§ Mr. Warren Hawksley (Halesowen and Stourbridge)I thank you for allowing me to raise the important issue of Hayley Green hospital and its proposed closure, Mr. Deputy Speaker. That is a very important issue in my constituency. The closure of any hospital is of great importance to Members of Parliament. Before I came to the House, I always believed that, in local government, small—whether in hospitals or schools—can be beautiful. I formed that view from an early age, perhaps because my late father was the chairman of a cottage hospital in Oswestry, which was set up with his help before the last war. Local small hospitals are something that the people are entitled to hope can be retained.
This case is made even worse because Hayley Green hospital is the only hospital in my constituency. Although every Member of Parliament would be worried about a closure, I suggest that the problem would be worse if it involved the closure of their only hospital.
Hayley Green is a very good hospital and, for more than 100 years, has provided useful hospital cover for generations of people in the Halesowen area. The purpose of that cover has changed and the hospital has had different uses. As time goes by, one accepts that changes are necessary, and I shall discuss the possibility that the hospital could, I hope, have a new use, but still in the health sphere.
The fact that the hospital is very popular was demonstrated when, in a very short time, the friends of the hospital received the signatures of 15,000 of my constituents who were calling for it to be kept open. The hospital is pleasant, the staff are very caring and it is set in beautiful grounds near a bus route. It is convenient for people visiting friends and relatives in the hospital.
As well as the massive objections from my constituents, it is interesting to note that, when the community health council was consulted, as the rules require, it formally objected to Dudley health authority's proposals. I suggest that it is the health watchdog to which we should listen.
If I were on the Opposition Benches, I would be saying that the closure was due to Government cuts, and I would be shouting and hollering political suggestions. I am sorry to disappoint the hon. Member for Wolverhampton, South-East (Mr. Turner)—the only Opposition Member present—but that is not the case. In Halesowen, we are paying for the fact that, since 1979, the Government have increased expenditure on health by about 68 per cent. in real terms. The increase in the health budget is causing our problems.
The hospital was full and well used until August last year, and no one locally thought that there was any danger of it being closed. The problem has arisen because of Government investment in the building of a new district general hospital in Sandwell. The opening of that hospital resulted in the withdrawal of patients who had been in Hayley Green but were residents of Sandwell. Naturally, the Sandwell authority has taken them back to their own area. I am sorry to disappoint the Labour party, but this is a case not of cost cutting, but of increased expenditure in the neighbouring authority.
Half the patients at Hayley Green came from the Sandwell area, which is why the hospital had only 50 per cent. occupancy after the new hospital opened in August 867 last year. I accepted, as did most of my constituents, that something had to be done. One cannot run a hospital on only 50 per cent. occupancy. I, and to a certain extent the health authority, started an appeal to find alternative uses for the hospital site. I ought to explain that it is a green-field site and cannot be sold, as some people have suggested, for use as a supermarket or petrol station. That would not be approved by the local council, which has confirmed its use as a health establishment, and that is how it must remain.
If the hospital is closed, one must assume that patients from my constituency will be moved to one of the Dudley hospitals. Interestingly, during the consultation period, when we heard people's concerns about the proposals, the only supporter of the closure I heard of was a Dudley resident. His reason was that the hospital was too far away, and was very hard to get to by public or private transport because the road system drags one through Merry Hill, which is an area of certain congestion. The public transport system does not easily allow the cross-Dudley route. I suggest that that argument was the greatest argument that we had in Halesowen for retaining the hospital.
When the consultation period started, Dudley said that only 48 local—that is, Halesowen—patients had been in the hospital during the previous year. At the end of the consultation period, as many of my constituents had argued that that figure did not look right, Dudley health authority admitted that the 48 should have been 119, and that the figure was nearly 150 per cent. out. That was not a very good basis for making the original decision to close the hospital.
I appreciate that Dudley health authority's request has gone to the region which, in the view of many of my constituents, merely rubber-stamped it, and that because the community health council objected, the matter is with the Secretary of State. I appreciate that it might well be slightly sub judice as it is in her hands and I do not expect an answer today. I do not expect a yes or a no, but I hope that the Minister will be able to cover a few of my questions in his reply.
During the consultative procedures, quite serious questions have been raised. The first concerns the Dudley hospital trust, which was set up in April 1994 and had been using Hayley Green for its patients. In April 1994, Hayley Green was not surplus to requirements and was still needed as part of its plan. Because the regional health authority's lawyers had not completed the paperwork when the closure was proposed, they are claiming that the property will remain with West Midlands regional health authority.
