cytology targets is a difficult, if not impossible, task. Doctors in a practice such as Lakeside can expect to work harder and to earn less than they would elsewhere—and with the high cost of living in the south-east, recruitment is always a problem.
Deprivation payments should be made to practices such as Lakeside which have problems that they cannot alter or overcome by adopting a different approach, because the problems are beyond their control. There is no logic in the present system, which stipulates that if an area does not have a Jarman score of more than 30 it does not qualify. Given that a small percentage of the population live in areas having a Jarman score of more than 20, it would be logical to pay the allowance on a tapering scale, at least to areas scoring more than 25. I urge my hon. Friend the Minister, who I know is always concerned with the quality of health care, to give that suggestion serious consideration.
Lakeside health centre does a first-class job in difficult circumstances, and its situation has not been helped by the delay in making vital changes to the centre's fabric, or by the current system for paying deprivation allowances. I ask my hon. Friend the Minister to exert what pressure he can to remedy the situation there. The doctors and staff at Lakeside do what is asked of them and the rest of the NHS, by putting the needs of their patients first. We must help by providing the resources that they need to continue providing my constituents in Thamesmead with health care of a standard that they are entitled to expect.
§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)I congratulate my hon. Friend for Erith and Crayford (Mr. Evennett) on his good fortune in securing this Adjournment debate and on the able way in which he presented the case for Lakeside health centre. My hon. Friend is a valiant and persistent defender of and advocate for his constituents. He is a Member of Parliament whom the Department of Health knows well and much respects for his activities in the south-east region and in his constituency.
I had the pleasure of visiting my hon. Friend's constituency on 16 January in relation to Erith hospital 1316 —an issue that has not yet been resolved, although I hope that it soon will be. In any event, that is not the subject of tonight's debate.
My hon. Friend alluded to the fact that my right hon. Friend the Member for Braintree (Mr. Newton) was much impressed by Lakeside health centre when he visited it in 1987. It provides a wide range of services, and my hon. Friend the Member for Erith and Crayford touched on some of them. They include audiology, dental care, dietary and speech therapy, family planning, child care, chiropody —an excellent range of services assisting his constituents, provided by a range of staff, including six general practitioners, a practice nurse, two qualified nurses, the equivalent of four and a half whole-time employees who act as receptionists and another four and a half whole-time equivalents acting as clerical and secretarial assistants. I was interested to hear my hon. Friend refer to information technology in use at the centre, a development that we are anxious to encourage.
How great the local need is for health care services, primary services in particular, of that quality was graphically described by my hon. Friend. Those needs, arising from social deprivation—one-parent families, limited employment opportunities and the arrival of new communities from as far afield as Bangladesh and Vietnam —were much in the mind of Professor Peter Higgins when setting up the general practice at the Lakeside health centre in the mid-1970s.
As professor of general practice at Guy's hospital, Professor Higgins was in the vanguard of those who believed that a health centre should play a positive social, as well as medical, role in the community, and for almost two decades he has guided young trainee GPs in that philosophy.
Professor Higgins, as well as being the vice-chairman of South East Thames regional health authority, has done much valuable work in developing funding for general practice and is currently advising the Department of Health on the general practice implications of the White Paper. Indeed, Lakeside health centre could hardly have two more formidable champions than Professor Higgins and my hon. Friend. I join my hon. Friend in paying tribute to Professor Higgins for his long service in the South East Thames regional health authority area. I recently had the pleasure of being with him when I visited the Medway towns.
My hon. Friend raised as his first issue the question of deprivation payments. The Government believe that it is right to reward GPs for the extra work involved in caring for patients who live in areas of deprivation. As part of the GPs' new contract, a capitation payment has been introduced from 1 April linked to an index of deprivation developed by Professor Jarman of St. Mary's hospital medical school.
The British Medical Association's general medical services committee agrees with the Government that the Jarman index provides the best means currently available. The index is made up taking into account a number of factors, including unemployment, the numbers of elderly people living alone, household overcrowding, the number of children under five, the number of unskilled, single-parent households, the number of residents in ethnic households and the numbers who have moved house, giving an indication of the mobility of the population.
My hon. Friend mentioned the census of 1981. We will shortly have a fresh census, in 1991, and I am the Minister 1317 responsible for its preparation. The index figures will be updated once the new statistics from the census are available.
Our policy objectives are to target deprivation payments on those practices that serve areas of highest deprivation. We have therefore chosen a cut-off point of 30 index points, although I accept that this means that some practices—for example, those to which my hon. Friend referred—which fall just short of that figure will not receive payment.
