(7 years, 8 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
It is an honour to have finally been successful in the debate ballot and to bring the issue of the proposed closure of in-patient care beds at Rothbury community hospital to the House and to the Minister today.
Rothbury is a thriving small town at the heart of the Coquet valley community in my constituency, in Northumberland. The valley is a large, very rural and sparse community of over 5,000 people across hundreds of square miles, and it runs from the A697 at its eastern edge across to the Cheviot hills and the Scottish border to the west. Small villages and hamlets are dotted across traditional agricultural territory with mainly upland sheep farms, some of which are within the Northumberland national park and the Otterburn Ranges—the Army’s largest training base in England.
Families’ commitment to living in this idyllically beautiful but quite challenging day-to-day environment is vital to the land management necessary for our tourism, our farming and our military needs as a nation. Over 30% of those living in the valley are over the age of 65—a figure that will only grow, as Rothbury and the surrounding villages are wonderful places to retire to or for people to stay in long after their children have flown the nest. Therefore, we must plan for the right long-term, sustainable healthcare offer for this close-knit community of families and businesses and for the unique challenges they face.
The local community hospital has, until now, provided 12 in-patient beds, primarily for palliative, post-operative recovery and respite care. The clinical commissioning group reviewed activity data last year as it brought in a system-wide approach to discharging patients home, and average bed occupancy in Rothbury was 50% through 2015-16. The CCG declared that to be too low to be sustainable.
As a result of nursing workforce challenges across the Northumbria healthcare trust—albeit that we face fewer challenges than the rest of the UK, thanks to our excellent forward-thinking trust, doctors and managers—the reality is that we do not have the nursing capacity adequately to cover the 12 in-patient beds at Rothbury at present. A combination of those workforce challenges, and the under-occupancy concerns cited by the CCG, meant that the use of those in-patient beds was suspended temporarily in September 2016.
Where I part company from our hard-working CCG on this issue is that I believe that those beds have been empty not because of a lack of demand, but because decisions have been taken to send people home to receive community care, or to Alnwick infirmary to receive in-patient care. As a result, Alnwick infirmary has been running near to capacity for some time, and those in the north and east of my constituency who might otherwise have been sent there have been forced to remain in the urgent care beds at the UK’s first specialist emergency care hospital at Cramlington— our new specialist care hospital for the whole of Northumberland and north Tyneside—for longer, placing greater strain and expense on our healthcare system than necessary.
If this in-patient ward is permanently closed, that will have negative impacts on my Coquetdale community and greater financial implications for our NHS across Northumberland. In particular, the challenge is that we do not have anything like enough community nurses and carers adequately to support those older patients who are sent straight home with their transition back to independent living. It has always been a challenge for our community teams, working across rural Northumberland, to see anything like the number of patients in one day that they would see if they were based in a town or a city, because our CCG is not funded to commission enough community nurses to genuinely provide the amount of care to meet the extra challenges that this sparse and disparate community generates. If a community nurse needs to visit someone three times a day but her other patients are 30 miles away, she will make three or four visits a day rather than the 10 or so that an urban-based community nurse would be able to make. Many of our older people who have received medical interventions live alone or have elderly partners who are no longer able to be full-time carers themselves. The value of a step-down care transition provided by a few days of recuperation at Rothbury community hospital would have medical as well as psychological value for these communities.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate my hon. Friend on the powerful case she is making for her rural constituency. Has she been able to compare and contrast the cost of a community hospital bed with the cost of a bed in the district general hospital to which she referred? I suspect that she has done so and will have found that there is a yawning difference between the two—a very good argument for community hospital beds.
Mrs Trevelyan
I thank my hon. Friend for making that point. This issue is critical, and it has brought some confusion to the community, who felt that the financial model did not seem to make sense. Why keep someone in a very expensive acute bed for longer than necessary if there is the capacity to have a local relationship with nurses who know the community very well? This is part of the CCG’s work, obviously, but we need to be very clear about it to be sure that we are not making a bad financial decision in the longer term.
