Accident and Emergency

Guy Opperman Excerpts

Wednesday 18th December 2013 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

What we have heard today is a deeply unconvincing attempt by the Opposition to turn A and E into a political football. As a former Health Secretary who missed his own target for 14 of the 26 weeks that covered winter, the shadow Secretary of State should know better than to run down the phenomenal achievements of hard-working NHS staff at this busy time of year.

The right hon. Gentleman threw out numerous statistics—[Interruption.] He asked me to give him some answers, so he should just listen. He threw out numerous statistics, but let us look at the facts he chose not to mention. First, given that A and E departments across the United Kingdom face similar demographic challenges and have similar structures and targets, a comparison with Wales is instructive, not least because, with a Labour-run Government, it is following policies that are closer to those that he favours. The most recent full-month data available for both countries show that England hit the target, with 95.7%, but Wales missed it, with 90.4 %. Last year, England hit the target, with 95.9%, but Wales missed it, with 87.7%. In fact, Wales has missed it every single year since 2009. He also talked about ambulance times. In October, the figure for England was 74.6%, and for Wales 65.2%.

The right hon. Gentleman used some strong language. He talked about complacency and crisis. Will he now demonstrate that those comments were not shallow point scoring by making the same criticisms of Labour in Wales? If not, the House will see those comments for what they are: a hollow attempt to turn an operational challenge—one that he faced, that I face, and indeed that all Health Secretaries face—into a political argument regardless of the impact on patients or staff. Vulnerable people are relying on our emergency services this winter, so to whip up fear and run down performance, as he has done, is frankly shameful. It is putting politics before patients, and not for the first time from the Opposition Benches.

If the right hon. Gentleman does not want to talk about Wales—[Interruption.] I will move on to that later. If he does not want to talk about Wales, let us look more closely at England. Again, the statistics he did not want to share with the House show that NHS A and E departments are actually performing much better than when he was Health Secretary.

[Guy Opperman (Hexham) (Con)]

Does the Secretary of State welcome the example being shown by the award-winning Northumbria NHS Trust, which is building a brand-new specialist emergency care hospital in these difficult times, offering 24-hour cover seven days a week with consultants? That idea preceded the Keogh review and shows the way forward that A and E should be taking.

[Mr Hunt]

My hon. Friend is absolutely right. Huge progress is being made on the ground to deal with the challenges, and under a lot of pressure, and that is why we need to use language responsibly, rather than using the kind of hyperbole we have heard this afternoon.

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[Mr Hunt]

I would urge him to urge his own MP to back this Government’s initiative to introduce seven-day GP surgery opening in pilots in every single region of the country, and to back plans like those in north-west London, where seven-day GP opening has been introduced—for which we have not had support from Labour.

[Guy Opperman]

Does the Secretary of State agree that prevention is the most important thing to alleviate A and E pressure, and that the simplest thing we can do is to encourage the populations in all our constituencies to take up the flu jab, which will prevent a large number of people going to A and E?

[Mr Hunt]

My hon. Friend is absolutely right. This year we have extended flu jabs to two and three-year-olds because we think that prevention is better than cure.

We have been looking at other causes of the long-term pressure on A and E, such as Labour’s 2004 GP contract. The right hon. Gentleman spent the past year telling this House that that contract, which scrapped named GPs, has nothing to do with the problems in A and E. This is despite what nearly every A and E department in the country is talking about—namely, the pressure being caused by poor primary care alternatives, particularly for the frail elderly. What did he tell Sarah Montague on the “Today” programme when we reversed that GP contract and brought back named GPs for the over-75s? He conceded to her, as he never has in this House, that our changes which reversed that contract would help A and E, so he is finally accepting on the radio what he does not accept in this House and what A and E staff have been saying for months—that having someone in the community responsible for frail elderly will help.

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[Guy Opperman (Hexham) (Con)]

As a jockey, I spent far too much time in A and E departments after coming off race horses. Once, I wandered into Leicester hospital with a broken collarbone and four bones sticking out of my shoulder. On another occasion, I spent a long time with a cut kidney and lost a spleen at Warwick hospital—I thank Dr Mike Stellakis and his team for saving my life that night. Also, two years ago, I collapsed in the House and spent a night in St Thomas’ with a young but capable bunch of A and E doctors. I thank them all and put on the record this Christmas the huge effort made by all our public sector staff, particularly in the NHS.

In Northumberland, we feel that we are leading the way in health care provision. Begun under the previous Government, that has continued under this one. Haltwhistle is a small cottage hospital that in the olden days would have been shut, but which now is being rebuilt as an integrated NHS and local authority facility. It is the first of its kind in the country, it is utterly transformative and it is exactly what the NHS and the local authority should be doing with old buildings, although I urge the trust to resolve the contracts that are not yet resolved. When I visited it last week, however, I saw that it was a truly innovative building and that it would be a great addition.

Hexham A and E is also a fantastic building. This November, I worked there as a hospital porter, and I thank Barry, the head porter, who has worked there 31 years, for keeping me in line and ensuring I did not put anything in the wrong place. Then there is Cramlington, an innovative, pre-Keogh assessment health care centre being built for the north-east. It is a perfect example of where we should be going: a 24-hour, seven-day-a-week, consultant-led facility. As an A and E specialist care facility, it is exactly what Keogh is talking about. Interestingly, it was planned under the previous Government and is being brought forward under this one. It is exactly the direction we should be heading in.

I shall deal briefly with another issue. Northumbria has outstanding health care, but sadly North Cumbria is having some difficulties, and I urge the Secretary of State to expedite the merger of Northumbria and North Cumbria NHS trusts as soon as possible.

I turn now to ways we can keep our constituents and patients out of A and E. I have no spleen—it was kicked out of me by a three-mile chaser at Stratford—so every year I need the flu jab. Consequently, like pensioners, some young children and vulnerable adults, I went to get my flu jab last month at Haltwhistle GP centre. I thank Sarah Speed—it was not painful and took only five minutes. Tragically, however, at least 10% to 20% of the population do not take up the flu jab and are therefore likely to end up in A and E over the winter or possibly die. As constituency MPs, we must ram home their failure to take up the opportunity to deal with their own health care.

Finally, I turn to the hospice and dementia care systems in Northumberland. In the Charlotte Straker hospice and Tynedale Hospice at Home, we have two outstanding hospices, both of which I have assisted and one of which I have fundraised for. Both do a great job keeping people out of hospital. I should also mention the Age UK programme dealing with elderly people in my constituency. It is making a huge difference and ensuring that everyone becomes a dementia friend. Only through such actions will we bring about real change in our health care system.

Mid Staffordshire NHS Foundation Trust

Guy Opperman Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

The change will absolutely extend to ambulance trusts. I know that my hon. Friend has had experience of poor leadership of ambulance trusts in her area. It will apply to all organisations registered with the Care Quality Commission. There will be a fit and proper persons test, because where people are responsible for poor care, we do not want them to pop up somewhere else in the system.

[Guy Opperman (Hexham) (Con)]

There has always been a professional duty on medical professionals to advise patients when errors occur; yet we know that that has not always happened. Although all hon. Members welcome the greater candour, transparency and protection in relation to whistleblowers that this Government are proposing through the fit and proper persons test, does the Secretary of State agree that true culture change will not happen unless the views of junior doctors, the staff generally in all hospitals and everyone in the NHS are made as important as the views of those at the very top?

[Mr Hunt]

My hon. Friend is absolutely right. True culture change is incredibly difficult to achieve unless we get behind the people on the front line and get them to want to change the culture. That is the insight in the report that Professor Berwick delivered in August. That is why today’s response is about backing front-line staff to deliver the care that they want to deliver and to be open when they are worried, and about supporting them in what is a very challenging period for the NHS. If we do not back them to do the right thing, then no matter what happens at the top, we will not see change on the front line.

Brain Tumours in Children

Guy Opperman Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Mr Raab]

I thank my hon. Friend for his intervention; I know that he feels very strongly about that point. It is an excellent point and the Minister will have heard it. I have a range of points that we can certainly follow up with the Minister if they are not addressed in her speech, but that is an important point on top of the critical importance of early diagnosis.

There is a wealth of clinical and scientific evidence to back up the argument that early diagnosis is key. Research up until 2006 showed that the median delay in diagnosing a brain tumour in a child in Britain was 12 to 13 weeks. In other words, half the affected youngsters took more than three months to reach diagnosis and then treatment. That was up to three times longer than the diagnosis delay in other countries, including the US and Canada. Let us just think about what that means. It means child after child walking around—in their home, around their school and even through their own GP’s surgery—with identifiable symptoms of brain tumours that could have been picked up but sadly were not.

