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22 Jun 2010 : Column 40WHcontinued
Mr Iain Wright (Hartlepool) (Lab): I want to reiterate what I said earlier in an intervention and congratulate the hon. Member for St Ives (Andrew George) on securing what I think is a very important debate; it is important not only in the south-west but across the country.
I also want to congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on what I think might be her maiden speech, although I am not entirely certain that it was. [Laughter.] I imagine that she will be as tenacious as the hon. Member for St Ives, her close parliamentary neighbour, in ensuring that she stands up for the interests of her constituents.
I want to make two or three key points about health funding issues that are affecting my constituents. The first point relates to something that the hon. Member for St Ives said; he has obviously done his homework and knows his brief incredibly well in this area. As he said, despite great improvements in recent years Hartlepool primary care trust is still some distance from its funding target. It is about 4.3% below its funding target, which is about £7.7 million. In the last two years, 5.5% more funding was provided year on year, but we still have some considerable way to go. I just want to press the Minister on the question asked by the hon. Gentleman-how far and how fast can we move to get to the funding target for deprived areas such as Hartlepool?
The second issue that I want to mention is access to health care and funding for health-care-related transport. The hon. Member for Truro and Falmouth made a telling point about how important it is that people should have access to transport in rural areas, to enable them to access health services. I certainly have that situation, to some extent, in my constituency. Hartlepool is a very urbanised constituency-one of the most urbanised in the country. However, we have outlying villages, such as Dalton Piercy, Elwick and Greatham, which I am thinking about in particular. In the last 12 months or so, Greatham's nurse-led clinic has been closed, largely on clinical grounds rather than because of cost-cutting exercises. Nevertheless, I think that finance has still had a role to play. I have tabled a number of parliamentary questions about the provision of nurse-led clinics in rural areas and the Government, in their written responses, have said that they are very much committed to those clinics. But I want to know from the Minister what extra assistance will be given to residents of Greatham and other rural areas, which can really
help communities to have access to health care-both preventive health care and care related to reactive clinical outcomes.
The third issue that I want to mention is the appalling health inequalities that we still have in Hartlepool, despite the improvements that we have made in recent years. A person is more likely to die earlier if they live in Hartlepool than if they live anywhere else in the country, with the possible exception of Easington, which is next door to Hartlepool. In certain parts of my constituency, particularly Stranton ward, the difference between the local life expectancy for men and the national life expectancy for men is 11 years; a man living in one of those parts of my constituency will die more than a decade earlier than if he lived in other parts of the country. That issue needs to be addressed, not only through funding but through reconfiguration of services so that they are really patient-led.
That brings me to my final point, which is my most relevant point at the moment. It is about the announcement made by the Chief Secretary to the Treasury on the Floor of the House last Thursday about the cancellation of the £464 million new hospital for North Tees and Hartlepool. That hospital was something like a decade in planning; it was not thought up in the last two months before a general election campaign. There has been an awful lot of pain with regard to reconfiguration of health services in Hartlepool. The issue dominated the by-election that I won to come to this House. It has been extremely painful for the community to get to this position, but with one swift swish of a pen we are back to square one, with no real vision about where we go to for hospital services north of the Tees in my area. With the co-operation of neighbouring primary care trusts, we are embarking on what is known as the momentum programme, whereby we are pushing services closer to the community. That has an impact on health funding allocation. What reassurance can the Minister give that we will receive additional services and additional resources, so that the momentum programme can go further and faster in pushing health care into the community?
Also, with regard to the cancellation of that hospital and with regard to the idea that we do not have a plan B-there is nothing in place-can the Minister provide me with a degree of reassurance that support will be able to maintain the existing North Tees and Hartlepool hospitals? Is that the way that his Department is suggesting that we are going? If so, that would be at odds with the clinical recommendations from the independent reconfiguration planning of a number of years ago. It was recommended that we should have a new world-class hospital, which could serve the communities of Hartlepool, Easington, Stockton and Sedgefield.
