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The financing of the new community hospitals might be under the local improvement finance trust—LIFT—private finance initiative, or traditional forms of funding, but does the Secretary of State not accept that there has been much criticism of the value for
money of LIFT as recently as this week, and of PFI? Is she confident that trusts will not be saddled with long-term financial burdens on over-the-odds terms, compared with more traditional ways of paying?
Is this process not yet another example of the centralism of this Government? Can the Secretary of State confirm that PCTs will need the permission of health authorities, which will need the permission of Whitehall? Where is the local democratic accountability in this process? Why cannot the Secretary of State let go? Why is there a control-freak tendency, so that when she talks the language of localism what she means is, “Whitehall will decide”?
Ms Hewitt: The hon. Gentleman, for whom I have considerable respect, is talking rubbish today. Whether the local NHS decides to close certain community facilities because they are no longer the right ones for local people, or to open new or refurbished facilities because they are the right ones for local people, should be local decisions. What I, as Secretary of State, am doing is ensuring that the support is in place for such local decisions, and in particular that the capital investment is in place, which many parts of the NHS have told us that they need so that they can reorganise their services—sometimes their existing cottage and community hospitals—in order to give better services to patients.
The hon. Gentleman needs to focus on the services that are being delivered to patients, rather than on the number of buildings or beds, because not only in respect of acute hospitals, but also of some community hospitals, it is better for many patients if community services are taken into their own homes. That was precisely the point that the excellent nursing and care team in the Norwich community hospital made to me: by reducing the number of beds and putting half of the staff into the community, they were able to give intermediate and rehabilitation care to more patients, some of them in the community hospital, and others looked after by community staff in their own homes. Moreover, they had reduced emergency admissions to the acute hospital by more than 600 in the past six months, thus enabling savings of money that can then be reinvested in better care. That is what the hon. Gentleman needs to look at.
Of course I will open community facilities, as I did at Prospect Park in Berkshire last week, regardless of whether they replace an old district general hospital—or, possibly, old community hospitals—or they are simply new hospitals. The test in all of this, which I invite the hon. Gentleman to support, is to get the best services for patients with the best value for patients and for public money.
Mr. Ronnie Campbell (Blyth Valley) (Lab): Blyth community hospital in my constituency is a wonderful community facility, but I have been told on the grapevine—not officially—that the minor emergency centre, which deals with minor injuries, is to close to save money. If we want to bring that sort of care nearer to the people, doing that is not the answer. I remind the Secretary of State that at least 35,000 people depend on this emergency facility; otherwise, they have to go five, six or seven miles to the next nearest hospital.
Ms Hewitt: I am not aware of the details of the situation to which my hon. Friend refers, and as he suggested, at this point it is a rumour rather than a firm proposal.
Mr. Campbell: Will the Secretary of State look into that?
Ms Hewitt: I will, and I know that my hon. Friend will, too.
Of course, one question with minor injuries units is exactly how many local people are using them and whether they therefore offer the best services for the best value for money. I know that my hon. Friend will be closely involved in any consultation on a local proposal, and I will of course examine it and write to him about it.
Mr. Quentin Davies (Grantham and Stamford) (Con): Does the right hon. Lady realise that last week my constituents received the devastating blow of being told by the United Lincolnshire Hospitals NHS Trust that it proposes to withdraw all acute surgery, the consultant-led accident and emergency department and critical care from Grantham hospital? That news has caused consternation in my constituency, and I hope that I may shortly have the opportunity to speak to the right hon. Lady about it. Does she appreciate that today’s announcement that a capital fund is available for setting up community hospitals will be regarded as incomprehensible—and, indeed, hurtful—by my constituents, who have been told that they are about to lose their first-class district general hospital, even though no other such hospital is nearer than three quarters of an hour away?
Ms Hewitt: There is, of course, an extremely difficult situation in the hon. Gentleman’s constituency in the wider health community. Unfortunately, there are serious deficits resulting from overspending, and the local NHS is having to consider some difficult options, to see how it can continue to offer the best possible services to people within the substantially increased budgets that we have given it. Indeed, other parts of the region are having to hold back on their own spending to compensate for that overspending while the problems there are sorted out. I understand completely the concern expressed by the hon. Gentleman’s constituents and other local people—I have received such correspondence myself—and I will of course meet him to discuss it. But I hope that he will work very closely with the local PCT to make certain that the best decisions are taken to ensure that the NHS in his community lives within its means and, within that very substantial budget, goes on offering the best possible care to his constituents.
