Accident and Emergency Services

Debate between Iain Wright and Simon Burns

Tuesday 14th September 2010 Westminster Hall

[Mr Burns]

Sorry, the shadow Minister. I was trying to make the hon. Lady relive old glory days.

[Mr Iain Wright]

Happy days.

[Mr Burns]

Obviously they were not happy for the country, or the hon. Lady would not be a shadow Minister now. But there we are; that is life. I pay tribute to the many members of NHS staff in the constituency of the hon. Member for Southport for all the hard work that they do to provide dedicated, committed health care to his constituents and those of other hon. Members in the neighbourhood who are served by the facilities there.

This Government were elected on a platform of reform of the national health service. Our White Paper, to which the shadow Minister alluded, sets out our plans. More than any other Government in the history of the NHS, we will devolve real power to patients, GP commissioners and all clinicians working on the front line. As the NHS becomes increasingly locally led, it will become locally accountable to local authorities and health watch groups. As the White Paper unfolds and reforms are implemented, subject to current consultations, I hope that that commitment will give some reassurance to all those hon. Members who mentioned democratic accountability. Local authorities and health and well-being committees will have a significant role, in terms of democratic accountability, in a way that primary care trusts and strategic health authorities did not.

Hospital Services (North-East)

Debate between Iain Wright and Simon Burns

Tuesday 27th July 2010 Westminster Hall

[Mr Iain Wright (Hartlepool) (Lab)]

It is a pleasure to speak under your chairmanship, Mr Sheridan. The debate is about hospital services in the north-east, but I shall focus on services in North Tees and Hartlepool, so I welcome the fact that I can see here my hon. Friends the Members for Stockton North (Alex Cunningham), for Easington (Grahame M. Morris) and for Sedgefield (Phil Wilson), as well as the hon. Member for Stockton South (James Wharton). I am also pleased to see a good north-eastern Member in the form of my hon. Friend the Member for Wansbeck (Ian Lavery). As I said, I shall focus on North Tees and Hartlepool, but I think that the hon. Member for Hexham (Guy Opperman) will wish to catch your eye, Mr Sheridan, and widen the debate so that it has a more regional perspective. I thank him for writing me a note, asking to participate in the debate.

I welcome the opportunity to discuss hospital services in North Tees and Hartlepool again. We had an important but too short debate on 5 July, initiated by my hon. Friend the Member for Stockton North, in which many hon. Members hoped to contribute so that they could express their concern about, and seek clarification on, the Conservative-Liberal Government’s decision to cancel the £464-million new hospital that was to serve the populations of Hartlepool, Stockton, Easington and Sedgefield. I am indebted to Mr Speaker, who, after discussing the matter with me, granted this longer debate so that we could discuss more thoroughly the vital issue of health care and hospital services in my area. We also had a meeting with the Minister in the week following that debate.

The decision by the new Government—one of their first decisions on coming to office—to withdraw the £500-million investment from our area throws the vital issue of health care and hospital services back into complete confusion and mayhem. My constituents and those of my hon. Friend the Member for Stockton North, as well as those of my hon. Friends the Members for Sedgefield and for Easington, are worth much more than that and deserve much better.

It is especially important that there should be excellent health care in Hartlepool and the surrounding areas because the people whom I represent experience some of the worst health inequalities in the country. Much of that is due to our legacy as a former heavy manufacturing town, with industrial diseases and injuries. Much of it is due to the deindustrialisation of the 1980s and ’90s, and the failures of Government at that time to put in place an alternative economic model. Economic inactivity and health inequality go hand in hand, and we have in the past 30 years suffered from high levels of deprivation. Much of the health inequality has to do with poor and inadequate investment in primary health care in Hartlepool in the last half-century. For example, we have had a much lower ratio of GPs per head of population than we should have had for much of the time that we have had an NHS. As a result, we have had to rely on hospitals, whereas other areas may have had suitably high levels of GPs and primary health facilities.

