§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Hill.]
§ 10.2 pm
§ Fiona Mactaggart (Slough)I requested this debate because of the series of cuts in community health services that were proposed by Berkshire health authority, which is responsible for health care across the area of the former Berkshire county council. As the House has heard, that has caused deep concern to more than 1,000 of my constituents who signed a petition on the subject which I have just submitted. I am glad, therefore, that since I requested the debate, Berkshire health authority has made significant changes to its proposals.
For many years, our county has been an area of major population growth, and only recently has health funding started to follow the people. Historically, Berkshire health authority has been underfunded in terms of the needs of the local population. Out of 100 health authorities, Berkshire comes 96th in spending per head, getting some £100 a head less than most health authorities.
The Labour Government have taken some initial steps towards rectifying that. I am glad to say that in both of the past two years, Berkshire has received among the highest percentage increases in health spending in England. Nevertheless, there is still an underlying deficit, and local health services remain very much under pressure.
Berkshire has an image of green prosperity, but the image is incomplete. The prosperity, and the good health that it brings, is not universal. Within Berkshire, the town that I represent, Slough, has the greatest deprivation. It also has the highest incidence of coronary heart disease in Berkshire. We are among the top 50 local authorities in the country for deaths of people under 65 from coronary heart disease—coming just between Birmingham and Newcastle-upon-Tyne—and among the top 10 for people of all ages, coming between Carlisle and Hackney. We have a worse record in terms of coronary heart disease—[Interruption.]
§ Fiona MactaggartI believe that I am responsible, Madam Speaker.
§ Fiona MactaggartI know that, Madam Speaker, and I sincerely apologise. I do not understand why it is doing that.
§ Fiona MactaggartWe have a worse record on coronary heart disease than not only other districts in Berkshire but neighbouring London boroughs such as Hillingdon, Hounslow and Ealing. We have the highest incidence of lung cancer, bowel cancer and pneumonia in Berkshire, and the most hospital admissions for all the top five causes of death.
118 "Our Healthier Nation" pledged to improve the health of the worst-off and to narrow the health gap. The pledge to tackle health inequalities was very important to Slough, as to other areas with a health record substantially worse than the national average.
§ Mr. Martin Salter (Reading, West)Will my hon. Friend give way?
§ Fiona MactaggartCertainly.
§ Mr. Salterrose—
Madam SpeakerOrder. Is the Minister aware that there is to be an intervention? The Chair has not been informed.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)I have no objection.
§ Mr. SalterDoes my hon. Friend agree that, in some aspects of the review and in the lamentable episode of attempting to make cuts in community health services in Berkshire, the health authority failed to take account not only of the White Paper on the national health service but of the recent policy document "Supporting Our Families", which envisaged an enhanced role for health visitors? Is it not important for Ministers to impress on health authorities the need to produce policies in line with Government health policies?
§ Fiona MactaggartAbsolutely. "Our Healthier Nation" talked about councils and health authorities working together, but it is striking that that has not been achieved. Pioneering work is being done in my local authority to introduce early years centres, very much along the lines of the surestart initiative, and that will be damaged by the review proposals to reduce the number of health visitors.
The national priorities guidance asks local authorities, the Department of Social Security and health authorities to work together for child welfare; the Home Secretary's document on supporting families, to which my hon. Friend the Member for Reading, West (Mr. Salter) has referred, proposed a greatly enhanced role for health visitors; and the conclusions of the Acheson report on health inequalities also have significant implications for Government policy that do not seem to have been seriously considered in Berkshire health authority's proposals.
The proposed cuts included £140,000 off the health visitors service—5.7 per cent. of its budget—which would have meant that it was unable to support the council's early years initiatives; and £40,000 from the speech and language therapy service, which was already under enormous pressure.
A consultant paediatrician told me of a five-year-old child of one of my constituents who had already waited a year and a half for speech and language therapy. The child does not have generalised developmental delay but has a specific speech and language therapy need that was not met in the pre-school years. Those are lost years for the child's education.
119 The proposals for cuts were called service reviews but, frankly, they were attempts to reach financial targets and did not reflect the serious thinking about service needs and future health provision that a community with as many health problems as Slough requires.
The health authority was surprised by the strength of popular opposition to its proposals. That is partly because the debate about health care has focused on waiting lists and not necessarily on community services. I believe that the reaction showed that local people really care about their community services.
I heard from many people who were concerned about the role of their health visitors. For example, one of my constituents wrote:
Being first-time parents, the health visitor was a source of help and reassurance and we found her invaluable.That comment sums up the many representations that I received from parents about the support that they had from health visitors.The proposals caused concern among the people of our community and its Members of Parliament. We had meetings with Ministers—I am grateful to my hon. Friend the Member for Reading, East (Jane Griffiths), who initiated a meeting—at which we had positive responses. It seemed illogical to us that during the process a substantial increase of £29.6 million was allocated to the authority, yet those cuts-led proposals were still being pursued.
