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Health Provision (South Gloucestershire)

Volume 598: debated on Tuesday 14 July 2015

I beg to move,

That this House has considered health provision in South Gloucestershire.

It is a pleasure indeed to serve under your chairmanship, Mr Hollobone. My focus in this debate will be largely on the Frenchay hospital site and the lack of any health provision there, which affects healthcare provision across South Gloucestershire. I am pleased to see in the Chamber my neighbours and hon. Friends the Members for Kingswood (Chris Skidmore) and for Thornbury and Yate (Luke Hall). I look forward to their contributions.

I have a great sense of déjà vu, because this is the third time in just over five years that I have spoken in such a debate and sought to enlist help from the Government to address the question of the promised community hospital at Frenchay. The previous Labour Government made the highly controversial decision in 2005 to downgrade Frenchay hospital. As part of their overall plan, which included building a new acute hospital at Southmead, a commitment was made to provide a community hospital on the Frenchay site. Five years later, in 2010, in the “emerging themes” proposals for healthcare in the area, we were again promised a community hospital at Frenchay. We were told that acute care services would move to the new acute hospital at Southmead and that the community hospital at Frenchay would have “step down” and “step up” services.

The “step down” service would allow patients who receive surgery at the new Southmead hospital to be moved to their local community hospital before being discharged, to reduce the number of beds required at Southmead and enable family and friends to visit patients more easily during their convalescence and recovery. The “step up” patients are those who require hospitalisation but do not require the full services of an acute hospital. The bed numbers for the new Southmead hospital were planned on community hospitals such as Frenchay being available for more minor matters.

In total, 68 beds were recommended at Frenchay. There was also to be a range of out-patient services, diagnostics and an enhanced community health service for care to be provided at home. There was also to be space left on the site for a doctors’ surgery, extra-care housing and possibly even a nursing home. Fine—that was not what local people wanted, but it was a clear plan with clear objectives.

Then, in July 2012, the primary care trust and the clinical commissioning group began to change their minds once again. However, they did not fully update South Gloucestershire Council’s public health and health scrutiny committee until April 2013. At that point, they confirmed that there had been a “stock take” of out-patient and diagnostic capacity at Frenchay.

In September 2013, the council’s health committee received confirmation that there was no longer a proposal to have out-patients and diagnostics on the Frenchay site. In August 2013, the CCG met and decided that, only for the interim, rehabilitation beds at Frenchay would be moved to Southmead for two years. My Conservative colleagues on the council’s health committee came up with a plan and identified funds within the council’s budget to keep the in-patient rehabilitation beds at Frenchay for two years until the new Frenchay health and social care centre opens in 2016. They proposed the plans to the health committee in September 2013. However, Liberal and Labour councillors joined to vote down the proposal. The issue was then referred to the Independent Reconfiguration Panel by the Secretary of State for Health.

The IRP made scathing comments on the way that local healthcare providers handled Frenchay community hospital, and Frenchay hospital in general. The IRP said it is understandable that residents

“should feel exasperated by the years of delay”

and by the

“amendments to plans”.

The IRP concluded that the whole process had shown a

“marked lack of empathy”

by local healthcare providers

“for patients and public who have the right to expect better”.

My hon. Friend the Member for Kingswood secured a debate on healthcare in South Gloucester in March 2014. I sought assurance from the Minister, and she said:

“I am assured that the local NHS is committed to finding a long-term solution for the provision of in-patient beds at Frenchay. Although the CCG is commissioning 68 beds at Southmead for May 2014, that is a temporary measure while the Frenchay site is being improved to accommodate them after April 2016.”—[Official Report, 19 March 2014; Vol. 577, c. 888.]

Frenchay hospital closed in the early summer of 2014 with a commitment that it would be closed for only two years and would reopen in 2016 as a community hospital. However, that date has moved once again and is now mooted for August 2018 at the earliest and more probably November 2019. Is it any wonder that a large number of my constituents feel bitter and that many are extremely sceptical that there will ever be a community hospital at Frenchay? Will the Minister explain why there is a further delay? I should like her to address the timings to help me explain to my constituents why that continues to happen.

