National Health Service

Hugh Bayley Excerpts

Wednesday 21st January 2015 Commons Chamber

[Mr Hunt]

I will, and that is what this is about—putting patients first. That is why we need important reforms such as ensuring that every vulnerable older patient has a named accountable doctor—I will mention that later in my remarks—and why we must remove barriers between the health and social care systems.

[Sir Hugh Bayley (York Central) (Lab)]

It has been well known in the NHS for decades that an ageing population means that more needs to be spent in real terms each year on the NHS than in the year before. In 2010, when the Government came to power, 8.2% of our gross national income was spent on the NHS, but that has now fallen to 7.9%. How can that possibly be an increase in the Conservative party’s commitment to the NHS?

[Mr Hunt]

Because the only way we could return the economy to growth was by tackling the deficit left by the Labour party—the worst deficit in the developed world. Labour left us with that problem; we have sorted it out and are turning the country round. If the hon. Gentleman wants to increase spending on the NHS, as I do, the only way to do that is through a strong economy, which is what the Government are delivering.

--- Later in debate ---

[Dr Huppert]

The hon. Gentleman ought to get his facts right. The Cambridge university trust put in a bid—it was the sixth last to do so—but then withdrew because the cost of the tendering process under the right hon. Member for Leigh was far too high. It did not have a partnership with Serco. The hon. Gentleman should check the facts and check the record. The trust was driven out by the tendering. The hon. Gentleman should also know that the bid to which I suspect he was referring was led by Serco. What he is saying, in essence, is that the current shadow Secretary of State had to undo the damage that had been done by previous Secretaries of State. That is a bit of Labour misery that I imagine Labour Members can sort out between them.

We know the history, and we know the problems that led to it: the Government had to decide between three private sector-led bids for Hinchingbrooke. What we must do now is work out what to do next, and I think we need to ensure that Hinchingbrooke stays in the public sector. Trying to remove it from the public sector in order to deal with the PFI problems, which was the original idea, simply has not worked. It must stay fully within the NHS.

Last year, before any of this happened, I led a debate about health in Cambridgeshire. I dealt with a number of issues, and I will not go into all the details now, but I spoke about health funding and, in particular, about mental health. I gave a number of detailed examples of some of the many challenges that we have faced and still face. For instance, huge cuts were made five or six years ago. During that debate, I called for a substantial amount of extra money, not just for Cambridgeshire—although I shall say something about that shortly—but for mental health throughout the country. Members in all parts of the House have made some excellent speeches about mental health, but it is not talked about enough. I find it regrettable that the motion does not mention it, and I suspect that a number of Members on both sides of the House do as well. Let us hope that we receive that extra money for mental health.

Cambridgeshire, however, suffers from a number of specific problems. We have been a test bed for experimentation for many years. We had the Hinchingbrooke experiment— the largest tender that the NHS has ever seen. We saw huge numbers of PFI projects not just at Hinchingbrooke, but at Peterborough. Paying off the NHS costs is still taking 18% of Peterborough hospital’s budget. That is only a small proportion of the 138 PFI projects that we saw under the last Government, the costs of which will amount to £11.7 billion over the next Parliament. That money could be used far more productively.

We have been hit hard by that, but we also receive very low funding. We inherited a formula from the last Government, and the process of changing it has been too slow under the present Government.

[Sir Hugh Bayley]

rose—

[Dr Huppert]

The hon. Gentleman can intervene if he wants to talk about why PFI is a great thing, but otherwise I will move on.

The Government have been too slow to move to the new formula, which properly takes account of ageing populations. We know that the elderly cost more in terms of health care. Cambridgeshire receives £961 per head, whereas West Norfolk, for example, receives £1,255. That is a huge difference. I asked for extra money during the debate that I mentioned, and I am delighted that we have managed to secure an extra £20 million as a result of the recent allocation. That will provide much more funding for mental health, on top of the extra £1.5 million that has been provided this year and the extra £2.2 million that will be provided for IAPT—improving access to psychological therapies—next year. That will make a big difference, and will reverse some of the challenges that we face.

We need that extra cash, but we still need more in Cambridgeshire and throughout the country. Simon Stevens called for an extra £8 billion by 2020, after savings and efficiencies had been taken into account. He said that an extra £8 billion, in real terms, was needed if the NHS was to keep going. I think that that is important, and we as a party think that it is the right thing to do. One of the problems with the motion is that it does not deliver what Simon Stevens has said is needed for the NHS. I am not all that keen to support the provision of less than a third of what is needed to keep the NHS going, especially after hearing from the shadow Secretary of State that, despite what the motion says, the money is not all for the NHS but constitutes the entire offer for the NHS and social care, which also needs its own funding. We need that £8 billion.

I voted against the Health and Social Care Act 2012 as I did not agree with much of it. There are some issues, such as parity of esteem, that are very good and that I hope will never be repealed. I also disagree, however, with many of the things that the Labour party did to bring in the private sector in some damaging ways, with people being paid for things that never happened.

The fact is, as was mentioned by the hon. Member for Brighton, Pavilion (Caroline Lucas), under the previous Government medical spending on private provision went from £1.1 billion a year in 1997 to £7.5 billion in 2009-10. That is a vast increase. I have no problem with people who say that they support that and that it was the right thing to do, but to suggest that that large increase was excellent for the NHS while the fact that it has continued at essentially the same rate under this Government is a disaster for the NHS strikes me as a rather bizarre claim.

I have criticisms of this Government, the previous Government and the one before that. I want the NHS to spend more of its time focusing on patients or, even better, avoiding the need for people to be patients in the first place. That needs a trained, motivated and well-paid staff—I think they should get the money from the independent review. It needs a focus on prevention and public health and proper funding—that is, the £8 billion by 2020.

--- Later in debate ---

[Sir Hugh Bayley (York Central) (Lab)]

NHS services in the vale of York are provided by well-qualified and hard-working staff and this year they received £367 million to provide their services. Nevertheless, services in my city of York are in crisis as a direct result of coalition Government policy.

The A and E service at York hospital has broken down over the past two months. In December, 71 operations were cancelled at the last minute so the beds could be freed up for emergency admissions from A and E. Between 1 and 11 January this year—11 days—84 operations were cancelled for the same reason. When my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) was Secretary of State for Health, he created the walk-in centre in York, which he visited with me, and it reduced pressure on A and E. He created NHS Direct, which reduced pressure on A and E. The walk-in centre was closed two or three years ago and NHS Direct has now been closed, so it is not surprising that we face these extra pressures with hundreds of thousands of extra presentations at A and E each year.

The pressures in A and E mean that when ambulances arrive with acutely ill patients they often have to wait a long time before they can pass the patient over to the A and E service. That inevitably has a knock-on effect on ambulance response times. A freedom of information request made last week by the trade union Unite found out that Yorkshire ambulance service failed to meet its national target of responding to 75% of emergencies within eight minutes in 11 of the 12 months leading up to October of last year.

The problems within mental health services are even worse. Last year, the Care Quality Commission highlighted major failings and, following an especially serious incident at Bootham Park hospital, the acute mental health hospital in York, in which a patient died, I wrote to the Secretary of State in April 2014 in support of the local clinical commissioning group and Leeds and York Partnership NHS Foundation Trust, the provider of mental health services in York, to press for urgent plans to replace the 250-year-old Bootham Park hospital. It is a fine grade I listed building, but because of its listed status English Heritage prevents the health trust from removing ligature points or installing anti-barricade doors and makes it impossible to provide clear lines of sight from nursing stations to the patients’ bedrooms.

The CQC’s concerns are not just about adult mental health services. The child and adolescent mental health unit in York, Lime Trees, was constructed more recently. It is a mixed unit for girls and boys, but it does not have sufficient bathrooms to preserve dignity with two genders within the unit. It also has inadequate space for clinical meetings, therapy sessions and family visits, and it only has limited space for the young people themselves to relax and, because of its deficiencies the more acutely ill young people have to be sent away, often to the other side of the Pennines, in order to get treatment. That does not make sense. We have heard from my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) and others today about the pressures on families when acutely mentally ill young people are moved away.

I got a letter back from the Minister of State saying that NHS Property Services was working with local commissioners

“to look at a comprehensive estate strategy for York.”

That was eight months ago, and I say to the Minister—I hope his Parliamentary Private Secretary will tap him on the shoulder now—that I would like him in his response today to say what progress has been made in those eight months in providing a capital package to replace Bootham Park hospital in York. It is urgently needed and he has had a long time to consider it.

