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17 Jun 2009 : Column 396

Julia Goldsworthy: To follow up on my hon. Friend’s points about primary care trusts saying that the cost of providing car parking needs to be recovered, is not the problem that, in some cases, the amount charged for parking is far in excess of the cost, and that trusts are generating an income, rather than simply covering their costs?

Dan Rogerson: My hon. Friend is absolutely right. It is fair to say that different trusts have taken different views. For example, the Plymouth Hospitals NHS Trust, which covers Derriford hospital, has recently undertaken a review, and has introduced much cheaper shorter-stay parking for visitors, which I welcome. The trust consulted widely before doing that. Unfortunately, probably because of the financial pressures that we have discussed, in Truro the situation is different. I do not want to drag the Minister too far into the specifics, but the barrier system introduced there means that people who are visiting for a long period, such as those who are visiting a sick child in the hospital, may pay for 24 hours of parking; however, if they leave the car park, going past the barrier, during the day and come back in the evening, they have to get a new ticket to get back in, although they have paid for 24 hours. That really adds to people’s costs, and if anything can be done to look into that, it should be done.

We have heard a little bit from my hon. Friends the Members for St. Ives, and for Falmouth and Camborne (Julia Goldsworthy), about the issues relating to the new health care provision that is to be allocated to the Falmouth and Camborne constituency. The model is a walk-in surgery for harder-to-access groups. Of course there are issues to address; we have migrant workers in Cornwall, and anything that can be done to make sure that we have adequate provision for everybody is all to the good. However, that proposal will divert resources into setting up a facility that, as my hon. Friend the Member for St. Ives said, is really aimed at an urban area. There may well be a solution that would have worked better in a rural area.

My constituents in Bude-Stratton and Camelford have been waiting for a long time to get decent medical centres in their area. Bude-Stratton is one of the most remote towns in Cornwall. It has been pretty near the top of the list for a new medical centre for a while. It has outgrown its older premises, and campaigners in the area, such as Mrs. Candy Baker, have long fought to make sure that the primary care trust is aware of that. It is below Camelford on the list, and I have arranged a meeting, to be held in a few weeks’ time, at which representatives from the local improvement finance trust company—Community 1st Cornwall—community groups and, I hope, the PCT will come together to talk about that situation. However, we have done that before, and we are not that much further forward. Of course, in those communities, there may be land and planning issues that delay matters, but the resources that are being put into the sort of centre that my hon. Friend the Member for Falmouth and Camborne spoke about may well have helped to overcome some of the problems, and might have taken us further forward in health care provision.

My hon. Friends the Members for St. Ives and for Falmouth and Camborne have raised crucial issues about accountability, which is not just about people
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having confidence in the system as a whole, but about their being able to influence where those resources are used and how they are spent locally. My hon. Friend the Member for Falmouth and Camborne and I are on the Local Democracy, Economic Development and Construction Bill Committee, which has had great discussions about the use of petitions. Upper gastrointestinal surgery, to which both hon. Friends have referred, is an example of an issue on which people are petitioning anyone whom they can think of, because they are not quite sure where the accountability lies. Despite having gone through the processes, and having become far greater experts on health funding than many hon. Members in this House—campaigners become experts during the course of their campaign—those campaigners will probably feel that they do not have the influence over decisions that they would like. That is a problem for us all.

My hon. Friend the Member for St. Ives mentioned midwifery services. The situation is exactly the same in North Cornwall. As the father of three children under the age of five, all of whom were born, by Caesarean section, in the Royal Cornwall hospital in Truro, I am well familiar with the services, and the excellent work that the staff there do. However, looking at the period covering those three deliveries, I have to say that I have noticed that the staff are perhaps a little more stretched than they were when my eldest son was born in 2004.

Community midwifery services have played a fantastic role. Arwen Folkes has driven forward the “real baby milk” campaign in Cornwall, and I think that it is being rolled out in other trusts across the country. She very much welcomes the opportunity to work alongside midwives to provide that service. Sure Start benefited in North Cornwall from having a midwifery service, but it has had to be withdrawn because of the overstretch in midwifery. I hope that that issue can be resolved.

Finally, I refer to mental health. We could spend a whole evening discussing that. The Cornwall Partnership Trust has had to deal with problems relating to learning disability, but it is now moving beyond them. I have had the privilege of seeing a number of new facilities that it has opened, which is good, but the community services in particular are extremely overstretched. The fundamental problem is that resources have had to go into the Royal Cornwall hospital at Treliske. Until the financial situation is resolved, the partnership trust will not be able to deliver the sort of community mental health services that we would like to see.

6.20 pm

The Minister of State, Department of Health (Mr. Mike O'Brien): I was wondering how long it would take before I was called to speak. The hon. Member for St. Ives (Andrew George) put his argument fairly. Essentially, he said that the area had received a significant increase in funding, but it was not enough. I have a great deal of sympathy with his case. The Government clearly have a funding target. It will take time—I shall explain why—to reach that target.

