Community Hospitals

Charlie Elphicke Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Charlie Elphicke (Dover) (Con)]

It is a pleasure to serve under your chairmanship, Mr Owen. I welcome the Under-Secretary of State for Business, Innovation and Skills, my hon. Friend the Member for Mid Norfolk (George Freeman), to the debate and congratulate him on his elevation in the reshuffle before the summer recess. It is a pleasure to speak in such a well attended debate, with so many parliamentary colleagues coming to share my concerns about the future of our community hospitals.

The purpose of this debate is to make the case for the Government’s putting the community back into community hospitals and for recognising that such hospitals should have a central role in coping with the issue of people living longer. Community hospitals are important providers of recovery beds that speed rehabilitation and recovery, which can also help older people in particular to continue to live independently.

I was inspired to seek this debate because people in my community care deeply about the local community hospitals in Dover and Deal. Years of centralisation have taken their toll. My constituents want more locally-based health services provided by their local hospitals.

Dover was deeply concerned to see services axed at its Buckland hospital; wards were closed one by one and a much-loved hospital was decimated over a decade. When I was elected in 2010, plans for a new hospital had been going nowhere for getting on for a decade and the new hospital project was set to be axed altogether. Meanwhile, in Deal, it was agreed in 2006 that out-patient services should be axed and residents were fearful that the hospital would be closed altogether. However, after much hard campaigning, the long-stalled new Dover hospital is being built. It will open in February or March next year and will have out-patient facilities, day surgery, diagnostics and a revamped urgent care centre. The number of journeys that will need to be taken to the big, far away hospitals will fall dramatically. It will make a massive difference.

In Deal, we campaigned hard to safeguard the future of the hospital. A massive survey and a packed public meeting ensured that NHS chiefs pledged not to close the hospital and they will now seek to expand its services. We now hope that out-patient services can be maintained for people who find it hard to travel: the elderly, the partially sighted and people with broken bones.

However, we have not achieved everything that we want. People in Dover want recovery beds to be located at the new hospital. Residents of Deal would like greater community and local general practitioner involvement in the hospital and its services. Both communities would like more locally-based services, to minimise the number of journeys to the large, far away acute hospitals for simple procedures and treatments. These concerns led me to move a ten-minute rule Bill earlier this year and I was delighted that so many parliamentary colleagues supported that.

The issue is not just for Dover and Deal; I have set out the local situation to provide context for the concerns of so many parliamentary colleagues. There are some 400 local and community hospitals throughout the land and there are similar stories to be told about many of them—stories of people battling to defend their hospitals and hospital services against the NHS leviathan and the forces of centralisation.

There is a sense that the tide has begun to turn. After all, a new hospital is being built at Dover, health chiefs have pledged to secure the future for Deal hospital, and there has been a move towards a fairer share of health care for rural and semi-rural communities far from acute hospitals. We have come a long way. Today, I am making the case for going further and asking what more we can do to embrace community hospitals and bring them closer to the heart of the NHS and, in particular, support the role that they play in providing recovery beds and more locally-based services, particularly for an ageing population. We need to put the community back into community hospitals.

We should note an important moment in the history of the NHS, marked by the comments of Simon Stevens, the new chief executive of NHS England, who recently made the case for patients to be treated more often in their own communities, saying that the NHS is currently too focused on

“a steady push towards centralisation”

and that Britain should learn from countries such as Sweden, the Netherlands and the United States, which have strengthened community care around small hospitals to meet the needs of local communities.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on obtaining this debate. In Northern Ireland, of course, we do not have as many community hospitals as there are on the mainland. Ours tend to feed into a main hub and we have out-of-hours services more than community hospitals. However, Mr Stevens, whom the hon. Gentleman mentioned, also says that we should consider community hospitals developing as social enterprises. What is the hon. Gentleman’s view on that?

[Charlie Elphicke]

The hon. Gentleman anticipates the direction of my speech. I wholly support it; it is a great idea. Mr Stevens also said:

“A number of other countries have found it possible to run viable local hospitals serving smaller communities than sometimes we think are sustainable in the NHS”

and that

“Most of western Europe has hospitals which are able to serve their local communities, without everything having to be centralised”.

In a speech to the NHS Confederation annual conference in June 2014, he outlined his plans for reform of community health services, reiterating the problems of the ageing population and the increasing number of long-term conditions, such as obesity and dementia, as well as more expansive and expensive treatments and the need for more localised health services to tackle these problems.

Mr Stevens is right. Community hospitals have an important role to play and perform best in respect of intermediate, step-down and step-up recovery beds, particularly for people recovering from an operation who need round-the-clock care, and in respect of helping older people get better and continue to live independently, keeping them out of end-of-life or long-term nursing home care.

[Richard Drax (South Dorset) (Con)]

I, too, congratulate my hon. Friend on this excellent debate. Does it not surprise him that the acute hospitals are not clamouring to keep the community hospitals, which could free up their beds, allowing patients to go home to their local communities, where they are going to get better, not worse? That, of course, would cost the Government less in the long term.

[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.