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14 Dec 2006 : Column 348WH—continued
Andy Burnham:
The hon. Gentleman makes an interesting point, and he knows his constituents’ views better than I do—I do not seek to claim otherwise. However, the important point about what Professor Sir George Alberti said last week is that it was an attempt to expose people to a different argument so that they can understand why change may need to be made. I
think that they have understood that argument— indeed, the hon. Gentleman nodded when I mentioned it a moment ago. What that argument makes clear is that we cannot, by definition, always provide the very best locally in every community for the most serious and life-threatening emergencies in which people may find themselves. It makes sense to base some of those services in regional centres or to group them in a more concentrated way. Sir George Alberti put that important argument before the public to improve the debate on the issue.
If the hon. Gentleman looks at the work of the royal colleges on similar and related topics, he will find that a growing body of clinical opinion says that some of this change is necessary and that it is important to explain it to the public and take it forward. The hon. Gentleman and every Opposition Member should ask—indeed, I would do the same in my constituency, too—whether any changes that are put before the public enhance and improve provision and help us save lives. That has to be the first question, does it not? If we hear local commissioners saying that those services will do that, we must, in all honesty, listen to their voice.
Conservative Members sometimes like to say that such issues arise only in their areas, but that is not true. Greater Manchester, where my constituency is based, has been through a difficult, long and controversial set of changes in respect of maternity and child care, which culminated in the PCT decision last Friday. It was very much a question of quality versus localised services. It was a difficult debate for many colleagues in the House—
Andy Burnham: I will just finish the Greater Manchester point before giving way to the shadow Secretary of State and then the hon. Gentleman.
The issue in Greater Manchester was a difficult one. It was difficult for people to be taken through the arguments, but a leading clinician in the region said clearly and publicly that the changes would lead to30 babies’ lives being saved in Greater Manchester every year. It is not always easy to get the local press on board on these issues, but the Manchester Evening News, to its great credit, ran an editorial the day after entitled, “Do mums want the nearest or the best?”. It concluded:
“It is right that decisions about our hospitals are closely examined and questioned. But we must also be willing to embrace whatever change is necessary to ensure our children get the best care possible.”
It was a difficult exercise, but I think that people could understand in the end why changes were being made. Such debates are taking place everywhere, not just in the south-east.
Mr. Lansley:
What has been going on in Greater Manchester is one of the reasons why we published a document at the beginning of this week asking about the evidence base for some of the changes that are occurring in maternity services. In Manchester, the changes will see us move from an average of 2,920 live
births in each of 13 units to an average of about 4,700 births in each of eight units. The Minister talks about clinicians. I have been to Macclesfield district general hospital and to Fairfield general hospital in Bury, and the clinicians there believe that they are providing a safe service. Macclesfield has obstetric cover, anaesthetic cover, neonatology cover, paediatric back-up and a dedicated obstetric operating theatre. Even though they have fewer than 2,000 live births, the clinicians there believe that their safety record justifies the maintenance of their service. What is the Minister’s evidence for the proposition that much larger units necessarily provide for greater safety in births?
Andy Burnham: As I said, the evidence that was put before people in Greater Manchester was that that would lead to babies’ lives being saved every year. It stands to reason that units will deal with more cases and that clinicians will not work in more isolated facilities. Precisely the same issue arose with the Calderdale and Huddersfield reconfiguration and, again, it came down to the volume of cases that clinicians have to see.
I did not give that example to suggest that every dot and comma was right or wrong, but simply because the hon. Member for Bognor Regis and Littlehampton raised a reasonable point. I made a general point about taking the public through difficult change in the health service and showing that the prism through which changes are judged should not always be financial pressures; it can and should be patient safety.
Mr. Lansley: The Minister claims to be a researcher, so he will have investigated this issue. He comes from the north-west, and I have read the document that led to the maternity reconfiguration in Manchester that was announced last Friday. It contained the assertion that children and babies do better in larger units, and there was a reference to a research paper that has been published. It looked at the number of neonatal deaths in southern California in 1991 in places where children were of low birth weight and there was no regional neonatal intensive care unit. I accept the proposition that babies of low birth weight should not be born in places where there is no good neonatal intensive care, but that does not stretch to the proposition that the larger the maternity unit is, the better it is. What is the Minister’s evidence? Given that the largest maternity unit in Germany, for example, has 4,000 births, and 3,000 births is about as large as it gets in France, why do we in Britain have to go to 5,000, 6,000 or 7,000 live births and deny mothers the access and choice that they need?
Andy Burnham: I was not actually arguing that large is necessarily best, and part of my argument here and when we were talking about the Alberti report was that—
Mr. Lansley: That is nothing to do with maternity.