More than ever, there is a case for a community hospital in South Gloucestershire at the Frenchay site. There will be a large population expansion in my constituency over the next 10 years. There was nearly a 10% increase in population across South Gloucestershire between 2004 and 2014, and a big increase in housing is planned over the next 10 years. For example, in my constituency the Cribbs Patchway new neighbourhood plan will create at least an additional 5,500 new homes. As a country, we have an ever-increasing elderly population, and the number of people aged 65 and over in South Gloucestershire increased by more than 30% between 2004 and 2014, and obviously that growth is ongoing.

The Save Frenchay Community Hospital group has recently published a report highlighting that Southmead hospital is currently unable to achieve the necessary national performance targets due to a lack of intermediate care beds in the community, which has resulted in a high number of patients being discharged due to a lack of appropriate sub-acute care beds in the community. Opening Frenchay community hospital would alleviate that situation and was supposed to be part of the overall solution and plan. I ask the Minister to insist that the CCG publishes its definitive plans for the Frenchay site. If the 68 beds are no longer required, I should like the CCG to explain how the gap in provision of intermediate care beds for patients discharged from Southmead hospital will be filled.

I am writing to ask South Gloucestershire Council’s health scrutiny committee to ask the Secretary of State to refer the matter back to the IRP. It has been more than a year since the IRP criticised the CCG for the length of time it was taking to make a final decision. Finally, my constituents and I need clarity and confirmation that a community hospital at Frenchay will actually happen with a realistic, achievable timescale that is in the public domain. The uncertainty and continual moving of goalposts drives the cynicism that has gone on for far too long.

I thank my constituency neighbour, my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti), for securing this important debate. Many people in South Gloucestershire are listening, and I put it on record that he has been a strong local champion for his area. At every moment, he has not been afraid to speak truth to power about what we feel is going wrong with healthcare across South Gloucestershire. The Minister will be more than aware that we have put South Gloucestershire on the map in raising our concerns about local healthcare provision. We have met her twice, and the last time was on 23 June. My hon. Friend and I have also met the Health Secretary. Over the past five years, we have secured several such debates in the House, and we will continue to do so until we resolve the issues that need to be resolved on behalf of our constituents.

Today, my hon. Friend has raised the issue of Frenchay. The delay caused by the CCG, for whatever reason, is inexcusable and needs to be solved, but I also want to talk about the situation at Cossham hospital, which is also part of the feted Bristol health services plan that took accident and emergency services from Frenchay to give to Southmead on the other side of Bristol. As part of that health services plan, a minor injuries unit was promised at Cossham hospital. Do not get me wrong—Cossham hospital had a full £20 million refurbishment after it was threatened with closure under the previous Labour Government in 2004, which is fantastic. As a member of the league of friends of Cossham hospital, I have volunteered to make the tea and, before we had our new baby, we turned up for antenatal classes at the hospital. It is a superb facility, but it has an empty room that should have housed a minor injuries unit, which, alongside Frenchay, is an outstanding sore point among my constituents, who were promised a minor injuries unit at Cossham and a community hospital at Frenchay. Those promises have not been delivered.

Cossham hospital is just outside my constituency in Bristol East, but it is used by 80% of South Gloucestershire residents, so it is a critical healthcare facility. There has been a 20,000-signature petition to the House of Commons, of which I delivered 2,500 signatures. That petition led to these debates and, just the other month, a referral to the IRP was published by the Health Secretary, who signed off and agreed the IRP’s recommendations. I understand that no Health Secretary has ever not agreed with the IRP’s recommendations, but the recommendations were that the CCG could go ahead as planned and not provide a minor injuries unit at Cossham. Instead, the CCG wants to pilot the introduction of minor injuries provision at general practitioner centres.

