§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Robert Ainsworth.]
§ 10 pm
§ Mr. Richard Livsey (Brecon and Radnorshire)It is my privilege to introduce this Adjournment debate. I am grateful to be given the time to look at the future of community hospitals in Powys.
This debate focuses on Powys. In the past 10 years, it has lost its health authority, its ambulance service and its fire service, and now there is the final nail in the coffin: a proposal for Powys to lose its health care trust. That is totally unacceptable to the people of Powys.
Powys occupies a quarter of Wales. The people of Powys believe that the fact that it has 10 community hospitals and 18 general practitioner practices within its boundaries gives it a comprehensive service in the NHS. I advise the House to remember that Powys is 130 miles in length. If one visited all 10 community hospitals, one could clock up in excess of 300 miles in a car.
Powys is a vast, sparsely populated area. The only other area with which it can be compared for sparsity is the highlands of Scotland. There is only one town in Powys—Newtown—with a population in excess of 10,000 people. Half the population live in the countryside. Those facts dictate why there is no district general hospital in Powys.
The strategy of the present Powys Health Care NHS trust and its predecessors has been to develop a successful network of community hospitals. Those hospitals now carry out about 40 per cent. of all patient operations, mainly through GPs. They provide a superb service and, because of that, attract intense loyalty from people in local communities.
Each hospital has an active league of friends: two in my constituency have raised £500,000 and £750,000 respectively in the past 10 years for capital projects to expand their hospital services. Local communities feel that they have ownership of those hospitals, and rightly so. That is demonstrated by the creation of Powys Action for Patients, which represents GPs, community health councils, nurses and communities in Powys in the fight to maintain our NHS trust in Powys.
I am sure that the Minister will remember recently opening Ystradgynlais community hospital's celebration of 50 years of the NHS a week ago last Saturday. I was there in the afternoon later on, and I know that he enjoyed himself. The hospital is the pride of local people. It is an excellent example of a modern community hospital.
Acute services in Powys are provided by 12 district general hospitals outside the county, with patients going to the nearest DGH. Services are delivered from many contrasting points—for example, Shrewsbury in the north-east and Swansea in the south-west. Only 8 per cent. of Powys patients travel to the district general hospital at Aberystwyth, while 92 per cent. are treated elsewhere. Patient referral patterns are widespread indeed. Frequently, patients have to travel 45 miles by ambulance—a 90-mile round trip—to get to a district general hospital. That happened to my hon. Friend the Member for Montgomeryshire (Mr. Öpik) when he had his recent accident.
673 Mental health care is delivered from within Powys by the current Powys national health service trust. Mental health services are not, for example, delivered within Ceredigion, but accessed via the Pembrokeshire and Derwen NHS trust, outside that new county.
A major paradox in the planning of health care is provided by the present state of community hospitals. At a time when their value is increasingly recognised by central planners in the Department of Health and the national health service executive, there are more threats to their role and existence than at any time in the past 50 years of the existence of the NHS. Thirty five out of the 350 community hospitals in England and Wales are under threat of closure. By contrast, in Scotland, the status of the 70 similar hospitals is relatively protected by the Scottish Office.
All threats are on financial rather than clinical grounds, as less conscientious authorities and trusts attempt to balance their budgets by withdrawing services. In no case that has been critically appraised will savings ultimately result, as the cost of re-provision of services at a distance from the community is invariably higher, and issues of quality, including access in time and place, are habitually ignored. The tensions inherent in sharing a limited health care budget are responsible for that.
The view that community hospitals are expensive to run and under-utilised, which is frequently aired by detractors who want to devote increased resources to district, general or regional hospitals, must be questioned. The demands for high-tech care of all forms, with inevitable centralisation of services, must be met on the clear understanding that that represents only a minority of in-patient care, and that it is a mistake to admit any patient to a level of hospital care that is higher than necessary. Indeed, one can envisage a situation in which in Powys, with its 12 adjacent DGHs, telemedicine might come into its own and more patients could be treated in community hospitals in the future.
Why does the Welsh Office want to reorganise health care in Powys? Why sideline the Welsh assembly before it has a chance to contribute to the debate? We are told that the status quo is not a runner, but Powys rejected the model of a combined single district general hospital and community hospital service 10 years ago. The adopted strategy, rightly, was to develop the network of community hospitals and upgrade the services available, which made a great deal of sense with such a sparse population—it was the most appropriate type of development.
