New targets are `unrealistic' as doctors fight social deprivation

TWO HOURS into the weekly ante-natal clinic at St Paul's Way health centre in the poverty-ridden London borough of Tower Hamlets, and a wilting Dr Alok Jain is splashing water on her face and redirecting the tiny fan whirring valiantly on her desk.

Beyond the sari-clad women gathered in the waiting room and the graffiti- scarred front doors, it is sweltering outside. But Dr Jain's fatigue owes more to the 5,000-strong patient list she shares with her doctor husband Anil, than the temperature.

Welcome to the orderly but down-at-heel consulting rooms of the Drs Jain, providers of health care in the Bangladeshi heartland of the East End.

Yesterday the husband-and -wife team received news of a White Paper, designed to "reduce the grotesque inequalities in health", with some trepidation.

Every fresh set of targets, they say, just seems to increase unrealistic patient expectations of an over-loaded system. "It is the history of the NHS to put up targets, increase patient expectations and provide no extra money," says Mrs Jain. What the Jains would like from government is cash to spend where experience tells them it is needed. They would employ more district nurses and take on another doctor, providing they could find one willing.

That would be hard. Last year Mr Jain managed to lure a GP to the surgery to discuss partnership. It was baby-clinic day, and in Tower Hamlets there are a lot of babies. The waiting room was heaving. When Mr Jain buzzed his receptionist to show his "partner" through, he had already bolted.

To improve health in Tower Hamlets, Mrs Jain insists, "the whole social structure needs to be improved". Mr Jain agrees. He blames unemployment for a high level of depression and related physical complaints.

Mrs Jain says low education and literacy levels make her job harder. Before she joined her husband's practice she worked in the more affluent borough of Barking. The most startling difference between the areas was the far higher consultation rate in Tower Hamlets. The poorly educated, it seems, rush to the doctor with the tiniest complaint. And the socially- isolated Bangladeshi community tends to use the trusted surgery as an outpost of social services.

The Jains also argue that some cultural conditions must also be tackled. In a community where man is king, wife battering is widespread, and women's health fails under the weight of constant pregnancy.

"We work our guts out," says Mrs Jain of her "no breaks", 9am to 7pm five-day week. "But I would not go back to Barking. We have made improvements here and with more money we could do much more."

WILL THE PROPOSALS WORK?

Cancer

CURRENT

SITUATION

69,000 people under 75 years old die each year from cancer

TARGET FOR 2010

Reduce death rate by at least a fifth to 55,000 a year, saving 100,000 lives

CAN IT BE DONE

For any real reduction in cancer, smoking rates need to be reduced. Major problem is the rise in numbers of young women smoking

Accidents

CURRENT

SITUATION

10,000 deaths of people under 75 years old per year

TARGET FOR 2010

Reduce accidents by at least one-fifth to 8,000 and reduce serious injury by one-tenth

CAN IT BE DONE

Majority of accidents resulting in death or injury for people over 65 are in the home. Alcohol consumption also needs to be tackled

Heart Disease

CURRENT

SITUATION

69,000 people a year die from heart disease

TARGET FOR 2010

Reduce the death rate by at two-fifths to 41,000 a year, saving 200,000 lives

CAN IT BE DONE

Death rates are naturally falling as better treatments are available. 20 years required to establish real benefit of lifestyle changes

Mental Health

CURRENT

SITUATION

4,500 die each year from suicide and other injury

TARGET FOR 2010

Reduce by a fifth to 3,600 a year, saving 4,000 lives

CAN IT BE DONE

Lack of money means that vulnerable people are not receiving best drug treatments that could prevent death. More resources required