Food, Diet and Obesity Committee Report

Baroness Coffey Excerpts

Friday 28th March 2025 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I declare an interest in that I worked for Mars for 12 years and I have a pension.

I am conscious that a lot of the discussion today is about food processes, not food producers, but I have spotted that the noble Baroness, Lady Batters, is speaking later, so I expect that she may cover the issue of food production.

One thing that struck me about this report is that it seems that the only way to try to get change is through regulation, taxes and strategies. I can genuinely say that, in the three different roles that I held at Cabinet level, particularly when I was at DWP, we worked with the Department of Health and Defra on the food strategy. We worked on increasing Healthy Start, and, when people asked for it to be online, we got the applications online.

This is all about how we try to develop habits and, as has already been referred to today, starting young is a key element of that. That can be in schools, but I would go further. Thinking of what the noble Baroness, Lady Brown of Silvertown said, there is a lot here for local government. That is where the health workers are and it has responsibility for planning permission, which was further strengthened last December—a key driver is not necessarily what happens at home, but what you purchase, particularly from fast food outlets. That is really where a lot of the focus should increasingly be.

To follow on from what the noble Baroness, Lady Meyer, said, I remember that, as a student, I used to go down from my halls of residence to the Berwick Street Market every Saturday at 5 am to get the cheap veg. The question is how councils can promote markets, and not just, dare I say it, the niche chichi farmers’ markets. Perhaps councils can do innovative things, such as removing business rates or similar, in order to try to get that fresh food habit as part of a regular shop, with people not just travelling to the supermarket.

One thing that the report frequently refers to is the 2021 national food strategy. I know that Henry Dimbleby was commissioned by Michael Gove to provide evidence to it. It somewhat mushroomed and went way beyond its remit and people referred to it as the “national food strategy”. I should point out that it was never adopted by the Government. However, it brought out a lot of important issues—I appreciate that Henry is not only charming but indeed passionate about this particular interest—that built on the work he had done in improving school meal standards and his other work. A strategy was produced in June 2022 and is now to be updated.

In thinking about processes, one thing your Lordships may not be aware of is the relationships that were forged, particularly during Covid, with the Food Resilience Industry Forum. Frankly, it was the partnership between government and the food processors that are being maligned that kept food on the shelves, so that people could get fed during the challenges that were faced at that time and to some extent during Ukraine a little bit later. Fast-forwarding somewhat and thinking about UPF and science, I would recommend that your Lordships read Dr Amati’s article in the Times today, which talks about this issue and the challenge of how, to be candid, the Nova classification is not just in the balance like the committee has suggested but has been discredited as being ineffective in its classifications. The Nova classification gave a starting point, which was a good thing, but it needs to evolve. That is why the important work still needs to continue. If more research could be done towards that, it would be a welcome move by the Government.

In thinking about the needs of families, we have to remember the cost of living challenge that people face. When food inflation was rising, we had food companies admitting in private that their policies of pursuing net zero by 2030 were increasing the cost of food for families right across the country. When we challenged them about changing that while we had the national emergency, the answer was, quite simply, no. That was a concern to me, but I appreciated that trying to legislate to change that, or creating some new strategy, would simply just add to a very long list. As a consequence, going into the Department of Health as I did, I was accused of all sorts of things at the time, despite the fact that we had a series of strategies. We sat down, looked at the impact assessments for all the different bits of legislation and tried to prioritise those that would make the most difference. That is why banning buy one, get one free during a cost of living crisis was not necessary, especially when the marginal impact was so low. I hope that the updated food strategy that we will see later this year will have a systemic approach to achieving the outcomes that noble Lords seem to be seeking.

I agree with the committee on one specific recommendation: getting the Food Data Transparency Partnership to complete its work. It is one of the best things I set up when in government. It is done on a basis of trust, but it should not be delayed. I encourage the Minister to work with her colleagues to make sure that goes through.

I speak as somebody who is super-obese. Noble Lords may not believe this, but about 20 years ago, I lost 8 stone. I did that by not eating or drinking alcohol—that was pretty much it. I cannot pretend that it has stayed off—far from it. It is not a lack of desire and, as I said to the health officials when I went in, I am a classic example of failure. What has gone wrong? It was not the nutritionist who advised me to eat more carbohydrates. What was it? This is still a journey and there are many good recommendations, but I encourage the Government to focus on delivery and not on more strategies and laws that distract from getting the job done.

Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Baroness Coffey Excerpts

Monday 10th March 2025 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, these regulations were laid before the House on 29 January. This draft SI uses powers conferred by the Retained EU Law (Revocation and Reform) Act 2023 to propose two reforms to the market authorisation process for regulated food and feed products in Great Britain. The first is the removal of the requirement for certain products to be reauthorised every 10 years, and the second is to allow authorisations to come into effect following ministerial decisions and to then be published in a public register, rather than prescribed by statutory instrument. The reforms are very much related to process.

These reforms are part of this Government’s mission to kick-start economic growth by increasing investment, driving up productivity and tackling regulatory barriers—something that I know noble Lords are concerned with. The UK food industry is worth some £245 billion in consumer spending annually. It is driving innovation, particularly as the UK’s growing engineering biology sector harnesses emerging technology to produce novel foods.

Regulated products are food and feed products that require safety assessment before they can lawfully be sold. The Food Standards Agency and Food Standards Scotland carry out this assessment and provide recommendations to Ministers across Great Britain on the authorisation of products. Innovation and growth across the food sector is increasing demand for authorisations. We need proportionate regulation to support investment, while maintaining safety and consumer trust. This statutory instrument removes requirements that are unnecessary for food safety without compromising it.

On renewals, certain authorised products must currently be reauthorised every 10 years. This SI removes that requirement. Instead, safety reviews will be carried out when necessary. The service will be more efficient if regulators focus on detailed reviews of products that potentially pose risk, instead of reassessing products that have many years of safe use.

The FSA and the FSS have earned public trust through rigorous risk analysis. These reforms build upon regulators’ existing powers to request safety information. They enable an efficient approach, where the regulators respond effectively to emerging risks. I emphasise that, where necessary, approvals can be modified, suspended or revoked. Food safety will continue to be the priority.

Although steady progress is being made, it is fair to say that the FSA and the FSS are not processing as many applications as are coming in. This is causing an increasing backlog, which is of concern. There are 481 current applications; although 97 applications have been completed since 2021, the caseload is growing, not reducing. Of those 481, about 100 are renewals, with almost 500 additional renewals expected in the next three years. This has to be dealt with. While the FSA and the FSS have implemented measures to improve the service within current legislation, it is essential that the service and the system are modernised. Removing automatic assessment for renewal allows a more targeted approach.

I turn to the removal of SIs. The second part of these reforms allows authorisations to come into force following ministerial decisions and to be published in a public register, rather than being prescribed by an SI. This will enable new products to be brought to market more quickly, without, I emphasise, compromising safety. Publishing authorisations together in online registers, rather than in complex legislation, will make finding information on authorised products more accessible than currently. This aligns with other UK regulators’ authorisation processes, such as for veterinary medicines and pesticides.

The FSA and the FSS provide scientific scrutiny through expert staff and independent scientific advisory committees. They provide safety assessments, risk management advice and recommendations for ministerial decisions. This process aligns with internationally recognised principles. The FSA and the FSS will publish risk assessments and authorisations, in line with their commitments to transparency. The statutory obligation to consult will not change, and authorisations will continue to be subject to public scrutiny.

