NHS Funding (North-East and Teesside)

Tom Blenkinsop Excerpts

Tuesday 5th November 2013 Westminster Hall

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

This is an important opportunity to discuss concerns that my north-east colleagues and I have. I hope that the Minister takes our points on board, and takes the necessary steps to rectify the issues in the region’s health service.

I will discuss four topics this afternoon. The first is the funding provided by central Government to the region’s accident and emergency departments, particularly in the south Tees area. The second is the funding of the North East Ambulance Service NHS Foundation Trust, and the rising use and cost of private ambulances. The third is the ongoing Monitor investigations into the two foundation trusts—the South Tees Hospitals NHS Foundation Trust and the Tees, Esk and Wear Valleys NHS Foundation Trust—that serve my constituents. Finally, I will seek reassurance from the Minister on future funding allocations to north-east clinical commissioning groups.

Over the past 18 months, the accident and emergency department at James Cook university hospital, which serves my constituency, has come under particular pressure. In the run-up to winter last year, there were problems with handover times; ambulances and paramedics waited up to two and a half hours to admit patients, despite the national target time being 15 minutes. I raised that last year with the Secretary of State for Health, who agreed that the situation was completely unacceptable, and I raised it with the Minister on 13 February 2013 in a Westminster Hall debate on A and E provision in the north-east. In addition to the issues that I raised with the Secretary of State, it has become evident that the James Cook hospital’s A and E department struggled to manage with the pressure caused by winter.

In January and February 2013, the South Tees Hospitals NHS Foundation Trust failed to meet its target of seeing 95% of A and E patients within four hours. With James Cook hospital so clearly overstretched, I admit that I was surprised to discover in September 2013 that the Secretary of State decided not to award it, or any hospital trust in the north-east, funding to alleviate the pressure on A and E departments. It is beyond belief that, of the £250 million awarded by the Secretary of State between 53 trusts, not a penny will reach the north-east, particularly as we live in a region that suffers from some of England’s harshest winter weather and has some of the harshest local government cuts in the country. I hope that the Minister reconsiders that allocation, or at the very least clarifies why the Secretary of State made such a seemingly absurd and regionally disparate decision.

Recurrently, over many weeks, I have received expressions of concern from constituents about the increasing use of private ambulances in response to 999 calls in my constituency. I corresponded with the North East Ambulance Service on two such incidents, and its reply made it clear that central Government funding cuts are eroding that blue-light service:

“Each year we have discussions with our commissioners on the forecast number of incidents in the forthcoming year. The outcome of these discussions for 2013-14 were that commissioners felt it necessary to set our income on activity for the next 12 months at a level less than we were forecasting… So for 2013-14, we have been contracted to respond to 376,000 incidents, although we are forecasting activity at an estimated 415,000. This means that any incidents above 376,000 will be funded on a one-off basis rather than as recurrent annual income. These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

[Ian Swales (Redcar) (LD)]

The hon. Gentleman is making a powerful speech. Is he aware that Cleveland police vehicles and staff are also being increasingly used as unofficial ambulances?

[Tom Blenkinsop]

Yes, the police, and particularly the police and crime commissioner for Cleveland, have raised that with me in private meetings on first responder calls. They have funding worries about what will happen if such practices continually recur.

The NEAS letter shows that there will be more cuts, more private ambulances and possibly a less responsive service. It is not me saying that, but the chief operating officer of the North East Ambulance Service. The figures are stark. In 2008-09, 865 call-outs were attended by private ambulances in our region, costing £86,000. In 2009-10, some 1,816 call-outs were attended by private ambulances, costing £151,000. In 2010-11, however, 6,429 call-outs were attended by private ambulances, costing £477,000, which is a huge jump. In 2011-12, there were 9,000 call-outs attended by private ambulances, costing £639,000. In 2012-13, 13,524 call-outs were attended by private ambulances, costing £754,000. So since 2010, there has been a fivefold increase in private ambulance costs in the north-east, with the funds going to private contract firms. It is obvious that from 2010 onwards, there has been an explosion of private ambulance usage by the trust, costing a huge amount of taxpayers’ funds. The chief executive states:

“These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

A third issue of particular concern to my constituents is that both the NHS trusts that serve them—the South Tees Hospitals NHS Foundation Trust, and the Tees, Esk and Wear Valleys NHS Foundation Trust—have found themselves under investigation by Monitor in the past 12 months. Since May 2010, the South Tees trust has failed on seven occasions to meet its referral-to-treatment target, most recently between March and August. That has resulted in the Monitor investigation, because the trust has failed to ensure that 90% of patients commence treatment within 18 weeks of referral. Furthermore, there has been an increase in reported “never” events at the trust, and an increase in the incidence of clostridium difficile.

