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Healthcare (Devon)

Volume 615: debated on Tuesday 18 October 2016

[Mrs Anne Main in the Chair]

I beg to move,

That this House has considered healthcare provision in Devon.

It is a great honour to serve under your chairmanship, Mrs Main, which I am sure will be fair and impartial; if only that were the case elsewhere in the House. It is a particular pleasure to welcome the Minister of State, Department of Health, my hon. Friend the Member for Ludlow (Mr Dunne); I fear he has had quite a few outings already this week, and will have more. I make no apology for summoning him here, on behalf of my colleagues from Devon, to address an issue that will not go away any time soon. I suspect that this will be one of many occasions on which we will seek to ask pertinent questions on behalf of our constituents across the county.

Healthcare is one of the biggest issues in Devon, largely for two reasons. The first is the demographics of the county: 17.7% of the UK population are aged 65 and over; that rises to 21.1% in the south-west and, in my part of the south-west—East Devon—to 27.7%, which is 10% more than the national average. Secondly, reforms are coming down the line, involving bed closures and so forth, that are sometimes seen as controversial. They are a result of the perilous state of Devon’s NHS, which is there for us all to see. Before we start our long list of asks and demands, it is worth remembering that the Northern, Eastern and Western Devon clinical commissioning group’s financial deficit is due to hit £490 million by 2019, which is clearly unsustainable.

Before I launch into my pleas and points, I point out the absence of some colleagues from Devon from across the political spectrum who I know feel passionately about this. The right hon. Member for Exeter (Mr Bradshaw) and my hon. Friend the Member for Totnes (Dr Wollaston) are both detained in the Select Committee on Health. I believe that they have either just interviewed, or are interviewing as we speak, the Secretary of State for Health and the chief executive of NHS England. Of course, my hon. Friend the Member for Central Devon (Mel Stride) is unable to take part in the debate on account of his particular office. He has an excellent relationship with the GPs in his constituency, and he is supportive of wellbeing hubs, provided they serve the local community appropriately.

On the whole, we welcome the Government’s intervention in Devon’s NHS in the form of the success regime. If followed properly, it will help to solve some of the underlying problems that beset Devon’s national health service. As part of its work, the success regime, along with the CCG, has recently published proposals to close 72 hospital beds in Exeter and East Devon. The Minister will quite properly respond that that is under consultation, but I think this is the only way that we can raise these points in a public forum to make sure that everybody knows what we are thinking.

I understand that recently, the success regime, although it has a preferred option, which includes the rather expensive Labour deal on Tiverton hospital, has now introduced a “none of the above” option. If that is now an option, it creates a whole new range of possibilities. If that is not an option, I argue—my colleagues will argue for other things—that option B, which sees the beds retained in Tiverton, and also in Sidmouth and Exmouth, is the option worthy of support. Sidmouth has an extremely high proportion of over-85s, with people increasingly living longer, and of people with dementia. Exmouth is the biggest town in Devon with more than 35,000 people.

Thank you, Mrs Main, for allowing me to serve under your chairmanship. Plymouth has around a quarter of a million people, and is the largest urban conurbation in the whole of Devon.

As my hon. Friend knows, Plymouth is a unitary authority; Exmouth is the biggest town in Devon. Local people—my constituents—are hugely supportive of our community hospitals. We have beds in Exmouth and Sidmouth; in Ottery St Mary we have 16 stroke beds, although they are eventually to be replaced by a health hub; and Budleigh Salterton hospital, which I will talk about in due course, will, we hope, be turned into a health and wellbeing hub.

Over the years, many local residents have donated significant sums to the hospitals. In Sidmouth alone, the Sidmouth Victoria hospital comforts fund has raised over £5 million. Local people are prepared to invest in ensuring first-class local health services. I pray in aid the position of Sid valley Admiral nurse—the Admiral nurse helps people with dementia—which was hugely supported locally. I am pleased to say that I was able to play my part in obtaining additional funding for that position from the Big Lottery Fund. If there is an identifiable health issue locally, people are prepared to back care with their own money.

If the Minister will allow me, I will talk about the consultation process and the lack of documentation. As I understand it, the consultation process has been overwhelmingly carried out online; there are very few paper copies of the consultation. Elderly people, who may have no access to the internet and who are disproportionately likely to be affected by the changes, are therefore disadvantaged. The consultation period ends on Friday 6 January. I ask the Minister to do everything he can to look at the issue, and to work out how we can get more people involved in what is, after all, an extraordinarily important process.

