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§ Mr. John Cummings (Easington)
First, I want to put the health of the local population in context. In socioeconomic terms, Easington is classed as one of the most deprived communities outside London, and it is sixth from bottom in the multiple index of deprivation. One in four deaths is due to coronary heart disease, which is 40 per cent. above the national average. Deaths from the complications of diabetes are 73 per cent. higher than the national average for men, and 62 per cent higher for women. There has been a 62 per cent. increase in deaths among men from cirrhosis of the liver. Life expectancy figures are among the worst in the country, at 72.42 years for males and 77.4 years for females.
Despite those appalling statistics, health care in the Easington district remains chronically underfunded. Easington currently receives only 89 per cent. of its target allocation, while Darlington receives 105 per cent. It is one of the most deprived and disadvantaged communities in the country in health terms, but primary health care is underfunded to the tune of almost £10.5 million, according to Department of Health and County Durham health authority figures. The Easington district includes part of the Prime Minister's Sedgefield constituency, and its population suffers some of the worst health in the country. It is ironic that it is one of the areas that are furthest from receiving their target allocation.
One might ask what happened to Government initiatives on areas with the worst health records. Easington has a population of almost 98,600, but it was not successful in securing health action zone status in the last round of bids.
Additional assistance to reduce death and illness due to smoking is also not available to residents in the Easington district, even though it is available to communities in neighbouring Sunderland and in Tees Valley; yet 28 per cent. of men and 24 per cent. of women in the district are smokers.
The problem is compounded by the fact that there is considerable pressure in the district on local authority budgets for disabled facilities grants to adapt people's homes, for disabled people in local authority accommodation and for elderly people who live independently in their own homes.
§ Mr. Murphy
The picture that my hon. Friend paints is almost identical to that in my constituency. He mentioned the disabled facilities grant, and there are major problems in our constituencies because the level of disability is well above average. Does he agree that it would be sensible for central Government to recognise that fact and to increase grants to enable local authorities in our constituencies to catch up with the huge backlog of work that needs to be done in that respect?
§ Mr. Cummings
My hon. Friend makes valuable points, and he speaks from first-hand experience. He 119WH represents an area much like mine, which relied on coal mining, with all the consequences that that hazardous occupation had.
Easington district's total financial commitment for adaptations and medical aids, including access ramps, showers and heating, is almost £1 million for the current year, and there is an estimated backlog of more than £500,000 of work for local authority properties alone. Without additional resources, that backlog is likely to increase further, as occupational therapists and social services make more referrals.
National policies for modernising services for older people place much greater emphasis on giving older people the support that they need to live independently in their own home. That is likely to have significant cost implications in terms of disabled adaptations, medical equipment, domiciliary care, personal medical and community care, home helps and meals on wheels. It is apparent that there are insufficient resources in the existing organisations and agencies to cope with the considerable growing demand for those services.
There needs to be an understanding of the resource implications of any change in the pattern of service delivery for older people, for all agencies involved in health and social care, including the primary health care sector, especially in Easington where resources are already stretched to the limit. Despite a record settlement for the national health service, with an increase of 9 per cent. in revenue budgets and a 9.9 per cent. increase in the allocation to the County Durham health authority, in this financial year Easington is moving further away from its target resource allocation.
A significant problem from Easington's perspective is that the substantial additional resources allocated to it in recent years have been for badged projects, such as modernising accident and emergency facilities and improvements in hospital-based cancer services. Without a dedicated hospital serving east Durham, the allocations that would otherwise have gone to Easington have been directed to the major population centres. It is the view of many Members of Parliament representing disadvantaged areas like my own that the index of multiple deprivation should be included as a basis for the allocation of resources for health.
The ill health of the local population can be addressed only by means of a protected increase in baseline resources with a bias in future allocations to areas in greatest need, such as Easington, where health inequalities are greatest. Although I welcome initiatives such as the national primary care collaborative, community healthworks, the warmer homes initiative, sure start, on track and the healthy schools award scheme, they need to be refined and streamlined so that there is better co-ordination between health, education, social care and community economic regeneration, which are vital to improve the life chances of the local population.
There is an argument that Easington and other similarly deprived areas identified by the multiple index of deprivation should receive an allocation above capitation target due to exceptional need. For 2002–03, Easington primary care trust receives £84.7 million as against a target allocation of £95.176 million, a shortfall of £10.47 million. In other words, Easington is funded in the current year at 89 per cent. of target. Nevertheless, 120WH in spite of the funding gap, Easington can take pride in some excellent examples of partnership working in overcoming health inequalities in the district of Easington.