The hon. Gentleman argued the case well. It is incumbent on the Government to ensure that we put in place the right formula and the adjustments that that requires. Both increases and, as he rightly said, decreases over time for some areas, or at least smaller increases than they might have expected, need to be phased in. As everyone knows, there is no unlimited pot of money. The Government have tripled the funding going into
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the NHS, and the hon. Gentleman rightly welcomed that. However, we must ensure that funding is properly managed. Very often that is done at a local level.

The funding formula needs to be reviewed from time to time. As the hon. Gentleman rightly said, the review was overdue, but it has now taken place. Part of the formula was set by the previous Conservative Government and it was enormously unfair to certain areas. We have put that right, which will result in Cornwall getting more money, as he recognised. He put his case fairly, as did the hon. Member for North Cornwall (Dan Rogerson).

The hon. Member for Falmouth and Camborne (Julia Goldsworthy) indulged in a bit of party political knockabout. Somewhere in the knockabout were a few serious points, but when she got to them, they struggled to get out. One thing on which I agree with her is that it is important that we congratulate NHS staff on their dedication and hard work. They are improving the quality of services in Cornwall and across the country, and they are working hard to do so.

As medical science continues to advance, the NHS becomes capable of ever more extraordinary feats of clinical care. For some complex procedures, well-equipped and well-staffed specialist centres are more effective. There, round-the-clock consultant and specialist nurse expertise can be assured and expensive technology can be concentrated. An increasing amount of care is happening in the NHS, and much of it is out in the community in GP practices, health centres and people’s homes, with more complex, specialist or emergency care concentrated in a few more specialist centres. However, Ministers or civil servants in Whitehall do not decide the organisation of local health care. It is decided by local health care professionals on the ground. Organisational changes must be based on medical grounds and what is best for local patient care.

Finance is one of the key issues. The NHS has benefited from an unprecedented growth in finance. When the Government first came to power, health spending was just £426 per head. In 2010-11, it will be £1,612. In 2009-10 and 2010-11, primary care trusts will be allocated £164 billion. That means that, on average, PCTs will receive an increase of more than 11 per cent.—actually, 11.3 per cent.—or an extra £8.6 billion. The people who are best placed to make decisions are those closest to it, and more than 80 per cent. of the entire NHS budget is now in the hands of local PCTs—a higher proportion than ever before, under any Government.

Andrew George: Will the Minister give way?

Mr. O'Brien: I shall, but I was just going to go on to the hon. Gentleman’s precise point, so I shall happily give way in a moment.

The hon. Gentleman’s point was about the formula, and the independent Advisory Committee on Resource Allocation is made up of GPs, NHS management and academics. It developed the fair funding formula to determine each PCT’s share of resources, and the new funding formula has been used for the 2009-10 and 2010-11 allocations. It takes account of the new information and builds upon and improves the previous formula so that it continues to meet the objectives of equal access for equal need and the reduction of health inequalities. The review leading to ACRA’s recommendations was comprehensive and led to important changes.

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When a new funding formula is introduced, the distance between a PCT’s target allocation and its actual allocation will change. Its actual allocation may move from being over-target 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 affects a PCT’s funding target and not, initially, the money that it actually receives. We are committed to moving PCTs closer to a fairer share over time.

I know that the hon. Gentleman feels that his local PCT should have been moved more quickly towards its target, and that is a fair point. However, there must always be a need to balance continuity and stability in NHS funding. If a PCT is under-target, it will benefit from higher growth than others. The amount that local PCTs, such as his, receive will increase at a higher rate than it will for those that are in the opposing position and being paid over-target.

What matters is not the distance from target but the levels of increased actual funding. I know that there is a historical issue as a result of the very issues that the hon. Gentleman raised, but to rectify any alleged underfunding would effectively mean reopening all the previous allocation rounds, and we are not in a position to do that. We must recognise that we are where we are and have to have a fair and reasonable funding formula for the areas to which it applies. Furthermore, we must not in any way undermine the stability of NHS funding and long-term planning, either in areas such as his, which benefit from the new criteria, or in areas that do not receive the increase that, up to now, they had expected.

Andrew George: I am very grateful to the Minister for giving way. I think that I acknowledged in my opening remarks much of what he has said. I have two questions. First, he said that the PCTs were taking the relevant decisions, and he described that as in some way local. However, those people are appointed indirectly by the Government and are not accountable to the local community, so I should welcome his thoughts on whether Cornwall might be one of the pilot areas where more local decision making takes place.

Secondly, on the formula itself, I acknowledge that Cornwall’s allocation is going up not by 11.3 per cent. but by 12.4 per cent., which is clearly welcome and above the national average. However, it is only a small degree above, and the county will take years to get even close to its target. Does the Minister not agree that some of those national programmes, such as the alternative provider medical services roll-out, the independent treatment centres and so on, involve decisions that would be far better taken in the local community by local people, and that it would be far better to apportion that money in order to move PCTs much more quickly towards their target?

