Community Hospitals

Andrew Gwynne Excerpts

Thursday 6th September 2012 Commons Chamber

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

I thank the Backbench Business Committee for granting this important debate today and I congratulate the hon. Member for Totnes (Dr Wollaston) on the eloquent case that she made in opening it. I also congratulate and welcome the new Minister to her place. She was a slightly unconventional Parliamentary Private Secretary to the former Minister of State for Health, the right hon. Member for Chelmsford (Mr Burns). I say “unconventional” because, as the hon. Member for Hexham (Guy Opperman) observed, PPSs are usually seen and not heard. I am sure that she will be even more vocal now that she has the freedom to speak from the Government Front Bench, and I look forward to our exchanges in the coming weeks and months.

As many Members have testified today, 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 clear that people generally prefer medical treatments to be taken nearer to their homes and families, whether that involves palliative care, minor injury services or maternity care, and those are exactly the services that community hospitals can help to deliver. Indeed, the Department of Health has estimated that about 25% of hospital patients could be better cared for at home or in the community.

Community hospitals usually also have good relationships with their local communities, and are often supported by local fundraising. We have heard from a number of hon. Members today about the great work being done by friends groups up and down the country. I pay tribute to those groups, and to the staff and volunteers who work to make those groups and the hospitals happen. Staff in community hospitals can also build personal relationships with local patients and carers as they deliver continuous care from outside the hospital environment. That is an important point that should not be overlooked.

It is fair to say that community hospitals continue to play an important part in local health care provision. Their role is valued, and we are right to support it. Labour continues to be committed to community hospitals, when they represent the best solutions for local communities. I take the point made by the hon. Member for Southport (John Pugh) that they might not be the solution everywhere. My own constituency is served by three large district general hospitals and 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.

Community hospitals can provide a vital step between social care and acute care, and Labour would seek to develop them further. For example, it might be possible for GP or dentistry services to be offered in more community hospitals, which could make some that are only marginally viable at the moment more viable for the future. 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. One of the most pressing tasks for the NHS in the coming years will be better to co-ordinate services around the needs of patients, and that might well mean that community hospitals have to change the way in which they provide services and the buildings from which they provide them. She will know, however, of our concerns about the Government’s structural reforms, which will make the co-ordination and delivery of services far more difficult. We believe that the future requires the integration of care, yet the Government’s policies are driving us more towards fragmentation. We know that they are already having a profound effect on the NHS. A recent survey of NHS chairs and chief executives by the NHS Confederation found that 28% described the current financial position as

“the worst they had ever experienced”.

A further 46% said the position was “very serious”.

It is also clear that the financial challenge will continue for many years after 2015, and all this could have an effect on community hospitals, whether it be the reduction of minor injuries provision, the closure of wards or the downgrading of services. As the hon. Member for Bracknell (Dr Lee) suggested in what I thought was a thoughtful contribution, these can sometimes be the right choices for an area. Sometimes, however, they will not be and they will just be financially driven; here, there is a danger that community hospitals will provide an easy cut for bureaucrats.

[Guy Opperman]

The hon. Gentleman will be aware that 3,000 community beds in community hospitals were shut under the previous Government. Is he going to enlighten us about what his policy is, specifically in respect of any particular cuts to community hospitals? Is he in favour of them, against them, or is there no policy?

[Andrew Gwynne]

Community hospitals have a vital role to play. As we have discussed in the debate, however, they may not be the right approach everywhere. We remain committed to community hospitals. The last Labour Government introduced a fund specifically for them. It is fair to say that that fund was not automatically taken up by primary care trusts up and down the country. Some areas had different viewpoints on the role of community hospitals. The Labour party has a commitment to community hospitals where they are the right choice for the local communities.

A further point about the impact of the Health and Social Care Act 2012 is that with responsibility for commissioning health care services moving into the hands of clinical commissioning groups and with primary care trusts no longer being in existence, there is a real danger that the role of community hospitals could be overlooked. Will the Minister reassure us that community hospitals will not be unfairly penalised in the new internal market of the NHS?