Frankly, much of the inequality has to do with people’s lifestyles. One third of the population of Hartlepool smoke, as opposed to 24% across England. Some wards in Hartlepool have smoking rates of 40% to 50%. The rate for smoking in pregnancy is way above the national average. The proportion of women who breastfeed their baby in Hartlepool is half what it is across the country. Hartlepool is above the national average for the proportion of people who binge-drink, although I would like to point out that it is below the average for the Teesside area as a whole. Rates of early death from heart disease, strokes and cancer are significantly worse in Hartlepool than the national average, as is life expectancy. Although the gap in life expectancy between Hartlepool and the rest of the country has narrowed in the past decade, it remains the case that a man in Stranton ward has a life expectancy some 11 years shorter than that of a similar man in a more affluent area.

All that history—the lifestyles and the poor health outcomes—means that it is vital that we have the best possible health service for my constituents. Although progress has been made, it will take more sustained help and support, and reconfiguration of services, to narrow the gap still further. We have seen more investment in Hartlepool health in the past 10 years—actually, we have seen more investment in primary health facilities in the past five years than in the previous half-century—but the people of Hartlepool still feel battered and bruised when it comes to the future of hospital services.

Since the 1990s, there has been huge uncertainty about what shape the health services will take, and where they will be located. There has been review after review after review—the Tees services review, the Darzi review, the report from the independent reconfiguration panel—and now there is the decision to scrap the hospital at Wynyard. In that time, other areas have seen a reconfiguration of hospital services; in our neighbouring area south of the Tees, one of the best hospitals in Europe—the James Cook University hospital—has been built. Those of us north of the Tees deserve something similar.

While the uncertainty has continued for my area, the hard-working staff in our local NHS have not been provided with the clear vision and leadership needed. That has compromised their ability to provide world-class health care for our area. The uncertainty has led to a loss of morale and subsequent difficulties in recruitment and retention. The trade union Unison is to be commended in my area for proudly standing up for the people who work in hospitals, but the Government’s decision, together with other reforms that they propose, is placing strain on local services and threatening jobs. We need certainty and continuing investment, and the Government, in one of their first acts in office, have provided neither.

It is fair to say that many people in my area might consider the Government’s decision to scrap the proposed new hospital to be appropriate—indeed, welcome—and might think that with a hospital not being built in Wynyard, the University hospital of Hartlepool will stay open, and that services will migrate back to it. It surely defies common sense, as I have been told by some constituents, that a town such as Hartlepool, with a population of 90,000, cannot have a fully functioning district general hospital, with all the modern services that hospitals should provide. It is argued that the decision to scrap the proposed new hospital at Wynyard presents an opportunity to provide that, and will mean that the University hospital of Hartlepool will have a secure future.

That is an understandable stance, based on affection for the great service that Hartlepool hospital has provided down the years. The big events of life have occurred in the hospital for many thousands of Hartlepudlians, including me. I am thinking of the births of my four children, the death of my nana and the saving of my son Benjamin’s life twice—first when he contracted meningitis at the age of eight, and then at the age of 12, when he suffered a stroke. The dedication of people working in that hospital is second to none, and my family are very much testimony to that.

However, I fear that we will not see the return of hospital services to Hartlepool, and that we will have the worst of all possible worlds—hospital services will move away from Hartlepool and become more inaccessible to the people whom I serve, and we will not have a world-class facility in the borough of Hartlepool to replace them.

I fully accept and embrace the changes in health services. I welcome the technological advances that mean that whereas previously certain medical procedures required extensive stays in district general hospitals, those procedures can now be done safely and more cheaply in a local setting. Just a few years ago, high-quality internet use, for example, could be provided only by bulky and costly desktop computers; now, people can have internet access in the palm of their hand. In the same way, such advances are pushing more and more medical and surgical procedures into the community, into GPs’ surgeries and even into people’s homes. I welcome that.

