HC Deb 03 June 1998 vol 313 cc341-8 1.30 pm
Dr. Evan Harris (Oxford, West and Abingdon)

I am delighted to open a timely debate on the crisis—that is not too strong a word—that affects our health service. Community hospitals are particularly under threat, and not only hospitals but community beds. Abingdon community hospital in my constituency, and the hospitals at Burford, in the constituency of the hon. Member for Witney (Mr. Woodward), at Wantage, in the constituency of the hon. Member for Wantage (Mr. Jackson), and at Watlington, in the constituency of the right hon. Member for Henley (Mr. Heseltine), are all at risk. Although none of those right hon. and hon. Members is present, I know that they feel strongly about the potential closures of those hospitals.

The closures faced by the people of Oxfordshire are caused by chronic underfunding of the health service and the acute financial crisis facing the health service this year, both of which are particular problems for Oxfordshire. It would be a false economy—bad not only for patients, but for financial reasons—to close community hospital beds in the way proposed. I plead with the Minister to intervene, even at this stage, because community hospital beds are threatened throughout the country. I ask him to ensure that extra money allocated this year is used not only to provide adequate community services for patients, but to avoid false economies and thereby to release cash for the health service.

The overall funding problem in the NHS has been well stated by the Liberal Democrats over the years. The NHS is chronically underfunded, to the tune of several billion pounds. Government leaks to the press confirm that sort of figure. The Daily Telegraph this morning says that the Department of Health will put in a megabid to the Treasury of around £8 billion. I do not know whether the Government will confirm that figure, but the British Medical Association and others who work in the field recognise that the NHS is chronically underfunded to around that sum.

On top of that, the health service, where the staff have to work hard just to keep it afloat, needs real-terms increases of about 3 per cent. a year to cope with NHS inflation, over and above retail price index rises. The Conservative Government wasted money on bureaucracy and the internal market, but they still managed to average 3.1 per cent. over their period in office, although it came in fits and starts. By adopting Conservative spending plans, the new Government have, sadly, managed real-terms spending increases of only 2.2 per cent. in the NHS budget for England in 1997–98 and 1998–99. That is not sufficient to keep the NHS going without cuts in services. We have seen the pressure on waiting lists. It is not so obvious in community hospitals, where there is no obvious proxy such as waiting list numbers or waiting times, but the pressure is there. It is also on mental health services.

It is fair to say that the Labour manifesto promised a real-terms increase of only 0.1 per cent. or less. However, the Government have revised that upwards, and have claimed that Labour is the only party able to revise its pledges upwards. They have done that not by allocating new money, but by using money initially allocated in other areas, such as the Department of Trade and Industry's underspend in 1997–98 for the £270 million allocated for winter pressures, and £1.2 billion from the Treasury reserve for this year. That is not new money. It is hard to believe that only a Labour Chancellor would spend that money from the reserve on the health service, while a Liberal Democrat or Conservative Chancellor would merely burn it on a bonfire.

An increase of only 2.2 per cent. is not enough to prevent pressures on waiting lists and other services. At the general election, I made it clear to the people of Oxfordshire, who were already worried about their community hospitals, that the Liberal Democrats would match existing resources, including the reserve and underspends, and, in addition, would give £550 million per year in new money raised by increasing tax revenues.

The extra money from the Government is based on old inflation figures, not the new figures that they found when they took office. In real terms, the money allocated in 1997–98 and—without including the allocation from the reserve, which all parties would have made—for 1998£99 is less than the Conservatives planned. More important, it is less than health authority finance bosses figured would come from a Government elected on the platform that there were "14 days to save the NHS" and "things can only get better". On community hospitals, and on waiting lists, things have only got worse.

It is important to nail the myth that the Government have offered more money than the Liberal Democrats promised at the election. They have offered significantly less. It is embarrassing for the Government that the money for community hospital services and other NHS services is less even than the amount that the Conservatives planned to spend in real terms.