That is unfair. If the Department could suggest that the capital that would be raised by selling the hospital, if it is sold, or as a result of whatever happens to the site, should be used for the benefit of people in the area, as Hayley Green is an old hospital that was raised by voluntary endeavour, my constituents would feel much better. That would not seem an unreasonable suggestion, as it should have been the capital of the trust when it started up in April last year.
The second question also involves the trust. I accept that this is early days—certainly for trusts in our part of the country—but we had many discussions as to what would happen to the hospital. I have here a leaflet entitled, 868 "Hayley Green Hospital: Need It be Closed?", which advertised a public meeting. I was listed as being present to speak, Dudley health authority sent its chief executive and the trust was invited to send its chairman or chief executive, but it did not do so and took little part in the consultative procedures.
I am concerned that, as a Government, we should persuade trusts to accept a certain amount of responsibility if a hospital closure is proposed because of the withdrawal of purchasing contracts on the site. They should take part in the consultative procedures and look actively for other ways in which the facilities that are being closed could be useful in the health field. I say that deliberately, because the chairman of the health authority—who attended the meeting with the chief executive and myself—felt that many of the questions asked could have been answered very much better by the trust.
My third point is whether the recent case of the 55-year-old Leeds man who complained to the NHS ombudsman has any relevance to this case, and some of my constituents have written to me recently regarding that case. My hon. Friend the Minister stated that some health authorities will now be forced to re-provide withdrawn intensive nursing and other services for the elderly as a result of the ombudsman case. I ask for a reassurance that we shall look again before a decision is made to see whether the local health authority might need the hospital provision to honour that judgment. I hope that that point will be given serious consideration.
My fourth point is that, if the decision is made to close the hospital, the site should be used for health. I have stated that the site would be unlikely to get planning permission for any other purpose. The local league of friends might well consider setting up an old people's home in the form of a trust, and the local social services committee might well be prepared to offer 15 people to put into such a home.
Can my hon. Friend say whether it is appropriate to encourage Dudley health authority to take an interest in what happens to the hospital, and to work with social services and possibly with the league of friends to see whether a trust can be set up? That is a possibility, but nobody will be prepared to give it serious consideration until we know that closure is inevitable.
But if that happens, will it be possible to have such provision on a site designated only for health? West Midlands regional health authority, which obtained the property by unfair means—on the day when the trust was set up, the property was in use—should offer a reasonable lease to Dudley health authority, social services or a trust, so that the site can be used for the elderly.
My fifth point is that I would like to know what is to happen to the proceeds that will be raised if the site is sold. That is important, and I hope that the proceeds will come back into the Dudley area or the west midlands area.
I hope that I have shown that we are realistic in Halesowen. We realise that we have to tackle the problem that has been created by the building of a brand new hospital at Sandwell, but we believe that Halesowen should not suffer to the extent of having no hospital provision at all. We believe that the hospital can and should be saved. If it is not saved, we should look at the possibility of another health-based public service being provided. To do that, we shall need the help and good will 869 not only of the Department and the Minister, but of West Midlands regional health authority and Dudley health authority.
Even at this late stage, I hope that we can convince the Department that the approval for closure that the West Midlands authority has requested should not be granted. I also hope that the Minister will be able to assure us that the use of the premises in the long term may include health purposes.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)I congratulate my hon. Friend the Member for Halesowen and Stourbridge (Mr. Hawksley) on having the opportunity to initiate this debate, and on the helpful and measured way in which he has done so. Hon. Members who have had small hospitals in their constituencies understand the loyalty and affection that they can engender, and the concerns that are raised when there are question marks over their future.
While my hon. Friend kindly excused me from giving an answer to his main question today—he is right to say that that is not possible—he asked for clarification and answers that might help to reassure people. As he said, if they do not have the facilities that they have now, they would like to ensure that there is good health provision in their area. That is why I am glad to respond to the debate.
As my hon. Friend said, the proposal to close Hayley Green hospital has been contested by the community health council, and it has been referred to the Secretary of State by West Midlands regional health authority. My right hon. Friend has yet to reach a decision on its future.
My hon. Friend will also know that the Dudley Group of Hospitals NHS trust, which serves the residents of the borough of Dudley, is divided among five sites. While I appreciate the desire of the residents of Halesowen to retain services at Hayley Green hospital, the proposal that the hospital be closed will be judged on whether it is based on sound clinical and managerial factors, and with the best interests of the residents of the borough of Dudley in mind.
Hayley Green hospital is sited extremely close to the south-eastern boundary of the borough and has traditionally performed several roles, mainly connected with services for elderly people. Those services include rehabilitation for elderly patients with medical conditions, chest medicine for patients with chronic conditions and a 10-place pre-discharge unit for patients getting ready to transfer home following treatment. That amounts to a complement of 47 beds. The hospital serves patients from all over Dudley and occasionally patients from outside the borough.
