Health and Social Care Bill

---

[back to previous text]

Mr. Denham: That was not the expression.

Mr. Burns: That was the expression. To be fair to the Minister, it was used in the vernacular in a friendly way. I accept the context in which it was said, and I agree with him. To be fair to the Government, there have been improvements—we have a new chief executive and a new chairman—but to paraphrase the Secretary of State, one cannot turn round an ocean liner overnight.

We will examine the fairness of the formula—the money that North Essex health authority receives from the Government and the fairness of that money—with the result of the change of the formula, and its impact on mid-Essex. On 31 March 1997, 104 people in mid-Essex were waiting 12 months or longer and 8,341 individuals were waiting between one day and 18 months for health treatment.

The Prime Minister kindly wrote to me about my problems. I say kindly, because every time I have asked him about them in the House—the only question that I have asked him, though on five occasions in two years—he seems totally oblivious to what is happening in mid-Essex. During my time in government, every time the Prime Minister had a named question on the Order Paper, every Department was expected to provide No. 10 with a briefing on particular issues in the relevant constituency on matters such as unemployment, health or education. I am slightly surprised, therefore, that the present Prime Minister does not have a clue about what is going on. I always remind him afterwards when he claims not to know.

Even the Prime Minister agrees that there have been problems with health care in my constituency because of the fairness of the distribution of the money. On 31 March, 104 people were waiting between one day and 18 months for hospital treatment. At its peak in late 1998, there were 10,000—up from 8, 341. Even today, more than 9,000 people are waiting. My constituents, having gone to Broomfield hospital, and, despite the impression given at the election, not having seen consultants queueing up to give them treatment, cannot understand why the Government's pledge to reduce waiting lists has passed them by.

Mr. Hammond: I suggest that the solution to my hon. Friend's problem, and, perhaps, the reason why the Prime Minister is not focused on the issue, lies in the following piece of information: one of the Prime Minister's constituents waiting for surgery is nine times less likely to have to wait 12 months or longer than one of mine. My hon. Friend is speaking about fairness and equity. Does he think that that is the result of the Government's attempt to bring fairness to the national health service?

Mr. Burns: My hon. Friend is absolutely right. Like me, he represents a home county constituency, and the figures that he has mentioned must be broadly similar to those for my constituency. It does not altogether help my argument—

Mr. Denham: Then the hon. Gentleman should not say it.

Mr. Burns: I shall say it for the sake of fairness and for a cheap laugh. During my career, I have been Parliamentary Private Secretary to Ministers at the former Department of Employment and the former Department of Education and Science. During the period of my noble Friend Baroness Thatcher's Government, I was at the Department of Employment, and I assure the Committee that no job centre was closed in Finchley. When I was at the Department of Education and Science, education in Huntingdon was looked after so that it received good treatment.

Lord Commissioner to the Treasury (Mr. David Jamieson): Oh!

Mr. Burns: It is somewhat disingenuous for the Whip to say, ``Oh!'' I could understand it from the lobby fodder on the Labour Benches, who do not understand such things, but the Whip and the Ministers are intelligent enough to realise that the constituency of a Prime Minister is, of course, looked after, as is that of the current Prime Minister. What saddens me is that, given the increased funding of the health service under this Government—which I do not criticise in any way, as I am proud to welcome and acknowledge it—there are still areas of this country, which do not have the Prime Minister or Deputy Prime Minister as their constituency Members, and which are being bypassed in terms of the pledge given at the last general election to reduce waiting lists. My constituency has not had waiting lists below the level of March 1997 for one single day. I warn the Minister that they will not fall below the level of March 1997 by 3 May either, although if he wants to pour money into getting my constituents better health care and quicker hospital operations during the next 10 weeks, I would be happy to drop the relevant part of my election literature, because I want a good deal for my constituents.

I shall return to my concern about the clause, and the reasons why I support the amendment tabled by my right hon. Friend the Member for North-West Hampshire. Despite what the clause states, neither the Secretary of State, his predecessor nor even the predecessors of my right hon. Friend the Member for South-West Surrey have allocated appropriately under the funding formula to pass money from the Department of Health or the Treasury to health authorities in areas in the home countries such as mine, if they have been linked—it is a slightly bizarre prospect but an historic one—to areas of extreme social deprivation.

Mr. Denham: I shall make a few brief points. According to my recollection, the expression that I may have used about a hospital in the hon. Gentleman's constituency was not the one that he stated.

Mr. Burns: It was.

Mr. Denham: No, it was a different expression, though I do not intend to put it on the record this afternoon. Undoubtedly, that hospital has had problems, which are being addressed.

Mr. Burns: I apologise to the Minister. I have just remembered that he was not referring to the hospital, as that would have been unfair, and he was not being unfair to the staff and nurses who work so hard in that hospital. He was referring to the trust, which is very different. Secondly, he did not say ``head case''. He said ``basket case''.

Mr. Denham: The hon. Gentleman will have to rely on his memory. I was indeed referring to the trust, not the hospital.