Despite the seriousness of those issues, Health Ministers have taken no action. My constituents would at the very least expect Ministers to have had conversations with Monitor and the trust on the issue, and on what support the Department of Health can provide, yet the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), confirmed to me in a written answer that

“No such discussions have taken place with Ministers.”—[Official Report, 22 October 2013; Vol. 569, c. 83W.]

Will the Minister please assure me that he will closely monitor the situation and have discussions with both Monitor and the South Tees trust on how the Department can provide support, including additional funding if necessary?

My final point is on allocations to the north-east’s clinical commissioning groups.

A recent working paper issued by NHS England on allocation and indicative target allocation outlines proposals that will reduce per-capita funding for CCGs across the north-east. People in Sunderland will each face a £146 cut, people in south Tyneside a £124 cut, people in Gateshead a £104 cut, and people in my constituency a £60 cut.

[Ian Lavery (Wansbeck) (Lab)]

Is it not perverse that deprivation and health inequality indicators are not part of the overall calculation, as regards the funding allocation for the north-east? That will potentially result in the north-east losing up to £230 million of NHS funding per annum.

[Tom Blenkinsop]

Yes, the cumulative effect of all the funding allocations in different areas is very worrying. If those allocations are all reduced, my genuine worry for my constituents, and for constituents across the north-east, is that all the hard work and financial effort in Teesside in the past 15 years to reduce cardiac risk, bad outcomes for cancer, and other problems will be undermined, and we will not build on the momentum gathered over the past 15 years.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Is that not all the more outrageous because a former Health Minister, the right hon. Member for Chelmsford (Mr Burns), gave a clear assurance at Health Question Time on the Floor of the House that the importance of the deprivation part of the calculation would not be downgraded? We asked for a clear assurance, and we were given a clear assurance. That assurance is not compatible with the current consultation.

[Tom Blenkinsop]

My right hon. Friend predicts the final part of my speech. I hope the Minister will take the opportunity to put our fears to rest. Unfortunately, the information that I have received to date does not reassure me.

[Grahame M. Morris (Easington) (Lab)]

I compliment my hon. Friend on securing such a timely and important debate. I completely agree that one of the most worrying aspects is the potential changes to the funding of clinical commissioning groups. Easington would lose £62 a head. Does he agree that that could be seen as political gerrymandering, with the poorest areas deprived of funding and the wealthiest, such as east Hampshire, getting increases of as much as £164 a head? The areas with the best health outcomes will get the biggest increases in resources.

[Tom Blenkinsop]

My hon. Friend has mentioned that in Health questions and in the Select Committee on Health, of which he is a doughty member who provides a lot of input. Someone from a poorer socio-economic background has a lower likelihood of reaching the age at which they would receive more funds under the allocation—it would probably never happen. This becomes a self-defeating, vicious circle of a lack of investment in people who might need it the most.

As I was saying, the proposals in a recent working paper issued by NHS England on the allocation and the indicative target allocation would have led to a per capita reduction in funding for CCGs throughout the north-east, and my constituents would have lost out. Meanwhile, CCGs in the south would have had a per capita increase; for example, those covered by Coastal West Sussex CCG would each gain £115, those in Hailsham £136, and those covered by South Eastern Hampshire CCG £164. That is clearly not a one-nation NHS. I received ministerial assurances that that formula was not ultimately used for 2013-14, but a response to a parliamentary question that I asked confirmed that

“No proposals or decisions regarding allocations for 2014-15 have yet been made.”—[Official Report, 22 October 2013; Vol. 569, c. 76W.]

The hon. Member for Stockton South (James Wharton), who is in the Chamber, told the Evening Gazette on 23 October that it was indeed “right” that NHS England was considering reducing health funding for his constituents and the north-east, but—

[James Wharton (Stockton South) (Con)]

The hon. Gentleman has either misread or misremembered, or perhaps the Evening Gazette did not give a full account of my comments. What I said was right was having an independent funding body that makes decisions based on a formula that is consulted on, and it is right that age should be a factor. That does not mean that deprivation should not be a factor. I recognise and welcome the debate, and the effort that hon. Members in all parties are making to put the case that deprivation has an impact on health outcomes and should be considered as part of the funding formula. I recognise, however, the independence of NHS England, and I support it being an independent body. Does he recognise its independence?

