This year, North Yorkshire and York primary care trust received a 9.5 per cent. increase in funding—an additional £69 million—taking the total NHS budget for the county to £870 million. The NHS in North Yorkshire has never been better financed, yet the PCT is predicting that it will end the year with a £35 million deficit, and York Hospitals NHS Trust anticipates a £2 million or £3 million deficit.
We face a paradox. NHS patients are being treated better and more quickly than ever before, but a small number of patients—250 so far, according to York’s local evening paper today—with non-urgent conditions have been refused treatment. It is not necessary to remind the Minister that the 250 patients who have been refused treatment, not the hundreds of thousands of patients who received treatment, hit the newspaper headlines. I do not deny that the Government must reduce the deficit, but they must not deny patients necessary treatment while doing so.
My first point is that my constituents in York pay the same taxes and national insurance as everyone else, and they are entitled to the same access to NHS care. On my birthday on 9 January, I asked the Minister:
“The national health service is based on the principle that care is provided on the basis of patients’ clinical needs, not their ability to pay, so will the Minister reassure the House that the rights of patients in north Yorkshire will be protected, despite the PCT’s deficit, and that they will retain access to the same range of NHS treatments, and experience the same waiting times, as NHS patients from other parts of Yorkshire and the Humber.”
I was pleased to hear the Minister’s reply. He said:
“I agree with my hon. Friend and I congratulate him on adopting a constructive approach towards the difficult financial circumstances that his PCT faces.”—[Official Report, 9 January 2007; Vol. 455, c. 143.]
I expect the Government to honour that commitment, under which the PCT must change some of its current policies. In December, I met the chief executives of the Yorkshire and the Humber strategic health authority, Margaret Edwards, the North Yorkshire and York PCT, Janet Soo Chung, and the York Hospitals NHS Trust, Jim Easton in my office in York. My hon. Friend the Member for Selby (Mr. Grogan) also came to the meeting.
During that meeting, I asked the strategic health authority to produce regular information for each PCT in the region showing patients’ access to NHS services in those PCT areas. The chief executive wrote to me in February saying that she had discussed the matter with the NHS information centre and asked it to develop some meaningful indicators. I call on the Government to ensure that that work goes ahead and that the indicators are published soon and regularly. They will reassure MPs and, most importantly, the public in areas with deficits that NHS standards in those areas are not falling below the standards in other parts of the country.
In the meantime, Margaret Edwards, the chief executive of the SHA has provided information devised by her own staff. Interestingly, it shows that waiting times for in-patient treatment in North Yorkshire have fallen by 13.6 per cent., while waiting times in the region as a whole have fallen by only 3.6 per cent over the same period. There is a 10 per cent. faster fall in waiting times in North Yorkshire. The national average has fallen by 1.1 per cent. That leaves fewer people in North Yorkshire on waiting lists for in-patient treatment—13.2 people per thousand in North Yorkshire compared with 15.2 per thousand in Yorkshire and the Humber, and 15.5 per thousand nationally. Also fewer people in North Yorkshire are waiting for out-patient appointments: 11.1 per thousand in north Yorkshire; 17.8 per thousand in Yorkshire and the Humber; and 20.4 per thousand nationally.
Such information should be published regularly. I regret, but expect that waiting times in North Yorkshire will increase as the PCT’s overspend is cut. If the number of people on waiting lists increased to the same level as in other parts of Yorkshire, I could not honestly complain, because I believe passionately in the equity principle that people in all parts of Britain should have the same access to NHS services, depending only on their clinical needs. However, if Yorkshire’s waiting lists became longer than regional or national ones, I would raise hell. I would be back in this Chamber pressing the Minister to adjust his policies.
My second point is that access to health care has always been rationed, although politicians do not like to admit that. In private systems, such as in the United States, care is rationed by price. Thankfully, we got rid of that in this country when the post-war Attlee Labour Government created the national health service. Care in the NHS is rationed by waiting lists and by doctors, particularly by general practitioners who traditionally act as the gatekeepers to NHS services. As waiting times have fallen sharply as a result of this Labour Government’s policies, the pressure on doctors to ration demand—to ensure that patients are treated according to their clinical needs—has increased.
