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24 May 2006 : Column 501WH—continued
3.51 pm
Mr. Edward Vaizey (Wantage) (Con): I am grateful for the opportunity to contribute to the debate and to my hon. Friend the Member for Gosport (Peter Viggers) for ensuring that it was called. As my hon. Friend the Member for Banbury (Tony Baldry) has said, the survival of community hospitals in Oxfordshire is a huge issue—probably the most important in my constituency.
There are three community hospitals in my constituency: one in Wallingford, one in Didcot and one in Wantage. My constituents are also served by a fourth, in Abingdon. As the people of Oxfordshire are now well aware, we are suffering an acute financial crisis. Oxfordshire is part of the Thames Valley strategic health authority, which has the lowest funding per head in the country. By contrast, I understand that the strategic health authority that covers the Prime Minister’s constituency is among those with the highest funding per head. I wonder whether that is a coincidence.
The Oxford Radcliffe Hospitals NHS Trust is the most efficient large hospital trust in the country, yet it is being asked to make £33 million-worth of cuts. My hon. Friend the Member for Banbury alluded to job losses. I understand that it may tomorrow also announce up to 150 bed closures. What will the result be? The answer is obvious: more pressure on our community hospitals.
The reason why those hospitals are called community hospitals is that they were built by the people who used them. They were built 70 or 80 years ago, by their communities, to serve their communities. Now they serve as an overspill for the John Radcliffe hospital, and just as they are under threat they are being asked to take on yet greater burdens.
Every hon. Member who has spoken in the debate and has alluded to a sham consultation process is right. People who have made their feelings known and want community provision and a community hospital are completely fed up with the fact that every year a consultation is held to try to persuade them to want something that they do not want. The debate that goes on between the high-ups—the professionals who claim
to know what they are talking about—and the people is about whether community care should be closer to home or in the home. It is put about that care in the home will be superior and better. I do not buy that. Most people in community hospitals are grateful for ready access to medical care and grateful to be with other patients.
The vital thing, to which my hon. Friend the Member for Ludlow (Mr. Dunne) alluded, is that those hospitals remain in their communities. Particularly in predominantly rural counties, the idea that elderly relatives can easily visit relatives in a hospital that is 10, 12 or 15 miles away is ludicrous. The mayors in Wantage, Wallingford and Didcot did the same exercise as that in Shropshire, and they spent six hours getting from A to B and back again. Such easy visits are simply not possible. Two weeks ago, the A34, the main trunk road in my constituency, was closed after an accident. The scene was like something from a disaster movie. People took four hours to travel from Wantage to Didcot. We need community hospitals in our communities.
It all comes down to money, I am afraid, and nothing angers people more than when the Government put out a White Paper saying that they will not close hospitals for financial reasons and that the money is there if the clinical case can be made. It is quite clear that these hospitals are being closed for financial reasons—there is no other reason. What particularly sticks in the craw of the people of Wantage is that they have just bought the land from the PCT to build a nursing home for £800,000. It is being built and paid for by the community. The money has gone to the PCT, which is now going to use it for what? The PCT will try to close down their community hospital.
The idea that a county such as Oxfordshire can be served by one huge hospital and nothing else is laughable, and I have told my PCT again and again that it could have a far more reasonable debate with the people of Wantage, Wallingford and Didcot if it accepted the principle that people want a community service. Instead of saying, “We are closing your hospital—let’s consult about it”, it should give some clear, credible, alternative proposals that people can sign up to.
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Mr. Graham Stuart (Beverley and Holderness) (Con): There have been a number of interesting contributions to the debate and I hope that the new Minister will take on board the strength of feeling of Members from all parties. As Members have mentioned, I am the chairman of CHANT—Community Hospitals Acting Nationally Together—which is an umbrella group for Members of all parties in the House of Commons, and those in the House of Lords, who are concerned about the future of community hospitals. They are concerned because they share precisely the aspirations of Government policy.
