§ Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]
2.27 pm§ Siobhain McDonagh (Mitcham and Morden)I am pleased to have secured this debate on an issue that is very dear to the hearts of my constituents—the future of the former Mitcham cottage hospital, the Wilson. It is no exaggeration to say that I speak for virtually all my 70,000 constituents—no matter what their politics—when I say that they would dearly love the Wilson to re-open its doors as a hospital. It is also no exaggeration to say that the people of Mitcham had, and still have, a strong and proud affection for the Wilson—it was, and is, cherished.
I can do no better to sum up the feelings of Mitcham people than to quote from a handful of the huge number of supportive but unsolicited letters that I have received since I took up the issue in December. Mr. John Brett of Imperial Gardens, Mitcham wrote:
Having been born in Mitcham 75 years ago I know what an asset it would be for local people, especially the elderly as patients and visitors. I am sure that the growth in Mitcham's population warrants the need for the Cottage Hospital.Mrs. J. M. Collins of Fenning Court, Mitcham wrote:I am behind you 100 per cent. It should never have been closed. I have been a patient of the Wilson having had both my hips replaced and received the best of care and attention. I cannot speak highly enough of the surgeons, doctors and nursing staff that attended me.Mrs. Marie Patterson of Sherwood Park road, Mitcham, wrote:
It would certainly be handy for the elderly of the borough who now have at least two buses to catch to get to any hospital for treatment.Mrs. Helen Manning-Legg of Commonside East, Mitcham, wrote:
Congratulations on initiating the debate for giving the Wilson Hospital back to the people for whom it was a gift! For years we have felt cheated, and in the beginning we fought to keep it open. You have our full support.
§ It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]
§ Siobhain McDonaghDr. Alan Cohen, a local GP and chair of the East Merton and Furzedown primary care group, wrote:
I am sure that it will not surprise you to know that it has been a stated aim of the Primary Care Group since our inception to provide clinical services at the Wilson … The PCG would very much like to put clinical services in the Wilson, but are currently prevented from doing so by the Health Authority insisting on using it for offices".The Wilson disappeared off the clinical radar in the closing years of the Conservative Government, becoming offices for Merton, Sutton and Wandsworth health authority. A much-loved and much-used amenity was lost. Desks and filing cabinets replaced beds; offices replaced wards and an operating theatre. Mitcham was stripped of the hospital that Sir Isaac Wilson, a local benefactor, specifically endowed for the people of Mitcham in 1928. Sir Isaac endowed a cottage hospital for the many, not an
591 office block for the few. The current misuse of the building is an affront to his intentions and to the people of Mitcham.
As a local councillor for 16 years in the 1980s and 1990s, I was involved in the campaign to keep the Wilson open. It was a strong and determined campaign, and we achieved a marvellous amount with next to no resources. In spite of initially being successful in preventing its closure, in the end we failed. We were let down by false promises from Conservative Health Ministers. It has been a constant regret to me that we failed.
Towards the end of last year, I took up a campaign in my constituency to urge Merton, Sutton and Wandsworth health authority, and the new south-west London strategic health authority, which is poised to replace it, to find alternative office accommodation to clear the way for the re-introduction of clinical services at the Wilson. Not only is the transition from the health authority to strategic health authority the perfect moment to restate the case for the Wilson, but it is crucial to me that the people of Mitcham are not elbowed to the back of the health queue again.
My campaign includes a petition signed by a large and increasing number of constituents that I plan to present to the House early next month. The campaign has gained eager support from local people of all ages and backgrounds. They include local GPs, and speaking to them has brought home to me the fact that Mitcham—which is part of the East Merton and Furzedown primary care group—is very much a victim of health inequality.
East Merton primary care group is some £4 million over target compared with Balham, Tooting and Wandsworth primary care group, which is £3 million under target despite similar levels of deprivation. The extra spend comes from the greater use of secondary care services by GPs in East Merton, as there has not been the investment in infrastructure in primary and secondary care from which Wandsworth has benefited so much.
