HC Deb 22 July 1997 vol 298 cc861-8

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

10.12 pm
Mr. John Burnett (Torridge and West Devon)

It became clear some months ago that the North and East Devon health authority was looking for savings. It predicted overspending of about £2 million this year—slightly below 1 per cent. of its annual expenditure—and further overspending for the year 1998–99. My aims today are to highlight the unfairness of the formula for apportioning public money between health authorities and to expose the decision temporarily to close Winsford hospital, pending a review, for what it is: precipitate, ill considered and illogical.

In the days of the rate support grant, it was said that only three people knew the formula by which it was arrived at: one was dead, the second was insane and the third was joining the second. I dare say that the formula for apportioning cash between health authorities is equally arcane and complex. Nevertheless, I am led to believe that it discriminates unfairly against rural areas in several ways.

The formula does not take account of the distance and time involved in delivering health services in rural areas. A district nurse, midwife or doctor working in a rural part of Britain can hope to treat only a fraction of the number of patients that his or her urban counterpart can treat. I understand that no allowance is made for that in the formula.

Matters such as car ownership are used as a measure of affluence. In rural areas, ownership of a car is not a luxury but a necessity because of the paucity—often the non-existence—of public transport. One must have a car or go nowhere. Many poor people who live in the country have to make considerable sacrifices to own and run old cars to get them to the shops, the post office or the doctor. Such issues are often referred to as the sparsity factor. I hope that the Government will consider the formula, and consider including a sparsity factor to ensure a more equitable distribution of funds between health authorities.

I described the temporary closure of Winsford hospital, pending a review, as precipitate, ill considered and illogical. I have known Winsford hospital for many years and visited it many times. It is a 15-bed hospital in the countryside, near the large village of Halwill Junction, which is designated for significant growth in the emerging local plan. The small town of Holsworthy is more than 10 miles away, and the North Devon district hospital at Barnstaple is 35 miles away. Winsford is in the centre of a large geographical area and although the population that it serves in scattered, it comprises many thousands more people than the health authority suggests.

The lack of consultation by the health authority and other procedural failures leading to the closure decision are the subject of judicial review proceedings. The decision stunned the local community because the health authority tried to close Winsford four years ago. In January 1994, Dr J. M. Dodds published her report on the hospital. I should like to draw the House's attention to some of her conclusions. She said: More than half the patients whose care I studied had in addition to their V60 admissions a significant number of acute hospital admissions. She added: I am aware of the general high quality of the acute medicine practised throughout the hospital. She continued: I was impressed by the integrated social and medical services offered to the thirteen rural parishes that Winsford serves. I could quote many other parts of the report to make Winsford's case. It was an objective report commissioned by North and East Devon health authority and the Northern Devon Healthcare NHS Trust. Dr. Dodds rightly paid tribute to the dedicated and skilled staff at the hospital.

My hon. Friend the Member for North Devon (Mr. Harvey) and I discussed the closures at Winsford and Lynton—which is in my hon. Friend's constituency—with the Secretary of State. Neither my hon. Friend nor I could understand the health authority's logic. The authority said that there would be no redundancies; yet more than 80 per cent. of the costs in the NHS are salaries. The figures given to the Secretary of State—presumably by the health authority or the trust—are flawed at best and misleading at worst. They predict savings on salaries at Winsford of £189,000; yet we were told in the report that there would be no redundancies. Winsford has an 80 per cent. occupancy rate, but nothing in the figures indicates who will bear the cost of treating those patients elsewhere. What do they propose to do with them?

There are many poor and neglected people in the countryside who need and deserve medical care within a reasonable distance of their homes. The roads in the Winsford area are poor and, as I have explained, there is little public transport. The Prime Minister went out of his way at his first Question Time, in reply to his hon. Friend the Member for Pendle (Mr. Prentice), to highlight the inadequacies of public transport—particularly, he said, in rural communities. The closure of their hospital will only add to the disadvantage and neglect suffered by some of the least well-off and most vulnerable people in Britain. For many, Winsford is a lifeline and it is immensely important for that isolated community.

