COMMUNITY HOSPITALS IN THE NEW FOREST – 4 July 2005
Mr Speaker: I call Dr Lewis.
Mr Desmond Swayne: Hear, hear!
Dr Julian Lewis: I am very grateful for the fact that I have attracted the above-average number of Members who are remaining this late in the proceedings. I am even more grateful for the vocal support of my hon. Friend the Member for New Forest, West (Mr Swayne).
I first raised the question of the closure of in-patient beds in community or cottage hospitals in the New Forest at Business Questions on 9 June. The Leader of the House – I am sorry not to see him here tonight, although I am pleased to see the far more appealing form of the Under-Secretary of State for Health, the hon. Member for Don Valley (Caroline Flint), in his stead – gallantly said that he was looking forward to reading my speech in the Adjournment Debate for which I would undoubtedly apply. This is that speech, and I hope that in due course the Leader of the House will feel informed by what he reads in the days ahead.
Even as we speak, events in New Forest Primary Care Trust are unravelling fast. Only this week, the Lymington Times featured an article headed:
"Why is Hythe minor injuries unit still closed?".
I should explain that the two hospitals to which I shall refer are Hythe Hospital and Fenwick Hospital in Lyndhurst. Both hospitals are much loved. Both were created as a result of money raised by the local communities, both have a high reputation, and both were part of something called the Community Health Services Trust, which was still in place when I became the Member of Parliament for New Forest East in 1997.
I am reliably informed that running the Community Health Services Trust was always financially tight, but that there was no question of its operating in deep deficit – a deep deficit that has become catastrophic in the four years or so since the Trust was replaced by New Forest PCT. I would say a word or two about the financial aspects, but that it is not the matter on which I propose to concentrate.
Certainly a good many PCTs started with deficits. I understand that New Forest PCT started with a deficit of about £2 million. But by March this year I was being told by the Chief Executive that the deficit would be up to £11 million, and now that gentleman – Mr John Richards – states that it will be £13.5 million.
When the PCTs were set up, there was an immediate expansion of management. Ten PCTs came into existence in Hampshire alone, instead of a single health authority. There have been many explanations for the increase in the debt. I have been told, for example, that New Forest has been charged up to 30 per cent. more for the same services because we are regarded as being more prosperous. It is a fact, however, that the community or cottage hospitals have never been a great drain on the National Health Service. Even today, the League of Friends of Hythe Hospital has £123,000 in the bank which it is willing to make available in the future, as it has made so many hundreds of thousands of pounds available in the past, to support the hospital and pay for equipment.
To be fair to the PCT, I should say that I got in touch with Mr Richards, told him about the debate and offered him an opportunity to give his account of why there is such a gigantic debt. He replied:
"The PCT has a recurring deficit as of the 1st April 2005 of £13.5 million"
– the figure that I mentioned a few moments ago.
"This is effectively the overspend that we had in 2004–05 plus the £4.8 million of support via SHA"
– the Strategic Health Authority –
"and adjustments from our balance sheet, being the reversal of prior year provision no longer required."
I hope that that is clear to everyone, even if it is not clear to me.
"This helped to reduce our overspend last year. The underlying deficit is added to by the funding of mandatory NHS investments/inflation (consultant contract, pay awards, agenda for change etc) which has to be passed on to all our providers. The impact of prior year commitments and the full year effect of last year's developments adds to our deficit, the bulk of which relates to the full costs of acute hospital activity under payment by results. Effectively the New Forest has in the past not paid the full cost as per the national tariff which gives us an in-year cost pressure. This is compounded by the fact that emergency admissions to hospitals are rising above the national average."
That is the financial picture as painted by the PCT. I do not wish to dwell further on that, because the PCT is not using financial pressure as the argument for closing in-patient beds in the New Forest's community hospitals. On the contrary, we are being given a doctrinal update of what we were given when so many mental health establishments were closed previously, in order to bring about care in the community. We are being told that people in in-patient beds in community hospitals do not really need to be there, and that they would be much better catered for in their own homes. We are told that there will be a consultation exercise.
[Sandra Gidley (Romsey) The hon. Gentleman will be aware that the consultation affects Romsey Hospital, which is in my constituency. Is he also aware that a bed-usage survey claimed that only a small percentage – some 16 or 17 per cent. – of people in community hospital beds need to be there? But the problem is that it is difficult to get hold of that document or to find out the assumptions on which it was based. Nor has there been any consultation with local general practitioners.]
