§ Mr. Peter Ainsworth (East Surrey)
I am grateful for the opportunity to bring before the House a matter that has, for some years, been the subject of grave and almost continuous concern to the people of Oxted and the surrounding area. In doing so, I am acutely aware that I am touching on issues that have divided and continue to divide the local community, health care professionals and the district council.
Let me say at once that I have not come here today with a ready-made solution to the various problems, nor am I here to carry the flag for any particular group or faction. However, I should like to thank the many people who have taken the trouble to keep me informed of developments: the health authority; the community health council; the trust; the GPs in Oxted and elsewhere; Mr. Josh Cosnett of the Save Oxted Hospital action group, who has tirelessly advanced the cause supported by many petitions; Mr. Graeme Waller; Councillor Gordon Keymer; the Rev. Guy Bennett; and others to whom the future of this vital local resource is paramount.
I make no apology for having no tailor-made remedy of my own. I have brought the matter to the House today to enable the Minister, who has more cause than most to realise that being in government is not all fun, to set out clearly and unequivocally his position and that of the Government, so that we can achieve a rapid and satisfactory outcome to a set of problems that have persisted for too long.
Let me start with a statement on which, I hope, all can agree. Oxted and Limpsfield (War Memorial) hospital, although originally sited elsewhere, was opened in its present position in 1939, and building work was completed shortly after the second world war. It was funded by public appeal. The hospital has thus served the community of Oxted and the surrounding area for nearly 60 years, providing both out-patient services and in-patient care. Not surprisingly, it has come to be regarded as a jewel in the Oxted crown. My own family has had cause to use the out-patient services, and many friends have passed through its doors or stayed overnight through the years.
The sad modern history of the hospital began about five years ago, when East Surrey Healthcare NHS trust announced that the building was in a poor—indeed, terminal—state of repair. I know that some people dispute that, but most accept it as a working proposition. A suggestion that the hospital should close and its services be relocated to the nearest accident and emergency hospital in Redhill gave rise to public outcry.
In the face of that, the trust was forced to reconsider. It came forward with a hospital redevelopment proposal, using the existing site and an adjacent one and providing 20 NHS beds. That was to be funded partly by the NHS and partly by the development of housing on the hospital grounds. That appeared to be good news, but that is the point at which trouble started and things began to go badly wrong.
After months of preparation and NHS expenses running to hundreds of thousands of pounds, the local authority, Tandridge district council, first insisted that the new housing should include additional affordable homes, 332 and then refused planning consent on grounds of excessive density. To that frankly perverse act, we owe much of the trouble that has ensued.
Various attempts were made to recast the proposals in a form acceptable to the local authority, but they came to nothing. There was even a march through the streets of Oxted—the only march I have attended in my constituency, and possibly the only one that has ever taken place there—under the banner "Save Oxted Hospital". It is ironic that the march was also attended by several councillors who had actively participated in the demise of the original redevelopment scheme.
In March 1997, the health authority issued a consultation paper, which, after minor alteration, formed the basis of a proposal published in June 1997. It envisaged the building of a new out-patient hospital on the existing site to include therapies and an X-ray unit; and 10 NHS beds would be provided in a private nursing home. The proposal was rejected by the CHC on a number of grounds, not least that it envisaged a reduction in the number of beds from 20 to 10. Although there is disagreement in the community about where the beds should be located, there is a strong feeling that halving the number of local beds is not acceptable. The 20 beds currently available are in great demand, for both geriatric and recuperative care.
Despite the CHC's objection, on 9 September the Minister wrote to me announcing his decision to close the hospital, and to endorse the health authority's proposal. Thus, Oxted joined the list of 25 war memorial hospitals currently threatened with closure. I understand that that is to be the subject of a mass lobby next week, and recently the issue was eloquently raised in the House by my hon. Friend the Member for North Norfolk (Mr. Prior).
The Minister added two provisos in his letter: first, that the 10 beds being removed from Oxted could realistically be provided in East Surrey hospital; and, secondly, that a suitable private sector partner could be found for the proposed nursing home development. The Minister will be aware that, earlier on, a possible private nursing home partner had dropped out. A deadline was set for March 1998, which was later extended, at the CHC's request, to May, primarily to accommodate discussions with a potential private sector benefactor. The second deadline has now passed: no new private sector nursing home provider has appeared, and continued bed blocking in East Surrey hospital casts doubt over whether the extra demand for beds there can be met.
Meanwhile, there have been several developments that are important to the context in which the struggle to maintain a hospital in Oxted is taking place. In no particular order, they are as follows. The East Surrey Healthcare NHS trust has merged with the Crawley Horsham NHS trust; the consequences of the merger are still being absorbed, and a new chief executive has been appointed to manage the combined trust. A new chairman will shortly take up position in the health authority.
A primary care group is being set up to embrace a huge area, from Limpsfield in the east to Reigate in the west. That is giving rise to extra bureaucracy, and it means that any decision affecting provision in Oxted must now be seen explicitly in the light of its implications for other parts of the area—for example, it is obviously important that developments at Oxted do not entail no developments in Horley.