Jane Kennedy (Liverpool, Wavertree) (Lab): Today’s statement will be welcomed by my constituents because it offers the best possibility of further development at Broadgreen hospital and, potentially, a much better future for the hospital in the constituency of my hon. Friend, and neighbour, the Member for Liverpool, Garston (Maria Eagle). Does my right hon. Friend agree, however, that the success of this project, which is very welcome, will depend on good quality commissioning locally? Will she therefore undertake to look at the GP contract? As GPs take on greater responsibility for commissioning locally, we will require them to be transparent and accountable in undertaking such commissioning, so that they can continually demonstrate that they are acting in the best interests of the patients whom they are there to serve.
Ms Hewitt: My right hon. Friend makes an extremely important point, and I hope that her local PCT will come forward with a proposal to use some of the new capital investment. She is absolutely right about the accountability of GP practices for decisions made under practice-based commissioning. We have already made it clear that it is the PCT’s responsibility to ensure proper transparency and accountability to local people—and, ultimately, to this House—in respect of decisions taken by GPs and the PCT on how the money is spent, and from where services are commissioned.
Mr. Peter Lilley (Hitchin and Harpenden) (Con): Is the Secretary of State aware that at a public meeting last September in my constituency, which I chaired, her local NHS officials told us that Red House hospital—that is, Harpenden memorial hospital—was safe, but that eight months later they announced that it was to close all beds in order to save £1 million a year? Can she confirm that her fund will not in any way help to avert that, and that when the East and North Hertfordshire NHS Trust, in pursuit of its obligation to cut spending by a quarter over the next three years—from £260 million to £200 million—downgrades the district hospital, she will not claim that that is somehow creating a new community hospital? And will she come to our constituencies and try to convince us of the value of that move?
Ms Hewitt: Far from cutting the budget for the East and North Hertfordshire NHS Trust, we are asking it to live within the very substantially increased budget that it has received over the years—thanks to the investment that we have made, which the right hon. Gentleman voted against. We have put more money than ever before into the NHS, in his area and everywhere else, but we do expect the NHS in Hertfordshire to live within its means. It should not expect the NHS in other parts of the country to bail out its overspending at the expense of patients in the rest of the country, where the NHS is balancing or even underspending on its budgets. This issue has to be sorted out and difficult decisions will have to be made across Bedfordshire and Hertfordshire to ensure that the local health community has the right services in the right facilities, giving the best possible value for money. I am sure that the right hon. Gentleman will continue to take part in the consultation that the local PCTs are having to undertake, in order to ensure that the best decisions are made, but that will be done within the framework of the increased budget that we have made available.
Gwyn Prosser (Dover) (Lab): I warmly welcome the Secretary of State’s statement about extra funding for small hospitals, but what advice has she got for the health trusts in east Kent that propose to strip away even basic services from Buckland hospital in Dover? That will almost certainly result in its closure, before it has an opportunity to look at the alternatives that such extra funding could provide.
Ms Hewitt:
As I pointed out earlier, I have been saying for some months to PCTs that they need to look at the longer-term strategy. In many cases, the local NHS is finding that by reorganising services—by
putting more services into people’s homes, for example, and sometimes by bringing together provision from several different sites—it can provide a better quality of care, but with better value for money as well. I know that my hon. Friend, who is very concerned about this issue, will ensure that his constituents’ voices are heard in the consultation that has to take place whenever any such reconfiguration of services is proposed.
Mr. Edward Davey (Kingston and Surbiton) (LD): On the question of making an early bid for some of the investment fund in order to rebuild Surbiton hospital, is the Secretary of State aware that Whitehall’s capital rules on the use of NHS moneys generated from the sale of surplus land and buildings in the local community prevent PCTs from taking up some of the best options to fund, or part-fund, the rebuilding of community hospitals? Will she look again at those rules, so that PCTs such as Kingston’s can use their own capital more efficiently, as well as gaining from her fund?
Ms Hewitt: The hon. Gentleman raises a very important point, and some PCTs have made representations to me about the difficulties associated with the current rules on disposal of assets. We need to look at that issue, and, as the hon. Gentleman will probably remember, I have already asked Sir Michael Lyons and the Audit Commission to look independently at the financial framework within which the NHS operates. I am waiting for their report and the recommendations that I hope they will make to ensure that we have the best possible framework, giving PCTs the real flexibility that they need to reorganise services and to use their assets in the best possible way for the benefit of patients.
