HC Deb 25 January 1993 vol 217 cc847-54

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Wood.]

12.23 am
Mr. Gary Waller (Keighley)

Convalescence as a specialist field of medicine within the national health service has been in decline for many years. However, I hope to show tonight that in many areas, that decline is being reversed as the clinical and economic case for convalescent care becomes ever more obvious.

I address my remarks specifically to the Grove convalescent hospital in Ilkley in my constituency with its 54 beds, of which 44 are currently convalescent. It now represents one of the last bastions of convalescence in this country. It is somewhat ironic that just when the tide of convalescent care might be turning, the Airedale NHS trust is preparing to close that hospital. The development of the internal market in the NHS can give such units an opportunity to demonstrate the value for money that they offer, if they are given that opportunity, and also show that they satisfy a need that is not easily met elsewhere.

As the demand for hospital services increases, fed by a more elderly population and rising expectations, throughput in the health service has become faster. As the Parliamentary Under-Secretary of State for Health, my hon. Friend the Member for Bolton, West (Mr. Sackville), is aware, the trend is towards short stays and day surgery wherever possible for good clinical as well as economic reasons.

Getting people up and on their feet speeds their recovery, but many of them will continue to need nursing care for some time following an operation or illness. Community care is the answer in many cases, but not in all. If an elderly person lives alone, a consultant may often see no alternative to a situation where the patient continues to occupy an acute hospital bed, preventing waiting lists from falling and preventing the expensive time of surgeons from being efficiently utilised. In money terms, convalescent units often represent good value. Purchasing authorities are currently charged only £49 per night for patients cared for at the Grove, compared with well over £200 per night in a typical acute unit.

Financial criteria, however, tell only half the story. Many medical practitioners believe that stressful and busy acute wards are far from an ideal environment in which patients can recuperate well. Quoted in the Health Service Journal, Professor Peter Millard of the geriatrics department at St. George's hospital in London sees a need for "healing halfway houses" where patients, particularly the elderly, can go between hospital and home to recover strength and independence. Keeping someone in hospital when that person no longer needs full medical care is expensive and inappropriate, but in Professor Millard's experience, discharging patients straight back home, even with intensive after care services, is rarely a solution.

There is, perhaps, no single model of convalescent care that is suitable for every patient. A number of different ones are developing, not only in this country but abroad. In Sweden, the concept of the patient hotel has rapidly gained ground, with units at Lund and Malmö, and spreading to Copenhagen in Denmark. Patients are treated very much as customers or hotel guests, with priority accorded to their own preferences, in a relaxed and comfortable atmosphere. Relatives who wish to stay with patients may do so, paying a reasonable fee to cover costs and overheads. That is also permitted at the Grove when beds are available.

Although the Swedish patient hotel model is based on single rooms, the costs are only a half or a third of those in acute hospitals. Patients like it and they prosper, but the health service also secures benefits as a whole. As one practitioner put it:

The patient hotel helps prevent institutional hospitalisation and saves money which can be transferred to patients needing more intensive treatment. Our experience of a patient hotel in Lund is an overwhelmingly positive one. In the United States, convalescent units have been developing from Connecticut, where a 93-bed medical hotel opened in January last year, to California, where Recovery Inns, charging an all-inclusive fee of $700 per day, demonstrate the diversity of the concept, if not a model that we would necessarily wish to emulate within the NHS.

The Kingston hospital NHS trust has created its own hospital hotel whose first objective is defined as being

to achieve a more efficient use of acute inpatient beds to reduce waiting lists and waiting time. An encouraging leaflet issued to patients on admission welcomes them and explains that becoming a guest in the patient hotel when a return home is not feasible is regarded as a way of releasing an acute bed for further admission. In Worthing, Oxford, Peterborough, Lambeth and south Derbyshire, too, different organisational patterns of convalescent care have come into being in recent times. I am sorry that I do not have time to refer to them in detail.

