Community Hospitals

Richard Drax Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Charlie Elphicke]

The hon. Gentleman anticipates the direction of my speech. I wholly support it; it is a great idea. Mr Stevens also said:

“A number of other countries have found it possible to run viable local hospitals serving smaller communities than sometimes we think are sustainable in the NHS”

and that

“Most of western Europe has hospitals which are able to serve their local communities, without everything having to be centralised”.

In a speech to the NHS Confederation annual conference in June 2014, he outlined his plans for reform of community health services, reiterating the problems of the ageing population and the increasing number of long-term conditions, such as obesity and dementia, as well as more expansive and expensive treatments and the need for more localised health services to tackle these problems.

Mr Stevens is right. Community hospitals have an important role to play and perform best in respect of intermediate, step-down and step-up recovery beds, particularly for people recovering from an operation who need round-the-clock care, and in respect of helping older people get better and continue to live independently, keeping them out of end-of-life or long-term nursing home care.

[Richard Drax (South Dorset) (Con)]

I, too, congratulate my hon. Friend on this excellent debate. Does it not surprise him that the acute hospitals are not clamouring to keep the community hospitals, which could free up their beds, allowing patients to go home to their local communities, where they are going to get better, not worse? That, of course, would cost the Government less in the long term.

[Charlie Elphicke]

I agree. I congratulate my hon. Friend on his hard campaigning in his constituency to secure the future of his own community hospitals. I understand that the campaign has met with great success, showing how fortunate his constituents are to have such a diligent, effective Member of Parliament. He is right; community care beds are more cost-effective and reduce the pressure of bed blocking on acute hospitals, meaning that acute hospitals can do more of what they are best at and that community hospitals can do more of what they, in turn, are best at.

Community hospitals are good at creating a friendly, personal and home-like environment, well suited to older people, particularly those who suffer from dementia yet live independently; such people have better health outcomes and a lower rate of readmission following rehabilitation and recovery. Community hospitals can be localised hubs for less complex health care and can have minor injury units, diagnostic provision, clinics for various specialities and even out-patient services and day surgery, and they are more cost-effective, when compared with acute hospitals, in respect of post-acute recovery. It is hard to see why we ever went down the route of centralisation, because it cost us more money and gave us less effective care. The move to putting the community hospital back at the heart of things will be more cost-effective and will give better care and better health outcomes.

I welcome Ministers’ comments in answers to oral and written questions, as well as the comments of Mr Stevens. Ministers have recognised that community hospitals are important in improving patients’ discharge from acute hospitals and in increasing access to treatment in the community. I welcome their acceptance that community hospitals are good bases for respite, palliative and intermediate care, and step-up and step-down care close to home. Community hospitals are also strong resources for people in rural areas, who have to travel long distances to reach general hospitals. Much of what I am saying is in line with the direction of travel of Ministers. I welcome that.

An important aspect of community hospitals is as providers of recovery beds. Study after study has shown that community hospital recovery beds are effective at getting people well, meaning they are less likely to be readmitted to hospital than if they recovered in an acute hospital. Older patients are more likely to enjoy continued independent living, and a friendly home life environment is preferred by patients.

I will cite a few studies and a bit of evidence in support of what I am saying. There was a study in Bradford in 2005, a study in the midlands and the north of England in 2007, research from 2009 into patient-reported experiences and research into intermediate care in Norway in 2007, so there is a significant evidence base. In addition, the NHS Confederation recently used Department of Health evidence to conclude that closer-to-home care produced a fall of 24% in elective admissions, a 14% reduction in bed days, a 21% drop in emergency admissions, a 45% reduction in mortality and a 15% fall in visits to accident and emergency. Those are encouraging figures. Community hospitals are more cost-effective, according to a 2006 research paper published in the British Medical Journal, so there is strong evidence to back up what I have set out.

The case is made in certain quarters that it is somehow easier and possibly cheaper to have intermediate beds in nursing homes. Nursing homes play an important role in long-term care and end-of-life care, but community hospitals are more suitable for recovery, rehabilitation and continued independent living. It is in their interest to get people out, but the nature of nursing homes is that people are not expected to leave very quickly. With an ageing population, community hospitals are particularly well suited to keeping older people healthier and more well. The clinical commissioning group covering Dover and Deal, ably led by the local GP, Darren Cocker, is building on that in creating an integrated care organisation. It sees the local hospitals in Dover and Deal as essential to the success of its vision.

Moving on, let us look at how we can put the community more into community hospitals. Many community hospitals were established and funded, as colleagues will know, through public subscription by locally based community trusts before the NHS came into existence. The trusts managed effectively and the move to nationalisation and centralisation saw those hospitals taken from communities and taken over by the NHS in Whitehall. Many communities want to be given the chance to have a greater say over what happens to their local hospitals. Allowing local communities to own, lease or manage their hospitals would be a clear way to accommodate the concerns many have and enable people to have the greater say they would like to have.

Reforging the strong link that GPs had with their local hospitals is important as well. My local GPs are up for that, and I want to encourage and support them in that move. Communities should also have greater influence over the provision of health care in their areas; that would allow them to give greater priority to the needs of their specific community. I hope that Ministers will take the opportunity to promote community ownership or management of community hospitals.