[Guy Opperman (Hexham) (Con)]

I am lucky enough that I collapsed in this austere palace and was taken straight to St Thomas’s hospital with a brain tumour, and I am living proof that someone can recover from a brain tumour. I should declare my support for the National Brain Appeal, which I raise money for.

Does my hon. Friend agree that there needs to be a designated GP within the cluster of GPs’ surgeries that we all have in our communities who is the first point of reference when an individual child or adult presents to a GP clinic with some designated head symptoms?

[Mr Raab]

I thank my hon. Friend for his intervention. That sounds to me like a perfectly sensible suggestion. Again, it is a practical recommendation about how to deal with the fast-tracking from diagnosis to treatment, and again I am sure that the Minister has taken it on board.

The key thing that I have realised from being informed by HeadSmart and others about this issue is that the warning signs of a brain tumour—particularly in children, who are the focus of this debate—are not especially technical or terribly difficult to detect. We are talking about regular headaches or vomiting; difficulty in co-ordinating, balancing, or walking; blurred vision; and fits or seizures. Those are the most common symptoms, and they are signs that parents, doctors, teachers and children should be able to pick up on.

111 Telephone Service

Guy Opperman Excerpts

Wednesday 5th June 2013 Westminster Hall

[Miss McIntosh]

The problem is similar in other professions, such as my original profession of law. The Chamber will welcome the Minister’s confirmation that it is not Government policy to ration or to charge for GP appointments, as we have heard under successive Governments. We are very reassured to hear that it is not their policy to ration GP visits.

How is the interface with GP out-of-hours providers being addressed? In the rural area of North Yorkshire, three and a half clinical commissioning groups cover one constituency, which poses some real practical problems. Where there are multiple GP out-of-hours providers, what regard has the Department had to the potential difficulties of rolling out the 111 service? Furthermore, are there any issues relating to delivery in rural as opposed to urban areas? I am talking in particular about the distances that GPs or nurses might have to travel to respond to calls under the 111 system.

Most worryingly, there seems to be a political vacuum here. Will my hon. Friend the Minister reassure us that there will be political accountability? Where does the political responsibility and accountability lie for any potential failings or successes of the 111 service? Does the Department plan to review the system further? I ask that because my own experience in the pilot area of County Durham has not convinced me that the review has borne any fruit. Does the Department plan to review the system after three or six months?

[Guy Opperman (Hexham) (Con)]

I congratulate my hon. Friend on securing what is a very important debate and thank her for sharing with us her genuine and very sad experiences. Does she agree that, while everybody would accept that 111 is the way ahead in reducing the burden on A and E, it is all about integration—be it urban areas or deeply rural areas such as those that she and I represent—and that there will be future improvements in GP, 111, A and E, and other services?

[Miss McIntosh]

The 111 service is a tool and should never be a substitute for the ability visit a GP. I accept that we cannot expect GPs and their families to put up with the antisocial hours of GPs of my father’s generation, who were leaving the profession in droves. I see 111 as a useful tool—an appendage, not a substitute. There are issues that must be addressed in that regard.

Will the system be reviewed, and if so will it be within three or six months? I repeat: is 111 really geared up to deal with sparsely populated rural areas such as those that a number of us here today represent? North Yorkshire has a sparsely populated rural area—one of the largest in the country—and a high number of older patients with complex medical needs, which the GPs are very cognisant of.

I welcome the Health Committee’s inquiry into 111 and NHS emergency care. We will all doubtless follow the proceedings, and look forward to its conclusions and recommendations with some interest.

This debate has been a wonderful opportunity to get a number of issues off my chest; to pay tribute, I hope, to my father; and to note my disappointment at how he and others were treated in the pilot scheme. I hope the issues I have raised can be addressed. The 111 service may be a useful tool—an appendage—but we need to look closely at what more needs to be done, and I invite the Government to do so. I am fearful of delegating the operation of all emergency services outwith political control, and I return to the point about where the political accountability for 111 lies. I look forward to hearing the Minister’s considered response to the debate.

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[Guy Opperman]

I am listening to the hon. Lady’s contribution, and given her background, it is clear that she is a specialist in this area. Like her, I met staff from my local CCG and local ambulance service last week to discuss the development of this system. I note that she talks about integration. Does she agree that the integration of those various parts of the NHS system is the absolutely crucial thing going forward?

[Barbara Keeley]

Indeed. We talk a lot about integration, but the feedback that I have received from both my local CCG and my local NHS trust is that we have just taken a backward step. We had a nurse-led service that was working fairly well, although it was not as integrated with other services as it should have been. We now have a system that is led by computer scripts and non-clinicians, in which the patients calling the service—if they get through to it—do not have confidence, and as a result, they are falling back on visiting their GPs or going straight to A and E. My point was that that single, integrated urgent care service—the single service that the hon. Gentleman just talked about—should include responsibility for GP out-of-hours triage, and at the moment it does not. The system could have been set up that way, but it was not. Does the Minister believe that the alternative that I have just put forward is the right direction for an improved NHS 111?

Beyond our experience in Greater Manchester, there have been many criticisms of the NHS 111 service and the shambolic transition to it from NHS Direct. Dr John Hughes, a GP from Manchester, said the service had been withdrawn in his area hours before the launch, owing to problems. He told the BBC that it was “an omnishambles” and

“a waste of public money.”

Dr Hughes has called for a full public inquiry into the procurement of that service, because he feels that it was

“forced forward to meet a political objective.”

Janet Davies of the Royal College of Nursing has argued that nurses from NHS Direct have been running NHS 111. She told the BBC for a report:

“Staff from NHS Direct, the service being abandoned, are supplementing the work of 111—staff that were being made redundant and still are at the end of this month… Specialist nurses that can talk to patients have not left and they are propping up that service.”

She felt that, unlike the nationally run NHS Direct, NHS 111 was a

“fragmented service with local contracts”,

which in her view was “very, very chaotic”. She also said that NHS 111 was an attempt to cut the cost per call, by using non-clinical staff to handle the majority of call time, and that it was

“not using qualified nurses, people with the skills to talk to people and make a sensible decision”.

She felt that the Government had thought about costs but not value. As we have seen, NHS 111 is offering poor value if patients turn away from that service, because it is far more expensive to go to A and E or a GP than to have a conversation with a trained nurse.

In Salford, patients were left waiting on phone lines for up to an hour and then turned to the more expensive options of a GP visit or A and E. Our out-of-hours service came under pressure and extra staff capacity had to be brought in. The opinion of staff at Salford Royal NHS Trust is that NHS 111 operates at a level and in a role that an “experienced grandmother” might achieve. Surely, we can and should do better.

Neonatal Care

Guy Opperman Excerpts

Wednesday 6th February 2013 Westminster Hall

[Chris Heaton-Harris (Daventry) (Con)]

It is a pleasure to serve under your chairmanship once again, Mr Streeter. I thank my hon. Friend the Minister, who could have been, but was not, slightly late, which is ironic in a way because the debate is about babies who turn up very early. He was due to be in the Chamber as we speak, but kindly rearranged a whole host of things to be here this afternoon to answer the debate. I thank him very much indeed. He and I have often spoken about neonatal care, and indeed stillbirth, so I know that he will do all he can to answer the debate with deeds as well as words.

Neonatal care is an absolutely vital service that no parent or prospective parent ever wants to have to rely on, but lots do. One in every nine babies in the UK is born either premature or sick—more than 80,000 every year. We therefore need a service that is fit for purpose and provides the best possible care to all premature or sick babies and their families in facilities that can give the best care—sometimes very specialised care—at a harrowing time for the parents concerned.

One of my constituents, a fantastic mum called Catherine Allcott, alas, had to rely on neonatal care a few years ago. Catherine’s twins, Luke and Grace, were born unexpectedly at 26-weeks gestation. At six weeks old, they were separated and sent to neonatal units 40 miles apart due to Luke’s critical condition. Catherine and her husband, Nigel, spent the next three months visiting two hospitals every day until Luke sadly died and Grace was discharged. Grace is now a delightful, happy, healthy six-year-old and Catherine’s experiences during that time have shaped her fundraising and campaigning work for Bliss—a fantastic charity that campaigns for continual improvements to neonatal care and is a strong advocate of care for babies.

When the results of the 2010 general election were announced, Catherine was one of the first people to find my advice centre. Before I knew it, I was being whisked around the Gosset neonatal ward of Northampton general hospital, looking at their facilities and talking to staff and parents. Since then, I have had the pleasure of visiting many other maternity and neonatal wards across the midlands and the south-east.

