Community Hospitals

John Whittingdale Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Mr John Whittingdale (Maldon) (Con)]

It is a pleasure to serve under your chairmanship, Mr Owen. I too congratulate my hon. Friend the Member for Dover (Charlie Elphicke) on obtaining this debate, and add my congratulations to the Minister on his appointment.

Every speaker so far has talked about the value of community hospitals. I do not want to repeat what has been said, but I utterly endorse the tributes that have been paid to the dedicated staff who work in those hospitals, the intimate care that they are able to provide to patients—sometimes lacking in very large, more general hospitals—the proximity they have to communities and the fact that patients can be visited by relatives and friends much more easily. All those factors are real strengths that contribute to faster recovery times.

I am afraid that, like every Member, I will talk about my own experience of my local community hospital in Maldon, St Peter’s community hospital, which is greatly loved. Like many, it offers out-patient treatments, has rehabilitation beds and offers therapies. It also has a maternity unit. In my early days as a Member of Parliament I marched down Whitehall with the local protest group in defence of that unit when it was suggested that it might close. I am pleased to say that it did not and is still there; although I cannot personally say that I have contributed to its work, my hon. Friend the Member for Witham (Priti Patel), who I am sure would be here had she not become a Minister, had her first child in the Maldon hospital maternity unit.

Like many community hospitals, however, it is an old building. It was built in 1874 as a workhouse for 450 inmates. Although it has had various refurbishments over the years, it is not really fit for purpose. It is in poor condition, with leaks in the roof, and there is a possibility that it could be declared unsafe. Everybody realises that services cannot continue there for much longer.

For almost all the time that I have been in Parliament, therefore, we have been discussing how best to replace the hospital—whether to rebuild on the existing site or to build a brand new community hospital. Various options have been put forward. At one point we thought we had an agreement, but then it was discovered that nobody could quite work out who owned the land on which the new hospital was to be built, so that agreement fell through.

We now face a serious problem: as the Minister may know, mid-Essex has one of the most severe financial problems of any area in the country. It is largely an historical problem that has come about through the formula for funding allocation and has been compounded by a private finance initiative scheme that is draining money out of the local health budget at our main general hospital in Broomfield. We have to look at more imaginative solutions: it is clear that it is unlikely that the local health service will be able to afford the capital cost of a new hospital and we have had our fingers burnt by PFI once before.

We are looking for a new solution, and one has appeared; I will describe it briefly and invite the Minister to endorse at least the principle behind it. The Maldon district, like many, has a severe housing need—we need a lot of new houses. The district council is preparing a development plan, which is now before the planning inspectorate. The development of new housing offers opportunities and a scheme has been suggested for a housing development that will bring with it a new hospital for the NHS, built by the developers at zero capital cost. Indeed, the scheme offers an even greater potential benefit, as not only will a new hospital probably be cheaper to run than the very old existing hospital, meaning that the revenue costs may be reduced, but it will free up the site of the existing hospital, which will be available to the NHS for potential sale for development and could therefore raise some money. It is potentially a win-win situation: Maldon will get a brand new hospital and the houses that, although they are controversial, there is no doubt we need, and the NHS will have additional resources and a hospital that is more up to date and cheaper to run.

Obviously the scheme still needs a lot of work. There are questions over who will own the new hospital building—whether it ought to remain in the developer’s ownership and be leased to the NHS or be passed to the district council—and it has to go through the planning process. At the moment, we are also wading through the treacle of NHS bureaucracy: dealing with the NHS Property Service, with the CCG, with the Mid Essex hospital trust and with Provide, which used to be called Central Essex Community Services. But everybody who looks at the scheme can see the potential to provide, at zero cost, the new hospital that my constituents so desperately need.

Although the Minister cannot get involved in the detail of the scheme, I hope that he can at least express general support for that kind of imaginative thinking, which will ensure that we have a new community hospital for the future. I also invite him to think about that model, which could well be applicable in many other areas.

[Several hon. Members]

rose—

--- Later in debate ---

The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman): Thank you, Mr Owen. It is a great pleasure to serve under your chairmanship in my inaugural appearance on the Front Bench on this subject. I thank hon. Members for their kind words of congratulation and welcome on my appointment.

I congratulate my hon. Friend the Member for Dover (Charlie Elphicke) on securing this debate and on his tireless work on this matter and the wider subject of social engagement and community ownership of public resources. I pay tribute to his work in his constituency, particularly on securing the future of the Victoria hospital in Deal.

