NHS: Cottage Hospitals

Lord Hunt of Kings Heath Excerpts

Monday 13th October 2014 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am sure that we are all grateful to the noble Lord, Lord Naseby, for raising this interesting Question. I enjoyed his heroic defence of the 2012 Act and the remarkable—and really quite dangerous—changes it brought about. I thought that today’s Times was an interesting read, and I recommend it to the noble Lord.

The role of cottage hospitals in the National Health Service is a very interesting question. We do not really call them that now; we call them community hospitals. It would be fair to say that they have had a mixed experience in the past few years. They are valued by the local community but are often at risk from the centralisation of services, and have tended to see their role downgraded over the past few years. Like the noble Lord, Lord Naseby, I was interested in the comments of Simon Stevens, the NHS chief executive, when he spoke about the experience of what he called running smaller, viable hospitals in other countries. I should be interested to know from the noble Earl, Lord Howe, what he thinks about that. Does he think that clinical commissioning groups should be encouraged to reverse the flow of services away from community hospitals into larger, centralised services? If he agrees, what attitude does he think that the regulatory bodies are likely to take? I am thinking here particularly of the Care Quality Commission, which has the responsibility of regulating all hospitals and care institutions.

I take it from the comments of the noble Lords, Lord Naseby and Lord Framlingham, that they would like to see an expansion in the services provided by community hospitals. However, that is unlikely to take place unless the regulator believes that it is safe to do so. I would be interested in the noble Earl’s comments on that. I have no doubt whatever that in terms of the current pressure on acute hospitals in particular, the more rehabilitative services and respite care that can be provided locally the better. Perhaps this could be an exciting role for smaller hospitals in the future.

As far as mutuals are concerned, I do not know if either noble Lord has read a report, sponsored by the Department of Health, called Improving NHS Care by Engaging Staff and Devolving Decision-Making: Report of the Review of Staff Engagement and Empowerment in the NHS. I do not know whether the noble Earl will refer to it but it is interesting because, on the one hand, it makes the point that,

“there should be greater freedom for organisations to become staff owned and governed, on a strictly voluntary basis, following detailed consultation with staff and staff-side trade unions”.

Clearly, some thinking is going on, which suggests at the very least that staff ownership—I know a mutual goes much wider than that—is one building block in the establishment of mutual organisations. On the other hand, I put to the noble Earl the comment made by the UNISON head of health—I should declare my interest as a member of UNISON—stating that there was,

“a very real danger that bringing the mutual model into hospitals will be a Trojan horse for privatisation”.

I did not take it from the comments of both noble Lords that that was what they had in mind. I took it that they both saw mutuals as being a support to the National Health Service and that they would not envisage patients paying money to go to those hospitals, which would very much be seen as being part of the NHS—although perhaps not run as other NHS bodies are. I thought that I should raise that issue.

I should also like to ask the noble Earl, Lord Howe, whether another approach could be to extend the foundation trust model. I have just given up chairing a foundation trust where we had 100,000 members, consisting mainly of members of the public but also 11,000 staff members. As members, they elect the governing body of the organisation. The governing body in turn appoints a board of directors. I have found that to be a useful mechanism whereby the board of the organisation is locally accountable. I have found the regular meetings of the governing body to be one of the most challenging experiences as chairman because there was a sense of accountability to the governing body, which represented both the locality and the members of staff.

I wonder whether the noble Earl, Lord Howe, thinks that perhaps we need to refresh the governance of NHS institutions in a way that allows much more mutual ownership. If he agrees, does he not think that clinical commissioning groups are an area where we should start? In our debates on the Health and Social Care Bill, one of my concerns about clinical commissioning groups was that essentially they have no accountability to their local population. One way around this would have been to adopt the foundation trust governorship model. Although the CCG is essentially a membership organisation of general practitioners, it could have a much wider responsibility and accountability as well.

We are all interested to hear the noble Earl’s comments on this interesting issue. I hope that, at the least, we get a sense of where the Government stand in relation to the role of community hospitals in the future.