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§ Mr. John Cummings (Easington) (Lab)Thank you, Mr. Deputy Speaker, for giving me the opportunity to raise the issue of health inequalities in Easington and to continue to press the case for a fair funding deal for Easington primary care trust.
Although Easington primary care trust is the prime provider of primary health care and the principal commissioner of secondary health care for my constituents, I should point out the fact that five of the most deprived local government wards—Wingate, Wheatley Hill, Thornley, Deaf Hill and Hutton Henry—which suffer some of the worst ill health in the Easington PCT area, are in the Sedgefield constituency of my right hon. Friend the Prime Minister. Easington PCT covers 26 local government wards and is responsible for health care for 93,900 people who reside in east Durham.
This is the second Adjournment debate that I have initiated on this issue, and although some progress has been made since the first debate in June 2002, I feel that I must keep up the pressure on Ministers for an equitable settlement for my constituents.
I begin by stating for the record that credit must be given to the Government for a record increase in funding for primary care. A 39 per cent. increase was awarded to Easington PCT over the current three-year funding allocation period of 2003–2006, compared with a national average increase of 29 per cent. Nevertheless, the size of the percentage increase must be put in context against the background of a relatively low baseline. Health inequality, like deprivation, poverty and affluence, is a relative concept. Easington PCT is £26 million a year short of the baseline resources required to deliver adequate health care to the people in east Durham.
A much more substantial increase is needed to address the historic underfunding of health care in the former mining communities in east Durham. Resources are needed to meet local health need and address the inequalities in health, an aim which the Secretary of State described as one of the cornerstones of the Government's social policy, and which was identified as one of his four key priorities in his speech to the NHS Confederation conference in Glasgow on 26 June 2003. At the present rate of catch-up—approximately 2 per cent. per year—it would take 20 years for Easington PCT to reach the target. That is clearly too long. Over the three years from 2003 to 2006, the health economy of east Durham is being deprived of £78 million in funding. That is a huge gap, which must be bridged.
Properly targeted, £78 million of additional resources could significantly improve the health of the local population. Easington PCT is more than 20 per cent. under target in the current financial year. The Secretary of State's reply to my parliamentary question in November 2003 showed that Easington PCT is the worst funded of the 304 PCTs in the country. The league table published in response to that parliamentary question shows clearly that although Easington PCT covers an area that is one of the most deprived by any accepted measure and suffers high levels of chronic ill health, it is funded at only 80 per cent. of target. At the 100WH other end of the scale, Kensington and Chelsea PCT and Westminster PCT, which cover relatively affluent areas, are funded well above target—at 130 per cent. in the case of Westminster PCT.
I fully understand that Ministers are required to strike a balance between how much is awarded to PCTs as a whole to maintain continuity and stability in the service and how much extra is awarded to under-resourced PCTs such as Easington to bring them up to target. It is important to recognise that not all PCTs are the same, and the needs of the populations that they serve are different.
I do not intend to develop the argument in this debate, but it would be perfectly reasonable to put forward the case that deprived communities such as Easington, suffering high levels of chronic ill health, should be funded well beyond target, compared with more affluent areas like Westminster, Kensington and Chelsea. I do not, however, seek a reduction in provision or to destabilise the system for anyone. All I seek is an uplift in the funding for Easington PCT to get it within striking distance of the target.
What I am looking for in this debate is some indication, or better still a clear statement from the Minister, that when a PCT is both under target allocation and significantly deprived, as Easington is, special measures should be applied to the allocation formula under a heading such as health needs or health inequalities readjustment. It is unjust that the district of Easington is consistently identified in the indices of multiple deprivation as one of the most deprived communities outside inner London, yet has the worst funded PCT in England.
There are a number of deficiencies in health provision that must be addressed in the short term if we are to make progress in improving the overall health of the population in the Easington PCT area. To begin with, there is an identified need for double the number of practice nurses in Easington. There are no hypertension, asthma, chronic obstructive pulmonary disease or diabetes clinics currently operating in my PCT area. All the GP practices in the Easington PCT area require and have requested additional nursing resources to improve the management of chronic disease.
We need more funding for mental health services, which have traditionally been a Cinderella service both nationally and locally when it comes to resource allocation. People living in east Durham are over 30 per cent. more likely than the national average to suffer from mental illness. GP practices have identified the need for their own community psychiatric nurses, as they would like to offer group therapy sessions and drop-in clinics for their patients. Some areas receive as little as three hours per week from community psychiatric nurses for counselling sessions.
Health services for young people are also sadly neglected in east Durham. A comprehensive counselling, family planning and advice service to prevent teenage pregnancy should be available. Easington's rate of teenage pregnancy is 55.3 conceptions per 1,000 women aged 15 to 17, which is one of the highest in the country.