I assure noble Lords that there has been extensive engagement with industry and consumer groups, including through public consultation. The reforms have received substantial support. The Secondary Legislation Scrutiny Committee was reassured by the FSA’s responses to questions raised during scrutiny. I have responded to those primary areas of focus in this opening speech.

These reforms prioritise efficiency and safety, focusing resources on innovative products. I hope noble Lords will feel able to support these reforms, which will create a service which manages risk in a proportionate fashion, without compromising our high food and feed safety standards. I beg to move.

[Baroness Coffey (Con)]

My Lords, I welcome these regulations, on several grounds. First, as the Minister mentioned, this is a deregulatory approach. There cannot be many regulations deemed to be deregulatory that have 104 pages, but 70 of those pages deal with revocations of existing legislation. That is to be welcomed.

I completely support that this will be a risk-based approach. I am conscious that consultations are ongoing on products being considered by the FSA under this approach. I am conscious that some may be concerned about removing the need for separate secondary legislation, which is a hangover from our days in the European Union, but this is perfectly routine.

I have a couple of questions for the Minister. First, I am conscious that the Food Standards Agency is a non-ministerial department, with the DHSC leading on this in government and in Parliament. Can she confirm whether DHSC Ministers will be making these decisions or whether it will be open to Defra Ministers?

Secondly, an issue that arose during the passage of what is now the precision breeding Act was concern that the devolved Administrations would be reluctant to have any GMO in products sold in their countries. The purpose of the United Kingdom Internal Market Act and the non-discrimination principle was to make sure that, where something had been given the go-ahead in England, say, it could be sold anywhere across the United Kingdom, respectful of the devolved Administrations but nevertheless giving consumers that choice. Will the UK Government fully assert the non-discrimination principle in the sale of future products? As I said, I support these regulations.

[Baroness McIntosh of Pickering (Con)]

My Lords, I support the comments made by my noble friend and concur entirely. I congratulate the Minister on bringing forward this streamlining and deregulatory process. However, I share some of the concerns put forward by the Secondary Legislation Scrutiny Committee.

My noble friend talked about GMO. I am personally very wary of GMO products: I would like to know if I were eating such a product or if such feedstuff was being fed to an animal that I may go on to eat. Can the Minister assure me that the removal of the renewals process will not lead to any information affecting the suitability of validation methods for GMOs being overlooked? Put simply, can the public and consumers rest assured that the processes that have been followed hitherto will be followed? How can the public be made aware of those processes and know that that is the case?

NHS Dentistry: Recovery and Reform

Baroness Coffey Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

The advice and guidance to dentists will be going out today, while the new patient premium that I have told the House about will come in from March—it is weeks away.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I thank my right hon. Friend the Secretary of State for an excellent statement and an excellent plan. It is exactly what patients in Suffolk have been waiting to hear—the rural payment, the bonus there and the mobile service. I am conscious that many dentists have chosen not to have more patients, and they might blame the contract—this, that or the other. That is why I welcome her plan about potentially tying in graduates to the NHS. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) has already referred to the General Dental Council, which, in my view, has not taken full advantage of the regulations that came into force last March. Will the Secretary of State also look at the NHS’s own rules that further restrict the rapid supply of dentists into the NHS for our constituents?

[Victoria Atkins]

I thank my right hon. Friend for all the work she did on dentistry in the Department. I am conscious that many people have contributed to this plan; I am grateful to her and others. Again, I hear the observations on the General Dental Council, and will ensure that the GDC hears them as well. That is a fair challenge to the NHS. Colleagues will see that the plan is co-signed by NHS England, which shares our ambition to deliver those 2.5 million more appointments and set up the future of NHS dentistry for our country.

Pharmacy First

Baroness Coffey Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

Oh, was it 8.31? I thank the Secretary of State. When will the services be available? I should think that many more are taking place already.

I am afraid that, while welcoming this, the hon. Lady is being a little pusillanimous with her praise. A lot of her suggestions, as she will know, are simply not true: already, well over 2,000 new GPs and tens of thousands of nurses are working in our NHS. Many thousands of additional practice staff are working in GP practices, and, as she will know, our brilliant GPs have made 50 million more appointments available each year ahead of the target in our manifesto. Good on them. They are doing an amazing job, and Pharmacy First will ease the ever-increasing burden on them.

The hon. Lady talks about technology. I am pleased to tell her that ensuring that the technology was in place was key in deciding when we could go live. There is a very short window in which some systems will have elements of manual intervention, but only for a few weeks. The whole system will be fully automated and will provide the ability to inquire into GP records and to swap advice, which is important for pharmacists to deliver the excellent service that they are already delivering.

Finally, the hon. Lady will know that community pharmacists have for some time now been delivering blood pressure checks, which in some cases are truly lifesaving. This is amazing patient access and patient convenience. The Labour party should, for once, simply praise it and be glad that the Government have stuck to our plan and got on with it.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I am so pleased to hear today’s announcement that we are delivering. It was one of the key things in our plan for patients that I wanted to ensure happened. In particular, many Members of this House, current and past, have had infections and, as a consequence of not dealing with them, have ended up in hospital. This is the sort of sensible approach that, frankly, met some resistance during my time in the Department, with worries about over-prescribing. It is about treating pharmacists like proper professionals and, most important, providing quicker access to necessary care, which patients will now properly enjoy.

[Dame Andrea Leadsom]

May I say a huge thank you to my right hon. Friend for her contribution to kicking this project off? I feel very fortunate to be at the Dispatch Box on the day we launch it, because many others were involved in setting it up. She rightly highlights some of the problems with spotting things such as sepsis infections, which pharmacists are trained to spot. They really can be the first line of defence. Being able to walk in off the high street to see a pharmacist is incredibly valuable to us all.

Draft Anaesthesia Associates and Physician Associates Order 2024

Baroness Coffey Excerpts

Wednesday 17th January 2024 General Committees

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

It is a pleasure to serve under your chairmanship, Dame Caroline. This may surprise Members, but I am not a member of the Committee. However, I care about this issue. I believe that the expansion in the number of associates is fully in the interests of patients. By virtue of this Order in Council—which has also been put forward by Scottish Government Ministers—there will be a necessary and rightful route by which physician associates and anaesthesia associates can be regulated by the General Medical Council, with all its professional elements. There will be a curriculum, continuous professional development, and a variety of other things that we expect of other professionals in the NHS and the wider health services.

This may all sound a bit odd. Why do we not just get more people to become doctors? The Government, however, have already addressed that, through the expansion in medical school places that is to happen. I will tell the Committee a personal story, through which I saw the issues at first hand. I will not pretend otherwise: when I was, for a brief time, Secretary of State for Health and Social Care, this event reinforced the reasons why I was keen to see this move make the progress that it is making.

About 18 months ago, Parliament was busy with a potential change in leadership, although Prime Minister Boris Johnson was still in post. I suffered an infection and went to a hospital in London, where I waited more than nine hours to see a doctor. I went home without any treatment, and then re-presented myself at a different London hospital, where I got the treatment that I needed within a much shorter time. This meant that I attended my last Cabinet meeting by phone from an NHS hospital bed.

The second hospital was quicker to deal with my situation, because it had a wider range of medical professionals, including a physician associate, who was able to do a lot of the work on the appropriate treatment, although of course that still needed sign-off by the doctor. Instead of patients waiting for hours for that one doctor, the hospital was using a full range of NHS professionals to the extent of their abilities. That is a sensible, practical way to ensure that patient care and safety is absolutely paramount.