There is a problem for my constituents, and for constituents elsewhere in South Gloucestershire. There is a minor injuries unit in Yate, which I am sure my hon. Friend the Member for Thornbury and Yate (Luke Hall) will discuss. It is a fantastic resource, and only one patient at the unit has not been seen within the four-hour target, but we should have had a minor injuries unit at Cossham because people pay their taxes and it was part of the deal, which has been signed and sealed but not delivered. We have now been grinding away at this for years, and we seem to be going around in circles. The CCG has not come up with any alternative provision, so someone in Kingswood with a minor injury such as a broken leg or a broken arm has to go up to Yate. There is simply no provision in place, which is totally unacceptable. The IRP reported the exasperation that constituents feel about Frenchay, which is happening all over again and is mirrored with the minor injuries unit at Cossham hospital.

I have three points to raise with the Minister as the MP for Kingswood. I will continue to fight for a minor injuries unit at Cossham. At the moment, the CCG has not ruled out a unit. It is common sense that, while a room is empty and there is an X-ray department just down the corridor, it is far simpler for someone with a broken bone to get to the X-ray department than having to go to a GP surgery to be treated by a nurse practitioner before getting in an ambulance to go up to a minor injuries unit at Yate or Southmead. It is that lack of joined-up thinking that I and my constituents find incredibly frustrating.

One of the recommendations in the IRP report published last month—moving forward from its regrettable conclusions—was about the CCG request for external support from NHS England to help to solve its problems with delivering the community hospital at Frenchay and minor injuries unit provision across South Gloucestershire. It has asked for help, citing the problems it has with the deficit it inherited from the PCT. To reassure constituents and campaigners that the CCG will gets the help it requires, can the Minister tell us what kind of support NHS England can provide and how soon that can take place? We need answers and we need a road map.

As CCGs become more embedded and more autonomous organisations, accountability becomes an issue, and I do not believe arrangements are in place. That is general point that could apply across the country. The Secretary of State for Health has rightly copied the model of the Department for Education and introduced an accountability regime into hospitals. We now have a chief inspector of hospitals and hospitals will be graded on whether they are inadequate or need improvements. We need that system for CCGs. We need to be able to turn around, as a local community, and stare at our CCG, and know that if it has failed in public engagement, as South Gloucestershire CCG patently has, it will be branded as needing improvement or even inadequate. I urge the Minister to take that policy proposal away and look at it, because the problem will only grow.

Funding in South Gloucestershire is a well worn theme. My hon. Friend the Member for Filton and Bradley Stoke has raised the fact that we have a rapidly aging population. With 30% growth in the over-65s demographic since 2004, there will be problems with co-morbidities and long-term chronic illnesses, which effect everyone once we reach a certain point in life. That is what we need to deal with in South Gloucestershire, but we can only deal with it with improved funding. When we look at South Gloucestershire and compare it with Bristol, there may as well be a Berlin wall running through the county boundary: on one side is Bristol with several thousand pounds per head more funding than South Gloucestershire. Yes, we have had an incredibly welcome health funding increase of 7% in the past year—17th largest rise in the country—but we need a fairer funding settlement. We have the f40 group for schools, and we need the same in healthcare to ensure that South Gloucestershire residents get the healthcare that they desperately deserve.

I thank my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) for calling the debate—I know how hard he has worked to keep the issue at such high prominence—and my hon. Friend the Member for Kingswood (Chris Skidmore) for his comments on healthcare in the region.

As a local man, born in Southmead hospital just next door, I have, like other hon. Members here, relied on the NHS in South Gloucestershire and Bristol all my life. I echo their thoughts, especially those of my hon. Friend the Member for Filton and Bradley Stoke, on Frenchay and the delays in the CCG. I followed the reforms to healthcare in the previous Parliament and broadly support the CCG approach, which is fundamentally a good one. I welcome the announcement that the CCG has recently signed a 10-year contract with Sirona Care & Health to continue providing services at Yate minor injuries unit—a fantastic resource for local people in my constituency. That has been a great relief to a large number of people across Thornbury and Yate.