Just last week the CQC, in a new report, made further criticism of the Leeds and York mental health trust. Most worryingly of all, it revealed that York receives much poorer services than Leeds, despite the same trust providing services to both places. The local paper in York had a headline story describing it as “A Tale of Two Cities.” The trust chief executive Chris Butler has told me that the reason for the disparity in services is simply because the CCG in Leeds is better resourced than the CCG in the Vale of York and therefore it receives more money per capita for the population served from Leeds than for that served from York. It is simply unacceptable for access to care to depend on a postcode lottery.

Two things have brought about this crisis. First, there has been a squeeze in funding in the NHS. As I pointed out when the Secretary of State was speaking, the NHS budget has fallen from 8.2% of our GDP in 2009-10 to 7.9% in 2013-14, and the situation is getting worse as we will see when the figures for this year are revealed. To put that fall in perspective, the difference between 8.2% and 7.9% of GDP is some £5 billion a year. That is the amount by which this coalition Government have cut the NHS budget.

The Government must address not only the overall level of funding, but the way the funding is split between different health authorities. Within the former North Yorkshire primary care trust area, where all patients used to get the same level of treatment, funding in the Vale of York is just £1,062 per person as against £1,270 in Scarborough and Ryedale. I went with colleagues from neighbouring constituencies to see the Secretary of State to say that parity of funding should be restored, but nothing has happened. This is a Government who talk the talk but do not walk the walk on the NHS.

[Several hon. Members]

rose—

Oral Answers to Questions

Hugh Bayley Excerpts

Tuesday 25th November 2014 Commons Chamber

[Mr Hunt]

I am happy to answer that, because for the first time we have a proper independent inspection regime. Labour tried to vote that down so that we could not have it, but we pressed on. A third of these trusts have been turned round. We are making good progress across most of the other 12 hospitals in special measures, including 1,500 more nurses, 200 more doctors, and 53 changes at board level. Where there were problems before, we are sorting them out.

[Hugh Bayley (York Central) (Lab)]

T4. Patients with mental health problems who are referred for psychological therapies wait, on average, less than 40 days for treatment, but in York the wait is 125 days. My constituent, Laura Goodacre, has now waited nearly 350 days. Will the Minister look at this worrying case and the need for our mental health trusts in York to reduce waiting times?

[The Minister of State, Department of Health (Norman Lamb)]

I will absolutely look at that case, and I am happy to talk to the hon. Gentleman about it. This is precisely why we are introducing, for the first time ever, an access standard—a maximum waiting time of six weeks for access to psychological therapies from next April.

NHS Patient Data

Hugh Bayley Excerpts

Thursday 27th February 2014 Westminster Hall

[Mr George Mudie (Leeds East) (Lab)]

It is a pleasure to serve under your distinguished chairmanship, Mr Bayley. I must compliment the hon. Member for Mid Norfolk (George Freeman). I have always regarded him as a talented man, but when a man can speak, take a telephone call, say who has rung him and switch the phone off without breaking a sentence, that is real ability.

I should almost apologise for daring to speak after the hon. Gentleman. I am at pains to say that I am not putting the opposite view to his. I had a debate last week. I only had half an hour to share with the Minister, but I gave up five of my valuable minutes to allow the hon. Gentleman to speak.

I do not see the debate as having two opposite sides; I see it as two different responsibilities or objectives that should be rolled into one objective. The hon. Gentleman spoke today for more than three quarters of an hour, and all but five minutes were on the medical side.

I said this last week—I will say it again—but I do not challenge the medical benefits of the exercise. I concede that medical improvements will flow from it. Those benefits are accepted and encouraged, but the other side is personal privacy in the important field of individuals’ medical records. There were indications, but I am not sure that the common ground was in the five points he made. We must search for common ground, but I will show the hon. Gentleman and the House why it is difficult to find.

This is not a dialogue; NHS England and the body with the long set of initials that was set up are not listening. They do not intend to listen or allow the public a real choice in the matter—that is the problem. If those bodies did as the hon. Gentleman said and saw the matter as, “If we are going to do this, we must gain the trust of the public”, we would all be in a better position. However, I do not see that as their objective, which has always been to get through the formal parliamentary Committee and medical-world structure. The less we know, the less interference from us and the fewer decisions we are allowed to take, the better, because the world will be better. Well, the world will be better medically, but the dangers that we are spelling out, in terms of putting every person’s full medical records on a database, worry us.

The dangers worry us in two ways. The first is the bringing together of the databases into one huge database, where all the information about an individual patient is stored. That is an important technological computer problem—a difficult problem that has to be argued out. The second worry, which I think is the greater, is also difficult. The exercise so far would not lead an objective member of the public to trust the authorities. The worry is about the flow of information out of that database to people outside the national health service or social care.

I have in my hand the document that has caused the fuss. It was sent out as junk mail, delivered on a Monday morning with all the other junk mail; the post office has a standard way of delivering it. A person gets their pile and looks for an individual letter—no. They know it is Monday, so the pile goes into the bin. That was how the document was delivered. Some 65% of the people who were polled, “Did you read it? Did you receive it?” said no.

Mr Bayley, you are a long-established politician. You know the number of times we deliver manifestos and leaflets to houses in an election. When we then go round, people say to us, “We never hear or get anything from you.” The public’s memory of what goes through the door is pretty short, but when things come in with junk mail, that is understandable.

The real objection, however, is inside the document, and we have heard about it today. The front page is the front page. The inside pages contain the lot, including “Introduction”; “What are the benefits of sharing my information?”; “Information will also help us to:”; and “What will we do with the information?”. It is all favourable. It is all on the medical side. That is not disputed, if we get the data together and look at complaints and how they are handled. I am a lad who is into computers and databases in politics. Databases transform information in ways one could never do with pen and paper. That is conceded and encouraged, but what about the other side—the disbenefits?

I challenge anyone to find from this piece of paper the down sides or things that we have to worry about that the bodies would like to discuss with us. They are not there. The document has two pages saying that the system is great and that it will do wonderful things, and then it has a section called, “What choice do I have?” Anyone getting a piece of paper like that would read two pages, be switched off before that, and say, “When we have to opt in, why would I want to opt out? This is wonderful.” Having listened to the hon. Member for Mid Norfolk, it is wonderful, so why would anyone want to opt out?

Let me discuss some matters of trust, because that is what the issue is all about. I have been in the House for 20 years, and I do not trust Governments. I would not tell people to trust Governments, whether Labour, Liberal or Conservative. I would say to people, “Put your trust in God if you wish, but don’t trust Governments”, because the state and Governments have a life and interest of their own. The document is an example of where something has been decided that might ruin the life of anyone sitting in the Chamber, especially those sitting on our Benches. We all know, as politicians, what happened to data that were secure beyond any reason—our expenses. How secure was that database? What damage it did! It killed people and imprisoned people, and it brought us down to below journalists, estate agents and perhaps lawyers in the esteem of the public. That was a “secure” database.

Is there such a thing as a secure database? That is one of the arguments, but I am still talking about trusting the Government. Do not trust the Government. Let me take the five things the hon. Member for Mid Norfolk said about what we should do. Four of them are about the Government and public bodies.

I serve on the Treasury Committee. We have gone through the banking world. Theoretically, everyone who matters to the financial world reports to the Treasury Committee. They appear for an hour—two, if pushed—before the Committee once a year, and they have been accountable to Parliament. I remember the lad who ran the Financial Services Authority coming before us. We were discussing, I think, the withdrawal of cheques. I said to him—I was in the Chair, I think—that the public were outraged by the proposal, especially the elderly. I said, “The Committee is outraged by it. We would like you to go away and withdraw the threat to cheques. Will you do that?” “No”, he said. “I am the regulator. I do not answer to Parliament. I have statutory powers. You will have to convince me.” Those were his exact words.

Reporting to Parliament is a form of pompousness on our part. What on earth do they report to Parliament about? How do they do that? When do we see them? When do we question them?

We can look at the Annunciator monitors in the Chamber. I commend the ability of the hon. Member for Mid Norfolk to speak for nearly an hour; his speech on the subject was important enough. However, if you, Mr Bayley, were speaking in the debate that was on the Floor of the House while the hon. Gentleman was speaking, you would be talking about an important subject—the treatment of welfare beneficiaries—and you would have had six minutes. Six minutes—that is accountability to Parliament. That is the ability of the majority of parliamentarians to raise an issue. This debate is a rare event.

The hon. Gentleman talked about duty of care and a bill of rights for patients. Well, we have a duty of care in the health service. It was good, was it not? We have had it since ’48. But what happened at Mid Staffordshire? The duty of care was there. A document such as the one I was talking about matters little; the issue is about how the service is run and what happens on the ground in reality. All those patients were protected by the duty of care. All the people who died had that duty of care. It was supposed to be wonderful and supposed to protect them—but we would want a bit better protection now.

