NHS Sustainability and Transformation Plans

Debate between David Mowat and Jamie Reed

Wednesday 14th September 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

In the six minutes available to me, it will not be possible to respond to the 40 or so speeches that we have heard today. I shall just pick out two contributions for special mention. First, so far as I can see, the shadow Secretary of State genuinely believes that an organisation that provides care to 45 million people on a budget of £100 billion should not do planning. That really appears to be the view of the hon. Member for Hackney North and Stoke Newington (Ms Abbott). Secondly, the hon. Member for Central Ayrshire (Dr Whitford) made an excellent speech, in which she used the word “opportunity” in connection with STPs, which is what they provide. She also said usefully that healthcare systems were about “more than buildings.” As we go forward with this process, it is important that we all think about what that means.

The health service is not static. Technology is changing; drugs are changing; expectations are changing; and, as we have heard, demography is changing. It is right to try to make it evolve and help it to change. The STP process is the planning mechanism to do so. It is a planning mechanism to put in place a five-year view—this was in the manifesto—that NHS England has developed. If it is to work, it must have three things: it has to be care driven; it has to be properly funded; and it has to be locally driven. It is all those things.

[Mr Jamie Reed (Copeland) (Lab)]

rose—

[David Mowat]

I shall not take interventions; I now have only five minutes left.

When it comes to funding, we have put in an extra £10 billion, and it is real money. If that money had been available in Wales, some of the points raised in the debate about the interface between us and Wales would have been quite different. This year, the increase in health funding is 4% in real terms—three times the rate of inflation. The real point, however, is not to do with money—however much the Conservatives put in and however much Labour says it might put in, although we have not heard that yet. But however much is put in, it does not detract from the need for the health service to be managed effectively and properly so that it can improve and innovate.

There is a prize from these STPs. At the end of the process, we will have a health service that is more oriented towards primary and community care where people live. The health service will provide better access to GPs, emphasise prevention more than ad hoc responses, properly address long-term conditions such as diabetes and begin to address more quickly our mental health and dementia commitments. I say again that if STPs do not address those things, they will not go forward. Perhaps the most important of all the advantages is that the unacceptable gap that currently exists between healthcare and social care will be breached. That is at the centre of the whole process.

NHS Funding (Ageing)

Debate between David Mowat and Jamie Reed

Tuesday 25th March 2014 Westminster Hall

[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.

[David Mowat]

Just to get clarity, is the hon. Gentleman’s position that ACRA’s formula was wrong and therefore should not have been implemented, or would he have liked to have seen it implemented over time?

[Mr Reed]

I will come on to that question. The funding formula on its own is a blunt tool that will struggle to address intricacies within a health economy as varied as the one in England and, therefore, more needs to be done at the interface between medic and patient to improve care for older people.

Funding is crucial, but financial pressures mean that we have to use existing funding more efficiently. Day after day, we are getting repeated warnings about the sustainability of the NHS and the £3.5 billion reorganisation that nobody wanted and nobody voted for has left NHS finances on a knife-edge. As such, more has to be done with less and that requires more than small changes at the system’s periphery. Last year, more than half a million pensioners had an emergency admission to hospital that could have been avoided if they had received better care outside hospital.

A study undertaken by researchers at Imperial college London found that nearly a third of hospital beds are used for patients who might not have needed them if their care had been better managed, which shows that we should focus on improving community care services to allow older people to remain in their own homes. The CQC has also found a general acceleration in the rate of avoidable hospital admissions.

Pensioners tend to have at least one long-term condition and those over 75 tend to have two or more. As society ages and the number of comorbidities increases, we need a system set up to care for the whole person, rather than the individual ailments that have no regard for the person behind them. The system needs greater integration and better co-operation between services to improve care for older people and ensure that they can be cared for in their own homes, rather than being forced into hospital just because the services in the community are not good enough or, in some cases, are not there at all.

The Government, however, have legislated for competition and fragmentation—and, as a result, for service isolation. Cuts to council budgets have meant that community services have suffered and patients are paying the price. I see that every day in my constituency. To improve health and well-being for the elderly in our society does not require penalising deprived areas with an obtuse funding formula; it requires improvement in collaboration between primary and secondary care and improvements in community care services to ensure that people can get the treatment they need, but also live independently in their own homes.

Thus far, the Government have provided no real solution to the challenges posed by changing health needs. We need to introduce a system of whole-person care and to respond to the changing health needs of our society: for young and old, and for the poor and those not in poverty. To do that—I end on a partisan note that reflects the tone of the debate so far—we need a Labour Government.

Policy for Growth

Debate between David Mowat and Jamie Reed

Thursday 11th November 2010 Commons Chamber

[David Mowat]

I am about to address infrastructure. We need High Speed 2 to link the north-west as quickly as possible, as we need our rail infrastructure to be linked through to the channel. Yes, I will give credit to the Labour Government for getting the west coast main line done. While I am at it, I shall give them credit for getting the BBC to move outside the M25 and up to the north-west, but that has not been enough, because of the massive disparity in value added per employee that is their legacy.

Like infrastructure, energy matters. I have not heard it mentioned in the debate yet, but energy is a very important component of growth. Broadly speaking, a unit of gross domestic product generated in an English region is more energy-intensive than a unit of GDP generated in London or the south-east, because we have more manufacturing and industry that uses energy. It is therefore very important to our prosperity in the regions for energy to remain competitive. A particular problem that we have inherited is the price of our electricity, which is 30% more expensive than in France. That is a tough issue to start with, but I am concerned that some of the initiatives we are taking will make the problem worse. We need to build more nuclear power more quickly.

[Mr Reed]

The hon. Gentleman is making some terrific points, and I agree with many of his comments so far. He will know that the energy sector is responsible for approximately half of our manufacturing sector, and that we need to get quicker investment in UK manufacturing and industry on stream right now, facilitated by the Government and the private sector, including the global private sector, to meet our energy needs. Does he share my fear that the constant re-evaluation, reinterpretation and reformulation of planning policy is inhibiting that, and will cost the country financially?

[David Mowat]

There is a risk of that, but the nuclear power industry needs to press ahead quickly, which it did not do under the previous Government. I think that the steps being taken by this Government will help in that regard.

Energy is important. The magnificent technical achievement that is the wind farm in Thanet has just come on line, but it will require a subsidy of £1 billion over its life. That subsidy will be paid by industry and in jobs, so we have to be very circumspect about how we do that.

My third point about building the economy in the regions and what we need to do differently concerns skills. The industries that we need to generate the jobs that will make the household names of the next 30 years will be in fields such as advanced manufacturing and biomedical engineering. We need more applied scientists, more engineering graduates and, yes, more apprentices.

One damning statistic relating to the last few decades—not only under the last Government—is the fact that we produced more engineering graduates 30 years ago, when there were only a quarter of the number of people graduating, than we do now. That is not sustainable. We have not yet been punished economically for that, because of the success of the City and, to a large extent, because of the success of North sea oil in bailing out our economy. We will not get away with that again in the next decade or so.

On the regional development agencies, it is true that they did some good things. If we give someone £4 billion a year to spend, some of it will be spent well, but it was not cost-effective. We need to make certain that what replaces the RDAs works well.

Finally, if the coalition Government, too, leave a legacy of such disparity behind them, they should hang their heads in shame—in a way that I hope the Opposition Front-Bench team will think of doing now.