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Mr. Patrick Hall (Bedford): I am very pleased to have secured this short debate on the funding of Bedfordshire health services, although I chose for the title, "Underfunding of Bedfordshire Health Services". I have sought this debate to draw attention to the long-term, underlying underfunding of national health services in Bedfordshire, and to ask that action be taken to put things right.
Bedfordshire has been at or below target since the funding formula based on population was introduced in the mid-1970s. Despite the real growth nationally in NHS funding that has thankfully occurred since the late 1990s, Bedfordshire health authority has continued to move further away from target: for example, from 3.61 per cent. below in 1998-99, to 4.4 per cent. below in the current financial year. That is contrary to the Government's general policy of moving health authorities closer to their capitation target.
The principal reason for that damaging trend is the scale of population growth in the area and the failure of NHS annual allocations to keep pace with it. Bedfordshire, in particular mid and north Bedfordshire, is located in the sub-region between Oxford, Milton Keynes and Cambridge, which is one of the fastest growing areas of England and is set to remain so for at least the next 20 years in the light of regional planning policies and housing allocations supported by the Government. Bedfordshire's difficult financial position was made even worse in the current financial year, when the pace-of-change policy on achieving target was suspended pending a major review of the national capitation formula, and replaced by an interim measure known as years of life lost.
I am in favour of these matters being reviewed to ensure that fair shares can be achieved more quickly than hitherto and that needs can be met, but I am not in favour of an allocation system whereby Bedfordshire loses out year after year. I welcome the improvements in revenue funding that have been made and sustained by this Governmentthey are realbut the point about Bedfordshire's weak position is that its budget base is too small. Therefore, the satisfactory and even very good percentage allocations that have been made in the annual budget rounds of late do not yield enough growth to strengthen that weak base sufficiently. Those things really matter in terms of delivering health services and making progress with modernisation.
The main issue at Bedford hospital is the lack of capacityinsufficient beds, inadequate operating theatre capacity, and insufficient out-patient facilities. Furthermore, there is long-term neglect of the local social services and home care infrastructure, poorly worked up intermediate care, excessive dependency on in-patient care and, of course, bed blocking. All those things chase each other around to create pressures on the budget, on staff and on patients.
Bedford hospital faces serious problems. It is not meeting its waiting list targets, waiting times are not reducing, and the number of cancelled operations is rising, forcing some people to go private at their own expense. That is offensive and unacceptable, not to mention all those people who are waiting longer at home, perhaps in pain but certainly anxious.
Admissions to Bedford hospital's accident and emergency department have increased substantially since early 1998. It is not limited to the winter months; admissions increase all year round. I understand that the annual rate of increase has been around 10 per cent. compared with the national average increase of 1.5 per cent. As I have recently seen for myself, pathology services at Bedford hospital are also considerably underfunded. I have raised the matter with the Under-Secretary of State for Health, Lord Hunt of Kings Heath. I hope that, within the next few weeks, the business case for improved facilities at Bedford hospital will be considered favourably. We shall wait and see.
Given those pressures, it is perhaps not surprising that Bedford Hospital NHS trust is heading for a projected £3 million overspend, £1 million of which is due to expenditure on elective surgery in the private sector and funding beds in private nursing homes. The key problem in community health services is its historically weak infrastructureits inadequate capacity. That causes negative knock-on effects for the acute sector. The threshold at which someone receives the care that they need is higher than it should be; it is higher than in many other parts of the country. In other words, to receive that care in Bedfordshire, a person's health has to be worse than that of a person who lives elsewhere. That is the clear impression of some district nurses in Bedfordshire who have recently worked in other places.
The lack of capacity puts great pressure on the community funding required to meet the exceptional needs of some patients in the community. Because of the lack of local facilities, the community trust, primary care trusts and Bedfordshire social services have to fund expensive out-of-county placements. Services for children and adolescents may incur heavy costs that last for many years.
