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We are committed to playing our part, not least through the Global Fund. I take this opportunity to
put on the record my appreciation of the considerable effort made by Richard Feachem, the first head of the fund, and of the excellent job that he has done. We have pledged some £359 million to date to support the fund, making us the fifth largest donor, and we recently supported the decision to triple the size of the fund so that it has the potential to reach $6 billion to $8 billion in 2010.
I touched on UNITAID. We pledged some $20 million for UNITAID as part of a 20-year commitment potentially increasing to some $60 million by 2010, subject to the performance of the organisation. We also pushed hard at the UN General Assembly in June to ensure that the international community in general made a commitment that no credible, costed national AIDS plan should go unfunded. That important commitment should play a central role in helping to get all donors working on the goal of achieving universal access in each developing country.
The AIDS response must support and strengthen health systemswe must not undermine them. In short, that is the only way to achieve universal access and better all-round health outcomes. We must do more collectively to strengthen health systems, not least because of the need to address the global shortage of 4.3 million health care workers, as estimated by the Global Health Workforce Alliance. People are not likely to stay on antiretroviral drugs without health care workers to support them as they take the drugs, and, potentially, the virus could become more resistant to drugs. I have no doubt that that issue will be of particular importance in the discussions that will take place at the G8 coming soon.
The UK is playing its part on that issue. In Malawi, for example, we are helping with a £100 million emergency programme over six years that seeks to double the number of nurses and to treble the number of doctors. The programme helps to do that by increasing salaries by some 50 per cent. We are considering options to extend that approach to other countries, and we are seeking to have discussions with other donors about how we can better pool our funding to make that happen more effectively in developing countries. I personally have had discussions with key people in the US Government about how we could do that.
My right hon. Friend touched on the importance of prevention. We are supporting ongoing research to develop new microbicides, which potentially offer the most appropriate technology most quickly to help women to protect themselves from HIV infection. We continue to put money into the international AIDS vaccines initiative to help to make progress there.
I know that my right hon. Friend shares our concerns about stigma and discrimination. I hope that he will be able to attend the launch tonight with England and West Indies cricketers of a stigma unit to promote our work in the Caribbean, which has the second fastest rising epidemic rates in the world. Discrimination is the single biggest blockage to making progress on that issue.
My right hon. Friend also asked about our position on trade-related aspects of intellectual property rights. We remain a strong supporter of the right of developing countries, including Thailand and Brazil, to implement the TRIPS agreement, as is appropriate for
their circumstances. We understand the concerns of Médecins sans Frontières and several others about the complexity of the agreement, which is why we are working in Kenya and Botswana to fund legal research and assistance that will help those countries to implement the flexibilities that are available under the TRIPS process.
We initiated an access to medicines conference just a matter of weeks ago because of concerns about TRIPS, about whether enough diagnostics are available, about whether we need new treatments and about how to cut through some of the other blockages to making drugs available to fight HIV/AIDS. The conference brought together experts in health systems and drug programmes from developing countries, people from the non-governmental organisation world, international pharmaceutical companies and generic drug companies. From those who came to that meeting, we are seeking to establish a small group to work with us, on a continuing basis, on the key blockages internationally to making progress on delivering more HIV/AIDS drugs and more drugs to help to fight other developing-country diseases.
I am grateful for the considerable effort that was put in by the many different stakeholders who turned up at the conference. As my right hon. Friend will know, access to medicines is often a politically contentious issue, but the constructive nature of the dialogue at that conference offers hope that we will be able to make faster progress. I know that he will be pleased in particular by the announcement by UNITAID and the Clinton Foundation.
Again, I welcome the opportunity for this debate. It is timely, with the G8 approaching so soon, with our launch on Thursday of a consultation on what we can do next about HIV/AIDS and with the launch of the stigma unit tonight. My right hon. Friend takes a considerable interest in the issue and has done so for a long time. I hope that he will continue to pursue that interest and to put pressure on us to do more.
Andrew George (St. Ives) (LD): I am delighted to have secured a debate on local health funding after having the good fortune to initiate a debate on midwifery and maternity services only a fortnight ago, to which the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), responded. I am pleased to see that the Minister of State will be responding to this debate. I will consider the Governments national policy and the way in which it affects local health funding, considering the local circumstances in my areaCornwall and the Isles of Scillyand, as I am sure the Minister expects, I will look constructively at potential solutions to local problems.