Dr Lewis: The hon. Lady is absolutely right, and I thank her for her contribution. A great deal of secrecy is involved in this process, and I give notice now that I intend to apply, under the terms of the Freedom of Information Act 2000, for as many documents as I can obtain from the PCT, in order to determine its real strategy with regard to closing beds. It has become blindingly obvious that the intention all along has been to close these hospitals and to remove a whole layer of care.
I began by saying that we were supposed to have a consultation exercise. I was assured at several of the public presentations that I attended, which were given by the PCT Chief Executive and members of his staff, that that consultation exercise had yet to begin. I was given an absolute assurance at those meetings that the consultation would come later, and that there were five options on which people could give their views to the PCT. They ran the full gamut – from not closing any community hospital beds to closing them all.
Now, we are led to understand that the goalposts have been shifted. The scene has been shifted, and in fact a piece of extremely sharp practice has been carried out. We are now told that the five options have become two. Given the tenor of my remarks, it will not surprise Members to learn that those two options are to close a lot of beds, or to close them all.
In a letter to the chairman of the health review committee, the Chief Executive of the New Forest PCT said that
"the feedback from the public has been that the most valued local services are outpatients, investigations and day surgery, and that where possible they would prefer to receive care in their own homes. In-patient beds were seen as a lower priority."
That will come as news to the 4,300 people who have signed a petition protesting against the closure of in-patient beds in the Fenwick Hospital in Lyndhurst.
My time is very short, as I wish others to have a chance to contribute to the debate, so I will just say this. It is clear – indeed, it is a mathematical certainty – that the closure of these hospitals will make the financial position worse, not better. It is absolutely obvious that if 20 patients are to be catered for in 20 different homes, they will require more people to support them than would be required if they were concentrated in a single location such as a cottage hospital. Even now there are not enough people to support those who require attention in their own homes and if the cottage hospitals disappear, one of two things will happen. Either people will remain at home when they should be in a cottage hospital, or they will go into the only remaining hospital beds – the expensive beds in the general hospitals. Indeed, general hospital beds are three times as expensive as community hospital beds.
I want to end my contribution on a positive note. Hampshire County Council, which has been repeatedly rated as ‘Excellent’, is introducing plans to provide 500 nursing care beds at 10 locations in the county. Out of the 500 beds, 100 will come to the New Forest. If the number rises to 800 beds, including rehabilitation beds, it will mean 160 beds in the New Forest. There is every possibility that Hampshire County Council can come to the rescue here by using the sites, if not the buildings, of these cottage hospitals to keep these much-loved and much-valued enterprises alive. Speaking for myself, Mr Deputy Speaker, I would have a lot more confidence in an excellent county council running these establishments than in the absolute catastrophic mess made by an incompetent management that has filled the local service with dismay and despair.
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[Mr Desmond Swayne: I thank my honourable, indefatigable and great Friend the Member for New Forest, East (Dr Lewis) for his persistence and generosity.
What on earth is happening, Mr Deputy Speaker? We are told that we are spending ever greater amounts on the National Health Service. We know that we are paying ever greater amounts in our income tax and national insurance contributions, but why are we not getting our share in South-West Hampshire? How is it that we are now being told that the New Forest Primary Care Trust may not be able to honour the decisions of the National Institute for Clinical Excellence when it comes to prescribing and that either all or most of our community hospital beds are to be closed?
What I really resent is being told that less means more, that all this does not represent a cut at all, as it is part of a new, improved model of working and an improvement in the service. We are even told that these people do not need to be in hospital as they would be much happier at home. Teams are to be provided, we are told, to go into people's homes to care for them so that they do not have to go to hospital. Anyone who has a domiciliary care package funded by social services in Hampshire will know that the staff to provide those services simply cannot be had. The notion that the cash-strapped New Forest PCT will be able to provide the services is utterly fanciful.
The hon. Member for Romsey (Sandra Gidley) referred to the bed survey. I have deep reservations about the work that went into that and I have received representations about it from general practitioners in the New Forest. It simply does not take into account the fact that the typical stay in an acute bed in Southampton or Bournemouth is a week, whereas in the New Forest community or cottage hospitals it is four weeks, because of the emphasis placed on rehabilitation. Add to that the completely inadequate arrangements for transferring patients from acute care back into the community – let us say in a rest home or a care home – and we have a recipe for absolute disaster. It is bad enough that beds are being blocked in acute hospitals, but if we lose the beds now available in the community hospitals in Milford and Fordingbridge in my constituency, for example, we will place an enormous burden on what is held out as the great prize – the new hospital to be built in Lymington.
Lymington holds out an enormous opportunity because it allows the possibility of bringing back some of the acute care that is now carried out in Bournemouth and Southampton, with huge financial savings for the New Forest Primary Care Trust. However, if we close the beds in the New Forest community and cottage hospitals, we run the risk of that opportunity completely disappearing, at great financial cost to the New Forest.
