Battersea Primary Care Group

– in the House of Commons at 11:01 pm on 24 April 2001.

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

Photo of Martin Linton Martin Linton Labour, Battersea 11:22, 24 April 2001

I am grateful for the opportunity to raise the issue of the funding of Battersea primary care group. I make no apology if this sounds like a cry for help, because the health service is seriously underfunded in Battersea by comparison with neighbouring areas. I do not wish to drown my right hon. Friend the Minister in statistics, but he will know from his Department that Battersea is underfunded by £4 million and he will be familiar with the figures produced by the Merton, Sutton and Wandsworth health authority. Battersea primary care group has an allocation of £70 million, its target spending is £74 million, and that leaves a shortfall of just over £4 million, or roughly £43 a head.

Battersea is not even in the flush of good health. Among the six primary care groups in the health authority, Battersea is in the unenviable position of having the highest rates of heart disease and respiratory disease. Indeed, it may have the highest asthma rate in the country, but this comparison is solely with the other primary care groups in the health authority. Battersea also has the highest neonatal mortality rate; the highest mortality ratio for all ages; the highest admission rate for respiratory diseases; the highest admission rate for men and women over 65; and the highest admission rate for diabetes. I am sorry if the list is long, but it is important to establish the facts. It also has the highest admission rate for epilepsy, the highest conception rate for under-age mothers—three times the London average—and the highest conception rate for teenage mothers. It has the highest proportion of single, widowed or divorced households. Battersea also has the highest proportions of one parent families and of pensioners living alone. All those factors are indicators of medical need.

Battersea also has the highest rates of claims for income support, jobseeker's allowance, attendance allowance and many other benefits. The NHS needs index is the Department of Health's measuring tool for medical need. It shows that Battersea comes top on the indices for acute needs, for community mental health, for district nurses, for health visitors, for community maternity, and for chiropody. Battersea comes top in every single category.

The needs are high in national as well as local terms; Battersea is 26 per cent. above the national average on the community mental health index, and 19 per cent. above the national average on the mental health index. It is 10 per cent. above the national average level for the chiropody index, and 10 per cent. above that for the health visitor index.

Battersea also has the highest limiting long-term illness ratio, according to the normal standardised basis that takes account of age. It has the highest proportion of adults in-household who are recorded as unable to work because of permanent sickness. Battersea has the highest mortality rate for people over 75, and for people under 65. That is extremely worrying, because the population is very young. Of all the 659 constituencies in the country, Battersea has the highest ratio of people aged between 25 to 34.

The last census showed that Battersea had the second most mobile health authority population in the country. I am sure that the new census will show that we have reached the number one spot—certainly in the Merton, Sutton and Wandsworth health authority and probably in the entire country. The electoral register shows that Battersea has gained 37,000 new voters since the 1997 election: that is, 53 per cent. of electors in Battersea were not living at their present addresses in 1997.

When Battersea is not first in terms of medical need, it is often second after the neighbouring primary care group of Balham, Tooting and Wandsworth, part of which is in my constituency. Balham, Tooting and Wandsworth is not much better off financially, having an allocation that is nearly £4 million under target. It has the highest mortality rate from lung cancer and diabetes, with Battersea in second place in both cases.

The Battersea and Balham, Tooting and Wandsworth primary care groups are at the top of every relevant league table bar one. Both are at the bottom of the spending league table, at roughly £4 million below target. This is not a simple demand for more cash. I want to ask my right hon. Friend the Minister about the criteria according to which funds are allocated to primary care groups. Should the guiding principle be equity, need or demand?

If the Government believe that the guiding principle should be demand, I concede that in some respects the Battersea primary care group has low demand. We have the lowest admission rate for cancer, for instance, and for bypass operations, even though we have the highest incidence of heart disease.

That sums up the problem: Battersea has low demand in some areas, but that is not because needs are low. We have the highest emergency admission-to-hospital rate, but a low admission rate from GPs. That is a classic symptom of people on low incomes in the inner city who need the NHS more but use it less. It is not because they do not believe in it—quite the reverse: it is usually because such people lead hard, stressful and chaotic lives. It is much easier for such people to miss an appointment with a GP or a hospital. To go through the system from diagnosis of a heart problem to a bypass operation often requires a lot of tenacity.

