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9 May 2006 : Column 67WH—continued
There is concern that despite the Government’s stated policy—and perhaps even intentions—the NHS is becoming more centralised. I have given examples of how trusts are reconfiguring services within their boundaries, and I have suggested that the reorganisations in place will create bigger units rather than smaller units, but the
situation is even worse than that. In my patch, there are two primary care trusts—they will probably shortly become one—both of which have financial problems. The Eastbourne Downs PCT anticipates an overspend of £7 million this year. What is the consequence of that £7 million overspend? The consequence is that it is delaying references to the acute trust for work to be done in hospital. It is keeping within the Government’s maximum times for operations, but delaying them for as long as possible within the Government’s framework. That is not sensible for patients. The other consequence is pulling services out of communities, rather than diversifying them out to communities, which is what the Government say they want, and I share that view. Instead, services are being pulled in. The consequence in Seaford, for example, which is a town of almost 25,000 people, is that there are virtually no services in the town, all the intermediate care beds have long gone and people who want intermediate care are now referred to Firwood house, north of Eastbourne. That is a long way away, and quite impossible to get to by public transport. Put simply, the NHS service in Seaford is unacceptable.
As I said, there are 25,000 people in Seaford; it is the largest town in my constituency. All we have in terms of NHS delivery is a GP centre with few facilities and a so-called day hospital which seems to me to provide peculiarly few facilities. In September 2005, I wrote to East Sussex County Healthcare NHS trust, as it then was, about this matter and pointed out that in my view the hospital was underused. In response, the chief executive Lisa Rodrigues pointed out how it was used, which was as a base for a community mental health team, and said that there were a number of out-patient clinics—that number is reducing, by the way—and some use of the building by older people’s mental health services. That is not a great deal for a town of 25,000 people, is it? I have long believed that building to be horrendously underused, and in need of reconfiguration. It could be the basis of a good community use that would take the pressure off the NHS and the acute trusts in Eastbourne—and indeed Brighton.
I wrote to Candy Morris of the strategic health authority about the matter, and she quite properly took it up with Lisa Rodrigues. I am afraid that Lisa Rodrigues said in her reply that she did not know what the building was, which does not exactly give confidence that the trust knows what it is doing with its buildings. I have asked Candy Morris to look further into the matter.
What Seaford needs is a new hospital. We need a hospital to deal with minor injuries, as Lewes has; Lewes Victoria hospital has a well-respected unit. We need a hospital in Seaford that can carry out minor operations. We need a focus for the community teams, such as chiropodists, to operate from. The Minister may say that that would involve a spending commitment and that the money would need to be found from somewhere. Of course that is the case, but my argument is that, with A and E admissions going up by 11 per cent. a year and services being withdrawn from communities, that would be a good investment, and it would take pressure off the health service. The Minister’s own policy is to have more localised delivery of services, more community facilities and more walk-in centres. I agree with all those things. Seaford is a case in point, as there is a huge gap.
A hospital dealing with minor injuries and minor operations would be an important facility for the town and a good use of NHS public money. The PCT has done some work on the matter, but it has a £7 million overspend and is now up to its neck in reorganisation, so unfortunately that work has all gone on hold and nothing much is happening. We are not making as much progress as we should with that.
There is also a problem with boundary disputes between the county council and the acute trust in terms of bed blocking. I have raised that issue in previous debates, as have other Members, including the hon. Member for Eastbourne. There are still 74 people on average in hospitals held by the East Sussex Hospitals trust—that is 9 per cent. of beds or two wards—who no longer require acute care and who are there largely because the county council has not taken responsibility for them and found residential care home places for them. The Minister and her predecessors have looked at that issue, but nothing much seems to be happening. For that situation to continue would be a terrible waste of NHS money, so it would be useful if it were sorted out.
The other boundary dispute is between different PCTs. Newhaven Downs, which is the rehabilitation centre in my constituency, has been mothballed since last November. It is an upgraded facility that cannot be used, so people are expected to go much further away for intermediate care. The move is simply a cost-cutting measure. The Minister’s boss, the Secretary of State for Health, said recently that community hospitals should not be closed for financial reasons. She is absolutely right, but that is, in effect, what has happened at Newhaven Downs. Will the Minister look into the position there and put pressure on the PCT to reopen that facility? Seaford people have lost facilities at the All Saints centre in Eastbourne. They have also lost Homefield cottages and are expected to go to Firwood house, having also lost Newhaven Downs. That is simply not good enough.
