Cambridgeshire and Peterborough CCG: Funding Pressures

Debate between Heidi Allen and Stephen Hammond

Tuesday 11th June 2019 Westminster Hall

[The Minister for Health (Stephen Hammond)]

It is a pleasure, as ever, to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for South Cambridgeshire (Heidi Allen) for bringing forward this debate. I know there are not many Members in the Chamber, but that should not in any way undermine or take away from the importance of this debate, which is clearly of great interest to her. She spoke powerfully about the problems that the CCG has had.

I recognise right at the outset that Cambridgeshire and Peterborough CCG has faced a number of difficult, interlocking and historical factors. The historically low funding settlement is obviously taking time to rise to target—there is a commitment to rise to target over time, which I will come on to in greater depth in a moment—and that has combined, as she rightly points out, with the fast rate of population growth across the area, which has put additional demands on the CCG.

I and the Government recognise that the CCG receives less per person than its neighbouring CCGs. As the hon. Lady rightly pointed out, it gets £119 per person less than its neighbouring CCG in Bedfordshire. Although it is moving towards target—as she rightly points out, it is 3.7% below target this year—that figure reflects some of the historical funding patterns. It does not reflect the allocation formula change that the NHS is working to resolve.

The hon. Lady and the hon. Member for Cambridge (Daniel Zeichner) pointed out the growth levels. She is right that Cambridge and Peterborough have seen substantial population growth in recent years, and that growth has been 0.6% above the England average over the past four years. Inevitably, that growth—plus the potential growth from the Oxford-to-Cambridge expressway, which will put more housing along the corridor—will clearly cause additional pressures.

The hon. Lady asked for a commitment from me. I can say that NHS England is committed to bringing all CCGs up to target as soon as possible, while also ensuring that all CCGs receive some additional funding this year. As a result, the CCG has received an additional 2.5% per capita growth in 2018-19, and will receive a further 5% per capita growth in 2019-20. That will bring the CCG funding up to £1.1 billion for 2019, which is below target but moving up. As I think the hon. Lady said, it was previously some 5% away from the target; it is now 3.7% away from the target. Our commitment is to bring all CCGs up to the target as soon as possible.

The hon. Lady will not be surprised to hear me say that it is, of course, a matter for NHS England to allocate funding to CCGs, and that process has been evolving. It might be helpful if I briefly set out how that happens. NHS England must ensure that funding is equitable and fair, taking into account the three main drivers of healthcare demand: population growth, deprivation and an ageing population. As a point of principle, CCG allocations are based on equal access for equal need and reducing health inequalities.

As the hon. Lady pointed out, a complex national formula supports the allocation of resources, and historically that has caused some distortions. That formula is developed by the Advisory Committee on Resource Allocation, known as ACRA, which is an independent body of experts, supported by the population projections of the Office for National Statistics.

The hon. Lady cited some population predictions, which I think come from the Cambridge Research Group as opposed to the Office for National Statistics. She will therefore understand that, although I accept that those numbers are shared locally, Ministers and the NHS have to rely on the independent and academically rigorous body. Otherwise, it could easily be perceived that we were using a local think-tank’s population growth estimates to privilege one group over another.

[Heidi Allen]

Am I allowed to intervene?

[Heidi Allen]

Thank you, Mr Hollobone. Forgive me—I have not led a Westminster Hall debate before. I accept all that the Minister has said, and it is a difficult matter, but the statistics are flawed. The Minister said that he accepts that the growth is 0.6% above the England average; the Office for National Statistics is working on its being 0.1% below. Something is therefore going a little astray.

[Stephen Hammond]

I am sorry—either I did not make myself clear, or the hon. Lady misheard me. I said that the population growth was 0.6% above the England average over the last four years. The number that she cited of the growth being below the average is from ONS predictions for the next two or three years.

[Heidi Allen]

Forgive me if I am mistaken, but I thought I heard the Minister agree that the growth was in fact 0.6% above the England average. If it is, why on earth are we working on the ONS figures that it is 0.1% below the England average?

[Stephen Hammond]

This is prejudging the tennis season, in that we can go backwards and forwards, but let me say for the record that if I misled the hon. Lady I apologise wholeheartedly. I agreed that the population growth of the Cambridge and Peterborough CCG area has been 0.6% above the England average over the last four years; I did not intend to suggest that it is expected to be 0.6% above the England average for the next one, two or three years. I think the ONS number that she cited is one that we recognise; however, as I said, the numbers that she produced from the Cambridge Research Group are different from those of the ONS.

This year, ACRA has recommended a wide-ranging set of changes to the formula, to ensure fairness across the country. In the case of Cambridgeshire and Peterborough CCG, that has led to an increase in NHS England’s estimate of what the fair share of resources should be. That is mainly due to the mental health and learning disability service estimate and the market forces factor.

Changes have also been made to the way population data is used. ACRA now uses the annual average registered list for the most recent year, rather than the size of the list at the time of allocations, to allocate resources on a per capita basis. That change will inevitably benefit Cambridgeshire and Peterborough CCG because it will reflect more recent population growth. The change is obviously also intended better to reflect cyclical patterns in areas with large numbers of seasonal workers or large student populations.

