HC Deb 06 November 2002 vol 392 cc405-12

Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]

11 pm

Mr. Brian Sedgemore (Hackney, South and Shoreditch)

I am delighted to participate in this debate on behalf of the citizens of east London. I have recently had extensive discussions with the primary care trusts of Hackney, Tower Hamlets and Newham, the major local hospitals, including the Homerton, Barts and the London, the East London and the City mental health NHS trust and the north-east London health authority. Put boldly, we all agree that the way in which the NHS is funded in the United Kingdom is unjust and unfair, leading to unnecessary pain and suffering and even early deaths in east London.

For too many local people, life really is nasty, brutish and short—thanks, in large part, to an outdated and antiquated funding formula. The formula has to change, not at some distant time over the horizon but within the next few weeks, before the forthcoming three-year settlement; our people will settle for no less. Those who think otherwise must think again unless they wish to see blood on the House of Commons carpets.

The NHS in east London has suffered from years of chronic underfunding. Despite the Chancellor's announcement in March of major sustained growth in NHS funding, east London remains one of the most under-resourced health communities in England. Over the past three years, the former East London and the City health authority has been below its target share of resources. Since April 2000 alone, it has missed out on more than £90 million of funding—a staggering figure.

In the face of persistent inequities in funding and mounting demand, this divide must be closed now. East London is currently £26 million behind where it should be in funding terms, and there is absolutely no justification for that. Unless urgently tackled, the gap between the best and the worst-funded health systems will continue to grow, resulting in even greater inequalities.

The case for east London is simple but powerful. A sound, equitable and transparent system for the allocation of funding is essential, particularly now, as we move into a new era of three-year revenue allocations direct to primary care trusts. The new formula must recognise that east London is an area of exceptional ethnic and cultural diversity with some of the worst social and economic deprivation in the country. We need to get the formula right; the cost of providing existing health services rises year on year as new treatments become available and the number of the heaviest users of these services—the very young and older people—increases.

Serious flaws in the current method of funding exist in eight key areas where improvements must be made. They relate to population projections, demography, general practice work load, diversity of the population, refugee health, forensic psychiatry, staff market factors and child and maternal health. I will touch tonight on just three of those factors—population projections, general practice work load and child and maternal health.

On population projections, a major concern is that over time the census-derived estimates issued by the Government have become increasingly unreliable. For example, in April 2001, 779,915 patients were registered with GPs in east London and the City, compared with the mid-year estimate of relevant population by the Office for National Statistics of 666,725—a variance of 17 per cent., and the fourth highest in the country. The average variation for England overall is just 4 per cent. East London's population is growing rapidly and has a much larger proportion of young adults than the rest of England. That growth has been most marked among five to 14-year-olds, 15 to 24-year-olds and 25 to 44-year-olds—the least funded groups. At least 142,000 homes are planned for the area in the next 10 years, so improvements to the quality and quantity of health services are essential to cope with the resultant demands.

As for general practice work loads, a feature of east London's practice not adequately reflected in the national resource allocation formula is the high turnover of patients. Applying recent research findings to east London, we see that patient turnover generates an additional 54,000 consultations for GPs and 28,000 consultations with nurses a year. The existing formula simply does not recognise that. Fair shares for non-discretionary expenditure should reflect the work load pressures faced by primary care, and would include recognition that patient turnover is a major determinant of work load. Moreover, 25 per cent. of GPs in east London are due to retire within five years. There are eight to 12 annual GP consultations in east London per patient, compared with a national average of five. Again, the existing formula does not recognise the enormous burden that that places on heroic local GPs.

As for child and maternal health, in addition to having some of the highest infant mortality rates in the country, east London has the highest rates of teenage pregnancy. It also has high numbers of children with low birth weight, a result of premature delivery and complications during pregnancy such as gestational diabetes and hypertension. Meanwhile, maternity services in east London are operating with 50 per cent. staff vacancy rates, and their models of care need substantial updating. The existing formula does not recognise that. Poverty can damage children's esteem, affecting their future mental health and life chances. Prevalence of psychiatric disorder in children in inner London is 13 per cent., compared with 6.8 per cent. nationally. Again, the existing formula does not recognise that.