The hospitals in Fordingbridge and Milford are near the centres of population and, more particularly, near the centres of elderly population. That is an important factor in the New Forest, where public transport is largely non-existent. The hospitals have a good standard of facilities, supported – as my hon. Friend has pointed out already – by extraordinary efforts by Leagues of Friends. They have an excellent record of clinical and rehabilitation care and infection control. Both are next door to local GP practices – a very important factor – and they both have parking, which Southampton Hospital, Bournemouth Hospital and the new hospital at Lymington do not have, which is another important factor.
Under section 10(2) of the National Health Service and Community Care Act 1990, the Minister has the power to set aside the requirement on the New Forest Primary Care Trust to balance the budget. I urge her to take the opportunity to do so this year, so that we can examine the case that has been made and ensure that an enormous opportunity for the new hospital in Lymington is not lost through the closure of the facilities in Milford and Fordingbridge. Their closure would place a huge burden on the new hospital that it would not be able to discharge, with financial and ongoing consequences for the Primary Care Trust.
Dr Andrew Murrison (Shadow Health Minister): I congratulate my hon. Friend the Member for New Forest, East (Dr Lewis) on introducing this debate, and I wish to contribute briefly to it. The clinical case for cottage hospitals is well made. We all know about the excellent health care that community hospitals provide to patients. We also know how loved they are by their communities. What has not been made clear enough is the economic case for community hospitals and I hope that the Minister will talk a little about that.
There is a natural centralising tendency by health care managers and policy-makers. When choosing between options, they invariably choose the closure of a peripheral unit. I hope that the Minister will note the comments made by my hon. Friend in terms of the relative cost of acute hospital care and community hospital care, and that they will influence the decisions that she makes and her vision for the future of community hospitals.
The Parliamentary Under-Secretary of State for Health (Caroline Flint): I congratulate the hon. Member for New Forest, East (Dr Lewis) on securing this evening's debate and I welcome the contributions from the hon. Members for Romsey (Sandra Gidley), for New Forest, West (Mr Swayne) and for Westbury (Dr Murrison).
On the point just made by the hon. Member for Westbury, it is important to consider a health service fit for the 21st century. As the Minister with responsibility for public health, I am keen to see what we can do outside hospitals to encourage preventive health measures that, in the medium to long term, will change the journeys of many people who, for all sorts of reasons, end up in the acute sector for treatments and operations that – with more emphasis on public health and treatment outside hospitals – they might not require.
We must also recognise that within our hospitals, acute and community, a wide-ranging debate is being held about whether all the services currently provided are fit for purpose and whether some of them could be better provided in a different environment. In addition, as the number of elderly in our population is expanding, we need to look into providing services that meet people's needs in different circumstances. I am sure that every Member in the Chamber acknowledges that older people prefer to have services that enable them to continue an independent life in their home environment for as long as possible. They want local services, but not necessarily in a hospital.
Having said all that, I agree that there is not a one-size-fits-all solution and there is a continuing role for acute hospitals and community hospitals. I am sure that hon. Members are aware that our General Election manifesto highlighted the fact that community hospitals would have a role. However, in a health service fit for the 21st century, we must have provision that meets the needs of local communities and I pay tribute to the staff in the areas of all the hon. Members, and in mine and that of my hon. Friend the Economic Secretary to the Treasury, for their important work to support patients.
I acknowledge that many campaigners, on whose behalf the hon. Member for New Forest, East spoke this evening, are concerned about the provision of local health services and have expressed their opposition to the proposals made by the South-West Hampshire Primary Care Trust alliance. I assure them and the hon. Gentleman that no final decision has been to close hospitals and that there will be extensive consultation.
Before talking in detail about the proposals, I shall outline how the NHS is organised and where responsibility lies. From some of the comments of Conservative Members and of the hon. Member for Romsey, one might think that they did not believe in local decision-making. From their comments, one might conclude that, although they argue for local decision-making, when it happens, they are not quite so much in favour of it. However, it is important that the stakeholders who lead the consultation listen to local communities and make their case.
Mr Swayne: To whom are those local decision-makers accountable and by whom have they been elected?
Caroline Flint: As the hon. Gentleman knows, it is the responsibility of PCTs, working in partnership with strategic health authorities, to determine how best to use funds to meet national and local priorities for improving health, tackling health inequalities and modernising services. There have been discussions and consultations with local service users on the best use of services and they will continue. I am sure that hon. Members will agree that hospital and community services need to continue to modernise to meet the needs of patients. That is the process under way in the New Forest.