The proposal for amalgamation with Ceredigion in the reconfiguration exercise is intended to save money, not to save lives. It is driven by Welsh Office civil servants and by managers in the Dyfed Powys health authority, who want solutions that are just that much too neat. Clearly, Mr. Peter Gregory, the senior health civil servant in the Welsh Office and Mr. Peter Stansbie, the chief executive of Dyfed Powys health authority, have their own agenda of imposing models of health care that are totally inappropriate for the extreme rurality of Powys. The outcome will be patient disadvantage. Rural Wales does not lend itself to the DGH-type model, which is too simplistic and far too expensive for our area. The existence of 10 community hospitals in Powys proves that. Hospital beds in those community hospitals cost £115 per night, compared with £250 in a DGH.
674 The Under-Secretary of State, the hon. Member for Bridgend (Mr. Griffiths), has told us that he wants to reduce the number of quangos. I understand that, but why does he not abolish the health authorities in Wales and have only one? That would save a lot of money—£4.5 million per annum by axing Dyfed Powys health authority for a start.
The people of Powys were outraged when they realised that the Powys and Ceredigion project team had a budget of £40,000 to promote the proposed amalgamation. That is taxpayers' money, whereas Powys Action for Patients has had to collect £15,000 of Powys people's own money to fight against the amalgamation with Ceredigion. Even the proposed name of the amalgamated trust—Canolbarth Cymru—will not be understood in many parts of Powys, which I regret: for example, only 2 per cent. of the population of Radnorshire speak and understand Welsh.
The experiment was put in motion because of the cumulative deficit compounded by the Ceredigion trust, which amounted to more than £1 million. The cumulative deficit in Powys was originally only about £50,000. The health authority financial projections in the document "Effective Care and Healthy People" showed that, if the two trusts were run separately, the annual deficit for Ceredigion would be £1.23 million in 2003, whereas that for Powys would be £420,000, which would be written off in six years. The plan to force Powys to amalgamate with Ceredigion would result in a total mismatch of functions. Moreover, the finances would not add up.
Conditions in rural areas are not conducive to such a model. There is no duplication of services and no competition between services—certainly not between Bronglais district general hospital and our 10 community hospitals. A city dogma is being applied to the countryside. The Welsh Office has a mindset that the urban model of health care applies to the whole of Wales, no matter how rural an area. Conditions in the M4 corridor and the valleys are very different from those in rural Powys.
The Welsh Office estimates that annual management savings from each trust merger will be £500,000 a year and that the cost of the merger will be equivalent to approximately two years' savings, or £1 million per merger. Those figures are a bit too convenient and need to be challenged. In the first draft of its merger document, the Ceredigion-Powys project board estimated a reorganisation cost of £2.79 million. Lo and behold, in the final draft, after Welsh Office persuasion, that figure had been massaged down to £1.2 million, so as to fit in with two years of savings at £500,000 a year.
We believe that those figures have been cooked. They are all guesstimates which have been plucked from the air. What about redundancy costs, for example? I know someone whom it would cost £300,000 to make redundant, but many others would attract redundancy costs. In Powys, redundancy costs alone could be more than £1 million. Those costs apply across Wales, where the trusts are of wildly different sizes and natures. It is projected that the 26 trusts will be reduced to 15. Does the Minister really believe that he will save £10 million by that exercise? I think not.
675 The costs of integrating IT systems between Dyfed and Powys would be enormous—two completely different computer systems would have to be married. Imagine the costs of employing one IT consultant to straighten that out. Studies in the USA have shown that savings from health mergers are usually only a seventh of what was estimated, so if the reorganisation costs £2.79 million and the savings are only £70,000 per annum, the new trust will be in for a shock and services will need to be reduced. We should also take into account the massive deficit that it is estimated the new merged trust would have.
The major reasons for opposing a trust merger in a rural area are that it would do no good and save no money—it would not solve any problems; indeed, it would bring its own. All that we need is a reorganisation and more local management. Health care in Powys would improve far more if the Minister said—as I am sure he did in Ystradgynlais—how proud he was of our community hospitals. A merger will not solve the problems of Bronglais hospital. I have a great deal of sympathy with the situation in Ceredigion, where I lived for 14 years—my youngest son was born in Bronglais hospital and I have many friends there. However, the two trusts do not match up.
All the pointers are that, if the merger goes ahead, at least three community hospitals in Powys will have to close. That is clearly shown in the Dyfed Powys health authority document "Effective Care and Healthy People", published this spring.
The document says that groups of hospitals are viable, but does not say which ones will close. Brecon is twinned with Bronglais, and Welshpool with Newton and Llanidloes, suggesting that some will have to close. We believe that that is a disaster course and that the situation in Powys is, indeed, perilous. We stand to lose an enormous amount.
A merger of the Powys and Ceredigion trusts is a mismatch of serious proportions. Transitional costs are likely to be high, the district general hospital model is not appropriate and Powys delivers mental health services, which Ceredigion does not.
§ Mr. Lembit Öpik (Montgomeryshire)Does my hon. Friend agree that the people of Powys are united against any prospect of a merger and that hospitals such as Llanidloes, which helped to save my life, are under a serious threat that has not been democratically sanctnioned?