Catherine is concerned, as Bliss is, about the national shortage of neonatal nurses, particularly those qualified in that specialty. Half of all units do not have enough nurses to meet national standards and one in 10 units is so busy or understaffed that they cannot release nurses for specialist training. According to Bliss’s report on saving our specialist nurses—by specialist, I mean nurses who have a recognised qualification in specialist neonatal care—that figure is pretty solid.

As was shown by a Bliss report in 2010, that boils down to the need for 1,150 extra qualified specialist neonatal nurses—the figure has changed since that date, but that is the latest I have—if we are adequately to provide the service that this country so desperately needs and that babies and their families deserve. Not all nurses working in neonatal care have the specialist qualification, but the “Toolkit for high quality neonatal services” states that 70% of a unit’s nursing work force should hold one.

According to an Oxford university study, an increase in the ratio of qualified and specialist nurses to babies in intensive and high-dependency care might reduce infant mortality rates by 48%, something that is surely worth every penny and for which it is definitely worth fighting. I am told that that works out at about £1,400 of additional investment per baby, which, as the Government have themselves highlighted, would benefit society in the longer term to the tune of approximately £1.4 billion.

As I have said, I have seen my local neonatal care unit in action and know the pressures that Gosset ward is under. The staff at Northampton general hospital do an excellent job, but they face significant pressures, even after an increase in staff equivalent to 4.3 full-time nurses. Despite that increase, the unit has had to close its doors to new admissions more than 20 times in the past year for non-medical reasons, a statistic that is surely not good enough. We should not and cannot restrict access to health care to some of the most vulnerable and innocent in our society—the next generation—on the basis of those lax numbers. Frankly, we must do better and we must do more.

The shortfall nationally shows the extent of the issues that we face. More than half of all units do not have enough specialist nurses to meet the national standard—that 70% of the nursing work force should hold a specialist neonatal care qualification—and the importance of such specialist care is so clearly shown in an area where such tiny and fragile babies can have such complex and often multiple conditions. It is not a hole that can just be plugged in the short term to meet a budget, but something that needs long-term planning and investment in a skilled work force.

If we are to achieve such a national standard and address the recruitment of specialist nurses that neonatal units require, continued investment in education is of paramount importance. I therefore welcome the national changes to the commissioning of specialised services. They promise to ensure that we do not face a postcode lottery, thus improving the consistency of services across the country and spreading best practice.

Locally, my constituents in Daventry and I have other concerns and opportunities. The Minister will know of the “Healthier Together” programme in the south-east midlands, which is looking at the services provided at the five main hospitals in Bedford, Kettering, Luton and Dunstable, Milton Keynes and Northampton. There are options or plans to reduce the number of maternity units that are consultant-led from five to three, an action that would have a clear impact on neonatal services, because it is most likely to result in the closure of neonatal units at the hospitals that have midwife-led units.

[Guy Opperman (Hexham) (Con)]

I congratulate my hon. Friend on securing this important debate. I have a very successful midwife-led maternity unit at Hexham general hospital. Does he agree that such units can provide a fantastic ongoing service, but that it is very important that parent and larger hospitals in the region provide them with neonatal transfers and ongoing support?

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[Guy Opperman (Hexham) (Con)]

I am most grateful to you, Mr Streeter, and to my hon. Friend the Member for Daventry (Chris Heaton-Harris) for letting me speak for literally 90 seconds at the end of his impressive speech.

I endorse everything that my hon. Friend says, and I want to add my endorsement of the amazing work done by the NHS staff in my area of Northumberland, specifically at Hexham general hospital. It is an outstanding hospital that the Minister will, with a bit of luck, visit when he comes to Northumberland in April. It fits well between the trusts developing in Northumberland and Cumbria and is effectively the heart of the wheel with the spokes being the various other health services around it. It is a general hospital, but it has an outstanding midwife-led maternity unit. I have visited it and met staff and patients, and it is fantastically popular and successful.

I want the Minister, who has great expertise in this field—let us not say that we do not have specialists in this Government—to endorse the fact that midwife-led units have a role to play in the ongoing provision of health services, particularly in rural areas such as mine. I hope that he agrees that the standard and quality of the care provided and the outcomes are just as good in midwife-led units as in consultant-led specialist hospitals. They are different, but they are just as good. It is to this Government’s great credit that we continue to support midwife-led units and provide such services.

Specifically on neonatal care and transfer, I am interested in the importance of neonatal transfer in the isolated cases where things do not pan out in the right way. Changes are afoot, and my hope is that the Minister agrees that it is incumbent upon the lead hospitals in the region to ensure that the quality of training throughout the region is high, so that where there is neonatal transfer, it goes off without a hitch.

I have taken up enough time. I thank you for your indulgence, Mr Streeter.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a great pleasure to serve under your chairmanship, Mr Streeter. I congratulate my hon. Friend the Member for Daventry (Chris Heaton-Harris) on securing this important debate on neonatal services. He strongly advocates the needs of his constituents, but also raises an important issue that we are already focusing on and improving, to give every child the very best start in life.

It is also a pleasure to hear from my hon. Friend the Member for Hexham (Guy Opperman), and I am looking forward to visiting his constituency in the near future. An April visit is in the diary at the moment, and I look forward to visiting and seeing for myself some of the excellent care delivered locally. He is right to highlight that midwifery-led units play an absolutely vital part in delivering high-quality care for women and their families. The Birthplace study absolutely supports his points and suggests that midwifery-led units may well play an even more vital role in the future provision of maternity services. I am sure that we will discuss such matters in future debates.

Before we get on to the specifics of neonatal care, I want to discuss some of the more general points made by my hon. Friend the Member for Daventry. He mentioned air ambulance services, and he is quite right to say that if we want a co-ordinated and integrated emergency response, particularly in more rural and sparsely populated areas, air ambulances must play an important part. The land and air-based responses need to be co-ordinated effectively, particularly for road traffic accidents. He makes a good point and I am sure that the local commissioners in Daventry and elsewhere will take note of our discussions today.

My hon. Friend was quite right to say that the payment- by-results system has been problematic in many areas of medicine. My right hon. Friend the Leader of the House, when he was Secretary of State for Health, made strides towards changing the tariff system in many areas of care, particularly the year-of-care tariff for people with longer-term and more chronic conditions. We also have changes being implemented to the maternity tariff to encourage a normalisation of birth. We want to view birth as a normal, everyday, natural process and to move away from births that need hospitalisation, by supporting people better in the round through antenatal care and more holistically throughout pregnancy, childbirth and the post-natal period.

My hon. Friend mentioned the unacceptable variations in care that exist across the country, which was highlighted poignantly today in the debate on the NHS in mid-Staffordshire. He has also previously advocated the reduction of stillbirths and supports the excellent work that Bliss does to raise the importance of high-quality neonatal care. More work is necessary, but I want to describe some of our achievements and the progress that the Government have made over the past couple of years, which shows that we are taking such issues seriously. As my hon. Friend quite rightly outlines, there is more that we can do and we intend to do more over the months and years ahead.

As has been said throughout the debate, we cannot divorce childbirth and midwifery care from neonatal care; the two are linked in terms of service provision and the care that is provided for premature babies. We want to provide more care and support for women during pregnancy, and the latest work force figures show that midwife numbers increased by 1,117 between May 2010 and October 2012. Training places in midwifery are at a record high, and we are ensuring that commissions for future training places will remain at a record high, so that we can continue to provide personalised, one-to-one midwifery care for women. The birth rate is increasing, and that is why we are employing more midwives and keeping training commissions high.

On neonatal care, 1,376 neonatal intensive care cots were available in December 2012, of which 951 were occupied. In December 2011, only 1,295 such cots were available. So in a period of 12 months—between 2011 and 2012—we have seen an increase in the number of neonatal intensive care cots available nationally, and I am sure that my hon. Friend will agree that that is a good thing.

The number of paediatric consultants has also increased, from 1,507 in 2001 to 2,646 in 2011, and the number of paediatric registrars—or middle-grade junior doctors—has also increased by almost fourfold in the same period, with some of those registrars specialising in neonatal medicine. Consequently, I believe that we must give some credit to the previous Government for some of the work that they did in this area, but this Government have taken their work forward with renewed vigour to make this a priority.

The number of full-time paediatric nurses has also risen, from 13,300 at the beginning of the century to 15,629 in 2011. So, in general, we are seeing good progress being made in putting more resources into children’s health care, giving every child the very best start in life.

Specifically on neonatal services, my hon. Friend is right to highlight the fact that we need to do more to ensure that there is no variability in the system. We made a commitment very clearly as a Government to high-quality, safe neonatal services, founded on evidence-based good practice and good outcomes for women and their babies. Improving outcomes, rather than focusing on process measures, is what we are all interested in. We want to ensure that babies who need neonatal care are given the very best care and have the very best outcomes in terms of their future life and, indeed, the care that they receive on neonatal wards.

