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Finally, I revert to the issue of hospital closures. We all, surely, want it to be the case that if a closure takes place it does so as a result of careful deliberation of what constitutes the best configuration of community and domiciliary services for patients in an area. We understand that represents government policy. What steps will the Government take to make sure that strategic health authorities and PCTs receive thenecessary guidance to place their decision-making on hospital closures on a footing that will command the confidence of local communities and will be seen tobe both fair and thorough?
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Baroness Barker: My Lords, I, too, thank the Minister for repeating the Statement made in another place. Given that I have on a number of occasions in debates in your Lordships’ House talked about the need to move services away from acute hospitals to settings that are more advantageous and afford easier access to patients, he will not be surprised that when I woke up this morning to the press coverage of this announcement I felt rather hopeful. Like the noble Earl, Lord Howe, my hopes were somewhat dashed when I looked at the contents of the Statement and the supporting documentation. The noble Earl was right; this is an announcement of up to £150 million a year for five years only and there is no revenue funding attached. It is capital only. I echo the noble Earl in asking where this money comes from and what will not be purchased as a result that otherwise would have been.
When one turns to the detail in the document, the only advice given by the Department of Health on the matter of revenue funding is a series of different funding mechanisms such as LIFT and community enterprises, but there are no actual resources. This is being announced at a time when primary care trusts are shedding jobs right, left and centre. One of the PCTs in the area in which I live is in the process of shedding one in six of its staff. According to this announcement, PCTs have until the end of this financial year to put in yet another bid for one piece of central government funding. There is too little time to work out the optimum healthcare system for those patients they are trying to treat. PCTs and strategic health authorities are at the moment undergoing a massive reorganisation, which is driven wholly and solely by the need to meet stringent financial targets. I do not understand who will have the time to carry out the consultation required before they get to the point of submitting business plans to establish the new community entities.
It seems that, once again, the Government have fallen into an obvious trap—that of equating standards of healthcare with standards of buildings.
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There seems to have been almost no research into, or thought given to, the impact of the establishment of these new services on acute centres, patient referral, or GP surgeries, which in many cases are working hard to get themselves ready for the new PBC—practice-based commissioning—regime but simply do not have adequate premises in which to offer enhanced services. Like the noble Earl, I too wish to know what advice will be given to PCTs and strategic health authorities about the optimum configuration for acute facilities, ISTCs, walk-in centres and some of the new community hospitals.
Finally, at a time when old community hospitals, which have served their populations well and which have adapted to changing healthcare needs, are closing, this announcement is not only short-term, but is highly inappropriate and comes without an evidence base. The last thing that the NHS needed today was another centralised, short-term announcement of small amounts of competitive funding. This is not a strategic response to changing healthcare needs and, therefore, is a missed opportunity.
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Lord Warner: My Lords, I was going to thank the noble Earl and the noble Baroness, Lady Barker, for their support for this proposal, but, as the noble Baroness went on and on, her support seemed to be extremely grudging. This is a strategic document. It sets out very clearly that there is a new direction in which parts of the NHS can travel, consistent with our White Paper. Some of the noble Baroness’s remarks suggested that there were not already community hospitals doing some of the things that are set out in this document. We are responding to the concerns of people in the NHS about being given support to take forward this agenda.
I was at Edgware General Hospital yesterday, where services have already been taken out of acute buildings and provided in a community setting, with specialists working in that community hospital and doing operations there that were previously carried out in an acute hospital. The guidance contains many examples of where people have put partnerships together but have found that capital is a blockage to making progress in this area. We are responding to what people say that they need locally. They wanted
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I have to say to the noble Baroness, Lady Barker, that we feel that people are mature and can make many of these local judgments for themselves. We have set out the range of services that it is possible to provide. We do not need to set out guidance that prescribes in every detail what people locally need to provide in their communities. We are trying to create a flexible capability for people to respond to their local services. We are not like the Liberal Democrats, wanting to try to control this from the centre. It is absolutely clear that there is no need to change the GP referral systems with community hospitals. They are working perfectly well now, and I do not agree with the noble Baroness that we need more guidance on this issue.
I turn to the questions and comments of the noble Earl, Lord Howe. I agree that some parts of the NHS are finding it difficult to manage their revenue allocations, but it is worth bearing in mind that the allocations this year are about 9.5 per cent higher than they were last year and that next year they will be another 9.5 per cent or so higher than this year. I remind the noble Earl that not all primary care trusts are in deficit. Many of them are creating surpluses so that they can develop their services. In this document, we are responding to their concerns by taking forward an agenda of moving services closer to home. We have put this document into the public arena because we know that a number of trusts now have proposals to take forward particular projects, and we want to give them the opportunity to do so.