I have always welcomed, strongly supported and voted for investment in the NHS. I appreciate that the Government were fearful that some of the money would go into a black hole and that they have therefore engaged in a number of reforms, but I fear that the Government have created some black holes of their own, particularly regarding the pursuit of the so-called choice agenda. Sadly, I believe that that agenda has swallowed up billions of pounds in IT systems and bureaucracy. Choice is desirable, but for many people it is a luxury to be considered after basic services are in place and are sure to be intact.
The theme of my speech is that I am worried about a lot of the changes to the NHS. I have seen some of the proposals for health reform and they seem to be promoted by PowerPoint-wielding management consultants who have too much say in how services are run. Instead, we should concentrate on running front-line services properly and effectively. Those are the issues that I want to consider.
When considering the national policy context, the Minister may wish to look at the British Medical Association document that was published last week, A rational way forward for the NHS. It puts the issue in context and provides some good, helpful and constructive comments, on which I am sure the Department has reflected. At the BMA conference in 2006, alarm was expressed at the incoherence of Government NHS policies. The letter that was attached to the BMA document and was circulated to MPsI am sure it was also sent to the Governmentstates:
Thanks to the government's injection of funds and the hard work of NHS staff, patients have seen considerable improvements in the health service.
However, there has been a failure to engage either the public or health professionals in the early stages of policy developments which undermine the long-term future of the NHS.
Progress...is under threat due to a constant wave of poorly integrated initiatives from the centre,
The NHS is suffering from reorganisation fatigue.
I am sure that those are themes that the Minister has heard many times before from critics of the system. Indeed, at the weekend, the former Secretary of State
for Health, the right hon. Member for Holborn and St. Pancras (Frank Dobson), said on The World This Weekend on Radio 4:
We started losing advantage when we started saying choice was the great thing and that the choice that people want is the choice between 5 competing hospitals. Every bit of polling evidence and common sense suggests that that's not the case. The first choice for most people is that the hospital down the road will do a first class job for them and do it promptly. That should've been the Government's task. It started going wrong there.
If the Government want to offer choice, in my area the choice of an NHS dentist would be nice. Those who get the opportunity of once in a while joining an NHS dentist seem to have that opportunity for only a short time before being presented with the ultimate choice of staying with the practice and going private or having no dentist at all. Sadly, that is the type of choice offered to the patientthe consumerson the ground.
The national programme for IT underpins the choice agenda and the choose and book system, which has been re-branded connecting for health. The system is immensely expensive, and the BMA News of 27 May last year states:
Connecting for health management has now admitted that it will cost at least £15 billion and final figures in excess of £30 billion have not convincingly been denied.
Perhaps the Minister will reflect on that. I have asked many parliamentary questions about the cost of the choose and book system and the nature of its assessment and costs locally. In March, I received an answer to a written question that I had asked about what measures the Secretary of State had put in place to assess the change in the overall administrative burden of the choose and book system. The answer provided was:
None. The choose and book system should reduce the overall administrative burden of managing referrals.[Official Report, 12 March 2007; Vol. 458, c. 142W.]
Yet we know that because of the creation of private sector contracts, which primary care trusts were forced into, the Government has had to encourage PCTs to establish referral management centres to intervene in the referral process. That has added a further administrative and cost burden, which has not been part of or factored into the overall budget of the service.
There is no evidence that the private sector offers improved services or better value for money than the NHS
support the NHS rather than supplant it.
I know that my hon. Friend the Member for North Cornwall (Mr. Rogerson) has been assiduous on that matter, particularly regarding the movement of a contract to a private sector hospital in his area in Bodmin. He shares my concern about that issue and I have asked parliamentary questions on the nature of the contracts and the basis on which PCTs were forced into them. In particular, I asked about the widely
understood target of contracting 15 per cent. of all elective procedures, and in an answer that I received last July, the Minister said:
The figure of 15 per cent. is not a target but a level of service that the independent sector might be providing by 2008.[Official Report, 18 July 2006; Vol. 458, c. 381W.]
Individual contracts performances are monitored to ensure facilities are utilised.[Official Report, 18 July 2006; Vol. 458, c. 376W.]
