NHS Funding (York and North Yorkshire)

Debate between George Freeman and Baroness McIntosh of Pickering

Wednesday 7th January 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

Thank you, Mrs Riordan, for calling me to speak. It is a pleasure to serve under your chairmanship this afternoon.

I start by congratulating my hon. Friend the Member for York Outer (Julian Sturdy) on securing this debate, with the support of our hon. Friends the Members for Skipton and Ripon (Julian Smith), and for Malton (Miss McIntosh), and I congratulate them all on their contributions to the debate. I am very aware of the personal interest of my hon. Friend the Member for York Outer in health matters affecting his constituents, and of course his interest in NHS allocations, including this question of fairness for rural areas.

I will also take this opportunity to pay tribute to all the North Yorkshire MPs who have worked so hard together on this issue since 2010: my hon. Friends the Members for Selby and Ainsty (Nigel Adams), for Skipton and Ripon, for Thirsk and Malton, and for Harrogate and Knaresborough (Andrew Jones), the hon. Member for York Central (Sir Hugh Bayley), my right hon. Friend the Member for Richmond (Yorks) (Mr Hague), and my hon. Friend the Member for Scarborough and Whitby (Mr Goodwill). I know they have had one meeting, if not more, with the Secretary of State for Health, and as a group they have been an effective and forceful lobby on this important issue, which we in the Department of Health all take seriously.

Of course, the whole House will agree that good-quality patient care is something we all expect, regardless of which part of the country, or indeed which county, we live in. As my hon. Friend the Member for York Outer has signalled, the question is how we work within the overall NHS budget—I welcome his acknowledgement of the Government’s increasing that budget—to determine how funding for each area should be assessed and decided. He made the key point: that it must be done in a way that is fair to all citizens and patients, wherever and whoever they are, and that where someone lives should not in any way unreasonably distort their access to health care. It is the NHS—the national health service—and those initials should mean something.

My hon. Friend will be aware that I, too, come from a very rural constituency—Mid Norfolk—where many of the issues he has identified chime, including ambulance response times and the extra time that clinical staff and patients take to travel around. Of course, there are other issues and problems, which he has highlighted: hidden deprivation, ageing and elderly populations, and isolation and loneliness compounding conditions such as dementia, making it harder to set up initiatives such as dementia cafés.

Health funding is an issue I have taken an interest in for a long time. Years ago, I did some work in County Durham to unpack the index of local conditions and the standard assessments in local government spending. When we unpack those formulae, we discover that those used to allocate funding for deprivation are all inner-city indicators: they are all about high-rise blocks, the percentage of black and minority ethnic people, and density. They are all urban indicators, as if only urban areas really experience deprivation. So my hon. Friend is raising an important point, which goes to the heart of much of the way that Whitehall allocates funding.

I will say something about how allocations within the NHS are made under the arrangements we have put in place. As my hon. Friend is aware, NHS England is the independent organisation responsible for managing the budget and the day-to-day workings of the NHS. It supports clinical commissioning groups—the local groups of GPs and other health professionals who commission NHS services on behalf of their patients. To make sure that the taxpayer has a say in how that money is spent, the Government provide direction and strategic ambitions for the NHS through a document called “the mandate”. The current 2014-15 mandate was reviewed and updated in December. There are eight key areas, which are about making general improvements; the Government deliberately leave the NHS free to make decisions about how these objectives should be met. They are: helping people to live well for longer; managing ongoing physical and mental health conditions; helping people to recover from episodes of ill health or injury; making sure that people experience better care, and integrated care; providing safer care, with a greater emphasis on patient safety; promoting NHS innovation; supporting the NHS to play a broader role in society; and making better use of our health resources.

NHS England has been given £98.7 billion this year, rising to £101 billion in 2015-16, to achieve the objectives in the mandate. I welcome my hon. Friend’s support for the extra £2 billion that the Secretary of State recently announced. NHS England has the responsibility to ensure that that money is well spent.

