Oral Answers to Questions

Jesse Norman Excerpts

Tuesday 5th January 2016 Commons Chamber

[Mr Hunt]

No I do not, because that had perverse consequences. When that target was in place, the number of people waiting to see a GP increased rather than decreased. In the last Parliament, the number of GPs went up by around 1,600—a 5% increase in the workforce—and we have plans to increase it by 13%, which would be one of the biggest-ever increases in the GP workforce in the history of the NHS, on the back of a strong economy.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

The Secretary of State will be aware from personal experience of the excellent work being done by GPs in Herefordshire, who won one of the first seven-day-a-week pilots. Can he assure me that this work will continue to be funded, as it is doing an extraordinarily good job in helping my constituents?

[Mr Hunt]

We are very pleased with the progress that is being made in Herefordshire and in many other areas, and we are looking at how to maintain funding for those areas. Already, 16 million people are benefiting from enhanced access to GPs in the evenings and at weekends, and we would not want to see the clock being turned back on that.

Health and Social Care

Jesse Norman Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

Yes, I will. The figures that my hon. Friend cites are right. I will tell him something else. Half a million fewer people took out private health insurance in the previous Parliament because the quality of care that they could get on the NHS was rising. The Government are committed to the NHS. If the right hon. Member for Leigh does not want to believe what I am saying about privatisation, perhaps he will believe the respected think-tank the King’s Fund, which is clear that his claims of mass privatisation were and are exaggerated.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

My right hon. Friend spoke eloquently about the importance of supporting mental health care, of parity of esteem and of technology. Does he share my view that the NHS has a strong embedded interest in the spread of fast broadband in rural areas, which would allow people better access to telemedicine and online psychotherapy?

[Mr Hunt]

Absolutely. I had a good visit to my hon. Friend’s county hospital, but I also remember seeing at Airedale hospital how reassuring it was for a vulnerable old lady to be able to press a red button on her armchair, be connected straight through to the local hospital and talk to a nurse within seconds. With that kind of service, that person is less likely to need full-time residential care. That is much better for her and more cost-effective for the NHS.

--- Later in debate ---

[Jesse Norman (Hereford and South Herefordshire) (Con)]

I congratulate all those who have given their maiden speeches in this Queen’s Speech debate today and on previous days. We have seen a galaxy of talent, and it has been a delight to listen to them. I feel like a thorn amid a garland of roses. I also take my hat off to the hon. Member for Bristol West (Thangam Debbonaire), now departing, for her elegant misattribution of my great hero Burke, for which I thank her.

Having won my seat in 2010, I am not in a position to give a maiden speech, but I am pleased to report to the House that the voters of Hereford and South Herefordshire have returned me with a majority that increased from 2,500 to just under 17,000. It has always been my aspiration to make my seat one where they weigh the vote rather than count it, and I am pleased to report that we are making a little progress in that direction.

With that progress comes responsibility, and I want to dwell on that a little. We had the Hay festival all last week, on the edge of my constituency—an extraordinary gathering of ideas and words and music, bringing people together from across this country, indeed across the world. It is an extraordinary institution and one of which I have had the honour to be a director for the past few years. The festival—I am talking here not so much about health and social care in the strict sense as about the health and care of our society more widely—formed a fascinating contrast with our proceedings in Parliament. For the Queen’s Speech had many excellent elements within it—enterprise, finance, education, immigration, cities and the EU referendum, to name just a few—and it had a heavily economic focus, as befits the times in which we live. But it was striking that the list of Bills barely touched, or touches, the areas of arts and culture—social care in the wider sense that I have described. It was doubly striking in the light of the many excellent speeches that we have heard in the past few days. Time and again they returned to the role of culture, of soft power, in supporting and advancing our understanding of ourselves and our place in the wider world.

I think of the spat mentioned yesterday between Charles I and his wife Henrietta Maria in 1621, which was healed by the soft breezes of rural Hampshire, as my hon. Friend the Member for Fareham (Suella Fernandes) pointed out, while from the opposite side of the Chamber the hon. Member for Birmingham, Edgbaston (Ms Stuart) rightly highlighted the importance of the English language and of British norms and values in our foreign policy.

This House is no friend to abstract ideas, and I am pleased to say that it is not, but it is worth asking ourselves what we mean by culture. For some it is

“The best that has been thought and said in the world”.

