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Health Services (Cornwall)

Volume 555: debated on Tuesday 11 December 2012

I am delighted to have secured this debate on health services, which are important in Cornwall—and, I am sure, in the rest of the world as well.

The national health service was created in 1948. It looks forward to its 65th birthday while facing the biggest challenges in its history, and nowhere more so than in Cornwall and on the Isles of Scilly. The previous Labour Government set a demanding target of £20 billion efficiency gain by 2015, something not advanced for any other health system on the planet, and the present Government have introduced the biggest reorganisation since the NHS was created.

As the Minister knows, I have argued, and voted, against the Government on what is now the Health and Social Care Act 2012. However, we must face up to what the Government have done, to ensure that, irrespective of the wisdom or otherwise of the policies, the Act does not undermine our vital local health services in Cornwall and on the Isles of Scilly.

Along with the significant financial challenges, which are a great deal more significant in Cornwall and on the Isles of Scilly than in the rest of the country, I hope to raise some of the many other challenges that the local NHS faces, including the consequences of the loss of the helicopter service to the Isles of Scilly.

I want to mention the important campaign that Sandra Cousins, one of my constituents, launched a year ago, following the tragic death of her daughter Mercedes Curnow, which led to the setting-up of the Mercedes Curnow Foundation. Mercedes died on 14 December 2011, aged 23. She and her mother had sought to highlight the need to strengthen the systems for detecting and treating cervical cancer in young women—particularly those under 25, who are denied screening in many circumstances.

There are many other issues. Nationwide, there needs to be a greater emphasis on registered nurse-to-patient ratios in some acute settings, and the need in Cornwall is significant. There is the risk of regional pay, the need to ensure adequate community hospital beds and primary care services, and the public health agenda, which must ensure adequate levels of NHS dentistry. That might be far too many issues to fit into the limited time available.

I am very reassured that highly professional and dedicated clinicians are already working hard to ensure that our local health services are the best they can be in the circumstances. In 2013, the new service in Cornwall will, as in the rest of the country, be largely led by local general practitioners. I am delighted that the shadow Kernow clinical commissioning group—“Kernow” is Cornish for Cornwall—chaired by Dr Colin Philip, was only this afternoon authorised by the NHS Commissioning Board to be responsible for the £700 million for commissioning health services across Cornwall.

The group is very open to working with the local community in ways that are extremely encouraging. For example, the Cornish campaign group 38 Degrees is already working with the group and suggesting amendments to its constitution to ensure that local health services are protected in ways that any local community would wish them to be protected. It is well on the way to creating new structures, challenging as they are, that will shape how the NHS operates in Cornwall.

A big challenge nationally is to ensure that the NHS really effectively puts patients before profit. The previous Government rolled out the red carpet for private health companies in Cornwall, as elsewhere, and gave them opportunities to profit their shareholders by delivering some of the less challenging elements of NHS work. I have questioned the basis on which tariffs will be awarded for procedures. After I raised questions with him about the risk of cherry-picking, the new Secretary of State told me, in a letter dated 30 October 2012:

“Under these new rules, commissioners should adjust the tariff price if a provider limits the type of patients it treats…resulting in lower costs than the average of the tariff category. As a result, providers undertaking only the more simple interventions—for example, because they do not have the proper facilities to handle more complex cases—would be paid a suitably lower price.”

That is certainly the case in Cornwall, where a number of private providers deal with some of the easier and less complex cases—for example, patients without anaesthetic risk and those without co-morbidities. If those providers are offered a lower tariff price the question that needs to be asked is whether that might have the unintended consequence of commissioners driving patients into the arms of the private providers that cannot provide the range of services that the Royal Cornwall Hospitals Trust, for example, excellently provides for our local community.

There is also fragmentation, which although a nationwide issue is a particular risk in a peninsula that depends on core services and has no alternatives. Although patient choice might well apply, and is welcome as a luxury beyond the core services, the risk is, of course, that it will not necessarily help services if it results in their fragmentation.

On the role of the private sector, my hon. Friend the Member for Truro and Falmouth (Sarah Newton) and I have raised concerns with the Care Quality Commission about what we detected had been going on with the out-of-hours GP service in Cornwall. The CQC, in its report in July, found—as the Minister will know because of the significant national ramifications—that there had been some manipulation of some of the data records, and inadequate staffing. The primary care trust, in its report on 20 September 2012, identified that it had deliberately altered data 250 times between January and June this year, which had the effect of inflating its published response times. That is not particularly encouraging. The problem is that in a very competitive environment there is an increased risk that that might happen.