§ Mr. LivseyIndeed, I agree completely. The merger is opposed by all GPs in Powys—that is, all the 151 British Medical Association members; all the consultants who treat Powys patients; Powys county council, which wants to co-operate further with the NHS through social services; both community health councils, in Montgomery and in Brecon and Radnor; both Members of Parliament; all nurses; and all trade union members in the NHS in Powys.
The Minister has a straight choice: allow the community hospitals in Powys to collapse, or use this opportunity—I hope that we are convincing him tonight—to build a superb NHS service, based on primary care and 676 locality groups. That would be the ideal clinical model for Powys, the most remote and sparsely populated area in England and Wales.
§ The Parliamentary Under-Secretary of State for Wales (Mr. Win Griffiths)I congratulate the hon. Member for Brecon and Radnorshire (Mr. Livsey) on securing this debate. I thank him for giving me the opportunity to consider some of the issues that he has raised.
Community hospitals have for 100 years or so played an important role in all our communities. Over the years, their place in the national health service and their relationship to the larger and more specialised district general hospitals have fluctuated, but there is now a wide acceptance that such hospitals, and other related local facilities, can provide an important complementary range of services.
Traditionally, the care provided in community hospitals is intermediate between care at home and that requiring specialist resources in large acute hospitals. They relieve pressure on acute hospitals by admitting and treating patients who otherwise would have to be admitted to general hospitals, by allowing the early discharge for rehabilitation and recovery of patients not yet ready for home care, and by providing respite and rehabilitation in a planned way.
Within that broad understanding of the services that may be appropriate in community settings, a number are particularly important: out-patient clinics with specialist clinicians, to avoid patients having to travel long distances; in-patient beds with care provided by local doctors, specialist doctors and nurses; minor injury services provided by local general practitioners with access to a wider range of facilities and support services than are available in surgeries; and, in some places, maternity services provided by local doctors and midwives.
In all those services, a balance needs to be struck between the convenience, practicality and efficiency of having them available locally, and the economy and clinical security of concentrating them in larger centres.
Community hospitals can also act as a resource and a focus for wider health activity in the area. The hon. Member rightly praised the work of hospital leagues of friends, which can coalesce around a hospital and help to improve not only the hospital service but the community spirit of an area. Community hospitals can provide a base for out-of-hours GP services; be the home of community mental health and learning disability teams; be a base for the provision of therapy services and community dental health services; and the list goes on impressively.
It is for health authorities, working with NHS trusts, local primary care professionals, local government and other interested local agencies and groups to decide what range of facilities is appropriate locally, and how they should be run. Yes, I very much enjoyed my visit to the Ystradgynlais community hospital and I am impressed by the service provided there. I have not forgotten that the hon. Gentleman is concerned about the provision in Powys and the need for a range of facilities and services that reflect its particular character. Community hospitals and other related health facilities have a distinctive role to play, but we need to make sure, too, that they reflect 677 healthcare provision for the 21st century, are in the right places, are the right size, and provide the right range of health and other services.
Dyfed Powys health authority is responsible for assessing the health needs of the people of Powys and, in consultation with its partner agencies and local people, for planning and commissioning services to meet the needs of the people in Powys. In future, much of that responsibility will pass to the Powys local health group, which is being introduced following the publication of the White Paper "Putting Patients First", with the Dyfed Powys health authority providing a strategic overview and ensuring that services are matched to need and available resources, and reflect best clinical and operational practice.
Yes, it is true that, under the trust reconfiguration, the Powys healthcare trust may disappear, but Powys will gain a local health group which will have a far greater say in the provision of services in Powys than has ever happened before. It is important to bear that in mind. There will be far greater local management. Local GPs, the local Powys county council, local voluntary groups connected with the health service and other primary health-care professionals will make the decisions about commissioning healthcare in Powys. They will decide where the community hospitals will be.
Let us make it absolutely clear right now: there is nothing in the trust reconfiguration process which will affect the services provided by community hospitals in Powys.
§ Mr. LivseyI understand what the Minister says. Our proposals, which are new proposals for Powys with a primary care, clinically led trust, are similar to his. The main thing is that the authority covers the whole of Powys, has a budget, and can make decisions strategically. The damage of taking that away will cause the closure of our community hospitals.
§ Mr. GriffithsIt will not, because the local health group, starting as a sub-committee of the health authority, will nevertheless have its own budget and be able to make its own commissioning decisions. That needs to be made absolutely clear. A problem with this debate is that people think that the new NHS trusts will be exactly the same as the old ones. They will be quite different.