For others it is

“the diffusion and extension of knowledge”

within a society. There is something in both definitions. We have a staggeringly rich and diverse national culture in this country. Indeed, in many ways, ours is among the very richest and most diverse cultures in the world today. But that knowledge, that culture, cannot exist unless it is shared; unless it is diffused and extended, as Cardinal Newman put it. And it must be diffused and extended across the whole country.

But Mr Deputy Speaker, this is not the case today. Let me pick out two areas in which I suggest that we need early and resolute action from the Government to support the diffusion of culture. The first is communications. Vast areas of our country still do not have decent broadband, fast or otherwise. Vast areas of our country struggle to get a decent mobile signal. This affects rural areas and some urban areas in England, Scotland, Wales and Northern Ireland alike. We need an urgent action taskforce, led by Government but involving local government and the private and third sectors, to review how these issues can be swiftly resolved, and then to resolve them.

My second area, over and above communications, has to do with what is communicated; with knowledge, with understanding and the value of education, which are the cornerstones of our culture. Over the past five years, the Government, led by the Conservative party, have made great strides in education, almost across the entire age spectrum, but one crucial group has been left out—indeed worse, the group’s great achievements have arguably been put at a certain amount of risk. I mean our sixth-form colleges, which have an extraordinary record of educating young people at low cost and to high quality. Mr Deputy Speaker, we need to do something about this collectively in this Parliament. We need to do something about communications, rural broadband and a rural mobile signal. We need to do something about the diffusion of our culture across our country and the way in which we educate our young people in our sixth-form colleges.

This Government have rightly laid claim to the mantle of one nation, and have done so in the name of compassionate conservatism, but that inclusiveness—that fellow-feeling—demands that everyone be equally able to enjoy our history and our traditions, and share in the endlessly dynamic and creative culture that is Britain. For that, we need better broadband and better mobile signals, and we need to support our sixth-form colleges. To those ends, I hope that the Government will be able to introduce measures swiftly to address the issues that I have raised.

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[Jane Ellison]

I am sure we will return to debating SABR and other cancer treatments, as we did often in the previous Parliament. The hon. Gentleman acknowledged in his speech the progress that has been made on radiotherapy, and we want to build on that.

[Jesse Norman]

I am glad that the Minister has mentioned radiotherapy. I had the honour of opening the radiotherapy unit at Hereford hospital. Does she share my view that for cancer sufferers an awful lot of the therapy needs to be complemented by wrap-around care for their other health needs? That is something we do terribly well at the Haven in Hereford, and at other centres across the countries, such as Maggie’s centres. Does she agree that that is an important part of cancer care?

[Jane Ellison]

It is a very important part of cancer care, and something we have debated often in this House. I have seen for myself while on visits just how important the services that wrap around clinical care are.

Let me turn to an issue that we hope to give particular focus to in this Parliament: the need to tackle obesity. It is appropriate that I do so just after an intervention on cancer, because we are understanding more and more about the links between obesity and cancer in later life. They are frightening and shocking. We want to tackle issues such as childhood obesity fiercely in this Parliament. The biggest link between obesity and ill health, however, is that between obesity and type 2 diabetes. If not properly managed, type 2 diabetes can have devastating consequences, including loss of eyesight and limb amputations.

A and E (Major Incidents)

Jesse Norman Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

We take responsibility and I take responsibility for everything that happens in the NHS. Let me tell the hon. Lady what we are actually doing, because there have been some serious bed capacity issues in Bolton. Bolton has had £3 million this winter to help deal with those pressures, which has included £340,000 to spend on additional beds in the hospital supporting the A and E department and more than £100,000 to pay for additional staff in A and E. Overall, compared with in 2010, there are 114 extra doctors and 571 extra nurses. She should welcome that, rather than trying to make a political issue of it.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

May I remind the House that the private finance initiative, which expanded hospitals to 100 from zero after 1997, created at least £2 billion to £10 billion, and possibly even £20 billion, of additional costs that could now be used? In Hereford, the hospital is too small because of PFI. I have estimated that £30 million could have been spent on the hospital if contracts had been properly implemented in the first place. That is why my hospital, which declared an incident this week, has been struggling and it is quite wrong to suggest otherwise.