333 In addition, to no one's surprise, we are told that the financial position of the health authority has deteriorated since March 1997, which is clearly unhelpful; and that the merged East Surrey and Crawley trust has a deficit of £4 million, which is hardly a propitious context in which to be considering a major investment in Oxted. I understand that that might no longer be a problem, as the latest news is that responsibility for community health care in the Oxted area is to be transferred to a trust in Croydon. However, I am told that that trust, too, has recently suffered a cut in funding. While all that turmoil is going on, nothing has been achieved to address the problems in Oxted, where, understandably, staff recruitment has become more difficult, and general frustration has mounted.
I should be grateful if the Minister could clarify certain specific questions. First—I realise that this is something of a fast ball, so perhaps he can write to me—is it true that the financial model used by the health authority to date to assess the cost of providing beds at Oxted assumes that the running costs will be the same as those in the hi-tech accident and emergency hospital at Redhill? If so, is it not rather unusual, and does the Minister believe that it is appropriate?
Secondly, does the Minister accept the view of local GPs and others, that a minimum of 20 beds is required to meet the current and growing future need of people in the locality? Thirdly, how do matters now stand between the NHS and the local private benefactor, who has reportedly promised a substantial sum towards the provision and maintenance of extra beds in Oxted? What is the Government's position on other offers of private funding from the local community for rebuilding the hospital?
Fourthly, what progress has been made towards satisfying the two provisos set out in the hon. Gentleman's letter of 9 September? Fifthly, what will happen if those cannot be met, given that the chief executive of the health authority is reported to have said on 9 March:We can no longer fund the current level of services in Oxted"?Sixthly, what will happen if the district council blocks the sale of the land necessary for the building of the nursing home? What powers have the Government to get their way, assuming that there is no change in direction? As I understand it, the district authority at present intends to block the sale of that land.
Mrs. Marlow of South Thames national health service executive has written that the Minister now regards the matter as one of local interest. I ask him not to wash his hands of the issue, but to work to ensure a successful outcome, based on the Secretary of State's words:I have made it clear that we would like to promote community hospitals because we want people throughout the country…to be able to turn to an efficient, effective, high-quality health service that is close to home."—[Official Report, 27 January 1998; Vol. 305, c. 142.]The Minister's actions over Oxted and Limpsfield war memorial hospital will be a test of that commitment.
Bearing in mind the story on the front page of The Times today, which tells us that a children's ward in Greater Manchester has been reprieved from closure on the eve of a visit from the Secretary of State, would the hon. Gentleman extend to his right hon. Friend a cordial invitation to visit Oxted hospital at his earliest convenience?
§ The Minister of State, Department of Health (Mr. Alan Milburn)
It is always a pleasure to reply to the hon. Member for East Surrey (Mr. Ainsworth), on this and other issues. As he said, I get to deal with many fun issues in the House, but this is not one of them. It is a serious matter, which is of concern to him and his constituents.
As the hon. Gentleman rightly said, community hospitals are a valued part of the national health service in many parts of the country. Patients often value them because they tend to deliver services in a friendly and homely way, which makes change extremely difficult. Change is not peculiar to this Government, or to the previous Government; it is endemic in the national health service, and it affects community hospitals just as it affects other parts of the service.
The hon. Gentleman is a strong supporter of Oxted and Limpsfield community hospital in his constituency, and I understand his concerns, which have also been expressed to me by local people and organisations. He will recall that I met representatives of the East Surrey community health council and the Save Oxted Hospital action group some months ago. Perhaps it would be useful if I recount how we got to the present position, and where things stand in trying to answer the hon. Gentleman's six questions.
In the first place, changes were necessary in the area, because, as the hon. Gentleman rightly said, health needs were changing, and it is broadly agreed that the hospital is in a poor state of repair. The local health authority has a responsibility to ensure that it makes the best use of the public money that it receives. It decided that it would be more cost-effective and appropriate to modern health care facilities to consider a new building in Oxted, rather than upgrading the present building.
As the hon. Gentleman knows, the proposal was to provide out-patients, minor injuries, X-ray, diagnostic and physiotherapy services in a brand new NHS facility. Changes would also be made to the number of beds available—acute beds would be transferred to East Surrey hospital, and beds available for the less acutely ill would be purchased from a private nursing home and managed by local general practitioners.
As the hon. Gentleman said, following East Surrey community health council's objections to the health authority's recommendations following consultation, I considered those proposals late last year, bearing in mind all that had been said locally. When I made my decision to approve the proposals by East Surrey health authority for the re-provision of Oxted hospital, I did so on two firm conditions, and I expect those conditions to be fulfilled in full. The first was that a viable private sector nursing home partner could be found; the second that adequate provision should be made at East Surrey hospital in Redhill to absorb the likely number of elderly patients being admitted there from the Oxted area.
I asked for an implementation plan from East Surrey health authority, and I subsequently extended the deadline for the production of that plan by two months, to the end of May, to enable further local discussions to take place. The appearance on the scene of a potential local benefactor might be a help, but it has certainly also been a hindrance in delaying the implementation of the overall plan.