“We will make the data release body a statutory body” sounds fine, but who appoints to that statutory body? The Government appoint, one way or another. Who appoints to the committee or body that released the leaflet I was talking about? The Government. “Yes Minister” has not disappeared from our memories, so would we expect someone from York who works on the railways, for example, to be on that body or on any body appointed by this building? No. Would we expect to see a permanent secretary or an ex-permanent secretary on this great committee? “Yes Minister” would say we would.

Public sector pensions are not what they were, and we cannot have a permanent secretary retiring without having a side job given to him—and he will behave himself, or he will never get another one. Surprise, surprise, on the committee I am talking about, there are two: one from the Ministry of Defence and the other, the interim chief executive who is just leaving, from the Department of Health. Trust Government! An inquiry, a review, a statutory body or a quango—what is the first criterion for people being appointed? They behave themselves—that they are a safe pair of hands. That is the reality.

The only one of the five points made by the hon. Member for Mid Norfolk with which I totally agree is the last one, and I would push it a bit further. Misbehaviour on data of such sensitivity should not involve a fine. When the pharmaceutical or insurance industries are involved, or even the media, the penalty should be jail. The information in the file of people with a sensitive medical history could lose them their career, job, marriage, relationship or even life. That is what is in those files. That is why when we go and unburden ourselves to the doctor, we should be secure in the knowledge that what is said in the doctor’s surgery stays in the doctor’s surgery. I am not opposing records coming out, but what about the basis on which people outside this building or the national health service will have access to and be able to identify those records? Trust—we are going to trust them.

What about the prevarication over opting out? How do we opt out? I have found out about this issue in greater detail over the past two months, but how do I opt out? I have not opted out yet, because there is more than one form to fill in when doing so. On Tuesday, the Secretary of State was asked whether opting out could be done online or by telephone. Apparently, we can do it on the telephone if we are able to get through to the doctors and get a person answering, rather than an answering machine, and we can go online if the doctor is online.

Yesterday, I met a nice gentleman sent from the organisation involved—it was a pleasure, and interesting, to meet him. I asked him about opting out. He said, “Opting out is a matter for the GP.” I had asked why there was not a full-page advert in the paper explaining the arguments in favour and the worries, saying to people, “Make a balance. It is your decision. It will affect you” and including some opt-out forms. “We cannot do that”, he answered. “The GP is the holder of the data, so GPs should do it.”

What is the situation on opt-out? It is the biggest argument and the biggest concern. If we listen carefully to the reasons for concern, the medical side do not want us to opt out. The more people who find out what could happen to their records, the more who will opt out. If the authorities were straightforward, such is the way of things that the number of people who opted out would be a small proportion of the population. Rather than trust to that, they have taken the decision to minimise opt-out in a most dreadful way.

We are told to phone and make an appointment with our doctor to discuss opting out, but we have little chance of doing that even if we have lung cancer. We do not have a chance. With a medical complaint, when we try to see our doctor, the surgery says, “Ah, well, we might be able to see you next week. Can you take a day off work?” What person will take a day off work to discuss opting out? That is absolutely nonsensical and not of the real world. They want us to say, “Forget about the opting out.”

Furthermore, before leaving that subject, if people opt out, they should not think that their details will not be in the database. They will be going into the database. The point of opting out is that any information going from the database to someone else, will have the personal information taken out—date of birth, postcode, gender and all sorts of things that can identify someone. We might opt out, but our records are still in the database.

Why should we trust the authorities? I am not as articulate as the hon. Member for Mid Norfolk, but I do not have to persuade people. As Nye Bevan said,

“Why look into the crystal ball when you can read the book?”

All the patient records of everyone in the Chamber who has had hospital treatment in the past 10 years were sold to a firm of actuaries, who passed the information on to insurance companies. As a result, the insurance companies have 47 million records.

Of course we can trust Government—Government are great! We can trust the word of an individual who stands up to say, “The security is great.” Yes, we can, but that same institution then allowed all our hospital records to be passed—in fact, sold—to a firm of actuaries. Thanks to The Daily Telegraph, we know that that happened and that the information was analysed and put into a form that insurance companies could use to put up premiums for individuals and certain groups. As a result, we are paying higher premiums. That was our hospital records—“They are safe with us.” I might be getting a bit bitty, but I can pass the article to the Minister, if she wishes.

Another article was bigger—a whole front page—but I have not brought the one that I was going to speak about with me. I think it was yesterday, or the day before, in The Daily Telegraph, or The Guardian. It reported that a private firm had been in discussion with the body that is holding our records and building up the database, because it wants to buy the records, and it wants to buy them quickly. We have to ask about that individual company having discussions before the matter is even agreed, but the interesting point was at the end of the article. Not only was the company set up to deal with pharmaceutical firms—that is already straightforward—but the owner set up another company and stated that among the clients would be pharmaceutical companies. That is the word, “among”. We have to ask who the other customers are—the ones that have not been named. If the pharmaceutical companies are in there, the insurance companies will not be far behind.

In terms of trust, however, the worst thing is that spokesperson for the body in question has said that that company has been told that there will not now be any prior discussions and it must make an application in the normal way, with others, at a later date. What does that spell out—that “not now”? Two days after the balloon goes up, we go into the second period of re-examining the scheme and the matter is in all the papers, the spokesperson suddenly says, “We are not now going to have prior discussions with the firm.” I am sure the Minister will say what in fact the Secretary of State said on Tuesday in the House, namely that that sort of thing went on before, but things have been toughened up. Well, the Secretary of State has toughened things up so much that private discussions are going on with an organisation that we would all wonder about.

A further issue about trust is this: the records were going to be uploaded to the big database last autumn, but the process was stopped because some information about it came into the public arena, and the organisation took fright and said, “We will look at the situation for six months.” Those six months, which run out on 1 March —that is, this Saturday—were used to produce the leaflet I referred to. For all that the hon. Member for Mid Norfolk says about improved efforts, that was the response. It was told that it would have to tell the public about the programme and get the public onside, and the leaflet is what it produced.

This Saturday the records would have started to be uploaded—indeed, there is a suggestion in some minutes from the HSCIC that maternity and children’s care records are already being uploaded. I will have to look at the exact wording of the board minutes, but that is worrying. In three months’ time, all the records would have been in the database and the job would be done, but that was stopped because of the fuss, including in this place. However, the trust is gone. The process was stopped because the public had to be told more, but who in this room feels we have been told more?

Now, the process has been stopped again, and what has the body responsible said publicly? It has not done what the hon. Member for Mid Norfolk did in his speech, in which he gave us some information and set out some starting points for discussion and dialogue to help improve things and to bring people together—I am grateful to him for that. Instead, it has said consistently in all the press releases that it is delaying the scheme so that it can persuade the public how good it is. Perhaps it will send out the hon. Gentleman’s speech. That would do the job, because it was wonderful—I could not fault it, as he told us all the conditions that could be improved.

Members who are not present could put this case better than me. There are genuine worries. We represent people whose records are going into the database without them being aware of what is happening. Questions have been raised by both Government and Opposition Members, and what does the organisation responsible do? It cancels the process for another six months in order to improve a leaflet.

There was a little light earlier this week, with an article in The Times—it was only a short one, but every little bit of light is welcome—saying that the bodies responsible have broadened their approach: they are now aware that there are dangers in pulling all these data together and that the question of security has to be taken more seriously. If that has pushed producing another leaflet to one side, and they are working on that instead, I think the scheme is back on the table. Nobody wants to kill it. I have not met anyone who wants to kill it, or anyone who does not agree that the basis for the scheme is first class. All we want is for our voices to be heard. I represent 60,000-odd people, all of whom have medical records. How could I look one of those people in the eye and say, “I had the chance to stop your private details being attached to your medical records, but sold out?” We have to do something to ensure that security is as good as it can be. It is about trust.

On 15 January this year, my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) asked a question in the House on this matter, just before the hon. Member for Mid Norfolk. The Minister here today is very good, but in a way I am sorry that the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), is otherwise engaged—he is the Minister who gave me a bad time when I raised the same point last week—as he answered the question from my hon. Friend the Member for Newcastle upon Tyne Central. She asked him:

“Has a risk assessment been carried out for the extraction service”—

that is, the extraction of GP records—

“and, if so, will he commit to publishing it and any recommendations made?”

Now that is a perfect question—educated, specific and designed to ease the worries of the general public. What answer did she get? It is parliamentary scrutiny at its best. Asked a specific question, the Minister said:

“We have, of course, constantly assessed it.”

He went on to say:

“I hope the hon. Lady is not criticising the principle of improving and joining up care”.—[Official Report, 14 January 2014; Vol. 573, c. 702-703.]