According to provisional Government figures, South Gloucestershire is scheduled to receive an extra £1.5 million next year, which is extremely welcome and only possible because of the Government’s management of the economy. As my hon. Friend the Member for Kingswood mentioned, the difference between funding per household in South Gloucestershire and Bristol is stark. Spending will rise to £1,856 per house in South Gloucestershire, but it is more than £2,100 per house Bristol—£273 more in Bristol than South Gloucestershire. I appreciate the raise we are receiving, but it is clear that we are inadequately represented in our funding.

I am particularly keen that the Government continue to address the problems associated with an ageing population in South Gloucestershire. The CCG has identified the problems of ageing, particularly diseases such as dementia, to be a significant priority for the area. I will support those efforts where I can by holding Dementia Friends events around my constituency to raise awareness of the disease in our communities.

The healthcare provision offered at Thornbury hospital is extremely important to my constituents. The previous proposals for Thornbury involved redevelopment of combined health centre and hospital sites, to lead to NHS rehabilitation beds to replace the Henderson ward as part of improved rehabilitation, re-ablement and recovery services for South Gloucestershire; a replacement healthcare centre with space for additional ambulatory services; and new extra-care housing and nursing home capacity, which is extremely important when we consider the 28,000 homes planned over the next 11 years in South Gloucestershire. I assure the Minister and my constituents that I will work with all the relevant bodies, including the CCG, NHS England and South Gloucestershire Council, to ensure that the services are delivered to Thornbury. That emphasis will ensure that my constituents receive the care that they need to remain active members of our local community.

More broadly, I should like to mirror the comments made recently by the Prime Minister and the Secretary of State for Health regarding the aspiration for a seven-day NHS. Yate minor injuries unit, which treats relatively minor injuries such as broken bones, minor head injuries or minor eye problems, is only open until 1.30 pm on a weekend. If we are to relieve the pressure on primary care centres, we must work to ensure that our community services can perform their duties any day of the week. I know that the Minister shares that aspiration and is working hard towards it.

In summary, I am pleased to welcome the move by the CCG to continue to provide crucial services at Yate minor injuries unit. I hope that people will join me in working to provide services and increased provision at Thornbury hospital as quickly as possible.

As ever, Mr Hollobone, it is a pleasure to serve under your chairmanship. This is my first Westminster Hall debate of the new Parliament; I responded in the last Westminster Hall debate of the last Parliament. It is nice to be back responding to a debate. It is nice to respond to a debate from my esteemed colleagues, my hon. Friends the Members for Filton and Bradley Stoke (Jack Lopresti) and for Kingswood (Chris Skidmore), and my new colleague, my hon. Friend the Member for Thornbury and Yate (Luke Hall), but I am sorry that we are revisiting themes that have been much discussed, both in private and in debates in the Chamber. My hon. Friends are, as ever, doughty champions for their local healthcare system. It is fair to say at the outset that I share some of their exasperation with regard to the timings that they expressed. I will revisit some of the history of the health service reconfiguration in the area and respond to the specific points they made.

I congratulate my hon. Friend the Member for Filton and Bradley Stoke on securing the debate and my other hon. Friends for coming to the Chamber and responding to the issues that were raised. This is a matter of long-standing importance—perhaps too long-standing, which is the thrust of what has been said today. I am sure that I speak for all my hon. Friends in saying that whatever the frustrations with the administration of healthcare in their local area, we have nothing but praise for the NHS staff who assiduously look after our constituents day in, day out.

The Bristol health services plan is the background to much of the issue. As my hon. Friends will be aware, the local NHS in Bristol, North Somerset and South Gloucestershire agreed the Bristol health services plan, which was a 10-year strategic plan to modernise and improve healthcare services across the area. It was the basis for developing a series of integrated proposals, including a new acute hospital for north Bristol and South Gloucestershire on the Southmead site, which opened in May 2014 following the transfer of acute service from Frenchay; and the new community healthcare facilities in South Gloucestershire, including the plan for a community hospital on the Frenchay site. In addition, the plans included the centralisation of some surgical specialties across the city, in a pattern now familiar to those following NHS reform, to concentrate specialisms and excellence at certain sites.

