---

Health Inequalities

I congratulate my good friend, the hon. Member for Wigan (Mr. Turner), on his excellent, well-informed and powerful speech, as well as on securing this vital debate. I want to focus on two issues: the allocation of funds to GP practices that serve poorer communities, and GP practices with a high proportion of student patients. First, ensuring that poorer areas receive their fair share of health funds is, as my hon. Friend said, at the heart of addressing health inequalities. It is not the only factor, and we know that housing, early years funding, schools funding and employment are also critical, but they compound the challenge because resources are not always allocated in proportion to need in those areas either. In Oxfordshire, the primary schools serving the most affluent areas receive virtually the same funding per pupil as the most disadvantaged areas, and that must also be true elsewhere. However great the other impacts, it is certain that we will not increase equality in health outcomes, even as overall health improves, as has been the case, unless there is fair funding for primary care services in poorer areas. That is a question not just of primary care services as a gateway to secondary and specialist treatment, but of the vital role that primary care and ancillary services at health centres provide in health education and prevention. There is an interaction between the funding mechanisms used at regional level and those used locally for practice-based commissioning. The money that ends up in a particular community is a product of both those stages. If a region is relatively affluent and with relatively good health, its regional allocation will be lower. We can all argue about the extent to which that may be the case, following the reviews of the formulae and so on, but within those more affluent regions, as my hon. Friend the Member for Regent's Park and Kensington, North (Ms Buck) said, it is all the more important that practices serving poorer areas and pockets of deepest deprivation are properly and fairly resourced. Yet demand pressures and historic factors suck resources in the opposite direction, or keep them in that opposite direction. It is disturbing that the excellent work by the Health Service Journal last autumn, which was reported in the Library’s very good debate pack, shows that budgets have not matched their fair share as indicated by the toolkit methodology issued by the Department of Health and that the""inverse care law—which says those who need healthcare the most are least likely to get it"" is, sadly, alive and well, so that some of the poorest parts of the country are being""systematically underfunded to the benefit of the healthiest and wealthiest."" I was concerned to see in that article that in the league table of PCTs with the strongest tendency to underfund poor practices, mine in Oxfordshire was second. I know that the PCT is doing a lot locally—for example, with capital investment in new health centres—to improve primary care in some of the most deprived parts of my constituency and elsewhere in the county, but that aspect of ongoing funding to practices, and the inequalities uncovered by the Health Service Journal, must be addressed. I am sure that the Minister shares my concern, and it would be good to hear him say what he and his Department are doing about that. As my hon. Friend the Member for Wigan said, they cannot micro-manage absolutely every allocation everywhere, and one understands that, but there needs to be much greater transparency, and perhaps the Minister will tell us that his Department is already working on that. If the formulae interact properly, we should be able to compare primary care provision in a deprived community in Oxfordshire with that in a similarly deprived community in Sunderland. If the figures are similar, those communities should have similar levels of resourcing, although I suspect that the analysis would show that the Sunderland community was better resourced, but I might be wrong. Areas might be sucked up by the regional average, or resources might be sucked out of pockets of deprivation within regions by the historic overfunding of the most affluent areas. Whatever the theory behind the statistical analysis, the practical politics of correcting the problem are very hard. This is not totally a zero-sum game, and budgets have been increasing quite quickly. However, if we give relatively more and relatively more extra to one area, we will be giving relatively less extra to another. If that other area has more articulate and demanding constituents, and they are kicking off about the issue, the practical politics make it very difficult to get the allocations right. The Department needs to keep a close eye on how allocations are working out in practice across the country, particularly with the introduction of practice-based commissioning. PCTs face some hard choices in the guidance on practice-based commissioning if sufficient extra resources are to get into the areas that need them most. The second issue, on which I want to touch more briefly, is the situation of practices with a high proportion of student patients. That will not be a problem across most of the country, but it is certainly an issue in Oxford, as I expect that it is in Cambridge, Brighton and one or two other places. Changing practice funding to relate income more to long-term acute conditions and changes in the minimum income guarantee has a logic to it, and the Minister may argue that that is part of tackling the very inequalities that I have just mentioned. However, the exceptional situation of practices with an overwhelmingly high proportion of student patients could threaten their viability if their circumstances are not taken sufficiently into account. Will the Minister confirm that he is aware of the situation of practices with a high proportion of students? Although students obviously do not have a high incidence of long-term physical conditions, they do have a high incidence of mental health conditions and sexual health issues. When looking at PCTs’ funding needs, it is important to take account of their patients’ particular needs. It is important that the good service that PCTs give students is not undermined by funding changes. I would appreciate the Minister’s assurance that the needs of such practices are being fully and properly addressed. I will bring my remarks to a close now to let others get in, but I congratulate my hon. Friend the Member for Wigan once again on securing this vital debate. He made a powerful point when he said that the importance of health allocations is such that they should be debated on the Floor of the House in the same way as local government, police and other allocations. This is as important an issue as any that the House ever addresses in terms of its impact on our constituents’ quality of life, and it would bear a great deal more scrutiny and informed public debate. My hon. Friend’s suggestion of a debate on the Floor of the House would help.