Hospital Services (North-East)

Diana Johnson Excerpts

Tuesday 27th July 2010 Westminster Hall

[Diana R. Johnson (Kingston upon Hull North) (Lab)]

I congratulate my hon. Friend the Member for Hartlepool (Mr Wright) on securing the debate this afternoon. He is a worthy champion of his constituency and the region, with respect to a range of matters including health, education and economic regeneration. He spoke passionately about the need to deal with the health inequalities that blight this country, and the problems in his constituency in particular, as well as the need for excellence in health care in the north-east, including the new hospital that is at the heart of the debate.

Like all hon. Members who have spoken, I pay tribute to the staff of the NHS, whose work for and commitment to the people of the north-east and the rest of the country is excellent. It was striking to hear the personal experience that my hon. Friend the Member for Hartlepool had in his local hospital, and what excellent care he and his family received. I pay tribute to all hon. Members who are present today, including my hon. Friends the Members for Stockton North (Alex Cunningham), for Easington (Grahame M. Morris), for Wansbeck (Ian Lavery), for Sedgefield (Phil Wilson), for North Tyneside (Mrs Glindon), and for North Durham (Mr Jones). I know that they all feel strongly and passionately about the issue.

I want to comment on the remarks of my hon. Friend the Member for Easington. He put patient care and safety, which is what the debate is really about, at the centre of his remarks. He set out his concerns about what will happen to patients who are left with the two hospitals, where they will now be treated. Will the abolition of targets affect care and safety? That is an important issue, which I hope the Minister will deal with. My hon. Friend also raised the important issue of finances and how they stack up. I would like to know in particular whether the difference in cost between building a new hospital and repairing and maintaining the two is £11,000 or £11 million. I am sure that the Minister will clarify that.

[Mr Burns]

If it will help the shadow Minister I shall clarify the point yet again. The reason the question ever came into the public domain was that on the morning of the previous debate the right hon. Member for Leigh (Andy Burnham) incorrectly put out a press statement saying that the building of a new hospital would be cheaper than the maintenance and upkeep of the two existing hospitals, over a 35-year period. The figures, which Hansard originally printed wrongly—hence the correction—showed a difference of £11 million. It was cheaper by £11 million to keep the two existing hospitals. The point was merely to show that the right hon. Gentleman was factually incorrect.

[Diana R. Johnson]

I am grateful to the Minister for correcting what he said earlier, when he talked about the figure of £11,000. We understand that the figure is £11 million. I suggest that in the great scheme of things, if the difference in cost between maintaining and repairing two hospitals and building a state-of-the-art new one is £11 million, Labour Members might think that it is £11 million that should be spent.

[Mr Iain Wright]

I just want to make two points. First, I am sure that it was an oversight, but I point out that my hon. Friend the Member for Gateshead (Ian Mearns) is here. In his short time in the House he has been a fantastic representative of that fair area. On the point about net present values and appraisals of the hospital, my hon. Friend may know more than I do about it, but—whatever the talk of £11,000 or £11 million—are the wider savings to the taxpayer from better health outcomes and from ensuring that people do not rely on hospitals for protracted periods also part of the appraisal system? Are they taken into account, or is it a matter of the narrow costs of maintaining existing or new sites?

[Diana R. Johnson]

I apologise to my hon. Friend the Member for Gateshead for not mentioning him; I know that he takes a particular interest in the issue.

I hope that the Minister will explain the rationale for the decision that was made about the hospital, and whether the cost-benefit analysis included the savings that would come about from a healthier population with better access to health services. I am sure that he will explain it. My hon. Friend the Member for Easington also mentioned health inequalities. It is important to ensure that patients and communities have access to high-quality in-patient facilities when they need them.

My hon. Friend the Member for Sedgefield argued compellingly on business grounds that the hospital could help lead the regeneration of the area. He described the hospital as an anchor tenant that could attract up to 12,500 private sector jobs, a telling point for an area of the country that wants to attract private sector business and stand on its own two feet. He made a compelling case. My hon. Friend also said how good the care that he and his family had received from the local NHS was.

