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25 Jan 2006 : Column 445WH—continued
Easington Primary Care Trust
11 am
John Cummings (Easington) (Lab): Easington primary care trust, which is coterminous with the district of Easington local authority boundary and located in the county of Durham in the north-east of England, is responsible for providing primary health care services in 17 GP practices with 56 GPs and for commissioning acute and mental health services for a population of almost 99,000 people, covering an area of 56 square miles.
Easington has some of the worst health experiences, the highest need for health services and the lowest financial allocation in the country. Having said that, the Government must be given credit, because the shortfall in resources is being corrected with a substantial uplift in the three-year allocation, beginning this year. The PCT has complex relationships with partner organisations, but an excellent record of performance against nationally set health service targets. The financial allocation awarded to the PCT for 2006 to 2008 will enable it to achieve improved performance, including implementation of "Standards for Better Health" and performance targets. The allocation will facilitate the development of local services, which will result in a radical difference to residents and enable the PCT, with local partners, to tackle the health inequalities experienced by people in the district of Easington.
At this time of change for PCTs, it is critical that the particular characteristics of Easington are understood in any future configuration. Sir Nigel Crisp visited my constituency in September to open officially the new urgent care centre in Peterlee, and he gave generous praise to Easington PCT for its record of improving the service infrastructure and the health of the local population. A strong locality focus is clearly required to retain the emphasis on tackling the health inequalities that are adversely affecting my constituents if we are to ensure continued health improvement and service development.
The purpose of this debate, for which I am grateful to Mr. Speaker for allocating me time, is to highlight the position of Easington PCT in terms of health experiences, financial allocation and complex relationships with partner organisations. I also intend to draw Ministers' attention to the excellent record of performance against key national targets achieved by the PCT, and to put the case for retaining Easington PCT, at least in the short to medium term, in the reconfigured structure of primary care trusts in the county of Durham and the Tees valley.
The health and disability domain of the index of deprivation 2004 identified areas with high numbers of people who die prematurely, whose quality of life is impaired by poor health or who are disabled. All but one super-output area in the district are ranked in the 20 per cent. most deprived nationally. Easington is the most deprived local authority district in a shire county. Its population suffers lower average incomes, high levels of worklessness and lower educational attainment at age 16.
Easington suffers some of the poorest health and worst deprivation in the country. Life expectancy for men and women in Easington falls below the national average. The PCT area has one of the highest rates of smoking in the region and nationally. It has one of the
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highest conception rates in girls under the age of 18 in the region. The two major causes of death in Easington are circulatory diseases, including coronary heart disease, and cancer. The death rate for circulatory disease is one of the highest in the northern region, and the population has one of the highest lung cancer rates.
A study undertaken by the Sainsbury centre in 1999 highlighted the fact that the prevalence of mental health problems was greater in Easington than anywhere else in the country outside inner London, and that the need for mental health services in Easington was 30 per cent. higher than the national average.
Easington is the most underfunded PCT in the country, at 86 per cent. of target. Historically, the PCT has been significantly underfunded against its fair share of national funding available to the national health service. I am talking about a shortfall of about £26 million per annum. The January 2005 announcement of allocations to the PCT from 1 April 2006 to 31 March 2008 appreciably addressed the underfunding. Even at that stage, Easington will be 3.5 per cent. below capitation, but it has been promised an additional £43 million.
Mr. Kevan Jones (North Durham) (Lab): I congratulate my hon. Friend on securing the debate and on the work that he has done to ensure that his local PCT receives funding to fight the deprivation that he has outlined. The position is similar in my constituency. Does he agree that one fear that our constituents have about the proposals for a single county-wide PCT is that that money, which has been targeted at the worst deprivation, is likely to be disbursed to more affluent parts of County Durham?
John Cummings : I thank my hon. Friend for his intervention. Only too well do we know that in the past moneys that should have been directed to Easington were subsumed into the old County Durham, and I certainly have similar fears for the future. One reason why Easington PCT has inherited a very low capitation is that each time there has been a change or reconfiguration of boundaries or commissioning arrangements, Easington has lost out because of the complexity of provider relationships and the relative smallness of our population compared with the populations of major urban centres.
In respect of commissioning for acute services, there are relationships with North Tees and Hartlepool NHS Trust, City Hospitals Sunderland NHS Foundation Trust and County Durham and Darlington Acute Hospitals NHS Trust. There are also commissioning relationships with South Tees Hospitals NHS Trust and Newcastle upon Tyne Hospitals NHS Trust for tertiary services. For mental health and substance misuse services, there are partnerships with Tees and North East Yorkshire NHS Trust, South of Tyne and Wearside Mental Health NHS Trust and County Durham and Darlington Priority Services NHS Trust.