Oral Answers to Questions

Jesse Norman Excerpts

Tuesday 21st October 2014 Commons Chamber

[Jesse Norman (Hereford and South Herefordshire) (Con)]

5. What steps he is taking to encourage hospital trusts to manage their PFI costs more effectively.

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

PFI schemes have had their contracts reviewed for potential cost savings. A major data collection on the results is currently under way. In 2013, the Treasury launched a code of conduct for operational PFI contracts which contained a number of new guidelines for better working relations between the public and private sector parties.

[Jesse Norman]

Thanks to determined work with which I have been closely associated and with outside experts’ advice, Hereford hospital has managed to save several million pounds on its exorbitant PFI contract—money that is already being ploughed back into medicine and services for local people. My studies make it clear that there are hundreds of millions, if not billions, of pounds still to be saved on the PFI across other NHS hospital trusts. Will my hon. Friend press Monitor and the NHS Trust Development Authority to do everything they can to encourage hospitals to take on specialist PFI contract advisers to help them make these savings?

[Several hon. Members]

rose—

Hospital Car Parking Charges

Jesse Norman Excerpts

Monday 1st September 2014 Commons Chamber

[Jackie Doyle-Price (Thurrock) (Con)]

I beg to move,

That this House welcomes the Government’s guidance that hospital car parking charges should be fair and proportionate; notes that some hospitals are still charging patients and their visitors excessive fees of up to £500 per week; further notes that the charity Bliss has said that parents with premature babies are having to pay on average £32 per week; further notes that for many patients it is essential that they travel to hospital by car; believes that such charges affect vulnerable patients at a very difficult time; and urges the Government to consider ways in which hospital car parking fees can be reduced.

I am extremely pleased to be able to open the debate and I am grateful to the Backbench Business Committee for making time to discuss this important issue, which has been impacting on so many constituents up and down the country. Before I go into my arguments, I must pay tribute to the work of my hon. Friend the Member for Harlow (Robert Halfon), who has done so much to highlight this issue and many others that directly impact on ordinary hard-working people. It is incumbent on all of us in the House, when people’s loved ones are ill or they themselves require hospital treatment, to ensure that the national health service makes the conditions appropriate for them to access the treatment that they need, and car parking charges get very much in the way of that. I reiterate that I thank my hon. Friend for his efforts to push this matter up the political agenda.

Hospital car parking charges have largely been abolished in Scotland and Wales, but that is not the case in England where 79% of hospitals continue to charge, often at punitive rates. For so many of our constituents driving to hospital is not a choice; it is essential. Many of them are undergoing treatment which means that travel by public transport is simply not an option, particularly when they have to be accompanied by members of their family. Members of their family will also wish to visit them if they have a prolonged stay, and they, too, should not be faced with punitive car parking charges. To put it simply, hospital car parking charges are a tax on NHS treatment.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

I congratulate my hon. Friend on procuring this debate, and I congratulate my hon. Friend the Member for Harlow (Robert Halfon) on his leadership of the campaign. Does my hon. Friend the Member for Thurrock (Jackie Doyle-Price) agree that at the root of this—I come from Hereford, where hospital parking charges are reportedly some of the highest in the country—is a private finance initiative contract in many cases, which it is often almost impossible for the hospital in question to control? Therefore, there must be wider action to control PFI costs alongside hospitals to support the people whom we are trying to help.

[Jackie Doyle-Price]

My hon. Friend is quite right. He has done much to highlight some of the PFI contracts, the long-term consequences of which we are now having to deal with, where the contractors may have been rather more savvy in negotiating a deal that suits them rather than the patients. We must remember that the NHS should serve the interests of patients, not the providers of any contracts or services within it. I wholeheartedly agree with my hon. Friend and I hope that the Minister will consider what more can be done to challenge some of the contracts.

Oral Answers to Questions

Jesse Norman Excerpts

Tuesday 15th July 2014 Commons Chamber

[Dr Poulter]

The most important thing in delivering local services is to ensure high-quality patient care and patient safety, so I would want the TSA’s plans to be delivered as quickly as possible to ensure that high-quality services are delivered locally and that patients’ best interests are protected.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

13. What steps he is taking to improve care for people affected by stroke.

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

Mortality from stroke has fallen by over 40% in recent years. Awareness of stroke symptoms is being raised through the Act FAST campaign. The strategic clinical networks are sharing best practice in stroke care by, for example, working with commissioners and providers to improve stroke rehabilitation services.

