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Community Hospitals

Volume 448: debated on Wednesday 5 July 2006

In the White Paper “Our health, our care, our say: a new direction for community services”, published in January, we outlined our proposals to create a new generation of community hospitals and services. Today I am announcing that we will make available up to £750 million of public capital investment to realise that vision, and I am publishing guidance on how primary care trusts can access the money. A copy of the guidance has been placed in the Library, and copies are available from the Vote Office.

Developments in medical technology and clinical practice are making it possible to provide far more care in local communities, closer to where people live, and even in people’s own homes. During the unprecedented public consultation for “Our health, our care, our say”, people made it clear that, whenever it is safe and effective, they want more convenient, local and personal services, with more consultations, diagnostic tests and treatments in local facilities. Moving more services out of acute hospitals and into communities will help to improve care for patients, and will deliver better value for money for taxpayers.

We are already making a major investment in GPs’ premises and health and care centres, as well as in community hospitals. A billion pounds of capital has been invested through the NHS local improvement finance trusts alone. We will now take the next step by making up to £150 million of capital available in each of the next five years, starting this year—a total of up to £750 million—for the development of a new generation of community hospitals and services.

The investment capital will be available to PCTs for a wide range of community schemes, including the redevelopment of some existing cottage hospitals. Services could include in-patient and out-patient facilities, diagnostic tests, specialist clinics, minor surgery, health and social care services for people with long-term conditions, dentistry, rehabilitation and palliative care and other services. For people who are seriously ill or injured, or people needing complex treatments, care will of course remain in acute hospitals, where patients can be treated by specialist teams using the most advanced technology.

PCTs that want to use the new investment capital will need to engage fully with local people to ensure that services are truly designed for the needs of patients and users. They will also be expected to work closely with other local partners, including general practices and other NHS services, local councils, voluntary organisations and others in the independent sector, to develop effective plans.

I made it clear in the White Paper that decisions on the long-term future of existing community hospitals should not be made solely in response to short-term budgetary pressures that are not related to the viability of the community facility itself. I have asked strategic health authorities to assure themselves that all PCT proposals for changes to community hospitals are consistent with the long-term strategy of the White Paper: to move care closer to patients’ homes, and to ensure that local people have been properly consulted.

Ultimately, however, changes in the configuration of local health care services in a particular area require local decision making. Primary care trusts, with their broad perspective across hospital, community and primary care, are best placed to make those decisions in consultation with local people and their SHAs. The new investment fund will make it easier for PCTs to establish the right services in the right places for the people whom they serve.

PCTs will be able to choose how they use the newly available capital, investing it simply as public capital, extending the scope of their local investment finance trust schemes or adopting a new approach: the community venture, a more flexible joint venture approach that will give a wider range of public, voluntary and private parties an opportunity to pool their skills, or indeed their investment, for the benefit of the local community. It will, however, be for PCTs to decide which model is adopted. Whichever one is chosen, PCTs will of course need to demonstrate that investment proposals are sustainable and can be funded over the longer term. As we said in the White Paper, we expect to see a strategic shift in how the NHS provides care, with a redirection of funding to support the provision of more convenient services in local communities.

PCTs that already have advanced plans for community services, as many have, should submit them to their strategic health authorities by the end of September. For schemes that are ready to start in the next financial year, proposals should reach the health authorities by the end of December. After that, there will be a regular rolling programme managed through the SHAs.

This new programme builds on the unprecedented investment that we have already made in the NHS. It will help to ensure that there are even better services for patients, with better value for money, and I commend it to the House.

I am, of course, grateful for advance sight of the Secretary of State’s statement, although it has all been trailed in the press beforehand, as usual. The Secretary of State once again claims that she is the saviour of community hospitals. [Laughter.] Well, Labour Ministers have been saying that for four years. The right hon. Member for Darlington (Mr. Milburn) said exactly the same thing in 2002. However, within recent months 80 community hospitals have been under threat of closure or partial closure.

In January, the Secretary of State said that community hospitals would be safeguarded by the White Paper. Why has that had so little positive effect? We discovered last week with the abortive notice in the Official Journal of the European Union that the Secretary of State’s policy is not even understood in her own Department. As a result of the White Paper, we also know that her policy is not understood or not listened to across the NHS. Why are they simply ignoring her?

The threat to community hospitals is little diminished since January. For example, in Wiltshire, services have already been lost at Westbury and Bradford-upon-Avon hospitals, and there are threats to Warminster, Melksham and Trowbridge. The Secretary of State talked about the review process, but the strategic health authority in Suffolk did the review process on proposals in the area and said that it would close Walnuttree hospital, St Leonards hospital, the Sage day hospital in Newmarket, Hartismere hospital, the Hayward day hospital in Ipswich and Bartlet hospital, and reduce services at Aldeburgh hospital. That is the result of the review process that that Secretary of State says will happen as a consequence of her White Paper.

