Westminster Hall
Tuesday 16 January 2007
[Miss Anne Begg in the Chair]
Community Hospital Services
Motion made, and Question proposed, That the sitting be now adjourned.—[Liz Blackman.]
9.30 am
Mr. Graham Stuart (Beverley and Holderness) (Con): I am grateful for the opportunity to speak again about a highly regarded local service: the community hospital. I introduced a debate on the same subject back in November 2005 when I spoke about the national crisis affecting community hospital care. Sadly, 14 months later, despite a raft of Government promises and announcements, that crisis has got slowly worse.
When I set up Community Hospitals Acting Nationally Together, an umbrella group for MPs and Lords of all parties who are concerned about the threat to community hospitals, the number of hospitals under threat of cuts or closure was about 80. According to the Community Hospitals Association, the latest assessment, which was completed yesterday, is that 148 community hospitals have closed or are under threat of cuts or closure—almost half of those that still exist. Twenty-two have already closed and 16 closed last year. More than 3,000 beds have closed since 1999. In Norfolk, eight hospitals are under threat and, in Devon, 19 are under threat and two have already closed. In Suffolk, seven hospitals are under threat, of which one has closed. In Wiltshire, eight hospitals are threatened, of which three have closed. There are 12 hospitals under threat in Derbyshire, two in north Yorkshire, four in the east riding of Yorkshire and two in Lincolnshire. Some 200 beds have closed in Devon in the past month alone. The list goes on.
Later today, I will join the hon. Member for Gosport (Peter Viggers) and his all-party parliamentary group on local hospitals to kick off a national rally in Westminster Hall. Health protests must seem a weekly occurrence for Ministers at the moment. The protests reflect the growing anger across the country towards Government cuts in services at a time, ironically, of record financial resources. The issue of health services has become so surreal that two health Ministers have protested against cuts on behalf of their own constituents.
In truth, it is disappointing to open yet another debate on community hospitals. This is the third debate on the subject in just over 12 months. There was a Government statement to the House during the middle of last year. It is frustrating because many of us—campaigners and politicians alike—share precisely the aspirations set out in Government policy. We share the commitment to bring care closer to home and welcome the vision of providing a new generation of modern NHS community hospitals and facilities. We
are not opposed to all change and do not wish to set any service or facility in aspic. However, the Government’s vision is not being delivered.
First, I will talk about the worsening situation in my constituency, which is part of the east riding of Yorkshire, before moving on to the growing national crisis in community hospital care.
Hornsea, Withernsea and Beverley are medium-sized rural towns that have older than average populations and suffer from poor transport infrastructure. Hornsea is the largest town in the country not to have a single A road. The A1079, which runs between Hull and York, is notorious for congestion and has an appalling safety record, while the local bus service is patchy at best. Neither Hornsea nor Withernsea have a railway station and, without the luxury of a car, it can take several hours to travel even relatively short distances. One elderly constituent, who is fortunate to live in a town, told me that returning home to Hornsea from Castle Hill in Hull at 2 pm took her more than four hours using public transport.
Each town has a community hospital providing beds and a minor injuries unit and all three hospitals enjoy tremendous local support. Hornsea and Withernsea have successful friends groups that raise many thousands of pounds to improve the experience of patients. The hospitals are run by the East Riding of Yorkshire primary care trust, which was set up just a few months ago in October. The hospitals and the people have been fighting against service cuts for more than two years. During that time, the number of in-patient beds at Hornsea was slashed from 22 to 12 and the minor injuries unit at Withernsea was closed overnight. Only last September, managers tried to axe the 12 remaining beds pending a review in March 2007.
A consultation was not published and the plan was shelved only after I launched a legal challenge threatening to take the trust to court. Now, the new PCT wants to remove all beds at Hornsea, Beverley, Withernsea and Driffield, which is in the constituency of my right hon. Friend the Member for East Yorkshire (Mr. Knight). The PCT’s preferred option is to retain beds only in Goole and Bridlington. Those proposals would remove every single NHS bed from my constituency. Patients would be forced to travel long distances to receive care in Bridlington or Goole, which is a four-hour round trip by car for some of my constituents who live in Holderness. Alternatively, they would have to be cared for in a private nursing home. However, nursing home provision in the east riding of Yorkshire is patchy—for example, Hornsea has no providers at all. The trust has admitted that, if a provider could not be encouraged to establish a home in Hornsea, patients would have to be cared for in other locations, away from family and friends and their natural home environment. In such an event, a medium-small town with a catchment population of 12,000 would have no medium to long-term beds or health provision.