We should bear in mind further issues about the possibility of creeping privatisation—an issue that we, at least, are concerned about. The whole health service is currently in a state of flux, but as the reforms in the NHS kick in, it is perfectly feasible for commissioning groups to look outside the NHS to the private sector to provide even more of their services than in the past. This has already happened in Suffolk in March, when Serco won a £140 million contract to manage, among other things, the area’s community hospitals.

It could well be that when trusts are faced with the choice of reducing clinical services, they will look to being more centralised for financial reasons and take services away from the community and, indeed, in some cases from district general hospitals, too. This will almost certainly have an effect on any extensions to these services in community hospitals. Clearly, community hospitals and other community health services need to be able to compete on a fair playing field with other health providers, and I would ask the Minister how she will support that practically.

I would like to ask about some of the additional funding arrangements in the NHS—an issue raised by the hon. Member for Totnes in her opening comments. Previously in the NHS, payment by results was introduced to finance care and treatment according to a national tariff. It was intended to reduce variation in the prices paid by different parts of the country and to encourage providers to do more work, particularly helping to reduce waiting times.

Community services, however, are not covered by payment by results and are instead paid under a block contract negotiated with the local commissioner. I know that some community hospitals are concerned that they will have to make greater budget reductions than providers covered by payment by results. Some community hospitals are concerned that the commissioner will reduce the size of the block contracts, which is easier to do than stopping activity under a tariff.

From April 2013, the NHS Commissioning Board and Monitor will set the national tariff, and we are encouraged that the Government have expressed an interest in expanding payment by results to community services. If payment by results is expanded, it must be done in a way that supports integrated care and does not disadvantage care that is delivered in a community setting. How will the Minister ensure that we do not have a pricing system that disadvantages care that is delivered in community settings and particularly in community hospitals?

Let me deal briefly with the issue of estate ownership, which has been touched on by a number of Members. Many community hospitals do not own the buildings from which they operate, which affects their ability to raise capital to create new services for patients because they cannot secure finance or loans against the value of their buildings. As we have already heard during the debate, earlier this year the last Health Secretary announced that a Government-owned firm, NHS Property Services Ltd, would take over the ownership and management of the existing primary care trust estate and dispose of property that was surplus to NHS requirements. Community hospitals will depend on the setting of affordable long-term rents by NHS Property Services Ltd. I hope the Minister will tell us how the firm will work with community providers, including social enterprises.

There should be no doubt that Opposition Members support the principle of community hospitals. Indeed, we rightly established a fund to support and develop the community hospitals that represented the best choice for local communities. A future Labour Government would also aim to develop community services further within community hospitals. For example, as I have already suggested, it may be possible for more GP, dentistry or other services to be offered by them, and I think that that opportunity should be explored further.

We are concerned about some of the wording of the motion, which calls for community hospitals to have

“greater freedom to explore different ownership models”.

We would need more details of any parameters before agreeing to such an arrangement. It could lead to an opportunity for further creeping privatisation of our national health service, which is something that the Labour party will not support or give carte blanche to. For that reason, Labour will abstain on the motion.

The motion also calls for a national database of community hospitals. Historically their number and location was not monitored, as that was a matter for primary care trusts. However, we believe that in the new NHS, with confusion over where responsibility lies, there may well be a case for a national database. We would be interested to hear more details of what the hon. Member for Totnes has proposed, because we believe that it could give some value to the Department of Health in the future.

We should pay tribute to the important work that community hospitals undertake, the quality of the health care that they give to local people, and the commitment and dedication of all their staff, from medical professionals to porters and cleaners. The Government should be doing all that they can to ensure that patients can make real choices about receiving the health care that they need near to their homes. It remains to be seen how the Government’s changes to our NHS will affect community services and community hospitals. I look forward to hearing from the Minister how she will protect the role of community hospitals, which are valued and must continue to have a role in the more integrated and people-centred health care system that I hope we all support.