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15 May 2007 : Column 248WH—continued

We seem to have quite a bit of potentially conflicting legislation to achieve such pooled arrangements. The BMA’s proposals for a new NHS framework stated that it wants a great deal more democracy introduced into the decision-making process for the future of that service. When considering bringing the two budgets together, I hope that the Minister will bear in mind the fact that health is free at the point of delivery, whereas social care is means-tested. It would be helpful to give some advice to the local community on how to ensure that those two budgets are brought together seamlessly and not fractured, which is the danger with the means-testing of certain activities but not others.

That is particularly important with regard to, for example, the many cases in which an elderly person might end up in hospital, when really they require care at home, which cannot be provided. Providing that service in hospital might be much more expensive that providing it at home, which might also be more appropriate. I hope that the Minister will consider those elements when answering my questions.

1.48 pm

The Minister of State, Department of Health (Andy Burnham): I congratulate the hon. Member for St. Ives (Andrew George) on securing this debate. I know that he takes a close interest in these matters and I pay tribute to him for the diligent way in which he seeks to improve health services in his area. I wanted to acknowledge that at the beginning.

At the same time, however, I would have hoped perhaps to have heard more acknowledgment from him of some of the major progress being made in the health services in the south west and in Cornwall specifically. It is an interesting day on which to have a debate on local health funding, because the Department published today a detailed breakdown of how the extra £8 billion that the NHS will receive this year will be spent in communities up and down the country.

At times, we can become complacent about the numbers, but by any reckoning, £8 billion extra for the NHS is a major increase and will produce tangible benefits on the ground in constituencies throughout the country, including those of the hon. Members for St. Ives and for Truro and St. Austell (Matthew Taylor). In the south-west, it means an extra £590 million a year for that health economy, and it will, among other things, make possible rapid progress towards achievement of the target of 18 weeks from GP referral to hospital treatment.

I hope that the hon. Member for St. Ives would acknowledge that significant and substantial improvements can be expected in all parts of the country this year. It is important, while we rightly address concerns, that those
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things are accepted and explained to the public, because it is the public’s money and they are entitled to know what it is paying for.

The transformation of services that I am talking about has been possible because of the extra funding that we have made available. Every primary care trust received an above-inflation increase in funding in 2006-07 and will do so again in 2007-08—an average of 9.4 per cent. across the NHS. The hon. Gentleman’s local PCT, Cornwall and Isles of Scilly PCT, received allocations of £646 million in 2006-07 and £711 million in the current financial year, which together represent an increase of £119 million over the two years, which in turn equates to a 20.1 per cent. increase in funding over the two years. Notwithstanding the issues that he put before me today, which I shall come to in a moment, that compares favourably with the England average for all PCTs of 19.5 per cent. growth in funding over the two years.

In addition, we have adopted a faster pace of change policy for the 2006-08 revenue allocations period. PCTs such as the one in the hon. Gentleman’s area have been moved more quickly towards their fair share of funding. In 2003-04, the most under-target PCT was 22 per cent. under its fair share allocation; by the end of 2007-08, no PCT will be more than 3.5 per cent. under target. Cornwall and Isles of Scilly PCT will be only—I say “only”—3.3 per cent. under its weighted capitation target by the end of this year. The hon. Gentleman would rightly say to me, “Come on. Let’s see further progress towards that target funding.” I, too, represent an area where the PCT is under its target allocation. Although it remains the Government’s intention to move PCTs towards their target allocation, we of course have to do that at a pace that is fair to the rest of the NHS.

Let me deal with some of the specific issues that the hon. Gentleman raised. He asked me to comment on the BMA document. I agree that it makes some very important points about how we take forward the debate about the future of health care and the NHS specifically, but he did not comment on one of the central points in that report, which was the call for, as I understand it, more rationing of services and more openness about where services may need to be rationed. We have shown in the past 10 years that a comprehensive NHS and universal service can be provided free at the point of use, and that certainly remains our intention. I hope—in fact, I expect—to continue to have the Liberal Democrats’ support in making the political case for such a service as the NHS approaches its 60th anniversary.

