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16 Jan 2007 : Column 216WH—continued

10.16 am

Mr. Dan Rogerson (North Cornwall) (LD): I congratulate the hon. Member for Beverley and Holderness (Mr. Stuart) on securing the debate, on his work in forming his group, of which I am a member, and on leading this issue.

“Community” is an overused word nowadays and is used in all sorts of contexts, but in this instance it is the right word. The sort of hospitals we are discussing are central to the communities in which they sit; they provide excellent care and are often a source of pride to residents. Unfortunately, they are also increasingly a source of concern, especially when people see health care becoming centralised in district general hospitals that might well be physically distant. That is certainly the case in my rural constituency in comparison with services in other parts of Devon and Cornwall. We have heard from other hon. Members about the particular challenges in such areas. One might need to travel by car for at least an hour to access a facility, so there are clearly problems in that regard when there is a lack of public transport, as the hon. Member for Stroud (Mr. Drew) said.

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There is also an issue with the institutional feel of the larger hospitals. The hon. Member for Beverley and Holderness talked about his constituent feeling much happier in a community hospital than in a larger one. In larger hospitals, there is depersonalisation and perhaps slightly less of a relationship between patients and staff. That is not the fault of the staff in the larger hospitals; the pressure that they are under with the throughput of patients and dealing with increased numbers of people means that they might not be able to offer the support that people welcome in community hospitals.

Staff in community hospitals often live in the community that they serve and are well known there. A nurse who used to be a Liberal Democrat councillor on North Cornwall district council recently showed me around her community hospital. As I went around with her, it was obvious how many local people she had helped in her nursing career in that hospital, and that there was a sense of community in the hospital. This is about proximity, the special atmosphere in community hospitals and the strong relationship between staff and patients.

North Cornwall is served by excellent community hospitals, which are each seen as “our hospital” by the people in the towns and surrounding areas that they serve. That is evident from the passionate groups of friends who support them. Those groups raise money, offer support to the staff, who are under great pressure, and seek to preserve services. In Bodmin some years ago, there was a long campaign to secure a new community hospital, which was successful, and it still has great support in the town.

There were recently huge meetings in Bude, which is perhaps the part of my constituency that is most remote from district general hospitals. I spoke at one of those meetings last year about health services in general in the area. There was a well attended public meeting on 2 January—a time of year when people might be expected not to turn out in the cold. It was about health services in general, but Stratton hospital is part of what people hold dear and of what they want to preserve and develop for the future. A great deal of positivity exists and community hospitals are a huge asset for areas such as mine.

There are great challenges ahead, however, and hon. Members have highlighted particular concerns in their areas. The lack of funding for social services is a problem in terms of the need to get people out of hospital quickly. I have been contacted by many constituents whose family members have been in hospital for far too long when they do not need to be. Such situations put an extra strain on hospitals, and this issue needs to be dealt with. We need closer co-operation between social services and the health sector, as well as democratic oversight to ensure that the process involves the community as much as possible, as other hon. Members have said.

Services have also been withdrawn in North Cornwall—minor injuries units have been closed overnight. Emergency dental services are also under threat. That is a particular problem, given that NHS dentists are hard to find generally, because if there is to be no emergency service there will be no care at all at
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times. A local doctor served as an anaesthetist at the Stratton hospital so that procedures could be carried out there, but he has retired and is yet to be replaced, so the work that he was able to do cannot continue.

There is a bright, new, independent sector treatment centre in my constituency. It was functioning under capacity and, although it looks modern and is quick, it is never ours in the way that a community hospital is. I have spoken to people who have been to it. They have perhaps done so under pressure, caused by waiting lists elsewhere, and have been given an artificial choice. That is a different issue from community hospitals, but I am trying to highlight the fact that community hospitals are part of their communities and some of the newer ways of providing care do not have the same feel.

The hospitals could offer so much more. I know that the current review of health services in Cornwall, which is being chaired by Professor Nick Bosanquet, will demonstrate that people want community hospitals to be developed further. I hope that the Government will strongly encourage and support PCTs to develop these resources—to expand rather than to contract.

Miss Anne Begg (in the Chair): If the next hon. Members to speak can keep their contributions to four minutes each, we will hopefully get them both in.

10.22 am

Mr. Colin Breed (South-East Cornwall) (LD): Thank you, Miss Begg. I, too, congratulate the hon. Member for Beverley and Holderness (Mr. Stuart) on securing the debate.

I want to reinforce, rather than repeat, what other hon. Members have said. In most communities, community hospitals have had a very long history and tradition. The two in my area were both set up more than 100 years ago by public subscription or by endowment. They are owned by the community and are felt to be part of it, not least because the various leagues of friends have raised tens of thousands of pounds, over many years, to sustain the hospitals. The hospitals belong not to the national health service or to the Government, but to the communities. Those communities are rightly up in arms about seeing any threat whatever to the hospitals, given that the largest amount of money ever is being allocated to health services. Yet, those hospitals remain under threat.

