Steve Barclay is MP for North East Cambridgeshire.
MPs will be watching closely today as the NHS England board comes together to decide how the extra £2 billon awarded to the NHS by the Chancellor in the Autumn Statement will be divided. What matters is not just how much money has been announced, but how it is spent.
The key question is whether £1.5 billion of this total, which is allocated to the Clinical Commissioning Groups (CCGs), will be applied under a fair funding formula, or under the existing formula, largely devised by the previous Labour government. Not only is using the fair funding formula the right thing to do in health terms, but it will also be politically toxic to communities predominantly represented by Conservative and Liberal Democrat MPs should the money awarded by this Government go disproportionately to areas which already have more than they should have on a fair funding basis.
Despite the fact that the meeting takes place later today, two critical items – planning guidance and allocations – are yet to be detailed on the agenda on the NHS England website. The Secretary of State for Health now needs to reassure constituents in Cambridgeshire and elsewhere, as well as MPs representing these communities, that this money will be allocated on a needs basis.
Of the money allocated, £200m will be for health innovation and a further £250m will go to primary care. As previously stated, the lion’s share will go to the CCG. The criteria for spending the first two funds has not yet been set. It also remains unclear, with regard to to the key £1.5 billion, whether this will be used to close legacy funding imbalances or will simply continue them.
As the situation stands, counties such as Cambridgeshire are below funding based on need. Given that an extra £1.5 billion will be allocated to CCGs, there can be no logical reason why this should not be rectified.
The decision will also expose the danger of outsourcing decisions to unelected bodies, given the unavoidable tension around the decision to make NHS England independent in how it spends money. Inevitably in a democracy, our constituents will not simply ask how much money has been allocated nationally but also how much they in their area will get – and will look to their elected representatives to ensure that they get a fair share.
It risks exposing the limitations of democracy if the answer is that the allocation of money awarded by government is not on a fair funding basis, despite both Conservative and Lib Dem health ministers saying that it should be, simply because unelected officials on the NHS board have deemed otherwise.
This is fast becoming a wider problem for Parliament, as is being demonstrated by a number of planning fiascos such as one currently taking place in North Somerset. There a mistake by the planning inspector is resulting in significant additional costs for the local council, which has done nothing wrong. The danger is that the housing allocations originally planned in Labour’s top down spatial strategy and rejected at the ballot box by the current Government is now being imposed by the back door. See here to read the details of an adjournment debate held on Monday by Somerset MPs.
The announcement of the extra £2 billion underlines how health will be a key issue in the General Election. Tomorrow is a pivotal day in determining how this money will play into the election debate. Conservative MPs want the money that they and the Chancellor have allocated to be spent on the basis of need – as, it appears, do NHS Health Ministers. If NHS England do otherwise, it will highlight a wider problem for Parliament that goes beyond the future direction of the NHS.