Mr. Michael Jabez Foster (Hastings and Rye): Perhaps my hon. Friend was referring to the hon. Member for West Chelmsford, not the trust.

Mr. Denham: If so, I would undoubtedly have used the other expression.

Despite the acknowledged problems that I am confident are now being tackled, the North Essex health authority waiting list for September 2000 was shorter than that for March 1997.

Mr. Burns: Will the Minister give way?

Mr. Denham: No. I should like to make some progress.

Mr. Burns: On that point.

The Chairman: Order. The Minister is not giving way.

Mr. Denham: Thank you, Mr. Maxton.

According to the figures for the North Essex health authority, the number of people waiting for in-patient treatment in March 1997 was—

4 pm

Sitting suspended for a Division in the House.

4.23 pm

On resuming—

Mr. Hammond: On a point of order, Mr. Maxton. When the Programming Sub-Committee met and agreed a tight schedule, consideration was not given to the possibility that our proceedings would be interrupted by Divisions. That has happened twice this afternoon, but there might have been more Divisions during the sitting. Will you advise the Committee, Mr. Maxton, what the appropriate procedure would be if, during its consideration of a group of clauses, scheduled for one sitting, it became apparent that more time was needed? Would it be appropriate for any member of the Committee to move that the Committee resolve itself into a programming sub-committee and seek to extend the sitting by half an hour to compensate?

The Chairman: Order. In theory, I am told that that could happen. I would have to clear the Room and call a meeting of the Programming Sub-Committee. However, in that case there would be a new programme motion, which would be debatable for half an hour; that would not necessarily be an appropriate way of spending the half hour that we lost. I think that we should play it by ear and see what happens.

Mr. Denham: These are new procedures that we are all learning to work with.

The waiting list in north Essex fell from 22,612 in March 1997 to 21,254 in September 2000.

Mr. Burns: I am sure that the Minister is not being disingenuous, but I was referring to mid-Essex. His written answer, which I have just received, states that waiting lists in mid-Essex, which is part of the North Essex health authority area, are about 700 patients higher, at 9,050, than they were at the last general election.

Mr. Denham: I am sure that the hon. Gentleman would want to confirm that his constituents are impressively served by the North Essex health authority and that the figures that I gave him were the correct ones.

The right hon. Member for North-West Hampshire made several points. Although we accept that the formula is capable of revision, and we have initiated such a revision, we would say that there are underlying health differences that justify the formula. It is not purely based on payment per head. For example, in north and mid-Hampshire, the death rate from coronary heart disease is 582 in the 65 to 74-year-old age group per 100,000, whereas for Salford and Trafford health authority, in the area represented by my hon. Friend the Member for Eccles (Mr. Stewart), the relevant figure is 797 per 100,000. That sort of difference in mortality rates and health statistics justifies the principle of a weighted formula approach.

Mr. Hammond: The Minister is quoting mortality figures; my right hon. Friend referred to morbidity figures. Does he accept that that is quite a different issue?

Mr. Denham: I agree that morbidity is different from mortality, although one frequently leads to the other, in popular experience. Whichever basis one chooses, a variation between areas is usually reflected in the figures.

The formula-based transparent approach is right, because it means that, if anything different from the formula is applied, the process is transparent. That is what we discovered when we made, in addition to health authority allocations, specific allocations to health action zones.

I agree with the point that health authorities occupy large areas and, with some of the mergers that have been proposed, they will become larger. Within them, there are significant variations, so it is important to have a fair shares target at the level of the primary care group or trust to keep pace with changes. Those of us familiar with Hampshire, for example, know that there are real inequalities, with some areas in the poorest health being under-targeted and those in the best of health above target. Targeting resources to a smaller area is an important principle.

However, it is worth saying, for the record, so that there is no avoidance or doubt, that no one has suggested redistributing the existing pool of general practitioners. The number of GPs is expanding, and will do so in the future; we must ensure that an appropriate proportion of the growing number of GPs goes to the areas that are under-doctored.

The same is true for resources. In 1996-97, in north and mid-Hampshire, the resources available to the health authority were £200 million. Next year, they will be £345 million. Even allowing for inflation, that is a huge increase, which outweighs the concerns about the detail of the formula. In the case of Southampton and South West Hampshire health authority, a health authority that I share with the hon. Member for New Forest, West, the funding in 1996-97 was £212.9 million. This coming year it will be £388.5 million. In the case of West Surrey health authority, to which the hon. Member for Runnymede and Weybridge referred, the figure for 1996-97 was £254.4 million. In the coming year it will be £432.5 million. In the much discussed case of North Essex health authority—I fear that this may not be the last time over the next three weeks that I have cause to refer to these figures—the funding in 1996-97 was £335.1 million. There has been an increase of £260 million during the period of this Government, and the figure for the coming year will be £595.4 million. Those figures put into perspective the claim that any right hon. or hon. Member's constituency has been hard done by under this Government.

 

---

Prepared 18 January 2001