[Jesse Norman]

I thank the Minister for that reply. Effective stroke care is extremely difficult to deliver in my county of Herefordshire, because patients are often scattered and inaccessible and the necessary treatment is highly time-critical. What are the Government’s plans to protect and enhance stroke care in rural communities, especially at Hereford hospital?

[Norman Lamb]

My hon. Friend raises an incredibly important point. I have the same experience in my county of Norfolk. Clinical commissioning groups are responsible for commissioning stroke care. The Herefordshire CCG is working with Wye Valley NHS Trust to improve the quality of stroke services and is seeking to establish a sustainable, hyper-acute service in the county, and it is clearly necessary that that is achieved.

Oral Answers to Questions

Jesse Norman Excerpts

Tuesday 10th June 2014 Commons Chamber

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

As the hon. Gentleman will be aware, patients need to be treated according to clinical need, and bed stays should not be determined by anything other than that. So if what he describes is actually the case, it would be very disturbing. If he would like to raise the issue further with me, I would be happy to look into it for him.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

T5. Like other rural communities, Herefordshire has long suffered from chronic underfunding in health care. Does the Secretary of State share my view that setting clinical commissioning group allocations should be an evidence-based process that takes into account factors including sparsity and old age? Also, will he ignore the calls from the shadow Health Secretary, who was seeking to cut the previous NHS allocations in areas such as Herefordshire?

[Mr Jeremy Hunt]

I agree with my hon. Friend that it has to be done on the basis of evidence. Part of that is an important change that the Government have made, which the Labour party criticised a great deal. We have depoliticised the process by giving it to NHS England, where it is decided at arm’s length from Ministers on the basis of need. It is challenging to do it fairly. There are some historical imbalances, and we have to do what we can to address them, but we have to do it in a way that is fair and is not tarnished by party politics.

Oral Answers to Questions

Jesse Norman Excerpts

Tuesday 14th January 2014 Commons Chamber

[Dr Poulter]

It is the right hon. Gentleman who needs a lesson about not rewriting history. Dr Mann said that this issue had been building for the past decade. When the right hon. Gentleman was Secretary of State and before that a Minister in the Department, he failed to make those long-term work force decisions and also signed up to the European working time directive, which exacerbated the problems on medical rotas. Those were decisions that he made. He created this crisis; we are fixing it and increasing the number of doctors working in A and E.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

5. What steps he is taking to promote the health and well-being of older people.

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

We will ensure that everyone over the age of 75 has a named GP responsible for delivering proactive care for our most vulnerable older citizens in the best tradition of family doctors. Through our £3.8 billion better care fund, we are also merging the health and social care systems to provide more joined-up health and social care.

[Jesse Norman]

Dementia is a terrible blight for an increasing number of older people. Last week, I had the great privilege of opening Henffordd Gardens in Hereford, a supported living scheme that will allow dementia sufferers in my constituency to enjoy a better quality of life for longer and is a model of good practice for the country. Will the Secretary of State join me in congratulating Herefordshire Housing and all those who have worked so hard to bring this plan to fruition?

[Mr Hunt]

I absolutely join my hon. Friend in congratulating Herefordshire Housing. One of the key things about people with dementia is that relatively small adjustments to their homes can make it possible for them to live at home healthily and happily for much longer under the care of a husband, wife or partner without having to go into residential care. Those are precious years that we should treasure and do everything we can to facilitate, so I am delighted that that is happening, and he will be pleased to know that, thanks to the Government’s initiative, it is happening all over the country.

Cross-border Health Care (England and Wales)

Jesse Norman Excerpts

Tuesday 25th June 2013 Commons Chamber

[Jesse Norman (Hereford and South Herefordshire) (Con)]

I start by thanking Mr Speaker for kindly granting this debate on a topic of great importance to many of my constituents and to many others living in English counties on the border with Wales.

I am grateful to two of my colleagues, my hon. Friend the Member for Monmouth (David T. C. Davies) and the Minister for Immigration, my hon. Friend the Member for Forest of Dean (Mr Harper), who have both worked with enormous diligence on behalf of constituents of theirs who have been similarly affected. I pay tribute to my constituent the indefatigable Patti Fender for bringing this issue to my attention, and to Action4Our Care, the action group which has pressed the matter so hard in Gloucestershire.

