Health and Social Care Bill

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Mr. Simon Burns (West Chelmsford): What is a statin?

Sir George Young: I was hoping that my hon. Friend would not ask me what a statin was. I imagine that it is a drug that is prescribed for coronary heart disease.

The profile goes on to state that,

for North Hampshire Primary Care Group residents, these treatments are carried out less frequently despite the higher levels of need.

As one reads on, one begins to question even more deeply the assumptions behind the formula that prosperous areas require less money.

The document continues:

The north Hampshire PCG has the highest mortality from CHD—

coronary heart disease—

but the lowest level of investment in invasive cardiac interventions.

The conclusion is that

North Hampshire PCG faces substantial costs in responding to the unmet local need and the Health Authority should recognise this in allocating resources for CHD.

Those two documents, written not by Conservative central office but by independent bodies, put a big question mark behind the extension of the provision to more of the NHS that is referred to in clause 1. I pursued the matter with the NHS, asking about the formula and the prospects for change. I received a reply from a representative of the NHS Executive for the south-east, Dr. Mike Gill, who referred to the review that the Minister mentioned. He stated:

One of the aims of the review of NHS funding is to develop a more sophisticated approach to the inclusion of measures of health inequalities in the resource allocation formula. It is possible, indeed perhaps likely, that the review will seek ways of ensuring that proper account is taken of the needs of pockets of deprivation within health authorities which have relatively good indicators of health overall.

I think that that would apply to my constituency, and that of my hon. Friend. Unhappily, Dr. Gill goes on to conclude that, whatever comes out of the review, any increases to allocations—that is, to north and mid-Hampshire—are likely to be below the national average. Before we roll out the formula to primary care, I want much more proof of its fairness to my constituents and to others.

The explanatory notes state that the measure is designed to deal with the problem of under-doctored areas. I would like to see more doctors in those areas; there is no dispute about that. However, that would not be cash-limited. That is the one bit of the budget that one can fill at the moment without going on bended knee to the Treasury.

I do not see why the Bill is relevant to meeting the needs of the under-doctored areas. If an area is under-doctored, all that must be done is to establish that it is under-doctored, and find a GP. There is no cash limit at all on meeting that particular problem. I do not follow the logic in paragraph 21 of the explanatory notes, which says that clause 1 is necessary to deal with under-doctored areas.

In my constituency, the one part of health care that is not being squeezed, and where we are not looking for £13.5 million, is primary care—the GP services work well. I was worried, as the Minister wound up the earlier debate, when he spoke of a potential distortion—I hope that I wrote his words down correctly—in the distribution of GPs. I am concerned that, having worked out the formula, he will tell me that I have too many GPs. He has already told me that my constituents spend too much on the NHS. The part of the health service that is working well in my constituency is going to come within the warm embrace of the Treasury's cash limits, and we will find that we must spend 20 per cent. less on that part as well.

At the end of his remarks, the Minister said that if there were not a redistribution of GP expenditure, then the exercise would have been pointless. Having listened to the Minister—a courteous and intelligent man—reply to the earlier debate, my concerns were exaggerated rather than allayed. He comes from the same part of the country as I do. I am happy to say that there are a large number of hon. Members representing Hampshire constituencies on the Committee, and I am sure that the needs of the county will be commented on as we progress through the Bill. However, before I am prepared to support clause 1 and the concept behind it, I need to be reassured that the problems that we face in the hospital sector will not be extended to the primary care sector. In a nutshell, those are the fears behind the amendment.

Mr. Burns: Like my right hon. Friend the Member for North-West Hampshire, I would like to probe the Government on clause 1. What I find attractive about the amendment tabled by my right hon. Friend is that it seeks to remove most of line 15. That part of the Bill worries me. It deals with the funding formula for health authorities and primary care trusts—how much money the Secretary of State, in whichever way that he thinks appropriate, will give to them. For historic reasons, that causes me tremendous worry. The explanatory notes for clause 1 state:

Clause 1 changes the way in which resources are allocated fairly—

the critical word in the explanatory notes is ``fairly''—

between Health Authorities ... by the Secretary of State and between Primary Care Trusts

by health authorities.

