Oral Answers to Questions

Lord Swire Excerpts

Tuesday 15th November 2016 Commons Chamber

[David Mowat]

As I said earlier, we accept that the system is under pressure, but we also make the point that there is a massive disparity between different councils. Some 13% of local authorities cause 50% of the delayed transfers of care—DTOCs. The real point is that those local authorities that go furthest and fastest in integration, with trusted assessors, early discharge planning and discharge to assess, have the most success.

[Sir Hugo Swire (East Devon) (Con)]

Northern, Eastern and Western Devon clinical commissioning group is already consulting on the possible closure of community beds across Devon. The social care budget in East Devon, an area of elderly people, and the rest of the county is already under severe pressure. That pressure will inevitably increase if community beds are closed. Will the Secretary of State therefore commit to putting those points to the Chancellor of the Exchequer in the run-up to the autumn statement?

[David Mowat]

The Secretary of State has already made the point that we do not give a running commentary on the status of discussions with the Treasury, but I accept my right hon. Friend’s point about his local issue.

Healthcare (Devon)

Lord Swire Excerpts

Tuesday 18th October 2016 Westminster Hall

[Sir Hugo Swire (East Devon) (Con)]

I beg to move,

That this House has considered healthcare provision in Devon.

It is a great honour to serve under your chairmanship, Mrs Main, which I am sure will be fair and impartial; if only that were the case elsewhere in the House. It is a particular pleasure to welcome the Minister of State, Department of Health, my hon. Friend the Member for Ludlow (Mr Dunne); I fear he has had quite a few outings already this week, and will have more. I make no apology for summoning him here, on behalf of my colleagues from Devon, to address an issue that will not go away any time soon. I suspect that this will be one of many occasions on which we will seek to ask pertinent questions on behalf of our constituents across the county.

Healthcare is one of the biggest issues in Devon, largely for two reasons. The first is the demographics of the county: 17.7% of the UK population are aged 65 and over; that rises to 21.1% in the south-west and, in my part of the south-west—East Devon—to 27.7%, which is 10% more than the national average. Secondly, reforms are coming down the line, involving bed closures and so forth, that are sometimes seen as controversial. They are a result of the perilous state of Devon’s NHS, which is there for us all to see. Before we start our long list of asks and demands, it is worth remembering that the Northern, Eastern and Western Devon clinical commissioning group’s financial deficit is due to hit £490 million by 2019, which is clearly unsustainable.

Before I launch into my pleas and points, I point out the absence of some colleagues from Devon from across the political spectrum who I know feel passionately about this. The right hon. Member for Exeter (Mr Bradshaw) and my hon. Friend the Member for Totnes (Dr Wollaston) are both detained in the Select Committee on Health. I believe that they have either just interviewed, or are interviewing as we speak, the Secretary of State for Health and the chief executive of NHS England. Of course, my hon. Friend the Member for Central Devon (Mel Stride) is unable to take part in the debate on account of his particular office. He has an excellent relationship with the GPs in his constituency, and he is supportive of wellbeing hubs, provided they serve the local community appropriately.

On the whole, we welcome the Government’s intervention in Devon’s NHS in the form of the success regime. If followed properly, it will help to solve some of the underlying problems that beset Devon’s national health service. As part of its work, the success regime, along with the CCG, has recently published proposals to close 72 hospital beds in Exeter and East Devon. The Minister will quite properly respond that that is under consultation, but I think this is the only way that we can raise these points in a public forum to make sure that everybody knows what we are thinking.

I understand that recently, the success regime, although it has a preferred option, which includes the rather expensive Labour deal on Tiverton hospital, has now introduced a “none of the above” option. If that is now an option, it creates a whole new range of possibilities. If that is not an option, I argue—my colleagues will argue for other things—that option B, which sees the beds retained in Tiverton, and also in Sidmouth and Exmouth, is the option worthy of support. Sidmouth has an extremely high proportion of over-85s, with people increasingly living longer, and of people with dementia. Exmouth is the biggest town in Devon with more than 35,000 people.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

Thank you, Mrs Main, for allowing me to serve under your chairmanship. Plymouth has around a quarter of a million people, and is the largest urban conurbation in the whole of Devon.

[Sir Hugo Swire]

As my hon. Friend knows, Plymouth is a unitary authority; Exmouth is the biggest town in Devon. Local people—my constituents—are hugely supportive of our community hospitals. We have beds in Exmouth and Sidmouth; in Ottery St Mary we have 16 stroke beds, although they are eventually to be replaced by a health hub; and Budleigh Salterton hospital, which I will talk about in due course, will, we hope, be turned into a health and wellbeing hub.

