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Health Care (Norfolk)

Volume 472: debated on Tuesday 26 February 2008

It is a pleasure to serve under your chairmanship, Mr. Marshall, for the second time this morning. We move seamlessly from Kosovo to Norfolk. I welcome this opportunity to speak in this short debate, which I am holding against the background of Norfolk primary care trust’s proposals, published in July 2007, for intermediate care services and, more recently, the Darzi review, which is proposing further reconfiguration of health services, which when firmed up will obviously have an impact on Norfolk and my constituents in Mid-Norfolk.

As in other parts of the country, health care in Norfolk depends very heavily on the work of our health professionals—doctors, nurses, specialists and carers—who do more than just the statutory hours that they are expected to work for the money that they earn. Between February and June last year, Norfolk PCT conducted a review, as I have said, of intermediate care services. There was quite widespread public consultation, which produced considerable local opposition to what was seen as a cost-cutting exercise at a time when Norfolk, along with many other PCTs, was heavily in debt, and to the closure and possible reduction of local community hospitals.

On 16 May last year, I initiated a half-hour debate in Westminster Hall on the future of St. Michael’s hospital in Aylsham in my constituency. On 24 July, Norfolk PCT approved a set of proposals that provided for 178 beds spread over five community hospitals in Norwich, Dearham, Kelling, north Walsham and Swaffham. Unfortunately, St. Michael’s hospital was down to close. On 18 October, Norfolk’s health overview and scrutiny committee effectively put that closure on hold for four months, because it was concerned about the alternative care plans proposed for Aylsham and the surrounding area. I declare an interest in that I live not in Aylsham but eight miles away in Reepham, so for me and my family what happens there is more than just academic.

Since the closure was put on hold, Norfolk PCT and the Aylsham group, which brings together local representatives, and on which I sit, have been in negotiations. I want to lay before the Minister a series of points, which I suspect that he will say are not his direct responsibility to a certain extent, owing to devolving responsibilities down to PCTs on many such matters. Nevertheless, he should have taken a view, not least because of the resource implications and the fact that we might very well be overtaken by the Darzi review.

The PCT is concerned, because St. Michael’s represents the only community hospital serving in the old Broadland PCT area, but has said that an analysis of the usage of the hospital established that only 24 beds on average were used by patients registered with Aylsham practices. It has been considering the most appropriate way in which to sustain the outpatient and therapy services provided at the hospital and to commission beds in the prospective nursing home planned for the site. It points out the requirement for sufficient beds to meet the needs of Aylsham people and that the consideration is for five beds at the nursing home. However, that figure is for guidance rather than prescription.

I consulted with local doctors who believe that the number of beds—five—is far too small, not only for meeting the current criteria but for meeting the likely population growth in the area over the next five to 10 years based on Government statistics, not those provided locally. That last point is important. The re-development of the site has, from the outset, involved a close partnership between Norfolk PCT and the Aylsham care trust. At the beginning of December 2007, the PCT’s provider services made available to Aylsham care trust the spatial requirements for the therapy and outpatient services that could be provided within a community facility, which was to be built for Aylsham care trust with the development of the overall site. Negotiations are now going on between the Aylsham community and Norfolk PCT.

I bring that to the Minister’s attention because my constituency is a microcosm of problems affecting health care throughout Norfolk. Pressures are greater or smaller, and I am not suggesting that Norfolk necessarily has tougher health care challenges than other parts of the country. It has specific health care challenges—not least an ageing population. There is also the sheer size of the area covered. One of the biggest challenges facing the health authorities, as in education, is presented by the distances involved in people getting to some form of health care or in merely transporting them around. It is obviously a different matter for urban areas.

Norfolk PCT has proposed the Aylsham health campus project. I do not think that that would have come about if the scrutiny committee had not deferred the matter for consideration for up to four months—it is fascinating to see what a little pressure does in getting PCTs to introduce proposals. Its objectives are to

“examine the health needs of the population of Aylsham … consider the ways in which a health campus at Aylsham could meet those needs … consider whether a health facility in addition to the Aylsham Care Trust Community Centre is needed or viable …consider how co-ordination can be achieved between the Community Centre, health services and the residential home”

and to

“consider the appropriateness of a ‘well-ness’ facility”.

