Community Hospital Closures: Public Consultation (Hansard, 27 April 1998)

§ Lord Hurd of Westwell
asked Her Majesty's Government:
How they propose to consult the public before closing NHS community hospitals.

§ The Minister of State, Department of Health (Baroness Jay of Paddington)
My Lords, the Government recognise that community hospitals often play a very valuable part in local health services. As I am sure the noble Lord is aware, changes to those services are primarily the responsibility of individual local health authorities. The Government become involved only if a community health council is unsatisfied with a local consultation process and refers a decision to Ministers. The community health councils regulations require local authorities to consult CHCs on any proposals which a health authority has under consideration for any substantial changes in its district. We also expect health authorities to take other steps, such as holding public meetings, to involve the public more generally.

§ Lord Hurd of Westwell
My Lords, I thank the noble Baroness for that reply. Will she go further and accept that many local community hospitals have over the years attracted extraordinary affection and support from those who depend on them? At a time when the Government say—and it is the Government who are telling us, as all previous governments have done—that so much extra 2 money is going to the NHS, is it not strange and sad that in my county, Oxfordshire, a consultation paper is being circulated on cuts and closures for community hospitals, and that both the options listed involve the closure of the much loved hospital at Burford? Will the noble Baroness further accept that that kind of consultation is in effect a pretence; and that, were closures to follow, whether of this hospital or similar ones in Oxfordshire, Cornwall and other counties, they would be regarded as closures by the Government, and would be received with great anger and sorrow?

§ Baroness Jay of Paddington
My Lords, I am entirely happy to confirm, and underline, the noble Lord's general point about the value of local community hospitals and the great affection in which they are often held by local communities. Our general policy is indeed to promote the better and greater use of those kinds of local facilities. As the noble Lord rightly said, it is part of our general policy of encouraging local services to be more accessible to local communities, and to use that type of facility as much as we can. I am afraid that I cannot comment on the individual situation in Oxfordshire, precisely for the reasons that I mentioned in my original Answer: if those decisions to which the noble Lord refers were finally to be referred to my right honourable friend the Secretary of State, it would be stupid at this point to prejudice his decision.

§ Lord Walton of Detchant
My Lords, in the light of her comments, will the Minister accept that community hospitals play an invaluable role not only in providing day care for disabled and elderly people but also in accepting for admission patients who would otherwise occupy beds for rehabilitation purposes for much longer periods in the acute hospitals? Given the Government's recommendations in their NHS White Paper towards a primary care led NHS based in part upon community hospitals, is it not short-sighted to recommend the closure of community hospitals, with the inevitable 3 effect of reducing the ability of acute hospitals to reduce their waiting lists, which is one of the Government's highest priorities?

§ Baroness Jay of Paddington
My Lords, I entirely accept the noble Lord's remark about the importance of some of the local community hospitals. I hope I made that point in my replies to the noble Lord, Lord Hurd. Of course it is true that community services which are local and accessible to people are extremely important. The noble Lord refers to a primary care led NHS. That slogan was used by the previous administration. The new NHS White Paper envisages a service in which swift advice and treatment are available as close to where people live as possible. Community hospitals will clearly be a part of that policy in some places.

§ The Lord Bishop of Oxford
My Lords, is the Minister aware that not only are these hospitals held in great affection but they receive significant financial support? Burford, for example, receives more than £40,000 a year raised by the local community. In 1987 I opened a new out-patient department there, for which some £140,000 had been raised. Would it not be a great pity if that money were lost to the National Health Service?

§ Baroness Jay of Paddington
My Lords, I am well aware of the extraordinarily important part that voluntary organisations play in supporting some of those bodies. Indeed, as the former chairman of the National Association of League of Hospital Friends, I have played a role in it myself. It is also important to emphasise that a great deal of public money has gone towards local community services in the Anglia and Oxford region. For example, I understand that recently £554,000 went to community rehabilitation services from the special moneys that were allocated for the winter. Overall, £2.1 million was allocated to community schemes in that area.

§ Lord Jenkins of Putney
My Lords, can my noble friend say whether the policy being followed is the Government's own policy or an inherited policy?

§ Baroness Jay of Paddington
My Lords, it is our own policy to give locally accessible services to local communities. I hope that I emphasised that point in my previous replies. Of course, there is no national blueprint for the most satisfactory way of delivering community services. It may be through a local community hospital; it may be, for example, through our new initiative of NHS Direct, in which nurse-led telephone services provide good local advice to people. There is no national template. As I said in answer to the noble Lord, Lord Hurd, it is for local communities to decide what is most appropriate.

§ Lord Geraint
My Lords, before we start the consultations, will the noble Baroness give an assurance to the people of Wales that community hospitals will not be closed before we set up our parliament in Wales?

§ Baroness Jay of Paddington
My Lords, were it within my power to give that assurance, I should be 4 delighted to do so. However, as I am sure the noble Lord realises, it is a topic which, for the moment, is for the Welsh Office.

§ Baroness Cumberlege
My Lords, does the noble Baroness agree that many small hospitals are in rural areas, serving rural communities? I understand that the White Paper which is likely to come out shortly will insist that it is for her right honourable friend the Secretary of State for Education to make any decision about closing rural schools. Will the noble Baroness suggest to her ministerial colleagues that it is a line that the Department of Health might wish to pursue?

§ Baroness Jay of Paddington
My Lords, the noble Baroness confirms what I said in reply to the noble Lord, Lord Hurd. If decisions at a local level are not agreed, then the decision to which he and other noble Lords referred will automatically be referred to the Secretary of State for Health, if the community health council does not accept the local decision.

§ Lord Dean of Beswick
My Lords, did not the Government a short time ago announce the biggest hospital building programme within memory? Is it not a fact that where large centres of excellence are produced, some other hospitals have to go out of existence? It may be a choice between an archaic hospital and the most up-to-date hospital. On that basis, are we not on the right track? Even though we must consider local services and what the people want, at the end of the day are not the big hospitals with modern, up-to-date facilities the right choice?

§ Baroness Jay of Paddington
My Lords, I am glad my noble friend recognises the large amount of investment which has been put into new acute hospitals. However, no part of health provision stands alone. It is an interconnected system and primary community and acute services must be delivered effectively. As I said in previous answers, the way in which that is best achieved is primarily best decided at local level.

§ Lord Hamilton of Dalzell
My Lords, on 26th February I asked the noble Baroness the following: What was the impact on hospital waiting lists of beds occupied by medically fit people awaiting discharge who cannot leave because there is no one to look after them?". In her kind reply, the Minister explained what the Government were doing about elderly people in order to find them beds. She said: However, it is not possible to quantify the impact of this on hospital waiting lists".—[Official Report, 26/2/98; col. WA.115.] I tabled the Question for Written Answer because the charity for which I am responsible is threatened with closure of a holiday home in Essex which gives respite to patients from national health hospitals during the winter. Does the Minister think she ought to have statistics on the subject? What sum is involved in terms of private contributions to help relieve the National Health Service of those who want to be given relief and respite?

§ Baroness Jay of Paddington
My Lords, I feel that the noble Lord's question is wide of the Question on 5 the Order Paper. However, I agree with him about the importance of community rehabilitation services and that is precisely why in my reply to one of the noble Lords who raised the issue in relation to Oxfordshire I mentioned the sums which had been given for community rehabilitation to try to reduce the acute stress on some hospitals. However, if the noble Lord would care to write to me again with the specific issue he wishes to raise about Essex, I shall try to help him.