Health Care (North Yorkshire and York)

Nigel Adams Excerpts

Wednesday 1st December 2010 Westminster Hall

[Julian Sturdy]

Absolutely. I agree entirely with my hon. Friend. The time limit given by the PCT to those voluntary organisations is despicable, and it has caused fear and concern in the sector. Not only that, if the organisations lose funding for six months, which might be seen as only a short period, the problem is that they might not start up again. That is my concern, and I will go on to discuss it in more detail.

Local residents have good reasons to believe that a huge range of treatments will be withdrawn, as I said. If the truth be told, the status quo is not only unacceptable but frightening, particularly for the most vulnerable members of our communities. Even describing the current situation as a postcode lottery is too generous. I fear that our patch is in danger of becoming an area of health deprivation.

Several different factors require deep consideration as we piece together this somewhat depressing picture. First, we must accept that the region has to some extent been underfunded in the past. Before 2008, the North Yorkshire and York PCT did not exist. Instead, four separate PCTs covered the area. Nevertheless, for the purposes of this debate, I have amalgamated funding data to show the PCT’s current funding allocation and the annual figures stretching back to 2003-04. For 2010-11, our region’s PCT received just over £1.1 billion, an allocation that places it in the lowly position of 140th out of 152 PCTs. From a starting point of 127th in 2003-04, it has dropped down the funding table each year. The current funding level is the lowest allocation per head of all Yorkshire and Humber PCTs.

PCT funding is currently allocated according to a complex funding formula, often referred to as the weighted capitation formula. In essence, the formula determines the target share of resources to which PCTs should theoretically be entitled, based on a broad range of criteria including population, the local cost of health care provision and the level of need and health inequality in the area. Unfortunately, most PCTs never receive an allocation equal to their deemed target share according to the formula. Rather, they move towards it over time, some faster than others.

Personally, I am slightly critical of the current formula. It often results in greater funding disparities between different regions, which provoke a profound sense of unfairness. Less deprived areas often seem to get a certain tag as well. For example, according to the formula, North Yorkshire and York does not have adequate need for additional resources, particularly compared to the needs of more urban areas such as Hull. I am not convinced that approaching regional health funding consideration with that mentality—judging whether areas are deprived enough—is a sufficiently robust methodology in current circumstances. We must look more deeply at the funding stream.

I agree that the funding shortfall has increased the strain on our local PCT and its ability to deliver the best possible health outcomes and equity access for local residents. I would appreciate the Minister’s comments on whether the coalition Government will review the funding formula at some future date. However, I also suggest that excusing our health care failings in our region on past funding alone would be somewhat naive. Over the past few years, North Yorkshire and York PCT has accumulated an overspend of some £17.9 million. Thus, despite the coalition’s welcome commitment to protect the wider health budget, services are being cut in our region to pay for the fiscal irresponsibility of the PCT. Moreover, the PCT seems to be intent on resolving this deficit immediately because the previous Government imposed a statutory obligation on all primary care trusts to break even by the beginning of 2011. Such a target-focused piece of bureaucracy has now resulted in the PCT cutting too many services too quickly, possibly leading to a diminished health care package for our local residents.

I have already listed some of the services that are under threat of withdrawal. My hon. Friend the Member for Skipton and Ripon (Julian Smith) has named the services in the voluntary sector as well. I shall expand on a few examples. First, there is the withdrawal of the pain relief injections. As Members from neighbouring constituencies know—my hon. Friend the Member for Selby and Ainsty (Nigel Adams) has campaigned with me on this—the PCT’s decision to restrict the provision of back pain relief injections has provoked a huge reaction from both patients and health care professionals alike.

[Nigel Adams (Selby and Ainsty) (Con)]

I, too, congratulate my hon. Friend on securing this debate. I am not sure whether I should declare an interest, having received several back pain relief injections in the past. The injections are a big issue in the north Yorkshire area, as evidenced by the huge postbags that my hon. Friend and I receive, and we have spoken to the Secretary of State on the matter. Can my hon. Friend recall a discussion with the Secretary of State in which he said that one of his officials would look into the York PCT’s interpretation of the NICE guidelines on back pain relief injections? Has he received any notification of those discussions or heard from the Secretary of State’s office?

[Julian Sturdy]

My hon. Friend makes a valid point. We did indeed meet, and I have not yet received a response from the Secretary of State. I hope that the Minister will hear our message here and chase up that response, because it is important that we get an answer to our question.