The potential closure of hospital beds raises the issue of 21st century healthcare, which obviously includes preventive as well as curative care. My constituents—like many across the country, we are told—prefer to be treated at home for as long as possible. They understand, on the whole, that community hospitals need to change and adapt in order to offer a service fit for the 21st century. In Budleigh Salterton, we have been working very hard to try to ensure that the community hospital is transformed into a health and wellbeing hub, which will involve bringing together the health, social care and voluntary sectors. I think that is a good template that can possibly be used across the country. In fact, if it works, there will be far greater footfall through the community hospital than there has been while it has been just a hospital. I remain very supportive of that.

There is, of course, a negative side to keeping people in hospital beds. According to Angela Pedder, the lead chief executive of the success regime, the cost of running a 16-bed community hospital ward is £75,000 a month. Home care could look after 82 people for the same money. However, we are in danger of putting the cart before the horse. Until we can absolutely ensure that we have got social care right, we should not look at unnecessarily closing community beds that some people will have to use. Equally, I am nervous that, just because we have well-supported community hospitals across East Devon, we are being targeted unfairly, so as to rebalance the books across other parts of the county.

If we are reducing the number of hospital beds, it is absolutely essential that the social care system is able to compensate for that loss. In the past five years, council budgets for social care have fallen behind demand by £5 billion, and 150,000 fewer people receive at-home help than five years ago. Social care can take the financial pressure off the NHS. For instance, the installation of a simple grab-rail in an elderly person’s home can help to prevent the falls and broken bones that cost the NHS £2 billion a year. The option of making greater use of technology remains hugely under-exploited, in terms of how we ensure that people are getting a first-rate service at home.

I am sure my colleagues will want to raise the whole issue of rurality this afternoon. Government policies are meant to be rural-proofed. Frankly, social care is far easier to administer in a conurbation such as Plymouth than in other parts of the county, where people are spread over much greater distances.

Another issue that I am sure some of my colleagues will want to talk about is recruitment. We are told that social care will be one of the big growth industries in future. That is all to the good, and it is inevitable. However, currently, people find it very difficult to recruit. It is much easier, I am told, for the NHS to recruit people to work in social care than it is for the private sector. It is all very well transferring people back home, but only provided that there are the people to carry out the social care.

Stephen Dorrell, a former Health Secretary, has said:

“Fetishising the NHS budget and imagining it’s the only public service that relates to health is fundamentally to miss the point…It is not true to say we are supporting the health service by asking it to do social care. We are using the health service as a very expensive social care service and then talking about efficiency. It’s insane economics and very bad social policy.”

I would like to know if the Minister agrees, and what he feels can be done to ensure that we have first-class social care in place before we start to close community beds. Given the closure of residential homes, and the fact that local authorities are increasingly unwilling to pay the fees demanded by residential homes, we might end up in a situation where, although a person can no longer be cared for at home and needs some kind of hospital bed—we want to keep them away, of course, from the main hospitals—we have got rid of all our beds, or a disproportionate number, and so have created an unnecessary problem.

I want to say something about NHS Property Services. Since the NHS provider in Devon changed from Northern Devon Healthcare NHS Trust to Royal Devon and Exeter NHS Foundation Trust—at least in my part of the county—on 1 October, ownership of the community hospitals has transferred to NHS Property Services. NHS Property Services, as we know, charges commercial rents, meaning that many hospitals will have to pay higher rent. Along with the planned bed closures, that has understandably made some of our constituents nervous. What happens if hospitals cannot pay the rent? Given that the Department of Health has committed to meeting any increased property costs for 2017 and 2018, the big question is what happens thereafter.

My general practitioners at the Blackmore health centre in Sidmouth increasingly feel that they have little influence over the redevelopment of the surgery, which I champion, as a result of the involvement of NHS Property Services. The practice wants to buy the building off NHS Property Services, either now or at some stage in future. It is proving extremely difficult to make that happen. It should be a simple move, as it is supported by local GPs and the local community.

There is some concern about Exmouth—Devon’s biggest town—losing its out-of-hours GP services, which will be replaced with use of the 111 service, in line with the new integrated urgent care commissioning standards. Perhaps the Minister could write to me to reassure me that my constituents in Exmouth will receive exactly the same cover that they did under the previous arrangement.

