Previous SectionIndexHome Page

11 Nov 2003 : Column 31WH—continued

11 Nov 2003 : Column 32WH

Health Funding (Cornwall)

2 pm

Matthew Taylor (Truro and St. Austell): I welcome this debate, and we welcome the fact that the Minister has taken a real interest in the health service in Cornwall. It was only in March that I introduced a previous debate on the health service issues facing the Royal Cornwall Hospitals Trust, in particular, so I might repeat some of what I said then. However, today I wish to speak about the wider financial issues facing the health service in the county. I understand that those are reflected throughout much of the rural south of this country, with numerous health providers struggling to overcome deficits at the same time as trying to put in place welcome changes as a result of the Government's attempt to rebuild and improve the national health service, with finances for the NHS that both the Labour party and the Liberal Democrats welcome. We believe that that investment is necessary.

There is no disagreement between our two parties about the fact that over many years, the NHS has been substantially underfunded for the services that we have asked it to provide. That is why the Government have now put up taxes and are making a substantial increase in investment in the NHS throughout the country. We welcome that, but it is important to realise that throughout Britain, NHS service providers have been trying to perform in the context of clear historical underfunding. In different parts of the country that problem has manifested in various ways, such as long waiting times, run-down, old and inadequate buildings and, in many cases, a lack of staff.

All too often, hospitals and health providers have not been able to operate within their budgets, especially when they have been hit by factors outside their control in the short term, such as increasing numbers of people attending accident and emergency departments. Even given what has happened historically, year after year the number is well above projections. Such issues cannot be easily controlled, especially when the health service is short of money to make the investment in alternative long-term health provision that might keep people away from accident and emergency departments.

It is important to explain to the Minister that many people providing health services in the county have an historical record of delivering financial responsibility. For example, until a year ago the Royal Cornwall Hospitals Trust had had nine consecutive years of living within its budget. With the abolition of the old health authority, the organisation that had responsibility for the deficits no longer exists, and the organisations that now have to pay for the consequences of the failure to deal with some issues in past years are the hospital providers and the primary care trusts. Independent views have been commissioned by the health community to examine how funds have been spent. The November 2002 service modernisation and financial plan, for example, said that the history

It must be said that in the past couple of years, primary care trusts have often been called in by the strategic health authority to be told that things are not right and that they have to tackle the deficit. There is a

11 Nov 2003 : Column 33WH

real feeling among them that they are doing their best and that, to some extent, they have been saddled with historical problems. If I were to sum up the position, I would say that people are desperately striving to deliver improved health services. Cornwall has a good record of doing that; it is very innovative.

On the subject of ensuring that patients are seen quickly in an emergency, it is a simple fact that the percentage of those seen within four hours at the Royal Cornwall Hospitals Trust has gone up from only 60 per cent. not so long ago to 90 per cent. That meets the Government target. As the Minister well knows, some hospitals met that target simply by calling in extra staff in March, just to get the figures right when they were due to be collected. One hospital not so far away from ours did that—indeed, another Minister said that it had done the right thing, as that is how the rules work.

The Royal Cornwall Hospitals Trust invested in changes to accident and emergency arrangements, and separated people in desperate need of emergency treatment from those with minor injuries, so that those with minor injuries did not wait for ever, but were seen separately by staff dedicated to such cases. The trust did all that it was asked to do, but there are costs involved in doing that properly. Our health authority has also been at the front of the pack in implementing National Institute for Clinical Excellence recommendations, such as those on cancer care and treatment, but there is a cost involved in doing that.

On the other hand, those on the health authority are criticised for not tackling the problem of the historical deficits for which they, individually, are not directly responsible; they did not take the strategic decisions that led to them. They feel that one thing or another has to give; it is not possible to continue making the changes, some of which—particularly those aimed at reducing the increasing numbers going to accident and emergency, and to hospital in general, by giving better care on the ground—will lead to lower costs in the long run. However, there are up-front investment costs involved in doing that, and they cannot be met if the health authority is also being asked to pay off the deficit at the same time.

I emphasise that we recognise the positive news in the investment that the Government are making. There is £5 million for the oncology unit at Royal Cornwall hospital, so at last it is getting proper funding for treatment for cancer. There is to be an extension to the maternity unit at St. Austell community hospital in my constituency. Work is under way on the Knowledge Spa, which should transform our health provision, because not only will it train the people we need for the NHS, but it will do that within the county, and that will improve quality and care for patients. Also, the new-build Bodmin hospital has been completed.

I also emphasise that we can see that patient needs are efficiently handled. The price per patient in Cornwall is much lower than the English average; Cornwall is 14.5 per cent. more efficient in cost terms, despite the high volume—well above the national average—of general and acute activity there.

There is real acceptance that there needs to be a plan to move people out of hospital acute care and into the community, and a lot of work is being done on that. The service modernisation and financial recovery plan is

11 Nov 2003 : Column 34WH

aimed at doing precisely that, and having more cost-effective prescribing programmes is a high priority. As the Minister knows, that is not easy to deliver, because the matter is to a large extent in the hands of private contractors and GPs. However, it is taking place, through getting consultants together with GPs to work through programmes. That has changed some consulting practices.

For example, there is more use of generic drugs within the hospital. That was not always the case in the past. KernoFlex is a nursing recruitment campaign aimed specifically at reducing the high cost of agency nurses by having a system within the health service for the kind of part-time and more flexible working for nurses that avoids those high agency costs. Again, however, there are up-front investment costs. There is the modernisation programme for mental health provision. A lot of extra money is going into mental health support in the county; that is welcome, and in the long run, will reduce the number of patients who have to go back into hospital, or spend time in hospital unnecessarily because eyes are on the other forms of provision and support. At the moment the health authority has to cut back on provision for many of those patients, to deliver the so-called efficiency savings. In the short run, that is likely to mean that we have to fund both the up-front investment, which is trying to change things for the better, and the increasing numbers of people who go to hospital because of lack of community support, so we get the worst of all worlds.

There is an agreement to create what is virtually a single operational management team across the entire community, so that everyone is working in the same direction, including social services through the county council, which is a big step in the right direction.

The Minister of State, Department of Health (Ms Rosie Winterton ) indicated assent.

Matthew Taylor : The Minister is nodding, but we both know that that has not always happened in the past. However, it is happening now—and it looks rather like the recreation of the Cornwall health authority. I would have preferred a single authority for Cornwall in the first place; I am not sure that three PCTs was ever a great idea. Anyway, all those people are coming together and working to a strategy.

