Community Hospitals

Guy Opperman Excerpts

Thursday 6th September 2012 Commons Chamber

[Dr Wollaston]

I wish to make the case for reinvigorating community hospitals as hubs for delivering the right care at the right time and in the right place. Of course, the right place, where possible, will always involve helping people to be independent in their own homes, but community hospitals have a vital role, through both step-up and step-down care, in helping to maintain that independence.

We should look at what community hospitals are capable of, because they are not just about in-patient beds: they provide a full range of diagnostics, minor injuries units, therapies—physiotherapy and occupational —and mental health care. In my constituency, people with cancer can access chemotherapy at Kingsbridge hospital, saving them a long roundtrip to Derriford hospital. Kingsbridge hospital—South Hams, I should say—supports a triangle centre helping people and their families living with cancer, while organisations such as Rowcroft hospice are looking to expand their care-at-home system through hubs in community hospitals and, at times, by utilising their beds and support. We can get so much more from community hospitals if we reinvigorate them.

We should not think of community hospitals as backwaters; they can be centres of great innovation. The nationally recognised Torbay pilot, which provides care based in the community, started at Brixham community hospital in my constituency and is now being considered for nationwide roll-out. That is a very good model.

[Guy Opperman (Hexham) (Con)]

I congratulate my hon. Friend on securing this important debate. She mentions the Torbay model, which is rightly a pilot and flagship for the integration of services, but does she envisage a situation in which not only are medical services integrated in one location but other emergency services can come together? The result could be enhanced training for people, such as firemen and policemen, who could qualify as paramedics and assistants to the medical services.

[Dr Wollaston]

Indeed I do, and there are many community hospitals that support first responders in the way my hon. Friend describes. That is an important role, and there is perhaps even an extended role in housing, where step-down housing can enable people to make the transition back to full independence. Indeed, there are many such roles.

What are the current barriers to providing the right care at the right time and in the right place? I would like the Minister to deal with five points. First, the biggest challenge we need to address is the tariff and tariff reform. She will know that most acute hospitals are paid through a system known as payment by results, which creates some perverse incentives, whereby acute hospitals want to hoover up as much activity as possible. Often, people are treated in an acute setting when they could be more appropriately cared for in a community hospital setting or at home. Can the Minister update the House on the progress we are making on reforming the tariff, by, say, working towards a “whole year of care” model or looking at other ways to remove the incentive in the system that means that people cannot be transferred into community hospitals or provided with the right care in the right place?

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[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

I thank the hon. Member for Totnes (Dr Wollaston) and the Backbench Business Committee for securing this important debate. We can see from the number of hon. Members across the Chamber who want to talk about this that it is a valid and timely debate. I also welcome the Minister to her new position in the Health team.

As many hon. Members and the Minister of State will know, community hospitals play a vital role in my constituency; Guisborough hospital and East Cleveland hospital are essential to East Cleveland’s health and well-being. I was privileged to secure an Adjournment debate on the future of community hospitals in the north-east on 20 June. While it was certainly good to hear from the hon. Member for Hexham (Guy Opperman), for instance, about the good work that community hospitals do in his constituency, it was clear from other hon. Members that some community hospitals are struggling. A general consensus was apparent to me that patient choice is key to this whole matter. While patients should be able to receive care at home, that is not necessarily what patients always want, and it is not always necessarily appropriate. Community hospitals therefore have a real role in providing care to such people, as well as in the provision of out-patient services, especially in rural areas.

With the Health and Social Care Act 2012 causing reorganisation that has cost the local NHS tens of millions of pounds on Teesside alone, it is perhaps not surprising that many trusts appear keen to centralise services to larger hospitals. In my constituency, we have already seen a significant reduction during this Parliament in the services available at Guisborough hospital, with the closure of the Chaloner ward and a reduction in minor injuries provision. Similarly, constituents have told me that they have been unable to receive the services that they need at East Cleveland hospital in Brotton. This is deeply worrying, as more than 50% of my constituency is rural, and I know how constituents without a car can struggle to attend hospitals further away, such as the James Cook university hospital near Marton, Easterside and Park End in the south Middlesbrough part of my constituency.

