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Tonbridge Hospital/Edenbridge Hospital

Volume 551: debated on Tuesday 16 October 2012

It is a pleasure to see you in the Chair, Mrs Osborne.

My constituents are most fortunate in that they have within my constituency geographical boundary not one community hospital, but two. We have the Edenbridge and District War Memorial hospital, and Tonbridge Cottage hospital. Both were founded between the two world wars with the outpouring of philanthropic and generous donations in remembrance particularly of those who suffered terrible injuries on such a huge scale during the first world war.

Of all the public assets in Edenbridge and Tonbridge, those two hospitals are the most highly prized by the two communities. The support for Edenbridge and Tonbridge community hospitals is far reaching and profound. In the forefront of that support are their two leagues of friends. Edenbridge Hospital’s League of Friends, chaired by Mrs Jo Naismith, and Tonbridge Hospital’s League of Friends, chaired by Dr David Goodridge, voluntarily and in an unceasing and dedicated way provide outstanding support to the two hospitals. I stress particularly the quality of the care and treatment provided at the two hospitals, and I pay tribute to the NHS nursing staff and doctors, and all the others who work in them for the quality of provision for local patients.

I want to raise two issues. First is the proposed transfer of the assets of both hospitals in April 2013 in accordance with the Government’s policy of relieving the former primary care trusts of their property assets. The Government’s policy in this area is seriously misguided. It is a major failure and misconception of policy to divide those property assets into the sheep and the goats with property from some community hospitals being transferred to mainstream NHS providers when that of other hospitals—the goats—is being transferred to NHS Property Services Ltd.

Despite all the soothing words and honeyed letters that I have received from Ministers about the issue—I am grateful to the Minister for the letter she wrote to me yesterday, which I received this morning—I am in no doubt whatever from the statements by the previous Secretary of State for Health that the main reason for the creation of NHS Property Services Ltd is to set up a vehicle inside the Department of Health that will count among its main objectives asset realisation, or asset stripping as some might say. To make the point clearly, it is necessary only to go back to the former Secretary of State’s original written statement in which he outlined the objectives of NHS Property Services Ltd, which included to

“deliver value for money property services; cut costs of administering the estate by consolidating the management of over 150 estates; deliver and develop cost-effective property solutions for community health services; and dispose of property surplus to NHS requirements.”—[Official Report, 25 January 2012; Vol. 539, c. 19WS.]

It is quite clear, therefore, that NHS Property Services is an asset realisation and disposal company being set up within the NHS.

I also find some of the criteria used by Ministers for whether community hospital assets go to NHS providers or to NHS Property Services Ltd seriously flawed. For example, why should a community hospital, simply because it shares parts of its property with another NHS trust, as is the case with Tonbridge Cottage hospital, automatically be sentenced to going to NHS Property Services Ltd? I see absolutely no justification or rationality for that criterion.

My anxieties about the policy were, if anything, increased when my hon. Friend the Minister gave the following reply in a debate initiated by my hon. Friend the Member for Totnes (Dr Wollaston):

“NHS Property Services Ltd will own and manage buildings that are needed by the NHS. However, it will also be able to release savings from its properties that are declared surplus to NHS requirements.”—[Official Report, 6 September 2012; Vol. 549, c. 485.]

Therefore, many other MPs may be in a similar position to me: will I wake up one morning, as will my constituents in the Tonbridge and Edenbridge area, and find that Tonbridge Cottage hospital or Edenbridge and District War Memorial hospital have been declared “surplus to NHS requirements”? That is a worrying and apparent possibility, and I hope that the Minister will be able to relieve me of my anxiety on that score. I appreciate that she cannot give any assurances beyond the lifetime of the present Government, but will she give a categorical, unequivocal, unqualified assurance in Hansard, in black and white, that during the lifetime of the present Government, neither of those hospitals will be declared surplus to requirements?

My other criticism of the whole policy is the lack of proper consultation. General statements have been made, but we as constituency MPs are deeply concerned about the specifics. So far, there has been no consultation with MPs, local councillors or local people on the specific intentions of the Government about the property assets of individual community hospitals. Here we are today, with less than six months to go before April 2013, and I, local councillors, leagues of friends, and local people have not received any official information about whether the two hospitals will belong to NHS providers or go off to NHS Property Services Ltd. As far as I am concerned, that lack of consultation with the public and their elected representatives is unacceptable. I hope that in her reply the Minister will convey this request to the Secretary of State, urging him to ensure that before final ministerial decisions are taken on whether individual hospitals go to NHS providers or to NHS Property Services Ltd, the public and their representatives are consulted, so that they can express a view on the Government’s proposals.