Not all hospital trusts have associates, nor are they necessarily planning to have them, but I would strongly recommend that they do. When I think about the number of operations that could be happening, I really welcome the expansion of anaesthesia associates. The anaesthetist will be a key part of that, but imagine one anaesthetist helping with three operations at one time, along with appropriately trained and regulated anaesthesia associates. That is an approach that modernises the NHS’s capacity and capability to treat as many patients as possible.

In the past, there has been resistance to Pharmacy Direct, which is about to be launched, expanding the number of things that pharmacists can do. There has also been resistance to expanding what nurses can do without a doctor’s sign-off. There will be plenty of situations where people in community hospitals say, “Ah, yes, you’ve come in. We will try to treat that in the minor injuries unit, but we don’t have a prescribing nurse here, so you’ve got to either wait, or go to the doctor to get a prescription.” The modern NHS has to think about those situations, and be careful in how it deploys staff. This Order in Council is a key element of that. It brings associates into the same professional regulatory body and inspection regime as doctors—of course, people will know that there are other regulators for different professions.

I felt strongly about coming along to the Committee to support this order and see it progress. For me, patient safety will always be paramount, but I see this as a professional step forward, and I look forward to the change happening right across the United Kingdom.

NHS Winter Update

Baroness Coffey Excerpts

Monday 8th January 2024 Commons Chamber

[Victoria Atkins]

I thank the hon. Lady for re-emphasising the critical timing of the strike actions and the impact it has on patients. We know that winter is difficult. It is not just difficult for our healthcare system. Around the world, when cold winter strikes, it has physiological impacts on people with underlying health conditions. We also have a rise in infectious conditions, too. As she will appreciate, that is precisely why, on the advice of clinicians, we brought forward the flu and covid vaccination programme to try to protect the most vulnerable in our society. But again, the timing of the strikes is so very cynical, because their impact and tail will, I am sorry to say, have consequences beyond tomorrow’s stop date.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I was really concerned when my right hon. Friend mentioned the number of requests made to the BMA for certain duties in hospitals and that only two had been responded to positively. That is really concerning for patients. Contrast that with the behaviour of Nick Hulme, the acting chief executive at Norfolk and Norwich University Hospital, who has transformed its A&E in terms of waiting times. We need to promote such leaders, but we also need to unreservedly condemn the actions of the BMA junior doctors committee and get the strikes over and done with.

[Victoria Atkins]

I thank my right hon. Friend for her work in the Department. She knows only too well the difference an inspirational leader can make to a local NHS trust, and at regional or national level. Managers who are good and committed to their local area, who work with their clinicians and other healthcare staff to try to look after patients all year round, have been put under the most enormous pressure over the last few weeks because of the strikes. I thank every single one of them for doing what they can to safeguard patient safety. As I say, I trust their judgment. If they have put patient safety mitigations in, it is because they consider, in their professional judgment, that they are needed.

Health

Baroness Coffey Excerpts

Monday 9th June 2014 Commons Chamber

[Andy Burnham]

I will move on to that point. Whenever there is a problem, we are told, “Speak to NHS England.” I am afraid that is not good enough. Up and down the country we are seeing services closed without adequate consultation. NHS walk-in centres continue to be closed, piling more pressure on A and E departments. It is just not good enough. We have seen top-down changes driven through, and the hospital closure clause is on the books, so sadly this will continue. It will only change when we have a Labour Government back in control—a Government committed to putting the public and patient voice at the very heart of the NHS.

I was talking about A and E and the reorganisation. We know that Ministers were explicitly warned about an A and E recruitment crisis by the College of Emergency Medicine a couple of years ago, but they said they were too absorbed with the reorganisation to listen or act. That brings me to the nub of the matter before the House: the root cause of the deterioration in the NHS is that reorganisation, which nobody wanted and nobody voted for. It threw the service into chaos just when it needed stability. As we warned, it has damaged standards of patient care. Four years ago the Government inherited a self-confident and successful NHS, with the lowest ever waiting times and the highest ever public satisfaction. Since then it has been destabilised, demoralised and reduced to an uncertain organisation that is increasingly fearful of the future.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

The right hon. Gentleman refers to cuts in funding. The only cuts in funding that we have seen in this country have been in the NHS in Wales. With regard to patient satisfaction, I can assure him that the targets left behind by the previous Labour Government did nothing to satisfy patients who were left on the ground by ambulance services because they had already gone past the eight or 19-minute limit. I am afraid that the focus on targets, rather than patients, is something that this Government have had to address.

[Andy Burnham]

I think that it would behove Government Members to have a bit more self-reflection and humility. The hon. Lady was not a Member of the House at the time, but she may recall that before 1997 people used to spend years on NHS waiting lists, and some never came off them. Over Labour’s 13 years in government we saw waiting lists come down, and down, and down, to the point that, when we left office, they were at their lowest ever level. I am not claiming that the NHS was perfect and did everything right, but it had the highest ever level of public satisfaction. We must have done something right. A bit of balance and accuracy in this debate is just what the NHS needs.

Ambulance Resources and Response Times

Baroness Coffey Excerpts

Wednesday 14th May 2014 Westminster Hall

[Mr Wright]

My hon. Friend makes an important point. How can an ambulance service plan for the next five years if it faces annual commissioning rounds? That does not work and does not provide long-term sustainability.

The North East Ambulance Service, which, like other ambulance services, has received a flat cash offer from the Government over the course of this Parliament, has been required to cut £4.83 million from its budget for 2012-13, which is some 5% in real terms, and another £4.35 million for 2013-14. Unison estimates that real cuts of about 20% to 25% have been made to ambulance services so far over this Parliament. Those cuts, coupled with rising demand, are having a detrimental impact on the quality of ambulance service that people receive.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

Will the hon. Gentleman give way?

[Mr Wright]

If the hon. Lady will allow me to continue for a moment, what I am about to say is relevant to her area. Response times, especially for the most life-threatening emergency cases, are getting worse. In March 2012, 75.5% of emergency calls in England were responded to within eight minutes. In March 2014, in the latest figures available, that had gone down to 74.7%, with seven of the 11 ambulance trusts, including the North East Ambulance Service, seeing a deterioration in performance. The East of England Ambulance Service saw the proportion of emergency calls responded to within eight minutes fall from 76.2% to 62.4%. That is simply unacceptable, and the hon. Lady will want to respond to it.

[Dr Coffey]

I congratulate the hon. Gentleman on securing the debate. I agree that this is a depressingly familiar situation, but I do praise Anthony Marsh, the new chief executive of the East of England Ambulance Service. I recognise the hon. Gentleman’s points, but what is the North East Ambulance Service’s board doing? MPs in the east of England campaigned and successfully managed to get rid of the entire board.

[Mr Wright]

As a north-east collective, we work closely to ensure that our constituents get the best possible services.

Let me move on to average response times. In the north-east, the average response time increased from five minutes and 16 seconds in 2011 to five minutes and 48 seconds last year. The east of England saw a 90-second increase in response times. Only one ambulance trust actually reduced the average emergency response time. Those figures reinforce what the senior management from the North East Ambulance Service confirmed at Mr Gouldburn’s inquest, namely that ambulance services do not have the resources to meet demand, that it is a national problem and that response times are suffering as a result. There has been an admission from a senior manager in the ambulance service that resources are not keeping up with demand. Response times, in particular for more serous cases, are deteriorating and lives are being threatened, if not tragically lost. Will the Minister therefore pledge this afternoon to provide more resources to ambulance services in Hartlepool, the north-east and across England to meet rising demand?