Perinatal and infant mortality rates are higher in east London than in the rest of the country. Stillbirths and deaths within the first seven days—perinatal mortality—are over a third higher than nationally. Infant mortality—deaths within the first year—is over a fifth higher. In simple terms, a baby born in Hackney is at more than double the risk of dying in the first year of life than a baby born in Bexley. A baby boy born in Newham is likely to die nearly six years earlier than a baby boy born in Westminster. That is appalling. How can the Minister justify a system that is killing us in the east end so early? What have the citizens of east London done to Ministers and civil servants at the Department of Health to warrant such early graves? The situation cannot continue.

East London also has a high fertility rate. The 2001 census showed that there were more under-one-year-olds than in any other part of the country. Newham had the highest proportion of children aged under 16 in the country. The area is increasingly densely populated; Hackney, for example, has the fourth highest population density in the country. The formula must begin to recognise that.

Ms Oona King (Bethnal Green and Bow)

My hon. Friend referred to mobility and patient turnover. In my constituency, some GP lists change by more than 20 per cent. every year, and that must be recognised in the formula. Will my hon. Friend ask the Minister whether any suggested change in the formula can first be tested in the east London area so that we can avoid an even greater widening of the health inequalities that he described?

Mr. Sedgemore

I am grateful for that intervention. I mentioned an overall figure for east London of 17 per cent., but my hon. Friend has informed us that the figure for Tower Hamlets is 20 per cent. I accept that her figure is correct. That means that there is an incredible increase in the number of GP and nurse consultations. I should prefer the problem to be dealt with, but if there is to be an experiment, I agree with my hon. Friend that it should be carried out in east London.

I do not want only to whinge in this debate. East London has demonstrated what can be achieved despite the challenging financial straits it faces. The area has a proven track record in delivering first-class services. Examples of new services in recent years include one-stop cardiology; community diabetology; chronic disease management; Newham language shop telephone interpreting services; stop smoking programmes and the Nile centre for Afro-Caribbeans with serious mental illness.

The additional resources provided by the changes that we want would provide the following key developments for east London. They would address serious recruitment and retention issues, especially in primary care; improve the quality of, and access to, primary care; extend the disintegrating population screening and immunisation programmes; integrate hospital and community mental health services, while reducing pressure on acute services; provide better new-entrant screening for refugees and asylum seekers—which we should have been discussing more thoroughly yesterday than some of the subjects that were raised—with better support and training for local services; improve screening, foot care and vascular services for diabetics; and work with community groups to expand their work to meet the needs of all minority ethnic groups in east London, including better advocacy and translation.

The message is simple: give east London the funding to catch up and to bridge the existing health inequality divide and we will deliver the first-rate services that our citizens deserve.

11.13 pm
The Minister of State, Department of Health (Jacqui Smith)

I congratulate my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) on securing this debate on national health service funding for east London.

I have listened to and appreciated my hon. Friend's comments, despite the threatening tone in which some of them were expressed. I am sure that represents the passion that he and other hon. Friends in the Chamber who represent east London constituencies bring to the debate.

I take this opportunity to acknowledge east London's good record in delivering high quality services and pay tribute to all the staff who are dedicated to that endeavour. I also acknowledge the document on funding the "Case for East London" cited by my hon. Friend, which was compiled by NHS organisations in east London. I, too, agree that this is a helpful paper and hope to talk about it in more detail a little later.

I think we would all accept that different parts of the country and different localities have different health needs. The national resource allocation formula that we use at present to determine fair shares for health authorities and primary care trusts already goes some way towards recognising that. The formula takes account of the age structure of the local population. Patterns of morbidity, or levels of sickness, vary by age group. The very young and the elderly, whose populations are not evenly distributed around the country, make more use of health services than the rest of the population.

Ms King

Does my hon. Friend recognise that a further change gave greater weighting to the elderly, which meant that east London lost out as, unfortunately, a lot of our older people have moved away or passed away?

