Community Hospitals (Hansard, 2 March 1998)

§ Sir Michael Spicer (West Worcestershire)
I am grateful for this opportunity to introduce a short debate on the very important subject of community hospitals. Community hospitals, as against local general district hospitals, have in recent years developed their own distinct role, ethos and dynamic. Linked to general practitioners' services and to other local health and social services, they provide a clear, specific and well-defined pattern of hospital services throughout the country. It is therefore all the more strange that their future should now be under threat.
There are 457 community hospitals in the United Kingdom, which provide approximately 10,000 beds—and several of my hon. Friends who are in the Chamber represent those hospitals. I am informed by the Association of Community Hospitals that 16 of those hospitals are now directly threatened with closure—as it happens, four of them are in Cornwall and four are in Norfolk—and that the continued existence of many others is under serious review.
Both the challenges and problems facing community hospitals are in no way specific to Worcestershire. However, there are reasons—not simply because I am the Member of Parliament for West Worcestershire—for using the case of the Worcestershire hospitals as an example of a more general problem.
Evesham hospital—which used to be in my constituency, but, following boundary changes, is now in the constituency of my hon. Friend the Member for Mid—Worcestershire (Mr. Luff), who has been most assiduous in espousing its cause—is one of half a dozen or so community hospitals listed as nationally recognised models of good practice. While in the marginal seat of Worcester during the general election campaign, the Prime Minister promised to speed up the building of a new acute Worcester infirmary, and so put into question the future existence of the satellite community hospitals, two of which—Pershore and Malvern—are in my constituency.
Although the health authority has recently announced that closure of the Worcestershire community hospitals is not an option, the strains on the funding of the county's hospital services has left question marks, and a good deal of scepticism surrounds the announcement. Any cutting back of the support services on which community hospitals depend, or of the number of beds and services provided by hospitals, will threaten the viability of hospitals, especially the smaller ones, such as Malvern and Pershore. It is in that context that I raise points about community hospitals in general.
Community hospitals exist essentially for two purposes: first, to allow patients to recover from traumatic surgery and medical treatment near their homes and local services, such as those provided by their GPs and physio and occupational therapy, as well as social services, in some cases; and secondly, to provide palliative care for the terminally ill. The ever-present context to all this is a rapidly aging population.
829 Alongside the need for community-based medical support have been the explosive financial requirements of the high-technology acute specialist hospitals. As life-saving medicine has become more advanced and successful, so in general it has become more expensive. The average bed cost per week in Worcestershire health authority is £2,500 to £3,000. The comparable figure for community hospitals is between £800 and £1,000—roughly a third of the acute hospital costs. Equivalent figures exist throughout the country.
These figures are, of course, non-comparable. High-technology medicine is bound to be much more expensive than recuperative nursing. The problem is that in-patient bed audits show that a large proportion of patients occupying beds in expensive specialist hospitals could easily be transferred more swiftly to the more appropriate community-based hospital.
A recent analysis in Worcestershire revealed that up to 42 per cent. of patients currently occupying an acute hospital bed could be nursed at an alternative health facility. In other words, if patients were sent back to community hospitals in Worcestershire more rapidly than they are at present following major surgery or medical treatment, there could be considerable savings. That is particularly germane in Worcestershire, where the hospital system is running a rapidly growing overdraft, currently standing at some £15 million, with a recurring deficit on present budgets of £8.8 million.
The case for the community hospital is only in part financial. The core philosophy and ethos is rightly different in community and acute hospitals. The acute hospital is primarily concerned with the saving of lives in a medical crisis. Rehabilitation and palliative care, especially for the elderly, are different roles altogether. They are best performed alongside local health and social services.
The danger, and the reason for the debate, is that, in the nature of things, community hospitals throughout the land will be squeezed out by the inexorable, high-profile but expensive onward march of breakthrough technology in life-saving developments in acute hospitals.
No one would argue against pushing out the frontiers of applied medical knowledge. What is true is that, the more successful the advance in medicine, the greater the need for the recuperative work of the GP-led community hospital. As people live longer, due in some measure to the wonders of new technology, so the requirement will grow for nursing care for those who are terminally ill at one end of the spectrum, and for those who are recovering from traumatic medical experiences at the other.

