HMRC Impact Analysis: Customs

Debate between Anna Soubry and Jesse Norman

Tuesday 8th October 2019 Commons Chamber

[Jesse Norman]

I would be delighted to do that. With the good grace of the people of Great Britain, they will have a Conservative Government for many good years to come, supporting their interests, their welfare and the growth and productivity of the British economy. No finer outcome could be hoped for by British business.

[Anna Soubry (Broxtowe) (IGC)]

Does the Minister have no shame at all in being a member of a Government who are meant to be on the side of business, having done a job in which, when I used to do it, we were so proud that for every one new piece of regulation we got rid of two? We see now a Government embarking quite clearly on no deal—this sham of trying to get a deal is exactly that—and imposing on our already struggling businesses an additional £15 billion. Has he no shame to be associated with this appalling Government?

[Jesse Norman]

I am unable to match the right hon. Lady’s capacity for bombastic intervention, but let me just tell her that if she looks at the statutory instruments that have been placed in front of this House, she will see that their purpose is not to regulate, but to create mitigations to protect people in the event of a no-deal Brexit. If we have a no-deal Brexit, these will be useful mitigations and supports for businesses and people. If she doubts that, she can avoid the issue altogether by supporting the Government on the deal that I have no doubt is being promoted vigorously.

Cross-border Health Care (England and Wales)

Debate between Anna Soubry and Jesse Norman

Tuesday 25th June 2013 Commons Chamber

[Anna Soubry]

Indeed. I will come to the effect on Hereford hospital, but I am more than happy to write to my hon. Friend about his specific point. The usual rules apply: if there are questions that I have not answered I will of course write to any hon. Member.

We have asked the Welsh Government to request that other local health boards along the border in Wales should similarly review the application of their own policies for out-of-area treatment affecting patients in the same circumstances. In many of those areas patient numbers are much smaller, but that does not matter; these are important issues for these individuals.

In the light of the further legal advice that NHS England is seeking, I am advised that it will review the protocol with the Welsh Government in view of my concerns and those of other hon. Members, the updated legal advice, the outcome of the local health boards’ reviews of the application of their policies on out-of-area treatment, and feedback that we have received from local NHS bodies on the operation of the protocol. The review will be undertaken in the autumn following completion of the reviews by the local health boards.

My hon. Friend the Member for Hereford and South Herefordshire is concerned that the policy of the Welsh Government that those who are registered with a Welsh GP must use Welsh NHS services will have a direct impact on the viability of Hereford hospital. I share his concern, but I understand that a number of other factors affect the viability of the hospital and the Wye Valley NHS Trust.

I was a bit concerned when I read the next part of my brief, because it has been worded in an interesting way by my very able officials. It states that those factors include

“the drop in the numbers of young people locally leading to a lack of activity in maternity services”.

I am not sure what “lack of activity” young people have been guilty of. I think that what is meant is that there are not as many young people in the area, because there is undoubtedly a higher proportion of retired elderly people in the population. It is obvious that if there are fewer young people, people are less likely to be having babies and are therefore less likely to use maternity services. I am sure that activity remains at a high level.

As my hon. Friend is aware, Wye Valley NHS Trust published a strategic outline case in March this year, setting out the options for its future form to create a clinically sustainable model for local people. I have been advised by the NHS Trust Development Authority that it has been working with the trust to develop a full business case, which it expects to receive for consideration by the end of this month. Again, I make it very clear that I am more than happy to revisit this issue with my hon. Friend and others following the outcome of that process.

[Jesse Norman]

Wye Valley NHS Trust has informed me that the policy has cost it between £1 million and £2 million so far. Given that it is running a deficit of £8 million to £10 million, that is a significant sum. The work that is being done pre-supposes the current funding formula. In a way, it therefore pre-supposes the point at question, which is whether the formula is fair. As I have submitted, it clearly is not.

[Anna Soubry]

I do not doubt for one moment the veracity of what my hon. Friend has told me about what he, in turn, has been told. That is a substantial amount of money and it would go a long way to explaining part of the deficit. These are terribly important matters.

The funding formula has been raised yet again. The argument advanced by many Members on both sides of the House is that the formula does not take account of the relatively high cost of delivering services in rural areas or reflect the fact that many rural areas such as Herefordshire have relatively older populations. I have had a number of conversations with hon. Members who make exactly the same complaint as my hon. Friend.

I am reliably informed—this point is important—that allocations to individual clinical commissioning groups, which are made up of the GPs and other clinicians who now commission services locally, and the formula that is used to decide what those allocations should be, are the responsibility of NHS England. I am not seeking to pass the buck, but it does bear that responsibility. In making those allocations, NHS England relies on advice from the Advisory Committee on Resource Allocation. ACRA provides advice on the share of available resources provided to each CCG to support equal access for equal need, as specified in the mandate given by the Secretary of State to NHS England.

Therefore, NHS England does not set income for CCGs on an equal cost-per-head basis across the country. Instead, allocations follow an assessment of the expected need for health services in an area, and funds are distributed in line with that, meaning that areas with a high health need should receive more money per head. The calculation is based on the age of the populations, relative morbidity and unavoidable variation in cost. The objective is to ensure a consistent supply of health services across the country. The greater the health need, the more money is received because the more health services are needed.

I know that some hon. Members just do not accept that that is the reality with the allocations to their CCGs and, in effect, to their constituencies. NHS England plans to review the funding formula for 2014-15 and the following years better to reflect the needs of local communities and enable the best outcomes for local people. Perhaps there is hope in that. Obviously, I must say quickly that I cannot make any promises.

If anybody would like to intervene, we do have the time. Hon. Members often want to make a point, but do not feel that they can make a speech.

--- Later in debate ---

[Jesse Norman]

We have a little time, so I am very grateful to the Minister for giving way again. Will she ask her officials to look more closely at the functioning of ACRA? The formula under which we are labouring was set up in 2002. There is a clear case to be made that, contrary to its desire, it is not delivering funding to the areas of greatest need, but to areas defined by a deprivation formula. The truth is that morbidity and age go together, not deprivation and morbidity.

[Anna Soubry]

I might not share my hon. Friend’s final remarks, but we know that NHS England, which is in charge of distributing funds to CCGs, is considering the formula. It will no doubt bear in mind the argument made by him and others who believe that ACRA’s formulation is not delivering in the fair way that we all agree was intended.

In conclusion, I am pleased that NHS England has responded to my concerns, and the concerns of my hon. Friend the Member for Hereford and South Herefordshire and others, most notably my hon. Friend the Member for Forest of Dean, with whom I had a long meeting. As a result, NHS England is doing what we had hoped it would. I am encouraged by the dialogue that has been taking place between NHS England, the Welsh Government and local health boards in Wales, and I hope to see further rapid progress. We must not let anybody drag their heels. I look forward to being able to update my hon. Friend the Member for Hereford and South Herefordshire, and others who represent border communities, in the autumn. I undertake to do that once NHS England has finished its review. I once again congratulate my hon. Friend on securing the debate on this important issue. While it might not affect a huge number of people, it is a very important issue for them and they feel that there is an injustice. It behoves all of us to ensure that we eradicate any injustice.

Question put and agreed to.