Health Provision (South Gloucestershire)

(Limited Text - Ministerial Extracts only)

Tuesday 14th July 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

As ever, Mr Hollobone, it is a pleasure to serve under your chairmanship. This is my first Westminster Hall debate of the new Parliament; I responded in the last Westminster Hall debate of the last Parliament. It is nice to be back responding to a debate. It is nice to respond to a debate from my esteemed colleagues, my hon. Friends the Members for Filton and Bradley Stoke (Jack Lopresti) and for Kingswood (Chris Skidmore), and my new colleague, my hon. Friend the Member for Thornbury and Yate (Luke Hall), but I am sorry that we are revisiting themes that have been much discussed, both in private and in debates in the Chamber. My hon. Friends are, as ever, doughty champions for their local healthcare system. It is fair to say at the outset that I share some of their exasperation with regard to the timings that they expressed. I will revisit some of the history of the health service reconfiguration in the area and respond to the specific points they made.

I congratulate my hon. Friend the Member for Filton and Bradley Stoke on securing the debate and my other hon. Friends for coming to the Chamber and responding to the issues that were raised. This is a matter of long-standing importance—perhaps too long-standing, which is the thrust of what has been said today. I am sure that I speak for all my hon. Friends in saying that whatever the frustrations with the administration of healthcare in their local area, we have nothing but praise for the NHS staff who assiduously look after our constituents day in, day out.

The Bristol health services plan is the background to much of the issue. As my hon. Friends will be aware, the local NHS in Bristol, North Somerset and South Gloucestershire agreed the Bristol health services plan, which was a 10-year strategic plan to modernise and improve healthcare services across the area. It was the basis for developing a series of integrated proposals, including a new acute hospital for north Bristol and South Gloucestershire on the Southmead site, which opened in May 2014 following the transfer of acute service from Frenchay; and the new community healthcare facilities in South Gloucestershire, including the plan for a community hospital on the Frenchay site. In addition, the plans included the centralisation of some surgical specialties across the city, in a pattern now familiar to those following NHS reform, to concentrate specialisms and excellence at certain sites.

In 2010, the South Gloucestershire Primary Care Trust presented its emerging themes proposals for the development of a health and social care centre at Frenchay with community in-patient facilities, but the trust did not really deal with the affordability of those proposals in any detail. Indeed, it was noted at the time that there was no new funding available for the project and that it would require reinvestment of existing resources.

A business case was subsequently developed by North Bristol NHS Trust in 2011 for Frenchay, resulting in proposals that were considered unaffordable in the context of the financial challenges faced by the local NHS. In addition, those proposals would have limited the scope for the development of new community-based services in the long term. The commissioners made it clear that further work was required to ensure that the model for the delivery of services was in line with best practice.

One of the frustrations about a situation that has developed over such a long period is that it is overtaken by new models of care, and this whole debate is overshadowed by the fact that the Keogh review of urgent and emergency care, which aims to establish the ideal model for delivering that care, is relevant. Moreover, there are emerging best practice NHS views about how we provide community care and how different models work. As I say, one of the frustrations about a situation developing over such a long period, and which has been subject to delay, is that it tends to be reinforced because new models of care emerge all the time, which require plans to be revisited. That has been one of the sources of frustration.

It was against that backdrop that a major review of rehabilitation services was launched, in conjunction with local commissioners. The review of rehabilitation and reablement services across Bristol, North Somerset and South Gloucestershire commenced in October 2012, with involvement from both NHS and local authority providers. Significant progress was made in agreeing a clear and consistent vision for that future model, which was largely a service-focused response built on the involvement of a number of local stakeholders. South Gloucestershire clinical commissioning group developed a detailed local model of care for rehabilitation in August 2013, building on the rehabilitation and reablement review.

The implementation of that model of care began in 2013 in a phased approach, and there have been a number of developments to date in relation to the review. For example, rehabilitation community beds were located at Elgar house on the Southmead site and at Thornbury hospital. I must stress, however, that these are interim arrangements until long-term plans for community beds at Frenchay and Thornbury are put in place. I have already mentioned the frustration about timings, and that frustration was expressed during the debate. However, it is the current position that these are interim arrangements.

Further developments include the new community rehabilitation and reablement beds that have been commissioned in local care homes, with new in-reach support services in place for individuals in these residential rehabilitation beds, and additional community reablement services have also been commissioned.

What is the current position? Over the past 10 years, many of the proposals in the Bristol health services plan have been implemented, together with a number of major additional developments. It was good to hear my hon. Friend the Member for Filton and Bradley Stoke speak about the new state-of-the-art hospital at Southmead, although there have been challenges in some areas. There is also a new community health care facility in Yate, which he also referred to, as well as a new NHS independent sector treatment centre in Emersons Green.