Capio and national health service sponsors are working to ensure that the full value of activity is delivered over the contract period.
I am pleased to say that the Plymouth and Bodmin treatment centres are on target for up to 100 per cent. capacity.[Official Report, 6 February 2007; Vol. 456, c. 703.]
Freedom of information figures showed, however, that the company met only 19 per cent. of its contracted activity in the first quarter up to April 2006; 45 per cent. in the six months between April and September, and only 65 per cent. in the final period to the end of March. Any yet it will be paid fully for the services that clearly are not being rendered to the local community.
On 7 March, in a debate that we had here, I raised another point with the Minister about the impact of European competition law, which he did not address that day. Indeed, I raised subsequent questions in the House and wrote to the Secretary of State to ask what assessment the Government had made of the impact that that significant move in trend will have on increasing the amount of work contracted through the private sector, and whether it will open a Pandoras box. On 5 April, in reply to a letter that I had written her, the Secretary of State for Health stated:
National Health Service bodies have generally fallen outside the scope of EU competition rules.
Generally that might be the case, but given the contractual and tendering processes, and the ability to alter, reconfigure or intervene, the NHS will be open to very complex challenges. In fact, the European Court is likely to deem the service a market and not a public service. I am sure that local health services will be most concerned about that.
On the local situation, as the Minister knows, at the end of the last financial year, the Royal Cornwall Hospitals trust ended up with a deficit of £45 million, and is currently one of 18 financially-challenged trusts undergoing a review. Obviously, it aims to balance its budget, but wants an agreement on how to repay the deficit. It believes that that can be done provided that it is given a reasonable time in which to repay. It is now in the second year of a three-year period, but it would be helpful to have the Ministers advice on whether it is
possible to consider a five-year period in which to achieve the kind of balance that a trust such as Royal Cornwall Hospitals needs.
I have another point to make that I really would like the Minister to address: unlike other trusts with severe deficits, for some reason, the strategic health authority, rather than the Department made the adjustment for the resource account budgeting arrangement for the Royal Cornwall Hospitals trust. As a result, it appears to have lost out significantly.
Matthew Taylor (Truro and St. Austell) (LD): I am sure that my hon. Friend would want also to reiterate to the Minister the fact that prior to the switch in health authority, the hospital never had a deficit. It inherited one that has built up subsequently and which it has struggled to overcome, primarily owing to the low levels of funding that it receives. Its cost per patient is low, and its outcomes good, but under the financial formula that ties its funding to low local wages, it will struggle ever to balance the books.
Andrew George: I am very grateful to my hon. Friend for making that point. I was due to come on to the income that the Royal Cornwall Hospitals trust and indeed the health community in Cornwall receives. He made the point very well.
I would appreciate it, however, if the Minister could answer this point: in order to help lift the burden we must address the purely administrative question of who adjusted the RAB for the Royal Cornwall Hospitals trust. If it had been the Department of Health, as in the case of many other trusts around the country, it would have been better off by a significant number of millions of pounds.
The Minister responded to me on 17 July last year regarding the market forces factor. I am sure that he would be surprised if I did not raise this issue, given that Cornwall is at the bottom of the league table for the income it will receive under that element of the funding formula. He said:
The advisory committee on resource allocation (ACRA) is carrying out a review of the approach to calculating the staff market forces factor.
It is expected that the work will be completed by autumn this year. The publication of the findings will be considered later.[Official Report, 17 July 2006; Vol. 449, c. 245-46W.]
We know that that work is completed and we are awaiting its outcome; it would be very helpful if the Minister could indicate when it is likely to be published and give us a timetable for making adjustments. Were the Royal Cornwall Hospitals trust to approach at least average funding and parity under the market forces factor, it could net at least £6 million to £8 million that is just for that trust, let alone others in Cornwall and the health community generally.
On positive proposals, I would like the Minister to consider the fact that under local government reform proposals in Cornwall we are looking closely at the possibility of bringing the health and social community far closer together. I know that the Minister would welcome that. I received a parliamentary answer that stated:
Local partnerships...under section 31 of the Health Act 1999
to deliver seamless services and develop close co-operative working.[Official Report, 10 May 2007; Vol. 460, c. 406W.]
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