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18 Mar 2009 : Column 279WH—continued
Addressing inequalities is not quite the same as addressing need. The most in need, technically, are the elderly, because the worst thing that people can do for their health is get old. However, areas with high numbers of elderly people are not necessarily the same areas that have, for example, low weight ratios for babies, premature deaths and high rates of working-age invalidity, although in seaside towns—there has been a report on this relatively recently—there can be both.
Mr. Neil Turner: Will the hon. Gentleman not recognise that although old people become ill and need care more, in areas such as mine, where there is severe deprivation, people reach old age earlier than they do in more affluent areas? A 70-year-old in an area with more deprivation may need the same level of care as an 80-year-old in a more affluent area.
Dr. Pugh: I absolutely recognise that. The hon. Gentleman has made an entirely valid point. I was making the point that there can be the worst of both worlds, if I can put it like that. Many seaside towns are characteristic of this. A population in an area may be aged or more aged than normal and at the same time there may be high pockets of deprivation. A Sheffield Hallam university study said that three quarters of seaside towns in England have greater health and disability deprivation than the English average, but I dare say that we could put in plugs for other areas as also being justifiably needy.
Inequality and inequity in the health service is difficult to resolve fairly. Not many hon. Members who represent a rural environment are here in the Chamber. They would probably make the point that the cost of delivery in rural areas is important and that there will be isolated pockets of rural deprivation, even though rural areas as a whole do not statistically seem to suffer in the same way as some inner cities. In other words, it is hard to get the resource mix right and fair. I recognise that. The recent Government taskforce—the Advisory Committee on Resource Allocation—recognised it. It teased out a difference between addressing needs and addressing inequity and came up with a formula that has appreciable merit, which is to weight funding based on disability-free life expectancy. That answers some of the points made by the hon. Member for Wigan.
I want to make two points about the issue. First, although we have recognised the situation and although the consequence of that is that we have suddenly realised that areas of the north have been underfunded compared with areas of the south-east and particularly London—all hon. Members present from the north have harped on this—there is not an immediate fix for that because of the system of floors and ceilings. In other words, we are expected simply to doff our cloth caps, shuffle off in our clogs and basically do what we normally do in the north, which is put up with it. I do not think that we should. A genuine case has been put by hon. Members that needs to be answered: given that that inequity and disparity exists between north and south, why is it not properly or more rapidly reduced?
Ms Dari Taylor: Was the hon. Gentleman as shocked as I was when reading something in the ACRA briefing? It stated that it was looking at a range of options that could be considered in relation to the weights to apply to health inequalities, and it came out with this statement:
“However, due to lack of evidence, ACRA concluded that it is not currently possible to technically determine the cost of reducing health inequalities”.
Does the hon. Gentleman, like me, think that that is a staggering statement?
Dr. Pugh: It is a bizarre statement, because the cost of not reducing health inequalities is allowing health inequalities to persist, which has damaging effects on real individuals in real time. Those effects have been sufficiently outlined in the debate.
The second point that I wanted to make is that there is an issue about the use of resources, regardless of what those resources are. There are clearly cases of gross and inexplicable misallocation of resources. The right hon. Member for Oxford, East talked about the provision of GPs in different areas of Oxfordshire. That is a good example. However—this is a point that the Government would probably love me to make—the qualities and outcomes framework has done something to address the problem. There seems to be some evidence that incentivising and encouraging GPs to do such things as taking blood pressure has, in part, succeeded in addressing some of the social inequities.
None the less, when considering the use of resources, we should not confuse access and service matters with underlying public health problems. I shall give a local example, as I understand it fairly well—that of my PCT area. The southern part of Sefton, which is largely Bootle, has more sources of funding, better clinics, generally more provision and wider access to hospital than the northern part, but it has worse health outcomes. Adding facilities to one area or another does not necessarily sort out the problem.
Fundamentally, what is needed in that context is to change the culture—[Interruption.] I am coming to the end of my remarks. The hon. Member for Hemel Hempstead (Mike Penning) indicates from a sedentary position that my time is up, but I was about to praise an element of Conservative policy; I hope that he will allow me to do so. The Conservatives differentiate public health spend and medical spend. That is notionally a good idea, though difficult to deliver. What is sometimes needed is not more spend but wise spend, and the spread of good practice. That is the real secret of addressing health inequities.
3.41 pm
Mike Penning (Hemel Hempstead) (Con): I thank the hon. Member for Southport (Dr. Pugh) for cutting his comments short, but we want to hear what the Minister has to say.
I congratulate the hon. Member for Wigan (Mr. Turner) on securing the debate and on making a passionate contribution. He said exactly what I would have said if I were a Back Bencher, and I agree fully on behalf of my town, which I may mention later.