The Government believe that the national health service should be founded on the principle of treatment on the basis not of demand of need. The health service should not simply meet the needs of the articulate or the well organised. We need a proactive health service that can find the people who need the treatment most.

The Government's system is based on measuring need, producing target figures based on need and providing more growth money to be distributed to health authorities with higher need. Primary care groups that are under target should be levelled up. Pace of change money is provided, but what happens? Health authorities have so many "must do" targets, such as reducing waiting lists, fulfilling the quota of cancer operations—all good aims in themselves—that it is easy to lose sight of the most important target of all, which is to meet medical need.

Merton, Sutton and Wandsworth health authority ended up with pace of change money of only £500,000. That may sound like a lot, but the portion that went to help Battersea PCG reach its target was only £281,000—just 0.4 per cent. of its annual budget. Wandsworth council has calculated that at that rate it would take 21 years for Battersea to catch up with its fair share of the budget.

I understand the reluctance of the Department of Health to reduce budgets. I understand why there is a principle of non-disinvestment, as it is called, and that PCGs should not have money taken away from them. It is not my aim to take money away from any of the neighbouring primary care groups, but I want the growth money to go to the primary care groups that need it most and to close the gap not in 21 years but in two or three years—the foreseeable future. That must be a "must do" target.

I remind the Minister that Battersea primary care group has been a pace setter. It was a pilot for locality commissioning schemes back in 1997–98. When my right hon. Friend the Secretary of State for Health was Minister of State, he visited Battersea primary care group when it was set up as a pilot because it was seen as a model of good practice. I pay tribute to the work done by the chairman of the primary care group, Dr. Sian Job, by Dr. David Finch, and by all the other members of the board who have set up a model PCG. It is involved in its community, it has good relationships with its general practitioners and it consults and listens to local people.

If the Government set up primary care groups, they must listen to them. If they have targets, they must make progress in meeting them. If they give more money to health authorities in deprived areas, they must ensure that the redistribution occurs not just between health authorities but within health authority areas. Wandsworth is in inner London, but in a health authority that is mainly in outer London, taking in the whole of Merton and Sutton. The danger is that this system of funding will turn into a huge disadvantage if money is allowed to drift towards demand rather than need. That argument has all-party support. The Minister will hear it from Wandsworth council as well as from me, as the Member of Parliament for Battersea.

Just as the deprivation of Wandsworth, as an inner London borough, is diluted and, to some extent, disguised by being joined with Sutton and Merton, so the deprivation of Battersea as the most inner London, deprived part of Wandsworth can be disguised by the creation of a new Wandsworth primary care trust, which would average out some of these inequities.

I do not seek to make a purely local point. The aim of this debate is to draw attention to a wider problem through the example of Battersea. Primary care groups need to become intelligent primary care organisations—the very point of setting them up in the first place. When general practitioners were purely reactive, one could not expect them to go out to discover the health needs of their areas. Battersea PCG provides a role model of a group determined to be proactive and intelligent in tackling its job, seeking out health needs and pushing preventive care programmes. It can make sure that the people who most need the health service receive the help.

I appeal to my right hon. Friend to take another look at the formulas used to determine how soon PCGs will meet their targets. While the situation that I have described has come about for the most understandable of reasons and out of the purest of motives, it would be unacceptable, having set targets, to allow it to be possible to take more than 20 years to achieve them. The Minister and his hon. Friends have set up PCGs and a system that can deliver intelligent primary care, but he must either provide the money for health authorities to make that a reality or loosen the system so that more resources can be put towards the most important health objective of all—medical treatment in relation to need.

Photo of John Denham John Denham Minister of State (Department of Health) 11:36, 24 April 2001

I congratulate my hon. Friend on securing an important debate on the funding of the Battersea primary care group. PCGs and primary care trusts are at the forefront of modernising the national health service, and we see them playing a key role in leading the way towards better patient services. I am aware from the debate and from recent correspondence of my hon. Friend's concerns about funding for Battersea PCG.

Before I address my hon. Friend's specific concerns, I want to clarify how PCGs and trusts receive funding, and to set out the background to my hon. Friend's points. Health authorities in partnership with primary care trusts, primary care groups and other local stakeholders should determine how best to use their funds to meet national and local priorities for improving health, tackling health inequalities and modernising services.