Having considered some fairly recent developments pointing perhaps towards the need for a diversity of responses to the need for convalescent care, I refer again to the Grove convalescent hospital in the town of Ilkley in my own constituency. In Victorian times, Ilkley was a spa to which many people came to take the waters and perhaps to convalesce at one of its hydropathic establishments. Today, they still come, not to take the waters but nevertheless to convalesce at the Grove following major surgery or intensive medical treatment in an acute hospital. An attractive folder about the hospital tells us that it was established in 1829 as the Ilkley Charity, that it overlooks the town centre, and is surrounded by attractive landscaped gardens.

"Patients", we are informed,

normally come to the Grove for two to three weeks following a wide range of hospital procedures; from heart by-pass and major cardiac operations to orthopaedic work, kidney and liver transplants and ophthalmic operations. Others are cared for following treatment for leukaemia or the effects of a stroke. All forms of post-operative care are available, as is specialist insulin control for diabetic patients. Treatment is carefully planned for each individual patient according to their own individual needs and includes the provision where appropriate of skilled rehabilitation therapy. It can be seen that the level of nursing care provided at the Grove is considerably higher than in most of the other models of convalescent units to which I have referred. It is true that patients do not have the total privacy of individual rooms which are commonly found in patient hotels, but efforts have been made to ensure that we are a long way from the rows of beds offering no privacy at all in traditional Nightingale-style wards. Everyone agrees that the staff and the excellent hospital manager, Mrs Sheila Wormold, have done a remarkable job.

Although the building may be more than 150 years old, nevertheless the ethos has much in common with that of the more recently invented patient hotel. It is clear from the comments of patients that they feel that they are treated as guests, with comfortable lounges on both the ground and first floors, a licensed bar and a wide choice of menus available. As patients start to feel better they can walk in the gardens, take a five-minute stroll down to take tea at Betty's or even venture as far as the famous Ilkley moor.

Letters received from patients following their stay are revealing. Mrs. Saxton of Bakewell, Derbyshire wrote:

It frightens me when I think of my condition on arrival at The Grove. I couldn't possibly have looked after myself at home. If places such as The Grove close, what will happen to future patients"? Mrs. Norris of Carnforth, which is a considerable distance away, wrote:

It was a truly wonderful fortnight in every way, and I returned home…looking and feeling so different to when I left the Royal Lancaster Infirmary … I was refreshed and strengthened in body, mind and spirit. That The Grove Convalescent Hospital should remain open for years to come is vitally essential, so that others may continue to benefit as I did (and, indeed, the Government should make it possible for similar establishments to be built throughout the country). Audrey Scriven, an Ilkley resident, wrote:

I don't think any other community has such a suitable convalescent hospital in such a wonderful situation as Ilkley … Open more homes like The Grove Convalescent Hospital, don't close down the gem that is here. Taking patient records almost at random, it is apparent that the Grove meets a need which could not otherwise easily be satisfied for patients not only from the immediate area but from many parts of the north.

The staff of the Grove spend much time talking to, listening to and reassuring patients. That is the kind of personal attention which the staff of an excellent convalescent hospital such as the Grove can give but which is far more difficult to provide in a busy general hospital ward.

Many consultants from many parts of the country—Lancashire, Yorkshire, the west and south—have written to me. The tenor of their remarks was that if the Grove closed they would have to keep patients in acute wards for longer, waiting lists would grow and patient care would suffer.

This is not the first time that I have raised the future of the Grove hospital in the House. Just over five years ago, on 16 November 1987, I sought leave to move the Adjournment of the House for the purpose of discussing a specific and important matter that should have urgent consideration, namely, the proposed emergency closure of the Grove hospital. The following day, the then Leeds Western health authority was considering a proposal to close the Grove within days as an emergency measure and as part of a package intended to deal with overspendng of £800,000 in that financial year. Statutory procedures were then in midstream. I said:

everyone realises that if the hospital were to be closed now, before the statutory procedures are completed and before objectors have even had a chance to put forward alternatives, the involvement of Ministers would be a parody of what Parliament intended."—[Official Report, 16 November 1987; Vol. 122, c. 776.] Time has moved on. At the eleventh hour the Grove was reprieved in 1987. With the encouragement of the Yorkshire regional health authority, it was taken over by Airedale health authority in whose area it was located. From April 1992, Airedale hospitals have been incorporated in an NHS trust and from 1 December that part of Airedale health authority with which we are concerned has merged to form a new Bradford and district health authority.