The Secretary of State now offers a capital fund. In some circumstances, capital for rebuilding or refurbishment will be useful and I welcome that. However, can the Secretary of State explain what proportion of this fund will go into providing health centres—her so-called polyclinics—for GPs and out-patients, rather than existing community hospitals that continue to provide in-patient services? Last year the NHS had capital that it did not spend. The underspend on capital budgets by the NHS last year was £1,165 million. The NHS has capital: it is overspending on revenue. PCTs are cutting revenue and contracts. Community hospitals are closing because their primary care trusts will not commission services from them, because of the revenue shortfall. Can the Secretary of State explain how a capital fund can be a solution to a revenue problem?

If the Secretary of State wanted to support community hospitals in the way they need it, she would ensure that the plan in the White Paper for unbundling the tariff happened now—not in 2007-08. Will she do that? Will she also ensure that the tariff is split so that part of the payment for patients who are stepped down from the acute sector goes to the community hospitals where they are sent? Will she also confirm that decisions about community hospitals will be reviewed in the way that she describes and will be made specifically in consultation with, and with the agreement of—if they offer it—local GPs? In theory, from the end of this year, practice-based commissioning should mean that GPs decide where they want to commission services, but the PCTs are pre-empting that and closing services so that they will not be available for GPs to send patients to.

The Secretary of State said that the fund would be available to the third sector, including charities. I hope that the whole range of charities and voluntary organisations will be able to bid. She mentioned community organisations and I hope that she will make it clear that local private sector and voluntary partnerships can work with GPs to take over community hospitals. Many such hospitals used to be locally owned, because they were established through public subscription. Will the Secretary of State ensure that the assets can be transferred to the third sector and out of the NHS, at a high discount, so that they can be owned and supported locally? That will be as important as the ability to bid on the fund.

No one can say that health care provision will not change. Care closer to home is a legitimate objective and has been for many years; that is what community hospitals offer. I know from my special interest in strokes that that is precisely what community hospitals can do; that kind of intermediate care bed is exactly what people need to step down at an early stage from an acute hospital. Under this Government, the number of such beds increased between 2002 and 2004-05, but they are now being shut down. There is a complete reversal of approach by the Government.

Why? Because community hospitals are being caught in a financial squeeze between rising costs in the acute sector and the cost of meeting GP contracts. We told the Secretary of State last year—she admitted it in January—that short-term financial pressures are forcing decisions that are contrary to the long-term interests of the NHS. Unfortunately, that is still happening and she needs to take more measures to stop it. She must give community hospitals the chance to prove their worth and GPs the chance to decide where patients are treated, and she must tell the House why the promises made in January have yet to be fulfilled.

The Secretary of State did not have the boldness to tell the House today what she told the Sunday Express last Sunday when she said:

“We want to make it as easy to access NHS treatment as it is to get a pint of milk. You can pick it up on your doorstep or go to a supermarket…All that’s needed is a bit of cash and encouragement.”

Well, back on Planet Earth we know what is really going on. I know what is happening in my own constituency, where services and wards are being shut at Brookfields community hospital in Cambridge; the young people’s mental health service is being shut down and the PCT is refusing to fund the hospice at home service. That is what is happening on Planet Earth. The Secretary of State should come back to Planet Earth and resolve those problems for community hospitals.

I thank the hon. Gentleman for a reply that was somewhat longer than my initial statement—[Hon. Members: “No, it wasn’t.”] Indeed, it was—[Interruption.] The Leader of the House was counting and I shall rely on him in the matter.

The hon. Member for South Cambridgeshire (Mr. Lansley) talked as though no new community hospitals and facilities had been opened under our Government, but thanks to the investment that we have been making, which Opposition Members voted against, new community hospitals have been opening in recent years; for instance, Withington hospital in south Manchester, Prospect Park in Berkshire, which I visited last week and which offers superb intermediate care, the new community hospitals in Edgware and Willesden and many others.

