Unavoidably Small Hospitals

Feryal Clark Excerpts

Tuesday 6th September 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is always a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Isle of Wight (Bob Seely) for securing this important debate. As we have heard, small and rural communities face a range of challenges when it comes to the provision of healthcare, so I am sure that his constituents will be grateful to him for putting the issues on the agenda today and for being a champion of their needs.

I also thank the hon. Members for Strangford (Jim Shannon), for Thirsk and Malton (Kevin Hollinrake), for Caithness, Sutherland and Easter Ross (Jamie Stone), for North Devon (Selaine Saxby) and for St Ives (Derek Thomas), and the right hon. Member for Richmond (Yorks) (Rishi Sunak) for their excellent contributions. I am delighted to see the right hon. Member for Richmond (Yorks) this morning, and am glad that he is enjoying his new-found freedom.

We should never think of the provision of accessible healthcare as a luxury but, as we have heard this morning, too many people across the UK face barrier after barrier to accessing even the most routine care. For too long, the drive towards economies of scale in the NHS has left many small and rural communities without the basic services they need. In the past 20 years, more than half of England’s hospitals have been closed or merged. The victims have too often been the smaller hospitals that provide healthcare to nearly half the population in areas that are frequently more remote, more deprived and have an older patient cohort than average.

Although the NHS has processes in place to recognise hospitals that are unavoidably small due to the remoteness of the communities they serve, they often do not go far enough. North Cumbria Integrated Care NHS Foundation Trust, which has received extra funding from the NHS, has patients who have been waiting more than six months to be discharged despite being medically fit to leave.

Sites falling outside the top eight sites identified by the NHS as in need of funding adjustments have not received any additional support. The consequence is not just that local patients receive a poorer service but that lives are put at risk. In Cornwall, we saw utterly shameful scenes when 87-year-old David Wakeley had to wait 15 hours for an ambulance in a makeshift shelter that his family constructed after he fell in his garden. In 21st-century Britain, no one should have to experience what David did, regardless of where they live.

We know the problems our NHS faces. Years of underfunding and poor staff recruitment and retention have caused universal challenges across the NHS, but the nature of small hospitals exacerbates those already pressing problems. Smaller hospitals are more likely to suffer from workforce issues—as all Members have said this morning—budget constraints and an inability to provide specialist services. As Members set out, the challenges of recruitment in remote communities leave smaller hospitals with the uncertainty of having to over-rely on locum staff. If hospitals do not have consistent and stable staffing levels, patients will not receive the standard of care they need.

The Government have had opportunities to put this right, but they have sadly fallen short every time. Nothing makes that clearer than the commitment in the 2019 Conservative manifesto to build 40 new hospitals. The hon. Member for North Devon said that she hoped her area would be one of those receiving one of the 40 hospitals, but I am sorry to say that nobody believes that cornerstone of the Conservative manifesto, because it contains not even a grain of truth. The policy has been such a failure that the National Audit Office is now stepping in to investigate the scheme and conduct a value-for-money review. When even the NAO does not believe the Government’s insistence that the commitment to build 40 entirely new hospitals can still be met, what confidence can patients have? Can the Minister tell us where the 40 new hospitals are or will be?

The reason that matters so much is that the Government’s blinkered focus on an unworkable, undeliverable policy is wasting precious time that could be spent on ensuring local services are able to provide people with the care they need in their community. There cannot be a blanket approach to the problems facing small hospitals; we must look at the entire health system for opportunities to relieve pressure and get services functioning. Care must be rooted in local communities to create trust and ensure that patients can build the relationships on which good community care relies. The introduction of integrated care systems is an ideal opportunity to do that and take a fresh look at the allocation of resources and at how we can maximise access for patients, particularly in small and rural areas. The Government must not waste this opportunity.

While I am talking about wasted opportunities, I would like to draw the Minister’s attention to the health disparities White Paper, which could be another crucial opportunity to look at inequality in care across the country and at issues facing isolated and deprived communities. We have been expecting the paper for months, so I would be grateful if the Minister could update us on where it is. We need to see progress on the paper, because patients in our small and rural communities cannot afford for the Government to waste this opportunity. This postcode lottery is putting lives at risk and it is time for it to end once and for all.

Finally, on a slightly more positive note, I wish the Minister all the best and good luck in today’s reshuffle. I hope she is returned to her place. Even though we may not agree on lots of things, I know she puts in more work than any of the other Ministers I have come across, so I wish her all the best.