History has not only moved on; it is repeating itself. The Airedale NHS trust is now having difficulty in matching its income with its expenditure. A closure proposal has been announced, but it will undoubtedly take many months for the community health council to give its view, for the public and interested parties to be consulted and for my hon. Friend the Minister to make his decision. In the meantime, the NHS trust has stated that it intends to proceed with an emergency closure no later than the end of March.

Such an emergency closure is regarded by many as just as unacceptable now as it was before. A hospital is much more than just walls and a roof. If the Grove is closed, the consultation which has not yet begun will be pointless because many or most of the staff will have been made redundant.

When I submitted a paper to the regional health authority in March 1988 I commented: The majority of convalescent patients are elderly, live alone and have nobody at home to provide the care which is essential to effect recovery. The difficulties of providing alternative cover are immense. The arguments point …towards the provision of convalescent care by nursing staff who are specialists in this sector and can meet the need more effectively and more economically for those patients who require it. I pointed out that the Grove suffered because there was no internal market in the NHS at that time. Well before the issue of a White Paper on the NHS, I urged that districts should be charged against their budgets in proportion to the usage which they make of the hospital so that they could offset those charges against savings made elsewhere by taking advantage of the Grove's facilities.

When I spoke earlier of convalescent facilities developing in the United Kingdom, it will perhaps have been noted that there is a major gap in the north of England. I regret the fact that, because of the pressure currently applied to it, Airedale NHS trust proposes to close the Grove without positively or adequately exploring alternative strategies. Money needs to be spent on the Grove. The trust says that it is required to spend £1 million over five years. Only some £100,000, or perhaps a little more, needs to be spent urgently to satisfy fire and environmental health regulations.

I am particularly attracted to the concept of a mixed unit serving both NHS and private patients. At present, the hospital takes private patients from BUPA, but clearly requires some modernisation and expansion of its facilities to develop that side of its work. As it happens, there is land to the rear of the hospital where it should be possible to obtain planning permission to build a new block, creating not only rooms for private patients on the patient hotel model but improved common facilities for the hospital patients as a whole. There are companies with a good track record in the health sector which could be interested in working with the Airedale NHS trust along those lines.

Some health authorities have indicated that they do not intend to send patients to the Grove in the future. However, I believe that judicious marketing would reveal that many health authorities and purchasers of services in Yorkshire and the north of England would benefit from sending some of their patients to the Grove.

I have already referred to the internal market. Every health authority is paying for patients to remain in acute hospital beds when they need not be there, simply because they have not considered the alternative of convalescent care, the cost of which could be a great deal less.

Finally, I shall refer to the important issue of GP beds in the hospital. Since late last year, the Grove has accommodated 10 GP beds which were formerly provided at the Coronation hospital in Ilkley. My hon. Friend the Member for Loughborough (Mr. Dorrell), who preceded my hon. Friend the Minister in his present post, wrote to me on 8 August 1991 to uphold the decision of the former Airedale health authority to end in-patient services at Coronation hospital. In his letter he said:

The health authority have been able to assure me that they can provide 10 beds to meet the GPs' needs at the Grove Hospital in Ilkley. Airedale have invested some £80,000 in improving this facility since taking over the management in 1989, and I am satisfied that the Grove will provide a good setting for the continuation of this important local service. So 18 months ago the Grove was seen as a good setting for GP beds. My hon. Friend also saw a move to the Grove as consistent with the wish

to ensure that the best standards of modern medicine are available for [patients] care. But now there is uncertainty about where the 10 GP beds which rightly concerned my hon. Friend should be located. As yet no solution has been found and the uncertainty remains. There has been talk about using a local nursing home. But many doubt whether that solution, appropriate as it might be for some patients, would provide the standard of nursing care available at present.