In addition to those developments, a £19.6 million refurbishment of Cossham hospital has been completed. The hospital reopened in 2013 with the area’s first midwife-led birth centre. My hon. Friend will be aware that Cossham hospital had originally been due to close, so was not part of the proposals in the Bristol health services plan. That is, if you like, a gain on what was originally proposed, and one that I know has been welcomed.

Over the past two years, local clinicians have continued to lead the major transformation programme for rehabilitation services. I am assured that providers, patients, members of the public and other stakeholders have been extensively involved in that programme. I very much hope that other stakeholders, including MPs, are involved. I often say in debates such as this one that it is absolutely essential that local NHS commissioners, including CCGs, work closely with MPs. It is often forgotten that MPs are a first point of contact for people who are concerned about the process of reform, whether they are frustrated by the timing of the process or worried about its relative opaqueness.

South Gloucestershire CCG has confirmed that it has made significant progress towards implementing that programme, which includes providing community beds in local care homes with in-reach support from NHS teams. As part of the next major transformation of rehabilitation services, in March, the CCG began procurement for services that are expected to lead to the redevelopment of the Frenchay and Thornbury hospital sites. As my hon. Friend said, the timetable published with these plans describes a procurement process that is expected to result in the award of a contract by March 2016. This is a good opportunity to provide an integrated health and social care development on the Frenchay site.

I understand the frustrations that are felt locally, including by my hon. Friends who are here today, about some of the timings involved. The CCG has confirmed that it understands the concerns felt by some members of the community. I will follow up this debate by writing to the CCG and asking it for more detail about the timings, because I am concerned to hear talk of 2018 or 2019. At first glance, it is quite hard to get one’s head round that timetable, so I will follow up by asking for more detail, and I will report back. This is a complex project, involving a lot of partner organisations that are co-ordinating multiple developments across a number of sites. Nevertheless, we need to have a bit more detail about how the timetable might slip by one year and potentially by another year.

The CCG has confirmed that it is determined to deliver transformed services that meet future health needs in line with current best practice, but any plan needs to be financially affordable. As I have already said, we need to ensure that plans are not constantly overtaken by new models, although the model based on best practice is much more settled than previous models and is in line with recent NHS England thinking and the five-year forward view, which is a very helpful road map for the health service for the next five years and which everything else relates to.

Regarding the minor injury unit plans, as my hon. Friend knows, South Gloucestershire CCG has decided to revisit those plans to take account of local evidence about their impact on accident and emergency attendances. Those plans are looking at key themes emerging from Sir Bruce Keogh’s national review of urgent and emergency care. That work is ongoing, but it is reshaping the way that the NHS thinks about urgent and emergency care, and it influences all the models of care that are being considered, with patient care at its heart. I can understand why the CCG believes that enhancing primary care services would help to improve urgent care services for the whole population, but what is needed is clarity about that process and about how it will be assessed.

Last October, following a period of engagement with the public, proposals were put forward and it was agreed that they would be developed on a pilot basis with the GP practice-based injury services described by my hon. Friend. The CCG is working with local GPs and community providers to agree detailed plans, but in my follow-up letter to the CCG after this debate I will ask for more information about those plans and the process of assessment for that pilot, which will feed into any final decision that is made. That work will include further discussions with local GP practices, but I will stress in my communication to the CCG that it must involve detailed discussion with local MPs, particularly when those MPs have been so assiduous in following this process, not just through one Parliament but now into a second Parliament. It is absolutely vital that my hon. Friends are kept informed and involved.

Subject to successful completion of that work by the CCG, plans are expected to be presented for approval to the September meeting of its governing body. I stress that a formal decision in relation to the previous plans for a minor injuries unit at Cossham hospital will be made once the proposed pilot scheme has been evaluated. Subject to the details being agreed, the pilot scheme is expected to commence in late 2015 and it will run for a minimum of 12 months, with evaluation that will include consideration of feedback from patients. Again, I expect local MPs to be closely involved in that process.

A number of challenges have been made to me, and hon. Friends have asked me to follow up on them. I will look to see where I can do so. More generally, as we have discussed before in Westminster Hall and in the main Chamber, it is the responsibility of local NHS organisations to determine how local services are delivered. They are best placed to understand the needs of the people they serve, but what this process has drawn out is that over time those needs can change and evolve, and our understanding of how best to respond to them must change and evolve. Nevertheless, we need to ensure that we are at all times moving forward, because local people do not really understand why things seem to be endlessly put into review and re-examined.

NHS England has rightly placed more emphasis in recent times on how it can provide support to parts of the system that are struggling to make progress at a pace that we would all recognise as ideal. Part of my follow-up to this debate will be to ask whether NHS England can provide any extra support to help to ensure that there is a clear timetable, which is well understood and which everyone can talk to their local community about. I will do that in my follow-up, and I will write to all three of my hon. Friends after this debate. As ever, I commend them for their interest in this subject, and I hope that we can see considerable progress in the early years of this Parliament.

Question put and agreed to.

Resolved,

That this House has considered health provision in South Gloucestershire.