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The hon. Gentleman ended his speech by scorning the idea of more convenient medical services. The reality is that, with modern medical technology, it is now possible to offer, for instance, some chemotherapy services for cancer patients not only in a community hospital or health and care centre, but in their own home, which is far more convenient and much better for such patients. Renal dialysis provides another good example of that. Thanks to the investment that we are making in the NHS, this capital fund will enable that new generation of services to be provided to our patients.
Mr. Kevin Barron (Rother Valley) (Lab): I welcome my right hon. Friend’s statement, but is she aware of the “breathing space” project, which is being built in Rotherham? It will bring services for COPD—chronic obstructive pulmonary disease—patients in both the acute and primary sectors under one roof, so that we can treat such lung disease a lot better than it has been treated before. Although that means that the local district general hospital will lose beds and some services, as consultants will work in other places, it will lead to a massive improvement in patient care. Will my right hon. Friend make sure that patients—and the work force, as well—will be consulted in all areas where we will have such changes to replace the great, big, all-singing, all-dancing district general hospitals of the past, which many patients do not need?
Ms Hewitt: My right hon. Friend is absolutely right. We can move many services, particularly for patients with long-term conditions such as COPD, into the community and into patients’ own homes. As a result, we will give people better care. My hon. Friend the Member for Doncaster, Central (Ms Winterton), who is the Minister responsible for health services, has confirmed that she has visited the site for the new services mentioned.
In many places, decisions are taken to reduce the number of beds in acute hospitals because those services can be better provided for patients within the community. That also represents better value for money, which means more savings, as Norwich—to give just one example—indicated, so that money can be reinvested in better care for other patients, and also in the costs of some of the extraordinary new drugs that are coming on-stream, but many of which are also pretty expensive.
Steve Webb (Northavon) (LD): I thank the Secretary of State for her statement. It is always fascinating to step with her into the parallel world that she inhabits, where shiny new hospitals are delivered to a glad and happy local population.
Something puzzles me about the Secretary of State’s statement. When swathes of community hospitals are closed, the Secretary of State does not come before the House, but when they are about to be opened, she does. Can she explain why the closure of community hospitals is somebody else’s fault, but the opening of them is her responsibility?
Does the Secretary of State envisage that at the end of this process—at the end of her vision—there will be more community hospitals than the Government inherited? Can she also clarify whether she will be counting in her total figure former district general hospitals, such as Frenchay hospital, which will be reduced to a community hospital? Will we find that the Secretary of State comes back to the House to tell us that she has opened Frenchay community hospital, while overlooking the fact that she has closed a district general hospital?
The
financing of the new community hospitals might be under 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 can the Secretary of State not 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): The 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 there resulting from overspending, and the local NHS is having to consider some difficult options, in order 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 where services are commissioned from.
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.
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