The Minister for Social Care (Helen Whately)
I congratulate the hon. Member for Tiverton and Honiton (Richard Foord) on securing this debate. I appreciate his interest and concern about the future of Seaton community hospital. As he said, it was built only as a result of a huge fundraising campaign in the local community, which was matched pound for pound by the NHS. It therefore holds a lot of importance for the hon. Member’s constituents. I fully understand his interest in making best use of the facilities. I know that my hon. Friend the Member for East Devon (Simon Jupp) also wants to see this situation resolved, and I met him earlier to talk about it. I remind the hon. Member for Tiverton and Honiton that decisions about the use of NHS property such as this community hospital are taken at a local level—as they should be—and not by a Minister in Whitehall.
It may be helpful to recap some of the history, as the hon. Member covered in his speech. Between 2015 and 2017, the then NHS clinical commissioning group—CCG—undertook a recommissioning of community services in Devon. That was about introducing a new model of care—more integrated and more community based, with more people receiving care at home. I heard him raise concerns about that model and the shift to getting care closer to the community. My ministerial brief includes supporting the discharge of people from acute hospitals to try to care for more people in their own homes. Some patients spend longer in hospital than is good for their recovery, so for many people it is much better that, when they are declared fit for discharge, they recover and receive care at home.
Returning to the situation of this particular community hospital, as part of the commissioning change there was a change of lead NHS trust as the provider of services in local community hospitals. That meant that ownership of 12 community hospitals, including Seaton, was transferred from the former NHS provider trust to NHS Property Services, as the hon. Member spoke about. NHS Property Services’ model of charging a market rent for properties is to build an incentive to make good long-term decisions about the use of buildings. NHS Property Services then invests that income into those properties and the services that they provide.
At the point of transfer, many community hospitals in Devon had a large amount of empty space. The transfer happened on the basis that the NHS commissioning body—now the ICB—would be responsible for the full cost of that space. The costs include the recovery of the market rent and service charges, such as energy, rates, cleaning and maintenance. Over the past seven years, progress has been made to identify sustainable, alternative healthcare uses for vacant spaces in other community hospitals in Devon, such as in Axminster and Ottery St Mary’s. However, I understand that Seaton and some others still have significant amounts of vacant space. In addition, the ICB and NHS Property Services have worked closely with the voluntary sector, and have supported local initiatives in some properties, such as the Waffle café at Seaton Hospital. However, it is for the local commissioners—not NHS Property Services—to determine the best use of the healthcare spaces that they are responsible for.
Despite sincere efforts from the ICB, I understand that no sustainable healthcare use has been identified for the former ward space at Seaton, which adds up to about half the hospital space. I know the hon. Member’s constituents are frustrated by this situation. Local community groups have expressed an interest in taking on some of the empty ward space, but they see the level of charges as an insurmountable barrier. The ICB has explored a range of potential healthcare uses with NHS providers, but the proposals have not yet come to fruition, so I know the situation is not satisfactory for them either.
The costs to the system of the vacant space are a pressure on the health budget. Clearly, having unused space is not a good use of resources and, ultimately, taxpayers’ money.
Helen Whately
It is important to note that NHSPS operates on a cost recovery basis. That means any reduction in its charges counts as a loss to the health budget if it is not directly offset by actual cost reductions in the facilities. As the hon. Member mentioned, the annual charges for the vacant space in this facility are approximately £300,000, of which £140,000 is the rental charge. The rest is spent on a share of the utilities, business rates, maintenance and cleaning costs for the property.
Richard Foord
I am grateful to the Minister for explaining the charge-back system. Could she explain why the NHS is charging the NHS and hence the NHS cannot have this space, and why it cannot be used for health purposes? Could she explain the charging mechanism a little bit more please?
Helen Whately
The hon. Gentleman says it cannot be used for health purposes. What I understand is that what is being looked at is what healthcare it can be used for, albeit recognising the shift of more care into the community and the changing model of care. On the way the system works, in essence the philosophy behind NHSPS is to ensure that best possible use is made of property. If there are no charges associated with the use of buildings, we could get lots of buildings sitting empty and there is not the same incentive to ensure the best possible use of facilities and resources. That is the philosophy behind having this kind of system. I think he mentioned in his speech bringing specific expertise together as part of the organisation that is NHSPS. I hope that addresses his query.
Helen Whately
I will make a bit of progress, if that is all right.
As I outlined, the ICB is required to pay for the costs and it is not sustainable for the ward space to remain empty for a further lengthy period of time. When an ICB decides there is no long-term healthcare use for an asset, it will usually be sold to allow the funds to be reinvested elsewhere. I have been told that that is not the plan in the case of Seaton community hospital, not least because half the building is an operational health facility and the ICB is fully committed to keeping those services open. I also appreciate that a huge fundraising effort was put in by the local community to build the wing at the hospital in the first place, a point that my hon. Friend the Member for East Devon (Simon Jupp) made when he intervened earlier, and so selling the facility would not be what the community wants.
We know that providing high-quality care and support in the community benefits patients, and their carers and families, helping people to stay well and independent for longer. Across the country, we have achieved a lot as part of our commitment to move more care out into the community. For example, urgent community response services are doing a great job of helping to keep people out of hospital when they are at risk of a crisis. Virtual wards or hospital-at-home services are providing hospital-level care in people’s own homes, helping to avoid admissions to hospital and allowing earlier discharge, and ensuring extra support is there if somebody is concerned about being discharged home, or, as I heard the hon. Member mention, is concerned about a family member being discharged home.
Richard Foord
I am grateful to the Minister for raising the concept of the virtual ward in this context. It reminds me a little of conversations that I have had with constituents in recent months about the virtual shopping experience, the virtual rail ticket purchasing experience, and the difficulty that they are having in dealing with humans. I think that the last thing people want when it comes to health and social care is “virtual”. They want the human touch.
Helen Whately
I can only encourage the hon. Gentleman to visit a team that supports a virtual ward, and speak to some patients who have been cared for through hospital at home or virtual wards. I have done both, and the feedback from patients is phenomenally positive. If someone is concerned about being discharged and supported in this way, it does not happen, but many people would much rather recover in their own homes with that support than be in a hospital where it is hard to get a good night’s sleep because there so much going on around them. Moreover, while people recover in their own homes, beds are freed up for people who really need acute hospital care on site.
A third model that is doing very well in helping people to receive care close to home is the proactive care model delivered by multidisciplinary neighbourhood teams. These are real game-changers, helping people to live independently and stay out of hospital. The teams consist of—among others—doctors, nurses, care workers, allied healthcare professionals, all coming together to ensure that people have the care that they need in order not to be going in and out of hospital, as sometimes happens when people become unwell.
While I fully understand the hon. Gentleman’s frustration, I have been assured that the integrated care board, local providers and NHS Property Services are working together to resolve the situation at Seaton Hospital to ensure that facilities—and, indeed, funds—are put to good use for patients.
Question put and agreed to.