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Column 1063Dewar, Donald
Ewing, Mrs Margaret (Moray)
Fields, Terry (L'pool B G'n)
Godman, Dr Norman A.
Golding, Mrs Llin
Griffiths, Win (Bridgend)
Hogg, N. (C'nauld & Kilsyth)
Hughes, John (Coventry NE)
Hughes, Robert (Aberdeen N)
Hughes, Simon (Southwark)
Lloyd, Tony (Stretford)
Macdonald, Calum A.
McKay, Allen (Barnsley West)
Mahon, Mrs Alice
Marek, Dr John
Marshall, David (Shettleston)
Moonie, Dr Lewis
Pike, Peter L.
Powell, Ray (Ogmore)
Quin, Ms Joyce
Reid, Dr John
Roberts, Allan (Bootle)
Ross, Ernie (Dundee W)
Smith, Andrew (Oxford E)
Welsh, Andrew (Angus E)
Welsh, Michael (Doncaster N)
Wise, Mrs Audrey
Tellers for the Noes :
Mr. Allen Adams and
Mr. Frank Cook.
Question accordingly agreed to.
Motion made, and Question proposed, That this House do now adjourn-- [Mr. Alan Howarth.]
Mr. Roger Knapman (Stroud) : My interest in the subject of community hospitals has been stimulated by the proposals of the Gloucester health authority, which seeks to close the Berkeley and Tetbury hospitals in my constituency. Those are hospitals that are greatly valued by the communities which they serve. The communities have responded generously, both to the modernisation and the upkeep of those hospitals, largely through the sterling efforts of the leagues of friends. Moreover, the communities were originally given these hospitals by local benefactors in the last century, although it would seem that, with a piece of Socialist spite, the property was confiscated from them in 1948.
The level of public concern for these hospitals is shown by the fact that at recent public meetings protesting against their closure about 1,000 people attended the Tetbury and over 600 turned up at Berkeley. The purpose of this debate is not to criticise the Gloucester health authority, which is one of the best in the country, but rather to challenge the basis on which the assessments of the working party which was set up by that health authority were made. I appreciate that if I dwell solely on constituency matters I shall receive virtually the standard response from the Minister, which is that small community hospitals make an important contribution to the NHS but that it is for individual health authorities to determine the appropriate pattern of district services. In doing so, they will balance the benefits of community alongside those of larger district hospitals in the light of changing circumstances so as to secure from the available resources the best possible value and level of service provision for all the local communities that they serve.
I have seen that answer on a number of occasions, but I hope tonight to hear a little more, and I respectfully suggest to the Minister that the Government should have a policy towards community hospitals beyond the bland statement that they make an important contribution to the NHS, because some are under the threat of closure or have closed for reasons which give cause for concern.
The role of community hospitals was perhaps best defined by Dr. Rou in the Health Service Journal dated 26 February 1987, when he said that
"patients suitable for admission to the community hospital may broadly be described as patients who, while requiring hospital care because they cannot be managed at home, do not require the facilities of a district general hospital or the services of a specialist team."
Indeed, the working party of the Gloucester health authority paid a generous tribute to the work of the community hospitals before proposing their closure. Can anybody suggest that there is any reduced demand for their services? Elderly people should not have to travel upwards of 20 miles for treatment that they could receive locally. In particular, the terminally ill must prefer to spend their final months or weeks in their own localities where their friends and families, and the vicar, can visit them and the doctor they know can treat them.
Can the Minister confirm that the NHS reforms that are currently being instituted--and should be pursued--include the belief that the NHS should be more
Column 1065consumer-orientated? If so, the protection of community hospitals should have top priority, for the reasons I have outlined. But it is not just in Gloucestershire that such concerns exist. The Association of General Practitioner Hospitals considers that there are about 400 general practitioner hospitals in Britain but would like to see that number increased to between 1,000 and 1,500. Yet fears have been expressed about the closure of such hospitals. They are indeed tempting targets, likely to be thought of as peripheral to those who believe that they can spend the money in a more effective way.
We are realistic enough to realise that the roles of community hospitals are not set in tablets of stone and that many operations are exceedingly complicated and can be carried out only at the district general hospitals with, among other things, modern anaesthetic equipment. So, seen from the eyes of a health authority, such proposals can make sense ; it is much easier for it to conduct its business under one roof and centralise its activities in one district general hospital.
It was reported in the General Practitioner dated 5 February 1988 :
"In hospitals which use nurses to work in theatre, in casualty and on the wards, a drop in operations can quickly make it easy for the district to cut staff, argue the theatre is not viable and ultimately the whole hospital is not cost-effective."
I would say that that summary entirely fits the pattern that has occurred in my constituency. Such proposals are directly contradictory to the views expressed in the DHSS report "The Way Forward", admittedly now some 11 years old, and more recently "Towards good practices in small hospitals" by Dr. Charles Shaw. The reason for this is best illustrated by the background paper "Community Care", which is available in the House of Commons Library. On page 3 of this paper it is shown that the principal agencies involved in community care are social security, health, social services, housing, the voluntary sector and the private sector. Does my hon. Friend agree that all those parties are concerned with health provision, including the care of the elderly? The reality is that if the health authorities are able to close community hospitals many of their elderly or geriatric patients will then be looked after and paid for by other services, and this is the crux of the matter. Health authorities have a duty to manage their budgets in the most efficient manner, but do they take into account the effect on other agencies, such as the Department of Social Security? The inescapable truth is that they do not. Therefore, the right answer for the health authority is often the wrong one for others affected--wrong for the taxpayer, wrong for other providers of health care and, above all, wrong for the people in the locality concerned.
Community care and community hospitals are inextricably linked. In most areas we have an aging population, some of whom require regular treatment, and they should not be required to travel long distances to obtain that treatment.
Can my hon. Friend confirm that the cost of care in community hospitals is about 60 per cent. of that in district general hospitals? That seems to be the experience in Finland, where I believe a study has been made. It is also estimated that 40 per cent. of all operations could be undertaken at community hospitals. Do the health
Column 1066authorities have the flexibility to analyse these matters and use the community hospitals more frequently, thereby taking pressure off the district general hospitals? What is our policy towards community care? Surely our response to the Griffiths report should be known before any more community hospitals are closed.
Towns with community hospitals are often treated like a pampered minority. But I suggest that in rural areas community hospitals are a natural and necessary focal point for medical care and community care in that district. Of course, economies can be made. In too many towns we have the doctors' surgeries in one street, provision for elderly people in another and the community hospital elsewhere--in other words, scattered all round the town and all the premises requiring staff round the clock. Sheer common sense dictates that huge savings could be made by concentrating these on one site wherever possible. In conclusion, can my hon. Friend confirm two main points? The first is that no more closures of community health hospitals will be made before our response to the Griffiths report is known--I gather this may be known soon. The second, and perhaps most important, is that when health authorities justify such closures by savings--I suggest often illusory savings--these figures will be considered only in the context of overall health provision and the financial effects on other providers of health care will be considered.
A former permanent secretary remarked :
"If you are not confused about community care and community hospitals it shows you are not thinking clearly."
I feel confident that my hon. Friend will help to lift the fog. 2.14 am