Mr. Mike Hall (Weaver Vale) (Lab): North Cheshire Hospitals NHS Trust, in my constituency, is considering reconfiguring services between Halton and Warrington, and the Mid Cheshire Hospitals NHS Trust is looking at reconfiguring services between the Victoria infirmary, in Northwich, and Leighton. Much of what is proposed is very welcome, but the real concern locally—in both towns—is that Halton could lose in-patient activity to Warrington, and that the Victoria infirmary could lose it to Leighton. The proposal affects Leighton because Victoria infirmary needs capital investment of some £2 million to bring its services up to standard. Will this fund help in that regard?
Ms Hewitt: As I have said, the fund is for community hospital provision—and I think that my hon. Friend is referring to the need for upgrading an acute hospital facility. [Interruption.] Where the aim is to upgrade facilities in an existing hospital to provide better community health services and to meet the strategy set out in the White Paper, the fund will be available. The details—the criteria that we will use—are all set out in the guidance to which I referred.
Mr. David Curry (Skipton and Ripon) (Con):
Is the Secretary of State not alarmed at the huge gap that there obviously is between the profession of a commitment to community hospitals that she makes here, and the near universal impression out in the country that community hospitals are under almost
permanent threat? Is that impression surprising, given that the Craven, Harrogate and Rural District Primary Care Trust, the chief executive of which she saw yesterday, has halved, literally overnight, the number of beds at Castleberg and Ripon community hospitals, reducing them to below the historical level of demand? Will the right hon. Lady please accelerate the review of the perverse funding system whereby PCTs buy a package of care at the acute hospital and a certain number of days’ stay, and if a patient is then transferred to the community hospital the funds do not follow that patient within the tariff, and the PCT has to find additional funds? That is the lifeblood that is being cut off from community hospitals, and that process is responsible for the halving of capacity at my community hospital.
Ms Hewitt: I think that if the right hon. Gentleman looks at the figures, he will find that large numbers of community and cottage hospitals closed in the years when his party was in government. He will also find that at least as many new community hospitals have been opened as have closed in the years of our Government. As for funding, he is right to say that the tariffs that we pay hospitals for acute services do, depending on the operation concerned, include an element of rehabilitation, although often not the full costs of rehabilitation. That is one of the reasons we are working on unbundling the budget, but even within the current system primary care trusts have considerable flexibility. A large part of NHS funding is not spent on acute services to which the tariff applies, and can be used outside the tariff with all the flexibility that primary care trusts need to deliver services within community hospitals and other community settings.
Michael Jabez Foster (Hastings and Rye) (Lab): I welcome my right hon. Friend’s statement, which provides the possibility of exciting developments in local services in Hastings and Rye, but may I put it to her that one of the problems with that yet further increased choice is that hospital trusts are saying that they are losing the critical mass of providing services in the hospitals? Proposals such as closing maternity units and accident and emergency departments are a result of that. What can she do to ensure that the critical mass is not lost in district hospitals?
Ms Hewitt: What we will ensure is that patients have more choice and control over their health services. That is very much what the public want, and what a modern health service ought to deliver. We will also make sure that services are available in the best possible way, with the best value for money. This is not about saying, “Let’s keep everything as it is,” in particular district general hospitals. It is about looking at which services can be better delivered—better for patients, that is—within the community closer to home, and which services, because of their medical complexity, need to be delivered in a regional or even national specialist centre. Where the issue about critical mass relates to the provision of an essential service—particularly accident and emergency—it is the responsibility of the primary care trust and the strategic health authority to make sure that the essential service is not threatened and that the right relationship continues between the accident and emergency service and, particularly, orthopaedics and trauma services.
Mr. James Clappison (Hertsmere) (Con): The Secretary of State mentioned the age of some community hospitals. Is she aware of the case of Potters Bar community hospital? It is a modern, purpose-built facility that is barely 10 years old, yet it is due to lose 15 of its 45 beds when a significant part of the hospital is put to other uses as a result of revenue shortfalls suffered by the primary care trust. Is there anything in the statement to help Potters Bar hospital, or to help the primary care trust with its financial problems? Does the Secretary of State have any other plans to help Potters Bar hospital, or are we to have the ludicrous situation of an excellent modern facility closing for the very type of short-term reasons that the Secretary of State says she wants to avoid?