[Tom Blenkinsop]

I recognise the health outcomes and needs of my local constituents; as their representative, I will voice those views and needs vociferously. I take on board, however, the hon. Gentleman’s comments and his desire to see deprivation recognised in the allocation of funds. On the future allocation for CCGs, I hope that he will advocate to the Minister on behalf of those of his constituents who share the same socio-economic background as me, in the way that we Labour Members do. I take his intervention in favour of those funds in a spirit of common north-eastern friendship.

Will the Minister assure us that he will urge NHS England to consider deprivation and regional health inequalities when determining funding formulae? Furthermore, will he guarantee that any funding formula used to determine allocations in 2014-15 will not leave the north-east comparatively worse off, and will not widen the north-south health divide? I thank the Minister for his time, and I hope that he will be able to provide the clarifications and assurances that my colleagues and I have sought this afternoon.

--- Later in debate ---

[Dr Poulter]

I will not give way again.

The hon. Member for Middlesbrough South and East Cleveland is being very disingenuous in the points that he is making, and I have put the record straight: health care funding has increased under the present Government. If I give way again, perhaps he will explain why the shadow Secretary of State said it would be irresponsible to increase the health care budget in real terms. We all think that would be irresponsible in the current environment.

I turn to local services in the hon. Gentleman’s constituency. When we discussed the matter earlier this year, he raised specific concerns about Guisborough, East Cleveland and Redcar hospitals. He did not put on the record the fact that matters have improved considerably since that meeting with me and local commissioners. Guisborough urgent care centre is open from 9 to 5 on Mondays to Fridays and from 8 to 8 at weekends. East Cleveland urgent care centre is open from 9 to 5 on Mondays to Fridays and from 8 to 8 at weekends, and Redcar urgent care centre is open 24/7. There are currently no vacancies for clinical staff that affect opening hours, which have been aligned to match service and patient need. The centres will continue to evaluate the situation.

It is worth highlighting that three additional nurses were recruited to support the urgent care centres in June 2013, and they are now at full complement, apart from one vacant clinical lead post to which the trust is continuing to try to recruit. It is looking at better ways to manage staffing. In response to concerns raised by the hon. Gentleman, there are now fully functioning urgent care centres. There is a 24/7 service in Redcar and additional staff working at those centres. That is good progress and it is disingenuous of him to suggest otherwise.

[Tom Blenkinsop]

rose—

[Dr Poulter]

I hope that when I give way, the hon. Gentleman will put on the record the fact that considerable progress has been made by local commissioners for the benefit of local patients.

[Tom Blenkinsop]

I thank the Minister for giving way during a response to a speech I made in February, although I deliberately did not mention those points because they were not part of what I wanted to talk about today. The Minister says that South Tees NHS trust is successful, so why is it under investigation by Monitor?

[Dr Poulter]

The hon. Gentleman has raised issues of health care funding, and I am making the point that there has been considerable investment in local health care services, the very services that he said earlier this year had received no investment. He is also raising urgent care services and other services at his local hospital trust. I am reassuring him that considerable investment has been made locally, and it is worth highlighting the fact that further investment has been made. He is incredibly disingenuous to stand here and run down his local health service when considerable steps have been made to improve patient care services. For his benefit, I will outline a few more improvements that have been made, so that they are firmly on the record.

[Tom Blenkinsop]

Will the Minister give way?

[Dr Poulter]

I will not give way because the hon. Gentleman should listen to the answers to some of his questions and realise that his local health care services are improving thanks to the Government’s increased investment in the health service—[Interruption.] Hon. Members have been incredibly political in everything they have said today, and I am putting answers on the record. If the hon. Gentleman does not want to hear them, he should not have raised the debate.

The latest data for 27 October 2013 show that South Tees Hospitals NHS Foundation Trust’s performance against the 95% standard for A and E waits is 96.8%. Over the last 23 weeks, it has met the national 95% target for A and E four-hour waits. The local trust is performing very well in treating patients in a timely way when they arrive at A and E. That is contrary to the points that the hon. Gentleman was trying to make.

At James Cook university hospital, the acute admissions unit is adjacent to the A and E department, so enabling the trust better to manage the flow of patients and to ease pressure on A and E. The trust has recruited two additional consultants and six additional junior doctors to the acute medicine departments, so easing pressure on the A and E department. Considerable investment is being made, and additional nursing staff have been recruited to support 50 more acute hospital beds that will be in place this winter. The hon. Gentleman must be aware that there is a lot of investment locally, with more beds, more staff and better care. It is a pity that he could not acknowledge that in his speech. I am putting it on the record, so that his constituents are aware of it.