As a result of this consultation, residents across the Coquet valley who have needed admission to an acute ward may well now find themselves staying longer than necessary on that acute ward; being re-admitted to an acute ward for lack of adequate rehabilitation care at home; sent home with inadequate support from an over-stretched community nursing service; or, at best, sent to recuperate in a different community hospital much further from friends and family, placing extra pressure on alternative populations needing to use that provision.
When, back in September, the decision was taken to temporarily suspend admissions to Rothbury community hospital for a period of three months, I wrote to every household across the valley calling on them to share with me their own experiences and concerns about the proposed threatened closure of the in-patient beds. The message came back loud and clear that being near family and their own community while they recuperated, or ending their days with dignity and privacy in the valley they have lived and worked in rather than dying at home alone, is invaluable. I know that this Government want our world-class NHS to provide not only the best medical interventions but the respect and provision of dignity for every patient while they are under its care.
The Coquet valley is frequently cut off during winter months, making travel to Alnwick infirmary to see loved ones receiving care especially difficult and sometimes not possible at all. Even during the summer months, there is little public transport to connect the valley and Rothbury to Alnwick. The ability of loved ones to visit patients receiving care at Rothbury community hospital was cited time and again to me as one of the primary reasons the in-patient beds are so vital to my constituents. The value of our community hospitals is often overlooked and certainly cannot be quantified when, too often, consultants have not been made aware of their option to transfer patients to receive care in Rothbury.
My constituents have come together in an extraordinary show of unity to speak in one voice under the banner of the Save Rothbury Hospital Campaign—4,500 people have signed the petition calling for the reopening of the ward. Our CCG has worked closely with the campaign team, for which I thank them, particularly Dr Alistair Blair, who has so many pressures on him and his team at this challenging time, and has invited us to bring forward a proposal that would see the beds made available for step-down and end-of-life care. I am concerned, however, that the CCG is telling me that because it does not commission respite or palliative care services, these cannot be part of a sustainable solution, as the valley residents would hope.
Northumbria Healthcare NHS Foundation Trust is one of NHS England’s vanguard trusts with its sustainability and transformation plan, and it will be the first accountable care organisation in England in the coming months, so surely we should be able to ensure that integrated care can work in one of our most challenging geographical locations. The University of Leeds is currently conducting a study called, “Cost Structure and Efficiency in Community Hospitals in the NHS in England”. The Public Accounts Committee, of which I am a member, regularly challenges NHS England on how it spends taxpayers’ money to deliver the best integrated health and social care provision. I know that the Minister is working hard to drive this forward, and we encourage him to go further, but until the results from the University of Leeds are published, the Minister has little economic evidence of the value of the intermediate care provided by community hospitals with which to work on the sort of sustainable solution that I want to see for our community hospital in Rothbury.
Dr Murrison
My hon. Friend is being generous in taking interventions. I am interested in the study to which she refers. Does she agree that a likely outcome of the configuration of healthcare in the longer term will be increasing specialisation at really quite large district general hospitals? If that is the case, there will be an even greater need for community hospital beds—step-down, step-up care—otherwise people’s only access to in-patient care will be at one of the huge regional or sub-regional centres that I suspect our NHS will be developing in the years to come.
Mrs Trevelyan
I thank my hon. Friend for his comments. We are unwittingly seeing what he suggests already. In Northumberland, we have an extraordinary specialist A&E hospital, with which we have led the way in England. It has drawn much more attention and patient focus than perhaps any of us expected, because there in one place are all the specialisms, with the best maternity care. The result is that patient needs have migrated to it.