I have raised a number of issues to which I hope the Minister can respond. The picture is not all doom and gloom, but there are a number of serious problems that need to be addressed.
1.46 pm
The Parliamentary Under-Secretary of State for Health (Caroline Flint): I congratulate the hon. Member for Lewes (Norman Baker) on securing this debate and on the constructive way in which he began his contribution. I hope that that will allow us to have a balanced and useful discussion about the things that are working in our health service, as well as about some of the things that are perhaps not working as well as we might like them to.
As the Minister with responsibility for public health, I am interested in how we can better look at services that could be provided outside hospitals and in communities and, importantly, at how, through more public health spend, we can swing the pendulum and get ahead of illness rather than always treating sickness—only about 2 per cent. of the NHS spend goes on prevention currently. It is quite difficult to argue that corner, when so much of what happens in the health service is tied up in our hospitals and
treating sickness. Please do not get me wrong—we all want to know that when we are ill we will receive the treatment that we need. That is vital and is one of the reasons why, when we came into government in 1997, the public were telling us that their top priority was dealing with waiting times. The second issue was the number of people dying too soon from cancer and heart conditions. Rightly or wrongly, that focused our attention and minds.
Now we are in a better place in terms of waiting times and treatment for those serious conditions. That allows us to consider how better we might deliver a health service that addresses prevention and, importantly, the long-term management of people with serious conditions. As we know only too well, despite the amount of money that might be spent on someone who has had a heart attack or has chronic heart disease, we do not get the best value for our money if there is no service to support them—usually much closer to where they live—to look at their lifestyle and what changes they can make, as well as through other activities.
I visited a YMCA in central London just the other day, where I met some people who had had heart treatment in the past few years who were doing exercise. They all had their own personal trainer. The trainers were young people learning to do physiotherapy or fitness activities in a sports environment—so, two birds for the price of one. The people at the YMCA told me that, at the end of about three years, they were beginning to see the value of that investment. Without it, some of those people might have gone back into hospital more times than was necessary. That is at the heart of the discussion, but as the hon. Gentleman rightly points out, it presents us with some difficult decisions and raises questions about how we are going to change the culture and the way in which, traditionally—and hierarchically—the NHS has provided for people’s health. At the same time, within whatever structure we have, the hard work of NHS staff and social care staff, who work with people locally, whether in hospital or outside, will be key to any improvement.
I shall talk a little more about job cuts, but I hope that in future some of the staff who are currently hospital-based will be based partly in the hospital and partly in the community. Alternatively, they may move into the community, where, through technology and changes, we can make better use of community hospitals or develop GP health centres to incorporate facilities and services currently provided in hospitals, while recognising that we need the best hospitals and staff in the world to deal with more serious, complicated cases that require operations and treatment.
We are dealing with the improvement of health, but the hon. Gentleman raised the point, totally fairly, that financial deficits in a minority of trusts in England have been allowed to accumulate in one way or another, or that there has been a game of pass the parcel from one part of the health economy to another to mask the problem. That has been exposed for what it really is—a system allowing a situation to continue whereby no one was getting hold of debts or understanding why they were arising.
Do the debts relate to mergers or the way hospitals are run? The hon. Gentleman made a very good point about delayed transfers, for example. He referred to an
average of 74 people in this situation, and I have that figure as well. Every day a person is delayed in hospital, social services made a payment of £100, but it costs £300 for every day of delay. That raises issues of sustainability and the close relationship that has to be maintained with social care services.
We are trying to consider how to keep our older people, and our older, older people—it is quite hard to define “older”—out of hospital. We have had fantastic success with primary care trusts, which have considered what they call their falls policies to establish how they can prevent accidents, provide better help in the home and support people in different ways to keep them out of hospital, while ensuring any necessary time in hospital is kept to a minimum. That is one example of a factor that contributes to financial pressures if it is not dealt with. There are examples throughout the country of trusts that are balancing the books and are being innovative in running services by using IT and new technology and by using their staff better. They use highly qualified staff for the jobs they were trained for, while finding other roles for support staff who are also important, but do not necessarily require the same qualifications.
Norman Baker: I accept what the Minister says in part. I would point out that a large number of trusts in Sussex have financial problems. Is she convinced that the funding formula is correct, given that a huge number of “older, older” people—as she puts it—are prevalent in my area? Polegate, for example, has the eighth oldest population in the country.