And there was more of that. Will the Minister tell us—I will be happy if, even with all the resources behind her, she has to answer in writing—whether a risk assessment has been carried out on the extraction service and, if so, will the Secretary of State publish it?

I will say, mischievously, that it does not really matter, because The Daily Telegraph has published extracts of the risk assessment—probably, hysterical extracts—so there is one, and it raises many questions. I do not say that in a hostile way. Thank God somebody who is not a hysterical parliamentarian or a computer whizz but is regarded as sensible has examined the scheme and said that there is a risk. All we wanted was for that to be acknowledged. We simply want a wee bit of movement, to get the maximum possible medical improvement with the minimum of risk to the security of the personal medical records of the general public.

I have a further point about trust—I see you looking at the clock, Mr Bayley, but it is such a pleasure to be serving under your chairmanship that I want to milk every moment. Even this week the Secretary of State was asked a question by the hon. Member for Totnes (Dr Wollaston), who is such a bright and straightforward colleague of the Minister’s in the Conservative party. She asked about those 47 million medical records that were sold to insurance companies, and she was talking about trust—

[Hugh Bayley (in the Chair)]

Order. I am not asking the hon. Gentleman to terminate his speech, but perhaps he would sit down just for a moment. I must vacate the Chair now, and my colleague will take over. We have had plenty of time for two speeches from both sides of the Chamber and they have ranged widely, but two more Members want to catch the Chair’s eye. The wind-ups will start a little before 4 o’clock, so I hope that the three Members concerned will keep an eye on the clock to ensure that everyone has a reasonable opportunity to express their views.

[Mr Mudie]

I apologise, Mr Bayley, and I apologise to my colleagues. I understood that only one other Member was on the speaker’s list.

[Mr David Amess in the Chair]

The hon. Member for Totnes, a Conservative, said:

“Nothing will undermine this valuable project more than a belief that data will be sold to insurance companies, so will he”—

the Secretary of State—

“set out the way in which he will investigate how that sale was allowed to happen and categorically reassure the House that there will be no sale of care data to insurance companies?”

The Secretary of State’s reply was long, but I will give only the first sentence:

“My hon. Friend is absolutely right to raise that issue”.

What issue? She raised two.

He continued:

“I am happy to give that assurance.”— [Official Report, 25 February 2014; Vol. 576, c. 147.]

What assurance was he giving?

May I ask the Minister what the Secretary of State intends to do—I do not need an answer now because the matter is in his head—and whether it will be something disgraceful? The BBC totally ignored the fact that 47 million patient records were sold outside the national health service. The Secretary of State’s colleague, the hon. Member for Totnes, asked him to conduct an investigation and give a specific answer.

The Secretary of State said there would be no sale of care data to insurance companies. That reassurance means nothing because the data will not be sold. There will be an appropriate charge to meet administrative costs. NHS England wanted to give it away for nothing, but the HSCIC said it would charge £1 for each data record to cover its costs. Will care data be moved to insurance companies directly or indirectly? Will the Secretary of State tell us in writing how he will ensure that such data do not land in the hands of insurance companies? He has given one of those assurances, and we will find out which one.

The refusal to acknowledge the security risk is at the heart of the issue. One objection is that all the data will be brought together in databases, whatever the hon. Member for Mid Norfolk says. He will remember that I asked how there could be a guarantee that they will not be breached. What is the answer? I will give the answer. They will be breached.

You may remember, Mr Amess, that a Glasgow man in his 20s breached the Pentagon’s database from his bedroom out of curiosity. The US Government wanted to extradite him to America but we fought against that. I asked the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, whether he was telling the House that the patient database is more secure than that of the Pentagon? I did not receive an answer, so perhaps the Minister will tell me now, because the Pentagon would like to know.

Will the patient database be more secure than Barclays database, from which the financial records of 27,000 customers were stolen? The computer world says that there is a constant fight to keep databases safe from eastern European countries and there are even cyber attacks in China. But we are being asked to accept that the NHS database will be so secure that it will never be breached.

How do the Government expect to obtain trust if they do not accept that there are limits to security, and that steps should be taken to protect such sensitive data? It is fine for the medical profession to have access to the actual records, because that is what it is interested in, but it is not fine to be able identify individuals. How many people live in one postcode? It could cover a whole street, or a couple of streets. If the age, gender and date of birth were available, it would not be difficult to identify an individual. That is what we are facing, and we want the Government to do something about it.

An extremely worrying suggestion from a good source is that GP databases will be put into a huge centralised database. I have been reliably informed that those databases are not in the GPs’ offices. They do not have separate databases. I have been told that data are sent to three private companies to be stored. I would like some reassurance that that is not so, but if it is the House should be told the basis on which those databases operate, what safeguards exist, and the criteria for the release of those data.

No one in the Chamber would trust the judgment of an organisation that entrusts so much sympathetic and sensitive data to Atos. It is probably deservedly one of the most despised public companies. The fact that it is French does not come into the picture. That does not matter. We laugh, but it is outrageous. It must have been mentioned in every sentence during the debate on welfare benefits. It received millions of pounds from the Government and, if I am charitable, over-extended its remit by putting people off disability benefit in enormous numbers and sometimes tragically. The Government have not sacked it; it decided to walk. However, the Government have now decided that it is such a good firm that the contract for uploading the patient database has been handed to Atos. It is unbelievable. If we are talking about trust, trust implies confidence and judgment—the people we trust must have that—so they have appointed Atos.

I simply say that trust is being lost daily. What we do in the next six months is important. As the hon. Member for Mid Norfolk did, I shall make some suggestions. There must be an urgent and transparent exercise to deal with concerns over security. There must be a streamlined, clear and convenient way to allow people to opt out and there must be massive steps to minimise identifiable data, or data being easily identified to an individual.

It is said that those conditions should be independently scrutinised—that is on the hon. Gentleman’s wish list—by some sort of board. To tie that in with what I said before, I would prefer somebody who has been writing these articles in Computerworld to be on that board. All the things that have happened—I accept that I have taken some time to spell them out—have happened, and trust has been lost. If we are saying that we will get a group of people together and try to bring together the two sides, one way to do it, as we normally do in politics and political life at a lower level, is to have some of the people who are criticising the thing on the board. That would give the public the greatest assurance that this is not a bunch of hand-picked people.

This matter is very important. I am sorry that I have taken so long, and that I am the man who has agreed to work for four days this week and all my colleagues are elsewhere, but there we are.

Oral Answers to Questions

Hugh Bayley Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. That is a critical job that we must do this year. The purpose of the G8 summit was to wake up the world to the huge threat posed by dementia, as the world woke up to the threat of HIV/AIDS in the 1980s and the threat of cancer in the 1960s. We need to continue that work. Summits will be going on in America, Canada and Japan over the course of the next couple of years, and we need to keep up the momentum, because everyone agrees on the need to do such work.

[Hugh Bayley (York Central) (Lab)]

T5. On 1 January, the York Teaching Hospital NHS Foundation Trust ceased providing antenatal advice classes for pregnant women and refers them instead to online advice on its website. Is that an approach the Government support, and will they urgently invite the National Institute for Health and Clinical Excellence to review the change in policy and look at its effectiveness?

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I am sympathetic to the point that the hon. Gentleman raises, and I am happy to meet him to discuss it further so that we can see whether the matter needs to be addressed.

Rare Diseases

Hugh Bayley Excerpts

Tuesday 17th December 2013 Westminster Hall

[Mark Durkan]

I absolutely accept that point. It also came through in the earlier inquiry work on some of the concerns voiced by the all-party muscular dystrophy group. That goes back to the point that I made about funding.

The real test of whether a strategy is coherent and effective is what happens when it comes to funding. We can have many good statements of intent. There are 51 commitments, which are very strong and sound. It all sounds great, but does it translate into money being available for support and treatment or, as happens with approving new drugs, does the finance test get in the way of support and treatment reaching people? The cost-effectiveness criteria used either by the National Institute for Health and Care Excellence or by the Joint Committee on Vaccination and Immunisation raise questions. Particularly in relation to rare diseases, if the test is almost that a possible new treatment has to throw two sixes to start, in circumstances in which people do not even have any dice, it is a serious problem. Although the rare disease strategy is a good start, it is only that—a good start. It will need more work and more resources, and will need to be informed by further research.

[Hugh Bayley (in the Chair)]

We now come to the winding-up speeches. I remind both Front Benchers that we have just under half an hour left.

--- Later in debate ---

[Norman Lamb]

I will continue, because I am conscious of the time. The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) made a valuable contribution. I learned something about trigeminal neuralgia, from which I think I understood him to say that he suffers. He asked whether it would be possible to meet once the report that he referred to is complete, and I would be happy to agree to that, diary permitting. I am sure it will be possible to do so at some point. He made some important points about misdiagnosis, and about the importance of support groups and networks. The internet now provides incredible assistance to people with rare diseases, because they can link up not only with those in their neighbourhood but with people and clinicians globally who can guide them in the treatment of their condition. He also spoke about unnecessary referrals to hospitals and the mental health implications of some rare diseases, and I completely agree with him.

