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Charlie Elphicke (Dover) (Con)
It is a pleasure to serve under your chairmanship, Mr Owen. I welcome the Under-Secretary of State for Business, Innovation and Skills, my hon. Friend the Member for Mid Norfolk (George Freeman), to the debate and congratulate him on his elevation in the reshuffle before the summer recess. It is a pleasure to speak in such a well attended debate, with so many parliamentary colleagues coming to share my concerns about the future of our community hospitals.
The purpose of this debate is to make the case for the Government’s putting the community back into community hospitals and for recognising that such hospitals should have a central role in coping with the issue of people living longer. Community hospitals are important providers of recovery beds that speed rehabilitation and recovery, which can also help older people in particular to continue to live independently.
I was inspired to seek this debate because people in my community care deeply about the local community hospitals in Dover and Deal. Years of centralisation have taken their toll. My constituents want more locally-based health services provided by their local hospitals.
Dover was deeply concerned to see services axed at its Buckland hospital; wards were closed one by one and a much-loved hospital was decimated over a decade. When I was elected in 2010, plans for a new hospital had been going nowhere for getting on for a decade and the new hospital project was set to be axed altogether. Meanwhile, in Deal, it was agreed in 2006 that out-patient services should be axed and residents were fearful that the hospital would be closed altogether. However, after much hard campaigning, the long-stalled new Dover hospital is being built. It will open in February or March next year and will have out-patient facilities, day surgery, diagnostics and a revamped urgent care centre. The number of journeys that will need to be taken to the big, far away hospitals will fall dramatically. It will make a massive difference.
In Deal, we campaigned hard to safeguard the future of the hospital. A massive survey and a packed public meeting ensured that NHS chiefs pledged not to close the hospital and they will now seek to expand its services. We now hope that out-patient services can be maintained for people who find it hard to travel: the elderly, the partially sighted and people with broken bones.
However, we have not achieved everything that we want. People in Dover want recovery beds to be located at the new hospital. Residents of Deal would like greater community and local general practitioner involvement in the hospital and its services. Both communities would like more locally-based services, to minimise the number of journeys to the large, far away acute hospitals for simple procedures and treatments. These concerns led me to move a ten-minute rule Bill earlier this year and I was delighted that so many parliamentary colleagues supported that.
The issue is not just for Dover and Deal; I have set out the local situation to provide context for the concerns of so many parliamentary colleagues. There are some 400 local and community hospitals throughout the land and there are similar stories to be told about many of them—stories of people battling to defend their hospitals and hospital services against the NHS leviathan and the forces of centralisation.
There is a sense that the tide has begun to turn. After all, a new hospital is being built at Dover, health chiefs have pledged to secure the future for Deal hospital, and there has been a move towards a fairer share of health care for rural and semi-rural communities far from acute hospitals. We have come a long way. Today, I am making the case for going further and asking what more we can do to embrace community hospitals and bring them closer to the heart of the NHS and, in particular, support the role that they play in providing recovery beds and more locally-based services, particularly for an ageing population. We need to put the community back into community hospitals.
We should note an important moment in the history of the NHS, marked by the comments of Simon Stevens, the new chief executive of NHS England, who recently made the case for patients to be treated more often in their own communities, saying that the NHS is currently too focused on
“a steady push towards centralisation”
and that Britain should learn from countries such as Sweden, the Netherlands and the United States, which have strengthened community care around small hospitals to meet the needs of local communities.
David Simpson (Upper Bann) (DUP)
I congratulate the hon. Gentleman on obtaining this debate. In Northern Ireland, of course, we do not have as many community hospitals as there are on the mainland. Ours tend to feed into a main hub and we have out-of-hours services more than community hospitals. However, Mr Stevens, whom the hon. Gentleman mentioned, also says that we should consider community hospitals developing as social enterprises. What is the hon. Gentleman’s view on that?
Charlie Elphicke
The hon. Gentleman anticipates the direction of my speech. I wholly support it; it is a great idea. Mr Stevens also said:
“A number of other countries have found it possible to run viable local hospitals serving smaller communities than sometimes we think are sustainable in the NHS”
and that
“Most of western Europe has hospitals which are able to serve their local communities, without everything having to be centralised”.
In a speech to the NHS Confederation annual conference in June 2014, he outlined his plans for reform of community health services, reiterating the problems of the ageing population and the increasing number of long-term conditions, such as obesity and dementia, as well as more expansive and expensive treatments and the need for more localised health services to tackle these problems.
Mr Stevens is right. Community hospitals have an important role to play and perform best in respect of intermediate, step-down and step-up recovery beds, particularly for people recovering from an operation who need round-the-clock care, and in respect of helping older people get better and continue to live independently, keeping them out of end-of-life or long-term nursing home care.
Richard Drax (South Dorset) (Con)
I, too, congratulate my hon. Friend on this excellent debate. Does it not surprise him that the acute hospitals are not clamouring to keep the community hospitals, which could free up their beds, allowing patients to go home to their local communities, where they are going to get better, not worse? That, of course, would cost the Government less in the long term.
Charlie Elphicke
I agree. I congratulate my hon. Friend on his hard campaigning in his constituency to secure the future of his own community hospitals. I understand that the campaign has met with great success, showing how fortunate his constituents are to have such a diligent, effective Member of Parliament. He is right; community care beds are more cost-effective and reduce the pressure of bed blocking on acute hospitals, meaning that acute hospitals can do more of what they are best at and that community hospitals can do more of what they, in turn, are best at.
Community hospitals are good at creating a friendly, personal and home-like environment, well suited to older people, particularly those who suffer from dementia yet live independently; such people have better health outcomes and a lower rate of readmission following rehabilitation and recovery. Community hospitals can be localised hubs for less complex health care and can have minor injury units, diagnostic provision, clinics for various specialities and even out-patient services and day surgery, and they are more cost-effective, when compared with acute hospitals, in respect of post-acute recovery. It is hard to see why we ever went down the route of centralisation, because it cost us more money and gave us less effective care. The move to putting the community hospital back at the heart of things will be more cost-effective and will give better care and better health outcomes.
I welcome Ministers’ comments in answers to oral and written questions, as well as the comments of Mr Stevens. Ministers have recognised that community hospitals are important in improving patients’ discharge from acute hospitals and in increasing access to treatment in the community. I welcome their acceptance that community hospitals are good bases for respite, palliative and intermediate care, and step-up and step-down care close to home. Community hospitals are also strong resources for people in rural areas, who have to travel long distances to reach general hospitals. Much of what I am saying is in line with the direction of travel of Ministers. I welcome that.
An important aspect of community hospitals is as providers of recovery beds. Study after study has shown that community hospital recovery beds are effective at getting people well, meaning they are less likely to be readmitted to hospital than if they recovered in an acute hospital. Older patients are more likely to enjoy continued independent living, and a friendly home life environment is preferred by patients.