It is absurd of the hon. Gentleman to imply, as I think he is trying to do, that every one of the existing community hospitals is fit for a modern health service. The reality is that many are not. We have many existing cottage and community hospitals where, despite the absolute dedication of the staff, they are struggling with Victorian workhouse facilities that are wholly unsuitable in a modern health service. In some cases—

Let me give the hon. Gentleman the example of Norwich, which I visited a couple of weeks ago, where the local director of community services and his staff explained that they had had too many community hospitals and too many community hospital beds. They have reorganised services and closed two community hospitals, taken beds from a third and put the services into a new facility in an existing hospital. They have put more staff into the community, so they are looking after more patients in their own homes, as well as in the community hospital. They are giving patients better care, the staff have greater job satisfaction and they are saving money that can be invested in other services. That is precisely what the NHS in Suffolk, Norfolk, Gloucestershire, Surrey, and many other parts of the country that have been overspending, needs to do to provide better services for patients, with more modern, but quite possibly fewer, community hospital facilities and more services delivered to people in their own communities, all of it fit for patients in the modern world.

The hon. Gentleman asked how a capital fund would help deal with revenue shortfalls or overspending in some parts of the country. Yesterday, I had the opportunity to meet NHS colleagues, my hon. Friend the Member for Selby (Mr. Grogan) and people from the wider Yorkshire area. Their primary care trust has financial problems, but they are clear that, by reorganising services that are currently spread across three or four NHS and local council sites and putting them into one new community hospital, enabled by our new capital fund for which they will bid, they will be able to give patients better services closer to home and save the money that they need to save to live within their very substantially increased means.

The hon. Member for South Cambridgeshire mentioned unbundling the tariff. Let me restate our commitment to unbundling the tariff: we are working on that, and we will introduce a pilot next year. But it is already perfectly possible for PCTs to contract outside the tariff, thereby perhaps getting better value for money for the community services that they need. In any good consultation on new community services and hospitals, GPs will already be involved; they have to be involved, of course, particularly in anticipation of practice-based commissioning.

The full range of partners certainly includes the private sector. For instance, it delivers MRI scans in Withington community hospital in south Manchester, which has brought down the waiting time for such scans from months in some cases to just two weeks for most patients, with the report delivered to the GP 48 hours later. That is a superb service. The future of community hospitals can also certainly include the transfer of assets, where that is appropriate and agreed by the local NHS, to a local community charitable trust. That is precisely what is happening with the Wells-on-Sea community facility, which was proposed for closure, but which will now house community facilities. Through such organisations, the voluntary sector and the local community has an enormously important role to play in modern community hospitals.

The hon. Gentleman ended his speech by scorning the idea of more convenient medical services. The reality is that, with modern medical technology, it is now possible to offer, for instance, some chemotherapy services for cancer patients not only in a community hospital or health and care centre, but in their own home, which is far more convenient and much better for such patients. Renal dialysis provides another good example of that. Thanks to the investment that we are making in the NHS, this capital fund will enable that new generation of services to be provided to our patients.

I welcome my right hon. Friend’s statement, but is she aware of the “breathing space” project, which is being built in Rotherham? It will bring services for COPD—chronic obstructive pulmonary disease—patients in both the acute and primary sectors under one roof, so that we can treat such lung disease a lot better than it has been treated before. Although that means that the local district general hospital will lose beds and some services, as consultants will work in other places, it will lead to a massive improvement in patient care. Will my right hon. Friend make sure that patients—and the work force, as well—are consulted in all areas where we will have such changes to replace the great, big, all-singing, all-dancing district general hospitals of the past, which many patients do not need?

My right hon. Friend is absolutely right. We can move many services, particularly for patients with long-term conditions such as COPD, into the community and into patients’ own homes. As a result, we will give people better care. My hon. Friend the Member for Doncaster, Central (Ms Winterton), who is the Minister responsible for health services, has confirmed that she has visited the site for the new services mentioned.

In many places, decisions are taken to reduce the number of beds in acute hospitals because those services can be better provided for patients within the community. That also represents better value for money, which means more savings, as Norwich—to give just one example—indicated, so that money can be reinvested in better care for other patients, and also in the costs of some of the extraordinary new drugs that are coming on-stream, but many of which are also pretty expensive.

I thank the Secretary of State for her statement. It is always fascinating to step with her into the parallel world that she inhabits, where shiny new hospitals are delivered to a glad and happy local population.

Something puzzles me about the Secretary of State’s statement. When swathes of community hospitals are closed, the Secretary of State does not come before the House, but when they are about to be opened, she does. Can she explain why the closure of community hospitals is somebody else’s fault, but the opening of them is her responsibility?

Does the Secretary of State envisage that at the end of this process—at the end of her vision—there will be more community hospitals than the Government inherited? Can she also clarify whether she will be counting in her total figure former district general hospitals, such as Frenchay hospital, which will be reduced to a community hospital? Will we find that the Secretary of State comes back to the House to tell us that she has opened Frenchay community hospital, while overlooking the fact that she has closed a district general hospital?

