Community Hospitals

John Pugh Excerpts

Thursday 6th September 2012 Commons Chamber

[John Pugh (Southport) (LD)]

It is an honour to follow the hon. Member for Bracknell (Dr Lee), who made an excellent speech. I also congratulate the hon. Member for Totnes (Dr Wollaston) on having initiated this important debate, and welcome the Minister, who has secured a deserved promotion. I think that we have all appreciated her analytical contributions to debates on health and on other matters.

I have only one simple point to make, which is better than my normal average. The fact is that community hospitals are in a slightly ambiguous category. Some are innovative, valued, highly rated and essential, while others are historical legacies of a previous age—expensive to run, limited in range, and out on a limb. Some areas depend on them, and some areas, such as mine, have absolutely none. I was a founder member of the all-party parliamentary group on small hospitals simply because my constituency contained a small acute general hospital. Dr Taylor was, of course, elected on an issue involving the closure of hospitals, which has been a shock to the whole political system ever since.

What a community hospital offers, what it consists of, how it is staffed and the services that it offers vary from one community to another, but what is universally the case is that, negatively or positively, we are now deciding what we will do about such hospitals and evaluating their place in the new system. There are three forces working against them. First, there are the perceived and evidenced benefits of specialisation—mentioned by the hon. Member for Bracknell—and the concentration of hospital services across many surgical and medical fields, leading to bigger and more expensively resourced general hospitals. Secondly, there is the encouragement given to GPs to provide more and more services in a primary care setting: tests, dermatology and the like. Thirdly, there is the encouragement given to non-NHS providers to offer clinical services at NHS prices. Given the additional fact that the last Government cut the umbilical cord which, in many instances, joined community hospitals to PCTs and effectively guaranteed their funding, the problem is clear.

The result of all that is that each community hospital has had to establish its own niche within an increasingly tightly regulated and exacting health economy. The range of services they provide varies: recuperative services, palliative services, minor injuries services, clinical and diagnostic services, blood tests, and—very importantly—the provision of satellite services for bigger players. It can look as if they are searching for a role, but their absence, closure or downgrading has the capacity to seriously unnerve communities and their MPs.

Hard-headed health economists and medics regard this as emotional populism; they see people getting upset about the survival of their community hospital as, in effect, a costly attachment to buildings. However, they misunderstand the public—and, to some extent, the rural—psyche. People have reasonable and rational expectations concerning the clinical quality of services, and the NHS tries to state them, define them and meet them. People also have reasonable, but generally unstated, expectations about access to services, and the NHS often dodges them, declines to state them, or shuffles off responsibility to the Department for Transport. People will travel to the ends of the earth for life-saving specialist care, but they see no reason in the modern age to travel 10 miles for a simple blood test or the triaging of bumps and falls.

We have to accept that acute care will increasingly take place only in ever-larger city hospitals, but there will be hassle for everybody, including relatives, if prolonged recuperation or chronic diseases are treated in the same place. It is true that over time GPs will do more and send fewer patients to hospital, but no GP will ever provide 24/7 open access. Very few GPs are now on call, and they do not offer the full raft of community hospital services.

If community hospitals are to have a long-term future, we have to be clear about access, access standards, what the reasonable standards of access are and what each citizen can reasonably expect from the NHS—a subject on which I had an Adjournment debate a few months ago. If that is not done, the future of community hospitals will be left to market forces to play out, which is not a game I see community hospitals winning.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Let me begin by congratulating my hon. Friend the Member for Totnes (Dr Wollaston) on securing the debate, and congratulating not just those who added their names to her motion but all who have spoken in what has been a very interesting and, indeed, passionate debate. In fact it has not really been a debate, because there has been an outbreak of agreement, certainly on the Government Benches, as so many speakers have spoken with such passion about the community hospitals in their constituencies.

I should also say thank you to all who have congratulated me on my appointment, and have said some rather kind things. I am sure that normal service will soon be resumed. Sadly, my right hon. Friend the Member for Chelmsford (Mr Burns), the former Minister with responsibility for health services, has now departed from that post and gone to another place, as it were—to another Department. We all miss him and thank him for his great service and his commitment to the national health service. He explained to the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) during a debate in June about community hospitals in the north-east that this Government support improvements in community hospitals across the country. That is because we know that community hospitals make it easier for people to get care and treatment closer to where they live. They allow large hospitals to discharge patients safely into more appropriate care. They free hospital beds for people who need them. Community hospitals allow many patients to avoid travelling to large hospitals—and many of those large, acute hospitals are in cities, with all the attendant problems of transport, parking and so forth.

Our community hospitals provide a wide range of vital services, including minor injury clinics and intensive rehabilitation, on patients’ doorsteps. They can also help save the local NHS money by moving services out of acute hospitals and closer to the people who use them. People are often rightly very protective of their community hospitals, as we have heard from many Members this afternoon. They deliver essential services, and provide employment for people who live nearby and spaces for community groups. It is therefore understandable that community hospitals are fiercely defended and inspire such loyalty.

If I am to retain responsibility for community hospitals, I shall be a busy Minister. I shall be going up to the north-east to Middlesbrough and Cleveland, to South East Cornwall, Bracknell, Newton Abbot, Cannock Chase, West Worcestershire, South Dorset, Penrith and The Border, Halesowen and Rowley Regis, Hexham, North Dorset, Wells, Tiverton and Honiton, including Seaton, and Denton and Reddish—although not to Southport as it does not have a community hospital. I am grateful for all those invitations, and if I can, I certainly will accept them.

