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Dr. Harris: I thank the hon. Gentleman for his intervention. I remind him that I am his hon. Friend only in that I seek to preserve community services. Given the Conservative funding that undermined the health service before the current cuts, I could not describe myself as his friend.
I accept the hon. Gentleman's point that his constituency hospitals are particularly badly hit, although the scale of the underfunding in Oxfordshire is such that
even radical trust mergers would not release sufficient management savings to provide the necessary funding to preserve those hospitals. That approach could be considered, however, as Oxfordshire has too many trusts. The Liberal Democrats have never opposed trust mergers. We feel that the issue of losing separate trust status is far less important than the loss of services.
The third R that community hospitals provide for local patients is respite care. If community beds are cut, patients will have less opportunity for respite care. That could mean extra admissions to acute hospitals when patients and their carers cannot cope at home for long periods. General practitioners use community hospitals as an alternative to acute hospital admission. The Government have considered it useful to fund that with their "winter pressures" money, with hospital-at-home schemes as an alternative to admission. I would argue that community hospitals are large-scale hospital-at-home schemes and are an alternative to expensive or inappropriate acute hospital admission.
Social services in Oxfordshire are badly affected by Government spending cuts. They have not benefited from a release from the reserve or from special money. I remind the Minister that the total social services standard spending assessment has, according to House of Commons Library figures, been cut by 1.4 per cent. in real terms in 1997-98 and by 1.1 per cent. in real terms in 1998-99, even before demographic pressures are taken into account.
Social services are simply unable to take up the extra work load that will be put on them as a result of hospital closures and reductions in community hospital beds. Therefore, I fear that the biggest work load will fall on acute hospitals. As has been predicted not only by me but by Lord Walton of Detchant, a local resident of Oxfordshire and an acknowledged expert on those matters, there will be a massive increase in delayed discharges and in admissions to hospital of people who could otherwise be managed at home or in a community hospital.
That makes no financial sense, because it is twice as expensive to keep people in acute hospital beds than it is to look after them in community hospital beds. It is certainly more expensive to the state to send patients without their own funding to a social services-funded nursing home than it would be, in the long term, to give them the rehabilitation that they may need in a community hospital.
As the matter is still out to consultation, I understand that the Minister will not be able to give his view, or even his likely view, on his decision on the proposal to close those community hospitals and beds. However, does he consider it reasonable for the local health authority and the NHS regional office to look carefully at whether the extra £65 million announced nationally, specifically for community and mental health services out of the extra £500 million announced for the NHS this year could be used profitably as a cash-releasing measure to avoid the false economy of increasing the number of delayed discharges? If he looks, as I suspect that he will have to in due course when the measure comes before him, at the consultation document issued by the health authority, he will notice that that question is not even addressed.
The question of whether the number of delayed discharges and admissions of patients who would otherwise be treated in community hospitals would increase was glossed over in the section on the effects on other acute trusts. Already, we read in the local newspapers today and yesterday that the Oxford Radcliffe hospital trust must close wards because it cannot provide enough staff to keep them open. Will it not result in double trouble for the Government's waiting list initiative if wards are closed to new admissions not only because of staff shortages but because of delayed discharges?
There is a good case for allocating the money given to the Oxford and Anglia region not on a weighted capitation allocation basis--that would be an unthinking way of proceeding--but as a cash-releasing measure to provide the resources that Oxfordshire needs to expand its services so that local people begin to see improvements. The Oxfordshire social services settlement suffered not only from an overall real-terms cut in the past two years, despite increased demography, but from a savage cut of 10 per cent. in its SSA for elderly residential care because of formula changes.
No reasonable explanation has been given to Oxfordshire county council why the Labour Government think that it suddenly costs 10 per cent. less to keep elderly people in residential accommodation. It is also hard to understand how local social services, which interlink crucially with community hospitals, can be rescued from such a huge cut in their resources.
The Minister of State, Department of Health (Mr. Alan Milburn):
I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on securing this debate. This is an important issue, as community hospitals can be a valuable part of the local health service in many parts of the country. I know that there are real concerns not just in the hon. Gentleman's constituency but in the constituency of the hon. Member for Witney (Mr. Woodward) about the health authority's proposals.
I should say at the outset that there is no single national blueprint for the configuration of services that will suit all localities. As I am sure the hon. Gentleman recognises, all localities are different and, in some cases, community hospitals may not be the best way of delivering local services. It is the job of health authorities and NHS trusts to ensure that local services are matched to local need.
The hon. Gentleman knows perfectly well the Government's position on the future of Oxfordshire's community hospitals. If a local community health council objects to the health authority's proposals, the matters will be referred to Ministers. Until then, we must remain impartial about any future decision.
The public consultation on the proposals to reshape community services in the county began on 4 April. Public meetings have now been held in all 11 towns that
have community hospitals. I understand that the health authority has circulated more than 5,000 consultation documents and 10,000 summary documents. I urge all hon. Members and members of the public who are concerned about the issue to submit their views to the health authority. The whole point of having a consultation is for the health authority to ascertain the views of local people and interested parties. I can tell the hon. Members for Oxford, West and Abingdon and for Witney that, if the issue is referred to Ministers, we shall listen carefully to what they and local people have to say.
Two options are being considered by the health authority and the NHS trust. Both options would mean that the 12-bed hospital at Bicester would be replaced by a new 30-bed hospital and a new minor injuries unit would be developed for Witney. To achieve that, the first option would involve closing Burford and Watlington hospitals and reducing the number of beds at five of the other community hospitals. The second option would also involve closing Burford hospital, and the wards and day hospital at Wallingford, and reducing the number of beds at four of the other community hospitals. Under that proposal, a new day hospital would be developed at Didcot, and there would be an increase in beds at Watlington. The health authority claims that, with both options, the aim is to reduce bed numbers in areas where there is relatively generous provision and to increase bed numbers where there is a greater need.
Again, it would be inappropriate for me to comment further on the pros and cons of the options while the consultation is still going on.
Mr. Woodward:
The Minister said that both options include the proposal to close Burford hospital. It may help him to know that the hospital has an average annual occupancy of over 90 per cent. If Burford were to close, the nearest available community hospital would be at Witney, which has 61 beds. It is proposed to close about 25 per cent. of the beds at Witney. When I was there a few weeks ago, there was only one empty bed, and the hospital's average occupancy was also over 90 per cent. As the acute hospital, John Radcliffe, has spent many months of this year on red alert, not only will be there be no community bed provision, but there will be no acute bed provision. That makes nonsense of the NHS White Paper's support for local provision, because there will be no provision for such patients in west Oxfordshire.
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