Health authorities such as Oxfordshire face a bill for millennium compliance, for which there is no separate funding allocation. They face initiatives, on pain of sanction, to reduce waiting lists. They face those things with a level of overall increased funding—including the new £500 million announced this year, which is still less than 3 per cent. more in real terms—that is likely to increase waiting times.

Oxfordshire is particularly badly affected, as it is significantly below its target funding. It got a little more than the average allocation, but that was nowhere near the 3 per cent. minimum increase required. All trusts in Oxfordshire are in recovery plan mode, except the community hospital trust, which still faces cuts. As all the trusts face cuts, the health authority cannot be accused of picking on the community hospital trust. It is seeking even bigger cuts from the bigger budgets of the area's acute trusts.

It is hard to say what makes me and the people of Oxford, West and Abingdon more angry. Is it the raised expectations that were dashed after the Government said that "things can only get better"? Is it the stance of Conservative Members, who blame the Government for underfunding the NHS although the Government are merely adopting Conservative spending plans?

Is it premature for the health authority to agree a three-year or four-year funding cut, including closure of community hospitals and community hospital beds, at a time when the new structure of the health authority will, at least in the medium term, move such decisions to primary care groups? They are keen to be given a chance to take a view on whether those cuts should happen, or whether, when they get the budget in one or two years, time, another way can be found to make the savings that the Government are forcing on them.

Given that Oxfordshire's problems result from the Government's underfunding of the health service, and given that cuts must be made, there is a question of whether those are the most appropriate cuts. They will affect local services that are delivered to people near their homes. Oxfordshire has rural areas, in my constituency and in that of the hon. Member for Witney, who is now here, in which transport is difficult. The requirement for community hospital beds to be locally available to people and to their general practitioners is vital to better care. The community hospitals uniquely offer what I have called—in a separate debate on community care with the Under-Secretary of State for Health—the three Rs of NHS community care.

The first is rehabilitation, which allows, for patients who need it, enough time for active physiotherapy before they are discharged to home care. Instead, too often, they are discharged to a nursing home or residential home care because there is no time for the active rehabilitation that would enable them to return to their homes. Most patients would rather be at home and, in many cases, although not all, that provides a cheaper package of care for the local social services, particularly if the patients do not have their own funding.

The second of the three Rs is recuperation. It is vital that patients are given a chance to recuperate from operations or acute emergency admissions—perhaps for serious illnesses such as pneumonia—in their own time. If they are rushed back into the community, an extra work load is placed on community services, which are already underfunded. When patients are discharged from acute hospitals too early and a community hospital is not available to help them recover in their own time, the work load falls on social services. Alternatively—this is just as bad—the acute hospital cannot discharge the patient because of the lack of services available to pick up the care. That causes an increase in delayed discharges, which are already high in Oxfordshire. A lack of recuperation beds is not only bad for patients: it is financially bad.

Mr. Shaun Woodward (Witney)

Is my hon. Friend aware that, in my constituency, we have three community hospitals? The first, at Burford, certainly faces closure under Oxfordshire health authority's plan. The second faces a 25 per cent. cut in the number of beds and the third faces further cuts. Thus, all three hospitals face either closure or dramatic cuts in beds. In the light of what my hon. Friend has been saying, does he feel that savings could be made by reducing the huge number of trusts in Oxfordshire to free up funds that would prevent dramatic cuts, not only in my constituency but in his and others in Oxfordshire?

Dr. Harris

I thank the hon. Gentleman for his intervention. I remind him that I am his hon. Friend only in that I seek to preserve community services. Given the Conservative funding that undermined the health service before the current cuts, I could not describe myself as his friend.

I accept the hon. Gentleman's point that his constituency hospitals are particularly badly hit, although the scale of the underfunding in Oxfordshire is such that even radical trust mergers would not release sufficient management savings to provide the necessary funding to preserve those hospitals. That approach could be considered, however, as Oxfordshire has too many trusts. The Liberal Democrats have never opposed trust mergers. We feel that the issue of losing separate trust status is far less important than the loss of services.