The consultation period is due to run until March and, before then, the trust will hold four public meetings in locations across the region. However, only one of those meetings will take place in my constituency, outside of Beverley in Tickton, which has weak public transport links to it. There will be no meetings in Beverley, Hornsea or Withernsea, which
are three of the towns affected despite the impact that the proposals have had on those communities. The people of Yorkshire are understandably angry. They feel that decisions are being taken over their heads and that they are being denied the opportunity to have a real say. A protest march was organised in Beverley on new year’s day and hundreds of people turned up, despite it being a bank holiday. Previously, on the last Saturday before Christmas, 1,000 petition signatures were collected in just three hours. There are marches planned in Hornsea and Withernsea and I pay tribute to the work of local campaigners; never have I seen communities so united.
The Beverley Health Action Group was recently established with united support from the Labour party, the Conservative party, the Liberal Democrats and independent councillors. After years of continuously fighting the threat of cuts, campaigners in Hornsey have brought everyone together, as have those in Withernsea. My right hon. Friend the Member for East Yorkshire is using his extensive parliamentary experience to oppose the threat to the Alfred Bean hospital in Driffield. The East Riding Mail’s “hands off our hospitals campaign” was launched in November 2004 and has collected about 20,000 signatures. The campaign has done an excellent job of keeping the issue at the top of the news agenda.
The future of community hospitals has brought communities together and united the whole region regardless of political persuasion. That is the current situation in my local area. However, I could be describing the situation in many constituencies across the country.
David Taylor (North-West Leicestershire) (Lab/Co-op): I congratulate the hon. Gentleman on this debate and on his work with CHANT, which is not a mindlessly partisan organisation—its website demonstrates that. He referred to the new PCT. The aggregation of PCTs in Leicestershire means that the Charnwood and North-West Leicestershire PCT, with three community hospitals, is now part of a mega-doughnut around the city of Leicester, which has two thirds of a million people. Under that new structure and with those inherited deficits, the new PCTs are more likely to take unpopular and unpleasant decisions because they are remote and detached from the areas where facilities will be jeopardised. Does he agree that that has played a part in this problem?
Mr. Stuart: The hon. Gentleman makes a good point. I am not sure that I agree, as I would be arguing against the large conglomeration of any authority. The more important issue is accountability, which I will return to, and the fact that the PCTs are not accountable to local people. Whether the PCT is small or large, the truth is that people feel that PCTs are untouchable. The statutory position——more learned hon. Members may put me right——is that PCTs are accountable only to the Secretary of State and not to local people.
Mark Simmonds (Boston and Skegness) (Con):
My hon. Friend makes a powerful case and I congratulate him on his excellent and continuing work with
CHANT, which he set up. He made a good point about the fact that his part of the country is not the only area that has suffered. I hope that he is aware of the excellent campaign that successfully reopened one of the wards that was closed by the PCT in Skegness hospital in my constituency. He will also be aware that the accident and emergency department will be considered for reconfiguration, which in NHS jargon means downgrading. Does he agree that that is not sensible, particularly given the growing and ageing population in east Lincolnshire and the vast numbers of tourists who visit the east Lincolnshire coast? If it is downgraded, up to 600,000 people per annum will no longer have an accident and emergency service on the east Lincolnshire coast at all and will have enormous distances to travel, either to Pilgrim hospital in Boston or to Lincoln.
Mr. Stuart: My hon. Friend is right and has fought tirelessly on behalf of his constituents. The situation in his constituency is reflected in many rural constituencies throughout the country and the problem particularly affects coastal communities. Perhaps the bureaucrats draw circles around units and use them to determine the viability of an asset. When a circle is drawn around a coastal town, there is an unfortunate tendency for half the circle to be in the sea, which is seen as a reason to remove services from people in what are often sparsely populated coastal areas. From Government downwards, we need to recognise the needs of coastal communities and the fact that they need resources, too.