In 2010, the South Gloucestershire Primary Care Trust presented its emerging themes proposals for the development of a health and social care centre at Frenchay with community in-patient facilities, but the trust did not really deal with the affordability of those proposals in any detail. Indeed, it was noted at the time that there was no new funding available for the project and that it would require reinvestment of existing resources.

A business case was subsequently developed by North Bristol NHS Trust in 2011 for Frenchay, resulting in proposals that were considered unaffordable in the context of the financial challenges faced by the local NHS. In addition, those proposals would have limited the scope for the development of new community-based services in the long term. The commissioners made it clear that further work was required to ensure that the model for the delivery of services was in line with best practice.

One of the frustrations about a situation that has developed over such a long period is that it is overtaken by new models of care, and this whole debate is overshadowed by the fact that the Keogh review of urgent and emergency care, which aims to establish the ideal model for delivering that care, is relevant. Moreover, there are emerging best practice NHS views about how we provide community care and how different models work. As I say, one of the frustrations about a situation developing over such a long period, and which has been subject to delay, is that it tends to be reinforced because new models of care emerge all the time, which require plans to be revisited. That has been one of the sources of frustration.

It was against that backdrop that a major review of rehabilitation services was launched, in conjunction with local commissioners. The review of rehabilitation and reablement services across Bristol, North Somerset and South Gloucestershire commenced in October 2012, with involvement from both NHS and local authority providers. Significant progress was made in agreeing a clear and consistent vision for that future model, which was largely a service-focused response built on the involvement of a number of local stakeholders. South Gloucestershire clinical commissioning group developed a detailed local model of care for rehabilitation in August 2013, building on the rehabilitation and reablement review.

The implementation of that model of care began in 2013 in a phased approach, and there have been a number of developments to date in relation to the review. For example, rehabilitation community beds were located at Elgar house on the Southmead site and at Thornbury hospital. I must stress, however, that these are interim arrangements until long-term plans for community beds at Frenchay and Thornbury are put in place. I have already mentioned the frustration about timings, and that frustration was expressed during the debate. However, it is the current position that these are interim arrangements.

Further developments include the new community rehabilitation and reablement beds that have been commissioned in local care homes, with new in-reach support services in place for individuals in these residential rehabilitation beds, and additional community reablement services have also been commissioned.

What is the current position? Over the past 10 years, many of the proposals in the Bristol health services plan have been implemented, together with a number of major additional developments. It was good to hear my hon. Friend the Member for Filton and Bradley Stoke speak about the new state-of-the-art hospital at Southmead, although there have been challenges in some areas. There is also a new community health care facility in Yate, which he also referred to, as well as a new NHS independent sector treatment centre in Emersons Green.

In addition to those developments, a £19.6 million refurbishment of Cossham hospital has been completed. The hospital reopened in 2013 with the area’s first midwife-led birth centre. My hon. Friend will be aware that Cossham hospital had originally been due to close, so was not part of the proposals in the Bristol health services plan. That is, if you like, a gain on what was originally proposed, and one that I know has been welcomed.

Over the past two years, local clinicians have continued to lead the major transformation programme for rehabilitation services. I am assured that providers, patients, members of the public and other stakeholders have been extensively involved in that programme. I very much hope that other stakeholders, including MPs, are involved. I often say in debates such as this one that it is absolutely essential that local NHS commissioners, including CCGs, work closely with MPs. It is often forgotten that MPs are a first point of contact for people who are concerned about the process of reform, whether they are frustrated by the timing of the process or worried about its relative opaqueness.

South Gloucestershire CCG has confirmed that it has made significant progress towards implementing that programme, which includes providing community beds in local care homes with in-reach support from NHS teams. As part of the next major transformation of rehabilitation services, in March, the CCG began procurement for services that are expected to lead to the redevelopment of the Frenchay and Thornbury hospital sites. As my hon. Friend said, the timetable published with these plans describes a procurement process that is expected to result in the award of a contract by March 2016. This is a good opportunity to provide an integrated health and social care development on the Frenchay site.

