Clevedon Community Hospital

Liam Fox Excerpts

Wednesday 5th December 2012 Commons Chamber

[Dr Liam Fox (North Somerset) (Con)]

I am pleased to have the opportunity in this short debate to raise some of the issues related to Clevedon community hospital.

There has been a cottage hospital in Clevedon since 1874. The hospital has a fine tradition of providing care for more than 100,000 people living in Clevedon and the surrounding area. The current cottage hospital has 18 in-patient beds, along with limited X-ray, physiotherapy, musculoskeletal and minor injuries facilities. It also hosts a range of out-patient clinics. It is an invaluable service for the local community, especially for the many pensioners who live in my constituency, for whom travelling to Bristol or Weston-super-Mare could take more than an hour on the bus—when the buses come, that is.

The original Victorian building has been tweaked over the years, but it is bursting at the seams and there is open concern among locals and NHS professionals that the building would not confidently pass a Care Quality Commission inspection. Those concerns are not new, so plans have been developed over the past four years for the building of a new community hospital in Clevedon.

I pay tribute to the League of Friends of Clevedon cottage hospital for its unstinting efforts in support of the existing hospital over the past 50 years. Since 2005, it has spent £500,000 on building improvements and endoscopy, ultrasound and other facilities. For the past four years, it has supported the plans for a new hospital and has raised another £200,000 towards further improving health care provision in Clevedon. It is a shining example of the volunteer groups that make such a difference in our local communities, and we should applaud its extraordinary efforts.

Over the past four years, four business cases have been submitted for the building of a new community hospital. The third business case was submitted in 2011 and was given to the consultancy firm PricewaterhouseCoopers for external scrutiny. It confirmed that the plans were affordable within the existing budget and made a number of suggestions to improve a subsequent business case. Those were incorporated in the fourth and final business plan.

During the development of the plans, a preferred bidder for building the hospital was engaged under a private finance initiative arrangement. The plans developed by Amber Solutions for Care were also changed as a result of the consultancy process to bring the PFI annual rental charge down to £858,000 and, therefore, within the amount affordable to North Somerset primary care trust. So by March 2012, building plans had been tailored to be within affordability levels, and an independent consultancy firm had improved and endorsed the business case.

In March, the business case was considered by the cluster board of the Bristol, North Somerset and South Gloucestershire primary care trusts and was recommended to the South of England strategic health authority for its endorsement at a meeting in May. North Somerset PCT issued a press release on 28 March, confirming that plans for the new community hospital were “on track”, and that

“the business case was revised to take into account changes in the NHS locally and to ensure the long term viability of the Hospital. This work has now been completed and has been endorsed by the Cluster Board.”

It ended by saying that

“the projected opening of the new Community Hospital will be in early 2014.”

After years of development, campaigning and fundraising, the many stakeholders and supporters in my constituency were delighted by the news.

However, on 19 July, North Somerset PCT issued a new statement, saying that the business case had been reviewed and that the hospital was

“unaffordable given the economic circumstances”.

It is hard to see what new information came to light between March and July, so it is natural to conclude that either someone in North Somerset PCT got their numbers very wrong at the beginning, or that the U-turn was not actually based on affordability, but on priorities.

I ask the Minister to confirm exactly what new information came to light between March and July. It is scandalous that perfectly reasonable questions from the community and its Member of Parliament were almost completely ignored, and left unanswered. We were all understandably disappointed at such a quick—and seemingly unexplained—reversal.

Research has shown that the North Somerset PCT underspent in 2010-11 and 2011-12 by £1.6 million and £1.06 million respectively. Transfers of £1.8 million were also made from North Somerset PCT to South Gloucestershire PCT last year, and plans exist to make a similar transfer this year.

North Somerset PCT, in its operational plan for 2011-12, notes that, for that year, it was the lowest funded PCT nationally. Being the lowest funded PCT in the country and still underspending seems mightily unfair to my constituents when they perceive that money is being transferred to other, better funded but less frugal PCTs, seemingly to the detriment of capital projects in North Somerset.

The PCT has also expressed concern that financial shortfalls at the general hospital in Weston-super-Mare have forced a changing of priorities, which, again, is to the detriment of capital projects elsewhere in North Somerset. It appears that they are losing out, not on grounds of affordability but because priorities lie elsewhere. If others cannot function competently, that should be their problem, not ours.

Then there is the wasted money. The process of developing the plans, securing planning permission and fees for external consultants, and administering the tendering process has cost around £1.5 million. The same again has been spent on procuring the Millcross site in Clevedon for building the new hospital. The preferred bidder may also be in the process of trying to recover some of the costs it incurred while redesigning the hospital at the PCT’s behest. More than £3 million of taxpayers’ money and more than four years of administrative effort may have been wasted on a hospital that never gets built.