§ Mr. Christopher Gill (Ludlow)
As my hon. Friend knows, one of the hospitals administered by the Worcestershire health authority is sited in my constituency, in Burford, near Tenbury Wells. In respect of that hospital, the health authority is saying that it believes that there are opportunities to develop Pershore and Tenbury community hospitals in partnership with GPs.
In another part of my constituency, a community hospital has been run in conjunction with fundholding general practitioners. That has led to a vast improvement in the range and quality of services for the local community. 1 hope that my hon. Friend will recognise how important the link is between GPs and community 830 hospitals, and how the advent of fundholding gave an enormous impetus to the improvement in primary health care within local communities.

§ Sir Michael Spicer
My hon. Friend is absolutely right. One of the definitions of community hospitals is that they are GP-led. The reforms that the Conservative Government introduced gave a boost to the entire community hospital movement. We are not sure what will emerge in terms of GP practice. We do not know whether they will fund-hold, and what other arrangements will be made. It will be a terrible shame if whatever emerges undermines the community-based, recuperative GP-led service, which the Conservative Government did so much to foster.

§ Mr. Shaun Woodward (Witney)
My hon. Friend may be aware that, in my constituency in west Oxfordshire, the Burford community hospital is faced with the threat of imminent closure. I wonder whether my hon. Friend would agree with me that nothing so sadly illustrates the Government's lack of concern for rural communities as the prospect of closure of hospitals such as the Burford community hospital, which play such an important role in rural communities. I shall find only words that express deep regret if the Government do not, as they are proposing to do with village schools, take urgent action to redress the prospect of closures.

§ Sir Michael Spicer
My hon. Friend makes an extremely important point, in two respects. First, he has identified yet another community hospital of which I was not aware which is under threat. Secondly, he makes the link between, especially, the smaller community hospitals and rural communities. Both those factors are extremely valuable additions to the case that I am trying to deploy.
Two functions are best provided locally—the palliative and the recuperative. These functions are best provided at the places where people live and where they have ready access to the services of their family doctors and the appropriate complementary rehabilitation services. My hon. Friend makes the strong point that that is especially true of rural areas such as his constituency and mine. The smaller rural hospitals are particularly under threat, where any cut and any removal of beds will make them less viable.

§ Mr. Peter Luff (Mid-Worcestershire)
Does my hon. Friend agree that small community hospitals such as the one at Evesham, about which he has spoken, are contributing enormously to the local communities they serve and are capable of developing remarkable expertise of their own? I think especially of the stroke rehabilitative work that is done at Evesham, which is testimony to what community hospitals can achieve. It is a potent example of why they must be saved at all costs.

§ Sir Michael Spicer
I must not delay the House for too long, but I know the Evesham community hospital well, because it was in the constituency that I represented for 23 years.
My hon. Friend makes an extremely important point. If we start cutting, in the case of Evesham, for example, the Macmillan unit would be involved. Such units are funded with voluntary assistance. The moment we start pulling out some of the plugs, the entire edifice is in 831 danger of collapse. Since so much outrage has been expressed by the Conservative party about these matters, there is the worry that the authorities will not confront the problem directly. Instead, they may salami-slice some of the hospitals. That will be particularly serious if small hospitals are involved.

§ Mr. David Lock (Wyre Forest)
Does the hon. Gentleman agree that, in Worcestershire, the root of the problems and the possibility of cuts, against which he rails, derive from an £8 million overspend that occurred substantially through mismanagement when the Conservative Government were in power, and when the people they appointed to the health authority were not managing it properly? So we now have substantial overspend, and a substantial accumulated deficit. That is the mess that the Government and the people they are appointing are having to sort out.

§ Sir Michael Spicer
We are rapidly running out of time when that argument can continue to be used. The countryside march yesterday showed that things are changing. We did not have these problems, and we did not have this debate, under the Conservative Administration. The Prime Minister, when he was Leader of the Opposition, came to Worcester for electoral reasons.

§ Mr. Michael J. Foster (Worcester)
Will the hon. Gentleman give way?

§ Sir Michael Spicer
I shall not give way, as the hon. Gentleman did not give way to me in the debate on fox hunting—that issue has become his trade mark.
Without having thought through the funding implications, the Prime Minister said when he came to Worcester that he would accelerate the building of a new acute hospital. Anyone who has examined the figures will know that that is what has brought this matter to a head, and is the reason why I secured this debate.

§ Mr. Gill
It may interest my hon. Friend to know that, when the hon. Member for Wyre Forest (Mr. Lock) was a parliamentary candidate, he did not blame the health authority. He said that there was a lack of money, and that money was the answer to the problem.

§ Sir Michael Spicer
That is what Labour Members always say; there is nothing new about that. Labour local authorities also say that more money will do the trick, whereas what is often needed is better management. Most of the problems that are emerging under Labour did not exist under the Conservative Government.
The case for the relatively low-cost community hospital as distinct from the all-purpose, local general hospital, whose days may be numbered, may go by default. It needs to restated, and I am grateful for this opportunity to do so.