I understand the frustrations that are felt locally, including by my hon. Friends who are here today, about some of the timings involved. The CCG has confirmed that it understands the concerns felt by some members of the community. I will follow up this debate by writing to the CCG and asking it for more detail about the timings, because I am concerned to hear talk of 2018 or 2019. At first glance, it is quite hard to get one’s head round that timetable, so I will follow up by asking for more detail, and I will report back. This is a complex project, involving a lot of partner organisations that are co-ordinating multiple developments across a number of sites. Nevertheless, we need to have a bit more detail about how the timetable might slip by one year and potentially by another year.

The CCG has confirmed that it is determined to deliver transformed services that meet future health needs in line with current best practice, but any plan needs to be financially affordable. As I have already said, we need to ensure that plans are not constantly overtaken by new models, although the model based on best practice is much more settled than previous models and is in line with recent NHS England thinking and the five-year forward view, which is a very helpful road map for the health service for the next five years and which everything else relates to.

Regarding the minor injury unit plans, as my hon. Friend knows, South Gloucestershire CCG has decided to revisit those plans to take account of local evidence about their impact on accident and emergency attendances. Those plans are looking at key themes emerging from Sir Bruce Keogh’s national review of urgent and emergency care. That work is ongoing, but it is reshaping the way that the NHS thinks about urgent and emergency care, and it influences all the models of care that are being considered, with patient care at its heart. I can understand why the CCG believes that enhancing primary care services would help to improve urgent care services for the whole population, but what is needed is clarity about that process and about how it will be assessed.

Last October, following a period of engagement with the public, proposals were put forward and it was agreed that they would be developed on a pilot basis with the GP practice-based injury services described by my hon. Friend. The CCG is working with local GPs and community providers to agree detailed plans, but in my follow-up letter to the CCG after this debate I will ask for more information about those plans and the process of assessment for that pilot, which will feed into any final decision that is made. That work will include further discussions with local GP practices, but I will stress in my communication to the CCG that it must involve detailed discussion with local MPs, particularly when those MPs have been so assiduous in following this process, not just through one Parliament but now into a second Parliament. It is absolutely vital that my hon. Friends are kept informed and involved.

Subject to successful completion of that work by the CCG, plans are expected to be presented for approval to the September meeting of its governing body. I stress that a formal decision in relation to the previous plans for a minor injuries unit at Cossham hospital will be made once the proposed pilot scheme has been evaluated. Subject to the details being agreed, the pilot scheme is expected to commence in late 2015 and it will run for a minimum of 12 months, with evaluation that will include consideration of feedback from patients. Again, I expect local MPs to be closely involved in that process.

A number of challenges have been made to me, and hon. Friends have asked me to follow up on them. I will look to see where I can do so. More generally, as we have discussed before in Westminster Hall and in the main Chamber, it is the responsibility of local NHS organisations to determine how local services are delivered. They are best placed to understand the needs of the people they serve, but what this process has drawn out is that over time those needs can change and evolve, and our understanding of how best to respond to them must change and evolve. Nevertheless, we need to ensure that we are at all times moving forward, because local people do not really understand why things seem to be endlessly put into review and re-examined.

NHS England has rightly placed more emphasis in recent times on how it can provide support to parts of the system that are struggling to make progress at a pace that we would all recognise as ideal. Part of my follow-up to this debate will be to ask whether NHS England can provide any extra support to help to ensure that there is a clear timetable, which is well understood and which everyone can talk to their local community about. I will do that in my follow-up, and I will write to all three of my hon. Friends after this debate. As ever, I commend them for their interest in this subject, and I hope that we can see considerable progress in the early years of this Parliament.

Question put and agreed to.


That this House has considered health provision in South Gloucestershire.

Sitting suspended.