Healthcare (Devon)

Debate between Lord Swire and Oliver Colvile

Tuesday 18th October 2016 Westminster Hall

[Sir Hugo Swire (East Devon) (Con)]

I beg to move,

That this House has considered healthcare provision in Devon.

It is a great honour to serve under your chairmanship, Mrs Main, which I am sure will be fair and impartial; if only that were the case elsewhere in the House. It is a particular pleasure to welcome the Minister of State, Department of Health, my hon. Friend the Member for Ludlow (Mr Dunne); I fear he has had quite a few outings already this week, and will have more. I make no apology for summoning him here, on behalf of my colleagues from Devon, to address an issue that will not go away any time soon. I suspect that this will be one of many occasions on which we will seek to ask pertinent questions on behalf of our constituents across the county.

Healthcare is one of the biggest issues in Devon, largely for two reasons. The first is the demographics of the county: 17.7% of the UK population are aged 65 and over; that rises to 21.1% in the south-west and, in my part of the south-west—East Devon—to 27.7%, which is 10% more than the national average. Secondly, reforms are coming down the line, involving bed closures and so forth, that are sometimes seen as controversial. They are a result of the perilous state of Devon’s NHS, which is there for us all to see. Before we start our long list of asks and demands, it is worth remembering that the Northern, Eastern and Western Devon clinical commissioning group’s financial deficit is due to hit £490 million by 2019, which is clearly unsustainable.

Before I launch into my pleas and points, I point out the absence of some colleagues from Devon from across the political spectrum who I know feel passionately about this. The right hon. Member for Exeter (Mr Bradshaw) and my hon. Friend the Member for Totnes (Dr Wollaston) are both detained in the Select Committee on Health. I believe that they have either just interviewed, or are interviewing as we speak, the Secretary of State for Health and the chief executive of NHS England. Of course, my hon. Friend the Member for Central Devon (Mel Stride) is unable to take part in the debate on account of his particular office. He has an excellent relationship with the GPs in his constituency, and he is supportive of wellbeing hubs, provided they serve the local community appropriately.

On the whole, we welcome the Government’s intervention in Devon’s NHS in the form of the success regime. If followed properly, it will help to solve some of the underlying problems that beset Devon’s national health service. As part of its work, the success regime, along with the CCG, has recently published proposals to close 72 hospital beds in Exeter and East Devon. The Minister will quite properly respond that that is under consultation, but I think this is the only way that we can raise these points in a public forum to make sure that everybody knows what we are thinking.

I understand that recently, the success regime, although it has a preferred option, which includes the rather expensive Labour deal on Tiverton hospital, has now introduced a “none of the above” option. If that is now an option, it creates a whole new range of possibilities. If that is not an option, I argue—my colleagues will argue for other things—that option B, which sees the beds retained in Tiverton, and also in Sidmouth and Exmouth, is the option worthy of support. Sidmouth has an extremely high proportion of over-85s, with people increasingly living longer, and of people with dementia. Exmouth is the biggest town in Devon with more than 35,000 people.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

Thank you, Mrs Main, for allowing me to serve under your chairmanship. Plymouth has around a quarter of a million people, and is the largest urban conurbation in the whole of Devon.

[Sir Hugo Swire]

As my hon. Friend knows, Plymouth is a unitary authority; Exmouth is the biggest town in Devon. Local people—my constituents—are hugely supportive of our community hospitals. We have beds in Exmouth and Sidmouth; in Ottery St Mary we have 16 stroke beds, although they are eventually to be replaced by a health hub; and Budleigh Salterton hospital, which I will talk about in due course, will, we hope, be turned into a health and wellbeing hub.

Over the years, many local residents have donated significant sums to the hospitals. In Sidmouth alone, the Sidmouth Victoria hospital comforts fund has raised over £5 million. Local people are prepared to invest in ensuring first-class local health services. I pray in aid the position of Sid valley Admiral nurse—the Admiral nurse helps people with dementia—which was hugely supported locally. I am pleased to say that I was able to play my part in obtaining additional funding for that position from the Big Lottery Fund. If there is an identifiable health issue locally, people are prepared to back care with their own money.

If the Minister will allow me, I will talk about the consultation process and the lack of documentation. As I understand it, the consultation process has been overwhelmingly carried out online; there are very few paper copies of the consultation. Elderly people, who may have no access to the internet and who are disproportionately likely to be affected by the changes, are therefore disadvantaged. The consultation period ends on Friday 6 January. I ask the Minister to do everything he can to look at the issue, and to work out how we can get more people involved in what is, after all, an extraordinarily important process.

The potential closure of hospital beds raises the issue of 21st century healthcare, which obviously includes preventive as well as curative care. My constituents—like many across the country, we are told—prefer to be treated at home for as long as possible. They understand, on the whole, that community hospitals need to change and adapt in order to offer a service fit for the 21st century. In Budleigh Salterton, we have been working very hard to try to ensure that the community hospital is transformed into a health and wellbeing hub, which will involve bringing together the health, social care and voluntary sectors. I think that is a good template that can possibly be used across the country. In fact, if it works, there will be far greater footfall through the community hospital than there has been while it has been just a hospital. I remain very supportive of that.