In our mandate to the new NHS Commissioning Board, we will be holding it accountable for all health outcomes. We want to see the NHS in England leading the way in Europe on health care outcomes. The Secretary of State for Health has made it clear that mid-table mediocrity must be a thing of the past in all areas of medicine, and I will make sure that I work closely with Bliss and other organisations and, indeed, with my hon. Friend to make sure that we hold the NHS Commissioning Board to account for delivering high-quality health outcomes everywhere, particularly in this important area of neonatal care.

It is worth highlighting, and I think that I have time to do so, the different types of neonatal facilities that are available; the different types of special care baby units, or the level 1, level 2 and level 3 units. Special care units, traditionally known as level 1 units, provide care effectively just for the local population in the local area. They provide neonatal services, in general, for singleton babies born after 31 weeks and six days gestation, provided the birth weight is above 1,000 grams. For slightly more complicated births or slightly more premature births, there are level 2 units, which provide neonatal care for their own local population and for some sicker, or more premature, babies from elsewhere. They provide neonatal services, in general, for singleton babies born after 26 weeks and six days gestation, and for multiple-birth babies born after 27 weeks and six days gestation, provided the birth weight is above 800 grams. Then we have level 3 units as they are traditionally known, which are neonatal intensive care units, and they are sited alongside highly specialist obstetric and fetomaternal medical services. For example, there is a level 3 unit across the river from here, at St Thomas’ hospital. Such units take very premature babies.

That description highlights the fact that neonatal care must be considered alongside the provision of high-quality maternal care; the two go very much hand in hand. The point that my hon. Friend made—my hon. Friend the Member for Hexham made it as well—is that when services are being redesigned or reconfigured the most important thing is to provide high-quality patient care. Reconfiguration is about delivering those high-quality patient outcomes and that high-quality care.

The best example of where service reconfiguration has really benefited patients that I can think of was in Manchester, which I visited towards the end of last year. A redesign of the maternity and neonatal provision in Manchester in a very planned, systemic way resulted in about 30 babies’ lives being saved every year. When the case for reconfiguration is made in terms of patient care and not in terms of cost, as my hon. Friend the Member for Daventry outlined, that is the right reason to reconfigure and redesign services. What we cannot have, and what has been expressly ruled out under the criteria for reconfiguration, is redesigning services purely on the basis of cost. If we are going to redesign the way that we deliver care, it must be done in the way that it was done in Manchester, where—as Mike Farrar, who is now the chief executive of the NHS Confederation, said—it is about saving babies’ lives. That service reconfiguration in Manchester was right, because it is saving 30 babies’ lives every year. That is the right reason for reconfiguration.

My hon. Friend was absolutely right to highlight that in some cases, when we look at these issues in areas where there are long distances to travel and considerable rurality, all these factors need to be taken into account when redesigning services. However, the end result must always be for the benefit of patients. It may be the case that sometimes people have to travel a little bit further to get that high-quality care, but these decisions must be considered in the round and on the basis of achieving high-quality outcomes and doing the best things for mothers and their babies.

In conclusion, it might be worth highlighting a few other specific things about neonatal care that the Government are committed to doing. We now have a toolkit for neonatal care, and we are looking to ensure that it is properly implemented across the NHS. Some parts of the country are doing very well in ensuring that the majority of their staff working as nurses in neonatal units have specialist training, but that is not the case everywhere. We have established that toolkit; that was a direct challenge that the Government have picked up and taken forward, to ensure that we drive up the standard of neonatal care everywhere.

[Guy Opperman]

Does the Minister accept that, as the health care reforms kick in, it is incumbent upon GPs to make the point when they first advise expectant mothers that they can give birth at various places and that midwife-led units provide the full spectrum of care from well before the birth to well after it?

[Dr Poulter]

My hon. Friend is absolutely right. It is vital that whenever there is a discussion with any patient—in this case, it is a discussion with an expectant woman about where she should give birth—that an informed choice is made. That should not just happen initially, but that choice should be reviewed consistently, according to what the risk factors might be throughout the pregnancy, and women should be helped and supported into choosing the most appropriate birth setting for them. And all factors, such as the woman’s safety or what care might be required immediately after the birth, are vital ingredients in that decision-making process.

What we want to promote, and what we all believe in, is patient choice in the NHS. One thing that is facilitating patient choice in maternity care is having a national set of maternity notes now, so that all women effectively have a transferrable set of notes that they can take from one unit to another. That is something that is being driven across maternity care, and I think that it will make a real difference if the location of care needs to change in the future.

I will also say something specifically about how we will ensure that we better implement the toolkit, which we agree is a good thing in driving up the quality of training available to neonatal nurses. Very shortly, I will be devising and helping to set up the Health Education England mandate, which will be responsible for training health care professionals in England; not just doctors but all health care professionals. A mandate will be established for how that body will operate and what it will prioritise as areas of training. I am very happy to give a commitment, just as we did on the mandate for the NHS Commissioning Board, to ensure that giving every mum the right support in pregnancy and every baby the very best start in life is something that we will look to incorporate in that mandate, to make sure that high-quality training is available for health care professionals involved in all aspects of pregnancy, birth and beyond, and of course neonatal care is an important part of that.

That is something that I will take away from this debate, to ensure that it is clearly an important part of the Health Education England mandate that we look very seriously at neonatal services, to help to iron out the unacceptable variability in training that we have identified. I hope that that is reassuring to my hon. Friend the Member for Daventry. I thank him for securing this debate, and I thank you, Mr Streeter, for chairing it.

Question put and agreed to.

Dementia

Guy Opperman Excerpts

Thursday 10th January 2013 Commons Chamber

[Guy Opperman (Hexham) (Con)]

These are, as Charles Dickens put it, the best of times and the worst of times. It is a time of plenty; it is a time of difficulty. It is a time of great medical advancements, and yet a time of a greater number of dementia sufferers. It is a time of conflict on the Floor, and yet a time of shared priorities and shared understandings of the difficulties that we all face. Any person who wishes to understand the House of Commons should have been present today when, to be frank, we have seen the best of the House. The hon. Members for Oldham East and Saddleworth (Debbie Abrahams) and for Bridgend (Mrs Moon) gave the finest speeches that I have heard for some time, and the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry) made the best intervention by a Minister that I have heard for a long time and for which we will all be grateful to her. These things are remembered in this place.

Members of my family have suffered from dementia and anybody who has suffered from a brain tumour, as I have, will know of the insidious creeping of memory loss, the loss of brain function through neurodegenerative disease and the huge difficulties that those things entail. I am very fortunate that I had the operation, recovered and am, I like to think, better than I was previously. I believe that my experience gives me a unique insight into the early onset of the brain disorder that constitutes dementia. It is a terrible thing. It is a harrowing, upsetting and difficult thing to have to deal with.

I will speak about the reality in my constituency, but I am having to abbreviate my speech massively. Tynedale, which I represent, is a dementia-friendly community with well over 1,000 sufferers. It has outstanding GPs, care homes and hospices, and an NHS community that is doing a fantastic job. I pay tribute to Age Concern, Headway and the Alzheimer’s Society, which do a great job. I also pay tribute to homes such as Wellburn House in Ovingham, Helen McCardle Care’s Acomb Court, the Abbeyfield homes in Corbridge and Ponteland, and Tynedale Grange in Haltwhistle, all of which provide exemplary elderly care and do all that they can to assist those who are suffering from the onset of dementia.

Ever-increasing work is being done by the national health service. As I said at the outset, it is good that there is greater understanding of this problem and that attempts are being made—of course, we all want more to happen—to provide the analysis and research that are so desperately needed for a true focus on neurodegenerative disease. Surely the most difficult part for the Government is to have joined-up services. We can talk about individual good examples from communities up and down the country, but until there are joined-up medical services, provided on a multitude of bases to individual patients, we will always struggle. That is the most important thing for the Government to work on, even if they do nothing more.

Like others, I welcome this debate. It does great credit to the Backbench Business Committee and to the right hon. Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) and others who have promoted this issue.

The Prime Minister has had the guts to stand up and make sure that people understand that dementia is no different from cancer or heart disease—it is a fundamental disease and a killer. However, because it is unseen and intangible, it is difficult to comprehend the problems that it entails. I welcome the increased funding.

I want to make three points in my abbreviated address. The first is about the need for joined-up Government. There must be ways in which Government can advise, cajole, improve and give assistance to the various providers at the various stages in the system, such that all their individual efforts become a collective effort.