Several hon. Members who are not here at this well attended debate, such as my hon. Friend the Member for Thirsk and Malton (Miss McIntosh) and my right hon. Friend the Member for Berwick-upon-Tweed (Sir Alan Beith), continue to support their local community hospitals through their constituency and parliamentary work. I extend my thanks to all hon. Members. It is wonderful to see so many of them here today representing their own community hospitals and the wider cause.

We have heard a range of excellent contributions from a distinguished and committed group of hon. Members, including two doctors—the Chairman of the Select Committee on Health, my hon. Friend the Member for Totnes (Dr Wollaston), and my right hon. Friend the Member for North Somerset (Dr Fox)—and my right hon. Friend the Member for North West Hampshire (Sir George Young), my hon. Friends the Members for Stroud (Neil Carmichael), for Congleton (Fiona Bruce) and for Maldon (Mr Whittingdale), and the hon. Members for Upper Bann (David Simpson) and for Strangford (Jim Shannon).

We have heard some important reasons why community hospitals and local health care facilities matter so much, and I will highlight and reinforce them. We have heard strong views about the invaluable role of community hospitals, clinics and local health centres in our communities; about the benefits of community engagement and patient voices in health care that flow from them; about the potential for community hospitals to be hubs of social care, intermediate care and recovery beds; and about the role of community hospitals in easing pressure on expensive clinical and bed space in our acute hospitals. Some colleagues have made the point that big is not always best in health care. We have also heard about the importance of integrating social care and health care, which is a Government priority, as is the role of local centres in facilitating that; the impact of reconfiguration on recruitment; the important role of community hospitals in providing respite care beds; and the strength of patient support and community voice in support of hospitals.

We have heard some important examples of imaginative new thinking in Dover, Maldon, Andover, Congleton and elsewhere, and of the risk of fundraising being channelled to the big, the professional and the remote by excessive bureaucracy and complexity. We also heard an important point about transparency and evidence-based, jargon-free language in consultations, the absence of which militates against the small, voluntary and local community.

I want to start by signalling that all Ministers in the Department of Health acknowledge absolutely the great benefits that community health care, hospitals and health centres provide to our communities. I will speak about the role we foresee them playing and highlight how our NHS reforms are changing the NHS in a way that should help to support more local and community facilities, putting in place specific protection for community hospitals. I will try to address some of the specific points that have been raised, and if time prevents me from doing so, I will write to colleagues to deal with points that they have raised.

We should remind ourselves about what community hospitals are and why they matter so much. They are local hospitals, units or centres providing an appropriate range and format of accessible health care facilities and resources. There are around 300 in England and they are overwhelmingly owned by NHS trusts, foundation trusts and NHS Property Services Ltd. Where they are wholly owned by the NHS and are needed for service delivery, they will remain in NHS ownership and will not be sold for profit. The sustainability of a community hospital is down to the decision making of local NHS commissioners, regardless of who owns the hospital.

Community hospitals can be invaluable assets that make it easier for people to get care and treatment in their community, as we have heard, closer to where they live. They allow large hospitals to discharge patients safely into more appropriate care, freeing up hospital beds for people who need them urgently, and they allow many patients to avoid travelling to large hospitals altogether, providing a wide range of vital services, from minor injury clinics and diagnostic services to intensive rehabilitation.

Therefore, people are often very protective of their local hospital, and with good reason. In many cases, they deliver a range of essential services, as well as providing employment for local people and often space for community groups and associated members of what one might call “the health big society”. It is understandable that community hospitals are fiercely defended and inspire such loyalty, and that support for local facilities is a sign of the growing appetite for the quiet revolution of patient empowerment and health citizenship at the heart of our vision of a 21st-century health service. That is why everything we are doing in central Government is designed to support local clinicians and patients to change and shape their local NHS for the better, making improvements to primary and community services to suit local needs.

As a result of the Health and Social Care Act 2012, PCTs have been abolished and responsibility for commissioning services has, as we know, moved to clinical commissioning groups and local clinicians are now in control. CCGs are free to commission services that they judge provide the best care and outcomes for their patients and free to work out which services are needed and where they should be located to best meet local needs. With strong local patient and clinician input, the CCGs will also be able to decide which providers are in the best position to offer those services. They—and, I am delighted to say, not the Ministers at the Department of Health or officials at NHS England—will determine whether a community hospital remains open and what services it should provide.