I will cite a few studies and a bit of evidence in support of what I am saying. There was a study in Bradford in 2005, a study in the midlands and the north of England in 2007, research from 2009 into patient-reported experiences and research into intermediate care in Norway in 2007, so there is a significant evidence base. In addition, the NHS Confederation recently used Department of Health evidence to conclude that closer-to-home care produced a fall of 24% in elective admissions, a 14% reduction in bed days, a 21% drop in emergency admissions, a 45% reduction in mortality and a 15% fall in visits to accident and emergency. Those are encouraging figures. Community hospitals are more cost-effective, according to a 2006 research paper published in the British Medical Journal, so there is strong evidence to back up what I have set out.
The case is made in certain quarters that it is somehow easier and possibly cheaper to have intermediate beds in nursing homes. Nursing homes play an important role in long-term care and end-of-life care, but community hospitals are more suitable for recovery, rehabilitation and continued independent living. It is in their interest to get people out, but the nature of nursing homes is that people are not expected to leave very quickly. With an ageing population, community hospitals are particularly well suited to keeping older people healthier and more well. The clinical commissioning group covering Dover and Deal, ably led by the local GP, Darren Cocker, is building on that in creating an integrated care organisation. It sees the local hospitals in Dover and Deal as essential to the success of its vision.
Moving on, let us look at how we can put the community more into community hospitals. Many community hospitals were established and funded, as colleagues will know, through public subscription by locally based community trusts before the NHS came into existence. The trusts managed effectively and the move to nationalisation and centralisation saw those hospitals taken from communities and taken over by the NHS in Whitehall. Many communities want to be given the chance to have a greater say over what happens to their local hospitals. Allowing local communities to own, lease or manage their hospitals would be a clear way to accommodate the concerns many have and enable people to have the greater say they would like to have.
Reforging the strong link that GPs had with their local hospitals is important as well. My local GPs are up for that, and I want to encourage and support them in that move. Communities should also have greater influence over the provision of health care in their areas; that would allow them to give greater priority to the needs of their specific community. I hope that Ministers will take the opportunity to promote community ownership or management of community hospitals.
In conclusion, much progress has been made on community hospitals, but more can be done. They could be embraced and put more closely at the heart of Government health care policy, and I look forward to hearing from the Minister what steps he will take in four key areas. First, what steps will he take to enable communities to have a greater say in running their local community hospitals: to own, to lease, or to manage? How can we have stronger links among GPs, GP-led clinical commissioning groups and community hospitals, as used to happen many years ago and could happen again?
What about the potential for community hospitals to be hubs for the integration of social care and the policy support that might be given for that? Finally, we need to accept that it is not always best just to drop off people at home after acute hospital treatment and that intermediate recovery beds are often a key element in the path to recovery, distinct from nursing homes, which are better suited to longer-term and end-of-life care.
Albert Owen (in the Chair)
Before I call Mr Jim Shannon, I say to Members that I will call the Front Benchers at 10.40 am. Seven Members have indicated in writing that they want to speak in this debate, and a couple of others have also indicated that they might wish to speak. As would be expected, those who have written in will get priority. The maths is easy: we have 55 minutes and 10 Members wishing to speak.
Jim Shannon (Strangford) (DUP)
It is always a pleasure to serve under your chairmanship, Mr Owen. The Minister and I have spent a bit of time together in Westminster Hall in the past couple of days, and it is nice to see him in his place. I wish him well. I congratulate the hon. Member for Dover (Charlie Elphicke) on securing this debate, which gives us all an opportunity to participate, and we thank him for that.
I have a deep interest in community hospitals and I therefore look forward to making a contribution. As the Democratic Unionist party spokesperson for health, the issue is of some interest to me. It is not often that we are the second largest party in the Chamber. [Laughter.] With my hon. Friend the Member for Upper Bann (David Simpson) and me, we have two Members, which makes us the second largest party. It is a pleasure to speak on this issue. The local hospital in my constituency of Strangford is in Newtownards. It is a community hospital, like Bangor and Downe, which are in neighbouring constituencies, and all those hospitals feed into the major hub of our hospitals, which is the Ulster hospital. I put on record, because I have to, the excellent staff we have at those hospitals. We are very much indebted to their work, the commitment they give beyond their hours and the quality of their experience.
Community hospitals have a big role to play in our society. Without them, the NHS health system would be under even greater pressure. We have one of the best, if not the best health system in the world, but being the best comes with pressures. Due to the nature of our health system, which entitles all UK residents to health care, delays and backlogs can, unfortunately, arise sometimes. In January this year, the Royal Victoria hospital in Belfast was forced to declare a major incident due to the large number of patients visiting accident and emergency. Health is a devolved matter, and although our Health Minister at home, Edwin Poots, dealt with the issue extremely well, I am under no illusion that the Belfast hospital was alone in declaring itself under extreme pressure. The nature of the NHS means that that happens sometimes, but community hospitals can come in to address that.
I am always thoroughly impressed by the work of staff in A and E departments, because they are often run off their feet, with many people coming in with a variety of problems, but community hospitals play an important role in easing their work. Often, people have injuries that need to be seen to that are not emergencies, and sometimes people have to look at how best to categorise those issues and which hospital to attend. Some people could see their GP at their local community hospital and use the out-of-hours service, rather than attending A and E departments. That is not meant as a criticism; I am always conscious that people respond in the way they see best, but sometimes we need to take a longer look at how things work. Community hospitals can play a greater role.
One thing that we need to do is raise awareness of community hospitals through this debate and look at how best the community and our constituents can respond. The role of community hospitals is to provide accessible health care and ancillary services to meet the needs of defined local populations, particularly in areas remote from district general hospitals. As an extension of primary care, they enable GPs and the primary health care teams to support patients within their own communities. Rehabilitation is a major role of community hospitals, and many offer a wide range of health promotion, diagnostic, emergency, acute and convalescent services, as well as out-of-hours treatment.
Community hospitals provide an undervalued resource, and those wishing to close such hospitals or downgrade them to no longer being community hospitals have often presented community support as irrational, but it is not irrational in my area. The community hospital in my constituency looks after the Ards peninsula. Travel from Portaferry, Portavogie or Kircubbin to the Ards hospital takes 15 to 20 minutes, but travel to the Ulster hospital would take twice as long, because of the traffic. The community hospital has a significant and important role to play, and we must look outside this place, to see what the issues are for my constituents. In the community hospital, they feel like they are treated as people, rather than numbers. That is not a criticism, but it is a reality.
Figures for Northern Ireland show that the waiting times at A and E are extremely good with just 294 out of 62,193 people waiting longer than 12 hours to be treated or discharged. That figure of 294 must also be addressed, but the numbers show the importance of the role that community hospitals play in treating non-emergency injuries, as well as the large-scale rehabilitation programmes that they offer. Community hospitals provide more convenient services, are less costly for the local population to access and are tailored to the local community’s needs. The hon. Member for Dover referred in his contribution to the significant and important role that community hospitals play in that respect. Furthermore, community hospitals provide a range of safe and appropriate services, often with considerable cost benefit to the NHS—minor injuries units being a prime example.
