Healthcare (Devon)

Philip Dunne Excerpts

Tuesday 18th October 2016 Westminster Hall

[Peter Heaton-Jones (North Devon) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Main. May I congratulate my right hon. Friend the Member for East Devon (Sir Hugo Swire) on securing this debate on a topic that is vital for all us, right across Devon?

It will not be a surprise to anyone that I intend to focus mercilessly on North Devon and to fight our corner very hard indeed against the threat to our acute services at the North Devon district hospital in Barnstaple. Before I go into that in any detail, I want to make a couple of points. First, I would like to thank the Minister, who has on a number of occasions met myself and other colleagues in Devon to address this issue. I know he understands the particular significance of the North Devon district hospital, because I have discussed it with him, as I have with a whole slew—I am not sure what the collective noun is—of managers in the Northern Devon Healthcare NHS Trust and other directors and managers within NHS England, who by now are well aware of the strength of feeling in North Devon. I want to put it on record that the Minister has been very proactive in arranging such meetings.

My right hon. Friend the Member for East Devon talked about community hospital beds. I do not want the impression to be given that that is not a serious issue also in North Devon, although I will not be majoring on it. In North Devon, there is a bit of history. We did the heavy lifting with the loss of many of our community hospital beds about 18 months ago under a different process from the one now being undertaken in the rest of the county. I agree with what my right hon. Friend said about the need to look very carefully at the provision of social care before community hospital beds are removed.

I do not think NHS England has done this in the right order. Community hospital beds have been removed in North Devon, specifically from the Tyrrell hospital in Ilfracombe, and there is a great amount of concern among the local community about what is replacing that provision. Is there integrated and fully functioning health and social care provision in North Devon to replace those beds? My view is that the answer is no. That is also the view of the community in Ilfracombe. Last Friday I met the League of Friends of the Tyrrell Hospital, and that is strongly their view. That is not my major point today, but I want it on record that that remains a concern in North Devon, as it will become in other parts of the county.

My focus today is on acute services in North Devon. The community is extremely concerned. Many constituents have contacted me and shown their strength of feeling through protests on the street, campaign marches and letters to me, as the local MP, and to my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox), whose constituents also use the North Devon district hospital in Barnstaple.

My point is absolutely clear and I will make it up front: there must be no cuts to acute services at North Devon district hospital in Barnstaple. I cannot see any clinical argument to justify even consideration of any such a reduction in services, let alone its implementation. Let me provide some background.

Healthcare in Devon is currently subject to not one but two separate review processes. We have the success regime, and the Northern, Eastern and Western Devon clinical commissioning group area was given this special treatment with only two other areas in the country—one in Essex and one in Cumbria. Because of the need to ensure that we do not fall into a future funding black hole, the success regime was implemented. I fully support that because we need this special treatment.

On top of the success regime we have a sustainability and transformation plan, which, as hon. Members will know, is being implemented in all NHS regions in England. We have this two-tier process and my understanding from conversations with NHS England is that the success regime will probably be folded into the sustainability and transformation plan, so North Devon will find itself subject to a target that we are at least more easily able to identify. The difficulty is that the ideas that are starting to emerge from the two, soon to be one, reviews are simply unpalatable for North Devon.

I put it on the record that I am fully aware that these are not firm proposals or ideas and no public consultation has been launched. None the less, what has started to emerge has, reasonably and understandably, created serious concern in the North Devon community because, looking across the piece at the various documents that have emerged from both the success regime and the sustainability and transformation plan, we see a picture that puts under threat some of the services at North Devon district hospital, which my constituents rely on most keenly and have done for generations. They include vital services such as accident and emergency, stroke and one that I want to focus on now, maternity.

I have here one of the latest documents to emerge, which hon. Members may remember. Unfortunately, NHS England decided not to make this series of documents public. I say gently to the Minister that that has not been helpful. I know it was not his direction, but it has given rise to the belief that stuff is being done in private behind closed doors and that leads to suspicions, rightly, among my constituents and the public in general. That latest document, which is about five weeks old, starts by talking about

“a two-site option for maternity”

and states that the

“Royal Devon and Exeter Hospital would most probably be the second site”—

after Derriford in Plymouth—

“rather than North Devon District Hospital”.

That is a clear indication that consideration is being given to closing the maternity unit at North Devon district hospital. That is not acceptable to my constituents and we will fight any such proposals if they come forward. We will do that forcefully for a couple of reasons.

North Devon is a special case, not least because of our geography. I have said many times in this Chamber, in the House and elsewhere that Devon has been historically underfunded, and North Devon even more so. We are and have been for too long the poor relation in public funding. Let me be clear. This is not something that has happened in the last 18 months or the last six and a half years. It has been an issue under Governments of all colours for many years, if not decades. It is something up with which we will no longer put.