I have not yet managed to find out what a “well-ness” facility means. Is there such a thing as an “unwell-ness” facility? If there is, I think that I, and many other MPs, would meet every criterion. The final objective is to

“consider the appropriateness of facilities for GP training and other GP activities not necessarily required to be provided at the two practices”

in Aylsham.

At the moment, therefore, the decision has been made to close St. Michael’s hospital, and many of its supporting facilities, which will affect the health care of an area larger than Aylsham. A number of beds at the hospital have been used by people from as far away as the north Norfolk coast and Norwich, which demonstrates that there is a bed shortage throughout Norfolk, although I accept fully that health services must be flexible. Nevertheless, negotiations are ongoing between the PCT and the local community. As I said, I do not think that, if the scrutiny committee had deferred the decision, we would have reached that stage.

What do we, the local community, want for the future of health care in Aylsham and the surrounding area? That forms part of the negotiations. The Aylsham group believes that the hospital should remain open, but has expressed a willingness to compromise to the extent that

“replacement services should be in place and proved to be effective before the hospital is closed.”

The date for the closure of the hospital is 2009.

The PCT has now been asked to keep the hospital open for five years for the following reasons. If at all possible, I would like the support of the Minister, at least indirectly. The reasons are that the percentage of elderly population in the area is about 30 per cent., which is 10 per cent. above the Norfolk average, which itself has a fairly high percentage nationally, although it cannot beat places such as Bournemouth and Eastbourne, and that we must consider the further projected population growth. Current discussions, as part of the local development framework, indicate additional housing for the town of Aylsham and the surrounding area. I know that from talking to the local authorities.

We have no way of knowing the success of staff recruitment for the nursing home, or indeed for the home care teams. The Minister knows that the combination of looking for savings in health budgets, and the medical assessment that the best way of dealing with many people who are ill or have had an accident is by looking after them in their home, will mean the redeployment of staff, and challenges in recruiting and retaining staff in areas where, given the geography and road communications, many of them will spend a great deal of their time on the road.

My hon. Friend makes a valid point about the diversity of Norfolk; it is a wide area, the use of health care facilities is diverse, and on occasions, people are far away from them. I draw his attention to a story in The Daily Telegraph today, which reports that Norfolk and Norwich university hospital NHS trust, and the Queen Elizabeth hospital in Kings Lynn, have been criticised for

“‘fleecing’ patients and their families”

through high car park charges. Does my hon. Friend agree that if those hospitals were properly funded, they would not have to resort to funding shortfalls through such schemes?

There is a problem. When my father was seriously ill a year ago, and I took my mother regularly to the Norfolk and Norwich university hospital NHS trust, the issue was not just about the financial aspect. Indeed, we MPs, as we know, are well paid, so with all our pay and allowances we can afford car parking charges, but many of my constituents cannot and most of the car parks are not large enough. The car parking aspect has been franchised out, but the Government must re-examine the problem, because I am sure that Norfolk is not the only area where it is an issue.

The issue may be not just about funding but about the whole business of the car parking contracts. I am grateful to my hon. Friend for mentioning the issue.

Bed blocking has been much in the news, including the local news. The Eastern Daily Press ran a series of articles showing that there were bed-blocking crises at the Norfolk and Norwich University Hospital NHS Trust and the Queen Elizabeth hospital in Kings Lynn. St. Michael’s hospital, along with others, has offered a safety net. Sadly, however, bed blocking will remain a problem, and it must be addressed.

Following recent alerts at the Norfolk and Norwich University Hospital NHS Trust, the number of beds at St. Michael’s hospital was increased from 24 to 26—a clear demonstration of the need for community beds in Aylsham and in the county as a whole. Currently, St. Michael’s hospital operates at 80 per cent.-plus capacity, and the effectiveness of the PCT’s alternative intermediate care strategy ought to be measurable by specific endpoints that include a significant reduction to below 50 per cent. in admissions to St. Michael’s hospital. As yet, the evidence is not available.

