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Community Hospitals

Volume 656: debated on Tuesday 12 March 2019

Motion made, and Question proposed, That this House do now adjourn.—(Michelle Donelan.)

I was pleased to note that on announcing his long-term plan for the NHS, the Secretary of State for Health and Social Care said he is a strong supporter of community hospitals, so I am today asking if Health Ministers will kindly look into how some of the additional resources announced with the long-term plan can be earmarked for the community care provided by community hospitals, such as the much loved Congleton War Memorial Hospital in my constituency.

Congleton Hospital needs sufficient resources to ensure that it can continue to provide the all-round services it has already provided for several generations of my constituents for generations to come. The hospital is much valued locally, providing a range of services, such as the minor injuries unit, which saves residents travelling some distance to hospitals further afield with A&E facilities. Minor injuries such as burns, cuts, splinters and sprains can be treated quickly and efficiently at Congleton. As one person, who sustained a hand injury, told me:

“I popped down to Congleton Hospital, the wound was treated straight away and I was back at work within the hour.”

That person would have lost at least half a day’s work travelling for treatment elsewhere.

In recent winters, the minor injuries unit has, on occasion, been closed temporarily by East Cheshire NHS Trust, with staff redeployed to Macclesfield’s A&E. Then, in September 2018, the trust stated that it expected closures to be in place throughout weekends and bank holidays, plus ad hoc weekdays, throughout this winter. As a result, the minor injuries unit is currently scheduled to open only between 9 am and 5 pm from Monday to Friday, but with additional ad hoc closures within these hours. It was not open, for example, when I visited last Friday afternoon.

It is therefore not surprising that some people in need of urgent treatment decide not to risk calling at a unit that may be closed unpredictably, with user numbers no doubt affected accordingly. It is also understandable that these closures are causing grave concern among local people. On their behalf, I am calling on Ministers to ensure, please, that resources are put in place so that valuable community hospital facilities such as Congleton Hospital’s minor injuries unit are not only stabilised but strengthened.

I congratulate the hon. Lady on bringing this issue to the Chamber. I spoke to her beforehand to ask what her thoughts were on this issue and how I might helpfully intervene. I spoke to the Minister, too. In the past few weeks, the national and provincial press have highlighted a number of incidents in hospitals. They report NHS staff referring to “war zone” conditions in A&Es. The community hospitals the hon. Lady refers to are vital for the treatment of patients, but it is also good for the mental health of NHS staff to have hospitals where they can do their job—their duty—without facing any injury or threat to their life.

The hon. Gentleman is right, as he so often is. Where they are properly resourced, minor injuries units can help relieve A&E facilities and enable them to treat more serious injuries more efficiently.

More broadly, the wide range of local healthcare services at Congleton Hospital includes a 28-bed in-patient intermediate care ward called the Aston unit, which is particularly appreciated by local families visiting patients. As the hospital’s website states, that unit helps those who no longer need the more acute wards of Macclesfield District General Hospital, relieves services there and allows people to

“recover in a homely and relaxed environment”

in Congleton. The website adds that the hospital

“has a very ‘family’ feel about it.”

The hon. Lady is making a wonderful point about the value of community hospitals. In north Staffordshire, Bradwell Hospital, Haywood Hospital and Leek Hospital all provide excellent care, but my clinical commissioning group is consulting on closing those hospitals and reducing bed spaces. Does she agree that closing community hospitals is detrimental to the overall impact of our health economy? Exactly as she says, such hospitals free up more expensive acute beds in the big hospitals and allow people who are medically fit for discharge but are not ready to go home to get the care they need.

I am sure the Minister will have heard what the hon. Gentleman has said. Indeed, that is why I entitled the debate “Community Hospitals” rather than simply “Congleton Community Hospital”.

As I have said, the hospital at Congleton has a family feel. I can testify to that following my most recent visit, just last week. I met kindly nursing staff who were clearly dedicated and committed to serving the community in and around Congleton, and who were proud to tell me that they had, through sound management, recently achieved an increase in the number of in-patients treated. About 350 are currently cared for each year in the Aston unit.