Caroline Flint: I appreciate what the hon. Gentleman says, but the funding formula takes into account geographical issues and age of population. In many respects, the age of the population in his area, and that part of the south of England, is taken into account. That is reflected in the funding. We consider other health needs as well.
I am sure that the hon. Gentleman would not disagree that the average life expectancy of someone in Doncaster—without being too partisan in referring to my own area—is considerably less than that of someone in parts of Sussex. We have to address those health inequalities. He makes a very good point, which shows why we have to consider what other services we need in his area to meet people’s needs. As we are all living longer, there will be more 75-year-olds in the future. How can we help them stay fit and healthy as long as possible? If I were in that position, my desired option would be to look after myself in my home.
I want to touch on the issues relating to jobs. The hon. Gentleman highlighted stories from his local newspapers in relation to this subject. It is true that the hospital and the trusts in question are considering cutting some posts. The Brighton and Sussex University Hospitals trust has said that it is looking to reduce the 5,000 jobs at the trust by 325. I understand that it thinks that it can make up a huge number of posts by introducing a vacancy freeze and through the reduction of agency and bank spend and the better use of technology.
The East Sussex Hospitals NHS trust, which also employs about 5,000 staff, is looking to restrict filling around 250 vacancies. I am told that in an average year, 500 posts fall vacant through natural staff movement and retirements, so we hope that the situation can be managed as fairly as possible and without compulsory redundancies.
This issue raises questions about how those hospitals are going to provide services, given that they may not fill posts or use agency staff as much as they have in the past. There are good examples of other trusts reducing their reliance on agency staff and better managing their permanent staff teams to achieve good results for patients. Seeing a different face every day because the trust overuses agency and temporary staff is not good for patients, particularly older patients, or for their sense of continuity of care. Of course, there is also an important safety issue there.
The changes to the structure of the SHA and PCTs are meant to help to create a stronger framework for the area and improve commissioning. We are looking at making savings by reducing the number of organisations, and putting the money back into front-line services so that funds can be better spent on the services that people most want. Alongside that, we must discuss what services people want in their local communities. That will be addressed in the consultation later this year—I understand that there will be discussions on contributions to the document for the end of May, to be published in the autumn—which should take into account many of the issues that the hon. Gentleman raised.
The hon. Gentleman talked about Seaford day hospital; I am sorry that the person whom he mentioned did not recognise the name of the hospital. It provides mental health services and older people’s mental health services, providing three—sometimes four—clinics a week. It also provides working age adult services, providing five—sometimes six—clinics a week. I understand that the hospital is also used as a base by staff who come into the town to treat Seaford residents. That demonstrates another way in which services can be provided without a permanent base. Those staff use the hospital to support people, but most of the treatment takes place in people’s homes, which is a good idea. It is also used by the Eastbourne Downs PCT physiotherapy service, which runs clinics every weekday.
So, I understand that the building is used by three services, involving two NHS organisations, to deal with a wide range of mental and physical health needs. That is a good idea and is to be welcomed. I understand, from the Sussex Partnership NHS trust that it will continue to use the building in that way and that there are no plans to reduce capacity there. The trust believes that the building is well utilised. I will ensure that the hon. Gentleman’s view that it could be used more isfed back; he should contribute to discussions about planning local services.
The work being led by the SHA in partnership with the four local health communities, including the one for east Sussex, is about trying to ensure that local people and stakeholders have the opportunity to get involved in developing the plan. As I said, that will be supported by a discussion document to be published by the SHA towards the end of May. I understand that it is also
working on settings for care options, and will consider access and travel issues as well as clinical and economic viability. The SHA expects to begin the full public consultation on the developed options in the autumn. I hope that that gives some clarification regarding the timetable.
The hon. Gentleman made some important and constructive points. Part of the debate that we must have is about raising people’s expectations of their health service in the future, as well as what they are
used to. Sometimes people defend what they are used to partly out of affection for a service that they have used and partly because it is the only thing that they see in town and they are fearful of what will happen if it goes. I hope that the hon. Gentleman will be a constructive and critical friend to his local health services, and a leader in developing discussions about the sort of health services that we could have.
It being Two o’clock, the motion for the Adjournment of the sitting lapsed, without Question put.
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