Community Hospitals

Rory Stewart Excerpts

Thursday 6th September 2012 Commons Chamber

[Rory Stewart (Penrith and The Border) (Con)]

I feel shy speaking in front of this extremely distinguished audience. It is impressive to take part in a debate involving people with so much expertise. I was impressed by the extraordinary confidence with which my hon. Friend the Member for Bracknell (Dr Lee) said things that we would not dare say to any of our constituents by calling for the closure, no less, of one of the community hospitals in Bracknell on the grounds of efficiency. The sense that expertise can deliver controversial and exciting policies is moving. It is also moving for me to be able to thank my hon. Friend the Member for Totnes (Dr Wollaston) for securing the debate, and to congratulate the Minister on her new position.

The debate on community hospitals should be held in a larger debate, and it is a debate that Conservatives should be proud to have: the ancient debate of the big against the small. The reason community hospitals are under threat, have been under threat and always will be under threat—I mean this not in a political sense, but simply ideologically—is the problem of the small.

In 2005, one in four members of the population in Cumbria signed a petition to keep our community hospitals open. Today, we face serious issues of the internal market and the tariff structure of the NHS, which may make it tempting for commissioners not to refer patients to community hospitals. All of that is about big and small. It is the same argument as that between the big supermarket and the small shop and between the small dairy farm and the big dairy farm.

This argument goes all the way back to the foundation of the NHS. One remembers Bevan’s great statement:

“I would rather be kept alive in the efficient if cold altruism of a large hospital than expire in a gush of warm sympathy in a small one.”—[Official Report, 30 April 1946; Vol. 422, c. 44.]

In that moment, Bevan, in founding the NHS, set up the fundamental challenge. My hon. Friend the Member for Bracknell expressed the problem clearly in explaining that in the choice between acute surgical care and local care of chronic conditions, we have the choice between fancy machines, specialisation and surgeons who perform the same operation again and again, and what is required for a new situation and a new population. We are no longer in the late 1940s.

If I may be so presumptuous in this distinguished company, I will put Cumbria forward as an example. We are an interesting example, because we are ahead of the rest of the country in one thing: Cumbria has more deaths than births, but a rising population. That is not, as one might imagine, because we have discovered resurrection; it is because we have old people moving to our constituency. The population of the constituency is getting older at a national record rate. We are about to go from one in six of the population being over 65 to one in three of the population being over 65. The number of people who are over 85 is about to double. The number of people with Alzheimer’s in my constituency is about to double. All that points, above all, to one thing—community hospitals. What people at that age need is not necessarily the technical services and equipment that are provided by acute hospitals, nor the specialties of their surgeons, but preventive care. That can be delivered through the hubs of which we have all spoken.

To give a local example, my neighbour recently broke her hip. To many of us in this Chamber, that seems fundamentally to be a problem of cost. It costs £350 to move her in an ambulance from her home to the hospital, it costs a minimum of £2,000 to admit her to the hospital, and it costs tens of thousands of pounds in ongoing costs as she struggles to get better and gets into other chronic conditions. But why did she fall? She fell because her husband died. The chance of somebody dying doubles in the year following the death of their husband. She was in trouble because she could not get anybody to take her to an optician. She was not eating properly, because nobody was able to take her to the supermarket regularly.

Those are things that the extraordinary network of local charities and community activity is in a fantastic position to provide, guided by the community hospital. In Cumbria, Cruse Bereavement Care provides counselling to people who are bereaved and Eden Carers could perhaps have taken my neighbour to the optician. Every Member has such organisations in their constituency. They have their equivalents of Hospice at Home and the Eden Valley hospice. There are also the first responders and other members of the emergency services. My hon. Friend the Member for Hexham (Guy Opperman) champions the air ambulance and others of us champion mountain rescue. It goes all the way down to Age UK and the Alzheimer’s Society. Indeed, we have made fantastic progress in neuroscience support at a community hospital level.

I conclude with a plea to the Minister. This is not just about good language. It is easy to talk about prevention, but also very easy to carry out bad prevention and waste an enormous amount of money tacking down carpets in the houses of people who do not need their carpets tacked down. My constituency includes surprised people who have suddenly found themselves given a new shower that they did not particularly feel they needed. What we need is the local knowledge, care and compassion that can target those resources. The Minister is now in a position to move just 2% or 3% of the budget towards community hospitals and community care and away from acute trusts.