I regret to say that relations between GPs and the four former PCTs in North Yorkshire were never good. Forming a close, trusting and co-operative partnership between GPs and the new North Yorkshire and York PCT is essential if the problems caused by the deficit are to be overcome. After the new PCT was established, a prior approval panel was introduced for certain procedures without consultation with the GPs through their local medical committee. The procedures included arthroscopies, grommets, vasectomies and diagnostic scans. That policy provoked strong opposition from GPs in North Yorkshire and York, and I met their local medical committee to discuss it. The committee sent me copies of letters that GPs from around the county had sent to the PCT expressing their concern on behalf of their patients.
It was because of that concern, and GPs’ inability to sit down in a room and sort out the difficulties with the PCT, that I asked the Prime Minister in the House on 31 January to broker a meeting between the PCT and the LMC. I am pleased that that happened the following week. The relationship between the new PCT and the GPs is improving, many of the differences are being resolved and mutual respect and trust are returning. That is happening not because sweet words have been said, but because some of the PCT’s policies will change. Many of the interventions that the PCT decided would require prior approval will be changed at the end of the month and before the start of the new financial year.
I ask the Government not to put pressure on the PCT to deliver quick cost reductions to overcome the deficit because, if they do, it will end up with inappropriate measures, such as some of those that have been introduced in recent months, and undermine the trust of the public in the local NHS and of GPs, whose support is absolutely necessary in partnership with the PCT. I hope that practice-based commissioning will be introduced in all parts of North Yorkshire and York shortly, so GPs’ co-operation is essential.
The York Hospitals NHS Trust has worked with North Yorkshire and York PCT. I pay tribute to both chief executives—Jim Easton at the trust and Janet Soo-Chung at the PCT—who have worked openly and constructively, and I thank them for the way in which they have kept me and other MPs from the county in the picture. However, the NHS trust has had to freeze a significant number of vacant posts and to close some beds to respond to the PCT’s funding difficulties and to reduce its deficit. The PCT may have reduced its deficit, because if it is £35 million, it will be £10 million less than was predicted a short time ago.
The trust has also had to accept that the PCT will not be able to pay York hospital for some of the patients that the hospital has treated. For the first time, therefore, the hospital will enter an end-of-year deficit—a fairly small deficit—of £2 million or £3 million. In effect, part of the PCT’s deficit will have been transferred to the local hospital.
Negotiations for next year’s service level agreement between the PCT and the NHS trust have been extremely tough. It is anticipated that, because more patients will be treated in the community in the coming year, there will be fewer admissions than in the past year and further job reductions. I ask the Government again not to push the pace of the PCT’s deficit reduction to the point at which necessary services to patients are cut.
Let me provide one example. Next year, York hospital will be paid for fewer emergency admissions than it had and was paid for this year. GPs will be brought to the forefront of the accident and emergency department’s work and NHS walk-in centre staff will also co-operate, along with hospital consultants, to try to reduce the number of admissions. However, if on any particular day or week, there are more patients from York needing an emergency admission to hospital, I ask the Minister to guarantee that they will be admitted and that the hospital will be paid for those excess admissions. If we do not have that guarantee, we will return to the dreadful situation that we experienced under the Conservatives and patients needing an emergency admission to hospital will rattle about in the back of an ambulance looking for a hospital with the capacity to take them.
It would be a tragedy if, after the Government have trebled the NHS budget, we were to return to that situation. I do not think that it is necessary, anyway, because next year the Government will increase the budget of North Yorkshire and York PCT by a further £77 million—an almost 10 per cent. uplift in expenditure and an increase in funding that is significantly greater than the rate of inflation.
Will the Department of Health reconsider some of its policies that, unwittingly, make dealing with the deficit in North Yorkshire rather harder? There is still huge variation in the productivity of consultants throughout the country. If one considers the case-mix adjusted work rate of consultants, some are dealing with twice as many patients in a single operating session—in the case of surgeons—than others. In some cases, that can be explained by complications with a particular individual, but if the case-mix adjusted work rates of consultants differ consistently over time and without a clear explanation, that ought to be built into doctors’ remuneration. It is a serious issue that the royal colleges must address, and I hope that the Government will prompt them to do so and to return with a revision of the consultants’ contract.