I came into this House in 1997, along with other hon. Members, partly because of the threat to community hospitals from the previous Government; there was also what now sounds like a rather hollow promise about having 10 days to save the NHS. Some 10 years later, many people feel that we are in the same position, except for the fact that millions of pounds have been spent. The situation could and should be much better.

Community hospitals can provide local services involving less travel, less cost and so on. They can provide day case surgery, and such provision should be increased. More emergency facilities can and should be provided to take the strain off the big accident and emergency centres in the district general hospitals. There are opportunities for more of the following:
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disease prevention clinics; health promotion; health education and dietary advice; regular health checks; prenatal and post-natal services; and mental health services. All those things are extremely important to people living in communities, particularly in rural areas, yet we seem to be back where we were 10 years ago.

No one really believes that the Government have any great strategy. They seem to be lurching from one crisis to another, and every time that happens people’s hospitals and facilities are threatened—things that people feel that they psychologically and physically own. Nothing else seems to come under threat, least of all large sums of money that are paid to primary care trust directors and so on.

Community hospitals have a special place in the hearts of people in the community. Hundreds will come to this place and stand outside this building having spent four, five or six hours in a bus and knowing that they will spend the same time returning—they will do so in their own time; they will not be getting paid for it—to say how much they support their hospitals and how much they want them to be maintained. I must warn the Government that back in 1997 the previous Government lost the election partly because of this sort of thing. This Government will not be forgiven by anyone if they persist in a policy that will continue to threaten my constituents’—and my—community hospital.

10.25 am

Norman Baker (Lewes) (LD): I am grateful to my hon. Friend the Member for South-East Cornwall (Mr. Breed) for his succinct and appropriate words. I entirely agree with them.

The Government’s document “Fit for the Future” talks about NHS services being delivered at the appropriate level—a kind of NHS subsidiarity. That implies that some services in acute hospitals will have to be delivered in more remote units, which is why acute hospitals in Haywards Heath and Eastbourne, which I mentioned, are threatened and why there will be a consequent benefit for Brighton. That is the bad bit as far as my constituents are concerned, and we are fighting it, because we do not believe the idea to be accurate and appropriate.

The rest of “Fit for the Future” talks about delivering services at the appropriate level in local communities. It says that many functions, including minor injuries treatment, minor operations, breast cancer screening and so on, can be delivered locally. I entirely agree. Such functions can be delivered locally in communities to avoid the sort of transport nightmares rightly mentioned by the hon. Member for Stroud (Mr. Drew) and my hon. Friend the Member for North Cornwall (Mr. Rogerson). We in my constituency are getting the bad bit, however, because the acute hospitals are being taken away from us to more remote places, but we are not getting the good bit of the community facilities delivered locally instead.

I am in favour of the direction of travel that the Government have set out—ensuring more community support in our local areas—but that is not happening. If we had more community hospitals and more local facilities, it would take pressure off the acute hospitals. If the Government’s policy is to have more localisation in respect of minor injuries treatment and minor
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operations, I simply do not understand why community hospitals across the country are closing, why there are restrictions on night-time services and why community dentists no longer exist. It does not make any sense. I am taking the Government at their word, so if this is their policy, let us have it.

Seaford in my constituency has a population of about 25,000. The Government’s document “Fit for the Future” says that a population of about 25,000 should be served by a facility that delivers the sorts of things that I have just mentioned, so let us have them. At the moment Seaford has almost nothing; it has some general practitioners and what is jokingly called a day hospital, which deals simply with mental health issues and a bit of physiotherapy in a completely clapped out and inappropriate building that is inaccessible to all and has no car parking facilities. That is not a facility fit for a town of 25,000 people.

If the Government’s policy is as they say it is, let us have a community hospital of some sort in Seaford. We should not be talking about closing community hospitals. The Government’s policy is that we should be opening them in towns such as Seaford and others across my constituency.

I shall make one further point, as I know that time is limited. I congratulated the hon. Member for Beverley and Holderness (Mr. Stuart) on his initiative in securing the debate. He talked about accountability in primary care trusts, which is a serious issue. I have long believed that there should be democratic accountability at local level for the NHS. County councils or some other body should be involved so that people can be turfed out of office when they are regarded as inappropriate. Such people should be the commissioners, rather than the unelected officials that do the job at present.

What is the consequence of the unelected officials being involved? Hon. Members may have seen a story in this weekend’s newspapers from my patch. A director of public health in the Eastbourne Downs PCT was appointed in 2002. He worked for three weeks before he had a row with a senior colleague. He was then put on gardening leave for two and a half years on full pay, at the end of which he was given a pay-off, in addition to his salary, of £243,000—he was paid £575,000 of public money for three weeks’ work. That is the sort of accountability that we have in the NHS and it is not working. I hope that the Minister will seriously examine that case, because the PCT that has now inherited that position says that all this was done within NHS guidelines. If that is the case, those guidelines are wrong and need to be changed.