Doctors can be summoned very rapidly to community hospitals, virtually all of which operate without resident medical staff in a satisfactory way. They have proved that they can do the job to a certain level, which is impressive and eliminates the argument that community hospitals do not provide enough of a service, forcing people to district general hospitals when injured or ill through the night. It is a fact of life that such things happen, but that does not downgrade the importance of the community hospital. It would be good, however, to see all community hospitals offering night-time services. In community hospitals, the patient is under the care of their own GP, who will continue to look after them on discharge. The community nursing teams are also able to retain closer links with the patient at community hospitals, which is vitally important for rehabilitation and is why community hospitals are so successful when it comes to patient recuperation
In conclusion—I am conscious that several other Members want to speak—the benefits of having the same doctors and nurses, who know a patient’s case and can get to know the patient, cannot be underestimated. That is why this debate is so important. I encourage the Minister to raise awareness of community hospitals’ work and to encourage people with minor injuries to use their local community hospital instead of A and E departments at district general hospitals. I congratulate the hon. Member for Dover on bringing forward this debate. I look forward to the Minister’s response and to hearing from the third party in the room today when the shadow Minister makes his comments.
Sir George Young (North West Hampshire) (Con)
May I begin by saying that it is a pleasure to serve under your chairmanship, Mr Owen, and by joining my hon. Friend the Member for Dover (Charlie Elphicke) in his warm welcome to our hon. Friend on the Front Bench, who will make his maiden ministerial speech in Westminster Hall? I also congratulate my hon. Friend the Member for Dover on his choice of subject. As we approach a general election, it is worth remembering that a Member of Parliament actually lost his seat in 2001 because of a perceived lack of commitment to a community hospital, but my hon. Friend’s powerful speech will have consolidated his position in Dover and Deal on health-related matters. Listening to his speech and reading some of the comments made about the NHS, one can understand the concern that district general hospitals and specialist services might sap the life blood out of community hospitals, some of which are fighting to hang on to what they have or even face closure. I want to speak briefly in the debate to show that, so far as North West Hampshire is concerned, the opposite is now happening.
I have no district general hospitals in my constituency—Basingstoke and Winchester are the nearest DGHs and are in next-door constituencies—but I do have the Andover War Memorial hospital in my largest town and what has happened there over the past few years shows what can be done. In 2012, a new trust was formed, amalgamating Basingstoke, Winchester and Andover hospitals and there were fears that Andover, as the smallest, would be squeezed as services were centralised. In fact, the opposite has happened, and I commend what Mary Edwards, the chief executive of the combined trust and Elizabeth Padmore, the chair, have done to bring services to Andover and so reduce the need for people who live in and around the town to drive to the nearest DGH—and most people have to drive as access by public transport is difficult. The process has actually helped the DGHs by reducing pressure on some of their services, not least on car parking, and has made it easier to recruit and retain NHS staff, as not everyone in Andover wants to work in Basingstoke or Winchester.
In Andover, as in other towns, the hospital has always had a strong claim on people’s loyalties, and we have to take note of that. Nowadays, however, one cannot make the case for investment on emotion alone; there has to be a hard-nosed business case to back it up. My hon. Friend drew on some research that underlines the need to invest in community hospitals. The reality is that bigger is better for some procedures, but smaller is better for others, and the position is not static as medical technology develops. A modern health service needs to make intelligent decisions about its assets to get the best value out of them.
After careful analysis of the best way forward by the new trust, we have seen service development in Andover and investment in the fabric, which has capitalised on the skills and commitment of the existing staff, whose energy and professionalism I pay tribute to, and has generated additional investment through, for example, an active league of friends. It has also helped to restore confidence in the NHS decision-making process as local people see the outcomes of the new method of running the NHS. For example, we now have a mobile chemotherapy unit that visits Andover weekly, avoiding a 50-mile round trip to Basingstoke or 30-mile round trip to Winchester, which was done in partnership with Hope for Tomorrow. A new minor injuries unit opened in 2010 and is run by highly skilled nurse practitioners with back-up support from the consultants in emergency medicine at the DGHs. We have a modern out-patients department to replace a building that dates from the era of “Carry on Nurse”. Instead of local folk having to travel to a DGH to see a consultant, consultants from nearly all the specialties now come to Andover. We have a mobile MRI scanner, and operations under local anaesthetic are now also taking place in Andover. The Hampshire hospitals birthing unit has just opened and is run by local midwives and provides ante and post-natal care. More and more local families are choosing a midwife-supported birth, and they can either have the baby at home or in the birthing unit.
The hospital campus is large and has always been used intelligently. The Countess of Brecknock hospice, run independently by a charitable trust, is next to the hospital. More consultants in palliative medicine are now based there and it is developing a hospice-at-home service. Also next to the hospital is a nursing home, funded and run by the county council on land provided by the NHS.
At this point, the cynic might ask what is so remarkable about a large building calling itself a hospital providing services for people who are ill, but that is to miss the point. The NHS must adapt and change if it is to continue to provide a quality service, which means specialisation where necessary and localisation where it is not and investment in both DGHs and community hospitals
I have two requests for the Minister—one general and one specific. First, I endorse the plea made by my hon. Friend the Member for Dover for an assurance that the Government support the continued provision of more services locally, as is happening in North-West Hampshire, and will encourage the trust to continue with its strategy of providing more services in the town, such as transferring patients who have had critical treatment elsewhere for rehabilitation in the hospital. We are pleased with what we have, but our appetite has been whetted and we want more. I was tempted to say, “Dover Andover again,” but I will not.
Secondly, and more specifically—I do not expect an answer this morning—the ugliest building in Andover is the Andover health centre, which houses a GP practice on the hospital campus owned by the trust. Not only is it ugly, it is past its sell-by date as a place where GPs can practise. Indeed, the trust wants to demolish it next year. The site could be sold for housing, for which there is great need, and could generate a capital receipt for reinvestment in health services. The dialogue between the various agencies of the NHS to relocate the practice, which is the largest in Andover with some 15,000 patients, has gone on for at least four years with no end in sight. It started off with the primary care trust, but now involves NHS England, the clinical commissioning group and the trust. The practice wants to be relocated near the hospital, where land is available, and there are advantages in having GPs next door. We need to resolve the matter before the Care Quality Commission looks too hard at the current building. In conclusion, I ask my hon. Friend the Minister to indicate that he will take a personal interest in the matter and use his influence to bring the dialogue to a satisfactory conclusion.
Neil Carmichael (Stroud) (Con)
It is a great pleasure to serve under your chairmanship, Mr Owen, and to speak in a debate instigated by my hon. Friend the Member for Dover (Charlie Elphicke), because it is such an important subject, in particular in my constituency. It is also a great pleasure to be present for the first performance of the new Minister—I congratulate him on his appointment.
Approximately 10 years ago, our hospital in Stroud was under threat, in essence because the previous Labour Government were obsessed with “big is better”, rather than small and local. The whole town and the wider community rallied together to ensure that their love of their hospital was understood and the fundamental case for keeping it open was made. Today, it is still open—quite right too.
At the same time, the Stroud maternity unit was under threat for much the same reasons. It also received a huge amount of support locally. It, too, is still open—again, quite right too. If I do nothing else, it would be to pledge my total support for those two institutions, as well as the Vale community hospital in Dursley, because it really matters to people that such hospitals—our community hospitals—are protected and allowed to thrive. That is a key priority for me in my constituency.
When I was first elected, it was a great pleasure to dig the first hole for the building of the Vale community hospital. It is now thriving, with 20 beds, and providing an increasing number of valuable services to my constituents.