I also want to question the assessment process used to screen calls and prioritise response times. Given Mr Gouldburn’s history of heart problems, his age and the fact that he had recently undergone surgery and had seen the doctor that same day, why on earth was he not prioritised as an emergency case and provided with an eight-minute response time? Why did it take seven calls to escalate the case to an emergency? The Minister must accept that that is simply unacceptable. Is there pressure from the Government to downgrade the priority of emergency calls due to inadequate resources?

This week, I received a letter from the Health Minister Earl Howe stating in response to Mr Gouldburn’s case that

“the 999 call was triaged correctly, although some of the questioning could have been better.”

Why was it not better? Why is the questioning not relevant and efficient in every case? The constituent whose father had kidney problems said to me:

“Phone assessments should be changed. In each assessment they asked me did dad have a rash and could he put his chin on his chest! Words like kidney failure and potassium should be taken note of. Because I’m not a rude person I didn’t react angrily, but wish I had because dad could have died. We realise that there is a shortage of ambulances and this can’t go on. We are a rich country. Shortages of ambulances are something you read about in poor countries. It shouldn’t be happening here.”

Assessment and prioritisation seem to be failing and the right questions are not being asked during initial screening. What will the Minister do to address that?

The third issue is that ambulances were delayed because of a problem in admitting patients to North Durham hospital due to a lack of available beds. That seems to show both a lack of joined-up thinking on hospital admissions and the fact that ambulance and NHS resources are hanging by a thread. Is it really acceptable, as seems to have happened in Mr Gouldburn’s case, that because of a delay at a single hospital in County Durham due to insufficient beds, the whole ambulance service for the north-east, or certainly the south of the region, grinds to a halt? The Minister surely cannot find that acceptable. Are resources being spread so thinly that services are not being provided to my constituents?

Hospital services in my area have gone through dramatic changes in the past few years, as my hon. Friend the Member for Easington (Grahame M. Morris) knows all too well. Hartlepool’s A and E closed in August 2011, much to the town’s concern, on the grounds of clinical safety and the specialisation and centralisation of appropriate medical skills. There is a mismatch between the Momentum programme of centralising services and the Government’s failure either to commit to funding a new hospital or to provide resources to reinstate services at the existing Hartlepool hospital. If there are fewer A and Es across the country and ambulances have to travel greater distances to a smaller number of centres, will that not increase the handover and turnaround times of patients between the ambulance service and hospital staff? Ambulance crews—my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) has been strong on this—are queuing up outside fewer hospitals, making handover and turnaround times worse. Does that not reduce the amount of time for which ambulance staff can be in a position to respond to emergency calls?

Tobacco Products (Standardised Packaging)

Baroness Coffey Excerpts

Thursday 3rd April 2014 Commons Chamber

[Jane Ellison]

I thank my hon. Friend for his support. There is a significant chapter about illicit trade in the report and there are reflections on the Australian experience throughout it. If the Government’s final decision is to move ahead, we will look to glean everything we can from the Australian experience.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

In November 2009, the right hon. Member for Leigh (Andy Burnham) wrote in a letter to the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell) that

“no studies have shown that introducing plain packaging of tobacco would cut the number of young people smoking or enable people who want to quit, to do so.”

I would be grateful to hear, because not all of us have had a chance to read the report, what additional studies have led Sir Cyril and my hon. Friend to reach the conclusion that she has set out today?

[Jane Ellison]

When my hon. Friend has a chance to look at the report, she will see that there have been a number of new reports in recent years. Sir Cyril commissioned an independent academic review that considered not just the Stirling review, which looked at more than 37 academic reviews on the subject, but the supplement to that, which was published in 2013. He concluded that the reviews were very robust. Much of his report is devoted to a scientific and forensic examination of the methodology used in those reviews. I commend it to her.

NHS Funding (Ageing)

Baroness Coffey Excerpts

Tuesday 25th March 2014 Westminster Hall

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

It is a great pleasure to serve under your chairmanship, Sir Edward. I thank Mr Speaker for granting this important debate. It is a pleasure to see that my constituency neighbour, the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), will reply for the Government. As a practising doctor, it is natural that he is active on local health matters. Before arriving in Parliament, he, together with my hon. Friend the Member for Ipswich (Ben Gummer), campaigned hard to secure better cardiac facilities at Ipswich hospital, which were formally opened by Her Royal Highness the Countess of Wessex last week. I was pleased to join that campaign, although rather late on, because I was selected only three months before the general election. Nevertheless, those facilities are in place. Together, we have continued to highlight issues that affect our constituents, particularly the performance of the ambulance trust and our local hospitals.

I am proud that the NHS budget has risen under this Government and will continue to do so. I am proud, too, that my right hon. Friend the Secretary of State for Health has continued the focus on patients and has been prepared to lift the lid on when a normally high-performing NHS has let patients down. I join him on that crusade to ensure that patients are not sacrificed at the altar of targets, which is a sad, though unintended, legacy of the previous Labour Government.

From my experience as an MP with a rather elderly constituency—more than a quarter of its population are pensioners—I have come to realise that how the NHS has allocated its funding is simply not fair to older patients. That unfairness has become embedded in NHS finances over several years and significantly increased under the previous Government. We have an increasingly elderly population, and we have to tackle that funding issue. Let us remind ourselves that although the Labour party substantially increased health funding during its time in government, it did not sufficiently reform the NHS, and that includes the particular factor in the funding formula that could have helped older patients by focusing more on their needs.

The right hon. Member for Leigh (Andy Burnham) signed off on the £20 billion savings challenge, commonly known as the Nicholson challenge, which was supposed to redirect funding towards coping with demand for NHS services from the UK’s ageing population and the higher costs of drugs and treatment. As the challenge is being followed through, Labour MPs often complain loudly about cuts to the NHS, but they effectively endorsed those cuts by starting those savings when they were in government. The savings are gradually being made, but the only evidence I can see of their helping the ageing population is the Government’s transfer of some NHS money to help with social care for that ageing population, which I welcome. Labour MPs seem to forget that the right hon. Member for Leigh set that in action. Just before the emergency Budget in 2010, he said that it was irresponsible to increase NHS spending in real terms. I do not think it was irresponsible to increase NHS spending, but it is irresponsible not to have addressed a funding formula that does not help the elderly.

The date of 17 December 2013 will go down as the landmark day when NHS England turned its back on the needs of elderly patients, stuck its head in the sand on the dawning impact of an ageing population and crumbled to political pressure from the Labour party. Here was an opportunity for the board of NHS England to put right the funding formula so that the NHS was no longer a postcode lottery and would provide equally for people in need and on access to services. Frankly, I think the NHS bottled it. I do not know why. It ignored the advice of its expert committee. Was it the letter sent to them by the right hon. Gentleman? Blatant political pressure was put on the board of NHS England, and it fell at the first hurdle.

Meanwhile, the Labour party has actively campaigned against the proposed change in the funding formula, which would have started to recognise the increased demands of an ageing population. One of the points made by the right hon. Gentleman in that letter was that he felt that money was being reallocated from certain areas in the north to certain areas in the south. He wanted

“to retain and strengthen the health inequalities and weightings in the allocations formula…and a health service based on need.”

Elsewhere, he has said that the NHS seems to be ignoring the needs of elderly patients. I am concerned that we end up—is this too strong to say?—speaking with forked tongues on this issue. He said:

“A country is defined by how it cares for its older people”.—[Official Report, 14 July 2009; Vol. 496, c. 157.]