The third R that community hospitals provide for local patients is respite care. If community beds are cut, patients will have less opportunity for respite care. That could mean extra admissions to acute hospitals when patients and their carers cannot cope at home for long periods. General practitioners use community hospitals as an alternative to acute hospital admission. The Government have considered it useful to fund that with their "winter pressures" money, with hospital-at-home schemes as an alternative to admission. I would argue that community hospitals are large-scale hospital-at-home schemes and are an alternative to expensive or inappropriate acute hospital admission.

Social services in Oxfordshire are badly affected by Government spending cuts. They have not benefited from a release from the reserve or from special money. I remind the Minister that the total social services standard spending assessment has, according to House of Commons Library figures, been cut by 1.4 per cent. in real terms in 1997–98 and by 1.1 per cent. in real terms in 1998–99, even before demographic pressures are taken into account.

Social services are simply unable to take up the extra work load that will be put on them as a result of hospital closures and reductions in community hospital beds. Therefore, I fear that the biggest work load will fall on acute hospitals. As has been predicted not only by me but by Lord Walton of Detchant, a local resident of Oxfordshire and an acknowledged expert on those matters, there will be a massive increase in delayed discharges and in admissions to hospital of people who could otherwise be managed at home or in a community hospital.

That makes no financial sense, because it is twice as expensive to keep people in acute hospital beds than it is to look after them in community hospital beds. It is certainly more expensive to the state to send patients without their own funding to a social services-funded nursing home than it would be, in the long term, to give them the rehabilitation that they may need in a community hospital.

As the matter is still out to consultation, I understand that the Minister will not be able to give his view, or even his likely view, on his decision on the proposal to close those community hospitals and beds. However, does he consider it reasonable for the local health authority and the NHS regional office to look carefully at whether the extra £65 million announced nationally, specifically for community and mental health services out of the extra £500 million announced for the NHS this year could be used profitably as a cash-releasing measure to avoid the false economy of increasing the number of delayed discharges? If he looks, as I suspect that he will have to in due course when the measure comes before him, at the consultation document issued by the health authority, he will notice that that question is not even addressed.

The question of whether the number of delayed discharges and admissions of patients who would otherwise be treated in community hospitals would increase was glossed over in the section on the effects on other acute trusts. Already, we read in the local newspapers today and yesterday that the Oxford Radcliffe hospital trust must close wards because it cannot provide enough staff to keep them open. Will it not result in double trouble for the Government's waiting list initiative if wards are closed to new admissions not only because of staff shortages but because of delayed discharges?

There is a good case for allocating the money given to the Oxford and Anglia region not on a weighted capitation allocation basis—that would be an unthinking way of proceeding—but as a cash-releasing measure to provide the resources that Oxfordshire needs to expand its services so that local people begin to see improvements. The Oxfordshire social services settlement suffered not only from an overall real-terms cut in the past two years, despite increased demography, but from a savage cut of 10 per cent. in its SSA for elderly residential care because of formula changes.

No reasonable explanation has been given to Oxfordshire county council why the Labour Government think that it suddenly costs 10 per cent. less to keep elderly people in residential accommodation. It is also hard to understand how local social services, which interlink crucially with community hospitals, can be rescued from such a huge cut in their resources.

Oxfordshire has suffered particularly badly under the Government's spending plans, which owe much to those that they adopted—unnecessarily, the Liberal Democrats believe—after the last election. There is therefore a strong case for providing the limited extra money that the Government allocated to Oxford and Anglia regional health authority to Oxfordshire health authority specifically to avoid cuts in community hospitals and in mental health services in Oxfordshire. Otherwise, those cuts will be bad, not only for the finances of the health authority, but for patients across Oxfordshire.

