Unavoidably Small Hospitals

Derek Thomas Excerpts

Tuesday 6th September 2022 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I thank my hon. Friend the Member for Isle of Wight (Bob Seely) for securing this important and timely debate. As I represent a set of small islands myself, it is good to have him banging the drum with me on so many shared issues.

We understand the urgency of the subject. We have pretty much all just come back from beautiful parts of the United Kingdom—fantastic parts of the world—but they have particular challenges and sometimes there are not enough people to justify the Government’s funding formulas. We understand the pressures on urgent care, such as the ambulance delays that none of us are hidden from. My urgent care hospital has around 160 people there who have no medical need whatsoever. There is a backlog because of covid and also housing, which was mentioned in the previous speech.

The massive pressures on our bigger hospitals in the urgent care system—in my case, that hospital is in Truro—are eased by the existence and support of smaller hospitals. The debate is not only about small hospitals, but about how critical they are in helping the whole of the NHS and social care system to provide for communities, so that when we say healthcare in the right place and at the right time, we actually mean it.

Along with the others who have already thanked their nursing staff, I want to thank the NHS staff in my three small hospitals: St Mary’s on the Isles of Scilly; Helston Community Hospital—when I was a child it was Helston Cottage Hospital—which is a brilliant outfit that we spend far too little time talking about; and West Cornwall Hospital, which is an urgent care setting in Penzance that provides an important set of services to avoid people going to the centre of Cornwall. The pressing issue right now for these small hospitals is access to the NHS care workforce. The problem we have with small hospitals is that for them to fully function we need a wide range of disciplines and, as we heard earlier, that is difficult to find when the bigger hospitals try to put all their services in one central place. I understand and agree with everything that has been said so far. However, I particularly want to raise the issue of capital funding because for all the pressures and concerns about urgent care hospitals we have heard from constituents over the recess, some could have been eased if the capital programme had moved just a bit quicker.

We heard that one of the 40 hospitals is in the constituency of my neighbour my hon. Friend the Member for North Devon (Selaine Saxby). A £9.1 million fund was promised in 2019—two Prime Ministers ago now. The building work is ready to go. It should have been opened by next year, but it was paused by the Treasury. The work has all been done locally, the plans are agreed and the hospital wants to get on and build it. It will deliver a new outpatient centre, which will take patients away from the more pressured urgent centre in Truro, and refurbish the urgent treatment centre in Penzance. That work could have been under way but it is not because it was paused by the Treasury. The money—£9.1 million—was promised by Government for West Cornwall Hospital in Penzance. In west Cornwall we are all waiting for the Treasury to agree that fund, which was committed. The work has been done and huge amounts of money have been spent to get the hospital to where it is now, and we want to get it built, so will the Minister feed that back? It is not even one of the 40 hospitals; it predates that.

St Mary’s Hospital on the Isles of Scilly has enormous challenges, and anyone who has been involved in Government for a while will know the challenges we on the Isles of Scilly have had with keeping health and social care alive. The council on the Isles of Scilly runs the nursing home. For a long time, it desire has been to integrate the home with St Mary’s Hospital and collocate them on one site. In fact, also in 2019, the Government agreed to progress plans to create one single campus, put care and health services in a single building and collate primary care, community health, urgent care, mental health and adult social care all in one place. It made complete sense.

We had a Chancellor who gave us the green light—the one previous to the former Chancellor, my right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak), who is in the room now—and we had a Health Secretary come over and see in detail what was being proposed. There are two reasons why the plan is such a good thing for the Government to support. One is that it integrates health and care on the Isles of Scilly, which stops people having to move or be flown out of the Isles of Scilly for no real reason to get healthcare on the mainland. While I am on that subject, a couple of comments were made about how funding is allocated for moving people from the Isles of Scilly to Penzance. If the situation on the Isle of Wight is reviewed, it would be far better to replicate what we do than to take away the great service that we have, so I ask the Minister to please go the right way when making that decision and ensure equality for the Isle of Wight.

We have a brilliant plan to do far more on the Isles of Scilly, again using the skills we have, which would enable those skills to be used more effectively and fully both in health and social care. Not only would it deliver for the Isles of Scilly, but it would provide a good blueprint for how health and social care could be delivered on the mainland, particularly across Cornwall. Again, the plan has sat with the Department of Health and Social Care for a very long time. I am told that a decision will be made before Christmas, and I urge the Minister to feed back again about St Mary’s Hospital and the integrated health hub. We urgently need a decision. Again, we were under the impression that it could have been built this year—2022. A lot of the delays that are putting pressure on the system across Cornwall and the Isles of Scilly unfortunately sit with the Department of Health.

My hon. Friend the Member for Isle of Wight made an important point about who controls funding. Unavoidably, small hospitals fall foul of pretty much every funding formula—for good reason, as public funding must deliver value for money. However, if that is interpreted as “bums on seats”, or in the case of hospitals “bums on beds”, smaller communities such as Scilly, rural Cornwall and the Isle of Wight will always be discriminated against, because they will never fully be able to compare or compete with places such as London or other vast urban masses where a hospital can deliver so many more outcomes for the local population.

On Scilly and in west Cornwall, it will always cost much more to deliver health and social care, so decisions about such areas must be taken separately to other NHS funding decisions, because care is not delivered for the same numbers of people. However, there is no reason why people living in rural and isolated areas should receive any less care. We should look very carefully at how the funding formulas are worked out. It will always be the case that an NHS funding body will prioritise the areas where we can deliver more health.