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?

--- Later in debate ---

[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.

Mitochondrial Transfer (Three-Parent Children)

Baroness Coffey Excerpts

Wednesday 12th March 2014 Westminster Hall

[Jacob Rees-Mogg]

There is consultation, but it worries me that it has been done before the prior research has been completed, so we cannot be certain about safety.

I am glad that my hon. Friend raises the issue of public opinion, which is unpersuaded. A ComRes poll for Care will be released tomorrow, and I can exclusively reveal some of the results to the House. It found that 34% are opposed and 35% are in support, so there is no strong balance of support but, crucially, 44% agree that as it is currently illegal to grow most genetically modified crops for commercial purposes on the ground of safety, it ought to be illegal to create genetically modified children.

I return to the point that change of even 0.1% leads to genetically modified children. It is not sufficient to say that that is a tiny modification so it does not matter. It is the essence of the line of inheritance that we all have from our mothers through successive generations and centuries.

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

Does my hon. Friend agree that it is worrying that the assumption is that this will happen and that the consultation is more about how it will happen? Would it not be better for the Minister to say today that the Government will stop the consultation and continue with the research until they are satisfied that the procedure is safe?

[Jacob Rees-Mogg]

My hon. Friend makes a very good point. If the Minister would say that, her standing in North East Somerset would rise even higher, although it is hard to believe that is possible.

The Government’s own consultation—this is crucial—says:

“It is estimated that 1 in 200 children born every year in the UK have some kind of mitochondrial DNA disorder.”

The number of serious disorders is much lower, but one in 200 has some kind of mitochondrial disorder. It is worrying that that is in the consultation because the premise is that 0.5% of the population are born imperfect and that in future only perfect people should be born. Many of us have imperfections, but they make up humanity, and the mixed variety of interest, thoughtfulness and development that is humanity often comes from our faults, as well as our abilities. It is a fundamentally dangerous road to start down because, although the technique cannot at this stage affect eye colour, some clever scientist will eventually work out how to ensure that babies have blue eyes and blonde hair, or whatever people want. Every time something like this happens, we go to the next stage and the argument becomes, “Well, we’ve done this, so it is logical to continue.” When that line has been crossed, the argument against going further is merely a matter of degree; it is not absolute.

Oral Answers to Questions

Baroness Coffey Excerpts

Tuesday 25th February 2014 Commons Chamber

[Mr Hunt]

No, I am not convinced. We need to do much better when it comes to the discharge of vulnerable older people, especially when they leave hospital not cured and still with a long-term condition. They may be recovering from a stroke or dementia or any other condition. We need to have much better links between hospitals and GPs and to have named accountable GPs in the communities looking after those very people.

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

I was disappointed with the allocation of funding by NHS England for care around the country because it did not reflect the demands of the elderly population. People in my constituency have to do a 200-mile round trip to receive support such as cardiac care. Will the Secretary of State ask it to think again for future years?

[Mr Hunt]

My hon. Friend is right to campaign hard on that issue. I agree that the funding formula does not always do justice to people, especially those in sparsely populated rural areas. I know that NHS England is trying to do what it can to move to a more equitable funding formula, but it is not something that can be done overnight. I encourage her to keep pressing on that issue.

NHS

Baroness Coffey Excerpts

Wednesday 5th February 2014 Commons Chamber

[Jeremy Lefroy]

I have no doubt that some of those things will have caused increased pressure. That brings me nicely to my next point.

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

My hon. Friend may not be aware that a briefing was given by the College of Emergency Medicine to Members of Parliament. One of its representatives, I believe it was Dr Mann, was asked by hon. Members about the closure of walk-in centres and he replied that there was an initial blip but that levels went back to what they were before. So in his view those closures made very little difference.

[Jeremy Lefroy]

We do not have sufficient data on this. I urge the Government to examine how we can collect more data about the reasons why people come to A and E and whether their visits could have been prevented by other provision. I am sure that that can be done in some cases, but at the moment we are arguing at cross purposes because we do not have sufficient data.

Another point, on the lack of integration, relates to discharges. There is pressure on hospitals to discharge people, particularly the elderly, because of the pressure on beds. One GP in my constituency raised this issue, citing one of their patients who was improperly discharged and saying that they were very distressed at the condition in which they found him. Stafford hospital has come up with a solution, which it will implement shortly, whereby every patient with complex needs will not be discharged unless it is absolutely clear that they have proper care in the community to go to. We would expect that for all patients, and I am very glad that Stafford hospital is taking that up.