One thing that affects all of us across Devon is the lack of provision of mental health facilities, which has exercised us for a long time. In my patch, I am concerned about St John’s Court, which is the only mental health and recovery facility in Exmouth. Two years ago, Devon Partnership NHS Trust spent £300,000 on a move from Danby Terrace, which was not at the time fit for purpose, to St John’s Court. On top of that, £140,000—this is all taxpayers’ money—was spent on refurbishing St John’s Court. Now the trust is pushing ahead with closing and selling St John’s Court. It has assured us that Exmouth will not experience a reduction in healthcare provision, and that St John’s Court will not be sold until an alternative venue can be found. We are talking about a growing town with a lot of mental health issues. I seek reassurance from the Minister that before anything is closed, something will be put in place to reassure the local community and my constituents that we have the same, if not a better, level of mental ill-health prevention and cure.

I wanted to speak for longer, but I am conscious that my colleagues will probably want to articulate their own slightly different visions for the future of healthcare in Devon. I say to the Minister in the friendliest manner possible that we are a pretty quiet bunch in our part of the world, and we do not seek trouble, but we do fight tenaciously to protect the livelihoods of our constituents. Too often, we feel that people forget about us in the south-west, and that money is diverted to all kinds of infrastructure projects in the huge urban conurbations, the northern powerhouse and so forth. This time, we will speak as one to ensure that whatever comes out of these consultations, and wherever we end up after them, we can argue these points in a mature way. It is simply no good saying, “It’s a lack of money. It’s Tory cuts.” That is an immature conversation to have. We have to, between us, design a health and social care service that is fully integrated, makes use of technology, and cares for all of us as we get older and more dependent. We need to be brave, but political sloganising is not the answer.

It is a pleasure to serve under your chairmanship, Mrs Main. May I congratulate my right hon. Friend the Member for East Devon (Sir Hugo Swire) on securing this debate on a topic that is vital for all us, right across Devon?

It will not be a surprise to anyone that I intend to focus mercilessly on North Devon and to fight our corner very hard indeed against the threat to our acute services at the North Devon district hospital in Barnstaple. Before I go into that in any detail, I want to make a couple of points. First, I would like to thank the Minister, who has on a number of occasions met myself and other colleagues in Devon to address this issue. I know he understands the particular significance of the North Devon district hospital, because I have discussed it with him, as I have with a whole slew—I am not sure what the collective noun is—of managers in the Northern Devon Healthcare NHS Trust and other directors and managers within NHS England, who by now are well aware of the strength of feeling in North Devon. I want to put it on record that the Minister has been very proactive in arranging such meetings.

My right hon. Friend the Member for East Devon talked about community hospital beds. I do not want the impression to be given that that is not a serious issue also in North Devon, although I will not be majoring on it. In North Devon, there is a bit of history. We did the heavy lifting with the loss of many of our community hospital beds about 18 months ago under a different process from the one now being undertaken in the rest of the county. I agree with what my right hon. Friend said about the need to look very carefully at the provision of social care before community hospital beds are removed.

I do not think NHS England has done this in the right order. Community hospital beds have been removed in North Devon, specifically from the Tyrrell hospital in Ilfracombe, and there is a great amount of concern among the local community about what is replacing that provision. Is there integrated and fully functioning health and social care provision in North Devon to replace those beds? My view is that the answer is no. That is also the view of the community in Ilfracombe. Last Friday I met the League of Friends of the Tyrrell Hospital, and that is strongly their view. That is not my major point today, but I want it on record that that remains a concern in North Devon, as it will become in other parts of the county.

My focus today is on acute services in North Devon. The community is extremely concerned. Many constituents have contacted me and shown their strength of feeling through protests on the street, campaign marches and letters to me, as the local MP, and to my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox), whose constituents also use the North Devon district hospital in Barnstaple.

My point is absolutely clear and I will make it up front: there must be no cuts to acute services at North Devon district hospital in Barnstaple. I cannot see any clinical argument to justify even consideration of any such a reduction in services, let alone its implementation. Let me provide some background.