However, we now rely much more than we should on sending patients straight home, whereas we should be using community hospital beds to provide the best step-down care for our older people, in particular, who really need that support to get back home. Getting home, getting up and about, making their own cups of tea, moving around and avoiding the risk of muscle wastage caused by staying in a hospital bed are real issues for them. As medical science moves on and that becomes more and more clear, in-patient bed units in community hospitals should probably adapt to reflect that. Such units must help to preserve the mobility of people who are taking that step-down approach to going back home; the term “in-patient bed” should not mean that they are stuck in their beds. We understand that continued movement and redevelopment of muscle are important in rehabilitation, and we must absolutely make sure that patients are not left in the wrong part of the NHS when they are trying to get back home after extraordinary medical interventions. Those interventions are now developing very quickly and giving us the opportunity to live much longer.
I therefore call on the Minister to pause the CCG’s consultation and the plans to close permanently the in-patient beds until the results from the University of Leeds have been published. Northumbria Healthcare NHS Foundation Trust is leading the way in establishing an accountable care organisation—a model that many people buy into and understand the value of. We all instinctively assume that the NHS is one block, but of course it is not; it has always been made up of separate parts, which work better or less well depending on where they are. The accountable care organisation offers a real opportunity for streamlining and making the flows work much better. We will be the first to do that in Northumberland, so we should be the beacon for fully integrated community care—making the best use of our taxpayers’ money and ensuring that my constituents have the most appropriate and supportive care framework —rather than being a victim of the short-term workforce challenges with which the NHS is struggling.
The Minister of State, Department of Health (Mr Philip Dunne)
I congratulate my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) on securing the debate. She is a doughty champion of her constituents’ interests and, particularly in relation to Rothbury community hospital, she has played a leading role in championing their interests in achieving the best outcome for patient care in the valley of Coquet—this was the first time I have heard that pronounced properly and I am sure I have not done it justice. She gave a thoughtful and considered speech, to which I shall endeavour to respond.
I will first rehearse the facts that have led NHS Northumberland clinical commissioning group to undertake the current consultation. In July last year, it set up a steering group to consider the use and function of community hospital beds in Northumberland. That group studied activity data and considered a model of care that reflected a drive set out by the NHS chief executive Simon Stevens in the five year forward view, which my hon. Friend will be aware of, to encourage the delivery of as much care as possible as close to the patient as possible—preferably in their homes, or at least out of hospitals, where appropriate.
We have had a geography lesson, with an interesting description of some of the challenges of living in the part of Northumberland centred on Rothbury, including the fact that the valley gets cut off from other parts of the county from time to time during the winter. Local factors undoubtedly need to be taken into account by the local commissioning group both when it sets out a consultation and when it responds to the results, and I am sure it will do so. Frankly, that is why we think the people best placed to plan the patient experience of care for the future are those who have direct responsibility for that community. As my hon. Friend knows, that is very much the direction of travel of this Government in supporting the five year forward view and the move to more local determination.
The steering group agreed that any new model should avoid any unnecessary or avoidable hospital admissions, and ensure that patients are discharged home in a timely manner once medically fit. The challenge for the Rothbury community hospital has been the relatively low use of its in-patient beds. Having discussed the issue with the CCG, Northumbria Healthcare NHS Foundation Trust, which runs the hospital, decided for operational reasons to suspend in-patient admissions from 2 September 2016, initially on a temporary basis. The staff were redeployed to ensure that nursing skills were used to support other parts of the Northumberland healthcare system, in which nursing vacancies were running at a high level and there were difficulties with recruitment.
I understand that, following the announcement, a comprehensive review of activity was initiated last autumn and a series of local engagement sessions was arranged. The review looked at the activity rate of the 12 in-patient beds at the hospital. It found that there had been a steady reduction in the number of beds used from 2013 to 2016. The overall bed occupancy at the hospital fell from an average of some 66% of beds in 2014-15 to 53% in 2015-16 and 49% in 2016-17. I am told that, at times, the rate was closer to 35%, meaning that only three or four of the beds were used although the ward was staffed to cope with a higher occupancy rate.