A single referral point for GPs has been developed, to encourage the use of alternatives to acute admissions. Integrated patient management provides a county-wide view of the availability of treatment facilities, so that they are used in the best way and costs are cut. An "acute care at home" model has been developed to minimise readmissions. The West Cornwall hospital pilot will maximise the range of services that can be provided locally, and I hope that that model will not only spread across Cornwall, but be picked up nationally. The Government have shown a lot of interest in that pilot. All those measures demonstrate progress in finding creative solutions, which, in the long run, will improve patient care and reduce costs—particularly by tackling the high levels of hospital admissions. Those are not in anybody's interest if they can be avoided to the benefit of the patient.

11 Nov 2003 : Column 35WH

However, all that is undermined by the county's need to repay those historical debts. That overhang, involving substantial sums—some £13 million still has to be found from ongoing expenditure—is putting its ability to deliver those measures in severe doubt. That is a process point. The debts are historical and non-recurring. If the health authority did not have to wipe out that deficit, it would be in nothing like the same financial pain, although obviously it would still have to address those issues.

We in the Cornish community have made an effort to resolve the problem ourselves. I have touched on the plans in place. I have no doubt about the willingness and eagerness of some of the best people in the country—dedicated members of the health service, both management and staff—to adopt the kind of approach that the Government are looking to for reform. However, they are struggling to achieve a solution.

The final blow came with regard to what had been designed as exactly the kind of innovative solution that the Government have asked for: a financing solution, involving a loan from the county council. Like most local authorities, Cornwall county council holds substantial reserves. It was in a position to make a loan of some £8 million—£4 million a year—to the health community, which would have paid interest, so the loan would have imposed no cost on the council tax payer. The council would simply have been investing in the health service rather than in a bank. It looked as if the loan would meet a substantial proportion of the targets that the health authority was being asked to meet, and help to solve those long-standing financial problems. The historical deficits would have been paid off over a longer period than the Government would otherwise have allowed.

That was done with the encouragement of the strategic health authority, and other strategic health authority moneys, which now seem in doubt, appear to have hinged on its success. The district auditor was happy in principle, but suggested taking legal advice, and the whole thing was scuppered on the grounds that the health community—the PCTs—did not have the legal authority to borrow. Whatever the rights and wrongs are, as I understand it the Minister is in no position to allow the loan to go ahead, because the decision is based on statute.

There was no practical way round that block, with the result that the underpinning of the effort to address the financial deficit was brought to a resounding halt. At that point I applied to secure this Adjournment debate, the community health council wrote to the Secretary of State raising its concerns, and I met the Central Cornwall primary care trust to discuss the financial situation. It said, "We'll try to get rid of this overhang—the historical deficit. That's the order, and that's what we'll do. But we simply don't see how we can do that and maintain the quality of care, let alone the improvements that the Government are looking for."

That brings me back to a fundamental point. The Government are putting increased resources into the NHS because they, like the Liberal Democrats, recognise its historical underfunding. It is no surprise that in parts of the NHS—not just in Cornwall, but in

11 Nov 2003 : Column 36WH

most southern rural areas—the result of that historical underfunding was not just poor service and long waiting lists, but deficits built up in one form or another. It is self-evident that it is counter-productive to demand that the deficits be paid off in short order when it is recognised that they built up partly because of poor service, which is now being addressed.

Although the money that the Government are putting into Cornwall is welcome, it is not sufficient both to pay off the historical deficit and to improve services. Indeed, the amounts are not calculated on that basis; they are calculated to provide the regular annual income needed to run the health service properly today, not to pay off past deficits. There is no allowance in the formula for more money to pay off a deficit, so at some point, patient services are bound to be squeezed.

The Minister would not expect me to finish without asking whether the formula is equitable in addressing the costs of providing health services in rural areas. She will be aware that there is good evidence that throughout rural southern areas—apart from the cities, and separate from the northern areas—there is a consistent pattern of deficits and spending difficulties, although those vary, and I understand that some areas are substantially worse than Cornwall and others are less bad. There does, however, seem to be a pattern, because there are some hidden costs in rural areas that have never been dealt with effectively.

The Minister will be aware that there have been studies in Scotland, Wales and Northern Ireland of the costs of providing rural health care, and in each case money has been allocated to try to redress the balance. Studies of comparable areas suggest that in rural areas there is an additional resource need of between 7.5 per cent. and 30 per cent., depending on the nature of the area in question. Scotland, Wales and Northern Ireland have all taken steps to adjust funding to take account of those additional rural costs, but England remains the exception. The strategic health authority has recognised that there are some outstanding cost factors facing Cornwall, but its attitude is that the budget for the next three years is fixed, so that argument is still some way down the line. None the less, it is important that the Minister is aware that the health authority has recognised the case.

The Royal Cornwall Hospitals Trust report published on Tuesday found that the cost of primary care for a patient in Cornwall was £206 per head—£25 higher than the national average. Having talked about historical deficits that are not the fault of the people now having to crack them, and having addressed the Government's acceptance that there have been financial shortfalls in the NHS as a whole, which are now being dealt with, we should not find such deficits surprising. There are real issues for the health authority to face in the delivery of care in Cornwall. Perhaps we will say to patients that they must travel to get care, and we will not bring it to them. We could, for example, close down all the cottage hospitals. The previous Secretary of State said no to some closures, precisely because people want care delivered locally, but unless there is a serious diminution of services in the county, costs are likely to remain high.

The county's health services are doing all that can be reasonably expected of them to deliver the improvements for which the Government are asking.

11 Nov 2003 : Column 37WH

They have imaginative ideas for addressing financial problems in the future. They are delivering exactly the kind of innovative solutions on the ground that will deliver a more efficient service and, more importantly, a better service for patients by helping them in their own homes and in the community, rather than allowing them to end up in emergency care in hospital. In the long run that will mean that more people will be better treated, and for less cost.

However, health services are now being asked to make huge savings to pay off a deficit for which they were not responsible, and which reflects historical underfunding, whether specifically in rural areas such as Cornwall or more generally. Now that the loan from the county council has fallen through, they can see no solution. Although the strategic health authority has regularly called them in to tell them that they need to do something, the SHA is at as much of a loss as they are about what they should do. There is no difference of opinion between the SHA and the local health community on the subject of making savings and making plans; the health services are simply told, "You have to find the money from somewhere."