Mitcham has the highest rate of teenage pregnancies and low birth weight pregnancies in the area covered by Merton, Sutton and Wandsworth health authority. Sadly and probably amazingly, Merton has the highest number of children put up for adoption in London. According to 1996 figures, Phipps Bridge ward, in which the Wilson stands, had the highest adult mortality rate in the borough.
Clearly, as well as crying out for the restoration of hospital facilities, there is much to be done to address the very real and disturbing health inequalities that people face in this area of my constituency. I understand that the public health department has been encouraged by local GPs to investigate the inequity between East Merton primary care group and Balham, Tooting and Wandsworth primary care group but, over the last two years, it has been unable to do so. Perhaps my hon. Friend the Minister would offer some help to hard-pressed GPs in my constituency on this point.
My main objective in this debate is to ask my hon. Friend to offer an undertaking to my constituents in Mitcham and Morden that an option appraisal of intermediate care services in Merton can be carried out to assess the viability of reopening the Wilson as an intermediate care centre and as an extension to the intermediate care service, thereby serving the elderly and the infirm in the Mitcham area who are in need of hospital care.
592 All hon. Members are aware of the colossal pressure on our large NHS hospitals, such as St. George's in Tooting and St. Helier in Carshalton, both of which serve my constituents. The Wilson is equidistant between the two and could ease the pressure on acute beds in both. Indeed, many former cottage hospitals nationally could be pressed back into use to ease the pressure on acute hospitals and to provide care for the elderly who cannot be cared for in their homes.
I fully realise that there is an on-going debate on how best to deliver intermediate care—whether it should be in the patient's home or in dedicated beds at a resource such as a cottage hospital, which the Wilson has the potential to be. I understand from talking to local GPs that current evidence indicates that care at home with intermediate care nursing teams is probably more effective and better liked by the user of the service. I believe that encouraging independence by providing care in the home is absolutely right.
There are circumstances, however, when respite beds are necessary, for instance when a patient's home circumstances may be unsuitable, or when patients are suffering from dementia or some other severe infirmity that means that they need clinical care 24 hours a day. The Wilson could come into its own in those circumstances, relieving pressure by relieving bed blocking.
Considerable work has been done in the Merton, Sutton and Wandsworth area on intermediate care services. A domiciliary provider team currently managed by South West London Community NHS trust and five residential home beds with rehabilitation services attached are available to support the discharges of Merton patients from St. Helier hospital.
There are between 40 and 55 delayed transfers of care each week from St Helier, the split between Sutton and Merton residents being approximately two thirds and one third respectively. The most significant group that experiences those delays in both boroughs is composed of patients who are waiting for long-term nursing home or residential care. Intermediate care services in their current form would not provide an appropriate level of service for that group of patients. Additional intermediate care beds, with the appropriate rehabilitation input, would, however, undoubtedly allow the trust to discharge some patients much more speedily. That could happen at the Wilson.
In respect of intermediate care needs at St George's, a recent study on such care identified a need for 60 to 70 intermediate care beds across the Merton, Sutton and Wandsworth area. For the area that St. George's covers in Battersea, at least 16 intermediate care beds are needed and the hospital has forwarded a proposal to the Department of Health to expand the intermediate care provision at the Bolingbroke hospital. Such intermediate care provision could also be provided at the Wilson.
On alternative offices for the health authority, I certainly would not want to hound the new strategic health authority out of Mitcham and Morden. I am pleased that such an organisation wants to have its base in my constituency. I acknowledge the good work done by the health authority and the work that its successor body will no doubt do. This is not about the individuals who have their office at the Wilson, but about the fact that that should not be at the expense of a hospital to serve the people of Mitcham.