335 I made my decision because the proposals will provide modern, high-quality health care for people living in south Tandridge. There would be flexibility, with local GPs managing the beds; and acutely ill elderly people, who need consultant care in the best possible modern setting, would have a full range of back-up facilities available, which might not always be available in that sort of setting.
With regard to the private sector partner, I understand that a number of expressions of interest have been received from nursing home providers by Surrey and Sussex Healthcare NHS trust, which are subject to further discussion, and those debates continue. To build a new nursing home on the existing hospital site, a land swap will be necessary, so that the existing hospital can stay open until the new facilities are ready. I understand that discussions are taking place with Tandridge district council about the land swap.
Alternatively, the existing hospital could be closed and demolished, and a nursing home built on the existing site. If that option were chosen, I understand that the health authority would purchase beds from existing nursing homes in the Oxted area, which would be used until the new nursing home was available on the Barnett Shaw site. I will say in a moment what I expect Tandridge district council to do to be helpful.
As the hon. Gentleman knows, at present GPs have access to six beds in Oxted hospital. As a result of local concerns expressed during the consultation exercise, the health authority helpfully increased its planned re-provision from six to 10 beds, giving the GPs an increase in access to local services. I hope that he also thinks that helpful. The use of a nursing home, which is likely to have around 40 beds in total, is designed to give maximum flexibility to accommodate local needs. Therefore, 10 GP beds in the nursing home is the minimum guaranteed future commitment. If the local primary care group can arrange treatment and care differently for its patients, it may be able to care for more patients in the new facilities in Oxted, subject, of course, to other demands, such as emergencies.
On the condition concerning capacity at East Surrey hospital—another important matter that the hon. Gentleman raised, and about which I am concerned—the regional office of the NHS executive is closely monitoring the plans by the Surrey and Sussex Healthcare NHS trust for the reconfiguration of services at the acute hospitals at Crawley and Redhill. The plans will now need to take full account of changes to service levels at Oxted and access for patients in their areas. Once finalised, those plans will be subject to full consultation.
Two further issues warrant a mention. First, the re-provision is being planned at the same time as a new, modern, primary health centre is being developed in Oxted. That will provide high-quality primary care facilities for patients in the centre of the town, and will complement the hospital re-provision. The GPs in the town will have access to a range of new, high-quality primary, community and nursing home facilities, all of them readily accessible to the local population. As the local practices develop into a primary care group, they will be able to have more say in the way in which those facilities are used for their patients. Frankly, it will be for 336 GPs to take those decisions, not bureaucrats sitting in health authority offices; I hope that the hon. Gentleman welcomes that sort of development.
There will be more flexibility for patients to be supported in their own homes, with the back-up of local, low-tech beds, and barriers between health and social care will be overcome, which is crucial, particularly to deal with the complex problems that many elderly patients often face. They require the support not merely of NHS services, but of social and housing services. The new primary care groups and the facilities that are being provided in the area will all help to that end. The availability of nursing home beds in Oxted will support primary care, and will therefore be an important element in the development of services for local people.
Secondly, since making my decision at the end of last year, a possible benefactor has emerged to provide a donation towards the re-provision of services, as the hon. Gentleman said. That was discussed locally, but initially no consensus could be reached on what form alternatives might take—the health authority listened carefully to the benefactor's views, but declined the offer. Since then, the health authority and representatives of the benefactor have had further discussions to establish whether a donation could be used to augment the proposed NHS in-patient provision.
Irrespective of whether charitable funding is available, the hon. Gentleman should be reassured that the people of Oxted will continue to have access to high-quality NHS-funded health care. I know that negotiations are progressing in, I hope, the spirit of co-operation that we are striving to encourage in the NHS. The best solution for people in the area is for local agreement to be reached about the future of their local services. I cannot say when the negotiations will finish, as I am not party to them.
The hon. Gentleman's first question concerned the financial background. I do not have the information with me, so I hope that, as he suggested, he will allow me to write to him on that. I know the concern that has been expressed locally, and I shall be happy to address that directly.
I hope that the hon. Gentleman is reassured by the fact that the implementation plan that is now in place will result in new in-patient, out-patient and therapy facilities, as well as a minor injuries service, being available in Oxted by the summer of 2001. The time scale and detail of the re-provision depend crucially, as he rightly said, on the planning decisions taken by Tandridge district council. The local authority will no doubt be mindful of the need for a rapid decision to allay the concerns of local people about the future of health services in the town, and I hope that it has listened to what both the hon. Gentleman and I have said today.
I have had a significant number of representations about the matter, and I stress that the final form of the re-provision—which depends on a number of factors that I have outlined; the hon. Gentleman knows the background to them—will be for local people and organisations to agree, albeit within the caveats that I set out in my approval of the plan. I shall not be revisiting my original decision, which I expect to be implemented in full.
337 I assure the hon. Gentleman that the South Thames regional office will be responsible for ensuring that the detail of the scheme accords with the terms of my approval of the Oxted and Limpsfield hospital re-provision scheme. The regional office is keeping a close eye on the matter, and I am sure that officials there will be helpful in answering any of his detailed concerns. If he has further difficulties, 338 I should be happy to deal with them personally, but I hope that I have been able to deal with the majority of the concerns that he has raised today.
§ It being before Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.