Easington PCT is a member of both the County Durham and Darlington and the Tees emergency care networks. It is a member of the Northern Cancer Network, covering the north of Durham, and of the Cancer Care Alliance, covering south Durham and Teesside. Whereas other networks are split in the same way based on patient flows, the PCT is a member of both.
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In developing local integrated services, particularly for older people, children, people with mental health problems and people with learning disabilities, effective partnerships with Durham county council and Easington district council have been critical. The PCT has strong relationships with the councils in developing services and tackling health inequalities. There is no forum that spans all those areas, so to ensure that the health needs of the residents of Easington district are not marginalised or viewed by the major players as peripheral, Easington needs a strong, locality-focused PCT to prevent regression to former times, when Easington lost out substantially on resource allocation and local service developments.
As regards performance against targets, Easington PCT has strengthened considerably its approach to performance over the past year and has in place robust arrangements to deliver the performance targets, "Standards for Better Health" and financial balance in 2005–06. Easington PCT has an excellent record of recent success. It is working in partnership to develop children's centres across the district, with 11 to be in place by April next year. Two are already open, and two are about to open. An urgent care centre in Peterlee opened in October 2004 on an appointment-only basis; it has been open 24 hours, seven days a week since March 2005. More than 22,000 patients have been seen to date. At Christmas, more patients attended the urgent care centre than the accident and emergency department. Furthermore, 1,254 smokers have successfully quit after four weeks.
With a 52 per cent. success rate, the PCT is the second best performing service in the country. On 31 March 2005, 1,512 patients were waiting for an in-patient appointment, representing a 21 per cent. reduction in the year from April 2004. The PCT has appointed four dentists since April 2005, including a vocational trainee. GPs with specialised interests have been accredited by the Deanery in substance misuse services, and there are plans this year to establish and accredit four new areas—in dermatology, coronary heart disease, emergency care, and sexual health and contraceptive services. A new door-to-door transport scheme funded by the PCT is now available in the district of Easington for people with mobility problems. The scheme can be used only for appointments with hospitals and primary care providers. There have therefore been substantial improvements in service delivery, which are a testament to the valuable work being carried out by Easington PCT.
In shaping up for the future and addressing the proposed changes to PCT boundaries, there seems to be considerable pressure from the centre and at strategic health authority level to accept a single PCT for County Durham. Although I fully understand and support the overall philosophy of delivering primary health care and, indeed, all health services in an efficient and cost-effective manner, with savings from a reduction in management and administration costs being reinvested in front-line services, there is a danger that the improvements in local services and infrastructure that Easington PCT has made to date will be put at risk unless the necessary safeguards on resource allocations are put in place.
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There is also the issue of the loss of local accountability, which causes me grave concern. The non-executive directors of Easington PCT are drawn from a range of local people with differing backgrounds and experiences. They have done an excellent job in consulting patient user groups and stakeholders to determine a set of local priorities within the overall NHS Plan. Who will act as champions for Easington's primary health care services in a County Durham-wide PCT, and what assurances will we have that resources earmarked for Easington will not be redirected to other, perhaps less needy areas?
In conclusion, there are six key points that I would like the Minister to note and comment on. First, health experience in Easington is worse overall than in most other areas of England. Secondly, the financial allocation to support interventions to tackle that poor health experience was, until this year, the lowest in the country, with Easington ranking 302 out of 302 PCTs, although that position will improve significantly over the next two years, with an additional £43.6 million on top of the baseline allocation promised by the Department of Health from 1 April 2006 until 31 March 2008. Thirdly, Easington has complex relationships with partner organisations because of patient flows.
Fourthly, Easington has a good record of performance against nationally set health service targets. Given the funding allocation to Easington for the years 2006 to 2008, there is a real opportunity to make a difference to the health experience of the people of Easington. Fifthly, if that funding is diluted or lost to Easington, there is a serious risk that the progress that has been made in recent years will be stopped in its tracks or even reversed. Finally, a unique case can be made for the retention of Easington PCT in the short to medium term, with Easington PCT coming under the umbrella of a merged County Durham PCT at some point in future, but only when the glaring problems of health inequality have been properly addressed. It is critical to ensure that Easington's unique position is fully understood and recognised and that a strong locality focus is maintained to ensure continued progress in improving health and health services in Easington in the future configuration of PCTs in County Durham and the Tees valley.
I am grateful for having had the opportunity to raise these issues, and I await the Minister's comments with great interest.