My hon. Friend the Member for Wealden (Charles Hendry) made powerful points about the extraordinary work of so many families, and he mentioned in particular the work of Charlie’s Challenge and Tildy’s Trust. Such families do the most remarkable work, and they are often hellbent on producing a really valuable legacy from their experiences. His point about the Department helping to co-ordinate the work of so many such groups was well made. He also referred to the fantastic work that is going on in Edinburgh university, and I applaud all those involved.

The hon. Member for Plymouth, Moor View (Alison Seabeck) made the point that there is extraordinary variability of service around the country. That is something that the strategy can absolutely address, and I believe we will get powerful results. She referred to her constituent, young James, who suffers from Duchenne muscular dystrophy, and she talked about the importance of transition to adulthood. I focus a lot on mental health, and that transition is often a complete disaster. We need to do far more to improve it.

The hon. Member for Foyle (Mark Durkan) made some important points about collaboration. He referred to the British-Irish Council, and although I have no idea whether his suggestion is possible, I am happy to look into it. He talked about the funding challenge. We are in very tough financial circumstances and often—the contributions of many hon. Members this afternoon have emphasised this—the question is how the money is used, because it is frequently not used effectively. A misdiagnosis usually results in an inappropriate referral to hospital, and a patient goes down completely the wrong track. An enormous amount of money is wasted, and the patient receives very poor care. It is essential to improve the way in which the system works to extract better value. We recently announced integration pioneers in 14 areas of the country. None has had extra money, but they demonstrate that, by co-ordinating their efforts more effectively, they are producing much better results for patients. The shadow Minister was absolutely right that the one thing we should all focus on is the patient—the individual citizen—and their experience of the system.

It is fitting that this debate should happen so soon after the launch of the UK strategy for rare diseases. This strategy is an overarching UK-wide framework, setting out a shared UK strategic vision for improving the lives of all those with rare diseases. It is owned by each country in the UK and commits them to more than 50 actions—I think it was identified as 51—that will deliver better outcomes for those with a rare disease. It means that for the first time we are in a position to make a tangible, co-ordinated difference to those suffering with a rare disease. That is something we can all be really positive about.

As we have heard, one in 17 people will experience a rare disease at some point in their life, with the majority of diagnoses made in childhood. That amounts to some 3 million people in the UK. A disease itself may be rare, but having a rare disease is, alas, not unusual, because there are so many of them—a point made by the hon. Member for Plymouth, Moor View. They are a major cause of illness and make considerable demands on the resources of the NHS and other care services. The strategy for rare diseases is based around the more effective and efficient use of services—a point I made earlier—with better links to research and innovation. As the NHS constitution states, no-one should be left behind because of their condition, be it rare, very rare or yet to be diagnosed. To achieve this, England, Scotland, Wales and Northern Ireland have agreed to deliver the 51 commitments that focus on five areas.

The first is empowering patients—perhaps the most significant of all—making sure that they are listened to, informed and consulted every step of the way. No one knows the condition better than the person suffering from it; too often, they are ignored in a rather paternalistic system. We will continue to work closely with patient groups and others to improve services for rare disease sufferers. We will improve access to knowledge and support networks at UK, European and international level, and we will help patients to participate in rare disease registries. We will look at how those might be developed in England to better capture the patient experience.

Secondly, we want to develop more effective methods for identifying and preventing rare diseases. Carrier testing, preconception and antenatal care, along with newborn screening, all play a part. Rare diseases are often genetic in nature, and so can affect more than one member of the family. This makes it important that testing of other family members, where appropriate, becomes more routine.

The third area is better diagnosis, which has been raised during the debate, and earlier intervention. Too many people still wait far too long to get an informed, correct diagnosis. There are several things we need to address. We need to ensure there is better awareness of rare diseases. That is important across all aspects of health care. Not everyone can be an expert, but ensuring that the possibility of a rare disease is considered when a diagnosis is proving difficult can help. We need to ensure that all doctors are alert to the possibility of a rare disease when they see patients, even if they are not able to diagnose specific diseases. This means including better training on rare diseases in university courses and in professional development at work.

The training and education of clinicians is critically important. Health professionals do not need detailed knowledge of every rare condition, but all medical specialties and multi-professional care teams should have a general awareness of rare diseases so that they can make rapid referrals to specialists in the appropriate field. Making genetic testing more mainstream, harnessing the potential of genomic technologies and focusing on what our DNA can tell us will also help us to reduce the time to diagnosis.

Perhaps the most important commitment is to develop clearly defined care pathways between primary and secondary care and regional and specialist centres. Health care professionals, especially GPs who are likely to be the first point of contact, need to know how to access the pathways for those at risk of rare disease.

Fourthly, we want to see better co-ordination of care. Building on the fantastic NHS genetic services that already exist—this country is well recognised internationally for that—we want to see the development of centres of excellence in rare diseases, providing one-stop-shop services to patients through co-ordinated consultation and treatment schedules. The centres should also be knowledge and skills hubs—concentrating the skills together—that support local delivery of services and facilitate clinical trials and other research projects.

The last area of the strategy, but by no means the least, is recognising the absolute importance of research, which several hon. Members have touched on today. The Government are committed to supporting research into rare diseases. Such research holds the key to improved personalised and targeted approaches to health care. These have the potential to improve the effectiveness and safety of treatments, the speed of diagnosis and patients’ quality of life.

In the UK, we are lucky to have some of the best academic and clinical research in the world. It was no coincidence that Earl Howe launched the strategy at Great Ormond Street hospital last month. The hospital itself hosts a National Institute for Health Research biomedical research centre that continues to lead on experimental medicine, including the discovery of diagnostics and new treatments for childhood diseases. The shadow Minister—if I can briefly divert him from his iPad; I am sure he is catching up on important stuff—made the point about how we ensure that we make the right decisions on research priorities. Ultimately, it comes down to the quality of the proposition that is put forward, but I will write to him and other hon. Members on the issues raised that I have not touched on.

We also want to see more collaboration between patients, health care professionals and researchers, and for that to become normal custom and practice. At that same event, Earl Howe also announced that the National Institute for Health Research is establishing a rare diseases translational research collaboration to translate research into actual practice. As part of the NIHR rare diseases translational research collaboration, researchers will share their considerable resources and world-leading expertise to increase research collaboration and improve treatment and care.

Some £20 million over four years is being invested by the NIHR to fund the NHS research infrastructure focused on deep phenotyping—the gathering of information on the physical characteristics of people with rare diseases. The TRC will build on our British heritage as a world leader in genomics. It will provide national co-ordination to bring those with significant relevant NIHR-funded infrastructure in the NHS together. That will speed up the development of new diagnostics and treatments. That is also why rare diseases is one of the three priority areas for the Government’s initiative to sequence 100,000 whole genomes over the next three to five years. We want to see innovative research and cutting-edge technology translated into real patient benefit.

The strategy for rare diseases will increase access and lead to a more patient-centred, co-ordinated approach to care and treatment, clearly focused on the needs of patients and families. Each country in the UK will develop its own implementation plans over the next few months. We will ask a reconstituted UK rare diseases stakeholder forum to maintain an overview of the implementation of the strategy. The original forum was established earlier this year and comprises policy officials from the four UK countries, service users, industry, regulators and service providers. The forum played an invaluable role in the development of the UK strategy and will now have an ongoing role in monitoring the strategy’s implementation and reporting back on progress.

In England, our key delivery partner is NHS England. The recommendations of the UK strategy for rare diseases that relate to NHS England’s responsibilities for specialised commissioning will form part of the scope of NHS England’s five-year strategy for specialised services—an £11.8 billion plan to co-ordinate specialist services.

I want to thank all hon. Members for their contributions to a very useful debate. On all the other points that I have not been able to deal with, I will write to hon. Members.

[Hugh Bayley (in the Chair)]

I very much look forward to seeing some of the Front Benchers when we scrutinise the Care Bill in the weeks to come.

NHS Funding (York and North Yorkshire)

Hugh Bayley Excerpts

Tuesday 18th June 2013 Westminster Hall

[Hugh Bayley (York Central) (Lab)]

Thank you very much, Mr Streeter. At the end of April, the hon. Member for York Outer (Julian Sturdy), who I see in his place, and I met the health overview and scrutiny committee of City of York council to discuss the perilous funding settlement received by Vale of York clinical commissioning group. The meeting was also attended by Patrick Crowley, the chief executive of York teaching hospital NHS foundation trust, who said:

“The NHS system in North Yorkshire and York is on the brink of a crisis”.