Taxpayers are also entitled to ask about the £80,000 which has been spent improving the Grove since 1989 and the additional amount spent since 1991 on providing the GP beds. Taxpayers are entitled to ask that, after such expenditure, decisions are not taken for short-term and perhaps short-sighted reasons.

There is good will on the part of the trust chairman, Mr. Peter Bell, to move towards a solution to the problems posed so soon after the creation of the Airedale NHS trust. The NHS management executive and the Yorkshire regional health authority have a responsibility in the matter because the Grove is essentially a regional facility. The regional health authority should work with Airedale to ascertain whether an alternative course can be followed. It needs to be a course which would provide clinical benefits for patients while enabling the hospital to pay its way in the internal market.

Therefore, I ask my hon. Friend the Minister to meet me at an early date to consider whether any possible way forward can be found. Obviously, I can ask him to make no commitment except that he consider the matter in a careful and thoughtful way, as I know that he will. But that is no less than the dedicated staff and the patients who have benefited from staying at the Grove deserve.

12.41 am
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)

I have listened with great interest to the comments made by my hon. Friend the Member for Keighley (Mr. Waller) in his well researched speech. I recognise the wealth of local knowledge that underlies his remarks. He shares with Mr. Peter Bell, the chairman of the Airedale NHS trust, a passionate concern that Keighley people should get the best available care from the NHS. The Airedale trust is striving to improve the health care of all Airedale residents: that is well understood and recognised.

The proposal at issue here is that the Airedale NHS trust wishes to close the Grove convalescent hospital in Ilkley. The trust is a second wave NHS trust which came into being in April of this year. The Grove is one of seven hospital sites which comprise the trust. It was built in 1829 as a hospital and convalescent home, and was taken over by Airedale health authority in April 1989 from Leeds Western health authority. It became part of the trust in April this year. The hospital was in a rundown condition when Airedale district health authority took it over and the facilities have been improved, upgraded and refurbished over the past three and a half years.

The Grove is a 54-bed convalescent hospital currently providing convalescent care to eight district health authorities in Yorkshire and Lancashire and accepting substantial numbers of extra-contractual referrals, particularly from the Greater Manchester area.

The hospital currently has 10 nursing care beds which are used by general practitioners in Ilkley—a service provided as a result of the closure of the in-patient beds at Ilkley Coronation hospital in 1991. Occupancy of the 44 convalescent beds has remained stable over the last 18 months: on average, 38 beds out of the available 44 are occupied representing an average occupancy of 86 per cent.

The GP beds have maintained an occupancy rate of approximately 50 per cent. since being transferred from Ilkley Coronation hospital in September 1991. Patients staying at the Grove will have an average length of stay of about two weeks, with the maximum being three weeks.

The position of patients housed in the Grove from other health authorities is as follows. The figures are from 1 April to 30 November, 1992 and are: Leeds 114; Harrogate 21; Burnley 102; Lancaster 58; Calderdale 52; Airedale 123; GP beds 86; private patients, 16; other extra contractual referrals 209. The House will note that only 15 per cent. of patients treated at the hospital are from the Airedale area.

I stress that quality care is undeniably being provided by a very devoted group of staff. However, it has become increasingly difficult to provide modern care for the elderly and pre-convalescent patients in facilities dating back to the early part of the 19th century.

The hospital urgently needs considerable capital expenditure to meet statutory safety requirements—for instance, upgraded and additional toilet and washing facilities, separation of beds and improved access to patients on upper floors. That would require an investment of £1 million or more, on a building that does not easily lend itself to adaptation.

In 1992–93, the Grove convalescent hospital will suffer a loss of about £77,000 in contract income, and in 1993–94, as purchasing authorities withdraw and redraw contracts for convalescent care, the deficit is likely to reach approximately £250,000. Two of the main reasons given by purchasing authorities for discontinuing their contracts are that the quality of accommodation at the Grove is no longer acceptable, and that the purchasing authorities wish to use their budgets on convalescent care within their own districts. As my hon. Friend will be aware, there is a growing trend within health authorities to provide convalescent care locally, using local provider units. That has advantages to patients, in making it easier for friends and relatives to visit.

