Burford Community Hospital (Hansard, 16 March 1998)

§ Mr. Shaun Woodward (Witney)
I am grateful for the opportunity to introduce a debate on the important subject of Burford community hospital. I am especially pleased to see the Minister in his place tonight, not least because I requested a meeting with the Department of Health about that hospital and, I am sorry to say, have not yet received a reply.
In the two options proposed by the Oxfordshire community health NHS trust, Witney community hospital will be subjected to a savage cut in beds, and in both options, Burford community hospital will close.
No community hospital is like another. Burford community hospital provides care for a neighbouring population of more than 27,000 people. It is in the heart of a highly rural area and, as such, it is at the heart of the community. It is the focus of enormous voluntary support in that community, with more than 80 volunteers, who share a wide variety of tasks, from staffing the reception desk to providing transport for the sick and elderly, and providing meals on wheels.
Most of the people who use the hospital are old. They are the most vulnerable in our community, and their numbers are projected to grow. Indeed, at the moment, only two miles from the hospital, at Bradwell grove, a new housing estate of 150 houses designed specifically for the elderly is taking shape.
Under the county structure plan, west Oxfordshire is about to grow considerably. An extra 7,500 houses will be built in the next few years. One thousand of those will be built just four miles from Burford, at Carterton. Indeed, the structure plan proposes that, in the next four years, west Oxfordshire's population will grow by nearly four times the percentage of Oxford city's growth, and significantly more than that of any other local authority area in Oxfordshire.
According to the community health trust's figures, west Oxfordshire has an average number of community hospital beds per 1,000 of the population. However, if it is projected that the population will grow by nearly 6 per cent. in the next four years, obviously the closure of Burford community hospital, and the savage cuts at nearby Witney community hospital, will lead to that rural community being dramatically under-provided.
Sadly, in the community health trust document that is to be released in the next few weeks, setting out the options for the future, there is no mention of those proposed population increases. Indeed, there is nothing in the document at present about the pressure that those increases would place on the ambulance service, which would be involved in ferrying people around as a consequence of the closure of Burford community hospital.
The document does discuss the number of beds, but it takes no account of other services in the hospital. It takes no account of the facilities provided by the new day care centre, built as recently as last year, at a cost of £135,000. None of that money came from the Department of Health: it was raised entirely by local people in the community.
1070 The crucial factor in the case of Burford community hospital is that it is a living institution, absolutely at the heart of a very rural town. The document does not refer to the splendid work being done for those who have Alzheimer's disease; at the Burford community hospital there is a pioneering new unit called the Specal unit, which is doing sensational rehabilitation work with people who suffer from that terrible illness. The document makes no mention of the importance of respite care, which is so important today, not only for the patient but for the carer.
Is the Minister happy that the community health trust proposals that are now being set before the public have been carefully prepared? Is he sure that the proposals that will be put on the table in the next week or so are genuinely fit to be the subject of public consultation?
My local newspapers, particularly the Witney Gazette and the Cotswold Standard, have worked brilliantly in the past few weeks to highlight the sheer desperation felt by those who live around Burford. They tell of the most desperate case histories and of people worried sick by the proposals. Such people are the most frail and vulnerable members of our rural countryside community. What will happen to the 68-year-old triple-bypass patient—who was saved by brilliant medical care in the John Radcliffe acute hospital—when the community hospital closes? What about the 75-year-old patient with Alzheimer's?
One of my constituents, Mrs. Read, who suffers from advanced dementia, lives two miles from the hospital. Her doctor says that she is one of the most magnificent rehabilitation cases that he has ever seen. Why? Her doctor says that it is because of the sensational work done by the local community hospital. What does her carer—in this case, her husband—have to say? It is very simple. He says: Without Burford Hospital my life would be horrible. My wife would have to go into a home, miles away from us. Every five weeks she goes in for respite care. Every week she visits the day unit. We can't say how much these breaks mean for us. I don't know how we would cope if Burford closed. We just don't know what we would do. What of the patients with terminal illnesses? General practitioners have told me: They will face the prospect of many hours on a hospital trolley in the John Radcliffe Hospital awaiting a bed. That hospital is a 40-mile round trip from Burford, and patients must wait in a corridor. By closing the Burford community hospital, what kind of new health national service will we be offering to someone who is dying and may have only weeks to live? What will happen to those people? What plans does the community health trust have for them?
I am sorry to tell you, Mr. Deputy Speaker, that, as the document is prepared to go out for public consultation, the answer to that question is none. The document contains no explanation of what will happen. It simply puts forward two options: option 1, close Burford hospital; and, option 2, close Burford hospital. Is the Minister satisfied that the research conducted by the community health trust justifies the panic and the worry that the proposals are generating?
Burford hospital may be small—it has only 11 beds—but the community health trust's figures for this year show an average occupancy of about 90 per cent. 1071 Indeed, from July last year until this month, bed occupancy has been consistently above 90 per cent., and is currently 96 per cent.