Many hon. Members have already referred to “Our health, our care, our say”, but we do not just need to consider that document. The new Minister may have seen the previous primary policy instrument for this Government on health, the 2003 document, which was called—believe it or not—“Keeping the NHS local”.
Before that, in 2000, we had the NHS plan, in which there was a commitment to bringing care closer to home. For six years, the Government have espoused views that Labour Back Benchers, Liberal Democrats, independents and Conservatives all agree make up precisely the vision that we need.
However, when we look around the country, we find that the very community facilities needed to make the change from acute hospital-centred care to care given much closer to home—either in the home, where appropriate, or in the community close to home—are being closed down. Hundreds and hundreds of beds have been closed in community hospitals during the past six years, while the Government are espousing a need for care closer to home.
The NHS Confederation has been mentioned. A few days ago, bizarrely, it issued a slim document called “Why the NHS Needs Fewer Beds”. In Hornsea community hospital in my constituency, the number of beds has been cut from 22 to 12 and there have been regular waiting lists. An elderly lady who could see the community hospital from her front room in Hornsea could not be admitted because there was a waiting list. Meanwhile, the chief executive and chairman of the acute trust in Hull told me that the hospital is often running at more than 100 per cent. capacity.
We have a bizarre conflict between stated Government policy and the reality on the ground. The Government should make good their position on health; all hon. Members recognise the near doubling of expenditure on the NHS. I hope that the new Minister might be like the new Home Secretary, coming to the Department with fresh eyes and able to see that it needs serious change. Members throughout the House want the Minister and the Department to defend our community hospitals and support them, because they will deliver the Government’s policy for them. Until now, we have questions that have not been answered.
John Bercow (in the Chair): To make a very, very short contribution, I call Dr. Julian Lewis.
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Dr. Julian Lewis (New Forest, East) (Con): It is a privilege to follow my hon. Friend the Member for Beverley and Holderness (Mr. Stuart), who has done an outstanding job in setting up the national co-ordinating campaign. All those of us who were fighting our individual campaigns knew that that needed to be done, and I take my hat off to him—he has done an excellent job and a service to us all.
Earlier today, Mr. Bercow, you renewed your efforts to save the Nuffield speech and language unit in Ealing. A couple of days ago, I received a delegation of mental health users from the emergency clinic at the Maudsley hospital in south London who were desperate that their specialist centre should not be closed down. Every so often a collective, pseudo-ideological mania seems to take over some of our public services, and it can be seen in the way in which children are taught to read or taught through play; in the wholesale closure of mental hospitals and the decanting into the community of far too many people who are unable to cope; in the closure
of special schools, which has been gathering pace; and in the current determination to say that the NHS needs fewer beds.
I have time to make only one point to the Minister, and it is this: when he winds up the debate, will he please not tell us that it is for local decision takers to take responsibility? The Government are at the top of the tree, the community is at the bottom, and the so-called local decision takers, who staff the PCTs’ bureaucracies, are in between. Which group is the odd one out? It is the one in the middle—the one that is not elected. It is the Government’s responsibility to ensure that the systems that they set up are responsive to the communities that they are supposed to serve.
Finally, the Minister should not tell us how much money he has been putting in. That is like saying that we are pouring more and more water into the bath when there is a great hole in the bottom of it. The bath will never be full, because the water will drain away faster than we can pour it in. We are interested not in the resources that are going in, but in the outcomes that are not coming out.
4.2 pm
Steve Webb (Northavon) (LD): It is appropriate that the final contribution before the winding-up speeches should highlight the issue that underlay many of the other contributions, but which was not made explicit: accountability. What has run throughout the debate is the notion that local people are clearly expressing their preferences—the term “sham consultation” keeps coming up in these Westminster Hall debates—but that we can do nothing about it when nobody listens.