The first thing to say on the financial aspect of the mandate is that we have protected NHS funding in this Parliament, as my hon. Friend acknowledged. In 2014-15, all CCGs received a funding increase matching inflation. Furthermore, like all CCGs in England, North Yorkshire CCGs will benefit from the £2 billion of additional funding announced in the autumn statement. As I say, those CCG allocations and the formula used to decide what they should be are the responsibility of NHS England. NHS England itself commissions some services directly, including all primary care, as well as making allocations to individual CCGs. So these allocations to CCGs, although they are crucial, are only one part of a broader picture. In making those allocations, NHS England relies on advice from the Advisory Committee on Resource Allocation. As my hon. Friend will be aware, ACRA provides advice on the share of available resources provided to each CCG, in order to support equal access for equal need, as specified in the mandate.

NHS England does not set income on an equal “cost per head” basis across the whole country. Instead, allocations follow an assessment of the expected need for health services in an area, and funds are distributed in line with that, which means that areas with a high health need, including rural areas, should receive more money per head. There have sometimes been suggestions that a single per capita payment should be made across all CCGs, but I am not sure that that would not in fact lead to further discrepancies. As my hon. Friend will be fully aware, the key question is what overall weighting should be given to a range of factors, including age, disability, rurality and disease prevalence. As he himself acknowledged, there is no simple answer that would please everyone; this process requires the making of difficult judgments.

Without knowing that background, it can sometimes be hard for people to understand what are misleadingly presented as huge anomalies in allocations to CCGs. In the Vale of York, the funding is £1,067 per head; in my constituency of Mid Norfolk, it is £1,050; and in central Manchester, an urban area with an urban CCG, it is £1,085. I appreciate that those small differences add up over large populations, but they are not huge variations. The objective is to ensure a consistent supply of health services across the country, with health funding following —as best the system can map it—health need. That is one of the reasons why the data steps that we are putting in place are so important to allow us to monitor disease and health need.

NHS England has reviewed the funding formula and made welcome changes that take into account three important factors in driving health care need: population growth, deprivation and the impact of an ageing population. That should go some way towards helping to address the points my hon. Friend made.

NHS England now believes, and tells us, that it has a funding formula that sets recurrent allocations to CCGs more accurately and fairly, which is what the formula is supposed to do. However, I welcome the scrutiny that my hon. Friend and other colleagues from North Yorkshire are rightly insisting that it be put under.

By reflecting changes in population around the country and better targeting of pockets of deprivation, the NHS should be able to offer the best services to patients where they need them. I know there is a perception in North Yorkshire that the area is relatively underfunded. However, the NHS in North Yorkshire has benefited from increased funding, and when the Vale of York CCG’s funding is compared to that of other CCGs across the country, it is evident that it is not a significant outlier in terms of either funding per head of population or the level of funding relative to the formula. I appreciate that those are average figures; my hon. Friend will know better than I do the specific details of his own constituency.

At a time of continued pressure on the public finances, the additional funding we have provided for the NHS underlines the priority that this Government place on it. It means that the NHS will continue to benefit from stable, real-terms increases in funding, which will allow us and NHS England to get those formulae more and more accurate. Next year, the recurrent allocations of all CCGs in North Yorkshire will grow by 1.94%, an increase of almost £17 million. I am delighted that these increases will ensure that CCGs, including those in North Yorkshire, can continue to meet ever-growing demands for services, while investing in new services.

As time is short, with my hon. Friend’s permission perhaps I could write to him on the specific points he raised about back pain and IVF.

[Miss McIntosh]

I have a very simple question. Obviously, we as Back Benchers scrutinise the Department of Health, but who scrutinises and monitors NHS England?

[George Freeman]

As Ministers, we are responsible and ultimately accountable to Parliament for that. However, I am conscious of the time, so perhaps I could pick that point up in a letter to my hon. Friend.

As I said, I welcome the attention my hon. Friend the Member for York Outer and other North Yorkshire MPs are bringing to this issue, and I hope I have signalled that I consider it a substantive concern. Citizens in this country, rural or urban, demand and expect a national health service—rightly so, because they have contributed to it—and they expect national access on a fair basis. The structure we have put in place is really about giving NHS England the clinical freedom to ensure that funding decisions are made on the right basis. No system will be perfect, but as Ministers we are absolutely committed to ensuring that the system we have is as accountable and transparent as possible, and to providing the security of funding to allow that process to be pursued.

I know from my own experience in County Durham and in my Norfolk constituency that these are important issues. It is about ensuring that our citizens in rural areas get equal access to health services. My hon. Friend the Member for York Outer and other colleagues are doing exactly the right thing in raising this issue. I will happily address in writing the points I have not had time to address this afternoon. I look forward to writing to colleagues with more detailed answers to the specific points they have raised.