The PCT and the Aylsham care trust will provide intermediate care. The health campus project is insufficiently developed, and indeed, I do not think that most of us are clear about what the PCT means by a health campus. It has a warm feeling about it, invoking the idea of a multi-disciplined university campus, and it may well be the answer to the area’s health care requirements. However, as yet, I have not seen sufficient details, and I suspect that one will have to pay the money up front in order to deliver such a campus and provide the health care that we want.

The Aylsham group has also been led to believe that there is a strong bid for the stroke unit to be developed in conjunction with the Norfolk and Norwich University Hospital NHS Trust, albeit with a greatly reduced number of beds—24 instead of 40. That, once again, may mean pressure on the local community hospitals.

Home care has been trialled in west Norfolk, and it must work there, because that part of the county lacks community hospitals. The Minister will be only too well aware if he plots health care centres and community hospitals on a map of Norfolk, that owing to its sheer size, little in the way of a safety net exists to deal with any future health care crisis.

Based on the points that I and other people have made, the PCT should at the very least think about postponing its original closure date for St. Michael’s hospital. The Minister should at the very least take an interest in the issue, and perhaps consult the PCT on whether it has enough financial resources to deal not only with that change, but with the impact of the Darzi review. I have been examining health care in Norfolk at the micro level, but I wonder whether the Minister might—to use the old music hall expression—show an ankle and give us some indication of the outlines of the Darzi review. We heard some of it when the Prime Minister, being desperate to recover from the non-election, performed like a clapping seal a few months ago, and Lord Darzi had to rush through with some initial ideas.

In conclusion, the issue is important for my constituents and for myself, but it is not unique to my constituency. There are major challenges throughout Norfolk, and I should therefore be interested in the Minister’s views.

I congratulate the hon. Member for Mid-Norfolk (Mr. Simpson) on securing this Adjournment debate about an issue that is important not only to his family but to his constituents and the local community.

The description of the dialogue, both in the hon. Gentleman’s presentation today and in my briefing for the debate, is almost an example of best practice. He said that the process would not have happened without the overview and scrutiny committee’s referral, but that is the very reason why the Government gave local authorities for the first time the statutory right to comment on NHS reorganisation proposals locally and, if they were dissatisfied with the proposals, the right, as he knows, to refer them to the Secretary of State, who would then refer them to an independent review configuration panel. Although I agree that it is probably unlikely that those discussions would take place without the role of the overview and scrutiny committee, I hope that the hon. Gentleman agrees that the new role for local government in scrutinising NHS decisions, which can be uncomfortable and difficult, is right.

The hon. Gentleman, understandably, represents the views of the local community, which feels, also understandably, that it would like to preserve what it has. People are attached to the hospital, which they believe provides an excellent service. The hon. Gentleman referred to demographic change, so the issue is not just about the existing situation, but about projections of future need. The local community would like the hospital to be preserved in its current form.

I do not live in the area, so I am less able to comment than the local people who make those decisions and live there, but the vision is for a much wider range of community-based services. The hon. Gentleman rightly raised the question of what a wellness facility is. These days, we use all sorts of jargon in public services, which confuses people, but the principle of a wellness service is the recognition that the modern health service—this is at the heart of Lord Darsi’s review—is as much about preventing sickness and ill health as about intervening once somebody becomes very ill. That can be achieved through better health education, promotion, screening and so on, and by intervening early to prevent people’s health from deteriorating, which is particularly relevant to older people. Once they deteriorate, the danger is that it is difficult to get them back on their feet and living independently. The notion of a wellness approach is about prevention, early intervention and ensuring that people are aware of how best to stay healthy.

We must get the right balance of prevention and early intervention services in the hon. Gentleman’s community and ensure that there are some beds, which is indeed part of the plan. Those beds might not be in the existing hospital environment, but there is a commitment to develop a nursing home-type provision in the community. That seems to me a better outcome for health care provision in Aylsham than the current position. The cynicism and scepticism among residents and professionals may be because they have not yet seen a tangible vision of what the alternative will look like. In defence of the primary care trust, it seems to me that it is trying to develop that vision in partnership with the local community rather than simply impose on it a “managers know best” or “professionals know best” approach.