Easington primary care group was chosen as one of the twenty PCGs in England to take part in the first wave of the national primary care collaborative, which is now a part of the NHS Modernisation Agency. In the first year, 2000–01, five local GP practices concentrated on reducing the time that patients wait to see a doctor or nurse and establishing effective planned care for people with heart disease. In only the second year of operation, 17 of the total of 18 GP practices are working together on these targets. In January, every patient in the participating practices was able to see their family doctor within 48 hours of their request. In most practices, 90 per cent. of patients could see their doctor on the day of their choice. At the same time, all patients who needed aspirin as a protective measure were identified and receiving that treatment, which is known to reduce the risk of heart attacks by 50 per cent. One hundred percent of people who needed treatment with beta-blockers after heart attacks were receiving them. The number of people benefiting from statin therapy to reduce high cholesterol had reached at least 70 per cent. of the eligible group in all practices and as much as 90 per cent. in some.
A handyman scheme has been supported, an example of partnership working between the local NHS, Easington council and Age Concern. It provides two handymen to undertake odd jobs for older people in the community, helping them to live independently by reducing the risk of accidents in the home. Where time allows, the handymen also deliver small aids to independent living and help to maintain gardens, improving the environment and reducing the hiding places for thieves.
A home safety scheme—a partnership between the local NHS specialist health promotion service, Easington district council and the fire service—provides new home safety equipment for families with special needs or those who have children aged under five, such as a fireguard, two safety gates, two smoke alarms and socket covers. Every ward in Easington is in the bottom 10 per cent. of communities in England for investment in home safety. There is a clear correlation between lack of local investment and every parameter of poor health—including accidents.
The project has been possible only because funding has been provided by a charitable source. A community healthworks partnership—a training programme—has promoted joint working between the local NHS specialist health promotion service and people from the local community. It aims to raise awareness of the many factors that affect health. Local trainers are used to support participants in developing locally relevant health-related research projects. Participants, through their interest in health issues, often become interested in the local community health forum. Unexpected benefits of the scheme have included participants gaining the confidence to return to full-time working.
A smoking cessation partnership has been established between local GP practices, the specialist health promotion service and local people. The primary care trust has invested heavily from its baseline allocation to support local services for people who want to give up 121WH smoking. A network of 35 intermediate smoking cessation advisers work in GP practices throughout the district. The specialist health promotion service provides them with training and support. It has a success rate of 66 per cent. of people quitting at four weeks, compared with the national average of 45 per cent. Preliminary data suggest that the percentage of people still not smoking after one year is 35 per cent.
Funding for that work went to health action zone areas in the first year of national support. In the second and third years, Easington primary care group received £25,000 to set up and run the smoking cessation service—a share of the £192,000 received by County Durham and Darlington health authority. As I said earlier, that was much less than the funding for health action zone areas.
The currant bun project is a partnership between the specialist health promotion service and the local community. It is a healthy eating programme that targets groups such as older people, people with mental health problems and single parents and covers healthy eating messages, food hygiene, budget meals and basic cookery skills. Links are made with local community workers to facilitate community involvement in other local projects. The significance of that work is that many people who suffer disadvantage find it difficult to link what they know about good nutrition with the need to manage both their time and their financial resources.
An important area of work, given the levels of deprivation in Easington, is the warmer homes partnership between the local NHS and Easington district council. The primary care trust has worked closely with Easington district council to improve local resident access to fuel conservation initiatives. Primary care staff working in GP practices refer patients who are at high risk because of health problems to the local medical officer. After assessment, adaptations are undertaken to improve the heating systems and insulation measures.
Sure start is an important area of work for primary care, which will pay dividends in improved health and lifestyle in future generations. There are three sure start areas in the Easington district. The primary care trust is the lead partner and is doing superb work.
A successful bid to the New Opportunities Fund under the healthy living centre initiative has provided funding for four interlocking community health promotion programmes: healthy food, healthy exercise, StressBusters and information for health and wellbeing. Since the primary care group was formed in 1999—it is now a trust—there has been a modest increase in the amount of consultant psychiatric services. A counselling service now works hand in hand with every GP practice in Easington, and funding has now been secured to strengthen the clinical psychology service. Bases for two community mental health teams and an out-of-hours helpline have been established.
As I have said, it is a matter of public record that levels of health need in Easington are the highest of any community outside London. National imperatives are also local priorities. Proportionately, local people have more heart disease, more mental health problems and more cancer than people in the rest of the country. In 122WH tackling those issues, the primary care trust must work closely with other agencies and organisations in the community, as well as with agencies in Sunderland, Durham, Hartlepool and North Tees. Easington primary care group is addressing the problem on two levels; first, by providing services for those people who are affected by disease and, secondly, by providing information and support for people at risk of serious disease to enable them to make informed choices about their lives. The NHS needs to make as much effort to prevent ill health and disease as it makes in treating disease. That is a real challenge when there is a funding shortfall, in excess of £10 million.
