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16 Jan 2007 : Column 222WHcontinued
My hon. Friend the hon. Member for South-East Cornwall (Mr. Breed) made the critical point that if a community hospital is closed, the NHS loses the active support of the local community. Local leagues of
friends raise a lot of money, but they do not campaign to raise money for large, acute PFI hospitals. We squander that support at our peril.
Much has been said about the lack of genuine consultation when proposals are put forward for closure of community hospitals. Too often, local people are left with the sense that the process is a total sham. My plea today is for the Government to listen to what people are saying throughout the land. We value our local community facilities and want to retain them. We should have genuine local decisions on our local health services and genuine local accountability.
I want to end on what is hopefully a more positive note. When the Secretary of State announced the £750 million fund for new community hospitals last July, she mentioned an exciting new development at Wells-next-the-Sea in north Norfolk. There, a small community hospital that was faced with closure was saved when a dynamic group of local campaigners developed a plan for the creation of a new community charitable trust to take it over. That has now happened with the support of the Community Hospitals Association, and particularly Helen TuckerI am pleased that she is here to listen to this debate. The trust provides services free to NHS patients and is developing a remarkable array of clinics, diagnostic work and physiotherapyfar more than was on offer when the hospital was run by the PCT. Out of a crisis, something positive and innovative is happening. I hope that that vision survives the dire financial situation in Norfolk, because there is a real risk that it will not.
The Liberal Democrats strongly support the development of such public benefit organisations and diversity of provision. They can play a positive role in the future of our health service. However, this debate must be a warning to the Government. We are at risk of losing valued local facilities because of short-term financial pressure and crises. We must not let that happen. If it does, the Government will be guilty of deceit on the British people. My hon. Friend the Member for South-East Cornwall said that the last Government lost power in large part because of their record on public services and what was happening around the country. The same could happen to this Government. These services are too precious to lose and the Government must listen to what people are saying.
Dr. Andrew Murrison (Westbury) (Con): I congratulate my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) on securing the debate. It is important and timely given that today a large number of people are travelling to Westminster to campaign in support of local health care facilities. I congratulate him also on his exceptional work with CHANT. Members from all parties have been impressed by that organisation and by what it has managed to achieve in a short period.
We have had a constructive debate so far. It has been one of the more consensual debates in which I have had the privilege of taking part, the only discordant note being set typically by the hon. Member for North Norfolk (Norman Lamb), who speaks for the Liberal Democrats. I gently remind him of our manifesto commitments on funding over the past three general
elections. If he were to revisit the Conservative partys manifesto on funding, he might benefit.
Andy Burnham: Is the hon. Gentleman mounting a defence of the patients passport?
Dr. Murrison: Miss Begg, you would count me out of order if I were to discuss the patients passport. All I say is that over three general elections, we have pledged to match Labours funding. That was the point I hoped to make in order to benefit the hon. Member for North Norfolk.
On Friday I had the privilege of being granted an audience with the new chief executive and chairman of Wiltshire primary care trust. It is important to note what primary care trusts are, because in the current climate I am afraid that despite what they might feel about themselves, they often act as ectopic parts of the Department of Health. It is unfair of us to lay into primary care trusts and their staff, and to pin on them the blame that rests with Ministers. We have had a consensual debate up to now, but I shall destroy the consensus by trying to pin the blame for the closuresabout which I feel stronglyon the Minister and not on the primary care trusts.
The Minister knows well that there are four community hospitals in my constituency. One has closed, and the other three are threatened with closure. A decision on them will be made on 30 January, and in addition it is likely that the mental health and maternity units in my constituency will also close on the same day. The issue is of profound importance to my constituents, and they are distraught that their hard work and effort to inform the debate has been ignored by those who are empowered with making decisions about the matter.
On 30 November 2001, during one of the first debates in which I took part in the House, the current Secretary of State for Work and Pensions, then a Minister in the Department of Health, said:
There are no plans to close the hospitals that I have mentioned. They have served the hon. Gentlemans constituents well for many years and are a valuable local component of the NHS in west Wiltshire. On the contrary, the local West Wiltshire primary care trust, which is now responsible for the running of the hospitals, is strongly committed to their future, and is seeking further to develop the services that the hospitals provide.[Official Report, 30 November 2001; Vol. 375, c. 1293.]
My word, things have changed, have they not?
What has happened in the intervening period? There has been extraordinary pressure from Ministers to sort out financial deficits. Jobs depend on it at the end of the day, and as the Secretary of State for Health has made clear, her job depends on it. That is what has happened between the remarks that the then Minister of State for Health made in 2001 and now, when all community hospitals in my constituency face likely closure.