There is, of course, a negative side to keeping people in hospital beds. According to Angela Pedder, the lead chief executive of the success regime, the cost of running a 16-bed community hospital ward is £75,000 a month. Home care could look after 82 people for the same money. However, we are in danger of putting the cart before the horse. Until we can absolutely ensure that we have got social care right, we should not look at unnecessarily closing community beds that some people will have to use. Equally, I am nervous that, just because we have well-supported community hospitals across East Devon, we are being targeted unfairly, so as to rebalance the books across other parts of the county.

If we are reducing the number of hospital beds, it is absolutely essential that the social care system is able to compensate for that loss. In the past five years, council budgets for social care have fallen behind demand by £5 billion, and 150,000 fewer people receive at-home help than five years ago. Social care can take the financial pressure off the NHS. For instance, the installation of a simple grab-rail in an elderly person’s home can help to prevent the falls and broken bones that cost the NHS £2 billion a year. The option of making greater use of technology remains hugely under-exploited, in terms of how we ensure that people are getting a first-rate service at home.

I am sure my colleagues will want to raise the whole issue of rurality this afternoon. Government policies are meant to be rural-proofed. Frankly, social care is far easier to administer in a conurbation such as Plymouth than in other parts of the county, where people are spread over much greater distances.

Another issue that I am sure some of my colleagues will want to talk about is recruitment. We are told that social care will be one of the big growth industries in future. That is all to the good, and it is inevitable. However, currently, people find it very difficult to recruit. It is much easier, I am told, for the NHS to recruit people to work in social care than it is for the private sector. It is all very well transferring people back home, but only provided that there are the people to carry out the social care.

Stephen Dorrell, a former Health Secretary, has said:

“Fetishising the NHS budget and imagining it’s the only public service that relates to health is fundamentally to miss the point…It is not true to say we are supporting the health service by asking it to do social care. We are using the health service as a very expensive social care service and then talking about efficiency. It’s insane economics and very bad social policy.”

I would like to know if the Minister agrees, and what he feels can be done to ensure that we have first-class social care in place before we start to close community beds. Given the closure of residential homes, and the fact that local authorities are increasingly unwilling to pay the fees demanded by residential homes, we might end up in a situation where, although a person can no longer be cared for at home and needs some kind of hospital bed—we want to keep them away, of course, from the main hospitals—we have got rid of all our beds, or a disproportionate number, and so have created an unnecessary problem.

I want to say something about NHS Property Services. Since the NHS provider in Devon changed from Northern Devon Healthcare NHS Trust to Royal Devon and Exeter NHS Foundation Trust—at least in my part of the county—on 1 October, ownership of the community hospitals has transferred to NHS Property Services. NHS Property Services, as we know, charges commercial rents, meaning that many hospitals will have to pay higher rent. Along with the planned bed closures, that has understandably made some of our constituents nervous. What happens if hospitals cannot pay the rent? Given that the Department of Health has committed to meeting any increased property costs for 2017 and 2018, the big question is what happens thereafter.

My general practitioners at the Blackmore health centre in Sidmouth increasingly feel that they have little influence over the redevelopment of the surgery, which I champion, as a result of the involvement of NHS Property Services. The practice wants to buy the building off NHS Property Services, either now or at some stage in future. It is proving extremely difficult to make that happen. It should be a simple move, as it is supported by local GPs and the local community.

There is some concern about Exmouth—Devon’s biggest town—losing its out-of-hours GP services, which will be replaced with use of the 111 service, in line with the new integrated urgent care commissioning standards. Perhaps the Minister could write to me to reassure me that my constituents in Exmouth will receive exactly the same cover that they did under the previous arrangement.

One thing that affects all of us across Devon is the lack of provision of mental health facilities, which has exercised us for a long time. In my patch, I am concerned about St John’s Court, which is the only mental health and recovery facility in Exmouth. Two years ago, Devon Partnership NHS Trust spent £300,000 on a move from Danby Terrace, which was not at the time fit for purpose, to St John’s Court. On top of that, £140,000—this is all taxpayers’ money—was spent on refurbishing St John’s Court. Now the trust is pushing ahead with closing and selling St John’s Court. It has assured us that Exmouth will not experience a reduction in healthcare provision, and that St John’s Court will not be sold until an alternative venue can be found. We are talking about a growing town with a lot of mental health issues. I seek reassurance from the Minister that before anything is closed, something will be put in place to reassure the local community and my constituents that we have the same, if not a better, level of mental ill-health prevention and cure.

I wanted to speak for longer, but I am conscious that my colleagues will probably want to articulate their own slightly different visions for the future of healthcare in Devon. I say to the Minister in the friendliest manner possible that we are a pretty quiet bunch in our part of the world, and we do not seek trouble, but we do fight tenaciously to protect the livelihoods of our constituents. Too often, we feel that people forget about us in the south-west, and that money is diverted to all kinds of infrastructure projects in the huge urban conurbations, the northern powerhouse and so forth. This time, we will speak as one to ensure that whatever comes out of these consultations, and wherever we end up after them, we can argue these points in a mature way. It is simply no good saying, “It’s a lack of money. It’s Tory cuts.” That is an immature conversation to have. We have to, between us, design a health and social care service that is fully integrated, makes use of technology, and cares for all of us as we get older and more dependent. We need to be brave, but political sloganising is not the answer.