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It is good that the hon. Member for Westbury has gone to Stroud maternity hospital. I am glad he reads my local paper regularlyit usually quotes me correctly, so that is all well and good. The maternity unit is also being sacrificed, so my simple question for my hon. Friend the Minister is this: do the same criteriawhich basically say that a better way forward
has to be provenapply to maternity units or are they purely to do with community hospitals? I am trying to elicit a reply because I have tabled a parliamentary question to that effect. I hope that the same criteria do apply and that we go through the same process, because there is a huge amount to do in Stroud already.
We must know by which criteria we are to judge whether it is right to close and what the alternatives are. I state categorically that the proposals are wrong. We have defeated them before and I think that we will defeat them this time. Now things are more difficult, because of the backcloth of huge cuts, but I want clarification on whether those cuts are real and necessary, and have to be met within the time scale that some are suggesting. That is the basis of the case.
Moving care closer to home is a useful document. It expresses in very precise terms what I think the Government want to happen. They want more facilities devolved to more local areas. However, the problem is that if facilities do not exist in a local area, it is difficult for services to be devolved to them. That is why I want some clarification about what we are doing and why. I want clarification about the funding streams and the alternatives if we lose the facilities. I would argue that funding and provision in Stroud are imbalanced, yetwe are still being asked to lose vital facilities. Consideration is even being actively givenalthough this is not part of the formal cutsto hiving off Stroud hospital to a private enterprise.
As someone who has worked through a health mutual, which I did for the Standish hospital site, I know a bit about the issue. I am not against looking at alternative models; what I am against is salami-slicing the NHS and saying, Thats all well and good, when in fact we are losing facilities and nothing is being put in their place. I would want to test out the model and the notion that the surgical work at Stroud hospital can be removed and replaced with medical beds. They might be needed, because people have to go somewhere, but that would have a huge knock-on effect on what the Gloucestershire royal hospital and Cheltenham general hospital can cope with. More particularly, if we are talking about choice, there is not much of it when the choice is between the acute hospital and nothing, because that is what most people face.
Those are my questions. I have written to my right hon. Friend the Secretary of State, but have not had an answer, although I have managed to talk to her privately about some of the issues. I shall continue to do so. We are lucky; the hon. Member for Forest of Dean (Mr. Harper) has secured an Adjournment debate for Thursday on health services. If business works as it might, some of us will say more about this issue then.
Community hospitals really matter. Stroud in particular has a wonderful league of friends, which is offering hundreds of thousands of pounds to rebuild the maternity unit, or parts thereof, and to work on other parts of the Stroud hospital estate. It seems contradictoryon the one hand, we say that we want partnership with the community; on the other, when the community brings forward such a partnership, the facilities in which it is prepared to invest are cut.
The Government have to get a grip. They must be clear that such cuts are not necessary. There has to
be some balancing of the books, but I want the Governments case to be proved to me. We should not be losing community hospitals, because they are the very things that we should enhance. I hope that my hon. Friend the Minister has good things to say, at least about how the arguments on the health service in my area and the area around it should be taken forward. People should not just relentlessly drive the cuts forward over a short period. That is unacceptable.
Mr. Philip Dunne (Ludlow) (Con): I congratulate my hon. Friend the Member for Gosport (Peter Viggers) on securing this debate; it is the second in which I have participated that emphasises the importance of our community hospitals.
In January, I joined the trustee group of community hospitals acting nationally together, which is chaired by my hon. Friend the Member for Beverley and Holderness (Mr. Stuart); a number of other hon. Members have also joined. The group identified that of 322 hospitals in England, 80 were at risk of service cuts or closure at the point when it did that work. Three of those hospitals were in my constituency, and I want to draw the Ministers attention to what has happened in them so that he gets a picture of what is going on in some of the more remote parts of the country, where the issues are particularly relevant.
As we have heard, the Government publishedtheir White Paper in February. It gave considerable comfort to those of us who are concerned aboutour community hospitals, as it suggested thatthe Government were listening to the concerns of the people who used those hospitals. Many of the arguments that we had put forward in the months leading up to the White Papers publication coincided with those of the Government, so we had some sense that our message was getting through. It was disappointing, to say the least, that very little of the Governments message seemed to filter down to the bureaucrats who run strategic health authorities and primary care trusts that are responsible for running our community hospitals.
David Taylor: I endorse the hon. Gentlemans remarks about the initiative taken by the hon. Member for Beverley and Holderness (Mr. Stuart), on which I congratulate him, to ensure that fragmented voices were turned into an organised chant.
Some months ago, we were reassured about the apparent new direction for community hospitals; effectively, 5 per cent. of general hospital expenditure was to be transferred over 10 years. However, there is, was and will be a risk that the finances of those acute hospitals will be destabilised by the proposal. Perhaps the funds should not be top-sliced from their expenditure. Does the hon. Gentleman agree?
Mr. Dunne: Actually, the experience in Shropshire has been the reverse: the primary care trusts are helping to fund the acute hospital deficits. In Shropshire, the deficits have been created in the acute trusts. To repair their budgets, they are looking to extract money from the primary care trusts.
