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Access to NHS Services

Part of Opposition Day — [15th Allotted Day] – in the House of Commons at 5:51 pm on 3rd July 2007.

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Photo of Norman Lamb Norman Lamb Shadow Secretary of State for Health, Liberal Democrat Spokesperson (Health) 5:51 pm, 3rd July 2007

I appreciate that the hon. Gentleman's report deals with that, but it is a legitimate concern.

Let me deal with equitable access to services and the related issue of health inequalities. The Secretary of State referred in his deputy leadership campaign to his specific concerns about health inequalities. I therefore know that he genuinely takes that seriously and I hope that the need to reduce inequalities will be a top priority for him. In 2002, the Government made a commitment—with which, I am sure, he is familiar—that by 2010 they would reduce inequalities in health outcomes by 10 per cent., as measured by infant mortality and life expectancy at birth. That is a legitimate direction in which to try to move.

However, this year's departmental report highlights a shift in the other direction: health inequalities in our country are increasing. On infant mortality, it stated that the gap had widened and that the rate for routine and manual workers was 18 per cent. higher than that for the total population, compared with 13 per cent. in 1997-99. The Department's statistics for 2001-03 show that among the most affluent, there were 2.9 infant deaths per 1,000 live births compared with 8.9 per 1,000 live births among the poorest members of our community. That is a stark contrast between the life chances of people born in good circumstances and those born in our most disadvantaged communities. I am sure that all Members are concerned about that and we need to find ways to reduce that gap.

The gap in life expectancy has increased, and it has done so most among women. The relative gap among women has increased by 8 per cent.; among men, it has increased by 2 per cent. Again, the Department's statistics for 2001-03 found that in the best area in the country—east Dorset, for some reason; it is a reasonably affluent area—men could expect to live to the age of 80, whereas in Manchester they could expect to live to the age of 71.8. That is a stark difference, which we should all find unacceptable.

Do those differences have anything to do with the health service or are they all to do with much broader factors? Clearly, many factors such as poverty, deprivation, lifestyle and so on, play a part, but health care is relevant. Let me draw the Secretary of State's attention to programme budgeting—a new development that the Department has pursued—which enables us to compare areas and consider not only how much is spent on each specialty, but the outcomes in each specialty. We can therefore ascertain the effectiveness of the money in each area of the country. A recent report concluded that there was a clear link between spending and health outcomes. If we commit resources where they are most needed, we can achieve improvements in health and longer life expectancy.

On the same issue of equitable access, I want to deal with access to GPs. In the least deprived PCT areas there are 62.5 GPs per 100,000 of the population, while in the most deprived there are just 54.2 per 100,000. Thus the areas with the greatest health problems have the fewest GPs as a proportion of the population. It is the wrong way around. All that points to a failure of policy—given that the Government highlighted the importance of the matter and set a target for reducing health inequalities in 2002, moving in the opposite direction is unacceptable.

What are the prospects for reversing those trends? I would like briefly to look at the issue of choice. There is a risk, which many people highlight, that increasing choice actually has the effect of accentuating inequalities, the argument being that the middle classes can exploit those opportunities while others cannot. There is a very good report by the Institute for Public Policy Research, called "Equitable Choices for Health", which highlighted the potential risks. It referred to a pilot in London—the London patient choice project—in which disadvantaged people were given help with transport and given advice by patient care advisers about how best to exercise choice of hospital, treatment and so forth. The conclusion was that the pilot had had a positive impact on reducing inequalities. It had empowered people, particularly those at the bottom end of the income scale.

However, the report also pointed out that when the Government rolled out patient choice nationally, none of those support mechanisms was in place. There was no help with transport and no guidance on how people should exercise choice. The IPPR's conclusion was that under the Government's scheme, choice was likely to increase inequality. I hope that the Secretary of State will further examine those conclusions from the research and consider how best to ensure that choice actually empowers the least powerful in society, rather than accentuating differences in health outcomes.

I need to deal with the impact of deficits. The Secretary of State has perhaps arrived at a good moment because his predecessor had a pretty tough year. She made a political commitment to ensure that the NHS as a whole was in balance by the end of the financial year. She achieved that, but there are questions about the price that was paid to do so. The Health Committee drew attention to the fact that in the efforts to clear deficits some serious soft targets were hit. Particular attention was drawn to mental health services, which have been cut back in many parts of the country, including my own county of Norfolk. It is the same with public health programmes. Cutting back on alcohol prevention work, smoking cessation work and other programmes often hits the most disadvantaged people and again has the effect of accentuating inequalities in health outcomes. If the Secretary of State is serious about his commitment to reducing inequalities, those are the sorts of issues with which he needs to deal.

I also want to draw attention to the extent of geographical variation in access to health care—the so-called health care lottery. It is often said that one of the risks of moving towards a more decentralised system—one that I favour—is that we end up with a postcode lottery. Well, the fact is that we already have a postcode lottery with a vengeance under the existing highly centralised system. Another problem is that there is no local accountability to achieve any change. One example of variation in access to services is care of the elderly. There is massive variation in how the criteria are interpreted from one area to another, so that people in one area can get access to free long-term care for the elderly under the NHS, but people in another area cannot. The Secretary of State should also look further into audiology—another example of where the variations are enormous. Hundreds of thousands of people are on a waiting list for digital hearing aids. In some parts of the country, there is no wait at all—the Health Committee looked into that—while in other areas people are waiting two or more years for access to and the fitting of a digital hearing aid. Reassessments for people who have had an analogue hearing aid and who want a digital one can involve a wait of up to 260 weeks—five years.

Macular degeneration—a condition under which people lose their sight—provides yet another example of where people in some parts of the country can get access to the drugs that prevent sufferers from going blind and others cannot. People living in the no-access areas who have money are okay because ultimately, they can pay for the treatment, but people who have no money go blind. It is as simple as that. I would hope that we all find that completely unacceptable, yet it is happening now and it needs to be dealt with. The excuse provided by many PCTs is that they are waiting for a ruling from NICE. In fact, NICE has provided a rather unfavourable ruling, which leads me to question the criteria that it follows.

Variations across the country are enormous. The subject of dentistry and orthodontic waiting times may have been mentioned in an earlier sedentary intervention. The waiting time is enormous in some parts of the country. More general access to NHS dentists is another problem. In some areas, it is almost a thing of the past. Many people moving to a new area can often simply not get access to an NHS dentist.