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Martin Horwood (Cheltenham) (LD):
I join others in welcoming the Bill and congratulating the hon. Member for East Surrey (Mr. Ainsworth) on promoting it. It can be very important in accelerating the development of renewable energy, particularly microgeneration. The Minister is right that it enjoys broad cross-party support in the House. The fact that the Government support it is welcome. Occasionally, Private Members’ Bills have to be watered down to enjoy Government support, but I am pleased to say that my assessment is that that is not the case with this Bill. I know that that is also the
assessment of the hon. Member for East Surrey. The Government have accepted all the important principles of the Bill and the key measures in it.
May I correct the Minister on one small matter? I do not believe that the Bill just relates to wind turbines and air source heat pumps. It has a much broader spread, and issues relating to micro-hydropower, which my hon. Friend the Member for Somerton and Frome (Mr. Heath) raised, are quite important. Certainly we can happily discuss them in Committee. We on these Benches wish the Bill well, and we would like the resolution to be passed without opposition.
5.23 pm
Mr. Peter Ainsworth (East Surrey) (Con): I thank the Minister for moving the motion, and I welcome him to his new responsibilities. He has an honourable track record on green issues, so it is good to see him in his post. I hope that he will have much influence on Government thinking on these matters. I also thank other hon. Members for their kind words.
There has been no attempt to water down the provisions that I am seeking to introduce. Speaking of water, I am afraid that there is a problem with introducing measures on micro-hydropower into the Bill. However, I hope very much to work with the Government and Liberal Democrat Members to put that problem right in another way at another time. I have no doubt that we will return to the matter during the Committee stage.
Business without Debate
Delegated Legislation
Motion made, and Question put forthwith (Standing Order No. 118(6),
That the draft Work and Families (Increase of Maximum Amount) Order 2009, which was laid before this House on 4 June, be approved.— (Mr. Blizzard.)
European union Documents
Motion made, and Question put forthwith (Standing Order No. 119(11)),
That this House takes note of the two unnumbered explanatory memoranda from the Department for Environment, Food and Rural Affairs dated 6 May 2009 concerning the placing on the market, in accordance with Directive 2001/18/EC of the European Parliament and of the Council, of maize products (Zea mays L., line Bt11 and Zea mays L., line 1507) genetically modified for resistance to certain lepidopteran pests; and supports the Government’s view that all the requirements of the Directive have been met in relation to these products and that their proposed authorisation for cultivation should be granted.— (Mr. Blizzard.)
NHS (Cornwall and the Isles of Scilly)
Motion made, and Question proposed, That this House do now adjourn.— (Mr. Blizzard.)
5.24 pm
Andrew George (St. Ives) (LD): I am delighted to have secured the debate, but I am sorry that the Minister whom I understood to be responding is not yet in his place—doubtless that will be put right shortly. The subject of the debate is important. [ Interruption. ] I am pleased that the Minister is now in his place and I welcome him to his new post.
The subject has significance beyond the geographical designation in the title of the debate. Many places other than Cornwall and the Isles of Scilly experience similar problems in that they suffer significant health inequalities in comparison with the national average and deprivation in terms of the population’s income profile. The geography of a peninsula also presents problems, and I believe that Cornwall and the Scilly Isles are further from target than anywhere else in the country, in the Government’s view.
We are grateful to the Government for ensuring that the Advisory Committee on Resource Allocation studied, over several years, every aspect of the NHS formula for the allocation and weighted capitation of funding to every primary care trust in the country. Consequently, there is a welcome uplift in the funding for Cornwall and other places. However, although Cornwall will receive a 12.4 per cent. increase as a result of the acknowledgement that it is significantly more underfunded than the Government recognised previously, it will still be 6.2 per cent. below target at the end of the current two-year cycle of NHS funding. That is as far as the Government will allow any PCT to be by that stage—the end of March 2011. Although the increase is welcome, it raises issues about which the Minister must, I am sure, be aware.
It is probably also worth pointing out that the problem has not arisen overnight. I have already congratulated the Government on ensuring that the Advisory Committee on Resource Allocation undertook a thorough review. However, Cornwall and the Isles of Scilly NHS services have long suffered from the underfunding arising from the funding formula that the Conservative Government originally introduced. It has taken such a long time to get around to addressing that underfunding, which has affected the poorest region in the UK.
As the Minister would expect, all the Cornwall Members of Parliament have campaigned for many years to ensure, first, that there would be a review and, secondly that it would be robust and thorough. It acknowledged that the revised formula should be introduced at the beginning of the financial year. However, that leaves Cornwall with funding that is £56.5 million below what the Government have identified should be its allocation.
In preparing for this debate I looked at the funding for other parts of the country. To be fair, there are areas in Norfolk, Nottinghamshire, Derbyshire and Lincolnshire where funding is 6.2 per cent. below the target, but where it is also marginally above Cornwall’s gross level of underfunding, because of the size of the PCTs by which those areas are served.
