Eric Illsley
Barnsley District Health Authority
I am grateful to have an opportunity to discuss the funding of Barnsley district health authority, which is of great concern to many of my constituents and to parliamentary colleagues in this Chamber this morning. I want to concentrate on what appears to be the low level of funding allocated to Barnsley district health authority, in contrast to the area's needs. That is not a new issue; it has not arisen overnight, this year, or recently. It has been of concern for many years, so it is not an issue for which this Government alone must take responsibility. Barnsley has been for many years one of the lowest funded health authorities in the whole country. I am probably right to say that, for a considerable period, we were the lowest funded health authority in the country, despite greater health problems and inequalities than many other areas, especially those in close proximity with similar problems. Barnsley's history at the centre of the Yorkshire coalfield has left a legacy of disability. A large proportion of households in Barnsley borough - about one in three - have one member of the family with a disability. Other acute needs are also made worse by the funding shortfall.
I want to consider funding in some detail. It is a complicated issue, which I do not profess fully to understand. I shall keep the figure as simple as possible. As hon. Members will probably be aware, health authority funding is expressed as an actual figure, in terms of money available, and as what is known as a percentage from target. For example, the target figure is usually expressed as 100, so the percentage figure is above or below 100 depending on whether there is underfunding or overfunding for the particular health authority. Barnsley is consistently underfunded. In 1997-98, Barnsley's percentage figure below target was 97.37 per cent, while in 1998-99 it fell to 94.76 per cent. In 1999-2000, the figure rose to 97.02 per cent. However funding for the forthcoming financial year - 2000-01 - is a decrease to 96.89 per cent.
It appears that Barnsley is falling further and further away from the target funding of 100 per cent. The figure of 96.89 per cent makes Barnsley the worst-funded health authority in the Trent regional authority, which comprises 11 others. However, according to the indicators used by Trent regional authority--morbidity, coronary heart disease, cancer, stroke or any other indicator--Barnsley has the worst problems in Trent. We have what I perceive as the greatest need, but we appear to be falling behind in relation to funding.
I said earlier that the problem has persisted for several years and that the present Government should not bear sole responsibility for the funding that is available. For the forthcoming financial year 2000-01, Barnsley's funding allocation is £168.14 million. That involves a cash uplift of 7.62 per cent, which compares favourably with a national average of 6.78 per cent and which is the highest cash uplift in the Trent region. However, in relation to authority funding in the Trent region, Barnsley is still at the bottom of the pile, and we are moving further away from the target funding. We are one of the lowest-funded health authorities in the country. We are in a sorry position - we cannot find solutions to the problems that we have identified, let alone attempt to pursue health prevention initiatives that involve, for example, changes in life style and diet.
The situation was highlighted on national television recently, and that coverage was discussed in our local press. We witnessed the unfortunate headline, "Barnsley on the sick list". The article stated:
Barnsley was today named as the worst health authority in South Yorkshire.
The first league table marking performance was based on death rates from cancer and heart disease . . . and deaths from "avoidable" diseases such as TB and asthma.
Barnsley was ranked 102 out of 120 . . . Experts said the league table showed that some of the country's most deprived areas had the worst healthcare provision. That is our problem--we are one of the most deprived areas but our health care provision is one of the poorest in the country. We do not seem to be able to access the funding that we need to correct the situation.
The report of the health authority finance officer, which was submitted to the health authority on 22 February, highlights some of Barnsley's problems. The report stated that following the financial settlement:
The forecast year end outturn . . . showed a projected underspending of £195,900 compared with the previously predicted significant overspend. That forecast outturn has been improved because an "additional allocation of £736,000" had been made available to the Authority in respect of generic prescribing and the identification of further sum of £421,000 of further slippage within the reserves. . . The forecast year end outturn took no account of the £800,000 borrowings which the Authority had been required to negotiate and which would form a first charge on its allocation for 2000-01. That means that the authority has a year-end deficit of about £1.2 million.