My hon. Friend the Member for Totnes delivered a speech that was, as ever, thoughtful, inspiring and well-informed, and she asked a number of questions of me. If I do not answer all the points she raised, I hope she will forgive me, and she will certainly get a letter from me answering all of them. Let me state at the outset, however, that she has made a very powerful case in relation to the Community Hospitals Association and its database. Funding for that database was stopped. I cannot promise that it will be restored, but I can say this: I have asked my officials to look at that decision again with great care.

I anticipate that we will not have a vote on this motion, and it is of interest that the two Opposition Members present will abstain if there is a vote, because we have rightly heard a cacophony of voices from the Government Benches in support of community hospitals.

My hon. Friend asked about tariffs, as did the hon. Member for Denton and Reddish (Andrew Gwynne). It may be of some assistance, especially to my hon. Friend the Member for Penrith and The Border (Rory Stewart), for me to state that work is under way in the Department, looking at a payment system for patients suffering from long-term conditions. That includes services delivered in community settings. I trust that provides some hope. From 2013 and into 2014, tariff settings will be decided by Monitor and the NHS Commissioning Board. My hon. Friend the Member for Totnes made a powerful point about the potential importance of tariffs in ensuring the future of our community hospitals.

A good point was made about the decline in the number of GPs in some areas. I hope my hon. Friend will take comfort from the fact that my information is that there is a 50% target in respect of medical trainees going into general practice—I do not much like targets, but this could be a good one—and a taskforce has been set up to try to achieve that.

The future of community hospitals will, I hope, be secure in many of our communities, but it has to be said that many of the concerns Members have raised relate to local decisions, and it would not be right for me, as the Minister, to interfere in any of those decisions. My door is always open and I am always happy to meet hon. Members and any of their constituents. I may not be able to help in Cannock Chase, in Rowley, where there is difficulty, in Wells or in some other places, but I am happy to provide such support, assistance or advice as I am able to give.

Hon. Members have rightly discussed the future of the estate. I am conscious of the time, Madam Deputy Speaker, so I hope you will forgive me if I read out this part of my speech. It is important that hon. Members know and understand that the Health and Social Care Act 2012 required new ownership arrangements for current PCT estates. That means that providers such as community foundation trusts, NHS trusts and NHS foundation trusts will be able to take over those parts of the PCT estate that are used for clinical services. That includes the community hospital estate, but—this is an important but—we have put safeguards in place so that providers cannot just sell off newly acquired land and make a quick profit. Estates must be offered back to the Secretary of State for Health if, for example, the provider fails to keep the service delivery contract associated with the property or if the property becomes vacant. In addition, where any former estate becomes surplus to NHS requirements 50% of any financial gain made by the provider must be paid back to the Secretary of State and will go straight to front-line NHS services.

A Department of Health-owned limited company called NHS Property Services Ltd, to which reference has been made, will take on the remaining estate, as announced in January this year. Its key objective will be to provide clean, safe and cost-effective buildings for use by community and primary care services. I would like to assure every hon. Member, and every member of the public, that any community hospital building taken on by this company will be well looked after. Local clinicians will decide how those estates are used; whether new buildings are built or existing ones are closed will be up to them, as will all decisions about local patient services. As I have said, it is right that these decisions are taken locally. In reality, patients and the public will not notice any difference, at least in the short term. In the longer term, they will see that the NHS estate is managed more efficiently, by people who know what they are doing; that money will go to improve properties and front-line services.

NHS Property Services Ltd will own and manage buildings that are needed by the NHS. However, it will also be able to release savings from its properties that are declared surplus to NHS requirements. That money will be used further to improve property provision in the NHS. All PCT properties will transfer to either NHS providers or NHS Property Services Ltd on 31 March 2013. Until the provisional lists of property transfers have been finalised later in the year, I cannot confirm whether any particular community hospital will transfer to either an NHS provider or NHS Property Services. In the latter case, the community hospital services provider will become a tenant of NHS Property Services, in the same way that it is currently a tenant of the PCT.

[John Pugh]

Should the tenant, be it a community hospital or whatever else, seek to expand and should it need further facilities, is there a dialogue it will be able to have with the company to get it to extend the premises?

[Anna Soubry]

I am grateful for that question, but I shall be blunt and say that I do not know the answer. I will make inquiries and I will certainly make sure that the hon. Gentleman gets a full report in response.

Under the statutory provisions, while a building is needed to deliver NHS services, no NHS organisation will be allowed to sell it off, so there is no question of useful NHS property being sold to or transferred to organisations outside the NHS. At the same time, this means that a league of friends—a number of hon. Members have spoken with great fondness and admiration in support of leagues of friends, and I am sure that they will relay this to their local league of friends and their community hospitals—is unable to own the freehold of an operational NHS property. A league of friends is able to bid to become an owner of a community hospital only when it is declared surplus to NHS and public sector requirements. Current Government policy is that surplus property should normally be sold by auction or competitive tender. In such cases, the hospital league of friends would be given the opportunity to bid for the property along with all other interested parties. A league of friends could form a social enterprise to compete to provide services from a community hospital but, even then, as a social enterprise rather than an NHS body it could not take ownership of the assets of the community hospital. That might disappoint some, but I hope that in many ways it will give people comfort for the future and go some way towards addressing many of the points raised by my hon. Friend the Member for Totnes.

In conclusion, the Government have taken steps to secure the assets of community hospitals and ensure they are used for the benefit of their community. Those decisions will be made by people qualified to do so. That is the best thing for the hospitals and it is certainly the best thing for the communities that they serve. It is quite clear why so many people speak out so strongly and forcefully about community hospitals; it is because of the great work that they do. On behalf of the Government, I want to pay tribute to everybody who works in community hospitals and all the organisations that support them. I thank everybody who has contributed to the debate, which has been a very good exposition of the fine qualities of our community hospitals and, in particular, the organisations, such as the leagues of friends, that do so much to make them the great hospitals that they invariably are.