We are certainly seeing that trend in Hartlepool. The Momentum programme is reconfiguring more and more services that were once the preserve of the hospital, putting them into the local clinic, closer to people. I met a man in Hartlepool recently who had had his toes amputated. Just a few years ago, that would have required an operation in a hospital and a lengthy stay there for recovery and recuperation. The man I met had had the procedure carried out in the operating theatre of his GP clinic in the Headland surgery, and he was home in a matter of hours. We shall see much more of that.

The newly opened One Life Hartlepool centre, built as part of the Momentum programme, is equipped to carry out minor skeletal surgery and will do orthodontic work that was previously the preserve of hospitals. GP surgeries increasingly take blood samples on-site rather than requiring the patient to attend hospital. Again, that is welcome.

However, we also have to admit that increases in medical specialisation, coupled with a wider and more miraculous range of things that can now be achieved through science and surgery, mean that many surgical procedures are now reserved for doctors and nurses with very specialised skills, as opposed to those in general medicine and surgery.

In preparing for this debate, I have been in contact with the Royal College of Surgeons of England, and I am grateful for its help. As part of its best clinical practice, for acute general hospitals that provide the full range of facilities, specialist staff and expertise for elective and emergency medical and surgical care, the college recommends a preferred catchment population size of between 450,000 and 500,000 people. However, the college estimates that hospitals of that size account for fewer than 10% of acute hospitals in England, and states that there is unlikely to be a significant shift to that size of hospital in the short to medium term. As it is, the majority of acute hospitals have, and are likely to continue to have, catchment populations of about 300,000. That is significantly more than the population of my constituency.

It is essential that MPs and all representatives listen to the professional advice of eminent surgeons. I do not intend to play fast and loose with patient safety and clinical excellence. As a politician, I realise that I do not know better than doctors, and I want the best possible health care for my constituents. I will fight to the last to achieve the best possible services for Hartlepool. They have to be safe and medically advisable, but if something is seen to be clinically essential by surgeons, it is right that my hon. Friends and I should listen. It is also right that Ministers should listen to eminent surgical and clinical advice, and I suggest that the cancellation of the proposed new hospital means that they did not. I hope that the Minister will do so today.

I believe that Lord Darzi’s proposals of 2005, under which Hartlepool hospital was to become a centre of excellence for women’s and children’s services, and the University hospital of North Tees was to become a centre of excellence for emergency surgery, were workable and feasible. Alas, it was not to be, as other parts of Teesside felt that they could not live with that. Although I thought that the subsequent independent reconfiguration panel review was unnecessary, I respect its decision, the quality of its evidence and its professionalism. I cannot argue with the overpowering weight of clinical advice on the matter.

In the IRP report, paragraph 4.8.5, entitled “Clinical views—the need for change”, stated:

“There was a common view across all staff that no change is not an option. Staff are keen to work with the Trust management and to embrace clinically-driven change”—

“clinically-driven change” is a hugely important phrase—

"that secures the best outcome for patients, staff and the Trust…There was widespread support for a new modern hospital, north of the Tees, concentrating on providing high quality hospital services that cannot be more appropriately provided in local communities”.

The IRP also stated:

“This is not simply a matter of recruiting additional staff. Specialist skills can only be acquired and maintained with sufficient ‘throughput’ of cases. Since safety standards can only be expected to rise in the future, the current model of service provision is unsustainable.”

In the concluding remarks in the report, the chair of the IRP—a GP and the chair of an acute NHS trust in Nottingham—stated in his personal recollections that:

“The clinicians were virtually unanimous in their desire to work on one site. This was not based on their personal convenience but on clinical evidence and a belief that a real and sustainable improvement in patient care would take place.”

I want the best possible services for Hartlepool. The ideal situation if I lived in utopia would be a hospital in the very centre of Hartlepool that provided the widest possible range of specialisms. In the real world, however, I realise that the desire to see a hospital serving the people of Hartlepool, Stockton, Easington and Sedgefield was driven by clinicians, based on clinical evidence and fuelled by a belief that patient outcomes would improve and health inequalities diminish as a result.