11.15 am
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne) : I congratulate my hon. Friend the Member for Easington (John Cummings) on securing this debate on the future of Easington PCT. I also express my thanks, as well as those of my right hon. and hon. Friends at the Department of Health, for his counsel and advice since we were appointed last May. He has ensured that Easington's voice has been heard at the highest levels in the debates over the reforms that we have made.
The level of investment in the NHS is rising rapidly, as my hon. Friend said, from £33 billion in 1997–98 to more than £92 billion in 2007–08. That increased investment, along with the hard work of 1.3 million NHS staff, is transforming our hospitals, reducing waiting lists and lowering mortality rates for some of the diseases that afflict my hon. Friend's constituents.
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There can be no resting on our laurels, however. Over the weeks to come we shall be explaining how the next phase of health reform needs to take the health service forward. The vast majority of patient contact with the NHS—90 per cent.—takes place in a primary care setting. Having spent seven years reducing waiting lists to record lows, we now face the challenge of strengthening primary and community services as well. We need to meet the needs of patients with long-term conditions far better, which my hon. Friend will welcome because it is such a priority in his constituency. There are still too many people waiting far too long for treatment.
Mr. Roger Gale (in the Chair): Order. I am sorry to interrupt the Minister, but could he address the Chair? He is off microphone and Hansard is finding it difficult to hear.
We have debated the need to bring down waiting lists, particularly for diagnostic scans. Too many people, especially in disadvantaged areas such as Easington, cannot find a GP, or when they have a family doctor they cannot get an appointment at a time that suits them. Too many patients are admitted to hospital because the care that they could have received or which they might have preferred to receive at home is not available in the right way at the right time. Patients want far more control over their own care. They want to make choices about where and when to use services and that is exactly what we will address in the forthcoming White Paper.
I was pleased that my hon. Friend rooted so much of his argument in the need to tackle health inequalities. He commented on low life expectancy in his constituency, which is a problem that afflicts many of our poorer communities. As we move into the next phase of health reform we must surely focus on a much broader mission for the NHS and our social care system, which is not just about delivering a service that helps people when they are ill. We must bring the health service much closer to local government, so that together they can get down to the business of transforming health inequalities in some of our poorest communities. I do not think that there can be any community where that mission is more important than in Easington.
Mr. Kevan Jones : I am listening carefully to the Minister, but that is exactly what is happening in the county of Durham. Local PCTs work closely with district councils and others to tackle some of the issues that my hon. Friend the Member for Easington (John Cummings) raised, so why does the Department want to break up what has been a successful partnership in my constituency and his?
Mr. Byrne : I am grateful to my hon. Friend for his intervention, as I want to address that point directly in the last third of my remarks.
To add a few facts to the analysis that my hon. Friend the Member for Easington gave, almost 29,000 adults in Easington consider themselves to have a long-term limiting illness. That is 30.8 per cent. of the population, which is the highest in England and Wales. More than
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16,000 adults in Easington describe their health as not good. At 17.3 per cent. of the population, that is the second highest figure in England and Wales. Some 11,000 people in Easington would describe themselves as permanently sick or disabled, which is the highest rate in England and Wales. The north-east is classified in the index of multiple deprivation as the most deprived region in the country, and Easington is the most deprived area in the north-east.
Against that background, my hon. Friend has raised three important points. The first is about money: how do we ensure that Easington continues to receive the resources that it needs to tackle deprivation and health inequality? The second is about services: how do we ensure that the boost to resources in Easington delivers world-class health services to his constituents? The third and final point, which was the subject of the intervention from my hon. Friend the Member for North Durham (Mr. Jones), is about structures: how do we ensure a PCT structure that delivers those benefits, working in partnership with local government and other players?
First, I shall talk about money, because money is often the route to so much progress in health. Following the sustained lobbying campaign in which my hon. Friend the Member for Easington played a vital part, Easington PCT is to receive another £43.5 million in funding for the two-year period to 2008. He is therefore entitled to an assurance that, should Easington PCT be merged with any other PCTs, its funding allocation for the period up to 2008 will reach the areas for which it was originally intended.
It will be for strategic health authorities and the newly formed PCTs to manage and to continue to use in the best possible ways the funding available to them in order to deliver Government targets and make service improvements. We expect those organisations to continue to direct funding towards areas of greatest need. The reconfiguration exercise should not be used locally to move resources from high-performing areas to underperforming areas and vice versa.
There are two important policies that will strengthen the process. The first is practice-based commissioning, which places far bigger budgets under the control of local doctors' services, working in local wards. It supports the allocation of resources according to the movement of PCTs towards target "fair share" budgets for practices, based on the health needs of the local population. Further, practices will be able to re-allocate freed-up resources to services that better meet the needs of the patient. That will allow GPs to focus more health services on tackling health inequalities.
