The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I congratulate my right hon. Friend the Member for North Somerset (Dr Fox) both on securing the debate and on his strong advocacy for Clevedon community hospital.
Members who represent more rural constituencies know the importance of high-quality community health care facilities, including community and cottage hospitals. They provide important close-to-home care for patients in more rural areas, particularly frail and elderly patients who have long distances to travel to receive health care.
We know the importance of such hospitals in meeting the long-term challenges of the NHS. We need to redesign services and deliver more services closer to home, and prevent inappropriate hospital admissions to big acute hospitals such as those in Bristol or Weston-super-Mare. That means ensuring that we have the right community resources properly to support local people, including those with long-term medical conditions such as asthma, diabetes and dementia. In particular, we need to ensure that we have community-based support for older people—the biggest group with long-term conditions.
We want to move the emphasis of care in this country away from acute crisis management, to which the NHS is accustomed, both to save the NHS money and to provide better care for people in their homes and communities. Community hospitals such as Clevedon are important in delivering such care. They provide invaluable beds for people with long-term conditions to give their carers respite, and important rehabilitation in a setting close to home, family and support networks for people who have broken hips, or who have had strokes or heart attacks. They provide the opportunity for step-up care for people who are not so unwell that they need to be admitted to an acute setting, but who can be better looked after temporarily in an environment that provides the additional care that people need. The Dr Foster report, which was published this week, highlights that 29% of patients did not necessarily need to be in acute hospital beds. If we are to meet the challenge of ensuring that people are better looked after and are not in hospital beds when they do not need to be, it is important that we invest properly in community resources, and Clevedon community hospital is just one of those resources.
I share with my right hon. Friend and the community he represents their frustration with the primary care trust, as I have Hartismere community hospital in my constituency. My predecessor, Lord Framlingham, had considerable struggles with the PCT about the potential closure of an important rural hospital. From what my right hon. Friend says, his constituents and local patients have been having considerable struggles and difficulties with the local PCT in Somerset.
I acknowledge the special role the League of Friends plays in the life of Clevedon community hospital, a point my right hon. Friend made in his speech. It has worked to raise a lot of money for the hospital and to ensure that it is retained as an important community health care resource. It is dismayed and disappointed, as are others in the local community, by the attitude of the PCT. I understand his disappointment, but under the PCT arrangements the provision of local NHS services remains with the local NHS. However, he is concerned that approximately £1.5 million or £1.6 million has been spent on project costs and other costs over a four-to-five-year period, in proposing to develop a new and sustainable community hospital facility in Cleveland. The money has been spent, but there is still no new facility. As physicians, we would rather the money had been spent on a new facility or on community care.
If it is any consolation to my right hon. Friend, I had a conversation with local health care representatives yesterday. They reassured me that even without the new facility at the allocated site, there are no concerns about any loss of services with the transfer from the PCT to the clinical commissioning group that will have responsibility for running community services. I hope it reassures my right hon. Friend to hear that when the new arrangements come into place in April next year services will remain as they are now.
On endoscopy services, as clinicians we know that strict evidence-based clinical standards must be achieved when delivering endoscopy services, which, for patient safety and to maintain high-quality patient care, have to be adhered to. There were concerns that facilities at Clevedon hospital were not able to maintain those high standards. For example, arrangements for the decontamination of endoscopy equipment would have to be substantially improved if the service was to achieve external accreditation by the national joint advisory group for endoscopy, and that would need to be achieved for the service to return to the hospital.
Despite my conversation yesterday with representatives from local health care commissioners, I am alarmed by what my right hon. Friend tells me about the business case to all intents and purposes being approved and then suddenly, between March and June, being disapproved—an extraordinary turn of events. It is inexcusable to raise the expectations of local patient groups, effectively giving a green light suggesting things were going ahead, and then to remove that expectation. I am happy to look into the matter further and to write to my right hon. Friend about it in more detail, because I am concerned about the issues he has raised. When something like £1.5 million has been spent on planning, and various plans and business cases have been brought forward, it is all the more concerning. It is not a satisfactory state of affairs, as far as the local management of NHS resources is concerned, and it is certainly not a satisfactory state of affairs, as far as local patients are concerned. I shall further investigate the matter and write to him on the basis of those investigations.
On future provision, I would like to reassure my right hon. Friend that, according to what local health care commissioners told me yesterday, the services currently provided at the hospital are safe and will still be provided. Even though plans do not appear to be in place, as they once were, to build a new hospital on a new site, it would be relatively easy, I understand, to maintain the buildings and the facilities on the current site in a state that would allow for the safe delivery of high-quality patient care and the ongoing provision of services for patients in the area. I understand that the older building can be improved, if required, to ensure that it can still deliver high-quality patient care.
With those reassurances, I will further investigate why the business case has gone from being approved to disapproved, as my right hon. Friend said. We have been reassured that the services currently provided at the hospital will continue to be provided for the foreseeable future.
Dr Fox
If we are to maintain clinical services on the original site, substantial investment will be required. I am sure that my hon. Friend will be sympathetic to our view. If a business case can be perfectly fine in March but dumped in July, if we, the poorest funded PCT, can give money to other less well-performing PCTs and given that the transfer is being put forward again this year, how can we have much confidence in the local management? Then, when our questions are not answered, as they continue not to be, we feel that there is not only insufficient competence but a lack of transparency. I am grateful for his reassurance that the matter will be looked into, but I would also like him to kick our local PCT in the proverbials to ensure we get the money required from the sale of the Millcross site or from additional investment, so that we can get the facilities that our taxpayers contribute towards but which seem to be getting siphoned off into other areas, whether because of a lack of adequate priorities or competence.
Dr Poulter
My right hon. Friend makes a good case. From what he has outlined, I fully agree that some of the circumstances surrounding the decision seem extraordinary and completely unacceptable. He described it as being far from competent, and I would not wish to disagree, judging from his analysis.
We are interested in delivering high-quality front-line patient care. The challenge for the NHS is delivering that care close to home and close to people’s communities. That is what Clevedon does and what it needs to continue to do. We need to ensure that PCTs, as they are at the moment, and clinical commissioning groups, as they will be in the future, invest in high-quality local health care services in order to meet the challenge of better looking after older people. That is the clear challenge that David Nicholson set for the NHS in 2009 in the quality, innovation, productivity and prevention challenge. It is about the need to redesign services in order to deliver better and more affordable care in the community.
That was also the challenge that Dr Foster outlined for the NHS earlier this week. It is about time that my right hon. Friend’s local health care commissioners acknowledged that challenge, invested in local health care services and made the argument for keeping investment locally, rather than, as he said, siphoning it off elsewhere. I will clarify the matter further by investigating with the PCT what has happened. From our discussions so far, I can reassure my right hon. Friend that the PCT and the clinical commissioning groups reassured me yesterday that they would, they thought, be able to find the investment to continue with the current older buildings, maintaining them as fit for purpose to continue with patient care, and that patient care will continue on the current site, as it does now, in April. Nevertheless, there are clearly questions for the local health care commissioners to answer.
Question put and agreed to.