To be fair, I think that the present Government recognise that, too. In a recent answer to my written parliamentary question on whether he would implement the recommendations of the Darzi review, the Minister replied:

“The recommendations of the Darzi review of acute health services north of the River Tees were superseded by the advice provided by the Independent Reconfiguration Panel to the then Secretary of State for Health in December 2006. This advice formed the basis of the ‘Momentum: Pathways to Healthcare programme’ which was developed by the local national health service to provide a new health care system for the people of Stockton, Hartlepool, Easington and Sedgefield.”—[Official Report, 28 June 2010; Vol. 512, c. 407W.]

From that response, it seems that the Minister accepts that clinical pressures were driving and pushing this matter.

In that context, will the Minister confirm that the proposed new hospital entirely meets the criteria set out in a letter of 20 May from the NHS chief executive to Monitor—criteria that are about ensuring that all service changes are led by clinicians and patients, not driven from the top down? Taking that point further, will the Minister explain how the Secretary of State reconciles his policy of clinical-led decisions with the pledge made during the general election campaign that Hartlepool hospital would not close if a Conservative Government were elected and a Tory MP returned for the seat of Hartlepool? What clinical evidence was there to back that pledge? Is that not an example of top-down meddling by politicians, regardless of clinical evidence? Is it now Government policy for the configuration of health services to be contingent on voting behaviour, rather than clinical decisions?

Will the Minister provide further clarity about his written answer to me, to which I referred a moment ago, on whether Darzi should be implemented? If he believes that Hartlepool hospital should remain open, will he provide additional support and resources to ensure that it can remain open, and that services will return to it? However, this is not just about money; it is about the way in which services are provided and how they are linked.

Since the Adjournment debate of 5 July, and our subsequent meeting with the Minister, the NHS White Paper has been published. It rightly pledges to put patients at the heart of services and decisions regarding services. I welcome that. The phrase used in the White Paper is

“nothing about me without me”.

The White Paper also asks for an enhanced local voice; again, that is welcome. However, I would be interested to hear the Minister’s view on what should happen if there is a stark difference between what the professionals want and what the public want—if surgeons and clinical teams say that specialism requires a concentration of services on a central site, but local communities say, as they often do, that they like the status quo and that change is unwelcome? How does the Minister envisage such tension being resolved, given that such views are often polar opposites?

The Minister may say that the independent NHS board will be important when it comes to resolving tensions or contradictions, and that its decisions will be based on clinical views and free from political interference. That would be welcome, but does that mean that the NHS commissioning board will have responsibility for resource allocation? The White Paper certainly suggests so, saying that the board will

“allocate and account for NHS resources.”

In that context, I think that “resources” means revenue resources, but does it also mean capital resources? What would happen if the NHS commissioning board recommended that, for hospital services north of the Tees, it was clinically essential that the recommendations of the independent reconfiguration panel were implemented? Would the board’s decisions overrule ministerial priorities?

The Minister may respond along the lines that the independent NHS board will take decisions out of the hands of politicians, but the White Paper contradicts that. It states on page 33:

“The Secretary of State will have a statutory role as arbiter of last resort in disputes that arise between NHS commissioners and local authorities, for example in relation to major service changes.”

In other words, the reconfiguration of hospital services, which can cause bitterness and fear in many communities, as it has in mine, can still be decided by the Secretary of State. That does not take politics out of changes to hospital services at all.

I ask the Minister to address a number of other points. Does he accept that the manner in which the project was assessed within Whitehall—in both the Department of Health and the Treasury—under the Labour Government was entirely in accordance with appropriate procedures? Does he accept that the project was appraised by officials in an entirely appropriate and rigorous manner, and that that was not done a couple of weeks before the general election, but had been planned and prepared for several years? Hartlepool borough council has written to the Secretary of State on the matter. The letter was signed by the chairman of the council and the leaders of the Labour, Conservative and Liberal Democrat groups; they have yet to receive a response, so I would be grateful if the Minister could expand on what he said in the earlier debate.