Before shutting the hospitals we must engage in consultation that will tick a box. Indeed, principle three of the NHS plan says:
The NHS will shape its services around the needs and preferences of individual patients, their families and their carers.
Unfortunately, in many parts of the country the principle has been little short of a charade. It does
none of us any good to be seen to be associated with such exercises. They engender in the public a culture of cynicism; politicians encourage the public to take part in consultation, but when decisions are made there is no obvious link between them and the publics input. I fear that that is true in my constituency and in many throughout the country.
I like to be fair and to give the Government their due when I can, and they have used many fine words about localising health care. In January 2006, Our Health, Our Care, Our Say: A New Direction for Community Health Services made some fine statements. They have been touched upon already but bear quoting verbatim. They refer to much thinking in the Department of Health, if not to what is happening locally. Paragraph 6.42 says that
community facilities should not be lost in response to short-term budgetary pressures,
PCTs taking current decisions about the future of community hospitals will be required to demonstrate to their SHA that they have consulted locally and have considered options such as developing new pathways, new partnerships and new ownership possibilities,
to which I think the hon. Member for North Norfolk referred.
The Community Hospitals Association points out, however, that on the ground, 80-odd community hospitals face the axe. That is not for want of support for the Labour Government, because the left-leaning think tank the Institute for Public Policy Research only 10 days ago produced a report, The Future Hospital: The Progressive Case for Change, which appeared to support community hospitals. The Care Services Improvement Partnership, in which the Department of Health is a partner, appears to agree, according to the partnerships lavish website.
The Government have said that community hospitals should not close for short-term financial expediency, but that is precisely what has happened. We know, because closures correlate largely with areas in deficit, and those areas are disproportionately Conservative and Liberal Democrat seats. They have suffered badly from the Governments rejigging of the funding formula and from their removal of end-of-year arbitrage. However, Ministers cling desperately to the ludicrous notion that somehow, health care managers gravitate towards constituencies with Liberal Democrat or Conservative Members of Parliament. That is at least the logical extension of the Secretary of States argument.
The Secretary of State appears to have washed her hands of the problem. However, Shifting the Balance of Power Within the NHS: Securing Delivery states:
PCTs will be accountable...to the Secretary of State through Strategic Health Authorities.
Apparently it means that there is accountability upwards but no responsibility downwards, which is a rather despotic state of affairs.
Let us explode some myths. First, on the cost of community hospitals, it costs £2,500 a week to keep a patient in an acute hospital, and about £900 a week to keep someone in a community hospital. When one
achieves the right case mix, community hospitals are cost-effective. Secondly, staff have not been discussed, apart from by the hon. Member for Stroud (Mr. Drew). He was right to say that consultants may spend a lot of time travelling between hospitals, and that it is dead time. I have been to Berkeley hospital, and it was clear from speaking to doctors there that they love it and that they are energised by practising in community hospitals. I am not convinced that it is all down time; they put in a lot more than is accounted for.
Many people who work in community hospitals would work nowhere else. There is a myth that, somehow, nurses will be redeployed in the community after the closure of a hospital. However, I know many people who work in community hospitals. They are there for special reasons and they are special people. When we close community hospitals, I suspect that many such people will be lost to the national health service.
Will the Minister update us on the situation regarding unbundling the tariff? It is vital to the future of community health services, and to community hospitals in particular. What stage has he reached with facilitating changing patterns in community hospital ownership? We have a moral responsibility to understand that although the NHS has owned such hospitals since 1948, they are nevertheless a part of the community. They were often given over by communities, and they are undoubtedly supported all the way along the line by leagues of friends and by others.
Will the Minister also update us on the estate impairment charge, which is an accounting trick? My right hon. Friend the Member for North-West Hampshire (Sir George Young) raised that issue in November 2005, and he was right to do so, but we do not seem to be any further forward. Will the Minister comment on the content of new generation community hospitals? My hon. Friend the Member for Banbury (Tony Baldry) inquired about that in November 2005 and got an unsatisfactory response; it would be nice to have an update on it. Will the Minister also describe how the capital fund of £750 million, which was announced for new generation community hospitals, will be deployed? We should know that right now.
This is a bad news story, and I hope that at the end of the day the Minister will be able to pull a few irons from the fire. Will he please listen to local communities? Their views are simply not in doubt. We need a halt to the wholesale closures that are happening for reasons of short-term financial expediency, and which do not take into account the proper design of community health care facilities.
The Minister of State, Department of Health (Andy Burnham): I congratulate the hon. Member for Beverley and Holderness (Mr. Stuart) on securing the debate, and I would also like to welcome the lobby of Parliament that is happening this afternoon. Representatives of that lobby will be meeting my right hon. Friend the Secretary of State.
