West Ham’s MP Lyn Brown spoke yesterday in a debate in parliament on NHS services in London. I’m not normally a huge fan of Lyn’s, but the speech is very good. It makes some excellent points about health inequalities and their impact on local people. It also touches on concerns about the future of A&E services at Newham General. It is worth reading in full:
I want to reflect on some of what my hon. Friend [Karen Buck, MP for Westminster North] said at the beginning of her speech and on the sentiments of a letter to The Guardian before Christmas from GPs, emergency doctors and nurses, midwives, physiotherapists, psychotherapists and NHS trusts. Their plea was for a page to be turned in the way we talk about the NHS. We need to talk about the failures in patient care, but we must also recognise that we have some extraordinary abilities in the NHS to reach and look after our communities as well as they do. Sadly, I have been close to the NHS in the past three years, and I have seen excellence and the pits. However, in general, the people who work in our hospitals do a fantastic job.
I wholeheartedly endorse the sentiments of that letter because I fear that the driver for the relentless daily trashing that the NHS receives comes from base political motivation—the softening up of public opinion so that marketisation and privatisation become acceptable. It will not be acceptable. It is not acceptable now and I do not believe it will ever be acceptable, so let us just stop it.
I am not the only one to mistrust the motivation and outcome of the coalition’s top-down, unwanted and wasteful reorganisation of the NHS. I did a survey of my constituents — I like to find out whether my impressions are the same as theirs — and 97% of those who responded said that the NHS would undoubtedly get worse under the new system. When they were asked about their main concern, 60% thought that the money intended for NHS staff and services would end up as profit for private companies. My constituents are very astute.
I want to turn to local circumstances.
In 2006-08, life expectancy for men in Newham was 75.8 years, lower than the London average of 78.2 years. In the same period, life expectancy for women was 2.3 years below the London average at 80.4 years. Even within my borough, there are variations that make the local situation much more complex and challenging. Life expectancy in some wards is 8.1 years shorter than in others. That is massive.
In primary care, the recommended ratio of GP provision is 1.8 GPs per 1,000 of population. In Newham, the ratio is appalling and equates to not much more than half that, at 0.56 of a GP per 1,000 of population. It is small wonder that in my survey, 35% of respondents reported that it is never easy to get a GP appointment, and just 10% said that it is always easy. Many practices—too many—are operated by single GPs, so it is no surprise that the patient experience in Newham is the worst in north-east London.
The primary care trust, before its abolition, had a clear plan for tackling that challenging situation and I enthusiastically endorsed and participated in it. Now, there are no mechanisms in place to root out poor practice and promote the best. I would like to hear from the Minister how she will ensure that Newham has the number of GPs to which we are entitled, and that we have performance and outcomes that are the same as other areas of London.
Incidentally, I would be interested to hear whether other hon. Members here are experiencing the new phenomenon that we have in Newham: dial a diagnosis. When people contact their GP to arrange an appointment, they are initially offered a telephone conversation with the GP. Is that because GPs must bolster the failing 111 non-clinical service, which is now contributing to the difficulties of our A&E departments? Is it to save money, to sift out or deter patients or to ration GP time? Has there been a risk assessment of what that might entail, and does it contribute to the problems that my community is facing? Again, I would like to hear from the Minister about that.
Another statistic from Newham that should be good news is that the incidence rate for breast cancer is 104.6 per 100,000 of population, significantly lower than the UK average of 123.6. However, disturbingly and distressingly, the percentage of women alive five years after diagnosis—the five-year survival estimate—is, at 75%, also significantly lower than the UK average of 83.4%. The reason in part is the take-up rate of breast screening services, but there is anecdotal evidence of women who were part of Barts hospital’s preventative health services being encouraged to go away and become part of the general population, and to present sometime in the future. That encouragement not to continue to attend for breast screening gave a rosy picture of health needs.
The London Health Commission, under the chairmanship of Lord Darzi, has a remit that includes healthy lives and reducing health inequalities. I will be interested to hear what the Minister says in anticipation of the commission’s report, and what assurance she can give that the Government will act on health inequalities.
Let me refer to the Barts health care trust, which is the largest in the country and incorporates Barts, the Royal London, Whipps Cross and Newham General hospitals. Our patch is the growing part of London, with growth in population, complexity, the number of homes and, of course, opportunity. I was therefore grateful to hear the hon. Member for Cities of London and Westminster (Mark Field), who made a well balanced speech, talk about resources being sucked into the large university hospitals in the centre. Even though those of us on the far-flung borders of the east belong to the same trust as one of those hospitals, we experience the difficulties he talked about in relation to Romford.Rumours abound at the moment that Newham General, as part of the Barts trust, is under threat of reconfiguration—a fascinating new word—to secure the viability of the trust as a whole. When I talked to the trust’s chief executive, he told me that the PFI represented only 10% of the trust’s entire budget and that, given that the budget was large, he did not see the PFI as having major consequences for the delivery of services.
However, there is an accusation that the trust is being a little disingenuous in its public statements that the A&E at Newham General will not be closed. Assurances have been sought that there will be no downgrading without full consultation, but those look weak in the face of a shortage of anaesthetists, for example, who are essential to support a viable emergency service.
Almost half of London trusts are struggling to achieve the 95% standard for patients waiting in A&E. Barts trust is just about achieving that target, but that is because Newham General performs well and helps the trust’s overall performance — a good example of how a local acute hospital catering for a place such as Newham can perform well, while larger hospitals struggle. Given that the future of Newham General’s A&E is under threat, the irony of the situation is not lost on me, and nor will it be lost on my constituents.
In that scenario, it is essential that we maintain Newham General as a fully functioning major acute hospital with a full range of services, including A&E and maternity. Given that we are seeing growth out to the east, it would be irresponsible and downright dangerous for us not to do that. It would also be a complete distraction from the absolute priority of putting in place improved, integrated care services in the community and in primary care.
Finally, I seek assurances from the Minister about the funding formula for CCGs being rolled out across England. In the London context, it is shifting resources from inner-London boroughs, with their younger populations, to boroughs further out, which have older populations.
Newham just happens to have the youngest population in the whole of Europe, apart from some tiny canton somewhere that is almost irrelevant. We will therefore lose substantial amounts, while London as a whole is losing 2.3% of its funding to other areas. I would like reassurance from the Minister that the funding formula will fully take account of deprivation, as the hon. Member for Cities of London and Westminster said, as well as of our population’s high level of mobility, with the health problems that brings with it, and diversity, with the specific demands that that puts on health care.
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