[Ian Mearns]

It is important that the Minister has now clarified that the figure is not £11,000, as he stated earlier, but £11 million. I am sorry, but the difference between the figures that he gave was in fact £11,000, and I hope that the record will show that. That said, we now know that the figure is £11 million over 35 years, or £314,000 a year, the lack of which will deprive the people in those five constituencies of a brand spanking new hospital facility that could add significant value over that period to detract from the additional cost.

[Diana R. Johnson]

My hon. Friend makes an important point about the cost over 35 years.

My hon. Friend the Member for Stockton North, who I understand is a former non-executive director of the North Tees and Hartlepool NHS Foundation Trust, spoke clearly about the need for a new hospital. I know that he also tabled early-day motion 273, which attracted a great deal of support, to request a review of the coalition decision about the hospital. He, too, made an important case about health inequalities and why the hospital is needed. He also pointed out that structural upheaval in the NHS at a time when we are facing such financial problems is a recipe for chaos. What is the future for the people represented by him and our hon. Friends? Again, I look to the Minister to explain the coalition Government’s thinking about what will happen to the needs of communities in the north-east.

I do not wish to rehearse the history of this £464 million hospital project—my right hon. Friend the former Secretary of State made it clear that it was a top priority for the NHS, and agreed in March this year that it should go ahead—but it had been in planning for a long time. It was not just signed off close to a general election. As we have heard, the coalition Government decided to cancel the hospital project within the first few weeks of taking up their position in Government. It is clear that the Treasury and other Departments reviewed every significant spending decision made between 1 January and the general election on 6 May. The proposal for the new hospital scheme, which received Government approval only in March, was considered properly during that review, but there are questions about why that particular hospital project was cancelled and others were allowed to proceed when my right hon. Friend had made it clear that the hospital was a top priority for the NHS.

[Mr Burns]

As I said to the hon. Member for Hartlepool, if the hon. Lady studies carefully our debate of 5 July, as I am sure she has—I do not usually recommend that people read my speeches—she will see that column 150 gives in detail the answer to that question.

[Diana R. Johnson]

The Minister will be pleased to know that I took great pleasure in reading his response to that debate, but I am still not satisfied with the explanation given. There is room for further explanation why that particular hospital was chosen.

[Mr Burns]

What precisely does not satisfy her in that explanation? What in particular causes her concern?

[Diana R. Johnson]

I am particularly concerned—I think that my hon. Friend the Member for Hartlepool mentioned this—about the clear view of all the clinical professionals—[Interruption.] I do not have the speech in front of me, but considering that the Secretary of State for Health talks continually about the need for doctors and clinicians to be in the driving seat when decisions are made in the NHS, and considering that, as my hon. Friend said, it is clear that the clinicians and health professionals involved were very centred on having that one hospital, why have those views been suddenly pushed to one side? Will the Minister explain that, given the coalition Government’s new approach of saying that clinicians are at the centre of decision making? If so, I will be pleased.

Also, on the cost of cancelling the project, how much money was spent getting to the point of preparing to proceed? What yearly maintenance and repair bill does the Minister think will now have to be paid for the two hospitals? What is the coalition Government’s plan for in-patient health facilities for that community? What does he see as the future for either a new hospital or a different style of health service provision in the area? What is his thinking? It is certainly not clear.

The Office for Budget Responsibility’s projections, to which one of my hon. Friends referred, show that the actual deficit was lower than was projected before the general election. We have also seen higher-than-expected growth figures this week, which hon. Members might find surprising. I ask the Minister to reconsider the economic impact of refusing to follow through on the decision to build the hospital, taking into account what my hon. Friend the Member for Sedgefield said about the potential for the hospital to be an anchor tenant to attract important private sector businesses and jobs. I know that the coalition Government are committed to helping the private sector grow us out of our present financial situation, so will the Minister reconsider? The range of Members present in the Chamber shows a clear commitment to ensuring that the people of the north-east get their fair share of resources and the kind of hospital service that they so richly deserve.

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate the hon. Member for Hartlepool (Mr Wright) on securing this debate. As he and his hon. Friends will know—as the shadow Minister rightly said, they are here in force—we have had a briefer debate on this subject, and I have had the pleasure of welcoming most of the Opposition Members present to a meeting at my Department, where we had a useful exchange of views.

Before I address the main thrust of most of the contributions, which is North Tees and Hartlepool, I will give a brief overview of the health situation in the north-east and will refer to some of the comments made by my hon. Friend the Member for Hexham (Guy Opperman).