That is the overall package that we have in the Stroud valleys and vale; it is one that we want to build on, to protect and to hand over to our successors, children and grandchildren in future. It is the core of our health care.
It is great that the reforms that we introduced early on in the Parliament have enabled general practitioners to have more say in community health provision. It is absolutely right that CCGs are able to direct patients more effectively and more easily to local community hospitals. That is certainly happening in my patch, because our local doctors know and understand the value of our community hospitals. The reforms that we introduced to localise decision making, and to put clinicians in charge rather than managers, have made a big difference. We should continue in that direction of travel.
The key word is “signposting”, to ensure that the patient gets to the place where he or she should be, rather than automatically assume that a large, city-based hospital is the place to go. We need to make it clearer that community hospitals are there and should be used as often as possible. It is a matter of signposting. Unless we make that clearer, from time to time we will find ourselves wondering why there are queues in big trust hospitals and, possibly, empty beds in community hospitals. We need to do signposting.
Richard Drax
I am listening attentively to my hon. Friend’s excellent speech. Dare I say, reorganisation in the NHS is not something that I particularly want to address, but is it not common sense for trusts to look again at how best to use what they have, rather than to play with what they have inherited? Community hospitals should be incorporated with the district or acute hospitals to ensure that they all work together in their relative areas to look after the people living in those areas.
Neil Carmichael
I thank my hon. Friend for that helpful intervention. It is absolutely right that we need a holistic approach to the use of hospitals. Such an approach would be better informed and implemented if more information were available. That is the essence of my point, which will be helped precisely by what he was talking about, which is having more and better relationships between the different types of hospital.
May I say a few words about the investment that the coalition Government have managed to provide for our hospitals? I have already said that the Vale community hospital was built during the early years of my time as Member of Parliament. We have also seen huge improvement in the Stroud maternity unit, with significant investment in access, the entrance area and a complete revamp of corridors and facilities. As a result, it is a very attractive place for expectant mothers to go. The questions are, do we have enough expectant mothers, and do we have enough of them who want to go that particular unit? I am not going to add to the baby count myself, as I have three children already, but those are questions we need to address.
Stroud general hospital can now boast improved diagnostics and excellent out-patient services. That is good for those situations, which we often see, that involve someone needing to go into a hospital, but not necessarily to stay overnight. The recently opened out-patient facility is therefore a good example of valuable and useful investment.
I want to pay tribute to the leagues of friends in Stroud hospital and in Vale community hospital. In particular, I want to single out one individual, David Miller, who has contributed a massive amount to our hospital over many years. He should be recognised as a powerful force for augmenting investment in our hospitals through very good use of locally raised funds.
In essence, I am utterly and absolutely determined to ensure that our hospitals are supported properly—financially, locally and in every other way. Secondly, the key thing is to signpost the patient to the right place and to recognise the powerful role of community hospitals in promoting public health, dealing with care after major operations and enabling out-patient activity to work, all in conjunction with general practitioners across my patch. That is the message that the Government must hear; that is the theme that the Government must pursue; and it is certainly what I will do in the Stroud valleys and vale.
Fiona Bruce (Congleton) (Con)
I am pleased to have the opportunity to speak in this important debate. I congratulate my hon. Friend the Member for Dover (Charlie Elphicke) on securing it, and I entirely concur with the major premise of his speech, as well as that of many of my colleagues’ speeches, that community hospitals should be further developed to promote additional services.
One such excellent community hospital is the Congleton War Memorial hospital in my constituency. Given the high standards it has provided for its local patients, it is well placed to extend its services. The recent patient-led assessment of the care environment rated Congleton War Memorial highly, with no less than 93%. Founded in 1924 by public subscription, it was a memorial to all those who had given their lives in the first world war. The hospital has served the community of Congleton ever since, and it is fitting that I should be able to stand up and praise that excellent local hospital in the centenary year of the start of that war.
I will give a little background. Built in 1924, the hospital was paid for by local people and opened by the King as a memorial to those 243 men from the town who gave their lives in the first world war. When the King opened the hospital, he said:
“The hospital will always be a reminder to generations to come of the prudent and generous instincts of the townspeople of Congleton”.
Indeed, it has been, and still is.
Until the inauguration of the health service in 1948, the hospital was maintained locally, first by an industrial hospital fund, to which every worker in the borough contributed one penny a week, deducted from their pay packets. That is why the hospital remains so close to many people’s hearts, in particular the many elderly people in my constituency. Additionally, it was supported by the proceeds of an annual hospital carnival, private subscriptions and bequests, the proceeds of special efforts, and donations from local fundraising, which continues today.
Its current services range from a minor injuries unit to physiotherapy and phlebotomy. It offers a personal and local service that a larger city or general hospital simply cannot match. It is a high-class facility on the doorstep of the people of Congleton, meaning that those who are less mobile due to age, infirmity or lack of transport can easily access health care facilities without needing to ride in a bus or taxi to the nearest larger hospital, which is in neighbouring Macclesfield.
Although a community hospital, it has a host of facilities and services for out-patients and in-patients. It provides a wide range of local health care for residents and has a specialist intermediate care unit. It gives respite care for people who no longer need the facilities of the larger hospitals in the region, such as Macclesfield district general hospital, so people can recover in a more homely and relaxed environment that is closer to home. That is very much appreciated, particularly by those who have more acute and severe needs. Such a facility is also a boon for visiting families and provides a halfway step between hospital and home. As I have said, the hospital is particularly valued by older constituents.
I want to reassure my constituents that I know of no current plans to reduce or close the services at Congleton War Memorial hospital. Indeed, my purpose in speaking today is to request that consideration be given to extending them. I assure hon. Members that my constituents would rise up in revolt should there ever be a hint of closure or reduction in services at the hospital—and it would not be the first time. In 1962, after a suggestion that the hospital be closed, there was a mass meeting at the town hall, with an overflow of some 2,000 residents. The meeting was presided over by the mayor and it was unanimously resolved to oppose every means by which closure could be attained. A petition was organised and got 24,000 signatures. The plans were well and truly dropped and the hospital has flourished ever since.
Members of my staff extol the importance of the hospital for the people of Congleton and call it an “invaluable asset”. They say that waiting times are short, even for minor injuries—half an hour, if someone is unlucky, which is far better than at an A and E at many larger hospitals. The service is treasured by the people of Congleton, who use it frequently and see its special services as something that should be available as a matter of course. Congleton residents rely on it for its family-friendly outlook. As I have said, its minor injuries unit helps to avoid long waits at A and E and serves the local community; it also potentially reduces waiting times at larger hospitals and takes a load off them by treating less acute injuries.
The value of Congleton War Memorial hospital cannot be overstated. It is beloved by local people and provides a level of personal service that I myself have witnessed when I have had the pleasure of meeting and spending time with the staff there, in fresh and attractive facilities that are maintained to a very high standard.
I hope the Minister will join me in extolling the virtues of important facilities such as those at Congleton War Memorial hospital, and perhaps even visit for himself one day to see, in Congleton, what a model community hospital looks like. It is ideally placed for the extension of the excellent facilities that it provides.