The financing of the new community hospitals might be under the local improvement finance trust—LIFT—private finance initiative, or traditional forms of funding, but does the Secretary of State not accept that there has been much criticism of the value for money of LIFT as recently as this week, and of PFI? Is she confident that trusts will not be saddled with long-term financial burdens on over-the-odds terms, compared with more traditional ways of paying?

Is this process not yet another example of the centralism of this Government? Can the Secretary of State confirm that PCTs will need the permission of health authorities, which will need the permission of Whitehall? Where is the local democratic accountability in this process? Why cannot the Secretary of State let go? Why is there a control-freak tendency, so that when she talks the language of localism what she means is, “Whitehall will decide”?

The hon. Gentleman, for whom I have considerable respect, is talking rubbish today. Whether the local NHS decides to close certain community facilities because they are no longer the right ones for local people, or to open new or refurbished facilities because they are the right ones for local people, should be local decisions. What I, as Secretary of State, am doing is ensuring that the support is in place for such local decisions, and in particular that the capital investment is in place, which many parts of the NHS have told us that they need so that they can reorganise their services—sometimes their existing cottage and community hospitals—in order to give better services to patients.

The hon. Gentleman needs to focus on the services that are being delivered to patients, rather than on the number of buildings or beds, because not only in respect of acute hospitals, but also of some community hospitals, it is better for many patients if community services are taken into their own homes. That was precisely the point that the excellent nursing and care team in the Norwich community hospital made to me: by reducing the number of beds and putting half of the staff into the community, they were able to give intermediate and rehabilitation care to more patients, some of them in the community hospital, and others looked after by community staff in their own homes. Moreover, they had reduced emergency admissions to the acute hospital by more than 600 in the past six months, thus enabling savings of money that can then be reinvested in better care. That is what the hon. Gentleman needs to look at.

Of course I will open community facilities, as I did at Prospect Park in Berkshire last week, regardless of whether they replace an old district general hospital—or, possibly, old community hospitals—or they are simply new hospitals. The test in all of this, which I invite the hon. Gentleman to support, is to get the best services for patients with the best value for patients and for public money.

Blyth community hospital in my constituency is a wonderful community facility, but I have been told on the grapevine—not officially—that the minor emergency centre, which deals with minor injuries, is to close to save money. If we want to bring that sort of care nearer to the people, doing that is not the answer. I remind the Secretary of State that at least 35,000 people depend on this emergency facility; otherwise, they have to go five, six or seven miles to the next nearest hospital.

I am not aware of the details of the situation to which my hon. Friend refers, and as he suggested, at this point it is a rumour rather than a firm proposal.

I will, and I know that my hon. Friend will, too.

Of course, one question with minor injuries units is exactly how many local people are using them and whether they therefore offer the best services for the best value for money. I know that my hon. Friend will be closely involved in any consultation on a local proposal, and I will of course examine it and write to him about it.

Does the right hon. Lady realise that last week my constituents received the devastating blow of being told by the United Lincolnshire Hospitals NHS Trust that it proposes to withdraw all acute surgery, the consultant-led accident and emergency department and critical care from Grantham hospital? That news has caused consternation in my constituency, and I hope that I may shortly have the opportunity to speak to the right hon. Lady about it. Does she appreciate that today’s announcement that a capital fund is available for setting up community hospitals will be regarded as incomprehensible—and, indeed, hurtful—by my constituents, who have been told that they are about to lose their first-class district general hospital, even though no other such hospital is nearer than three quarters of an hour away?

There is, of course, an extremely difficult situation in the hon. Gentleman’s constituency in the wider health community. Unfortunately, there are serious deficits resulting from overspending, and the local NHS is having to consider some difficult options, to see how it can continue to offer the best possible services to people within the substantially increased budgets that we have given it. Indeed, other parts of the region are having to hold back on their own spending to compensate for that overspending while the problems there are sorted out. I understand completely the concern expressed by the hon. Gentleman’s constituents and other local people—I have received such correspondence myself—and I will of course meet him to discuss it. But I hope that he will work very closely with the local PCT to make certain that the best decisions are taken to ensure that the NHS in his community lives within its means and, within that very substantial budget, goes on offering the best possible care to his constituents.