Easington also has a relatively high incidence of diabetes. Providing a quality service to fit in with the recommendations in the national service framework 101WH published by the Department of Health would include providing access to dieticians, physiotherapists, chiropodists and retinopathy screening. Developing the service in this area would have a rapid impact on the quality of life for diabetics in my area. As a diabetic myself, I would like to declare an interest in seeing an improvement in that area of service provision.
Providing resources to support GPs with a special interest who can offer secondary care services in the community would have the added benefits of taking pressure off the acute sector and relieving patients of the need to make long and difficult journeys by public transport to the nearest hospital. Easington, as the Minister may appreciate, does not have its own hospital. The acute hospitals serving my constituency are located in Sunderland, North Tees and Hartlepool, Stockton and Durham City.
We need to develop our primary health care infrastructure in terms both of facilities and of the human resource element. New premises are urgently required in many communities. A recent report commissioned by the PCT indicates that health visitors and district nurses are currently working from inadequate premises. In some cases the premises are in a shocking and dilapidated condition, which is hardly the image that the NHS would wish to portray in the 21st century, particularly if we are to attract more staff, especially dedicated health care professionals, to work in the Easington PCT area.
We desperately need more community nurses. Nurses working in east Durham tend to have large case loads—twice as large as those in the neighbouring areas of Sunderland and Hartlepool. That means that our community nursing staff are working under intense pressure. They do not have time to promote health and give advice to their patients on healthy eating or smoking cessation, or offer general advice on how to maintain good health. The Wanless report highlighted the cost-effectiveness of investing in public health, but first there is a cost to be borne in having sufficient staff to promote good health interventions.
There is an excellent, if rather depressing, report produced by the public health intelligence service and the County Durham and Tees Valley Public Health Network with the apt title of "Miserable Measures". The report makes grim reading for the uninitiated. It analyses the range and severity of deprivation in the County Durham and Tees valley area, and—in case there is any doubt in the minds of hon. Members and the Minister about this—it clearly demonstrates the link between deprivation and ill health.
The report uses the index of multiple deprivation to analyse the various strands—or domains, as they are referred to—of deprivation. They are housing, income, employment, health, education and child poverty. It may he useful at this point to consider the definition of deprivation in health terms. Deprivation has been defined and measured in many ways. It is a word used to convey the idea of an individual or a community being in need, and having unfulfilled needs in absolute or relative terms.
Absolute needs are commonly assessed in relation to some kind of standard or baseline, whereas relative needs are evident when one individual or group is 102WH compared with another. Relative deprivation can and does exist in the absence of absolute deprivation. For the record, people living in Easington suffer both absolute and relative deprivation. As long ago as 1980, the Black report demonstrated the link between poverty, deprivation and ill health, and that link was reinforced by work carried out by Professor Townsend in the 1990s.
In 2003–04, Easington PCT received £104.6 million, whereas the target was £131.2 million. That is a £26.5 million shortfall, or 20.23 per cent. below target. In 2005–06, Easington PCT will receive £131.3 million compared with a target of £156.7 million. That is a £25.4 million shortfall, or 16.2 per cent. below target. To put it another way, as I said earlier, Easington PCT will forgo about £78 million of funding over the three-year allocation period, comparing baseline with actual allocations. In effect, the health care professionals, GPs, community nurses, health visitors and so forth who are expected to improve the health of the population in my constituency are being asked to deliver five years of health care with four years of funding.
The Secretary of State and the Under-Secretary of State for Health, my hon. Friend the Member for Welwyn Hatfield (Miss Johnson)—the member of his ministerial team who is here today—have both visited Easington PCT. I am sure that they will agree that there is the capacity and ability to improve health outcomes, and I would like to take this opportunity to thank them for visiting, as they promised to, to see some of the problems at first hand.
From lengthy correspondence with a succession of Ministers in the Department of Health, I gather that the Secretary of State understands and sympathises with the problems that we face in Easington. I respectfully point out to the Minister that the Secretary of State's warm words to the NHS Confederation and his reference to a commitment to address health inequalities in funding are not a test of political faith; they are more a test of political will. A promise is only a promise when it is delivered, and I am looking to the Minister for a commitment to address the funding anomaly that leaves health services for my constituents underfunded to the tune of £78 million over three years. In the short term, I am also seeking special measures to bring additional health resources to Easington to bring my PCT at least within striking distance of its target. That will allow the dedicated team of professionals that we have in place to get on with the job of improving health outcomes in one of the most deprived communities in the country.
I await the Minister's response with great interest and, as a loyal member of the Labour party, some expectation. I remind her that with loyalty come obligations. The nation owes a debt of honour to mining communities such as Easington that have suffered ill health over many generations to produce the coal that the nation required The mines have closed but the legacy of ill health remains, and must be addressed if the Government's commitment to their heartlands and to social justice are to have any credence.