Mental health services are also under pressure. The Sainsbury Centre for Mental Health undertook an external review and concluded that such services are 20 per cent. below their target level compared with similar health authorities. Historic underfunding has prevented the community trust from reproviding mental health services at the Weller wing at Bedford hospital and from meeting its obligations under the national health service framework for mental health. The closure some 10 years ago of Clapham hospital and John Bunyan ward at the Bedford hospital north wing site, which provided beds for the long-term sick elderly, was not followed by the reprovision of rehabilitation, intermediate and home care facilities.
Andrew Selous (South-West Bedfordshire): Does the hon. Gentleman agree that it is important for consultation between NHS trusts to be improved when there are closures? I refer to what is happening at Hemel Hempstead, where services for women and children are being closed. Does he agree that it is not right that the first senior management at Luton and Dunstable Hospital trust knew about the closure was when they heard it on the local radio? At such short notice, it is impossible for them to plan properly.
As I said, the closure of Clapham hospital and the John Bunyan ward at Bedford hospital's north wing site was not followed by reprovision of facilities in the community. If such facilities had been provided, elderly patients might have been able to leave hospital more quickly. It might also have prevented many of them from going into hospital in the first place. Again, there is a failure to invest. It contributes to the real problems facing the NHS in Bedfordshire. There are many other matters, including tackling health inequalities and drug addiction, but lack of time prevents me from pursuing such issues.
Mr. Jonathan Sayeed (Mid-Bedfordshire): I shall be brief, as I do not wish to interrupt the hon. Gentleman's excellent speech. The critical questionfor not only this Government but previous Governmentsis why Bedfordshire has not received the funding to which the Government acknowledge it is entitled.
In the light of limited time, I am concentrating on what I understand to be the key problems. They have been put to me by people who work in the NHS and my constituents; I have seen them, too. I acknowledge the efforts of, and the high standards that are often achieved by, those who work in the NHS. There is no doubt that morale is not that high. However, I am convinced that the staff believe in the NHS and want it to work. That reflects the views of the public.
Of course, some positive things have happened and are happening at all levels in Bedfordshire. Bedford hospital has a refurbished operating theatre and accident and emergency department. It has doubled the number of beds in the critical care unit. The Bedfordshire and Hertfordshire Ambulance and Paramedic Service NHS trust has attracted and trained 800 volunteers to assist qualified staff. NHS dentistry has returned to Bedford and Kempston. A community outreach programme for children and adolescents with mental health problems has received national recognition, and a project aimed at employers to enhance the awareness of adults with mental health problems has been acclaimed. In primary care, there are innovations of a 24-hour advanced care scheme and the use of electronic patient records to help general practitioners and hospitals to deal with patients more efficiently.
I have great hope in the sustained development of co-operation at different levels in the local NHS economy. In sharp contrast with the past, people are talking to each other. There is a culture change. People in the NHS at management and other levels are prepared to learn from each other and to put the patient and the community first. The primary care trusts have been instrumental in triggering that. It is a new way of working that belongs to all and includes social services.
I have a number of points to put to my hon. Friend the Minister. First, will she acknowledge the long-term underfunding and the lack of capacity that is associated with that in the area served by Bedfordshire health authority?
Secondly, I am delighted by the announcement of next year's allocation, which is the third most generous in England and, for the first time in years, begins to close the gap. None the less, Bedfordshire remains the second worst funded health authority in England in terms of distance from the fair shares target. Will the Minister acknowledge the case for above-average capitation increases year on year in Bedfordshire to close that gap as soon as possible?
My third point is also about capitation. Will the Minister acknowledge that population estimates and forecasts consistently indicate that the population of the northern and middle parts of the county taken togetherbroadly the catchment area of Bedford general hospitalwill continue to grow quickly? Between 1991 and 2011, the growth in the total population will be 121 per cent.. However, more significantly for the NHS, the growth in the number of over-65s will be 120 per cent., in the number of over-75s 131 per cent. and in the number of over-85s 149 per cent.. The growth of 108 per cent. in the population of the under-fives reflects a growing younger population. Those demographic pressures are important because, as the Minister knows, roughly two thirds of NHS expenditure is on the over-65s and the very elderly. A further 10th of expenditure is on under-fives. Both categories are growing fast in Bedfordshire, and they are set to continue doing so.
