Eastbourne District General Hospital

HC Deb 22 November 2000 vol 357 cc102-9WH

1 pm

Mr. Nigel Waterson (Eastbourne)

It is a pleasure to have secured this debate, Mr. Deputy Speaker, especially as you are in the Chair.

My advice surgeries and mail in recent months have been taken up with cases of individuals and organisations who cannot obtain funding from social services in East Sussex. They include the old, the young, those with disabilities, people looking for respite care and others right across the spectrum. One such individual is Mr. Denis Stringer, of the Eastbourne blind society, who has written to me about the long and wholly unacceptable delays in blind and partially sighted people having their condition assessed. The voluntary sector has been hit hardest: Eastnet, which provided information technology training for disabled people in my constituency, has recently been forced to close.

At their most acute, the delays are causing the bed blocking that is the subject of my debate today: by that, I mean that there are people occupying beds in the district general hospital in Eastbourne who could and should be discharged, but who cannot be discharged because of the turmoil in the social services budget. I shall give the House an idea of the dimension of the problem. Angela Knight, the chief executive of the primary care group wrote to me, saying: The bed blocking situation at the DGH is new and peculiar to this year. Prior to this there were no delayed discharges. The hospital wrote to me, setting out the size of the problem. A total of 88 patients fall into that category, representing almost one in six of all beds. The most worrying thing is that 36 of those patients are awaiting assessment by social services. On average, patients have to wait four weeks to be assessed. The hospital authorities suspect that the social services department has purposely slowed down—I put it no higher than that— assessments so as to massage the figures that show the number of people who have been assessed, but cannot be moved out of hospital beds.

Wherever the blame lies, however, the numbers are increasing inexorably. The hospital said also that the trust had "virtually no delayed discharges" last winter. The hospital mentioned the financial difficulties of the social services department, in particular noting that the price that East Sussex County Council is willing to pay is significantly below DSS rates. At this rate there are virtually no available beds in Eastbourne, although at a higher rate beds are available. The hospital is considering persuading patients and relatives to accept a placement in other parts of the county. That, however, is wholly unacceptable for those who have recently been in hospital and who may be elderly or confused or both, and who need their families nearby.

The health authority has provisionally made £100,000 available to ease the situation. To be fair to the hospital authority, I should state that it is taking all sorts of imaginative steps to minimise the impact on waiting lists and operations. It has invested £500,000 in additional capacity at nearby Uckfield hospital and it is making heavy use of the Esperance private hospital in my constituency, which provides another good example of the private sector stepping in to help with problems in the public sector.

Despite those efforts, the authority is still not hitting its targets. Current figures— the Minister may have more up-to-date information—show that it is still 242 short of the waiting list target. Trolley waits of more than four hours increased to 10 in October, compared with two in August, and there were 21 cancelled operations in October. I suspect that if it is not tackled, the problem will get worse as the winter takes hold and flu and other complaints strike down some of my constituents. The medical assessment unit that was recently opened in my constituency seems to be making a difference, but, like all such attempts to improve matters, it only makes a bad situation slightly better, as it is not designed, as it should be, to improve an existing stable situation.

East Sussex health authority wrote to me confirming that it put £100,000 into the area; it stressed that, although it does not have that money at present, it is delighted that it is already making a difference. That shows how desperate the situation is. The authority put in the money on a wing and a prayer, hoping that it would get the money back from the Government in due course. The county had overspent by a staggering £3 million only two months into the new financial year. There were 550 people in category 1 to whom the authority has a statutory obligation to provide care once they are assessed. Thus, the county council is breaking the law on a large scale by not offering those people care, and because of incompetent budgeting it has to cut spending on social services.

It is a sorry story. As long ago as 1997, councillors were warned of the long-term trends: first, people are living longer, and, secondly, more people privately arrange to go into homes and later have to be funded by the public sector because they have run out of savings, or because their savings have fallen below the statutory limit. The county administration either ignored that advice or failed to take account of it. The authority might, as I hope, get extra Government funding, but will it be able to find beds in the private sector? That concern was flagged up by the hospital.