Prior to the establishment of primary care groups in April 1999, health authorities established contracts with NHS trusts and other bodies to provide health care services to meet the needs of their populations. Since then, health authorities have been responsible for allocating resources direct to their primary care trusts or primary care groups within national guidelines.

The formula used to set targets for PCTs and PCGs is essentially that used for health authorities. Health authority PCT and PCG allocations are based on a weighted capitation formula that combines the population number for the area with the levels and types of problems historically found in that area. The aim is to distribute NHS funds fairly on the basis of health care needs in the local population. Although the weighted capitation formula is largely based on utilisation, it includes a wide range of socioeconomic variables associated with the need for health care. It takes full account of the age profile of local populations.

A review of the existing funding formula used to distribute resources is under way. The NHS plan has made the direction of travel clear. We want reducing inequalities to be a key criterion for allocating NHS resources, as the NHS plan specifically says. The review is being carried out under the auspices of the Advisory Committee on Resource Allocation, which has NHS management, GP and academic members. We are adopting an incremental approach to the review of resource allocation. ACRA will make regular reports to Ministers as the review proceeds, and will move towards fairer resource allocation as improvements become possible.

When my hon. Friend described the situation in Battersea, he made no acknowledgement of the substantial increase in resources invested in the NHS in his area—as has occurred throughout the country. Although I understand his concerns, to talk solely about distance from target may be inadvertently to give the impression that substantial investment is not going into the NHS in his area. An increase of about 24.9 per cent. in resources in the area covered by the Battersea primary care group in three years is, by any measure, a more substantial investment in the health service of that part of London than was experienced in most previous years. Of course, we are only at the beginning of the unprecedented expansion of resources announced in the second spending review, which underpins the NHS plan. That is important in setting the context for the remainder of my remarks.

Overall, health authorities are receiving an increase of about £3 billion for 2001–02. That represents an average cash increase of 8.9 per cent.—a real-terms rise of 6.2 per cent. Merton, Sutton and Wandsworth health authority received an increase of £42.4 million—a 9.3 per cent. increase. That health authority received the ninth largest increase of any health authority in England.

Within national guidelines, health authorities determine the pace of change at which individual PCTs and PCGs in their area move towards their fair share. For 2001–02, the national guidelines state that all PCTs or PCGs should be given a 2.5 per cent. uplift on their unified baselines. All health authorities should distribute the funding for implementing the NHS plan to PCTs or PCGs on the same basis as allocations have been made to health authorities.

Within those parameters, health authorities are encouraged to make progress towards fair shares, especially for those PCTs or PCGs that are most under target. That should take into consideration the service investment that all PCTs or PCGs will need to make this year. In addition, health authorities will continue to follow the principles of pace of change guidelines that we set out in 1998, including moving towards equity, maintaining continuity and stability.

It is true—and, I think, right—that we do not want to take funds away from PCGs even when they are over target, although that is allowed in exceptional circumstances with their agreement. We want PCGs instead to move towards target through levelling up—by allocating bigger shares of the extra money that we are giving the NHS to those PCGs that are furthest under target.

Battersea PCG is one of the five PCGs and one PCT within Merton, Sutton and Wandsworth health authority, covering the three local authority areas. Battersea PCG consists of 51 GPs working in 17 practices, six of which are single handed. The PCG covers a very mobile and multicultural population of 99,000, which has a wide variety of health needs.

In terms of funding, Battersea PCG and Balham, Tooting and Wandsworth PCGs are under target. The Nelson and East Merton PCT and PCG are close to target, while Putney and Roehampton and Sutton PCGs are above target. We do recognise, however, that Battersea PCG is still about £3 million, or 4 per cent., below the figure suggested under the allocation formula.

Nothing in national policy prevents under-target PCGs from moving towards their ultimate target. Although national policy has stipulated a minimum increase in allocations for all PCGs and PCTs during the past three years, there is still scope for all health authorities to allocate extra funds to under-target PCGs and PCTs, provided that does not destabilise services.

Merton, Sutton and Wandsworth and all its stakeholders—including the primary care groups and trusts—agreed how the additional 9.3 per cent. funding should be allocated. They agreed to focus on maintaining stability within the local health economy by levelling up under-target PCGs and PCTs. A sum of £500,000 was made available for pace of change for Battersea and Balham, Tooting and Wandsworth PCGs within the borough of Wandsworth. That has moved the two under-target PCGs in Wandsworth 0.6 per cent. closer to target. This is the third year the health authority has set aside funding for the pace of change initiative. Battersea PCG has received the largest increase of any of Merton, Sutton and Wandsworth health authority's PCGs this year.