§ Mr. Robert Jackson (Wantage)
I thank my hon. Friend for giving way. Is he aware that at Wallingford, which is another hospital on the community health trust's hit list, bed occupancy is currently 98 per cent?

§ Mr. Woodward
I am grateful to my hon. Friend for that intervention. That is part of the serious picture in Oxfordshire, which I hope that the Minister will take seriously. The beds at those hospitals are not under-utilised. Those hospitals are not failing to provide critical local care based on local need: they are needed, they are local, and their future is crucial.
The House knows how important community hospitals are in relieving bed blocking at acute hospitals and reducing waiting lists. I am grateful to the Minister for providing me with the most recent figures for waiting lists in Oxfordshire. At the end of last year, 6,371 people were awaiting hospital admittance. I am sorry to say that that figure has now risen to just below 7,000. The picture for day-case admissions is far worse—it has increased by nearly 50 per cent. in Oxfordshire in the past 12 months, from just over 4,000 to 6,000.
In the run-up to the last election, the Labour party promised to cut waiting lists. The figures speak for themselves. Many would like to know why the Labour Government, on the basis of their own figures, are presiding over such a dramatic increase in waiting times, yet seem to do nothing to call the health authority to its senses and prevent it from closing the hospital.
I am sure that the Minister would respond by saying that he has no power to do so. However, just two weeks ago, on the eve of the countryside march, when 300,000 people gathered in London to protest about the impact of Government policy on rural communities, the Government announced that they would halt the closure of village schools. Can the Minister respond in the same way tonight and say that he will halt the closure of hospitals such as the Burford community hospital?
It is difficult to see the strategy behind the plans. There is no intellectual coherence. The section on the health strategy for Oxfordshire, updated just two years ago, entitled "Elderly people and mental health problems" states: Services should be as close as possible to people in their homes…and be integrated between hospitals and community settings. In the light of that strategy, particularly given the importance of the hospital in the life of the elderly, the options to close Burford do not make sense.
At the end of last year, the Government published their White Paper "The New NHS", which I have read. Reading it, one could be forgiven for thinking that the Government care about hospitals such as that at Burford, and that they would fight to save them. In theory, they emphasise the value of community hospitals.

§ Mr. Tony Baldry (Banbury)
My hon. Friend is looking for some rationale. The only rationale is that the community health trust must save some £1.5 million. That cut of £1.5 million affects the entire county and will be achieved through the proposed cuts in community 1072 hospitals in the constituencies of my hon. Friends the Members for Witney (Mr. Woodward) and for Wantage (Mr. Jackson). There is no rationale, other than the necessity for the trust to make a cut forced on it by the Government.

§ Mr. Woodward
I am sad to say that my hon. Friend is probably correct in his assessment of the situation.
There is an opportunity for the Government to recognise the damage that is being done. As page 41 of their own report on the new NHS states: Too often in the past community hospitals have been sidelined. Their potential contribution to managing the pressures of rising emergency admissions has often been ignored. Patients will be able to use local community hospitals to the full rather than having to travel to more distant acute hospitals. This will be particularly significant in rural areas. The rhetoric is there, yet the two proposals on the table for Burford are that it will close.
I remind the House what the Secretary of State for Health said in his statement when he presented the White Paper last December. He said: When I became Secretary of State, I promised that we would listen to people on the front line—the nurses and doctors, midwives and the other professionals and staff in the NHS."—[Official Report, 9 December 1997; Vol. 302, c. 796.] Yet the proposals for the closure of Burford have not been based on listening. Of course there is a consultation exercise, but there is no confidence among the people who depend on that community hospital that that is any more than the rubber stamping of a decision taken by the community health trust and forced on it by cuts in its budget by the Oxfordshire health authority.
I beg the Minister to listen, as the Secretary of State said he would.

§ Mr. Geoffrey Clifton-Brown (Cotswold)
Is my hon. Friend aware that the Burford community hospital is just three miles from the county boundary of Gloucestershire? Many thousands of people who live within a 10-mile radius of the hospital may need to use its services.
I face in Gloucestershire the same sort of pressures as my hon. Friend faces in Oxfordshire. Does he agree that the way forward for community hospitals is for them to develop a specialty different from that of the neighbouring community hospital, so that all community hospitals have their own specialty and people have the maximum choice?

