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Health Inequalities

Again, the hon. Gentleman is pinching my lines. His point is valid and important. The problem with underfunding, when it lasts for so long, is that it is not just £25 million this year, but £25 million last year and £20 million in the previous two years, and way beyond the previous 10 years, with perhaps even 20, 30, 40 or 50 years of underfunding in terms of facilities and doctors. That has an impact on health. That is an important point. We are talking not about a one-off situation—one year—but about a cumulative build-up, which means that we have to allocate even more resources to overcome it. Hull is £698,000 closer to target, on £30 million, meaning that it will only take 45 years to reach the target, but in percentage terms, that is 0.2 per cent. in the time I am talking about, meaning 6 per cent. in total, so it will take Hull 30 years to get back to being allocated the resources it is entitled to under the formula. Richmond and Twickenham PCT is £51 million away from target in 2009-10. Inexplicably, it will be £52.25 million away in 2010-11, so in fact it is moving further away from target over those two years rather than getting closer to it. At that rate of change it will never, ever reach the target. At a rate of change of 0.1 per cent., when it is 23.4 per cent. over, it will take 234 years. That is not an acceptable pace of change. There is sufficient leeway in such areas to be able significantly to improve the rate of change. We need to take into account another element. HRG4—the health resource group funding—has just been announced. I welcome that because, again, it gives hospital trusts the right amount of money. My right hon. Friend the Member for Oxford, East (Mr. Smith), who is in the Chamber, and I have long campaigned together on the orthopaedic element of that to ensure that the extremely complex orthopaedic surgery that is carried out at the Nuffield and the Wrightington hospitals is properly recognised in the amount of funding. HRG4 does that, which is important, but its impact is enormous. Wigan PCT has estimated that if it just makes the mandatory payments, £12 million extra each year will have go straight from the PCT to the hospital. If it does all the discretionary work as well—the discretionary part of the HRG4—it will cost £24 million. I want hon. Members to hold those figures for a while. Some £12 million will have to go and another £12 million may go. The increase in funding to Wigan PCT in one year is £27 million, so for primary care improvements, we will be left with £3 million at worst or £15 million at best. Obviously, all the drugs, pay increases and so on must come out of that sum. The effect will be that Wigan PCT will be in a reduced situation and will have to make changes to the way that it does things. If Wigan has to do that when it is £25 million below target, it is not beyond the wit of areas such as Richmond and Twickenham—I have chosen it as an example, but there are plenty of others—which is £50 million, £60 million, £70 million or £80 million above target, to make similar changes. What can be done? We need to manage the changes. When the allocations were announced, inflation was somewhere between 3 and 4 per cent. I accept that the drugs bill has been announced and fixed, and wages agreements are in place for the next two years, but there will still be significant payments to be made in respect of the expenses that PCTs incur, even though those sums are significantly lower than anticipated, given the inflation rate when the allocations were announced. If we reduced the floor from 10.6 per cent. to whatever over a year, it would allow a significant amount of money to go to areas that are underfunded, bringing them closer to the target and increasing the pace of change. We need a faster pace of change, and the Minister should commit to that today. Targets that cannot be achieved for tens or hundreds of years are not acceptable, because of the impact on people’s health, and because health professionals despair of ever being able to tackle inequalities properly. We should also have a debate on the allocations. It is amazing that we have debates on police allocations from central Government, on fire service allocations from central Government and on local authority allocations from central Government, but we do not have a debate on allocations to primary care trusts. My local authority in Wigan receives £129 million of grant from central Government, and we have a half-day debate about that. We have consultation and debate and then confirmation or alteration of the amount. The health allocation to Wigan PCT is £565 million, four and a half times as much, yet it goes through with no debate whatever, unless there is a Westminster Hall debate. That is a hangover from the Tory years when the Conservative Government did not want to talk about health inequalities and allocations. We thought ourselves lucky if we had a health allocation, let alone an increase. Ministers should relish the opportunity to champion all the good that has been done over the past 10 years, and to put the Opposition on the spot by saying, "We know what we want to do about health inequalities and we know how we are going to tackle them, but where are you? We know what you did with the Black report. Have you changed?" We should be able to look forward to an annual debate on health allocations when so much money is involved compared with police and fire authority allocations. If we do not make inroads, we will go on the merry-go-round of people being unable to see their doctor, clogging up A and E, or leaving problems until it is too late to treat them with primary care so that they have to be treated by health care, with primary care having to fund that instead of funding family care properly. That is a downward spiral. So many effects of health inequalities need personal intervention, because health workers must talk to people and guide them. Obesity is not an individual problem; it is a family problem. One does not see fat people; one sees fat families. That is unfortunate, but if someone’s problem is only tackled individually, the mother or whoever does the cooking will continue to provide chips, pies and so on. It is unusual to hear someone from Wigan denigrating pies, but I accept that they are not a healthy pattern of eating. Smoking must also be tackled individually, so intervention is labour intensive and, therefore, expensive. If we do not have the resources to tackle it, we will not deal with health inequalities. Poorer health areas have below-target health and local authority funding, and do not have the resources to tackle such problems. I urge the Minister to commit to a debate so that we can raise the profile of health inequalities. I urge him to commit to a faster pace of change, and to considering the inflation element in the last year to see whether money can be pulled out and given to authorities that have less. The Minister could give a commitment today on those three practical areas, which would have a longer-term impact on health inequalities and ensure that this country is no longer scarred with areas where people have a mortality rate and morbidity rate of between 10 and 15 years higher than their more affluent neighbours.