Mr John Whittingdale (Maldon) (Con)
It is a pleasure to serve under your chairmanship, Mr Owen. I too congratulate my hon. Friend the Member for Dover (Charlie Elphicke) on obtaining this debate, and add my congratulations to the Minister on his appointment.
Every speaker so far has talked about the value of community hospitals. I do not want to repeat what has been said, but I utterly endorse the tributes that have been paid to the dedicated staff who work in those hospitals, the intimate care that they are able to provide to patients—sometimes lacking in very large, more general hospitals—the proximity they have to communities and the fact that patients can be visited by relatives and friends much more easily. All those factors are real strengths that contribute to faster recovery times.
I am afraid that, like every Member, I will talk about my own experience of my local community hospital in Maldon, St Peter’s community hospital, which is greatly loved. Like many, it offers out-patient treatments, has rehabilitation beds and offers therapies. It also has a maternity unit. In my early days as a Member of Parliament I marched down Whitehall with the local protest group in defence of that unit when it was suggested that it might close. I am pleased to say that it did not and is still there; although I cannot personally say that I have contributed to its work, my hon. Friend the Member for Witham (Priti Patel), who I am sure would be here had she not become a Minister, had her first child in the Maldon hospital maternity unit.
Like many community hospitals, however, it is an old building. It was built in 1874 as a workhouse for 450 inmates. Although it has had various refurbishments over the years, it is not really fit for purpose. It is in poor condition, with leaks in the roof, and there is a possibility that it could be declared unsafe. Everybody realises that services cannot continue there for much longer.
For almost all the time that I have been in Parliament, therefore, we have been discussing how best to replace the hospital—whether to rebuild on the existing site or to build a brand new community hospital. Various options have been put forward. At one point we thought we had an agreement, but then it was discovered that nobody could quite work out who owned the land on which the new hospital was to be built, so that agreement fell through.
We now face a serious problem: as the Minister may know, mid-Essex has one of the most severe financial problems of any area in the country. It is largely an historical problem that has come about through the formula for funding allocation and has been compounded by a private finance initiative scheme that is draining money out of the local health budget at our main general hospital in Broomfield. We have to look at more imaginative solutions: it is clear that it is unlikely that the local health service will be able to afford the capital cost of a new hospital and we have had our fingers burnt by PFI once before.
We are looking for a new solution, and one has appeared; I will describe it briefly and invite the Minister to endorse at least the principle behind it. The Maldon district, like many, has a severe housing need—we need a lot of new houses. The district council is preparing a development plan, which is now before the planning inspectorate. The development of new housing offers opportunities and a scheme has been suggested for a housing development that will bring with it a new hospital for the NHS, built by the developers at zero capital cost. Indeed, the scheme offers an even greater potential benefit, as not only will a new hospital probably be cheaper to run than the very old existing hospital, meaning that the revenue costs may be reduced, but it will free up the site of the existing hospital, which will be available to the NHS for potential sale for development and could therefore raise some money. It is potentially a win-win situation: Maldon will get a brand new hospital and the houses that, although they are controversial, there is no doubt we need, and the NHS will have additional resources and a hospital that is more up to date and cheaper to run.
Obviously the scheme still needs a lot of work. There are questions over who will own the new hospital building—whether it ought to remain in the developer’s ownership and be leased to the NHS or be passed to the district council—and it has to go through the planning process. At the moment, we are also wading through the treacle of NHS bureaucracy: dealing with the NHS Property Service, with the CCG, with the Mid Essex hospital trust and with Provide, which used to be called Central Essex Community Services. But everybody who looks at the scheme can see the potential to provide, at zero cost, the new hospital that my constituents so desperately need.
Although the Minister cannot get involved in the detail of the scheme, I hope that he can at least express general support for that kind of imaginative thinking, which will ensure that we have a new community hospital for the future. I also invite him to think about that model, which could well be applicable in many other areas.
Albert Owen (in the Chair)
Order. Because of Members’ self-discipline, we have some 10 minutes remaining, and two doctors to finish the Back-Bench contributions.
Dr Sarah Wollaston (Totnes) (Con)
It is a pleasure to serve under your chairmanship, Mr Owen.
I, too, congratulate my hon. Friend the Member for Dover (Charlie Elphicke). I cannot remember a more encouraging debate in this House about community hospitals. The success stories we have heard—not just from Dover, but the extraordinary success in Andover outlined by my right hon. Friend the Member for North West Hampshire (Sir George Young), and those in Vale, Congleton, Maldon and other places—show what community hospitals can achieve.
I was encouraged by what Simon Stevens had to say. He talked about how we should learn from other countries in providing care closer to home, but we do not need to go to other countries. The Health Committee has visited Scandinavia, and in Denmark and Sweden I was shown slides from Brixham community hospital. There we go: we actually have wonderful examples in this country. I pay tribute to the four community hospitals in my constituency: Brixham community hospital, Totnes community hospital, South Hams hospital in Kingsbridge, and finally Dartmouth hospital. They are wonderful services.
I do not want to reiterate the excellent points that have been made by my hon. Friend the Member for Dover, but community hospitals do not exist in isolation. The debate should consider not just community hospitals, but all the volunteers and services that surround them and enable them to fulfil their role. I talk not just about the wonderful leagues of friends, which work so hard for our communities and in community hospitals, but about the wider networks that help community hospitals to prevent hospital admissions, to facilitate early discharge and to prevent readmission. I will focus on why that is so important.
Simon Stevens has said that the greatest challenge facing the NHS is the rising elderly population and how we care for them. It is good news that we are living longer. That is sometimes presented as if it is gloomy news when it is great news. However, with that comes an increased number of people living with long-term conditions. From our recent Health Committee inquiry, we know that long-term conditions now account for 70% of our entire NHS and social care spending. The number of people aged over 85 will double in the next 20 years. Again, I stress that that is a good thing, but it needs some forward planning.
I ask the Minister how we will ensure that the resources from the better care fund support our community hospitals and the wider webs around them. Last month, Simon Stevens heard an important message when he visited Dartmouth hospital and met with representatives from staff, community volunteers and patients. The message was how frustrating the complications of tendering rounds can be for these volunteer groups. Sometimes those groups spend their time trapped in endless cycles competing for small pots of money. Those funds tend to go to new projects and often do not provide the ongoing funding that well-established, excellent community services provide. Will the Minister look at the mechanisms that sometimes lead to national organisations receiving funding because they can put forward flashier bids, at the expense of excellent local services? Those national bodies might have no local-facing presence.
We need to look at how we can ensure that the arrangements get money to the local services and the right people, and at how to make the processes simpler and less bureaucratic. There is nothing that drives out volunteers quicker than being trapped in endless contracting rounds, rather than doing what they really want to do: provide services to people. I hope the Minister will look at what is happening on the ground in local communities and try to sweep away some of that bureaucracy. That will help our community hospitals to deliver better services.
As my right hon. Friend the Member for North West Hampshire said, we need to demonstrate value for money, not just excellent care. I have worked in community hospitals and I know, from patients and colleagues, how important they are to local communities. We know that, but we also have to be able to demonstrate that they are financially viable. That viability often comes from adjusting the way financial drivers in the NHS work. If the Minister wants to help community hospitals, my message to him is to look at what is happening on the ground and make those adjustments happen.
