Community Hospitals

Albert Owen Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Charlie Elphicke]

I agree. I congratulate my hon. Friend on his hard campaigning in his constituency to secure the future of his own community hospitals. I understand that the campaign has met with great success, showing how fortunate his constituents are to have such a diligent, effective Member of Parliament. He is right; community care beds are more cost-effective and reduce the pressure of bed blocking on acute hospitals, meaning that acute hospitals can do more of what they are best at and that community hospitals can do more of what they, in turn, are best at.

Community hospitals are good at creating a friendly, personal and home-like environment, well suited to older people, particularly those who suffer from dementia yet live independently; such people have better health outcomes and a lower rate of readmission following rehabilitation and recovery. Community hospitals can be localised hubs for less complex health care and can have minor injury units, diagnostic provision, clinics for various specialities and even out-patient services and day surgery, and they are more cost-effective, when compared with acute hospitals, in respect of post-acute recovery. It is hard to see why we ever went down the route of centralisation, because it cost us more money and gave us less effective care. The move to putting the community hospital back at the heart of things will be more cost-effective and will give better care and better health outcomes.

I welcome Ministers’ comments in answers to oral and written questions, as well as the comments of Mr Stevens. Ministers have recognised that community hospitals are important in improving patients’ discharge from acute hospitals and in increasing access to treatment in the community. I welcome their acceptance that community hospitals are good bases for respite, palliative and intermediate care, and step-up and step-down care close to home. Community hospitals are also strong resources for people in rural areas, who have to travel long distances to reach general hospitals. Much of what I am saying is in line with the direction of travel of Ministers. I welcome that.

An important aspect of community hospitals is as providers of recovery beds. Study after study has shown that community hospital recovery beds are effective at getting people well, meaning they are less likely to be readmitted to hospital than if they recovered in an acute hospital. Older patients are more likely to enjoy continued independent living, and a friendly home life environment is preferred by patients.

I will cite a few studies and a bit of evidence in support of what I am saying. There was a study in Bradford in 2005, a study in the midlands and the north of England in 2007, research from 2009 into patient-reported experiences and research into intermediate care in Norway in 2007, so there is a significant evidence base. In addition, the NHS Confederation recently used Department of Health evidence to conclude that closer-to-home care produced a fall of 24% in elective admissions, a 14% reduction in bed days, a 21% drop in emergency admissions, a 45% reduction in mortality and a 15% fall in visits to accident and emergency. Those are encouraging figures. Community hospitals are more cost-effective, according to a 2006 research paper published in the British Medical Journal, so there is strong evidence to back up what I have set out.

The case is made in certain quarters that it is somehow easier and possibly cheaper to have intermediate beds in nursing homes. Nursing homes play an important role in long-term care and end-of-life care, but community hospitals are more suitable for recovery, rehabilitation and continued independent living. It is in their interest to get people out, but the nature of nursing homes is that people are not expected to leave very quickly. With an ageing population, community hospitals are particularly well suited to keeping older people healthier and more well. The clinical commissioning group covering Dover and Deal, ably led by the local GP, Darren Cocker, is building on that in creating an integrated care organisation. It sees the local hospitals in Dover and Deal as essential to the success of its vision.

Moving on, let us look at how we can put the community more into community hospitals. Many community hospitals were established and funded, as colleagues will know, through public subscription by locally based community trusts before the NHS came into existence. The trusts managed effectively and the move to nationalisation and centralisation saw those hospitals taken from communities and taken over by the NHS in Whitehall. Many communities want to be given the chance to have a greater say over what happens to their local hospitals. Allowing local communities to own, lease or manage their hospitals would be a clear way to accommodate the concerns many have and enable people to have the greater say they would like to have.

Reforging the strong link that GPs had with their local hospitals is important as well. My local GPs are up for that, and I want to encourage and support them in that move. Communities should also have greater influence over the provision of health care in their areas; that would allow them to give greater priority to the needs of their specific community. I hope that Ministers will take the opportunity to promote community ownership or management of community hospitals.

In conclusion, much progress has been made on community hospitals, but more can be done. They could be embraced and put more closely at the heart of Government health care policy, and I look forward to hearing from the Minister what steps he will take in four key areas. First, what steps will he take to enable communities to have a greater say in running their local community hospitals: to own, to lease, or to manage? How can we have stronger links among GPs, GP-led clinical commissioning groups and community hospitals, as used to happen many years ago and could happen again?