Secondly, I welcome the fact that intellectual stimulation is still seen as the best method of preventing degeneration in cases of dementia. In that respect, we must be careful not to become too accountant-focused in the provision of health care services. I made my name as a pro bono lawyer fighting the decision to close services at Savernake hospital. I regret to say that the previous Government were involved in that, but other Governments have done such things in the past. We have to focus on the parts of the health care system that are providing the intellectual stimulation that is the preventive in these matters.

Finally, I represent a community that contains one school with a catchment area roughly the size of the area inside the M25. West Northumberland is the least populated part of the country and rural health care is monumentally more difficult than urban health care. I do not dispute that these matters are difficult everywhere, but if someone is two hours’ travel from a hospital or an hour from their local GP and has problems on an ongoing basis, it is immensely difficult to provide health care. The Government must bring their attention to bear on how they can assist NHS organisations in the provision of rural health care in the future, and on how to tackle this insidious and terrible disease.

Mental Health Act 1983

Guy Opperman Excerpts

Monday 29th October 2012 Commons Chamber

[Mr Hunt]

The truth is that no one in the Department of Health knew that this irregularity was happening. I do not think that anyone in the system knew that it was happening, until the issue arose in Yorkshire and Humberside when a particular decision was challenged. However, the hon. Gentleman is right: there is an important question mark over why it was possible for the irregularity to continue for so long without being noticed. I think that we need to listen to what Dr Harris says about why he believes that it was possible for it to continue for so long, and to act on his advice.

[Guy Opperman (Hexham) (Con)]

I declare an interest, as someone who represented a number of individuals under section 12 of the Mental Health Act—and also as someone who is owed money by the state for the work that he did on behalf of such individuals three and a half years ago, but I leave that to one side.

I welcome the drafting of retrospective legislation to resolve this problem, but has advice been obtained on whether the section 12 patients will retain any right to challenge their original detention procedures by way of judicial review?

[Mr Hunt]

My hon. Friend makes a very important point. All the patients’ rights to challenge their detention are preserved, with the exception of their rights relating to the technical irregularity over the authorisation of doctors under section 12. If they are challenging any other clinical or legal due-process decision, they are free to continue to do so: that will be completely unaffected by the retrospective legislation.

Community Hospitals

Guy Opperman Excerpts

Thursday 6th September 2012 Commons Chamber

[Dr Wollaston]

I wish to make the case for reinvigorating community hospitals as hubs for delivering the right care at the right time and in the right place. Of course, the right place, where possible, will always involve helping people to be independent in their own homes, but community hospitals have a vital role, through both step-up and step-down care, in helping to maintain that independence.

We should look at what community hospitals are capable of, because they are not just about in-patient beds: they provide a full range of diagnostics, minor injuries units, therapies—physiotherapy and occupational —and mental health care. In my constituency, people with cancer can access chemotherapy at Kingsbridge hospital, saving them a long roundtrip to Derriford hospital. Kingsbridge hospital—South Hams, I should say—supports a triangle centre helping people and their families living with cancer, while organisations such as Rowcroft hospice are looking to expand their care-at-home system through hubs in community hospitals and, at times, by utilising their beds and support. We can get so much more from community hospitals if we reinvigorate them.

We should not think of community hospitals as backwaters; they can be centres of great innovation. The nationally recognised Torbay pilot, which provides care based in the community, started at Brixham community hospital in my constituency and is now being considered for nationwide roll-out. That is a very good model.

[Guy Opperman (Hexham) (Con)]

I congratulate my hon. Friend on securing this important debate. She mentions the Torbay model, which is rightly a pilot and flagship for the integration of services, but does she envisage a situation in which not only are medical services integrated in one location but other emergency services can come together? The result could be enhanced training for people, such as firemen and policemen, who could qualify as paramedics and assistants to the medical services.

[Dr Wollaston]

Indeed I do, and there are many community hospitals that support first responders in the way my hon. Friend describes. That is an important role, and there is perhaps even an extended role in housing, where step-down housing can enable people to make the transition back to full independence. Indeed, there are many such roles.

What are the current barriers to providing the right care at the right time and in the right place? I would like the Minister to deal with five points. First, the biggest challenge we need to address is the tariff and tariff reform. She will know that most acute hospitals are paid through a system known as payment by results, which creates some perverse incentives, whereby acute hospitals want to hoover up as much activity as possible. Often, people are treated in an acute setting when they could be more appropriately cared for in a community hospital setting or at home. Can the Minister update the House on the progress we are making on reforming the tariff, by, say, working towards a “whole year of care” model or looking at other ways to remove the incentive in the system that means that people cannot be transferred into community hospitals or provided with the right care in the right place?

--- Later in debate ---

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

I thank the hon. Member for Totnes (Dr Wollaston) and the Backbench Business Committee for securing this important debate. We can see from the number of hon. Members across the Chamber who want to talk about this that it is a valid and timely debate. I also welcome the Minister to her new position in the Health team.

As many hon. Members and the Minister of State will know, community hospitals play a vital role in my constituency; Guisborough hospital and East Cleveland hospital are essential to East Cleveland’s health and well-being. I was privileged to secure an Adjournment debate on the future of community hospitals in the north-east on 20 June. While it was certainly good to hear from the hon. Member for Hexham (Guy Opperman), for instance, about the good work that community hospitals do in his constituency, it was clear from other hon. Members that some community hospitals are struggling. A general consensus was apparent to me that patient choice is key to this whole matter. While patients should be able to receive care at home, that is not necessarily what patients always want, and it is not always necessarily appropriate. Community hospitals therefore have a real role in providing care to such people, as well as in the provision of out-patient services, especially in rural areas.

With the Health and Social Care Act 2012 causing reorganisation that has cost the local NHS tens of millions of pounds on Teesside alone, it is perhaps not surprising that many trusts appear keen to centralise services to larger hospitals. In my constituency, we have already seen a significant reduction during this Parliament in the services available at Guisborough hospital, with the closure of the Chaloner ward and a reduction in minor injuries provision. Similarly, constituents have told me that they have been unable to receive the services that they need at East Cleveland hospital in Brotton. This is deeply worrying, as more than 50% of my constituency is rural, and I know how constituents without a car can struggle to attend hospitals further away, such as the James Cook university hospital near Marton, Easterside and Park End in the south Middlesbrough part of my constituency.

I know that this problem is unfortunately replicated around the country. In the South Tees Hospitals NHS Foundation Trust area alone, a district general hospital in Northallerton—the Friarage—and Redcar’s primary care hospital are facing problems due to the centralisation of services. With the reallocation of public health funds as well, which are used primarily for community nursing, we are seeing what I can only describe as a vice-like grip between the reduction in services in community hospitals and the reduction in funding for community nursing, especially for palliative care for elderly and vulnerable people.

[Guy Opperman]

I accept that the hon. Gentleman is a champion for his constituency, but he surely accepts that this is a process that started under his Government. For example, his maternity unit closed in 2006, so it is not something new.

[Tom Blenkinsop]

I can tell that the hon. Gentleman has a good memory, because that point was raised in my debate. While many services at that hospital have been closed in recent months, the maternity services at Guisborough were centralised at James Cook and the community was consulted on that. However, I did not see any proper community consultation when services at East Cleveland hospital and Guisborough were very much reduced.

Also, a massive number of long-serving, skilled nurses, mainly women, have been leaving Guisborough hospital before reaching retirement age. That is very worrying. They are choosing to go to other hospitals or simply to leave their careers altogether. The trust acknowledges that this is happening, and the reasons include stress, a lack of available nurses on the wards and the low-paying contracts being offered.

This seems to involve a central funding issue for the trust. The James Cook University hospital is now consulting the community on privatising wards at the hospital. So, while the trust is centralising services away from the community hospitals, it is also trying to find other funding sources to pay for the services that it has centralised. That suggests that this is a central funding issue and nothing else.

I sincerely hope, for the sake of my constituents, that the Minister takes urgent action to address the problems faced by district, general and community hospitals. Such action should include commissioning a database of information on what they do, providing trusts with the funds that they need to secure the future of those hospitals, and replacing the money that they have been forced to waste on an unwanted, unnecessary, top-down NHS reorganisation.

--- Later in debate ---

[Anne Marie Morris (Newton Abbot) (Con)]

I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing this debate. We are discussing an important topic and there are many wide-ranging issues to be addressed. I also congratulate the Minister on having been appointed to her new role. We all look forward to working with her.

Community hospitals do not just provide excellent clinical medical care. They are also places where patients feel the warmth of the community, which adds to a sense of well-being that is also part of their recovery. One reason why people feel so strongly about having community hospitals close and accessible is because it means friends and relatives can attend, which helps to make patients feel well. That is not just emotional clap-trap.