The final reason to mention is that patients are often confused about where to go, and I am therefore glad that the Government have undertaken a review of the classification of A and E departments. We have A and E departments, urgent care centres and minor injuries units, and we have various grades of A and E. We need a national classification that makes it clear what services people can get at which point. Often people turn up and find that they have come to the inappropriate place.

I also wish to make a few remarks about the competition matters that have been raised in the debate, and I do this from a local perspective. The trust special administrators for the Mid Staffordshire NHS Foundation Trust have proposed that Stafford hospital should merge with University Hospital of North Staffordshire in Stoke and that Cannock hospital should merge with Wolverhampton’s trust. That is the right solution, it is not being opposed and we are not finding any problem with competition law. There is a big difference between the acute and non-acute sectors. As the acute sector runs in a tight way around the country, it is very difficult to see how there can be much competition in provision within it, because that has been provided exclusively by NHS trusts up to now. Within the non-acute sector we have found in my constituency that, under competition rules, an NHS service that went to the private sector under the previous Government has come back into the NHS under this Government, because it was determined that the NHS would provide a better service. So this does work both ways; it does not always go the way some people think it might.

We must not lose sight of the real hard work that people are doing in A and Es up and down the country. Almost all the work that goes on there is incredibly good and is what our constituents need, but we must make sure that the points that I and others have outlined are dealt with, because with the demographics going the way they are, we will face increasing pressures year on year.

--- Later in debate ---

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

It is always a pleasure to speak about the NHS in this House and to recognise the hard-working staff who do their best for their patients and our constituents. I am pleased that the shadow Secretary of State is still in his place. I recognise that the NHS is important to him, but I strongly suggest that his accusation that Government Members are complacent is far from the truth, as the evidence of nearly four years in government shows.

The right hon. Member for Leigh (Andy Burnham) is rightly proud, as are other Labour Members, of increased spending on the NHS during their 13 years in government, but he is at risk of seeing that as the only way of helping patients. My concern is that that led to a complacent attitude under Labour that simply putting in more money would solve everything, with the result that it missed the opportunity to make significant reforms.

Instead, over the past 18 months in particular, the Care Quality Commission has been truly strengthened. There is now no concern about opening the lid on the problems that we know exist in parts of our NHS. Many Members will bring such examples, from our casework, to the House today. That is why I am proud that we have strengthened the CQC through an independent inspector of hospitals. At times, I have criticised the CQC for being too timid and for not being prepared to be more public about its concerns and to go in and act. However, the short-notice inspections are important in ensuring that patients feel confident that they will get not only excellent treatment, as they largely do, but the care that they deserve when they are under the custodianship of the NHS.

I cannot see how Government Members are being complacent in any way, but another element of complacency on the part of the Opposition crept in with the suggestion that targets were the right thing. We all know that if we do not measure something it often does not get done. With regard to ambulance services, however, while the regional targets of 75% of patients being covered within eight minutes of red 1 calls may well have been met in most of the country, that did not show what was actually happening on the ground. My hon. Friend the Minister of State, and the Under-Secretary, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), have been vocal for a long time in pressing the case for not just hitting a regional target, but focusing on individual patients. Complacency set in whereby it was thought that as long as we were hitting our regional target everything was fine, yet we knew, as MPs, that everything was certainly not fine.

In the east of England, resources were focused on the main urban centres. People out in the countryside—not even that isolated, but in smaller towns or villages—were almost ignored because they did not help the centre to hit its regional target. If they had broken their hip, it almost did not matter that they were lying on the floor for four hours waiting for somebody to come, because it was not a life-threatening injury. The hon. Member for Warrington North (Helen Jones), who is no longer in her place, referred to the North West ambulance service. I am proud that Members of Parliament from across the east of England—I particularly mention my hon. Friend the Member for Witham (Priti Patel)—have worked together to hold our ambulance service to account, with the outcome that we managed to get its entire board replaced. That was a very difficult thing to do, especially when we were at times accused of attacking and undermining the NHS. In fact, far from showing complacency, individual MPs were working together to make sure that patients came first, not some artificial target that was bad for patients.