Healthcare in Devon is currently subject to not one but two separate review processes. We have the success regime, and the Northern, Eastern and Western Devon clinical commissioning group area was given this special treatment with only two other areas in the country—one in Essex and one in Cumbria. Because of the need to ensure that we do not fall into a future funding black hole, the success regime was implemented. I fully support that because we need this special treatment.

On top of the success regime we have a sustainability and transformation plan, which, as hon. Members will know, is being implemented in all NHS regions in England. We have this two-tier process and my understanding from conversations with NHS England is that the success regime will probably be folded into the sustainability and transformation plan, so North Devon will find itself subject to a target that we are at least more easily able to identify. The difficulty is that the ideas that are starting to emerge from the two, soon to be one, reviews are simply unpalatable for North Devon.

I put it on the record that I am fully aware that these are not firm proposals or ideas and no public consultation has been launched. None the less, what has started to emerge has, reasonably and understandably, created serious concern in the North Devon community because, looking across the piece at the various documents that have emerged from both the success regime and the sustainability and transformation plan, we see a picture that puts under threat some of the services at North Devon district hospital, which my constituents rely on most keenly and have done for generations. They include vital services such as accident and emergency, stroke and one that I want to focus on now, maternity.

I have here one of the latest documents to emerge, which hon. Members may remember. Unfortunately, NHS England decided not to make this series of documents public. I say gently to the Minister that that has not been helpful. I know it was not his direction, but it has given rise to the belief that stuff is being done in private behind closed doors and that leads to suspicions, rightly, among my constituents and the public in general. That latest document, which is about five weeks old, starts by talking about

“a two-site option for maternity”

and states that the

“Royal Devon and Exeter Hospital would most probably be the second site”—

after Derriford in Plymouth—

“rather than North Devon District Hospital”.

That is a clear indication that consideration is being given to closing the maternity unit at North Devon district hospital. That is not acceptable to my constituents and we will fight any such proposals if they come forward. We will do that forcefully for a couple of reasons.

North Devon is a special case, not least because of our geography. I have said many times in this Chamber, in the House and elsewhere that Devon has been historically underfunded, and North Devon even more so. We are and have been for too long the poor relation in public funding. Let me be clear. This is not something that has happened in the last 18 months or the last six and a half years. It has been an issue under Governments of all colours for many years, if not decades. It is something up with which we will no longer put.

Part of the difficulty of singling out North Devon and Barnstaple as a place that can apparently sustain further reductions in services is that we start from a lower base of funding than in many other regions. That feeds perfectly into the point that my right hon. Friend the Member for East Devon raised about rurality. North Devon is a largely rural constituency, and for many years a series of funding formulae have dealt unfairly with North Devon because of its rurality. There seems to have been a belief that, because we are a rural area with a sparse population, we can somehow do with less funding. In fact, the opposite is true, and I am delighted that this Government are starting to recognise that. Across the piece of funding for local government, the police, education and health services, we are starting to right that wrong and equalise that funding gap, but the history is still there and that is why North Devon is the last place where we should be looking for further cuts.

I am grateful to my hon. Friend for allowing me to intervene during his limited time in this debate, but I would like to respond specifically to his point about funding and allocations.

In the 2016-17 funding round, the allocation formulae have been looked at again and we have, for the first time in several years, introduced three differentials that are relevant to rural areas and that I think will affect my hon. Friends here. They include looking at the combination of rurality, remoteness and sparsity of population to improve the ambulance emergency cost adjustment, to reflect the greater distances travelled in rural areas; an adjustment to support continued provision by hospitals with 24/7 A&E services that are remote from the wider hospital network—my hon. Friend’s North Devon district hospital will be one of those’and an adjustment to remove from the formula supply-induced demand in urban areas where people live close to hospitals. Those three measures have led to a change and I gently suggest that my hon. Friend may care to look at the CCG allocations table which sets that out. For Northern, Eastern and Western Devon CCG, the per capita allocation for 2016-17 is £1,250, which is slightly above the average for England of £1,221 per head.

I thank the Minister for his intervention and I welcome it, but I say gently to him and NHS England, which I am sure is monitoring this, that all that good work will be entirely undone if we then lose our acute services at North Devon district hospital. This is not about figures on a spreadsheet; it is about the services and healthcare provision that my constituents will receive in Barnstable.

