Health and Social Care

Debate between Sarah Wollaston and Andrew Murrison

Monday 27th February 2017 Commons Chamber

[Dr Wollaston]

I thank the hon. Gentleman for making that point, although I think we should use the term “delayed discharges” rather than “bed-blocking”, because the latter can make older people who are in that position feel as if somehow they might be to blame. Nevertheless, I take his point.

The estimates memorandum seeks a transfer from the capital departmental expenditure limit of £1.2 billion to prop up revenue. It also seeks a £23 million transfer from Her Majesty’s Treasury reserve, a £58.5 million transfer from other Government Departments, and a £6 million transfer to capital from other Departments. Again, we see an unsustainable position, as pointed out by the Comptroller and Auditor General.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I am following closely my hon. Friend’s remarks, which are, as ever, wise. Does she share my concern that if we are to transfer money from capital to revenue, the sustainability and transformation plans, most of which imply a certain level of capital investment in order to save revenue in the long term, will not be possible?

[Dr Wollaston]

I absolutely agree with my hon. Friend and will discuss that later.

The point about the raids on capital budgets over the years—this is the third year in which we have seen transfers from capital to revenue budgets—is that we are talking about the money required to keep facilities up-to-date, and for essential repairs and the roll-out of new technologies. Putting off such repairs and investments means they cost more down the line, so it is a false economy. It is simply an unsustainable ongoing mechanism. The Department of Health has indicated that it would like to see an end to the practice by 2020, but both the Public Accounts Committee and the Health Committee have called for it to be stopped immediately because we feel it is, as I say, a false economy. As my hon. Friend the Member for South West Wiltshire (Dr Murrison) pointed out, it is about raids not only on capital budgets, but on the sustainability and transformation fund. It is increasingly becoming all about propping up the sustainability part rather than putting in place the essential transformation.

NHS Sustainability and Transformation Plans

Debate between Sarah Wollaston and Andrew Murrison

Wednesday 14th September 2016 Commons Chamber

[Dr Wollaston]

I thank my hon. Friend for that invitation. In fact, I have visited the Community Hospitals Association on many occasions, to hear from community hospitals around the country. I will continue to do so and I commend them for the valuable role that they play.

[Dr Murrison]

Does my hon. Friend agree that community hospitals can also keep the bean counters happy? If they get the case mix right, it is much more affordable to treat people in community hospital beds than in an acute unit, which is extraordinarily costly. Furthermore, that would clearly give patients what they would like, which is care close to their homes, as my constituents in Warminster—we still have community hospital beds—will attest. I know that my hon. Friend the Member for North Dorset (Simon Hoare) would say the same for Shaftesbury.

[Dr Wollaston]

Members on both sides of the House are aware of how valuable and important community hospitals are to our constituents. Taking that a step further, I would say that the best bed for any patient is their own bed, provided that they can be given the right package of care close to home. We know that there are many people even in community hospital beds who do not need to be there. They are there for want of the right social care package that could enable them to be at home.

In welcoming STPs, we should be realistic about the financial challenge that they also face and the costs sometimes of providing those services. That is a huge challenge for them. In my area alone the STP is facing a £572 million shortfall by 2021 if no action is taken. I can understand why, for example, it will look at the relative cost of providing care to people in acute hospitals, in community hospitals and at home, and make an argument that sounds very reasonable about how a larger number of people could be much better cared for at home.

I return to the point that the hon. Member for Central Ayrshire (Dr Whitford) made. Access to the transformation part of the sustainability and transformation plans is necessary to be able to put those services in place and very often to build the infrastructure that we need. For example, in Dartmouth in my area, the possibility of providing more care closer to home within a community hub will require the up-front funds to build a new centre that allows the workforce to be developed and more services to be provided closer to home. Unfortunately, what we often see is the closure of a much loved facility without the new service in place.

As the sustainability and transformation plans progress, I would like to see a genuine focus on the opportunities to provide more care closer to home. I fear that we will miss that opportunity because, as we have heard, £1.8 billion of the £2.1 billion sustainability and transformation fund is going towards the sustainability bit, for which read “plugging provider deficits”, and only £300 million is left nationally to put in place all these plans.

We know also that part of the way that the Government have managed to fulfil their promise to NHS England in respect of the funding that it asked for has been by taking funding out of capital budgets because those are essentially flat cash, and also by taking money out of Health Education England budgets and public health budgets. It concerns me that many of the principles behind the sustainability and transformation plans are put at risk by other parts of the system being squeezed. We have heard the point about prevention. Central to the achievements of the sustainability and transformation plans is the prevention piece—the public health piece. It is a great shame that public health budgets have been squeezed, limiting the ability of those aims to be achieved.

I know that many Members wish to speak so I shall move on and make some asks of the Minister, if I may. There is more that the Government can do. We on the Health Committee were very disappointed that none of the witnesses who came before us from NHS England, NHS Improvement or the Department of Health was able to set out the impact of cuts to social care on health planning. We need to do much better at quantifying the cost to the NHS of cuts to the social care budget.

The Minister needs to take the long view on prevention and help the service by implementing policies that could help local authorities to make changes. For example, I suggest making health a material consideration in planning and licensing, in order to provide the levers to make a difference. We need a much greater focus on workforce, because the STPs cannot achieve their aims if the workforce to achieve them is not in place. Finally, will the Minister kindly visit my area to look at the proposals in the sustainability and transformation plans in south Devon, and at the opportunities and how we would achieve them?

European Union Referendum Bill

Debate between Sarah Wollaston and Andrew Murrison

Thursday 18th June 2015 Commons Chamber

[Dr Wollaston]

There will always be inconsistencies. We will never get complete consistency on the threshold issues; we will continue to have different thresholds for different things, and the points at which we choose cut-offs tend to be around 16 and 18. I am comfortable with that. The issue is whether we feel as a Committee and as parliamentarians that we should look those 16 and 17-year-olds in the eye and say to them on an issue that will have far-reaching implications for their future that although they have the capacity to make decisions, we are going to deny them the vote and kick it into the long grass.

If we are honest, there are other political reasons at stake, and we should be honest about them. We should give young people a voice and the vote in this referendum and then let us have the other discussions. As I say, I will make the same arguments about the wider general election franchise, but I feel that the case for this particular referendum is compelling. I can see no reason why we would not want to give young people a vote on this extremely important issue, which will affect them for far longer than it will affect me.

[Dr Murrison]

I am always keen to follow what my hon. Friend has to say and the thoughtful way in which she makes her case. Does she agree that this is indeed all to do with maturity, and that the reason why we protect children concerns their level of maturity and the need for society to make sure that they are okay? The same argument can be deployed for the age of enfranchisement. We need to define what we mean by a child and what we mean by an adult. The argument about enfranchisement is really a supplementary and consequential argument, depending very much on the age we have determined.

[Dr Wollaston]

I thank my hon. Friend for his intervention, but I feel that this is the right age to have the opportunity. Do I think that 16-year-olds have the capacity to make decisions and weigh all the arguments in the balance in this referendum vote? Absolutely. I cannot believe how I could walk into classrooms to meet 16 and 17-year-olds, look them in the eye and say, “Actually, I do not believe that you have the capacity to understand and make a case.”