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

I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on securing this debate. This is an important issue, as community hospitals can be a valuable part of the local health service in many parts of the country. I know that there are real concerns not just in the hon. Gentleman's constituency but in the constituency of the hon. Member for Witney (Mr. Woodward) about the health authority's proposals.

I should say at the outset that there is no single national blueprint for the configuration of services that will suit all localities. As I am sure the hon. Gentleman recognises, all localities are different and, in some cases, community hospitals may not be the best way of delivering local services. It is the job of health authorities and NHS trusts to ensure that local services are matched to local need.

The hon. Gentleman knows perfectly well the Government's position on the future of Oxfordshire's community hospitals. If a local community health council objects to the health authority's proposals, the matters will be referred to Ministers. Until then, we must remain impartial about any future decision.

The public consultation on the proposals to reshape community services in the county began on 4 April. Public meetings have now been held in all 11 towns that have community hospitals. I understand that the health authority has circulated more than 5,000 consultation documents and 10,000 summary documents. I urge all hon. Members and members of the public who are concerned about the issue to submit their views to the health authority. The whole point of having a consultation is for the health authority to ascertain the views of local people and interested parties. I can tell the hon. Members for Oxford, West and Abingdon and for Witney that, if the issue is referred to Ministers, we shall listen carefully to what they and local people have to say.

Two options are being considered by the health authority and the NHS trust. Both options would mean that the 12-bed hospital at Bicester would be replaced by a new 30-bed hospital and a new minor injuries unit would be developed for Witney. To achieve that, the first option would involve closing Burford and Watlington hospitals and reducing the number of beds at five of the other community hospitals. The second option would also involve closing Burford hospital, and the wards and day hospital at Wallingford, and reducing the number of beds at four of the other community hospitals. Under that proposal, a new day hospital would be developed at Didcot, and there would be an increase in beds at Watlington. The health authority claims that, with both options, the aim is to reduce bed numbers in areas where there is relatively generous provision and to increase bed numbers where there is a greater need.

Again, it would be inappropriate for me to comment further on the pros and cons of the options while the consultation is still going on.

Mr. Woodward

The Minister said that both options include the proposal to close Burford hospital. It may help him to know that the hospital has an average annual occupancy of over 90 per cent. If Burford were to close, the nearest available community hospital would be at Witney, which has 61 beds. It is proposed to close about 25 per cent. of the beds at Witney. When I was there a few weeks ago, there was only one empty bed, and the hospital's average occupancy was also over 90 per cent. As the acute hospital, John Radcliffe, has spent many months of this year on red alert, not only will be there be no community bed provision, but there will be no acute bed provision. That makes nonsense of the NHS White Paper's support for local provision, because there will be no provision for such patients in west Oxfordshire.

Mr. Milburn

All I can say to the hon. Gentleman is that, if the health authority's proposals come to Ministers, they will of course be judged in the context of the White Paper. However, I understand that the health authority claims that the proposals, which are fully supported by the community health trust, aim to tackle fairness of access to services. Our White Paper clearly states that there should be an end to unfairness and that high standards should be available to all patients. I expect that the hon. Members for Witney and for Oxford, West and Abingdon would support that principle. I understand that, even without any financial pressures, the health authority and the NHS trust believe that change would have to be made to ensure a fairer distribution of health care in the county.

The health authority has stated that there are considerably more community hospital beds for people aged over 65 in the south and west of the county than in the north. Clearly, those are difficult issues, which will need to be considered carefully. As I said, they will be considered within the policy context of our White Paper, "The New NHS". There is no doubt that community hospitals will be part of our vision for the NHS. As the hon. Member for Oxford, West and Abingdon rightly said, nobody benefits if people are admitted to hospital unnecessarily or are kept in acute hospitals longer than necessary. Waiting lists get longer and hospital services become stretched to the limit.

