Disability Equality Training (Taxi and Private Hire Vehicle Drivers) Bill

Debate between Albert Owen and Andrew Gwynne

2nd reading: House of Commons
Friday 18th November 2016 Commons Chamber

[Albert Owen (Ynys Môn) (Lab)]

I congratulate my hon. Friend on securing his private Member’s Bill and leading the debate today. He mentioned that the law would apply in England and Wales. We already have guidance on this in Wales, and Guide Dogs Campaigns is working with the Welsh Government on it. Will he work with the Welsh Government to ensure that a similar Bill can be enacted in Wales?

[Andrew Gwynne]

Absolutely. I discovered as a result of the discussions I had when preparing my Bill that not all the relevant functions have yet been devolved to Ministers in the Welsh Government and that some of the duties therefore still rest with the Secretary of State for Transport here in Whitehall. That is why some of the provisions in the Bill relate to Wales. But my hon. Friend is absolutely right: we need to get these provisions in place across the whole United Kingdom. There are parts of the UK that have advanced further down this track than England and Wales have done, and my Bill is trying to put that right.

Community Hospitals

Debate between Albert Owen and Andrew Gwynne

Wednesday 3rd September 2014 Westminster Hall

[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.