With the abolition of PCTs in April 2013, ownership of a significant number of community hospitals changed. Some were transferred to local NHS trusts and NHS foundation trusts. Other hospitals went to NHS Property Services, the Department of Health-owned property management company. I know some hon. Members—some not here today—have concerns about some of those transfers, which I want to touch on. I want to make it clear that the conditions applying to those transfers mean the hospitals will not be closed unless commissioners determine that they are no longer fit for purpose. As with all decisions about local patient services, it is absolutely right that those decisions are taken locally, taking account of local views.

Sometimes tough decisions need to be taken. Buildings become tired and inefficient. New and better treatment, diagnostics and technological innovations are transforming the way in which health care is delivered, and, of course, communities grow and evolve. It is understandable that sometimes old infrastructure, though much loved by the community, cannot always keep up with the community’s needs. It is right then that commissioners explore how services can continue to be delivered efficiently and accessibly to patients.

That could mean decommissioning a hospital, in part or wholly, and moving some services even closer to the community. It could mean extra investment to modernise and develop existing community hospital centres, such as the development of the new Buckland hospital in the constituency of my hon. Friend the Member for Dover. These are tough decisions about meeting the changing health needs of the local community in the decades to come and it is absolutely right that they should be taken locally, driven by what is best for local people.

I am well aware that some hon. Members have been asked by their constituents about promoting community ownership of hospital assets in order to save at-risk or surplus hospital and clinical space, and I emphasise that all NHS property decisions are driven by clinical decision making by the CCG, and not the other way round.

First, under statutory provisions, while a building is needed to deliver NHS services, no NHS organisation will be allowed to sell it off, so there is no question of useful NHS property being transferred outside the NHS. The commissioners decide that, not the providers. At the same time, that means that a community-owned company is unable to own the freehold of operational NHS property.

Secondly, current Government policy is that property that is surplus to the NHS and the wider public sector should normally be sold by auction or competitive tender. In such cases, a community-owned company would have the opportunity to bid for the property along with other interested parties, but there is no guarantee that the community-owned company’s bid would be successful. However, if they were successful, we need to be clear that it would be in circumstances where NHS commissioners would have already decided that the site is no longer required for health service delivery. It would therefore no longer be operated as an NHS community hospital, but that is not to say an alternative community use could be found for the site. I think that is a key point. We will not necessarily be helping our constituents in advocating community ownership where commissioners have taken a decision to decommission services at particular site.

In conclusion, I want to highlight that the Government and Ministers are absolutely committed to greater diversity, choice and local community influence in our modern NHS. We have taken steps to secure the sites of community hospitals and make sure they are used for the benefit of their community where there is an ongoing use for them. However, the lifespan of those hospitals is solely down to the decisions made locally by clinicians and service providers—the people qualified to make those decisions. That is the best thing for the hospitals themselves, and it is certainly the best thing for the communities we serve.

If my hon. Friends or any other hon. Members have raised specific concerns that I have not addressed or highlighted in my earlier comments, please—

[Mr Whittingdale]

Will the Minister give way?

[George Freeman]

I would be delighted to.

[Mr Whittingdale]

Just before the Minister sits down, I accept that decisions will be made locally, but I raise again the specific proposal that I suggested was under consideration, of obtaining a new hospital as a benefit of the development scheme. Although that is to be locally determined, it would help enormously if the Minister could at least smile on it and encourage that kind of thinking. If he would like to write to me once he knows a little more about it, I would be very grateful to him.

[George Freeman]

I am very grateful to my hon. Friend for flagging that point up. It was concealed within my list of exciting and imaginative bold thinking, but I did hear him and I would be very interested to pick that up. I invite him to write to me with the details.

The vision at the heart of our NHS reforms is of an NHS freed from the 20th-century model of health care in which health has been something done to the people we serve when government deems it appropriate, with the shape of health driven from the top down, to a model of 21st-century health care in which services are shaped by local priorities and greater freedoms to innovate and differentiate, combining the local, the personal and the voluntary with the general, the central, the specialist and the world-class. Exciting breakthroughs in diagnostics, remote sensing, e-health and telehealth, and in non-invasive new surgical and informatics technologies are driving new models of integrated health and social care. I believe that it is one in which local community-based hospitals, clinics and health centres will play a key role in the next century.