I wonder whether the hon. Member for Wigan recognises this:
“Healthy Towns has all the failings of previous policies, indicating that the Government has learnt nothing from the past mistakes.”
It comes from the report of the Select Committee on Health, published on Sunday. I was a proud member of that Committee for many years, but it is still Labour-dominated and has a Labour Chairman. Nevertheless,
it has released a scathing report into health inequalities. If Members have not yet had the opportunity to read it, I ask them please to do so. Not only does it deal with many of the questions that have been raised today, but it sets out some ways in which we can go forward, which is what we all seek. We all wish to improve the quality of health for all our constituents in this great country. I was fascinated to read the report. In many ways, it follows on from the report on funding formula and deficits, which was published when I was a member of the Committee. That argument will go on and on, and I may touch on it in my short contribution.
The Advisory Committee on Resource Allocation was rightly asked by the Government to look into the way in which health is funded. I was as surprised as the hon. Member for Stockton, South (Ms Taylor) to read that those experts were not capable of working out how to address the inequalities argument. It is not a question of cash flying back and forth. If it were only about cash going into communities, Glasgow would have the best health outcomes and Wokingham the worst. As we know, Glasgow still gets the greatest amount of cash. We heard about the north-south divide, and the north-east gets a huge proportion—some 70 per cent. more in 2009-10 than other parts of the United Kingdom.
I listened intently to the debate on the difference between the north and the south, but those on the Front Benches—I am sure that the Minister has found this when visiting the north-east—know that although they have some fantastic facilities in the north-east, and the area is very well funded, other parts of the country would love to have the same.
Ms Dari Taylor: I hope that hon. Gentleman will put that into context. We were a long way behind in 1997, and we had a long way to go to get to the average point. Secondly, a great deal of that funding goes into acute medicine; again, I have no problem with that.
Mike Penning: The hon. Lady has raised an important point. My constituency gets disproportionately low funding compared with the midlands, let alone the north. That may be one reason why my acute hospital closed at the weekend—because of the lack of funding, it will close permanently.
I shall touch quickly on the comments of other Members. The right hon. Member for Oxford, East (Mr. Smith) raised the question of funding and how it can disproportionately affect certain parts of our communities. One part of a community may be relatively affluent and another deprived, but nothing in the formula addresses that problem. That is the cause of real disparity; the poorer seem to get worse treatment. Nothing in the formula, not even the new one, deals with that problem. In my constituency, I have some of the most affluent villages in the south, but I also have three of the most deprived wards in the country. Nothing in the funding formula allows my strategic health authority to allow for that, and the PCTs struggle enormously.
I listened carefully to what the hon. Member for Weaver Vale said about targets. I point him to the devastating report—a statement was made about it a few moment’s ago in the Chamber—on the investigation into Mid Staffordshire NHS Foundation Trust. One of
the most striking comments in the report was that at “virtually every stage” of emergency care, targets were being pursued to the detriment of patient care.
Mike Penning: Will the hon. Gentleman bear with me, because I am short of time and it is not be possible for me to give way?
Although I understand the ideological issue, we have to address the fact that some of our clinical experts, surgeons and consultants, are looking at the clock. They obviously did so in Staffordshire, rather than looking after the patients. That is something that has to be addressed.
Mike Penning: I have only four minutes, and I want to leave 10 minutes for the Minister to respond to the debate.
It cannot be right for our clinicians to be more worried about the tick-boxes of the target culture than they are about treating the patients—the reason why they came into the profession. Those who do not believe me should read the Health Committee report. It is there in black and white. The Healthcare Commission will remain in existence until the end of the month.
Mr. Hall: Will the hon. Gentleman give way?
Mike Penning: No. At the end of the month, the commission will be abolished, and the parliamentary health ombudsman will take over the complaints procedure.
All too often as I go around the country, I see ambulances sitting outside A and E; patients are not being accepted because hospitals are worried about the four-hour target. [Interruption.] The hon. Member for Wigan may not believe me, but I was in Birmingham recently with the West Midlands ambulance service, and the chief executive will confirm that ambulances regularly have to wait outside A and E. I was in London ambulance control centre only two months ago, and there was a capacity problem in Romford; 12 ambulances were stuck outside while I was at the centre. It happens. It may not happen in Wigan, and it may not happen in Stockton, but it is happening elsewhere in the country, and it is affecting the outcome for our constituents. That problem has to be addressed.
I completely agree with something that all hon. Members who have contributed to the debate, including the hon. Member for Southport, have said, namely that we must try to separate the acute medical care and public health budgets. So often, PCTs set up public health budgets, so that they can work on the long-term inequalities within our communities, but when things get tough and money becomes tight—it seems to happen often in the constituencies that we have heard about today—those budgets are raided. If the public health budget is raided this year, the knock-on effect will last for generations, yet it is happening all the time. I believe that that is due partly to the targets—some bodies are 6 or 7 per cent. behind.
