§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Anthony Coombs.]
§ 10.1 pm
§ Sir Michael Shersby (Uxbridge)For me, the care of the elderly in Uxbridge and in the borough of Hillingdon as a whole is one of the most important parts of public policy. As president of the Uxbridge Abbeyfield Society, which provides care for many of our senior citizens, I have been able to learn at first hand, and gain valuable insight into, the way in which places are funded and provided in the community.
The recent media coverage of Hillingdon hospital's patient admissions policy has caused unnecessary alarm and distress to my elderly constituents and to the constituents of my hon. Friends the Members for Ruislip-Northwood (Mr. Wilkinson), for Hayes and Harlington (Mr. Dicks) and for Harrow, West (Mr. Hughes), whose constituencies, with mine, share the hospital's catchment area.
A headline in The Guardian at the beginning of October, "Hospitals in cash crisis bar many elderly", triggered a mass of reports in the press and on the radio and television to the effect that Hillingdon hospital was no longer admitting people over 75. The facts behind that health scare are very different. That is why I am raising the matter this evening, and why I invite the comments of my hon. Friend the Minister.
It is also why I want the Government to make it clear beyond any shadow of a doubt, first, that there is no cash crisis at Hillingdon hospital; secondly, that at no time were people over 75 who came from the hospital's catchment area refused admission on the ground of their age; and, thirdly, that the responsibility for funding and providing beds for elderly patients is the responsibility of the local agencies concerned—the hospitals, the local health authority, the local social services department and the local medical committee. It is for them to co-operate and co-ordinate the necessary arrangements to ensure that the necessary accommodation is always available to everyone, irrespective of age.
I was first made aware of the pressure on Hillingdon hospital at a meeting that I had with the chairman of the Hillingdon Hospital NHS trust, Mr. William Glyn-Williams. and the chief executive, Mr. Philip Brown, on 1 October. I was told that the hospital faced the possibility of having to refuse accident and emergency admissions for a short period because the number of elderly patients referred by general practitioners, especially from the north of the borough, was resulting in more than 30 additional admissions each day.
There are 600 beds in Hillingdon hospital and I am told that about 300 of them are occupied by elderly patients. The 30 referrals a day, multiplied by the number of days in the month, was equivalent to 900 bed days a month. That was the scale of the problem that Hillingdon hospital was facing.
I was also told that Mount Vernon hospital in Northwood, in the constituency of Ruislip-Northwood, was not admitting as many patients as it might have done because of the case mix in the hospital, and that it would greatly assist if Hillingdon council's social services department could receive into community care as quickly 1338 as possible patients who no longer required hospital treatment and needed to be cared for in community homes or, if insufficient places were available, in independent residential care.
I was very concerned to learn of the situation. I advised the chairman to discuss the matter urgently with the chairman of Mount Vernon and Watford Hospitals NHS trust—a former chairman of Hillingdon health authority—the officers of the authority and the social services department and to sort out the problem. I also offered to arrange a meeting with my hon. Friend the Minister if it was thought that that would help to find a quick solution to the problem.
I heard no more until 8 October, when the chief executive of Hillingdon hospital wrote a letter to general medical practitioners in the north of the borough—areas such as Ruislip, Eastcote, Northwood, Harefield and elsewhere on the borders of the north of the borough—advising them that elderly patients over 75 years old should be referred to the most appropriate local hospital, Mount Vernon.
There is great concern in Ruislip and Northwood at the moment because many elderly people do not like the prospect of being referred to Watford general hospital, which principally admits accident and emergency patients, because they feel that Watford is a long way from Northwood and is not easy for people to visit. There is considerable pressure when a patient cannot be admitted to Mount Vernon to send that patient to Hillingdon, to which, of course, the doctors have to respond.