§ Mr. Woodward
My hon. Friend makes an important point. Of course, if Burford community hospital is closed, it will have no opportunity to develop anything.
I beg the Minister to listen to what people are saying, as his right hon. Friend the Secretary of State has said that he will. I ask him to listen to my constituents such as Frank and Joan Sedlemeier. Frank, who is 80, had pacemaker heart surgery a year ago. He moved out of the John Radcliffe at Oxford to convalesce at Burford. He now attends the hospital's day care centre every Wednesday. His 68-year-old wife, who looks after him round the clock, is desperate for a bed to be made available at Burford so that she can have a break. She cannot get one because the beds are all full.
1073 We need the Minister to listen to the local doctors, such as those who work at the Burford surgery. As Dr. Sharpley said to me: In the event of closure of we will have only one option of patient management open to us. This will be inappropriate and more expensive as we will be forced to admit patients to the John Radcliffe. Dr. Sharpley continued: We are currently receiving daily faxes from the John Radcliffe claiming their beds are full. If our patients face refusal of acute emergency admission, where will these 'inappropriate' admissions go? They will certainly not go to Witney, which is the other hospital in my constituency; the community health trust plans to close at least 13 of its beds. Those 13 beds are always in use. Only last Friday, I was in the hospital and I was told that only one of the 61 beds was available.
The Minister may wish to know that I raised the matter with the community health trust. He may be staggered to know that it replied: The population will continue to have access to community hospital services through Witney hospital, which has good road and public transport links from Burford (less than eight miles)—average car journey time of nine minutes. Think about it. Unless it is proposed that the people of Burford travel under police escort, it is impossible for anyone living in Burford to get to Witney in that time. If anyone were to do so, it would be necessary to travel at 60 mph. That is a ludicrous proposal. It is one more example of how nothing has been thought through by the community health trust in its planned closure.
Doctors and patients do not feel that they have been consulted. There is an onus on the Minister to tell the House whether he is satisfied that the community health trust has done its homework. Has he the confidence to say tonight that it has properly consulted the general practitioners? If there had been proper consultation, the Minister would know, as I do, that the GPs will be unable to serve their patients if they are forced to go to Witney or Oxford, not least because Witney is way outside their practice areas.
The Minister may wish to know that the GPs have told me that there has been no proper consultation with them. This clearly makes nonsense of the trust's suggestion in its letter to me of 13 March that, as a result of effecting either of the options, more health care can be delivered in the home setting. The health professionals disagree.
The Secretary of State has said that he will listen to the health professionals, so I hope that the Minister is listening tonight. I am talking of a crucial hospital, a community hospital. Local people have raised nearly £500,000 over the past 10 years; they want to save their hospital. I have letter after letter in which people set out their desperate concern. That concern is supported by Carterton town council and West Oxfordshire district council. It is a battle for survival.
I hope that the Minister will take the opportunity to reassure the people of Burford that he will do everything in his power to save a vital community resource.

§ The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng)
I congratulate the hon. Member for Witney (Mr. Woodward) on securing the debate. It is obviously an important issue in his constituency. Community hospitals play a valued part in the local health service, providing health care in a friendly and homely way, and in a way that I know commands the support of the hon. Gentleman's constituents. He has outlined that support tonight.
Obviously, any proposals to reconfigure the service involving the proposed closure of the community hospital is bound to excite the concern and attention of local people. The hon. Gentleman seeks assurances, of course, from Ministers about the future of Burford community hospital. He must understand—it was made absolutely clear to him by my hon. Friend the Minister of State only two weeks ago—that it would be grossly inappropriate for Ministers to be drawn into detailed commentary on each and every consultation on proposals for the reconfiguration of the service. He will understand, as, I hope, will his hon. Friends, that it would not be right for us to prejudge the outcome of any local consultation, and I have no intention of doing so.

§ Mr. Robert Jackson
I quite understand that, at this stage, it might be difficult for the Minister to comment, but, if the proposals are persisted with, he will, in due course, have to decide whether they are acceptable. In general terms, does he feel that the Government's policy of trying to maximise efficiency in the health service is compatible with trying to create additional pressure on acute hospitals by closing the cheaper beds that are available at community hospitals?