In addition to the minor injuries unit and in-patient care facilities, the hospital provides out-patient clinics, with approximately 9,000 out-patient attendances each year in a wide range of specialties. For instance, there are about 1,600 appointments a year for adult audiology treatment and about 1,000 for general surgery, and a similar number of gynaecology treatments. There are also about 2,000 trauma and orthopaedic appointments. Other services include blood tests, occupational therapy, a physiotherapy gym, district nursing, dementia services, and a highly popular GP out-of-hours service.

In my constituency, Burnham On Sea War Memorial Hospital, West Mendip Community Hospital and Shepton Mallet Community Hospital do so much of the great work that my hon. Friend is describing. Does she agree that in areas where the main hospitals are somewhat distant—in my case, Bristol, Yeovil, Taunton or Bath—community hospitals are vital in filling that gap, and it is essential for them to remain a core part of our future NHS?

My hon. Friend has made one of my points for me. None of the major hospitals in east Cheshire lie within my constituency, although it is reasonably large, so my constituents must travel some distance to use their services.

I have mentioned the four-hour GP appointments on Saturdays and Sundays. They are always full, and are meeting a very clear local need. The convenience of such services cannot be overstated. During my visit, an elderly gentleman, clearly frail, arrived asking for directions to the X-ray department. I watched as he was directed to it immediately. He was seen, and he departed. All that happened within what seemed to me to be about three minutes flat.

The value of such local services for a population like mine, which contains a higher than average number of older residents, cannot be overstated. They are particularly appreciated by those who are less mobile owing to age or infirmity, or for whom a lack of convenient public transport facilities would make travel to the larger hospitals outside my constituency very difficult, if not impossible. Moreover, 9,000 fewer out-patient appointments across east Cheshire must reduce congestion.

The trust informs me that the Congleton Hospital site also has space for use by other NHS organisations, including providers of mental health and health visiting services. As local health partners and providers increasingly work together in support of their local communities’ health and wellbeing, Congleton Hospital, located as it is almost in the centre of the town, is ideally placed to become an even more strategic community health hub for additional services.

The hon. Lady is making a powerful speech on behalf of community hospitals. South Bristol Community Hospital was opened only in 2012, after 60 years of campaigning by local people. As three providers run different services in it and as it is a LIFT building, no one is really responsible for making it work. Does the hon. Lady agree that the health service must bear in mind that such hospitals are developed and fundamentally loved by their communities, and that those communities should have the ultimate say in what goes into them?

The hon. Lady is absolutely right. Indeed, members of the community in Congleton are speaking out about the importance to them of their community hospital. I shall say more about that shortly.

On behalf of my constituents, I am pressing Ministers to consider resourcing Congleton Hospital as a community hub going forward. It has a very special place in local people’s hearts, as I have said, not least because of the manner in which it was funded many decades ago by local people’s contributions from wage packet deductions. It was founded in 1924 by public subscription as a memorial to those locally who gave their lives in the first world war, hence its full name: Congleton War Memorial Hospital. I spoke at greater length about this here in this place in 2014, when I raised concerns about the future sustainability of the hospital, so this is by no means a new issue. Indeed, in 1962 when there was a suggestion that the hospital be closed, it resulted in a mass meeting in the town hall with an overflow of some 2,000 residents, presided over by the then mayor leading to a petition of 24,000 signatures. Plans were quickly dropped. More recently, the £20 billion additional funding announced by the Prime Minister for investment in the NHS surely offers an opportunity for the future of the hospital to be secured, or even augmented as a community hub for the long term.

I have been in continuing dialogue for some months now with—and have met, together with local councillors—John Wilbraham, chief executive of the local NHS trust responsible for the management of the hospital, the East Cheshire NHS Trust. I am grateful to Mr Wilbraham for that open dialogue. We spoke again recently when he confirmed that, in his words, the sustainability of the site is on the agenda for the transformation programme to be discussed by the trust shortly. So also on the agenda is the future of the minor injuries unit, which is, as I have mentioned, causing particular concern to residents, as the trust is aware from recent public demonstrations which involved people from right across the community and political divides, including me and Congleton town mayor Suzie Akers Smith, who was in full mayoral regalia and chain.