That causes me to ask the fundamental question of whether we need to look at accountability in the national health service and decide whether we are satisfied with the present arrangement, whereby just one person—obviously, she is not present today—is accountable for the 1.3 million people who work in the NHS, or whether there needs to be closer, more local accountability. We have that in embryo form in local authorities’ overview and scrutiny committees, but they are weak, and one of the few things that they can do—this links to the introductory remark made by the hon. Member for Gosport (Peter Viggers)—is to refer a decision to the Secretary of State and ask her, in turn, to refer it to the independent reconfiguration panel.
I was interested in the hon. Gentleman’s remarks, because his experiences are identical to mine. I had a hospital closure in my area, and the local authority asked the Secretary of State to have it looked at independently, but she refused. There is history in that respect. Although there is an independent panel, it does not, on average, get asked to look at the things that local authorities want it to consider, because the Secretary of State stands in the way. We therefore have no serious local accountability, and the one bit of local accountability that we do have gets overridden by the Secretary of State, who refuses to let someone independent look at things.
We therefore need to look at serious local, democratic accountability in the NHS, and it will be interesting to find out in the Conservative winding-up speech whether there is anything in the Conservatives’ plans, to the extent that they exist, to deal with local
democratic accountability and to determine whether the people who make the decisions—it is rude to call them faceless, but they are the people whom we cannot get rid of—should be replaced or answerable to elected representatives, because, at the moment, they are not. That is the frustration.
We have heard some important points. The hon. Member for Gosport, who secured the debate—I congratulate him on that—gave some powerful examples of micro-management and of targets distorting the NHS. I met a woman only this morning who had a specific need to see a particular consultant. She said that she was happy to wait to see the right person, but was told that she could not wait because she would go past the target. She was told that she would be sent to someone else and said that that specialist would not know about her. She was told that which did not matter and that she had to see a consultant so that she would be off the list. She went to see the other consultant, who asked, “What are you doing here? I cannot help you.” She said that she knew that but that she had been sent so that the box could be ticked. That is the sort of absurdity that arises.
I was interested to hear from my constituency neighbour, the hon. Member for Stroud (Mr. Drew), about the situation in his area. He came up with a criterion with which many of us have sympathy. None of us is emotionally wedded to bricks and mortar. Buildings that were once fit for purpose may no longer be so or may be in the wrong place. No one is saying that nothing must ever change, but we want proper public engagement without a preconceived agenda.
It was good to hear the hon. Gentleman and the hon. Member for North-West Leicestershire (David Taylor)—the Statler and Waldorf of the Labour Back Benches—pointing out that Government health policy rhetoric is fine, but the disjunction between the rhetoric and reality shows that the Department of Health is out of touch with what is really happening. The classic example is the White Paper on community hospitals. The disjunction is that when something goes wrong locally, the decision was made locally, but when 500 new or upgraded community hospitals are planned, they are the Government’s responsibility. How can both be true simultaneously? The Government are responsible for good news and new hospitals, but bad news and closed hospitals are due to local decision making and nothing to do with the Government. Both cannot be true, so which is?
In this very Chamber the hon. Member for Ludlow (Mr. Dunne) properly raised the issue of his local community hospitals and the hon. Member for Banbury (Tony Baldry) raised another critical point about the absurd division between health and social care. While we have different budgets and something can be shunted into someone else's budget, the welfare of the individual will come second to the financial pressures. Again, the logic of the argument that we have heard today is that budgets should be merged and pooled with a single stream of health and social care funding and democratic, local accountability. Those are two big steps, but that is what I want and it would
deal with many of the points raised. We would then have responsive public consultation and effective social and health care.
My hon. Friend the Member for St. Ives (Andrew George) properly raised the issue of capacity and the extraordinary situation that when beds are cut, occupancy rates rise well beyond the level at which even experts in infection control believe they can do a good job. There will then be another Government target, initiative and action plan to tackle MRSA or whatever the bug of the day happens to be. There is no joined-up thinking in the whole process.