Ms Hewitt: The hon. Gentleman has just referred to the fact that there is an excellent modern facility at Potters Bar, so it does not sound as though it will need the capital investment fund that I have just announced. He said that it was proposed to remove 15 out of the 45 beds. I am not aware of the detailed situation, but I know that in many parts of the country, community nursing and therapy teams have found that by reducing the number of in-patient beds, staff can support more patients who need, for instance, rehabilitation support within their own home. That model is already working well in Berkshire, Norwich, Dudley and many other places. That may well be precisely the logic that the local NHS is applying in Potters Bar. I think that I also heard the hon. Gentleman say that although those beds are closing, other services will be provided in that part of the building. On the face of it, without knowing the details, that sounds exactly like the flexible use of community facilities, responding to changing patient needs and changing medical technology, that the local NHS should be engaging in as it continues to get the best possible services with the best value for money.
Mr. David Drew (Stroud) (Lab/Co-op): In the Secretary of State’s letter to strategic health authorities of 16 February, which looked at how community hospitals would fit within the White Paper “Our health, our care, our say”, mention is made of specific criteria for judging the future of community hospitals. Obviously that relates both to the capital spending that we are hearing about today and to the problems in a place such as Gloucestershire, where we are having a huge review on the back of deficits largely run up elsewhere. Are the criteria now published, and if not, when will they be published? May we have them as soon as possible?
Ms Hewitt: My hon. Friend raises an important point, and he and I have met to discuss some of the local issues in his constituency. The guidance that I have published today includes the criteria for access to the capital investment fund. The broader issues of how community services should be reconfigured, and the strategic direction, were set out in the White Paper itself. Obviously I am happy to look in more detail at the points that he has raised and to write to him.
Peter Viggers (Gosport) (Con):
Is the Secretary of State aware that her references to consultation and local decision making will be treated with anger and
contempt by many people who have been embittered by an empty consultation procedure of which the Government take no notice whatever? I chaired a meeting in Alverstoke in my constituency, at which 800 people unanimously demanded the retention of the hospital at Haslar, which has excellent facilities. Those are not stupid, uninformed people. In many cases, they are former patients who know that the facilities are outstandingly good. Will the Secretary of State, even at this stage, order an investigation by the independent reconfiguration panel into the future of medical services in south Hampshire?
Ms Hewitt: It is simply untrue to say that the NHS or the Government ignore local consultation. I refer to the recent consultations that we had on the reconfiguration of primary care trusts, where a number of options went out for consultation and decisions were made in the light of that local consultation. The overview and scrutiny committees of local councils have an increasingly important role to play in ensuring that local consultations held by the NHS on reconfiguring services are genuine, and that the outcome is satisfactory for local people. If an overview and scrutiny committee is dissatisfied with the way in which the NHS has conducted the consultation, it has the power to refer the matter to me. Obviously, I look at each of those cases extremely carefully, and where I think it right to do so, I refer them to the independent review panel for its advice. However, I stress again that those decisions are best made locally wherever possible. I hope that in the hon. Gentleman’s constituency, in relation to the situation to which he refers, the local primary care trust, local GPs, local people and the council will continue to work together to try to get the best outcome as they reorganise services.
Mr. John Grogan (Selby) (Lab): Will my right hon. Friend say a further word about the community venture model of community hospitals that she referred to? That will be particularly welcomed by the strong partnership being formed to plan the rebuilding of Selby war memorial hospital, given the strong belief locally that that hospital is likely to be more sustainable in the long run if there is strong co-operation between GPs, the local council, the local health service and the voluntary sector.
Ms Hewitt: I am grateful to my hon. Friend for coming to see me yesterday to discuss that, and bringing NHS colleagues who described the possibilities for a new community hospital in Selby. The thinking behind the community venture model is that it would allow not simply a public-private partnership on the LIFT—local improvement finance trust—model, but a much more flexible partnership between the NHS, other public service partners, such as, for instance, the local council, and the voluntary sector, as well as, potentially, the private sector. That would focus not just on a building, which is really what the LIFT partnership is about, but on the services that need to be provided both in a community hospital building and in other settings such as GP practices, health centres and patients’ own homes.
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