The second policy involves retaining the high priority that has been given to tackling health inequalities in 2006 and 2007. That policy is important. We expect PCTs to focus their work on meeting locally agreed delivery plans that make the most progress towards reducing health inequalities by 10 per cent. by 2010—concentrating on life expectancy at birth. The focus on tackling health inequalities will be at the centre of the forthcoming health and social care White Paper.
Secondly, I want to talk about how the money will be turned into services to help my hon. Friend's constituents. Several important initiatives are already under way in his constituency. He mentioned some of them: the two urgent care centres in the district; the
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young people's centre, which provides a new focus on the treatment of substance misuse and sexual health; and the PCT-run, second most successful quit-smoking programme in England.
In the PCT's business plan for the next three years, there are new ambitions, including the improvement of life chances for children, new access to high-quality services and the creation of more opportunities for good health. The PCT has already made much progress, with some key headline indicators already moving in the right direction.
John Cummings : Is the Minister able to assure me that the three-year plan will be adopted and carried out by any future reconfiguration of primary care trusts in County Durham?
Mr. Byrne : If I may, I shall check the guidance being issued around the consultation process, so that I can give my hon. Friend chapter and verse on how those local delivery plans will be taken forward. I do not want to give him a glib answer now. The matter is of such importance that I shall write to him with as full an answer as possible.
The final point about structures is important to this debate. Primary care trusts need to earn the trust of the people whom they serve every single day. That means that they need to get better every day at securing the best possible services, representing good value, from a growing range and diversity of health care providers. The creation of foundation trusts and the planned introduction of payment by results will mean that the hospital sector gets stronger in relation to primary and community services. That new hospital sector might well tend to suck resources towards it unless it is counterbalanced by an equally strong organisation that buys services for the community and represents patients' interests in designing and locating services.
We need strong PCTs to design, plan and develop better services for patients, to work more closely with local government, and, in some cases, to hold GPs to account for the services that they deliver. As my hon. Friend will know, SHAs were invited to submit reconfiguration proposals to the Department of Health by 15 October last year. An external panel, representing a wide range of stakeholder interests, was established to advise Ministers on whether the proposals for reconfiguration submitted by SHAs adequately engaged local stakeholders and met the criteria set out in "Commissioning a patient-led NHS". Following debate and, where necessary, some reworking by Ministers, we forwarded proposals for the reconfiguration of PCTs, which were fit to go forward for a 14-week consultation period starting on 14 December. With some PCTs, that included a wider range of proposals for reconfiguration than was originally put forward, because our objective was to ensure that the consultation on PCTs covered the broadest and most appropriate range of options for reconfiguration.
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My hon. Friend is concerned about the two reconfiguration options that are currently out to consultation in County Durham and Tees valley, both of which propose the merger of Easington with Derwentside, Durham Dales, Sedgefield, and Durham and Chester-le-Street PCTs to form a single organisation for County Durham. Those options are out to consultation until 22 March, and no decisions on the future of any PCT will be taken until those local consultations are complete.
Mr. Jones : Is that not a bit of a sham? Why has Darlington, which was part of the original merger in County Durham, been taken out? Is it because the former Secretary of State for Health, my right hon. Friend the Member for Darlington (Mr. Milburn), has been lobbying hard? If that can be done for Darlington, why can it not be done for Easington and other PCTs in Durham?
Mr. Byrne : Ministers felt that the two options on the table for County Durham would adequately reflect the criteria that were put forward. We felt that those options warranted going out to public consultation. There can be no pre-judgment of that consultation. Ministers will need to be satisfied, when consultation responses come forward and the SHAs finalise their proposals, that there are reassurances on the way in which local delivery plans will be taken forward.
My hon. Friend the Member for North Durham made an important point about the way in which the current structure puts in place a range of successful relationships with local partners—I have seen how that works in my constituency in east Birmingham. Those relationships will be extremely important—particularly those with social care departments. In a health economy in which we seek to put care far closer to home and to give people the opportunity to live in their homes for longer, which is what most people want, the relationship between primary care organisations and local social services departments is absolutely critical. We have talked about the Berlin wall that has separated the NHS and social care departments for many years. We need to start taking that wall down, so if Ministers think that certain reconfiguration options take that process backwards, they cannot be approved. We have asked the SHAs which have proposed options to explain how they will ensure that the range of local partnerships in place will continue.
My hon. Friend the Member for Easington also asked how we can ensure that champions for Easington are intimately involved in the new organisation. That has to be part of the advice that comes back. Unless there is specific advice about how champions for his local health economy are to be kept involved, we cannot be satisfied that any new arrangements will take health and social care forward in his constituency.
It being half-past Eleven o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.
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