I am aware of the time, Mrs Main, but I want to raise a second issue, which is important and recognisable to us in North Devon, but perhaps not to those beyond: our unique geography and the distances. An Australian historian once referred to the tyranny of distance, and I think we suffer from that in North Devon. If one looks at a map, it is all too easy to think that there is a decent road network between Barnstaple and Exeter. I can give several reasons why that would be a wrong assumption. First, vast numbers of people live in isolated regions far north of Barnstaple. Secondly, the road network is not all it is cracked up to be—although that is a subject for another day and one on which I am fighting heavily.

My main point is that what no map or distance table shows is that in North Devon we have pockets of serious deprivation. In Ilfracombe, I have two of the most deprived wards in the south-west and by some metrics the most deprived in south England. In those areas car ownership is less than 80%. Put another way, one in five households do not have access to their own private transport and, because of the demographics, some of those who do are elderly and perhaps have their own vehicle but simply would not feel comfortable or up to going long distances to Exeter or Plymouth. Those two reasons alone are sufficient to argue strongly that the last place where we should be looking to make cuts to acute services is at North Devon district hospital.

I am aware of the time, Mrs Main, so I will conclude. I welcome the fact that the Government are looking at the funding. I welcome the repeated assurances that local clinicians will make the final decisions. However, I want it to be in no doubt whatever—the community of North Devon are very clear about this—that North Devon is a special case and needs to be treated as such. In that regard, I make no apologies whatever for fighting for North Devon and for appealing for there to be common sense and no cuts at North Devon district hospital.

We have approximately 35 minutes before the winding-up speeches and there are five speakers. I am sure we can do the maths.

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my right hon. Friend the Member for East Devon (Sir Hugo Swire) on securing the debate. I will be mindful of your comments about the time. I presume that a maximum of eight minutes will be appropriate.

I am reminded that it is seven minutes. [Interruption.] The more heckling there is, the longer I might get.

For me, this debate is prompted by what is one of the greatest successes of the NHS: the fact that life expectancies are rising. In parts of my constituency, life expectancy has reached 90, and in one ward that I represent, Wellswood, 9% of the entire population are aged over 85. That brings challenges not only in health and social care, but in relation to the wider selection of services that those who have reached that age will need in order to have a whole life and not just have their healthcare needs taken into account.

Today, however, the focus is on the health service. Clearly, the proposals announced by South Devon and Torbay clinical commissioning group have created a lot of concern across Torquay, Paignton and the rest of the bay and south Devon. In fact, public concern was so great that the first three consultation meetings that it arranged in Paignton did not go particularly well. It arranged what were obviously going to be very large meetings in rather small venues, so when I attended the first one, at 9 am, I found myself, with about 40 residents, my predecessor, the former mayor and a number of councillors, plus trade union representatives, being told that the room was full and we could not go in. Things got worse at the 4 o’clock meeting. I ended up addressing more people at an impromptu meeting on the steps of the venue than had actually got into the official meeting. Then finally, in the evening, although there was a reserved seat for me, that meant that another resident was turned away because I was there speaking. It was a shambolic start to a serious consultation, but thankfully I notice the trust has now arranged further meetings.

Local concern about Paignton hospital is so great because of the breadth and importance of the services that it provides, not least the beds that many people are discharged to from Torbay hospital. When the Public Accounts Committee did its recent report on delayed discharges, Torbay had one of the best records. I am sure that my right hon. Friend the Member for East Devon would reflect that, sadly, the Royal Devon and Exeter did not. That is not so much about the hospital’s own services as about its ability to discharge to a social care setting.

We have already seen the impact that the consultation has had in terms of beds. Qualified staff have decided to seek jobs elsewhere, seeing the numbers of beds already reduced. During the consultation, the fact that there are hundreds of beds in residential and nursing care homes in Paignton was cited. I took the time to ask the obvious question: how many of those are actually vacant at the moment? The answer that I got back—this was a snapshot taken two weeks ago—was that 12 of the beds are vacant, yet two are in places that are accepting no new placements at the moment and four are in a place that specialises in caring for children. That causes real concern that we will see more delayed discharges at our local hospital if the proposals for Paignton go ahead.