Question put and agreed to.

Offshore Gambling Bill

Debate between George Freeman and Baroness McIntosh of Pickering

Friday 25th January 2013 Commons Chamber

[George Freeman]

My hon. Friend makes an interesting point. I dare say there is an extent to which the industry needs to think about how it allocates its prize money, but the fundamental point is that unless it has a sustainable link to a reliable source of revenue from its principal input, which is betting, all this discussion is academic. The central point we are confronting today is how this great industry, which successive Governments have acknowledged needs a statutory basis, continues to ensure that the betting activity that feeds off it puts back a sustainable and responsible contribution to promote it.

The truth is that the levy has not been able to react quickly enough to the transformation in the gambling industry, which has seen so many of our gambling businesses move offshore. Eighteen of the 20 biggest bookmakers are now offshore. We have heard of one this morning—it is an “n of 1”—proudly maintaining a presence here in the UK, but the trend is indisputable and has been very significant in reducing the industry’s income.

Prize money has been significantly affected. It is important to acknowledge that prize money is vital for ensuring that we attract the best horses for breeding here, the best horses in training and the best people in the industry. Our elite racing sector at the very top is, of course, world beating, but prize money is also crucial to sustaining the less glamorous part of the industry out in our more diverse parts of the rural economy.

The levy contribution has nearly halved over the last five or six years. I want to highlight that by having a look at today’s Racing Post, which will illustrate some Members’ points. I do not intend to read it all, but let us look at today’s card at Lingfield. The first race at 1 o’clock is the Bet at bluesquare.com claiming stakes. The prize money is £2,045. If we divide that up between the first, second and third and between the owner, the trainer and jockey, and we take off the costs—of fuel, of staff, of getting a lorry to get a horse to the races— we see that that simply does not add up. Across the country, we are seeing small trainers and breeders packing up.

The other interesting thing to notice about the 1 o’clock at Lingfield is that there are only four runners in it. What is happening across the sector is that in that lower half of the market, fewer and fewer people are able to survive. That feeds in on itself. The smaller the fields, the less attractive for TV coverage and the less attractive for betting. In case anyone is concerned that there is a bumper race with huge prize money somewhere in the middle of the afternoon, the 1.30 prize money is £2,000, the 2 o’clock is £2,700 and the 2.30 is £2,040. These are disproportionately small sums compared with prize money in France or in Ireland. That is why we are seeing increasing numbers of trainers leaving this country and going to those territories. We are allowing this structure to undermine one of our great industries at a time when the Government are rightly doing everything they can to remove obstacles to growth and to drive economic recovery.

[Miss McIntosh]

I am following my hon. Friend’s arguments very closely. Does he share my concern that the average prize money in British racing is £10,135, while in France it is approximately £21,500 and £15,700 in Ireland? I think that helps to make the case that the hon. Member for Newcastle-under-Lyme (Paul Farrelly) was making.

[George Freeman]

As ever, my hon. Friend makes an excellent point. That was exactly the point I was about to make. The differences in prize money are significant and make a very significant difference. We are not talking here about marginal competitiveness, but fundamental differences in the rate of prize money that no sensible or rational operator in the industry could ignore. Indeed, they are not ignoring them. In the last few years there has been an 8.4% drop in the number of horses in training, and that continues year on year. There has been a 32% drop in foal production, which is an even more significant figure in the context of forthcoming years. Britain now ranks bottom of the global league in terms of the percentage of trainers’ costs that they are able to recoup through prize money—the figure is 21%—which means that trainers are increasingly dependent on their fees. That raises the costs of having a horse in training, with the result that fewer and fewer people—such as my hon. Friend the Member for Shipley (Philip Davies)—can afford to do it. We want to make racing an activity that more and more people can access, enjoy, participate in and contribute to, but by allowing the present structure we are doing exactly the opposite. We are feeding an increasing diaspora of British racing talent overseas.

The last Government’s attempt to deal with this problem, as with so many others, failed. The Gambling Act 2005 did not sort the problem out. It allows betting operators to base their remote operations offshore, often simply by placing the servers offshore while many of the offices are in the United Kingdom. It creates loopholes by allowing offshore bookmakers to avoid Gambling Commission regulation, and by exempting them from payment of their fair share of the levy.