Last April, the Dudley Group of Hospitals trust had to accept a large reduction in the contract that it had with Sandwell health authority. That was as a direct result of Sandwell Healthcare NHS trust planning to open, and subsequently opening, the new Rowley Regis community hospital in September. It enabled Sandwell health authority to purchase more locally accessible services for its population, removing much of its requirement for services from the Dudley Group of Hospitals. As my hon. Friend said, the problem has been caused by increased Government investment in the health service, which has resulted in new facilities that have affected his constituency.
870 The Dudley Group of Hospitals, as a self-governing trust, chose to concentrate the impact of the contract change on one site rather than try to spread savings attempts across a variety of sites in the trust. That meant the closure of more than half the beds at Hayley Green hospital, leaving the unit—in its view—unviable and extremely expensive to run. If the Dudley Group of Hospitals was to retain the site with its residual services, I am told that that would entail an additional cost of £180,000 per annum to Dudley health authority. As I am sure my hon. Friend can understand, those are funds that the health authority would prefer to invest in health care for the residents of Dudley, rather than—as the authority sees it—spend them on the maintenance of underused buildings.
As my hon. Friend is aware, Dudley health authority proposed that Hayley Green hospital should he closed and that the services previously purchased from there should be purchased from Corbett hospital, which is a part of the Dudley Group of Hospitals NHS trust, and from the newly opened £12 million Rowley Regis community hospital in Sandwell.
I am told that the majority of patients treated at Hayley Green are from outside the Halesowen area, although a not inconsiderable minority are locally based. During the consultation exercise, some of those people from outside Halesowen—it sounds as if my hon. Friend heard from one of them—commented on the travel difficulties they faced in getting to the hospital. That is a serious and important issue locally, and I understand that the proposals acknowledge those concerns. If the proposals were to be approved, Halesowen residents would have the choice of two nearby hospitals, while residents of the rest of Dudley would also benefit from improved access to services.
I am aware that other benefits have been identified, such as those arising from the development of an integrated service at Corbett hospital. The proposals outline a service better supported by a full multidisciplinary team, with on-site medical staffing at all times—facilities that are not available at Hayley Green. It is said that patients would also benefit from safer, speedier transfer to the rehabilitation programme after acute care.
Dudley health authority has also identified net savings of more than £200,000 a year through the removal of services from Hayley Green hospital and their reprovision at Corbett hospital and Rowley Regis community hospital. Those savings come from reduced site costs and through being able to offer alternative services on a more integrated basis, with only small cost increases.
The proposal is to use those savings to improve services for people in need of rehabilitation. My hon. Friend asked about the role of the regional health authority. Capital receipts from the disposal of assets go to the region, and it is for the regional health authority to decide how best to dispose. I am sure that it would wish to take into account the points that my hon. Friend made today, and other points that are made locally between now and any such decision, should it be made. Other revenue savings can be reinvested, and I understand that there are two possible plans. One is to set up a stroke rehabilitation service and the other is to establish a post-discharge support team, to lend home-based support to patients recently discharged from hospital. 871 I am assured that services at Hayley Green would not be removed until their replacements were up and running. As far as is practicable, patients currently at Hayley Green hospital, and any subsequently transferred there, would have their hospital treatment concluded at that hospital if they so wished.
My hon. Friend raised the concern today that he raised with the chairman of the Dudley Group of Hospitals NHS trust, about why the trust was unable to lead in the public consultation exercise. It may be helpful if I point out that procedures must be followed when a significant change of service provision, or closure of a hospital, is being considered. That involves the purchaser—in this case, Dudley health authority—conducting a public consultation explaining the proposals and seeking local views, including those of the community health council.
We would expect local providers, such as the Dudley Group of Hospitals trust, to be fully involved in that process. However, as purchasers are responsible for ensuring effective local health care provision, responsibility for any changes in that provision must fall to them. The effectiveness of the consultation exercise is one of the issues to be considered when the proposals are placed before the Secretary of State.
My hon. Friend mentioned the fact that, two weeks ago, I was involved in issuing clear and practical guidance to health authorities, local authorities and other agencies on NHS responsibilities for meeting continuing health care needs. In drawing up that guidance, we looked very carefully at the points raised in the many helpful and thoughtful responses that we received on the draft guidance, which we issued for consultation last summer. My hon. Friend is right to draw attention to that matter.