NHS services in York are now provided in part by the privately owned Clifton NHS treatment centre, which is run by Capio UK. Doctors in York have expressed concerns to me that, despite being paid to treat a certain number of patients, the centre has not treated those numbers. I do not know whether that is true, but I tabled a written question that was answered by the Minister of State, Department of Health, my hon. Friend the Member for Leigh (Andy Burnham). I asked,
“how many procedures for NHS patients will be (a) paid for and (b) provided by the York Capio Centre in 2006-07”.
The Minister gave me some background information about the NHS, but ended his answer by saying that
“payments for services and operational costs of Capio UK is commercially sensitive.”—[Official Report, 25 January 2007; Vol. 455, c. 2052-54W.]
The centre provides an NHS service that is paid for with public money for NHS patients from my constituency and from that of my hon. Friend the Member for Selby. The Government must be publicly accountable for those services in the same way that they are publicly accountable for NHS services provided by NHS doctors—as it happens, the self-same people who operate in the Capio centre—at York Hospitals NHS Trust.
Parliament cannot properly scrutinise the NHS budget unless that information is made public. I have written to the Comptroller and Auditor General about that, and I hope that the Government will revise their policy and publish as full a body of information about activity in privately run NHS treatment centres as they do about the NHS’s own hospital trusts.
There is some inconsistency between the tight limits on funding, which will be imposed on the NHS trust in its new service level agreement and the Government’s choose-and-book arrangements. If there is to be a cap on the number of patients that the trust is funded to treat, how will choose and book operate? If patients were to choose to be treated at York hospital and the funding were not made available for treatment, how could the system operate?
Finally, I asked the Library statisticians to examine the geographical distribution of NHS deficits. I was told that of the PCTs in deficit in February—the time at which the Library undertook its work—12, or 44 per cent., of those trusts were in areas that are classified as predominantly rural; 11, or 41 per cent., were in other urban or mixed urban-rural areas; and just four, or 15 per cent., were in areas that are considered as major or large urban areas.
The Library statistician told me that such distribution could not be explained just by poor management. He referred me to work done in June 2006 by BioMed Central Health Services Research, which concluded that PCTs with deficits tended to be in relatively affluent and rural areas and that poor management alone was unlikely to be the cause of the deficits.
I appreciate that there are PCTS in many predominantly rural areas that do not have deficits, but independent bodies have expressed enough concern, which the Select Committee on Health has repeated and underlined, to persuade the Government to set up a review of the resources allocation working party—RAWP—health service funding formula. I hope that the Minister will confirm that the review is taking place, and that among other things, it will analyse the cost of providing health services in predominantly rural areas and ensure that the costs are properly funded.
It has been suggested by GPs in my area that, if only North Yorkshire and York had the same health service funding per capita as Hull, there would be no deficit, and of course that is the case. One has to accept, however, that the distribution of funding for health care will vary from area to area according to the burden of ill health. Hull clearly has a higher burden of ill health. There is much lower life expectancy and higher death rates from cancer, heart disease and so on than in North Yorkshire; it has more demand for health care. I would not expect the Government to equalise funding across—
Thank you very much, Mr. Jones—not for interrupting my colleague, I hasten to add.
I begin by paying tribute to my hon. Friend the Member for City of York (Hugh Bayley) for securing this debate and for handling the situation in a responsible and balanced way. He did not attempt to mislead his constituents into thinking that this was an easy situation, but equally he has championed, publicly and privately, their right to have access to high-quality, responsive NHS services, despite the financial challenges faced by his local health economy. His constituents are entitled to know that he has been strident in putting the case for their interests, while making it clear that he believes that there is no future for an NHS that does not insist on financial discipline. Most hon. Members accept that financial discipline is ultimately the route to a stable NHS that can take maximum advantage of the incredible, unprecedented sustained investment that the Government have made available in recent years. As my hon. Friend said, by next year, that investment will have nearly tripled.
I pay tribute to my hon. Friend the Member for Selby (Mr. Grogan), who has also made consistent representations on behalf of his constituents, both publicly and privately, and expressed concerns about the consequences of the current financial situation with regard to their access to health care.