The problem is compounded by the unwillingness of East Sussex to pay the proper rate to the private care sector. I should be interested to know the Minister's thoughts on the matter. I have raised the subject in the current and the previous Parliament and the situation remains the same. the county of East Sussex makes the second lowest payments to the private care sector. It pays about £434 per bed per week to its own social-services run homes, but only £229 to the private care sector, which is unsustainable. Professor Walter James, who is chairman of the local community health council said recently: The county council could save £3.25 million if it showed financial prudence…27 per cent. of its budget is spent on management and support costs. A bad situation is compounded by the unwillingness of social services to face up to the benefits of using the private sector more, and an unwillingness—or an incapacity —to budget properly. For example, social services recently entered into an agreement recently to place some patients in Parker house, a residential home—not a nursing home—in my constituency, paying £630 a head per placement. To be fair, Angela Knight, who represents a primary care group, states that there are other factors to be taken into account in those calculations and that the rate quoted is for an average of 10 days. That may be correct, but it illustrates the county's bizarre approach to budgeting and best value— which are what we are told to look for in local government—that they pay over the odds compared to the private sector, especially private nursing homes.

We know the likely effects of implementing the "Fit for the Future" proposals in respect of the private care sector—that could be the subject of another long debate—yet we must remember that more than 90 per cent. of the care beds in East Sussex are provided by the private sector. Many have closed already and many more are under threat of closure. There is is an incompetent county administration whose ineptitude at managing its own budget is having a detrimental impact on the most vulnerable of my constituents.

I believe that the leading cabinet member responsible, Councillor David Tutt, should apologise and resign. Being Liberal Democrats, of course, they attempt to blame everyone else, which will not get them too far. As Mr. Tony Andrews, chair of the East Sussex residential care homes association recently pointed out, even if East Sussex social services receives extra funding, there will soon be insufficient beds in the residential care sector. He accuses Councillor Tutt of doing too little, too late.

Nevertheless, there is an element of truth in the council's blaming of the Government. The council refers to changes to the standard spending assessment 1999–2000, especially the decision to exclude from a local authority's assessment of spending needs some elderly people living in institutions, which reduced the SSA by £2.5 million. It is estimated that 8,400 East Sussex elderly people currently in residential care are simply ignored in the SSA calculation, and because of a freeze on SSA calculations, that unfairness has been carried forward to the current year. The council says that the change resulted in a reduction of the increase in the SSA for social services to only 1.2 per cent., compared to an inflation rate of 2.5 per cent. The national average increase was 5.8 per cent. The council also suffered because of the loss of the special transitional grant. Area cost adjustment is another problem, with councils such as East Sussex likely to be disadvantaged when the Government fiddle with the formula. Therefore, there is some basis for the county's allegation that the Government are, in part, to blame.

The problem is not limited to Eastbourne, or even to East Sussex. I have a briefing from the NHS Confederation, which states that other areas experiencing problems include Hertfordshire, west Surrey, west Kent, Cheshire and part of the south-west. The briefing speaks of the need for a joined-up policy between the NHS and social services. The Minister may have come here today with her departmental cheque-book, but the NHS Confederation is right to express its concern that the NHS should not be regarded as an alternative to properly funded local government.

Finally, some important questions remain to be answered. Ministers have known about the problem for weeks, if not months, so why has action not been taken? Will the Minister announce today that she will meet in full the bid of £860,000 made jointly by the authorities in East Sussex, and if not, why not? If the answer to that question is yes, how soon will those funds be available to make a difference to people on the ground? Will even such a sum be sufficient to deal with bed blocking over the winter? Can the Minister confirm that it equates to more than £3 million on a full yearly basis?

What will happen next year and in subsequent years? Will there be an adjustment to the SSA calculations, or will any funds announced by the Minister today amount merely to a cynical ploy intended to prevent further problems for the Government this winter and in the run-up to a general election? What about all the other clients and potential clients of social services in East Sussex who will not be covered by such a payment because they are not in hospital or about to go to hospital? My constituents need convincing answers to these questions now.

1.14 pm

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I congratulate the hon. Member for Eastbourne (Mr. Waterson) on securing this afternoon's debate on bed blocking in Eastbourne district general hospital. I also pay tribute to Eastbourne as the first place in England in which I spent any time. That was where 1 discovered that one cannot play cricket when it rains.

The hon. Gentleman raised some important issues. One is wide in scope and concerns public services, how the NHS and local government are affected and how Government Departments are working together. In that context, I am sure that he will warmly welcome the Prime Minister's announcement today of a commitment to spend £43 billion in the next three years on public services.