The hon. Member for Wantage (Mr. Vaizey) made an important and incisive point about the difference between care closer to home and care in the home. People often slide between the two. It is assumed that we all want care closer to home, but many of us need specialist and local NHS facilities close to where we live which we can get to even when the A34 is blocked. The Government increasingly do not mean beds close to home; they mean people going from their homes to a super-GP clinic or something like that. There is no intermediate step.
What is it about community hospitals that we favour? It is localness. Being treated close to home has a medical benefit, because loved ones can pop in and friends and family are nearby. It is the human scale of such hospitals. People do not want one dirty great hospital for the whole county. They want local hospitals where they know the names of the staff and can build a relationship. Caring for people locally is evidence-based medicine on a human scale and takes pressure off the large acute trusts.
We must not allow the myth to continue that community hospitals are inefficient and bad value for money. Putting someone in a small community hospital instead of tying up an expensive acute hospital bed is good value for money and good for the individual.
We need a merger of health and social care budgets to avoid cost shunting and we need serious local accountability. We also need funding—funding is not irrelevant—and I have supported that, but we need more than funding and the Government should listen to what local people are saying because, at the moment, local people have no voice.
4.9 pm
Dr. Andrew Murrison (Westbury) (Con): We need to be clear about what we are dealing with. We are dealing with closures that have been prompted by deficits, which is the responsibility of Ministers. The hon. Member for Northavon (Steve Webb) asked what the Conservatives would do to improve accountability. Accountability rests squarely with the Secretary of State for Health who, ultimately, is responsible for the closures that we have seen. Most Conservative Members would, for reasons to which my hon. Friend the Member for Gosport (Peter Viggers) alluded, attribute the deficits to the actions of the present Government, and I would like the Minister to answer for the 80 or so closures that are threatened up and down the country.
I admit a constituency interest. On Friday, I visited the four community hospitals in my constituency, all of which are threatened with the axe. There was a
fifth—Bradford-on-Avon—but it has already closed. I also visited an EMI—elderly mentally infirm—unit for 26 in-patients in Trowbridge, which caters for a large part of Wiltshire. That, too, is threatened with closure, together with the maternity unit, so I have some sympathy for the hon. Member for Stroud (Mr. Drew). All those facilities will go.
The hon. Member for Northavon talked about evidence-based medicine. I do not think he really understands what evidence-based medicine is. There is no evidence that the plans that the primary care trust has produced would do anything other than destroy what we have traditionally enjoyed in my part of Wiltshire—good local health care. All the evidence suggests that we would lose a great deal and pick up very little in return. The PCT, in the spirit of the age, will talk about taking health care closer to patients, and of course we would all wish to be treated in our home if that were possible.
Mr. Geoffrey Clifton-Brown (Cotswold) (Con): I apologise for not being present for the whole debate—it is not possible to do everything in this place. My hon. Friend is aware of the announcement made in Gloucestershire on black Wednesday, as I call it, that 12 institutions would be closed or have their services severely curtailed. That was to involve a loss of 250 beds and more than 200 staff. In Gloucestershire, we will not have many health facilities left other than the two acute hospitals. That is what the present Government have reduced the health service to in Gloucestershire. Does he agree that what needs to be considered is people’s welfare, not just bottom-line budgets to rake back last year’s and this year’s deficits?
Dr. Murrison: I agree. What my hon. Friend describes is what Ministers have told us should happen. It is clear from the White Paper that short-term budgetary fixes should not result in the closure of community hospitals, so he is right. I have visited a couple of his local community hospitals and I am as distraught as he is to hear of their closure. We are told that intermediate care teams will sally forth and look after people in their own homes. Come on, we live in the real world. We all know that people will not receive proper hospital care at home. The best that people can hope for is health care in homely settings in the community. That is what people have at the moment in areas that are blessed with community hospitals. I understood from the White Paper that the community hospital model would be expanded across the rest of the country, but it appears that that will not happen. We hear about new-generation community hospitals, but the reality is that well before they appear, we see hospitals such as Bradford-on-Avon and those in my hon. Friend’s area closing. At the very least, we are putting the cart before the horse.
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