It is particularly ironic that the services and community hospitals that we are discussing survived post-war economic difficulty and through the economic difficulties of the 1970s, when we last had a Labour Government—sorry, I was not going to make a partisan point; I withdraw that. It is ironic that the events that we are discussing are happening at a time when the Government have doubled—in real terms; it is not fiddled—the expenditure on the NHS. I pay tribute to the Government for hearing the public desire for improved public services. Given that the services have been able to be sustained through all those periods of up and down and of recession and otherwise, how ironic is it that they are to be cut now, just as the money has been doubled? People are genuinely confused. As the hon. Member for North-West Leicestershire (David Taylor) mentioned, that is not a partisan point, because it unites people in the areas affected. I pay tribute to Labour party members, councillors and activists in my local area, who are absolutely onside in opposing the cuts.
Sandra Gidley (Romsey) (LD): The point about reconfiguration is important. The hon. Gentleman will be aware that, in Romsey and the New Forest, I worked with Conservative Members to preserve five local hospitals. Now, we are having to go back to the new PCT to re-establish the ground rules and the promises that were made then to keep the hospitals open. A recent article in the Health Service Journal pointed out that many people were not reappointed to the new trusts if they did not have financial expertise. Does the hon. Gentleman share that concern, too?
Mr. Stuart:
I do. We are trying to find out what has caused the deficits—what has led to the financial position that is often the trigger for the cuts. The larger
PCT should offer the opportunity for better-quality financial management on the board. It should be easier to find half as many good people as were required previously. There is some truth in that. I was open-minded, when first elected, about the cause of the financial deficit in my local PCT—Yorkshire Wolds and Coast PCT. The view was that perhaps there was financial mismanagement locally, but the Government sent in their financial hit squad—one of the big four accountancy firms—and it found that there was no financial mismanagement in my local PCT, so the attacks that some people had made on it turned out to be ill judged.
Clearly, if the closures and the financial deficits are not the fault of local health service managers, they must be caused by central Government. PCTs are struggling to cope and are being quietly urged by the Government to close smaller units. As the boards of PCTs are appointed and unelected—[Interruption.] Would the Minister like to intervene? I would be delighted for him to do so.
The Minister of State, Department of Health (Andy Burnham): I am listening carefully to the hon. Gentleman and he just said that the Government are urging PCTs to close smaller units. Can he provide some evidence of that?
Mr. Stuart: I am glad to have the Minister’s intervention. The guidance that has been sent out is that, ideally, services should serve a population of 100,000. For many urban-based Ministers, that may seem to cover a very small geographical area, but if the Minister cared to look at a map of my area, he would see that three constituencies in Hull form an area perhaps the size of my hand, yet my constituency, with one third of the population, covers an area 10 or 12 times greater than that. There is that geographic difficulty. I would be grateful if the Minister would address whether that 100,000 population figure is being used, because if there is not such guidance, it is hard for those of us on the ground to work out what is the invisible hand. Statements from Ministers say that they welcome community hospitals, support them and want to see them, yet right across the country an invisible hand seems to be closing smaller units.
One problem, which I hope the Minister will also address, is the nature of the accountability of PCTs locally. As the Minister will know, when I last spoke on this issue, opening a debate on exactly the same issue in November 2005, the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), said in effect that it is not up to the Government; it is all being decided locally by the PCT. However, the PCT is not elected. It is not accountable locally but only to the Secretary of State. Surely in a democracy it is essential that someone who is democratically elected should take responsibility and that surely must be Ministers. I hope that the Minister present today will give a more parliamentary and more constitutional answer and accept accountability for the behaviour of PCTs, which are, as I said, accountable to no one other than Ministers.
Andy Burnham:
I notice that the policy of the hon. Gentleman’s party is an independent NHS. How would that work? How would Ministers be more accountable
for decisions in an independent NHS? What rights would they have to step in under the policy proposed by the hon. Gentleman’s party in such situations?
Mr. Stuart: I am grateful to the Minister for that intervention. As so often with Ministers today, they are keener to debate the emerging Conservative party policy than they are to debate the policy of the Government, who have been in place for 10 years.
Norman Lamb (North Norfolk) (LD): What is the answer?