In March, the primary care trust in my area eventually announced that it would not close any of the three hospitals in my constituency. That was a great relief to the community. The primary care trust then produced a document at the beginning of May. As I said directly to the trust when it presented the document to the overview and scrutiny committee, the service plan for Shropshire County primary care trust is a thin, weak document. It fails both to give the context in which the savings are supposed to be made and to provide any clear guidance about whether the proposed savings will be sufficient to meet the deficits that it seeks to identify.
Bridgnorth community hospital has had a great deal of investment by the NHS over the previous 12 months and is currently in the process of being rebuilt, which is welcome. The document said that it would be saved and that it would face no job or bed cuts. That is a great tribute to the people of Bridgnorth, who campaigned actively to save it. The leader of Bridgnorth district council is listening to this debate, and I pay tribute to Councillor Elizabeth Yeomans for the work that she and many others did to save their hospital. That is the good news.
The bad news relates to the other two hospitals. Ludlow community hospital is threatened with the closure of two of its wards, with the loss of more than 30 beds and many jobsas yet, the detail has not been enunciated by the PCT. The hospital is faced with the closure of the final mental health ward in the Shropshire community, with the exception of a small number of beds in Whitchurch in north Shropshire. Bishops Castle community hospitalthe third hospitalwill close; at least, there are plans for that to happen. The site will be handed over to a nursing home operator who currently operates on part of the site. The number of NHS-funded beds will be reduced from 24 this time last year to 12.
The mental health aspect particularly worries me and many of my constituents in Ludlow. The primary argument is that this is a value-for-money exercise, as the mental health ward has not been operated in Ludlow at full capacity and should therefore be closed. The director of mental health in Shropshire County PCT has admitted in public meetings that it is not his preference to have to close the ward and that the decision is entirely driven by efficiency savings required by the PCT to help shore up the financial deficits in the remainder of the Shropshire health economy.
One of the reasons why the mental health divisionin the PCT has operated so successfully within budget in recent years is that its primary provision is at the Shelton hospital. I understand that it is the second to last Victorian mental health asylum still operating in the UK, and it will be the last remaining one, because there are no plans to redevelop it for some time. While its staff do the best that they can, the provision is acknowledged to be substandard. The impact on patients who require acute care of going to that facility is likely to be significant and the impact on the carers who look after them is likely to be even more so, because the geography involved in travelling from the Ludlow catchment area to Shrewsbury is significant.
I shall briefly illustrate that point. Yesterday, a group of concerned residents led by John Nash undertook a journey from Ludlow to Shelton for a theoretical one-hour visit by public transport. The six of them caught the 435 bus from Ludlow to Shrewsbury at 11.50 am. They had to change in Shrewsbury to catch the bus to take them to the hospital at Shelton. One of the group is a frail lady in her 80s who is a former physiotherapist, and she got home to Ludlow at5.40 pm, which represents a journey of almost six hours for a one-hour visit. She would currently be able to walk around the corner to her local community hospital. The ability for the carers of our most vulnerable mental health patients to continue to provide such family contact, as it were, will be severely reduced.
I should like to dwell briefly on the impact of the closure of the other rehabilitation wards. The NHS has argued that it should justify the closures on the basis of an equity audit. The equity profile of primary care and community services for Shropshire County PCT, published in May 2005, argues that
NHS improvement, expansion and reform should narrow the health gap by ensuring that service planning is performed by an equity audit.
The equity audit that has supposedly been carried out to justify the reduction of rehabilitation beds has not been made public. It has been argued that attempts are being made to provide a fairer allocation of beds across the county, which is why beds are being cut in Ludlow and Bishops Castle. Yet the document also covers the question of need, which was not addressed in the PCTs latest analysis, among the 18 catchment areas in Shropshire. Four of them serve the Ludlow community hospital area, and they all have a higher need for the 65 to 74-year-olds, as identified in the summary, and all bar one are in the higher category for the 75-plus group. Three of the four catchment areas have the highest dependency ratio per catchment area in Shropshire. Three of the four have the lowest ratio of GPs per head of population in Shropshire, and two of the four have the lowest number of patients per practice nurse.
There is a clear need for beds to be available in Ludlow, and for long-term beds in Bishops Castle. I have been pressing the PCT to commit itself to a 10-year contract for NHS-funded beds. Experience elsewhere in Shropshire shows that it will commit to much shorter contracts, but that once they end, the number of beds is cut. That salami slicing cannot continue, or our community hospitals will all be closed within a short time.
The NHS in Oxfordshire is in freefall. Today, the Oxford Radcliffe NHS Trust is telling its staff that between 650 and 700 posts will be lostthe exact number will be known tomorrow. By my calculation,
that is equivalent to about 8 per cent. of the work force. The loss is occurring as a consequence of £33 million of savings imposed on the trust, in addition to the£17 million of savings that Oxfordshire PCTs have been obliged to make. As a result, the new and enlarged Bicester community hospital promised by the right hon. Member for Darlington (Mr. Milburn) when he was at the Department of Health has now become a complete fantasy.