There was a Labour Secretary of State from 1973 to 1979, and then a Conservative one from 1979 until my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley)—who I know is not the greatest of favourites with the Department of Health—took over. For 23 years, I have admired the appropriateness of the sums that Secretaries of State have allocated to health authorities for health care. In most of that period, we had the old resource allocations working party system. My constituency is, to use a gross generalisation, affluent and middle-class. It is also part of an old regional health authority area, North East Thames which links my area with the east end of London—Newham, Redbridge and other places. We found that the funding distribution was not fair at all, by any definition. The east end of London, where there were regrettable social deprivation and problems but a falling population, took, if we use the crude terminology of pounds per head, a disproportionate amount of the health care budget, at the expense of areas at the other end of the regional health authority which were affluent and middle-class.

3.45 pm

From 1977 until about 1990, therefore, we received, although we had an expanding population, an unfair proportion of the financing for health care because the part of the regional health authority area that had genuine social problems and needed more money had a declining population. I am not saying that more money from the centre should not be put into areas with greater problems, but I criticise the fact that affluent middle-class areas are linked with areas of utter social deprivation in the east end of London. That causes distortion.

My right hon. Friend the Member for South-West Surrey abolished that system when she was Secretary of State for Health and gave us a fair deal that led to substantial annual increases in health funding to make up for the adverse impact of RAWP until that time. Sadly, however, one of the first things that the current Secretary of State for Health did, when he was Minister of State in summer 1997, was to fine-tune the formula that my right hon. Friend had put in place. That meant that it slightly—not totally: we did not go back to a pre-1990 position—but adversely affected the formula for mid-Essex so that, although we no longer had a regional health authority area, more money was channelled back into the east end of London.

I do not begrudge the east end of London more money for health care because of its social problems. However, the Government should have given that area the money without fine-tuning a formula in such a way that they took money away from an area that did not have the social problems but had been adversely affected and was finally beginning to improve its position.

The impact has been bad. I am sure that you, Mr Maxton, unlike me, spent six weeks in March and April of 1997 heralding from the rooftops the little pledge on the Prime Minister's pledge card. The Prime Minister promised—[Interruption.] There is nothing awful in that. You, Mr. Maxton, were probably proud to tell your constituents in 1997 that if a Labour Government were returned, waiting lists would be reduced. I am sure that you did it.

Mr. Hammond: My hon. Friend is talking about the pride of Labour Members, but are they not desperately trying to forget about that little pledge card?

Mr. Burns: I am extremely grateful to my hon. Friend for slightly anticipating my next point. You, Mr. Maxton, and, I imagine, everybody on the Labour Benches, spent the six weeks of the election campaign shouting from the rooftops. In fact, my Labour opponent—sadly, he was direly unsuccessful, although I hope that he will be less unsuccessful at the next election, because I am counting on him to give me a good majority—banged on a lot—[Interruption.] We are talking about the fairness of allocation of money for health care through health authorities, which is relevant. You, Mr. Maxton, would have ruled me out of order if my point was not relevant.

It took my Labour opponent six weeks—and he is obviously not a convincing individual, because he is no longer standing as a Labour candidate—but he tried to convince my constituents that if a Labour Government were elected on 1 May 1997, there would be a new Jerusalem. My constituents would be able to go to the excellent local hospital, the Broomfield, where consultants would be queueing at the door and fighting among themselves to operate on them, because there would be no waiting lists. There would be no problems in the new Jerusalem.

Sadly, and this is when we return to fairness and the formula, that has not happened in mid-Essex. At the end of a Health Committee sitting, the Minister kindly told me that my health trust was a head case. Ironically, he was right.

 

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Prepared 18 January 2001