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NHS Funding (North-East and Teesside)

Volume 570: debated on Tuesday 5 November 2013

This is an important opportunity to discuss concerns that my north-east colleagues and I have. I hope that the Minister takes our points on board, and takes the necessary steps to rectify the issues in the region’s health service.

I will discuss four topics this afternoon. The first is the funding provided by central Government to the region’s accident and emergency departments, particularly in the south Tees area. The second is the funding of the North East Ambulance Service NHS Foundation Trust, and the rising use and cost of private ambulances. The third is the ongoing Monitor investigations into the two foundation trusts—the South Tees Hospitals NHS Foundation Trust and the Tees, Esk and Wear Valleys NHS Foundation Trust—that serve my constituents. Finally, I will seek reassurance from the Minister on future funding allocations to north-east clinical commissioning groups.

Over the past 18 months, the accident and emergency department at James Cook university hospital, which serves my constituency, has come under particular pressure. In the run-up to winter last year, there were problems with handover times; ambulances and paramedics waited up to two and a half hours to admit patients, despite the national target time being 15 minutes. I raised that last year with the Secretary of State for Health, who agreed that the situation was completely unacceptable, and I raised it with the Minister on 13 February 2013 in a Westminster Hall debate on A and E provision in the north-east. In addition to the issues that I raised with the Secretary of State, it has become evident that the James Cook hospital’s A and E department struggled to manage with the pressure caused by winter.

In January and February 2013, the South Tees Hospitals NHS Foundation Trust failed to meet its target of seeing 95% of A and E patients within four hours. With James Cook hospital so clearly overstretched, I admit that I was surprised to discover in September 2013 that the Secretary of State decided not to award it, or any hospital trust in the north-east, funding to alleviate the pressure on A and E departments. It is beyond belief that, of the £250 million awarded by the Secretary of State between 53 trusts, not a penny will reach the north-east, particularly as we live in a region that suffers from some of England’s harshest winter weather and has some of the harshest local government cuts in the country. I hope that the Minister reconsiders that allocation, or at the very least clarifies why the Secretary of State made such a seemingly absurd and regionally disparate decision.

Recurrently, over many weeks, I have received expressions of concern from constituents about the increasing use of private ambulances in response to 999 calls in my constituency. I corresponded with the North East Ambulance Service on two such incidents, and its reply made it clear that central Government funding cuts are eroding that blue-light service:

“Each year we have discussions with our commissioners on the forecast number of incidents in the forthcoming year. The outcome of these discussions for 2013-14 were that commissioners felt it necessary to set our income on activity for the next 12 months at a level less than we were forecasting… So for 2013-14, we have been contracted to respond to 376,000 incidents, although we are forecasting activity at an estimated 415,000. This means that any incidents above 376,000 will be funded on a one-off basis rather than as recurrent annual income. These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

The hon. Gentleman is making a powerful speech. Is he aware that Cleveland police vehicles and staff are also being increasingly used as unofficial ambulances?

Yes, the police, and particularly the police and crime commissioner for Cleveland, have raised that with me in private meetings on first responder calls. They have funding worries about what will happen if such practices continually recur.

The NEAS letter shows that there will be more cuts, more private ambulances and possibly a less responsive service. It is not me saying that, but the chief operating officer of the North East Ambulance Service. The figures are stark. In 2008-09, 865 call-outs were attended by private ambulances in our region, costing £86,000. In 2009-10, some 1,816 call-outs were attended by private ambulances, costing £151,000. In 2010-11, however, 6,429 call-outs were attended by private ambulances, costing £477,000, which is a huge jump. In 2011-12, there were 9,000 call-outs attended by private ambulances, costing £639,000. In 2012-13, 13,524 call-outs were attended by private ambulances, costing £754,000. So since 2010, there has been a fivefold increase in private ambulance costs in the north-east, with the funds going to private contract firms. It is obvious that from 2010 onwards, there has been an explosion of private ambulance usage by the trust, costing a huge amount of taxpayers’ funds. The chief executive states:

“These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

A third issue of particular concern to my constituents is that both the NHS trusts that serve them—the South Tees Hospitals NHS Foundation Trust, and the Tees, Esk and Wear Valleys NHS Foundation Trust—have found themselves under investigation by Monitor in the past 12 months. Since May 2010, the South Tees trust has failed on seven occasions to meet its referral-to-treatment target, most recently between March and August. That has resulted in the Monitor investigation, because the trust has failed to ensure that 90% of patients commence treatment within 18 weeks of referral. Furthermore, there has been an increase in reported “never” events at the trust, and an increase in the incidence of clostridium difficile.

