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24 May 2006 : Column 507WH—continued
We have to accept that when those institutions close, a whole generation of health care workers will be lost. People who work in community hospitals are very special. They are often seen to be on the margins of health care, and often they are. They usually work in community hospitals for particular reasons. They choose to work in those hospitals, yet there seems to be an assumption that when the hospitals close, the workers will all march off and rebadge themselves as
community nurses or district nurses, or perhaps work in acute centres. Clearly, many of them will not do so and many of the particular skills that they have will be lost. I do not think that the Minister has thought that through adequately.
I shall not dwell at length on sham consultations. Suffice it to say that I am as incensed as most other hon. Members who have spoken that a culture of cynicism should be built up around what should be a perfectly reasonable thing for us to do—ask people what they want in terms of health care delivery in their locality. I now have to say to my constituents, “Please respond to the primary care trust’s consultation because it will take your silence as assent to the plans.” However, most people are reluctant to take part, because they see themselves putting a great deal of time and effort into consultation in good faith and then finding the PCT simply proceeding with an agenda that it created beforehand.
The White Paper makes a number of referencesto community hospitals, and it actually refers to Trowbridge community hospital, which is interesting, because under the primary care trust proposals, that is one of the community hospitals that will close. It says, in bold, that
“PCTs taking current decisions about the future of community hospitals will be required to demonstrate to their SHA that they have consulted locally and have considered options such as developing new pathways, new partnerships and new ownership possibilities.”
There is very little room for weasel words there.
There is a delicious irony, because many of the hospitals had what I suppose, in retrospect, were new partnerships, which were created by the communities that they served. They were often the gift of a local benefactor and they have been supported royally over the years through local effort. I am intrigued and, in all candour, I am interested to hear the Minister’s take on exactly what those words mean, and to hear how he will encourage new partnerships and new ownership possibilities. What does he have in mind, and how will he make sure that those partnerships happen? I actually think that partnerships are quite an imaginative solution for the future, but they will not happen if the Government do not support them, and they will certainly not happen if PCTs do not support them. His comments on that point would be most welcome.
On Monday, the NHS Confederation produced what is best described as a leaflet. It was much trumpeted but it contains very little apart from anecdote, and it does not mention community hospitals at all, really. The issue of what on earth will be done as the number of acute hospital beds continues to be reduced is left hanging in the air, but people will have to go somewhere.
Interestingly, a couple of months ago, Dr. Foster, a body that is in some level of partnership with the Department of Health, published a paper in the British Medical Journal that compared health care in America with health care in this country. Of course there are differences between the two countries, but it is instructive to note how much more reliance America puts on intermediate care, and how little time people spend in acute hospitals in America compared with
people in this country. America also has greater reliance on intermediate care beds, which of course are cheaper.
Health maintenance organisations that manage health care in America are, of course, run by accountants, and they are very exercised by how much health care costs. Primary care trusts are getting it all wrong in trying to save costs by disestablishing the intermediate care level. The Minister looks surprised, but I am surprised that he has not been given the paper by members of Dr. Foster—they came to see the Opposition Front Bench team earlier this week—because it has a partnership arrangement with the Department of Health, and it seems that the research is crucial to what we are discussing today. I can send it to him, but I point out that it is in the BMJ of March this year, so he can look it up for himself. It seems that we have been given a false prospectus by primary care trusts, which hold that we will save money, as we will, of course, in the very short term, in terms of balancing the books in-year, but in the longer term the result will simply be more cost.
We are rusticating cost from one part of the public purse to another. We heard earlier about how social services will bear much of the burden for all this. Likewise, voluntary organisations will pick up the bill for things such as palliative care, and of course carers will pick up a lot of the burden, as well. So when we talk about cost, we must ask: the cost to whom? That is extremely important.
I apologise to the hon. Member for Stroud for intervening on him, but we take a particular interest in what is going on in Stroud. I am pleased that his contribution was so powerful, because it is all very well for my hon. Friends to debate the issue, but the fact that someone on the Labour Benches is doing so will, I hope, have more impact on the Minister than we have had hitherto. In connection with Stroud maternity hospital, it will be particularly interesting to hear which of the following holds: the January 2006 operating framework for 2006-07, which said:
“All NHS organisations should plan to recover deficits for previous years and balance their books for 2006-07
or the Secretary of State’s letter dated 12 April to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who was here earlier. That letter says that
“organisations which are overspending will be required to show improvement and by the end of 2006-7 be in monthly balance.”
That is, monthly expenditure should cancel out or equal monthly income. It will be interesting to know which one of those propositions holds true, because clearly both of them cannot be true. There appears to have been something of a difference, and clearly Gloucestershire is working to the former proposition, not to the latter. That is important in the context of Stroud maternity hospital.
