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Care of the Elderly (Hillingdon)

Motion made, and Question proposed, That this House do now adjourn.--[Mr. Anthony Coombs.]

10.1 pm

Sir Michael Shersby (Uxbridge): For me, the care of the elderly in Uxbridge and in the borough of Hillingdon as a whole is one of the most important parts of public policy. As president of the Uxbridge Abbeyfield Society, which provides care for many of our senior citizens, I have been able to learn at first hand, and gain valuable insight into, the way in which places are funded and provided in the community.

The recent media coverage of Hillingdon hospital's patient admissions policy has caused unnecessary alarm and distress to my elderly constituents and to the constituents of my hon. Friends the Members for Ruislip-Northwood (Mr. Wilkinson), for Hayes and Harlington (Mr. Dicks) and for Harrow, West (Mr. Hughes), whose constituencies, with mine, share the hospital's catchment area.

A headline in The Guardian at the beginning of October, "Hospitals in cash crisis bar many elderly", triggered a mass of reports in the press and on the radio and television to the effect that Hillingdon hospital was no longer admitting people over 75. The facts behind that health scare are very different. That is why I am raising the matter this evening, and why I invite the comments of my hon. Friend the Minister.

It is also why I want the Government to make it clear beyond any shadow of a doubt, first, that there is no cash crisis at Hillingdon hospital; secondly, that at no time were people over 75 who came from the hospital's catchment area refused admission on the ground of their age; and, thirdly, that the responsibility for funding and providing beds for elderly patients is the responsibility of the local agencies concerned--the hospitals, the local health authority, the local social services department and the local medical committee. It is for them to co-operate and co-ordinate the necessary arrangements to ensure that the necessary accommodation is always available to everyone, irrespective of age.

I was first made aware of the pressure on Hillingdon hospital at a meeting that I had with the chairman of the Hillingdon Hospital NHS trust, Mr. William Glyn-Williams, and the chief executive, Mr. Philip Brown, on 1 October. I was told that the hospital faced the possibility of having to refuse accident and emergency admissions for a short period because the number of elderly patients referred by general practitioners, especially from the north of the borough, was resulting in more than 30 additional admissions each day.

There are 600 beds in Hillingdon hospital and I am told that about 300 of them are occupied by elderly patients. The 30 referrals a day, multiplied by the number of days in the month, was equivalent to 900 bed days a month. That was the scale of the problem that Hillingdon hospital was facing.

I was also told that Mount Vernon hospital in Northwood, in the constituency of Ruislip-Northwood, was not admitting as many patients as it might have done because of the case mix in the hospital, and that it would greatly assist if Hillingdon council's social services department could receive into community care as quickly

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as possible patients who no longer required hospital treatment and needed to be cared for in community homes or, if insufficient places were available, in independent residential care.

I was very concerned to learn of the situation. I advised the chairman to discuss the matter urgently with the chairman of Mount Vernon and Watford Hospitals NHS trust--a former chairman of Hillingdon health authority--the officers of the authority and the social services department and to sort out the problem. I also offered to arrange a meeting with my hon. Friend the Minister if it was thought that that would help to find a quick solution to the problem.

I heard no more until 8 October, when the chief executive of Hillingdon hospital wrote a letter to general medical practitioners in the north of the borough--areas such as Ruislip, Eastcote, Northwood, Harefield and elsewhere on the borders of the north of the borough--advising them that elderly patients over 75 years old should be referred to the most appropriate local hospital, Mount Vernon.

There is great concern in Ruislip and Northwood at the moment because many elderly people do not like the prospect of being referred to Watford general hospital, which principally admits accident and emergency patients, because they feel that Watford is a long way from Northwood and is not easy for people to visit. There is considerable pressure when a patient cannot be admitted to Mount Vernon to send that patient to Hillingdon, to which, of course, the doctors have to respond.

The letter sent by the chief executive of Hillingdon health authority to doctors was leaked to The Guardian and resulted in the highly misleading headlines that I have mentioned and the subsequent alarm that spread throughout my constituency. I have been assured by my hon. Friend the Minister that Hillingdon hospital was not seeking to discriminate on the basis of age but wished to ensure that all patients received safe and effective NHS treatment in the most appropriate location in accordance with their clinical need.