§ Mr. Boateng
The hon. Gentleman is an old stager in these matters, but I am not so wet behind the ears to respond to his lure or give any indication of our view on the proposals, either generally or specifically. We expect the consultation to take place on the two options that have been outlined, to see whether either of the two should go ahead. It should begin around the end of the month and last for three months. Hon. Members from the official Opposition and from other parties will have an opportunity to make their views known.

§ Dr. Evan Harris (Oxford, West and Abingdon)
I understand the Minister not wanting to discuss the specific proposal, but my constituents are affected due to Abingdon community hospital facing a loss of beds, so I shall be grateful to hear in general terms how the Government will ensure in the coming months that health authorities and trusts do not create longer-term problems through the need to make necessary short-term cuts because of existing plans—I accept that they are not his own, and they are grossly insufficient—by cutting the number of beds and reducing respite care, which means increased emergency admissions and delayed discharges.

§ Mr. Boateng
I hear what the hon. Gentleman says. No doubt his health authority will take into account his arguments when making its proposals for hospitals in his community.
Hon. Members must understand that we inherited a poisoned legacy from the Conservatives and are endeavouring to tackle the real problems that the NHS in 1075 general and constituents of the hon. Member for Witney face. We endeavour to do that through a number of principles, one of the most important of which is delivering cost-effective health care as close to the homes of our fellow citizens as possible.
Within that overarching principle, there is a role for community hospitals. We all value the contribution that they make. I have no doubt that Burford community hospital and other hospitals of that nature in Oxfordshire are well loved by their local communities. Oxfordshire health authority will have to look at how the hospital fits into its overall strategy for the county. It will need to be assessed against a range of criteria, including clinical quality and accessibility. The hon. Gentleman knows that, as do we. He will make his point during the consultation process. If the community health council objects to the health authority's proposal, the hon. Gentleman can make further representations when the matter comes before Ministers.
It is important to make it clear that this area has benefited substantially from the election of a Labour Government. There has been a considerable injection of new money into Oxfordshire since May last year. It was uncharacteristically churlish of the hon. Gentleman not to give the Government credit for providing new resources for the NHS.

§ Mr. Woodward
Will the hon. Gentleman give way?

§ Mr. Boateng
No, the hon. Gentleman has had his say, and he must now listen.
More than any other health authority in the Anglia and Oxford region, Oxfordshire received additional help to cope with winter pressures. It received £3.4 million, which is 22 per cent. of the total allocation to the region of £15.2 million. Of that £3.4 million, £554,000 went to the community trust for community rehabilitation services. Overall, £2.1 million was allocated to community schemes. That is what the new Labour Government made available to serve the hon. Gentleman's constituents. He should at least recognise that.
The hon. Gentleman did not represent his constituency in the previous Parliament, but had he done so he would know that his constituents were starved of resources by the Tory Government.

§ Mr. Woodward
rose—

§ Mr. Boateng
No, the hon. Gentleman will listen.
1076 NHS staff were thoroughly demoralised by the lack of recognition that the Department of Health gave under Conservative Ministers to the needs of the hon. Gentleman's constituents.

§ Mr. Clifton-Brown
Will the hon. Gentleman give way?

§ Mr. Boateng
No, I shall not give way. Conservative Members have had ample opportunity to make their case, and I am now explaining to them and to their constituents what the Government intend to do to regenerate the health service in Oxfordshire.
We shall ensure that health and social care services work closer together on the issues that concern the hon. Gentleman, such as mental health, rehabilitation and recuperation. [Interruption.] It is no use the hon. Member for Witney muttering from a sedentary position that we are going to close the hospital.

§ Mr. Woodward
Will the hon. Gentleman give way?

§ Mr. Boateng
There is no need for the hon. Gentleman to get over-excited. It is no use his muttering from a sedentary or from a vertical position that we are going to close the hospital. He knows that it is a matter for the health authority. His community health council will have the opportunity to comment on the issue, and, in due course, Ministers will come to a view. We shall give the most careful consideration to the points made by the hon. Gentleman. When we consider what is in the best interests of the people of Oxfordshire, we shall take into account the impact of any proposals on the patients in the Burford area. We shall make our decision in the best interests of the service.
The hon. Gentleman has sought to serve his constituents as best he can. I thank him for making the debate possible. He can be sure that the points that have been made tonight have been carefully noted and will be taken into account. We all have an interest in ensuring that the best of the NHS grows and develops. Community hospitals have an important role to play in delivering our vision for the NHS. We intend to put the patient first, to recognise local needs, and to provide a cost-effective NHS for all the people. That is the Government's priority, and we shall see it through.