Andy Burnham:
Manchester was not just about maternity; it was also about children’s services. My argument was that there is clear evidence that higher quality care can be delivered to critically ill children by services that see a greater volume of such cases. There is a body of clinical evidence that says that that is the
thing to do. Maternity is a different point, and there is a balance to be struck between safety, access and local services. The debate over the balance between safety and access is being had in other places all the time. We support the principle of choice as far as possible when it comes to child birth and where women deliver, and I guess that the hon. Member for South Cambridgeshire does, too. That will continue to be the case. I shall give way now to the hon. Member for Chichester (Mr. Tyrie) if he wishes.
Andy Burnham: The hon. Gentleman is okay; all right.
New drugs have been developed over the past10 years, which have allowed us to treat new conditions. People are becoming more educated about their care and demand to have more say in it, and the latest drugs and treatments. Their expectation of public service is also changing. They want access to services quickly, at a time that is convenient to them. In recent years the NHS has improved the services that it offers, and waiting lists are at a record low, but we are building on that. By the end of 2008, patients should wait no more than 18 weeks from GP referral to hospital treatment, and the NHS is funded to meet that commitment in its 60th anniversary year. It will be the end of waiting lists as we have known them in the national health service.
Mr. Tyrie: The Minister has returned to the highly controversial issue of funding, and many Opposition Members think that the deprivation weighting has been skewed to enable one part of the country—mainly the midlands and the north—to receive a disproportionate share at the cost of the south and rural areas. Has the Minister become concerned about that, and does he think that the fact that the Opposition Benches are packed, whereas there is not a Labour Back-Bench Member here to help him, may have something to do with the fact that Labour Members are reasonably satisfied with the huge cash handouts that they have had for the NHS, at the expense of the south?
Andy Burnham: I am happy to debate the funding formula with the hon. Gentleman—
Mr. Tyrie: The hon. Member for Ogmore (Huw Irranca-Davies) is leaving; they are all going now. [Laughter.]
Andy Burnham: And then there was one.
I do not have the figures to hand for the region of the hon. Member for Chichester, but I attended the meeting with the strategic health authority that he attended, where the issue was discussed at some length. It may have been in a parliamentary answer to him that we issued the capitation figures for PCTs in his region. If memory serves me correctly—and I do not think that I am wrong—the figures for PCTs in his part of the world vary from somewhere below the England average to somewhere above it. There was actually a fair mix of funding above and below the
average, and overall the region was, yes, below the England average, but not far below it.
Mr. Nigel Waterson (Eastbourne) (Con): While we are on the crucial subject of funding, may I also point out that in our area we have the highest proportion of over-85-year-olds in the country? I have one constituent, Mr. Henry Allingham, who is 110, although he is in quite good order. The formula does not sufficiently reflect that high proportion. To put it another way, 26 per cent. of the population of East Sussex is over 65.
Andy Burnham: I think that we should debate that point—although I accept, Mr. Illsley, that I have spoken for a long time—because clarity about the funding formula is needed. Age is a factor in how funding is allocated, but it is balanced by other factors, including deprivation and the market forces test—the cost of delivering health care in one part of the country compared with another. A range of factors has an influence on how health care funds are allocated. It is right to say that the funding formula that was in operation for many years—certainly under the Conservative Government—was largely age-driven. The age component of that funding formula—and I acknowledge that it was not just age-related—was given more weight than now. However, I hope that the hon. Gentleman understands that in constituencies where life expectancy is lowest—Manchester is the example with the lowest male life expectancy in the country; even today there is a 10-year gap between male life expectancy in Kensington and Chelsea and in Manchester—people get sicker younger and there are higher levels of chronic disease, caused by a range of factors but crucially linked to deprivation. Those are the communities in which—and I think this is a no-brainer—health funds should go to health need.
I know that the Conservative party has said that funding should be allocated by burden of disease. The hon. Member for South Cambridgeshire has written to me at some length and I shall reply to him soon.
Mr. Lansley: The letter to the Secretary of State, actually.
Andy Burnham: I am sorry; it was to the Secretary of State. In the letter, the hon. Gentleman makes a neat side-step into the question of age, and argues that burden of disease equals age, effectively.
Andy Burnham: He does. That is not his party’s policy. Burden of disease is something very different. We debated that in the House the other day. Burden of disease, to me—and perhaps we misunderstand each other—is rates of cancer per 100,000 of population and rates of coronary heart disease per 100,000 of population. Does he agree that that is the indicator of burden of disease?