That is not to say that we do not recognise the hard work and dedication put in by such practices in providing general medical services to their patients. As my hon. Friend will recognise, the question where to draw the line is a matter of judgment. Under the scheme, about 9 per cent. of patients in England will generate a deprived area payment for their general practitioner. That seems to us very reasonable.
If we had chosen a much lower cut-off point—say, 16 on the Jarman index, which would then certainly include my hon. Friend's general practice patient lists—we would be including about 25 per cent. of the population in England. a much broader number, and we would, if we were not to provide additional resources by deducting them from some other part of the NHS, have to spread the £25 million, which it will cost in 1990–91 to make those payments, much more thinly.
Therefore, I strongly believe that that would have been to the detriment of the existing scheme. In areas where the deprivation index is between 30 and 39, it amounts to £4.90 per head on the patient list; for an index of between 40 and 49 it amounts to £6.40; for an index of more than 50 points—that is very severe deprivation, such as in some of the inner-London wards—it amounts to a payment of £8.50. Therefore, as my hon. Friend will calculate, for an average patient list of 2,000 patients, that means £17,000 extra to the general practitioner to help him to develop his services.
The Government believe that we have got the concentration and the targeting right, but I can give my hon. Friend the assurance—we shall study the Official Report of the debate with care—that the Government will monitor the GPs' new contract to ensure that it is achieving the Government's objective of raising standards and extending services. We shall bear in mind what my hon. Friend says about the consequences of a cut-off point at 30.
On the second point that my hon. Friend made, I can perhaps give him greater encouragement and assurances than I have been able to give him so far—the building at Lakeside. It is perhaps a product of the 1970s— a glass and concrete design with flat roofs. There is so much glass that in cold weather the building has been too cold, and in sunny weather the staff and patients have been too hot. The Lakeside centre was an award-winning architectural design but technical problems have arisen and, sadly, vandalism has also defaced the building.
In modern designs for such health centres, we would concentrate more on energy conservation; we might use brick, which is certainly a more friendly medium for a building; we would certainly have pitched roofs; and we would try to make buildings more vandal-proof.
It is of course the roof that has been the cause of most recent problems but, as my hon. Friend has tellingly pointed out, other structural renovations are sorely 1318 needed. Bexley health authority and South East Thames regional health authority are both very much aware of this. In fact, a £100,000 renovation programme was planned for 1989, which would have brought the centre up to a generally acceptable standard. Unfortunately, after £40,000 of that sum had been spent on roof repairs, the programme had to be frozen. The reasons for that, although complicated in financial terms, can be traced back, link by link, to the primary cause of a fall in land values.
Apart from capital money from regions, most district health authorities, particularly in the south-east, have planned to supplement their funds from capital derived from land sales. Bexley health authority was no exception. I understand that genuine expectations were held by Bexley health authority of selling a plot of land adjacent to Bexley hospital for more than £350,000. Of this sum, £100,000 was earmarked for the renovation of Lakeside health centre. South East Thames regional health authority had in fact advanced £350,000 to Bexley in anticipation of the sum being raised. Unfortunately, the sale has not been completed because of issues involving planning permission, particularly tree preservation orders.
I recall that, as a Back Bencher, I introduce a private Member's Bill, which eventually became law, dealing with the protection of trees and the prevention of the removal of trees subject to preservation orders when planning permission was required. To that extent, I apologise to my hon. Friend if I have in any way caused problems to him and to his constituency.
Bexley health authority hopes to find a way round those problems, but is not in a position yet to give any guarantee. In view of this, and in the light of its own serious shortfall in capital resources—another consequence of falling land values—South East Thames regional health authority had reluctantly to withdraw its bridging loan to Bexley.
Bexley health authority's capital programme for 1990–91 stands at £1.1 million. The authority does not yet know how much of the programme it will be able to fulfil until it learns what uncommitted capital it can expect to receive from the regional health authority. Negotiations are taking place. I am sure that my hon. Friend will understand if I do not say anything further here which may prejudge them. I can say, however, that Bexley health authority is optimistic that, from one source or another, it will have sufficient funds to complete the programme for Lakeside health centre during 1990–91. Thus rejuvenated, the centre will, I am sure, provide as fine a service for future generations of Thamesmeaders as it has for almost two decades past.
As for my hon. Friend's point regarding deprivation allowances, although by targeting the resources we have omitted the ward in which the centre is placed, I can assure him that we shall monitor carefully the effect of the scheme. Where changes are necessary, we shall certainly consider them.
I am as confident as I can be that the problems with the building to which he alluded will be put right. I plan to visit Lakeside, upon my hon. Friend's invitation, in the spring of next year—by which time I hope that Bexley's plans will have been brought to fruition—to see progress for myself and to see a fine health centre in operation.
§ Question put and agreed to.
§ Adjourned accordingly at ten minutes past Eleven o'clock.