The hon. Gentleman spent some time attacking the notion of choice and quoted others in aid of that point. He needs to think: in this day and age, on what basis can we say that people cannot have the right to choose what is best for them and their families? I ask him to think about his own constituents. There may be a family with a young child who has a rare condition. I am sure that his constituents are like mine: they want full rights to go to wherever in the health service may be able to help them. I do not think that it is right to say that that is a political construct or a fad that is being imposed unnecessarily.

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It is true that people want a good local service, but what if they do not have one? What if they live in a part of the world like mine, where a number of reasonably large district general hospitals are within easy reach? For my constituents, Warrington, Wigan, Bolton and even Hope hospital in Salford are within pretty easy reach of one another. Why should people not be able to look at the service provided by those organisations and choose which one suits them best? It is true to say that providing choice is not an end in itself, but if it can help to achieve the goal of better local services for patients in areas where they are not good enough, surely it is a justifiable policy. It is not the be-all and end-all, but it is an important part of improving the system from the bottom up.

Andrew George: I do not want to detain the Minister on choice—I would rather that he moved on to the local questions—but just to clarify the position, of course choice is desirable, and I think that I acknowledged that, but the point is that it is important that the Government recognise that local health services need to walk before they run. Routine services need to be in place and to be reliable and local. By all means, once we have achieved that, the desirability and luxury of choice is something that I think we can all applaud.

Andy Burnham: I accept that point; it is one on which we can agree. I have to say to the hon. Gentleman, though, that we cannot will the end without willing the means. He mentioned “choose and book”. Last week, 40 per cent. of appointments were dealt with through that system, and some 68,000 patients received their appointment in that way. It is important that people do not just cast aspersions, as they tend to, on these projects. Just think about the benefits for those 68,000 patients: they got their appointment immediately; straight away they knew their time, so they could then start making plans. The alternative would be people waiting for the hospital to contact them with an appointment that might not suit them. There are direct benefits to the individual from these systems, and it is important to recognise them.

On the use of the private sector, the hon. Gentleman raised concerns about the utilisation rate of Bodmin independent sector treatment centre. I can tell him that utilisation is building month by month. In May the rate was 85 per cent. and in April it was 80 per cent., so I hope that he can see that there is a build-up. The point of the policy is that, as services become established, they will work towards the full utilisation rate. It is very important, if his constituents are to benefit from the 18-week target, as I expect all people in the country to be able to, that that capacity be made available to the NHS.

In many ways, what we are describing is a different relationship with the private sector. It is not one in which the private sector trades on the back of failings by the NHS and the really awful notion of choice that applied under the previous, Conservative Administration: “You can wait two years or the feller down the road will deal with you in two days.” That was utterly appalling. Now, the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.

On European law, I understand the point that the hon. Gentleman makes, but I think that perhaps he is overstating the issue. Within the European settlement,
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as I understand it, it is possible for domestic Governments to manage and control health services as they see fit, but I take his point that these things need to be carefully watched.

The Royal Cornwall Hospitals NHS trust has particular financial challenges. We are looking case by case at each of these trusts in this particular period, in which they would struggle to repay at the same time as keeping services stable. I can assure the hon. Gentleman that we will inform both him and the hon. Member for Truro and St. Austell about any decisions taken in relation to recovering that trust’s financial position, but it is making improvements this year through its turnaround process, and I hope that we can see a clear way forward in the not-too-distant future.

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On the market forces factor, a review is going on that will inform this year’s allocations—the allocations to be made later this year for all PCTs. That is the timetable. The hon. Member for St. Ives asked me about that. The representations that he has made over a period and that others have made about the issue will be listened to, but obviously I cannot prejudge the outcome of that review of the market forces factor.

Let us finish on a positive note. I completely agree with and support the notion of a greater partnership between local government and the health service. I would welcome progress in the hon. Gentleman’s county on that issue, so—

It being Two o’clock, the motion for the Adjournment of the sitting lapsed, without Question put.

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