During that time, the trust has provided an increasing level of care outside hospital and in people’s homes, for example through services provided by community nurses and the short-term support service. There has also been an increase in the number of people receiving long-term care packages in their own homes. The ambition to encourage people to lead independent lives as much as possible and to stay out of hospital when possible, because in that way they have a better prospect of maintaining independent living, is working in Northumberland. Regrettably from that perspective, the community hospital is seeing the consequence of such success: fewer patients need in-bed care in the community hospital.
The decision was subsequently taken to close the ward and to undertake a three-month public consultation, which began on 31 January. The consultation asked for views on whether to close the ward permanently, and on whether to change the services undertaken there, so that a health and wellbeing centre on the hospital site could offer a range of services in addition to those currently available and provide treatments for a wider range of patients than are presently served by the in-patient beds alone.
My hon. Friend asked whether the current consultation, which is running to 25 April, could be extended. It is not for me to direct the CCG how to undertake its consultation, but she referred to interest in the locality about the future of the hospital. That does not surprise me at all, although I am impressed that as many as 4,500 local people have signed the petition. I strongly encourage as many of them as possible to participate actively in the consultation so that the decision makers are aware of the views of the local people whom they serve.
I also encourage local people to suggest what other services they might find beneficial. My hon. Friend suggested palliative and respite care as possibilities. She is right to say that those services are not currently provided by the trust, as they are not within its mandate, but in the event that Northumberland becomes one of the pilot areas for the new type of accountable care organisation, it will be up to all the organisations that are providing care in the area to work together, and the existing palliative and respite care providers could work with the commissioners and other providers to look at all the options. I very much hope that she will encourage those organisations to participate in the consultation as well so that that is factored into the decision making.
At present, I can give my hon. Friend one piece of reassurance: we in the Department of Health have very high regard for Northumbria Healthcare NHS Foundation Trust. It is one of only six non-specialist acute trusts in England rated as outstanding. It has some of the best performance data on treating patients and local residents of anywhere in the UK. It is meeting all three of its key cancer targets and exceeding the 18-week waiting time targets. The numbers of operations and treatments provided are much higher than they were, and they are happening more or less within target. The number of operations at the trust has gone up from 71,000 to 80,000 in the past six years, and the number of diagnostic tests increased from 98,000 to 164,000 between 2009-10 and 2015-16. That all demonstrates that the trust is coping with increased demand remarkably well.
As my hon. Friend rightly said, the new hospital at Cramlington, which I have driven past in a former life but have yet to visit with my present responsibilities, is an exemplar of how concentrating specialist hospital services in one place can lead to better quality outcomes for patients. It is hard for me, at this distance, to judge what direct impact that is having on the community hospital, but it might be a contributory reason to why fewer in-patients need to go to the community hospital for their rehabilitation.
I encourage my hon. Friend to focus on the choices that are being considered across Northumberland, as they affect Rothbury, but also to look at the way in which Rothbury patients can help themselves by encouraging Northumberland’s highly regarded health leadership to reshape services to provide a facility that serves more of the local community than has been the case. Indeed, one reason why that leadership is highly regarded is that it has a reputation for listening to what local opinion formers are saying, as she pointed out. Whether or not those changes should include the continuing use of in-patient beds is something that will have to come out of the consultation.
My hon. Friend asked about the study by the University of Leeds. I will be very interested to see what that study reveals. Like my hon. Friend the Member for South West Wiltshire (Dr Murrison), I represent a rural area, so I know that these issues are not unique to Northumberland, as he rightly said.
The results of the consultation are expected in April. I cannot give my hon. Friend the undertaking on extending it that she is looking for, but there will be a period during which the CCG reviews its response. Hopefully the study to which she refers will have concluded and it will be possible to take it into account before the CCG responds formally. I am not familiar with the timetable, so I cannot make an absolute commitment on that, but it seems to me to be a relevant consideration. I shall encourage the CCG to at least investigate whether that would be possible.
I conclude my remarks by encouraging my hon. Friend to continue to engage with the CCG.
Question put and agreed to.