At that meeting, the hon. Member for York Outer and I agreed jointly to seek a debate to discuss that crisis in Parliament. In the light of that, I hope, Mr Streeter, that you will allow the hon. Member for York Outer to make his own contribution to the debate. I am also pleased to see that the hon. Member for Selby and Ainsty (Nigel Adams) is present for the debate.

The funding for Vale of York clinical commissioning group has suffered a triple whammy. First, it started from the lowest base in Yorkshire and the Humber, because its predecessor body, the North Yorkshire and York primary care trust, received less money than any other PCT in the region. Secondly, the PCTs’ base funding was not split evenly between the five new clinical commissioning groups in north Yorkshire and York, and Vale of York CCG, which covers the city of York, received the lowest share of the funding. Thirdly, that meagre amount was top-sliced, because the former PCT had overspent its budget in the previous year. I will say a little more about all three issues, after which I will suggest an immediate remedy to the problems and a longer-term solution to the funding crisis.

The baseline funding received by PCTs in Yorkshire and the Humber in 2012-13 varied considerably across the region. North Yorkshire and York PCT received £1,475 per patient; Leeds received £1,550 per patient; Sheffield received £1,700 per patient; Wakefield received £1,800 per patient; and Barnsley received £1,900 per patient. Why did the other PCT areas get more? It was because the NHS funding formula allocates a base amount of money for each member of the public, adds or subtracts an element to reflect the age or youth of each person, and adds additional elements in respect of social deprivation. Areas of Yorkshire and the Humber other than north Yorkshire and York are deemed to face greater deprivation and, therefore, greater unmet health needs, and as a consequence they receive more money per capita.

The funding worked out through that formula, which reflects deprivation, was about £1,300 million for north Yorkshire and York in 2012-13. That sum was reduced this year by some £430 million, largely as a result of top-slicing for services to be provided on a national basis by the NHS Commissioning Board, which left some £865 million to be divided between the five clinical commissioning groups. However, they were not treated equally. Vale of York CCG received £1,050 per patient, whereas Scarborough and Ryedale CCG received £1,234 per patient, which is almost £200—20%—more per patient. The odd thing is that the same NHS foundation trust provides services for patients in Scarborough and Malton, which is part of Ryedale, and in the city of York. For some of those patients, however, there is substantially higher funding, which is likely to exacerbate the problems of postcode rationing. Some patients from the better-funded part of the patch will receive access to a wider range of treatments than those from the city of York.

How is the split justified? We are told that the funding was split between the clinical commissioning groups in north Yorkshire and York on the basis of the use that patients from their areas made of NHS services in the previous year. It is well known that middle-class people in more prosperous areas make greater demands of the NHS than do poorer people in deprived areas, so the two parts of the funding calculation for the Vale of York clinical commissioning group are pulling in diametrically opposite directions. The funding formula that allocates money to north Yorkshire and York reflects disadvantage, so north Yorkshire and York gets less than Barnsley, but the funding for the CCGs in north Yorkshire is split based on the use that they made of services, so relatively deprived inner-city areas of York receive less. The problems in those areas are not as severe as those in Bradford or Sheffield, but they are still greater than the problems faced by Richmondshire or Hambleton. It really is unfair to provide a baseline pot of money based on a lower allocation for north Yorkshire and York because it is deemed to have lower deprivation, but to choose the most deprived part of north Yorkshire and York and cut the funding further because people in deprived areas do not use health services as much as people in more prosperous areas.

I understand that when the funding body was determining how to split funding between the CCGs in north Yorkshire and York—indeed, across the country—it decided to use a demand-led formula rather than a needs-based formula, but it looked at what the results of a needs-based formula would have been. I asked the Minister whether he would release that information, but it was not readily to hand. If at least he released the figures on the north Yorkshire and York split, it would help us to work through with clinicians and health service managers in our patch whether the current double whammy, as I call it, is appropriate.

[Julian Smith (Skipton and Ripon) (Con)]

When the group of North Yorkshire MPs met the NHS on several occasions this year, did the hon. Gentleman feel, as I did, as though it was less than transparent with us about how any of the calculations were made?

[Hugh Bayley]

All of us in north Yorkshire and York share concerns about the low level of funding for our patch. I share the hon. Gentleman’s concern about the lack of transparency, which is why it would be enormously helpful for the Minister to ask his funding advisory panel to carry out the calculation I have mentioned. That would illustrate whether there is a problem such as I have suggested, and it would help us to tease out an appropriate solution.

The third part of the triple whammy is that as a result of historical underfunding—under the previous Government as well as the current one—the North Yorkshire and York PCT had a deficit of some £20 million or £30 million year after year. As a consequence of the deficit in the final year of its operation, some £12 million was top-sliced from the baseline funding for the CCGs in our patch. I was afraid that that would happen, so on 4 July last year, I asked the former Secretary of State, the right hon. Member for South Cambridgeshire (Mr Lansley), whether he would guarantee that each CCG would start off with a clean balance sheet, and he replied that

“we, along with the NHS Commissioning Board, intend all the new clinical commissioning groups across England to start on 1 April 2013 with clean balance sheets and without legacy debt from primary care trusts.”—[Official Report, 4 July 2012; Vol. 547, c. 930.]

I do not think that anyone could argue that that was a slip of the tongue, because paragraph 3.2 of the Department of Health’s “Handover and Closedown Guidance” for 2012-13 states:

“CCGs will not inherit legacy debt.”

Furthermore, paragraph 4.5 of “The Operating Framework for the NHS in England 2012/13” states:

“CCGs will not be responsible for resolving PCT legacy debt”.

What should the Government do about this issue?

The first, and immediate, action should be to honour the commitment given to me in the House—similar commitments have been given to other hon. Members from north Yorkshire—and agree, as was requested by York’s director of public health in a letter at the end of April, that the Department of Health will “absorb and manage” the final north Yorkshire and York deficit, which is some £10 million to £12 million. I understand that that has happened in some areas, and has given those new commissioning groups a start without carrying debt that has arisen from management by predecessor bodies.

Secondly, I ask the Minister to assure us that in good time for next year’s funding allocation the contradiction between the needs-based formula that divides funding between the old PCT areas and the demand-based fix, which was used this year to divide the PCT patch budgets between the various commissioning groups, will be resolved.

--- Later in debate ---

[Dr Poulter]

I will of course continue to press NHS England and raise concerns, as we have with representatives from the area, about the funding challenges being faced in north Yorkshire. It is also important to be aware that, because of how the new system works, with a mandate that sets clear priorities, NHS England recognises the need for a review of the funding formula for not only north Yorkshire, but nationally.

I agree with the remarks of my hon. Friend the Member for York Outer (Julian Sturdy) and the hon. Member for York Central about ensuring that funding goes to areas of greatest health care need. NHS England will obviously want to take account of rurality, age, the needs of older people and the complexity of care when it reviews the funding formula.

[Hugh Bayley]

The Minister says that Barnsley gets more money than north Yorkshire because of its higher level of deprivation, which I acknowledge, but why has the new formula given York less money than leafy Richmondshire and Hambleton, when York has higher levels of teenage pregnancy, drug addiction and deaths from asbestos-related diseases among people who had a career in industry. We have higher levels of deprivation than other parts of north Yorkshire, and yet we get less money. That cannot be right.

[Dr Poulter]

The hon. Gentleman makes a good case on his constituents’ behalf, but he should recognise that the Vale of York CCG—it serves not only his constituency, but others in the surrounding area—has received £357,891,000 which is the highest allocation in the area. He is right that its allocation is relatively lower per head than, say, that of Scarborough and Ryedale CCG, but I have outlined the factors that inform the capitation formula for funding, including density of population, and the obvious advantages of delivering health care in an urban environment.

I would be very happy to talk through such issues with the hon. Gentleman and my hon. Friends who are here today, and I am sure that we can arrange a meeting to do so in more detail than this debate allows. I also point out that NHS England will fundamentally review the funding formula to take account of demographics, age and rurality, which I am sure we all welcome. I look forward to meeting hon. Members in due course for further discussions and to see how I can assist them with the matters that they have raised.

Question put and agreed to.

Oral Answers to Questions

Hugh Bayley Excerpts

Tuesday 11th June 2013 Commons Chamber

The Secretary of State was asked—

[Hugh Bayley (York Central) (Lab)]

1. What plans the Government have to change the NHS formula for funding clinical commissioning groups; and if he will make a statement.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Allocations to CCGs are the responsibility of NHS England. However, I have been advised that NHS England will rely on advice from the Advisory Committee on Resource Allocation (ACRA) for changes in the CCG formula.