My hon. Friend the Member for Totnes put her finger on a key point when she said that this is about the community and trying to extend and expand the range of community services that are available. My community hospitals in Teignbridge are going from strength to strength, and there is a move towards integrating social and health care. That will be the salvation of community hospitals in the future. I support my hon. Friend’s comments about volunteers, too. The league of friends and the community transport in my three hospitals are first class. Without them, our community hospitals would not be nearly as successful and happy.

My three hospitals are quite different, but they all have minor injuries units and X-ray facilities, and provide a variety of services to the old and the young. Dawlish was the first private finance initiative hospital ever built, and patient surveys consistently put it in the top three of the 22 Devon hospitals. Remarkably, Teignmouth still has an operating theatre, as well as a physio unit funded by the league of friends—well done! Newton Abbot got the 2007 PFI deal of the year. Unusually, it has a maternity unit, as well as a first-class stroke unit.

My hon. Friend the Member for Totnes also raised the important issue of ownership. I raised this matter last year in a Westminster Hall debate. It is crucial that we get clarity about how ownership is to be managed once the asset is transferred from the primary care trust. In the case of Teignmouth hospital, the property is owned outright by the PCT. As I understand it, that property will be transferred to NHS Property Services Ltd. My local community has put in £850,000, so how does it feel about that? What will happen on future fundraising? Will the money just go into a central pot? What terms and conditions will be imposed on the service provider?

The situations at Newton Abbot and Dawlish are much more complicated, because those hospitals are the subjects of PFI contracts. That means that the buildings are owned by a private contractor and are, in effect, rented out to the service provider subject to two charges, an availability fee and a service charge, both of which have historically been extraordinarily high. In those cases, the contracts will be transferred to the NHS Commissioning Board. That raises a number of legal questions about the validity of the transfer, given the nature of that contract, and about the ability of the new owner to renegotiate the contract. Why do I talk about renegotiation? I do so because it is well known from evidence in the press that some of the charges that have been levied are disproportionately high. What can we do to enable such a renegotiation? Clearly it will be completely inappropriate for a local trust provider to undertake such a renegotiation, so will the NHS Commissioning Board do it?

My hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) has been brilliant in raising a campaign to look at renegotiating these contracts. The Government have already started to look at the whole management issue of these contracts to see whether costs can be cut, and they reckon that a substantial saving has been made and 5% savings can be achieved. They have established a fund of more than £1.5 billion for this; that is the amount that any one trust can get over 25 years to assist with the blighting cost, but that can be obtained only in exceptional and historic circumstances. The fund has been used, but generally that has been in much larger cases involving much bigger hospitals; I cannot see a community hospital being able to pass the test of having exceptional and historic problems. So what can the Government do to help those hospitals blighted with the burden of a PFI contract? I have heard of hospitals that, under the service charge, have had to pay £333 just to change a light bulb. I am pleased to say that that was not the case in my local hospital, but my goodness me that sort of situation has to change.

[Guy Opperman]

My hon. Friend rightly raises the issue of PFI and asks what the Government can do. I would venture to suggest that the previous Health Secretary’s decision to approve the county council’s assistance to the health trust so that it could buy out the PFI contract that was crippling Hexham hospital is exactly the right way forward. Under that approach, a PFI arrangement is bought out and a much better financial basis is put in place—an ongoing future financial basis approved by all.

[Anne Marie Morris]

My hon. Friend makes absolutely the right point, but the tragedy is that few communities can afford that sort of buy-out. As he rightly says, if we could achieve that, it would undoubtedly be the answer.

All we need from the Minister is some clarity as to exactly how these properties are to be transferred; what the position with the local community will be when properties are owned by NHS Property Services Ltd; and what the position will be on the PFI contracts when they get passed across to the NHS Commissioning Board. Clarification on those matters would be helpful and it is now urgently needed, because local trusts that are looking at continuing to run these hospitals need certainty about what they are going to be including in their budgets, and the sorts of figures that the availability fee and the service charge take out are phenomenal. The availability fees at my local hospitals range from 18% to 35%; that is the fee simply to repay the funding costs of the overall PFI arrangement. The service charge can also be high, reaching 18% to 20%. Set against that, private investors are currently seeing returns of up to 50%. That is huge and it seems unreasonable. The previous Government entered into a voluntary arrangement whereby any excess profits, particularly as a result of contracts being bundled by external private bodies, should be shared between the taxpayer and the private investor.

All those tools, which are available for the Government, need to be used. We need certainty and manageable budgets so that our community hospitals can thrive and so that money is available for what we really need—the services.

--- Later in debate ---

[Guy Opperman (Hexham) (Con)]

At this moment, Mr Speaker, you must be feeling like Shakespeare’s Henry V at Agincourt, and I suggest you will look back on 6 September 2012 as the day when hon. Members in the Chamber heard many potential Ministers speak for the first time. We had the great honour and privilege of hearing my hon. Friend the Member for Totnes (Dr Wollaston). She is a doctor and spoke with great wisdom when she introduced the debate. The other doctor in the House, my hon. Friend the Member for Bracknell (Dr Lee), also made a fine contribution. We welcome to the Whips Bench my hon. Friend the Member for Guildford (Anne Milton), who formerly distinguished the Department of Health, and throughout the past hour and a half a plethora of Labour Members have indulged us with their oratory and commitment to community hospitals. Finally, I welcome the new Minister who, as you prophesied, Mr Speaker, has a glittering career in front of her. Those were fine words, although I believe that you also admonished her most robustly for being a little too chatty when she was a Parliamentary Private Secretary.

I strongly look forward to hearing the gentle, reticent, shy, self-effacing style that the Minister has characteristically formed throughout the past two and a half years as an MP. Some have described her as Nottinghamshire’s modern Boadicea of Broxtowe, which may stick in the future. If she is able to survive the cake-fests of south Dorset, and future requests to visit many a hospital, she will surely go far.

I must make a brief declaration because I would not be in this House were it not for my campaigning as a lawyer on behalf of community hospitals, and the fact that my grandmother was an NHS matron. Furthermore, over the past two and a half years, I have probably spent more time in hospital than any other Member of Parliament, conducting an in-depth study of all aspects of NHS treatment. Owing to the fact that I was not a very good jockey, I have conducted an in-depth study of orthopaedic skills because I repeatedly seemed to come a cropper at the second last at Stratford, and various other delightful destinations. I am also fundraiser for various charitable organisations in my constituency—the Great North Air Ambulance service and the National Brain Appeal.

The subject of the debate is community hospitals. Amid the requests for preservation, strengthening and support, I want to enlighten the House with some success stories. The Haltwhistle hospital in Northumberland—a small community hospital in the heart of the town—is being completely rebuilt. There have been efforts to rebuild it for many years, and that is now happening on the same site in exactly the right way. That is what all hon. Members would like for their community hospitals. People in Northumberland would suggest that its integrated care is the way forward. There are standard community beds and care beds, and even one room for the larger patient, which is known in the trade as a bariatric room. That is a proper, integrated, long-term local solution in the community, for the community and involving the community. That must be the way forward.

[Jessica Lee (Erewash) (Con)]

Ilkeston community hospital in my community is held in great affection. Recently, one ward closed—the decision divided opinion among local GPs. We need to examine what services are provided and remind local residents and patients what facilities are available and what procedures they can obtain locally.

[Guy Opperman]

I endorse entirely what my hon. Friend says and am sure the Minister has taken due note of her comments.

I want to sell and extol the groundbreaking decision in Northumberland in favour of the PFI buy-out of Hexham general hospital. The hospital was built and opened under the former Prime Minister—the right hon. Member for Sedgefield as was—with a substantial PFI that patently impeded its ability to function, but it is among the first in the country to have been bought out by the local community. The way forward must be to try to refinance and improve the financial situation of such hospitals.

Northumberland has a rebuilt community hospital and a general hospital at Hexham, which delivers all the services, including cancer care and maternity, that we would like in local facilities. That should continue, but the problem I want to raise with the Minister is the future of rural health care—the problem will also apply to my hon. Friend the Member for Penrith and The Border (Rory Stewart) and any number of representatives of truly rural communities. Community hospitals are clearly at the heart of that, but the way in which community hospitals integrate in rural health care is one of the significant challenges for the Department of Health in the next five, 10, 15 and 20 years. I suggest that the way ahead must be for rural health care to become more automated—we should provide computer facilities for prescriptions and check-ups—but we must also integrate facilities using examples such as the Torbay and Haltwhistle models. We should also attempt to provide paramedic and GP services in an integrated way. It is good that the hon. Member for Denton and Reddish (Andrew Gwynne), the shadow Minister, is in the Chamber, because that will take co-operation between the unions and between local facilities. Any problems should be overcome if we make the point that people in the community are helping one another.

