Primary Care: Tottenham

Catherine West Excerpts

Wednesday 16th December 2015 Westminster Hall

[Mr David Lammy (Tottenham) (Lab)]

I beg to move,

That this House has considered primary care in Tottenham.

I am grateful, Sir Roger, for the opportunity to introduce the debate. It is now 67 years since my party introduced the national health service. At that time, living to 100 would have been a newsworthy event, but today more than half the children being born in our country can expect to reach that age. This is clearly a sign of great progress and the quality of our healthcare system. However, that progress has not been the same across the board. There remain in this country huge discrepancies and a postcode lottery that determines the quality of healthcare people can expect to receive. I am particularly worried that the life expectancy of many children in Tottenham is nowhere near the national average.

The current situation paints a worrying picture. Today, average life expectancy for a male in this country stands at more than 80 years, but in my constituency, in the wealthiest city in one of the richest countries in the world, a male can expect to reach an average age of just 74. That is some five years lower than the national average, lower than Cuba where the average wage is £15 a month, and lower than Slovenia, Colombia, Bosnia and Peru. Perhaps most worrying, it is more than eight years lower than the life expectancy of men just a couple of miles away in Crouch End, in a wealthier part of the London borough of Haringey. That is a troubling and stark difference within the same London borough, and the same is true for women.

Primary care is the first point of contact in the healthcare system. In this country, that usually means GPs. They are the very frontline of our health services, the entry point for all our healthcare needs and the means by which we access a whole array of treatments. Primary care is, therefore, the linchpin of our healthcare system. In fact, it accounts for 90% of patients’ interaction with the NHS. Because of that, NHS England’s five-year forward view stated that in future a much higher proportion of its budget would be spent on GP services.

Both this Government and their coalition predecessor claimed to understand the importance of primary care, and to some extent matched their words with funding. For example, £550 million was earmarked in March 2015 to improve GP access, to modernise facilities and to provide better care outside hospitals. Then in May 2015, the Prime Minister announced the “seven-day NHS”, proudly stating that by next April 18 million patients will be able to see a GP in the mornings, evenings and at weekends, with everyone being able to do so by 2020. One would therefore be forgiven for thinking that primary care provision on an average weekday is securely in place, given the £8 billion of extra funding earmarked in a time of austerity to provide additional services outside the current working week. That may be true in some areas of our country, but it is not true in mine.

Recent research paints a stark picture of primary care in Tottenham. The data come not from NHS England or from the Department of Health, which does not seem to be monitoring the situation adequately, but from a small local organisation, Healthwatch Haringey. With no extra funding or support, it went out and listened to local people about the problems they were facing in accessing primary care, and it found something quite disturbing. Some 86% of the patients at one GP surgery were either unhappy or very unhappy with their surgery. That surgery is ranked in the bottom 10 practices in England, with 41% of patients reporting they were unable to get an appointment.

That is apposite because, on Monday this week, Rob Clarke in my constituency tried to access his surgery, Bridge House surgery, with his three-year-old. He tried repeatedly for many hours and was ultimately told to go to A&E. That is not what we want in Britain, where A&E is always overrun, and it was appropriate in that circumstance for the child to be treated at the GP surgery.

Across Tottenham, there are currently 1,300 too few appointments a week, which equates to 52,000 appointments a year fewer than the NHS benchmark. In just one ward of my constituency—Tottenham Hale—there is a shortfall of 18,000 GP appointments a year. Tottenham Hale is undergoing significant regeneration and now has several large blocks of apartments, a sizeable retail park, 500 more properties under construction and a further 1,900 planned for the medium term. It is one of the Mayor of London’s designated housing zones, but despite the influx of thousands of new residents, no new GP surgery was planned. It was only when the desperate need was pointed out by Healthwatch that NHS England’s task and finish group eventually arrived to complete a planning exercise. I note that a final decision on a new surgery will be made on Friday 18 December.

Our treasured national health service has been fractured by this Government and their coalition predecessor, but even with the best will in the world and even when clear need is established, nothing can be achieved quickly. I want to press the Minister on how fast we can and need to move in the circumstances I am outlining. It will have taken over a year for a decision to be made and, if that decision is positive, nearly 18 months for the surgery to finally open. During that period—I put this starkly—people are dying as a result of not being able to get an appointment, and children are being born unregistered. They are the truly dispossessed in our city. Will the Minister look closely at the issue and do all in his power to make the process as swift as possible?

The issues surrounding primary care in Tottenham relate not just to the number of GP places, but to quality and accessibility. According to NHS England, three quarters of GP buildings there do not meet legal compliance, and there are not enough consulting rooms. Some of the facilities in use in the fifth largest economy in the world are shocking. Healthwatch found that 20% of young mothers were not registered with a GP at all.

The consequences of not being able to obtain a GP appointment are stark: more avoidable deaths from cancer, worse life chances for children, and a lack of antenatal and postnatal care when women and, of course, their infant children are at their most vulnerable. My constituency is where Victoria Climbié and Baby P met their tragic end. The ability to obtain an appointment is important if we want to safeguard children. If people cannot do so, it raises serious concerns for mothers and their unborn children, and has led to the grave situation of three unregistered births in my constituency, one of which was of a disabled child whose mother gave birth at home with no one to help her.

Furthermore, Healthwatch discovered clear health inequalities between the west and the east of the Haringey borough, where my constituency is located.