Over the years, many local residents have donated significant sums to the hospitals. In Sidmouth alone, the Sidmouth Victoria hospital comforts fund has raised over £5 million. Local people are prepared to invest in ensuring first-class local health services. I pray in aid the position of Sid valley Admiral nurse—the Admiral nurse helps people with dementia—which was hugely supported locally. I am pleased to say that I was able to play my part in obtaining additional funding for that position from the Big Lottery Fund. If there is an identifiable health issue locally, people are prepared to back care with their own money.

If the Minister will allow me, I will talk about the consultation process and the lack of documentation. As I understand it, the consultation process has been overwhelmingly carried out online; there are very few paper copies of the consultation. Elderly people, who may have no access to the internet and who are disproportionately likely to be affected by the changes, are therefore disadvantaged. The consultation period ends on Friday 6 January. I ask the Minister to do everything he can to look at the issue, and to work out how we can get more people involved in what is, after all, an extraordinarily important process.

The potential closure of hospital beds raises the issue of 21st century healthcare, which obviously includes preventive as well as curative care. My constituents—like many across the country, we are told—prefer to be treated at home for as long as possible. They understand, on the whole, that community hospitals need to change and adapt in order to offer a service fit for the 21st century. In Budleigh Salterton, we have been working very hard to try to ensure that the community hospital is transformed into a health and wellbeing hub, which will involve bringing together the health, social care and voluntary sectors. I think that is a good template that can possibly be used across the country. In fact, if it works, there will be far greater footfall through the community hospital than there has been while it has been just a hospital. I remain very supportive of that.

There is, of course, a negative side to keeping people in hospital beds. According to Angela Pedder, the lead chief executive of the success regime, the cost of running a 16-bed community hospital ward is £75,000 a month. Home care could look after 82 people for the same money. However, we are in danger of putting the cart before the horse. Until we can absolutely ensure that we have got social care right, we should not look at unnecessarily closing community beds that some people will have to use. Equally, I am nervous that, just because we have well-supported community hospitals across East Devon, we are being targeted unfairly, so as to rebalance the books across other parts of the county.

If we are reducing the number of hospital beds, it is absolutely essential that the social care system is able to compensate for that loss. In the past five years, council budgets for social care have fallen behind demand by £5 billion, and 150,000 fewer people receive at-home help than five years ago. Social care can take the financial pressure off the NHS. For instance, the installation of a simple grab-rail in an elderly person’s home can help to prevent the falls and broken bones that cost the NHS £2 billion a year. The option of making greater use of technology remains hugely under-exploited, in terms of how we ensure that people are getting a first-rate service at home.

I am sure my colleagues will want to raise the whole issue of rurality this afternoon. Government policies are meant to be rural-proofed. Frankly, social care is far easier to administer in a conurbation such as Plymouth than in other parts of the county, where people are spread over much greater distances.

Another issue that I am sure some of my colleagues will want to talk about is recruitment. We are told that social care will be one of the big growth industries in future. That is all to the good, and it is inevitable. However, currently, people find it very difficult to recruit. It is much easier, I am told, for the NHS to recruit people to work in social care than it is for the private sector. It is all very well transferring people back home, but only provided that there are the people to carry out the social care.

Stephen Dorrell, a former Health Secretary, has said:

“Fetishising the NHS budget and imagining it’s the only public service that relates to health is fundamentally to miss the point…It is not true to say we are supporting the health service by asking it to do social care. We are using the health service as a very expensive social care service and then talking about efficiency. It’s insane economics and very bad social policy.”

I would like to know if the Minister agrees, and what he feels can be done to ensure that we have first-class social care in place before we start to close community beds. Given the closure of residential homes, and the fact that local authorities are increasingly unwilling to pay the fees demanded by residential homes, we might end up in a situation where, although a person can no longer be cared for at home and needs some kind of hospital bed—we want to keep them away, of course, from the main hospitals—we have got rid of all our beds, or a disproportionate number, and so have created an unnecessary problem.

I want to say something about NHS Property Services. Since the NHS provider in Devon changed from Northern Devon Healthcare NHS Trust to Royal Devon and Exeter NHS Foundation Trust—at least in my part of the county—on 1 October, ownership of the community hospitals has transferred to NHS Property Services. NHS Property Services, as we know, charges commercial rents, meaning that many hospitals will have to pay higher rent. Along with the planned bed closures, that has understandably made some of our constituents nervous. What happens if hospitals cannot pay the rent? Given that the Department of Health has committed to meeting any increased property costs for 2017 and 2018, the big question is what happens thereafter.

My general practitioners at the Blackmore health centre in Sidmouth increasingly feel that they have little influence over the redevelopment of the surgery, which I champion, as a result of the involvement of NHS Property Services. The practice wants to buy the building off NHS Property Services, either now or at some stage in future. It is proving extremely difficult to make that happen. It should be a simple move, as it is supported by local GPs and the local community.

