The Parliamentary Under-Secretary of State for Health (Jane Ellison)
Thank you very much, Mr Deputy Speaker—Madam Deputy Speaker, I apologise.
Jane Ellison
Yes, it has.
I congratulate the hon. Member for Leyton and Wanstead (John Cryer) on securing this debate on issues that are clearly of great importance to him and his constituents. Before I try to address some of the issues he has raised—I have listened carefully to what he has said, and if there are issues to which I cannot respond now, I will certainly take them up with NHS London—I would like to put on the record my thanks to all those who work in the NHS, not only in his constituency but right across the service, for their dedication to providing first-class services to his and all our constituents.
As the hon. Gentleman is aware and as he described in his speech, Wanstead hospital closed in 1986 so the services that are the subject of this debate are provided from the Heronwood and Galleon unit on the site of the former hospital. As he said, it houses 48 rehabilitation beds in two wards, and it is one of three community rehabilitation units providing intermediate care for people in the three boroughs of Barking and Dagenham, Redbridge and Havering. The two other units are located at Grays Court in Dagenham and the Foxglove ward at King George hospital. The proposal put forward by the clinical commissioning groups for the three boroughs is to centralise these services at King George hospital, and that is the subject we are addressing this evening.
As the hon. Gentleman described, the three local CCGs outlined five possible options for the future of intermediate care services in the document issued on 9 July. I understand what he says about the preferred option steering people, but we would also probably be critical if local health leaders did not tell us what their preferred option was. I suspect we would want them at least to tell us what their thinking was in order to guide the public and be transparent. The proposals are currently the subject of a full 12-week public consultation. I understand that he has recently met Redbridge CCG and has expressed his concern, as he has done again tonight in the House, about the current length of the consultation, asking for an extension. That is being considered by the CCGs and I have asked that they respond to him as soon as possible after this debate, having given that further consideration and heard the strength of his feeling on the subject.
On support for the proposals, I know that in June, as partners on the local integrated care coalition, the three local authorities all agreed the content of the intermediate care pre-consultation business case. That includes the case for service change and the proposal for the local CCGs to go to public consultation. Subsequently, the three local CCG governing bodies all agreed to go to consultation and to consult on the preferred option, which we have described. I also understand that the Havering health and wellbeing board is very supportive of the proposals, urging the CCGs to get on with the proposed changes more quickly. Discussions are to be held next week with the health and wellbeing boards for Redbridge and Barking and Dagenham.
The head of nursing at the Partnership of East London Co-operatives has described the proposals in positive terms, and a number of positive comments have been made about the innovative ideas on home care, which the hon. Gentleman has been fair to describe as positive and good for his constituents. I know that in Redbridge the CCG is continuing to engage with community groups, some of which he has alluded to, in order to explain the proposals in more detail, and that is quite right. I was concerned when he said that members of the public locally are not clear about what is happening and do not feel that they are in the know, because these processes should always have at their heart the desire to convey what is being proposed to the public in order that they can comment meaningfully on them.
Under the preferred option, the overall number of rehabilitation beds provided would reduce from 104 to 40, with the capacity to increase to 61 should the need arise. On the face of it, that does sound like a very significant reduction, and I can understand why the hon. Gentleman and other local people may be concerned when they hear those figures. Local people needing intermediate care have generally been cared for in beds at community rehabilitation units, which means that the number of intermediate care beds across his area is relatively high compared with many other areas. However, I am advised—he made mention of this in his speech—that many of those beds are not being used because there is insufficient demand. The latest bed figures for August show that 49 intermediate care beds—47% of the total capacity—were unused across the area for that month. I note that he disputes those figures, and he makes a fair point about the waxing and waning of demand across the year. I would certainly hope that the local clinicians and managers who put these plans together would take into account those shifts in demand across the year.
The CCGs have also heard from the public that people want to be cared for and supported in their own homes wherever possible. That is a consistent message we get from the public across a range of health services. Keeping people at home helps them to stay independent for longer, and they recover just as well, and in some cases better and more quickly, at home. That is why the CCGs are developing a model of care where people are cared for and supported in their own homes, not in hospital. That model has been developed by clinicians, with, properly, input from patients and carers. However, patients who need a community bed will still be able to get one. The CCGs believe that concentrating all the rehabilitation beds on one site is the best way to develop high-quality care for the hon. Gentleman’s constituents and other patients who need to stay in a rehab unit.