Following the meeting with the Minister, the situation began to change almost day by day. I am glad to say that the health authority withdrew the bulk of its proposals last Monday and promised further reviews of health visiting and school nursing—affecting cuts that had been proposed in the west of the county, but not Slough—including consulting the local councils and leaving out the savings targets. I thank my right hon. Friend the Minister for Public Health and her colleagues for that outcome and I hope that the health authority can move on and seek, as the petition that I presented earlier requested, to work instead to improve the health of the people of Slough.
I have to say that it is a crazy way to run a railroad. The health authority, if it is accountable to anyone, is accountable to the body that appoints it—the Government. It has no separate lines of accountability to local communities. Indeed, that is one of the weaknesses of our local health authority, which does not have members with long experience as councillors playing a large role on it. I do not understand how the local health authority can carry on making proposals that run directly counter to the priorities set out by the Government in several different documents and that have to be hauled back from the brink by the intervention of Members of Parliament and the outrage of the people for whose health care the authority is responsible.
A number of questions must be considered. First, I hope that the Minister will assure me that Berkshire health authority will not try to slide some of the cuts in under the wire, because the final version of its decision is not explicitly available to all of us. We do not know exactly what it plans to do. We know that it has withdrawn the present reviews, but it is not clear whether my local community trust will be expected to make the same savings on health visitors and speech and language therapists as were envisaged in the original proposals.
120 Secondly, when health authorities plan changes to our services, have they been directed to take account of the Government's policies, as outlined in "Our Healthier Nation", "National Priorities Guidance" and "Supporting Families"? Thirdly, if we are going to join up work in health and social services, I urge the Government to consider giving local councils a formal role in the national health service consultative process, perhaps putting them on a par with community health councils, at least in places where such co-operation has not taken place. Finally, in respect of Berkshire health authority, will the Minister outline what steps are being taken—through the Anglia and Oxford NHS region or otherwise—to ensure that the health authority's future actions conform to Government health policy and address the real health care needs of local people?
If we consider the figures, we can see that the town I represent has a health care crisis. The health authority has, so far, demonstrated an absolute inability to tackle it. The Government's published policies create a model through which we could tackle the crisis, but I want to know how we can deliver that model in practice in our community.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)First, I congratulate my hon. Friend the Member for Slough (Fiona Mactaggart) on securing time for this important debate, on the way in which she presented her arguments and on the tenacity with which she has represented her constituents' interests in this matter in the House.
My hon. Friend asked four direct questions, and I shall answer each in turn. First, health authorities are given explicit guidance that changes to services must fully reflect Government policy. Regional offices of the national health service will approve an authority's service and financial framework and the health improvement programmes only if those requirements are fully met. That covers my hon. Friend's point about national priorities guidance, which, as she will be aware, applies also to social services departments.
Secondly, health authorities are expected to consult representatives of local councils, together with other groups such as users and carers. That responsibility is set to increase with the introduction of health improvement programmes from next year, when local authorities will play a crucial part in working more closely with the NHS and delivering better services to local people.
Thirdly, the roles of community health councils and local authorities are different, but both exercise considerable influence. CHCs have a unique role in the health service, representing the public interest. Local authorities have a key role in health improvement programmes, as they will be co-signatories, so co-operation will have to take place. As my hon. Friend knows, social services departments will be represented on the new primary care groups. In future, local authority chief executives will also attend health authority meetings.
My hon. Friend asked some questions about Berkshire, which I will explain more fully during my speech. Briefly, it may be worth reminding her that officials from the regional office met the health authority and emphasised the need to ensure that any proposals were fully compliant with Government policy. That involvement will continue into the new year, as the health authority devises its new strategy for families and children.
121 My hon. Friend mentioned community services, which have a key role to play in the NHS. The Government have made it clear that they expect to see that role develop. Those services are often undervalued, but they cover a vital link between acute services, primary care and patients.
A whole of host of community services are valued by the patients who rely on them. However, as with other health services, it is important continually to review community health care to take account of modern clinical practice. Health authorities must ensure that the services they provide are focused on the patients who most need support, while making sure they make the best use of resources.
The major public health agenda set out by the Government is contained in the Green Paper "Our Healthier Nation", together with the Home Office's "supporting families" initiative. Both have important implications for nurses, midwives, health visitors and other key staff working in the community health sector.
Our White Paper "The new NHS: modern, dependable" established significant changes in the way in which services will be organised. In particular, the development of primary care groups will play a key role in the way community health services are provided in the future. Those groups will also bring a local dimension to how services are best delivered, and will ensure that they reach the people who really need them.
Against that background, Berkshire health authority embarked on a review of community services in both the east and west of the county. Many of those services had not been reviewed for some time, and the health authority was committed to a programme of modernising the services it commissioned for Berkshire patients.
Following the review, but before any changes were made, Berkshire health authority carried out a consultation exercise, which was completed on November 16. Since then, there has been an intensive round of meetings with interested parties, including the two community health councils and the six unitary authorities. Of course, it is to be welcomed when a health authority works closely with its community health councils and listens to the views of local people, to achieve a consensus on how services should be delivered locally.