I know that this problem is unfortunately replicated around the country. In the South Tees Hospitals NHS Foundation Trust area alone, a district general hospital in Northallerton—the Friarage—and Redcar’s primary care hospital are facing problems due to the centralisation of services. With the reallocation of public health funds as well, which are used primarily for community nursing, we are seeing what I can only describe as a vice-like grip between the reduction in services in community hospitals and the reduction in funding for community nursing, especially for palliative care for elderly and vulnerable people.

[Guy Opperman]

I accept that the hon. Gentleman is a champion for his constituency, but he surely accepts that this is a process that started under his Government. For example, his maternity unit closed in 2006, so it is not something new.

[Tom Blenkinsop]

I can tell that the hon. Gentleman has a good memory, because that point was raised in my debate. While many services at that hospital have been closed in recent months, the maternity services at Guisborough were centralised at James Cook and the community was consulted on that. However, I did not see any proper community consultation when services at East Cleveland hospital and Guisborough were very much reduced.

Also, a massive number of long-serving, skilled nurses, mainly women, have been leaving Guisborough hospital before reaching retirement age. That is very worrying. They are choosing to go to other hospitals or simply to leave their careers altogether. The trust acknowledges that this is happening, and the reasons include stress, a lack of available nurses on the wards and the low-paying contracts being offered.

This seems to involve a central funding issue for the trust. The James Cook University hospital is now consulting the community on privatising wards at the hospital. So, while the trust is centralising services away from the community hospitals, it is also trying to find other funding sources to pay for the services that it has centralised. That suggests that this is a central funding issue and nothing else.

I sincerely hope, for the sake of my constituents, that the Minister takes urgent action to address the problems faced by district, general and community hospitals. Such action should include commissioning a database of information on what they do, providing trusts with the funds that they need to secure the future of those hospitals, and replacing the money that they have been forced to waste on an unwanted, unnecessary, top-down NHS reorganisation.

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[Anne Marie Morris (Newton Abbot) (Con)]

I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing this debate. We are discussing an important topic and there are many wide-ranging issues to be addressed. I also congratulate the Minister on having been appointed to her new role. We all look forward to working with her.

Community hospitals do not just provide excellent clinical medical care. They are also places where patients feel the warmth of the community, which adds to a sense of well-being that is also part of their recovery. One reason why people feel so strongly about having community hospitals close and accessible is because it means friends and relatives can attend, which helps to make patients feel well. That is not just emotional clap-trap.

My hon. Friend the Member for Totnes put her finger on a key point when she said that this is about the community and trying to extend and expand the range of community services that are available. My community hospitals in Teignbridge are going from strength to strength, and there is a move towards integrating social and health care. That will be the salvation of community hospitals in the future. I support my hon. Friend’s comments about volunteers, too. The league of friends and the community transport in my three hospitals are first class. Without them, our community hospitals would not be nearly as successful and happy.

My three hospitals are quite different, but they all have minor injuries units and X-ray facilities, and provide a variety of services to the old and the young. Dawlish was the first private finance initiative hospital ever built, and patient surveys consistently put it in the top three of the 22 Devon hospitals. Remarkably, Teignmouth still has an operating theatre, as well as a physio unit funded by the league of friends—well done! Newton Abbot got the 2007 PFI deal of the year. Unusually, it has a maternity unit, as well as a first-class stroke unit.

My hon. Friend the Member for Totnes also raised the important issue of ownership. I raised this matter last year in a Westminster Hall debate. It is crucial that we get clarity about how ownership is to be managed once the asset is transferred from the primary care trust. In the case of Teignmouth hospital, the property is owned outright by the PCT. As I understand it, that property will be transferred to NHS Property Services Ltd. My local community has put in £850,000, so how does it feel about that? What will happen on future fundraising? Will the money just go into a central pot? What terms and conditions will be imposed on the service provider?