Will the Minister publish the revised criteria and assessment considerations on which the project failed, so that we can see what is to be done to address the matter? Why are Hartlepool and North Tees rejected, when Liverpool and Epsom are not?

[The Minister of State, Department of Health (Mr Simon Burns)]

I might be able to help the hon. Gentleman on that point, so that he need not get confused. As he is a diligent Member, I need only remind him that in our debate on 5 July—in column 150 in Hansard—I went into great detail in answering that question. I am afraid that the situation has not changed since then. That was the accurate answer then, and it is the accurate answer today.

[Mr Wright]

I thank the Minister for that clarification. Some of my hon. Friends might probe him a bit further on that point, because we are unclear about a number of aspects. Let me return to the point about the appropriate and rigorous procedure that took place in Whitehall. My recollection might be incorrect, so the Minister may have to provide further clarification. Will he confirm whether a letter of direction, which would be needed if the permanent secretary was unhappy with the decision taken by the Secretary of State, was needed for the proposed new hospital? The decision has left Hartlepool and the surrounding communities high and dry. There will be no new world-class hospital, the plans for which were based on clinical decisions, and no money to upgrade existing facilities. I fear that we will soon have one hospital serving the people of my constituency, and that hospital will be in North Tees. That is completely unsuitable for the task, and for the people of Hartlepool, who will find it appallingly hard to travel to.

We have no clear direction from the Government on the future of hospital services; there is only a vague sense of having been told, “You are on your own; you can do what you like.” That is part of a worrying pattern emerging in the north-east. First, there was the future jobs fund, then the working neighbourhoods fund, then the decision on the hospital, and then the scrapping of Building Schools for the Future. The people of Hartlepool and the surrounding areas are worth more than that and deserve better. I hope that the Minister will acknowledge that this afternoon and clarify how we will provide help, support and additional resources to improve hospital services in North Tees and Hartlepool.

--- Later in debate ---

[Mr Burns]

I admire the hon. Gentleman for his persistence. If he could have a little patience, I shall talk about the points made by my hon. Friend the Member for Hexham, and will then come on to the hospital that has so dominated the debate.

My hon. Friend mentioned Northumbria Healthcare NHS Foundation Trust and its proposal to build a £75-million emergency care hospital in Cramlington. I am advised that planning permission is currently being sought for the proposed site and that further development work is under way. I hope that that goes some way to answering the point that he raised. I will make sure that I write to him during the next week or so on the other points that he mentioned to explain all the outstanding issues.

I shall now turn to the review of the hospital in North Tees and Hartlepool. The hon. Member for Hartlepool specifically raised the Government’s decision to cancel North Tees and Hartlepool NHS Foundation Trust’s proposal for a new hospital building. As I stated in the House in our last debate on this matter on 5 July, the original proposal for a publicly funded capital scheme received Treasury approval in March this year, in the run-up to the general election. In view of the shocking state of the public finances and the desperate need to reduce the £155 billion deficit, which I need not remind Labour Members was left to us by their Government, the Treasury and other Departments reviewed every significant spending decision made under the previous Government between 1 January 2010 and the general election on 6 May.

[Mr Iain Wright]

I appreciate the Minister’s explanation and analysis, but if the Conservative-Liberal coalition Government are concerned about the state of the public finances and want to help drive down the debt quicker, why was there not a moratorium on all capital spend in the NHS, similar to that which the Secretary of State for Education put in place with regard to Building Schools for the Future?

[Mr Burns]

Because, as I will again explain—this is similar to what I said on 5 July—there were a range of criteria determined and, as the hon. Gentleman is aware, we took the decision on the hospital on the grounds of affordability and the foundation trust status of the hospital. If he will bear with me, I will explain that again, so that even if he does not accept the decision, he will, I hope, come to understand the reasoning behind it.