Jacqui Smith

I will return to that important issue and the question of infant deaths, raised by my hon. Friend the Member for Hackney, South and Shoreditch, a little later, if my hon. Friend will allow me. We do recognise that although the existing formula already takes into consideration the variation in the cost of providing health services across different parts of the country and health needs, it has been criticised—passionately, this evening—for failing to get health resources to the areas of greatest health need. East London—where there are high levels of deprivation and where the financial cost of delivering patient services is also high—is a case in point. That is why we have set up a wide-ranging review of the allocation formula. The NHS plan stated that

by 2003, following the review of the existing weighted capitation formula used to distribute NHS funding, reducing inequalities will be a key criterion for allocating NHS resources to different parts of the country".

The review of the formula has been carried out under the auspices of the advisory committee on resource allocation. ACRA is an expert body, and its academic members include Professor Sir Brian Jarman, emeritus professor of general practice at the Imperial college of medicine, Professor Glennerster, professor of social policy at the London school of economics, and other individuals with a wide range of relevant experience and expertise from within and outside the NHS.

The researchers working on the new formula were asked specifically to look at potentially new and better measures of deprivation. We are currently considering ACRA's recommendations and I can reassure my hon. Friend the Member for Hackney, South and Shoreditch that we intend to introduce the new formula for the next round of NHS allocations. These allocations will be announced later this year and will cover the three years 2003–04, 2004–05 and 2005–06 and will go directly to locally run primary care trusts. It is worth noting that moving to direct allocations to primary care trusts will enable resources to be much more closely matched to the needs of local people.

The review has already enabled us to make progress towards fairer resource allocation in areas that are particularly challenging to east London. In the 2001–02 allocations, we introduced a health inequalities adjustment. This targeted resources at the most deprived areas. We provided £130 million for this in 2001–02 and increased it by 14 per cent. to £148 million in 2002–03. East London and City health authority received over £6 million of this for 2002–03 and just over £3 million in 2001–02.

My hon. Friend the Member for Hackney, South and Shoreditch and my hon. Friend the Member for Bethnal Green and Bow (Ms King) referred to infant deaths. For 2002–03, the rates of years of life lost—which form the basis of the health inequalities adjustment—were extended to include infant deaths under one year from all causes. That followed the announcement of an additional target for tackling health inequalities based on infant mortality. I recognise the point raised about the particular needs in those communities where, for a range of reasons, infant mortality is likely to be high, as well as the need to ensure that the way in which we distribute resources recognises that.

In the same year, we also introduced a cost of living supplement that targeted resources at locations where NHS employers faced the most pressing recruitment and retention issues. East London received more than £4.9 million for that in 2002–03 and more than £3.6 million in 2001–02. We also announced in the NHS plan that there would be a new way of distributing resources to address inequities in primary care services. I recognise the concerns expressed by my hon. Friends this evening about the particular challenges for primary care, and especially for GPs, in the areas that they represent. They are right, of course, that the ability to recruit, retain and fund those crucial activities in primary care are important for their constituents, which we have borne in mind in our new unified allocations. We shall continue to consider that as we move forward with the formula.

Ms Diane Abbott (Hackney, North and Stoke Newington)

I support everything that my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) said. He and other colleagues who have spoken raised a specific point about population mobility and how it hears down on resources and on GPs. Is there any possibility in the future of the formula taking into account population mobility? As we know, there are excellent services in the area—I had my baby in Homerton hospital, and I could not have had better care anywhere. As the Minister will also know, however, east London saw a swathe of hospital closures in the 1980s and 1990s: the Mothers hospital, the old Hackney hospital, St. Leonard's, and the Queen Elizabeth II hospital. We were promised increased resources for primary care, and we are still waiting to see them.

Jacqui Smith

My hon. Friend makes an important point about the particular pressures that come from population disruption as much as from population numbers. I believe that we already recognise, in the way in which we distribute primary care resources, some elements of that disruption, but she makes a very strong case. That is something that we need to consider in the way in which we allocate resources, and in the way in which we target some of the additional support that I shall talk about in a moment.