I hope that the Minister will agree to meet me and my neighbouring MPs, so that we can discuss these issues and ensure that the health inequalities and the uncertainty that has been created by the announcement last Thursday can be addressed; so that the concerns of my constituents and those of people in neighbouring constituencies can be addressed; and so that we can really begin to address health inequalities in the north-east.
Diana R. Johnson (Kingston upon Hull North) (Lab):
It is a pleasure to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for St Ives
(Andrew George) on securing today's debate. From my reading in preparation for the debate, I know that this is an issue that he has taken up over many years during his time in Parliament and that he is a very committed campaigner for health funding for his local area and the wider area of Cornwall. I welcome the Minister of State, Department of Health, the hon. Member for Chelmsford (Mr Burns), to his role and wish him well in his new position.
It has been very interesting to hear the contributions of the two Members who have also spoken in the debate today, the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Hartlepool (Mr Wright). As my hon. Friend said, I want to congratulate the hon. Member for Truro and Falmouth on her maiden speech, if that is how it is going to be seen. Like the hon. Member for St Ives, she is making a very strong case for her constituents and ensuring that there is an advocate for them in this House who stands up for the real health funding that is required for people in her constituency.
It was also very interesting to hear what the hon. Member for St Ives said about some of the different criteria that have been used to allocate funding and about some of the tensions that exist when one looks at some of those criteria. I hope that I shall have an opportunity to say a few words about those tensions shortly.
My hon. Friend the Member for Hartlepool made some very pertinent points about the need to get to the target for health funding for primary care trusts. I noted that he said that his constituency was 4.3% below the funding target. As a result, I had a quick look to see where my primary care trust was in terms of being on target. It is actually 6% below target, so we are just above the group of PCTs that the hon. Member for St Ives referred to, which are 6.2% below the funding target.
It was also very pertinent to raise the issue of access to health services, and of course there is a funding implication to that issue. If we want to have services out in the community, there is a need to look at how funding is allocated and at the issues related to health inequalities. It is not acceptable that there are still parts of this country where the mortality rates show that men in particular will live for fewer years than men born in the south of England. I know that in the north there are real concerns about that issue.
Very importantly, there is also the issue of hospitals and capital funding. I know that that is mainly about PCTs' revenue funding, but we need to keep an eye on what happens to capital funding. Of course, the hospital at Hartlepool that my hon. Friend the Member for Hartlepool mentioned has been in the planning for a very long time and there has been a huge investment in it, through the PCT and other people and other organisations in that area ensuring that it was really going to deliver for local people.
Therefore, I am particularly concerned about the cancellation of that hospital, especially in the light of the reassurances that were given by the new coalition Government that the cuts that they would make this year would not to be to front-line services and that, as I understood it, they would protect hospital builds. So it would be very helpful if the Minister could say a little
more about his view of how the cancellation of the Hartlepool hospital fits in with the agreement not to cancel front-line services.
The main thrust of the debate is the funding of health services in Cornwall, and I have looked with interest at what the hon. Member for St Ives has said about it previously. Today I also had a quick look at his website, where he trails the debate and says that he is looking to secure an additional £56 million of funding for his area. He also says:
"The Conservatives created a system of endemic underfunding. Now they are in Coalition they can put this right."
The press cuttings prepared by the Library for the debate also include an article from The West Briton of 10 May, in which he says:
"The coalition is already starting to deliver many outcomes which Cornwall has craved."
I admire his positive view of what the new Government will deliver for him and his constituents and I very much hope that he is correct.
What the coalition Government have said so far about the NHS is quite limited. Section 22 of the coalition agreement sets out their priorities for the NHS, and the first bullet point says:
"We will guarantee that health spending increases in real terms in each year of the Parliament".
Paragraph 21 of the revision to the operating framework for the NHS in England for 2010-11, which was published just yesterday, reiterates that commitment, and I have just heard the Chancellor of the Exchequer make it clear in the Budget debate on the Floor of the House that the commitment remains.