The key objectives of the guidance are, first, unambiguously to remind health authorities that it is a fundamental responsibility of the NHS to arrange and fund services to meet people's needs for continuing health care, including, where appropriate, continuing in-patient health care. Secondly, the guidance requires all health authorities to review their current arrangements. Here, I suspect, is my hon. Friend's rub. They should draw up policies and eligibility criteria for continuing health care and, where significant gaps in provision exist, take action to fill them. The guidance offers a further opportunity to strengthen collaboration between health and local authorities.
Thirdly, the guidance sets out a detailed national framework, which all health authorities must reflect in their local arrangements. I hope that that will lead to much greater consistency across the country in how those issues are handled, while preserving an appropriate level of local flexibility to respond to local needs. Fourthly, it reinforces the special care required in making decisions about hospital discharge for frail and vulnerable people who are likely to need continuing intensive support, whether on a long-term or short-term basis, to aid rehabilitation and recovery. Again, that is germane to the points that my hon. Friend raised.
Finally, it encourages greater openness on how decisions about continuing health care are taken. Local policies and eligibility criteria will be subject to public consultation. They will be published with details included in community care charters. From April 1996, patients 872 who consider that eligibility criteria have not been correctly applied in their case will have the right to ask the health authority to review their case.
The need to strengthen local collaboration has been a central feature of the new community care arrangements. We have strengthened the incentives for close working by requiring local authorities, as a precondition to receiving the community care special transitional grant, to facilitate agreement between their social services departments and local health authorities, on the arrangements for hospital discharge.
My hon. Friend is right to raise this matter. In return, I assure him that we shall ensure that the principles within the guidance are fully accounted for before any decision is made on the proposal to close Hayley Green hospital. Indeed, if my hon. Friend studies the guidance carefully, he will see that it contains a fairly clear timetable for the next stages of continuing care provision and that we do not expect any closures to take place, unless they meet the conditions within the guidance, before the review has taken place.
On the broader issue of health care within Dudley, I am sure that my hon. Friend will wish to join me in congratulating the Dudley Group of Hospitals trust on managing to increase its activity levels by 7 per cent. over the past year, while reducing prices by 2 per cent. He referred to many of its achievements. The number of patients seen is formidable. It is forecast that, this year, it will treat 14,500 elective and 24,400 emergency in-patients; 20,600 day cases; 7,700 maternity cases; 46,850 out-patient first attenders; 5,100 day-care attenders; and more than 73,000 accident and emergency attenders.
While work remains to he done, some of the patient charter standards that have been achieved are impressive. No in-patients wait for more than 12 months, and it is expected that the target of no in-patients waiting for more than nine months, set as part of the ambitious West Midlands waiting times initiative, will be achieved by the end of March. There is immediate assessment in accident and emergency, and 30 minutes is the maximum waiting time for urgent cases. In 1994-95, I believe that no operation was cancelled twice, and that all patients whose operations were cancelled on the day of admission were admitted within one month, as required by the new patients charter. That is progress indeed.
I understand that the Dudley Group of Hospitals NHS trust has received a SIGMA award—a West Midlands award for quality developments—for its accident and emergency department. The trust is running initiatives to reduce trolley waits and delays in getting X-rays reported by senior doctors. A 20-bed ward designed to provide immediate admission for patients needing urgent medical attention was opened at Russell's Hall hospital last October and a second is due to open this September at Wordsley hospital. Those wards will allow patients to bypass the accident and emergency department and so reduce trolley waits further.
As my hon. Friend will be aware, good health care within Dudley is not restricted to the Dudley group alone. In 1993-94 the Dudley Priority Health NHS trust achieved a five-star rating in five areas of the performance league tables. Last year, the trust opened a new £10.9 million mental health unit. Work was started on a new health facility incorporating a child and family psychiatric unit, which is due to open in July this year, and the trust is working closely with the local community and schools 873 on the project. Three new mental health units have been established in conjunction with social services in the borough, and a fourth unit is under discussion.
My hon. Friend has a particular interest in the area of Halesowen and I am sure that he will agree that over the past seven years there has been considerable expansion in the range of health facilities available locally. The residents of Halesowen have seen the commissioning of a new health centre, a new community mental health service base and the creation of a 24-place home, primarily for local people with mental health problems. In addition, a new clinic is currently being built on the eastern side of Halesowen, which will provide extensive local services.
I hope that my hon. Friend will agree with me that the people of Halesowen and Stourbridge, as well as the rest of the borough of Dudley, are provided with a first-class service of which both patients and staff can be justifiably proud. I thank him for bringing his concerns to my attention. I assure him that they will be given full consideration before any decision is taken, and any decisions will be made in the best interests of the people of Dudley.