Despite the seriousness of those issues, Health Ministers have taken no action. My constituents would at the very least expect Ministers to have had conversations with Monitor and the trust on the issue, and on what support the Department of Health can provide, yet the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), confirmed to me in a written answer that

“No such discussions have taken place with Ministers.”—[Official Report, 22 October 2013; Vol. 569, c. 83W.]

Will the Minister please assure me that he will closely monitor the situation and have discussions with both Monitor and the South Tees trust on how the Department can provide support, including additional funding if necessary?

My final point is on allocations to the north-east’s clinical commissioning groups.

A recent working paper issued by NHS England on allocation and indicative target allocation outlines proposals that will reduce per-capita funding for CCGs across the north-east. People in Sunderland will each face a £146 cut, people in south Tyneside a £124 cut, people in Gateshead a £104 cut, and people in my constituency a £60 cut.

Is it not perverse that deprivation and health inequality indicators are not part of the overall calculation, as regards the funding allocation for the north-east? That will potentially result in the north-east losing up to £230 million of NHS funding per annum.

Yes, the cumulative effect of all the funding allocations in different areas is very worrying. If those allocations are all reduced, my genuine worry for my constituents, and for constituents across the north-east, is that all the hard work and financial effort in Teesside in the past 15 years to reduce cardiac risk, bad outcomes for cancer, and other problems will be undermined, and we will not build on the momentum gathered over the past 15 years.

Is that not all the more outrageous because a former Health Minister, the right hon. Member for Chelmsford (Mr Burns), gave a clear assurance at Health Question Time on the Floor of the House that the importance of the deprivation part of the calculation would not be downgraded? We asked for a clear assurance, and we were given a clear assurance. That assurance is not compatible with the current consultation.

My right hon. Friend predicts the final part of my speech. I hope the Minister will take the opportunity to put our fears to rest. Unfortunately, the information that I have received to date does not reassure me.

I compliment my hon. Friend on securing such a timely and important debate. I completely agree that one of the most worrying aspects is the potential changes to the funding of clinical commissioning groups. Easington would lose £62 a head. Does he agree that that could be seen as political gerrymandering, with the poorest areas deprived of funding and the wealthiest, such as east Hampshire, getting increases of as much as £164 a head? The areas with the best health outcomes will get the biggest increases in resources.

My hon. Friend has mentioned that in Health questions and in the Select Committee on Health, of which he is a doughty member who provides a lot of input. Someone from a poorer socio-economic background has a lower likelihood of reaching the age at which they would receive more funds under the allocation—it would probably never happen. This becomes a self-defeating, vicious circle of a lack of investment in people who might need it the most.

As I was saying, the proposals in a recent working paper issued by NHS England on the allocation and the indicative target allocation would have led to a per capita reduction in funding for CCGs throughout the north-east, and my constituents would have lost out. Meanwhile, CCGs in the south would have had a per capita increase; for example, those covered by Coastal West Sussex CCG would each gain £115, those in Hailsham £136, and those covered by South Eastern Hampshire CCG £164. That is clearly not a one-nation NHS. I received ministerial assurances that that formula was not ultimately used for 2013-14, but a response to a parliamentary question that I asked confirmed that

“No proposals or decisions regarding allocations for 2014-15 have yet been made.”—[Official Report, 22 October 2013; Vol. 569, c. 76W.]