Of course, that is just the headline, and we do not actually know what it will mean for services in the NHS in England in the coming years. Obviously, the Minister will be working hard on the comprehensive spending review over the summer months. He will be looking at how he can make sure that his Department secures all the resources that it needs to ensure that the view of the hon. Member for St Ives that he will get his £56 million comes to fruition. The written reply to a question that the hon. Gentleman tabled to the Minister contained a commitment just to increase spending
"in real terms in each year of the Parliament."-[Official Report, 7 June 2010; Vol. 511, c. 47W.]
We really need to have the detail. I accept that it is very early days for the Minister, who has been in office a few weeks, and that the coalition Government are still trying to sort out their policies on NHS funding.
The hon. Member for St Ives made a clear and effective case for raising the funding for his constituency and primary care trust. There have been many written questions and debates on the issue, and I pay tribute to everybody who has been involved in the campaign to get additional resources into the primary care trust and into Cornwall. I also pay tribute to the staff, who are working hard day in, day out with the resources that they have.
Funding is obviously a key issue. The hon. Gentleman has given us quite a detailed canter through the historic reasons why we are where we are on funding, which was very interesting, but many of the views about why there is underfunding in certain constituencies and areas point to the 1970s as the time when allocations perhaps
did not work in quite the way that they should have. That is the view that comes out of the debates and explanations about the current funding criteria.
At this point, it is worth reflecting on how the NHS has changed over the years. Patients now want access to high-tech, specialist services with the best nursing and clinical advice. There is also a tension around the fact that people want services much closer to home-in their local GP surgeries or at home if at all possible.
The Minister of State, Department of Health (Mr Simon Burns): I was just reflecting on what the hon. Lady said before she got to this section of her speech. I must gently remind her that her party was in power for 13 years and introduced the funding formula that the hon. Member for St Ives (Andrew George) is complaining about. Having put that on the record, I beg to ask why the last Labour Government did nothing in those 13 years to remove the problem facing Cornwall and the Isles of Scilly.
Diana R. Johnson: I am grateful that the Minister intervened on me, because I am coming to that. I recognise, as the hon. Member for St Ives probably does, that where we are today might not be perfect, but the previous Labour Government made huge strides in terms of putting money into his area and others that were underfunded. The statistics show that there have been significant improvements since 2003-04, when some PCTs were 22% below target; now the figure is 6.2%, so there has been movement. I am not saying that everything done under the Labour Government was done as fully as we would have liked, but it would be interesting to hear what plans the Minister has to target the pace of change and how soon he feels we will reach the target level for all PCTs. We have to recognise, as I am sure the hon. Member for St Ives does, that taking money from other areas of the country in one fell swoop is not the best way to have a stable national health service.
Andrew George: If the hon. Lady rereads what I said earlier, she will see that I very much acknowledge that. Just to reassure her and, indeed, the Minister, let me say that it was in fact 1980 when the impact of the market forces factor changed quite significantly and created the detrimental impact that I described. Yes, I did make some disparaging remarks about the then Conservative Government and I welcomed the additional funding that the Labour Government put in, which I voted for and the Conservatives did not; that is a matter of record. However, I simply urge the hon. Lady to recognise that the formula change, which I fully applaud the last Labour Government for introducing, puts a responsibility on whichever party is in government to ensure that underfunded areas receive their target funding as quickly as possible.
Diana R. Johnson: We can probably agree that history is history. We are where we are today, and we need to make sure that we move forward as quickly as possible to get to the point that we all want to be at-an NHS that is funded fairly across England and that addresses some of the issues that the hon. Gentleman raised about rural constituencies and rural areas.
I want to address the rural nature of the hon. Gentleman's constituency, the primary care trust and the patients that it serves. The issue of islands and peninsulas is also quite unusual, and few primary care trusts have to deal with it, so there needs to be some recognition of that.