The only person to whom we can look now is the Minister, who could offer some help, at least in spreading the time over which the deficit can be paid off. However, I would say that she might take a hand in this, and accept that there is a reason for the deficit, because there has been historical underfunding. The Government themselves, with the vast unallocated funds that still exist within the money allocated to health over the next few years, could write off those historical deficits.

2.22 pm

Linda Gilroy (Plymouth, Sutton): I congratulate the hon. Member for Truro and St. Austell (Matthew Taylor) on securing this important debate. I recognise the constructive way in which he made the case for Cornwall, and the fact that he acknowledged the Government's significant investments. He would also probably join me in welcoming the increases in service personnel—40,000 nurses nationally and some 1,800 in the south-west peninsula. We are all proud of the Peninsula medical school, which is training about 200 of the extra 1,000 plus doctors whom we desperately need if the health service, not just in the south-west but nationally, is to continue to make progress.

I assure hon. Members that Plymouth is still located on the east bank of the Tamar, and has no aspirations to build an empire in Cornwall; I hope that the same applies vice versa. However, many Cornish constituents look to Plymouth Derriford hospital for acute services, including some 130,000 from the east end of Cornwall. People from throughout Cornwall come to Plymouth for tertiary specialist treatments. As a Plymouth MP, therefore, I take great interest in the impact of Cornish funding on our hospital in Derriford and its many challenges.

Today, my hon. Friend the Member for Falmouth and Camborne (Ms Atherton) is receiving NHS treatment in Cornwall. Some might think it opportune that she is at the front line of the NHS in Cornwall while it is being debated in Westminster; she will have an insider's view of services. Members must be assured,

11 Nov 2003 : Column 38WH

however, that the timing of her appointment depended on the recommendation of the consultant, and is not part of a fact-finding mission for this debate. I spoke to her earlier today, and although she has been experiencing excellent service, the shortage of staff is undoubtedly putting more pressure on existing staff and impacting on services. There has been some freezing of recruitment to try to address the deficit problem in the short term and, as the hon. Member for Truro and St. Austell outlined, that is of concern to the local health service.

The strategic health authority that covers Cornwall and the Isles of Scilly has a challenging three-year programme of reform and redesign of services, which it is working to implement with the health community in Cornwall. That is helped by the significant increase in local funding. As the hon. Member for Truro and St. Austell said, it had a plan to clear its non-recurrent debt of £34 million over the next three years, which would have minimised the impact on the delivery of health care. The recovery and efficiency savings required across Cornwall and the Isles of Scilly during 2003–04 would have been £15.8 million, which represents a 3.5 per cent. saving on the total budget of £453 million. Therefore, the project that is in hand to address the situation is substantial. Everybody has been innovative, and looked in every possible corner to see what can be done.

I understand from my hon. Friend the Member for Falmouth and Camborne that her constituency—which is mainly served by West of Cornwall primary care trust, and partly by Central Cornwall primary care trust—has had its allocations increased by 9.42 per cent. next year, 9.23 per cent. for 2004–05 and 8.93 per cent. for the following year. Those are healthy increases but the historical debt, which the hon. Member for Truro and St. Austell outlined, is the principal problem facing the health community in Cornwall.

Objective 1 funding is an indication of poverty, which, as my hon. Friend the Minister will be aware, is always accompanied by significant health inequalities. I urge her to take that into account in her consideration of the case laid out by the hon. Member for Truro and St. Austell—which will, no doubt, also be made by his colleagues when they speak.

Funding of out-of-area treatment is an issue that other hon. Members may refer to in more detail. I understand that the Royal Cornwall Hospitals Trust is owed £2 million for the treatment of holiday visitors, which has to be claimed in arrears. The number of visitors has been rising in the past two years, and although other counties have a tourist industry, I do not think that any of them are on a greater scale than Cornwall's. Plymouth, too, has experienced increased demand; although numbers are not as high as they are in Cornwall, this year they have been the highest ever, and they were exceptionally high in August. Tourism is a growing part of Plymouth's economy, so this aspect of health funding will be an increasing problem for us, too. I therefore urge my hon. Friend the Minister to consider the way in which that funding is processed to find out whether it can be part of the package that I hope will evolve to address these serious issues in Cornwall.

As I mentioned earlier, the links between Plymouth and the Cornish health community and economy are strong: 60 per cent. of North and East Cornwall PCT patients go to Derriford hospital. Therefore, any

11 Nov 2003 : Column 39WH

pressure on the Cornish health economy will have knock-on effects at Derriford both in terms of commissioning decisions and because of the links that we know exist at the interface between acute and primary care. If there are difficulties, people can end up being admitted to hospital inappropriately and prematurely, and there can be similar problems on discharge.

Derriford already faces significant financial challenges. With some assistance from the strategic health authority, it has been able to get the sums down until the gap was narrow enough for it to break even. That was a considerable achievement, and it was part and parcel of the trust's regaining its two-star status this year. People have worked their socks off to achieve that. However, the position continues to be very difficult, with accident and emergency admissions going up significantly. The hon. Member for Truro and St. Austell mentioned that that had also been the case in Cornwall.

I conclude by asking my hon. Friend the Minister to keep my hon. Friend the Member for Falmouth and Camborne and me fully informed of the steps being taken to ensure that the deficit can be—and is—addressed through genuine efficiencies rather than cuts, and to keep the situation under close scrutiny with regard both to the objective 1 issues, which I have mentioned, and to Plymouth Derriford hospital, for the reasons that I have just outlined.

I am sure that the Minister knows that the strategic health authority is very supportive and is playing a key role in helping our health communities to get best value for money out of the significant extra investment and to meet the challenges in developing and implementing robust delivery plans. In Cornwall and Plymouth, however, the upsurge in accident and emergency work is putting those plans under significant pressure. Spending at Derriford has already increased by 50 per cent. since 1997 and will more than double within the period of the 10-year plan. That is, of course, reflected across health communities the length and breadth not only of our peninsula but of the whole country.

Will the Minister accept that as an objective 1 area, Cornwall faces particular challenges across the range of public service delivery? Health inequalities associated with high levels of deprivation present particular challenges to primary care trusts that take on a backlog of inherited deficits.

2.31 pm

Mr. Paul Tyler (North Cornwall): I am pleased to follow the hon. Member for Plymouth, Sutton (Linda Gilroy). I am sure that all my colleagues in Cornwall will appreciate the trouble that she has taken in examining the issues on both sides of the Tamar. She mentioned that many of my constituents look to Derriford hospital for their tertiary care, and I take to heart her point about the knock-on effect on Derriford. At the north end of my constituency, those living in and around Bude must look to Barnstaple, so the problems cause a knock-on effect in north Devon as well as in Plymouth.

