The Parliamentary Under-Secretary of State for Health (Ben Gummer)
I thank my hon. Friend the Member for Bedford (Richard Fuller). As a fellow Member of Parliament for a county town with distinct and important interests, I recognise his campaigning work. I know the pleasures and vicissitudes of representing a town such as Ipswich or Bedford and can see why he feels so passionately about this subject and why he continues to fight for the good of his hospital.
It is no wonder that Bedford hospital is held in such affection and high regard by the people of that town. It was founded in 1803 by Samuel Whitbread with a bequest of £8,000, which was not inconsiderable at the time, and three physicians—if only we could provide healthcare on such limited means now. That long history has clearly placed the hospital at the heart of the community. I can quite see why the charitable and community efforts that go into the hospital are so considerable.
My hon. Friend is right to point out that Bedford hospital is classed as requiring improvement by the Care Quality Commission. Although the CQC recognised that there were areas that were good and, most importantly, that the hospital was good at caring for patients, significant areas required improvement. I know that puts it with the majority of hospitals in this country, but it does not put it in a good place. The point of having these scorings by the CQC is to ensure that we can measure progress, so that hospitals across the country improve and become better at what they do.
All of us agree that the current quality of care provided at Bedford, as with other hospitals that require improvement, is not good enough and that something needs to be done about it. I know that my hon. Friend has not shirked that responsibility. In his speech, he made it clear that there are areas of clinical care, which are currently provided outside the county, that need to be provided because of the nature of the change in medical technology. They are provided outside the county because of the need to have clinicians doing work on a regular basis, which they cannot given the relatively limited population base. My hon. Friend’s hospital serves about 280,000 people, which is a small population for a district general hospital. Therefore, it is impossible for it, as it is for my own hospital, to provide the full panoply of services. That means that, in the future, the kind of services it provides will change. I hope—and this is the intention of NHS England—that, in some areas, it will increasingly do more of the work that was otherwise done at a regional level and that we will begin to see services in Bedford hospital that have not been provided there before.
By the same token—to take one particular clinical example—I imagine that the advance of stroke medicine will mean the establishment of major stroke centres, as we are seeing in London. The new technologies, which are currently very little used in the NHS, will require investment of a kind that we have never before had in stroke medicine, and that will have implications across the country. We must be honest about that, because it will require moving services so that people can have access to better treatment and therefore a higher likelihood of their lives being saved.
My hon. Friend is also right to say that the hospital has a deficit. Many hospitals in the NHS do so. Some manage their finances better than others, and there is a close correlation across the NHS between those hospitals that run their services well and those that run their finances well. The hospitals that are scoring outstanding ratings from the CQC are the ones that run their finances best. Those that cannot run their hospital well and are classed inadequate are those with the biggest financial problems. Given the fact that there is a standard formula across the country, that is to do with the internal management both by clinicians and managers, and not to do with differences in funding.
Clearly, there are issues with the quality of care at Bedford, and the future will be secured at that hospital only if, like other district general hospitals across the country, it can evolve, change and respond to changing medical technology and best practice. It also needs to provide new and additional services and to play to its strengths. One particular strength that I wish to highlight, because it is fantastically provided in Bedfordshire as a whole, is end-of-life care. It is noticeable that it was rated good by the CQC and clearly plays a part in the system-wide approach to end-of-life care, which I have held up to people across the country as a symbol of how to get it right, rather than wrong.
I will have to disappoint my hon. Friend in this regard: I cannot comment on the specifics of the reviews. There are two reasons. First, reconfigurations do not concern the Department. They are to be done locally; that is the point of reconfigurations. I will talk about the generality of that later, but I cannot direct one way or the other how that reconfiguration should happen.
I completely understand my hon. Friend’s frustration. He has been let down, and his community has been let down. This has been going on for far too long—its current phase goes back to the mid-2000s. That is not acceptable. There is one thing worse than making a bad decision or a mediocre decision, and that is putting off making a bad or mediocre decision and putting everything into chaos in the meantime—something on which we can reflect on a larger scale at the moment. If we do not move forward with proposals, we are not changing the hospital in the way that it might need to be changed or responding to changing circumstances. That means that in the end we create greater instability, and instability itself is a bigger problem for the hospital that might or might not remove one or two services.
That is not to say that I endorse whatever plan comes out from the joint committee, or to say anything otherwise, but I am absolutely determined that reconfigurations, as they happen around the country—and continue to happen through the NHS—should abide by the principles of reconfiguration. They should be independent, they should be clinically led and they should reflect the full gamut of clinical opinion across any area. They should be cognisant of the wider interests of the NHS; it is not right to be able to reconfigure something that has detrimental effects on neighbours. That is how our system works. They should also be expeditious, and this is where we have singularly failed over the whole history of the NHS. People hang around, they do not make decisions, they vacillate, and consequently when decisions are made they are often out of date, even if they are right.
This is where I hope that the STP process correctly identified by my hon. Friend will help. The chief executive of the NHS, Simon Stevens, has made it absolutely clear that we need to ensure that we have consistent, rigorous plans that have the agreement of the central bodies but are locally driven, that have the buy-in of all the local organisations involved in healthcare and that actually happen, so that they will happen within the period of the five year forward view, into which we are 18 months advanced already. That is why, whatever happens, the joint committee’s report needs to work with the STP when it is eventually published and agreed. The two need to work together; we cannot have two separate plans. It will be impossible to do that, and that goes for the situation across the country. We cannot have one plan that is not reflected in the STP.
I would encourage my hon. Friend to continue his hard work and that of his council to influence how the STP is formed and to bring maximum pressure to bear to ensure that it reflects the wishes of local people, so that the STP is something into which everyone can buy and so that it is realisable.
I want to reflect quickly on the generality of mergers. My hon. Friend spoke about the relationship with Milton Keynes. Again, it is not for me to make a determination on whether that is the right or wrong thing, but the whole NHS needs to get out of the rut of feeling that mergers can happen only between two neighbouring places. Often, it is the right thing to do, but being neighbours does not always make it the right thing to do. I would be as happy to see a relationship between Bedford hospital and another outstanding hospital elsewhere in the country if that was the right thing for Bedford.
Realistically—this is the same for my hospital as for others—we will have to see scale, not only so that we can better manage overhead costs but so that we can spread good practice, which is something that the NHS has been terrible at doing throughout its history. Some of the experience of the emerging chains elsewhere in the country—I point my hon. Friend to the work of Sir David Dalton at Salford royal hospital and the remarkable work done by Jim Mackey at Northumbria NHS trust—shows the advantage of creating partnerships, which would secure Bedford’s future and ensure that Samuel Whitbread’s original vision lives on into this century and therefore into the third century of the hospital’s foundation.
I thank my hon. Friend for bringing these important local issues to the attention of the House. I share his frustration. He is right in his analysis that this has taken too long. None of us in the House is able to determine the clinical adequacy, or not, of the plan as it emerges, but I impress on local commissioners and NHS England that we must ensure that a plan is agreed locally as quickly as possible and just to get on and do it, so that we stop this indecision and vacillation, which has clearly caused local people in Bedford such concern over so many years.
Question put and agreed to.