NHS Funding (York and North Yorkshire)

Debate between Hugh Bayley and Julian Smith

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.

World Heritage Status (York)

Debate between Hugh Bayley and Julian Smith

Tuesday 11th January 2011 Westminster Hall

[Hugh Bayley (York Central) (Lab)]

Every MP is proud of his or her constituency, and I, like the hon. Member for York Outer (Julian Sturdy), am specially privileged to represent the city of York. As the new film “The King’s Speech” puts King George VI very much in the public eye, let me remind Members that on a visit to the city, he said that the history of York was also a history of England. When I tell people that York is applying for UNESCO world heritage status, they often express surprise that York has not already achieved such a status. To see why, one just has to look at York’s city walls, York minster, which is the largest gothic cathedral in northern Europe and contains some 60% of our country’s mediaeval stained glass, and the Roman Multangular tower that still stands 10 metres above the ground.

When I speak to people from abroad and tell them that I come from York, everyone, without exception, has heard of the city, and many have visited it in the way in which they have visited Florence, Athens or Jerusalem. York has an enormous international reputation, but I am afraid that that has made us complacent. Until a few years ago, we did not seriously think of applying to UNESCO for designation as a world heritage site, because we knew that we lived in one of the most precious gems in the western world and thought that nothing more needed to be said or done. I pay enormous tribute to Janet Hopton, who has led the campaign locally to seek world heritage designation for the city of York. I stress that it is a citizens’ campaign; it is a campaign that has come not from politicians but from the people of York. None the less, the campaign has all-party support, and we will hear in this debate from the city’s two Members of Parliament.

Over the past three years, I have worked with the Department for Culture, Media and Sport and the Minister’s predecessors, my right hon. Friend the Member for Barking (Margaret Hodge) and Barbara Follett, the former Member for Stevenage, to discuss how we in the UK can possibly get the door open again so that UNESCO will consider bids from cities such as York. I should like to thank the Department and the Minister’s officials for their support over that period.

If York had applied for this status a decade ago, I am pretty certain that our application would have been accepted. Now, however, UNESCO understandably and rightly wants to see a balance in its world heritage list. There are already many great walled cathedral cities in this country and other countries on the list, and UNESCO has new ambitions. It may not accept an application for the built heritage of a city such as York. That has made us think more clearly about what is absolutely unique and irreplaceable about York, and we came to the conclusion that it is not what is immediately apparent—the Roman, the Viking or mediaeval built heritage. It is not what is above ground, but what is still hidden underground.

York has been continuously inhabited as a city for 2,000 years. It is built at the confluence of two rivers, the Ouse and the Foss, which makes the ground waterlogged. Such unique anoxic conditions—conditions where the water prevents oxygen getting to objects buried in the ground—preserve centuries-old objects, which, in any other place, would have disintegrated. The water preserves organic material, such as wood, leather and textiles, that otherwise would simply rot away.

We have a Viking shoe and Viking cloth from the Jorvik dig. Wooden buildings from Jorvik can now be seen plank by plank, beam by beam, in the same way in which they would have been seen 1,000 years ago had they not been buried. Even the leftovers from meals are available for analysis. They tell us what people ate 1,000 years ago. There is nowhere else in western Europe with similar anoxic conditions. We know a lot about York from the excavations that have taken place, but only 2% of the ancient city has been excavated; 98% is fully preserved. That is what needs UNESCO’s designation and protection.

If successful, York’s bid would provide the only UNESCO world heritage site inscribed solely on the basis of its underground deposits. York’s unique subterranean heritage is complemented by world-class archaeology in teaching, research, conservation and entrepreneurship. The university of York’s department of archaeology is a centre of excellence in computing for archaeology and bio-archaeology through its environmental archaeology unit. The Council for British Archaeology, which promotes public engagement with archaeology, is a national body but is based in the city of York. The York Archaeological Trust is respected as one of the most successful archaeological trusts. It dug Coppergate 30 years ago and not only produced an incredible record of what life was like in Viking Jorvik but turned archaeology into a commercial success.

Some 17 million visitors have visited the Jorvik Viking centre since it opened in 1984, including the former Prime Minister, Tony Blair. I encourage the present Prime Minister and his family to come and join the many who have visited the Jorvik Viking centre, because I know that he visits north Yorkshire from time to time. The Archaeological Trust also runs the dig centre, which provides hands-on opportunities for young people to experience archaeology. There are also many other bodies based in York, such as the York Glaziers Trust, English Heritage, the Civic Trust, the Georgian Society, the Mediaeval Guilds, the Archaeological Data Service and others. Between them, they create a culture of support for scientific study and conservation of this wonderful and great city, which the hon. Member for York Outer and I have the great privilege to represent.

This bid looks to York’s future as well as its past. We receive 7 million visitors a year, who spend almost half a billion pounds in York, which sustains 20,000 people in employment. We have a visitor economy; people have come to the great cathedral city of the north of England for centuries. The only thing that we really miss in York is a good saint, with relics in the minster. World heritage status would protect and enhance the city’s global reputation.

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

Just on the economic benefit that the hon. Gentleman describes, Skipton and Ripon has one of the other Yorkshire world heritage sites of Studley Royal and Fountains Abbey, and one cannot underestimate the huge benefits that such a status gives to the local economy. I pay tribute to my hon. Friend for his campaign and give it all my support. For Skipton and Ripon, it makes a huge difference and it would also make a huge difference to York.

[Hugh Bayley]

That is a very valuable, very kind and very important testimony, because there are some people who believe that world heritage status would act as an economic deadweight on the city and it is my very strongly held view—one shared by all the parties on the city council—that nothing could be further from the truth. Inappropriate development of buildings in York cannot, should not and will not take place whether or not the city gains world heritage status, because York has a duty to respond as if it had the status whether it wins it or not. Nevertheless, the increased international recognition and support that York could receive to preserve the heritage of the city as a result of designation would further benefit the visitor economy.

I should perhaps say how pleased I am to see other Members from Yorkshire here for this debate—the hon. Member for Selby and Ainsty (Nigel Adams) and the hon. Member for Colne Valley (Jason McCartney)—as well as my fellow representative of the city of York, the hon. Member for York Outer, all supporting the argument that I am making to the Minister.

I have a few questions to put to the Minister. I would like him to clarify for us the timetable for the decisions by the Department for Culture, Media and Sport on the tentative list of bids for world heritage status. I ask him personally to read York’s bid; I know that there are 38 bids, but I would like him to give a commitment to us during this debate that he will read York’s bid. I want to tell him that he is welcome to visit York, to see what is being proposed and to discuss with some of the archaeology and heritage bodies in the city why the bid is so important. If he is not able to visit York but would like further briefing, we can arrange for people from the city to come and visit him down here in Westminster. I also want to ask him how many of the 38 applications he believes will end up on the tentative list and, finally, how many of those he would expect to receive approval from UNESCO and when.

Those are my questions to the Minister. I will sit down now, to leave a little time for the other Member for the city of York, the hon. Member for York Outer, to make his own contribution to the debate.