All public services working together contribute to the nation's health. I can do no better than to quote the Prime Minister who said, Every school we invest in helps our children earn more. Every nurse we employ in the NHS is a guarantee people won't be forced to pay privately when they are ill. Every penny spent on new track and trains, even amidst the present problem, is a step towards the transport system…this country, the fourth largest economy in the world, needs. He added: Yes it takes time. Yes it takes patience. But it takes, above all, investment. I want to talk about investment and planning, particularly as they relate to the NHS working with social services. Some consists of short-term measures for dealing with immediate problems, but more crucial is the underlying investment aimed at sustainable public services. All our public services face a common challenge. Some people say that they cannot be run and funded and that at a time when the consumer is king the private sector is the answer. 1 take issue slightly with the hon. Member for Eastbourne for saying—I hope that I am not misquoting him—that the private sector had to step in to help the public sector when it could not cope. I prefer to say that we hope to work together with the private sector in a constructive and strategic way.

It is most important that the health service exists for everyone: the elderly and young alike. It is for young people leaving care and for society as a whole. However, we must recognise that the NHS has problems. We inherited a system with services that were too slow and standards that were too variable. When we published the NHS plan in July, few of us had any doubt about what was at stake. The system was chronically underfunded and short of staff. It needed investment, new buildings and new equipment, but also, very importantly, new ways of working together. It needed money, but that money came at a price: a commitment to change the way in which the various agencies work together. In the end, we want first-class public service, whether in health or social services.

Last week, we announced further funding to speed up the pace of implementation. The announcement included confirmation that from April next year health authorities will receive an average cash increase of £29 million. East Sussex, Brighton & Hove health authority will receive £594.5 million in 2001–02. That is a cash increase of £44 million and it compares favourably with the much lower increase in 1997–98 under the previous Government.Social services are also receiving more resources. In the previous Parliament, spending on personal social services rose by an annual average of just 0.1 per cent. in real terms. Under the Labour Government, by the end of 2003-04 spending will have risen by 22 per cent. in real terms.

East Sussex county council's overall standard spending assessment increased by 5.4 per cent. The national average increase was 4.4 per cent. in 2000-01. The council's personal social services SSA increased by 5.3 per cent. compared with a national average of 5.1 per cent. The increases have been above national averages. Those resources will help to tackle the constraints faced in the past, which are partly to blame for the problems raised today. The reform of the NHS and social services and the additional resources that the Government are investing in those services will count for nothing if the two do not work in partnership.

Next month, the Government will be publishing a detailed NHS plan implementation programme for the health service and for social services. It will set out the investment and the progress that will need to be made by health and social services in the next year. They should be in no doubt that we expect them to work together to deliver our reforms. The East Sussex, Brighton and Hove winter plan highlighted strong local planning systems and the development of good joint working relationships between health and social care at an operational level. However, a joint strategic approach is also crucial and I have instructed the health and social care regional offices to ensure that that is in place.

The hon. Member for Eastbourne does not need to remind me that winter is just around the corner and that some parts of the NHS will come under intense pressure. However, I take a slightly cynical approach if a winter crisis is being talked about in the media. We must be realistic about what is happening and how we intend to tackle it. Such pressure would not have arisen if many of our services had not been neglected for so long, particularly the NHS. We have already asked those areas throughout the country that are experiencing particular problems to inform the regional offices of the NHS Executive of the risks that they will face this winter and the immediate measures that must be taken to ensure that local people have the services they need, when they need them.

East Sussex, Brighton and Hove took part in that exercise and we considered the information that was provided, along with representations that we received from my hon. Friend the Member for Hastings and Rye (Mr. Foster), who I am delighted to see in the Chamber. We expect shortly to make an announcement about the additional funding to help those areas. I am sorry to disappoint the hon. Member for Eastbourne that I have not arrived today with a cheque. The announcement will be made shortly—it is part of the plans. The money will come with a clear expectation of what is to be delivered on the ground. The additional funds will be spent on ensuring that health and social services throughout the country can cope this winter and that patients receive appropriate care and treatment. Dealing with issues such as bed blocking will be a priority in any funding allocation and I shall write to the hon. Gentleman with details when the announcement has been made.

