Healthcare (Devon)

Anne Main Excerpts

Tuesday 18th October 2016 Westminster Hall

[Peter Heaton-Jones]

I thank the Minister for his intervention and I welcome it, but I say gently to him and NHS England, which I am sure is monitoring this, that all that good work will be entirely undone if we then lose our acute services at North Devon district hospital. This is not about figures on a spreadsheet; it is about the services and healthcare provision that my constituents will receive in Barnstable.

I am aware of the time, Mrs Main, but I want to raise a second issue, which is important and recognisable to us in North Devon, but perhaps not to those beyond: our unique geography and the distances. An Australian historian once referred to the tyranny of distance, and I think we suffer from that in North Devon. If one looks at a map, it is all too easy to think that there is a decent road network between Barnstaple and Exeter. I can give several reasons why that would be a wrong assumption. First, vast numbers of people live in isolated regions far north of Barnstaple. Secondly, the road network is not all it is cracked up to be—although that is a subject for another day and one on which I am fighting heavily.

My main point is that what no map or distance table shows is that in North Devon we have pockets of serious deprivation. In Ilfracombe, I have two of the most deprived wards in the south-west and by some metrics the most deprived in south England. In those areas car ownership is less than 80%. Put another way, one in five households do not have access to their own private transport and, because of the demographics, some of those who do are elderly and perhaps have their own vehicle but simply would not feel comfortable or up to going long distances to Exeter or Plymouth. Those two reasons alone are sufficient to argue strongly that the last place where we should be looking to make cuts to acute services is at North Devon district hospital.

I am aware of the time, Mrs Main, so I will conclude. I welcome the fact that the Government are looking at the funding. I welcome the repeated assurances that local clinicians will make the final decisions. However, I want it to be in no doubt whatever—the community of North Devon are very clear about this—that North Devon is a special case and needs to be treated as such. In that regard, I make no apologies whatever for fighting for North Devon and for appealing for there to be common sense and no cuts at North Devon district hospital.

[Mrs Anne Main (in the Chair)]

We have approximately 35 minutes before the winding-up speeches and there are five speakers. I am sure we can do the maths.

--- Later in debate ---

[Julie Cooper (Burnley) (Lab)]

I thank the right hon. Member for East Devon (Sir Hugo Swire) for tabling a debate on this important issue. It is heartening to see Members for Devon coming together with a unified voice on this subject. I, too, will mention Members who are not here today: the hon. Member for Totnes (Dr Wollaston), who has been mentioned, and my right hon. Friend the Member for Exeter (Mr Bradshaw). As we speak, they are questioning the Secretary of State for Health on finance for the NHS—a subject that cannot be totally separated from the issue at hand.

The healthcare challenges that Devon faces are immense, but I disagree with some of the points that hon. Members have made. I do not believe that the challenges are limited to this region; I believe they are systemic. Demand for NHS services is increasing nationally faster than ever before, fuelled in part by an increase in social deprivation and an ageing population. The need to address the increased demand, together with the need to keep pace with new technologies, is placing hitherto unseen financial pressures on NHS providers.

There are 280,000 people in Devon living with one or more long-term conditions, such as asthma, diabetes, hypertension and cancer; 150,000 people have a mental illness; and there are 40,000 people with cancer who need rapid access to high-quality services. Alongside that increased demand, there have been cuts to adult social care, and to public health and prevention budgets. If we are just to stand still, funding needs to be increased by an extra 2.6% above inflation. I am interested to see whether the Minister’s promised extra funding matches that; I doubt that it will. If no changes are made by 2020, the NHS in Devon will face a deficit in excess of £440 million.

In 2015, the Northern, Eastern and Western Devon success regime was introduced by Simon Stevens, the chief executive of NHS England, in an attempt to address the rising deficit and the failure to meet important health targets, including cancer waiting times. There is no doubt, as I am sure hon. Members agree, that there is a compelling case for change. Change is desirable; it would indeed be better for care to be more patient-centred, and of course it would be better to have more care needs met in the community. It is also true that the majority of patients receiving end-of-life care would prefer to die at home.

But, and it is a big “but”, change on this scale—massive, transformational change—needs leadership, transparency, a whole system change and, above all, investment. Making changes of this order—closing community hospitals with no proven plan for care in place—is downright reckless. That is why so many GPs in Devon are opposing the proposals, and have stated that they have

“grave concerns over patient safety.”

They say:

“we are concerned that the untried, untested closures of so many community hospital beds in this area could prove dangerous for a significant population of patients who might need to rely on community beds”.

The well-respected Chair of the Health Committee, the hon. Member for Totnes, has declared that she also cannot support the plans without an assurance that services will improve as a result of the changes.

People the length and breadth of Devon have expressed their concerns. The very active women’s institute in Devon has raised objections, as have communities across Devon. As we have heard from Members today, the consultation process has been woefully inadequate; there have been undersized rooms, and an online consultation. Frankly, it is not good enough.

Everybody is right to be worried. Only last week, the Care Quality Commission published its report, entitled, “The state of health care and adult social care in England”. The report states that

“the sustainability of adult social care is approaching a tipping point”.

In addition to the financial pressures, the sector is also experiencing massive problems with recruitment and retention of staff. The people of Devon are being asked to place their trust in a system that is on already on the brink and, quite understandably, they are not going to—and nor should they.

Local GPs have described the proposals as a “hasty cost improvement process”. This is the crux of the matter: the proposals as they stand, without adequate funding for alternative care, will save money, but they will not improve patient care, and may even compromise patient safety. I agree with the right hon. Member for East Devon that the cart is being put before the horse; that absolutely hits the nail on the head. Local NHS trusts in Devon are on their knees, desperately crying out for more funding to enable them to plan for the increased demand and changing needs of the population in the 21st century. This is not just about extra funding, but about making the kind of transformational change that is needed to deliver high-quality, excellent healthcare in the 21st century. It needs proper planning and proper systems in place, and that cannot be achieved on the cheap.

I am shocked that in this context, the Prime Minister is refusing to give the health and social care sectors more funding, which they desperately need. We have one of the lowest percentages of health and social care funding, as a proportion of our GDP, in the entire region of Europe. That cannot be right. I urge the Minister to use whatever influence he has with the Prime Minister to get her to revisit this issue, for the sake of the people of Devon, and for people across the country. This situation is not unique to Devon; we face many of the same problems in my region of Lancashire and, as I know from my work with the Health Committee, across the country.

I also ask that the consultation process be firmed up, and that people be offered a full, transparent and real consultation, rather than lip service being paid to having one. During Health questions the other day, the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), promised to visit Devon and to listen at first hand to stakeholders. I urge this Minister to take that away with him, and to look at making sure that the Government listen properly to the voices of Devon and the very legitimate concerns being raised in this debate. No one is trying to say that change is not needed, but one system cannot be taken away until there is a fully proven plan in place.

[Mrs Anne Main (in the Chair)]

I call the Minister. If possible, could you leave a minute or two at the end for the right hon. Member for East Devon (Sir Hugo Swire) to respond, Minister?