Earlier this month, as hon. Members know, we published our vision for the national health service in the White Paper “Equity and excellence: Liberating the NHS”, which signals the beginning of the most profound reform in the NHS’s 62-year history. By taking power away from Ministers and civil servants in Whitehall and handing it to patients and clinicians, we shall transform the health service from the ground up.

[Diana R. Johnson]

Will the Minister give way?

[Mr Burns]

I thought that the shadow Minister might want to intervene.

[Diana R. Johnson]

I am intrigued. I read carefully the coalition agreement, which said that there would be no top-down reorganisation of the NHS and mentioned having elected representation on primary care trust boards, which I understand are now to be scrapped. Will he explain why, in a few weeks, the Government have completely ditched that proposal, which was in the coalition agreement?

[Mr Burns]

I will certainly explain that when I get on to the specific point about Hartlepool because, unfortunately, as will be unveiled to the shadow Minister and the hon. Member for Hartlepool, their comments today are based on a false premise and show that they do not fully understand the previous speeches on the issue, or the meeting we had at the Department of Health. All will be unveiled shortly, and I hope that the shadow Minister will understand the reasoning behind the decision taken.

As I was saying, as part of the vision, and the moving forward on the White Paper, we want every hospital trust in the country to become a foundation trust. We want to direct every aspect of the national health service at delivering clinical outcomes that are as good as, or better than, any in the world. The north-east is already ahead of the game in many respects. In November 2009, it became the first and only region in England to have all of its NHS hospital and mental health trusts awarded foundation trust status. When the Care Quality Commission reviewed hospital services in the region last year, every single hospital trust and every ambulance service was rated either good or excellent for the quality of their services. That gave the north-east the highest score in England for the third year running.

Among those hospital trusts, Gateshead Health NHS Foundation Trust, Newcastle upon Tyne Hospitals NHS Foundation Trust and Northumbria Healthcare NHS Foundation Trust all received double excellent scores for both quality of services and the use of resources. The high quality of services across the north-east is down to the skill, dedication, creativity and sheer hard work of the thousands of NHS staff across the region. I want to take this opportunity to pay tribute to them and wish them well in their continued success in providing first-class care and services to the people of the north-east.

--- Later in debate ---

[Mr Burns]

It is perfectly reasonable for the hon. Gentleman to express concern about and an interest in finding out what would happen. The answer is that that will depend on a combination of factors, including the national commissioning board that will be created, the GP commissioners and the decision of the local health community. If a local health community put forward any proposals to reconfigure health patterns in its area, it would have to go through all the procedures that are currently in place, and there will also be the changes that my right hon. Friend the Secretary of State will put in place to strengthen the community’s input into any proposed reconfiguration. The views and support of clinicians and GPs will be sought, and the focus will be on improving outcomes and affordability, and including the views of local populations.

The hon. Gentleman will know from reading the White Paper and the five related documents that have so far been published, which flesh out the details, that local authorities will have a greatly enhanced role in the provision of health services and the maintenance of health care standards in the local community, and will not be restricted solely to their current role in public health.

The hon. Gentleman asked whether the Government will implement the recommendations of the Darzi review on acute health services north of the River Tees. The recommendations of that review were superseded by advice provided by the independent reconfiguration panel to the then Secretary of State for Health in December 2006. That advice formed the basis of the “Momentum: Pathways to Healthcare” programme, which was developed by the local national health service to provide a new health care system for the people of Stockton, Hartlepool, Easington and Sedgefield. We understand that NHS Hartlepool and NHS Stockton-on-Tees will continue to work closely with North Tees and Hartlepool NHS Foundation Trust on delivering the wider Momentum programme, and will be discussing the options available with the trust. I hope that that goes some way towards satisfying the hon. Gentleman.

The hon. Member for Kingston upon Hull North mentioned the generality of the provision of health care, and new health care facilities, in the region, and I can reassure her by mentioning a number of initiatives that have taken place in the Stockton-on-Tees area in recent years.

[Diana R. Johnson]

In recent years.