[Hugh Bayley]

The failure of the Government to use the long-established funding formula for the NHS in dividing the budget between CCGs in north Yorkshire has left us with glaring anomalies, so that in York, the funding is £1,050 per head, but for Scarborough and Ryedale, which is served by the same NHS foundation trust, the funding is £1,234 per head. That is quite unsustainable and will lead to further postcode rationing. The same funding formula must be applied to all CCGs throughout the country. When will that happen?

[Mr Hunt]

I share the hon. Gentleman’s concerns about the way that NHS funding is allocated to different parts of the country. The allocation in my constituency is about the same as in his constituency, and I have long worried that things like age and rurality are not factored into the final amounts in the way that they need to be. However, in this case NHS England decided that if it was to follow precisely the ACRA recommendations, it would lead to higher growth for areas with better health outcomes and lower growth, or even cuts, for areas with less good outcomes, which it thought would be inconsistent with its responsibility to reduce health inequalities. That is why it is conducting a fundamental review, which it says it hopes will inform the next set of allocations for 2013-14.

Health and Social Care

Hugh Bayley Excerpts

Monday 13th May 2013 Commons Chamber

[Andy Burnham]

I do not think the right hon. Gentleman is listening. I said that if there were to be any increase, it should go into supporting social care. I now hear that Government Members are proposing emergency transfers from the NHS budget to social care because of the crisis that the Secretary of State has created.

[Hugh Bayley (York Central) (Lab)]

Surely the Secretary of State has forgotten that he received a letter in December from Andrew Dilnot, the chair of the UK Statistics Authority, which said that

“we…conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10…In light of this, I should be grateful if the Department of Health could clarify the statements made.”

[Andy Burnham]

I am very grateful to my hon. Friend. He has now embarrassed the Secretary of State who, just a moment ago from the Dispatch Box, claimed the opposite. Similarly, the Work and Pensions Secretary was pulled up last week for doing exactly the same thing. They think they can stand there and say whatever they like, and they think they can get away with it, but they cannot, because people have seen through them. They have cut the NHS; they have broken the central promise on which this Government came to office. Now they are saying that the pressure on A and E has nothing to do with social care funding or NHS funding, but is all to do with the GP contract in 2004. That is what they have been saying on the radio for the last three weeks.

Let the Government answer this. In 2009—five years after the GP contract came into force—98% of people were seen within four hours at A and E departments across England. What we have seen recently is that, week after week, major A and E units are missing their lowered target. That is the reality right now, and the Secretary of State had better start facing up to it.

--- Later in debate ---

[Hugh Bayley]

Will the hon. Lady give way?

[Pauline Latham]

I am running short of time; I am sorry but I must make progress.

I urge my right hon. and hon. Friends on the Front Benches to look again at this matter because the Government have set up the CDF to ensure that people get access to the life-saving cancer treatment they need. I have constituents who need access to a form of radiotherapy called “SIR-Spheres”, which is used where bowel cancer has spread to the liver. That treatment is not now available anywhere in the NHS—people can pay for it, of course—although it was previously available in most CDF areas, although not the east midlands. Will the Minister look again at the issue and meet me and my constituents’ hospital consultant, Dr Jamie Mills, to see whether we can make progress?

I recently started working with the British Heart Foundation on sudden adult death syndrome after I was contacted by two constituents whose son, Sam, died suddenly as a result of cardiac arrest. He was 19 years old. SADS claims the lives of at least 12 young people such as Sam every week, but many of those fatalities are completely preventable. I knew a young man in his 20s who died in the middle of his round in a dressage competition. Like Sam, he was a very fit young man. All such young deaths are devastating for everyone concerned, family and friends alike.

The seconds and minutes after someone has a cardiac arrest are vital to ensuring their survival. Cardiopulmonary resuscitation should be used immediately until a defibrillator can be located. If those activities are used together, the potential for survival is immediately increased. In fact, here in the UK, we currently have only a 20% survival rate—that figure is for all cardiac arrests, not just cardiac arrests among young people—but in Seattle, where there is mandatory CPR education in secondary schools, the survival rate has increased to 54%. I am sorry that my hon. Friend the Under-Secretary of State for Skills in the Department for Education is no longer in the Chamber—he was here a few minutes ago. My suggestion is that, if we roll out a schools programme, we could increase survival rates, as more children are trained to undertake CPR and to follow-up with defibrillators.

I am deeply concerned about those figures. I should like to highlight the pressing need for the availability of life-saving equipment and skills in our schools. In the first instance, will the Department of Health work with local authorities through health and wellbeing boards to urge them to consider providing funding to install automated external defibrillators in all schools and other local authority facilities? AEDs are very simple to use, even for the untrained layperson. Detailed instructions on how they are to be deployed are delivered through a set of simple audio and visual commands. The machines are programmed to administer an electrical shock only if the patient’s condition requires it. In order to prevent mortality as a result of SADS, it is essential that those easy-to-use and relatively inexpensive devices are made available in schools.

Further to the availability of AEDs, it is also extremely important that, through citizenship lessons, children of school age are aware of, and able to administer, life-saving treatment such as CPR. Such a scheme would cost local authorities very little, and ultimately has the potential to save many lives every year. Organisations such as St John Ambulance would be able to go to schools to train students and teachers so that they are able to undertake such treatment.

In addition, I should like to point out to hon. Members that the British Heart Foundation provides grants to schools for defibrillators. Many schools are not aware of that. Perhaps MPs on both sides of the House could make schools in our constituencies aware of the grant. I look forward to working with the Department of Health on the issues that I have raised about the cancer drugs fund and on defibrillators.

Regional Pay (NHS)

Hugh Bayley Excerpts

Wednesday 7th November 2012 Commons Chamber

[Mr Hunt]

Perhaps the right hon. Gentleman will explain why he voted for the Health and Social Care (Community Health and Standards) Act 2003, which gave foundation trusts the freedom to introduce their own terms and conditions. Until he explains that, which we are simply supporting, I am afraid that his position is extremely tenuous.

[Hugh Bayley (York Central) (Lab)]

The NHS budget is actually going down. It is certainly much more constrained than it was under the previous Government, so if the Secretary of State accelerates the regionalisation of pay, it will presumably fall in low-pay areas such as mine in Yorkshire and rise in the leafy suburbs of Surrey, which he represents. Will the health budget then be transferred from poorer areas in the north of England to the high-pay places in the south?

[Mr Hunt]

Let me remind the hon. Gentleman that he supported the 2003 Act, which gave foundation trusts the power to set their own terms and conditions. Let me also remind him that this Government have increased the NHS budget in real terms—something that the right hon. Member for Leigh said was “irresponsible”. Let me say clearly that we are not changing the allocation of resources to different parts of the country, but we are allowing the flexibilities that the Labour Government introduced for local NHS managers to make sure that they get the benefit. If the hon. Member for York Central (Hugh Bayley) listened to what I said about a million more people being treated in accident and emergency, one and a half million more diagnostic tests being carried out, and about half a million more out-patient appointments being dealt with, he would understand that all our constituents are benefiting from that. That is because we have the flexibilities that that Government introduced.

--- Later in debate ---

[Hugh Bayley (York Central) (Lab)]

It would be a good thing, when debating the future of the health service, to talk a little more about the work done by health service professionals. If a woman has breast cancer and consults the oncologist, and he is working out what the best chemotherapy would be, she would want him to be as well qualified and skilled whether he lived in Plymouth or in a part of the country where wage levels were higher. She would expect her doctor to be as well remunerated. Exactly the same would apply for a nurse planning a care and rehabilitation regime for an elderly stroke victim. A number of colleagues made the point that a nurse in Plymouth should get the same rate of pay as a nurse in the City of London. The reason why they should receive the same rate of pay is that we, as their patients, want the same level of care, the same level of service and the same likelihood of survival if we have an illness.

My remarks are based on my experience before I joined the House. We heard a number of Conservative Members trashing the trade unions. I spent seven years as a full-time trade union official for the National and Local Government Officers Association, now part of Unison, negotiating pay and conditions in the national pay bodies for nurses, midwives, ambulance officers, and administrative and clerical staff. I put the interests of the health service and patients very high on my agenda when I did that job. I spent a number of years as a health economist, working at the university of York, advising health authorities and trusts on how best to use their budgets. I spent time as a member of York health authority—they were called health authorities in those days—which would now be the equivalent of being a non-executive member of a trust board. Before the debate, I consulted senior NHS managers, finance directors, chief executives, a trust chair, and Professor Alan Maynard, a professor of health economics who was an adviser to the Health Committee, and my remarks reflect what they told me.