The future of integrated services—health care, fire, police or ambulance services—must be addressed by whoever is in government. I strongly urge the Minister to come to Northumberland to see the flagship model of the health service and the great job that my trust is doing.

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[Andrew Gwynne (Denton and Reddish) (Lab)]

I thank the Backbench Business Committee for granting this important debate today and I congratulate the hon. Member for Totnes (Dr Wollaston) on the eloquent case that she made in opening it. I also congratulate and welcome the new Minister to her place. She was a slightly unconventional Parliamentary Private Secretary to the former Minister of State for Health, the right hon. Member for Chelmsford (Mr Burns). I say “unconventional” because, as the hon. Member for Hexham (Guy Opperman) observed, PPSs are usually seen and not heard. I am sure that she will be even more vocal now that she has the freedom to speak from the Government Front Bench, and I look forward to our exchanges in the coming weeks and months.

As many Members have testified today, community hospitals play an important role in the communities they serve. They provide rehabilitation and follow-up care, and they can help to move care, diagnostics and minor injury and out-patient services, among others, from acute hospitals back to the community. They provide planned and unplanned acute care and diagnostic services for patients closer to home, and contribute to the local community by providing employment opportunities and support for community-based groups.

It is clear that people generally prefer medical treatments to be taken nearer to their homes and families, whether that involves palliative care, minor injury services or maternity care, and those are exactly the services that community hospitals can help to deliver. Indeed, the Department of Health has estimated that about 25% of hospital patients could be better cared for at home or in the community.

Community hospitals usually also have good relationships with their local communities, and are often supported by local fundraising. We have heard from a number of hon. Members today about the great work being done by friends groups up and down the country. I pay tribute to those groups, and to the staff and volunteers who work to make those groups and the hospitals happen. Staff in community hospitals can also build personal relationships with local patients and carers as they deliver continuous care from outside the hospital environment. That is an important point that should not be overlooked.

It is fair to say that community hospitals continue to play an important part in local health care provision. Their role is valued, and we are right to support it. Labour continues to be committed to community hospitals, when they represent the best solutions for local communities. I take the point made by the hon. Member for Southport (John Pugh) that they might not be the solution everywhere. My own constituency is served by three large district general hospitals and not one community hospital, but I acknowledge that other parts of the country have a very different geographical make-up, and that community hospitals are the right way forward for the provision of health care in those communities.

Community hospitals can provide a vital step between social care and acute care, and Labour would seek to develop them further. For example, it might be possible for GP or dentistry services to be offered in more community hospitals, which could make some that are only marginally viable at the moment more viable for the future. That possibility should be explored.

Some concerns remain, however, and I hope that the Minister will be able to offer the House some reassurance today. One of the most pressing tasks for the NHS in the coming years will be better to co-ordinate services around the needs of patients, and that might well mean that community hospitals have to change the way in which they provide services and the buildings from which they provide them. She will know, however, of our concerns about the Government’s structural reforms, which will make the co-ordination and delivery of services far more difficult. We believe that the future requires the integration of care, yet the Government’s policies are driving us more towards fragmentation. We know that they are already having a profound effect on the NHS. A recent survey of NHS chairs and chief executives by the NHS Confederation found that 28% described the current financial position as

“the worst they had ever experienced”.

A further 46% said the position was “very serious”.

It is also clear that the financial challenge will continue for many years after 2015, and all this could have an effect on community hospitals, whether it be the reduction of minor injuries provision, the closure of wards or the downgrading of services. As the hon. Member for Bracknell (Dr Lee) suggested in what I thought was a thoughtful contribution, these can sometimes be the right choices for an area. Sometimes, however, they will not be and they will just be financially driven; here, there is a danger that community hospitals will provide an easy cut for bureaucrats.

[Guy Opperman]

The hon. Gentleman will be aware that 3,000 community beds in community hospitals were shut under the previous Government. Is he going to enlighten us about what his policy is, specifically in respect of any particular cuts to community hospitals? Is he in favour of them, against them, or is there no policy?

[Andrew Gwynne]

Community hospitals have a vital role to play. As we have discussed in the debate, however, they may not be the right approach everywhere. We remain committed to community hospitals. The last Labour Government introduced a fund specifically for them. It is fair to say that that fund was not automatically taken up by primary care trusts up and down the country. Some areas had different viewpoints on the role of community hospitals. The Labour party has a commitment to community hospitals where they are the right choice for the local communities.

A further point about the impact of the Health and Social Care Act 2012 is that with responsibility for commissioning health care services moving into the hands of clinical commissioning groups and with primary care trusts no longer being in existence, there is a real danger that the role of community hospitals could be overlooked. Will the Minister reassure us that community hospitals will not be unfairly penalised in the new internal market of the NHS?

We should bear in mind further issues about the possibility of creeping privatisation—an issue that we, at least, are concerned about. The whole health service is currently in a state of flux, but as the reforms in the NHS kick in, it is perfectly feasible for commissioning groups to look outside the NHS to the private sector to provide even more of their services than in the past. This has already happened in Suffolk in March, when Serco won a £140 million contract to manage, among other things, the area’s community hospitals.

It could well be that when trusts are faced with the choice of reducing clinical services, they will look to being more centralised for financial reasons and take services away from the community and, indeed, in some cases from district general hospitals, too. This will almost certainly have an effect on any extensions to these services in community hospitals. Clearly, community hospitals and other community health services need to be able to compete on a fair playing field with other health providers, and I would ask the Minister how she will support that practically.

I would like to ask about some of the additional funding arrangements in the NHS—an issue raised by the hon. Member for Totnes in her opening comments. Previously in the NHS, payment by results was introduced to finance care and treatment according to a national tariff. It was intended to reduce variation in the prices paid by different parts of the country and to encourage providers to do more work, particularly helping to reduce waiting times.

Community services, however, are not covered by payment by results and are instead paid under a block contract negotiated with the local commissioner. I know that some community hospitals are concerned that they will have to make greater budget reductions than providers covered by payment by results. Some community hospitals are concerned that the commissioner will reduce the size of the block contracts, which is easier to do than stopping activity under a tariff.

From April 2013, the NHS Commissioning Board and Monitor will set the national tariff, and we are encouraged that the Government have expressed an interest in expanding payment by results to community services. If payment by results is expanded, it must be done in a way that supports integrated care and does not disadvantage care that is delivered in a community setting. How will the Minister ensure that we do not have a pricing system that disadvantages care that is delivered in community settings and particularly in community hospitals?

Let me deal briefly with the issue of estate ownership, which has been touched on by a number of Members. Many community hospitals do not own the buildings from which they operate, which affects their ability to raise capital to create new services for patients because they cannot secure finance or loans against the value of their buildings. As we have already heard during the debate, earlier this year the last Health Secretary announced that a Government-owned firm, NHS Property Services Ltd, would take over the ownership and management of the existing primary care trust estate and dispose of property that was surplus to NHS requirements. Community hospitals will depend on the setting of affordable long-term rents by NHS Property Services Ltd. I hope the Minister will tell us how the firm will work with community providers, including social enterprises.

There should be no doubt that Opposition Members support the principle of community hospitals. Indeed, we rightly established a fund to support and develop the community hospitals that represented the best choice for local communities. A future Labour Government would also aim to develop community services further within community hospitals. For example, as I have already suggested, it may be possible for more GP, dentistry or other services to be offered by them, and I think that that opportunity should be explored further.

We are concerned about some of the wording of the motion, which calls for community hospitals to have

“greater freedom to explore different ownership models”.

We would need more details of any parameters before agreeing to such an arrangement. It could lead to an opportunity for further creeping privatisation of our national health service, which is something that the Labour party will not support or give carte blanche to. For that reason, Labour will abstain on the motion.

The motion also calls for a national database of community hospitals. Historically their number and location was not monitored, as that was a matter for primary care trusts. However, we believe that in the new NHS, with confusion over where responsibility lies, there may well be a case for a national database. We would be interested to hear more details of what the hon. Member for Totnes has proposed, because we believe that it could give some value to the Department of Health in the future.

We should pay tribute to the important work that community hospitals undertake, the quality of the health care that they give to local people, and the commitment and dedication of all their staff, from medical professionals to porters and cleaners. The Government should be doing all that they can to ensure that patients can make real choices about receiving the health care that they need near to their homes. It remains to be seen how the Government’s changes to our NHS will affect community services and community hospitals. I look forward to hearing from the Minister how she will protect the role of community hospitals, which are valued and must continue to have a role in the more integrated and people-centred health care system that I hope we all support.