Today’s statement will be welcomed by my constituents because it offers the best possibility of further development at Broadgreen hospital and, potentially, a much better future for the hospital in the constituency of my hon. Friend, and neighbour, the Member for Liverpool, Garston (Maria Eagle). Does my right hon. Friend agree, however, that the success of this project, which is very welcome, will depend on good quality commissioning locally? Will she therefore undertake to look at the GP contract? As GPs take on greater responsibility for commissioning locally, we will require them to be transparent and accountable in undertaking such commissioning, so that they can continually demonstrate that they are acting in the best interests of the patients whom they are there to serve.

My right hon. Friend makes an extremely important point, and I hope that her local PCT will come forward with a proposal to use some of the new capital investment. She is absolutely right about the accountability of GP practices for decisions made under practice-based commissioning. We have already made it clear that it is the PCT’s responsibility to ensure proper transparency and accountability to local people—and, ultimately, to this House—in respect of decisions taken by GPs and the PCT on how the money is spent, and from where services are commissioned.

Is the Secretary of State aware that at a public meeting last September in my constituency, which I chaired, her local NHS officials told us that Red House hospital—that is, Harpenden memorial hospital—was safe, but that eight months later they announced that it was to close all beds in order to save £1 million a year? Can she confirm that her fund will not in any way help to avert that, and that when the East and North Hertfordshire NHS Trust, in pursuit of its obligation to cut spending by a quarter over the next three years—from £260 million to £200 million—downgrades the district hospital, she will not claim that that is somehow creating a new community hospital? And will she come to our constituencies and try to convince us of the value of that move?

Far from cutting the budget for the East and North Hertfordshire NHS Trust, we are asking it to live within the very substantially increased budget that it has received over the years—thanks to the investment that we have made, which the right hon. Gentleman voted against. We have put more money than ever before into the NHS, in his area and everywhere else, but we do expect the NHS in Hertfordshire to live within its means. It should not expect the NHS in other parts of the country to bail out its overspending at the expense of patients in the rest of the country, where the NHS is balancing or even underspending on its budgets. This issue has to be sorted out and difficult decisions will have to be made across Bedfordshire and Hertfordshire to ensure that the local health community has the right services in the right facilities, giving the best possible value for money. I am sure that the right hon. Gentleman will continue to take part in the consultation that the local PCTs are having to undertake, in order to ensure that the best decisions are made, but that will be done within the framework of the increased budget that we have made available.

I warmly welcome the Secretary of State’s statement about extra funding for small hospitals, but what advice has she got for the health trusts in east Kent that propose to strip away even basic services from Buckland hospital in Dover? That will almost certainly result in its closure, before it has an opportunity to look at the alternatives that such extra funding could provide.

As I pointed out earlier, I have been saying for some months to PCTs that they need to look at the longer-term strategy. In many cases, the local NHS is finding that by reorganising services—by putting more services into people’s homes, for example, and sometimes by bringing together provision from several different sites—it can provide a better quality of care, but with better value for money as well. I know that my hon. Friend, who is very concerned about this issue, will ensure that his constituents’ voices are heard in the consultation that has to take place whenever any such reconfiguration of services is proposed.

On the question of making an early bid for some of the investment fund in order to rebuild Surbiton hospital, is the Secretary of State aware that Whitehall’s capital rules on the use of NHS moneys generated from the sale of surplus land and buildings in the local community prevent PCTs from taking up some of the best options to fund, or part-fund, the rebuilding of community hospitals? Will she look again at those rules, so that PCTs such as Kingston’s can use their own capital more efficiently, as well as gaining from her fund?

The hon. Gentleman raises a very important point, and some PCTs have made representations to me about the difficulties associated with the current rules on disposal of assets. We need to look at that issue, and, as the hon. Gentleman will probably remember, I have already asked Sir Michael Lyons and the Audit Commission to look independently at the financial framework within which the NHS operates. I am waiting for their report and the recommendations that I hope they will make to ensure that we have the best possible framework, giving PCTs the real flexibility that they need to reorganise services and to use their assets in the best possible way for the benefit of patients.

North Cheshire Hospitals NHS Trust, in my constituency, is considering reconfiguring services between Halton and Warrington, and the Mid Cheshire Hospitals NHS Trust is looking at reconfiguring services between the Victoria infirmary, in Northwich, and Leighton. Much of what is proposed is very welcome, but the real concern locally—in both towns—is that Halton could lose in-patient activity to Warrington, and that the Victoria infirmary could lose it to Leighton. The proposal affects Leighton because Victoria infirmary needs capital investment of some £2 million to bring its services up to standard. Will this fund help in that regard?

As I have said, the fund is for community hospital provision—and I think that my hon. Friend is referring to the need for upgrading an acute hospital facility. [Interruption.] Where the aim is to upgrade facilities in an existing hospital to provide better community health services and to meet the strategy set out in the White Paper, the fund will be available. The details—the criteria that we will use—are all set out in the guidance to which I referred.

