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Mr. Desmond Swayne (New Forest, West) (Con): I thank my honourable, indefatigable and great Friend the Member for New Forest, East (Dr. Lewis) for his persistence and generosity.
 
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What on earth is happening? We are told that we are spending ever greater amounts on the national health service. We know that we are paying ever greater amounts in our income tax and national insurance contributions, but why are we not getting our share in south-west Hampshire? How is it that we are now being told that the New Forest primary care trust may not be able to honour the decisions of the National Institute for Clinical Excellence when it comes to prescribing and that either all or most of our community hospital beds are to be closed?

What I really resent is being told that less means more, that all this does not represent a cut at all, as it is part of a new, improved model of working and an improvement in the service. We are even told that these people do not need to be in hospital as they would be much happier at home. Teams are to be provided, we are told, to go into people's homes to care for them so that they do not have to go to hospital. Anyone who has a domiciliary care package funded by social services in Hampshire will know that the staff to provide those services simply cannot be had. The notion that the cash-strapped New Forest PCT will be able to provide the services is utterly fanciful.

The hon. Member for Romsey (Sandra Gidley) referred to the bed survey. I have deep reservations about the work that went into that and I have received representations about it from general practitioners in the New Forest. It simply does not take into account the fact that the typical stay in an acute bed in Southampton or Bournemouth is a week, whereas in the New Forest community or cottage hospitals it is four weeks, because of the emphasis placed on rehabilitation. Add to that the completely inadequate arrangements for transferring patients from acute care back into the community—let us say in a rest home or a care home—and we have a recipe for absolute disaster. It is bad enough that beds are being blocked in acute hospitals, but if we lose the beds now available in the community hospitals in Milford and Fordingbridge in my constituency, for example, we will place an enormous burden on what is held out as the great prize—the new hospital to be built in Lymington.

Lymington holds out an enormous opportunity because it allows the possibility of bringing back some of the acute care that is now delivered in Bournemouth and Southampton, with huge financial savings for the New Forest primary care trust. However, if we close the beds in the New Forest community and cottage hospitals, we run the risk of that opportunity completely disappearing, at great financial cost to the New Forest.

The hospitals in Fordingbridge and Milford are near the centres of population and, more particularly, near the centres of elderly population. That is an important factor in the New Forest, where public transport is largely non-existent. The hospitals have a good standard of facilities, supported—as my hon. Friend has pointed out already—by extraordinary efforts by leagues of friends. They have an excellent record of clinical and rehabilitation care and infection control. Both are next door to local GP practices—a very important factor—and they both have parking, which Southampton hospital, Bournemouth hospital and the new hospital at Lymington do not have, which is another important factor.
 
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Under section 10(2) of the National Health Service and Community Care Act 1990, the Minister has the power to set aside the requirement on the New Forest primary care trust to balance the budget. I urge her to take the opportunity to do so this year, so that we can examine the case that has been made and ensure that an enormous opportunity for the new hospital in Lymington is not lost through the closure of the facilities in Milford and Fordingbridge. Their closure would place a huge burden on the new hospital that it would not be able to discharge, with financial and on-going consequences for the primary care trust.

10.47 pm

Dr. Andrew Murrison (Westbury) (Con): I congratulate my hon. Friend the Member for New Forest, East (Dr. Lewis) on introducing this debate, and I wish to contribute briefly to it. The clinical case for cottage hospitals is well made. We all know about the excellent health care that community hospitals provide to patients. We also know how loved they are by their communities. What has not been made clear enough is the economic case for community hospitals, and I hope the Minister will talk a little about that.

There is a natural centralising tendency on the part of health care managers and policy makers. When choosing between options, they invariably choose the closure of a peripheral unit. I hope that the Minister will note the comments made by my hon. Friend in terms of the relative cost of acute hospital care and community hospital care, and that they will influence the decisions that she makes and her vision for the future of community hospitals.

10.48 pm

The Parliamentary Under-Secretary of State for Health (Caroline Flint): I congratulate the hon. Member for New Forest, East (Dr. Lewis) on securing this evening's debate and I welcome the contributions from the hon. Members for Romsey (Sandra Gidley), for New Forest, West (Mr. Swayne) and for Westbury (Dr. Murrison).

