Healthcare (Devon)

Geoffrey Cox Excerpts

Tuesday 18th October 2016 Westminster Hall

[Kevin Foster (Torbay) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my right hon. Friend the Member for East Devon (Sir Hugo Swire) on securing the debate. I will be mindful of your comments about the time. I presume that a maximum of eight minutes will be appropriate.

[Mr Geoffrey Cox (Torridge and West Devon) (Con)]

Seven minutes.

[Kevin Foster]

I am reminded that it is seven minutes. [Interruption.] The more heckling there is, the longer I might get.

For me, this debate is prompted by what is one of the greatest successes of the NHS: the fact that life expectancies are rising. In parts of my constituency, life expectancy has reached 90, and in one ward that I represent, Wellswood, 9% of the entire population are aged over 85. That brings challenges not only in health and social care, but in relation to the wider selection of services that those who have reached that age will need in order to have a whole life and not just have their healthcare needs taken into account.

Today, however, the focus is on the health service. Clearly, the proposals announced by South Devon and Torbay clinical commissioning group have created a lot of concern across Torquay, Paignton and the rest of the bay and south Devon. In fact, public concern was so great that the first three consultation meetings that it arranged in Paignton did not go particularly well. It arranged what were obviously going to be very large meetings in rather small venues, so when I attended the first one, at 9 am, I found myself, with about 40 residents, my predecessor, the former mayor and a number of councillors, plus trade union representatives, being told that the room was full and we could not go in. Things got worse at the 4 o’clock meeting. I ended up addressing more people at an impromptu meeting on the steps of the venue than had actually got into the official meeting. Then finally, in the evening, although there was a reserved seat for me, that meant that another resident was turned away because I was there speaking. It was a shambolic start to a serious consultation, but thankfully I notice the trust has now arranged further meetings.

Local concern about Paignton hospital is so great because of the breadth and importance of the services that it provides, not least the beds that many people are discharged to from Torbay hospital. When the Public Accounts Committee did its recent report on delayed discharges, Torbay had one of the best records. I am sure that my right hon. Friend the Member for East Devon would reflect that, sadly, the Royal Devon and Exeter did not. That is not so much about the hospital’s own services as about its ability to discharge to a social care setting.

We have already seen the impact that the consultation has had in terms of beds. Qualified staff have decided to seek jobs elsewhere, seeing the numbers of beds already reduced. During the consultation, the fact that there are hundreds of beds in residential and nursing care homes in Paignton was cited. I took the time to ask the obvious question: how many of those are actually vacant at the moment? The answer that I got back—this was a snapshot taken two weeks ago—was that 12 of the beds are vacant, yet two are in places that are accepting no new placements at the moment and four are in a place that specialises in caring for children. That causes real concern that we will see more delayed discharges at our local hospital if the proposals for Paignton go ahead.

Many residents of Paignton are concerned about the wider clinical services provided there, not least the minor injuries unit. The suggestion made in the consultation is that if a minor injuries unit closes at Paignton, residents will travel to either Totnes or Newton Abbot. I am sure that we will hear from my hon. Friend the Member for Newton Abbot (Anne Marie Morris) that the facility there is in excellent condition, but the reality is that that involves travelling past the acute hospital at Torbay, with its A&E department. I think it is far more likely that there will be more pressure as a result of people who would have been at the minor injuries unit in Paignton ending up at A&E in Torbay—the very place that we want to discourage people from going to unless they need to be there. There are also services such as X-rays and other clinics that many local residents find convenient and that support local GPs in delivering excellent healthcare.

My other concern about the consultation document is that although it is very detailed about what will be taken away from the south Devon area, it is not detailed at all about what will replace it. For example, there is talk of a clinical hub in Paignton, but no location. There is talk of doing more through GP surgeries, yet many of the practices are in buildings that predate 1948 and are in effect converted houses—not places that would be able to provide extended facilities for healthcare.

I find it very concerning when I speak with local people about what engagement there will genuinely be as part of the consultation, not least given the meetings arranged for small venues and the way that much of the questioning really produces only one logical answer. No one is going to say, “Yes, I’d like to spend the night in hospital,” but we would spend the night in hospital if we felt that we needed to be there. This is about ensuring that people have genuinely been able to express their views. That is why I hope that my hon. Friend the Minister will take a close look at the consultation being undertaken.

