NHS Funding (Ageing)

Debate between Thérèse Coffey and Dan Poulter

Tuesday 25th March 2014 Westminster Hall

[Dr Poulter]

If that was the case—I may have missed it—my hon. Friend has made an important clarification. It is important that we have a formula that is as far as possible beyond reproach and set according to clinical need—the needs of patients. It is important that a number of factors be taken into account when that formula is put in place, as has been articulated clearly by NHS England in the discussions about how the formula is set. Deprivation is a factor. It is important to note that one of the primary drivers for setting the funding formula is now age and the needs of an ageing population. That is an important factor to highlight in this debate.

I shall now deal with some of the points made by my hon. Friend the Member for Suffolk Coastal. She may be aware NHS England has undertaken a fundamental review of its approach to allocations, drawing on the expert advice of ACRA and other external groups. The review’s findings have resulted in a new formula that provides a more accurate model of health care need. Last December, NHS England published the allocations for 2014-15 and 2015-16, based on the new formula. That gives CCGs two years of certainty about what their funding allocation is, which we can all welcome.

I know that my hon. Friend is very busy and may not have had the time or opportunity to review in detail during the past three months the information relating to the new formula, but I hope I can reassure her on the direction of travel. The formula is putting us much more on the trajectory she wants to see. It is independently set and therefore has a lot of clinical merit.

[Dr Coffey]

Will the Minister also recognise that the concept of unmet need was reintroduced in a more significant way than previously, and that that does not necessarily help where we know there are elderly populations with specific conditions that need treating?

[Dr Poulter]

It may be helpful if I outline the way the new formula works and how some of the weighting has changed, which will help to address the point my hon. Friend has just made and shed more light on the direction of travel that is under way.

The new formula uses a new indicator to recognise how health inequality should be reflected, which is based on the standardised mortality rate for those aged under 75. Previously, adjustment has been made on the basis of a measure of disability-free life expectancy. The new indicator is technically better, in that it can pick up pockets of deprivation within more affluent areas. The formula focuses much more on real population need, rather than taking a blanket approach across the population.

The new formula moves to the more powerful method of using individual rather than small area utilisation data—this is fundamental to the formula—to derive estimates of need. The main factors in the model are age, gender and 150 morbidity measures from the diagnoses of admissions to hospitals. That picks up on the point that my hon. Friend just raised. The formula looks at the pressure of long-term illness. Those 150 morbidity measures will pick that up. The increased need for health care in deprived areas is captured in the base formula by directly taking account of much of the increased need in deprived groups. In addition, further adjustments are made for factors such as the claimant rate for key benefits. That ensures that the model captures increased need that is linked to deprivation but is not linked to earlier utilisation of hospital services.

The new formula reflects more up-to-date data on population growth and measures population based on registered GP lists, rather than population projections based on the census. I am sure we can all recognise that where there has been growth in a population or changes are happening at local level, basing the formula on up-to-date GP lists is a much more accurate way of reflecting the health care needs of the local population than basing it on a 10-yearly census.

The new formula also reflects the responsibilities of CCGs rather than PCTs, as my hon. Friend outlined in her contribution. CCGs are not responsible for specialist services or primary care, although of course NHS England is now also taking over responsibility for the GP contract, as she will be aware. As a consequence, it is important to stress that the new formula for allocating funds to CCGs follows the advice provided by ACRA. A strong element of the allocation is focused on age. The primacy of age, an ageing population and the needs of older patients are very much built in, as are the needs of patients with long-term conditions. There is still a strong weighting for deprivation.

Oral Answers to Questions

Debate between Thérèse Coffey and Dan Poulter

Tuesday 26th February 2013 Commons Chamber

[Dr Poulter]

I know that the hon. Lady had tabled a question on this matter. The point is that a foundation trust has autonomy and cannot be coerced or forced into a merger. It is for the board of that trust to make decisions for the benefit of patients.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

T8. Patients in Suffolk are very worried about the performance of the ambulance service. In the past two months, less than 60% of ambulances have hit the target for reaching emergency cases. The strategic health authority and others, including all the MPs in the region, are not happy about that. Will the Government intervene, too?

Oral Answers to Questions

Debate between Thérèse Coffey and Dan Poulter

Tuesday 27th November 2012 Commons Chamber

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), is my constituency neighbour. He will know that, although the East of England Ambulance trust is hitting its targets for the entire region, it is not helping in Suffolk. Will he advise on what more we can do locally to ensure that it serves all rural patients?