[Mr Burns]

Yes, in recent years—there is no point in the hon. Lady sitting there and saying that because, to be frank, anyone who takes a sensible approach to such matters will not try to score cheap party political points. I recognise that for the past 13 years we have had not a Conservative but a Labour Government, and I am mature enough and comfortable enough within myself to recognise that during those years advances in health care were made. I am not one of those narrow politicians who say that, because there was not a Tory Government, everything was awful, or that everything done by a Tory Government is wonderful; it is a mixture of the two. One has to be mature enough to recognise that, as I do. The initiatives I will refer to took place in the past few years, so they were under a Labour Government.

As the hon. Lady will know, 26 of the 46 Momentum business service change projects are under way as part of the “Momentum: Pathway to Healthcare” programme. They consist of detailed service reviews, a revised pathway based on a map of medicine, a value impact assessment and a service implementation plan. Examples of pathways reviewed to date include those on diabetes, respirology, cardiology and haematology. There are also cross-cutting business service change projects under way in the areas of work force and education, IT, and communications and engagement. There is also an integrated care centre at Hartlepool, with which the hon. Member for Hartlepool will be familiar, and an integrated care centre at Billingham, which I expect the hon. Member for Stockton North (Alex Cunningham) and my hon. Friend the Member for Stockton South (James Wharton) will know.

[Diana R. Johnson]

Will the Minister give way?

[Mr Burns]

I will give way briefly for one final intervention.

[Diana R. Johnson]

I am pleased that the Minister has read out a list of initiatives introduced under a Labour Government, but I am interested in the coalition Government’s thinking on health service provision in the north-east. What initiatives do they have planned for dealing with the health inequalities that have been mentioned by Members today?

[Mr Burns]

I thank the hon. Lady for giving me the opportunity once again to tell her that those are all contained in the vision outlined by my right hon. Friend the Secretary of State in the White Paper that was published last week. It is a vision that puts patients at the heart of health care, so that they can have the best health care of the highest quality. It is based on the premise that there should be a local, bottom-up system, rather than one in which politicians and bureaucrats in Whitehall issue diktats and tell local communities with which they are unfamiliar what they should and should not do. That is the way forward for enhancing health care.

Our vision is based not on processes that are distorted for party political purposes, but on the need to improve outcomes so that people get better health care. The patient experience, whether in a hospital setting or when a patient visits their GP, should be tailored to their needs, rather than to what the state tells them that they should have. That move will be spearheaded by GPs, through GP consortiums, as it is they who are closest to patients, know the health care that they need, and know how patients can best access it. That will all be determined by improving outcomes and the patient experience in order to give the finest quality care that the country can provide—the highest in the world. That is the answer to the hon. Lady’s question.

Oral Answers to Questions

Diana Johnson Excerpts

Tuesday 29th June 2010 Commons Chamber

[Mr Lansley]

My hon. Friend makes an extremely good point. When we set out proposals for an outcomes framework, I hope that he and others will respond, because that is one of the ways in which we can best identify how late detection of cancer is leading to very poor levels of survival to one year. I hope that we can think about that as one of the quality indicators that we shall establish.

[Diana R. Johnson (Kingston upon Hull North) (Lab)]

I welcome the Secretary of State to his new position and wish him well in his role. I understand that he is keeping the two-week target for seeing a cancer specialist, but abandoning the work that the Labour Government did on the one-week target for access to diagnostic testing. Professor Mike Richards stated in the annual cancer reform strategy that improving GP access to diagnostic tests is essential to the drive for early diagnosis of cancer. Can the Secretary of State spell out some of his current thinking on what the alternative would be if we no longer have the one-week target?

[Mr Lansley]

Let me make it clear to the hon. Lady and the House that only 40% of those diagnosed with cancer had actually gone through the two-week wait. Establishing a better awareness of symptoms and earlier presentation across the board is, as we have been discussing, important to achieve. I am afraid that the hon. Lady is wrong: I have not said that we are abandoning any of the cancer waiting-time targets at the moment, but that we have to be clear about what generally constitutes quality. For example, seeing a cancer specialist without having had prior diagnosis is often pointless, whereas getting early diagnosis is often a serious indicator of quality.

Health Funding

Diana Johnson Excerpts

Tuesday 22nd June 2010 Westminster Hall

[Diana R. Johnson (Kingston upon Hull North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for St Ives (Andrew George) on securing today’s debate. From my reading in preparation for the debate, I know that this is an issue that he has taken up over many years during his time in Parliament and that he is a very committed campaigner for health funding for his local area and the wider area of Cornwall. I welcome the Minister of State, Department of Health, the hon. Member for Chelmsford (Mr Burns), to his role and wish him well in his new position.