We have gone from facing a considerable overspend to facing an underspend of £200,000, although there is a first charge of £800,000 on the authority's funding, and £400,000 has been taken from the reserves. The health authority's funding involves a deficit of £1.2 million for this year end. Why does Barnsley health authority have an underspend of £200,000 at the end of the current financial year when in reality it faces a considerable deficit?
I raised the issue of deprivation and health need in Barnsley when I met the chief executive of Trent regional health authority last year. The indicators and statistics that the authority uses were beginning to show Barnsley in a very poor light in terms of various categories of health provision - consistently the worst of the 11 authorities in the Trent regional health authority area. I have already referred to the television survey that ranked us 102nd nationwide.
Of the 11 authorities, Barnsley has the worst level of morbidity, in respect of every cause of death, for people under the age of 65. It has the worst record for lung cancer, cervical cancer, hypertensive and cerebrovascular disease and coronary heart disease, and for the early detection of cervical cancer and inappropriate surgery in respect of children's glue ear. Looking at that list, it is easy to see where Barnsley's problems lie, and the difficulties that it faces. I have referred only to the categories in which Barnsley has the worst record. Categories in which it is second worst include colon cancer and suicide, and the list goes on.
To make matters worse, there is only a narrow gap, in terms of health provision, between the best and worst areas of Barnsley. That suggests that problems extend throughout the borough; no area is better or worse than any other, and the situation is poor across the whole health authority area. I should point out that that is not the fault of the local hospital. A recent headline in the local newspaper, headlined "Praise for hospital", states:
Hospital bosses in Barnsley have been praised for bucking a national trend by rarely cancelling operations. The health authority staff at the hospital have recently been singled out for substantial praise.
It is clear from the establishment of the South Yorkshire coalfields health action zone that some of Barnsley's problems have been recognised. Given the priorities that will be addressed by the action zone, I hope that the position can gradually be alleviated by encouraging people to improve their life style by changing their diet and so on. The question of low incomes and deprivation is a different kettle of fish, which can be addressed only by better economic performance in the longer term.
When I raised the matter with the director of Trent regional health authority last year, I pointed out that Barnsley is an area of extreme need in terms of health provision; it has a poor record and the least amount of money. He replied that the people of Barnsley have low aspirations and are reluctant to complain. I suggested to him that if I start to tub-thump and shout about it, his budget situation will deteriorate, because I will make people aware of the situation that they face and the fact that they should be demanding more from their health authority, but the money is not available. He was inclined to agree, which surprised me. More should be done to equalise funding across Trent regional health authority to try to alleviate Barnsley's problems.
I shall refer to a couple of other problems that Barnsley faces. We have recently lost accreditation for an ear, nose and throat surgeon because we could not provide sufficient training opportunities for junior doctors and we contravened the rules on junior doctors' hours. We are also facing accreditation problems with orthodontic surgery, orthopaedic surgery, dermatology and general surgery.
There are major problems throughout the area with the prescribing of wrong drugs and too many drugs. Problems will also arise with the reconfiguration of health authorities in Barnsley, but they do not concern funding and I do not expect the Minister to respond to them today. I hope that any attempt to reconfigure the health trusts in Barnsley will not disguise the fact that our funding is low, but I have considerable reservations about that reconfiguration.
I refer the Minister to a letter that I received recently from the Barnsley local medical committee of general practitioners. There is an air of desperation in the letter which refers to funding being badged for various purposes but schemes and areas in Barnsley being desperately in need of development with no funding to allow diabetic and cardiology services, both of which are Government priorities, to be pursued. Dr. Kenneth McDonald, secretary of the committee, concludes his letter by stating:
It feels very much as if we are being penalised for achieving financial probity in an area where there is a large amount of socio-economic deficit leading to considerable medical problems that as GPs we are very keen to address, but are hamstrung due to funding deficit.
I look forward to the Minister's response and hope that she can give me some hope for the future.
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