In a programme of public information designed to correct the misleading information that had been given, Hillingdon hospital went to very considerable lengths to reassure the public whom it serves by means of an advertorial in the local press, which appeared for two consecutive weeks. I welcome that initiative, which I hope will go a long way towards dispelling any remaining doubts that elderly people might have about their right to treatment in hospital when they need it, at any time, irrespective of age.

As I have said, I undertook to raise the matter of more community care with the acting director of social services of the borough of Hillingdon and to find out what could be done to place patients in the council's homes and independent homes as quickly as possible. I have done that. The acting director tells me that Hillingdon council has 330 beds in eight homes; in addition, it currently funds 219 permanent residential and nursing placements, has 172 permanent complex home care packages and approximately 100 short-stay residential nursing home care packages. About 70 permanent residential or nursing home care packages are to be made available between the beginning of this month and 31 March next year.

The current community care budget for the elderly is £5 million, and the council intends to allocate another £1.3 million to its community care budget next April.

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I put on record the accommodation that is available, because it was suggested to me that one of the problems facing Hillingdon hospital in discharging elderly patients into the community was Hillingdon social services' slowness to take some patients. Following my discussions with the acting director of social services only today, I am assured that Social Services will take all necessary steps to speed up admissions and to increase the availability of beds.

I am glad to report that, as a result of all that activity, Hillingdon health authority has taken immediate action to reduce significantly the number of Hillingdon residents--56 at the end of September--waiting in hospitals solely for residential and nursing home placement. It will use six of the 12 care beds that it currently funds at Hayes Cottage nursing home, will agree with Hillingdon council how it can assist with the temporary funding of 30 additional nursing and residential home places at a cost of £90,000 this year, and will continue to work with the council to ensure the effective use of all the in-house residential beds and services that provide care in the community.

For 1997-98, there will be further costs to be met by the council, which will be expected to accept the responsibility for funding. I understand that Hillingdon council estimates that it will have to provide £100,000 to fund 30 beds. It is expected that those proposals will allow 30 people currently waiting for a nursing or residential home to be placed by Christmas.

Another six beds are to be made available immediately at Mount Vernon hospital by reopening beds in existing medical wards, which will make possible about 18 additional admissions a month. There will be joint monitoring to ensure the effective implementation of the health authority's short and medium-term plans.

I greatly welcome the fact that it has been agreed that the chief executives of the health authority and of the two trusts and the director of social services will in future meet on a fortnightly basis to keep the situation under review.

Taken over two years, the proposals will represent a cost to the health authority of £283,000 and will better enable the two local hospitals safely to meet this winter's demand for emergency admissions. That point was raised by the chairman of the Hillingdon medical committee, and I hope that he and his colleagues will be reassured that all the necessary steps have been taken.

As president of the Abbeyfield Society, I declare an interest in asking my hon. Friend the Minister why better use cannot be made of Abbeyfield places to provide additional beds for people being discharged from hospital. I tabled some parliamentary questions on that topic that were answered by my hon. Friend's Department as long ago as July, and I was advised that the elderly people who were in Abbeyfield homes before a certain date were protected there but that, for some reason that I cannot quite follow, they could not go into Abbeyfield places after that date.

It is extraordinary that we are in such a situation when a national charity that is well represented locally has some extra places and could take additional patients discharged from hospital. I hope that my hon. Friend the Minister will be kind enough to look into the matter and find

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whether further steps can be taken to fund places in Abbeyfield homes for patients who are discharged from hospital.

In passing, because it is too good an opportunity to miss, I mention that the Uxbridge Abbeyfield Society has acquired a site in the Greenway, Uxbridge on which it could build a home for about 35 elderly people to live in very good conditions. It is unable to build the home because it cannot get its bid high enough up in the local authority's bidding list, because the local authority has responsibility for families with children, who come ahead of the elderly in budgetary terms and in bidding generally. I hope my hon. Friend the Minister will consider that matter, because Uxbridge cannot be alone; there must be other towns and cities where people have voluntarily raised considerable sums to buy land and which are ready to build but are unable to do so because of the way in which the system works.

Finally, 36 extra beds have been provided in the borough of Hillingdon. The pressure on Hillingdon hospital has been relieved. The problem has been solved. The headlines in The Guardian and other papers were unjustified. I hope that my elderly constituents and those of my hon. Friends--my hon. Friend the Member for Harrow, West is in his place tonight--will be greatly reassured. I look forward to hearing my hon. Friend the Minister because I hope that he will be able to give further assurance on these matters.

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