Clinicians locally believe that that is the safest way to provide care and the best way to provide care of consistent quality. Concentrating the service on one site would enable staff to maintain their practice standards and share expertise more easily. The hon. Gentleman referred to the fact that the CCGs have been trialling two new services—the community treatment team and the intensive rehabilitation service. The community treatment team provides short-term intensive care and support so that people can be cared for in their own home, rather than in hospital. That is something that my constituents, his and other Members’ constituents say all the time: they would much prefer to do that. The intensive rehabilitation service provides support, such as physiotherapy, for people in their own homes and further reduces the need for patients to stay in community beds.
Figures for the last seven months are very encouraging. They show that nearly all patients supported by the community treatment team—90%—do not go on to be admitted to hospital. There are important issues to consider such as knock-on effects and the sustainability of local health services. The intensive rehabilitation service is similarly successful, with 90% of patients able to recover at home without needing to go to hospital.
Before the trial of the new services, patients waited an average of five days to access bed-based care. Since the trial, patients are able to access community beds or the intensive rehabilitation service in less than two days on average. Most people who need the community treatment team are contacted within two hours. We should pay tribute to the innovation that has taken place and to some excellent local service delivery.
I understand that patient satisfaction ratings for both the new services have been consistently high across the three boroughs since the trials began. The results of the latest satisfaction survey, published in June, were taken from patients recently discharged from the community treatment team, and it is good to hear patients being positive about their experience. In Redbridge, patient satisfaction with the service scored an overall average of 9.5 out of 10; 94% of patients and relatives said they would be “extremely likely” to recommend the community treatment team service to family and friends—the new family and friends test is being introduced across the NHS and is a good measure of what people really think of the service—and 100% of community treatment team patients were responded to within two hours.
Most of the patients surveyed felt that they either would have attended A and E or would have been admitted to hospital if that service had not been available, which goes to my point about the sustainability of local acute services. Since the trial started, 7,600 patients have been seen by those two new services, 1,000 from Redbridge. Only 1,300 patients would have been seen in a “beds only” service. Therefore, we can see service change bringing great quality of service to the hon. Gentleman’s constituents and others in the area.
Demand for rehabilitation beds has further reduced during the trial of the new services as more people are being cared for at home. I am advised that, during July, 46 of the available 104 beds were unused, as I have mentioned.
The Government are clear that reconfiguration of front-line health services is a matter that should be led by the local NHS. It is best placed to know the needs of local people and it knows how to deliver them. Putting the patient first is central to that, although it always concerns me when hon. Members bring to the House their worries that consultation and transparency have not been as good as they could be. I note the hon. Gentleman’s points, as will local health leaders, with concern. I know that they have met him on a number of occasions. I am sure that we will meet him again to take up those points, but at the heart of reconfiguration is the all-important issue of putting patients first and delivering a better service for all patients. The NHS in London, as elsewhere, has to constantly evaluate the way in which services can best be tailored to meet the needs of local people and improve standards of patient care.
I recognise that proposals for service change inevitably arouse public concern, and that is why it is important that we get consultation processes as good as they possibly can be. It is absolutely the role of hon. Members to express those concerns, to hold all of us who are involved to account, to engage with local clinical and operations leaders and to test the NHS’s response to those concerns.
I know that the hon. Gentleman has both corresponded and met senior staff from the local NHS, and I have met local health leaders, and I hope the response he received from the chief officer of Redbridge clinical commissioning group has gone at least some way towards addressing his concerns about the proposed reconfiguration of intermediate care services. The consultation on the proposals is open until at least 1 October and, as I said earlier, an extension is being considered. I undertake after this debate to further draw to the attention of local health leaders the strength of feeling the hon. Gentleman has expressed tonight about the need for more time for him and his constituents, but I urge him to participate and to make his constituents’ views known during the course of that consultation, as he has done tonight in the House.
Question put and agreed to.