Oral Answers to Questions

Debate between Philip Dunne and Peter Heaton-Jones

Tuesday 14th November 2017 Commons Chamber

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

The NHS sustainability and transformation plan review in my region recently recommended that all acute services be maintained at North Devon District Hospital. That was a very welcome decision and a victory for the community. Will the Minister work with me and local NHS managers to ensure that the clinical need that has been identified can be fully met?

[Mr Dunne]

I share my hon. Friend’s ambition. I greatly enjoyed visiting his hospital in Barnstaple during the summer, and I have been impressed by the way in which the four trusts in Devon that provide acute services have decided to come together and provide a collaborative pool of, in particular, emergency department staff to ensure that each hospital is adequately covered and there is continuity of service. I think that is a model that we can adopt elsewhere.

Healthcare (Devon)

Debate between Philip Dunne and Peter Heaton-Jones

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.