Many residents of Paignton are concerned about the wider clinical services provided there, not least the minor injuries unit. The suggestion made in the consultation is that if a minor injuries unit closes at Paignton, residents will travel to either Totnes or Newton Abbot. I am sure that we will hear from my hon. Friend the Member for Newton Abbot (Anne Marie Morris) that the facility there is in excellent condition, but the reality is that that involves travelling past the acute hospital at Torbay, with its A&E department. I think it is far more likely that there will be more pressure as a result of people who would have been at the minor injuries unit in Paignton ending up at A&E in Torbay—the very place that we want to discourage people from going to unless they need to be there. There are also services such as X-rays and other clinics that many local residents find convenient and that support local GPs in delivering excellent healthcare.

My other concern about the consultation document is that although it is very detailed about what will be taken away from the south Devon area, it is not detailed at all about what will replace it. For example, there is talk of a clinical hub in Paignton, but no location. There is talk of doing more through GP surgeries, yet many of the practices are in buildings that predate 1948 and are in effect converted houses—not places that would be able to provide extended facilities for healthcare.

I find it very concerning when I speak with local people about what engagement there will genuinely be as part of the consultation, not least given the meetings arranged for small venues and the way that much of the questioning really produces only one logical answer. No one is going to say, “Yes, I’d like to spend the night in hospital,” but we would spend the night in hospital if we felt that we needed to be there. This is about ensuring that people have genuinely been able to express their views. That is why I hope that my hon. Friend the Minister will take a close look at the consultation being undertaken.

In closing, I emphasise the point that has been made about recruitment. The movement of qualified staff out of Paignton the moment the proposals to close the hospital were mooted speaks to a wider problem of recruitment across health and social care in south Devon. Although seeing the Torbay and South Devon trust receive Fair Train’s gold standard work experience accreditation last Friday was welcome, more still needs to be done to convince people that careers in health and social care are just that: careers. Many male jobseekers in particular see a job in that field as an entry-level job that they would not progress from, yet there are so many opportunities there. This is another concern for me, as it is for colleagues. We can put things down on paper, but if, in the social care market locally, there are not the providers, there is not the quality of provider and, bluntly, the vacancies that we already have for GPs are spreading across other health professions, then whatever position we come up with in the consultation will not be able to be implemented unless we address those long-term challenges in our economy.

Does my hon. Friend share my concern about recruitment in social care and care homes: that a lot of staff are, of course, from the Philippines and other countries around the world? We must all hope that that is taken into account when the UK comes up with a new immigration policy.

I thank my right hon. Friend for his intervention. It is worth saying that the outcome of the EU referendum and Brexit is probably not going to affect those from the Philippines, given that the Philippines is not a member, but I fully accept the point that we have for too long relied on importing healthcare professionals—doctors and others. We have to have a debate about whether it is ethical for us basically to be depopulating parts of the third world of much-needed doctors, nurses and other trained medical professionals and to be relying on other countries’ training schemes to provide the numbers of healthcare professionals we need. The key point is that we want our own young people to be taking up those opportunities, as well as having the services provided.

I can see you indicating that my time is coming to an end, Mrs Main, or has come to an end. I will finish with one plea: I want to see Paignton hospital and Paignton people’s services continuing into the future.

I, too, congratulate my right hon. Friend the Member for East Devon (Sir Hugo Swire) on securing the debate. Over the next few moments, I want to concentrate on NHS England’s proposals to close three GP surgeries in my Plymouth, Sutton and Devonport constituency and how I hope we can take some pressure off the principal acute hospital at Derriford in the constituency of my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer).

I am told that the reason why NHS England is considering the closures is the size of the GP practices. The Cumberland GP practice has 1,800 patients, Hyde Park 2,800 and St Barnabas 1,700. They are considered by NHS England to be unsustainable and too small. It also tells me that closing those practices is not down to saving money, but to deliver better value for money. However, before I speak about those issues, let me put my constituency in context.

Plymouth, Sutton and Devonport runs from the A38 down to the sea and from the River Plym to the River Tamar. It is the home of one of the largest universities in the country, with more than 27,000 students, thousands of whom live in the city centre, and it is a naval and Royal Marine Commando garrison city, as my hon. Friend the Minister, for whom I was a Parliamentary Private Secretary in a previous life, knows only too well.