My hon. Friend mentioned the back pain relief injections, and the issue is causing real concern among our constituents. Members of the public came to my last surgery to discuss the matter. The PCT, as my hon. Friend said, based its decision to cut back pain injections on its interpretation of the NICE guidelines. Unfortunately, almost every other PCT interprets the same guidelines in a different way. As such, countless local people are being forced to suffer enormous and unnecessary pain.

Alongside other hon. Members from the region, I have lobbied the Secretary of State. Campaign groups such as York and District Pain Management Support Group have been leading the way on this as well. I have also received representations from concerned health professionals. Only last week, Dr Peter Toomey, a consultant anaesthetist at York hospital wrote to me, stating:

“I consider that the PCT have made serious errors of judgement in coming to their decision to restrict access to spinal injections for the relief of pain. The PCT will not reimburse York Hospital for any injection into any part of the spine for any diagnosis unless it has been approved by the PCT’s Funding Request Panel.”

We know—my hon. Friend the Member for Selby and Ainsty will back me up on this—that many people are being refused by that request panel. Dr Toomey and a number of his colleagues have fought hard to challenge the PCT’s policy, but—alas—their medical expertise seems to have fallen upon deaf ears.

Patients and medical professionals are united in the view that this pain relief service should not have been withdrawn. It has been taken away for the wrong reasons and should be reinstated without delay. The withdrawal of such vital services is causing me great concern, as is the withdrawal of funding for numerous voluntary services. My hon. Friend the Member for Skipton and Ripon touched on that matter earlier. The York Council for Voluntary Service has been informed of a 37% in-year cut, which has been issued by the PCT with just one month’s notice. Angela Harrison, the chief executive of the YCVS, summed up the whole situation quite aptly when she said:

“These cuts have already had a disastrous effect on front-line voluntary groups who serve some of the most vulnerable members of society. At the same time, the infrastructure groups who support them have had their funds withdrawn at very short notice, reducing their capacity at a time when it is most needed.”

One specific voluntary case vividly highlights the poor management of the way the PCT has handled this situation. On 19 October, Yorkshire MESMAC received a letter from the PCT, informing the organisation that its contracted health care funding was to be withdrawn within one month. Such blunt and definitive notice is absolutely outrageous. Not only has an agreement been broken, but no consultation took place with the organisation, which—knowing the PCT’s overspend—would have been happy to sit down and reach a more amicable agreement. As Tom Doyle, the director of Yorkshire MESMAC, said:

“I want to express my deep frustration at how the process has been handled, which was, in my opinion, unlawful, disrespectful and showing an arrogant disregard for the PCT’s own agreements and processes.”

It is now feared that Yorkshire MESMAC will be forced to close.

On a wider note, the voluntary services budgets are expected to lead to a saving of some £150,000 for the PCT this year. Given that that is a small drop in the £17 million overspend, I would urge the PCT to look internally for structural and efficiency savings, rather than merely reducing the funding of voluntary groups, whose work often plays such as vital role in our health service. If our voluntary health services are forced to close, I predict that far greater numbers of patients will actually require more hospitalised, long-term and expensive treatments through the NHS, thus undermining the PCT’s initial savings.

Due to the overspend and service reductions, there now exists a lack of trust in the PCT and a complete absence of confidence over its future intentions, and I fear that local people are simply paying too high a price for that. In the long term, I am more optimistic about health care provision in north Yorkshire and York, largely due to the contents of the health White Paper. The localised drive to ensure that PCTs are, at some point, abolished altogether and replaced by GP-led commissioning bodies, which are influenced by local patients, is a measure that I wholeheartedly welcome.

At long last, local patients will have a say in their local services, holding the decision makers to account and freeing up our nurses, doctors and health providers from the red-tape that so often binds them and takes them away from the front line. I hope that the Minister can reassure me that the transition from PCTs to GP-led commissioning will be carried out swiftly to ensure that the interim transitional period will not see a lack of leadership or direction for local health care services—especially in our area.

I believe that the PCT will continue to operate until 2013, and I plead with the Minister to review to the situation in north Yorkshire and York in the meantime. Our constituents simply cannot afford to wait three years for the situation to be remedied. Most specifically, I would welcome any comments from the Minister on the previous Government’s imposition of a statutory obligation on PCTs to break even by the end of this year. Could that deadline be extended to soften the blow of the cuts over a greater time period?