From all the information I have, from both the hon. Gentleman’s contribution and my briefing for the debate, I think that what is happening is what we would want to happen in communities where change is essential. We want engagement between the health bodies and local communities, and we want the local authority, Members of Parliament and local residents to be involved to try to come up with a solution in the best interests of the relevant community.

The hon. Gentleman asked about resources. It is important to point out that if the PCT can emerge from the process with a credible, sensible vision, which will improve health care and be more up to date, modern and responsive to the needs of the community, and if it puts a credible and robust bid to the strategic health authority, demonstrating improved outcomes for patients, of course resources will be available. There are resources both regionally and nationally—SHAs can seek resources from the Department of Health—to support the reorganisation and reconfiguration of services. The hon. Gentleman says that has not yet happened, so resource problems are not preventing progress. We need a clear vision about a new range of health services that best meet the needs of the Aylsham community.

I will be happy to meet the hon. Gentleman at a later stage if he is dissatisfied with the outcome of the engagement and consultation process. I urge him to show a little leadership in the local community—I am not saying that he is not already doing so, because I have no reason to believe that—and to say that, although not all change is good, if there can be change that leads to a better range of services, focused on prevention, early intervention and ensuring that older people do not deteriorate and need acute hospital care, it will be in the interests of all families in Aylsham. The hon. Gentleman was right about the impact on the work force and on professionals, recruitment and so on, but the changes mean that a different mix of professionals—doctors, community nurses and social care staff—will need to work together to ensure that there is a shift to prevention and early intervention.

I understand that it was originally feared that, under the proposals, the five existing beds would be removed and not replaced, but from what the PCT has said, it seems that as well as an NHS campus with integrated services and a shift from acute to primary health care, there will also be guaranteed protection of at least five beds in any new organisation of services. I ask the hon. Gentleman to see the proposals as a major opportunity, not as a threat. He must consider the range of services currently provided and the consequences for patient care in Aylsham and surrounding areas, and whether the proposed changes would lead to better outcomes in the long term. It is easy to hang on to the status quo and, understandably, people are emotionally attached to existing services. They are not necessarily persuaded of the need for change until it is clear to them what the change will be and whether it will lead to improvement or to the diminution or undermining of existing services.

The hon. Member for South-West Norfolk (Mr. Fraser) made an important contribution, but it is difficult to see how he can argue that we should seek maximum devolution for managers and professionals on the front line and minimal Government interference—his party supported the foundation hospital model on the whole, for example—and then ask the Government to intervene in individual hospitals where he feels the car parking charges are excessive. Although it is acceptable for hospitals to charge for car parking, and there is no law or rule to prevent them from doing so, they certainly should not abuse that right by charging extortionate amounts. The test of reasonableness should be applied to decisions on the matter.

As a Member of Parliament, the hon. Gentleman has the right to make strong statements and representations if it can be demonstrated that the charging regime is either extortionate or disproportionate. I do not know the details of the case that he mentioned, so I cannot make a definitive comment, but charges should be proportionate and reasonable.

I am enormously grateful to the Minister for giving way, given that this is not my debate. Does he accept that because of budget balancing issues hospitals are put under undue pressure over parking charges?

I have great respect for the hon. Gentleman, whom I met for the first time over dinner last night—I am not going to show him my ankle during the debate, by the way—but I do not believe that is the case. The NHS has had unprecedented resources in the past eight or nine years, including in Norfolk, and there will be a continued increase in resources over the next three years as part of the comprehensive spending review settlement, so even if it is true that parking charges are extortionate and disproportionate, I do not accept that it is necessary. If the high charges are for resource reasons, why are they not happening in hospitals throughout the country, and why are there such different approaches to charging? There has been unprecedented sustained investment in the NHS, so although car parking charging is perfectly acceptable under current rules, we expect proportionality and fairness.

I say to the hon. Member for Mid-Norfolk that I hope that the PCT’s engagement with the local community leads to a clear vision about how a shift in health services can be provided, with maximum local support, which leads demonstrably to an improved range of services, particularly for older people. I urge him to consider the fact that moving towards prevention and early intervention is, on the whole, in the interests of maintaining the independence of older people. My ankle will not be shown in the debate, but my door will remain open to the hon. Gentleman as the process evolves in case he wishes to discuss it further with me.