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Community Hospitals (Oxfordshire)

1.30 pm

Dr. Evan Harris (Oxford, West and Abingdon): I am delighted to open a timely debate on the crisis--that is not too strong a word--that affects our health service. Community hospitals are particularly under threat, and not only hospitals but community beds. Abingdon community hospital in my constituency, and the hospitals at Burford, in the constituency of the hon. Member for Witney (Mr. Woodward), at Wantage, in the constituency of the hon. Member for Wantage (Mr. Jackson), and at Watlington, in the constituency of the right hon. Member for Henley (Mr. Heseltine), are all at risk. Although none of those right hon. and hon. Members is present, I know that they feel strongly about the potential closures of those hospitals.

The closures faced by the people of Oxfordshire are caused by chronic underfunding of the health service and the acute financial crisis facing the health service this year, both of which are particular problems for Oxfordshire. It would be a false economy--bad not only for patients, but for financial reasons--to close community hospital beds in the way proposed. I plead with the Minister to intervene, even at this stage, because community hospital beds are threatened throughout the country. I ask him to ensure that extra money allocated this year is used not only to provide adequate community services for patients, but to avoid false economies and thereby to release cash for the health service.

The overall funding problem in the NHS has been well stated by the Liberal Democrats over the years. The NHS is chronically underfunded, to the tune of several billion pounds. Government leaks to the press confirm that sort of figure. The Daily Telegraph this morning says that the Department of Health will put in a megabid to the Treasury of around £8 billion. I do not know whether the Government will confirm that figure, but the British Medical Association and others who work in the field recognise that the NHS is chronically underfunded to around that sum.

On top of that, the health service, where the staff have to work hard just to keep it afloat, needs real-terms increases of about 3 per cent. a year to cope with NHS inflation, over and above retail price index rises. The Conservative Government wasted money on bureaucracy and the internal market, but they still managed to average 3.1 per cent. over their period in office, although it came in fits and starts. By adopting Conservative spending plans, the new Government have, sadly, managed real-terms spending increases of only 2.2 per cent. in the NHS budget for England in 1997-98 and 1998-99. That is not sufficient to keep the NHS going without cuts in services. We have seen the pressure on waiting lists. It is not so obvious in community hospitals, where there is no obvious proxy such as waiting list numbers or waiting times, but the pressure is there. It is also on mental health services.

It is fair to say that the Labour manifesto promised a real-terms increase of only 0.1 per cent. or less. However, the Government have revised that upwards, and have claimed that Labour is the only party able to revise its pledges upwards. They have done that not by allocating new money, but by using money initially allocated in other areas, such as the Department of Trade and

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Industry's underspend in 1997-98 for the £270 million allocated for winter pressures, and £1.2 billion from the Treasury reserve for this year. That is not new money. It is hard to believe that only a Labour Chancellor would spend that money from the reserve on the health service, while a Liberal Democrat or Conservative Chancellor would merely burn it on a bonfire.

An increase of only 2.2 per cent. is not enough to prevent pressures on waiting lists and other services. At the general election, I made it clear to the people of Oxfordshire, who were already worried about their community hospitals, that the Liberal Democrats would match existing resources, including the reserve and underspends, and, in addition, would give £550 million per year in new money raised by increasing tax revenues.

The extra money from the Government is based on old inflation figures, not the new figures that they found when they took office. In real terms, the money allocated in 1997-98 and--without including the allocation from the reserve, which all parties would have made--for 1998-99 is less than the Conservatives planned. More important, it is less than health authority finance bosses figured would come from a Government elected on the platform that there were "14 days to save the NHS" and "things can only get better". On community hospitals, and on waiting lists, things have only got worse.

It is important to nail the myth that the Government have offered more money than the Liberal Democrats promised at the election. They have offered significantly less. It is embarrassing for the Government that the money for community hospital services and other NHS services is less even than the amount that the Conservatives planned to spend in real terms.

Health authorities such as Oxfordshire face a bill for millennium compliance, for which there is no separate funding allocation. They face initiatives, on pain of sanction, to reduce waiting lists. They face those things with a level of overall increased funding--including the new £500 million announced this year, which is still less than 3 per cent. more in real terms--that is likely to increase waiting times.

Oxfordshire is particularly badly affected, as it is significantly below its target funding. It got a little more than the average allocation, but that was nowhere near the 3 per cent. minimum increase required. All trusts in Oxfordshire are in recovery plan mode, except the community hospital trust, which still faces cuts. As all the trusts face cuts, the health authority cannot be accused of picking on the community hospital trust. It is seeking even bigger cuts from the bigger budgets of the area's acute trusts.

It is hard to say what makes me and the people of Oxford, West and Abingdon more angry. Is it the raised expectations that were dashed after the Government said that "things can only get better"? Is it the stance of Conservative Members, who blame the Government for underfunding the NHS although the Government are merely adopting Conservative spending plans?

Is it premature for the health authority to agree a three-year or four-year funding cut, including closure of community hospitals and community hospital beds, at a time when the new structure of the health authority will, at least in the medium term, move such decisions to primary care groups? They are keen to be given a chance to take a view on whether those cuts should happen, or

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whether, when they get the budget in one or two years, time, another way can be found to make the savings that the Government are forcing on them.

Given that Oxfordshire's problems result from the Government's underfunding of the health service, and given that cuts must be made, there is a question of whether those are the most appropriate cuts. They will affect local services that are delivered to people near their homes. Oxfordshire has rural areas, in my constituency and in that of the hon. Member for Witney, who is now here, in which transport is difficult. The requirement for community hospital beds to be locally available to people and to their general practitioners is vital to better care. The community hospitals uniquely offer what I have called--in a separate debate on community care with the Under-Secretary of State for Health--the three Rs of NHS community care.

The first is rehabilitation, which allows, for patients who need it, enough time for active physiotherapy before they are discharged to home care. Instead, too often, they are discharged to a nursing home or residential home care because there is no time for the active rehabilitation that would enable them to return to their homes. Most patients would rather be at home and, in many cases, although not all, that provides a cheaper package of care for the local social services, particularly if the patients do not have their own funding.

The second of the three Rs is recuperation. It is vital that patients are given a chance to recuperate from operations or acute emergency admissions--perhaps for serious illnesses such as pneumonia--in their own time. If they are rushed back into the community, an extra work load is placed on community services, which are already underfunded. When patients are discharged from acute hospitals too early and a community hospital is not available to help them recover in their own time, the work load falls on social services. Alternatively--this is just as bad--the acute hospital cannot discharge the patient because of the lack of services available to pick up the care. That causes an increase in delayed discharges, which are already high in Oxfordshire. A lack of recuperation beds is not only bad for patients: it is financially bad.

Mr. Shaun Woodward (Witney): Is my hon. Friend aware that, in my constituency, we have three community hospitals? The first, at Burford, certainly faces closure under Oxfordshire health authority's plan. The second faces a 25 per cent. cut in the number of beds and the third faces further cuts. Thus, all three hospitals face either closure or dramatic cuts in beds. In the light of what my hon. Friend has been saying, does he feel that savings could be made by reducing the huge number of trusts in Oxfordshire to free up funds that would prevent dramatic cuts, not only in my constituency but in his and others in Oxfordshire?

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