Mr. Stuart: I will, none the less, answer the question. The point of an independent board is to ensure that the gerrymandering of financial resources that is at risk of happening——and that is suspected by many at the moment——cannot happen and that, once the moneys have been allocated by Ministers who are responsible for the overall budget setting and for the strategic aims of the NHS, they are allocated downwards. The other aspect of the Conservative plan is a genuine return of power and real budgets to general practitioners, so that we have advocates on behalf of the patient at ground level. However, we are here not to discuss Conservative party policy but to discuss the failure of implementation of the current Government’s policy.
As PCTs are appointed, unelected and too often unaccountable, few people on their boards want to rock the boat, but Pat Barlow, a non-executive member of the Cheltenham and Tewkesbury PCT, recently resigned over cuts to local services. She said:
“I certainly could not stand up in public again and expect local people to believe that their wishes counted for much in a climate where every decision could be over-ridden on the basis of financial balance.”
That is from the inside of one of the PCTs set up and appointed by the current Government. That is the climate in which decisions are being made.
In 2003, the NHS policy document, “Keeping the NHS Local—A New Direction of Travel” stated that the guiding principle of any health service changes should be
“developing options for change with people, not for them”,
yet the views of local people, however unanimous, seem to be ignored. The problem, as most people can see, is the lack of accountability. Ministers continue to point the blame at PCTs for the loss of facilities.
When I wrote to the Secretary of State for Health recently to ask for a meeting to discuss the situation in the east riding, which one would think was a legitimate request by a Member of Parliament who is about to see every single NHS bed in his constituency closed, she wrote back saying that it would not be worth while because
“decision making on the configuration of local services must always be a matter for the local PCT.”
To turn anger on the PCT is useless. PCTs are not elected; they are wholly appointed. So much for the Government’s commitment to accountability in the NHS. Every day, it seems, I read of Labour MPs—I am not making a partisan point—who can meet the Secretary of State, yet despite the calamitous situation in my area, I am denied a meeting with her.
David Taylor: I just want to clarify that, although PCTs are not legally accountable to the populations that they serve, there have been PCTs that have striven to be accountable. I am thinking of the former Charnwood and North West Leicestershire PCT, serving 250,000 people, which strove to be accountable, holding open meetings and conducting polls and surveys of opinion in relation to changes that it was considering making. Some PCTs have tried, and are trying, to rise above the narrow legal definition of accountability that the hon. Gentleman articulated.
Mr. Stuart: The hon. Gentleman is right. He is also right that we should pay tribute to PCTs that behave in that way, but the difficulty is that the system does not ensure that PCTs that do not wish to behave in that way are accountable, and I think that many hon. Members would agree. I hope that the Minister will tell us how the Secretary of State is being accountable to voters when she refuses, for instance, to meet a democratically elected Member of Parliament and throws up her hands, saying “It’s nothing to do with me.”
Talking of meetings, it is only three months since we were told that a secret meeting had taken place between Ministers and Labour party officials to work out ways of closing hospitals without jeopardising key marginal seats. We discovered that the Health Secretary had called for those at the meeting to be provided with heat maps.
Andy Burnham indicated dissent.
Mr. Stuart: The Minister shakes his head, so perhaps he can tell us that no heat maps were provided. We also found out that community hospitals in Conservative and Liberal Democrat constituencies are bearing the brunt of the Government’s hospital closure programme, and more than 70 per cent. of the community hospitals under threat are in Conservative-held seats. Every NHS bed is to be closed in my constituency, and there are headlines in the local paper about the marches, campaigning and petitioning against the closures. Not long ago, the same paper revealed that the local trust in Hull had announced that it was to build at least three new mini-hospitals at a cost of £45 million to take pressure off Hull Royal infirmary and Castle Hill hospital in Cottingham—the self-same acute hospitals that my constituents use and to which they may have to turn increasingly if the beds in my constituency close.
Norman Baker (Lewes) (LD): Does the hon. Gentleman recognise that there are proposals to increase the capacity of the NHS in Brighton, where, as it happens, all three MPs are Labour Members? Under other proposals, however, the Princess Royal hospital at Haywards Heath, in the constituency of the hon. Member for Mid-Sussex (Mr. Soames), would probably be closed and the Eastbourne district general hospital could be downgraded. There has also been a failure to provide a community hospital in Seaford, in my constituency. Given the population figures, the town should be provided with one under the proposals in “Creating an NHS Fit for the Future”, but there is no proposal to do so.
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