I have concerns about the way consultations about changes to services take place. We need honesty about changes to community hubs. If that means losing beds in community hospitals, we need to be clear about that with communities. Where other arrangements are going to be put in place, such as using nursing home beds rather than community hospital beds, we need to be clear that there is an evidence base that that provides the services people want. We sometimes lose the heart of our community hospitals if we lose their beds. Community hospitals work better if we can retain those step-down, step-up intermediate care beds. That is crucial for communities. If there are to be changes, we need to have honesty during consultations.
Adequate notice also has to be given. This morning I was very concerned to see in an e-mail that Northern, Eastern and Western Devon clinical commissioning group proposes to close some community hospital beds. The detailed consultation will be given to the health and well-being scrutiny panel only the day before. That is not adequate time to scrutinise the plans. Will the Minister ensure that a clear message comes down that, if we want to have local democratic accountability, people must be given adequate time to scrutinise proposals? We must try to avoid terms such as “the direction of travel” in consultations with local communities. People do not know what that means. They want to be clear on what the proposals are and to be given an opportunity to feed back.
Finally, on community ownership, putting the “community” back into community hospitals is important. We need flexibility so that communities that want to take that on can take over from NHS PropCo. That issue, which I would like the Minister to comment on, was raised in a previous debate. I also have a word of caution on social enterprise. I fully support social enterprises but, in some rural communities, a change from NHS terms and conditions of service can place community hospitals under threat if NHS staff do not wish to work there. If people have the choice to work at a hospital where they will have NHS terms and conditions of service or at a hospital where they will not, I can tell the Minister where they will choose to work. That can pose a threat. No one can campaign to keep open a hospital with no nurses. Can the Minister touch on that? If we are going to shift to a social enterprise, we have to be mindful of the impact on future recruitment.
I pay tribute to all the community hospitals in my constituency, their staff and volunteers. They are valued beyond belief by their local communities. I wish them well for the future.
Dr Liam Fox (North Somerset) (Con)
I add my congratulations to my hon. Friend the Member for Dover (Charlie Elphicke). Having visited his constituency, I know how important community hospitals are for the well-being of his constituents. His commitment is greatly appreciated. I also warmly welcome the Minister to his place. It is wonderful to have a Minister in a Department who has a genuine passion for his subject, and a level of expertise that will be hugely welcomed—no doubt that will be a great threat to the civil service.
Like my hon. Friend the Member for Totnes (Dr Wollaston), I have served on both sides—as a Member of Parliament with a local community hospital, and as a doctor working in community hospitals. Clevedon hospital has been at the heart of our community in North Somerset for many years. Like many of those who have spoken, we have a league of friends, which over many years has performed heroically raising community funding to support the hospital. Despite that, our hospital is still under threat. We had a perfectly sound plan for a replacement, which we approved and then dropped. It was the subject of an Adjournment debate in the House. I will not repeat what I said then. Our CCG is under pressure from legacy funding issues, and from a funding formula that does not properly reflect issues of rurality or take into account our demographic patterns. The Department needs to look at that but, none the less, we have very good services in our community hospital. We have recently improved and replaced ultrasound facilities, we have increased facilities for ambulatory care and we retained our in-patient beds. I agree with my hon. Friend that that is one of the most crucial issues.
In-patient beds in community hospitals are good for several reasons. They are good for patients. As my hon. Friend the Member for Maldon (Mr Whittingdale) said, one of the most important things is that families are close by. With increased centralisation of acute hospitals in cities and away from many communities, community hospital beds are valued for enabling people to get close. They can make frequent visits to their relatives, who often are elderly or disabled. We cannot put a price on that social element. Community beds also allow preparation time for patients with complex support needs. All too often, patients leave an acute hospital with nursing or social care needs, and there is not sufficient preparation time before their discharge. As my hon. Friend the Member for Totnes said, community hospital beds used on a step-down basis allow proper preparation time, so that that patient gets proper support.
In addition, I believe that community hospital beds are good health economics. There is too big a gap between our increasingly specialised acute services in hospitals and patients’ homes. Because acute beds are expensive, there is often pressure on hospital staff to discharge patients early. We have all come across far too many constituency cases in which patients have been discharged inappropriately early from an acute hospital. The trouble with that in terms of health economics is that it leads to rebound admissions. Patients are sent home too early and it is not possible to prepare appropriate care, or they cannot recover sufficiently, and they end up back in an acute hospital, blocking another acute bed. The system is less efficient than it would be if patient care were put at the centre.
The value of respite care beds has not been raised in the debate. Society depends hugely on carers, who are often the unsung heroes of the health care system. Respite care beds can be invaluable in giving carers a break, so that they can be strong enough to give the care they want to give. We have lost far too many respite care beds. In my constituency, we lost the planned Portishead cottage hospital, which meant fewer beds, and we lost a range of respite care beds at Orchard View. We were always promised that alternatives would be found, and they never materialised. We must understand that if we do not care for the carers and if they become unable voluntarily to carry out those functions, for which they should be given more thanks by the nation, it will cost the NHS a great deal of money.
The issue is not a party one, although I am rather surprised that not a single Labour Back Bencher seems to have a community hospital problem to talk about today. However, there is no doubt that people believe that community hospitals are good for them and their local identity. They are good value for money and good health economics and, above all, good for patients. My hon. Friend the Minister is new to his post, and I want to tell him that community hospitals are what the public undoubtedly want from health care. It is up to the Government to ensure that that is what the public get.
Andrew Gwynne (Denton and Reddish) (Lab)
It is, as ever, a pleasure to serve under your chairmanship, Mr Owen. I congratulate the hon. Member for Dover (Charlie Elphicke) on the eloquent case that he made in opening the debate, and I warmly welcome the Minister, for whom I have a great deal of respect. He will be a huge asset to the Government.
Now that the hon. Member for Strangford (Jim Shannon) has been deserted by the hon. Member for Upper Bann (David Simpson), we are on an equal footing. I assure him that he can aspire to be the second party, because I hope very much that in eight months’ time my party will be back in its rightful place as the main one in the House. However, I am sure that that view will not garner full support in the Chamber today.
As many Members have testified, community hospitals play an important role in the communities they serve. They provide rehabilitation and follow-up care, and they can help to move care, diagnostics and minor injury and out-patient services, among others, from acute hospitals back to the community. They provide planned and unplanned acute care and diagnostic services for patients closer to home, and contribute to the local community by providing employment opportunities and support for community-based groups. It is fairly clear that people prefer the more common medical treatments, whether palliative care, minor injury services or maternity care, to be brought nearer to their homes. Those are exactly the services that community hospitals can help to deliver, as we have heard in the debate.
Community hospitals usually have good relationships with their local communities, and many of the speeches this morning attest to that. They are often supported by local fundraising and, indeed, many were opened prior to the creation of the NHS, by public subscription, as the hon. Member for Congleton (Fiona Bruce) outlined.
We have heard from a number of right hon. and hon. Members today about the great work being done by friends groups. The right hon. Member for North West Hampshire (Sir George Young) and the hon. Members for Stroud (Neil Carmichael) and for Totnes (Dr Wollaston) mentioned those in their areas. I pay tribute to those groups and to the staff and volunteers who work to make things happen in those hospitals. Staff in community hospitals can also build personal relationships with patients and carers as they deliver continuous care from outside the hospital environment, as the hon. Member for Strangford, among others, pointed out. That is an important point that should not be overlooked.