Cornwall must ensure that it gets a fair share of the cake. Our allocation is significantly less than what the Government say we deserve—their stated target—and they should take account of the underfunding we have had in recent years. For example, between 2006 and 2012 Cornwall has received £201 million less than its target. That is a significant amount, and I would be surprised if anywhere else in the country had been allocated so much less than what the Government said it should get. This year, 61 primary care trusts will receive a total of £1.3 billion over target, while 88 PCTs, one of which is Cornwall and the Isles of Scilly, will receive £1.3 billion below target.

Added to that, Cornwall receives less money for each medical procedure within a national tariff, using the market forces factor framework as the index. The Royal Cornwall Hospitals Trust receives the lowest payment of any acute trust in the country. It inherited debts from troubles that originated in 2006-07, which rose to £46 million in 2008-09. Although repayments have reduced the debt to £22 million, it will be passed on to the new quasi-independent foundation trust, which we hope will be established next year.

Although we have had disappointing responses from Ministers so far, my hon. Friends the Members for Truro and Falmouth and for North Cornwall (Dan Rogerson) and I are still arguing that the debt should be written off to give that foundation trust a clean slate on which to begin its work next year.

I entirely support and thoroughly endorse the trust’s response to the latest revelations with regard to concern in the obstetrics and gynaecology department. I make it clear, so that there is no equivocation or uncertainty, that I entirely endorse the actions the trust has taken with the external review, and we hope that that will be brought to a conclusion as soon as possible. The trust is certainly doing all it can to reassure patients in Cornwall. The trust has high standards, and we entirely support the work it is doing. We hope that patients who may be concerned will contact the trust.

Sandra Cousins of the Mercedes Curnow Foundation has been working tirelessly. Although I have written to Ministers on this issue over the past year and have received helpful and instructive replies, a large number of young women are still dying, unnecessarily in my view and certainly in the view of Sandra Cousins and her many supporters across the country.

Sandra is also concerned that, even where GPs are prepared to undertake a smear test—smear tests for young women under 25 have to be authorised by a doctor—laboratories, apparently, are not always following through by undertaking work on those tests. She argues that laboratories must accept and follow through the necessary tests. She draws a comparison with Australia, where the cervical screening limit is 18 and where, since 2009, the human papilloma virus vaccination has been available for those up to 26 years old, which is much higher than in this country. The mortality rate from cervical cancer in Australia is half the UK’s.

Sandra Cousins says:

“I also feel regarding the hpv vaccination that it should be done nationwide in schools. Cornwall is a prime example of low uptake of the vaccination, 49% compared to many counties that are 89%, because it is done at G.P. practice not in schools.”

She advances the case for schools, but she is also concerned about the 18 to 26-year-old cohort, because HPV vaccination ends at the age of 18 and there is no cervical screening for those under 25. Her daughter, of course, fell into that cohort, and I certainly believe she has a strong case for advancing the points that she is making.

Of 20 cervical smear and HPV tests that the Mercedes Curnow Foundation has funded, 18 were positive. Those women went on to have further investigations and treatment. Sandra Cousins cites other examples where that is an issue that needs to be addressed in more detail.

I have mentioned regional pay, and I am pleased that MPs across the south-west met the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) last week. We were reassured by his response, and he will be writing to the south-west consortium. Indeed, those south-west MPs will be writing to the chief executives of the 19 trusts engaged in that consortium to encourage them to get back to national negotiation.

I urge the Government to consider nurse staffing levels. With all the stories about poor care and nursing in hospitals, few are prepared to consider the resources that are going into the hospital wards themselves. On many occasions, nurses are running around unable to fulfil all of their duties because there is an insufficient number of them on the ward. There are mandatory registered nurse-to-patient ratios in places such as Australia and they work well, with good outcomes.

The commercial helicopter service to the Isles of Scilly ceased just over a month ago, and it is already having an impact on services to my constituents on the Isles of Scilly. Blood samples and patients are unable to get over to the mainstream health services on the mainland, and I hope the Minister is prepared to look closely at that and perhaps work with the Department for Transport to help find a solution. Cross-departmental co-operation is required.

We have low levels of NHS dental provision in Cornwall, and I am concerned that the local authority might put the director of public health not on the chief officers board of the local authority, but under one of those senior officers. There are major concerns across Cornwall that Peninsula Community Health, the community interest company set up last year, is unable to provide the necessary staff to staff community hospital beds. It is important that we front-load community and primary care to get the balance right between those acute hospitals seeking to discharge patients earlier than they are able and avoiding unnecessary admissions to those hospitals.