The additional funds are for short-term solutions, however. The regional offices will closely monitor their use to ensure that they deliver what has been promised. We cannot live in the long term on quick fixes. We need to build an NHS that offers people fast and convenient care that is delivered at a consistently high standard. Eastbourne has already made a start and the hon. Member for Eastbourne has recognised some of the improvements that have been made. Eastbourne hospital's NHS trust opened its medical assessment unit in September at a cost of £300,000. Although the verified official figures are not yet available, it is making a considerable impact on the throughput of patients. The trust has spent 1.3 million in additional activity to reduce overall waiting list sizes. It has also received £844,000 capital funding this year to reduce out-patient waiting lists. It is using those funds to build a purpose-built eye and cataract unit to undertake an additional 400 cataract procedures a year, to improve capacity and the environment of the trauma and orthopaedic outpatient department, and to extend and enhance outpatient consulting facilities in the ear, nose and throat department.

The trust has received £900,000 to build an extension to the accident and emergency department, enhanced by an additional donation of £400,000 from the local league of friends, to which I pay tribute. Furthermore, £250,000 of the £63 million additional funding that has already been provided by the Government for this winter has been spent on initiatives in Eastbourne and Wealden, including a multidisciplinary intermediate care rapid response team. That is important because it prevents unnecessary hospital admissions from nursing and residential homes and the local community as a whole. The funding will enable a social services assessment officer to cover Crowborough and Uckfield hospitals between December and March and will expand the community psychiatric nurse out-of-hour services during the Christmas and new year period and the CPN elderly service from December to February. It will provide additional general practitioner surgeries during the weekend prior to Christmas.

As the hon. Member for Eastbourne will realise, it is not all doom and gloom in Eastbourne as he would have us believe. I have outlined the good foundations that can be built on, and build on them we shall because we want to ensure that patients in Eastbourne receive health services that the spending plans of a Conservative Government would fail to deliver. Investment in public services is key to all the success this winter and in future, and there will be a continued development of intermediate care. Such treatment is concerned with promoting independence, providing care closer to home, preventing avoidable hospital admissions and supporting timely discharge and active rehabilitation following hospital.

The NHS plan announced that, by 2004, there would be an extra 7,000 beds in the NHS. Of those, 5,000 will be in intermediate care in a variety of settings. There will also be an extra 1,700 non-residential intermediate care places. The NHS plan also announces an extra £900,000 million for intermediate care and related services by 2004. Although that investment was announced in the NHS plan, the money is for both health and social care, recognising the interdependence of the services in delivering intermediate care.

Intermediate care will be a vital weapon in meeting the target that the Government set in the NHS plan, which was to end widespread bed-blocking by 2004. Eastbourne has already made a good start in developing intermediate care services. I shall give some examples. Two community and rehabilitation teams have been established in Eastbourne and Wealden. Funding for the rapid response team that I mentioned will be made available throughout the year. Also, four additional intermediate care beds will be provided through the local community trust during the winter months. Of course, we expect much more to be done and the social care and NHS Executive regional offices will continue to provide support.

The hon. Member for Eastbourne asked some specific questions. I did not come with a cheque today, but an announcement will be made shortly. We insist that the announcement be linked with some realistic plans and careful monitoring. That is because it is not meant as a way in which social services, or health economies that do not work together as effectively as they should, can be used simply to buy a way out of short-term problems without tackling the bigger difficulties. For example, I note that East Sussex social services prefers to spot purchase places in the private sector.

Our relationship with the private sector was best signified by the concordat. We want a long-term strategic relationship by which the two sectors work together, but not by which one develops at the expense of the other. We expect some strategic planning, which would be best value. I do not agree with the tenor of the hon. Gentleman's comments. He thinks that best value is some sort of gimmick, but it is a real issue.

The hon. Gentleman quoted the NHS Confederation and I found myself in unexpected agreement as I also thought it important to quote it. It said: Whilst it is a short term solution, it is not sustainable in the long term. Inevitably money spent on social services means money is not spent on modernising the NHS. We say that money that goes to both social services and the NHS must be spent in a strategic, co-operative way, so that we end up with a long-term, sustainable structure.

The winter emergency services capacity and planning team, which we fondly call WEST, plans to visit East Sussex in the next month, and the regional intermediate care change team plans to visit in the new year. Those visits are part of the national programme and will ensure that good practice and the most efficient patient pathways are shared with the local health service.

We all know that there will be problems in parts of the NHS during the winter; it would be foolish for me to pretend otherwise. I assure the hon. Gentleman that we listened to his concerns. People will see two streams of funding, one dealing with immediate problems, the other with long-term investment. That will mean that the services increasingly improve and that we can show that public services funded from taxation are the way forward, rather than the private sector alone. Our commitment is clear. We want first-class treatment for every patient free at the point of delivery and a first-class national health service delivered by first-class public services.