Hon. Members, especially on the Conservative Benches, have always been keen to advocate prudent financial management. There are some real issues relating to deficits and efficiency. Part of what we are trying to encourage, which I hope that hon. Members will support, is a good look at how services are being provided and whether they meet the needs of local communities or whether they could be provided in a better way to meet both local needs and financial accountability.
The two Primary Care Trusts responsible for community hospitals in the constituency of the hon. Member for New Forest, East – New Forest PCT and Eastleigh and Test Valley South PCT – have formed an alliance under one management team to undertake a strategic review of community services. Nationally, there is increasing emphasis on providing services for patients, where possible, in the community – I acknowledge that it may not always be possible – enabling them to remain at home, without the need for a stay in hospital. That is a vision of a patient-centred service – not one size fits all, but a service that delivers health care where the patient wants it, and it underpins our drive to modernise NHS services.
Locally, other factors have necessitated the alliance's review of community services. Five community hospitals will come under the review: Milford on Sea, Hythe, Fenwick Hospital in Lyndhurst, Romsey and Fordingbridge. They are all about 25 minutes drive from one another. Together, they provide up to 119 beds, including GP, consultant, maternity and orthopaedic beds.
Research commissioned by the alliance shows that only 16 per cent. of patients in the community hospitals were treated appropriately. More than half of in-patients are waiting either to transfer to a more appropriate facility or to their own home with appropriate support. I heard what the hon. Member for Romsey (Sandra Gidley) said about the research on which that is based and I am happy to provide her, where I can, with some information. I understand that someone was sought to carry out an extensive consultation of some 1,300 service users. I am sure that the hon. Gentlemen and the hon. Lady agree that the alliance must review how better services can be provided for patients.
There are some other difficulties. Some of the community hospital buildings are inappropriate to modern health care and require an estimated £20 million to bring them up to standard. Apparently, there have been difficulties in recruiting the staff needed to deliver clinically safe services – one of the issues uppermost in patients' minds when they enter a hospital. For reasons of patient safety, 20 beds at Fenwick Hospital have been closed since February. The minor injuries unit at Hythe Hospital was also closed for more than 18 months.
Dr Lewis: Exactly the same techniques have been used at Hythe and Fenwick hospitals. They relate to saying that the recruitment of nurses has been inadequate. At Hythe hospital, there was a shortfall for a month. When that shortfall was made good and those involved were ready to reopen, the PCT refused to allow them to do so. They are not a bunch a disinterested people who are trying to make an open-minded assessment, but a bunch of outside hatchet men who are determined to close those hospitals. The Minister says that only 16 per cent. of the people should have been there, but where will that 16 per cent. go when the hospitals are closed? It is not even those hospitals that are responsible for the financial deficits. The whole thing is a set up.
[Mr Deputy Speaker (Sir Alan Haselhurst): Order. The hon. Gentleman must leave the Minister time to reply.
Caroline Flint: Thank you, Mr Deputy Speaker.
Part of the consultation involves considering the better use of beds. For example, a recent bed audit at Southampton Hospital showed that 30 per cent. of patients awaiting transfer from the acute hospitals were awaiting transfer to community hospitals. That equates to 23 patients for the New Forest. Community hospital provision for those patients needs to be spelt out in the strategy document and should be considered across the piece to ensure that patients are treated in community hospitals, not acute hospitals, where that best serves their interests. However, those people who would be better placed outside community hospitals should be looked after in an appropriate service for their needs elsewhere. Therefore, the discussion relates to considering how the whole service might best be provided.
The Lymington unit, while still open, has also experienced some staffing difficulties. Against that backdrop, I would at least hope that hon. Members will recognise that the status quo is not an option. The alliance has taken a broad approach to identify a way forward. It has presented strategic options to improve community services for adults and older people to the two PCT boards and to the Hampshire and Isle of Wight Strategic Health Authority.
I shall point out a number of new services that are available in the community. A new respiratory assessment unit for people with chronic obstructive pulmonary disease opened on 1 July, thus allowing New Forest patients to be seen closer to home, rather than having to travel to Southampton. The heart failure nurse for the New Forest, based at Hythe Hospital with a clinic at Lymington, offers lifestyle and nutrition advice and support on coping with heart failure. The nurse also makes home visits. The endoscopy service, based at Lymington and available to New Forest residents, has expanded, thus allowing more people to be seen closer to home.
All those issues are difficult because people get used to what they have, but this is part of an exciting agenda, with more money that the Government have provided, to develop services that are not only fit for purpose but that have a sustainable future in an ever-changing health environment.]