Community and Voluntary Services: Derbyshire
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The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
I thank the hon. Member for High Peak (Ruth George) for bringing forward this important matter for debate.
First and foremost, I would like to reiterate the vital role that the voluntary sector plays in ensuring that people have access to the services that they need in the places where they live. Indeed, I go much further: I am an extremely firm advocate of encouraging NHS commissioners to commission services from the voluntary sector to get much better coverage nearer people’s homes and achieve better outcomes for patients at good value for money. I defer to no one in my support for the voluntary sector. The principle of making use of and commissioning services from the voluntary sector is a key theme in the long-term plan, and we will be investing at least an extra £4.5 billion a year in primary care and community health services.
This is the first time in the history of the NHS that real-terms funding for primary and community health services is guaranteed to grow faster than the rising NHS budget overall. Clearly, that is not reflected in the comments that the hon. Lady has just made. I understand her concerns about the cuts in funding for services in Derbyshire. I am advised by the CCG that it has confined the cuts to those services that are not associated with delivery of their statutory services and that of a potential £1.25 million that was earmarked as meeting those criteria, only £300,000 has been cut. It is worth putting into context why that is.
Clearly, the Derbyshire CCGs have a duty to ensure the long-term sustainability of health services in the area. In the light of well-known financial challenges, that CCG has had to make difficult decisions on where to prioritise funding. As part of asking taxpayers to contribute £20 billion more a year to the NHS, it is right that we ask how effectively that money is spent and that we ensure that local areas are not running at a deficit. This is absolutely essential if we are to have an NHS that is financially sound and sustainable in the long term. Owing to their financial position, all Derbyshire CCGs are required to scrutinise their financial spend to ensure the best outcomes for patients for the investment made and to deliver financial balance. They have been working on that in close collaboration with NHS England. The joint saving plan agreed with NHS England states that if the CCGs make savings of £51 million, the remaining £44 million will be absorbed by NHS England. It is very much a joint approach to tackling the financial position in which the Derbyshire CCGs find themselves. None the less, they need to live within their means, and that is why they have had to review the overall spend and identify where savings can be made. It is challenging, but I have been assured that the absolute top priority of the CCGs is to minimise the impact that cuts have on patients.
I listened with sympathy to some of the points the hon. Lady made about spending on services provided by the voluntary sector that keep patients out of hospital and support them to live independently, and clearly I want to encourage all CCGs to commission exactly those services. I am reassured that those services that continue to be funded by CCGs, rather than remaining with grants, have been issued with NHS commissioned contracts—that has been done for stroke support, eating disorder and bereavement services—and I am satisfied with the efforts of CCGs in that area.
Ruth George
The Minister says that the cuts are to services that do not deliver such good statutory support. How does she think that community transport does not deliver for patients struggling to get to, say, follow-up appointments for bowel screening?
Jackie Doyle-Price
The advice I received from the CCGs was that they had reduced grants only for services not part of their statutory functions, which fall to other agencies, particularly local authorities, with which they are working closely to make alternative funding available for some of the organisations that have been cut. I cannot answer the hon. Lady’s specific question about transport, but I understand that the total cut to transport amounts to £24,000 out of £300,000, so we are talking about quite a small part of what have been significant savings of £44 million that the CCGs have had to find. Support for local transport and accessibility normally falls to local authorities.
The voluntary and community sector has been an important part of the health system for many years, and partnership working between the voluntary sector, local government and the NHS is crucial to improving care for people in their communities. I expect all local CCGs to build much stronger relationships with local authorities to better join up all support services for patients. I welcome the scrutiny of this process by the health overview and scrutiny committees. I appreciate that it has been extremely political, but it is important that those decisions be taken transparently.
We also recognise the important role the community can play in helping people to maintain their health and wellbeing. Social prescribing is crucial. We are encouraging CCGs to look much more at such solutions, and not just at the medicalised solutions, and we will be using part of the £4.5 billion investment set out in the long-term plan to recruit more than 1,000 social prescribing link workers. I hope they will be able to work with the voluntary sector in the hon. Lady’s constituency.
We will also be looking at funding expanded community multi-disciplinary teams, meaning that in five years all parts of the country will have improved the responsiveness of their community health response services to deliver crisis services within two hours and reablement care within two days.
I appreciate that it will always be difficult to tackle a financial deficit of the size of that of the Derbyshire CCGs, and I welcome hon. Lady’s engagement in that process and the public scrutiny. I also pay tribute to the work of my hon. Friend the Member for Erewash (Maggie Throup), who has been representing the concerns of her constituents in this respect. I am assured and satisfied, however, that the Derbyshire CCGs have done the best they can to support funding for the voluntary sector where it has been delivering a valuable service to the rest of the health sector. Indeed, one of the overriding criteria for making decisions regarding these cuts was that it would not lead to additional demand on health services and additional spending elsewhere, and I am satisfied that the decisions have been taken on that basis.
Ruth George
The GPs on the CCG themselves stood up in the meeting and said there was a recognised risk that these service cuts would create cost pressures on other areas of services, so I am sorry, Minister, but it is simply not guaranteed at best, very likely at worst.
Jackie Doyle-Price
I say respectfully that we expect the CCGs working with NHS England to properly interrogate the implications of their decisions, and they have done that; I have been given that advice, and I stand by the advice I have received from them on that.
I recognise, however, that those local commissioners in Derbyshire have had to make very difficult decisions, and we do believe that they are best placed to make those decisions. They have access to the local expertise and clinical knowledge needed to make an informed decision.
While I recognise the hon. Lady’s concerns, I hope she can reassure her constituents that the local CCGs are working to provide sustainable services that meet the needs of the people living in Derbyshire. The Government will continue to work with the local CCGs and NHS England to help progress with ongoing work and to help create those sustainable services for the future.
Question put and agreed to.