Rural and Community Hospitals (Hansard, 12 May 1998)

§ Mr. David Prior (North Norfolk)

I beg to move, That leave be given to bring in a Bill to establish procedures to place restrictions on the closure of rural and community hospitals. I represent a rural constituency with many elderly, retired people. Public transport is not readily available, and the general hospital is a good 40 miles away for many people. There are five community hospitals in north Norfolk, a pattern reflected across the United Kingdom.

Over the years, many community hospitals have been chopped and changed, many have closed, others have been threatened with closure and then reprieved, and wards have been closed. The fortunes of those hospitals have yo-yoed with the annual financial settlement. There has been no long-term security or strategic plan.

In funding terms, community hospitals have been the Cinderella of the health service, relying on financial support from countless leagues of friends, appeal committees and supporters. They have been squeezed by the high-profile and expensive march of new technology in acute hospitals. The sword of Damocles has always hovered above them.

That is no way to run such a vital local service; no way to treat dedicated nurses and frail, and sometimes terminally ill, patients. The public have no confidence in the impartiality or correctness of the decision-making process. Matters have reached such a stage that one chairman of a cottage hospital told me that, if the health authority spent money on a hospital, it was a sure sign that it would try to close it in a year or two. Another said that a consultation was a cosmetic exercise—a case of, "We've written the minutes, now let's have the meeting." There have been many debates in the House about community hospitals, usually prompted by a particular closure. Today is an opportunity to look at community hospitals in a less emotional setting.

The United Kingdom has 457 community hospitals. Many are approaching their centenary, and many of the war memorial hospitals had their origins in the great war. No two hospitals are the same; they have evolved to meet local patient needs. Most commonly, they allow patients to recover from traumatic surgery and to receive medical treatment near their homes. There is clear evidence, anecdotal and otherwise, that people recover more quickly in small, friendly local hospitals.

Perhaps most important, especially in an area such as north Norfolk, local hospitals have developed a special expertise in treating elderly people. That has led to a growing requirement to provide respite and palliative care for the terminally ill. The increasing number of older people, especially those who are frail or who have mental health needs, require a service sensitive to their needs and preferences. Evidence shows that older people are less likely to be disoriented if cared for at home or close to home, particularly by staff with whom they are already familiar and by their local GP.

The fact that community hospitals are so well supported by the community means that literally thousands of volunteers provide help. Taking time to listen and to talk to ill, old and sometimes lonely people can make a huge difference. During the next 10 years, the Government predict an increase of about 100,000 people over the age 169 of 85, many of whom will need the services of their local hospitals and their community pharmacists. That massive local support, part of the moral capital of the NHS, will evaporate if the hospitals are closed.

By contrast, the big acute hospitals are organised primarily for major surgery. They employ highly specialised people, and are hugely expensive. It is essential to move patients out as quickly as possible. The community hospital is the logical halfway house between acute hospitals and home. They can also be used to manage winter pressures and the pressures of rising emergency admissions.

To summarise, community hospitals meet essential patient and clinical needs. They have massive public support, and fulfil a vital role between the large district hospitals and care at home. So it was that I welcomed a number of statements in the Government's White Paper called "The New NHS". They commit themselves to real, not synthetic, consultation, and to three, five, even 10-year funding agreements to give greater stability to NHS trusts. They also commit themselves to allowing local doctors and nurses, who best understand patient needs, to shape local services.

The Government specifically commit themselves to community hospitals in the White Paper, which states: Too often in the past, Community Hospitals have been sidelined. Those are fine words, but, as they say in Norfolk, "Fine words butter no parsnips." Community hospitals from Cornwall to Wales, from the midlands to East Anglia, are under threat. Community hospital associations believe that at least 16 are threatened with closure. To bridge the gap between political rhetoric and platitudes and what is happening on the ground, I bring the Bill before the House. It is not fair to raise expectations without providing the wherewithal to achieve them.

The broad objective of my Bill is to make it much harder to close community hospitals, by introducing safeguards. First, there should be a presumption, albeit rebuttable, in favour of community hospitals remaining open. For the health authority, there must be a clear burden of proof to show that there is no longer patient or clinical need for the hospital. It would not be sufficient justification to suggest a lack of short-term financial resource.

Secondly, the obligation on the health authority to consult openly and seriously should be entrenched. Consultation must include not only community health councils, but everyone directly involved in primary health care, including doctors, nurses, health visitors and the like, as well as the public.

Thirdly, an independent panel should review the decision of the health authority and the assumptions and the reasoning behind the proposed closure. Specifically, it would consider bed utilisation and management objectively, and satisfy the public that the figures had not been cooked and bed occupation artificially lowered to support the case for closure. It would not take into account short-term financial considerations. An independent panel would restore public confidence in the decision-making process.

170 A proposed closure would have to have the seal of approval from the Secretary of State. In practice, he would overrule the independent body only if there were an overriding political imperative. However, the decision should have democratic legitimacy.

Those measures would make it more difficult, but not impossible, to close community hospitals. Some will close in response to changing patient needs, demography or technology, but at least those measures would make closure more acceptable to the public, and better understood. The Government would have to make available funds to support the health authority's strategic plan. No hospital should close because of a short-term funding gap.

The Bill puts down a marker to the Government. Community hospitals are a vital part of the health service. They have widespread public support and must be given a long-term future. There must be no more closures until proper safeguards have been put in place.

Question put and agreed to.

Bill ordered to be brought in by Mr. David Prior, Mrs. Gillian Shephard, Mr. John MacGregor, Mr. Keith Simpson, Dr. Ian Gibson, Mr. Christopher Fraser, Mr. Richard Spring, Mr. Damian Green, Mr. James Gray, Mr. Tim Loughton, Mr. John Bercow and Mr. Shaun Woodward.