It has been very interesting to hear the contributions of the two Members who have also spoken in the debate today, the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Hartlepool (Mr Wright). As my hon. Friend said, I want to congratulate the hon. Member for Truro and Falmouth on her maiden speech, if that is how it is going to be seen. Like the hon. Member for St Ives, she is making a very strong case for her constituents and ensuring that there is an advocate for them in this House who stands up for the real health funding that is required for people in her constituency.

It was also very interesting to hear what the hon. Member for St Ives said about some of the different criteria that have been used to allocate funding and about some of the tensions that exist when one looks at some of those criteria. I hope that I shall have an opportunity to say a few words about those tensions shortly.

My hon. Friend the Member for Hartlepool made some very pertinent points about the need to get to the target for health funding for primary care trusts. I noted that he said that his constituency was 4.3% below the funding target. As a result, I had a quick look to see where my primary care trust was in terms of being on target. It is actually 6% below target, so we are just above the group of PCTs that the hon. Member for St Ives referred to, which are 6.2% below the funding target.

It was also very pertinent to raise the issue of access to health services, and of course there is a funding implication to that issue. If we want to have services out in the community, there is a need to look at how funding is allocated and at the issues related to health inequalities. It is not acceptable that there are still parts of this country where the mortality rates show that men in particular will live for fewer years than men born in the south of England. I know that in the north there are real concerns about that issue.

Very importantly, there is also the issue of hospitals and capital funding. I know that that is mainly about PCTs’ revenue funding, but we need to keep an eye on what happens to capital funding. Of course, the hospital at Hartlepool that my hon. Friend the Member for Hartlepool mentioned has been in the planning for a very long time and there has been a huge investment in it, through the PCT and other people and other organisations in that area ensuring that it was really going to deliver for local people.

Therefore, I am particularly concerned about the cancellation of that hospital, especially in the light of the reassurances that were given by the new coalition Government that the cuts that they would make this year would not to be to front-line services and that, as I understood it, they would protect hospital builds. So it would be very helpful if the Minister could say a little more about his view of how the cancellation of the Hartlepool hospital fits in with the agreement not to cancel front-line services.

The main thrust of the debate is the funding of health services in Cornwall, and I have looked with interest at what the hon. Member for St Ives has said about it previously. Today I also had a quick look at his website, where he trails the debate and says that he is looking to secure an additional £56 million of funding for his area. He also says:

“The Conservatives created a system of endemic underfunding. Now they are in Coalition they can put this right.”

The press cuttings prepared by the Library for the debate also include an article from The West Briton of 10 May, in which he says:

“The coalition is already starting to deliver many outcomes which Cornwall has craved.”

I admire his positive view of what the new Government will deliver for him and his constituents and I very much hope that he is correct.

What the coalition Government have said so far about the NHS is quite limited. Section 22 of the coalition agreement sets out their priorities for the NHS, and the first bullet point says:

“We will guarantee that health spending increases in real terms in each year of the Parliament”.

Paragraph 21 of the revision to the operating framework for the NHS in England for 2010-11, which was published just yesterday, reiterates that commitment, and I have just heard the Chancellor of the Exchequer make it clear in the Budget debate on the Floor of the House that the commitment remains.

Of course, that is just the headline, and we do not actually know what it will mean for services in the NHS in England in the coming years. Obviously, the Minister will be working hard on the comprehensive spending review over the summer months. He will be looking at how he can make sure that his Department secures all the resources that it needs to ensure that the view of the hon. Member for St Ives that he will get his £56 million comes to fruition. The written reply to a question that the hon. Gentleman tabled to the Minister contained a commitment just to increase spending

“in real terms in each year of the Parliament.”—[Official Report, 7 June 2010; Vol. 511, c. 47W.]

We really need to have the detail. I accept that it is very early days for the Minister, who has been in office a few weeks, and that the coalition Government are still trying to sort out their policies on NHS funding.