Julia Goldsworthy (Falmouth and Camborne) (LD):
Will my hon. Friend put the level of underfunding into perspective, perhaps by giving an indication of the
debts that the Royal Cornwall Hospitals NHS Trust has accumulated over a number of years and saying to what extent just giving Cornwall the funding that the Government’s formula says it needs would help to address that long-standing problem?
Andrew George: I am grateful to my hon. Friend for raising that point. She has been a champion for the NHS in Cornwall. It is as a result of the teamwork among Cornish MPs, in bringing the case to the Government and ensuring that the message is heard loud and clear, that we have made so much progress, although we obviously still have a great deal of progress to make.
The figure of £56.5 million for underfunding in the financial year 2010-11 stands in contrast with the position in 2006, when the Royal Cornwall Hospitals NHS Trust was placed in special measures, after it was discovered to be more than £15 million in deficit. That figure for debt changed rapidly to £32 million, as a result of the resource account budgeting system, which the Treasury insists that Departments put in place, and, later that year, to £57 million, as a result of an estimate of the commitments that the trust had already made.
We are still awaiting a review this year of where the trust is now. We are reassured by the messages from the trust that it is not only in recurring balance, but doing its best to retrieve the situation financially. However, as my hon. Friend rightly pointed out, there is the question how a trust can get itself into such a position of underfunding when the Government and their advisory committee have acknowledged that for all these years—one might argue for at least the last decade, because that is how long we have been campaigning to get the formula changed—we have been underfunded by the equivalent of the debt that, under its worst interpretation, the trust has faced. That is a significant issue.
In 2006, when the trust’s debt was first identified, it was placed in special measures and given support from the Department of Health. The chief executive resigned and initially—certainly in the first year—the trust went through a period of what I would describe as panic-laden decision taking to try to recover the financial situation as quickly as it could. Since then, the trust, under the Department’s close guidance, has had a turnover of five chief executives and five chairmen.
I am not prepared to comment on individual cases, but since the fact that the trust faced serious financial problems was first identified, issues have arisen that are clearly not the responsibility of the local community. One of the themes that I want to draw out from this evening’s debate is the importance of establishing a system of NHS delivery in local communities that is far more accountable to those communities than has hitherto been the case in Cornwall and the rest of the country.
I know that Ministers use the language of encouraging greater localism and greater local decision making on the priorities relating to the allocation and spending of NHS resources, but in Cornwall we have experienced the serious problem of too much micro-management from Richmond House and, arguably, from the strategic health authority. That has clearly not contributed to a calm situation that would allow the kind of decision making that Cornwall has needed over the period in question.
Martin Horwood (Cheltenham) (LD): My hon. Friend has identified an incredibly important subject. In 2006, we in Gloucestershire also found that the level of accountability to the local population for some of the drastic decisions that were taken was not very high. We are still fighting to restore services, such as the overnight children’s services at the Battledown children’s ward in Cheltenham, that were lost in those cuts. Does he agree that, in looking for cost savings and greater accountability, we might consider the future of the strategic health authority for the south-west as a whole as a possible area for economy and improved accountability between the Government and the local people?
Andrew George: I am grateful to my hon. Friend for raising that issue. Government quangos and departmental bodies are making decisions that are vital to the local communities that benefit from these crucial services, yet the people in the communities have very little influence over those decisions. Most people in my area are pretty cynical about the consultation exercises and believe that they are merely a process of public window-dressing before a decision that has already been made is implemented.
Julia Goldsworthy: Is not that exemplified by the fact that people are not consulted on two different possible outcomes? Rather, the consultation is simply an exercise in providing information. Does not that devalue the process of consultation altogether?
Andrew George: The Minister is certainly listening, and nodding at some of these points. I do not know whether he is in partial agreement, or whether he at least agrees with the sentiments being expressed. Perhaps there is a potential for finding some common ground on the points that we are raising.
I took part in a debate on these issues on 18 March 2009 with the Minister’s predecessor, the right hon. Member for Exeter (Mr. Bradshaw), who is now the Secretary of State for Culture, Media and Sport. The broad issue of the allocation formula was debated at that time. The Minister said that 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.”—[ Official Report, 18 March 2009; Vol. 489, c. 285WH.]
One of the big issues for Cornwall and the Isles of Scilly is the impact of the market forces factor on the allocation of funding. That element of the funding formula seems to suggest that, because wage levels are low in Cornwall, we deserve less money. The argument seems to be that, because the market circumstances are somewhat lower, we deserve less funding. I was pleased that, as a result of the academic study by the consultant body, that issue was reviewed and put right.
Many in our communities feel that the Government should move much more quickly to allow PCTs that are below target to move more rapidly to meet their target. The response of the right hon. Member for Exeter was that
“moving faster over the next two years would result in painful cuts to services”.—[ Official Report, 18 March 2009; Vol. 489, c. 286WH.]