The hon. Member for Stockton South (James Wharton), who is in the Chamber, told the Evening Gazette on 23 October that it was indeed “right” that NHS England was considering reducing health funding for his constituents and the north-east, but—

The hon. Gentleman has either misread or misremembered, or perhaps the Evening Gazette did not give a full account of my comments. What I said was right was having an independent funding body that makes decisions based on a formula that is consulted on, and it is right that age should be a factor. That does not mean that deprivation should not be a factor. I recognise and welcome the debate, and the effort that hon. Members in all parties are making to put the case that deprivation has an impact on health outcomes and should be considered as part of the funding formula. I recognise, however, the independence of NHS England, and I support it being an independent body. Does he recognise its independence?

I recognise the health outcomes and needs of my local constituents; as their representative, I will voice those views and needs vociferously. I take on board, however, the hon. Gentleman’s comments and his desire to see deprivation recognised in the allocation of funds. On the future allocation for CCGs, I hope that he will advocate to the Minister on behalf of those of his constituents who share the same socio-economic background as me, in the way that we Labour Members do. I take his intervention in favour of those funds in a spirit of common north-eastern friendship.

Will the Minister assure us that he will urge NHS England to consider deprivation and regional health inequalities when determining funding formulae? Furthermore, will he guarantee that any funding formula used to determine allocations in 2014-15 will not leave the north-east comparatively worse off, and will not widen the north-south health divide? I thank the Minister for his time, and I hope that he will be able to provide the clarifications and assurances that my colleagues and I have sought this afternoon.

It is a pleasure to serve with you in the Chair, Mrs Riordan.

A lot of political smoke has been blown across the Chamber today by the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop). I have a lot of time for him personally, and he came to see me earlier in the year to express some legitimate concerns about the performance of his local trust. On the basis of our meetings, I hope to reassure him that there has been considerable progress locally in his area.

More broadly, it is worth setting the record straight on some of the points made today. We have had discussion about the ambulance service, which I will come to, and we have talked about winter pressures, which I will address. First, however, on the funding formula, my hon. Friend the Member for Stockton South (James Wharton) was right to point out that it is set independently of the Government. Before we handed independent formula setting to NHS England, the Government made it clear that deprivation is a factor and it is taken into account in the current arrangements. There is a 10% weighting for deprivation in the funding formula, which as a Government we ensured was preserved in the formula. Under the new arrangements, there is more political independence in setting the funding formula.

Not at the moment. The independent Advisory Committee on Resource Allocation, or ACRA, as hon. Members have mentioned in the debate, historically has advised that the funding formula should be readjusted to take into account demographics and the increased health care needs of older populations in other parts of the country. The Government, however, in the past chose to maintain support for deprivation as a factor in health care funding, but the decision is now not one for the Government. It is now for NHS England to listen to the independent advice, but I would find it strange were there a sudden change in the funding formula that did not factor in deprivation, as done in the past.

It is important to set the record straight. The decision is not political; in the past, the Government preserved a weighting for deprivation, but now the decision will be taken separately by NHS England. Its decision will be made on the basis of clinical need, although of course deprivation will be a factor.

I asked the Minister’s predecessor for a clear assurance that he would not downgrade the importance of economic deprivation in his resource allocation formula. The Minister’s predecessor, once he had consulted the Secretary of State at Health questions, then said:

“Yes, I can give that assurance.”—[Official Report, 12 June 2012; Vol. 546, c. 167.]

It is impossible to misunderstand what was being said. What weight can we put on that now?

My predecessor was in place when setting the resource allocation was in the Government’s gift. As the then Minister made it clear, a weighting in the formula for deprivation would be preserved—he stood by his word and that weighting was preserved. NHS England, not the Government, now sets the funding formula—to avoid political interference—and those in NHS England, in conversation, have made it clear that they also value a weighting apportioned to deprivation.

No, I will not give way. I have said things clearly for the record, without any political smoke.