The people of north Yorkshire and York depend upon their health care services, and many are extremely worried at present. I hope that hon. Members from the region—I was going to say “regardless of political allegiances”, but as we only have coalition Members here I will not say that. To give the hon. Member for York Central (Hugh Bayley) credit, he did say that he would try to be at the debate today.

We must protect the essential health care services and funding that our region deserves. I ask and urge hon. Members to fight and to campaign for that. We must ensure that, before GP-led commissioning starts, the PCT delivers the best service that it can within its budget. It must focus on service delivery and the outlying services to our communities, rather than cutting.

I hope that the Minister will give serious consideration to the issues that I have raised. I am grateful for his time. I know that it has been a hectic day thanks to the Divisions, but I am grateful to him for giving us the time, and I hope that he will give the matter serious consideration.

--- Later in debate ---

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

I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing this debate, and I note the cross-party support that he has gained, with the arrival of the hon. Member for York Central (Hugh Bayley). I note the presence of my hon. Friends the Members for Skipton and Ripon (Julian Smith), for Selby and Ainsty (Nigel Adams) and for Scarborough and Whitby (Robert Goodwill), and I know that they are all interested in and concerned about the issues that my hon. Friend the Member for York Outer has raised. He has made a powerful case for why we need the radical reforms across the NHS to which the Government are committed.

Before I turn to the points that my hon. Friend has raised, I join him in praising the work of NHS staff across Yorkshire. They do an excellent job, often in the most trying circumstances, and he is right that the NHS is a national treasure. Our White Paper reforms are, first and foremost, about freeing those hard-working professionals from the bureaucracy that stands in the way of good patient care.

We will be cutting management costs by a third, moving decisions closer to patients through new GP consortiums and giving local councils more responsibility for the health of their communities. All those will help to create a more flexible, efficient, interconnected and accountable health service.

We are now entering a transition to the new system, which brings its own challenges for all parts of the NHS. The descriptions that my hon. Friend has given of circumstances in his constituency demonstrate the challenge that is exacerbated by the fragile state of the local NHS finances. The Government have inherited that fragility and they will have to address it.

I understand from the strategic health authority that the North Yorkshire and York PCT is likely to end the year with a significant deficit unless it takes drastic action of the sort that my hon. Friend has described, and to which others have referred in this debate. That process clearly involves some tough decisions, which will have a distressing impact on his constituents, and I will return to those in a moment. I want to answer his concerns about funding allocations for the NHS in that part of the country.

At present, as my hon. Friend has described, the NHS uses a funding formula based on objectives set by the previous Government and developed by the independent Advisory Committee on Resource Allocation. I know that one of the big frustrations for North Yorkshire is whether its rural nature is taken fully into account in the funding formula, and my hon. Friend has alluded to that. As a Government, we have asked for that formula to be examined. The Secretary of State has asked ACRA to review how NHS resources are distributed, and has explicitly requested that consideration be given to the issues that face rural communities.

Looking ahead, from 2013-14 we will have moved to the new system of the independent NHS commissioning board allocating resources to general practice consortiums. How it does that will be up to the commissioning board itself, but we are clear that it must do it fairly and consistently across the country. For places such as his constituency, my hon. Friend the Member for York Outer is right—real pace and purpose are vital to getting the NHS on to a more stable financial footing. I can assure him that we are keen to make fast progress on GP commissioning consortiums taking on responsibilities. In that regard, shadow allocations for GP consortiums will be published late next year for 2012-13, giving the new organisations the time and space to test financial plans before the full system goes live in 2013-14.

My hon. Friend asked whether GP consortiums would have to take on PCT debt. I have heard that anxiety expressed around the country. The NHS operating framework, which we will publish in a few weeks, will set out the rules on legacy debt to ensure that no debts carry forward into the new system. That is challenging, and we are keen to work through it effectively.

I shall now come back to the present and say a few words about the current financial position in North Yorkshire and York. The strategic health authority tells me that the local PCT has had a problematic financial history stretching back many years, which may be an understatement. [Interruption.] I can see colleagues nodding.

Over the past 12 months, its situation has deteriorated due to a number of factors, including a significant overspend on community services and the fact that its QIPP—quality, innovation, productivity and prevention—programme has not delivered the expected savings. As a result, the trust is having to take radical steps to put its finances in order, including temporary reductions to some non-urgent health services. I very much regret that.