What about the potential for community hospitals to be hubs for the integration of social care and the policy support that might be given for that? Finally, we need to accept that it is not always best just to drop off people at home after acute hospital treatment and that intermediate recovery beds are often a key element in the path to recovery, distinct from nursing homes, which are better suited to longer-term and end-of-life care.

[Albert Owen (in the Chair)]

Before I call Mr Jim Shannon, I say to Members that I will call the Front Benchers at 10.40 am. Seven Members have indicated in writing that they want to speak in this debate, and a couple of others have also indicated that they might wish to speak. As would be expected, those who have written in will get priority. The maths is easy: we have 55 minutes and 10 Members wishing to speak.

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[Several hon. Members]

rose—

[Albert Owen (in the Chair)]

Order. Because of Members’ self-discipline, we have some 10 minutes remaining, and two doctors to finish the Back-Bench contributions.

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[Andrew Gwynne (Denton and Reddish) (Lab)]

It is, as ever, a pleasure to serve under your chairmanship, Mr Owen. I congratulate the hon. Member for Dover (Charlie Elphicke) on the eloquent case that he made in opening the debate, and I warmly welcome the Minister, for whom I have a great deal of respect. He will be a huge asset to the Government.

Now that the hon. Member for Strangford (Jim Shannon) has been deserted by the hon. Member for Upper Bann (David Simpson), we are on an equal footing. I assure him that he can aspire to be the second party, because I hope very much that in eight months’ time my party will be back in its rightful place as the main one in the House. However, I am sure that that view will not garner full support in the Chamber today.

As many Members have testified, community hospitals play an important role in the communities they serve. They provide rehabilitation and follow-up care, and they can help to move care, diagnostics and minor injury and out-patient services, among others, from acute hospitals back to the community. They provide planned and unplanned acute care and diagnostic services for patients closer to home, and contribute to the local community by providing employment opportunities and support for community-based groups. It is fairly clear that people prefer the more common medical treatments, whether palliative care, minor injury services or maternity care, to be brought nearer to their homes. Those are exactly the services that community hospitals can help to deliver, as we have heard in the debate.

Community hospitals usually have good relationships with their local communities, and many of the speeches this morning attest to that. They are often supported by local fundraising and, indeed, many were opened prior to the creation of the NHS, by public subscription, as the hon. Member for Congleton (Fiona Bruce) outlined.

We have heard from a number of right hon. and hon. Members today about the great work being done by friends groups. The right hon. Member for North West Hampshire (Sir George Young) and the hon. Members for Stroud (Neil Carmichael) and for Totnes (Dr Wollaston) mentioned those in their areas. I pay tribute to those groups and to the staff and volunteers who work to make things happen in those hospitals. Staff in community hospitals can also build personal relationships with patients and carers as they deliver continuous care from outside the hospital environment, as the hon. Member for Strangford, among others, pointed out. That is an important point that should not be overlooked.

Community hospitals continue to play an important part in health care provision. Their role is valued, and we are right to support it. For the record, Labour continues to be committed to community hospitals when they represent the best solutions for local communities. My constituency is urban and it is served by several large district general hospitals, with not one community hospital, but I acknowledge that other parts of the country have a very different geographical make-up, and that community hospitals are the right way forward for the provision of health care in those communities.

However, the NHS Healthier Together consultation is under way in my area; that is a proposed radical upheaval of hospital care, with fewer and larger specialist hospitals, which will leave some of the smaller district general hospitals to become, effectively, large urban cottage hospitals. It remains to be seen whether that approach will work, but it is at least an option that keeps some hospital care in the community in urban areas. Often full-scale hospital reorganisations do not do that, so perhaps what is happening is a new venture.

Community hospitals can provide a vital step between social care and acute care, and Labour would seek to develop that further. The case made by the right hon. Member for North Somerset (Dr Fox) about, particularly, the invaluable role that community hospitals could play in providing extra respite care beds, is one we should take seriously, especially given the new obligations under the Care Act 2014.