Clearly, the influx of people during the summer months must swell the demands on the national health service; all that must be recognised and factored in. There is also the issue of poverty. There can be pockets of poverty in rural areas; they are not just in urban areas, although we recognise that there might be different solutions to poverty in different parts of the country.
Let me reiterate that 80% of NHS spending is at primary care trust level, which means that the best solutions for an area can be put forward, debated and agreed at that level. I want to remove the myth that seems to exist that everyone is being told that certain areas have to do things in a certain way. That is wrong. Primary care trusts have much more capacity to design local services to meet their area's needs. I understand that the new coalition Government will introduce directly elected representatives into primary care trusts to increase the level of local involvement and accountability. I hope that I have that correct, because the Minister is looking at me as if I do not.
Mr Burns: No, I am not doing anything.
Diana R. Johnson: I just wanted to make sure, because that was not a Conservative manifesto policy. As I understand it, such engagement and increased accountability in the NHS was one of the Liberal Democrat policies; but it is part of the coalition agreement.
Mr Burns: May I just reassure the shadow Minister that I am just listening intently to what she has to say.
Diana R. Johnson: I am delighted to hear it.
I now want to move on to the matter of health spending. I recognise that the hon. Member for St Ives would like more money for his constituency, but I think he recognises that since 1997 the relevant spending on St. Ives, and on Cornwall, has increased. This year the allocation for all PCTs is £164 billion. As I said, 80% of the entire NHS budget is now in the hands of PCTs-the highest proportion ever. That means that local decision making is possible. The PCT for Cornwall and the Isles of Scilly is this year receiving £856.2 million and its budget has increased by 12.4%, but we recognise that it is still 6.2% away from the target.
I am grateful that the hon. Member for St Ives has recognised the work of the independent Advisory Committee on Resource Allocation, which is made up of GPs, academics and health service managers, to develop a new funding formula to determine each PCT's allocation. That has built on previous formulae to meet the objectives of providing equal access for equal need, and a reduction in health inequalities. Of course, a huge debate has raged about the tensions between the criteria used for allocating resources. For instance, there has been a debate about age versus deprivation, and the Conservative party in opposition would often argue that it was not deprivation but age that should be given more weight. The Conservatives also criticised the weighting of health inequalities in trying to remove those inequalities.
I hope that we now recognise that a series of criteria must be considered. Since last year a new formula has been introduced. We can clearly see how far the PCTs' actual allocation is from their target allocation. The previous Government's commitment was to move towards the target, while recognising that that would have to be done over a period of time, ensuring that it did not cause major problems to the smooth running of the NHS throughout the country.
When I looked again at the figures I found that the PCT that was the furthest over its target was Richmond and Twickenham; it was 23.4% over the target. I thought that it would make an interesting example to consider, as the relevant MPs are the Secretary of State for Business, Innovation and Skills, who is a member of the Liberal Democrats, and the hon. Member for Richmond Park (Zac Goldsmith), who is a member of the Conservative party. I can just imagine the tension and debate in that case about chopping the funding allocation for that PCT. Perhaps it would add some strains to the tensions within the coalition.
Andrew George: The hon. Lady makes a reasonable point about Twickenham and Richmond PCT, and about all those PCTs that receive significantly more than their target, because of the change in the funding formula. If she reads what I have said, she will notice that I recognise that it would be catastrophic to pull the rug out from under those PCTs, and we cannot do that: over a period of time, which I hope would be as short as possible, we need to find ways to ensure that if there are constraints on NHS spending, the areas that are now below their targets should not suffer.
Diana R. Johnson: I hope that the Minister will enlighten us with his thoughts on the pace of change in approaching the target and tell us whether he thinks the Department should adopt a target, with deadlines and dates. I know that he is not keen on targets, as we have seen from announcements in the past few days, but it would be helpful if he would explain his thinking about how we can arrive at a situation in which the hon. Member for St Ives gets his £56 million for his PCT, and other PCTs also receive the money that they feel they need.
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