The second issue that I want to raise is equally serious: the failure of the West Kent primary care trust to discharge its statutory consultation obligations when it put into effect a major change of use recently at Tonbridge Cottage hospital. I stress that I am not here to debate the merits or otherwise of the change of use; I have come to discuss the legality or otherwise of the process that was followed, and whether there was a breach of statutory consultation obligations.

However, in brief, and by way of background, the change of use has arisen because the West Kent primary care trust had to find a home for the stroke rehabilitation unit that was at the Kent and Sussex hospital when the hospital was closed relatively recently. The unit was not incorporated in the main buildings of the hospital; it was in temporary buildings—so-called pods—placed on the car parking area of the Kent and Sussex hospital. The West Kent primary care trust had the option of moving those pods, which clearly had been working perfectly satisfactorily and to NHS standards, lock, stock and barrel, and putting them in the car parking area, which has recently been expanded, at Tonbridge Cottage hospital. Instead, it took the easy option, deciding to shut down half the community beds at Tonbridge Cottage hospital and move the stroke rehabilitation unit there. That process, which involved a major change of use at the hospital, was carried out with no statutory consultation whatsoever.

I make it clear to the Minister that I am perfectly happy, as are the Friends of Tonbridge Cottage hospital, to have stroke rehabilitation at the hospital. However, we are profoundly unhappy that instead of its being an additional facility at Tonbridge Cottage hospital, the change was achieved at the expense of cutting in half the number of very valuable community beds there. That has now left Tonbridge Cottage hospital with the smallest number of community beds in Kent, among all the community hospitals there; I have the figures from the West Kent PCT. Notwithstanding the fact that Tonbridge Cottage hospital is the one and only community hospital serving the entirety of Tonbridge, Tunbridge Wells, Southborough and the surrounding areas, it now has the smallest number of community beds in Kent.

I have to make it clear that the policy runs directly contrary to the stated policy of the Government. The Minister, in her reply of 6 September said

“this Government support improvements in community hospitals across the country. That is because we know that community hospitals make it easier for people to get care and treatment closer to where they live.”—[Official Report, 6 September 2012; Vol. 549, c. 483.]

The action taken by West Kent primary care trust has made it significantly more difficult for people in the Tonbridge, Tunbridge Wells and Southborough area to get care and treatment closer to where they live.

I come now to the statutory requirements. I raised them originally in my letter of 17 June 2011 to the former Secretary of State for Health. My right hon. Friend the Member for South Cambridgeshire (Mr Lansley), in his reply of 18 July, set out very clearly the two statutory obligations falling on NHS trusts to consult. He referred me to sections 242 and 244 of the National Health Service Act 2006. The key provision in section 242 is subsection (2):

“Each body to which this section applies must make arrangements with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are, directly or through representatives, involved in and consulted on—

(a) the planning of the provision of those services,

(b) the development and consideration of proposals for changes in the way those services are provided, and

(c) decisions to be made by that body affecting the operation of those services.”

In my view, the breach of that statutory consultation obligation by West Kent primary care trust is absolutely clear. There was no consultation, directly or through representatives, in the Tonbridge area about those significant changes. It seems to me entirely clear that section 242 was not complied with.

Even more stark is the failure of West Kent primary care trust to comply with its obligations under section 244. That is the section of the 2006 Act that places on NHS trusts a statutory duty to consult local authority overview and scrutiny committees—in this case, the overview and scrutiny committee of Kent county council. The key document in this respect is “Overview and Scrutiny of Health—Guidance”, which was published by the Department of Health in July 2003 and which is now statutory guidance, as the former Secretary of State made clear to me. The key paragraph is 10.4.1, which states:

“Where an NHS trust plans to vary or develop services locally, it will need to discuss the proposal with the overview and scrutiny committee to determine whether the proposal is substantial. If the outcome of those discussions is that it is a substantial development or variation, the trust must consult the overview and scrutiny committee.”

