Health Care (North Yorkshire and York)

Debate between Paul Burstow and Nigel Adams

Wednesday 1st December 2010 Westminster Hall

[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.