I am sorry that I have gone on for a minute longer than I intended. There are many challenges, but the biggest that we face—I hope the Minister will take this on board—is Cornwall’s unfair funding deal: £200 million of missing money over the past six years alone.

It is a pleasure to serve under your chairmanship, Mr Leigh.

I congratulate my hon. Friend the Member for St Ives (Andrew George) on securing this debate and on raising what can only be described as a rich pot-pourri of topics relating to the state of the health service in his county and to his constituents, whom he serves not only in St Ives and across Cornwall but on the Isles of Scilly.

I assure my hon. Friend that the total revenue allocated to NHS Cornwall and Isles of Scilly increased by 2.8% in 2012-13, which is entirely in line with the 2.8% overall increase nationally. That represents an additional £26 million to invest in front-line care in his local area. Indeed, the total budget for NHS Cornwall and Isles of Scilly is £941.8 million for 2012-13. On top of that, I am advised that the local NHS expects to achieve efficiencies of 4%, totalling £36 million, with those funds being made available to support improved services to patients in Cornwall and the Isles of Scilly.

I understand that the independent Advisory Council on Resource Allocation has been developing a new allocations formula. I am told that allocations to clinical commissioning groups for 2013-14 will be announced by the NHS Commissioning Board later this month and that ACRA’s final recommendations are due to be published alongside those allocations.

It is not for me to say whether Cornwall should receive more or less money—it is difficult to think that Cornwall could possibly ever receive less—but if there are some inequities, I am sure my hon. Friend and his colleagues from the county will do their best, as they always do, to put forward those arguments with full force. I assure him that they will continue to be listened to.

The Government are clear that Cornwall receives less money than they say it should. I gave the figure earlier that Cornwall received more than £200 million less than the Government said it should.

Indeed, but it is for ACRA to come up with a new formula, and it is hoped that that can be advanced. The formula might, of course, be to the benefit of the county.

There is a rich number of topics to address, and it is difficult to know where to begin, but I will start by saying that I am disappointed that my hon. Friend chose to vote against the Government’s excellent NHS reforms. In his area, as he has already told us, the CCG was authorised yesterday. I will give some examples of how that movement of power and determination into the hands of front-line professionals will benefit his constituents.

The CCG has secured more than £500,000 from the Government’s dementia challenge fund to improve the lives of people in Cornwall living with dementia and their carers. The funding will be spent on improving dementia care in residential and nursing homes and in the community, and increasing peer support in communities and hospitals. Those are just some of the things that that successful application for £500,000 will achieve. The CCG is also investing £300,000 to expand the acute care at home programme. I have many other examples, including four services in Cornwall that have been expanded through the “any qualified provider” scheme: psychological therapies, back and neck pain treatments, adult hearing services and ultrasound and MRI diagnostic services. My hon. Friend raised concerns about the march of the private sector, but if there is such a march—I have no evidence of it—it would seem that in his county, it is by no means to be feared; indeed, it is to be welcomed.

My hon. Friend mentioned the loss of the helicopter from Penzance to the Isles of Scilly. I know that the service has ceased, and I understand the worry that that causes him and many of his constituents. I understand that the service previously fulfilled all non-emergency health transportation needs, but I am informed that emergency transport is usually carried out by RNAS Culdrose, so any interruption to routine travel affects only non-emergency appointments. The islands are also served by a passenger ferry, and the NHS has back-up arrangements in place to use a cargo ship if needed for medical samples.

In response to the ending of the helicopter service, I am told that the Isles of Scilly Steamship Company, which runs the fixed-wing aircraft Skybus and the passenger ferry Scillyonian—forgive me for not pronouncing it correctly—

My hon. Friend knows it better than I. The company has enhanced its services to accommodate NHS needs, and has committed to purchasing a second aircraft to enable it to increase flights. I hope that those arrangements are of some assurance to him.

On registered nurse staff ratios and the skill mix, we know that patient care in the 21st century is different from what it used to be. Hospitals report that the type of demand that they face is changing. In particular, the average lengths of hospital stays are about one third shorter than they were 10 years ago. It is true that the number of nurses has been decreasing, but the total number of professionally qualified clinical staff in the NHS is rising.

Planning the number of nurses and the shape and size of the work force must be based on the needs of the people in our care. Services must be properly designed around the care and treatment that people need. Those decisions could result in a need for nursing numbers to change, but that must be based on properly redesigning services, not just on affordability. Changes must be decided at a local level, based on evidence that they will improve patient care. It is important to use this valuable staffing resource wisely, in properly constructed multi-professional teams with appropriately blended skills focused on the care and treatment needed by patients, families and communities.