There is some concern about Exmouth—Devon’s biggest town—losing its out-of-hours GP services, which will be replaced with use of the 111 service, in line with the new integrated urgent care commissioning standards. Perhaps the Minister could write to me to reassure me that my constituents in Exmouth will receive exactly the same cover that they did under the previous arrangement.

One thing that affects all of us across Devon is the lack of provision of mental health facilities, which has exercised us for a long time. In my patch, I am concerned about St John’s Court, which is the only mental health and recovery facility in Exmouth. Two years ago, Devon Partnership NHS Trust spent £300,000 on a move from Danby Terrace, which was not at the time fit for purpose, to St John’s Court. On top of that, £140,000—this is all taxpayers’ money—was spent on refurbishing St John’s Court. Now the trust is pushing ahead with closing and selling St John’s Court. It has assured us that Exmouth will not experience a reduction in healthcare provision, and that St John’s Court will not be sold until an alternative venue can be found. We are talking about a growing town with a lot of mental health issues. I seek reassurance from the Minister that before anything is closed, something will be put in place to reassure the local community and my constituents that we have the same, if not a better, level of mental ill-health prevention and cure.

I wanted to speak for longer, but I am conscious that my colleagues will probably want to articulate their own slightly different visions for the future of healthcare in Devon. I say to the Minister in the friendliest manner possible that we are a pretty quiet bunch in our part of the world, and we do not seek trouble, but we do fight tenaciously to protect the livelihoods of our constituents. Too often, we feel that people forget about us in the south-west, and that money is diverted to all kinds of infrastructure projects in the huge urban conurbations, the northern powerhouse and so forth. This time, we will speak as one to ensure that whatever comes out of these consultations, and wherever we end up after them, we can argue these points in a mature way. It is simply no good saying, “It’s a lack of money. It’s Tory cuts.” That is an immature conversation to have. We have to, between us, design a health and social care service that is fully integrated, makes use of technology, and cares for all of us as we get older and more dependent. We need to be brave, but political sloganising is not the answer.

--- Later in debate ---

[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.

[Sir Hugo Swire]

Does my hon. Friend share my concern about recruitment in social care and care homes: that a lot of staff are, of course, from the Philippines and other countries around the world? We must all hope that that is taken into account when the UK comes up with a new immigration policy.

[Kevin Foster]

I thank my right hon. Friend for his intervention. It is worth saying that the outcome of the EU referendum and Brexit is probably not going to affect those from the Philippines, given that the Philippines is not a member, but I fully accept the point that we have for too long relied on importing healthcare professionals—doctors and others. We have to have a debate about whether it is ethical for us basically to be depopulating parts of the third world of much-needed doctors, nurses and other trained medical professionals and to be relying on other countries’ training schemes to provide the numbers of healthcare professionals we need. The key point is that we want our own young people to be taking up those opportunities, as well as having the services provided.

I can see you indicating that my time is coming to an end, Mrs Main, or has come to an end. I will finish with one plea: I want to see Paignton hospital and Paignton people’s services continuing into the future.

--- Later in debate ---

[Mr Dunne]

I heard my hon. Friend mention the lack of reference to Okehampton and Honiton. I gently draw attention to the fact that the option to retain community beds in both those hospitals was considered as part of the 15 options in the document. The option was rejected as one of the four recommended for consultation, but that does not prevent him, his constituents or local representatives in those areas from putting those alternative options forward.

My right hon. Friend the Member for East Devon asked whether there was a “none of the above” option. I think he may have been referring to page 42 of the consultation document, on which the organisers say that they

“welcome all views and will carefully consider all responses and analyse these against the decision making criteria. That will include options which are not currently in the consultation document”.

They are open for proposals to be made by others, but those need to be looked at in the context of the criteria.

[Sir Hugo Swire]

I am grateful for that clarification. Presumably, that does not alter the fact that Tiverton—that rather expensive private finance initiative that we have inherited—stays part of any outcome.

--- Later in debate ---

[Sir Hugo Swire]

I am grateful for an interesting and mature debate. The Minister has an invidious job of trying to reconcile the competing demands across the country, to say nothing of the competing demands across God’s own county of Devon. I can think of no better man to attempt to do that. If the consultation is a genuine opportunity, and is not an excuse to reduce levels of care, the Minister will find us supportive. He will find us supportive if, as I suspect, the consultation is an opportunity to deliver a fully integrated hospital, and a community care and social care system, that is fit for the 21st century.

I am pleased to remember a conversation I had with the Secretary of State, who repeated his commitment to community hospitals. I leave the Minister with one thought: as the previous Prime Minister freely admitted, it was the Conservative party in the south-west that delivered a victory at the last general election. The Minister has seen how formidable we can be when we come together, and come together we will to protect our vital services for our constituents across the county of Devon.

Motion lapsed (Standing Order No. 10(6)).