I wanted to say thank you to the hon. Member for Leicester West (Liz Kendall), who is sadly no longer in her place on the Opposition Front Bench, because she put me in contact with Anthony Marsh, who was chief executive of the West Midlands ambulance service and is now, thanks to action by this Government, chief executive of the East of England ambulance service. During his very short tenure, he has already been able to bring a new sense of urgency and a recognition that staff are not coming through the pipeline quickly enough, and he is doing something about that. I am confident that when we meet him next week, we will be able to understand his plans even further.

One of the reasons I was accused of Gove-itis earlier is that it frustrates me that Members of Parliament are accused of complacency when in fact they are working hard to help their constituents. Far from being complacent, we have approached this in a consistent way. I recommend to MPs from other parts of the country that instead of just waiting for someone in Whitehall to act on these issues, and mocking MPs who say they are working hard to press their case and hold their local board to account, they should get on and do it, not just wait for others to do so. I give credit to NHS England. At times, getting it to recognise the real problems that we were facing on behalf of our constituents felt like wading through treacle, but it has finally got the message, and together we are starting to turn the situation around.

We have heard about aspects of hospital provision. I do not wish to go on for too much longer, Madam Deputy Speaker, because it is important that everyone who wants to have their say can do so. In fact, I am putting in a bit of a bid for an Adjournment debate in Westminster Hall about NHS funding and the elderly population. [Interruption.] Well, if you don’t ask, you don’t get. I listen to patients in my area who have 200-mile round trips to get to the specialist hospitals. We are concerned about a potential reconfiguration of stroke services that would make it physically impossible for patients to be seen within 60 minutes of the 999 call being made. As a consequence, as my hon. Friend the Minister of State will know, we have been pressing the case for more funding to be given to areas of rural sparsity in light of the fact that geography matters in trying to deal with such situations.

I recognise that Labour Members feel strongly about the NHS, but so do Government Members; it is a universal thing. As we continue to support the NHS, there is no way that we can ever be accused of complacency. The reality is that we are dealing with the issues, not putting a lid on the problems. We have had the Francis inquiry and we continue to work on many of its recommendations. I am therefore very happy to support the Government’s amendment.

Accident and Emergency

Baroness Coffey Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andy Burnham]

I mentioned the reorganisation, through which we saw the complete disruption of training arrangements in the NHS. The Government’s eye was taken completely off the ball of the growing problem of recruitment, not just of GPs but of A and E doctors. That is a real problem around the country. We now have fewer GPs per 1,000 of population than we had a few years ago, so my hon. Friend is absolutely right to raise that issue.

The new spin is that the Secretary of State admits that A and E has got worse on the Government’s watch, but it is not his fault and it is not a crisis. That is the public line, at least. In private, it is a different story. This is the Secretary of State who has taken up ringing hospital chief executives who are not meeting their A and E targets. I have heard from two senior sources that the Secretary of State has discussed within government whether Cobra should be convened to discuss the A and E crisis. Can he confirm or deny whether that is the case? I have no way of knowing, but he needs to give a straight answer.

The longer we see the Secretary of State in this job, the more familiar we become with his style: spin before substance. That is the real danger when someone holds a job as important as his. If they use spin to distract people from the real causes of the problems, they end up neglecting those problems and precious time is lost.

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

I know that the right hon. Gentleman is passionate about the NHS, but he seems to ignore the history. In the last year of the Labour Government, the average wait in A and E was 77 minutes. It is now 33. The Labour-run Welsh NHS has missed every target since 2009. Frankly, I am proud that our Government are putting the patient at the heart of the NHS by tackling the issues in hospitals and in our ambulance services.

[Andy Burnham]

Last week, the NHS missed its A and E target—the hon. Lady’s A and E target—which is a lowered target. If she is going to maintain that complacency through the winter, I suggest that it might well backfire on her.

Mid Staffordshire NHS Foundation Trust

Baroness Coffey Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

That is absolutely vital. I have been to the A and E department in George Eliot hospital, and reports I have heard say that morale is really turning a corner. I want to back the staff: it is incredibly difficult to work in a hospital that has been put into special measures, knowing that everything is not as it should be. They now have a sense that a corner is being turned and that the problems that they have long worried about are finally being addressed, particularly because of the link with University Hospitals Birmingham, which is one of the best in the country.