The Government are committed to improving quality standards in the NHS. Our role is to clarify the standard of patient care demanded of the NHS through the mandate and to underpin it with robust external monitoring and validation by appropriate bodies. We are not here to impose management solutions.

I am interested in what the Minister says. However, is she saying that she and her fellow Ministers are content that registered nurse staffing levels are currently adequate in all settings within the NHS?

With great respect, I could not possibly say either yea or nay to that, because I do not know what they are, but I always look forward to the continuing representations made by hon. Members urging Ministers to raise or change the numbers.

I turn to the concerns expressed about the financial situation of the Royal Cornwall Hospitals NHS Trust. I hope that those concerns will now be allayed; the trust is forecasting a surplus of £3.8 million for 2012-13, and is progressing well on its path to achieving foundation trust status. Yesterday, through a video link, I spoke to one of the trust’s officers, who told me with much encouragement about plans for the future of the hospital and said that the trust believes that it is now on top of its financial situation. By way of example, I asked specifically about the trust’s preparations for winter, as it looks like we are going to have one of the hardest winters in this country for a long time. I was heartened by not only the trust but the PCT and others to whom I spoke about the high level of preparedness in Cornwall and Devon, two counties that are used to unusual snaps of weather, quick changes and sudden emergencies. I was left with a feeling of great confidence that those two counties are doing everything that they should to be ready. For what it is worth in this short time, I urge all counties to be in as great shape as Cornwall and Devon are.

In my remaining few minutes, I will turn to one particular point. My hon. Friend may have raised others. If I have not answered them, I will write to him. He rightly talked about a foundation trust set up by one of his constituents in memory of another of his constituents. I did not catch their names, so if he will forgive me, I will not make a hash of them, as it is a serious matter and a young woman lost her life. I am told that 80% of eligible women in Cornwall and the Isles of Scilly took part in the NHS cervical screening programme in the previous five years. That uptake has increased from the previous year and exceeds the percentage of women who took part nationally.

My hon. Friend’s point was about screening for women under the age of 25. He said that it concerns him, and asked why the age should not be reduced. In May 2009, the advisory committee on cervical screening reviewed the screening age specifically and considered all the latest available evidence on the risks and benefits of cervical screening in women aged between 20 and 24. The committee was unanimous in deciding that there was no reason to lower the age from 25, which happens to be in line with the World Health Organisation’s recommendations. The committee gave a number of reasons, which I cannot read out given the time available. I am more than happy to supply him with a list of those reasons.

That is not to say by any means that my hon. Friend and his constituents should cease their campaign to achieve better levels of screening and awareness among young women about the fact that cervical cancer can affect them even though they are young. I say that as the mother of two daughters, one aged 21 and one 22. It may be of some interest to him that by complete coincidence, I was stopped today by my hon. Friend the Member for Loughborough (Nicky Morgan), who approached me because she too, unfortunately, had a constituent under the age of 25 who died of cervical cancer. She raised the same issue with me. I gave her an undertaking that I am more than happy to meet with her and her constituents to discuss it further, and I extend that invitation to my hon. Friend the Member for St Ives and to his constituents who are campaigning. It may well be that the matter should be revisited. As I said, the advisory committee considered the issue in 2009. The technology may have changed—I know not—but it is certainly a matter that needs to be considered, and I am more than happy to meet hon. Members to talk about it and see whether anything can be done.

It would appear that I have dealt with all the items on my list of notes, and so—

I am absolutely delighted that the funding formula is being reviewed, but a crucial question for us in Cornwall, when the formula arrives at a solution saying how much Cornwall should get, is whether we actually get it. It has not necessarily been a problem with the formula; it is that we have never reached the existing formula. It is about renewed determination that there will be a road of travel.

With 50 seconds remaining, this is a perfect opportunity for any other Member to stand up and make exactly the same point. It is a good point, and it is about to be made again.

I am pleased that we have made a lot of progress through the coalition—the gap has decreased from minus 7 to minus 2 —but a great enough rate of change to get Cornwall up to where it should be within this Parliament is essential for the people of Cornwall.

I am grateful for my hon. Friend’s intervention. She makes a good point. Like others who have spoken in this short debate, she advances her county’s cause eloquently and undoubtedly with some merit. I cannot make any promises, but I can ensure on my return to the Department that the matter is raised yet again at the highest level so that we can see whether we can make some progress.