Deprivation is accounted for in the NHS funding formula, which reflects both deprived and older populations' greater need for health care. An additional health inequalities component in the formula directs funding to the places with the worst health outcomes, targeting health inequalities better than ever before.
Can the Secretary of State tell the House whether he has any further plans to try to reduce health inequalities by targeting resources further towards the most deprived areas of the country? Does he agree that the Opposition's premium pledge is just a sham, because the policy is already being implemented by the Government?
I can say to my hon. Friend that next year County Durham PCT will receive £1,800 per head of population, £200 more than the England average, reflecting the fact that there are higher levels of disease and deprivation in her local community. Obviously that has been a component of the formula since 1999. The Advisory Committee on Resource Allocation in the NHS keeps the matter under review, and it says that the decision is an interim step to give more money to tackle health inequalities. We keep the matter under review, and I can advise my hon. Friend that Professor Marmot will shortly give us his report on further action to tackle health inequalities, which we shall consider in due course.
Surely the purpose of the NHS is simply to treat individuals, wherever they happen to live around the country, with the treatment that they need to deal with their particular problems. Will the Secretary of State confirm that all health spending will be given on that basis, and that basis alone, rather than basing it on the socio-economic environment in which an individual lives?
I am told that there is a general election not too far off. May I respectfully point out to the hon. Gentleman that it might help him to read his party's draft manifesto from last week, which included the commitment to
"weight public health funding so that extra resources go to the poorest areas"?
He is going to be standing on that manifesto in a few months, so he had better read it-and pretty quickly, I would say.
I can say to the Chairman of the Select Committee on Health that the England average next year will be £1,600 per head of population. Turning the clock back 10 years, we see that it used to be £426 per head of population. That figure demonstrates the change that this country voted for when it elected a Labour Government. The country was saying, "Our NHS needs to be put back on its feet. We need to invest in it to give people in all parts of the country the best possible health care." In that figure alone we can see the difference that this Labour Government have made.
The Secretary of State will be aware that GP practices in deprived communities lose out financially and that there are 18 per cent. fewer GPs working in poorer communities. He will also be aware that the Health Committee heard evidence of the failure of the incentive scheme for payments to GPs to do anything effective about health inequalities. There is evidence supporting the call for radical action to change the way in which the qualities and outcomes framework works. When will the Government take action to change the current completely unacceptable situation, whereby GPs in richer areas are paid better than those in poorer communities?
Of course we keep such matters under review at all times. However, the funding formula for general practice contains a minimum practice income guarantee, which protects precisely those practices to which the hon. Gentleman referred. I would also point him towards the respected international Commonwealth Fund, which late last year published a comparison of primary care in the 12 most developed countries around the world. It is a source of huge pride to me and to every Member on the Government Front Bench-indeed, to every Member on the Labour Benches-that primary care under this Labour Government is the envy of the world.
Is my right hon. Friend aware that the alternative formula that was put forward in this Chamber three years ago by Mr. Lansley would reduce the funding going to our local NHS in Gloucestershire by £109 for every man, woman and child who lives there? Will my right hon. Friend resist that 9 per cent. cut to our local NHS?
What I would say to my hon. Friend is that we have sat in the House over the past five years of this Parliament and heard every member of the shadow health team criticise the Government for allocating more resources to communities with higher health needs and more deprivation. So when we read what the Opposition's policy in their draft manifesto is, I do not know how they have the brass neck to sit there today and look as though it was always their policy: it beggars belief. The Opposition need to spell out which PCTs will win and which will lose under the new policy. I suspect that my hon. Friend's PCT might lose from a policy that gave more money to deprivation, on top of what we give such communities today.
May I just say how much we will miss David Taylor at our Health questions and health debates? He was always here, and always had good insights and real commitment to the national health service. He will be much missed, as he was a good colleague to us all.
Will the Secretary of State confirm that patients should be able to expect equivalent access to treatment from the NHS wherever they are in the country? Will he explain why in his Leigh constituency, the NHS spends over 40 per cent. more on cancer services per cancer patient than it does in my constituency?
I would like to begin by echoing the shadow Health Secretary's remarks about David Taylor, who was a regular attender at Health questions and health debates; I am sure that his voice will be sorely and genuinely missed by Members on all sides of the House.
The answer to the hon. Gentleman's question is that my constituency has more deprivation and ill health than his does, and that is picked up in the funding formula. I am amazed that the hon. Gentleman is asking this question when his manifesto of last week said in terms that his party will adopt precisely the same policy-so how can he stand at the Dispatch Box and criticise the fact that my constituency of Leigh, a former mining area, receives more for its greater health needs?
The Secretary of State just doesn't get it. I was quoting the figures on the amount spent by the NHS in each of those areas per cancer patient-not the overall allocation between the areas, but the amounts spent per cancer patient. Let me give him another example. Perhaps he can explain why, although higher NHS allocations go to more deprived areas, the money is spent on responding to the consequences of ill health rather than on preventing disease, which is the reason why it is allocated. Why is there one hospital bed for every 245 people in the north-east of England, but one bed for every 408 people in South Central?
I am genuinely confused, because for five years, from his side of the Dispatch Box, the hon. Gentleman has accused us of spending too much money in constituencies such as mine. The reason why my area can spend more on cancer is that, historically, smoking has been higher in the constituency. It was the hon. Gentleman's manifesto of last week that said that the Conservatives would weight public health funding so that more went to deprived areas. So he would give my constituency more money than it gets today-yet every one of the Conservative Front-Bench team has criticised our funding plans. The hon. Gentleman should either accept the situation today and tell us which primary care trusts will get more and which will get less, or realise that his policy will have no credibility whatever.
He still doesn't get it, does he? Will he explain why the local PCT in his constituency presently spends £39 a head on its management costs but just £31 a head on its healthy individuals programme, which is preventive spend. That is the point; this is about prevention. What is needed is higher public health budgets for the areas with the poorest health: less bureaucracy, more prevention-that is our health premium. Will he not just accept that we need real help to reduce health inequalities through preventive health care-because we can't go on like this?
It is our policy to allow local PCTs to decide where they spend the money on the areas that they think will have the most impact, whether that be prevention or cancer. For the last five years the hon. Gentleman has accused me of giving too much money to those areas, and now he has completely abandoned that pledge. It would appear that it is not him but his party leader who is now writing his shadow health policy. Let me tell the hon. Gentleman, who sits there and gives out the orders, that he has had his policy on single rooms dropped, and he has had his policy on health resources dropped, so why does he not book himself-
Order. I am extremely grateful to the Secretary of State, and I know that he wants to say something about other parties' policies, but he must now focus exclusively upon his own.
My right hon. Friend will know that my constituency has had significantly increased funds. None the less, we have very high death rates from heart problems and cancer in low-income wards. How can we manage that situation? What education and community programmes are there to help people in low-income families understand the serious dangers from smoking and poor nutrition?
My hon. Friend is right. We need to give the resources to areas such as hers so that they can spend them on smoking cessation programmes and improving access to primary care. Research has shown that communities of that kind benefit greatly from improved primary care, and also that national targets have played an important role in improving health outcomes in the most deprived communities. I assure my hon. Friend that that will remain a central tenet of this Government's health policy.