It is a fortunate and happy feature of debates in this Chamber that we often seem to start on a point of agreement, which is a positive advantage of this

11 Nov 2003 : Column 40WH

assembly. As my hon. Friend the Member for Truro and St. Austell (Matthew Taylor) said at the outset, we can agree that the problems originated before 1997; we are not suggesting that the problems suddenly developed under this Government. We are dealing with historical underfunding and the deficits that have developed in Cornwall.

I shall briefly underline some of the important points made by my hon. Friend. The problems in Cornwall are probably endemic to several areas in southern Britain. I hope that the Department of Health and the Secretary of State for Health will take the lessons that we in Cornwall have painfully learned in recent months to heart in examining similar problems across southern Britain.

In a curious way, the issue that we are now addressing has far more to do with accountancy than with medicine. I am no doctor, and certainly no accountant, so I would not profess to be an expert who can advise the Minister. However, I hope that she is receiving good advice. I recall only too well going to see the former Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), with a series of deputations to argue the case for trying to ensure that any new structure in the health service took better account of the need for year-to-year management of budgets and deficits.

The extraordinary regime of strict year-to-year control is ridiculous. It would not be applicable to the private sector, or even to local authorities. It imposes impossible restraints and constraints on the people trying to manage the budgets. Even if we did not have the historical deficit in Cornwall, it would still be an anomaly that the time scale for dealing with any temporary deficit is so short.

My Cornish mother brought me up on the old saying "Penny wise, pound foolish", and it is extraordinary how often in public life we see people trying to make desperate economies so fast that in the long term they spend more money. That point should be addressed very quickly if the national health service is to survive in its current form. Even with new investment, which we all welcome, it is important to get that balance right. In Cornwall, intense efforts are being made to recruit more permanent staff into the NHS and to bring back people who have had broken careers because of family commitments. It is obviously sensible to economise on the otherwise considerable extra costs of agency and bank staff, but, as my hon. Friend the Member for Truro and St. Austell said, the danger is that, as there is a comparatively small outlay in the short term, the deficit is increased, and therefore that policy, which makes such good sense in the longer term, is at risk.

Both hon. Members who have spoken have made it clear that the members of the Cornwall health community have been working hard together in recent months to deal with the historical problems. I know the team that works in the North and East Cornwall primary care trust very well and I know the team in the Central Cornwall PCT, which serves my constituents in and around Newquay. I also work with and talk to a large number of other people in the health community. All the trusts have been working with the strategic health authority to deal with the problems that have

11 Nov 2003 : Column 41WH

arisen. They were not caught napping by those problems; they have been considering them and trying to deal with them over a substantial period.

I am struck by the substantial work that went into the service modernisation and financial plan—I am sure that the Minister will be well aware of that. One of the factors that comes out strongly is that the risks of taking short-term decisions for short-term deficit management have been carefully identified. Those risks are considerable, and if the Minister cannot do anything else this afternoon, I hope that she will agree that they are real. If she can indicate where cuts can be made without risk to the current level of health provision in Cornwall, I am sure that we will all be extremely grateful. I challenge her. It is extremely difficult to see whether the cuts that are being considered could be made to the extent that would be necessary to achieve the savings required.

There is another subject that concerns many of us: the level of investment in preventive medicine and long-term planning to reduce the expectations on our health service. Across the parties, hon. Members will, and should, be concerned about that. Whatever investment goes into the health service, we cannot simply have an illness service. The service must be concerned with improving the health of the community. It is all too easy to deal only with the immediate reaction to the emergency that we face, and to make short-term savings, but fail to recognise the longer-term problems.

My hon. Friend the Member for Truro and St. Austell and the hon. Member for Plymouth, Sutton have already referred to some of the special features of the demography of Cornwall. As everyone will know, Cornwall has not only an elderly population, but a growing elderly population. That is partly because of the natural climate and the good food, good air and good environment of Cornwall. It is also because people of Cornish blood have a longevity that is renowned throughout the country. My mother lived to over 100—and my wife is scared stiff that I might do the same. The serious issue is that it is difficult to plan for that type of long-term development in the demography of any part of the country, and that is certainly an element of the equation in Cornwall.

As has already been said, it is also difficult to plan for the emergencies that may arise where there is a big summer holiday population. My Newquay experience is appropriate in that context. For a few months of the year, the excellent minor injuries unit in Newquay hospital has a work load for which it is difficult to plan. As we all know, it is a great deal easier to budget for a steady demand for a service, whatever that demand might be, than for a service with ups and downs, particularly if there are dramatic ups for a small part of the year. That is certainly true of the way in which we have to provide health care for our visitors. There is a time lag between the provision of that care and our being paid for it through claims made in arrears.

Both hon. Members who have already spoken have said that Cornwall has been trying to do precisely what it has been asked to do by Government in many areas; I hope that the Minister will agree. There have been innovative, intelligent and imaginative attempts made to meet the particular needs of Government policy and

11 Nov 2003 : Column 42WH

National Institute for Clinical Excellence priorities. In some ways, those attempts have been a model of how best to react to those extra demands and expectations.

We are in a very serious situation, and I hope that the Minister takes that seriously. The morale of staff, who have put in so much during recent months to make those improvements, is being badly hit by the current indecision, and the crisis atmosphere hanging over their work and the service that they provide to the community. In the end, the people who will suffer from that are the patients—the people of Cornwall. I believe that they deserve better, and I hope that the Minister agrees.

2.40 pm

Andrew George (St. Ives): I join others in congratulating my hon. Friend the Member for Truro and St. Austell (Matthew Taylor) on securing this timely and important debate. I shall follow on from the constructive comments made by my hon. Friend and by the hon. Member for Plymouth, Sutton (Linda Gilroy) and my hon. Friend the Member for North Cornwall (Mr. Tyler).

In case we risk being admonished for being ungrateful, for the Minister's sake I shall repeat our gratitude to the Government for the funding of the peninsula's medical schools, the health action zones, the West Cornwall hospital study, to which I shall refer in a moment, and the intervention of the former Secretary of State, the right hon. Member for Holborn and St. Pancras (Mr. Dobson) in 1998. He implicitly accepted that his Department would assist the then Cornwall and Isles of Scilly health authority with its deficit of £5 million inherited from the previous Administration, and the threats to community hospitals in Cornwall that existed at the time.