The basic problem can be simply stated. There are more than 20,000 NHS patients who are resident in England, yet registered with a Welsh general practitioner. Of these, some 3,500 are resident in my county of Herefordshire. Many of these people, like my constituents in the village of Welsh Newton—a Welsh name, but an English village—have no choice but to register with a Welsh GP because no English practice covers their location.

These people live in England, but they are being denied access to hospital services in England. That is grossly unfair, especially as for many, if not all, of them Hereford hospital is the closest and the best place to be treated. The situation also has the damaging knock-on effect of depriving Hereford hospital of revenue from patients who are being treated in Wales. The result is a double whammy: the patients cannot receive the health care that they want and need, and Hereford hospital, already undermined by the deeply iniquitous NHS funding formula, must suffer an unexpected additional financial burden. This burden is already becoming evident. Outpatient treatments for patients living in England but registered with a Welsh GP fell by 10% to 11% in March, April and May this year compared with the same period in 2012, and the hospital expects them to fall further in the months to come.

[Stephen Mosley (City of Chester) (Con)]

Is my hon. Friend aware of the situation in Chester, where the Countess of Chester hospital serves large numbers of people who live in north Wales? One third of the people presenting at accident and emergency at the Countess of Chester live in north Wales. There is no funding available for them so people in Cheshire are losing out. Does my hon. Friend think that is fair?

[Jesse Norman]

It is interesting to have the parallel case, and I thank my hon. Friend for bringing it to the attention of the House.

Let us look at the issues in more detail. The relevant NHS regulations state that legal responsibility for these patients remains with the relevant clinical commissioning groups in England, but that local health boards in Wales take day-to-day responsibility for their care. The English and Welsh NHS take their guidance from the protocol for cross-border health care services, the latest version of which was agreed by Welsh and English Ministers in April this year. However, it appears that the protocol does not give full effect to the law. Specifically, point 14 of the current protocol implies that patients from England who are treated in Wales are to be seen and treated within the maximum waiting time targets of the NHS in Wales, which are of course rather different from those of the NHS in England. Why does this matter? It matters for three particular reasons.

First, as we have seen, these South Herefordshire patients struggle to get referred to the hospital of their choice. The Welsh Assembly Government Minister for Health and Social Services has openly stated that choice is not the basis of the health system in Wales.

[Jim Shannon (Strangford) (DUP)]

The hon. Gentleman will be well aware of the land border between the Republic of Ireland and the United Kingdom of Great Britain and Northern Ireland. There is co-operation, although it is not full blooded, between the health service in Northern Ireland and the health service in the Republic. Perhaps the Minister should look at that to see how it can work for the situation on the border between England and Wales.

[Jesse Norman]

I am grateful to the hon. Gentleman for that intervention. There is co-operation at the moment between England and Wales, but I think that it would absolutely benefit from further examination of the situation he describes between Northern Ireland and Eire.

The fact that the Welsh Assembly Government Minister for Health and Social Services does not believe that choice is the basis of the health system in Wales means that my constituents do not have the choice of health care, hospitals or consultants that is their proper legal right.

Secondly, the Welsh NHS’s performance in meeting its own waiting time targets continues to deteriorate. In England the waiting time target is 18 weeks, but in Wales it is 26 weeks, and that is regularly missed. Some patients are not even treated within 36 weeks. For example, some 4% of patients are not treated within 36 weeks at Cardiff and Vale hospital, according to recent Welsh Government statistics for April this year.

Thirdly, the current set-up is giving rise to serious clinical concerns. Earlier this year, in evidence to the Silk commission on devolution in Wales, the Royal College of Surgeons, the British Medical Association and the Royal College of Nursing made the following submission:

“The Panel... acknowledged that increasing policy divergence between health services in Wales and England was a challenge, especially in regards to cross-border services. The Panel added that there was a need to strengthen commissioning arrangements to improve current delays for processing individual cases... It was also agreed that it made sense for some specialist facilities to be shared by both England and Wales; and to work together to deliver economies of scale and efficiency savings, including cross border sharing of procurement and use of high-tech equipment.”

However, as I have mentioned, that ban on hospital access for those patients is not merely grossly unfair to them but places further financial pressure on Hereford hospital.