On 28 April 2004 the Secretary of State made a speech to a conference on 28 April 2004 entitled "Choosing Health: Closing the Gap on Inequalities." In his opening remarks to the conference my right hon. Friend restated his commitment to the principles that established the NHS—a health system based on the principle of equal 103WH access to health care that is free at the point of need. The Government have signed up to reducing inequality with a public service agreement target to reduce health inequalities by at least 10 per cent. in terms of outcomes, measured by infant mortality and life expectancy at birth.
Those are admirable targets, which my colleagues and I fully support. To achieve the targets and fulfil the Government's pledge, the issue of resource allocation and inequalities in funding for PCTs such as Easington must be addressed as a matter of urgency. Thank you, Mr. Deputy Speaker, for giving me the opportunity to raise the subject today, and I await the Minister's response with anticipation.
§ The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)I warmly congratulate my hon. Friend the Member for Easington (Mr. Cummings) on securing today's debate, which is of great interest and concern to his constituents and the health community in Easington. As he has already reminded us, I had the pleasure of visiting his constituency and talking to people there. I saw good work being done and place on record my thanks to all the staff involved.
I have listened carefully to the points that my hon. Friend has raised, but before responding directly to them, I would like to say a few words about the progress and investment being made in the Easington area, and in particular to praise the hard work and dedication of the NHS staff there.
There are a number of drivers for change across government, the NHS and the Department of Health. Ministers, including the Prime Minister, have put a real focus on making reducing health inequalities a top priority for the Government. Following the cross-cutting review, the Office of the Deputy Prime Minister: Housing, Planning and Local Government Committee has responsibility for overseeing the implementation of the inequalities strategy. That will be crucial in ensuring that tackling health inequalities remains a key priority across government. Indeed, the NHS improvement plan explicitly sets out how the NHS will develop into a health service rather than one that focuses primarily on sickness, and will in partnership make further inroads into levels of smoking, obesity and the other major causes of disease. There will be a sustained drive to reduce inequalities in health.
Strategic health authorities have a key role to play in performance managing health inequalities, not just on the key targets, but on other public health and health inequalities performance indicators and on progress with local delivery plans, which for the first time include tackling health inequalities as a priority. The recent launch of the consultation paper "Choosing Health?" was aimed at helping us put inequalities at the core of the nation's health. We want to use the consultation to promote a wide debate on the roles and responsibilities of individuals, the NHS and all the other players in civil society, as well as the Government, in the debate on choosing health.
Governments on their own cannot reduce inequalities. They depend on the hard work of disadvantaged people working to overcome the 104WH conditions that have in the past disadvantaged them. We help, but they must do it themselves. The publication in July 2003 of "Tackling health inequalities: a programme for action" is an indication of our commitment to addressing this issue. The programme provides the basis of meeting the 2010 national health inequalities target on life expectancy, by geographical area, and on infant mortality, by social class, by building on current work, and addressing the wider causes of inequalities in years beyond.
Key issues that are addressed in that programme are, first, health inequalities, which affect a large part of the population, not just the most deprived. Action to meet the targets will need to address the needs of the poorest 30 to 40 per cent. of the population. In the context of overall health improvement, the aim is to improve the health of the poorest fastest. Secondly, health inequalities must be integrated into mainstream service delivery, focusing on disadvantaged areas and groups, and recognising that a one-size-fits-all approach to health care will not reduce the health gap. Thirdly, co-ordinated effective activity is required across traditional boundaries at all levels, working in partnership with communities and service users.
As for the local picture in Easington, I am pleased to note that Easington PCT achieved all its key targets in 2003 performance ratings, and was awarded two stars. In particular, according to the latest available figures, from April 2004, 100 per cent. of patients were able to see a GP within two days or a primary care worker within one day.
I recognise that there are challenges facing the local health community. My hon. Friend is right to say that Easington is indeed one of the most deprived areas of the country, with significant levels of deprivation in its wards. However, it should be noted that the PCT has an admirable track record of meeting its population's needs. When I visited the area earlier this year, I was most impressed with the commitment of the staff delivering the health agenda. The PCT is taking part in a number of initiatives designed to address health inequalities. It reduced the incidence of heart disease by 25 per cent. over a two-year period, and I commend the PCT and its partners for the progress that has been achieved in that area.
Easington was one of three sites that helped the Modernisation Agency to win first prize in the health and social care awards in 2003 for its work focused on reducing falls in the community. Easington achieved a 63 per cent. reduction in falls over that periods, and I again congratulate the PCT and its partners for their contribution to that fine achievement.