He also suggested that the problem of ageing

“will become more pressing as the population gets older…If the system is left unreformed, there are real questions about its sustainability in the long term.”—[Official Report, 8 December 2009; Vol. 542, c. 165-166.]

Since being in opposition, the right hon. Gentleman has said:

“Should we not all set much higher ambitions for the care of older people and, in so doing, learn the most fundamental lesson of all from what happened at Mid Staffs?”—[Official Report, 19 November 2013; Vol. 570, c. 1099.]

He also said:

“The ageing society is not a distant prospect on the horizon. Demographic change is happening now and it is applying increasing pressure on the front line of the NHS.”—[Official Report, 5 February 2014; Vol. 575, c. 282.]

There are a number of times when the right hon. Gentleman has rightly highlighted the challenges facing the NHS.

The Keogh review states that much of the pressure on operational effectiveness

“is due to the large increase in the numbers of elderly patients with complex sets of health problems.”

There we have it. In responding to the Age UK report, the hon. Member for Copeland (Mr Reed)—I am sure he will participate in the debate—said:

“Older patients in the NHS are paying the price of the financial crisis this Government is inflicting on the health service.”

I am not sure what financial crisis he is referring to, given that the Government have increased health spending and are simply putting in place the Nicholson challenge set by the previous Government. He also said:

“Warnings do not come more authoritative than this report. Yet as long as Ministers remain in denial, patients will continue to face the agonising choice of going without treatment or paying to go private. Labour has repeatedly warned of the postcode lottery now running riot in the NHS.”

That is absolutely ridiculous. The hon. Gentleman will have his chance to respond later, but I put it to the House that it is consistently not addressing the funding formula that leads to the postcode lottery for elderly people. It is disgraceful that we allow it to continue in the 21st century. Patients need a board that stands up for them and does not bow to political pressures, from one side or the other.

I thought it might be useful to give a little history on the funding formulas, and I thank the Library for producing the briefing on that. Going back some time, there used to be a weighted capitation formula. That always presented a challenge, because the pace of change showed that it would take more than 20 years to reach an equitable formula. People will know that the urban authorities tend to get higher funding per head than rural authorities. We are still a significant distance from the target under the new formula released in December 2013.

The clinical commissioning group allocations are not the same as those of the primary care trusts, because they have different commissioning roles. Public health has gone to local authorities and specialist commissioning is done centrally. The PCTs started to do a person-based resource allocation, trying to allocate at practice level, recognising that they knew what problems patients had and could fund according to their needs. In 2011, the Department of Health commissioned a Nuffield Trust report to look at approaches to that particular direction, and in 2012 the former Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), was specific in saying:

“Wherever you are in the country you should broadly have resources equivalent with access to NHS services.”

He also strongly recognised that the age of a patient was the most significant factor in determining their health needs. People mainly use the NHS in the first six months and the last years of their lives. There is no doubt that an increasingly elderly population, as has already been recognised, continues to bring the NHS challenges, with more and more complex needs.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Lady on securing this debate. Does she agree that GPs have a lot to answer for in putting pressure on the NHS? Under the new contracts, they no longer have to look after their patients out of hours, which puts a lot of pressure on the NHS and its finances. Surely we need to look at some way of getting round that.

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[Dr Coffey]

I respect what the hon. Gentleman is saying. There is no doubt that allowing doctors to lose the responsibility for effectively caring for their patients 24 hours a day has caused significant change. An ageing population means that that is increasing and will continue to be a pressure on alternative sources of health treatment. A lot of work is going on and I am pleased that the landmark Health and Social Care Act 2012 will start to tackle some of the issues, but I want to give credit to GPs, who are doing so much more for patients in our local surgeries now than 20 or 30 years ago, mainly because of technology changes, but also through a recognition that we can prevent people from going to hospital by doing more in primary care. That is an admirable change, so I want to praise GPs, while agreeing with the hon. Member for Upper Bann (David Simpson) that rescinding that 24-hour care responsibility was a backwards step for patients. The lack of out-of-hours care was one of the big doorstep issues before the 2010 general election.

Turning to the different formulas, one big change in the 2012 Act was splitting funding for the NHS, with public health going to authorities, recognising the deprivation inherent in different parts of the population. That was the right thing to do. Surrey ended up with £20 a head for public health and places such as Hackney had £115. Westminster, for example, has an even higher allocation, recognising that parts of the borough have significant deprivation, but it was the right thing to do. Local authorities not only got the staff from NHS trusts who focused on public health campaigns, but were also given responsibility for tackling the long-term factors that contribute to health inequalities, be they quality of housing or local employment. Frankly, the NHS was not in a position dramatically to change the levers affecting such inequalities in local communities, so it is right that councils took on that leadership. I hope and pray that they continue to take the initiative, rather than just focusing on public health programmes. It is a real step change in the responsibility of and the opportunity for our local councillors to make a difference.

Meanwhile, the opportunity was there to examine the formula for the rest of the NHS budget. I refer to section 23(1) of the 2012 Act, which inserted a new chapter into the National Health Service Act 2006. Section 13G, “Duty as to reducing inequalities”, of that new chapter states:

“The Board must, in the exercise of its functions, have regard to the need to—

(a) reduce inequalities between patients with respect to their ability to access health services, and

(b) reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services.”

The effect is twofold, but the latest funding formula has not taken account of the

“ability to access health services”,

and inequalities have been strengthened.

[David Mowat (Warrington South) (Con)]

I thank my hon. Friend for giving way and congratulate her on securing the debate. The problem is not with the formula that was developed by the Advisory Committee on Resource Allocation, but that the board of NHS England inexplicably decided not to implement it. That is what we are now living with.

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[Dr Coffey]

I agree with my hon. Friend. Funnily enough, I do not think that the formula was strong enough in reflecting the demands of age. It could have gone a lot further. The sparsity challenges are also a constant issue for those of us who represent rural seats. There is no doubt that a patient’s health care experience is somewhat diminished when a cardiac check-up means a 200-mile round trip. I realise that we cannot have a cardiac hospital within five or 10 miles of everybody—that might be the case in London, but I will not get into the London health funding debate. There is no doubt, however, that such trips are not helpful with regard to the patient experience. The funding formula has had negative consequences. We have seen a more rapid reconfiguration and regionalisation of services. The quality of care for patients has been affected and there are funding challenges. The problem is particularly acute where there is a high proportion of elderly patients. That is not good enough.

[Sarah Newton (Truro and Falmouth) (Con)]

My hon. Friend is making a powerful case for patient care in rural communities and I wholeheartedly agree with her. Does she agree that the market forces factor is having a negative impact on rural communities in poorer parts of the country where average incomes are much lower? People within the NHS and the care system are often paid national wages, but the funding formula discounts for local wages.

[Dr Coffey]

My hon. Friend makes an interesting point. I have not gone into that level of detail and do not have that level of understanding, but she makes an important contribution to the debate. Local clinical commissioning group and NHS trusts must contend with that challenge and should make that point to the board of NHS England.

I come back to the formula. I said in response to my hon. Friend the Member for Warrington South (David Mowat) that the focus on age may have slightly increased, but that it did not go far enough. The correlation between age and per capita funding increased only marginally between the old formula and the partially adopted current formula. South Sefton receives 40% more per capita than Ipswich and east Suffolk, but it has 50,000 fewer pensioners and a lower proportion of pensioners. Life expectancy in my part of Suffolk is considerably higher than in others, which is good, but that does not necessarily mean that people, in particular the elderly, do not have complex health needs that need addressing. At the moment, the formula continues to discriminate against the elderly and even further against people in rural areas.