Although demand is relatively high, the trust has already received indications that Calderdale and Burnley health authorities will no longer be contracting with Airedale NHS trust for that type of care in 1993–94. It is also likely that Leeds health authority will reduce the size of its contract, as it has not been able to utilise its present contract fully. Furthermore, Bradford health authority can no longer contract for its patients.

The change in the attitude of purchasing authorities will mean a reduction of about 20 per cent. in income, and the price of £49 per night would have to be raised to £68 to balance such a loss. There is also a need to account for inflation, pay charges on capital expenditure to meet safety regulations, and—as I have mentioned—for considerable upgrading.

I understand that the length of stay of patients in the Grove hospital is falling below the historic average of two weeks. That is likely to continue in 1993–94, with a consequent loss of income. As my hon. Friend will agree, that trend will lead to the Grove becoming less attractive to the few health authorities that continue to purchase its services. The increase in price would also threaten the current level of extra contractual referrals. They represent 35 per cent. of income, which would be vulnerable as the price per patient per night increased.

I emphasise, on behalf of the trust, that the closure of the Grove is not designed to release capital for other trust purposes. While its sale would eliminate the need for the trust to pay capital charges of £112,000 per annum, by the nature of the capital charging system, there would be a resulting loss of income. Hence the sale of the Grove would have a neutral effect, in terms of capital charges, on the trust's finances.

The trust has always been prepared to consider any collaborative proposal to develop the site of the Grove for hospital/hotel type accommodation or any other suitable health care provision. However, the capital and revenue implications of such schemes must not be such as to damage the overall finances of the trust. In its review of that and other options, the trust has indicated that any such developments should be based on a new-build approach on the site rather than endeavouring to make provision within the constraints of a building dating from 1829.

The care and interest of patients has been the most important factor in the Airedale trust's deliberations. There are, as I have identified, a number of factors involved in the proposal to close the hospital: first, a decrease in the number of referrals and the number of contracts from the purchasing authorities; secondly, the fact that the cost per patient per night is likely to increase; thirdly, an ever-increasing drain on the trust's financial resources; fourthly, the need for considerable capital investment to bring the hospital up to modern standards; and fifthly, a decreasing need for convalescent beds as clinical procedures make more and more use of non-invasive therapy techniques and day surgery.

A trust can only provide the services which purchasing authorities will buy. It cannot, as I am sure my hon. Friend will agree, continue to run an increasingly uneconomic hospital for a decreasing number of patients. The trust will continue to meet the requirements for GP beds, contract referrals and extra contractual referrals by using other hospital sites in the area. The planned closure date is 31 March 1993, with possible emergency closure before that date.

My hon. Friend may prefer there to be a longer consultation period on the closure or more widespread discussion on the matter. However, the economics and the purchaser wishes will not change. The trust is best placed to make decisions on how to meet its contracts with purchasing authorities and how to continue to provide the excellent patient care found at the Grove convalescent hospital. If the trust decides that it is in the best interests of patients and the trust to close the Grove convalescent hospital, it should—I fear—be allowed to do so.

Let me reassure my hon. Friend that the Government wish to invest in the Airedale NHS trust and the care of patients in Ilkley. There are plans for a new eight-theatre block, including dedicated day-care facilities at the Airedale general hospital. Those plans are being formulated by the trust with the NHS management executive. The trust has also invested £250,000 on the upgrading of the out-patient services at the Coronation hospital in Ilkley. That is another example of how the trust is investing in local care. I understand that my hon. Friend has kindly offered his services to open that unit in the new year.

I listened with interest to my hon. Friend's remarks about convalescence. All such decisions must be made by purchasers on a local basis. Purchasers must take the decisions on how best to provide care in the most economic and efficient way for all their patients.

I hope that my hon. Friend will bear in mind what I have said today. I assure him that I am firmly committed to the best interests of patients in the NHS, both in Ilkely and elsewhere. I will ensure that the Airedale NHS trust continues to have the best interests of its patients to the fore.

Question put and agreed to.

Adjourned accordingly at seven minutes to One o'clock.