Our constituents and patients do not care about that. What they want is treatment as close to home as possible that is safe and free at the point of delivery. That is a commitment that we must all make. Yes, the funding formula has to be changed. Yes, we have to address inequalities within our communities. I urge those who have not yet read the Health Committee’s report to do so. It is not a Conservative-led Committee, but its report into health inequalities is scathing.
3.49 pm
The Minister of State, Department of Health (Mr. Ben Bradshaw): I congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this important debate. I do not intend to broaden my response to include health inequalities in general; we will have plenty of opportunities to debate those and the Health Committee’s report in the House on future occasions. With regards to the remarks of the hon. Member for Hemel Hempstead (Mike Penning), an hour or so ago a statement was made in the main Chamber during which the Conservative claim that what happened at Mid Staffordshire NHS Foundation Trust was the result of targets was comprehensively demolished—thank you very much—so I shall not respond to that either. Again, there will be plenty more opportunities to do so.
Mr. Mike Hall: Will the Minister give way?
Mr. Bradshaw: Does my hon. Friend mind if I do not? So many Members have made so many points about allocations, and I really want to get to the nub of the debate, rather than have yet another debate about Mid Staffordshire NHS Foundation Trust. The Conservative argument that this is about targets has been totally demolished, as well as denied by the independent Healthcare Commission itself. I hope that that satisfies him.
Let us get to the issue at hand. When this Government first came to power, health spending was just £426 per head, but in 2010-11, it will be £1,612. In December, we announced what PCTs will receive for the years 2009-10 and 2010-11—a total across England of £164 billion. PCTs will therefore receive an average increase of 11.3 per cent. Given the current economic climate, that settlement is extremely generous. At this stage in an economic downturn, it is important to maintain investment, rather than cut it, as has been suggested by other political parties. Our investment means that PCTs and the NHS will have the necessary certainty to plan better services for their patients over the next two years.
I shall turn to how the allocations are set. England is a highly mobile and dynamic society. The size, make-up and demographics of our communities are constantly changing, and the allocation of resources needs to reflect those changes. The formula that decides the allocations is drawn up by the independent Advisory Committee on Resource Allocation, which is made up of general practitioners, NHS managers and academics. ACRA regularly reviews and improves the funding formula to reflect changes in local communities as well as new data and improved techniques, and it is, of course, open to representations, including to those from hon. Members.
The aim of the formula is to ensure that PCTs with similar needs have sufficient funding to commission comparable health services and to reduce avoidable
health inequalities. A PCT’s fair share, as calculated by the formula, is known as its target allocation. The formula is made up of a count of the population served by the PCT, with adjustments made to reflect factors such as the age of the population, the level of deprivation, unavoidable differences in costs, which are known as the market forces factor, and rurality.
The new funding formula takes account of new information, changes in service provision and changes in health outcomes. It builds on, and improves, the previous formula, so that it continues to meet its objectives of equal access for equal need and the reduction of health inequalities. The review of ACRA’s recommendations was comprehensive and led to a number of important changes, including an improved estimation of need. For the first time, that assesses age and other drivers of need together and includes out-patient data and a separate transparent health inequalities formula.
Improvements have also been made to the market forces factor, reducing unrealistic variations between PCTs and hospitals. In addition, population estimates have been moved on to the latest sub-national population projections from the Office for National Statistics. When a new funding formula is introduced, the distance between a PCT’s target and actual allocation will change—PCTs may move from over to under target, or vice versa. It all depends on the relative need of the PCT’s population, as determined by the new formula.
A change in target allocation does not mean that a PCT loses out—far from it. The new formula impacts on a PCT’s funding target, not on the money that it actually receives. We are committed to moving PCTs closer to their fair share over time, but that must be balanced with the need to maintain continuity and stability in NHS funding. If a PCT is under-target, it will benefit from higher growth than others. In this sense, such PCTs actually gain from being under target. What matters most to the public is not distance from target, but the levels of increased funding. For example, at the start of 2009-10, Bassetlaw PCT will be furthest below target, at around 10.6 per cent. under target. Over the next two years, it will receive more than 17 per cent. additional funding, so that by the end of 2010-11, the gap will have been reduced to 6.2 per cent.
Most of the hon. Members who have spoken in this debate live near, or represent, PCTs that will enjoy average, or above average, increases in allocations over the next two years. Cornwall is in the top decile, with 12.4 per cent.; Norfolk has 11.8 per cent.; Stockton has 11.5 per cent., and the PCTs of my hon. Friends the Members for Wigan and for Weaver Vale (Mr. Hall) are both at 11.3 per cent. Although the latter is the average, it is still more than most, because some of the worst-off PCTs, such as Bassetlaw, are getting such big increases.
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