As a Government, when we had control of the funding formula, we clearly put in a weighting for deprivation and for some of the poorest communities. I am proud that we did so, but it is now for an independent body to look at the case and at the independent advice that it has been given. I would find it extraordinary, however, if it were not to factor deprivation into its decision making, although there are other factors that it will want to put into the equation, such as the fact that older people are the greatest users of health care, so places with lots of older people also need to be recognised. A number of factors will be taken into consideration, and deprivation will be one of them. I have been reassuring about that, and I will not allow the Labour party or any hon. Member to make mischief with something that the Government have stood by.

No, I will not give way any more. I have clarified the point considerably, and the hon. Gentleman would do well to listen. I will not allow the Labour party to make political mischief, when my party has made it clear that we value the deprivation weighting. In fact, if we look at the public health allocations to every local authority, they have been generous. As I hope to reassure hon. Members, we can see that the health care funding allocations to the north-east have also increased under this Government, so the assertion that funding to the north-east is being reduced is clearly not the case.

The Government have increased the NHS budget, which the shadow Secretary of State described as “irresponsible”. At the same time, the Labour-led Welsh Assembly Government have cut the budget by more than 8%; in England, however, we have ensured that we have increased the health care budget in real terms. In the north-east specifically, CCGs have received an above-real-terms increase in funding for 2013-14 of 2.3%, compared with the primary care trusts’ funding for the equivalent set of services last year. Opposition Members should be pleased about increases in funding for the north-east, because if the Opposition spokesman were Secretary of State at the moment, he would have considered that irresponsible.

If the proposals in the consultation document had been implemented this year, can the Minister confirm that the north-east would have lost out to the tune of a little more than £228 million?

The hon. Gentleman is right in saying that had the Government followed the advice of the Advisory Committee on Resource Allocation in the past, we would potentially have cut the budget for the north-east. I can reassure him that we maintained the resource allocation budget, and the north-east has received an increase in real terms. Those are the facts. He may want to create political smoke, but there is none. We preserved and increased funding to the north-east for patients in Opposition Members’ constituencies and in those of my hon. Friends.

I will not give way again.

The hon. Member for Middlesbrough South and East Cleveland is being very disingenuous in the points that he is making, and I have put the record straight: health care funding has increased under the present Government. If I give way again, perhaps he will explain why the shadow Secretary of State said it would be irresponsible to increase the health care budget in real terms. We all think that would be irresponsible in the current environment.

I turn to local services in the hon. Gentleman’s constituency. When we discussed the matter earlier this year, he raised specific concerns about Guisborough, East Cleveland and Redcar hospitals. He did not put on the record the fact that matters have improved considerably since that meeting with me and local commissioners. Guisborough urgent care centre is open from 9 to 5 on Mondays to Fridays and from 8 to 8 at weekends. East Cleveland urgent care centre is open from 9 to 5 on Mondays to Fridays and from 8 to 8 at weekends, and Redcar urgent care centre is open 24/7. There are currently no vacancies for clinical staff that affect opening hours, which have been aligned to match service and patient need. The centres will continue to evaluate the situation.

It is worth highlighting that three additional nurses were recruited to support the urgent care centres in June 2013, and they are now at full complement, apart from one vacant clinical lead post to which the trust is continuing to try to recruit. It is looking at better ways to manage staffing. In response to concerns raised by the hon. Gentleman, there are now fully functioning urgent care centres. There is a 24/7 service in Redcar and additional staff working at those centres. That is good progress and it is disingenuous of him to suggest otherwise.

I hope that when I give way, the hon. Gentleman will put on the record the fact that considerable progress has been made by local commissioners for the benefit of local patients.

I thank the Minister for giving way during a response to a speech I made in February, although I deliberately did not mention those points because they were not part of what I wanted to talk about today. The Minister says that South Tees NHS trust is successful, so why is it under investigation by Monitor?

The hon. Gentleman has raised issues of health care funding, and I am making the point that there has been considerable investment in local health care services, the very services that he said earlier this year had received no investment. He is also raising urgent care services and other services at his local hospital trust. I am reassuring him that considerable investment has been made locally, and it is worth highlighting the fact that further investment has been made. He is incredibly disingenuous to stand here and run down his local health service when considerable steps have been made to improve patient care services. For his benefit, I will outline a few more improvements that have been made, so that they are firmly on the record.