Mr. Lansley:
The point that is made in what is admittedly a long letter to the Secretary of State is that the resource allocation formula should be set both independently and on the basis of the burden of disease. The burden of disease of course represents things such
as the amount of cancer in the population. However, the Government interpreted it as premature mortality. It is a bit like saying that there are people under the age of 75 in Greater Manchester who die of cancer. Indeed there are, and a disproportionate number. But with a population like that of Eastbourne—because the older the population is, the greater the occurrence of cancer—there is a great deal of cancer. The only point that we are making—which my hon. Friend the Member for Eastbourne (Mr. Waterson) made—is that the formula does not sufficiently recognise that age is the principal determinant of morbidity.
Andy Burnham: I may be wrong, but I tend to think that if people live longer they are healthier, generally. An area may have longer life expectancy—Kensington and Chelsea has the highest life expectancy in the country. Is burden of disease there greater or lower than in Manchester? I have a direct question for the hon. Member for South Cambridgeshire to answer: is the burden of disease higher in his constituency, in the constituency of the hon. Member for Eastbourne or in my constituency? It is his policy I am talking about, not mine. Where is the burden of disease higher?
Mr. Lansley: I do not have the statistics for all three constituencies, but my guess would be that the burden of disease is lower in South Cambridgeshire than in either of the other two constituencies. Leigh probably has a lower burden of disease than Eastbourne simply because, although it may have greater areas of deprivation, the average age is considerably lower. The Minister can see in the evidence on deficits to the Select Committee that the burden of disease rises significantly and the principle determinant of morbidity is age. Will he now accept what the Health Committee accepted on the evidence that it received—that the resource allocation formula requires review, and consideration should be given to actual need rather than proxies of need? That is precisely our point. Let us find out, in the formula, what is actually required to deal with disease in an area, rather than simply use deprivation indices.
Andy Burnham: Obviously, Mr. Illsley, you cannot join the debate, but I think that what I am saying is relevant to your constituency, too. In such areas as ours—former mining areas—there are high levels of chronic disease. Many people have chronic obstructive pulmonary disease, for example. The hon. Gentleman—his hon. Friends are not listening, but perhaps they will listen to this—said that, yes, the burden of disease is probably higher in Leigh than in South Cambridgeshire. Therefore, Leigh, under his funding formula, should get more money than South Cambridgeshire. That is the logic of his funding formula. How would the burden of disease formula reallocate funds around the country? There is not a chance that the burden of disease is higher in the constituency of the hon. Member for Eastbourne than it is in mine.
Mike Penning:
I suggest that the Minister read the report by the Select Committee on Health. I had the honour of being a member of that Labour-dominated Committee. It criticised almost everything that the Minister has said and called for an inquiry into the funding formula. It cannot be right that constituencies
in some parts of the country get twice as much money through their PCT as constituencies in other areas— the Secretary of State acknowledged that to the Committee—and it cannot be right that a Secretary of State comes before a Select Committee and says that the reason that her constituents get £400 per head more than, for example, my constituents is that my constituents are healthier. That is absolute madness. It does not matter whether someone who is knocked down by a car is healthy, because they still need an accident and emergency department at the end of the street.
Andy Burnham: The Government will respond to the Committee in due course, but I refer the hon. Gentleman to what the hon. Member for South Cambridgeshire said a moment ago. He acknowledged that the burden of disease is higher in constituencies such as mine and that therefore more money should go to them. I fail to understand how the policy that the hon. Member for Hemel Hempstead and his colleagues are advocating is substantially different from the current funding formula.
The advisory committee to the Department of Health is made up of academics and others who advise on funding. The consideration of how to track health need is very complicated and precise. [Interruption.] The hon. Member for Hemel Hempstead and his hon. Friends repeatedly suggest that it is a political fix to benefit certain parts of the country. There is no debate about that. We have established that more money should go where the burden of disease is higher. That is what our funding formula does, and it is what the hon. Member for South Cambridgeshire acknowledged his formula would do.
Let us move on. [Interruption.] How can age apply?
Mr. Lansley: The Minister does not understand.
Andy Burnham: If age was the basis of the Conservative position in the past, why does their policy document not say that the funding formula should be principally determined by the age profile? That is the position that they held before, and it is one that they are advocating today.
Mr. Lansley: I shall not repeat myself, but I do not think that the Minister quite understands. The present formula allocates almost the same weight to measures of deprivation under the additional needs index as it does to age. It is not just us who make the point that weighting for deprivation indices is inappropriate. Academics made that point to the Health Committee. One can look in the formula for things such as morbidity indicators, but what is measured is the number of people on income support or the number of people receiving attendance allowance. The formula does not measure, directly in relation to deprivation, the extent to which age gives rise to disease. We are saying what the Committee rightly said: let us try to determine actual need rather than what the formula determines, which is deprivation indices that use proxies of need.
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