[David Mowat]

This is a really important point on which we need clarity. The issue here is not the formula. Indeed, it does not really matter what the formula comes up with, because NHS England will not implement a formula that does not give everybody an inflation-based pay rise. That is what happened. With all due respect, the formula could be anything we liked, but if it will not be implemented, it just does not matter.

[Dr Coffey]

I can understand why the board of NHS England made a decision not to cut per patient funding in different parts of the country. We could get into the politics of the different aspects of what happened under previous Governments when overall funding went up, but parts of the country, such as the one that I represent, did not receive the same increases and seemed to suffer as a consequence, despite overall funding going up.

I am not into playing party politics with NHS or public funding, so I recognise exactly what my hon. Friend says. I guess that is what led to the outcry in the autumn about the “Tory-run NHS cutting funds to northern Labour seats,” which was disgraceful, because it was down to the ACRA’s independent assessment. I recognise, however, that that must be managed. Nevertheless, the board of NHS England bottled it by not being prepared to be a little braver in deciding on the allocations. It also ignored the formula and, as a consequence, effectively decreased the recommendation on the proportion that should go to elderly patients, which was wrong in principle, but I recognise what my hon. Friend says.

Various proposals were suggested—I say this as a constituency MP and not as a Conservative party representative—that could have seen an improvement in the pace of change towards getting a fairer funding formula while still not cutting funds to patients in different parts of the country. I regret the final decision of the board of NHS England. Of the two options proposed, I would have hoped that it would have gone for the first, recognising that it was a unique opportunity to tackle the unfairness, but the board bottled it.

I want to discuss why the issue matters. There are four community hospitals in my constituency: Felixstowe, Aldeburgh, Southwold and the Patrick Stead, in Halesworth. The first three have been highly commended by the Care Quality Commission and they are well recognised and loved in the community. The Patrick Stead also does an excellent job. The CQC made some slight criticism, but, true to form, the hospital addressed that straight away and is back to doing good things. After I was elected to the House, it was understandable that my constituency neighbour, who is now the Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), should be the local expert on health, as he is a distinguished doctor. However, in my own case work, the experiences of older patients in particular, who had not got the care or treatment they needed, kept coming up. That is what got me going on the entire issue.

We have in the past debated the East Of England Ambulance Service NHS Trust. That was a classic example. At the top line things were running fine. The trust was hitting its targets and financially it was very good. It was trying to get foundation trust status, and the chief executive was awarded the Queen’s ambulance service medal. However, at the heart of things, the NHS relied on the meeting of targets, and forgot about patients. As a consequence, elderly people with broken hips waited for hours for an ambulance to arrive, because their condition was not life-threatening. I am pleased about the big shift that has happened only in the past few months: finally we have got rid of the entire board of the ambulance trust. I am sure that they were all good people who wanted to do the best to help guide the trust. Nevertheless, they seemed to be satisfied with hitting targets, and patients were forgotten. The arrival of Anthony Marsh will be particularly useful.

I supported most of the service reconfigurations, as the Minister knows, but there was one I did not support. A proposal to reconfigure stroke services would effectively have removed them from Suffolk. One need not know a lot about medicine to know of the excellent FAST campaign, which I recommend all MPs share with their constituents. That recognises the need to act quickly and get good treatment after someone has a stroke. Ambulances in the east of England were not reaching people quickly enough to help them with the first steps in care. If stroke services had been removed from the county, it would have taken well over an hour to get access to the sort of care that is necessary to enable a stroke sufferer to have a good life. In the case of cardiac services, when people were treated en route and taken to the regional specialist centre in Cambridge, they got higher-quality care, and I support that, but I was concerned about the stroke proposals. That is why I was pleased when the local clinical commissioning groups came together and said, “No. We are going to keep stroke services in the county.”

However, I must admit that our significantly lower funding per head means that that decision has potential consequences in the local NHS. The fact that our funding level is so different is one of my concerns. Despite a small above-inflation increase, which I am pleased about, I contend that we should be doing considerably more to help NHS CCGs to meet the needs of a significantly higher proportion of the relevant population. The constituencies with the highest proportion of people over 85 include places such as Worthing West, Christchurch, North Norfolk and Newton Abbot—largely rural and often coastal areas. By definition, those are often the places away from regional centres of excellence. I am concerned that the funding formula did not address the needs of patients living on the coast.

I have discussed at length my concerns about what the NHS board has not done, but opportunities are coming through, to do with local innovation. The King’s Fund report, “Making our health and care systems fit for an ageing population”, was an important contribution. One of the examples of local innovation to which it referred was at Gnosall GP surgery in Staffordshire, which provides patients over 75 with an annual health review and uses experienced “elder care facilitators” to support patients, helping them to navigate the system and draw up care plans. That is a good example of local innovation. I tabled a parliamentary question on 20 January at column 76W asking about bringing health visitors in for people over 75. I recognise that health visitors’ primary focus is, rightly, young children. However, there may be something that we can do, and perhaps the board of NHS England could think about rolling out the practice I suggest, particularly in parts of the country with a high proportion of elderly patients.

I could speak for the entire hour and a half on this subject, but I will not, the House will be pleased do know. It is regularly talked about. The board of NHS England had a golden opportunity, with the Health and Social Care Act 2012, to step away from the political pressures and do what was right for patients. As I said, I think it bottled it, and I am sad about that. I hope that it will reconsider its decision and think again about the needs of the elderly. Those people have served the country with distinction. We say that we do not want to discriminate by age, but the postcode lottery seems to determine whether elderly patients get the treatment they deserve. The debate will not be settled today. Unusually, perhaps, the Government cannot wave a magic wand and change the formula. It is for the board of NHS England to do that. I hope it will reconsider and truly look after the patients in question. In a few years we will be the ones in their position, and we need to do our bit to address the challenge.

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[Jim Shannon (Strangford) (DUP)]

It is a pleasure to make a contribution to the debate. I congratulate the hon. Member for Suffolk Coastal (Dr Coffey) on bringing the matter before the House for consideration and giving us all the opportunity to contribute.

We are long past the days when people who die at the age of 68 would be considered to have had a good innings. Now, we would shake our head and describe them as in their prime. The rising age of our population has meant an increase in the pension age, with further increases to come. That is something my parliamentary aide has questioned, saying that she will have to work until she is 72. She wonders who will hire her to write speeches and come to the House then. At the age of 35 or thereabouts, she is already thinking of the future.

One of the figures in the press last week, which hon. Members have referred to, was that we in the United Kingdom now have the greatest number of people living to the age of 100 since records began. Approximately 600 people have lived to 105, which is another indication of the statistical trends. Although that is perhaps great for families who use the free grandparent babysitting service offered nationwide—that is what grandparents do—and which has ensured that families get to enjoy time together, with stories and wisdom passing easily down the generations, it has also put a lot more pressure on our NHS. The NHS is not equipped to handle that pressure without major investment or a redirection and reprioritising of funding.

The sheer beauty of my constituency and the area’s strong links to Belfast and other cities make it one of the most desirable places for older people to retire to—indeed, Strangford and the neighbouring constituency of North Down are the top two retirement locations in Northern Ireland. The hon. Member for Suffolk Coastal said that people want to retire to her constituency because it too is beautiful, and quieter and more serene than many places. As they do in my constituency, people might look forward to seeing the sea in the morning and taking walks, because these are the attractions of such locations. More people retiring to such places, however, certainly puts pressure on our local NHS.