The situations at Newton Abbot and Dawlish are much more complicated, because those hospitals are the subjects of PFI contracts. That means that the buildings are owned by a private contractor and are, in effect, rented out to the service provider subject to two charges, an availability fee and a service charge, both of which have historically been extraordinarily high. In those cases, the contracts will be transferred to the NHS Commissioning Board. That raises a number of legal questions about the validity of the transfer, given the nature of that contract, and about the ability of the new owner to renegotiate the contract. Why do I talk about renegotiation? I do so because it is well known from evidence in the press that some of the charges that have been levied are disproportionately high. What can we do to enable such a renegotiation? Clearly it will be completely inappropriate for a local trust provider to undertake such a renegotiation, so will the NHS Commissioning Board do it?

My hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) has been brilliant in raising a campaign to look at renegotiating these contracts. The Government have already started to look at the whole management issue of these contracts to see whether costs can be cut, and they reckon that a substantial saving has been made and 5% savings can be achieved. They have established a fund of more than £1.5 billion for this; that is the amount that any one trust can get over 25 years to assist with the blighting cost, but that can be obtained only in exceptional and historic circumstances. The fund has been used, but generally that has been in much larger cases involving much bigger hospitals; I cannot see a community hospital being able to pass the test of having exceptional and historic problems. So what can the Government do to help those hospitals blighted with the burden of a PFI contract? I have heard of hospitals that, under the service charge, have had to pay £333 just to change a light bulb. I am pleased to say that that was not the case in my local hospital, but my goodness me that sort of situation has to change.

[Guy Opperman]

My hon. Friend rightly raises the issue of PFI and asks what the Government can do. I would venture to suggest that the previous Health Secretary’s decision to approve the county council’s assistance to the health trust so that it could buy out the PFI contract that was crippling Hexham hospital is exactly the right way forward. Under that approach, a PFI arrangement is bought out and a much better financial basis is put in place—an ongoing future financial basis approved by all.

[Anne Marie Morris]

My hon. Friend makes absolutely the right point, but the tragedy is that few communities can afford that sort of buy-out. As he rightly says, if we could achieve that, it would undoubtedly be the answer.

All we need from the Minister is some clarity as to exactly how these properties are to be transferred; what the position with the local community will be when properties are owned by NHS Property Services Ltd; and what the position will be on the PFI contracts when they get passed across to the NHS Commissioning Board. Clarification on those matters would be helpful and it is now urgently needed, because local trusts that are looking at continuing to run these hospitals need certainty about what they are going to be including in their budgets, and the sorts of figures that the availability fee and the service charge take out are phenomenal. The availability fees at my local hospitals range from 18% to 35%; that is the fee simply to repay the funding costs of the overall PFI arrangement. The service charge can also be high, reaching 18% to 20%. Set against that, private investors are currently seeing returns of up to 50%. That is huge and it seems unreasonable. The previous Government entered into a voluntary arrangement whereby any excess profits, particularly as a result of contracts being bundled by external private bodies, should be shared between the taxpayer and the private investor.

All those tools, which are available for the Government, need to be used. We need certainty and manageable budgets so that our community hospitals can thrive and so that money is available for what we really need—the services.

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[Guy Opperman (Hexham) (Con)]

At this moment, Mr Speaker, you must be feeling like Shakespeare’s Henry V at Agincourt, and I suggest you will look back on 6 September 2012 as the day when hon. Members in the Chamber heard many potential Ministers speak for the first time. We had the great honour and privilege of hearing my hon. Friend the Member for Totnes (Dr Wollaston). She is a doctor and spoke with great wisdom when she introduced the debate. The other doctor in the House, my hon. Friend the Member for Bracknell (Dr Lee), also made a fine contribution. We welcome to the Whips Bench my hon. Friend the Member for Guildford (Anne Milton), who formerly distinguished the Department of Health, and throughout the past hour and a half a plethora of Labour Members have indulged us with their oratory and commitment to community hospitals. Finally, I welcome the new Minister who, as you prophesied, Mr Speaker, has a glittering career in front of her. Those were fine words, although I believe that you also admonished her most robustly for being a little too chatty when she was a Parliamentary Private Secretary.