On 17 June, the Chief Secretary to the Treasury, my right hon. Friend the Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander), announced to the House the decisions made following the Government’s review of spending commitments. The review cancelled 12 projects, including the proposed new hospital at North Tees and Hartlepool.

The aim of granting foundation trust status is to give bodies, such as the trust in the area represented by the hon. Member for Hartlepool, greater financial independence. As well as being able to keep any internally generated resources, foundation trusts also have greater freedom to borrow from either the public or the private sector. As the proposals required an allocation of public dividend capital from the Department of Health of more than £400 million, they were not consistent with that financial independence. Treasury and Department of Health Ministers, including me, decided that, overall, those factors—affordability within the changed economic climate and the hospital’s foundation trust status—weighed against the £458-million scheme for North Tees and Hartlepool more than they did against the other three schemes at Liverpool, Epsom and St Helier, and the Royal National Orthopaedic hospital. For those reasons, the Government withdrew support for the scheme.

Following our previous debate, I was pleased to meet, on 8 July, Paul Garvin—the chair and non-executive director of North Tees and Hartlepool NHS Foundation Trust—together with the hon. Member for Hartlepool and many of his hon. Friends now present. At that meeting, we discussed the possibility of the trust putting forward a new proposal under the private finance initiative. As I have said repeatedly, I cannot in any way give any guarantees that such a scheme would, or would not, be approved. Like any proposal, it would have to be considered on its merits and in the light of the economic climate at the time it was put forward for consideration and possible approval.

However, the advice I would offer the foundation trust is the same advice I would offer any organisation putting forward such a proposal. Any scheme must reflect the changed realities of the national health service, as set out in the White Paper. It would clearly have to demonstrate that it passed the four tests for reconfigurations set out by my right hon. Friend the Secretary of State. That is, it has to have the support of GP commissioners; arrangements for public and patient engagement, including with local authorities, must be strengthened; there must be clear clinical evidence underpinning any proposal; and it must develop and support patient choice.

The economic and policy circumstances have changed since the original proposals were put forward. It would be advisable for the foundation trust to make sure that any revised proposals reflect those changes, and can demonstrate that they have the full support of GPs, the public and the local authority. Any new proposal must be realistic, affordable and provide value for money.

--- Later in debate ---

[Mr Burns]

I will now answer some of the Opposition Members’ questions. The hon. Member for Hartlepool asked whether there was an optimal population size for a hospital. I have consulted my officials, who tell me that they are unaware of whether there is an official optimal population size for hospitals, so I will look into the matter and write to him with a satisfactory answer as soon as possible, giving him any information we have.

I have already explained, including on 5 and 8 July, the decision that governed the withdrawal of approval for the hospital. On the hon. Gentleman’s question about the future of Hartlepool hospital, there are currently no plans to close it, and that will remain the case unless the strategic health authority and the PCT propose closure. There are no such proposals at present, as far as I am aware.

[Mr Iain Wright]

I thank the Minister for that clarity. Given the proposals to abolish SHAs and PCTs, what will happen after that?

North Tees and Hartlepool NHS Foundation Trust

Debate between Iain Wright and Simon Burns

Monday 5th July 2010 Commons Chamber

[The Minister of State, Department of Health (Mr Simon Burns)]

I begin by congratulating the hon. Member for Stockton North (Alex Cunningham) on securing the debate on the future of the North Tees and Hartlepool NHS Foundation Trust and its hospitals. I join him, with the greatest pleasure, in congratulating clinicians, GPs, ancillary workers and all those who work so hard on Teesside, in the north-east and in the rest of the country to provide a first-class quality health care service for the people of this nation.