In conclusion, much progress has been made on community hospitals, but more can be done. They could be embraced and put more closely at the heart of Government health care policy, and I look forward to hearing from the Minister what steps he will take in four key areas. First, what steps will he take to enable communities to have a greater say in running their local community hospitals: to own, to lease, or to manage? How can we have stronger links among GPs, GP-led clinical commissioning groups and community hospitals, as used to happen many years ago and could happen again?

What about the potential for community hospitals to be hubs for the integration of social care and the policy support that might be given for that? Finally, we need to accept that it is not always best just to drop off people at home after acute hospital treatment and that intermediate recovery beds are often a key element in the path to recovery, distinct from nursing homes, which are better suited to longer-term and end-of-life care.

--- Later in debate ---

[Neil Carmichael (Stroud) (Con)]

It is a great pleasure to serve under your chairmanship, Mr Owen, and to speak in a debate instigated by my hon. Friend the Member for Dover (Charlie Elphicke), because it is such an important subject, in particular in my constituency. It is also a great pleasure to be present for the first performance of the new Minister—I congratulate him on his appointment.

Approximately 10 years ago, our hospital in Stroud was under threat, in essence because the previous Labour Government were obsessed with “big is better”, rather than small and local. The whole town and the wider community rallied together to ensure that their love of their hospital was understood and the fundamental case for keeping it open was made. Today, it is still open—quite right too.

At the same time, the Stroud maternity unit was under threat for much the same reasons. It also received a huge amount of support locally. It, too, is still open—again, quite right too. If I do nothing else, it would be to pledge my total support for those two institutions, as well as the Vale community hospital in Dursley, because it really matters to people that such hospitals—our community hospitals—are protected and allowed to thrive. That is a key priority for me in my constituency.

When I was first elected, it was a great pleasure to dig the first hole for the building of the Vale community hospital. It is now thriving, with 20 beds, and providing an increasing number of valuable services to my constituents.

That is the overall package that we have in the Stroud valleys and vale; it is one that we want to build on, to protect and to hand over to our successors, children and grandchildren in future. It is the core of our health care.

It is great that the reforms that we introduced early on in the Parliament have enabled general practitioners to have more say in community health provision. It is absolutely right that CCGs are able to direct patients more effectively and more easily to local community hospitals. That is certainly happening in my patch, because our local doctors know and understand the value of our community hospitals. The reforms that we introduced to localise decision making, and to put clinicians in charge rather than managers, have made a big difference. We should continue in that direction of travel.

The key word is “signposting”, to ensure that the patient gets to the place where he or she should be, rather than automatically assume that a large, city-based hospital is the place to go. We need to make it clearer that community hospitals are there and should be used as often as possible. It is a matter of signposting. Unless we make that clearer, from time to time we will find ourselves wondering why there are queues in big trust hospitals and, possibly, empty beds in community hospitals. We need to do signposting.

[Richard Drax]

I am listening attentively to my hon. Friend’s excellent speech. Dare I say, reorganisation in the NHS is not something that I particularly want to address, but is it not common sense for trusts to look again at how best to use what they have, rather than to play with what they have inherited? Community hospitals should be incorporated with the district or acute hospitals to ensure that they all work together in their relative areas to look after the people living in those areas.

[Neil Carmichael]

I thank my hon. Friend for that helpful intervention. It is absolutely right that we need a holistic approach to the use of hospitals. Such an approach would be better informed and implemented if more information were available. That is the essence of my point, which will be helped precisely by what he was talking about, which is having more and better relationships between the different types of hospital.

May I say a few words about the investment that the coalition Government have managed to provide for our hospitals? I have already said that the Vale community hospital was built during the early years of my time as Member of Parliament. We have also seen huge improvement in the Stroud maternity unit, with significant investment in access, the entrance area and a complete revamp of corridors and facilities. As a result, it is a very attractive place for expectant mothers to go. The questions are, do we have enough expectant mothers, and do we have enough of them who want to go that particular unit? I am not going to add to the baby count myself, as I have three children already, but those are questions we need to address.

Stroud general hospital can now boast improved diagnostics and excellent out-patient services. That is good for those situations, which we often see, that involve someone needing to go into a hospital, but not necessarily to stay overnight. The recently opened out-patient facility is therefore a good example of valuable and useful investment.

I want to pay tribute to the leagues of friends in Stroud hospital and in Vale community hospital. In particular, I want to single out one individual, David Miller, who has contributed a massive amount to our hospital over many years. He should be recognised as a powerful force for augmenting investment in our hospitals through very good use of locally raised funds.

In essence, I am utterly and absolutely determined to ensure that our hospitals are supported properly—financially, locally and in every other way. Secondly, the key thing is to signpost the patient to the right place and to recognise the powerful role of community hospitals in promoting public health, dealing with care after major operations and enabling out-patient activity to work, all in conjunction with general practitioners across my patch. That is the message that the Government must hear; that is the theme that the Government must pursue; and it is certainly what I will do in the Stroud valleys and vale.