It is worth noting that all PCGs in the health authority, including Battersea, have confirmed in their 2001–02 service and financial framework that they will deliver the main NHS plan targets this year. One of the aims of the guidance issued nationally was to ensure that the targets set out in the NHS plan would be met in every area of the country.

My hon. Friend has mentioned that although Battersea has poor health indicators, that has not been reflected in the use of services. The health authority's public health department and the two under-target PCGs are working together better to understand the relationship between health needs and utilisation and the range of actions that may be most appropriate better to address health needs.

My hon. Friend mentioned many of the borough's specific problems, which relate to high teenage pregnancy rates, lung cancer and respiratory disease, coronary heart disease and diabetes. I understand the points that my hon. Friend made about funding, but it is also worth acknowledging the many initiatives that are currently in place in Battersea PCG to tackle those problems. The PCG is piloting a "young person friendly" GP practice in Battersea. There is the smart heart campaign, with the London ambulance service and the British Heart Foundation. Work is being done with Battersea research group, through the conduit project, to create active coronary heart disease registers in all practices. A multidisciplinary diabetes taskforce is being established, and there is a relatively new walk-in centre at Tooting.

Those initiatives reinforce what my hon. Friend says about the PCG's ambition and vision. Although I have absolutely no doubt that the PCG would like to make faster progress towards the target than has so far been possible, I am sure that it will recognise that the rate of increase in resources is far greater than practices in the area might have expected under the previous Government.

Of course, health needs are not always met just by increased funding; existing resources need to be matched to health needs. Currently, a health impact assessment is being undertaken in Clapham, which is expected to be completed in the autumn. Such reviews should enable the health community to develop appropriate pathways of care between primary and secondary care, ensuring that the right person delivers the right treatment at the right time in the right environment.

The concerns that my hon. Friend has raised about funding and health inequalities are those that drive the Government's policy to modernise primary care services. They are the very reasons why the NHS plan sets out the vision and the ambition that all PCGs will be in PCTs by 2004. The PCTs will have control of much larger budgets. They will have greater flexibility and influence over local health care decisions, as PCTs, rather than health authorities, will be responsible for commissioning services in the future.

I am aware that the PCGs in Wandsworth are considering applying for PCT status as one PCT for the whole borough next year. As I might well have to take a decision on that proposal in the future, my hon. Friend will understand that I should not comment further, but it is legitimate for me to say that, as part of any consultation on any PCT proposal in any part of the country, the question of how the trust intends to deal with health equality issues, patterns of under-provision and unequal access to services are perfectly legitimate issues to be raised by the public, local authorities, patients or others as part of the consultation process. Indeed, such issues are included among those that should be addressed in any application for a PCT. So there will be opportunities for such issues to be addressed as part of any PCT proposal in any part of London.

As part of the allocation to health authorities, more than £54 million was made available last year to improve access to primary care in the United Kingdom, of which London received £8 million. In Battersea, that has enabled an enhancement of the intermediate care team and packages of care; the extension of the falls prevention project; a reduction in waiting times for community-based physiotherapy; and the employment of a PCG-wide phlebotomist. It is good to see that, in that part of London, the additional funds allocated to primary care are being put to good use.

PCGs and, increasingly, PCTs play a central role in the development of primary care itself and in the future shape and direction of the health service. Merton, Sutton and Wandsworth health authority has followed national policy in its funding allocation for 2001–02 and it is inevitable that, as with the national allocation in which there are over-and under-target health authorities, there may at any one time be over-and under-target PCGs and PCTs. The speed at which we can move health authorities towards their targets and the speed at which health authorities can move PCTs and PCGs towards their targets has to balance two issues: the desire to move health authorities progressively towards equity as represented by weighted capitation targets, and the need for across-the-board increases to maintain continuity and stability in the service and to make progress nationally in priority areas.

I hope that I have indicated to my hon. Friend that we are making progress nationally and in the health authority. Substantial additional funds are available to the national health service and, in the longer term, a review of the national funding formula that is under way will seek more explicitly to tackle the issues of health inequality that he raised in his speech.

Question put and agreed to.

Adjourned accordingly at nine minutes to Twelve midnight.