I will not give way because the hon. Gentleman should listen to the answers to some of his questions and realise that his local health care services are improving thanks to the Government’s increased investment in the health service—[Interruption.] Hon. Members have been incredibly political in everything they have said today, and I am putting answers on the record. If the hon. Gentleman does not want to hear them, he should not have raised the debate.

The latest data for 27 October 2013 show that South Tees Hospitals NHS Foundation Trust’s performance against the 95% standard for A and E waits is 96.8%. Over the last 23 weeks, it has met the national 95% target for A and E four-hour waits. The local trust is performing very well in treating patients in a timely way when they arrive at A and E. That is contrary to the points that the hon. Gentleman was trying to make.

At James Cook university hospital, the acute admissions unit is adjacent to the A and E department, so enabling the trust better to manage the flow of patients and to ease pressure on A and E. The trust has recruited two additional consultants and six additional junior doctors to the acute medicine departments, so easing pressure on the A and E department. Considerable investment is being made, and additional nursing staff have been recruited to support 50 more acute hospital beds that will be in place this winter. The hon. Gentleman must be aware that there is a lot of investment locally, with more beds, more staff and better care. It is a pity that he could not acknowledge that in his speech. I am putting it on the record, so that his constituents are aware of it.

The Secretary of State announced an additional £250 million to relieve pressure on A and E, but none of it was allocated to any of the hospitals in the constituencies of my right hon. and hon. Friends here.

On the incidence of ill health in deprived areas, half of the people presenting to hospitals suffering from hepatitis C, which is completely treatable and curable, come from the poorest 20% and three quarters come from the poorest 40%. Is it not right that additional resources are provided to those poorest areas to tackle such diseases?

The hon. Gentleman is absolutely right, and that is why the Government have given local authorities the power to deal with sexual health services. He will be aware that a major cause of hepatitis C—for the record, it is not curable—

Indeed, but it is not curable as the hon. Gentleman stated. He should get his facts right before making statements in the Chamber. It is not curable, but it is treatable and the best treatment is prevention, which is why we have given a considerable amount of money to local authorities to take on the public health responsibility and to ensure that local authorities are in the right place to look at primary prevention of transmissible sexual diseases. He will be aware that hepatitis C is sometimes transmitted via the sexual route. The Government have put us in a better place to deal with sexual health issues and to tackle them in future.

There has been talk about ambulances, and it is worth highlighting that the most recent data, for September 2013, show that the North East Ambulance Service NHS Foundation Trust is meeting the category A8 red 1 measure 80.6% of the time and the A8 red 2 measure 80.8% of the time against an operational standard of 75%. The ambulance service is doing marvellously well in the north-east. It is meeting category B19 with a performance of 97.7% against an operational standard of 95%. That is a good performance in the north-east by anyone’s standard. The ambulance service is performing very well. Other ambulance services that may receive more generous funding are struggling, sometimes due to mismanagement, particularly in my part of the country in eastern England.

It is very difficult for the hon. Member for Middlesbrough South and East Cleveland to make any case for lack of funding or other problems with his ambulance service when health care funding for the north-east is going up under this Government and the ambulance service is performing well according to national performance indicators. Those are the facts, and if he did not want them on the record, he should not have raised the debate.

It is more in sorrow than anger that I make those points. When the hon. Gentleman and I had a constructive meeting earlier this year to discuss local health care services, there was not the political smoke or the chorus backing him that there has been in this debate. Genuine issues were raised about his local health care service, and he and I, with local commissioners, worked to put improvements in place. As a result of that meeting, there are more staff, more winter beds and more investment in his local trust. The local community hospitals that he was so concerned about are in a much better place.

I am sure the hon. Gentleman will come back to me if further issues arise, but his part of the country is much better placed than many others to deal with the pressures of winter. He should be proud of that, and I hope he will take the opportunity after this debate to champion his local NHS and the good work at local level by front-line staff who are delivering improvements. I hope he will take that opportunity and that we will not have to come back here and listen to him running down his local health services.