Is the Secretary of State not alarmed at the huge gap that there obviously is between the profession of a commitment to community hospitals that she makes here, and the near universal impression out in the country that community hospitals are under almost permanent threat? Is that impression surprising, given that the Craven, Harrogate and Rural District Primary Care Trust, the chief executive of which she saw yesterday, has halved, literally overnight, the number of beds at Castleberg and Ripon community hospitals, reducing them to below the historical level of demand? Will the right hon. Lady please accelerate the review of the perverse funding system whereby PCTs buy a package of care at the acute hospital and a certain number of days’ stay, and if a patient is then transferred to the community hospital the funds do not follow that patient within the tariff, and the PCT has to find additional funds? That is the lifeblood that is being cut off from community hospitals, and that process is responsible for the halving of capacity at my community hospital.

I think that if the right hon. Gentleman looks at the figures, he will find that large numbers of community and cottage hospitals closed in the years when his party was in government. He will also find that at least as many new community hospitals have been opened as have closed in the years of our Government. As for funding, he is right to say that the tariffs that we pay hospitals for acute services do, depending on the operation concerned, include an element of rehabilitation, although often not the full costs of rehabilitation. That is one of the reasons we are working on unbundling the budget, but even within the current system primary care trusts have considerable flexibility. A large part of NHS funding is not spent on acute services to which the tariff applies, and can be used outside the tariff with all the flexibility that primary care trusts need to deliver services within community hospitals and other community settings.

I welcome my right hon. Friend’s statement, which provides the possibility of exciting developments in local services in Hastings and Rye, but may I put it to her that one of the problems with that yet further increased choice is that hospital trusts are saying that they are losing the critical mass of providing services in the hospitals? Proposals such as closing maternity units and accident and emergency departments are a result of that. What can she do to ensure that the critical mass is not lost in district hospitals?

What we will ensure is that patients have more choice and control over their health services. That is very much what the public want, and what a modern health service ought to deliver. We will also make sure that services are available in the best possible way, with the best value for money. This is not about saying, “Let’s keep everything as it is,” in particular district general hospitals. It is about looking at which services can be better delivered—better for patients, that is—within the community closer to home, and which services, because of their medical complexity, need to be delivered in a regional or even national specialist centre. Where the issue about critical mass relates to the provision of an essential service—particularly accident and emergency—it is the responsibility of the primary care trust and the strategic health authority to make sure that the essential service is not threatened and that the right relationship continues between the accident and emergency service and, particularly, orthopaedics and trauma services.

The Secretary of State mentioned the age of some community hospitals. Is she aware of the case of Potters Bar community hospital? It is a modern, purpose-built facility that is barely 10 years old, yet it is due to lose 15 of its 45 beds when a significant part of the hospital is put to other uses as a result of revenue shortfalls suffered by the primary care trust. Is there anything in the statement to help Potters Bar hospital, or to help the primary care trust with its financial problems? Does the Secretary of State have any other plans to help Potters Bar hospital, or are we to have the ludicrous situation of an excellent modern facility closing for the very type of short-term reasons that the Secretary of State says she wants to avoid?

The hon. Gentleman has just referred to the fact that there is an excellent modern facility at Potters Bar, so it does not sound as though it will need the capital investment fund that I have just announced. He said that it was proposed to remove 15 out of the 45 beds. I am not aware of the detailed situation, but I know that in many parts of the country, community nursing and therapy teams have found that by reducing the number of in-patient beds, staff can support more patients who need, for instance, rehabilitation support within their own home. That model is already working well in Berkshire, Norwich, Dudley and many other places. That may well be precisely the logic that the local NHS is applying in Potters Bar. I think that I also heard the hon. Gentleman say that although those beds are closing, other services will be provided in that part of the building. On the face of it, without knowing the details, that sounds exactly like the flexible use of community facilities, responding to changing patient needs and changing medical technology, that the local NHS should be engaging in as it continues to get the best possible services with the best value for money.

In the Secretary of State’s letter to strategic health authorities of 16 February, which looked at how community hospitals would fit within the White Paper “Our health, our care, our say”, mention is made of specific criteria for judging the future of community hospitals. Obviously that relates both to the capital spending that we are hearing about today and to the problems in a place such as Gloucestershire, where we are having a huge review on the back of deficits largely run up elsewhere. Are the criteria now published, and if not, when will they be published? May we have them as soon as possible?