Community hospitals continue to play an important part in health care provision. Their role is valued, and we are right to support it. For the record, Labour continues to be committed to community hospitals when they represent the best solutions for local communities. My constituency is urban and it is served by several large district general hospitals, with not one community hospital, but I acknowledge that other parts of the country have a very different geographical make-up, and that community hospitals are the right way forward for the provision of health care in those communities.
However, the NHS Healthier Together consultation is under way in my area; that is a proposed radical upheaval of hospital care, with fewer and larger specialist hospitals, which will leave some of the smaller district general hospitals to become, effectively, large urban cottage hospitals. It remains to be seen whether that approach will work, but it is at least an option that keeps some hospital care in the community in urban areas. Often full-scale hospital reorganisations do not do that, so perhaps what is happening is a new venture.
Community hospitals can provide a vital step between social care and acute care, and Labour would seek to develop that further. The case made by the right hon. Member for North Somerset (Dr Fox) about, particularly, the invaluable role that community hospitals could play in providing extra respite care beds, is one we should take seriously, especially given the new obligations under the Care Act 2014.
Perhaps community hospitals could move into that role more, along with the provision of more GP and dentistry services. There could be much more provision from within the existing bricks and mortar—services could be nearer to where people live, and there could also be support provision, which is particularly relevant for community hospitals that may at present be only marginally viable. That possibility should be explored.
Some concerns remain, however, and I hope that the Minister will be able to offer the House some reassurance today. He will, I hope, be aware of our ongoing concerns about the Government’s structural reforms. I know that the hon. Member for Stroud has come to a different conclusion, but I think that evidence is mounting that some of the reforms have made the co-ordination and delivery of integrated services far more difficult. I suspect the Government now agree with that view, and that they are permitting the emerging integrated care organisations to be exempted from parts of the regulations on competition under section 75 of the Health and Social Care Act 2012 for precisely that reason. We believe totally that the future requires the integration of care and health services. Yet I fear that some of the Government’s policies are driving us more towards fragmentation. Let us not be in any doubt: community hospitals have a vital role to play. However, as we have discussed, the approach may not be the right one everywhere.
The Labour party remains committed to community hospitals. The last Labour Government introduced a fund specifically to help them, and I suspect that the Vale community hospital in the constituency of the hon. Member for Stroud, which opened in 2011, was paid for partly from that fund. The fund was not automatically taken up by primary care trusts throughout the country and in some areas there was a different view of the role of community hospitals, but where it was taken up, it has clearly made a huge difference to those communities.
I looked at the Care Quality Commission’s website, and the Vale community hospital has an outstanding reputation. The Labour party made a commitment to community hospitals where they are the right choice for the local community, and that commitment continues. I hope that the hon. Member for Maldon (Mr Whittingdale) secures a future for his community hospital because it sounds as though it is really needed in his community.
We are just over a year into the changes introduced by the Health and Social Care Act 2012. I hope that the Minister will take stock of some of those changes and some of the service reconfigurations that are now being proposed in different parts of the country, and reassure us that community hospitals are not being unfairly penalised in the new internal market.
Responsibility for commissioning health care services has moved into the hands of clinical commissioning groups from the former primary care trusts, and there was a worry during deliberation of the Bill that the role of community hospitals might be overlooked. Has the Department assessed whether those fears have come to anything anywhere in the country? The hon. Member for Totnes hit the nail on the head when she referred to the complexity of tendering rounds for funding at the expense of local services. I would be interested to hear the Minister’s view on that.
One obvious consequence of the 2012 Act has been the introduction and rapid expansion of “any qualified provider”, which made it easier for commissioning groups—indeed, it often became necessary—to look outside the NHS to the private sector to provide even more services than ever before.
I am still worried that when trusts are faced with the financial pressures that we have heard about, which arise for a variety of reasons, they often look at the need to remodel clinical services and centralisation, as the hon. Member for Dover said. That takes services away from the community and sometimes from district general hospitals. Sometimes there are sound clinical and financial arguments for that, but it is often financially driven. That will almost certainly have an effect on any extension to the provision of those services in community hospitals.
The concept of whole-person care necessitates patient-centred care closer to where people live, and there may be a huge opportunity for cottage hospitals and other smaller localised health facilities to adapt and to fit comfortably into this model. Clinical commissioning groups and integrated care organisations should look seriously at the possibilities that such facilities provide for the future delivery of joined-up health and social care in a community setting.
The hon. Member for Dover and other hon. Members, including the hon. Member for Totnes, raised the prospect of community hospitals becoming social enterprises. To me, as a member of the Co-operative party, that is an interesting concept. However, in response to an intervention, the hon. Gentleman referred to the NHS “leviathan”. There are pressures on centralisation, as we have heard, but I am worried that under the 2012 Act cottage hospitals will also have to compete with the leviathan of large corporate private providers. I am worried that “any qualified provider” means that private sector organisations will cherry-pick services and leave cottage hospitals vulnerable to the pressures of centralisation and of losing key local services; such organisations are often better at going through the bidding process, as the hon. Member for Totnes said.
This Government and the next should do all they can to ensure that patients can make real choices about receiving the health care they need close to their homes. We must make the vision of whole-person care a reality. Community hospitals are valued and must have a real role in developing and delivering a more integrated and people-centred health care system. I hope that we all support that, and I look forward to the Minister’s reply.
Albert Owen (in the Chair)
Before calling the Minister, I add my congratulations to him and welcome him to his new position.
I congratulate my hon. Friend the Member for Dover (Charlie Elphicke) on securing this debate and on his tireless work on this matter and the wider subject of social engagement and community ownership of public resources. I pay tribute to his work in his constituency, particularly on securing the future of the Victoria hospital in Deal.
Several hon. Members who are not here at this well attended debate, such as my hon. Friend the Member for Thirsk and Malton (Miss McIntosh) and my right hon. Friend the Member for Berwick-upon-Tweed (Sir Alan Beith), continue to support their local community hospitals through their constituency and parliamentary work. I extend my thanks to all hon. Members. It is wonderful to see so many of them here today representing their own community hospitals and the wider cause.
We have heard a range of excellent contributions from a distinguished and committed group of hon. Members, including two doctors—the Chairman of the Select Committee on Health, my hon. Friend the Member for Totnes (Dr Wollaston), and my right hon. Friend the Member for North Somerset (Dr Fox)—and my right hon. Friend the Member for North West Hampshire (Sir George Young), my hon. Friends the Members for Stroud (Neil Carmichael), for Congleton (Fiona Bruce) and for Maldon (Mr Whittingdale), and the hon. Members for Upper Bann (David Simpson) and for Strangford (Jim Shannon).