I strongly look forward to hearing the gentle, reticent, shy, self-effacing style that the Minister has characteristically formed throughout the past two and a half years as an MP. Some have described her as Nottinghamshire’s modern Boadicea of Broxtowe, which may stick in the future. If she is able to survive the cake-fests of south Dorset, and future requests to visit many a hospital, she will surely go far.

I must make a brief declaration because I would not be in this House were it not for my campaigning as a lawyer on behalf of community hospitals, and the fact that my grandmother was an NHS matron. Furthermore, over the past two and a half years, I have probably spent more time in hospital than any other Member of Parliament, conducting an in-depth study of all aspects of NHS treatment. Owing to the fact that I was not a very good jockey, I have conducted an in-depth study of orthopaedic skills because I repeatedly seemed to come a cropper at the second last at Stratford, and various other delightful destinations. I am also fundraiser for various charitable organisations in my constituency—the Great North Air Ambulance service and the National Brain Appeal.

The subject of the debate is community hospitals. Amid the requests for preservation, strengthening and support, I want to enlighten the House with some success stories. The Haltwhistle hospital in Northumberland—a small community hospital in the heart of the town—is being completely rebuilt. There have been efforts to rebuild it for many years, and that is now happening on the same site in exactly the right way. That is what all hon. Members would like for their community hospitals. People in Northumberland would suggest that its integrated care is the way forward. There are standard community beds and care beds, and even one room for the larger patient, which is known in the trade as a bariatric room. That is a proper, integrated, long-term local solution in the community, for the community and involving the community. That must be the way forward.

[Jessica Lee (Erewash) (Con)]

Ilkeston community hospital in my community is held in great affection. Recently, one ward closed—the decision divided opinion among local GPs. We need to examine what services are provided and remind local residents and patients what facilities are available and what procedures they can obtain locally.

[Guy Opperman]

I endorse entirely what my hon. Friend says and am sure the Minister has taken due note of her comments.

I want to sell and extol the groundbreaking decision in Northumberland in favour of the PFI buy-out of Hexham general hospital. The hospital was built and opened under the former Prime Minister—the right hon. Member for Sedgefield as was—with a substantial PFI that patently impeded its ability to function, but it is among the first in the country to have been bought out by the local community. The way forward must be to try to refinance and improve the financial situation of such hospitals.

Northumberland has a rebuilt community hospital and a general hospital at Hexham, which delivers all the services, including cancer care and maternity, that we would like in local facilities. That should continue, but the problem I want to raise with the Minister is the future of rural health care—the problem will also apply to my hon. Friend the Member for Penrith and The Border (Rory Stewart) and any number of representatives of truly rural communities. Community hospitals are clearly at the heart of that, but the way in which community hospitals integrate in rural health care is one of the significant challenges for the Department of Health in the next five, 10, 15 and 20 years. I suggest that the way ahead must be for rural health care to become more automated—we should provide computer facilities for prescriptions and check-ups—but we must also integrate facilities using examples such as the Torbay and Haltwhistle models. We should also attempt to provide paramedic and GP services in an integrated way. It is good that the hon. Member for Denton and Reddish (Andrew Gwynne), the shadow Minister, is in the Chamber, because that will take co-operation between the unions and between local facilities. Any problems should be overcome if we make the point that people in the community are helping one another.

The future of integrated services—health care, fire, police or ambulance services—must be addressed by whoever is in government. I strongly urge the Minister to come to Northumberland to see the flagship model of the health service and the great job that my trust is doing.

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[Andrew Gwynne (Denton and Reddish) (Lab)]

I thank the Backbench Business Committee for granting this important debate today and I congratulate the hon. Member for Totnes (Dr Wollaston) on the eloquent case that she made in opening it. I also congratulate and welcome the new Minister to her place. She was a slightly unconventional Parliamentary Private Secretary to the former Minister of State for Health, the right hon. Member for Chelmsford (Mr Burns). I say “unconventional” because, as the hon. Member for Hexham (Guy Opperman) observed, PPSs are usually seen and not heard. I am sure that she will be even more vocal now that she has the freedom to speak from the Government Front Bench, and I look forward to our exchanges in the coming weeks and months.