[Dr Poulter]

The problem has affected both Suffolk and Norfolk—the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), also takes an active interest in it. One problem was that the managers of the local ambulance trust were not listening to front-line staff on how to design and deliver services. In a staff survey, only 4% of front-line staff in the East of England Ambulance Service said they were being properly listened to, which is completely unacceptable. This Government, in contrast to the previous one, want to put front-line professionals in charge of running services, meaning that, in future, more patients will be properly prioritised and ambulance response times will be better met.

Firearms Control

Debate between Thérèse Coffey and Dan Poulter

Monday 20th December 2010 Commons Chamber

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

The events earlier this year in which two gunmen took the lives of 13 other people using shotguns were deeply tragic. The public interest in the two cases and the questions asked about the efficacy of our gun laws are certainly understandable, and I therefore welcome this debate. I also welcome the publication of the Home Affairs Committee’s report, although I cannot say that I agree with all its recommendations.

Seneca the younger once said,

“quemadmodum gladius neminem occidit, occidentis telum est”

or

“a sword never kills anybody, it is merely a tool in the killer’s hand”.

Almost 2,000 years later, the satirical Welsh rap group Goldie Lookin’ Chain brought the message up to date with their 2004 hit “Guns don’t kill people, rappers do”—and Chris Moyles took it even further with, “Guns don’t kill people, rabbits do”. Please be assured that I do not highlight the lyric as a slur on the rapping community, but rather in support of the message of the song, which is that each holder of a gun is responsible for its mode of use.

In this country, by and large, we have not historically seen widespread gun ownership, or indeed gun crime. As is the case under the American constitution, we originally had the right to bear arms, but that right was overturned by the Firearms Act 1920. Unlike our American cousins, however, the public have shown little appetite for domestic gun ownership—long may that continue—other than for use as a countryside management tool or among interest groups who use firearms in their leisure and sporting time.

My hon. Friend the Member for Bournemouth East (Mr Ellwood) has already mentioned page 10 of the report and the disproportionate focus on those who legally hold firearms as opposed to those who hold them illegally. In paragraph 12, on page 58, the Committee refers to the fact that there is no evidence of

“an increase in misuse of lethal firearms”

since the last review of holding the licence renewal period at five years rather than two. I am not suggesting that there has been a knee-jerk reaction, but that shows that we need to continue to be measured. I am delighted that my right hon. Friend the Minister said that he would do that.

Firearm control has been considered repeatedly for more than 100 years. The Pistols Act 1903 regulated the sale of pistols and later Acts placed conditions on the ownership of firearms—such as the need to apply for a certificate to own a firearm or shotgun. The Firearms Act 1968 forms the basis for our gun laws and has been amended 34 times since then, creating the confusing and complex system to which the Committee referred.

Shotguns were used by both Moat and Bird, the perpetrators of the crimes that took place earlier this year, and the latter was licensed to own his. Incidentally, in an interview given to the BBC, one of Bird’s victims who survived the incident, himself a shotgun owner, described the current gun laws as “rigorous”, an opinion shared by the independent inquiry into the incident. My right hon. Friend the Prime Minister also said:

“You can’t legislate to stop a switch flicking in someone’s head”.

Perhaps he, too, had been listening to Goldie Lookin’ Chain, but he was absolutely right. It appears—this seems to be the general consensus among those involved in the case—that no rule, regulation or more fierce application of the current processes would necessarily have prevented the tragedy.

It should be remembered that, although we share with many of our neighbours in Europe and the Commonwealth a comparatively low rate of gun homicide, we also have some of the most stringent gun laws in the world. A balance must be struck between legitimate use and safeguarding the public. I am not convinced that ever tighter regulation is likely to prevent each and every death caused by firearms, whether intentional or accidental, but it could prevent law-abiding, responsible citizens from using firearms in a legitimate, socially acceptable manner.

This morning the Home Affairs Committee released its report on firearms control. I agree with its conclusion that the legal construct of the various laws is rather complex and confusing. It recommends codification and simplification of the law, so that firearms owners and the police are clear about the circumstances of ownership and responsibilities. I welcome the proposals to try to simplify the law. I also welcome the potential inquiry into creating a single licensing system for section 1 firearms and shotguns.

In considering the role of GPs in the issuing of licences, I am not suggesting that simplification should be used as an excuse further to tighten already stringent regulation. The move to involve GPs in the process of awarding firearms certificates seems to be little more—dare I say it—than an exercise in bureaucracy. As my hon. Friend the Member for Hendon (Mr Offord) has said, there is strong evidence to suggest that one cannot necessarily predict somebody’s future capacity in terms of owning a firearm.