John Bercow (in the Chair): Order. I am sure that the hon. Gentleman will bring his remarks to a close very soon, as the Minister must have an opportunity to reply.
Dr. Murrison: Thank you, Mr. Bercow. I am indeed bringing my remarks to a conclusion. I hope that the Minister will address those points. In particular, I make no apology for underscoring my constituency interest, which informs my more general concern that stems back 25 years.
4.20 pm
The Minister of State, Department of Health (Andy Burnham): I congratulate the hon. Member for Gosport (Peter Viggers) on securing the debate. He raised a number of interesting and important issues that deserve a proper response. We have heard good contributions to the debate, particularly from the hon. Member for Ludlow (Mr. Dunne). The hon. Member for Northavon (Steve Webb), as always, made a good contribution and some important points. The good turnout this afternoon shows the depth of feeling about community hospitals in communities across the country.
I do not doubt the sincerity of the hon. Member for Gosport, but I doubt the quality of some of the analysis he gave us about what is happening in the national health service today and since 1992. I have doubts about some of the statements that have been made in the course of the debate, such as the suggestion that the Government are doing nothing to support community hospitals.
The hon. Member for Banbury (Tony Baldry) made something of a rant, which was uncharacteristic—if that helps, as I do not think he is normally associated with such speeches. He talked about the Government “waging war” on community hospitals. That is simply not borne out at all by the facts on the ground. I have a quote for him from the Community Hospitals Association, an organisation with which he will be familiar. On its website, it states:
“Despite common belief there are still, in Great Britain, over 470 Community Hospitals. And for every closure in recent years there has been a new hospital opened.”
The hon. Gentleman’s views are simply not borne out by the facts.
A number of hon. Members have mentioned the NHS Confederation’s analysis that was put before us this week. I refer the Chamber to a table in that report that shows the number of hospital beds lost in the20 years from 1984 to 2004-05. If we consider the figures for 1997-98, we see that there were 148,828 beds in the national health service. In 2004-05, there were 145,218. That is broadly the same figure, with a small reduction. If we look further down the table, we see in the period from 1984 to 1997-98 a reduction of 63,000 beds during those years of Conservative Government. A little more humility tempering the strident comments of Conservative Members might not have gone amiss.
Bob Spink (Castle Point) (Con): Will the Minister give way?
Andy Burnham: I do not have a great deal of time, so I will press on.
Our manifesto made absolutely clear our commitment to a new generation of community hospitals, rebuilt or refurbished, with state-of-the-art NHS facilities. Our commitment to the future of
community hospitals was further highlighted by the recent White Paper, to which many hon. Members have referred. “Our health, our care, our say” firmly placed community hospitals, old and new, at the heart of achieving the shift in care and resources that the White Paper signalled. I say to Conservative Members that during the period when they were in government it was very much the trend that the acute sites began to draw in more and more services. That is what we saw in communities up and down the country, not least in my own, where the accident and emergency department at Leigh infirmary was closed. That was the direction of travel in the ’80s and ’90s.
Mr. Vaizey: Will the Minister give way?
Andy Burnham: I will not. The reduction of 63,000 in the number of beds in our national health service is the evidence of that process. The direction that the White Paper has laid out—
Dr. Murrison: On a point of order, Mr. Bercow. Is it in order for the Minister not to have read the NHS Confederation’s pamphlet, produced on Monday, to which I referred? He has completely misled us.
John Bercow (in the Chair): That is a point either of debate or of frustration.
Andy Burnham: I reject the suggestion that I have misled Members. I was giving figures from the NHS Confederation, issued this week, which show the true state of our national health service. Raising a frivolous point of order when I have been left with little time does not help our debate.
We made our commitment to community hospitals because that was what the public told us strongly in the consultation, “Your health, your care, your say”. People want services to be available closer to where they live, and they want health and social care to become more seamless with more personalised and integrated care. That point was fairly made by the hon. Member for Northavon. It is true that people want to be treated in familiar, comfortable surroundings.
England is unusual among developed countries in that a high proportion of care is accessed through large, acute hospitals on-site, particularly for out-patients. That is why the White Paper laid out clearly our intention to move toward more local and community provision. We want the NHS to challenge the status quo that has seen care increasingly centralised in large institutions. If we are serious about shifting care, we need to make sure that the facilities out in the community are fit for purpose, and that they are not simply bricks and mortar that have been there for a long time, but modern, good quality facilities in which the kind of care for our constituents that we all aspire to can be provided.
Picking up on the NHS Confederation theme, there is a challenge for all elected politicians, in this place and locally, to get beyond some of the emotion. Thatis what it is challenging us to do. The NHS Confederation called for a well informed debate on these matters. It is incumbent on every one of us, as leaders within our communities, to lead that debate
rather than follow it. We, too, should put informed positions into the public domain about hospital reconfiguration. Let us make no bones about it: from time to time there will need to be reconfiguration of services to reflect modern standards and aspirations. The duty to lead that debate is incumbent on us all.