Community Hospitals (North-East)

Guy Opperman Excerpts

Wednesday 20th June 2012 Commons Chamber

[Tom Blenkinsop]

There is an element of truth in what the hon. Gentleman says, but I will come to that when I make suggestions. Community hospitals have a role as part of an overall package, but I have seen an erosion of those services in my locality. The reason I have introduced this debate is that a pattern is emerging in the north-east and across the country in how services are allocated by trusts.

[Guy Opperman (Hexham) (Con)]

I applaud the fact that the hon. Gentleman has introduced this debate on behalf of north-east community hospitals. I want to address the issue of the quality of the service provided by them. We retain maternity services in Hexham. The service is so popular that Northumbria Healthcare NHS Foundation Trust has said that it is hopeful that more women will choose to have their babies there. Does he agree that that is an example of a community hospital going forward?

[Tom Blenkinsop]

I praise the hon. Gentleman—it sounds like the services in his constituency are going forward and doing very well—but I am addressing the broader pattern in my local area and elsewhere. Some worrying trends are a symptom of the Health and Social Care Act 2012, which I opposed vociferously—that is on the record.

The future of community hospitals is being plunged into uncertainty because of the 2012 Act. With responsibility for commissioning health care services now falling to clinical commissioning groups, and with primary care trusts being axed, centralisation is a real temptation both for the CCGs and for the foundation trusts that have taken over responsibility for the management of primary care hospitals in Teesside.

Another future scenario for community hospitals is the possibility of privatisation. As cuts are made, commissioning groups could look outside the NHS to provide their services. That happened in Suffolk in March, where Serco won a £140 million contract to manage, among other things, the area’s community hospitals. Neither the public, who cherish their NHS, nor workers, want that, and there is a concern that such deals are made solely to save money and not necessarily to improve patient care. In the north-east, where health inequalities are most pronounced, such moves could lead to a significant decrease in the quality of service offered, and to a loss of any long-term strategic vision that might exist to tackle such deeply ingrained public health problems.

When I challenged the Prime Minister about the future of community hospitals and district general hospitals at Prime Minister’s questions last week, all he did was cite a supposed increase in funding to the “primary care trust” in my constituency—he is so oblivious and out of touch that he failed to realise there are, in fact, two primary care trusts: NHS Redcar and Cleveland, and NHS Middlesbrough.

Regardless of what spin the Government put on the state of the NHS, it is clear that the NHS throughout the country is struggling financially. In GP magazine earlier this week, research collected through a series of Freedom of Information Act requests showed that nine out of 10 trusts find themselves “rationing” care such as cataract surgery and knee and hip operations. If trusts have to do that, there is clearly an issue with funding, despite the Government’s assertions, especially when trusts such as Redcar and Cleveland have to spend tens of millions of pounds to deal with the consequences of the 2012 Act.

I worry that many trusts, when faced with the real possibility of having to reduce clinical services, will turn towards centralising them and taking them away from community and district general hospitals. They will certainly be wary of extending the services offered in such hospitals. Redcar primary care hospital, which is in the neighbouring constituency of the hon. Member for Redcar (Ian Swales), needs such an extension, but the localisation agenda is threatened by the lack of funding necessary to pursue it.

The Health Secretary and Prime Minister need to remember the pledge they made in 2007 to protect district general hospitals, and to listen to what communities, patients and medical professionals are saying about the importance of securing the future of community hospitals. It would take some of my constituents, such as those in Cowbar, 45 minutes by car or around three hours by public transport to reach the large hospital 20 miles away into which services are being consolidated. I imagine the situation is even worse in more rural parts of the north-east and north Yorkshire. That is clearly not acceptable. Individual members of the Government, such as the Foreign Secretary and Minister responsible for care services, have been critical of the effect of the Department of Health’s policies on the provision of services in local hospitals following campaigns by angry and worried constituents, but it is time for the rest of the Government and the other Health Ministers to act. Steps need to be taken, and funding provided, to ensure that patients have the choice to receive as many services as is medically possible in hospitals near their homes, not as a replacement to care at home or in more specialised hospitals, but to complement it.

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) on securing this debate, and I pay tribute to NHS staff in his constituency, who do so much for the health and well-being of his and other hon. Members’ constituents.

Robust community services are a vital element of emerging models of care, providing treatment to patients closer to home and improving health outcomes. The Government remain committed to extending and improving access to care and treatment in the community and at home. This includes sharing best practice to enable the smooth discharge and transition of patients from acute settings to robust community services, allowing them to be cared for closer to home.

Community hospitals play an important role in that process. The care that Guisborough hospital provides includes rehabilitation and follow-up care in a community setting. Community hospitals have the potential to make considerable efficiency savings in the local health economy by shifting care, diagnostics, minor injuries and outpatient services, among others, from acute hospitals to the community. They provide both planned and unplanned acute care and diagnostics services for patients closer to home, support best practice in reducing the need for admission to acute hospitals and contribute to the local community by providing employment opportunities and support for community-based groups.

Those are a few reasons the community estate is a core part of the NHS. It can help to transform care pathways, moving care from acute settings to community settings. Local investment in this type of facility is part of a dynamic service model that supports health and well-being for the whole community. The hon. Gentleman will be aware that under the transforming community services programme, responsibility for community services was transferred from primary care trusts to NHS and other providers. To this effect, South Tees Hospitals NHS Foundation Trust took over the operation of Guisborough hospital in April 2011.

The transfer of community services enabled the NHS to develop new innovative models of care using local multi-disciplinary, clinically led teams to improve services and health outcomes for local patients, families and communities. This has enabled the NHS to be creative in its approach to delivering community services. However, I fully appreciate the context within which all NHS organisations operate. They have to provide high quality services while remaining sustainable and efficient in making the best use of limited resources. The Government recognise this challenge, which is why we have protected NHS funding and are increasing funding in real terms during this Parliament.

In the hon. Gentleman’s constituency, Middlesbrough PCT will receive an allocation in 2012-13 of more than £299 million, which is an increase of more than £8 million, and Redcar and Cleveland PCT will receive more than £269 million, which is an increase of more than £7 million. Despite this generous settlement, however, the NHS needs to do more. It needs to find up to £20 billion of efficiency savings over the same period to meet the rising demand for NHS services and to continue to invest in new technologies and drugs to help meet these demands.

We will not dictate from the centre how efficiency savings should be achieved. Decisions about local health services should be made as close to local people as possible. Local NHS commissioners are best placed to identify the scale of the financial challenge and the opportunities for making savings, while driving up and maintaining quality. Every penny of those savings can be reinvested in front-line services and health care.

[Guy Opperman]

An example of that, I would suggest, is Haltwhistle hospital in west Northumberland, which has been rebuilt by the local NHS trust to provide a hospital facility and an integrated care facility. Does the Minister agree that that is a good example of the Department and the trust supporting a community hospital?

[Mr Burns]

I am extremely grateful to my hon. Friend, because I understand that the campaign for that decision was kept up for more than 25 years. I congratulate NHS North of Tyne, Haltwhistle council and the friends of the hospital, as well as my hon. Friend, for all their work in ensuring that it is finally happening.

Oral Answers to Questions

Guy Opperman Excerpts

Tuesday 27th March 2012 Commons Chamber

[Guy Opperman (Hexham) (Con)]

8. What his policy is on the rationalisation of PFI deals in the north-east for the purposes of making savings on long-standing PFI hospitals; and if he will make a statement. [R]

[The Secretary of State for Health (Mr Andrew Lansley)]

Any plan to rationalise a PFI contract, such as that being considered by Northumbria Healthcare NHS Foundation Trust, would be a local decision. Any trust will need to satisfy itself of the value for money of any proposal. Northumbria Healthcare is a foundation trust, so Monitor is also considering its plans.

[Guy Opperman]

Many hospitals around the country are struggling under PFI debt. What plans does the Secretary of State have to ensure that other types of organisations, aside from Northumbria NHS Foundation Trust, will benefit from the new deal, just as my constituents in Hexham are?

[Mr Lansley]

I am grateful to my hon. Friend. We have recently made it clear that where there is unsustainable PFI debt—as is the case for seven PFI contracts—we stand ready to support those trusts in meeting some of those costs, which we inherited from the last Government. Beyond that, working with the Treasury, we have undertaken a pilot project that has demonstrated how 5%, on average, can be taken out of the cost of PFI contracts through the better management of them. I hope that will be applied across the country. I welcome, as I know my hon. Friend does, the way in which Northumbria Healthcare, with its local authorities, is looking at resolving its PFI debts, and if that represents value for money, I am sure that others across the country will benefit from the experience.