[Bill Wiggin (North Herefordshire) (Con)]

My hon. Friend and neighbour is making an important and powerful speech and should be congratulated on securing the debate. Does he agree that when one has a national border next to one’s county, it should be treated like a coastline, because it is not the Minister’s responsibility to control the health service in Wales? But if we do not have proper funding we will suffer as a result of not only our rurality but our sparsity, and once again people living in the marches will be at a disadvantage. We have the Barnett formula, but should we not have something similar for people on the Welsh border?

[Jesse Norman]

I am grateful to my hon. Friend and neighbour for that kind intervention. I share his view that the situation needs to be addressed, and it needs to be addressed in the spirit of amity and co-operation between the two sides.

In 2009-10 I commissioned an independent study of the funding of public services in Herefordshire relative to other suitable comparators across the country. I was only a parliamentary candidate at the time and such a study had never before been undertaken, but it seemed obvious to me that Herefordshire suffered from a serious shortfall in public funding and I was determined to get to the bottom of the matter. The results were astounding—even frightening. The study found that Herefordshire had been underfunded by no less than £175 million over the previous five years across all public services. In health care, the underfunding was £44 million, or roughly £9 million a year. It is no coincidence, I suggest, that Hereford hospital is currently running a deficit of almost exactly that amount. It is that deficit that is being worsened by the denial of choice to cross-border patients in my constituency and elsewhere.

Why did that funding shortfall occur? The reason is that the NHS funding formula is systematically skewed against areas that are highly rural and have a large population of older people, and systematically favours urban areas with younger populations. The formula does not recognise the relatively high cost of delivering services in sparsely populated areas, as my hon. Friend the Member for North Herefordshire (Bill Wiggin) indicated, and it does not adequately recognise the special costs imposed by caring for older people—particularly the over-85s, the very oldest in our society. Research by Professor Sheena Asthana at the university of Plymouth indicates that the areas of greatest health care need are those with the highest proportion of over-75s. However, the current funding formula is focused on deprivation rather than on need for health care. That means that less funding is available to treat older people with chronic diseases.

Nationally, 17% of people are aged 65 or over. In Herefordshire, the figure is already 22% and pensioners will make up a third of the population by 2030. In 2010-11, Herefordshire had the highest proportion of over-75s in the west midlands, and the most patients per 100,000 on the cancer register.  It also had the lowest cancer spend per cancer patient per year—a little over £5,000—and was in the lower half of the per capita allocations.

By contrast, the Heart of Birmingham PCT had the lowest proportion of over-75s in the region, and the fewest patients per 100,000 on the cancer register.  However, the spend per cancer patient per year there was not £5,000 but more than £10,000—nearly double that in Herefordshire. Thus the effect of the funding formula is that Heart of Birmingham has twice as much funding per cancer patient as Herefordshire, for a much lower incidence of cancer. That is not merely unfair; it is a monstrous injustice.

I conclude by asking the Minister three questions. First, will her Department amend the cross-border protocol and reintroduce patient choice for English residents registered with GPs in Wales? Secondly, will she acknowledge the strain that the protocol places on hospitals such as Hereford hospital? Thirdly, will she press her Department to make the case to NHS England for a fairer funding settlement, which will give older people—not merely in Herefordshire, but up and down the land—the funding for cancer and for other health care that they so richly deserve?

--- Later in debate ---

[Anna Soubry]

Indeed. I will come to the effect on Hereford hospital, but I am more than happy to write to my hon. Friend about his specific point. The usual rules apply: if there are questions that I have not answered I will of course write to any hon. Member.

We have asked the Welsh Government to request that other local health boards along the border in Wales should similarly review the application of their own policies for out-of-area treatment affecting patients in the same circumstances. In many of those areas patient numbers are much smaller, but that does not matter; these are important issues for these individuals.

In the light of the further legal advice that NHS England is seeking, I am advised that it will review the protocol with the Welsh Government in view of my concerns and those of other hon. Members, the updated legal advice, the outcome of the local health boards’ reviews of the application of their policies on out-of-area treatment, and feedback that we have received from local NHS bodies on the operation of the protocol. The review will be undertaken in the autumn following completion of the reviews by the local health boards.

My hon. Friend the Member for Hereford and South Herefordshire is concerned that the policy of the Welsh Government that those who are registered with a Welsh GP must use Welsh NHS services will have a direct impact on the viability of Hereford hospital. I share his concern, but I understand that a number of other factors affect the viability of the hospital and the Wye Valley NHS Trust.