I will now pick up on a point made by thehon. Member for Gosport. There is an onus on the NHS to listen to local opinion when it is expressed ina moderate and reasonable way, where local representatives have gone out to listen to their communities and taken the trouble to work through the detail of proposals. The NHS needs to be good at hearing that debate and the argument coming back the other way. I accept that it might not have done that well in the past, and that we need to make sure that our consultation within the NHS is true consultation, but that is a two-way street. All hon. Members should reflect on that.
A new generation of facilities is already being put in place. The hon. Member for Banbury asked where they are. Examples include Colchester and Tendring PCTs, which have recently seen a primary care centre and a community hospital open under the NHS LIFT—local improvement finance trust—initiative. There are other examples with a number of other services: Colchester primary care centre is providing a renal dialysis unit that will provide local facilities for patients who currently travel to London or Cambridge three times a week for treatment. Harwich hospital is a new facility constructed on the grounds of an outdated community hospital. It will provide numerous specialist primary care and diagnostic services, as well as an operating theatre, in-patient beds and a maternity unit. They are the evidence of the new generation of facilities that the hon. Gentleman asked for. It is there, on the ground, and it is benefiting patients across the country.
I was asked for evidence of the manifesto commitment. There is capital: a significant sum of money has been set aside to enable communities around the country to come forward with plans for new community provision. More information will be made available and a statement will be made soon as to how that capital can be accessed. It is not possible to build new hospitals within a year of our manifesto commitment, but the commitment will be honoured.
I shall pick up on some of the specific points raised by the hon. Member for Gosport, because he deserves a detailed response to them. I understand the concerns in his communities about the transition in service provision; we all acknowledge that that can be difficult to understand. The hub-and-spoke model that is proposed for his area—given the geography of his constituency—must respect all the communities in it. To be viable, the hub-and-spoke system needs to consider all the communities, not just one in isolation. A new facility is being constructed at Fareham. Seeing the health economy in the round is important, and it is crucial to ensure that one community’s aspirations do not cut across the legitimate aspirations of another for modern health care facilities in their area.
I say to my hon. Friend the Member for Stroud(Mr. Drew) that we will make an announcement on the White Paper in due course, which will apply to all kinds of services, including maternity units; it will cover the breadth of services. We want PCTs to look carefully at
the White Paper; it is not just words, and we want them to see clearly the direction of travel and provide the kind of services that his constituents and mine want on the ground.
John Bercow (in the Chair): Order. I am sorry to interrupt the Minister, but we must now move on the next debate.
Home Information Packs
4.30 pm
Mr. Greg Hands (Hammersmith and Fulham) (Con): I am pleased to have this short debate on home information packs, better known as HIPs. This is not the first time that they have been debated in this place and it will probably not be the last. Given the number of hon. Members who wish to speak, I shall try to be brief and not cover all the objections that I and others have to HIPs. Suffice it to say, they are included in early-day motion 2240, which is entitled “Introduction of home information packs” and was tabled by my hon. Friend the Member for Surrey Heath (Michael Gove). I also pay tribute to my hon. Friend the Member for Bridgwater (Mr. Liddell-Grainger) for his recent excellent ten-minute Bill on the subject.
Having spoken to a variety of groups from all sides of the HIPs debate in recent days, I have picked up a common theme, which is perhaps best described by an individual whose role it is to promote and sell HIPs but who unsurprisingly does not wish to be named this afternoon. He told me that doing something to help house buyers was long overdue but that with HIPs,like other new Labour policies, the execution was fundamentally flawed.
HIPs are a new stealth tax, dressed up as a proposal to help hard-pressed buyers in the housing market. However, rather like the huge stamp duty hikes seen in recent years, which were introduced in the name of cooling down the housing market, while netting the Chancellor huge amounts of additional funds, HIPs will create a whole new tax scheme for the Treasury. Assuming annual home sales of around 1.3 million, it will take an average HIP price of only £770 to create a new billion-pound industry in this country. That would result in an additional £175 million going to the Chancellor each year in VAT. Moreover, the tax is regressive, as it seems quite possible that the cost of putting together a HIP for a studio flat might be the same as for a mansion.
My first objection to HIPs is therefore that they add another part to the complex process of buying and selling a property and will probably not remove any of the other hurdles. Currently, some 80 per cent. of buyers do not have a formal or second-level survey. Those who are borrowing to fund the purchase—that is, the home buyers—consider the lender’s valuation survey, which is, after all, designed solely to protect the lender’s interest, to be sufficient. However, lenders are not compelled to accept the new home condition report as a basis for valuation, and many lenders have signalled that it will be no substitute for a full valuation.
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