Healthcare (Devon)

Oliver Colvile 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 ---

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

I, too, congratulate my right hon. Friend the Member for East Devon (Sir Hugo Swire) on securing the debate. Over the next few moments, I want to concentrate on NHS England’s proposals to close three GP surgeries in my Plymouth, Sutton and Devonport constituency and how I hope we can take some pressure off the principal acute hospital at Derriford in the constituency of my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer).

I am told that the reason why NHS England is considering the closures is the size of the GP practices. The Cumberland GP practice has 1,800 patients, Hyde Park 2,800 and St Barnabas 1,700. They are considered by NHS England to be unsustainable and too small. It also tells me that closing those practices is not down to saving money, but to deliver better value for money. However, before I speak about those issues, let me put my constituency in context.

Plymouth, Sutton and Devonport runs from the A38 down to the sea and from the River Plym to the River Tamar. It is the home of one of the largest universities in the country, with more than 27,000 students, thousands of whom live in the city centre, and it is a naval and Royal Marine Commando garrison city, as my hon. Friend the Minister, for whom I was a Parliamentary Private Secretary in a previous life, knows only too well.

The city’s population is growing. Although it has a global reputation for marine science and engineering and research, it is a low-wage and low-skills economy. It is an inner-city seat. I do not have a single piece of countryside in my constituency, unless we include the Ponderosa pony sanctuary, which is a rather muddy field. Between Compton and Peverell in the north-east of my constituency and Devonport in the south-west, there is an 11-year life expectancy difference. Compton and Peverell is where many of the university lecturers and hospital consultants live. In the run-up to the 2010 general election, when I won the seat on the third attempt, the Conservative party pledged to do something about healthcare in deprived inner cities.

We have started to make good our word. In 2014, our hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), one of the Minister’s ministerial predecessors, came to Devonport to open the Cumberland GP practice, which is now under threat. Other facilities on the Cumberland campus include a minor injuries unit, the new Devonport health centre and a pharmacy. The Cumberland GP practice was set up by Plymouth Community Healthcare—now Livewell Southwest—and the Peninsula medical school. There was and is a desperate need to provide a tailor-made alternative service to the existing GP practice—then the Marlborough Street practice; now the Devonport health centre—for this deprived Devonport community, and a need to look after drug users and the city’s homeless in hostels such as the neighbouring Salvation Army’s.

The practice also offers practical placements to students at the Plymouth medical school. Until earlier this year it was funded by Livewell Southwest, a social enterprise, which found it too expensive to maintain. Despite Devonport’s real deprivation, NHS England did not want to get involved in providing a contract to the Cumberland GP practice, which has consequently been operating without a formal contract and is managed by Access Health Care.

I understand that in the past the neighbouring Devonport health practice has not been interested in offering facilities to homeless people and drug users. Indeed, I understand that some of the Cumberland practice’s patients were not keen to transfer back to the Devonport centre, which is where they came from in the first place.

NHS England’s reason for putting the Cumberland GP practice under threat is because it considers it to be too small and is operating in unsuitable, cramped premises. Unless we are very careful, we could potentially put more pressure on Derriford’s acute emergency unit, which is under enormous pressure. I became aware of NHS England’s proposals for the three GP practices in August, during the summer recess, when no doubt NHS England expected me and other MPs to be away on parliamentary trips or taking a holiday. I immediately put together a series of meetings with the city council’s director of public health, the leader of the council and the cabinet member for adult social care, people from NHS England, the dean of the medical school and Dr Richard Ayres, who runs the Cumberland GP practice.

At the meeting I suggested that the Cumberland GP practice could share Devonport health centre’s brand-new building, which has space and operates as a federation, sharing receptionists and back-room staff. This was supported by everyone present. Indeed, the city council’s health and wellbeing board also supported it following an inquiry that recommended measures to allow the Cumberland GP practice to continue. However, I understand that Devonport healthcare might not be willing to do this, and it appears that the Devonport community may be deprived of a second GP practice and that patients will have no choice in which doctor they can go to.

I have also had representations from patients at both Hyde Park and St Barnabas surgeries. At Hyde Park, although Dr Stephen Warren is keen to continue as a GP following a heart attack, he has transferred the ownership of his practice to Access Health Care, as he no longer wishes to deal with the back-room tasks of administration, which is part of running a practice. He argues that his and his partner’s growing 2,800 practice—the Cumberland is growing as well—has attracted outstanding reviews and he would not be able to inform his patients where he was going if he relocated to another practice. He also thinks that some patients like to have a relationship with an individual doctor who they can see speedily rather than having to wait weeks.

The St Barnabas surgery, which is also run by Access Health Care, was set up in a new development next to a residential care home for the elderly where patients do not have to walk far to get to it. In all three cases, NHS England, for supposedly technical reasons, gave patients only 24 hours’ notice of their initial engagement. I must say I found the public consultation process utterly appalling. I wrote to NHS England asking it to give more time to engage with local communities, and I am grateful that it bothered to listen.

On Friday, at my weekly constituency surgery, I was asked to write to NHS England to ask whether it had engaged with other GP surgeries and with Derriford hospital and whether it had consulted them, because some GPs will have to accommodate more patients. That is a big issue.

There are wider issues in all this. At the moment, commissioners in north, east and west Devon spend a higher amount of money in east Devon than in the more deprived western locality. The Government’s success regime is keen to correct that, so that resources are focused on deprived communities such as Devonport. Finally, we need to make much more use of pharmacies. As my hon. Friend the Minister knows, I am the Government’s pharmacy champion. What are we going to do to make sure we have pharmacy funding and how will that operate?