In closing, I emphasise the point that has been made about recruitment. The movement of qualified staff out of Paignton the moment the proposals to close the hospital were mooted speaks to a wider problem of recruitment across health and social care in south Devon. Although seeing the Torbay and South Devon trust receive Fair Train’s gold standard work experience accreditation last Friday was welcome, more still needs to be done to convince people that careers in health and social care are just that: careers. Many male jobseekers in particular see a job in that field as an entry-level job that they would not progress from, yet there are so many opportunities there. This is another concern for me, as it is for colleagues. We can put things down on paper, but if, in the social care market locally, there are not the providers, there is not the quality of provider and, bluntly, the vacancies that we already have for GPs are spreading across other health professions, then whatever position we come up with in the consultation will not be able to be implemented unless we address those long-term challenges in our economy.

--- Later in debate ---

[Mr Geoffrey Cox (Torridge and West Devon) (Con)]

The problem with North Devon district hospital has for decades—certainly for as long as I have been in politics in Devon—been quite simple: it is a general hospital that is far out on a limb of sustainability, in terms of the range of services it offers. For decades, there has been a decision begging to be taken, but it has never had the proper, honest and frank discussion that it really needs.

A general hospital generally requires something around a third of a million people to sustain it. The population of northern Devon, including Torridge and the hospital’s catchment area, is some 80,000 or 90,000 people short of the figure that generally sustains a general hospital. However, historically, it has been universally accepted that Barnstaple requires a general hospital. We cannot provide health services to the population of northern Devon unless we have an acute hospital in Barnstaple. We are therefore faced with a clear and stark choice: either make a special case for funding it in the way that a rural hospital that otherwise could not survive needs to be funded, and make it an exception to the principles that apply to general hospitals for which the population is sufficient; or see it slowly wither on the vine, dying by a thousand cuts, and by weasel words used by clever civil servants and others to justify one saving after another. Those savings really mean services reduced, and patients redirected over 40, 50, 60 or 80 miles away, with some expected to travel into the heart of Somerset for treatment that other residents enjoy on their doorstep.

I endorse what my hon. Friend the Member for North Devon (Peter Heaton-Jones) said; there are red lines for Devon’s Members of Parliament. Of course we accept that the current model of healthcare cannot be preserved in aspic. There must be change and transformation, but we cannot put accountants’ methodology over the interests of patients and the citizens we represent.

I say to my hon. Friend the Minister that I know the green and pleasant lands of Shropshire well. What a fine county it is. It, too, has had its battles on this score; I know, because I have family who live there. Let him come to Devon and see the wide distances. I do not believe that in Shropshire there is a place over 70 miles from a main conurbation, as many communities in my constituency are. Travelling 70 miles to, say, have a child delivered puts at risk and prejudices the interests of those who are to be treated.

A decision must be taken on health services in north Devon. It is the same with hospitals in the far north of Scotland; they are highly rural, deeply isolated and not sustainable unless a special formula and a special approach are taken. Words such as “care closer to home” are all well and fine, but the difficulty is that communities see an historic legacy of underfunding that has left the health authorities in our area with an £80 million annual deficit. That deficit has built up over decades of accounting measures, and of conjuring with accounts. On the one hand, communities see this vast deficit, and on the other, they hear words such as “care closer to the community,” or, “Cut your beds and we will provide you with a service that is just as good, and that better fulfils the needs of patients.” Of course we can listen to the logic and rationality of that argument, but while it is all the time moved by the spectre of deficit, they will suspect that it is being made for one reason only: to reduce the budget.

My plea is for fairness. It is a plea to be heard, made on behalf of a neglected, extraordinarily rural area—possibly one of the most rural in England. It is a plea for a special look at this problem in northern, eastern and western Devon. The language coming from well-meaning and, I accept, wholly sincere health administrators has an Orwellian flavour to it while it is governed by this shadow of deficit that hangs over it.

I welcome the news from my hon. Friend the Minister that there has been allowance for rurality in the 2016-17 budget, but one or two minor tweaks do not reverse the legacy of decades. The truth is that the health services we represent—of the people we represent—are being seen to perpetrate a grave injustice. For example, public health spending alone—spending on the prevention of ill health—in the county of Devon is less than half the national average. On any analysis, the funding we receive in Devon is wholly inadequate to deal with its wide disparities and distances, its ageing population, and the other factors that affect Devon.

My simple plea to the Minister today is to hear the voice of those whom we represent, and to hear them pleading with him. Until the deficit is addressed and there is fair funding for rural health services, we will not believe the assurances from well-meaning administrators that our health services are safe. They are not safe. We need a major amendment to the rural health funding formula; we need to improve on what has been done this year; and we need to assuage the anxieties of our constituents by a proper, demonstrably fair health funding formula.