Community Hospitals

Sarah Wollaston Excerpts

Thursday 6th September 2012 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move.

That this House recognises and supports the contribution of community hospitals to the care of patients within the National Health Service; requests the Secretary of State for Health to commission a comprehensive database of community hospitals, their ownership and current roles; and believes that the assets of community hospitals should remain for the benefit of their community while allowing them greater freedom to explore different ownership models.

I warmly welcome my hon. Friend the Minister to her new role. She will know that there are more than 300 community hospitals in England. I used to work at one of the very smallest at Moretonhampstead in the heart of Dartmoor, so I know just how important community hospitals are, especially to isolated rural communities. I may have lost one, but I fortunately gained four, and I am happy to represent Brixham, South Hams, Dartmouth and Totnes.

Community hospitals vary in size and function—some are urban, some are rural, for instance—but they share a common theme: they are deeply rooted in their communities and provide an extraordinary level of support with volunteering and charitable giving through leagues of friends. The reason for that support is clear: people value their personalised approach and want to be treated closer to home. Community hospitals score well on things such as dignity, respect and nutrition. We should be treasuring and enhancing their role because although small is beautiful, unfortunately it can make them a tempting target for cuts.

The need for efficiencies in the health service is nothing new. I remember reading in 2009—before the general election—about the Nicholson challenge. We have known for some time that we have to make £20 billion of efficiency savings over the next four years—that is 4% efficiency gains year on year—but there is a misunderstanding about what this means. It is not about doing less of the same; it is about spending what we spend more efficiently and looking at the needs of our population. Over the next 20 years, the number of over-85s in our country will double.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

In my constituency, Abingdon community hospital has played a fascinating role in supporting the wider NHS in Oxfordshire. It has assisted with the problem of bed blocking by supporting early and late-stage rehab and preventing patients from needing acute beds. I do not think that community hospitals should face cuts, given the role they can play in easing pressures on acute hospitals. Does my hon. Friend agree?

[Dr Wollaston]

I agree absolutely. Their role in so-called step-down care and rehabilitation is vital, and I am glad to hear that it is happening well in Abingdon.

Seventy per cent. of the total spend on health and social care goes on people with long-term conditions. We should all understand that the burden of disease in England has completely changed—from tackling life-threatening emergencies to managing people with long-term, complex conditions.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

I congratulate my hon. Friend on securing this timely debate. She mentioned the growing elderly population, and nowhere is that more of an issue than in north Yorkshire. Does she agree that the Government—and this is a good opportunity for me to congratulate our new Minister, whom I hope will respond positively—should not be obsessed only with home care, which has its place, and that there will always be a place for community hospitals in our health care structure?

[Dr Wollaston]

I wish to make the case for reinvigorating community hospitals as hubs for delivering the right care at the right time and in the right place. Of course, the right place, where possible, will always involve helping people to be independent in their own homes, but community hospitals have a vital role, through both step-up and step-down care, in helping to maintain that independence.

We should look at what community hospitals are capable of, because they are not just about in-patient beds: they provide a full range of diagnostics, minor injuries units, therapies—physiotherapy and occupational —and mental health care. In my constituency, people with cancer can access chemotherapy at Kingsbridge hospital, saving them a long roundtrip to Derriford hospital. Kingsbridge hospital—South Hams, I should say—supports a triangle centre helping people and their families living with cancer, while organisations such as Rowcroft hospice are looking to expand their care-at-home system through hubs in community hospitals and, at times, by utilising their beds and support. We can get so much more from community hospitals if we reinvigorate them.

We should not think of community hospitals as backwaters; they can be centres of great innovation. The nationally recognised Torbay pilot, which provides care based in the community, started at Brixham community hospital in my constituency and is now being considered for nationwide roll-out. That is a very good model.

[Guy Opperman (Hexham) (Con)]

I congratulate my hon. Friend on securing this important debate. She mentions the Torbay model, which is rightly a pilot and flagship for the integration of services, but does she envisage a situation in which not only are medical services integrated in one location but other emergency services can come together? The result could be enhanced training for people, such as firemen and policemen, who could qualify as paramedics and assistants to the medical services.

[Dr Wollaston]

Indeed I do, and there are many community hospitals that support first responders in the way my hon. Friend describes. That is an important role, and there is perhaps even an extended role in housing, where step-down housing can enable people to make the transition back to full independence. Indeed, there are many such roles.

What are the current barriers to providing the right care at the right time and in the right place? I would like the Minister to deal with five points. First, the biggest challenge we need to address is the tariff and tariff reform. She will know that most acute hospitals are paid through a system known as payment by results, which creates some perverse incentives, whereby acute hospitals want to hoover up as much activity as possible. Often, people are treated in an acute setting when they could be more appropriately cared for in a community hospital setting or at home. Can the Minister update the House on the progress we are making on reforming the tariff, by, say, working towards a “whole year of care” model or looking at other ways to remove the incentive in the system that means that people cannot be transferred into community hospitals or provided with the right care in the right place?

[Neil Carmichael (Stroud) (Con)]

I congratulate my hon. Friend on securing this debate and I entirely agree with her important point about the tariff and acute hospitals. I hope she agrees that it is also important to signpost patients to the right place, which, because we are talking about a caring issue, is in many cases a community hospital.