Mr. O'Brien: On the question of PCT members, the hon. Gentleman is aware that an independent appointments commission deals with such matters. Ministers do not determine who joins those committees, and the aim is that, wherever possible, people should be appointed locally. I take that view and encourage the appointments commission to ensure that people are genuinely local
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and have lived in the area at least for a period. That does not always happen, but that is because the commission is trying to get a balanced membership.

One party will say, “Cut this and provide increases for that”; that is always part of political debate. The key point is that as a result of the Government’s changes, the hon. Gentleman’s PCT is looking at larger funding increases than those for many other areas of the country. The PCT funding allocation for Cornwall and the Isles of Scilly is £808.4 million for this financial year and £856.2 million for 2010-11; in 2006, it received £1,227 per head and it received £1,488 per head this financial year. Furthermore, it will receive £1,558 per head next year.

There will be a steady improvement in the PCT’s finances. The NHS in Cornwall is relatively healthy. Staff there are working enormously hard and making an enormous contribution. The funding for them is increasing; they can look forward to that increase as a result of the decisions made following the review. The draft end-year accounts of the hon. Gentleman’s PCT and acute trusts show surpluses of approximately £5.6 million and £2 million respectively, so there is still some latitude in the budgets. However, I appreciate that some PCTs want to put aside cash and roll it over to fund particular projects later.

Andrew George: I am not begrudging the increases that the Minister has just mentioned; indeed, I welcomed them in my opening remarks. However, the proportion of funding available to Cornwall and the Isles of Scilly is still significantly distant—6.2 per cent.—from its ultimate target. The acute trust is clearly not just in a recurring balance; it is also paying back some of the historic debt. The Minister may argue that the situation is due to past mismanagement—not that local communities made the decisions—but the fact is that Cornwall has been chronically underfunded in comparison with the rest of the country, and that is clearly the primary cause of the pressure on mental health, dentistry and other services there. It would be helpful if he acknowledged that that is a likely outcome of a long period of historic relative underfunding.

Mr. O'Brien: The hon. Gentleman and I could stand here and knock seven bells out of the previous Conservative Administration, saying that their funding formula was awful and that they are to blame for a lot of the problems in the health service. We can both agree on that, but I am not sure that it will take us very far. We have to deal with the current problems. The situation is not just one in which the Government can decide to give a lot of extra money to one area; the funding is allocated. The issue is devolved and pushed down to the PCTs. If we take funding from one area to give to another area such as Cornwall, we will create problems for that first area.

The best way of managing the situation is by making it clear that we recognise when there is a strong and good case, and we have been clear that Cornwall has a good case. We have acknowledged that and increased the funding steadily to bring it up to the target that we want to hit, without damaging other areas. We want to make sure that the issue is addressed over a period of time. We can rehearse this argument time and again, but that is essentially how the Government approach it. Such an approach is a perfectly reasonable way to ensure NHS funding stability.

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Andrew George rose—

Mr. O’Brien: I give way for the last time.

Andrew George: I am grateful to the Minister; he is being extremely patient, and I appreciate that.

Of course, one’s view of reasonableness depends on from which end of the telescope one is looking at the matter. The Minister says that things will happen “over a period of time”. How long does he anticipate that it will take for Cornwall and the Isles of Scilly ultimately to reach these targets at the current rate of progress?

Mr. O’Brien: I cannot give the hon. Gentleman a precise period. Assuming that we stay in office and the other lot do not get in—sadly for him, I am not talking about his lot—we will steadily increase NHS funding. We all know about the issues in relation to the wider political debate and the fact that the main Opposition party does not have a good record on the NHS, so it depends to some extent on what happens in the future. However, we are committed to moving towards the targets. We accept the funding formula that has been agreed, and as a result, over a period of time, Cornwall will steadily benefit from those changes.

The hon. Gentleman raised several other issues apart from finance, including dentistry and midwifery. On midwifery, Cornwall and Isles of Scilly PCT has invested an extra £1.6 million in maternity services in the three years from 2008-09. Women in Cornwall ought to have the choice as to where they have their baby, whether at a midwifery-led unit or at home, and in the years ahead we want to ensure that they do have that choice. He says that it is not always available, but in my experience that is sometimes because people have not been informed or simply do not know that they have a degree of choice about where they can give birth. There is a real need for better information and better engagement with local communities. We need to ensure that PCTs are out there telling people about the choices that they can have. Sometimes those choices are not exercised for the convenience of the system—because it is easier, safer and so on to have children in hospitals, or so some think. Choice should be given to women, and it is important that it is available and publicised.

As for dentistry, people in Cornwall are still unable to access an NHS dentist as quickly as they would like. The latest figures show that Cornwall and Isles of Scilly PCT saw fewer patients in the past two years than the national average. I can see that there is an issue in that regard, because that represents 51 per cent. of the population as against 53 per cent for England as a whole. The PCT knows that access to NHS dentistry is an important issue for it. In 2007, it produced an oral health strategy, and it is working further to grow its services and to promote oral health. We can already see the difference being made. In March 2008, the PCT had 1,800 patients waiting for an NHS dentist; now, there are only 160 patients. That is 160 too many, but progress is being made.

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