On the point just made by the hon. Member for Westbury, it is important to consider a health service fit for the 21st century. As the Minister with responsibility for public health, I am keen to see what we can do outside hospitals to encourage preventive health measures that, in the medium to long term, will change the journeys of many people who, for all sorts of reasons, end up in the acute sector for treatments and operations that—with more emphasis on public health and treatment outside hospitals—they might not require.

We must also recognise that within our hospitals, acute and community, a wide-ranging debate is being held about whether all the services currently provided are fit for purpose and whether some of them could be better provided in a different environment. In addition, as the number of elderly in our population is expanding, we need to look into providing services that meet people's needs in different circumstances. I am sure that every Member in the Chamber acknowledges that older people prefer to have services that enable them to continue an independent life in their home environment for as long as possible. They want local services, but not necessarily in a hospital.
 
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Having said all that, I agree that there is not a one-size-fits-all solution and there is a continuing role for acute hospitals and community hospitals. I am sure that hon. Members are aware that our general election manifesto highlighted the fact that community hospitals would have a role. However, in a health service fit for the 21st century, we must have provision that meets the needs of local communities, and I pay tribute to the staff in the areas of all the hon. Members, and in mine and that of my hon. Friend the Economic Secretary to the Treasury, for their important work to support patients.

I acknowledge that many campaigners, on whose behalf the hon. Member for New Forest, East spoke this evening, are concerned about the provision of local health services and have expressed their opposition to the proposals made by the South-West Hampshire primary care trust alliance. I assure them and the hon. Gentleman that no final decision has been to close hospitals and that there will be extensive consultation.

Before talking in detail about the proposals, I shall outline how the NHS is organised and where responsibility lies. From some of the comments of Conservative Members and of the hon. Member for Romsey, one might think that they did not believe in local decision making. From their comments, one might conclude that, although they argue for local decision making, when it happens, they are not quite so much in favour of it. However, it is important that the stakeholders who lead the consultation listen to local communities and make their case.

Mr. Swayne: To whom are those local decision makers accountable and by whom have they been elected?

Caroline Flint: As the hon. Gentleman knows, it is the responsibility of PCTs, working in partnership with strategic health authorities, to determine how best to use funds to meet national and local priorities for improving health, tackling health inequalities and modernising services. There have been discussions and consultations with local service users on the best use of services, and they will continue. I am sure hon. Members will agree that hospital and community services need to continue to modernise to meet the needs of patients. That is the process under way in the New Forest.

Hon. Members, especially on the Conservative Benches, have always been keen to advocate prudent financial management. There are some real issues relating to deficits and efficiency. Part of what we are trying to encourage, which I hope hon. Members will support, is a good look at how services are being provided and whether they meet the needs of local communities or whether they could be provided in a better way to meet both local needs and the requirement for financial accountability.

The two primary care trusts responsible for community hospitals in the constituency of the hon. Member for New Forest, East—New Forest PCT and Eastleigh and Test Valley South PCT—have formed an alliance under one management team to undertake a strategic review of community services. Nationally, there is increasing emphasis on providing services for
 
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patients, where possible, in the community—I acknowledge that it may not always be possible—enabling them to remain at home, without the need for a stay in hospital. That is a vision of a patient-centred service—not one size fits all, but a service that delivers health care where the patient wants it, and it underpins our drive to modernise NHS services.

Locally, other factors have necessitated the alliance's review of community services. Five community hospitals will come under the review: Milford on Sea, Hythe, Fenwick Hospital in Lyndhurst, Romsey and Fordingbridge. They are all about 25 minutes drive from one another. Together, they provide up to 119 beds, including GP, consultant, maternity and orthopaedic beds.

Research commissioned by the alliance shows that only 16 per cent. of patients in the community hospitals were treated appropriately. More than half of in-patients are waiting to transfer either to a more appropriate facility or to their own home with appropriate support. I heard what the hon. Member for Romsey (Sandra Gidley) said about the research on which that is based and I am happy to provide her, where I can, with some information. I understand that someone was sought to carry out an extensive consultation of some 1,300 service users. I am sure that the hon. Gentlemen and the hon. Lady agree that the alliance must review how better services can be provided for patients.

There are some other difficulties. Some of the community hospital buildings are inappropriate for modern health care and require an estimated £20 million to bring them up to standard. Apparently, there have been difficulties in recruiting the staff needed to deliver clinically safe services—one of the issues uppermost in patients' minds when they enter a hospital. For reasons of patient safety, 20 beds at Fenwick hospital have been closed since February. The minor injuries unit at Hythe hospital was also closed for more than 18 months.

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