[Dr Wollaston]

I thank my hon. Friend for making that important point. Quite often patients are not aware of the full range of services available in their community hospitals. We can do far better in signposting them. It is also important that GPs understand and support those services and make referrals to the right place.

The second issue I would like the Minister to address is the community hospital estate. She will be aware that many community hospitals around the country are being pushed into ownership by NHS Property Services. However, there are examples around the country of community hospitals that are owned by their communities, for example, or by a social enterprise. If those hospitals are unable to have ownership of their premises, that can hold them back if they have ambitions to expand their roles in future. Obviously we want to reassure the public that these valuable community assets remain in public ownership, as it were, but we also want to ensure more flexibility in their ownership model. I would therefore be grateful if the Minister addressed that point.

Thirdly, there is an accountability issue. There are occasions where having multiple providers operating out of a community hospital can cause confusion. Situations can arise where, because everybody is responsible, nobody is responsible, and accountability can end up being shunted around the system. Does the Minister agree that it would make more sense to have a single body, or even individual, with overall responsibility for what happens to patients and the way in which care is organised in a community hospital?

Fourthly, I want to raise an important point that goes beyond community hospitals to the whole way in which we look at a primary care based system, namely the looming crisis in general practice numbers. For the first time we now have a vacancy rate for GPs of 12% in the south-west. On top of that, in about four or five years we will have a retirement bulge—I am afraid that I have not helped the situation—and we are also moving, quite rightly, from a three-year period for general practitioner training to a four-year period. All that coming together means that across the country, the south-west included, we will face a shortage of skilled practitioners both to deliver commissioning and to staff our community hospitals. We need their support. It would be a great shame if GPs who were enthusiastic about getting involved in commissioning and helping out in their community hospitals were unable to do so because of their clinical commitments. Can the Minister therefore update the House on how we are going to stop the problem, which has been going on for years, of too many medical students going into training in acute hospital specialties? We need more of them to go into general practice.

Finally, will the Minister support the Community Hospitals Association? It does a tremendous job. In 2008 it received a £20,000 grant to help set up a detailed database that documented not only where community hospitals are but what they do. At this time of change I hope she agrees that it is particularly important that we keep track of what they are doing. The CHA has also highlighted innovation and helped to spread best practice, so I hope that she will give it further support.

No debate about community hospitals would be complete without thanking the leagues of friends, which around the country have provided millions of pounds. They do not provide luxuries; we are talking about major building projects, equipment, funds for care, volunteers who come into the hospital—an extraordinary level of support. We could not manage without them in our community hospitals. I know that the whole House will want to join me in paying tribute to our leagues of friends.

This is a call to arms to people listening to the debate. If you value your community hospital, let your GPs know, let your commissioners know, let HealthWatch know, let your local health and wellbeing boards know. If we want community hospitals to be treasured, as we all do in the House, we need to make that very clear.

[Several hon. Members]

rose—

--- Later in debate ---

[Dr Wollaston]

I thank the Minister for her reply.

Who could forget the passionate cry from the heart from my hon. Friend the Member for South Dorset (Richard Drax) and the invitation to take cake in Swanage hospital? How wonderful it was to hear an alternative vision for the future from my hon. Friend the Member for Hexham (Guy Opperman) and to hear how we could see community hospitals as the heart of community care provision. I hope that the commissioners in south Dorset will see the light and see that that is a much better alternative.

Many Members have contributed to the debate and I am grateful to them all. We heard from the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) and from my hon. Friend the Member for South East Cornwall (Sheryll Murray), particularly about the difficulties of rurality and transport. We heard likewise from the hon. Member for Southport (John Pugh). We want to tackle rural health inequalities and the speech made by my hon. Friend the Member for South East Cornwall clearly made the point that if we do not have transport, that contributes to health inequalities. We heard from my hon. Friends the Members for Bracknell (Dr Lee) and for Penrith and The Border (Rory Stewart) about the need for leadership and how we can deliver the right care at the right time and in the right place.

My hon. Friend the Member for West Worcestershire (Harriett Baldwin) made a knowledgeable contribution about different ownership models in her constituency. My hon. Friend the Member for Newton Abbot (Anne Marie Morris), whose constituency neighbours mine, paid tribute to the marvellous stroke service that operates out of her community hospital. She also spoke knowledgeably about the problems with PFI in the NHS that have dogged so many hospitals and burdened the NHS with unnecessary debt. My hon. Friend the Member for Halesowen and Rowley Regis (James Morris) spoke about the campaign to keep in-patient beds at Rowley and it is clearly disappointing that we will not be able to see more direct intervention on unnecessary closures in parts of the area.

It was good to hear the speech from the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), but Labour Members are not so much abstaining as absenting themselves from the debate, which is clearly disappointing. I assure him that I fully understand that there must be reassurance for the future that community hospitals will always stay for the benefit of their local communities and that it is good to hear the Minister reiterate that very important point. If we are going to see the contribution from leagues of friends continuing for the future, they must have absolute confidence that those valuable community assets will always stay for the benefit of local communities.

I thank all Members for their contributions and pay tribute to all the staff and leagues of friends of our wonderful community hospitals.

Question put and agreed to.

Resolved,

That this House recognises and supports the contribution of community hospitals to the care of patients within the National Health Service; requests the Secretary of State for Health to commission a comprehensive database of community hospitals, their ownership and current roles; and believes that the assets of community hospitals should remain for the benefit of their community while allowing them greater freedom to explore different ownership models.