The letter sent by the chief executive of Hillingdon health authority to doctors was leaked to The Guardian and resulted in the highly misleading headlines that I have mentioned and the subsequent alarm that spread throughout my constituency. I have been assured by my hon. Friend the Minister that Hillingdon hospital was not seeking to discriminate on the basis of age but wished to ensure that all patients received safe and effective NHS treatment in the most appropriate location in accordance with their clinical need.
In a programme of public information designed to correct the misleading information that had been given, Hillingdon hospital went to very considerable lengths to reassure the public whom it serves by means of an advertorial in the local press, which appeared for two consecutive weeks. I welcome that initiative, which I hope will go a long way towards dispelling any remaining doubts that elderly people might have about their right to treatment in hospital when they need it, at any time, irrespective of age.
As I have said, I undertook to raise the matter of more community care with the acting director of social services of the borough of Hillingdon and to find out what could be done to place patients in the council's homes and independent homes as quickly as possible. I have done that. The acting director tells me that Hillingdon council has 330 beds in eight homes; in addition, it currently funds 219 permanent residential and nursing placements, has 172 permanent complex home care packages and approximately 100 short-stay residential nursing home care packages. About 70 permanent residential or nursing home care packages are to be made available between the beginning of this month and 31 March next year.
The current community care budget for the elderly is £5 million. and the council intends to allocate another £1.3 million to its community care budget next April. 1339 I put on record the accommodation that is available, because it was suggested to me that one of the problems facing Hillingdon hospital in discharging elderly patients into the community was Hillingdon social services' slowness to take some patients. Following my discussions with the acting director of social services only today, I am assured that Social Services will take all necessary steps to speed up admissions and to increase the availability of beds.
I am glad to report that, as a result of all that activity, Hillingdon health authority has taken immediate action to reduce significantly the number of Hillingdon residents—56 at the end of September—waiting in hospitals solely for residential and nursing home placement. It will use six of the 12 care beds that it currently funds at Hayes Cottage nursing home, will agree with Hillingdon council how it can assist with the temporary funding of 30 additional nursing and residential home places at a cost of £90,000 this year, and will continue to work with the council to ensure the effective use of all the in-house residential beds and services that provide care in the community.
For 1997–98, there will be further costs to be met by the council, which will be expected to accept the responsibility for funding. I understand that Hillingdon council estimates that it will have to provide £100,000 to fund 30 beds. It is expected that those proposals will allow 30 people currently waiting for a nursing or residential home to be placed by Christmas.
Another six beds are to be made available immediately at Mount Vernon hospital by reopening beds in existing medical wards, which will make possible about 18 additional admissions a month. There will be joint monitoring to ensure the effective implementation of the health authority's short and medium-term plans.
I greatly welcome the fact that it has been agreed that the chief executives of the health authority and of the two trusts and the director of social services will in future meet on a fortnightly basis to keep the situation under review.
Taken over two years, the proposals will represent a cost to the health authority of £283,000 and will better enable the two local hospitals safely to meet this winter's demand for emergency admissions. That point was raised by the chairman of the Hillingdon medical committee, and I hope that he and his colleagues will be reassured that all the necessary steps have been taken.
As president of the Abbeyfield Society, I declare an interest in asking my hon. Friend the Minister why better use cannot be made of Abbeyfield places to provide additional beds for people being discharged from hospital. I tabled some parliamentary questions on that topic that were answered by my hon. Friend's Department as long ago as July, and I was advised that the elderly people who were in Abbeyfield homes before a certain date were protected there but that, for some reason that I cannot quite follow, they could not go into Abbeyfield places after that date.
It is extraordinary that we are in such a situation when a national charity that is well represented locally has some extra places and could take additional patients discharged from hospital. I hope that my hon. Friend the Minister will be kind enough to look into the matter and find 1340 whether further steps can be taken to fund places in Abbeyfield homes for patients who are discharged from hospital.