If the Government took account of this debate and increased the funding given to the NHS, offering additional ring-fenced funding to the devolved Assemblies, the level of care would be much greater. I look forward to the Minister’s response, as I always do, because he understands the issues and I respect his comments. It is fantastic to read about the available drugs, treatments and therapies, but the fact is that the NHS cannot afford to provide them fully. Any additional funding would benefit not simply the ageing population, but the entire community. There are pressures on the NHS, given the prioritising of funding to the sections where it is needed most, but I am sure I am not the only person in the Chamber to have read the media speculation about the NHS and the ageing population. Statistics from the Institute for Fiscal Studies indicate that spending per patient will have fallen by 9% within four years even if health service funding is ring-fenced and protected.

I have already alluded to the reasons: 2 million more over-65s on the UK mainland, which is a 20% rise, will place far greater demands on the NHS. To give the Northern Ireland perspective, new figures released by the Northern Ireland Statistics and Research Agency show that the number of people aged 65 and over is projected to increase by a quarter, to 344,000, by 2022. That indicates the pressures on the NHS in Northern Ireland, where health is a devolved matter.

[Dr Coffey]

Has the hon. Gentleman seen the figures circulated by the Royal College of Physicians, which show that two thirds of people attending A and E and admitted to hospital are aged over 65? We all recognise that we need to do more to prevent people going into hospital when they might not need to, and certainly to expedite their leaving. Does he recognise that, right here, right now, we still need to allow CCGs to have appropriate funding to address that need?

[Jim Shannon]

I agree with that. If more preventive action is taken at an early stage in surgeries, that will have dividends further down the line. The hon. Lady is quite right and I wholeheartedly agree with her.

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[David Mowat (Warrington South) (Con)]

I congratulate my hon. Friend the Member for Suffolk Coastal (Dr Coffey) on securing this important debate. Although NHS funding has increased in real terms, what matters is the allocation that we get in our communities. We have learned a lot already from hon. Members’ remarks. Personally, one of the most important things I have learned is that my right hon. Friend the Member for Banbury (Sir Tony Baldry) reads the Daily Mirror. I will reflect on that fact.

The issue of ageing has been a known problem in the NHS for some while. It was a problem for the previous Government and there was an attempt to reflect it better in what was then the ACRA formula. Like the current Government, the previous Government did not implement that formula. The direction for travel adjustments that should have been made in the years before the general election were not made and the formula was essentially static.

As an MP for an underfunded area—Warrington is underfunded—I was optimistic that a new Government bristling with talent and enthusiasm for sorting out such issues would fix the problem. As has been mentioned, the Secretary of State asked the independent ACRA committee to make a clinically based decision on how money should best be allocated—of course, allocation can mean that there are winners and losers—based on ageing, deprivation, population and any other salient factors. The consequence was that a new formula was developed and submitted.

To be clear, nobody who wants the problem fixed is expecting a new formula to be implemented immediately. As hon. Members have pointed out, some areas are significantly under-allocated while others are over-allocated. There therefore has to be a process by which we move towards the correct number over a period of years—that is, the direction of travel adjustment—so that big, unmanageable changes do not happen. That would be perfectly acceptable.

Is that what happened, however, when we went to the board of NHS England with the new, clinically developed formula designed by an independent group? The answer is no. The board of NHS England said, “If we implement the formula, there will be winners and losers. Our view”—perhaps this was because of political pressure—“is that the losers complain more than the winners celebrate. We are going to give everybody an inflation increase. With the bit left over, we will give a little more to those furthest away from target.”

One of those areas was Warrington. We are grateful that we got extra money, but it was not enough. I suspect that the situation was similar in Suffolk and Oxfordshire: some extra money was allocated, but not as much as would have been allocated had the formula been implemented.

What does that mean for public health? We are stuck with a static formula, developed around 2002 or 2003. The previous Government made no direction of travel adjustments to it other than for inflation and we are apparently reluctant to make those adjustments as well. That is a pity. A static formula may be politically expedient but it is not right. That is why we have ACRA—to go into the issues and come up with the right answer. The situation, for me, raises the question of why someone would be on the board of ACRA, given what happens to its recommendations.

There are consequences. I have seen the numbers: 34 CCGs are more than 5% underfunded—that 5% is a lot of money in health allocation—and 38 CCGs are more than 5% overfunded. What to me is even more significant is that 84% of CCGs that will have a deficit are underfunded. That is an issue because if we are trying to make people accountable for managing an efficient operation, but start that process by saying that we are not going to implement a formula that would give a fairer allocation, it is reasonable for them to come back and say, “Yes, and therefore we have a deficit.” It hits the whole process.

What is the impact in our constituencies? We have heard about Harrow, Oxfordshire and Suffolk. Warrington is also underfunded. The issue is not necessarily that older folk get worse services, but that marginal or discretionary activities are not carried out in underfunded CCGs. For example, in Warrington we are unable to provide IVF in the way that the National Institution for Health and Clinical Excellence would like because funding is not available. GPs decide how to allocate what funding they have and consequently the people who lose are not always the ones who would be imagined to have lost in the formula. Overfunded CCGs can undertake more discretionary activity than others, and someone should look at which parts of our NHS are spending large amounts of money on alternative therapies such as homeopathy. That is likely to be the result of overfunding, and that is not acceptable.

There was an element of politics. Everyone agrees that ageing is a good proxy of health need, but there is an issue about the weighting that we should give to deprivation. That was in the letter from the shadow Secretary of State for Health that was read out, and it may have been part of his concern. That does not allow for the fact that ACRA was an independent committee and either we accept what it said or we do not. I have some questions for the Minister on that because it goes to the heart of whether the NHS is manageable. If such important decisions are, in the end, made for reasons of political expediency, why do we have an NHS board and senior NHS managers who are supposed to provide the right answers? We would not need any of that; we could just link the issue to inflation or inflation plus a little bit.

[Dr Thérèse Coffey]

My hon. Friend is making a key point. One point about the Health and Social Care Act 2012 was to remove that party political element of manipulating or managing the formula or putting in extra factors. That is where a key opportunity has been missed.

[David Mowat]

I agree with my hon. Friend, but as I said, the issue is not the formula, although it may also be the formula—my hon. Friend and I may not agree on that. I accept the formula, and I would have liked it to have been implemented. I have difficulty in accepting that, for political reasons, it was not implemented.

People in my constituency and elsewhere who are not affluent and do not understand this stuff lose out because the previous Government did not do the distance from target adjustments under the old formula and NHS England has refused to implement the right thing under the new formula. It is hard to justify that. Why have ACRA if we are not going to do what it says, and why have an NHS board if it cannot manage change and do the right thing? That is why big organisations have senior managers who are paid lots of money.

Are there symptoms of waste in the 38 CCGs that are overfunded by 5% or more? Is the incidence of alternative therapies and all that goes with that higher there because they have the money, so why not spend it? Does the Minister really believe that he can hold CCGs accountable for budgets given that how those budgets are allocated is apparently so political and not based on clinical judgements by independent people such as those on ACRA?

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[Mr Reed]

I am even more afraid that it is a fraternity I will never be invited to join.