ACRA also now uses specific data regarding age and gender population projections produced by the ONS, so that if population growth in an area is disproportionately in a younger or older population, which will obviously affect the relative need, that will now be reflected in the new way that NHS England calculates the allocations. As I said earlier, the formula changes will more accurately reflect population growth, deprivation and the structure of the population over the next few years.

[Heidi Allen]

I appreciate the sincerity, and my CCG knows that NHS England intends to improve the formula to make it more representative. However, a question remains, and it is the same question that the hon. Member for Cambridge (Daniel Zeichner) referred to regarding education: what happens in the meantime? Our CCG is talking about significantly cutting community services. That will affect elderly care in the community. That will stop vasectomies. It may take IVF treatment away altogether, as we are at just one round at the moment. Although I appreciate that NHS England is an enormous machine and improving the health formula will take some time, what do I say to my constituents whose health services are being cut while we wait?

[Stephen Hammond]

I will say two things to the hon. Lady. First, the reflection of the formula and the increase in the money is coming through this year and next year. We have spoken about the additional per capita funding that is coming through.

[Stephen Hammond]

All I have are the percentage increases in additional per capita funding for 2018-19 and 2019-20. I will seek inspiration to confirm the absolute totals, and if that inspiration reaches me while I am still on my feet, obviously I will relay it to the hon. Gentleman. If not, I am happy to confirm that I will write to him.

My point is that the NHS England allocation is based on the ACRA assessment and on the change in the funding formula. The hon. Member for South Cambridgeshire and the hon. Member for Cambridge rightly point out that, historically, the funding of their CCG has not been equivalent to that of local areas. That historical funding disparity is being improved, and is moving back towards the target of funding for CCGs over the next two or three years. I pointed out that last year there was a funding increase of 2.7%, and there will be one of more than 5% this year.

[Heidi Allen]

While the Minister’s inspiration is working diligently on the back row behind him, may I ask to be included in that? If we do not have time now, perhaps the Minister could come back to us. He is right that some additional funding has been provided to the CCG, but more than that amount is in mandated national programmes over which it has no control, so how much extra will the CCG receive for core services—not for something that has been put on it from a national point of view?

[Stephen Hammond]

The hon. Lady will know that some of those core mandated services are providing core services as well. I am happy for the hon. Member for Cambridge to correct me, but my understanding is that an additional £8.5 million will go into the CCG. If he wishes to write to me with his figures, I will happily source those numbers for him. However, I have just received inspiration from somewhere, for which I am very grateful, and I can confirm that that is the number.

Leaving the EU: Customs Arrangements

Debate between Heidi Allen and Stephen Hammond

Tuesday 10th July 2018 Westminster Hall

[Stephen Hammond]

Again the hon. Gentleman guesses what I was about to say next. I was using the ports of Dover and Calais as examples of ports across the United Kingdom. Of course, it would also require restrictions and a border infrastructure to be in place between the two ports he mentions.

Over the last few years, some people have called that project fear, but the reality is that we are facing risks to our economy and to people’s jobs. In the last two weeks, businesses such as Airbus and Jaguar Land Rover have been increasingly vocal about these events and the risks. A recent Institute of Directors poll found that business leaders want a post-Brexit customs arrangement that avoids the new customs processes and maximises EU market access by minimising regulatory divergence. Warnings from big employers and investors in the UK should not be ignored, and certainly not by a Government who are committed to protecting jobs and enhancing employment opportunities.

[Heidi Allen (South Cambridgeshire) (Con)]

On that point, it is important for everyone to recognise that although big businesses can be noisy and have press contacts, the way that business filters through like a food chain means that they provide work for medium-sized businesses, who provide work for small businesses. As a country, we would be completely foolish to risk fundamentally changing the way we deal with our existing EU customers without having a clue about what the new customers in the rest of the world might want. We have to find a way to preserve frictionless trade with our existing customers if we want to protect our economy.

[Stephen Hammond]

My hon. Friend is right. The supply chain provides jobs in all sorts of areas across the country. It is not just the big employers, but the thousands of people who are employed in their supply chain. For a small firm, the bureaucracy of restrictions such as rules of origin requirements and certificates, will be so extreme that some of them are likely to go out of business. We need to realise that.

We need a solution to those problems that protects jobs and businesses, that reflects the realities at ports, that avoids a border in Ireland and that can be fully enforced by the end of the implementation period. It is no good just relying on the technology being there, because at the moment it does not exist or it has never been tested on anything like that scale.

I am not sure that I am in universal agreement with all hon. Members, but I welcome the Chequers plan as a sensible proposal. As with everything, it will be in the detail, and as I said earlier, we are in a slight vacuum at the moment because the White Paper’s timely publication will be important, but it is not yet with us. One ambiguous area is the suggestion that maintaining frictionless trade with the EU will limit our ability to pursue new free trade deals. I will leave it to the Minister to explain exactly how those proposals will ensure that we can keep the option of free trade open.

The Government’s proposal is a welcome step towards at least recognising the economic reality that will hit us. I do not want to say that the debate has secured all the answers yet, because we will have the White Paper, but I will say that the Brexit debate has not yet faced up to some of the inevitable trade-offs between different rules around the world. If barriers are removed somewhere, they will almost certainly be put up somewhere else. That is the consequence.