Part of the difficulty of singling out North Devon and Barnstaple as a place that can apparently sustain further reductions in services is that we start from a lower base of funding than in many other regions. That feeds perfectly into the point that my right hon. Friend the Member for East Devon raised about rurality. North Devon is a largely rural constituency, and for many years a series of funding formulae have dealt unfairly with North Devon because of its rurality. There seems to have been a belief that, because we are a rural area with a sparse population, we can somehow do with less funding. In fact, the opposite is true, and I am delighted that this Government are starting to recognise that. Across the piece of funding for local government, the police, education and health services, we are starting to right that wrong and equalise that funding gap, but the history is still there and that is why North Devon is the last place where we should be looking for further cuts.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am grateful to my hon. Friend for allowing me to intervene during his limited time in this debate, but I would like to respond specifically to his point about funding and allocations.

In the 2016-17 funding round, the allocation formulae have been looked at again and we have, for the first time in several years, introduced three differentials that are relevant to rural areas and that I think will affect my hon. Friends here. They include looking at the combination of rurality, remoteness and sparsity of population to improve the ambulance emergency cost adjustment, to reflect the greater distances travelled in rural areas; an adjustment to support continued provision by hospitals with 24/7 A&E services that are remote from the wider hospital network—my hon. Friend’s North Devon district hospital will be one of those’and an adjustment to remove from the formula supply-induced demand in urban areas where people live close to hospitals. Those three measures have led to a change and I gently suggest that my hon. Friend may care to look at the CCG allocations table which sets that out. For Northern, Eastern and Western Devon CCG, the per capita allocation for 2016-17 is £1,250, which is slightly above the average for England of £1,221 per head.

[Peter Heaton-Jones]

I thank the Minister for his intervention and I welcome it, but I say gently to him and NHS England, which I am sure is monitoring this, that all that good work will be entirely undone if we then lose our acute services at North Devon district hospital. This is not about figures on a spreadsheet; it is about the services and healthcare provision that my constituents will receive in Barnstable.

I am aware of the time, Mrs Main, but I want to raise a second issue, which is important and recognisable to us in North Devon, but perhaps not to those beyond: our unique geography and the distances. An Australian historian once referred to the tyranny of distance, and I think we suffer from that in North Devon. If one looks at a map, it is all too easy to think that there is a decent road network between Barnstaple and Exeter. I can give several reasons why that would be a wrong assumption. First, vast numbers of people live in isolated regions far north of Barnstaple. Secondly, the road network is not all it is cracked up to be—although that is a subject for another day and one on which I am fighting heavily.

My main point is that what no map or distance table shows is that in North Devon we have pockets of serious deprivation. In Ilfracombe, I have two of the most deprived wards in the south-west and by some metrics the most deprived in south England. In those areas car ownership is less than 80%. Put another way, one in five households do not have access to their own private transport and, because of the demographics, some of those who do are elderly and perhaps have their own vehicle but simply would not feel comfortable or up to going long distances to Exeter or Plymouth. Those two reasons alone are sufficient to argue strongly that the last place where we should be looking to make cuts to acute services is at North Devon district hospital.

I am aware of the time, Mrs Main, so I will conclude. I welcome the fact that the Government are looking at the funding. I welcome the repeated assurances that local clinicians will make the final decisions. However, I want it to be in no doubt whatever—the community of North Devon are very clear about this—that North Devon is a special case and needs to be treated as such. In that regard, I make no apologies whatever for fighting for North Devon and for appealing for there to be common sense and no cuts at North Devon district hospital.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am grateful to you for taking the Chair this afternoon, Mrs Main, and for encouraging me to leave some time for my right hon. Friend the Member for East Devon (Sir Hugo Swire) to respond, which I will endeavour to do. I congratulate him not only on securing this debate, which has been very well supported by his colleagues from across the county, but if I may—this is the first opportunity for me to do so publicly—on the recognition that he received of his time in Government from the previous Prime Minister.

I start by highlighting some of the excellent work carried out every day by all those who work in the NHS, not only in my right hon. Friend’s constituency but in mine and those of all the others who have spoken today. I will attempt to address some of the specific points that have been raised, particularly by my right hon. Friend, but I shall first provide the House with a little context and background regarding health services in Devon.

Devon is a leader in many areas of the health service—perhaps to the surprise of some hon. Members who have spoken—relative to other parts of the country. Not least, the Torbay and South Devon NHS Foundation Trust was the first trust in England to join up hospital and community care with social care. A plea to do that was made by my right hon. Friend and it is already happening in South Devon. The trust operates as a single organisation, working with partners to improve the way it delivers safe, high-quality health and social care. The trust is showcasing exactly the kind of joined-up, patient-centred care that we want the NHS to provide to meet the needs of the ageing population.

I also pay tribute to the staff at the Royal Devon and Exeter NHS Foundation Trust, who last month celebrated their fifth anniversary since the last incident of hospital- acquired MRSA. That remarkable accomplishment comes as the result of continuous improvements at the trust over the last 10 years. The trust is now considered a national leader in infection control, being the only general hospital in the whole of England to have avoided any MRSA infections in the last five years.

However, I absolutely recognise that the region is facing difficulties. NHS staff across the region are working hard to provide good care to patients, but services are not keeping pace with the changing needs of local people. It is becoming increasingly difficult to make sure that local people have access to consistently high-quality care that is affordable and sustainable.