As many Members have testified today, community hospitals play an important role in the communities they serve. They provide rehabilitation and follow-up care, and they can help to move care, diagnostics and minor injury and out-patient services, among others, from acute hospitals back to the community. They provide planned and unplanned acute care and diagnostic services for patients closer to home, and contribute to the local community by providing employment opportunities and support for community-based groups.

It is clear that people generally prefer medical treatments to be taken nearer to their homes and families, whether that involves palliative care, minor injury services or maternity care, and those are exactly the services that community hospitals can help to deliver. Indeed, the Department of Health has estimated that about 25% of hospital patients could be better cared for at home or in the community.

Community hospitals usually also have good relationships with their local communities, and are often supported by local fundraising. We have heard from a number of hon. Members today about the great work being done by friends groups up and down the country. I pay tribute to those groups, and to the staff and volunteers who work to make those groups and the hospitals happen. Staff in community hospitals can also build personal relationships with local patients and carers as they deliver continuous care from outside the hospital environment. That is an important point that should not be overlooked.

It is fair to say that community hospitals continue to play an important part in local health care provision. Their role is valued, and we are right to support it. Labour continues to be committed to community hospitals, when they represent the best solutions for local communities. I take the point made by the hon. Member for Southport (John Pugh) that they might not be the solution everywhere. My own constituency is served by three large district general hospitals and not one community hospital, but I acknowledge that other parts of the country have a very different geographical make-up, and that community hospitals are the right way forward for the provision of health care in those communities.

Community hospitals can provide a vital step between social care and acute care, and Labour would seek to develop them further. For example, it might be possible for GP or dentistry services to be offered in more community hospitals, which could make some that are only marginally viable at the moment more viable for the future. That possibility should be explored.

Some concerns remain, however, and I hope that the Minister will be able to offer the House some reassurance today. One of the most pressing tasks for the NHS in the coming years will be better to co-ordinate services around the needs of patients, and that might well mean that community hospitals have to change the way in which they provide services and the buildings from which they provide them. She will know, however, of our concerns about the Government’s structural reforms, which will make the co-ordination and delivery of services far more difficult. We believe that the future requires the integration of care, yet the Government’s policies are driving us more towards fragmentation. We know that they are already having a profound effect on the NHS. A recent survey of NHS chairs and chief executives by the NHS Confederation found that 28% described the current financial position as

“the worst they had ever experienced”.

A further 46% said the position was “very serious”.

It is also clear that the financial challenge will continue for many years after 2015, and all this could have an effect on community hospitals, whether it be the reduction of minor injuries provision, the closure of wards or the downgrading of services. As the hon. Member for Bracknell (Dr Lee) suggested in what I thought was a thoughtful contribution, these can sometimes be the right choices for an area. Sometimes, however, they will not be and they will just be financially driven; here, there is a danger that community hospitals will provide an easy cut for bureaucrats.

[Guy Opperman]

The hon. Gentleman will be aware that 3,000 community beds in community hospitals were shut under the previous Government. Is he going to enlighten us about what his policy is, specifically in respect of any particular cuts to community hospitals? Is he in favour of them, against them, or is there no policy?

[Andrew Gwynne]

Community hospitals have a vital role to play. As we have discussed in the debate, however, they may not be the right approach everywhere. We remain committed to community hospitals. The last Labour Government introduced a fund specifically for them. It is fair to say that that fund was not automatically taken up by primary care trusts up and down the country. Some areas had different viewpoints on the role of community hospitals. The Labour party has a commitment to community hospitals where they are the right choice for the local communities.

A further point about the impact of the Health and Social Care Act 2012 is that with responsibility for commissioning health care services moving into the hands of clinical commissioning groups and with primary care trusts no longer being in existence, there is a real danger that the role of community hospitals could be overlooked. Will the Minister reassure us that community hospitals will not be unfairly penalised in the new internal market of the NHS?