I am grateful that Mr. Wilbraham has agreed to meet a cross-party group in the town shortly to discuss the hospital’s future further and look forward to that meeting. In the meantime, for the record I note that in his most recent letter to me of late December 2018 he confirmed, and I welcome this, that

“the Trust has no plans to change the service provision at the Congleton Hospital site and this remains the case. I continue to discuss with health and social care partners about the service offer from the hospital site and I understand the desire of you and the local population to maintain the facility. We await the publication of the NHS 10-Year Plan in early 2019 which provides the basis for the local health partners, including the town’s GPs, to set out its plans for the next 5-10 years. I am certain this will provide the opportunity to be clear on future service provision across the local health economy including Congleton.”

I am optimistic that both Mr. Wilbraham, as its chief executive, and the trust itself have listening ears. We need only witness the furore that arose in Congleton three years ago when there was a suggestion that car-parking charges be introduced at the hospital. The trust clearly registered the indignation of local residents, not least through a petition I presented here in Parliament at that time. That they could be asked to pay to park at their own hospital—a hospital they and their forebears had paid for by both wage packet deduction and subsequent fundraising and donations over the decades—aroused considerable consternation. The trust subsequently discounted the suggestion of car park charges outright; it listened to local people’s concerns.

I was pleased to note the chief executive’s reconfirmation of this in his most recent letter to me, with the words:

“I note the suggestion of car parking charges being introduced to supplement the income for the hospital site but this is not something the Board will be considering.”

Now that the 10-year plan has been published, and in the light of the Secretary of State’s indication of his support for community hospitals, I am today asking the Minister what more can be done to ensure that vital services provided by community hospitals in the heart of our local communities, like Congleton, are not swallowed up by larger hospitals at a distance. What the Congleton community seeks is reassurance that the future of Congleton hospital is put on a firm, clear and sustainable footing going forward, so that the periodic recurring concerns over the years about its future can be fully and finally put to rest.

I would like to start by thanking my hon. Friend the Member for Congleton (Fiona Bruce) for bringing forward this incredibly important matter for debate, and for articulating so beautifully the great value of the Congleton War Memorial Hospital to her constituency. I would also like to reiterate the important role that community hospitals play in local areas. She could not have articulated those great values more beautifully this evening.

Community hospitals provide vital in-patient care for people who need it most. As a whole, patients should be supported to recover in the most appropriate setting, which is quite often back in the heart of their local community and closer to home. However, community hospitals do far more than just provide hospital beds. They also offer a range of out-patient services that provide much-needed support to patients, including physical therapy, lab tests, X-rays and counselling. They can also contain minor injuries units, which, as we have heard, can have people in and out and back to work or back home much more quickly. They also offer a welcome local alternative to the big emergency facilities at an acute hospital that is many miles away. To its credit, Congleton Hospital already does all this for its local community and for local people. It is these services, this outreach and these minor injuries units that place these institutions firmly at the heart of their local communities.

The Government are absolutely committed to ensuring that patients have access to care that is as close as possible to where they live. This is very evident in the NHS long-term plan, which focuses on shifting to a new way of delivering care, with services in the community at the very forefront of planning. Community hospitals represent much more than just medical services. Many, such as Congleton Hospital and my own, the Gosport War Memorial Hospital, were originally built through the donations of local people to address local need many decades ago. It is this history, along with the important services that they provide, that make community hospitals the object of affection and appreciation in local communities. It is therefore important that any planning decisions about these much-loved institutions must be taken locally, and with enormous care and the utmost sensitivity. Fundamentally, this is about developing sustainable health and care services in the community. We care deeply about ensuring that residents in all areas can access excellent health and care services, both now and in the future.

Our social media timelines are busy enough at the moment, so in order to avoid attracting the ire of a quarter of my constituents, I must remedy the fact that I neglected to mention the brilliant Weston-super-Mare General Hospital in my intervention. I am putting it on the record now.

I am glad that my hon. Friend said that, because if he had not, I would have been forced to do so. We should all celebrate the hospital provision in Weston-super-Mare and the great work that is being done there.

