Six months ago, when we last debated the health service in London, I raised concerns about the future shape of community health services in east London. At that time deep anxiety was expressed about the proposal to have a single trust-run community health service for Newham, Tower Hamlets, Hackney and the City. I was delighted when the Government announced at the beginning of December that there would be three separate trusts, and I welcomed the Government's response to the points that were made during the debate.
We were anxious that there should be separate trusts in order to expose how much money was being spent in each of the three areas. Our suspicions about funding disparities were confirmed when advertisements for senior positions in each of the new trusts were published. The published budget for Newham per head of population was less than half of that for the rest of the area. That fact highlights the issue of health service funding in London upon which I shall concentrate my remarks this evening.
The Government's amendment to the Labour party's motion on the Order Paper
commends the Government for its record in investing in … the long-term interest of … the people of London;
That choice of words betrays a complacency which rings very hollow all over London. There is growing and compelling evidence, including work commissioned by the Government, that areas such as Newham are deeply under-resourced and yet are still being cut back further in the allocation of national resources.
Two weeks ago the King's Fund published a report, called for by the former Government chief medical officer, entitled, "Tackling Inequalities in Health". The report's conclusions were forthright and unequivocal. It says:
People who live in disadvantaged circumstances have more illnesses, greater distress, more disability and shorter lives than those who are more affluent.
During the 1980s social divisions accelerated at a rate not matched for such a sustained period by any other rich industrialised country. Not surprisingly, the impact that this increase has had on health is now beginning to emerge. Death rates in some of the most
disadvantaged areas in Britain not only worsened in relative terms between 1981 and 1991 … but among some age groups, such as young men, the death rates actually rose.
That cannot be accepted as just an unfortunate fact of life. It must be addressed by those responsible for the health service.
The King's Fund report also says:
The injustice could be prevented but it will require political will. The situation could be substantially improved if the political will existed to recognise that tackling inequalities in health is a fundamental requirement to social justice for all citizens. The question is: can British policy makers rise to the challenge?
We cannot afford to ignore that challenge. The spiral of poor health and under-achievement cannot be allowed to continue. The social and economic costs as well as the moral responsibility will he borne by us all.
In October, the Centre for Health Economics at the University of York reported to the Government on the distribution of health resources. Its findings were unambiguous. It said:
The current formula (introduced in the early 1990s) has resulted in a shift of resources away from the poorer and sicker areas.
The York report produced a new capitation formula which would yield a significant shift of resources to the inner cities.
Tragically, the Government's response has been to water down that report and we are now told that in my area of east London we are to lose out even further when the Government's adaptation of the formula is fully in place. We will lose out by £14 million in a budget of £322 million. The pattern is the same elsewhere in inner London. It is a travesty of the York report's recommendations and the figures show that the Government are moving in the opposite direction to that recommended by the York team.
There is a crisis in the health service in London. Departing general practitioners cannot be replaced. In our accident and emergency unit at Newham general hospital, only seven of 11 vacant posts could be filled in the last recruitment round. The work load for many health workers is far greater than would be tolerated in more prosperous areas. There is a shortage of children's nurses, and orthopaedic wards have to rely on agency staff.
I want to raise deep concerns about what has happened to the funding that has been earmarked for primary care improvements in east London. The Secretary of State made a great deal about the need to redirect resources into primary care. We all welcome improvements in primary care and there is no doubt that, by one means or another, the Government have made some funds available. What has become of that money? Where are the improvements that it is supposed to bring?
I have with me an astonishing document. It is the latest district audit management letter on the City and East London family health services authority—the body that is charged with the responsibility for overseeing the primary care improvements that the Government have promised in east London. Those improvements are, without doubt, desperately needed. The document talks about the affairs of the authority and it says:
there have been clear failures to recognise that there are legal limits on the powers of the FHSA … there have been instances where officers have maintained unofficial bank accounts in respect of FHSA funds … little regard was given to recommendations at audit for improving the management and financial affairs of the authority.
Those serious allegations are documented in the report, which goes on to conclude that
such failures have resulted in the consequent loss of scarce resources to health services in the area.
The document tells us that significant sums of money have been wasted.
I am aware that there have been personnel changes at that FHSA, but it has shown itself wholly unable to oversee the capital projects that the Government have required it to deliver and which the Government have promised to the people of east London.
The Star Lane medical centre in the constituency of my hon. Friend the Member for Newham, South (Mr. Spearing) was allocated a grant of £1.9 million in the first year of the London implementation zone programme. Three years later there is no sign of a single brick being laid. I have tabled a parliamentary question asking where that money now resides.
This morning I received a letter from the Newham GP forum which says:
We are at the bottom of a major recruitment crisis as well as suffering from rock bottom morale.
The root of the problem is a catalogue of projects involving GP premises which have gone catastrophically wrong. The letter lists five of them. About one project it says that, because of his experiences with the FHSA, the doctor
is on the verge of a nervous breakdown and bankruptcy.
It says about another project:
Despite this length of time and commitment no clear path has been agreed as to how these premises can be developed any further.
That "commitment" involved a dentist putting in £150,000 of his own money.
About the next project the letter says:
there is a strong possibility that recently started building works will be stopped before completion because
the doctor's bank has
advised him that he has too much negative equity.
Another doctor secured a promise of £700,000 towards the cost of the premises from the London Docklands development corporation, subject to the work being started by 1 July this year. The letter states:
there is no likelihood of any building works commencing before the deadline and as a result the whole project may have to be shelved.
The letter adds that if that happens the doctor has decided to leave his practice, and Newham.
That is a catalogue of appalling mismanagement. Far from improving primary health care in east London, it is literally wrecking it. Those charged with delivering the improvements have been wholly incapable of doing so. I call on the Secretary of State to make an urgent and thorough investigation of what has happened to the London implementation zone funding for east London, because I am increasingly worried that terrible damage has been done.