10.29 am

Norman Lamb (North Norfolk) (LD): My hon. Friend the Member for Lewes (Norman Baker) made a powerful point about the financial accountability of primary care trusts.

I add my congratulations to the hon. Member for Beverley and Holderness (Mr. Stuart) on securing this debate, and pay tribute to him for his work in setting up CHANT—Community Hospitals Acting Nationally Together—which is an important group that represents the interests of those who care about community hospitals. He has been assiduous in ensuring that its
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representations have been on an all-party basis, and I, for one, certainly appreciate that.

We have heard stories this morning about the threat facing community hospitals, and many of us have direct experience of that in our constituencies In Norfolk, the primary care trust has an historic deficit of some £50 million, which it has been burdened with since its creation at the beginning of October last year. We face the prospect of losing up to half the community hospital beds in the county, despite the fact that the number is about average for the rest of the country, and the possible closure of four or five of our community or cottage hospitals. The financial crisis facing our health service in many parts of the country seems to be inextricably linked to the threats hanging over so many community hospitals.

Mr. Christopher Fraser (South-West Norfolk) (Con): Does the hon. Gentleman share the view in Norfolk that community hospitals are just one area where the Government have over-promised and under-delivered? Does he also share the concerns of many people in rural areas such as his and mine who feel desperately let down by a Government who seem to have no idea about and no interest in the realities of rural daily life?

Norman Lamb: I share the hon. Gentleman’s concerns, which are real in a rural county with an elderly population who often struggle to get to more remote health centres.

It is worth mentioning that the financial crisis would have been an awful lot worse had we not had extra investment in the health service. The hon. Member for Beverley and Holderness distanced himself from his party’s position on that, but if we had had £35 billion less in the NHS and if the Conservatives had had their way, the position would be far bleaker. The public should be aware of that.

Mr. Stuart: Will the hon. Gentleman give way?

Norman Lamb: I will not give way because I have limited time.

I want to speak about the confused, mixed and misleading messages emerging from the Government on their attitude to community hospitals. The hon. Gentleman was right to draw a distinction between stated policy and what is happening on the ground. I shall start with the Labour Manifesto, which talked of

That is a wonderful vision, which we could all sign up to, but the manifesto did not say that at the same time the Government would sanction the closure of many existing community hospitals that provide care close to where people live. People could reasonably conclude that they were misled, but perhaps that is unduly cynical.

Taking the manifesto at its word, it is fair to assume that because it said nothing about closures the grand plan did not involve closing hospitals. If that is the case, one is led to the inevitable conclusion that the closures are an unplanned knee-jerk reaction to the
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financial crisis facing the NHS this year. Which is it? Were the closures planned and we were not told, or is it crisis management? It must be one or the other.

The confusion continued in January last year. In a White Paper, the Secretary of State gave a reassurance that decisions on the long-term future of existing community hospitals should not be made solely in response to short-term budgetary pressures. She stated that she had asked strategic health authorities help to police that and to stop PCTs closing hospitals for the wrong reasons. Yet in Norfolk, we understand that the strategic health authority, far from blocking closures, was putting private pressure on the PCT to close community hospitals. That was not very accountable to the public.

Then in July last year, the Secretary of State was back offering more good news: £750 million was to be made available for public capital investment to realise the vision of creating the new generation of community hospitals. She stressed in her statement to Parliament that judgments on reconfigurations—the jargon for closures—were for local decision making. The simple maxim seems to be that dispersal of largesse for the provision of wonderful new state-of-the-art facilities is for the Labour Government, but decisions to close existing, much loved, cottage hospitals are taken locally—there is no interference from the Government on that. That is highly selective localism, based on saying “Centralise the good news, decentralise the bad news.”

The truth, of course, is that the whole programme is being driven from the centre. The chief executive of the NHS announces that there will be reconfigurations—there is no question of local areas deciding—and strategic health authorities are then required to apply pressure on local PCTs to force change. The funding comes from Whitehall, where the power lies in our over-centralised health service.

What has been happening over the past 12 months? We know of at least 16 community hospitals that have closed and, as we heard from the hon. Member for Beverley and Holderness, there are reports of a total of 140 being under threat or having already closed. That is a bleak picture.

It is worth restating the case for community hospitals, lest we forget just how important they are. They provide care close to people’s homes and the Government seem to support that vision. They provide an essential safety valve for acute hospitals to keep bed-blocking to a minimum. They gain particular value in areas with large elderly populations by offering rehabilitation, general medical care and respite to relieve carers. They offer end-of-life care, which my own family has experienced, and enjoy low infection rates for MRSA, Clostridium difficile and other infections. They are critical in rural areas where public transport is generally poor for people who must get to more remote general hospitals. It also seems to make sense in rural areas to concentrate professionals together rather than compelling them to travel long distances by car from house to house to deliver care in people’s homes.

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