§ The Minister of State, Department of Health (Mr. Alan Milburn)
I congratulate the hon. Member for West Worcestershire (Sir M. Spicer) on securing this debate. This is an important issue. Community hospitals 832 excite much local concern in many parts of the country, and have a great deal of local support. It is a pity that the hon. Gentleman has not read the White Paper "The New NHS", which deals with some of these issues in detail.
The hon. Gentleman asked for a clear steer on the direction of Government policy. Community hospitals are valued parts of the local health service in many areas. Patients value them because they tend to deliver services in a friendly and homely way. Our White Paper "The New NHS" sets out a vision of a service in which swift advice and treatment is available as close to home as possible. Community hospitals will be part of that vision in some places.
Dartford is different from Darlington, and it is the job of health authorities to ensure that local services are matched to local need. I thought that the Conservative Government supported that principle. If there has been a dramatic U-turn, I am happy to take an intervention on the issue; otherwise, I shall continue.
The hon. Gentleman is a strong supporter of Malvern community hospital in his constituency, and I understand his concerns. Public consultation on the future of health services across Worcestershire was launched last Monday by Worcestershire health authority with the document "Investing In Excellence". While that public consultation is taking place, it would be wrong for me to either endorse or oppose the preferred option of the Worcestershire health authority.
Different views and different options on the overall strategy for Worcestershire have been appraised by the health authority against a range of criteria, including clinical quality and accessibility. The preferred option is to centralise specialist services on one site—either Worcester or Bromsgrove depending on the specialism—with local access to diagnostic services, out-patient appointments and post-operative rehabilitation. Emergency services would also be available locally, with major trauma cases going to Worcester.
There are, of course, a number of options that the health authority must consider. One of those options—I think it was option seven, which is of most concern to the hon. Gentleman and, perhaps, other hon. Members—would involve integrating acute and community services across the county, with the closure of all community hospitals. Again, it would be inappropriate for me to comment on the pros and cons of that wide variety of options while the consultation is in progress. The point is that it illustrates just how difficult the decision will be.
Clearly, only one option will finally be approved, and the criteria that we shall use to assess the issue—if it comes to Ministers—will relate to what is in the best interests of patients.

§ Mr. Woodward
The Minister makes much of the importance of public consultation. In Oxfordshire, the community health trust has presented two options for the future of community hospitals. Option one is the closure of Burford community hospital; option two is the closure of Burford community hospital. Will the Minister explain just what public consultation means, when both options mean that the hospital is faced with closure?

§ Mr. Milburn
I will not be drawn into a detailed commentary on each and every consultation that is going on. The hon. Gentleman knows perfectly well why that is the case. If a local community health council objects to any of the proposals, the objection will end up on my desk, but until it ends up on my desk I must retain a sense of objectivity and impartiality.

§ Mr. Lock
Community hospitals are important, but in many areas—such as Kidderminster, in my constituency—people are desperate for their general hospitals not to be downgraded to the status of community hospital. Does my hon. Friend understand the strong feelings in Kidderminster about the proposal for the hospital—just before receiving its charter mark—to be reduced to a hospital of 35 beds, one for every 2,600 people, as opposed to the one bed for every 160 people that there is in Evesham? Will he assure the House that, as far as he is concerned, all options will remain open until and unless the matter comes to his desk?

§ Mr. Milburn
Of course I am aware of my hon. Friend's concerns. He and his colleagues have been to see me about the health authority's consultation proposals. During any consultation, I shall expect to see a full appraisal of the preferred option of the health authority, but it will be open to local communities and their representatives to make representations to the health authority about other options. The health authority will be expected to examine those options—as, indeed, I would, if they came to me.

§ Mr. Luff
The Minister, who is taking a very fair approach, will recognise that Evesham community hospital serves not just Evesham, but the whole of south Worcestershire. Many people from Worcester, for example, go into Evesham for rehabilitation.

§ Mr. Milburn
I am aware of the local position. I know that a number of community hospitals serve a number of communities in the Worcestershire health authority area. I also know of the concern in the areas that could be affected if option seven were given the go-ahead. Equally, I am concerned about the anxieties that have been expressed to me by those in Kidderminster and other parts of the county.
These are clearly difficult issues, which will need to be considered carefully. That is why it is important for the health authority to do everything in its power to ensure that there is a full and open debate about the issues during the next few months. I know that the health authority is promoting that consultation through a number of public meetings. I understand that it has also established a freephone helpline and a website. Moreover, views can be sent to the health authority by freepost.
Let me tell hon. Members on both sides of the House that, when difficult decisions must be made, it is important for those representing local communities in all parts of the area covered by the Worcestershire health authority to submit their views. I assure hon. Members 834 that their views will be properly considered by health authorities. Views that are brought to me will also be properly considered.