I was a bit concerned when I read the next part of my brief, because it has been worded in an interesting way by my very able officials. It states that those factors include

“the drop in the numbers of young people locally leading to a lack of activity in maternity services”.

I am not sure what “lack of activity” young people have been guilty of. I think that what is meant is that there are not as many young people in the area, because there is undoubtedly a higher proportion of retired elderly people in the population. It is obvious that if there are fewer young people, people are less likely to be having babies and are therefore less likely to use maternity services. I am sure that activity remains at a high level.

As my hon. Friend is aware, Wye Valley NHS Trust published a strategic outline case in March this year, setting out the options for its future form to create a clinically sustainable model for local people. I have been advised by the NHS Trust Development Authority that it has been working with the trust to develop a full business case, which it expects to receive for consideration by the end of this month. Again, I make it very clear that I am more than happy to revisit this issue with my hon. Friend and others following the outcome of that process.

[Jesse Norman]

Wye Valley NHS Trust has informed me that the policy has cost it between £1 million and £2 million so far. Given that it is running a deficit of £8 million to £10 million, that is a significant sum. The work that is being done pre-supposes the current funding formula. In a way, it therefore pre-supposes the point at question, which is whether the formula is fair. As I have submitted, it clearly is not.

[Anna Soubry]

I do not doubt for one moment the veracity of what my hon. Friend has told me about what he, in turn, has been told. That is a substantial amount of money and it would go a long way to explaining part of the deficit. These are terribly important matters.

The funding formula has been raised yet again. The argument advanced by many Members on both sides of the House is that the formula does not take account of the relatively high cost of delivering services in rural areas or reflect the fact that many rural areas such as Herefordshire have relatively older populations. I have had a number of conversations with hon. Members who make exactly the same complaint as my hon. Friend.

I am reliably informed—this point is important—that allocations to individual clinical commissioning groups, which are made up of the GPs and other clinicians who now commission services locally, and the formula that is used to decide what those allocations should be, are the responsibility of NHS England. I am not seeking to pass the buck, but it does bear that responsibility. In making those allocations, NHS England relies on advice from the Advisory Committee on Resource Allocation. ACRA provides advice on the share of available resources provided to each CCG to support equal access for equal need, as specified in the mandate given by the Secretary of State to NHS England.

Therefore, NHS England does not set income for CCGs on an equal cost-per-head basis across the country. Instead, allocations follow an assessment of the expected need for health services in an area, and funds are distributed in line with that, meaning that areas with a high health need should receive more money per head. The calculation is based on the age of the populations, relative morbidity and unavoidable variation in cost. The objective is to ensure a consistent supply of health services across the country. The greater the health need, the more money is received because the more health services are needed.

I know that some hon. Members just do not accept that that is the reality with the allocations to their CCGs and, in effect, to their constituencies. NHS England plans to review the funding formula for 2014-15 and the following years better to reflect the needs of local communities and enable the best outcomes for local people. Perhaps there is hope in that. Obviously, I must say quickly that I cannot make any promises.

If anybody would like to intervene, we do have the time. Hon. Members often want to make a point, but do not feel that they can make a speech.

--- Later in debate ---

[Jesse Norman]

We have a little time, so I am very grateful to the Minister for giving way again. Will she ask her officials to look more closely at the functioning of ACRA? The formula under which we are labouring was set up in 2002. There is a clear case to be made that, contrary to its desire, it is not delivering funding to the areas of greatest need, but to areas defined by a deprivation formula. The truth is that morbidity and age go together, not deprivation and morbidity.

[Anna Soubry]

I might not share my hon. Friend’s final remarks, but we know that NHS England, which is in charge of distributing funds to CCGs, is considering the formula. It will no doubt bear in mind the argument made by him and others who believe that ACRA’s formulation is not delivering in the fair way that we all agree was intended.