I turn now to the Dyfed Powys plan for making recovery from the deficit which exists within the Dyfed Powys area. That is both a health authority and an NHS trust responsibility. Today, there was a meeting at which the partners with the Welsh Office agreed on a way forward and on measures to achieve a break-even point.
There was a stab at the strategy outlined in "Effective Care and Healthy People", but it was rejected by people in Dyfed Powys. In the light of those comments, the Dyfed Powys health authority revised its strategy. A new document is now available. It commits the health authority to a joint review with the Powys NHS trust of community hospitals in Powys. It is important that this review goes ahead quickly, is robust, and reaches conclusions which will allow services in Dyfed Powys to be developed in ways that will stand the test of time.
My Department has taken a close interest in the authority's planning. I met the former chair of the health authority last month to discuss the position. My officials 678 held meetings today, and I am sure that between us we will tackle the problem successfully. However, I cannot comment on particular aspects of the Dyfed Powys strategy, because, if there are disputes to be resolved within Dyfed Powys, they will come to the Welsh Office, to my right hon. Friend the Secretary of State, for decision.
However, I am absolutely confident that the community hospitals in Powys are more likely to be strengthened by the reconfiguration of the trust, because it will make more money available directly for patient care, and the local health group in Powys—the doctors, the primary care professionals, the local voluntary groups, local government and Powys county council—will be at the heart of the decision-making and commissioning. The new NHS will give Powys a far better deal than it has ever had before.
§ Mr. ÖpikIs the Minister aware that, for all the promises of extra money made for health in Wales this week, unless he resists what we regard as a potentially expedient bringing together of Powys with Ceredigion, that extra money is not worth the promises made in the Chamber? Within that, will he reaffirm the promise made by the Secretary of State for Wales when he was the shadow Secretary of State, that he would resist the closure of any community hospitals if that was proposed in Powys?
§ Mr. GriffithsI make it quite clear that this year already we have provided about £140 million extra for the health service in Wales. Dyfed Powys health authority has £3 million of the £20 million to tackle the waiting list problem. We are investing more money in the health service in Wales.
Yes, we recognise that not sufficient was invested in the past, and that there are some historical problems to be dealt with. But my right hon. Friend the Chancellor's public expenditure announcement gives us another £175 million next year on top of what we had this year, the following year the accumulated extra will be £345 million, and in the third year the accumulated extra will be £510 million. All told, during the three years, more than £1 billion extra will go into the health service. Dyfed Powys health authority and the Powys local health group will get their fair share of that money to develop services within the area.
It is clear that the Dyfed Powys health authority strategy will enable community hospitals to prosper where they provide an effective local service. From what I know of the Powys area, most fall into that category. I am sure that the local doctors, the primary care professionals, who want to strengthen the role of community hospitals, will be given the capacity to do so by the local health groups. There is no problem there. As we provide more money for the health service, more money will go to Dyfed Powys.
§ Mr. ÖpikI am sorry to press the Minister on this point, but will he give us an assurance that he will honour the pre-election promise by the then shadow Secretary of State for Wales, now the Secretary of State, that he would resist the closure of community hospitals if they were proposed in Powys?
§ Mr. GriffithsThat is impossible, because in Dyfed Powys, the closure of Tenby cottage hospital has already been agreed with the community. The facilities available in Tenby will be provided in another way in the town. I understand that everyone is happy for that to happen. If the hon. Gentleman is saying that the Secretary of State should have stepped in and told people in Tenby that that hospital could not be closed because of a promise made before the election, that is ludicrous.
Let us get down to the serious issue of ensuring that we provide a high-quality health service throughout Wales. That has nothing to do with what the head of the Welsh Office health division or the chief executive of the Dyfed Powys health authority wants; it is all about what the Labour party promised before the election. It said then that it would rationalise the trusts in Wales to save money. The hon. Member for Brecon and Radnorshire mentioned £10 million, but in fact it will be between £7 million and £10 million. I would not plump on £10 million exactly, but more than £7 million of savings will go directly into patient care, and will help to keep hospitals open in the Dyfed Powys area.
680 I also want to make it explicit that doctors in Powys will be able to send their patients to the appropriate district general hospitals outside their area where they consider that their patients can attain the best treatment. That is critical, because doctors will have far more say than they ever had before. I am sorry that the hon. Member for Brecon and Radnorshire has not taken up the offer made by the chair of the local project group for the trust reconfiguration to meet Powys Action for Patients.
§ Mr. LivseyI intend to do that, but it has not been possible to do so yet.
§ Mr. GriffithsI am pleased that that will happen, because I know that so far she has heard nothing.
On behalf of the Welsh Office, I give an absolute commitment that community hospitals which provide an effective service in Dyfed Powys will continue to do so, and that the trust reconfiguration exercise will make that more rather than less likely.
§ The motion having been made at Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at half-past Ten o'clock.