I welcome the debate because it allows us to make two points very clear. First, there is a strong, bright future for community hospitals in a modernised
national health service. An unprecedented programme of investment in community hospital estates and infrastructure is currently under way throughout the country. Secondly, although that is the principal policy direction, the future of community hospitals is essentially a matter for local people and local decision making. Decisions about how services are provided locally and how services should be provided should be taken by primary care trusts and practice-based commissioners. They are decisions for local people to make, and there would be objections from Opposition Members if the situation were any different.
If there is common ground in this debate, I hope it is that we should all be in the business of saving lives rather than buildings. We should be securing better services for our constituents. To oppose all change to the health service and to describe all change as cuts is to fail the health service and our constituents. Such a response to change in the health service possibly stands in the way of both human progress and progress in matters of health. We should recognise that, as society changes, health services may need to change to keep pace.
Norman Lamb: When the manifesto was written, were these closures envisaged, or have they come into the Governments plans only since the general election?
Andy Burnham: I shall take the hon. Gentlemans point head on because I believe he is confused about it. There is a difference between campaigning for every brick and bit of cement in the current estate and saying that there is a role for community hospitals, but ones that are modern, appropriate places in which health care can be delivered. They should be places into which we can bring services out of an acute setting because they can be safely delivered in a high quality community hospital environment. He needs to make a distinction between the principle of community hospitals playing a role close to local communities, and campaigning to retain every piece of existing estate within the NHS by saying that there can be no change.
Mr. Stuart: Will the Minister give way?
Hon. Members: It is his debate.
Andy Burnham: Figures show that 38.2 per cent. of the community hospital estate was constructed prior to 1948, and although I accept the point of the hon. Member for Lewes (Norman Baker) that a sense of ownership has been created among those in local communities because they helped to build the facilities, those figures also show that some of the estate is in dire need of modernisation, and nothing should stand in the way of that.
As has been said, the hon. Member for Beverley and Holderness secured this debate, and I shall try to answer some of his points in the time that remains. He raised some fair points, and I do not dispute the strength of feeling in his local community about the ongoing consultation. I say to him that the Secretary of State did not refuse point blank to meet him, and I will happily give the hon. Gentleman a list of all his
colleagues whom the Secretary of State has met during the past year. The consultation is ongoing and it is inappropriate for the Secretary of State to intervene in what is essentially a local process.
We keep hearing from the Opposition that the matter should be one for the local community, but when they do not get what they want, they say, Politicians should intervene. Let us allow the local decision-making process to take place. It is important to say that it is a question not of closing hospitals, as the hon. Gentleman described, but of changing the way in which they provide services to the local community. There is a big difference between the two points.
The hon. Gentleman ran two lines of argument against us, which were repeated by the hon. Member for Westbury (Dr. Murrison). Essentially, the hon. Member for Beverley and Holderness said that a politically driven process was going on, driven from the centre, using heat maps. However, he also made the point that Ministers are out campaigning against changes in the health service. I am afraid by making those two contradictory statements, all he has proved is that change is going on in the health service. I accept that point. If he is trying to allege that some areas are politically insulated from that change, he has disproved that with the very admission that people are out there making the case for their communities as part of the consultation. There is a major difference between people saying that the general direction of policy is right and their making a case for their own community.
My hon. Friend the Member for Stroud (Mr. Drew) made an excellent contribution. He asked about the definition of a community hospital, as did the hon. Member for Beverley and Holderness. That is an important point, and I would like to convey to all hon. Members attending this debateI am pleased that so many have comethe fact that in the majority of cases, it is for the local community to define what they want. That is the point of our policy. We want local communities to bring proposals to us that describe a modern way of delivering community services, and we will then decide whether those proposals should receive backing. It is not a matter of rigidly prescribing that process at Department of Health level, so that every proposal emerging from a local community is batted away because it does not meet a rigid central definition.
Mr. Stuart: The Minister seems to think that primary care trusts are the local community. The situation we have described throughout the countryand admittedly, to agree with the Minister, it exists in the constituencies of all political partiesis one where the primary care trust and the community are at completely opposite ends of the spectrum.
Andy Burnham: We announced the first four schemes paid for by the £750 million fund before Christmas. They combine a mix of brand new facilities and redeveloped existing facilities, such as the Gosport War Memorial hospital, which is in the constituency of the hon. Member for Gosport (Peter Viggers). Surely that is the point: not every piece of the existing community estate can or should be redeveloped to provide health care for the future. People have to open their minds to the provision of services in the best way possible to meet local circumstances.
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