I believe that the health authority and the trust consider that a temporary closure, pending a review, is the easy way to close the hospital permanently. They believe that closing Winsford is a soft option. Winsford costs a total of £395,000 per year to run, according to the health authority's own figures, and that includes all the employees' salaries. That represents one third of 1 per cent. of the annual budget of the North and East Devon health authority—a small sum to provide some 10,000 people in that rural community with the health support that they require and deserve. I hope that the Government will prevail upon the health authority to abandon its plan to close the hospital.

10.22 pm
Mr. Nick Harvey (North Devon)

I congratulate my hon. Friend the Member for Torridge and West Devon (Mr. Burnett) on securing the debate to discuss this important issue and on the eloquence with which he has made his case, which is formidable. He is right on three counts.

First, it is urgent that the new Government look at the basis on which health authorities are given their funds. My hon. Friend the Member for Torridge and West Devon has rightly drawn a comparison with the basis on which local authorities are given their funds. There is a clear cost implication of running health services across large, scattered and rural populations, every bit as much as there is a cost implication of running local authority services in such communities. One needs more staff to cover the same population, as well as more car journeys and more person hours to provide the same level of service.

Any formula seeking to allocate funding to authorities should not take funding away from rural communities and divert it to wealthy urban and suburban communities, but should recognise that—aside from London weighting allowance—we should be putting money into rural communities, not taking it away. It is essential that, as a matter of urgency, there is a review of health authority funding, just as it is absolutely urgent that there should be a review of local authority funding.

The second point to which my hon. Friend referred with great eloquence was the essential nature of those services to the communities which they serve. We have been impressed by the speed and determination with which the new Secretary of State for Health has intervened to prevent the closure of London hospitals, which he did not think was warranted or justified. He has acted decisively. The small communities around Lynton and Lynmouth and those near my hon. Friend's community of Winsford depend on those small cottage hospitals every bit as much as the communities in the large urban areas depend on the more famous London hospitals which the Secretary of State has now prevented from closing. I urge the new health team on the Treasury Bench to recognise the strength of feeling in those communities.

For example, Lynton and Lynmouth are more than 20 miles from the nearest hospital. As many hon. Members who have chosen to visit that picturesque area will know, the casualty service at Lynton is called upon greatly during the summer months when the population is swollen a good deal. I am extremely worried that the closure of Lynton hospital on 15 August will occur eight weeks before the Lynton and Lynmouth season is over. It is also most unfortunate that the closure comes on the anniversary of two events—first, the opening of the hospital 100 years ago and, secondly, the Lynton flood of 1952. It is macabre timing indeed to choose that particular date.

The third point that I wish take up from my hon. Friend's speech is the sheer illogicality of what has been proposed. The health authority is pretending that with the temporary closure of the hospitals for half a year one can make savings worth half the annual running costs. That is absolute nonsense. The staff will be kept on and paid to work elsewhere; the health authority will also pay for treatments to be carried out in other places; and it will pay to keep the buildings heated, lit, insured and maintained because other services will be provided within them. It is therefore nonsense to suggest that savings can be made. My hon. Friend is absolutely right to refer to the sheer illogicality of the proposal and the haste with which it has been proposed.

In common with my hon. Friend, I urge the new health team to act in the same decisive manner as has been shown towards the glamorous London hospitals and to recognise that, for the communities involved, those two small cottage hospitals are every bit as important.

10.26 pm
The Minister of State, Department of Health (Mr. Alan Milburn)

I am pleased to have the opportunity to respond to the debate. I congratulate the hon. Member for Torridge and West Devon (Mr. Burnett) on securing the debate and the terms in which he addressed the important issues. I also congratulate his hon. Friend the Member for North Devon (Mr. Harvey). I know that they met my right hon. Friend the Secretary of State for Health recently and expressed to him some of their concerns. I am also aware of correspondence between them and my right hon. Friend subsequent to that meeting.

At the outset, I acknowledge the hon. Members' concern about rural hospitals and the important role they play in their communities and in the wider health service. It is important, however, that all hon. Members should get the position straight.