I agree with my hon. Friend that safe staffing is one of the measures that matters. George Eliot hospital has some pretty antiquated IT systems that mean staff spend much longer than they should filling out forms, rather than spending time with patients.

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

Will my right hon. Friend give more details about how we can stop bad leaders and bad providers from working in the NHS? Will he confirm that that change will extend to ambulance trusts as well as to hospitals?

[Mr Hunt]

The change will absolutely extend to ambulance trusts. I know that my hon. Friend has had experience of poor leadership of ambulance trusts in her area. It will apply to all organisations registered with the Care Quality Commission. There will be a fit and proper persons test, because where people are responsible for poor care, we do not want them to pop up somewhere else in the system.

Accident and Emergency Departments

Baroness Coffey Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

The hon. Gentleman is right to say that that is one of the key issues in the underlying pressures on A and E departments. About a quarter of the money announced today will be used to increase the capacity of A and E departments, including increasing consultant cover. In the end, however, we need more trained consultants; we need more doctors who want to work in A and E departments. That is a longer-term challenge, but one of the ways in which we will make A and E more attractive is by convincing doctors that we have a long-term, sustainable strategy to make sure that it does not become an impossible job. That is what the measures on improving GP access, IT systems and the social care system aim to achieve.

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

The Secretary of State may be interested to know that in a parliamentary seminar earlier this year the College of Emergency Medicine said that walk-in centres provided temporary help with A and E attendances but that their closure has had no impact at all. More importantly, does my right hon. Friend agree that we should praise those hospital trusts that have not needed extra money and that that is a ringing endorsement of their leadership?

[Mr Hunt]

My hon. Friend speaks extremely wisely, as ever. She is right. The reason why the 100 or so hospitals that have not benefited today did not get money is that our assessment is that they have outstanding leadership and will be able to cope. That is not, however, to minimise the pressure they will be under or the fact that it will be extremely hard work. I pay tribute to them because, as good hospitals, they often have to deal with more people wanting to go through their doors than through those of other hospitals with less good reputations. We need to support everyone and my hon. Friend is right to say so.

East of England Ambulance Service

Baroness Coffey Excerpts

Tuesday 25th June 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Howarth. I thank my hon. Friend the Member for Witham (Priti Patel) for leading this debate so well; her speech was a tour de force. I will bear in mind your time limit, Mr Howarth, although I could take the whole 90 minutes to tell the sad tale. It is a pleasure to follow my hon. Friend the Member for North West Norfolk (Mr Bellingham). The East of England Ambulance Service NHS Trust is actually responsible for out-of-hours care in Norfolk, so the left hand should be talking to the right hand.

I also thank the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who started work on the issue. It was right for my hon. Friend the Member for Central Suffolk and North Ipswich, a doctor, to take the lead on such matters in Suffolk, but pushing on, consistent performance from colleagues across the counties in the east of England has brought the issue to the fore.

As I suggest, this is a sad tale that started some time ago. My timelines of the issue start in the middle of 2011. We are driven by the experiences of our patients —those who have suffered. Let us be honest: the vast majority of people in our constituencies have a good ambulance service. Once an ambulance arrives, care is very good; nobody denies that. However, too often that excellence of service is concentrated in certain areas of the region in order to meet a false regional performance target, and almost everything else is put aside. It does not matter if only 50% of people in south Norfolk get an ambulance within 90 minutes as long as the regional target is met. That is all that matters to the leadership and the board of the East of England Ambulance Service NHS Trust.

We have had a long series of meetings, Care Quality Commission inspections and promises of change. Transparency has been lacking. The trust has been dragged kicking and screaming into showing its performance targets in a meaningful way—first by county, now at clinical commissioning group level—but that took a long time. It used to say, “You can look in the minutes of your local primary care trust to find response times.” It is unacceptable for those at the very top to say, “Well, that’s all right; we’re hitting our regional target.”

I have used the constituency of the hon. Member for Copeland (Mr Reed) to say that if it can happen in Cumbria and Cornwall, it can certainly happen in Norfolk and Suffolk. It is important that the Opposition spokesman does not try to drag party politics into this debate or talk about finances. The issue is about those at the top having wrong priorities and forgetting that every patient matters.