The hon. Member for St Ives made a clear and effective case for raising the funding for his constituency and primary care trust. There have been many written questions and debates on the issue, and I pay tribute to everybody who has been involved in the campaign to get additional resources into the primary care trust and into Cornwall. I also pay tribute to the staff, who are working hard day in, day out with the resources that they have.

Funding is obviously a key issue. The hon. Gentleman has given us quite a detailed canter through the historic reasons why we are where we are on funding, which was very interesting, but many of the views about why there is underfunding in certain constituencies and areas point to the 1970s as the time when allocations perhaps did not work in quite the way that they should have. That is the view that comes out of the debates and explanations about the current funding criteria.

At this point, it is worth reflecting on how the NHS has changed over the years. Patients now want access to high-tech, specialist services with the best nursing and clinical advice. There is also a tension around the fact that people want services much closer to home—in their local GP surgeries or at home if at all possible.

[The Minister of State, Department of Health (Mr Simon Burns)]

I was just reflecting on what the hon. Lady said before she got to this section of her speech. I must gently remind her that her party was in power for 13 years and introduced the funding formula that the hon. Member for St Ives (Andrew George) is complaining about. Having put that on the record, I beg to ask why the last Labour Government did nothing in those 13 years to remove the problem facing Cornwall and the Isles of Scilly.

[Diana R. Johnson]

I am grateful that the Minister intervened on me, because I am coming to that. I recognise, as the hon. Member for St Ives probably does, that where we are today might not be perfect, but the previous Labour Government made huge strides in terms of putting money into his area and others that were underfunded. The statistics show that there have been significant improvements since 2003-04, when some PCTs were 22% below target; now the figure is 6.2%, so there has been movement. I am not saying that everything done under the Labour Government was done as fully as we would have liked, but it would be interesting to hear what plans the Minister has to target the pace of change and how soon he feels we will reach the target level for all PCTs. We have to recognise, as I am sure the hon. Member for St Ives does, that taking money from other areas of the country in one fell swoop is not the best way to have a stable national health service.

[Andrew George]

If the hon. Lady rereads what I said earlier, she will see that I very much acknowledge that. Just to reassure her and, indeed, the Minister, let me say that it was in fact 1980 when the impact of the market forces factor changed quite significantly and created the detrimental impact that I described. Yes, I did make some disparaging remarks about the then Conservative Government and I welcomed the additional funding that the Labour Government put in, which I voted for and the Conservatives did not; that is a matter of record. However, I simply urge the hon. Lady to recognise that the formula change, which I fully applaud the last Labour Government for introducing, puts a responsibility on whichever party is in government to ensure that underfunded areas receive their target funding as quickly as possible.

[Diana R. Johnson]

We can probably agree that history is history. We are where we are today, and we need to make sure that we move forward as quickly as possible to get to the point that we all want to be at—an NHS that is funded fairly across England and that addresses some of the issues that the hon. Gentleman raised about rural constituencies and rural areas.

I want to address the rural nature of the hon. Gentleman’s constituency, the primary care trust and the patients that it serves. The issue of islands and peninsulas is also quite unusual, and few primary care trusts have to deal with it, so there needs to be some recognition of that. Clearly, the influx of people during the summer months must swell the demands on the national health service; all that must be recognised and factored in. There is also the issue of poverty. There can be pockets of poverty in rural areas; they are not just in urban areas, although we recognise that there might be different solutions to poverty in different parts of the country.

Let me reiterate that 80% of NHS spending is at primary care trust level, which means that the best solutions for an area can be put forward, debated and agreed at that level. I want to remove the myth that seems to exist that everyone is being told that certain areas have to do things in a certain way. That is wrong. Primary care trusts have much more capacity to design local services to meet their area’s needs. I understand that the new coalition Government will introduce directly elected representatives into primary care trusts to increase the level of local involvement and accountability. I hope that I have that correct, because the Minister is looking at me as if I do not.

[Mr Burns]

No, I am not doing anything.

[Diana R. Johnson]

I just wanted to make sure, because that was not a Conservative manifesto policy. As I understand it, such engagement and increased accountability in the NHS was one of the Liberal Democrat policies; but it is part of the coalition agreement.

[Mr Burns]

May I just reassure the shadow Minister that I am just listening intently to what she has to say.

[Diana R. Johnson]

I am delighted to hear it.