Bedford hospital has experienced heavy increases in A and E admissions, which have added to cost pressures. I understand that no systematic research into that trend has taken place, despite the fact that it has been continuing for about three years. Will the Minister ensure that that research is conducted soon, so that action can be taken, resources can be effectively targeted and additional resources can be allocated, if necessary?
I turn to the insufficient bed capacity at Bedford hospital. There is a strongly held view within the trust that, although increased capacity and other changes are required throughout the local NHS, the situation is so severe in Bedford that, to break the cycle, a new, fully staffed, 25-bed modular ward is needed as soon as possible. I recently read that the national beds inquiry had suggested that, as a guide, an extra 55 general and acute in-patient beds, 45 intermediate care beds, and 23 day care beds should be provided by 2003-04 in the Bedfordshire health authority area, which includes the south of the county. I also learned that that issue did not necessarily revolve around increasing bed provision at acute hospitals, and that the development of intermediate care could lead to a substitution of acute beds by community provision.
Mr. Kelvin Hopkins (Luton, North): My hon. Friend mentioned Luton and Dunstable hospital. I support his excellent speech by pointing out that the problems in Bedfordshire are not caused by the inefficiency or the lack of dedication of the staff. On the contrary, they have done a tremendous job, as is demonstrated by the fact that Luton and Dunstable hospital obtained a three-star ratingit is, I understand, the 11th best hospital in the country. The problem is lack of resources.
Mr. Hall : The problem is lack of resources throughout the health economy, not just with regard to hospitals, which is what the media tend to concentrate on: the rest of the NHS matters very much, as my hon. Friend understands.
I am convinced that if a modernised NHS is to be achieved, which all of us want, it will need to include, in Bedfordshire, a strengthening of the acute sector at Bedford hospital, as well as at Luton and Dunstable hospital, and the creation of decent community services, so that a comprehensive and balanced service that puts the needs of patients first is created.
The Parliamentary Under-Secretary of State for Health (Yvette Cooper) : I congratulate my hon. Friend the Member for Bedford (Mr. Hall) on securing this important debate on the funding of Bedfordshire health services. He has rightly been raising concerns about the matter for a long while.
I want to try to address my hon. Friend's concerns in turn. As he will be aware, the Government's plans for the NHS involve both extra money and reform. It must be reformed to deliver improved and more responsive services to match modern needs, and to ensure that patients have more power and greater choice over services. Reform is also necessary to empower communities to have greater involvement with local services. My hon. Friend mentioned many of those points. They are the reasons why we are shifting the balance of power in the NHS by getting money to the people who are on the front line, so that they can, in consultation with patients and local communities, decide on the services that they need to deliver.
The NHS needs more investment, in Bedfordshire and across the country. My hon. Friend will be aware that the Secretary of State for Health announced on 6 December that health authorities in England will receive total allocations of £41.5 billion in 2002-2003. That is an increase of £3.7 billion from this year and represents an average cash increase of 9.9 per cent., which is a real-terms rise of 7.2 per cent. Our key priorities for the money are to make an enhanced effort
Health services in the eastern region will receive an extra £373.4 million. Those extra resources will help us to cut waiting times for treatment and build local health services with more doctors and nurses. The extra funding will also help us to continue the fight against cancer and coronary heart diseasetwo of the country's biggest killers. Next year, Bedfordshire health authority will receive an increase of £39.1 million, or 10.5 per cent. As my hon. Friend the Member for Bedford said, that is the fourth largest increase provided to a health authority in England.
My hon. Friend is right to say that Bedfordshire's allocation will remain 4 per cent. below its fair share as calculated under the formula. However, he will recognise that the Government are making sustained additional investment in local health services. In Bedfordshire, that amounts to £100 million extra, or 33 per cent. extra, in the past three years.
The speed at which we move health authorities towards their targets, and the speed at which health authorities move primary care trusts and primary care groups towards their targets, depends on two objectives. First, we want to move health authorities towards equity as represented by weighted capitation targets. Secondly, we want to introduce increases across the board to maintain continuity and stability in the service and make progress nationally in priority areas. As my hon. Friend would agree, every area in the country is in need of additional investment. We are committed to helping health authorities and PCTs reach their target fair shares. We think that that is important. However, that obviously cannot be achieved overnight.