§ Sir Michael Spicer
Do the Government have a policy on distinguishing between community hospitals and their development and the old-fashioned district general hospitals?

§ Mr. Milburn
I am coming to that, and trying to go beyond the boundaries of Worcestershire.

§ Mr. Michael J. Foster
Before my hon. Friend leaves Worcestershire, perhaps I could ask whether he agrees that my right hon. Friend the Prime Minister, when Leader of the Opposition, at no time visited Worcester to make the great electoral pledge that we have heard about. Does he further agree that the new hospital that is planned for Worcester springs from medical necessity, and is not the result of some sort of electoral deal?

§ Mr. Milburn
One of my most pleasing actions as a Health Minister was to give the go-ahead to some new hospitals. I am surprised that some Opposition Members seem to oppose that. I thought that new hospitals were welcome in the national health service. That is certainly what some Opposition Members call for.
The value of community hospitals was recently emphasised in the White Paper that sets out how new primary care trusts will be able to take over the running of community hospitals and other community services to provide a broad range of treatment and care. Precise arrangements will depend on local circumstances, but it is envisaged that, in time, the primary care trust will employ all relevant community health staff and run community hospitals and other community facilities to provide an integrated system of primary and community care. That will allow patients access to an integrated service.
Under the White Paper proposals, primary care groups and trusts will be a focus for better integrating primary and community care services. Clinicians in primary and secondary care will together be able to set quality standards and service protocols so that the patient receives properly integrated programmes of care. By integrating primary care and community health care, we shall bring together health care professionals with many and varied complementary skills. The sharing of skills and expertise in that way will create greater flexibility in the provision of health care services, and will allow general practitioners to use their time more effectively to provide a better service to patients.

§ Mr. John Burnett (Torridge and West Devon)
Are the Government considering changing the appeals procedure for rural community hospitals to match the one that was announced on Friday for rural primary schools, so that there will be a presumption against closure, and a decision to close will have to be referred to the Secretary of State?

§ Mr. Milburn
I assure the hon. Gentleman that, in some parts of the country—in rural areas, for example—community hospitals may have an important future role. It is a question of horses for courses. We certainly do not have a single national blueprint that can be applied to all areas. There are differences between 835 rural and urban areas, but not all rural areas are the same. We must have a system that allows proper inspection and an analysis of what is needed in each area.
I hope that all hon. Members share our aim of achieving services that are better attuned to local health needs. The consultations that are going on in Worcestershire and in other areas will allow us to do precisely that.

§ Mr. John Hayes (South Holland and The Deepings)
In south Lincolnshire, where we face problems similar to those that have been mentioned, the issue is sparsity. The Minister says that different solutions must be applied to different areas. Can he assure us that sparsity will be fully taken into account? It may not always have been fully considered in the past—I do not seek to make a party political point—but can he assure the House and those in rural areas, many of which are represented in the Chamber for the debate, that it will be considered in future?

§ Mr. Milburn
We must take into account whether any change in local health services will improve care for patients—that is the bottom line, the barometer and the yardstick against which any change or reconfiguration proposal should be judged. There is no exception for community hospitals.
As the hon. Member for West Worcestershire rightly said, with such wide variations in the types of service provided by community hospitals, it would be wrong to 836 attempt to impose a national blueprint from the centre. The centre's role is not to be prescriptive, but to establish clear national standards to help local planners develop services that best meet local needs. As I have said several times, all districts are different, and all have differing needs. The range of services they commission and the various unit types must be determined locally, and by much more than only physical environments.
We want—more importantly, local people in all parts of the United Kingdom want—local services that best meet their local health needs. As I said, there are many possible models for community hospitals, and a variety of factors will determine the right model to suit local circumstances.
A modern national health service—which is what we want—is one that provides high-quality and appropriate services, and has a capital and staff infrastructure that is capable of delivering those services to meet patients' needs in the 21st century. However, no part of health care stands alone: it is an interconnected system, between primary, community and acute services. It simply is not possible artificially to separate one service from another. In all parts of the United Kingdom, we need to give proper consideration to ensuring that the nature of local health services in totality better meets local health needs.