We have an extremely challenging legacy as a consequence of the situation that the Government and, more importantly, the NHS and local communities now face. In particular, we have a challenging financial legacy. The hon. Members will be well aware that the local health authority is on the front line in terms of meeting some of those challenges. It is fair to say that those problems are more deep-seated than we and, I suspect, the health authorities had anticipated.

We know that the NHS is under considerable pressure this year. As Liberal Democrat Members will appreciate, we have taken decisive action to agree with the health service that the immediate pressing priority, particularly as we approach the winter months, is to respond effectively and efficiently to emergency pressures. We must also secure a more stable financial environment in the future. Hon Members will be aware that my right hon. Friend the Chancellor has announced a substantial level of investment in the NHS for the next financial year.

All health authorities and trusts have been asked by the NHS executive to balance their budgets this year. I freely acknowledge that that will require considerable effort, but there is a straightforward choice facing the House and the national health service: either we take difficult decisions now, or we defer difficult decisions, but difficult decisions there will be. They will not go away, and no amount of wishful thinking and magic-wand waving will make them go away. They are here, and we have to tackle them.

Mr. Burnett

The point I tried to make was that, on a cold, calculating analysis of this year's figures, we do not believe that there will be anything like the savings that the Secretary of State is being misled into believing there could be. We invite him to scrutinise those figures again, because we believe that they are at best misleading, and at worst fallacious.

Mr. Milburn

I am willing to accept the hon. Gentleman's concerns at face value, and I am happy to receive representations from either him or his hon. Friend the Member for North Devon disputing the jointly agreed health authority and trust figures. If he wants to make further representations in the light of information sent to my right hon. Friend the Secretary of State, I shall gladly examine those representations.

As I said, a considerable effort will be required to balance budgets this year. As the hon. Gentleman is aware, North and East Devon health authority faces a difficult financial situation in that it has a recurrent deficit of £2.2 million, which is clearly an untenable and unviable position to take into the next financial year.

The authority is now engaged on a three-phase review of services. The range of proposals announced on 4 June, which includes the temporary closure of Lynton and Winsford hospitals, is designed to save some £6 million by the turn of the century. At the same time, I have been assured that a full range of services to patients will continue to be available locally, although the means of their delivery may inevitably change.

I am aware of concerns about that, and, in particular, of the substantial concerns expressed here this evening and in the community about the way in which decisions regarding the temporary closure have been taken, so, in preparation for this debate, I inquired closely into the background of this rather unusual decision.

Wherever possible, decisions that pre-empt a full-blown health authority consultation on reconfiguration plans should be avoided. I am informed, however, that the health authority felt obliged to close temporarily both Winsford and Lynton hospitals in order to meet its statutory obligation to remain within its financial allocations. Clearly that is a decision and a set of circumstances that everyone involved—including the health authority and the trust—would have preferred to avoid. As I said earlier, the health authority and the trust are at the sharp end of the legacy I described.

The health authority and the trust are not alone—the situation is not unique and very difficult decisions have to be made—but, for the benefit of Opposition Members, I repeat that decisions have to be taken sooner or later. I do not want health authorities, trusts and the national health service to enter the next financial year with the sort of deficit problems with which they entered this financial year.

Opposition Members may smirk, as they are doing, but every pound that health authorities are in debt at the beginning of a financial year is a pound less to invest in front-line patient services. I want public money to go into front-line patient services so that patients in all parts of the country get the services they need and deserve.

Mr. Harvey

The Chancellor in his Budget, and Ministers since, have made much of the additional funding that is going into the NHS next year. Would it not get us out of the position that these two hospitals and many others must find themselves in, if just a small amount of debt were allowed to be carried forward into next year, which we are told will be so much more benignly funded than previous years have been? As my hon. Friend the Member for Torridge and West Devon (Mr. Burnett) said, the sums involved are tiny. If it were allowed to carry just that much forward into next year when the bounty arrives, we need not suffer the pain and anguish of this temporary closure now.