He went on to identify a number of PCTs, mostly in London and the south-east, with allocations over target, whose resources would be cut over a period, resulting in painful decisions having to be made. I sympathise, and
if I were the MP representing those areas, I would argue strongly that those changes should not be made—or at least not in a precipitate way that might undermine services. That option might not necessarily need to be taken.
In the chief executive of the local PCT in Cornwall, Ann James, the Minister has a very loyal advocate for the Government and the Department. In preparing for this debate, I asked for her opinion on our distance from target and on the impact of Cornwall’s underfunding on the ability of the local NHS to ensure that services were adequate. She told me that the local PCT, even at this distance from target, had been able to make tremendous advances in health care. She said that it had received more than £400 million of extra funding over the past four years; £2.5 million had been invested in NHS dentistry, resulting in a cut in waiting lists; £1.6 million had been invested in maternity services; and a new GP-led health centre was being built in the constituency of my hon. Friend the Member for Falmouth and Camborne (Julia Goldsworthy). Ann James also mentioned further investment in a number of other services in Cornwall, which I shall come to in a few moments.
The Minister should recognise that this is not just special pleading on behalf of Cornwall, as there is a reasonable case to be heard. Simply saying that funding for areas that are clearly suffering from underfunding cannot be raised because of the potential impact on other areas is not good enough. The Government have been able to sink substantial amounts into an IT project, including the choose and book system, at a cost of £12.4 billion. Another example is the £150 million spent on the roll-out of what some people call the “super-surgeries” as alternative providers of medical services—or “polyclinics”, as some prefer to call them, although I know that the Minister’s Department does not like that term and calls them something different.
Local PCTs have had to deliver in their own areas a number of centrally driven or centrally funded top-down initiatives. Whether such decisions relate to independent treatment centres or the other projects I have mentioned, my argument is that they would be far better taken in communities such as Cornwall, where the services that people are concerned about might be enhanced—and more effectively than by the initiatives from Richmond House. There is scope for argument there, and I suspect that the Minister will disagree, but the matter needs to be considered.
The impact of underfunding on services is very clear. It leads to pressures on staffing levels in acute services. As I witnessed myself, that can be dangerous. Staff levels on some wards really need to be looked at. I was fortunate a couple of years ago to have the opportunity to shadow nurses on four wards at the Royal Cornwall hospital in Truro and the West Cornwall hospital in my own constituency. I was seriously concerned about staffing levels, and particularly about the ratio of staff to the acuteness of the cases that needed to be dealt with. I was also concerned about bureaucracy, form filling and targets, which staff had to chase up at the same time. There were a number of issues of concern.
West Cornwall, a very small hospital in my constituency about which the local community rightly feel extremely passionate, has experienced a rollercoaster of emotions in recent years as a result of panic-laden decision making. Uncertainty and anxiety about the true future of the
hospital and the services available to local patients have been a predominant theme. As I said, the trust has undergone a large number of changes of chief executives and chairmen, and is still struggling to recover from decisions that were made only a couple of years ago.
Cornwall has one of the most threadbare NHS dentistry services in the country. I was privileged to be able to invite the chairman of the independent review body, Professor Jimmy Steele, to see what was going on in Cornwall back in February, in the early days of his inquiry. He told me this week that his report would be published next week, and we look forward to reading it.
Most adults in Cornwall simply assume that they will never be able to get on to an NHS dentist’s list—at least, I was going to refer to such a list, but obviously people do not register with NHS dentists nowadays. It is incredibly difficult to arrange to be seen by an NHS dentist. It is not just a question of access, although on a long, thin peninsula there are no alternatives in the form of other PCTs or health services, and as my hon. Friend the Member for Falmouth and Camborne knows, the further west one goes the worse the position is. There is also the perpetual uncertainty. We can be pretty sure that for every new NHS dentist whose arrival in one of the towns in my constituency is trumpeted, another will jettison NHS patients or go private within months, if not weeks, because of the pressure that dentists feel that they are under.
Julia Goldsworthy: I am grateful to my hon. Friend for being so generous in giving way. Does he agree that the contract is making the problem of access even worse? I visited an entirely NHS-run dental surgery in Mylor—the only dental surgery in Cornwall that is accepting new NHS patients. Because of the contract and the illness of one of the dentists, the practice had spare capacity which it had to fill by the end of the year. It took on a new dentist and a number of new patients, but the position is no longer sustainable, and it faces having to close its doors to new patients and make an NHS dentist redundant.
Andrew George: As I suspect the Minister will hear when Professor Jimmy Steele reports next week, that is a common theme, and I hope that the Government will reflect on it.
The Select Committee on Health largely precipitated the demand for an inquiry by encouraging the then Secretary of State to call for one, and I congratulate the then Secretary of State on doing so. It was clear that the Government would have to review the impact of the new contract that was introduced in April 2006. Many members of the profession had warned the Government about its potential impact. In places such as Cornwall and, no doubt, Gloucestershire, it resulted in perpetual uncertainty.
Andrew George: No doubt my hon. Friend is about to say the same about his area.
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