In relation to primary care in particular, it is important to note that Department approval has been given for two first-wave local improvement finance trust schemes, one of which is in east London and the City. The East London and City LIFT Project will bring £30 million of new investment into primary care buildings in the first wave. Most people's experience of the NHS is in primary care environments and that much-needed investment will make an important difference to the east London community.

I said earlier that I would talk about the "Case for East London" paper, and I know that east London NHS organisations have completed a helpful analysis of the pressures facing those wanting to provide high-quality patient care, to which my hon. Friend the Member for Hackney, North and Stoke Newington (Ms Abbott) has referred. All NHS services throughout the country have been under pressure to deal with the demands placed on them day to day, and the historic increases in NHS spending announced recently should help the whole of the NHS in that respect. That, and the reforms to the NHS, in which decisions about patient care are devolved to local decision makers, means that the NHS in London should in future be in a better position to deal with the pressures under which it currently works. That takes time, but we recognise the need—and the pressure from hon. Members—to do that as quickly as possible.

The priorities and planning framework, which was recently distributed by the Department, sets out what we believe are the national priorities for the NHS and social care provision. That, combined with the details of the financial allocations that will be made available, will ensure that the NHS in east London will know what is expected of it, and what levels of resource distributed under a reviewed formula it will have to deliver high-quality patient care. Analysis calls for a review of how the relative needs of different populations are to be assessed and taken into account in national resource allocation decisions. The issues raised are complex, but deprived populations undoubtedly place additional demands on services due to their increased levels of need. Many of the factors that hon. Friends highlighted are known to increase the need for services. The weighted capitation formula attempts to capture many of those for hospital and community health services. As I said, the formula review will further refine consideration of those pressures.

I want to make clear the levels of funding that have been going into east London over the past few years. The "Case for East London" paper highlights only some of those. East London and the City health authority received more than £225 million extra in revenue allocations in the past five years. It also received an increase in 2001–02 of £68 million. For 2002–03, it received an allocation of £703 million, which represents a real terms increase of nearly 11 per cent. above the average throughout the country. In addition, of the £2.5 billion being invested in major capital to redevelop and build brand new hospitals across London, a community facility in Newham costing £3 million was completed in April 2002 and is now open, and a £14 million mental health unit in Newham was opened this July.

I recognise that there is a particular demand on mental health services in my hon. Friend's area. Barts and the London trust is considering proposals from two private sector bidders for a £620 million development programme. That will include the creation of a world-class cancer and cardiac centre at Barts and the building of a new teaching hospital at Whitechapel. The decision to build on both sites reversed the previous Government's decision to close Barts, the country's oldest hospital, altogether.

We have been working hard on addressing some of the issues highlighted in east London and by my hon. Friends. For example, we have funded a number of personal medical service pilots that focus on refugee and asylum-seeking communities. Those pilots address access to primary care services for those communities, as well as encouraging opportunities for health professionals from those communities to gain employment in the NHS locally. Private medical services have an important role to play in GP recruitment in areas such as east London because they provide a different way in which GPs can operate within the health service.

East London's approach to delivering language services is among some of the best practice in London. We are building on that by disseminating good practice and initiating discussion across the city on the London language plan. Regional colleagues in London are working with partners such as the King's Fund to encourage more local people to train as community bilingual advocates, which my hon. Friend also highlighted.

Work in east London highlights the pressure being put on local staff. That is why we recently set out the work force challenge facing the capital over the next few years to modernise services and respond to the growing population in London. We are working with a range of organisations in east London to see how we can recruit more people locally, thereby meeting our work force needs and acting as a spur to local regeneration and to tackling poverty and unemployment. In that way, we hope to alleviate the need for health care, which my hon. Friend rightly linked to poverty and deprivation, and to increase the capacity of the NHS to respond.

The Government recognise that poverty and deprivation bring not only excess morbidity and mortality but extra costs to local health services. I assure my hon. Friends that we will continue to provide extra health resources in areas of greatest health need to recognise, as my hon. Friend does, the ambitions of local health services in east London to provide the best service possible for constituents.

11.30 pm

Sitting suspended, pursuant to order [29 October].

On resuming—

Question agreed to.

Adjourned accordingly at fifteen minutes to Twelve o'clock.