The PCT has also established a local education and training programme to develop the expertise and skills of local health professionals, to ensure that it can attract and maintain motivated and experienced staff. In 2003–04, £750,000 was invested in expanding the nursing workforce. It is expected that by April 2005, multidisciplinary teams will be working in defined communities with delegated budgetary responsibility. We are taking the decision making and provision closer to the local communities.
With regard to specific action on health inequalities, the PCT is active in a number of areas, including the smoking cessation service, a range of activities based on 105WH the healthy living centre, participation in the health communities collaborative, and the expert patient programme. In addition, the Department and the strategic health authority have been working with the PCT to explore other possible initiatives to support the PCT's priorities, where those can be linked to existing central Department of Health or Modernisation Agency schemes.
To tackle health inequalities effectively, the big programmes—where the big money is—must change, and that means working through the mainstream and getting health inequalities thinking into existing and future programmes. Real change will be delivered only by changing the way in which mainstream services work, to ensure that we do not leave the worst off behind. We have learned that deep-rooted problems such as health inequalities cannot be tackled by short-term initiatives that dry up when the money runs out.
My hon. Friend referred to finance in his speech, and I should say straight away that the NHS must deliver overall financial balance and the NHS plan targets if we are to maintain credibility and meet our obligations to Parliament and the public. It is important to remember how much funding has been made available. In the 2002 Budget, the Chancellor announced the largest sustained increase in funding of any five-year period in the history of the NHS. Over the years 2003–04 to 2007–08, those plans mean that expenditure on the NHS in England will increase, on average, by 7.4 per cent. a year above inflation.
All NHS organisations must be clear that they have a responsibility to manage their resources effectively. Although we expect overall financial balance across the NHS, that is not to say that there are no health bodies facing financial pressures. There are always pressures to be managed in year, and substantial moneys, including the NHS bank support for the most hard pressed health economies, have been allocated to the NHS to meet the increasing demands placed on it.
My hon. Friend addressed the issue of the allocation of resources to primary care trusts in considerable detail, and I emphasise that Easington PCT will receive an increase of £36 million over the three years from 2003–04 to 2005–06. That represents a cash increase of 41 per cent. I am, of course, aware that that will mean that the Easington PCT continues to receive less than its target share. However, the pace of change policy that we have adopted for 2003–06 will reduce the PCT's distance from its target over the three-year period. For 2003–04, Easington PCT was 22 per cent. under its target share, but by 2005–06 it will be 16 per cent. under that target share. The allocations have been made direct to PCTs as part of the process of shifting the balance of power, by putting resources and responsibilities in the hands of front-line services. PCTs now control more than 75 per cent. of the NHS budget.
In response to some of what my hon. Friend said, I can see that it is not unreasonable to ask why some PCTs continually receive less than their target share. Our pace of change policy involves a balance between how much we give to all PCTs to maintain continuity and stability and make progress nationally in priority areas, and how much extra we give to under-target PCTs to bring them nearer to their weighted capitation targets. Allocations to all PCTs include resources to finance the cost of pay reform, new drugs and treatments, and additional capacity. However, we have also given extra resources to under-target PCTs.
It is important to remember how much extra funding we are making available. There has been an increase of £3.8 billion in the allocations to PCTs, bringing the total for 2003–04 to £45 billion. By 2005ߝ06 that total will be £53.9 billion—an increase of £12.7 billion over three years. We are committed to bringing all PCTs, including the Easington PCT, to their target allocations as soon as is practical. However, that must be consistent with all PCTs receiving sufficient extra funding to enable them to deliver national end local priorities. I hope that my hon. Friend will appreciate that there is a balancing act to be done.
We will consider a new pace of change policy before the next round of allocations are announced in the autumn. That will be decided in the light of the circumstances at the time. I am sure that my hon. Friend will understand that I cannot pre-empt any decision regarding the pace of change policy. However, I assure him and his constituents that his representations have been noted carefully and will be taken into account.
The pace of change policy decided by Ministers for each allocation round varies from round to round to take account of a number of factors. I believe that we have struck the right balance for this allocation round. I think that there will be an announcement about the new pace of change policy in the autumn, which, as I said, will be devised in the light of the circumstances prevailing at the time.
As a result of the Secretary of State's commitment to supporting the PCT, the Department of Health policy and Modernisation Agency officials continue, where appropriate, to define the support that can be given to Easington PCT in line with the relevant Department and Modernisation Agency work programmes, and will work through the strategic health authority to give meaning to that support. The Department of Health policy and Modernisation Agency officials will continue to monitor the progress of the support that is secured. My hon. Friend has made a strong case on behalf of his PCT on several occasions, and I assure him that Ministers are listening carefully to what he says.
§ Sitting suspended until Two o'clock.