My hon. Friend raises an important point, and he and I have met to discuss some of the local issues in his constituency. The guidance that I have published today includes the criteria for access to the capital investment fund. The broader issues of how community services should be reconfigured, and the strategic direction, were set out in the White Paper itself. Obviously I am happy to look in more detail at the points that he has raised and to write to him.

Is the Secretary of State aware that her references to consultation and local decision making will be treated with anger and contempt by many people who have been embittered by an empty consultation procedure of which the Government take no notice whatever? I chaired a meeting in Alverstoke in my constituency, at which 800 people unanimously demanded the retention of the hospital at Haslar, which has excellent facilities. Those are not stupid, uninformed people. In many cases, they are former patients who know that the facilities are outstandingly good. Will the Secretary of State, even at this stage, order an investigation by the independent reconfiguration panel into the future of medical services in south Hampshire?

It is simply untrue to say that the NHS or the Government ignore local consultation. I refer to the recent consultations that we had on the reconfiguration of primary care trusts, where a number of options went out for consultation and decisions were made in the light of that local consultation. The overview and scrutiny committees of local councils have an increasingly important role to play in ensuring that local consultations held by the NHS on reconfiguring services are genuine, and that the outcome is satisfactory for local people. If an overview and scrutiny committee is dissatisfied with the way in which the NHS has conducted the consultation, it has the power to refer the matter to me. Obviously, I look at each of those cases extremely carefully, and where I think it right to do so, I refer them to the independent review panel for its advice. However, I stress again that those decisions are best made locally wherever possible. I hope that in the hon. Gentleman’s constituency, in relation to the situation to which he refers, the local primary care trust, local GPs, local people and the council will continue to work together to try to get the best outcome as they reorganise services.

Will my right hon. Friend say a further word about the community venture model of community hospitals that she referred to? That will be particularly welcomed by the strong partnership being formed to plan the rebuilding of Selby war memorial hospital, given the strong belief locally that that hospital is likely to be more sustainable in the long run if there is strong co-operation between GPs, the local council, the local health service and the voluntary sector.

I am grateful to my hon. Friend for coming to see me yesterday to discuss that, and bringing NHS colleagues who described the possibilities for a new community hospital in Selby. The thinking behind the community venture model is that it would allow not simply a public-private partnership on the LIFT—local improvement finance trust—model, but a much more flexible partnership between the NHS, other public service partners, such as, for instance, the local council, and the voluntary sector, as well as, potentially, the private sector. That would focus not just on a building, which is really what the LIFT partnership is about, but on the services that need to be provided both in a community hospital building and in other settings such as GP practices, health centres and patients’ own homes.

Is the Secretary of State aware that in the eastern part of my constituency, it is not so much hospital closures that are taking place, as the downgrading of the services in those hospitals? For example, Epsom hospital is losing its general hospital status quite rapidly, and three community hospitals are being starved of revenue because the primary care trust is encouraging patients to move out of a general hospital straight home, which has led one local GP to say that there were unsafe discharges. There are serious revenue problems, so how will the Secretary of State’s announcement about her capital plan help my constituents?

The proposals for Epsom involve the development of a smaller critical care hospital surrounded by—I think—nine community hospitals or health care centre settings. More care will thus be delivered closer to patients’ homes, which will be much more convenient for them, but critical care and complex acute cases will be located in one specialist hospital facility. There has been wide consultation on that model of care, and it got widespread public support. The issue is not cuts in funding—I think that the hon. Gentleman suggested something of that kind—but the way in which the unprecedented sums that we are investing in the NHS, which will continue to grow by 9 per cent. this year and next year, are used to best effect for the local population, and how we ensure that when there is overspending, the NHS in the area comes back into financial balance and does not expect other parts of the country to go on bailing it out.

A little girl born this morning in the middle of the most deprived ward in my constituency will live 14 years less than a little girl born this morning in Wollaton, the prosperous ward next door. It will not surprise the Secretary of State to know which ward has a mega regional hospital, and which has no community hospital or facilities whatever. In that context, will she consider entertaining bids not merely from the local PCT, but from the collective local strategic partnership—such partnerships exist in each of the major cities in the UK—so that we can move forward a lot more quickly? One of the most difficult points that was raised with me this morning when I tested the idea locally was anxiety about having private finance initiative-related schemes, or LIFT-related schemes, because of their long-term expense. Will she consider bids and offers from organisations other than PCTs, with a broader financial base?

Yes, we certainly would consider such bids. My hon. Friend is doing outstanding work as chair of his local strategic partnership, so I thank him for that. The community venture model to which I referred earlier is precisely suited to a bid from a partnership of the kind that he describes. Capital investment could come from a variety of places, thus reducing the revenue implications for the NHS in future years. The model is good and it will help to address some of the shocking health inequalities that persist in our country, which are why we are determined to insist on fair funding for different parts of the country with different health care needs.