Much work is being done to provide imaginative alternatives to traditional rehabilitation and recuperation services which meet patients' needs. However, we need to ensure that access to such services is dependent not on where patients live but on meeting their needs. Again, if proposals come to Ministers, we shall judge them in the context of that principle.

We currently do not have enough evidence to stipulate whether intermediate care should be provided through community hospitals or in the patient's home. There is a need for better evaluation as models of care develop. In particular, the health authority will need to consider how community hospitals best fit in with acute hospitals and other community facilities to ensure the best balance of emergency, planned and rehabilitation care.

Dr. Peter Brand (Isle of Wight)

The Minister has highlighted the national importance of having a policy for community hospitals. Would it not would be a great shame if the hospitals that he has mentioned—which I visited recently—were to close and the opportunity to use the set-up in Oxfordshire as a national pilot for a more integrated health service were lost?

Mr. Milburn

As I said, first, there is no uniform community hospital and, secondly, local needs vary according to local circumstances. That is why the health authority and the NHS trusts concerned must be clear about the relationship between community hospitals, acute care, primary care and other NHS services. That is for the health authority to determine following consultation. There is no single national blueprint. If we tried to impose one, the national health service would not best meet local patients' needs, and we want to avoid that result at all costs.

No part of the national health service stands alone. Clinicians, other members of staff and, increasingly, patients have reached that understanding over the past few years. The NHS is an interconnected system. The hon. Member for Isle of Wight (Dr. Brand) is right, and we want more integrated forms of care in future so that patients who need access to hospital services, and, equally, to primary care, rehabilitation and social services, have a greater continuum of care than in the past. In some parts of the country, community hospitals will provide a vital role in providing that form of integrated care, but that is a matter for local determination.

That brings me—sadly, because the debate had been going well—to money. I say to the hon. Member for Oxford, West and Abingdon that the Liberal Democrats are playing a tired old record. Time and again, we hear fantasy figures conjured out of thin air. The facts are straightforward: the Government have allocated an extra £2,000 million to the national health service on top of the allocations planned by the previous Government. [HON. MEMBERS: "Hear, hear."] I am grateful for the support for that proposition from the Liberal Democrat Benches, where there is at last a glimmer of reality.

I remind the hon. Member for Oxford, West and Abingdon that it is important that all hon. Members remember what we promised the electorate at the general election. We promised real-terms increases in funding for the national health service, and we are delivering them. The Liberal Democrats promised increased investment of £540 million per annum. That was generous, but we have doubled that. Now the hon. Gentleman is crying crocodile tears and trying to leapfrog the Government's additional investment in the NHS.

I make it clear to the hon. Gentleman that we recognise that Oxfordshire has particular problems. That is why we have allocated an extra £2.8 million to help with the strategic changes taking place in the county. That is why more money was given to Oxfordshire to help with winter pressures than to any other county in the region. That is why, since we came to power on 1 May last year, we have allocated to the health service in the county £20 million more than the previous Government were planning. I hope that the hon. Gentleman will welcome that.

Dr. Harris

It is necessary to point out, for the record, that the cheers for the Minister's statement came from Labour Members—including the Chairman of the Select Committee on Health, the hon. Member for Wakefield (Mr. Hinchliffe)—sitting in Liberal Democrat seats, who are queueing for Gallery tickets. Clearly, the Liberal Democrats would spend more in real terms than the Government, and for the Government to ignore inflation is to ignore reality for patients in Oxfordshire.

Finally, does the Minister agree that it would not be unreasonable for the local NHS executive to make specific cash releasing allocations of extra money to prevent false economies?

Mr. Milburn

That is an extremely good point. As the hon. Gentleman is aware, £65 million was made available for the waiting list initiative and to improve primary, community, mental health and social services. I expect that the region will take account of local circumstances in determining how best to allocate that money for the maximum benefit of patients.

We all want a modern national health service. There is no doubt that community hospitals will have a role to play in some areas. If the matter comes before Ministers, I can assure the hon. Gentleman—

It being 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.