NHS: Cottage Hospitals

Lord Naseby Excerpts

Monday 13th October 2014 Lords Chamber

Asked by

[Lord Naseby]

To ask Her Majesty’s Government what plans they have to assess the possibility of all cottage hospitals, both current and future, being established on a mutual model.

[Lord Naseby (Con)]

My Lords, one has to look at this subject against the background of a Government who have taken through some of the biggest reforms that the NHS has had. On the whole, the analysis of those reforms is that basically they have gone down well, despite enormous challenges in the early stages. I say that because satisfaction levels for the NHS today are standing at a high level. It is to the credit of the Government that they have seen them through. Not least, they have provided proper money and resources for the NHS, as they said they would.

Nevertheless, one element is missing. It is the element that will provide the answer to the extreme pressure that A&E units are under up and down the country, basically because of rising demand for healthcare—which is not surprising when the population is increasing at the pace it is—and the fact that regardless of who is in government there will inevitably be tight budgets. That is what prompted this debate. Indeed, the missing link in our healthcare in this country is something that is not missing in much of the world. I say that having looked at a number of examples across the world, which I shall cite later. I refer to the cottage hospitals.

The reason why I was prompted to raise this debate at all was that back in April I used the 24-hour care telephone link and was asked to go to the Biggleswade Hospital, which is about five miles from where I live. I think that it was once a sort of cottage hospital; now the 24-hour unit is there, plus one or two other minor health services. It is in a pretty sorry state, quite frankly, and there have been numerous moves by the NHS to close it, but thank God it is still there. That is what prompted me to do something about this whole topic.

I asked myself whether there was a demand. Yes, there is. Are the public in favour? Yes, they are. Are the chiefs in the NHS in favour? Much to my amazement, when I did a bit of digging for this debate, I found that the new head of the NHS, Simon Stevens, said back in May—thankfully, after I had decided to table this debate—in his first interview:

“The NHS must stop closing cottage-style hospitals and return to treating more patients in their local communities”.

So the leadership is there and they are onside—that is great. There is a need, plus latent enthusiasm. The question is how we make it happen, organise it and pay for it. What should a 21st-century cottage hospital look like?

What I want to hear from the Minister is that we are going to do some blue-sky thinking. First, we should look at the case histories from around the world. I have looked at Holland, where the Dutch have basically decided that it has to be the local municipalities that determine what each and every cottage hospital does. There is not a formula set up from above; it is totally up to the local municipalities, which involve all the local organisations to decide what they want.

Then I looked at Singapore. I happen to be vice-chairman of the All-Party UK-Singapore Parliamentary Group, so I know a bit more about that in detail, and how good it is to see the president come here next week. They do it differently but, basically, they look at real value for money and really push down hard to make sure that whoever offers the service provides good value for money. Secondly, they have appointed a specific Minister for Wellness. I think that there should be a junior Minister with responsibility for cottage hospitals.

What is to be the catalyst? It has to be the community where there is the ownership; it means a structure where the organisation has involvement at a local level. To me it does not matter whether it is the public sector in terms of parish councils, town councils or district councils. I want to see voluntary groups involved as well as local medical charities and organisations such as Rotary. But you still have to have leadership somewhere, which means that we have to find leadership within those communities. Perhaps that will come from some of the GP practices, or maybe not. Perhaps we can enthuse the Deputy Lieutenants throughout our counties, but we have to find it somewhere.

I move to the nub of the problem—money. We have to find external capital to set up these cottage hospitals. Of course, I accept that the NHS has to determine what the facilities are that have to be provided and to provide the framework and template, but there is no money lying around for more cottage hospitals. That is where, in my judgment, the mutual movement has something to offer. Back in the 1930s, the mutual movement was highly involved through the friendly societies in setting up healthcare and was the backbone of healthcare provision.

I chaired the Tunbridge Wells Equitable Friendly Society for seven or eight years, and we tried desperately to get into healthcare, but we were unable to raise the capital to do it. At the moment, there is one particular friendly society that is at work—Benenden Health. Interestingly, it has announced that it is going to run a pilot with a local healthcare trust to extend the support of the NHS into the community, but it goes on to say:

“Lack of access to capital prevents mutuals exploring this potentially more significantly at present”.

I ask my noble friend to encourage his noble friend in the Treasury to support my Private Member’s Bill, which comes up on Friday 24 October. That Bill is geared to mutuals and mutual friendly societies and their ability to raise capital; it is geared to deferred shares—in other words, to the community. Perhaps we as Members of this House as well as local MPs and all the other leaders in the community can chip in 4,000 or 5,000 as a family unit to get these cottage hospitals going. A market rate will be paid on the interest, but it is locked in there—and that is good, because you want families to continue their association with these units. It is a very exciting opportunity. I have had encouraging meetings with a fair number of mutuals and friendly societies which say, “This is the answer, because then we can raise capital”. It is brand new capital; it has nothing to do with existing capital in the NHS. Without disclosing any confidences, I have to say, having had a meeting with the Treasury this afternoon, that things look encouraging, but you must never count your chickens before they are hatched. But this proposal would allow the local community to run an appeal and have a legacy programme, and it would allow the local community to tap into either the national lottery or the health lottery. Perhaps it is time that we looked more closely at getting the health lottery locked into something local throughout the United Kingdom.

There are so many opportunities, and it is possible to make it happen. Of course, someone has to do the groundwork—and I suspect that the Minister will tell me who is doing the groundwork at the moment. Perhaps an organisation such as the Nuffield Trust should set up a task force involving certain of the mutuals, and there should be a specific Minister, perhaps from the Opposition, because this is totally non-political. But to succeed, we have to tap into the community. I do not know about your Lordships’ local communities; all I know is that it is perfectly viable, as far as I can see, in east Bedfordshire. We live in a vegetable-growing area of the country, and I can see people wanting to look after the ground, the flowerbeds and vegetable patches, growing tomatoes and so on. There is a great drive there, but we have somehow to unlock it, and that is the whole purpose of the debate. It needs a great deal of thinking outside the box, but the building blocks are potentially there. It is politically neutral, and I hope that the details will be the catalyst to make it happen.