The real deficit in the district is evidenced by a lack of community service infrastructure. We can identify the levels of demand and the lack of resources in Easington. The area requires another 10 GPs to reach the national average. In some practices in Easington, there is one GP for every 2,600 patients, and the district average is one GP for 2,100 patients. Although it would be useful to establish specialist GP clinics and extended-role nursing provision to support people with chronic disorders, in reality Easington needs to increase its staffing establishment as well as develop leading-edge services.
There are, of course, physical limits to how much change a system under pressure can cope with, but the primary care trust's response has been to support and work with the practices to find a way through the uncertainty. What, practically, does Easington need? I have already said that we need more GPs and more community nurses. More palliative care beds and intermediate care beds are also needed. There is a clear remit for the PCT to work even more closely with the local authority to ensure that local people are not disadvantaged when funds are distributed throughout the county. We need more specialist diabetes nurses, dieticians and podiatrists. The national service framework will set out a requirement to build integrated services for people with diabetes. Complications of diabetes account for a 73 per cent. increase in deaths in men and a 62 per cent. increase in deaths in women in Easington. That situation cannot be allowed to continue.
Children and young people require access to a robust child and adolescent mental health service. Adult mental health services are poorly developed in the district and need more resources to enable them to carry out their most useful function.
There are good services for people with heart disease, which causes one in four deaths in adults in Easington. Lack of access to echocardiography means that effective care for people with congestive heart failure is not available. New funding would allow that deficiency to be tackled immediately. The development of community-based rehabilitation services could significantly reduce pressure on hospital out-patients and doctors' surgeries. Those matters could be tackled immediately if the resources were made available.
It would be extremely useful if, when he responds, the Minister would identify possible funding initiatives that the PCT could tap into in order to address those problems. There is considerable pressure from members of the public and local health care professionals to redress the historic and recurrent £10.5 million annual shortfall. That shortfall is based on population alone, and does not take need and deprivation into account. I 123WH urge the Minister to take the opportunity to make an unequivocal commitment to address that anomaly through a needs-based funding allocation at the start of next year's financial settlement.
More than six generations of miners and their families in the Easington district have produced the coal to fuel the engines of industry that powered the industrial revolution, made the steel and fired the ships that made the nation great. Unfortunately, the coal mines are no longer with us. Many miners suffer from chronic ill health as a result of their long service in terrible conditions underground. The nation owes a debt of honour to those miners, their families and descendents, and to areas such as Easington.
In the grand order of things, we are talking about a modest commitment in each district of about £100 per resident. That modest sum could make a significant difference to the health of the local population. My colleagues and I look to the Government to address inequalities and injustice, and to repay a debt owed to mining communities, such as Easington, that are struggling to overcome disadvantage and deprivation, and want to look forward to a healthier, happier future under this Labour Government.
§ The Minister of State, Department of Health (Mr. John Hutton)
I pay warm tribute to my hon. Friend the Member for Easington (Mr. Cummings) for raising such important issues in this Chamber. I share many of his concerns and I hope that, in the time that I have left, I can at least reassure him about the future direction of policy and resources as they will affect his constituency. I also pay tribute to him for the balanced way in which he presented his arguments. He carefully and effectively raised the issue of the lack of resources for the national health service in his constituency. He also drew attention to those areas where progress is undoubtedly being made, thanks to the efforts of the Labour party to tackle some of the deep-rooted problems of health inequality that have scarred our society in the past 500, not five, years. As a fair-minded man, he will understand that what is important is that the Government recognise the priorities and commit the resources to tackle them. Dealing with those deep-rooted health inequalities is a long-term project. However, I can at least reassure my hon. Friend that the Government are determined to bear down on the problems that he vividly and candidly described, which are still of concern in his constituency.
My hon. Friend was right to make prevention, not treatment, the focus of his remarks. We all know that that is the right way to tackle some of those inequalities. He also rightly referred to the progress that has been made, and to the widely available anti-cholesterol treatments that are now available, thanks to the coronary heart disease national service framework that we published two years ago. The treatments are now widely available throughout the NHS, and will undoubtedly yield a long-term dividend in all our constituencies. My hon. Friend also mentioned the programmes to support people who want to give up smoking—that terrible habit, which we know is the cause of unnecessary deaths through cancer and coronary heart disease. He rightly paid tribute to the effective smoking cessation service in his constituency.