In passing, because it is too good an opportunity to miss, I mention that the Uxbridge Abbeyfield Society has acquired a site in the Greenway, Uxbridge on which it could build a home for about 35 elderly people to live in very good conditions. It is unable to build the home because it cannot get its bid high enough up in the local authority's bidding list, because the local authority has responsibility for families with children, who come ahead of the elderly in budgetary terms and in bidding generally. I hope my hon. Friend the Minister will consider that matter, because Uxbridge cannot be alone; there must be other towns and cities where people have voluntarily raised considerable sums to buy land and which are ready to build but are unable to do so because of the way in which the system works.
Finally, 36 extra beds have been provided in the borough of Hillingdon. The pressure on Hillingdon hospital has been relieved. The problem has been solved. The headlines in The Guardian and other papers were unjustified. I hope that my elderly constituents and those of my hon. Friends—my hon. Friend the Member for Harrow, West is in his place tonight—will be greatly reassured. I look forward to hearing my hon. Friend the Minister because I hope that he will be able to give further assurance on these matters.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Horam)I am pleased to have the opportunity to respond to my hon. Friend the Member for Uxbridge (Sir M. Shersby). I congratulate him on securing a debate on the important topic of care for the elderly in Hillingdon and on the part that he has played in explaining some of the issues more sensibly than would otherwise have been the case. I know that he speaks on behalf of several colleagues, including my hon. Friend the Member for Harrow, West (Mr. Hughes).
He is also to be congratulated on securing a debate on health care 50 years to the day after Royal Assent to the Act that established the national health service. We shall see in considering health care in Hillingdon that the founding principles of the NHS are very much alive and well there as they are throughout the country.
It is a pity that the letter written by the chief executive of Hillingdon hospital has been taken out of context and used to generate unnecessary concern about hospital care for local elderly residents. I will put the letter into its proper context later, but first I want to make it absolutely clear—this is the most important point for my hon. Friend's constituents—that there was no question at any time of any Hillingdon resident of whatever age not getting from the NHS the care and treatment demanded by that resident's clinical condition. The health authority and local hospital trusts acted promptly to reassure local people of that.
Hillingdon hospital made it clear that it would under no circumstances decline to treat any patient, elderly or otherwise, and that no patient requiring emergency treatment would be turned away from accident and emergency untreated. Those reassurances have been fulfilled. In the four weeks since the chief executive's letter, no patient has been disadvantaged, and everyone who has needed a bed at Hillingdon has got one.
1341 Before discussing the Hillingdon situation in more detail, I should like to reassure the House on the treatment of elderly people generally. It is not and never has been Government policy for NHS treatment to be withheld from anyone on the ground of age. We have always made it clear that, whatever the age of a patient, there are no exceptions to the fundamental principle that the NHS is there to provide services for everybody on the basis of clinical need.
Let me turn to the recent circumstances at Hillingdon. The letter from the chief executive was not a panic measure in the face of a crisis but one part of a complex issue that local health and social services agencies had been working on constructively for some time. As my hon. Friend knows, two excellent hospitals serve Hillingdon residents: Mount Vernon hospital to the north, and Hillingdon hospital to the south. They are run by Mount Vernon and Watford Hospitals NHS trust, and Hillingdon Hospital NHS trust respectively.
Both are extremely good hospitals with good reputations and devoted and caring staff. More particularly, both hospitals provide comprehensive and excellent services for elderly people. The record speaks for itself. Hillingdon hospital provided 34,800 ordinary and day case treatments in 1995–96, and Mount Vernon provided 61,295 treatments—in both cases, some 4 per cent. more than in the previous year. That is a considerable tribute to the doctors, nurses and other staff at both hospitals. Both trusts have been in discussion with Hillingdon health authority about how services can best be provided to meet the needs of residents.
Back in the spring, Hillingdon hospital became concerned about the pressure on beds at the hospital. It already had an acclaimed bed management system which enabled it to use the 630 beds that it has as efficiently as possible. The reasons for the pressure appeared to be twofold. First, the hospital was seeing an increasing number of patients, particularly elderly patients, requiring hospital admission. Secondly, elderly patients were staying in hospital for longer.
