Healthcare on English Islands

Debate between Steve Barclay and Bob Seely

Wednesday 27th June 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

It is a pleasure to serve under your chairmanship, Mr Hanson. I pay tribute to my hon. Friend the Member for Isle of Wight (Mr Seely) for raising the issue in the way that he has. He has used Westminster Hall exactly as it should be used—to bring the concerns of his constituents front and centre before the House. He set out not only the challenges faced, but the ways forward and a number of solutions for different issues. In short, he raised issues of funding that relate to population and geography, travel, the potential for further integration, and also a way forward involving digital and data. I will address each of those in turn.

This is also a timely debate, as the shadow Minister mentioned, following the Prime Minister’s announcement at the Royal Free Hospital last week of a significant funding boost to the NHS. Alongside that, NHS leaders are drafting a long-term, 10-year plan on services, which will look at many of the issues he cited in his speech. As we start that journey with NHS leaders, bringing the issues of the Isle of Wight front and centre is timely and helpful.

I would segment the funding formula issue into two: the challenges that the Island has in common with other parts of the country, such as those posed by the over-80s and by the significant number of constituents with dementia, and those that are unique to it. Indeed, few hon. Members feel that their constituents’ circumstances do not merit being higher up the funding formula than they currently sit. It is valid to raise those issues, and NHS England will look at them on the advice of the Advisory Committee on Resource Allocation, which advises on the funding formula. Those decisions are common to other areas, but they need to be made in respect of the Island. If my hon. Friend wishes, I am happy to facilitate a meeting with NHS England so the funding pressures pertaining to the demography of the Island can be raised. He will recognise that the setting of the funding formula is an independent process.

There are specific issues about the geography that my hon. Friend raised very well, not least about maternity services and paediatrics. The Island needs to supply those services and that will have an impact on its funding. I am happy to look at those issues. Integration is one way that headroom will be facilitated to meet those challenges. As he said, the Island was a vanguard site that has received £8.4 million of extra funding since 2015 to facilitate the transformation of services. That funding recognised some of the Island’s specific geographical challenges.

Although geography can be, and is in certain areas, a disadvantage and a driver of cost, it is also a driver of opportunity, as my hon. Friend set out. The Island has a strong sense of place and identity, and there are strong personal links between key decision makers and stakeholders. As the shadow Minister rightly said, the move towards greater integration between health and social care—as is reflected in the name of the Department—is also an opportunity to drive integration between the council and health services. My hon. Friend alluded to the bureaucratic obstacles to that, and I am happy to work with him to overcome them. As patients present with multiple conditions and as we move away from silos of care to a more holistic approach to patients and their wellbeing, the Island offers a huge opportunity for greater integration.

On my hon. Friend’s point about data, I had an interesting meeting yesterday with the chief executive of the Christie in Manchester, which is one of our outstanding trusts. I was struck by the fact that 19% of its patients take part in medical research programmes. The chief executive set out how that is hugely beneficial to the trust and to the patients, who get access to cutting-edge drugs and the latest thinking. He has also been able to attract some of the world-leading figures in research because he has a population that researchers can work for, which is very attractive to them. That is a real win-win, and the demographics of the Island offer an opportunity in that regard.

[Mr Seely]

One point that I did not make was that when it comes to looking at dementia, the Island would be very open to becoming a national leader or a place where academics and researchers could investigate how we can live better with dementia in this country. We have double the national average of people with dementia, so it would be a natural fit for us.

[Stephen Barclay]

I am keen to work with my hon. Friend on that, because the Government have prioritised their research and development budget, as I know from my time at the Treasury. A significant investment has also been made in health R&D. The NHS has an opportunity to combine its patient data with our world-leading universities and R&D to attract researchers, drive forward the most innovative approach on healthcare and translate that cutting-edge research into day-to-day care. That can be a frustration for our constituents; it is fine to have the research, but we need to roll it out to scale in a way that is meaningful for patients. The challenge of the Island’s geography is also a huge advantage to it. I do not know what percentage of its patients are taking part in research, but that may be an area for him to explore and for the Department to work with him on.

My hon. Friend also raised the potential of digital. He will be aware that the Secretary of State has asked Dr Eric Topol, one of the world leaders on the use of digital in healthcare, to undertake a report for the Department. My hon. Friend is right that rather than a patient having to be physically present in all instances, as was traditionally the case, there is scope to use digital much more for them to see a consultant online and for information to be sent digitally. I recognise that if the clinical commissioning group is in deficit, finding the headroom to invest in that technology becomes a trade-off and a challenge, but that is one of the opportunities that will be opened up by the Prime Minister’s investment in the NHS and it is an area that the 10-year forward view will specifically examine.

In terms of timing, the Island has a chance to look at how it can become a leader, what has been done with digital enablers and early adopters in the NHS, and in which areas it can lead on in technology. I will come on to the challenges of travel, but reducing the need for journeys is a more sustainable solution than seeking to subsidise them. Our starting point should be how we can use technology to reduce the need for as many journeys, rather than how we can subsidise more journeys. That offers significant scope.

On travel, I heard my hon. Friend’s remarks about the cost and its wider impact on families. There is a correlation with a separate debate we have had about car parking charges. Clearly, there are specific challenges related to travel, but as he also set out, it is quite complex, because there are already arrangements with the ferry companies and national schemes for subsidies and assistance that can be given to people who are financially challenged. It is a question of looking at how we can fit in with the existing schemes and what agreements can be reached with the companies concerned. I am happy to meet him to pick up on that specific point to better understand our current approach and what can be done, given the challenges. Again, the challenge of distance is not unique to the Island, but as he mentioned, there are certain features of travel to the Isle of Wight and the Scilly Isles that pose challenges.

As my hon. Friend will be aware, the NHS healthcare travel cost scheme provides financial help for travel costs for patients on low incomes who are referred. The scheme is part of the NHS’s low-income scheme, under which people are also entitled to free prescriptions and glasses. Under the scheme, the full cost of transport can be reimbursed by the NHS to eligible patients. Schemes are in place, but I hear the wider points that he has raised and I am happy to discuss them with him.

In short, my hon. Friend has set out that the Isle of Wight is ideally placed to be at the vanguard of the NHS’s approach as we move forward with the 10-year forward view, in embracing digital and integration and in looking at how to deliver place-based commissioning most effectively. There are some specific challenges with regard to its population and its geography in terms of travel. The interplay of those two things is another challenge in terms of efficiencies of scale and the services that are considered essential on the Island, which may be dealt with at a larger-population level elsewhere.

In the NHS more widely, as we move to a hub-and-spoke model and to more flexible population sizes, and as we look at place-based commissioning, the Isle of Wight has huge potential to be at the forefront, as my hon. Friend has set out. I am very happy to follow up this debate by meeting my hon. Friend, and to facilitate a discussion between him and NHS England, to ensure that we deliver what he has campaigned passionately for—the best healthcare for residents of the Island—and that the significant investment set out by the Prime Minister is maximised for his constituents.

The shadow Minister quite reasonably asked whether we were open to changes to the legislation. As he will be aware, the Prime Minister said to the NHS leadership in her remarks at the Royal Free Hospital that we are open to such suggestions if NHS leaders feel that changes are necessary. As part of the workings of the long-term plan, those leaders will need to look at what they need, and whether much of the integration—I know that the Mayor of Manchester supports the integration that is taking place in Manchester—can be done under existing legislation, or whether changes are needed, and if so, what those are. That will be part of the discussions with Simon Stevens and others in the weeks and months ahead.