Mr. Milburn

I know that Liberal Democrat Members are always tempted to try to defer decisions, but the present Government believe in taking decisions—that is what government is all about.

I return to the substantive issue that the hon. Members for Torridge and West Devon and for North Devon addressed. Decisions on the long-term future of services in Winsford and Lynton will be taken by the health authority in consultation with the local community later this financial year, following completion of a review of the health and social care needs. I should like to reassure both hon. Members that any proposals for permanent service changes will be subject to full public consultation.

I give both hon. Members a further assurance: that I will ask the south-west regional office of the national health service executive to monitor that consultation exercise very carefully indeed, and especially to ensure that it embraces and engages with all of the key stakeholders in the community, to ensure that the right decision is ultimately reached.

That is important because small cottage hospitals inspire a great deal of affection and attachment in the community. As hon. Members are aware, traditionally the role of the rural cottage hospital has been to provide basic cost-effective care, generally for an elderly population, in an environment that is close to their homes and where there is easy access for relatives and friends to visit.

However, as I am sure all hon. Members are aware, the pattern of health service demand has altered radically during the past few years. Change is endemic in the national health service, and change will continue. I believe that, overwhelmingly, most changes in the NHS will be positive changes that will benefit patients.

That is not to say that local community hospitals closely linked to primary care services will not have an important role to play in future; they will. However, decisions must be taken in the context of the resources available to the local health service.

The hon. Member for Torridge and West Devon made some important points about the resource allocation system. As he knows, health authorities are responsible for the expenditure of significant amounts of public money. I do not know whether I am one of the dead or the insane, being in the Chamber at this time of night, but the national formula for the allocation of resources to health authorities distributes resources on the basis of the relative needs of local populations, and takes account of several key factors. Those include the age structure of the local population, the additional health needs of that population and the unavoidable local variations in cost that occur in the delivery of local health services.

I can tell the hon. Member for Torridge and West Devon—and in so doing respond to the concerns and promptings of the hon. Member for North Devon—that the weighted capitation formula is being kept under review, and we shall continue to look at the way in which resources are distributed throughout secondary and primary care, to ensure that their allocation fully reflects the needs of local people and operates as fairly as possible.

The hon. Member for Torridge and West Devon will be interested to know that work has been commissioned to investigate the possible extra costs associated with the provision of accident and emergency and ambulance services in rural areas. A report is expected in the autumn, and the results will be carefully considered. I hope that that helps to provide some reassurance to hon. Members who represent important rural communities.

The review of how resources are allocated notwithstanding, priorities in the NHS have to be established. Whereas clinicians will always have the lead role in deciding the care and treatment of patients, it is health authorities that must decide on the right investments for differing population groups in different areas. In doing so, they will seek and pay heed to any advice that clinicians and other stakeholders can give.

Health authorities assess the health care needs of their resident populations, draw up strategies and purchasing plans in collaboration with local people and other interested organisations, and secure a range of primary, acute and community health services which will best satisfy those needs.

The challenge facing health authorities in Devon is how best to get the right mixture: how to provide as comprehensive a range of services as possible for their local populations within the resources at their disposal. I hope that the hon. Member for Torridge and West Devon will agree with me that rural hospitals are an important element in the NHS, but that they are also just one element of a comprehensive range of services available throughout the country.

I hope that the hon. Gentleman will further agree that the staff of small hospitals and other hospitals in rural areas, in collaboration with family doctors, community and district nurses, and the larger, more specialised hospitals, together provide and integrated service which offers the community a continuing excellent standard of care.

Unfortunately, when closure plans are in operation, attention inevitably centres on the many difficult decisions that the NHS is having to take. It is always important, therefore, to remind ourselves that most patients and staff take the view that the NHS is something of which to be proud. It is the envy of the world; I want to make sure that it continues to be the envy of the world. To that end, NHS care must be available on the basis of clinical need to all patients who need it. Above all, every part of the country must have access to one standard of NHS services of the highest possible achievable quality.

Question put and agreed to.

Adjourned accordingly at nineteen minutes to Eleven o'clock.