This is not an easy situation for anybody. The Government have decided that for the first time, arguably, in the history of the NHS, we are going to look it in the eye and say, “Like any other public sector organisation, or any household in this country, you have a finite budget and the expectation—the norm—will be that you manage within that budget.” As my hon. Friend the Member for City of York said during his excellent contribution, that is unquestionably the case. If hon. Members, or residents of York and the surrounding area, were to consider the year-on-year increases that their local health economy has received, irrespective of any global or national figures, they would find it hard to dispute that the increases have run considerably ahead of inflation, and will continue to do so next year. The Government cannot and will not apologise for asking the NHS in every locality to achieve that balance.
My hon. Friend has been incredibly active—including submitting a question to the Prime Minister—in making the case for the centrality of an integrated working relationship based on mutual trust and respect between the primary care trust and local general practitioners, and also the three-way relationship between the PCT, GPs and the acute hospital trust, to ensure that the locality takes a holistic view of the resources available to secure health care. He has played a major part in rebuilding bridges, which hon. Members would admit, if they were frank, were severely damaged by the historical relationships between GPs and the former PCTs. In the end, that situation undoubtedly got in the way of patients having access to the quality care that they deserved, and got in the way of the best use of resources.
It is always difficult to strike a balance between the responsibilities given to managers and leaders, and the professional judgment and leadership provided by practitioners, whether they are doctors, nurses or others. In York and elsewhere, it is crucial that those different professional responsibilities in the NHS do not get in the way of an acceptance of the common cause of ensuring equal access for patients to high-quality, responsive services.
As my hon. Friend said, the history of the coming together of four primary care trusts is difficult because each of the four had a deficit at the point of merger. Therefore, it was never going to be an easy management task for the leadership of the new PCT. I am pleased that he praised the leadership of the PCT and the hospital trust for the way they are working to get through those difficulties together.
It is important to be honest about the inevitability of redirecting resources within the NHS from acute NHS care to community-based health care, and beyond that, to social care. Medical advances, patient expectation and the desire of people to receive treatment closer to home so that they can remain in the community instead of being hospitalised unnecessarily are all factors, and many such decisions and choices are the right ones for the NHS, irrespective of financial difficulties. We must disentangle, where we can, good practice from what should be happening anyway with regard to the redirection of resources and the appropriate balance between primary and acute care. Some changes should be happening anyway, irrespective of the financial pressures.
I shall respond to some of my hon. Friend’s specific points. He talked about accident and emergency. Ministers will always add caveats to statements in such debates by saying that we no longer run the NHS from offices in Westminster and Whitehall. However, as he said, we are accountable to hon. Members for ensuring that patients have equal access to NHS care in their constituencies. It is a difficult balance to strike with regard to where the responsibility lies. I shall try to address the points that my hon. Friend made in that context.
On access to accident and emergency, we need to have a sensible, mature approach that deals with the relationship between the hospital and primary care. It should mean that in all circumstances other than the most exceptional cases, nobody is turned away who genuinely needs emergency care and admission to hospital. The problem with that statement is that there are exceptional cases sometimes where an individual believes they should be admitted to hospital, but the genuine view of the clinicians is that that is not appropriate. Some of us, indeed, have our own personal experience of that over the years.
My hon. Friend asked about Capio and the question of commercially sensitive information. I am not at liberty to undermine the Government’s entire policy on this matter—that is probably a little above my pay grade—but one way round it might be to encourage Capio, in the interests of transparency, to be clearer about its facility in York, with regard to how much it has been paid and how much capacity has been utilised as a result of those payments. That does not totally address my hon. Friend’s point, but it seems reasonable to approach Capio directly—at the end of the day, it is not doing anything wrong, as far as we can see—and ask it to share its funding situation and outcomes with hon. Members.
I agree with my hon. Friend about consultant productivity. Variability should be addressed, and the royal colleges and the professional bodies should take responsibility. It is not just a matter for Government, but a question of being a true professional, and what that means in terms of productivity. I understand his point about the choose and book process. We want patients to have the maximum choice possible when choosing a hospital, and despite the financial challenges that we see at the moment, I hope that the vast majority of patients in York will continue to have that authentic and genuine choice.
It being Five o’clock, the motion for the Adjournment of the sitting lapsed, without Question put.