124WH My hon. Friend the Member for Wansbeck (Mr. Murphy) made an important point in an intervention about the role of social services. Although the NHS undoubtedly has a special contribution to make as the expert provider of health care, the Government recognise clearly that we must look beyond it to tackle health inequalities. We must consider the contribution that social services and other vital public services can make. We must also look critically at the economy, wages, jobs, housing and education, which are all fundamental to tackling health inequalities, to give people some of the life chances that many others have taken for granted for many years.
The Easington constituency is not unlike mine in many key respects. If my hon. Friend the Member for Easington came to Barrow-in-Furness he would see many similarities and parallels. I know that the same would be true of Wansbeck. In all those areas—on the economy, jobs, housing and social services—the Government are trying to get in the extra investment.
My hon. Friend the Member for Wansbeck referred to the need to support additional investment in grants for disabled facilities. Thanks to the prudent way that my right hon. Friend the Chancellor of the Exchequer is running the economy, we announced in the Budget that we are doubling the trend rate of growth going into social services spending. It is important that we do that as we are increasing spending in the NHS. If those two vital pillars of the welfare state get out of kilter, we shall not make the progress that we want. Investing in social services must be done in parallel with investment in the NHS.
I hope that my hon. Friend the Member for Easington will allow me in the remaining five minutes to say a few words about the national picture. I will then address the issues in Easington. I know that part of the world very well and I have a great deal of affection for it. I hope that I also have some affinity with it. From the very beginning, when we took office, we recognised the importance of tackling health inequalities. It is one of the issues that characterises the difference between us and our predecessors, who would not even mention the term "health inequalities". We accept that it is a problem and we are trying to put the measures in place to deal with it.
A stark challenge faces us. At the beginning of the 21st century the opportunity for a healthy life is linked to social circumstances and childhood poverty, just as it was in the 19th and 20th centuries. To all of us who are privileged to serve in this House as Labour Members and who describe ourselves as socialist, that is unacceptable. We are determined to challenge that state of affairs. There have been considerable overall improvements over the past 50 years, but there is still a great deal more to do.
My hon. Friend referred to some of those changes. He rightly mentioned sure start, which is making an investment in the early years of a child's life. That will bear dividends. We have a range of other policies. We are improving home insulation and energy efficiency schemes as well as tackling some of the deep-rooted economic problems that are still apparent in County Durham. I am glad to see that unemployment rates in my hon. Friend's constituency have fallen dramatically since Labour came to power. That will bear dividends too.
125WH My hon. Friend was particularly concerned about dealing with the underfunding, as he saw it, of the health service in his constituency. I do not take issue with him about that. We want to close that gap. We are currently reviewing the basis on which funds are allocated to primary care trusts. The purpose of the review is to develop a solution that will link health needs and service provision much more closely. That new allocation funding mechanism is due to come on stream next year. I hope that in the course of that review we can make further progress in dealing with the current inequality of funding.
For the moment, and over the past two years, we have included an interim health inequalities adjustment as part of the resource allocation system. It is worth £148 million this year and it will help to compensate those parts of the NHS whose residents suffer the worst health in the country. That is certainly true in Easington. It is a scandal that a young boy born today in Easington has a life expectancy several years shorter than that of a similar boy born in Kensington, Chelsea or Westminster. The extra resources that we are trying to put in, of which County Durham received an extra £2.5m this year, will help us start to redraw that balance.
On general finance, Easington has edged closer to its target funding allocation over the past four years. It was 13.3 per cent. below target; it is now 11.4 per cent. below target. It has benefited from £4.3 million in additional funds between 2000–01 and 2002–03. Overall, County Durham has benefited from new hospital facilities and substantial additional investment in its mental health services, which will benefit my hon. Friend's constituents. He is right that the centres that provide that care are not based in Easington, but they are services for his constituents.
I hope that building health inequalities into the NHS performance assessment framework will also help focus the attention of NHS managers on these issues. We are reworking the NHS funding formula, specifically with a view to tackling some of the problems raised by my hon. Friend.
My hon. Friend rightly mentioned the importance of primary care and the shortage of general practitioners in his constituency. He will be aware that in April, two new GPs were appointed to cover the Easington area; we are hoping that a further two will be appointed in August. I hope that that will make a significant contribution to solving the problem that my hon. Friend identified.
There is much more that I would like to say about the problems of health inequalities, and about how much more the Labour Government still have to do. However, I hope that I can reassure my hon. Friend that Ministers share his view about the importance of the issues that he raised in the debate. Ministers in the Department of Health and in other Departments look forward to working with him and my hon. Friend the Member for Wansbeck to find new solutions to the problems—