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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 that 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 reason for the proposal affecting Leighton is that the 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 in 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 a figure 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 the operation concerned, include an element of rehabilitation, although often not the full costs of rehabilitation. That is one of the reasons why 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 out 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.
Mr. Ian Taylor (Esher and Walton) (Con): Is the Secretary of State aware that in the eastern part of my constituency, it is not so much hospital closures that are taking place, as the downgrading of the services in those hospitals? For example, Epsom hospital is losing its general hospital status quite rapidly, and three community hospitals are being starved of revenue because the primary care trust is encouraging patients to move out of a general hospital straight home, which has led one local GP to say that there were unsafe discharges. There are serious revenue problems, so how will the Secretary of State’s announcement about her capital plan help my constituents?
Ms Hewitt: The proposals for Epsom involve the development of a smaller critical care hospital surrounded by—I think—nine community hospitals or health care centre settings. More care will thus be delivered closer to patients’ homes, which will be much more convenient for them, but critical care and complex acute cases will be located in one specialist hospital facility. There has been wide consultation on that model of care, and it got widespread public support. The issue is not cuts in funding—I think that the hon. Gentleman suggested something of that kind—but the way in which the unprecedented sums that we are investing in the NHS, which will continue to grow by 9 per cent. this year and next year, are used to best effect for the local population, and how we ensure that when there is overspending, the NHS in the area comes back into financial balance and does not expect other parts of the country to go on bailing it out.
Mr. Graham Allen (Nottingham, North) (Lab): A little girl born this morning in the middle of the most deprived ward in my constituency will live 14 years less than a little girl born this morning in Wollaton, the prosperous ward next door. It will not surprise the Secretary of State to know which ward has a mega regional hospital, and which has no community hospital or facilities whatever. In that context, will she consider entertaining bids not merely from the local PCT, but from the collective local strategic partnership—such partnerships exist in each of the major cities in the UK—so that we can move forward a lot more quickly? One of the most difficult points that was raised with me this morning when I tested the idea locally was anxiety about having private finance initiative-related schemes, or LIFT-related schemes, because of their long-term expense. Will she consider bids and offers from organisations other than PCTs, with a broader financial base?
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