I have a few comments to make. Some embellish previous points, but they will largely cover new areas. I hope that I shall be sufficiently brief to allow Front-Bench Members to give the Minister ample time to answer the many questions that have been raised during the debate. First, there is the issue of the strategic view. Where is the strategy for the future of Cornwall's health service coming from?

I want to elaborate on a point made by my hon. Friend the Member for Truro and St. Austell. In order to get a strategic view for the Cornish health community under the reformed structure, it is necessary to bring together at least eight chief executives: those of the three primary care trusts, the Cornwall Partnership NHS trust, the acute trust and the ambulance trust, the director of social services—who is essential—and the head of the strategic health authority. Moreover, as the hon. Member for Plymouth, Sutton pointed out, Cornwall does not look to those trusts alone to serve all its needs.

As we well know, those on the eastern frontier of Cornwall have to look to their friends on the western side of England, in Plymouth and Barnstaple, to the north and south of that boundary, for assistance. That brings other trusts and services into our consideration of the approach that should be taken in delivering health services in Cornwall. If we are talking about joined-up government, we have to bear in mind that all the money coming from the Government is originally joined up in

11 Nov 2003 : Column 43WH

the Department of Health, but ends up extremely unjoined-up when it arrives on the ground, for social services and trusts. Although the bodies that deliver services across the whole of Cornwall make herculean efforts, they are drawn into a tremendous bureaucratic process to achieve the agreements that are required. Most of the divisions, particularly the primary care trusts, are largely defined by artificial boundaries, because most services are provided across the boundaries, not within them, so they may not be helpful.

That arrangement represents a challenge, rather than a solution, to the problems that we are discussing today. The challenge exists country-wide, but I want to emphasise its impact to the Minister. Chief executives will not complain publicly about it, but complaints and comments are made in private about the way in which the system operates.

In May I asked some parliamentary questions about inherited debt, to which I received some rather delphic responses. On 19 May, I received an answer to the following question:

The response from the Minister's fellow Minister of State at the Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton) was:

Although non-financial targets are part of the equation, there is no clear indication as to whether the balance should fall in favour of meeting targets or clearing debt. It would be helpful if the Minister told us how that difficult balance, which was well described by my hon. Friend the Member for North Cornwall, is to be achieved. As we understand it, the health community in Cornwall must balance its books by the end of this financial year. It would be helpful to have a clear indication.

Another question, to which I received a response on the same day, was:

The response, from the same Minister, was:

That is reassuring, but the West of Cornwall primary care trust reported to me that one of its most significant difficulties is inherited debt. It would be helpful to have some clear explanation from the Minister of what assessment her Department has made of the impact of inherited debt on the operation and decision making of PCTs, and on the targets that they can set and achieve.

On formula funding, a subject that has been addressed by all hon. Members so far, I point out to the Minister a legislative solution that I introduced in the

11 Nov 2003 : Column 44WH

autumn of 1997. Under the ten-minute rule, I tabled the National Health Service (Equity of Funding) Bill, which proposed a method by which a more transparent arrangement could be put in place to enable the Government to consult the wider community, both politically and statistically, on the difficult issue of establishing an acceptable formula.

Some measures used to calculate the allocation formula have been identified as inappropriate or inadequate for rural areas. The first is the proportion of unemployed people. That is used as one of the variables on the acute need index, but that fails to recognise the poverty in areas such as Cornwall that is caused by low pay. A perennial feature in Cornwall has been much low-paid, part-time seasonal employment, rather than long-term unemployment.

Car ownership is another part of the formula, and has been used as a measure of affluence, but that fails to recognise that in Cornwall people need private cars. Even if they are driving around in old bangers that struggle to pass their MOTs, access to a car is essential if people are to have any kind of quality of life. I do not know how we could measure the number of old bangers, compared with the number of properly functioning cars.

Thirdly, there is the market forces factor, which captures the low-pay features of rural areas such as Cornwall. We have been at the bottom of the earnings league table pretty much since records began—but the vast bulk of NHS staff are on national pay scales, and that is not properly taken into account.

Additional costs of providing services in areas such as Cornwall are created not only by rurality and the dispersed nature of the population but, particularly in areas such as mine—west Cornwall and the Isles of Scilly—by peninsularity. In the acute emergency services sector, we cannot call on neighbouring authorities to the north, west or south to help us out when a crisis occurs. No account is taken in the funding formula of the extra costs of ensuring, or attempting to ensure, that acute services are provided equally in areas where there are geographical challenges as well as the fundamental problem of rurality.

A further problem concerns economies of scale. To avoid sacrificing accessibility by concentrating resources, rural primary care trusts must develop more numerous smaller units. That was exposed in the debate on community hospitals in Cornwall. Yes, logistically it would be good for health managers to have one or two big hospitals and make everyone go to them, but, for historical and geographical reasons, adequate service provision can be made only by using smaller dispersed units. The provision of a network of community hospitals, which has been mentioned before, presents a challenge. As I have said, there was a successful campaign in 1998, when the Secretary of State said that he would assist. He had withdrawn, and did not support, the health authority's plan to close four community hospitals in Cornwall, which was intended to address the problem of a £5 million debt. The Secretary of State told us covertly that he would assist the health community in Cornwall to overcome the debt problem through other means. Unfortunately, rather than addressing the problem of that debt, we have now inherited further debt.

11 Nov 2003 : Column 45WH

There are higher travel costs, too, and problems of skills mix, which mean that wage costs in rural and dispersed areas are bound to be higher. The Royal Cornwall Hospitals Trust, reflecting the views of the Cornwall health communities, has campaigned for greater funding to reflect the unique nature of Cornwall in terms of rurality and relative poverty and deprivation. Cornwall argues that if it had been allocated a deprivation ratio in line with other objective 1 regions, as the hon. Member for Plymouth, Sutton implied, it could have attracted an additional £18 million a year on that basis alone. There are significant issues in the formula funding, which must be addressed. I urge the Minister to look seriously at them when responding, and when reflecting on the debate.

There are various impacts. As I said earlier, I am grateful to the Minister and her Department for its assistance in addressing the challenging issue of the future of West Cornwall hospital. I have debated that in this Chamber and on the Floor of the House before. The particular geographical challenges in Cornwall mean that it would be unwise to have only one acute emergency centre there. Leaving aside the historic legacy of the area's geography—such as why the main hospital was established in Truro and not a few miles further east, and why West Cornwall hospital was established in Penzance—if we consider the trolley waiting times and the number of ambulances waiting outside the accident and emergency service at Treliske, the Royal Cornwall Hospitals Trust base in Truro, it is clear that the system cannot manage.