The decision to cancel the North Tees and Hartlepool NHS Foundation Trust proposal has to be seen within the context of the wider economic climate. This year’s budget deficit of £155 billion—inherited, I gently remind Opposition Members, from the previous Government—illustrates the scale of the economic challenge facing this Government. As part of this Government’s determination to face that challenge head on, the Treasury and other Departments have reviewed every significant spending decision made between 1 January and the general election on 6 May. As the proposed new hospital scheme at the foundation trust received the previous Government’s approval only in March, the North Tees decision formed part of that review.

In these tough economic times, it is essential that all major hospital building schemes be affordable. On 17 June, as the hon. Member for Stockton North rightly said, my right hon. Friend the Chief Secretary to the Treasury announced to this House the decisions of the Government’s review of spending commitments. The review cancelled 12 projects throughout Government and considered four major NHS capital investment schemes with a total capital value of more than £1.2 billion.

The size and funding of the schemes were considered in relation to the nature of the organisations concerned. The aim of granting foundation trust status is to give such bodies greater financial independence. As well as being able to keep any internally generated resources, foundation trusts have greater freedom to borrow from either the public or the private sectors, and, by requiring an allocation of public dividend capital from the Department of Health of more than £400 million, the proposals were not consistent with that financial independence.

[Mr Iain Wright]

What local clinical advice did the Minister and his ministerial team take prior to the decision to scrap the new hospital?

[Mr Burns]

If the hon. Gentleman waits, as I develop my argument I shall continue to explain the reasons for cancelling the scheme within the public spending review.

Treasury and Department of Health Ministers, myself included, decided that, overall, these factors—affordability within the changed economic climate and the foundation trust status—weighed more against the scheme for North Tees and Hartlepool than against the other three schemes for the Royal Liverpool and Broadgreen University Hospitals NHS Trust, Epsom and St Helier University Hospitals NHS Trust and the Royal National Orthopaedic hospital. For those reasons, the Government withdrew their support for the scheme.

If I may, I shall just answer one question that was mentioned in an intervention on the hon. Member for Stockton North. The question was, “Why North Tees and Hartlepool and not the three other schemes?” After looking into the situation, we found that, for example, the Royal Liverpool university hospital building is not compliant with fire safety regulations, and that its mechanical and engineering services are more than 30 years old and at increasing risk of failure. Some 94% of St Helier hospital’s buildings are more than 50 years old, and the 2007-08 data show that the total maintenance backlog for the Royal National Orthopaedic hospital is £53.8 million; for Epsom and St Helier it is £23.8 million; for the Royal Liverpool it is £16.3 million; and for North Tees and Hartlepool it is £3.5 million.

Health Funding

Debate between Iain Wright and Simon Burns

Tuesday 22nd June 2010 Westminster Hall

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate my colleague, the hon. Member for St Ives (Andrew George), on securing this debate on NHS funding allocations. I also congratulate the shadow Minister, the hon. Member for Kingston upon Hull North (Diana R. Johnson), on her appointment to the Health Front Bench. In Government she was a Minister with other responsibilities, and a Whip, and I assure her that she will find serving as a shadow Health Minister tremendously rewarding, because of the important role of such matters in our lives and those of our constituents. I also congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on her almost but not quite maiden speech.

I pay tribute to the NHS in Cornwall, which provides an excellent level of care to the constituents of my hon. Friend and those of my honourable colleague; he has long campaigned on how best to distribute resources and has argued that PCTs should be moved to their target allocations. Before I respond in detail to his points, perhaps I might set out the general principles of the system of funding allocation; that may help the hon. Member for Kingston upon Hull North.

The Government believe in an NHS that is free to all, irrespective of need or ability to pay; in which professionals are freed from the shackles of centralised targets and empowered to take responsibility for their patients; where better access to services is matched by improved quality and greater efficiency; and which provides value for money and health outcomes that are second to none. That is our vision for the national health service, and the coalition’s programme for government sets out how we will achieve it.

