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Dr. Julian Lewis (New Forest, East) (Con): 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 HouseI 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 steadgallantly 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.
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 deficita 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 gentlemanMr. John Richardsstates 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
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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:
"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) (LD): 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 percentagesome 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 GPs.
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.
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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 gamutfrom 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.
"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. Inpatient beds were seen as a lower priority."
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 clearindeed, it is a mathematical certaintythat 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 bedsthe expensive beds in the general hospitals. Indeed, general hospital beds are three times as expensive as community hospital beds.
I want to end 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, 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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