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The Minister for Health (Edward Argar)
It is a pleasure to serve under your chairmanship, Sir Charles, in a sense for the second time. In my first Committee post in the House, when I was first elected, I served under your chairmanship on the Procedure Committee.
I congratulate my hon. Friend the Member for Newton Abbot (Anne Marie Morris) on securing this debate on such an important subject, and one that I know she has taken a close and long-standing interest in on behalf of her constituents, for whom she is a very strong local voice. From the outset, I pay tribute—I suspect with her—to the amazing work during the pandemic that has been done by not only all those working in our NHS but those in her local trust and hospital. I hope I might prevail on her to pass on my thanks to her local team.
As my hon. Friend set out, Teignmouth Community Hospital is part of Torbay and South Devon NHS Foundation Trust and provides health and care services to patients across Teignmouth and Dawlish. She set out their work very clearly in her speech, alongside a very helpful exposition of the broader health and social care context in the area in which she serves as the Member of Parliament. She recognised it, quite rightly—I hear her plea—as a whole system, and the broader picture, rather than as individual siloed parts of a health system. In the past, she and I have had the pleasure of discussing what she cares deeply about, which is the future evolution of health and social care as a coherent single model. I hope that it will not be too long before we can have those conversations in person again in this place.
As part of its work on ensuring that services across Devon are, as the CCG sees it, fit for the future and fully address the aspirations of the NHS long-term plan, the CCG, as my hon. Friend says, has been reviewing how services are provided and how to best integrate services in order to make improvements for the most vulnerable people in the communities that it serves. Considerable progress has been made in this area, for which I highlight the work of the CCG.
However, the ongoing review process has highlighted that three main cases for change remain, in the view of the CCG: that the joined-up community care now provided means that, in the CCG’s view, the 12 rehabilitation beds previously promised for Teignmouth community hospital are no longer needed, and my hon. Friend made very clear her views on that on behalf of her constituents; that there is a pressing need to safeguard the future of primary care across the entirety of the area she represents; and that both the national local strategies to integrate care further make the best use of the NHS estate.
The CCG’s reviews of the need for rehabilitation beds at Teignmouth hospital led it to believe that the health and wellbeing team was successfully meeting the needs of local patients without them, but my hon. Friend set out clearly her concerns about that conclusion and the reasons why she has those concerns. I will mention at this point an important contextual point. While hopefully many things we have seen in the past year relating to covid will become things of the past soon, it is highly likely that covid has changed the nature of how we look at the provision of healthcare, and that there are lessons to learn there for the long term and for the future. I think I heard her clearly saying that we should not lose that by virtue of something that was begun before covid not being able to scoop up and learn those lessons for the future—i.e. future-proofing the services that her constituents rely on. I am sure that the CCG will have heard her message loud and clear on that particular point.
My hon. Friend talked about the consultation and the decision-making process in some detail. Clearly, as I gather from that and from a letter she has recently written to the Secretary of State, which I will turn to in a moment when I conclude, she has undertaken a lot of work in looking at these consultation processes, the history of them, the genesis of them and how over time they have changed what they have been looking at.
As my hon. Friend said, the CCG undertook a formal consultation from 1 September to 26 October 2020—I caveat that with the point that my hon. Friend and I made earlier, which is that that was mid covid and not after the covid pandemic—which proposed to move high-use community clinics from Teignmouth community hospital to a health and wellbeing centre in Teignmouth; to move specialist outpatient clinics from Teignmouth community hospital to Dawlish community hospital, four miles away; to move day-case procedures from Teignmouth community hospital to Dawlish community hospital, which she picked up on clearly in her speech at the opening of the debate; to continue with that model of community-based intermediate care; and to reverse the decision to establish 12 rehabilitation beds at Teignmouth community hospital, as advocated by the CCG and, it asserts, as supported by previous public engagement in 2018 on the success of the service provision without the beds.
I understand that NHS England’s position is that the consultation in 2020 set out that a likely consequence of the reconfiguration was that the requirement for those beds in Teignmouth would no longer be there for the local NHS. However, I hear what my hon. Friend says; she highlighted that, in her view and that of her constituents, that is worthy of a more discrete and focused consultation.
The consultation was overseen by the independent Healthwatch for Devon, Plymouth and Torbay, which analysed the just over 1,000 responses received, finding that 61.3% of respondents were in favour of the overall proposals. The equality impact assessment undertaken indicated that, overall, the impact on people using the services affected by this proposal was deemed by them to be of benefit, while the EIA indicated that, overall, the impact on people using the services affected by this proposal was neutral or of benefit.
Following a review of both consultation feedback and the quality and equality impact assessments, the steering group approved the consultation and agreed to make a recommendation to the CCG governing body that all four elements of the consultation proposal be approved. The Teignmouth steering group approved the consultation and the local NHS plans to continue to review the proposed model of care in light of potential changes in levels of need within the local area, as well as—they have related to my office—the impact of covid-19 on ways of working. I will turn to that in a minute, as well as an offer that I will make to my hon. Friend when I conclude.
I am aware that, as she has said, local councillors recently wrote to the independent reconfiguration panel to seek informal advice on this reconfiguration, and have been advised to continue to work co-operatively with the CCG to find a local resolution. My understanding is that the IRP is constrained in what it can or cannot do and how it can engage where it is not a formal referral, but I understand from what my hon. Friend said that that remains a possibility, so I will be a little cautious about prejudging whether that may or may not happen. She asked a number of specific questions—for example, about Chorley, and then her asks at the end of her speech. What I would say about Chorley is that we do not have the power to instruct in the context of reconfiguration at this point, hence the legislative proposals that she talked about. We requested that they look at this, which they accepted, but I add the slight caveat that, as I understand it, we do not have the legal power to instruct the local CCG to do x or y at this point in the reconfiguration.
However, what I can offer to her within that legal constraint, which may be of help to her, is that first, of course, I will endeavour to reply to her letter swiftly, with responses to the detailed points she has raised in it. Secondly, although the legal powers available to me in the name of the Secretary of State are limited until and unless an IRP referral is received and the advice is then given, I am always delighted to meet with my hon. Friend if she feels that would be helpful. It may be helpful to her if I arrange to meet with her outwith this debate, to discuss with her in more detail some of the process points and legal constraints, but also to listen in more detail than she is perhaps able to set out in a debate of this sort. I would expect her CCG to have heard her voice in the House today loud and clear, as I suspect it does in her capacity as the local Member of Parliament on the ground in Newton Abbot.
It is right that all reconfiguration decisions are taken in the best interests of patients and the local population following the due process, and it is that due process that slightly constrains what I can say or do in this context. However, the Government are committed to ensuring that the appropriate resources are available to the NHS in Devon to support patients, and to continue to provide the people of Devon and of her constituency with the best possible care, so the people affected by these changes need to be involved in making the key decisions—including my hon. Friend, of course, as their elected voice. I would hope and expect that the CCG will set out a clear plan to engage proactively with her and with the local population, and would encourage all of her constituents to be involved in that process.
I will reiterate two things on the record. First, I will of course reply to my hon. Friend’s letter. Secondly, I repeat my offer to meet with her separately to discuss in more detail what is and is not possible within the legal constraints around the reconfiguration process, and also to learn more about Teignmouth Hospital. I hope that in more normal times, when such things are possible, I might be able to come down and see my hon. Friend in sunny Devon, to visit that hospital with her.
Question put and agreed to.