We have heard some important reasons why community hospitals and local health care facilities matter so much, and I will highlight and reinforce them. We have heard strong views about the invaluable role of community hospitals, clinics and local health centres in our communities; about the benefits of community engagement and patient voices in health care that flow from them; about the potential for community hospitals to be hubs of social care, intermediate care and recovery beds; and about the role of community hospitals in easing pressure on expensive clinical and bed space in our acute hospitals. Some colleagues have made the point that big is not always best in health care. We have also heard about the importance of integrating social care and health care, which is a Government priority, as is the role of local centres in facilitating that; the impact of reconfiguration on recruitment; the important role of community hospitals in providing respite care beds; and the strength of patient support and community voice in support of hospitals.
We have heard some important examples of imaginative new thinking in Dover, Maldon, Andover, Congleton and elsewhere, and of the risk of fundraising being channelled to the big, the professional and the remote by excessive bureaucracy and complexity. We also heard an important point about transparency and evidence-based, jargon-free language in consultations, the absence of which militates against the small, voluntary and local community.
I want to start by signalling that all Ministers in the Department of Health acknowledge absolutely the great benefits that community health care, hospitals and health centres provide to our communities. I will speak about the role we foresee them playing and highlight how our NHS reforms are changing the NHS in a way that should help to support more local and community facilities, putting in place specific protection for community hospitals. I will try to address some of the specific points that have been raised, and if time prevents me from doing so, I will write to colleagues to deal with points that they have raised.
We should remind ourselves about what community hospitals are and why they matter so much. They are local hospitals, units or centres providing an appropriate range and format of accessible health care facilities and resources. There are around 300 in England and they are overwhelmingly owned by NHS trusts, foundation trusts and NHS Property Services Ltd. Where they are wholly owned by the NHS and are needed for service delivery, they will remain in NHS ownership and will not be sold for profit. The sustainability of a community hospital is down to the decision making of local NHS commissioners, regardless of who owns the hospital.
Community hospitals can be invaluable assets that make it easier for people to get care and treatment in their community, as we have heard, closer to where they live. They allow large hospitals to discharge patients safely into more appropriate care, freeing up hospital beds for people who need them urgently, and they allow many patients to avoid travelling to large hospitals altogether, providing a wide range of vital services, from minor injury clinics and diagnostic services to intensive rehabilitation.
Therefore, people are often very protective of their local hospital, and with good reason. In many cases, they deliver a range of essential services, as well as providing employment for local people and often space for community groups and associated members of what one might call “the health big society”. It is understandable that community hospitals are fiercely defended and inspire such loyalty, and that support for local facilities is a sign of the growing appetite for the quiet revolution of patient empowerment and health citizenship at the heart of our vision of a 21st-century health service. That is why everything we are doing in central Government is designed to support local clinicians and patients to change and shape their local NHS for the better, making improvements to primary and community services to suit local needs.
As a result of the Health and Social Care Act 2012, PCTs have been abolished and responsibility for commissioning services has, as we know, moved to clinical commissioning groups and local clinicians are now in control. CCGs are free to commission services that they judge provide the best care and outcomes for their patients and free to work out which services are needed and where they should be located to best meet local needs. With strong local patient and clinician input, the CCGs will also be able to decide which providers are in the best position to offer those services. They—and, I am delighted to say, not the Ministers at the Department of Health or officials at NHS England—will determine whether a community hospital remains open and what services it should provide.
With the abolition of PCTs in April 2013, ownership of a significant number of community hospitals changed. Some were transferred to local NHS trusts and NHS foundation trusts. Other hospitals went to NHS Property Services, the Department of Health-owned property management company. I know some hon. Members—some not here today—have concerns about some of those transfers, which I want to touch on. I want to make it clear that the conditions applying to those transfers mean the hospitals will not be closed unless commissioners determine that they are no longer fit for purpose. As with all decisions about local patient services, it is absolutely right that those decisions are taken locally, taking account of local views.
Sometimes tough decisions need to be taken. Buildings become tired and inefficient. New and better treatment, diagnostics and technological innovations are transforming the way in which health care is delivered, and, of course, communities grow and evolve. It is understandable that sometimes old infrastructure, though much loved by the community, cannot always keep up with the community’s needs. It is right then that commissioners explore how services can continue to be delivered efficiently and accessibly to patients.
That could mean decommissioning a hospital, in part or wholly, and moving some services even closer to the community. It could mean extra investment to modernise and develop existing community hospital centres, such as the development of the new Buckland hospital in the constituency of my hon. Friend the Member for Dover. These are tough decisions about meeting the changing health needs of the local community in the decades to come and it is absolutely right that they should be taken locally, driven by what is best for local people.
I am well aware that some hon. Members have been asked by their constituents about promoting community ownership of hospital assets in order to save at-risk or surplus hospital and clinical space, and I emphasise that all NHS property decisions are driven by clinical decision making by the CCG, and not the other way round.
First, under statutory provisions, while a building is needed to deliver NHS services, no NHS organisation will be allowed to sell it off, so there is no question of useful NHS property being transferred outside the NHS. The commissioners decide that, not the providers. At the same time, that means that a community-owned company is unable to own the freehold of operational NHS property.
Secondly, current Government policy is that property that is surplus to the NHS and the wider public sector should normally be sold by auction or competitive tender. In such cases, a community-owned company would have the opportunity to bid for the property along with other interested parties, but there is no guarantee that the community-owned company’s bid would be successful. However, if they were successful, we need to be clear that it would be in circumstances where NHS commissioners would have already decided that the site is no longer required for health service delivery. It would therefore no longer be operated as an NHS community hospital, but that is not to say an alternative community use could be found for the site. I think that is a key point. We will not necessarily be helping our constituents in advocating community ownership where commissioners have taken a decision to decommission services at particular site.
In conclusion, I want to highlight that the Government and Ministers are absolutely committed to greater diversity, choice and local community influence in our modern NHS. We have taken steps to secure the sites of community hospitals and make sure they are used for the benefit of their community where there is an ongoing use for them. However, the lifespan of those hospitals is solely down to the decisions made locally by clinicians and service providers—the people qualified to make those decisions. That is the best thing for the hospitals themselves, and it is certainly the best thing for the communities we serve.
If my hon. Friends or any other hon. Members have raised specific concerns that I have not addressed or highlighted in my earlier comments, please—
Mr Whittingdale
Just before the Minister sits down, I accept that decisions will be made locally, but I raise again the specific proposal that I suggested was under consideration, of obtaining a new hospital as a benefit of the development scheme. Although that is to be locally determined, it would help enormously if the Minister could at least smile on it and encourage that kind of thinking. If he would like to write to me once he knows a little more about it, I would be very grateful to him.
George Freeman
I am very grateful to my hon. Friend for flagging that point up. It was concealed within my list of exciting and imaginative bold thinking, but I did hear him and I would be very interested to pick that up. I invite him to write to me with the details.
The vision at the heart of our NHS reforms is of an NHS freed from the 20th-century model of health care in which health has been something done to the people we serve when government deems it appropriate, with the shape of health driven from the top down, to a model of 21st-century health care in which services are shaped by local priorities and greater freedoms to innovate and differentiate, combining the local, the personal and the voluntary with the general, the central, the specialist and the world-class. Exciting breakthroughs in diagnostics, remote sensing, e-health and telehealth, and in non-invasive new surgical and informatics technologies are driving new models of integrated health and social care. I believe that it is one in which local community-based hospitals, clinics and health centres will play a key role in the next century.