It would be a dangerous folly simply to put all the eggs in one basket, and hope that that basket will manage to provide a service. That is why I am pleased that the Department of Health has put some money into considering how emergency services can be managed using two acute centres. Admittedly, West Cornwall hospital is small, with only 80 beds, but it has a good range of experienced staff, including general surgeons and general medical consultants with wide experience.

West Cornwall hospital has provided a model that allows it to work very closely with the Royal Cornwall Hospitals Trust in Truro, but it faces difficulties. It requires adequate back-up staff, particularly anaesthetists, on site or at least on call, to ensure that it meets the levels of clinical safety that we all want.

The stakeholder steering group of which I am a member has provided an interim report to the Department, and funding will inevitably be an issue. I hope that the Minister and her Department will reflect on the possibility that the West Cornwall hospital initiative might provide an excellent model for use in other remote rural areas. Funding is clearly an issue, and when the pilot scheme produces its proposals late this year or early next year, Andy Black, who has undertaken the work for Durrow Consultancy, will provide a clear idea of what the Department must do. This debate is not about special pleading for Cornwall; rather, it has emphasised an admittedly challenging case that is clearly reflected in other areas.

2.57 pm

Mrs. Patsy Calton (Cheadle): I congratulate my hon. Friend the Member for Truro and St. Austell (Matthew Taylor) on bringing to the attention of the House and

11 Nov 2003 : Column 46WH

the Minister an issue of great importance to Cornwall. I look forward to the Minister's view on how the problem can be solved.

I echo the comments of my hon. Friends about the increased investment in health. It is welcome, and it has been called for by the Liberal Democrats for a long time. However, because the investment in health has come later than we hoped, several historical problems have to be worked through. Cornwall faces particular difficulties, with the £31 million of debt that has been mentioned.

Health service staff are working very hard; they are attempting to introduce innovative measures to solve problems. Cornwall is one of two areas that are using the most Government-recommended National Institute for Clinical Excellence cancer drugs. This means that treatment in Cornwall is likely to be of a higher quality than it is elsewhere.

The funding problem stems partly from £31 million of debt and partly from the annual overspend that the Cornwall health economy has extreme difficulty dealing with. The chairman of Central Cornwall primary care trust said:

I shall echo some of the points made by my hon. Friends. The Royal Cornwall Hospitals Trust is reported to expect a £2.2 million overspend this year, although the figure could be between £4 million and £5 million. The overspend is because of clinical issues rather than mismanagement of money. Indeed, an independent review commissioned by the health community showed that the trust is handling its money well.

Some of those problems are caused because the costs of living are high in a tourism area. The cost of employing nurses is great because they need to live in the area and buy homes. It is difficult to recruit nurses. Cornwall has been forced to employ agency nurses, who are more expensive in the long term. Recruitment is becoming increasingly challenging, and it is especially difficult to attract people from outside the county as house prices and the cost of living in Cornwall continue to rise. The overspend on agency nurses at the Royal Cornwall Hospitals Trust is £210,000.

Additional costs are incurred by emergency admissions, which are 11 per cent. greater than the trust is funded for. It has dealt with an extra 2,386 emergency patients above its funded level. Emergency admissions account for an overspend of £850,000.

The number of visitors to Cornwall has increased by 18 per cent. this year. From April to August, out-of-area treatments—treating tourists—increased by 11.4 per cent. The trust has been struggling with the increases for some time. Department of Health rules mean that payments for out-of-area patients are made two years in arrears.

There are other indications that the hospital is struggling to meet targets, such as the Government target for patients to be dealt with within four hours of admission at accident and emergency. We have heard that there are queues of ambulances waiting outside the accident and emergency department. In July, the 90 per cent. target was achieved, but the figure dropped back to 88.3 per cent. in August. The hospital is also struggling to deal with the county's many orthopaedic patients.

11 Nov 2003 : Column 47WH

It seems to me that the plan to work with Cornwall county council is exactly what the Government want to see. An £8 million loan has been requested, and work has obviously gone into getting the local county council and the health economy to work together, which is exactly the sort of co-operation that one would want between local authorities and health authorities. Because of a legal opinion, which obviously has validity, and the district auditor's belief in that legal opinion, the action has been deemed illegal and has not been allowed to go ahead. That situation must be re-examined. The work was painstaking and was a genuine attempt to sort out the problems caused by the historical debt, but it has not been allowed to progress in spite of what the Government and, indeed, the Liberal Democrats want to see.

My hon. Friend the Member for North Cornwall (Mr. Tyler) mentioned the need for the health economy to get hold of the prevention and public health agenda. It is running to catch up in that area and must be allowed to work on those issues. It will be extremely difficult for it to do so while it must make cuts.

There is a real fear that vital patient services will be cut in this area. It has been reported that the North and East Cornwall PCT has started making cuts, and it is feared that the West of Cornwall and the Central Cornwall PCTs will follow suit. There is particular concern about elderly patients. My hon. Friends mentioned the increase in the numbers of elderly patients in the area, which is a strain on the entire health community.

Matthew Taylor : I, too, wanted to draw the Minister's attention to the large numbers of elderly patients, but did not get the opportunity to do so. A consultant in Cornwall alerted me to the fact that, for understandable reasons, there is a tendency for people with disabilities or people caring for people with disabilities to move to places such as Cornwall because of the quality of its community support. Cornwall also reports much higher than normal numbers of epileptics and patients with learning difficulties, and historically has had high numbers of people with statemented special needs, many of whom moved into the county. There is nothing wrong with that if the county wants to support them, but that may be a less obvious cost than the one incurred by elderly people moving into the county.

Mrs. Calton : I thank my hon. Friend for that intervention. I was about to point out that area rehabilitation centres for patients who have suffered strokes or Parkinson's disease have closed in Liskeard and Saltash in north and east Cornwall. That may be part of a larger plan, but those patients have lost services.

I was brought up in different parts of the country, but my grandparents came from Plymouth. I grew up in the certain knowledge that the Tamar was much more than a river and that Cornwall was considered a different country from the mainland. As hon. Members have said, Cornwall is an objective 1 area with some of the lowest incomes in the UK. It has large numbers of older people and pockets of great deprivation. As the hon.

11 Nov 2003 : Column 48WH

Member for Plymouth, Sutton (Linda Gilroy) said, it would not have objective 1 status if the community were not deprived. However, Cornwall has not been defined as a priority social need area in the health budget. It would receive an extra £18 million a year if it received the same treatment as other objective 1 areas. The low incomes relative to house prices in the area also exacerbate health inequalities.