In conclusion, I am pleased that NHS England has responded to my concerns, and the concerns of my hon. Friend the Member for Hereford and South Herefordshire and others, most notably my hon. Friend the Member for Forest of Dean, with whom I had a long meeting. As a result, NHS England is doing what we had hoped it would. I am encouraged by the dialogue that has been taking place between NHS England, the Welsh Government and local health boards in Wales, and I hope to see further rapid progress. We must not let anybody drag their heels. I look forward to being able to update my hon. Friend the Member for Hereford and South Herefordshire, and others who represent border communities, in the autumn. I undertake to do that once NHS England has finished its review. I once again congratulate my hon. Friend on securing the debate on this important issue. While it might not affect a huge number of people, it is a very important issue for them and they feel that there is an injustice. It behoves all of us to ensure that we eradicate any injustice.

Question put and agreed to.

Selective Dorsal Rhizotomy

Jesse Norman Excerpts

Wednesday 18th April 2012 Commons Chamber

[Chris Heaton-Harris]

I absolutely concur. Indeed the final paragraph I wanted to read from “Holly’s Diary” states:

“Finally—we are continuing with Holly’s strict physio programme. She has 1 hour a week from the NHS and we pay privately for a further 2 hours a week from different therapists.”

As we have just heard, for the best results from SDR the operation must be followed by intensive physiotherapy. As an aside, one thing that all the parents who have raised the money for their child’s operation have in common is the basic lack of interest in the patient from the NHS when they return home from abroad, especially when they try to get regular physiotherapy to ensure that their children benefit from the operation to the maximum extent possible. Essentially, the more physio a patient receives in the first years after the operation, the greater the level of ongoing success and the level of manoeuvrability in the patient. Can the Minister help to remedy the situation?

[Jesse Norman (Hereford and South Herefordshire) (Con)]

I congratulate my hon. Friend on securing this debate. Is he familiar with the case of young Ellis Jones in my constituency, who has just returned to the UK after his family raised an extraordinary £45,000 to fund what appears to be highly successful SDR surgery with Dr Park in St Louis? I pay tribute to Ellis and his family, to the generosity of the communities around them, and to the Hereford Times, which led the way in gathering local publicity and support. Ellis is just two years old. Does my hon. Friend think there may be a case for extending the current treatment under NICE guidelines to include suitable children as young as two years old?

[Chris Heaton-Harris]

I thank my hon. Friend for that intervention. I will come to that, but I entirely concur. The earlier the problem can be tackled, the better, in general terms.

As I mentioned previously, the global medical community gradually became aware of Dr Park’s superb work in St Louis. Here in the UK, on 3 May last year, the very first UK micro-neurosurgical SDR was performed in Frenchay hospital in Bristol. Kristian Aquilina, the consultant neurosurgeon, and his team carried out this operation. Towards the end of last year, I took Mr Aquilina and some parents whose children have benefited from SDR, including my constituent Jo Davies into the Department of Health for a very helpful meeting with a couple of the Minister’s officials, in a bid to encourage the NHS to offer SDR here in the UK. The hope is that there would be three or four centres of excellence that could offer the operation to those patients who had been evaluated as able to benefit massively from the procedure.

From speaking to Mr Aquilina, I know that he has now set up a multidisciplinary team at Frenchay hospital to evaluate and select children for SDR. This team consists of a number of people—a paediatric physiotherapist with special expertise in cerebral palsy, a paediatric neurosurgeon, a paediatric orthopaedic surgeon and a paediatric neurologist. Mr Aquilina tells me:

“Children over four years of age, with a diagnosis of spastic diplegia following premature birth, should be considered for SDR. Children with typical spastic diplegia, whether born prematurely or at term, should also be considered. These children tend to have delayed motor development and spasticity interferes with their progress.”

I am also aware that another surgeon, Mr John Godden, from Leeds has been out to St Louis to learn about the procedure and is ready to undertake his first operation.

One of the common causes of cerebral palsy is premature birth and there is now extensive evidence, recognised by NICE, that demonstrates the value of SDR for these children. The NICE guidelines for SDR were issued in December 2010 and concluded:

“The evidence on efficacy is adequate. Therefore this procedure may be used provided that normal arrangements are in place for clinical governance and audit.”

But a more recent guideline focused on the lack of long-term studies of outcome and changed the first NICE guidelines, recommending that SDR be done in the context of clinical research. The problem with that is that a long-term study for, say, 10 or 20 years after surgery, costs an awful lot of money, and because no long-term study has been done on any of the non-surgical and surgical treatments currently employed here in the UK, following that rationale to its logical conclusion would mean that this successful proven treatment for cerebral palsy cannot be covered by the NHS for years.