Two in-bed units at Doddington community hospital in my constituency have already closed recently, in the teeth of opposition from GPs and the total opposition of local people. What price the much-vaunted boast of listening to local opinion, I ask myself. Does the Secretary of State agree that if GP practice-based commissioning is to mean anything at all, GPs should have a crucial say in what services are provided in their local community hospitals?

As I said earlier, it is absolutely essential that local people are consulted. In many parts of the country, those consultations, which often take place on very difficult issues, have been extremely well led and conducted by primary care trusts, and they often lead to a solution being found that is better than the original options put forward. It is important that that happens and that GPs are closely involved. GPs who are closest to their patients are superbly qualified to act as not only advocates for those patients, but experts on redesigning services and bringing them closer to home. If services are redesigned they will change, so, for example, there might be fewer beds in some places and more in others. The reconfiguration of services, difficult and unpopular though it sometimes is, is part and parcel of creating the best possible modern health care service, so I would hope that the hon. Gentleman would support that.

I warmly welcome the additional money that the Secretary of State has announced and congratulate her on her victory over the Treasury in securing it. How will it affect the pathway project in Leicester? As she knows, that project will be downsized by £200 million and the downsizing will fall primarily on the hospital in my constituency, Leicester general. Will the reorganised PCT be able to apply for money from this fund to deal with any of the facilities and services that it will not be able to provide because of the reduction in funds for pathway?

My hon. Friend raises an important point. The pathway project in our city is a PFI project. At the moment, there is no reason at all why it should not continue under the private finance initiative. As he and I heard recently from a hospital chief executive, the aim is to provide far better services for patients from Leicester and Leicestershire with all the facilities in the original proposal, but with better value for money, so that the local NHS does not find itself in financial difficulties in future years. It will certainly be possible for the PCT to examine whether the new fund would also assist in improving community facilities, but whether it uses the new capital fund or PFI, one test, of course, is that the services and buildings must be financially sustainable for many years to come.

May I return to the central question of the capital nature of the funding? How precisely will the availability of capital funding help Brookfields hospital, for example—I have to say to the hon. Member for South Cambridgeshire (Mr. Lansley) that that hospital is in my constituency, not his, although his constituents use it? It has three wards that are threatened with closure because of a PCT revenue deficit that amounts to some £45 million. Surely the two policies do not fit together, and on a day when closures are being announced, the new policy makes no difference.

As the hon. Gentleman knows, there is, unfortunately, overspending in the NHS in Cambridge and Cambridgeshire. That must be dealt with because it is taking place despite the fact that there is more money than ever before and more growth money is coming in future years. Of course the NHS in his constituency is examining how it can reorganise services. I described earlier the situation in Norwich, where by reducing beds in some facilities and closing two of the older community hospitals, better services are being provided for patients and financial savings are being made that can be reinvested in other services. It seems to me that that is precisely what the hon. Gentleman should be supporting and expecting from his local NHS. The capital will help when what is needed is a reorganisation of services, perhaps across different facilities, the modernisation of existing old buildings, or the creation of a completely new facility that would, for example, allow services to be taken out of the acute hospital and provided more effectively, with better value for money, in the new facility. Although the capital cannot be used simply to cover overspending on the revenue account, it can certainly be used to support a reorganisation of services that will be more cost-efficient and thus help to deal with financial problems.

Given the turmoil being caused in south-west Kent by the threat to services at Sevenoaks hospital, Edenbridge hospital and Tonbridge hospital, and the fact that the Secretary of State is now allowing a year for primary care trusts to submit bids for the new capital, would it not have been more sensible to have announced a moratorium on any further closures until all the bids had been received and evaluated and the tariffs had been sorted out?

No, I do not accept that at all. There are circumstances where it is clear that the local NHS has too many community hospitals or that some such hospitals are based in outdated buildings that no amount of capital can sensibly be expected to modernise. There may be too many beds in some community hospitals, or perhaps more staff could be working to support more patients in their own homes. Those are judgments that the local NHS needs to make—particularly, but not only, in view of current financial difficulties. The White Paper at the beginning of January set out a very clear strategic direction, which we have reinforced with PCTs and strategic health authorities. The new capital fund will meet many of the requests for capital support that PCTs have put to us. Contrary to the repeated assertions of Opposition Members that we have had nothing but closures of community hospitals, the Community Hospitals Association has confirmed that for every closure in recent years, a new hospital has been opened.