The noble Earl asked whether there was a subtle change in the population range for community hospitals. The answer is no. We have repeated the figure of 100,000 but we want to be a bit more flexible here by saying that there may be circumstances in which smaller communities can have a facility that meets their local needs. There is no significance to the figure other than providing a bit more flexibility.
I am grateful for the noble Earl's support on partnerships. What he said is very much our view. With this document, we are trying to encourage people to think widely about the number of people and services with which they might involve themselves in these projects. We have tried to create a model in the form of a flexible community venture so that other public sector organisations, such as the local authority, may bring some of their patterns of revenue and capital into play. Voluntary organisations may wish to join these ventures and private sector organisations may also have something to offer. We know that as we sit here today projects are being developed with people coming forward in a wide range of partnerships.
The noble Earl rightly asked about the tariff. The tariff can already be unbundled if people choose to separate the components. We will be providing more guidance for the year 2007-08. The big, more formal, change on unbundling is likely to take place in 2008-09. People in the NHS have told us that they can use capital to help to re-engineer services in order to
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Finally, when you put services closer to people, people get quicker access. With regard to the suggestion that community hospitals are closing, the Community Hospitals Association website states that for every closure in recent years, a new hospital has been opened. This body has responsibilities in relation to community hospitals and I do not think that it views the situation in quite the gloomy way that the noble Earl and the noble Baroness have done.
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Baroness Murphy: My Lords, I welcome the Minister's announcement of this new money, particularly as the White Paper, Our health, our care, our say, said that money was needed to give the proposal some teeth. Although it may not strictly be new money—it is retargeted money—we all know that, in the health service, revenue money follows capital and buildings. Although I wholly agree with the noble Baroness, Lady Barker, that it is people, not buildings, who provide the health services, people in the community need office space, places for meetings, treatments and so on, so I strongly welcome this.
How will the Minister guarantee—I say this having witnessed the closure of many dozens of community hospitals in the NHS through the 1970s, 1980s and 1990s—that the new community hospitals will be different from the old community hospitals in providing a truly cost-effective solution, and not, as so often happened with the old ones, a white elephant sitting in a community that could not provide the technological advances of the new central district general hospitals?
Lord Warner: My Lords, I am grateful for the noble Baroness’s support. I share her view that we need to make these new facilities sustainable and cost-effective. What is changing, and what people who read the document carefully will realise, is that we are trying to raise people's sights in terms of the range of services—diagnostic services, in particular—that can be made available. Medical technology and knowledge have moved on. We are able to provide many more procedures on a day-care basis. That is another opportunity that probably was not available in the same way in the 1970s and 1980s.
The examples in the document show that people are already putting together a much wider range of services than were traditionally provided in a cottage hospital. The NHS is much better at business planning, and the document emphasises the importance of putting together a range of services that meet people's needs and can be funded over the long haul. I hope that that reassures the noble Baroness. We shall ensure that the strategic health authorities oversee these plans so that they are sustainable for local communities.
Lord Phillips of Sudbury: My Lords, I wonder whether the Minister can offer some hope and help to the situation prevailing in my home town of Sudbury,
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Lord Warner: My Lords, I cannot, so to speak, reprieve any individual community hospital. That is not the purpose of this announcement. It is down to people locally in the form of the PCT to make decisions based on all the available evidence. Since the publication of the White Paper, we have tried to say to the NHS that, before making short-term decisions about closing particular facilities or changing particular services, it should think about the longer-term direction of travel towards moving services closer to where people live, as set out in the White Paper. The guidance tries to raise people's sights on the range of services and is certainly intended to give strong support to the general idea of community hospitals having a wider range of services closer to people. I remind the noble Lord, Lord Phillips, that changes in primary care trust configurations will come into operation on 1 October this year. It will be for many of the new primary care trusts to ensure that the decisions are appropriate for communities in their particular areas.
Baroness Howarth of Breckland: My Lords, while welcoming this document with my noble friend, I ask for the Minister’s reassurance on behalf of another group of communities: those with specialist needs. I speak with a particular interest in children with cardiac difficulties. These communities would prefer not to have their services close to home but to have the best possible services that specialists can provide. Many children with, for example, hyperplastic left heart syndrome depend on a few specialists who know how to carry out a set of complex heart operations. I am looking for reassurance on their behalf that, while we develop this community service—which, as I say, I welcome—their needs will be thoroughly recognised. There are fears, particularly in Birmingham, that services are being lost.