First, the Government will increase spending on the NHS in real terms for each year of this Parliament, as the shadow Minister acknowledged. It is a commitment that reflects a deeper belief: that the NHS must be protected and properly resourced to continue its vital work. We must focus our resources where they are needed most. That means stopping the flow of resources from the front line to the back office, giving front-line staff the responsibility and resources to improve outcomes for patients, and entrusting local professionals—and local people—with the means to improve local health. By committing to cut the costs of health bureaucracy by a third, we will release resources that can be reinvested in front-line services; by giving GPs the power to commission services based on need, we will push decisions about health care provision close to patients; and by giving local communities more responsibility for public health, we will create a more flexible national health system—one that is responsive to local demand for health services, and is able to react to changing health needs and to direct funds towards emerging priorities.

Secondly, we will establish an independent NHS board to allocate resources and provide commissioning guidelines. The board will ensure access to health services that are designed around the needs of the patient, not the needs of the bureaucracy. It will set standards based on clinical evidence, not political micro-management. The aim is to achieve the best outcomes for patients, instead of simply ticking boxes and meeting targets.

[Mr Iain Wright]

I congratulate the Minister on securing his post. I know that he is passionate about health, and I wish him all the best as a Minister in the Department of Health. He mentioned the establishment of an independent NHS board whose focus will be on clinical standards as opposed to political micro-management. Bearing in mind health services north of the Tees, a clinically led, independent reconfiguration panel recommended that a new hospital should be built. Is that not something that the Government should be doing?

[Mr Burns]

I have to congratulate the hon. Gentleman. I remember that as a Minister he was extremely helpful, within the confines and straitjacket of his remit. He was tenacious both in that job and this afternoon, and is using his skills to try to tease out an answer beyond the one that was given to him in my letter to him last Thursday explaining why that capital project was cancelled as part of the public spending review. However, to be helpful, and if he would like it, I will repeat basically what the letter said. Facts are facts, and I am afraid that the situation has not changed since I wrote to him.

When this Government came into power in May, we were faced with the largest deficit and debt that any Government had ever inherited from an outgoing Government. The debt is a financial problem that must be addressed urgently. Therefore, the incoming Government announced a review of spending commitments that were made by the previous Government after 1 January 2010—that is, in the run-up to the general election. As a result of the review, which has been carried out over the past seven weeks or so, an announcement was made on 17 June in which the coalition Government announced the go-ahead of four major hospital programmes, ranging from the Pennines to Liverpool and to St Helier in south-west London. Unfortunately, the North Tees and Hartlepool project did not get permission to go ahead. I am afraid that that is the answer. It is because of the economic situation and debt in which we find ourselves.

[Mr Wright]

The Minister is gracious in giving way a second time. On that basis, and given what the Prime Minister said about NHS funding increasing in real terms despite the financial problems that we find ourselves in, capital spends will be provided elsewhere in the country, but seemingly not in my constituency. Are my constituents’ health outcomes not to be thought of because of financial considerations?

[Mr Burns]

The hon. Gentleman knows the answer to that question. That is not why the hospital was not given the go-ahead last week. I can appreciate his frustration. As a constituency MP myself, I too would be frustrated, but the hon. Gentleman, who is a generous man, must not try to reinterpret the decision for other reasons. Sadly, the decision was taken simply because of the urgent need of this Government to take decisions to start curbing the ballooning debt problem, which needs to be addressed. That is the reason, I am afraid. It has nothing to do with our commitment to reducing health inequalities and spending more money on providing health care and services for people throughout the country.

I hope that the hon. Gentleman is satisfied with that. If he is not, and if it would be of any help to him, I would be more than happy to meet with him and, if he wants to bring them along, his colleagues from the Hartlepool area and the surrounding constituencies. They can discuss the matter with me—my door is always open. I would be more than happy to do that, if we can arrange a meeting, and if he thinks that it would be helpful.

Let me return to Cornwall and the general position on health funding allocations. I was saying, before discussing Hartlepool again, that we will establish an independent NHS board.