Mr. Hopkins : My hon. Friend the Minister says, understandably, that we cannot reach our targets overnight. Does she accept that we have an enormous distance to go, given that the difference between spending on health in France and spending on health in Britain is the equivalent of £40 million for each constituency every year?
Yvette Cooper : I agree that increased additional investment is needed in the NHS. In the past few years, we have invested substantial additional resources. However, we need national debate on our future direction and the need for additional investment. That debate is on-going, and is informed by the interim report by Derek Wanless.
One of the biggest issues for Bedfordshire is population growth in the county, which means that the target moves every year. We recognise the pressures that population growth creates for Bedfordshire. However, funding in Bedfordshire has increased faster than population growth. The population has grown by 2 per cent. in the past three years, but funding has increased by 33 per cent. As other health authorities have also received large increases, Bedfordshire has remained below its fair shares target.
Yvette Cooper : We remain committed to moving areas towards their target fair shares. As I said, different factors need to be borne in mind, as we also need to maintain continuity and stability and to increase investment across the country. We are at present engaged in a review of the formula and how it works. It will have implications for Bedfordshire, and I shall say something about it later.
I agree that there are investment needs throughout the country and in Bedfordshire. However, they must be linked to reform. Investment is already increasing and making a substantial difference in Bedfordshire and elsewhere. More must be done, but it must be conditional on getting the right reforms in place so that the additional investment has the biggest impact.
A review of the existing funding formula used to distribute resources is under way. The NHS plan has made the direction of travel clear: we want reducing inequalities to be a key criterion for allocating additional NHS resources. The review is being carried out under the auspices of the Advisory Committee on Resource Allocation, which has NHS management, GP and academic members.
We will adopt an incremental approach to the review of resource allocation and to its implementation. We shall move towards fairer resource allocation as improvements become possible. As we said in the NHS plan, by 2003, following the review, reducing inequalities will be a key criterion for allocating NHS resources to different parts of the country.
Allocations for the current year and for next year already include a health inequalities adjustment. In part, that replaces the targeted funding for those health authorities such as Bedfordshire with health action zones. Bedfordshire has benefited from the Luton health action zone, which receives £700,000 per year.
Bedfordshire has benefited in other ways from allocations in the current year. An additional £1.1 million was awarded in recognition of the high costs of living, providing a 2.5 per cent. pay rise on top of the review body allocations. For 2002-03, the cost of living supplement has increased to £1.56 million. In addition, £300 million is being invested across the
My hon. Friend the Member for Bedford mentioned capacity at Bedford hospital. I can confirm that there have been discussions between the trust and the regional office about additional capacity at the hospital. That, as well as improved efficiency, will form part of the strategic and financial framework negotiations for next year. I understand that the trust is looking
Andrew Selous : The Minister referred to £500,000. Her notes may show that that is the figure over two years. Does she agree that it is set against the £10 million for which Bedfordshire social services is looking to sort out the problem over the next two years?
Yvette Cooper : I can write to the hon. Gentleman with the details of the allocation. The investment plan to tackle bed blocking is planned over two years but it is also about freeing up capacity in the acute sector.
My hon. Friend the Member for Bedford mentioned increased accident and emergency admissions at Bedford hospitals. I can confirm that officials from eastern regional office visited the trust in the summer to discuss the issue. The region and the trust are working together to identify the action required to identify the possible causes of the increased activity in A and E and to improve the accuracy of the data collected on admissions and treatment.
As I said, the Government are determined to increase investment in the NHS but in that regard the NHS also needs to reform to deliver first-class care to patients. The Wanless report identified cumulative underinvestment over at least 30 years but also the need for reform, so that additional resources to Bedfordshire and elsewhere make the biggest possible impact. The biggest and most sustained growth in any four-year period in the history of the NHS was announced in the 2000 Budget. However, we need to look to the long term, so that investment and reform can provide my hon. Friend's constituents and those of other hon. Members with the national health services that they need.