The hospital explained its concerns to the health authority and the social services department and in June a working party was set up to examine the issues. Immediate action was also taken, including the provision of additional social work posts in the hospital to ensure prompt assessments of patients' continuing care needs and to assist in the hospital discharge process. Since then, hospital discharge has been kept under close review, and early last month the social services department made additional facilities available to take elderly patients discharged from hospital by re-opening 10 places in a refurbished residential care home, and by the approval of seven extra nursing home places.
It is clearly in everyone's interest to ensure that GPs refer patients to the most appropriate local hospital. It appeared, however, as my hon. Friend says, that in a few situations GPs in the vicinity of Mount Vernon hospital were referring elderly patients to Hillingdon hospital although Mount Vernon was the closest local hospital and could provide the service required.
This was the background to the Hillingdon hospital chief executive's letter to GPs of 3 October. It did not seek to deny treatment to anyone; rather it sought to 1342 ensure that patients were treated in the most suitable NHS hospital, and the one most conveniently situated for the patients themselves. The intention behind the letter was to ensure that NHS resources were used to best effect, for the benefit of all patients, whether young or old and wherever they lived in the Hillingdon borough.
When it became clear that the letter had generated anxiety, albeit misplaced, among the elderly of Hillingdon, the hospital promptly explained that under no circumstances did this mean that patients would be turned away. Mount Vernon and Watford Hospital NHS trust also acted to reassure residents, pointing out that, since the merger of Mount Vernon and Watford General hospitals under single trust management, the trust now guarantees admission for the elderly patients of local GPs and has some 90 beds for the elderly across the two sites.
I have already mentioned the working party set up in June to examine the pressures on Hillingdon hospital and to develop an action plan to address these concerns. The working party consisted of representatives from the two hospital trusts, Hillingdon health authority, social services, and Age Concern. The group was tasked with producing an action plan for the health authority meeting of 31 October. I stress that local co-operation between local agencies—health agencies, social services and the voluntary organisations—is essential. I am pleased to say that the group's action plan was duly prepared and endorsed at the health authority meeting last Thursday.
The action plan provides immediately 30 additional places in the community, including six in the independently run Hayes cottage hospital. Those 30 places include the 17 that I mentioned earlier. It also provides six new medical beds at Mount Vernon hospital to provide enhanced services to GPs' patients in the north of the borough. These steps should relieve the pressure on Hillingdon hospital now and into the future.
The health authority has also agreed in principle to provide further investment next year to support hospital discharge procedures at Hillingdon hospital, and to look at innovative approaches to patient care as an alternative to hospital admissions. All parties will be looking to improve working practices to ensure the timely discharge of patients from both trusts.
I should of course also point out that this action is complementary to the plans that Hillingdon and all other health authorities have prepared with trusts during the summer to ensure that the service is best placed to respond to any surges in emergency demand in the coming winter.
My hon. Friend also made the point that the problems in Hillingdon were not due to a lack of funds. That is true. I can tell him that the total personal social services resources available to Hillingdon stand at almost £35 million a year, 8.5 per cent. more in cash terms than last year and more than double the resources available six years ago.
Hillingdon health authority has more resources than ever before. Its revenue allocation for this year is £106.4 million, £3.3 million more in cash terms and more than £500,000 more in real terms than it was the previous year. I therefore agree with my hon. Friend that it is not a problem of lack of resources locally.
1343 My hon. Friend also spoke about Abbeyfield homes. That serious issue needs to be investigated, and I undertake to reflect upon it and correspond with him about it.
As my hon. Friend was pleased to note, Hillingdon hospital is now reporting that although it is busy, the pressure on beds has eased, and it is managing its work 1344 load satisfactorily. My hon. Friend will also be pleased to note, as I am, that the founding principle of the national health service to provide health care to all, on the basis of need, regardless of ability to pay, is alive and well in Hillingdon, as it is throughout the country on this day, the 50th anniversary of the Act that established the NHS.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-five minutes past Ten o'clock.