I regret that the fragility of the organisation has placed my hon. Friend the Member for York Outer’s constituents in a position where they face these service changes. I hope he will understand that it is not for me to give a running commentary on every aspect of what the PCT is doing. On the issues that he highlights—particularly about the QIPP programme implementation, which I have looked at carefully—there are lessons for how we ensure that we get a proper grip on financial management in local NHS organisations.

It is striking, for instance, that the neighbouring PCTs with similar populations to North Yorkshire and York’s are not facing the same financial challenge, nor are they having to resort to the desperate actions that the trust is taking. My hon. Friend is right to say that the trust should not seek excuses in how the funding formula works. None the less, we need to look at the formula.

Equally, it is important to bear in mind that the QIPP programme in North Yorkshire and York has not delivered. I understand that it set some ambitious and challenging plans; the problem was that the implementation has not been as robust as the plans. I understand that one issue appears to be a failure to bring on board the full range of stakeholders to deliver on the improvement plans. That is a significant failing, because where the PCT is doing that, the signs are extremely positive. For instance, local GPs are working with the trust on prescribing practices—together they are looking to cut costs by more than £1 million, while protecting quality and service. I highlight that because it shows the power of GPs in managing efficiencies, and is a sign of how our reforms will help in the future.

Perhaps most troubling of all is the fact that the PCT has slammed the brakes on funding for the voluntary sector in a way that may have serious consequences for the future. The PCT may, technically, be within its rights to give the minimum of notice to providers, but pulling the plug on small organisations with just a month’s notice—or in some cases, less—is alien to the spirit of collaboration and partnership that we want the NHS to cultivate. As my hon. Friend the Member for Skipton and Ripon said, it seems to be against the notion of the compact.

There is an important general point here. As we move through transition there will be difficult choices, and the NHS needs to be clear about what it needs to protect and how best to maintain vital voluntary community services. Therefore, in response to this debate, I have asked the NHS chief executive, Sir David Nicholson, to consider how to ensure that local NHS organisations act responsibly towards voluntary sector organisations during any period of retrenchment. My hon. Friend is right: we need candour and early discussions. about where the cost pressures are in the system, because, given the opportunity, the voluntary sector can contribute to managing them.

Reference has been made to the issues of pain relief injections and of treating chronic back pain. The hon. Member for Selby and Ainsty (Nigel Adams) asked a question about the discussions that he has had with the Secretary of State, as did the hon. Gentleman who secured this debate. I am not cited in regard to those discussions, but I will undertake to ensure that we look very carefully at the issue and come back to both hon. Members who raised it, to satisfy them and ourselves that NICE guidance is being followed properly.

However, I believe that the PCT understands that its decision has affected a significant number of patients with chronic back pain, and that it has written to a number of those patients, commissioned a series of initiative clinics where patients are fully assessed and given new treatment options to manage their pain.

[Nigel Adams]

Just on that point, it is worth remarking that the reason given by the PCT for the withdrawal of the procedure is not a financial one, which is very difficult for colleagues to comprehend. Apparently, it is based on medical advice via the NICE guidelines, but the PCT seems to be the only one in the country that has adopted that stance. Does the Minister agree that that sort of logic is a perfect reason why our reforms must come through in terms of GP commissioning, so that decisions can be made by health professionals rather than bureaucrats?

[Paul Burstow]

There is no doubt in my mind that getting clinicians far more engaged in commissioning will be a key driver to a significant improvement in quality and outcomes in the system in future. I certainly undertake to ensure that we have a proper look at this issue of the guidance, and I will come back to both the hon. Gentleman and his hon. Friend, the hon. Member for York Outer, on that point.

I certainly share the belief that those reforms are needed to ensure that the NHS in north Yorkshire, and Yorkshire in general, moves in the positive direction that we all want to see it move in. Our proposals will bring the right leadership and purpose to sustain and improve the services that the constituents of the hon. Member for York Outer, and those of the other hon. Members who have come to support him in this debate, expect the NHS to deliver.

Decisions that are made much closer to the patient will ensure that health care is shaped in the best interests of the community and the general population. By introducing greater transparency and democratic accountability, we will ensure that the local NHS is far more answerable to the people whom it serves and that there will be much more scrutiny and community involvement in the decisions that it takes.

That is something that I am sure all hon. Members want to see. It is how we can move our NHS forward, maintaining it as a national treasure but one that really delivers the best possible outcomes—outcomes that are among the best in the world. That is what we really want to see.

Question put and agreed to.