I can tell hon. Members from real experience that negotiating pay and conditions is a slow, painful and labour-intensive task. There is an opportunity cost. If health service managers spend time determining pay on a regional or local basis, that removes them from focusing on something else—driving up productivity, improving care outcomes or developing new prevention services, perhaps. There is a cost if more effort is put into regional pay negotiations, because less is done on something else. Regional pay would divert hundreds of managers from thousands of hours of managing the health service into doing something that they currently do not need to do. The Labour Government permitted a measure of local flexibility, but we specifically did not go for the introduction of regional pay.

[Dan Rogerson]

The other approach that, unfortunately, the consortium seems to have taken is putting aside money and employing consultants to come up with a model for it. That has the potential to be even worse than the approach the hon. Gentleman describes.

[Hugh Bayley]

I am grateful to the hon. Gentleman for enhancing my argument. As has been pointed out, the limited flexibility that was introduced by the Labour Government has been used by only one hospital to date, Southend, and in that case it was to raise, not reduce, pay.

Abandoning a national pay framework for the NHS is likely to be inflationary for NHS pay. Let us start with doctors. We know from experience that doctors are tough negotiators—[Interruption.] I can see the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) smiling. When GPs were negotiating with the previous Labour Government about the cost of the change in out-of-hours services, they—let us be blunt about it—did extremely well out of the agreement. Why did they do well? Because they have immeasurably high leverage. If they were to withhold their services, in whole or in part, from patients, the consequences would be dramatic.

If we had regional pay, the charge would be led by groups, such as doctors, in the highest-cost areas such as London, and they would be in a position to leverage large increases in pay. What would then happen? Doctors would inevitably be drawn away from areas of the country where they are paid 20% or 30% less. What would happen in an area such as mine, which would lose doctors to high-cost areas in London and the south-east of England? Of course, my area would have to raise pay to attract people back. There would be a general pressure, raising wage costs across the NHS, not just in the medical profession, but in other health professions too.

If the Department of Health loses control of pay in the NHS, which accounts for 70% or 75% of its budget, it would blow the Nicholson challenge straight out of the water. The Government have set the NHS the challenge of finding £20 billion of efficiency savings. If regional pay is introduced, they have no prospect whatever of achieving that because of the inflationary pressures of the change that they are making. Fragmentation and liberalisation of pay regimes only reduce pay where there is a surplus of labour—where the employer has the economic power and the leverage.

The health professions are highly regulated, however, and the professionals are extremely skilled workers who train for a long time, which makes it an inflexible labour market, and that gives health professionals immense bargaining power—a power that, as we know from experience, is used. If the Government really want a levelling down of pay in the NHS, they should train more doctors, nurses, physiotherapists and radiographers, so that there are 10% more than we need, which would have two advantages: first, the NHS could get rid of poor performers, and secondly, there would not be the same inflationary pressure on pay.

If we had regional pay variations, there would be an impact on quality of care in those regions that paid less, because the best clinicians would go to the best jobs paying higher salaries in high-cost areas. It would inevitably divert resources from poorer regions of the country to richer regions, which would fly in the face of the “No Stone Unturned” plan for growth produced for the Government by Lord Heseltine.

I want to respond briefly to the Secretary of State’s statement that under this Government spending on the NHS has increased in real terms. If he or other Members were to consult Her Majesty’s Treasury’s public expenditure statistical analyses of 2012, in table 1.8 they would find that expenditure on the NHS in 2009-10—the last year of the last Labour Government—at 2011-12 prices was £105.1 billion. In 2011-12—the first year of the coalition Government—it fell to £104.4 billion, and last year to £104.3 billion. That is a real-terms reduction in expenditure on the NHS. In comparison, under the Labour Government, we had on average a 6.2% increase each year. That shows why the NHS is in such a parlous financial position now.

Adult Social Care

Hugh Bayley Excerpts

Monday 16th July 2012 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

Let me begin by striking a note of agreement between Government and Opposition, before moving on to the areas where we disagree. I agree with the hon. Member for Leicester West (Liz Kendall) that our debates about our ageing society are too often couched in terms of burdens and impacts on public expenditure, when they should be a cause for celebration as we have more people living longer and living healthier for longer. That stands as a tribute to our national health service, our local authorities and many others besides.

I sat in the House for 13 years in opposition to a Labour Government, and it became very clear to me that, despite the wealth of the nation being much greater at that time than it is now, the Labour party was not willing to tackle the pressing need for serious systemic reform of social care. I shall talk in a moment about the Labour Government’s last-minute moves to address that agenda.

Social care is Bevan’s orphan. It was left over after the NHS was established in the 1940s, and it has suffered ever since. It has been hidden behind its favoured sibling, the national health service, out of sight until life takes a turn and tips people into crisis. Social care’s founding principles date back to the Poor Law; it was a poor relation to the NHS, ripe for reform, but neglected for decades.

Much of last week’s reporting about the Secretary of State’s statement in the House and the publication of the White Paper and draft Bill gave the impression that the only subject that was talked about was who pays for care—where the line is drawn between what an individual personally is responsible for in meeting their care costs and what costs the state would pick up. The Government do not dispute that that is an important issue, and we have made significant progress on that agenda, but it is not enough simply to redraw the boundary between personal responsibility and state support, because the system of social care in England is undoubtedly broken.

Given that there were 13 years of Labour inaction, the hon. Member for Leicester West must face up to some of the challenges in respect of social care. A White Paper finally emerged in the dying days of the last Labour Government; it was published on 30 March, just seven days before a general election was called. That is not good enough; it is too little too late. What did that White Paper say? It talked about national eligibility, but when? It was by 2015, so it was going to take Labour five years to introduce that change. On portability, it did not commit to ensuring that support would be provided immediately in the area to which the person was moving. In other words, there was still a risk of interruptions. In addition, that Labour White Paper said nothing about the rights of carers. The hon. Member for Leicester West was absolutely wrong when she told the House that Labour was responsible for introducing carers legislation. Back-Bench Members in this House, tirelessly arguing the case, were responsible—[Interruption.] Labour, Conservative and Liberal Democrat Members supported those many measures over a number of years, but none came from the Front-Bench and none came from the Labour Government.

[Hugh Bayley (York Central) (Lab)]

I would like to get back to the issue in hand and call a spade a spade. The only substantial asset that most families have to pass on to their children and grandchildren is the home they live in. If the Government want a new inheritance tax, would it not be fairer to levy it at the same percentage rate on rich and poor alike, and not simply target those people who have the misfortune to fall ill at the end of their life?

[Paul Burstow]

I will come in a moment to our response to the Dilnot commission recommendations, so I will deal with the hon. Gentleman’s point at the right time.

[Hugh Bayley]

Now would not be bad.

[Paul Burstow]

No, I am talking about the time at which in the sequence of my speech I will make the point about the Dilnot commission recommendations.

I wish to make one other observation on the national care service White Paper that the Labour Government published seven days before the last general election was called. Our White Paper addresses the end-of-life care issues, but Labour’s failed to address them.

--- Later in debate ---

[Paul Burstow]

The hon. Gentleman identifies one of the issues associated with the design of the introduction of a cap. It is worth pointing out that the interaction between the cap and the means-test threshold means that every family would have a different level for which they would be liable to meet their care costs. The issues relating to design are real, as are those about how to meter the system from the point someone enters it, and they require detailed work as part of the design of an effective implementation alongside the costings of it.

[Hugh Bayley]

The hon. Member for Cities of London and Westminster (Mark Field) is right to identify that there is a link between inheritance and the high cost of end-of-life care for people. May I put it to the Minister that if there is a cap of £100,000, the entire inheritance could be wiped out for a family who have a modest home in the north of England, whereas somebody living in a home worth 10 times as much in southern England would still maintain a large proportion to pass on?

[Paul Burstow]

That is why we have to explain this clearly. By lifting the means-test threshold to £100,000, the interaction between the absolute cap and the means test means that the amount the individual will ultimately pay as their lifetime contribution towards their care costs is related to their wealth. I urge the hon. Gentleman again to look at both the tables and the graphs in the progress report, as he will see exactly how it protects the assets of a family, even in the scenario he has described.

It is also important to understand that redrawing the boundary between what the individual pays and what the state pays does not—things all too often were conflated in this way last week—add any new spending power to the system. That leads me to the question of getting funding into the system. Before the 2010 spending review, the Dilnot commission urged the Government to protect baseline funding for social care, and we did just that. In October 2010, we confirmed an extra £7.2 billion of support for adult social care, which, together with a programme of efficiency, was sufficient to protect access to support. That included an unprecedented £4.2 billion of NHS resources to support social care, to promote integration and innovation, and to support the expansion of reablement services. The Labour party wants to paint a picture of doom and gloom up and down England on these services, tarring every council with the same brush of being crude cutters of services, when that is not the case.