At the meeting between my hon. Friends and my noble Friend the Parliamentary Under-Secretary of State in another place, it was agreed that the regional nursing director and the director of performance from the Anglia and Oxford regional office of the NHS should advise the health authority on the best way forward.
The role of the regional office was to ensure that the health authority was fully aware of Government policy and its implications for services in Berkshire. As I said in response to my hon. Friend's direct question, that involvement continues today.
At its board meeting last Monday, the health authority announced that it would substantially reconsider the proposals for health visitors, school nursing, and speech and language therapy services. The decision was taken after listening to the views and concerns of the public, local authorities and the two community health councils, and having considered the advice of the regional office. I know that the health authority, in deciding the next stages in its strategy, has also been mindful of the recent letter about community services to regional chairmen from my right hon. Friend the Minister for Public Health.
122 Although some aspects of the proposals have faced opposition, the proposed changes to community dentistry and podiatry have been broadly supported by the two CHCs. The changes to community dentistry would enable the service to care for the neediest patients. The podiatry service would be focused on patients suffering from diabetes, so that they get the help that they need.
The main question for hon. Members and their constituents is where we go from here. Now that the health authority has decided on this new approach, what will it mean for the people of Berkshire? The aim must be to target resources effectively, while meeting the aspirations of local people and fully reflecting Government policy.
For health visiting, school nursing and speech and language therapy, any proposals will now take in the wider perspective of the health and social needs of children and families, particularly those who are most vulnerable. I am sure that those children are among the main concerns of my hon. Friend. That will mean developing a joint strategy focused on children and families, and then devising a range of health, social and educational services to meet those needs. The health authority will involve staff and local authorities in that process of change. That is in keeping with the national priorities guidance that we announced earlier in the autumn.
Such partnership working had already been identified in the White Paper when it highlighted the need for health improvement programmes, which will have an important role in promoting effective health services for local communities. As I have said, they will not be the responsibility only of health authorities. Social services will have a key role as well in having to ensure that the programmes' objectives are reflected in local plans covering community care and children's services. In reviewing its community services, it is crucial that Berkshire health authority links any review with the health improvement programme, and in particular works together with all six unitary authorities.
The Government's Green Paper "Our Healthier Nation" stressed the need to tackle fundamental inequalities, such as the fact that people on low incomes are ill more often and die sooner. That has been reinforced by the report of the independent inquiry into inequalities in health, which was published last month. The inquiry was commissioned by the Government, led by the former chief medical officer, Sir Donald Acheson, and made a number of recommendations directed specifically at the NHS.
Most notably, it stated that providing equitable access to effective care in relation to need should be a governing principle of all policies in the NHS. Priority should be given to the achievement of equity in the planning, intervention and delivery of services at every level of the NHS.
I know that Berkshire health authority is acutely aware of the problems of deprived areas in a predominantly affluent area. I immediately think of my hon. Friend's constituency of Slough, which has greater needs than much of the rest of Berkshire. I know that parts of it are among the most deprived 10 per cent. in England. I am glad to say that the health authority is now committed to targeting services on the people with the greatest need, and resources will be allocated locally using a formula to be developed with the help of all stakeholder groups and the CHCs.
123 Those are admirable concepts that the Government will always welcome, but the health authority has still to develop a strategy for children and family services and then put together detailed proposals. Any significant changes would then need to be consulted with and agreed by both CHCs. Should either object, the matter will have to be referred to Ministers for determination. In those circumstances, we will need to be fully satisfied that any changes will improve the delivery of local NHS services in Berkshire.
My hon. Friend raised the issue of funding for the national health service in Berkshire. The Government are well aware of the concerns that the health authority has about funding, but Berkshire has done well under the Labour Government: for the next financial year, it will receive the highest allocation in the Anglia and Oxford region—£.431 million. It will also receive the greatest increase in the region, of nearly £30 million—a real-terms increase of almost 5 per cent.
The health authority has also benefited from the Government's determination to reduce high waiting lists, and it has received further funding to tackle that 124 inheritance from the previous Administration. The health authority was given £1.8 million to deal with the 1997–98 winter pressures, nearly £4 million of the waiting list additional funding and a further £871,000 to tackle waiting lists this financial year. That all adds up to a great deal of extra money to help to treat more patients in Berkshire. Clearly, some of that money will be spent on providing community services.
The current challenge for Berkshire health authority is to find a way forward in its community services that fully reflects true partnership with other agencies. As I have said, should the matter fail to win the approval of either of the community health councils, it will come before Ministers, who will be mindful of the Government's commitment to supporting the family, and to targeting social exclusion and inequalities in health. I assure my hon. Friend that those are crucial parts of the Government's commitment to improve health. We shall expect them to be properly reflected in any proposals that come from Berkshire health authority.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-six minutes past Ten o'clock.