The White Paper was another fantasy. Our health, our care, our say repeated the promise made at the previous general election about having a new generation of community hospitals. Can the Minister tell the House where that new generation of community hospitals is? It is figment of the Ministers and the Departments imagination. There are no community hospitals. Then we are told that community hospitals no longer need beds and that the Governments new concept of primary care centresbetter, larger GP practice centresare somehow new community hospitals. It will not wash.
Last week, I met the acting chief executive of the PCT, who said that because of the enormous squeeze on its budget it is concerned only about acute care. Anything that can be moved off into social careanything that can be means-tested by the county councilwill be moved. An article in one of the Sunday newspapers referred to a new kind of nursing home in Hampshire, in which people are moved from NHS beds simply to die under the responsibility of social care.
We will see an increasing number of people who would have expected in the past to be treated at community hospitals shunted off to somewhere else in means-tested social care, because the NHS no longer has the funds to manage such cases. The PCTs say that they no longer wish to look after such patients. Somehow, they will become lost in the community. It is a disgrace. We are not going to see a new community hospital in Bicester. If we were to have a new generation of community hospitals of the sort that was promised at the Dispatch Box by the Secretary of State in the mid-1990s, one would have expected it to have been delivered. It is a fantasy.
I want to know this from the Minister: what from this White Paper has ever been delivered? It is a public policy disgrace that Ministers come along and waste taxpayers money with a fake consultation. No public meetings were ever organised in Oxfordshire on Our health, our care, our say; what the Government had was a fake meeting in Birmingham with a hand-picked audience. People are becoming increasingly cynical about what the Government are delivering, and I say to the hon. Member for Stroud (Mr. Drew) that the part of the Stroud newspaper that he ought to start reading is the appointments page, because given the way the Government are cuttinghe used terms such as cuts and sacrificescome the next election I fear he will be looking for another job. Clearly, as is evidenced in our debate, across the country, county by county, this Government are waging war on community hospitals and community medical services.
Andrew George (St. Ives) (LD): I congratulate the hon. Member for Gosport (Peter Viggers) on securing
the debate. Many useful points have already been made. The hon. Gentleman said that the Royal hospital Haslar is one of the best known in Parliament. That is true; it comes a close second after West Cornwall hospital.
I wish to raise a single issue, which I hope the Minister will respond to. It is to do with the thesisor, as I would argue, mantrathat has been coming from the NHS Confederation, which is, as I understand it, the provisional wing of the NHS; it certainly puts out a lot of the arguments that Ministers might not be prepared to argue. Its argument is that the acute sector requires fewer hospital beds. It is a thesis that has become a mantra in the style of the management consultant culture that seems to have pervadedthe NHS.
What worries me is the way in which that approach relates to the future of community hospitals, which is a very pertinent question. When I have debated this matter with GPs nationally and locally and with the trusts that argue that we should push for such an approach, I can understand the frustration of those running the acute sector about large numbers of patients going into acute hospitals who, they argue, should not even be going through their front doors. In other words, they are saying that there are unnecessary admissions to acute hospitals. That may well be the case, and there is also another argument that has been made today and which is repeated regularly with regard to the difficulty of discharging patients once they have come into acute hospitals.
The approach taken by the NHS Confederationand supported by Ministers, I would argueis causing a great deal of difficulty for acute hospitals and nursing staff, who have to cope with other Government targets on communicable diseases. In many acute hospitals, bed pressures mean that there is a lot of hot-bedding. Severely and acutely ill patients are being moved around hospitals or discharged from them, and other patients are moved in. One of the best ways of getting on top of infection control issues is to manage beds so there are surplus beds in acute hospitals, not too few.
In order to achieve the outcome of fewer acute hospitals, which may be desirable in the longer run, the Government need to address such issues, many of which they have in fact contributed to. The way in which the primary care GP out-of-hours service is currently managed means that many patients are not seen by their GPs out of hours. Given an environment in which there is an increasingly litigious public, ambulance-chasing lawyers and so forth, on the precautionary principle many patients are admitted to acute hospitals when they do not need to be. That trend will inevitably continue, and it may get worse.
Mr. Dan Rogerson (North Cornwall) (LD): As my hon. Friend will be aware, the out-of-hours service in our county of Cornwall has recently changed from a locally based service to a service provided by a much larger company. Does he agree that there are concerns in communities that the provisions under the new contract perhaps do not deliver as local people expect them to?
Andrew George: I agree with my hon. Friend, although in view of the time available I shall not
elaborate. There is a scenario in which clinicians appear to be overruled by bed managers, while chronic conditions are still not well managed in the community and many patients who could be managed in the community therefore go into acute hospitals. Crucially, in the light of social services and primary care funding, it is not possible to discharge patients from acute hospitals to social services care or community hospitals, because beds have been cut. In my constituency and in many parts of the country it is becoming impossible to discharge such patients.
To achieve the desired outcome I urge the Minister to recognise those factors and reflect on the need to front-load the argument by ensuring that investment is made in primary care and community hospitals and that there are sufficient social services resources to enable patients to be discharged safely to community hospitals or the community, away from acute hospitals.
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