Perhaps community hospitals could move into that role more, along with the provision of more GP and dentistry services. There could be much more provision from within the existing bricks and mortar—services could be nearer to where people live, and there could also be support provision, which is particularly relevant for community hospitals that may at present be only marginally viable. That possibility should be explored.

Some concerns remain, however, and I hope that the Minister will be able to offer the House some reassurance today. He will, I hope, be aware of our ongoing concerns about the Government’s structural reforms. I know that the hon. Member for Stroud has come to a different conclusion, but I think that evidence is mounting that some of the reforms have made the co-ordination and delivery of integrated services far more difficult. I suspect the Government now agree with that view, and that they are permitting the emerging integrated care organisations to be exempted from parts of the regulations on competition under section 75 of the Health and Social Care Act 2012 for precisely that reason. We believe totally that the future requires the integration of care and health services. Yet I fear that some of the Government’s policies are driving us more towards fragmentation. Let us not be in any doubt: community hospitals have a vital role to play. However, as we have discussed, the approach may not be the right one everywhere.

The Labour party remains committed to community hospitals. The last Labour Government introduced a fund specifically to help them, and I suspect that the Vale community hospital in the constituency of the hon. Member for Stroud, which opened in 2011, was paid for partly from that fund. The fund was not automatically taken up by primary care trusts throughout the country and in some areas there was a different view of the role of community hospitals, but where it was taken up, it has clearly made a huge difference to those communities.

I looked at the Care Quality Commission’s website, and the Vale community hospital has an outstanding reputation. The Labour party made a commitment to community hospitals where they are the right choice for the local community, and that commitment continues. I hope that the hon. Member for Maldon (Mr Whittingdale) secures a future for his community hospital because it sounds as though it is really needed in his community.

We are just over a year into the changes introduced by the Health and Social Care Act 2012. I hope that the Minister will take stock of some of those changes and some of the service reconfigurations that are now being proposed in different parts of the country, and reassure us that community hospitals are not being unfairly penalised in the new internal market.

Responsibility for commissioning health care services has moved into the hands of clinical commissioning groups from the former primary care trusts, and there was a worry during deliberation of the Bill that the role of community hospitals might be overlooked. Has the Department assessed whether those fears have come to anything anywhere in the country? The hon. Member for Totnes hit the nail on the head when she referred to the complexity of tendering rounds for funding at the expense of local services. I would be interested to hear the Minister’s view on that.

One obvious consequence of the 2012 Act has been the introduction and rapid expansion of “any qualified provider”, which made it easier for commissioning groups—indeed, it often became necessary—to look outside the NHS to the private sector to provide even more services than ever before.

I am still worried that when trusts are faced with the financial pressures that we have heard about, which arise for a variety of reasons, they often look at the need to remodel clinical services and centralisation, as the hon. Member for Dover said. That takes services away from the community and sometimes from district general hospitals. Sometimes there are sound clinical and financial arguments for that, but it is often financially driven. That will almost certainly have an effect on any extension to the provision of those services in community hospitals.

The concept of whole-person care necessitates patient-centred care closer to where people live, and there may be a huge opportunity for cottage hospitals and other smaller localised health facilities to adapt and to fit comfortably into this model. Clinical commissioning groups and integrated care organisations should look seriously at the possibilities that such facilities provide for the future delivery of joined-up health and social care in a community setting.

The hon. Member for Dover and other hon. Members, including the hon. Member for Totnes, raised the prospect of community hospitals becoming social enterprises. To me, as a member of the Co-operative party, that is an interesting concept. However, in response to an intervention, the hon. Gentleman referred to the NHS “leviathan”. There are pressures on centralisation, as we have heard, but I am worried that under the 2012 Act cottage hospitals will also have to compete with the leviathan of large corporate private providers. I am worried that “any qualified provider” means that private sector organisations will cherry-pick services and leave cottage hospitals vulnerable to the pressures of centralisation and of losing key local services; such organisations are often better at going through the bidding process, as the hon. Member for Totnes said.

This Government and the next should do all they can to ensure that patients can make real choices about receiving the health care they need close to their homes. We must make the vision of whole-person care a reality. Community hospitals are valued and must have a real role in developing and delivering a more integrated and people-centred health care system. I hope that we all support that, and I look forward to the Minister’s reply.

[Albert Owen (in the Chair)]

Before calling the Minister, I add my congratulations to him and welcome him to his new position.