The people of Clevedon and North Somerset want a new hospital, and that is my main aim in the debate. Local reports are that endoscopy examinations have already been transferred out and the gynaecology unit is being transferred to Portishead, and rumour has it that the minor injuries unit is being transferred to the physiotherapy department, raising the question of the future location of the physiotherapists. I also understand that visits by consultants from Bristol are to be scaled back.

I also want to secure the Minister’s assurance that there are no plans for reducing the services currently provided at Clevedon cottage hospital, and that the move of endoscopy and gynaecology services are only temporary measures.

The handover from the North Somerset PCT to the North Somerset clinical commissioning group could be both an opportunity and a threat. I know the CCG has been involved in the decisions taken thus far, but it is important to know whether it has the same view on the need for a cottage or community hospital in Clevedon.

Let me be clear that my constituents are wedded not to any particular piece of ground but simply to the maintenance of community facilities. That is why we need reassurance from the Minister. We have watched plans for the proposed Portishead community hospital disappear, and we watched Orchard View, with its exceptional care facilities, disappear. We will not tolerate community facilities in Clevedon disappearing too. If the Millcross site cannot be built on and is subsequently sold, we must have assurances that the moneys raised from the sale will come back into our health authority, so that they can be reinvested in the Clevedon cottage hospital on its current site.

It is clear that there has been a managerial shambles, so the management should pay the price, not the people of Clevedon and the surrounding area. Responsibility, accountability and transparency are all we seek. Surely that is not too much to ask. This has been a long, costly and frustrating process that has damaged my constituents’ trust in their local PCT. Millions of pounds have been wasted. It is still unclear what changed between March and July. The old cottage hospital is in an ageing building that has previously been deemed not fit for purpose.

If the cottage hospital is to remain in service, it must be invested in so that its future is secure. At the very least, the proceeds from the disposal of Millcross must be reinvested in the current site. I seek an assurance that, if no new hospital is to be built, there will be no reduction in the services offered by Clevedon cottage hospital, and that endoscopy and gynaecology will be returned soon.

We need to know whether there is really no way that a new hospital can be built. The plans are made; the affordability study has been completed; a contractor is secured; planning permission has been received; and public support is firmly in favour. The League of Friends Of Clevedon Hospital has been outstanding in its support for both the old hospital and the development of a new one. Whatever the outcome of this administrative tangle, I hope it will not be deterred from maintaining its fantastic efforts.

We stand as one community to ensure that in the NHS we get fair treatment, a fair hearing and our fair share of the health care that is due to the people of Clevedon.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I congratulate my right hon. Friend the Member for North Somerset (Dr Fox) both on securing the debate and on his strong advocacy for Clevedon community hospital.

Members who represent more rural constituencies know the importance of high-quality community health care facilities, including community and cottage hospitals. They provide important close-to-home care for patients in more rural areas, particularly frail and elderly patients who have long distances to travel to receive health care.

We know the importance of such hospitals in meeting the long-term challenges of the NHS. We need to redesign services and deliver more services closer to home, and prevent inappropriate hospital admissions to big acute hospitals such as those in Bristol or Weston-super-Mare. That means ensuring that we have the right community resources properly to support local people, including those with long-term medical conditions such as asthma, diabetes and dementia. In particular, we need to ensure that we have community-based support for older people—the biggest group with long-term conditions.

We want to move the emphasis of care in this country away from acute crisis management, to which the NHS is accustomed, both to save the NHS money and to provide better care for people in their homes and communities. Community hospitals such as Clevedon are important in delivering such care. They provide invaluable beds for people with long-term conditions to give their carers respite, and important rehabilitation in a setting close to home, family and support networks for people who have broken hips, or who have had strokes or heart attacks. They provide the opportunity for step-up care for people who are not so unwell that they need to be admitted to an acute setting, but who can be better looked after temporarily in an environment that provides the additional care that people need. The Dr Foster report, which was published this week, highlights that 29% of patients did not necessarily need to be in acute hospital beds. If we are to meet the challenge of ensuring that people are better looked after and are not in hospital beds when they do not need to be, it is important that we invest properly in community resources, and Clevedon community hospital is just one of those resources.

I share with my right hon. Friend and the community he represents their frustration with the primary care trust, as I have Hartismere community hospital in my constituency. My predecessor, Lord Framlingham, had considerable struggles with the PCT about the potential closure of an important rural hospital. From what my right hon. Friend says, his constituents and local patients have been having considerable struggles and difficulties with the local PCT in Somerset.

I acknowledge the special role the League of Friends plays in the life of Clevedon community hospital, a point my right hon. Friend made in his speech. It has worked to raise a lot of money for the hospital and to ensure that it is retained as an important community health care resource. It is dismayed and disappointed, as are others in the local community, by the attitude of the PCT. I understand his disappointment, but under the PCT arrangements the provision of local NHS services remains with the local NHS. However, he is concerned that approximately £1.5 million or £1.6 million has been spent on project costs and other costs over a four-to-five-year period, in proposing to develop a new and sustainable community hospital facility in Cleveland. The money has been spent, but there is still no new facility. As physicians, we would rather the money had been spent on a new facility or on community care.