Lord Warner: My Lords, of course I accept the noble Baroness’s general point. We are concerned that specialist services are appropriately commissioned,
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Lord Christopher: My Lords, can the Minister help me with Cheltenham, where I grew up? When this Statement receives the publicity that I think it will, there will be considerable confusion. Prima facie, we are going to provide local and personal services wherever that is safe and more convenient. Two segments of hospital work in Cheltenham are being moved 12 miles away to Gloucester: paediatrics and maternity. Neither is necessarily wholly covered by this paper, but the population will be very confused by, on the one hand, the decisions that have already been taken and, on the other, what is now proposed in this paper. Can the Minister please help me?
Lord Warner: My Lords, the community hospitals document and today’s announcement in no way suggest to local people that there may not be some need to modify aspects of their service provision, as may well be going on in the part of the country that my noble friend mentions. We are not saying that all those changes that are being consulted on—and where change may indeed be needed—should be put into abeyance while this document is considered and absorbed by people locally. We are saying that, when people in the NHS have to reconfigure local services for a variety of reasons, they must take into account the options relating to services that might be put into a community hospital. I shall be happy to look into my noble friend’s concerns if he writes to me.
Lord Biffen: My Lords, does the Minister foresee a substantial expansion of the number of renal satellite units in the execution of this policy, particularly in the spirit of trying to bring treatment closer to patients?
Lord Warner: My Lords, there is potential in that area, so I can reassure the noble Lord in that regard. It will be down to local people to work out the best—the safest as well as the most convenient—way to provide particular services, which is the big message of this announcement. We must leave that to the clinicians, managers and local populations to sort out for themselves in particular localities.
Lord Roberts of Llandudno: My Lords, health is a devolved matter in Wales, but concern about the continuation of community hospitals is just as great. Do the Government envisage a similar investment by the Assembly to make such projects possible in Wales?
Lord Warner: My Lords, I am sure that the noble Lord does not expect me to commit the Assembly in any way in this area. I believe that the Assembly already has access to this information, but I will make
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Lord Walton of Detchant: My Lords, I welcome the Minister’s Statement. It concentrates on capital provision for building new community hospitals, but is there a possibility that community hospitals that have closed may benefit from this new money if local circumstances allow? For example, some years ago, I was greatly involved in a campaign to save a much-loved community hospital in Burford, in the Cotswolds, which provided in-patient care for patients discharged from acute hospitals, had a newly built local accident and emergency department, which had been paid for by more than £200,000 raised locally, and provided outpatient services, minor surgery and many other services. If local primary care trusts agree, could some of this money be used to reopen that hospital, which is still—to use a common phrase—fit for purpose?
Lord Warner: My Lords, where local primary care trusts and other stakeholders decide that a particular facility could be refurbished or reopened to meet a particular need and have a well thought-out plan that can be sustained financially, it will be possible for them to seek capital money to redevelop or reopen those facilities, provided the services are what the local community needs and can be sustained.
Baroness Masham of Ilton: My Lords, is the Minister aware that there is considerable concern throughout the country about cuts in the number of specialist nurses and occupational therapists who help people with long-term conditions? Can he assure the House that people with long-term conditions such as Parkinson’s disease, rheumatoid arthritis, diabetes, multiple sclerosis and cancer get the right sorts of drugs? Who will monitor those drugs if such people are treated closer to their homes? Can the Minister assure the House that consultants will come out to see patients who cannot come in to see them and that there will be highly trained staff to treat patients, not just cheap care assistants, which happens in many hospitals?
Lord Warner: My Lords, these changes are to ensure that safe and effective services are provided closer to people. We know that specialists in existing community hospitals—for example, the one I visited yesterday—carry out sessions and see people in that setting. We expect that to continue. These changes mean that there will be a range of specialist and general services in community hospitals. I share the noble Baroness’s support for the splendid work done by specialist nurses, such as those concerned with Parkinson’s. We hope that that will continue, but more of the work will take place in community settings in future.
Lord Stoddart of Swindon: My Lords, I welcome these proposals, but how will local populations be able to put pressure on primary care trusts to establish
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Lord Warner: My Lords, I welcome the noble Lord’s support for these proposals. It is down to people locally to use methods open to them to bring their views to the attention of the primary care trust. That can involve their MPs working together, sending petitions or involving their local councillors and local authorities, and, possibly in some cases, using voluntary organisations to make their views known. Some of these deputations have sat in my room and they are articulate in putting across their views. The NHS has to think about how to respond best to some of the concerns. In many places, it is getting better at engaging in public consultation about how to reshape services.
Lord Colwyn: My Lords, two speakers—perhaps even the Minister—have mentioned this new money giving community hospitals new teeth. Can I take that literally?
Lord Warner: My Lords, if the noble Lord listened carefully to the Statement I repeated, he would know that dentistry was mentioned in some of the possibilities.
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