The lack of rural public transport is key, as other hon. Members have said. Health care closer to home is important for people in rural areas, as they otherwise have to travel long distances to receive out-patient care. Bearing in mind that none of the towns has more than 25,000 inhabitants, the development of diagnostic and treatment centres throughout the county is vital, as it will enable patients to receive better care nearer to where they live.

Rural areas are very different from urban centres, and the targets devised for them often do not make as much sense. There should be more freedom for areas such as Cornwall to innovate locally, which Cornwall has clearly been trying to do through the local authority and the health authority. Cornish people should also have a greater say in how their local services, including their health services, are run. It is well known that the Liberal Democrats want health services to be delivered locally and to be locally accountable. We have had the potential for providing local solutions to local problems, but the county council and the health community have been prevented from supplying them. I look forward to hearing what the Minister can offer to address the justifiable concerns of my hon. Friends who represent Cornish constituencies.

3.9 pm

Dr. Andrew Murrison (Westbury): I congratulate the hon. Member for Truro and St. Austell (Matthew Taylor). I enjoyed reading the contribution that he made earlier this year, and have also enjoyed his remarks today. This morning, I discussed with the Minister how we could address the historical debt that arose in the Bath area and that greatly affects my constituents in west Wiltshire. I suspect that many of the problems that affect the hon. Gentleman's constituents are also relevant to my neck of the woods, so I feel his pain. We can debate how the debt has arisen because the main thesis that we are discussing is health service debt, but addressing that debt is central to the way in which I hope to see health care developing in my area. I appreciated the remarks the Minister made in that context this morning.

I am pleased to be making my Front-Bench debut on the subject of health services in the south-west region. I think that we all share some of the problems that have been related today. I caution against focusing overly on debt, and talking of historical debt as if it arose many years ago. The Labour Government have been in power for six and a half years, and perhaps we have to apportion blame for the arising of that debt within that time as well as in the time of the previous Administration. I shall try to do so, but I find the area extremely complicated. I think that the hon. Member for North Cornwall (Mr. Tyler) remarked that he was neither a doctor nor an accountant. I am a doctor, but it does not help me very much with the accounts.

11 Nov 2003 : Column 49WH

Trying to define exactly where the debt has arisen, and who is responsible for it, is difficult and probably counter-productive. In many areas of the country, debt relates to financial mismanagement. I accept that that is not the case in Cornwall, but it probably is in my area. The debt has arisen for many reasons, but we need to move on and decide how to move forward. It is very much the case that debt is demoralising to health service managers and the health professionals who see their services being cut and their service planning driven by the need to address debt.

In my area, a number of health professionals have said to me how they regret the need always to think about where the axe will swing. I would say that the axe tends to swing in a disproportionate sort of way. In my experience, it tends to go for primary and intermediate health care services. One of my worries concerns community hospitals. They are very much under the spotlight in my area at the moment as we consider how we can address a health service debt for which we do not really feel responsible. It was arrived at under a previous health authority, and has little to do with the structures currently in place and even less to do with what one might call democratically accountable structures in the area.

There is a feeling that in the not-too-distant future we shall see a threat to primary health care services, intermediate health care and community hospitals that disproportionately affects the elderly and disabled. In that context, it is worth while discussing briefly the particular problems faced in Cornwall where, as in the rest of the south-west region, there has been a considerable loss of care home places, which has affected elderly people in particular.

There have been problems with primary health care, with a number of vacancies in general practice: there are 94 in the south-west peninsula area. I cannot understand why that is the case. I have practised in Plymouth and it is a truly delightful part of the world. I cannot see why GP trainees and people coming into general practice for the first time would not be queueing up to practice in Devon and Cornwall, but there we are. Those vacancies have increased in the region by 31 per cent. since 2002, and the number of applicants has decreased by 61 per cent. since 2000. There is a real problem with primary health care. On top of that, we have the problem of historical debt, which must be addressed. As I have suggested, it will disproportionately affect primary health care.

If I were to make one small criticism of the contribution of the hon. Member for Truro and St. Austell in March, it would be that he perhaps fell into the trap that many Ministers fall into by focusing heavily on the acute sector. Although I am sure that he did not mean to give this impression, he seemed to focus heavily on hospitals rather than on primary health care. That is something of which we as politicians need to be very aware. The Government are right to underscore and underline primary health care in their words, but we sometimes find it very difficult—particularly when health service managers are instinctively centralising—to focus on primary health care, which arguably has a greater capacity for increasing the sum of human happiness than the acute sector.

11 Nov 2003 : Column 50WH

Another difficulty facing the Government is that they have focused very much on targets, principally in the hospital sector. It is perhaps to be welcomed that we have seen a slight change in emphasis of late away from targets towards more rational measures of health care provision. We must hope that primary care benefits as a result. Several hon. Members have drawn attention to the difficulties of rurality and they were right to do so. Such matters affect my area just as much as they affect Cornwall. Although it pains me to do so, I must say that the Scottish Parliament has perhaps got it right, given how it has reflected the difficulties of the provision of health care in rural areas. Were such matters to be factored into Cornwall, they would wipe out almost half of the debt that we are discussing today.

Rural areas face particular health care funding challenges. Cornwall has problems with the ambulance service, for example, with the handover time of ambulances, which at the Royal Cornwall hospital is 20 minutes compared with 11 minutes at Derriford. We need to find a cause for that considerable difference. I draw attention to the number of delays between one and two hours for the last quarter for which figures are available. There were 151 such delays at the Royal Cornwall hospital compared with 99 at Derriford and 39 at Taunton.

We must ask why there is a problem with the ambulance service. We have heard about more general problems in accident and emergency departments and I am led to conclude that they are owed to difficulties with primary care. Recently, the number of emergency admissions has increased by 10 per cent. in Cornwall, Devon and Somerset compared with an increase of 4 per cent. in ambulance calls described by doctors as urgent. The reason for the difference in the two figures is that the general public has access to emergency ambulances, but not to urgent ambulances. They are probably finding difficulty in accessing primary care and calling out ambulances. That brings me back to my original thesis, which is that the historical debts that we face in many areas throughout the country, especially rural areas, affect us disproportionately in primary health care. In many of those areas, primary health care is already under some pressure.