I now want to move on to the matter of health spending. I recognise that the hon. Member for St Ives would like more money for his constituency, but I think he recognises that since 1997 the relevant spending on St. Ives, and on Cornwall, has increased. This year the allocation for all PCTs is £164 billion. As I said, 80% of the entire NHS budget is now in the hands of PCTs—the highest proportion ever. That means that local decision making is possible. The PCT for Cornwall and the Isles of Scilly is this year receiving £856.2 million and its budget has increased by 12.4%, but we recognise that it is still 6.2% away from the target.

I am grateful that the hon. Member for St Ives has recognised the work of the independent Advisory Committee on Resource Allocation, which is made up of GPs, academics and health service managers, to develop a new funding formula to determine each PCT’s allocation. That has built on previous formulae to meet the objectives of providing equal access for equal need, and a reduction in health inequalities. Of course, a huge debate has raged about the tensions between the criteria used for allocating resources. For instance, there has been a debate about age versus deprivation, and the Conservative party in opposition would often argue that it was not deprivation but age that should be given more weight. The Conservatives also criticised the weighting of health inequalities in trying to remove those inequalities.

I hope that we now recognise that a series of criteria must be considered. Since last year a new formula has been introduced. We can clearly see how far the PCTs’ actual allocation is from their target allocation. The previous Government’s commitment was to move towards the target, while recognising that that would have to be done over a period of time, ensuring that it did not cause major problems to the smooth running of the NHS throughout the country.

When I looked again at the figures I found that the PCT that was the furthest over its target was Richmond and Twickenham; it was 23.4% over the target. I thought that it would make an interesting example to consider, as the relevant MPs are the Secretary of State for Business, Innovation and Skills, who is a member of the Liberal Democrats, and the hon. Member for Richmond Park (Zac Goldsmith), who is a member of the Conservative party. I can just imagine the tension and debate in that case about chopping the funding allocation for that PCT. Perhaps it would add some strains to the tensions within the coalition.

[Andrew George]

The hon. Lady makes a reasonable point about Twickenham and Richmond PCT, and about all those PCTs that receive significantly more than their target, because of the change in the funding formula. If she reads what I have said, she will notice that I recognise that it would be catastrophic to pull the rug out from under those PCTs, and we cannot do that: over a period of time, which I hope would be as short as possible, we need to find ways to ensure that if there are constraints on NHS spending, the areas that are now below their targets should not suffer.

[Diana R. Johnson]

I hope that the Minister will enlighten us with his thoughts on the pace of change in approaching the target and tell us whether he thinks the Department should adopt a target, with deadlines and dates. I know that he is not keen on targets, as we have seen from announcements in the past few days, but it would be helpful if he would explain his thinking about how we can arrive at a situation in which the hon. Member for St Ives gets his £56 million for his PCT, and other PCTs also receive the money that they feel they need.

The hon. Member for St Ives made a strong case for his constituents. I am grateful for his acknowledgment of the work of the Labour Government to deal with the problem; it may not have gone as far as he would have liked, but an attempt was made to deal with it. I look forward to hearing the Minister’s comments on NHS funding in this context. I wonder whether he will also discuss the issue of capital spending, which is preying on the minds of many hon. Members.

--- Later in debate ---

[Mr Burns]

I believe that I can help my honourable colleague. The ultimate decisions will be made by the NHS board when it is established, but he will appreciate that primary legislation will be required and that that will take time. In the meantime, the allocation of funding for health care throughout the country will be done initially following the spending review, but when the board is established on a statutory basis and operating, it will take over that function. I hope that has cleared up the matter for my honourable colleague.

[Diana R. Johnson]

I am wondering about the time scale for the board’s establishment. When will the Minister be in a position to provide some dates for when it will come into existence?

[Mr Burns]

That is a reasonable question, and I shall be reasonable in my response. The date will be determined partly by Parliament because primary legislation will be required, as outlined in the Queen’s Speech last month. Speaking as an ex-Whip rather than a Minister for Health, I anticipate that the legislation will make progress through Parliament this Session and receive Royal Assent in July next year, or perhaps September, depending on whether there is a spillover in September or October next year, which I do not know at the moment. That is my guess as an ex-Whip for the timetable for the primary legislation. We will then have to wait to see at what point after that it will be up and running, but my guess is that it will be as soon as is feasible.