I therefore asked the leader of Kent county council, County Councillor Paul Carter, if the council’s overview and scrutiny committee had been consulted on whether the change was substantial. In his letter to me of 18 September 2012, he replied that

“there was no formal consultation on the specific decision relating to stroke rehabilitation beds at Tonbridge Cottage Hospital…Nor was the issue specifically brought to the attention of the Committee. Therefore the Committee has not been in a position to determine whether the proposal was substantial.”

That, I suggest, is starkly clear evidence of a breach of the statutory consultation obligation.

I do not expect the Minister, in her reply to this debate, to give an instant response to and judgment on the legal case that I have advanced for there having been a breach of statutory consultation obligations. It would be unreasonable of me to expect that when I have only just presented the evidence, but I do request that in the light of what I have said in the debate, she consults the Secretary of State, and I hope that my right hon. Friend will take his own legal advice. I wish to hear in writing—I hope from the Secretary of State himself, following the legal advice that he has received—whether he agrees that West Kent primary care trust failed to discharge its statutory consultation obligations in bringing about a substantial change of use at Tonbridge Cottage hospital.

I hope that if the Secretary of State comes to the same view as I have done that there has been such a breach and that therefore the change of use process was unlawful, he will tell me what action he believes is appropriate. I hope that he will tell me what action he would see fit to take in relation to the individuals in the former West Kent primary care trust who were responsible for non-compliance with statutory duties. I hope most of all that the Secretary of State will take this action: I hope that he will issue a direction to the successor body to West Kent primary care trust, NHS Kent and Medway, and that that direction will instruct NHS Kent and Medway to carry out—admittedly belatedly—the statutory consultation on the change of use at Tonbridge Cottage hospital that has occurred.

If the consultation takes place, as I earnestly hope it will, it will give me, the Friends of Tonbridge Cottage hospital and, most important of all, the people of the entire Tonbridge, Tunbridge Wells, Southborough and surrounding area the opportunity to make it clear to the NHS and to the Secretary of State that although we welcome the stroke rehabilitation facility at Tonbridge Cottage hospital, we want the half of our community beds that have been removed to be restored for the benefit of the people of the local community.

First, I congratulate my right hon. Friend the Member for Tonbridge and Malling (Sir John Stanley) on securing the debate and on the many questions that he has raised. As the clock is against me, I shall deal at the beginning of my response to his speech with some of the issues that he has specifically asked me to deal with.

It strikes me that these matters should and could have been dealt with locally. As my right hon. Friend will appreciate, one of the Government’s aims has been to ensure that national politicians do not get involved in the stuff of sorting out the NHS locally. He raises concerns about his local PCT and calls into question procedures undertaken by it. He says that decisions that it has made should have been referred to the overview and scrutiny committee. I do not know whether that is right or wrong. What I do know is that it is incumbent on local politicians to raise such matters, as they do the length and breadth of England. It may be that the horse has bolted from the stable and it is too late, but I think that I can say with some certainty that it is not the role of the Secretary of State for Health to seek legal opinion on whether the PCT has acted lawfully.

With respect to my right hon. Friend the Member for Tonbridge and Malling, I suggest that those are local matters, to be determined locally, and it is for the league of friends, himself, councillors and other concerned people to look into the legality of the decisions that have been made and the processes that have been chosen. It is for the local NHS and local politicians to deal with that. It is not the role of Whitehall and Ministers to get involved in the stuff of local NHS decisions and those processes.

The league of friends and I have pursued these issues in detail over a considerable period with the local PCT. Does the Minister not agree that under primary legislation, the Secretary of State ultimately has a responsibility for addressing issues of NHS trusts’ compliance with statute?

I am grateful to my right hon. Friend for his comments. I will look further into the matter. I cannot give a definitive answer, but in my experience such matters are invariably taken up by local politicians, often led by their local Member of Parliament, who go to the overview and scrutiny committee of the county council to urge upon it all the reviews and challenges that he has sought and raised in this debate. I will, however, look into this further, and if he will forgive me, I will come back to him probably by way of a letter or a meeting between the two of us. May I move on to the future of his community hospitals?

I am reliably informed that there are no plans whatsoever to close either of the two hospitals. I will get through as much of my speech as I can in the time available—I will be guided by you, Mrs Osborne, but I think I have to sit down at half-past 4. I make it absolutely clear again that the future of hospitals is not determined by national Government, but is in effect determined by the local commissioning process. From what I am told, there is no reason to fear for the future of either the Tonbridge Cottage hospital or the Edenbridge and District War Memorial hospital, because the services that they provide will be commissioned by the local clinical commissioning group. They are doing a grand job now, so there is no reason to think that they will not continue to do a grand job, and therefore their services will continue to be commissioned.

