NHS Funding (Ageing)

David Simpson 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.

--- Later in debate ---

[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.

[David Simpson]

Does my hon. Friend agree that more emphasis is needed on care for the elderly at home, and that adequate funding needs to be put in place so that the older generation can be comfortable and be looked after at home?

[Jim Shannon]

I thank my hon. Friend for that contribution. That is probably a subject for a different debate, but at the end of the day it is also clearly a matter for us all. Most elderly people in my constituency would like to spend their days at home. They do not want to go into homes, which may not be as homely, if I can use that terminology, but there are additional pressures on carers who support the elderly at home. That is a debate for another day, but it is an important factor. It is about balancing the budget and making the butter go even further, as it were. Many elderly people want to spend their time at home and enjoy being with their families.

That puts us under even greater pressure in providing a high-quality NHS. The number of the oldest people—those aged 85 and over—is expected to rise by 50%, from 33,000 to 48,000. When we take into account the fact that the average 80-year-old costs the NHS seven times more than a typical person aged 30, even those without a degree in mathematics can see that there is a major accountancy problem in the NHS, and difficulties with funding streams.

Thus far only efficiency savings have been requested, but they have not been enough to keep things ticking over. The Institute for Fiscal Studies has said that to keep pace with the ageing population, spending needs to grow by 1.2% a year above inflation, which has been running at about 2.4%. Again, that gives a clear indication of what the financial issues are. Such an increase has not happened so far, and the pressure cannot be sustained without something giving. I look forward to the Minister’s response on the difficult but urgent question of how that situation will be addressed.

I recently held a public meeting on the provision of cancer care in my trust area, at which were the top breast cancer consultant and the director of policy for the trust. Both cited the pressure their hospital faces due to care of the elderly. Indeed, almost 10% of the people at that meeting said they had been operated on by the consultant and owed their lives to that man, but probably only one of them was under the age of 50. Again, that shows the pressures that are on the elderly generation and the greater level of care that they need.

Those pressures, ranging from broken bones to cancer, diabetes and strokes, are increasing. Levels of diabetes are higher among the elderly population. The lifestyles we have lived over the years have contributed to that, I suppose, but it is a growing problem affecting those over 50 much more seriously than any other group. Given those increased pressures, we need to increase the funding. We cannot ignore the situation. Unless we, God forbid, begin to put an age limit on what services and treatments are available, we will have increased pressure every year. It therefore follows that funding must keep pace with that pressure. I see little point in funding research and development into cutting-edge technologies if the Government are unable to fund their use within the NHS.

I am a great believer in the notion that money does not grow on trees. I have used the analogy on many occasions. My parents said it to me, I said it to my children and they in turn now say it to their children. I understand that we need to cut borrowing and to restore a workable bank balance, but I also understand that life is precious and that if there is one thing we cannot afford to scrimp on, it is health care and quality of care for our elderly. There are a large number of elderly people in my constituency—I meet them, probably, more than any other group. They tell me what the issues are and I want to see care delivered for them in every way possible.

It is said that a society is judged on how it treats the most vulnerable, including the elderly and children. I ask the Minister to consider the compelling facts that all hon. Members have put on the record today, and which will be added to by those yet to speak, and to realise that there must be a ring-fenced increase in NHS spending if we are to do our duty by the most vulnerable in our society.