593 I have done some research into the office accommodation available in Merton that is of a sufficient size—more than 1,000 sq ft—to house the new strategic health authority, its support groups and the primary care trust that will be co-located with it. With a bit of imagination and, more importantly, the will to move, the health authority could find office accommodation within a few miles of the Wilson. I hope that Merton's Labour council will assist the health authority to find a new home, just as it has made strenuous efforts to help Wimbledon football club find a site for a new stadium. For instance, the partially empty Brown and Root tower in Colliers Wood, just opposite Colliers Wood tube station, has more than enough space for the health authority. More controversially, perhaps, there is space in the soon-to-close Rowan school in Longthornton, which is a fine building in need of a new use. There are others, too.
I ask the Minister to give an undertaking to my constituents, the people of Mitcham and Morden, that an option appraisal of intermediate care services in Merton will be carried out to assess the viability of reopening Wilson hospital as an intermediate care centre. I further ask her to take steps to deal with the inequity between local primary care groups.
I have spoken a lot about the feelings of the people of Mitcham. As someone who has lived in the constituency all my life, I share their feelings. Mitcham has suffered over the years as its facilities and its civic pride have taken a battering. Reopening the Wilson would be a tremendous boost for Mitcham. It would give an entire community great pleasure to see it reopened for the purpose for which it was intended. Sir Isaac Wilson never intended to endow an office block. I therefore strongly urge the Government to respect his wishes, and the wishes of my constituents in Mitcham.
§ The Parliamentary Under-Secretary of State for Health (Yvette Cooper)I congratulate my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) on securing the debate. She has made a powerful case on behalf of her constituents about Wilson hospital and about tackling health inequalities in her area. In the wake of our recent consultation on how to narrow health inequalities across the country, I will happily talk to her further about specific issues that she, general practitioners and in particular her constituents face.
The main subject of my hon. Friend's speech was the future of Wilson hospital. I welcome the opportunity to discuss the future of a facility that, as she has made clear, is strongly valued by her constituents.
As my hon. Friend will be aware, responsibility for deciding what services are provided in Mitcham rests with the local NHS in south-west London. The key decisions must be taken locally and with proper public consultation where appropriate. Nevertheless, I will respond to her as far as I can about the issues that she has raised, the local position, and how it fits in the context of the national approach to intermediate care.
Clearly, the issue is important to my hon. Friend's constituents. As she said, Wilson hospital, which was established as a cottage hospital by Sir Isaac Wilson in 1928, was a gift to the local community.
594 In 1990, following consultation, it was agreed that in-patient services at the Wilson be transferred within the district, in line with the previous Government's policy. By that time, the Wilson was offering mainly out-patient services and elective orthopaedic surgery, and had some elderly in-patient beds. Many of the services were transferred to Sutton hospital, part of the current Epsom and St. Helier NHS trust. During that time, the district headquarters, now the Merton, Sutton and Wandsworth health authority, was searching for new accommodation, so it moved into the empty space at the Wilson.
A health clinic still serves local residents. It offers dental services, a blood clinic and district nurse and health visitor services for the South West London Community NHS trust. The Merton community mental health team is also based on the site. I am aware of local concern about the future of the site and have been very impressed by the strong community feeling on the issue.
My hon. Friend is right to stress the value of local cottage hospitals. The Government are committed to making appropriate and effective use of those community services. There is an important role for cottage hospitals in the delivery of local health care and in the future development of intermediate care.
In the NHS plan, we pledged that, as well as additional money, by 2004 there would be 5,000 extra intermediate care beds across the country. Some of those will undoubtedly be in cottage hospitals, some in existing facilities and some in new developments. I agree that often the potential of such hospitals has been ignored. Now, with a new emphasis on intermediate care and delivering care "closer to home", there is an opportunity to breathe new life into local services.
The NHS plan announced extra investment of £900 million annually by 2003–04 for intermediate care and related services to promote patient independence, of which around one quarter was earmarked specifically for NHS investment in intermediate care. With the £150 million made available recurrently from the previous financial year, that will bring earmarked NHS resources for intermediate care to a total of £405 million by 2003–04.
