Geoffrey Cox calls for fair funding for rural health in special Parliamentary debate

18th October 2016

Speaking in a special Parliamentary debate on healthcare provision in Devon, Geoffrey Cox calls an amendment to the rural health funding formula to ensure fair funding for rural health services.

The problem with North Devon district hospital has for decades—certainly for as long as I have been in politics in Devon—been quite simple: it is a general hospital that is far out on a limb of sustainability, in terms of the range of services it offers. For decades, there has been a decision begging to be taken, but it has never had the proper, honest and frank discussion that it really needs.

A general hospital generally requires something around a third of a million people to sustain it. The population of northern Devon, including Torridge and the hospital’s catchment area, is some 80,000 or 90,000 people short of the figure that generally sustains a general hospital. However, historically, it has been universally accepted that Barnstaple requires a general hospital. We cannot provide health services to the population of northern Devon unless we have an acute hospital in Barnstaple. We are therefore faced with a clear and stark choice: either make a special case for funding it in the way that a rural hospital that otherwise could not survive needs to be funded, and make it an exception to the principles that apply to general hospitals for which the population is sufficient; or see it slowly wither on the vine, dying by a thousand cuts, and by weasel words used by clever civil servants and others to justify one saving after another. Those savings really mean services reduced, and patients redirected over 40, 50, 60 or 80 miles away, with some expected to travel into the heart of Somerset for treatment that other residents enjoy on their doorstep.

I endorse what my hon. Friend the Member for North Devon (Peter Heaton-Jones) said; there are red lines for Devon’s Members of Parliament. Of course we accept that the current model of healthcare cannot be preserved in aspic. There must be change and transformation, but we cannot put accountants’ methodology over the interests of patients and the citizens we represent.

I say to my hon. Friend the Minister that I know the green and pleasant lands of Shropshire well. What a fine county it is. It, too, has had its battles on this score; I know, because I have family who live there. Let him come to Devon and see the wide distances. I do not believe that in Shropshire there is a place over 70 miles from a main conurbation, as many communities in my constituency are. Travelling 70 miles to, say, have a child delivered puts at risk and prejudices the interests of those who are to be treated.

A decision must be taken on health services in North Devon. It is the same with hospitals in the far north of Scotland; they are highly rural, deeply isolated and not sustainable unless a special formula and a special approach are taken. Words such as “care closer to home” are all well and fine, but the difficulty is that communities see an historic legacy of underfunding that has left the health authorities in our area with an £80 million annual deficit. That deficit has built up over decades of accounting measures, and of conjuring with accounts. On the one hand, communities see this vast deficit, and on the other, they hear words such as “care closer to the community,” or, “Cut your beds and we will provide you with a service that is just as good, and that better fulfils the needs of patients.” Of course we can listen to the logic and rationality of that argument, but while it is all the time moved by the spectre of deficit, they will suspect that it is being made for one reason only: to reduce the budget.

My plea is for fairness. It is a plea to be heard, made on behalf of a neglected, extraordinarily rural area—possibly one of the most rural in England. It is a plea for a special look at this problem in northern, eastern and western Devon. The language coming from well-meaning and, I accept, wholly sincere health administrators has an Orwellian flavour to it while it is governed by this shadow of deficit that hangs over it.

I welcome the news from my hon. Friend the Minister that there has been allowance for rurality in the 2016-17 budget, but one or two minor tweaks do not reverse the legacy of decades. The truth is that the health services we represent—of the people we represent—are being seen to perpetrate a grave injustice. For example, public health spending alone—spending on the prevention of ill health—in the county of Devon is less than half the national average. On any analysis, the funding we receive in Devon is wholly inadequate to deal with its wide disparities and distances, its ageing population, and the other factors that affect Devon.

My simple plea to the Minister today is to hear the voice of those whom we represent, and to hear them pleading with him. Until the deficit is addressed and there is fair funding for rural health services, we will not believe the assurances from well-meaning administrators that our health services are safe. They are not safe. We need a major amendment to the rural health funding formula; we need to improve on what has been done this year; and we need to assuage the anxieties of our constituents by a proper, demonstrably fair health funding formula.

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