We should bear in mind further issues about the possibility of creeping privatisation—an issue that we, at least, are concerned about. The whole health service is currently in a state of flux, but as the reforms in the NHS kick in, it is perfectly feasible for commissioning groups to look outside the NHS to the private sector to provide even more of their services than in the past. This has already happened in Suffolk in March, when Serco won a £140 million contract to manage, among other things, the area’s community hospitals.

It could well be that when trusts are faced with the choice of reducing clinical services, they will look to being more centralised for financial reasons and take services away from the community and, indeed, in some cases from district general hospitals, too. This will almost certainly have an effect on any extensions to these services in community hospitals. Clearly, community hospitals and other community health services need to be able to compete on a fair playing field with other health providers, and I would ask the Minister how she will support that practically.

I would like to ask about some of the additional funding arrangements in the NHS—an issue raised by the hon. Member for Totnes in her opening comments. Previously in the NHS, payment by results was introduced to finance care and treatment according to a national tariff. It was intended to reduce variation in the prices paid by different parts of the country and to encourage providers to do more work, particularly helping to reduce waiting times.

Community services, however, are not covered by payment by results and are instead paid under a block contract negotiated with the local commissioner. I know that some community hospitals are concerned that they will have to make greater budget reductions than providers covered by payment by results. Some community hospitals are concerned that the commissioner will reduce the size of the block contracts, which is easier to do than stopping activity under a tariff.

From April 2013, the NHS Commissioning Board and Monitor will set the national tariff, and we are encouraged that the Government have expressed an interest in expanding payment by results to community services. If payment by results is expanded, it must be done in a way that supports integrated care and does not disadvantage care that is delivered in a community setting. How will the Minister ensure that we do not have a pricing system that disadvantages care that is delivered in community settings and particularly in community hospitals?

Let me deal briefly with the issue of estate ownership, which has been touched on by a number of Members. Many community hospitals do not own the buildings from which they operate, which affects their ability to raise capital to create new services for patients because they cannot secure finance or loans against the value of their buildings. As we have already heard during the debate, earlier this year the last Health Secretary announced that a Government-owned firm, NHS Property Services Ltd, would take over the ownership and management of the existing primary care trust estate and dispose of property that was surplus to NHS requirements. Community hospitals will depend on the setting of affordable long-term rents by NHS Property Services Ltd. I hope the Minister will tell us how the firm will work with community providers, including social enterprises.

There should be no doubt that Opposition Members support the principle of community hospitals. Indeed, we rightly established a fund to support and develop the community hospitals that represented the best choice for local communities. A future Labour Government would also aim to develop community services further within community hospitals. For example, as I have already suggested, it may be possible for more GP, dentistry or other services to be offered by them, and I think that that opportunity should be explored further.

We are concerned about some of the wording of the motion, which calls for community hospitals to have

“greater freedom to explore different ownership models”.

We would need more details of any parameters before agreeing to such an arrangement. It could lead to an opportunity for further creeping privatisation of our national health service, which is something that the Labour party will not support or give carte blanche to. For that reason, Labour will abstain on the motion.

The motion also calls for a national database of community hospitals. Historically their number and location was not monitored, as that was a matter for primary care trusts. However, we believe that in the new NHS, with confusion over where responsibility lies, there may well be a case for a national database. We would be interested to hear more details of what the hon. Member for Totnes has proposed, because we believe that it could give some value to the Department of Health in the future.

We should pay tribute to the important work that community hospitals undertake, the quality of the health care that they give to local people, and the commitment and dedication of all their staff, from medical professionals to porters and cleaners. The Government should be doing all that they can to ensure that patients can make real choices about receiving the health care that they need near to their homes. It remains to be seen how the Government’s changes to our NHS will affect community services and community hospitals. I look forward to hearing from the Minister how she will protect the role of community hospitals, which are valued and must continue to have a role in the more integrated and people-centred health care system that I hope we all support.