As my right hon. Friend said, in June 2015, NHS England announced that north, east and west Devon would be one of the three areas in the country to take part in a success regime. That is designed to improve health and care services for patients in local health and care systems that are struggling with financial or quality problems. Following intense diagnostic work, the north, east and west Devon success regime published, in February this year, the “Case for Change” report, which was referred to earlier. The report sets out the underlying challenges facing the area and the opportunities to improve access to services and ensure clinical and financial stability. The work concluded that if nothing was done, Northern, Eastern and Western Devon would have a system deficit of £398 million by 2020/21, as has been referenced by a couple of hon. Members, including the hon. Member for Burnley (Julie Cooper).

As well as the financial challenge, the work identified significant health inequalities and some clinical services that will be unsustainable in their current form. There are good reasons for that. As we have heard from hon. Members, people in north, east and west Devon are living longer successfully, particularly in areas of the constituency of my right hon. Friend the Member for East Devon and in Torbay.

People are living with increasingly complex care needs and require more support from health and social care services. More than one in five people in north, east and west Devon are over the age of 65, and that figure will be almost one in four by 2021. Some 40% of local people use almost 80% of health and social care services. There are 280,000 local people, including 13,000 children, living with one or more long-term conditions such as asthma, diabetes, hypertension, cancer and mental illness.

Although Devon is regarded from the outside as generally affluent, we are all aware—hon. Members have explained this—that there are areas of significant deprivation. There are big differences in health outcomes between some areas, particularly in Plymouth. There are also spending disparities between different parts of the county.

More than 10% less for each person is spent on healthcare in west Devon compared with north and east Devon, even when age and deprivation is taken into account, as my hon. Friend the Member for North Devon (Peter Heaton-Jones) emphasised. Somebody living in Ilfracombe Central is statistically likely to die almost 15 years earlier than a person living a two-hour drive away in Newton Poppleford.

Inequalities need to be reduced, and the spread of health and social care across north, east and west Devon needs to be made more equal. I am sure that my right hon. Friend the Member for East Devon agrees that his constituents should have access to the same high-quality healthcare services as those in the rest of Devon, let alone the rest of the country. He referred to the success regime consultation as being at fault. I gently remind him that it was only published on 7 October. I am sure that comments made today about the lack of available paper copies of the consultation will be taken into account by the organisers, and that we can respond to that.

[Neil Parish]

I want to press the Minister on the success regime’s consultation. Is it right for a hospital to have its beds taken away as part of that consultation? Surely a consultation should be for people to have a say on a public decision.

[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 ---

[Mr Dunne]

My right hon. Friend would not expect me to be drawn on any of the specific options. I would not want to be seen to be influencing the consultation prematurely or, indeed, at all until we see the recommendations that come out of it.

It has come out of the investigations leading up to the consultation that every day more than 500 people in north, east and west Devon are being cared for in a hospital bed who do not need to be there. That is at the heart of the challenge that we face not just in Devon but across the country, as the hon. Member for Burnley mentioned.

The system is keeping people in community beds or acute beds longer than they need to be because of discharge challenges. That gets back to the initial remarks of my right hon. Friend the Member for East Devon about whether we are integrating the consultation properly with improvements to social care. It is important, when we come to look at the recommendations arising from the consultation, that we take into account the capacity that will need to be created in social care to provide alternative models of care if the number of beds is reduced.

The formal consultation concludes on 6 January. As I have said, I will not comment on specifics while that is under way, but I strongly encourage my right hon. Friend, all other hon. Members who have spoken in the debate, and those who were not able to because they are elsewhere in the House today to ensure that their views are taken into account. The next phase of the success regime will look at how services are provided in acute hospital settings, as my hon. Friend the Member for North Devon highlighted, as did my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox) in his characteristically robust contribution. I am sure that they will make their views known in the consultation that we anticipate will follow next summer, and the clinicians involved with the acute services will be preparing their recommendations.

My right hon. Friend the Member for East Devon is aware that the success regime plans are part of a broader sustainability and transformation plan that covers the whole of Devon. That creates the opportunity for health and local authorities—not just NHS bodies but local authorities with responsibility for social care—to work together to try to formulate plans that give care packages the kind of integration and coherence that hon. Members have sought for Devon. It will build on the work that has been done by north, east and west Devon’s success regime and on the “Case for Change” published by South Devon and Torbay CCG in September. The latest iteration of the plan is due to be submitted to NHS England this Friday.

Before I conclude, I can confirm that I will write to my right hon. Friend on the Exmouth out-of-hours service. I understand that he has a meeting with the Minister responsible for NHS property services later this month, so he will be able to take up his concerns then. On other challenges that were mentioned, we recognise that there is pressure on recruitment and retention of clinicians in rural areas. Hon. Members will be aware of the announcement made by my right hon. Friend the Secretary of State to try to recruit 25% more doctors over the next few years; of our plans to recruit up to 10,000 more nurses over this Parliament; and of the announcement, last week, that we will be introducing a new category of nursing associate to provide more capability. We are acutely aware of those needs.

It is the responsibility of local NHS organisations to determine how local services are delivered. Hon. Members have made some important points, and I urge them to do so as part of the consultation. I hope that we will have another opportunity to discuss the forthcoming recommendations.