Firearms are used in 6% of homicides, and known licensed firearms are used in 0.6% of homicides, so the move to include GPs is quite interesting. The idea of tagging medical records has already been described as potentially draconian, particularly in the light of fears about the security of NHS medical records. I join the Committee in dismissing calls for mandatory medical checks, because we cannot look into the future, and because of the guidance that has been given, which I thought was stronger than that. I thought that GPs were already obliged to notify the police of people in their practices who are potential threats to the community. As the hon. Member for Kingston upon Hull North (Diana Johnson) said, there was no suggestion that Mr Bird had recently seen his GP, and there were only six people in a year with whom such checks by a GP might have had an effect.

Let me turn now to employment in the sector. If we choose to go down the route of investigating a simplification of the law, it is imperative that any changes proposed have at their heart ring-fencing the rights of legitimate users, as those people play an important economic and social part in our communities. In September 2004, a report was undertaken on behalf of the British Association for Shooting and Conservation, the Country Land and Business Association and the Countryside Alliance in association with the Game Conservancy Trust, entitled “The Economic and Environmental Impact of Sporting Shooting”. It found that some 70,000 people are employed by the sport shooting industry, and in my area, the east of England, £140 million was brought into the economy through the sport. Indeed, seven constituents wrote to me about this matter and told me how they wanted to be able to continue shooting, seeing it as valuable as pest control and also as a sport that they enjoy.

Nationwide, shooting is worth a total of £1.6 billion. That does not take into account other forms of shooting such as shooting in gun clubs, which are also popular and serve a social as well as an economic purpose. Felixstowe rifle club, for example, was first formed in 1900. More than 100 years later, it is still going strong and has formed links with a number of local charities and local schools. It offers lessons to a number of local children as part of the Duke of Edinburgh award, and is one of only a few clubs in the country that caters for blind shooters, which is interesting.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I am sure that my hon. Friend is aware that Suffolk has the lowest recorded level of gun crime in the United Kingdom. Does she agree that that is in spite of the fact that we have 97,000 licences for shotguns and firearms in the east of England, which suggests that the focus should be on dealing with unlicensed shotguns rather than licensed guns?

[Dr Coffey]

I could not agree more strongly with my hon. Friend and neighbour. That message is reinforced not only by my constituents who have contacted me but by patrons of my local, who are all regular shooters and wish not to be demonised for being so.

Felixstowe rifle club is one of many that had to adapt to the 1997 ban on handguns, which seems to have put an end to the sport of pistol shooting but done little to prevent the use of handguns in crime. Although legitimate handgun owners have given up their weapons, criminals show no sign of abating their use of them: in 1980 handguns were used in 529 robberies, and by 2008 the number had risen to 2,565 cases—down from a peak of 3,544 cases in 1992. In 2008 handguns were involved in 28 of the 39 firearms-related homicides that year—almost three quarters of all murders perpetrated using a gun. In contrast, only seven involved a shotgun and three a rifle. Rather than spending our time and energies picking off legitimate owners as easy targets—I include young people in that—we should be grappling with the more difficult, but much more important, question of how to tackle the criminal fraternity on the illegitimate use and manufacture of guns.

Young people have been mentioned, and although there is no connection with the recent incidents I take this opportunity to remind the House that 10 years ago the Government of the time said there should be no ban, and no minimum age for the issuing of licences, because supervised shooting is an important way of encouraging young people to use weapons appropriately.

The use of illegal handguns in our inner cities to commit crimes, including murder, has gone relatively unreported by the media, who seem happy to focus more on anomalous cases than on the real problem at hand. Some 55% of all firearm offences occur in just three police areas—the Metropolitan, Greater Manchester and West Midlands areas—and many involve handguns. Given that those weapons are already illegal, I reiterate that we should not legislate further to ensure tighter control of weapons but should ask ourselves, as has been mentioned in relation to air rifles, how we can better enforce current laws.

I hope that the planned introduction of a dedicated border police force will bring material results in reducing the smuggling of illegal weapons into England. I understand that there is a problem with the smuggling of illegal weapons, particularly from eastern Europe, but we also need to tackle the illegitimate use of guns already on our shores and the ability of criminals to manufacture guns by adapting decommissioned or other guns. This, in all likelihood, requires not the introduction of new laws or regulations but a range of measures and enforcement by the police.

With gun and knife amnesties our police forces have done good work in attempting to clear those weapons from our streets and take them out of the hands of youngsters who feel that they need to carry a knife to feel safe. Amnesties have taken place across the country and should continue; indeed, I call on people in my constituency and elsewhere who hold a gun in their house to ask themselves whether they still need it. However, it is equally important to look into the causes of gun crimes. What makes somebody pick up a gun or a knife before they leave the house, and what can we do to persuade them that they do not need to purchase an illegal weapon, let alone use it?

It seems to be an increasing feature of gang culture to use or brandish a firearm or to kill somebody with one as a way of going up the respect agenda. We need to cut that out of our culture, and I welcome some of the work that has been done on that.