I thank the hon. Member for Suffolk Coastal (Dr Coffey) for securing this timely debate and for her opening remarks. Particular thanks should go to Government Whips for drafting so much of it. As she knows, the last Labour Government took a malnourished, failing NHS with an annual budget of approximately £30 billion and left it with a budget of more than £110 billion. The Conservative party voted against every increase in that budget. The same Labour Government oversaw the biggest ever hospital building programme in this country. It recruited tens of thousands more doctors and nurses. It inherited an NHS in which Bruce Keogh said people were dying waiting for treatment, and left a service with the lowest waiting times and the highest patient satisfaction rates in its history. Of course, there was much more to do.

I warn the hon. Lady against complacency. If she wants to see a health economy that has been plunged into crisis as a result of the Government’s policies, she should come to Cumbria where a crisis is unfolding, patients are paying the price and the Secretary of State is entirely disinterested in what is happening.

It is incredible to hear that NHS England does whatever it is told by the Labour party. That is extraordinary—this must be the most powerful Opposition of all time. Government Members should consider whether they are in office but not in power. A canard seems to be being established whereby the NHS England board have become the new reds under the bed. That fascinating argument will be rolled out between now and the next election.

[Dr Coffey]

I am not suggesting that anyone on the NHS board made a decision because they supported the Labour party—the reds under the bed. I am suggesting that the Labour party had the opportunity in the legislation to try to break away from party political interference in the formula and it failed to take advantage of that.

[Mr Reed]

I thank the hon. Lady for her intervention. I am not sure that I agree with her. Not for the first time today—I am not laying this singularly at her feet; she knows that I have great respect for her—we have heard the argument that I hear frequently from Government Members about there somehow being an enemy within. That does not deserve significant air time in this Chamber or on any other platform in this House.

It is a mark of how important these issues are that so many hon. Members attend these debates—not just today, but every time I have responded to a debate such as this in Westminster Hall. As we have heard again today, hon. Members passionately represent their constituents, often with moving testimony of constituents’ experiences. Today, we are discussing an issue that will affect many more people in the future.

The NHS is now more than 65 years old and to ensure that it is still here in 65 years’ time, it needs to adapt to the challenges of this new century. In 1948, the health challenges facing the UK were clearly very different from those we now face. As consistent improvements in medical knowledge have enabled more people to live better for longer, we are now tasked with providing a system to cope with an ageing society. Surely we all agree on that. One of the core principles of Labour’s plans for the NHS is that there should be a system fit for the 21st century. My right hon. Friend the Member for Leigh (Andy Burnham) will speak about that and the impact of an ageing society later today.

The hon. Member for Suffolk Coastal has raised on the Floor of the House and in recent Health questions the issue of the NHS funding formula and its impact on the elderly, and in my view the Government’s response has been poor. Late last year, NHS England consulted on a new funding formula based on recommendations from ACRA and we have covered such issues widely this morning. ACRA said:

“The objective of the formula is to provide equal opportunity of access for equal need. The basic building block of the formula is the size of the population of each CCG, and then adjustments or weights per head for differential need for health care across the country. The weights per head are based on need due to age (the more elderly the population, the higher the need per head, all else being equal) and additional need over and above that due to age (this includes measures of health status and a number of proxies for health status). There is also an adjustment or weight for the higher costs of delivering health care due to location alone, known as the Market Forces Factor…This reflects that staff, land and building costs are higher in”

for example,

“London than the rest of the country.”

I can point to life expectancy gaps in Cumbria exceeding 20 years. Healthy life expectancy ages in some areas of the country are well below 60 years and the local population, by default, will be younger than in areas where healthy life expectancy is much higher. Health funding in areas with low life expectancy will be disproportionately affected.

It is right that NHS England listened to the concerns not just of the Opposition, but of medical professionals and others about the funding formula, and it is right that deprivation will be taken into account as part of the formula, but that has not changed the overall direction of travel. Over time, money will still be taken from areas with the poorest health and given to those where healthy life expectancy is longer. I would be grateful if the Minister explained how that is justifiable. It is the very antithesis of the founding principles of the NHS that funding should be allocated disproportionately to more wealthy areas.

The pattern is also demonstrated across the public health spending formula. Areas such as Westminster and Kensington and Chelsea receive in excess of £100 per head more than my own county, Cumbria, despite Cumbria’s having some of the greatest health inequalities in the country.

--- Later in debate ---

[Dr Poulter]

If that was the case—I may have missed it—my hon. Friend has made an important clarification. It is important that we have a formula that is as far as possible beyond reproach and set according to clinical need—the needs of patients. It is important that a number of factors be taken into account when that formula is put in place, as has been articulated clearly by NHS England in the discussions about how the formula is set. Deprivation is a factor. It is important to note that one of the primary drivers for setting the funding formula is now age and the needs of an ageing population. That is an important factor to highlight in this debate.

I shall now deal with some of the points made by my hon. Friend the Member for Suffolk Coastal. She may be aware NHS England has undertaken a fundamental review of its approach to allocations, drawing on the expert advice of ACRA and other external groups. The review’s findings have resulted in a new formula that provides a more accurate model of health care need. Last December, NHS England published the allocations for 2014-15 and 2015-16, based on the new formula. That gives CCGs two years of certainty about what their funding allocation is, which we can all welcome.

I know that my hon. Friend is very busy and may not have had the time or opportunity to review in detail during the past three months the information relating to the new formula, but I hope I can reassure her on the direction of travel. The formula is putting us much more on the trajectory she wants to see. It is independently set and therefore has a lot of clinical merit.

[Dr Coffey]

Will the Minister also recognise that the concept of unmet need was reintroduced in a more significant way than previously, and that that does not necessarily help where we know there are elderly populations with specific conditions that need treating?

[Dr Poulter]

It may be helpful if I outline the way the new formula works and how some of the weighting has changed, which will help to address the point my hon. Friend has just made and shed more light on the direction of travel that is under way.

The new formula uses a new indicator to recognise how health inequality should be reflected, which is based on the standardised mortality rate for those aged under 75. Previously, adjustment has been made on the basis of a measure of disability-free life expectancy. The new indicator is technically better, in that it can pick up pockets of deprivation within more affluent areas. The formula focuses much more on real population need, rather than taking a blanket approach across the population.

The new formula moves to the more powerful method of using individual rather than small area utilisation data—this is fundamental to the formula—to derive estimates of need. The main factors in the model are age, gender and 150 morbidity measures from the diagnoses of admissions to hospitals. That picks up on the point that my hon. Friend just raised. The formula looks at the pressure of long-term illness. Those 150 morbidity measures will pick that up. The increased need for health care in deprived areas is captured in the base formula by directly taking account of much of the increased need in deprived groups. In addition, further adjustments are made for factors such as the claimant rate for key benefits. That ensures that the model captures increased need that is linked to deprivation but is not linked to earlier utilisation of hospital services.

The new formula reflects more up-to-date data on population growth and measures population based on registered GP lists, rather than population projections based on the census. I am sure we can all recognise that where there has been growth in a population or changes are happening at local level, basing the formula on up-to-date GP lists is a much more accurate way of reflecting the health care needs of the local population than basing it on a 10-yearly census.

The new formula also reflects the responsibilities of CCGs rather than PCTs, as my hon. Friend outlined in her contribution. CCGs are not responsible for specialist services or primary care, although of course NHS England is now also taking over responsibility for the GP contract, as she will be aware. As a consequence, it is important to stress that the new formula for allocating funds to CCGs follows the advice provided by ACRA. A strong element of the allocation is focused on age. The primacy of age, an ageing population and the needs of older patients are very much built in, as are the needs of patients with long-term conditions. There is still a strong weighting for deprivation.