A substantial component of that money is to be provided to local government for a range of services to link to intermediate care—for example, through the provision of home care, giving people enough day-to-day help to enable them to live in their own home rather than have to remain in hospital or nursing care. The results of a survey on intermediate care undertaken in August last year show that good progress is already being made. From a baseline of 1999–2000, there will be 2,400 more intermediate care beds by the end of this year. Of course, there is still progress to be made. Our aim now must be to ensure that everyone has access to high-quality, effective intermediate care services.
Locally, Merton, Sutton and Wandsworth health authority, Merton social services and the proposed Sutton and Merton primary care trust have been working closely together to increase intermediate care provision. There are currently 31 intermediate care beds for Sutton and Merton residents and 10 beds for Wandsworth residents. Intermediate care provision for Merton residents includes beds for elderly people at Bolingbroke hospital, which is part of St. George's Healthcare NHS trust, as well as beds at Eltandia nursing home and Carshalton War Memorial
595 hospital. Earlier this month, Merton social services received £248,000 from money allocated to councils to reduce the number of delayed transfers of care, and it has developed a plan with local partners to use the funding to offer older people more opportunities to return to or stay in their own home—for example, through the provision of additional home care arrangements.
Together, local NHS and social care organisations will develop a more detailed strategy on intermediate care over the next 12 months. Current estimates of need suggest that a minimum of nine additional beds plus additional community placements will be required by 2003–04 for Sutton and Merton residents, although projections are still being reviewed. To meet that need and to reach targets for intermediate care, the health authority, social services and the PCT will need to consider all the options, including enhancing home support as well as providing additional beds in the area.
It will be for the NHS at local level to decide how and where services should be provided and how best to use local NHS resources, but it is important to involve the local community in discussions on those matters and to take account of local people's views. I am sure that my hon. Friend agrees that there is also a need to take into account issues of clinical viability, accessibility for patients, and cost-effectiveness for the NHS, so that the NHS can provide the best possible services across the board.
My hon. Friend will be aware that some of the changes resulting from the NHS plan and "Shifting the Balance of Power" announced by the Secretary of State last year were about putting patients and staff at the heart of the NHS and moving power from Whitehall back to those on the front line. The key aim is to reshape the NHS around the needs of its users, to offer them choices and to involve them in decision making and planning. That is key to the discussions that must take place locally and involve local communities, as well as discussions with local authorities,
596 the voluntary sector and other key partners. To create a more responsive health and social care system built around the needs of local communities, patients, front-line staff and local people must be involved in consultation.
My hon. Friend mentioned the fact that the Wilson is currently used for office accommodation. The proposed Sutton and Merton PCT is in need of headquarters office accommodation. That is currently under review, and I am advised that the Wilson is one of the sites being considered. She will be aware that, because the Wilson is not in the commercial sector, the cost of providing offices there is considerably lower than that of leasing commercial premises; that is one of the factors that must be taken into account locally. That will also be a factor in the considerations of the new strategic health authority.
How far facilities may need to be Modernised will also have to be considered. If the Wilson were to be considered as a cottage hospital in the way that my hon. Friend and the community suggest, there will be concerns about the costs associated with Modernising the building to the standards expected today for clinical services. Such factors must be taken into account by the local NHS when considering the future of the services in the area.
I have listened carefully to the points made by my hon. Friend, who spoke clearly and happily on behalf of her constituents. Merton, Sutton and Wandsworth health authority welcomes her interest in the matter and would be happy to discuss it further.
As far as possible, discussions and decisions must take place at the local level, but we shall take a continued interest in the discussions that my hon. Friend has at that level. I shall be happy to discuss the matter further with her when local discussions have taken place about the development of intermediate care in her area and the Wilson hospital.
§ Question put and agreed to.
§ Adjourned accordingly at nine minutes to Three o' clock.