Access to primary and community health care (Supplementary) [1]

Session date: 
June 18, 2014
Question By: 
Andrew Dismore
Labour Group


Andrew Dismore AM:  I would like to raise with you the challenge of a growing population.  It does not seem to figure in your charts.  In London the Office of National Statistics (ONS) estimates that we are going to see a 13% growth in population up until 2022.  If you channel that down, you see in Barnet, one of the areas I represent, that the population is one of the fastest growing in the country, sixth highest in the country, going from 264,000 to 422,000.  If we narrow that down even further to one ward, Colindale, the population there is going to go up, doubling to 35,300-odd, 11,000 new homes in one ward.  In fact, it is not just one ward, it is one polling district; it is that concentrated. 


The real problem seems to be that NHS England - maybe this is a question for your colleague - does not seem to understand that.  Our CCG tell me - and I have the figures from NHS England and them - that the funding always lags way behind the growth in population.  Although we are getting above average increases, it is not matching the above average growth in population that goes with it.  What has happened for these people in Colindale - and you talk about a postcode lottery - they did not have a ticket in the lottery because there is no new GP provision at all in that area for these additional people. 


They will probably come under your mostly healthy people.  The people moving in tend to be young families and young people, but inevitably that therefore feeds through into this impact on the local A&E departments.  You know yourself about the Barnet and Chase Farm problem; the woeful performance of its A&E and its other services is a result of this.  When is NHS England, hopefully through your good offices, going to realise that they have got to have resources for these new developments in place before or as the people move in, not lagging behind?  You will never solve this A&E crisis until we have the primary care in place.  The way the funding system works, it is always after the event.


Answer for Access to primary and community health care (Supplementary) [1]

Answer for Access to primary and community health care (Supplementary) [1]

Professor the Lord Darzi (Chair, London Health Commission):  I could not agree more; you are making a very, very good point here, and that is that health is always behind when it comes to planning, whether that is a population increase.  Schools, education, has a challenge too; when your population is increasing by 30% we need to start really looking at the health provision, the educational provision, and all sorts of other infrastructure things.  I think, coming back to the point I made earlier, a closer co‑operational, co‑production of plans between the boroughs and the CCGs is the way to address that. If you are a commissioner looking at the local population through the lens of health only without actually knowing and getting the intelligence about the increases in population, you are always going to find yourself on the back foot, and in many ways this will help us plan.


I think planning is also coming up quite interestingly in terms of health being not just about health provision.  Health is about housing, as well, which we need to address, too.  To my surprise, we looked at the NHS’s footprint, the estate.  It is three times the size of Hyde Park.  A significant percentage of that estate is either underused or misused.  In the capital we are spending £60 million on the estate.  It is not even used for clinical purposes.  There are a number of issues here that we need to look at very carefully. How do we utilise that estate to build new primary care centres, to enhance housing, to start thinking about education?  That NHS estate is one very important enabler.


Andrew Dismore AM:  That is a very important point because one of these enormous, very dense developments in Colindale is actually being built on the site of the former Colindale Hospital.  The original idea was that there was going to be a primary care centre as part of that development, but that has been shelved by the developer, by the council and by the Mayor.  The problem here, as you identified correctly, is, unless the Mayor when he allows these developments to go ahead, which are very, very dense - so although it may be a high standard of housing they are very, very cheek-by-jowl, to say the least, very small properties - unless the Mayor is going to start getting tough and saying to developers, “You cannot have this until the health provision is in place”, and until NHS England starts to put the cash in terms of the running costs to match the capital, which the developer may well provide, we are not going to solve this problem.


Professor the Lord Darzi (Chair, London Health Commission):  Good point.  I will hand over to Simon, but just to say from the Mayor’s perspective I suspect there is a reason why I am doing this, so his priorities are absolutely in the right place when it comes to an exemplar in your patch, because historically I do not think there has been an alignment between the Mayor being actively involved, at least to seeing what the local vision is.


Simon Weldon (Regional Director of Operations and Delivery, NHS England (London)):  To make a couple of points, firstly, every CCG would acknowledge the challenge that you have just made, actually.  At the moment, every CCG across London is thinking about its long-term plan, and you are exactly right that it has to demonstrate that the services that it is proposing to commission in its local community have to demonstrate that there is an offer that is compelling, real and available to patients so that they would feel confident in going to their local services rather than to an A&E department or feeling the need to always go there.  I would say confidently that, having spoken to all of the CCGs across London, they recognise that as their central challenge.


To add a couple of further points, just emphasising what Lord Darzi has said, in making those plans it will be an essential test that they come together with local government colleagues. A great deal of the services that we are talking about here will give people confidence and also help keep people out of hospital will need to be commissioned with local government, who are increasingly important partners in those plans. 


The last point: we are asking and working with CCGs to plan for the longer term.  A lot of fixing these problems involves planning for the longer term.  These are not short-term fixes that can be applied quickly.  You have to allow CCGs to think over the longer term.  They are all planning for a five-year time horizon, precisely to address some of the problems that you have just raised.


Andrew Dismore AM:  That is interesting because I know my CCG has been in contact with NHS England, as have I, and the response I have had from the Chief Executive Officer (CEO) of NHS England makes it quite clear there is a significant time lag between the growth in population and the NHS England funding catching up.  There we are. 


Professor the Lord Darzi (Chair, London Health Commission):  It is back to what I said earlier: we need to be much more proactive whether that is in customer service in terms of the patients or planning.