We care deeply about ensuring that residents in all local areas can access excellent health and care services, both now and well into the future, and that is why the NHS is this Government’s No. 1 spending priority. The NHS budget will increase by £33.9 billion in cash terms by 2023-24, which is the single biggest cash increase in the NHS’s history. We have set out the what, and we now have to set out the how, which is why we are focusing on successfully implementing the NHS long-term plan. The NHS will develop a clear implementation framework, setting out how the long-term plan’s commitments will be delivered by local systems. This will be shared shortly, and it is being led by NHS England.

My hon. Friend asked whether some of the additional resources from the NHS funding settlement could be earmarked for community care so that valuable community resources such as Congleton Hospital can continue to deliver their vital services. I can confirm that we have prioritised investment in primary and community healthcare through the long-term plan, in which we have committed at least an extra £4.5 billion a year to primary medical and community health services. That additional money will fund expanded community multi-disciplinary teams and will help to ensure that, within five years, all parts of the country will have improved community health response services that can be delivered by flexible teams working across primary care and local hospitals, and developed to meet local needs.

I fear that the Minister may have been about to answer my question, so I apologise if she was. I welcome the suggestion that community care should be the focus of part of the new investment that is coming into the NHS. Where CCGs take a decision to reduce the number of community facilities in their area, what recourse will the public have to say, “The Minister said this, but your actions are different”? In places such as Stoke-on-Trent, what the Government are outlining is not what our CCG is doing.

The hon. Gentleman makes an incredibly strong point. I often stand at the Dispatch Box—usually during Adjournment debates—having listened to hon. Members talk about CCG decisions that they feel may not be in the best interests of their local area, but it is up to local areas to decide. The whole point of devolving money and decision making down to CCGs is that we trust them to be able to make the best decisions in the best interests of local communities to deliver services that best meet needs and priorities. If the hon. Gentleman feels that that is not happening and if he has had the opportunity to discuss that with his CCG, it could be a good idea to take the matter up with NHS England.

CCG funding allocations are decided by an independent committee, which advises NHS England on how to target health funding in line with a funding allocation formula. This objective method of allocation supports equal opportunity of access and reduces health inequalities. That way, the decision of where taxpayers’ money goes is decided in an independent and impartial manner.

As my hon. Friend the Member for Congleton will be aware, it is down to the CCG—in this case Eastern Cheshire CCG—to decide how it spends its allocation and to determine which services are the right ones for the local community it serves. One would hope that CCGs have the necessary clinical knowledge and local expertise to make informed decisions on how to spend taxpayers’ money. To support the long-term planning of services, NHS England has already informed all CCGs about how much funding they can expect to receive between 2019-20 and 2023-24. My hon. Friend may be interested to know that Eastern Cheshire CCG’s funding will increase from £270.2 million to £311.6 million over that period—a substantial increase. I hope that she will agree that that information gives CCGs the stability to plan appropriately and establish their services for the long term.

I do not disagree with much of the thrust of what the Minister is saying, because CCGs—I used to work for one—do spend taxpayers’ money. She will often have heard hon. Members say that there is no link between the accountability for that money, the work that we do as Members of Parliament and the decisions that are made by CCGs. The new NHS plan looks like it may want to do something about that, but will the Government send a message to NHS England and the CCGs that local democratic accountability must somehow start to be built into the CCG decision-making process?

The hon. Lady makes an interesting point, and it is one with which I have a certain sympathy. When NHS England comes up with the implementation plan for the long-term plan, I hope it will include suggestions as to how such issues might be addressed.

It is important to remember that the NHS is close to all our hearts. Fundamentally, it belongs to the people of this country. It is founded on a common set of principles and values that bind together the communities and people it serves. For that reason, it is welcome to hear my hon. Friend the Member for Congleton talk so highly of the open and honest relationship between her local NHS and the residents of Congleton. The examples she gave of the decision-making process for introducing car parking charges highlights how local people in Congleton are being listened to and, if I might say so, it says a lot for the people of Congleton. It takes a lot for the people of Congleton to demonstrate, but this shows that they do so effectively when they decide to take such action.

I commend my hon. Friend for the role she has played in the work to protect her local hospital and for all her activities in that direction. I also commend her for her ongoing efforts in forging constructive relationships, which are so important. These open conversations between health systems and the people they serve will, ultimately, allow us to continue building a sustainable future for the NHS.

Question put and agreed to.

House adjourned.