Many Members have great affection for their community hospitals, and rightly so. As my right hon. Friend alluded to, they provide a wide range of vital services, from minor injury clinics to intensive rehabilitation. They inspire much love and respect in their communities. They are fiercely defended and rightly inspire loyalty.

My right hon. Friend and the local league of friends have raised the issue of the beds at Tonbridge hospital. I am not the PCT’s mouthpiece, but as he will appreciate, inquiries are made and I am supplied with information. I am assured that the 12 community beds in question were designated as general rehabilitation beds. They were then redesignated as stroke rehabilitation beds and are now housed in the new £400,000 purpose-built stroke unit, which opened at the hospital in September 2011. The PCT then created 12 additional general rehabilitation beds across west Kent, to replace the 12 community beds that had been redesignated. Of those 12, two, as he mentioned, are at Tonbridge hospital. We do not agree that there was a loss of beds, because 12 of the beds became stroke rehabilitation beds. I take the point that there were 12 community beds previously and now there are two community beds, but we should not forget that there are an additional 12 stoke rehabilitation beds.

It was the opinion of the PCT at the time that there was no real change in the use of the beds at Tonbridge hospital, because their primary function had been rehabilitation. The 12 community beds were designated for rehabilitation, and the 12 stroke beds are obviously for rehabilitation, too. The hospital has gained two extra beds for community rehabilitation that were designated specifically for older people. The PCT therefore considered that there was no real service change, so it did not deem formal consultation necessary or appropriate.

The Government have pledged that in future all service changes must be led by clinicians and patients, not driven from the top down. That principle has been at the heart of our reforms for the NHS. To that end, we have outlined and strengthened the criteria that we expect decisions on NHS service changes to meet: they must focus on improving patient outcomes, consider patient choice, have support from GP commissioners and be based on sound clinical evidence.

Everything that we do in central Government is designed to support local clinicians and patients changing the local NHS for the better and to ensure that improvements are made to primary and community services. As a result of the Health and Social Care Act 2012, primary care trusts will be abolished from April 2013 and responsibility for commissioning services will move to clinical commissioning groups, so local doctors, clinicians and experts are in control. I see no reason why they would not commission services from those two excellent community hospitals.

My right hon. Friend mentioned the community hospital estate and its future. The 2012 Act requires new ownership arrangements for current PCT estates. In August last year, the Department of Health announced that NHS providers would have the opportunity to acquire parts of the estate. Therefore, providers, such as community foundation trusts, NHS trusts and NHS foundation trusts, will be able to take over those parts of the PCT estate that are used for clinical services. That of course includes the community hospital estate. We have put safeguards in place, so that providers cannot just dispose of newly acquired land and make a quick profit. I hope that that satisfies him.

Before the Minister concludes, will she respond to my request that before Ministers take a final decision on whether individual hospital properties go to NHS providers or NHS Property Services Ltd, they consult on the proposed final destination of the properties, so that local people have an opportunity to express a view?

I cannot give that undertaking. The point is well made; I will take it back to the Department and ensure that the Secretary of State is aware of it. Many such decisions will be taken locally. My right hon. Friend and the league of friends should continue to make all the representations that they have already made, and I know that they will do so.

The safeguards have been put in place. As my right hon. Friend knows, where any former estate becomes surplus to NHS requirements, 50% of any financial gain made by the provider must be paid back to the Secretary of State for Health and will go straight to front-line NHS services. Based on what I have been told and what I have seen in the 2012 Act, I am of the view that if a community hospital—if this is what occurs—is transferred to NHS Property Services Ltd, it will not in some way be deemed surplus to requirements by NHS Property Services Ltd.

The two hospitals that my right hon. Friend rightly champions would only ever become surplus to requirements if the CCG stopped commissioning their services. I am told that that is extremely unlikely to happen. He should have no fear at all that NHS Property Services Ltd will sit and looking at its assets and simply decide to sell things off for a quick buck. The hospitals’ future is secure. I thank him for securing the debate and for the points that he has made. I have not answered them all, but I will, in either a meeting or a letter.