[Catherine West (Hornsey and Wood Green) (Lab)]

My right hon. Friend is making an excellent speech with some good points about the disparity between those who live well and live long lives in the London borough of Haringey and those who do not. Does he accept that it is not solely Tottenham where there is a lack of primary health care? Parts of my constituency—for example, Noel Park—have similar problems with provision of basic, high-quality primary healthcare. Will he give that some consideration?

[Mr Lammy]

My hon. Friend is absolutely right. Her constituency includes Wood Green, and there are pockets of deprivation across Crouch End and Muswell Hill. She is absolutely right to make that point. In a way, this debate stands in both our names, because the crisis affects the borough of Haringey. It is not a coincidence that life expectancy of a male in the far west of the borough and the east correlates with the statistics that I have given, especially when so many mothers of infants are unable to register children in the constituency.

None of us should accept the situation. It is the sort of thing we associate with parts of urban America where there is no universal health provision. In the UK, we have a proud history of our national health service with its own constitution, which states clearly that people have the right to access NHS services. I fear that that is not the reality for many of my constituents.

These issues are not a reflection on the doctors in Tottenham, the vast majority of whom do an excellent job on behalf of the local community. I have recently met, for example, Dr Muhammed Akunjee of West Green surgery and Dr John Rohan of Lawrence House surgery, and I am very grateful for the work that they and their colleagues do in the constituency. As usual, the problems arise much higher up the chain of command. However hard GPs in Tottenham work, there are simply not enough of them and not enough facilities to serve our growing community. That leads me to wonder what it will take for the Government to address the crisis.

We know that there is a well documented link between poverty and ill health; we know that social conditions such as unemployment, overcrowding and inadequate housing make illness more likely; and we know that deprivation increases health problems and therefore pressures on the health system. Given that, I ask the Minister why one of the poorest constituencies in the UK receives significantly less health funding than wealthier areas nearby. Given the greater pressures, it should be receiving more. It is clear that the way to alleviate the GP crisis in Tottenham is to attract new GPs to the area and to retain the ones we already have. However, it is impossible to do that, because despite the huge workload, the urgent pressures and the ceaseless demand, GPs in my constituency are paid significantly less than those in wealthier areas just a few miles away.

For example, a GP in Holborn and St Pancras, the 126th most deprived constituency in the UK, receives £154.64 per registered patient, whereas their counterparts in Bethnal Green and Bow, the 36th most deprived community, receive less—£144.48 per patient. Despite the huge pressures on GPs operating in Tottenham, the 23rd most deprived constituency in the whole country, they receive only £124.94 per patient. That is a full 20% less than in Holborn and St Pancras. Clearly there are fundamental problems with the Carr-Hill formula, which is used to calculate GP funding. There are also real concerns about the impact that withdrawing minimum practice income guarantee payments has had on GP practices in deprived areas such as my constituency. I urge the Minister to look at what he can do to incentivise new GPs to come to areas such as mine.

If the GP situation in my constituency is to improve, GPs in Tottenham must be paid at least the same as their colleagues working nearby. That is an urgent need, given that one third of GPs in the borough are over 60 and therefore due to retire. Things could get considerably worse before they get better. Clearly, younger GPs are being attracted to work in other London boroughs because of the price differential.

It was this Government who wanted the NHS run on market principles, yet they have failed to grasp the obvious problem that for a GP to set up a business in Tottenham, he has to do more work, in worse facilities, for lower pay. Any 12-year-old fan of “The Apprentice” knows that that is not the way to run a successful business. It clearly demonstrates the inherent problem with trying to force a market on the health service, yet we are stuck with this Government’s NHS market framework, so I ask the Minister this: will market rules be applied so that GPs are given proper incentives to set up practices in Tottenham? Also, will he ask the chief executive of NHS England to finally take an interest? I am not clear whether it is Simon Stevens I should talk to or his London lead, but I would quite like the London lead at least to come down to the constituency for herself. I would have thought, given the work that Healthwatch has done, that she would have sought to do that.

I understand that following Healthwatch’s report, NHS England has started to take the problems in Haringey seriously and has produced a detailed 10-year capacity plan, which sets out how many full-time GPs and clinical and treatment rooms are required. Growth is predicted in four key areas: Green Lanes, Northumberland Park, Tottenham Hale and Noel Park, which is in the constituency of my hon. Friend the Member for Hornsey and Wood Green (Catherine West). Three of the four areas are exclusively within my constituency. NHS England has identified a need for five extra GPs in the Green Lanes area, six in Northumberland Park, 16 in Tottenham Hale and eight in Noel Park over the next 10 years. That is 35 extra full-time GPs, 27 of whom are needed exclusively on my side of the borough.

There are a few questions that I want to ask. Does the Minister agree that it is unacceptable that 20% of my constituents in Tottenham Hale do not have access to a GP? Is he concerned that the gaping holes in primary care provision in Tottenham have contributed to the fact that the average life expectancy of a man in Tottenham is just 74—below that of Cuba? Will he explain how, within the NHS market framework, he will attract more than 27 GPs to my constituency, where, despite the far higher workload, GPs are paid significantly less than those in leafy areas just a few miles away?

Will the Minister give me his word that there will be a transparent process to increase the funding per patient in Tottenham by 20%, so that it is brought up to the level of its far wealthier neighbour, Camden? Does he agree that it is disgraceful that the Government have committed themselves to providing a “seven-day NHS”, with weekend GP appointments for 18 million patients, many of whom are in the richest areas of the country, whereas in my constituency 20% of new mothers and their infant children have no access to a GP at all? I look forward to hearing what the Minister, the Government and NHS England, which I hope is paying attention, have to say.