If it is any consolation to my right hon. Friend, I had a conversation with local health care representatives yesterday. They reassured me that even without the new facility at the allocated site, there are no concerns about any loss of services with the transfer from the PCT to the clinical commissioning group that will have responsibility for running community services. I hope it reassures my right hon. Friend to hear that when the new arrangements come into place in April next year services will remain as they are now.

On endoscopy services, as clinicians we know that strict evidence-based clinical standards must be achieved when delivering endoscopy services, which, for patient safety and to maintain high-quality patient care, have to be adhered to. There were concerns that facilities at Clevedon hospital were not able to maintain those high standards. For example, arrangements for the decontamination of endoscopy equipment would have to be substantially improved if the service was to achieve external accreditation by the national joint advisory group for endoscopy, and that would need to be achieved for the service to return to the hospital.

Despite my conversation yesterday with representatives from local health care commissioners, I am alarmed by what my right hon. Friend tells me about the business case to all intents and purposes being approved and then suddenly, between March and June, being disapproved—an extraordinary turn of events. It is inexcusable to raise the expectations of local patient groups, effectively giving a green light suggesting things were going ahead, and then to remove that expectation. I am happy to look into the matter further and to write to my right hon. Friend about it in more detail, because I am concerned about the issues he has raised. When something like £1.5 million has been spent on planning, and various plans and business cases have been brought forward, it is all the more concerning. It is not a satisfactory state of affairs, as far as the local management of NHS resources is concerned, and it is certainly not a satisfactory state of affairs, as far as local patients are concerned. I shall further investigate the matter and write to him on the basis of those investigations.

On future provision, I would like to reassure my right hon. Friend that, according to what local health care commissioners told me yesterday, the services currently provided at the hospital are safe and will still be provided. Even though plans do not appear to be in place, as they once were, to build a new hospital on a new site, it would be relatively easy, I understand, to maintain the buildings and the facilities on the current site in a state that would allow for the safe delivery of high-quality patient care and the ongoing provision of services for patients in the area. I understand that the older building can be improved, if required, to ensure that it can still deliver high-quality patient care.

With those reassurances, I will further investigate why the business case has gone from being approved to disapproved, as my right hon. Friend said. We have been reassured that the services currently provided at the hospital will continue to be provided for the foreseeable future.

[Dr Fox]

If we are to maintain clinical services on the original site, substantial investment will be required. I am sure that my hon. Friend will be sympathetic to our view. If a business case can be perfectly fine in March but dumped in July, if we, the poorest funded PCT, can give money to other less well-performing PCTs and given that the transfer is being put forward again this year, how can we have much confidence in the local management? Then, when our questions are not answered, as they continue not to be, we feel that there is not only insufficient competence but a lack of transparency. I am grateful for his reassurance that the matter will be looked into, but I would also like him to kick our local PCT in the proverbials to ensure we get the money required from the sale of the Millcross site or from additional investment, so that we can get the facilities that our taxpayers contribute towards but which seem to be getting siphoned off into other areas, whether because of a lack of adequate priorities or competence.

[Dr Poulter]

My right hon. Friend makes a good case. From what he has outlined, I fully agree that some of the circumstances surrounding the decision seem extraordinary and completely unacceptable. He described it as being far from competent, and I would not wish to disagree, judging from his analysis.

We are interested in delivering high-quality front-line patient care. The challenge for the NHS is delivering that care close to home and close to people’s communities. That is what Clevedon does and what it needs to continue to do. We need to ensure that PCTs, as they are at the moment, and clinical commissioning groups, as they will be in the future, invest in high-quality local health care services in order to meet the challenge of better looking after older people. That is the clear challenge that David Nicholson set for the NHS in 2009 in the quality, innovation, productivity and prevention challenge. It is about the need to redesign services in order to deliver better and more affordable care in the community.

That was also the challenge that Dr Foster outlined for the NHS earlier this week. It is about time that my right hon. Friend’s local health care commissioners acknowledged that challenge, invested in local health care services and made the argument for keeping investment locally, rather than, as he said, siphoning it off elsewhere. I will clarify the matter further by investigating with the PCT what has happened. From our discussions so far, I can reassure my right hon. Friend that the PCT and the clinical commissioning groups reassured me yesterday that they would, they thought, be able to find the investment to continue with the current older buildings, maintaining them as fit for purpose to continue with patient care, and that patient care will continue on the current site, as it does now, in April. Nevertheless, there are clearly questions for the local health care commissioners to answer.

Question put and agreed to.