I have never had to call an ambulance in the east of England, or indeed at all, but I like to think that if I did, I could have some confidence that it would arrive in time. In reality, however, there are not enough ambulances and not enough staff. Mr Andrew Morgan recognised that early on when he came into office as interim chief executive. As Dr Marsh pointed out in his excellent report,

“the current leadership from the board just isn’t strong enough to take them forward…there is a lack of focus and grip from the board which has contributed towards the deterioration of performance across the trust.”

Many of the issues breaking open at the moment have been deteriorating for some time. The non-executives have not shown leadership by asking hard questions and going beneath the surface; they have relaxed and considered only the top regional performance target.

I thank our local newspapers, the East Anglian Daily Times and the Eastern Daily Press. Nigel Pickover and Terry Hunt have done good things to keep up the pressure and stand up for their readers, our constituents, who are patients of the East of England Ambulance Service NHS Trust.

[Robert Halfon (Harlow) (Con)]

And the Harlow Star.

[Dr Coffey]

And the Harlow Star, apparently.

In December 2011, we finally got a meeting with the Health Minister and a range of other people around the table who could have fixed the issue. We were promised that there would be change and more focus at county level, and that patients mattered. The postcode data released in November 2011 showed that that had not been the case. We have never been able to get data at that level since then, because the trust does not want to share it with us and, frankly, I am not sure that I should spend all my time on freedom of information requests.

One of the things agreed at that meeting was that contracts would change. That did not happen, which is one issue relating to trust. In October 2012, Hayden Newton resigned. Coincidentally, that was a week after a series of complaints, including about the case of Nora Dennington, whose family finally went to the press to get an answer after three months. To be fair to Maria Ball, the former chairman of the trust, she got answers to those complaints then and there, and within a week, Hayden Newton resigned.

However, Newton was still on the payroll until the end of March 2013, and the chair at the time gave him a glowing tribute, saying that he would be greatly missed and

“a hard act to follow”

and that under his leadership, front-line staff were still being recruited and quality of care had improved. The chair also said:

“Thanks to Hayden’s stewardship, EEAST is now a stable, sustainable and financially sound organisation”.

I am afraid that the Marsh report blows that out of the water.

I could go on about all the different meetings, but I will not, as I am conscious of the time. What I will say is that patients’ complaints were not being answered, and patients were not being treated as individuals. The board should have seen it in the survey and the climb in sickness rates, and the CQC should have done more than tick the box saying that the trust had passed staff compliance on the basis that appraisals had been done. There was an element of external scrutiny by the CQC, the strategic health authority and, to some extent, Monitor, which did not approve the foundation trust status application, but passed the trust on the governance rating. All those different regulators, as well as the leadership of the board, need to look at themselves to understand why they, in effect, let people down. The board was fixated on getting foundation trust status; it was only focused on the regional target, and it did not matter that residents in Suffolk were being failed, as long as the regional target was okay.

Moving forward, my hon. Friends who have spoken are absolutely right: it is imperative that the remaining non-executive directors resign their posts immediately and that the NHS Trust Development Authority acts on that. The ideal solution for me would be to ask Dr Marsh to come in, whether permanently or on an interim basis, to turn around our ambulance trust, because he has the skills to make that happen. I want Dr Harris to succeed; however, it is important that we do not rely on the management speak to which my hon. Friend the Member for North West Norfolk referred, but recognise that we need to clean the slate.

There are of course external factors—we need to work with GPs and A and E—but much of the problem is internal, because there were not enough training places or staff. Incidentally, it is right that Whitehall should not seek to control everything, but it is vital that MPs have confidence that the NHS Trust Development Authority will take the matter seriously. Furthermore, CQC needs to be quicker—not to be rash, but not to be tick-box driven. It failed the ambulance trust and, more recently, it decided to withdraw from a meeting with MPs to talk about its reaction to the trust plan issued in April.

I could have spoken for longer, Mr Howarth, and I have spoken for longer than you requested, but I genuinely want to ensure that our patients, constituents and residents can rest assured that we will not stop continuing pursuit of excellence on their behalf, wherever they live in our great part of the country—they deserve nothing but the best. Again, if Cumbria and Cornwall can do it, we can certainly do it in Suffolk, Norfolk, Essex and Cambridgeshire. Frankly, until those non-executive directors go, we will not have confidence in the leadership of the trust to make the difference.