The hon. Member for Truro and St. Austell was a little generous by not going for the Minister about the drift of moneys towards metropolitan areas. Each week, it seems that a Labour Back Bencher gets to his or her feet and says how grateful he or she is for new investment in hospitals that are principally in metropolitan areas. That undoubtedly impacts on those of us who represent predominantly rural communities. The Prime Minister claimed that his priorities were "schools 'n' hospitals". He should have rephrased that, perhaps more prosaically, and said instead, "schools 'n' health care".

3.17 pm

The Minister of State, Department of Health (Ms Rosie Winterton) : I congratulate the hon. Member for Truro and St. Austell (Matthew Taylor) on securing today's debate, which has covered many issues thoroughly. I also congratulate the hon. Member for Westbury (Dr. Murrison) on his new position. He obviously has a wide-ranging knowledge of the health service, and I am sure that that will stand him in good

11 Nov 2003 : Column 51WH

stead in his new role. I congratulate my hon. Friend the Member for Plymouth, Sutton (Linda Gilroy) not only on her contribution to the debate, but on managing to bring in my hon. Friend the Member for Falmouth and Camborne (Ms Atherton), which she did so skilfully. We all know that my hon. Friend the Member for Falmouth and Camborne is a great champion of the health service in Cornwall, and we wish her a speedy recovery.

Specific issues have been raised this afternoon, and I shall try to deal with them all in the time available to me. However, before I do I shall take the opportunity to pay tribute to the good work that has been carried out throughout the south-west peninsula. High-quality services have been delivered by dedicated staff, many of whom I had the good fortune to meet when I visited the area recently.

I was extremely impressed not only by the way in which the health service and the social services were working together, which has been mentioned many times today, but by some of the innovative ideas. For example, with my hon. Friend the Member for Falmouth and Camborne, I launched a "telemedicine contraption", if I may call it that, which links one of the outer centres to the accident and emergency department. That is a very imaginative way of delivering accident and emergency care, to which many hon. Members have referred today.

I have two examples of how performance across the whole region has improved. The Cornwall health community achieved all in-patient and out-patient waiting time targets in 2002–03, and the Royal Cornwall Hospitals Trust has improved from one-star to two-star status. Various people, as well as myself, have talked about the accident and emergency services, but achieving 93.6 per cent. on the four-hour target is a tribute to the hard work and dedication of staff. I know only too well that the targets are not achieved unless there is imaginative thinking and real effort by local front-line staff.

Many hon. Members have acknowledged the Government's increased investment in the national health service: 7.4 per cent. a year above inflation until 2007. That is an increase of £34 billion. Central Cornwall PCT has benefited from that, and received £172 million this year, an increase of 9.4 per cent. Many hon. Members have highlighted the changes that that has brought to service delivery in the area. However, I am also aware of the issue of inherited debts and the general financial position in the Cornish health community, which has been raised by hon. Members.

To backtrack slightly, I should perhaps explain that although the health service has received significant additional resources it is still true that annual expenditure must remain within the resources allocated by Parliament. All NHS organisations must be clear that, having received their fair share of resources, they have a corresponding responsibility to manage them effectively without relying on further help from the centre or from other parts of the NHS. It is now the responsibility of the strategic health authorities both to deliver the overall financial balance for their economies and to ensure that each and every body achieves financial balance.

11 Nov 2003 : Column 52WH

By shifting the balance of power and devolving to local areas we are trying to ensure that local people find local solutions to local challenges. Some 75 per cent. of the entire NHS budget is now devolved to PCT level. However, where an individual NHS body has a deficit, overspends have to be matched by underspends elsewhere. There is a degree of flexibility in that, as I have said. I do not deny that it is a challenging task in Cornwall, but the local health community, with the support of the strategic health authority, is taking steps to address its financial position. Cornwall and the Isles of Scilly have worked together as a community to produce a service modernisation and finance plan. That is a three-year programme of reform and service redesign, aimed at achieving sustainable services in financial balance, and the delivery of key targets.

Andrew George : Has the Department assessed whether the cause of the debt that the trusts are experiencing is not any failure on their part, but a failure to anticipate the real costs of providing health services in an area such as Cornwall, which has so many geographical and other challenges?

Ms Winterton : Plenty of areas have had similar challenges over the past few years, but they have not necessarily had the same kind of inherited debts as Cornwall. I do not deny that there is a challenge, but the health communities across the south-west peninsula have already supported a package of measures totalling £18 million worth of non-recurrent flexibilities to help offset the one-off debts in the current year. Steady progress was achieved in 2002–03, and further savings in 2003–04 are being considered as part of the three-year plan.

In addition, the health community in Cornwall and across the peninsula will address the £13 million shortfall that still remains in order to achieve financial balance in 2003–04. I stress that a key part of drawing up the recovery plans has been ensuring that there is as small an impact as possible on direct patient services. That has been attempted in a variety of ways, including reducing recruitment and travel costs and considering home treatment as opposed to in-hospital treatment. I reassure hon. Members that my Department and I are working closely with the strategic health authority to ensure that the £13 million debt is considered carefully—with all the reassurances that I have given about the effect on patient care and targets—and I will continue to talk with hon. Members about those issues.

Matthew Taylor : I thank the Minister for her response. Her visit to Cornwall was welcome, and people appreciated her comments. Following this debate, will she ask the strategic health authority what advice it is giving on how Cornwall should tackle the problem, given the unravelling of the financial plan involving the county council? There is a feeling that the strategic health authority is waving a stick, but not making any constructive proposals about what to do.

Ms Winterton : Yes, I certainly undertake to do that.

I will make two more points before I finish. The issue of the funding formula for rural areas has been raised. The new formula takes account of the effects of access, transport and poverty. The allocation that Cornwall

11 Nov 2003 : Column 53WH

received is some £3.2 million more than the average under the national allocation formula. Finally, I understand what hon. Members have said about out-of-area treatment. Since March 1999, reimbursement for such treatment has been through annual non-recurring payments. However, hon. Members may be aware that the Department is considering ways in which the out-of-area treatment system can be improved. That has recently been consulted on, but I will certainly give careful consideration to the comments that have been made today and take them on board before making any further decision.

I hope that hon. Members will now be reassured that I am aware that there are real challenges ahead for the NHS in Cornwall. However, I am confident that the health community is responding to those challenges and that significant efforts are being made to achieve financial balance. I hope that hon. Members agree that it is necessary to get that financial balance to achieve sustainable services and to deliver key targets. The strategic health authority will continue to offer support and guidance to the community and individual organisations across the health economy during this period of significant reform, and I will keep in touch with hon. Members about the progress that is made.

Next Section

IndexHome Page