The city’s population is growing. Although it has a global reputation for marine science and engineering and research, it is a low-wage and low-skills economy. It is an inner-city seat. I do not have a single piece of countryside in my constituency, unless we include the Ponderosa pony sanctuary, which is a rather muddy field. Between Compton and Peverell in the north-east of my constituency and Devonport in the south-west, there is an 11-year life expectancy difference. Compton and Peverell is where many of the university lecturers and hospital consultants live. In the run-up to the 2010 general election, when I won the seat on the third attempt, the Conservative party pledged to do something about healthcare in deprived inner cities.

We have started to make good our word. In 2014, our hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), one of the Minister’s ministerial predecessors, came to Devonport to open the Cumberland GP practice, which is now under threat. Other facilities on the Cumberland campus include a minor injuries unit, the new Devonport health centre and a pharmacy. The Cumberland GP practice was set up by Plymouth Community Healthcare—now Livewell Southwest—and the Peninsula medical school. There was and is a desperate need to provide a tailor-made alternative service to the existing GP practice—then the Marlborough Street practice; now the Devonport health centre—for this deprived Devonport community, and a need to look after drug users and the city’s homeless in hostels such as the neighbouring Salvation Army’s.

The practice also offers practical placements to students at the Plymouth medical school. Until earlier this year it was funded by Livewell Southwest, a social enterprise, which found it too expensive to maintain. Despite Devonport’s real deprivation, NHS England did not want to get involved in providing a contract to the Cumberland GP practice, which has consequently been operating without a formal contract and is managed by Access Health Care.

I understand that in the past the neighbouring Devonport health practice has not been interested in offering facilities to homeless people and drug users. Indeed, I understand that some of the Cumberland practice’s patients were not keen to transfer back to the Devonport centre, which is where they came from in the first place.

NHS England’s reason for putting the Cumberland GP practice under threat is because it considers it to be too small and is operating in unsuitable, cramped premises. Unless we are very careful, we could potentially put more pressure on Derriford’s acute emergency unit, which is under enormous pressure. I became aware of NHS England’s proposals for the three GP practices in August, during the summer recess, when no doubt NHS England expected me and other MPs to be away on parliamentary trips or taking a holiday. I immediately put together a series of meetings with the city council’s director of public health, the leader of the council and the cabinet member for adult social care, people from NHS England, the dean of the medical school and Dr Richard Ayres, who runs the Cumberland GP practice.

At the meeting I suggested that the Cumberland GP practice could share Devonport health centre’s brand-new building, which has space and operates as a federation, sharing receptionists and back-room staff. This was supported by everyone present. Indeed, the city council’s health and wellbeing board also supported it following an inquiry that recommended measures to allow the Cumberland GP practice to continue. However, I understand that Devonport healthcare might not be willing to do this, and it appears that the Devonport community may be deprived of a second GP practice and that patients will have no choice in which doctor they can go to.

I have also had representations from patients at both Hyde Park and St Barnabas surgeries. At Hyde Park, although Dr Stephen Warren is keen to continue as a GP following a heart attack, he has transferred the ownership of his practice to Access Health Care, as he no longer wishes to deal with the back-room tasks of administration, which is part of running a practice. He argues that his and his partner’s growing 2,800 practice—the Cumberland is growing as well—has attracted outstanding reviews and he would not be able to inform his patients where he was going if he relocated to another practice. He also thinks that some patients like to have a relationship with an individual doctor who they can see speedily rather than having to wait weeks.

The St Barnabas surgery, which is also run by Access Health Care, was set up in a new development next to a residential care home for the elderly where patients do not have to walk far to get to it. In all three cases, NHS England, for supposedly technical reasons, gave patients only 24 hours’ notice of their initial engagement. I must say I found the public consultation process utterly appalling. I wrote to NHS England asking it to give more time to engage with local communities, and I am grateful that it bothered to listen.

On Friday, at my weekly constituency surgery, I was asked to write to NHS England to ask whether it had engaged with other GP surgeries and with Derriford hospital and whether it had consulted them, because some GPs will have to accommodate more patients. That is a big issue.

There are wider issues in all this. At the moment, commissioners in north, east and west Devon spend a higher amount of money in east Devon than in the more deprived western locality. The Government’s success regime is keen to correct that, so that resources are focused on deprived communities such as Devonport. Finally, we need to make much more use of pharmacies. As my hon. Friend the Minister knows, I am the Government’s pharmacy champion. What are we going to do to make sure we have pharmacy funding and how will that operate?

Devon shares a challenge with many other rural parts of the country. We can safely say that the things we are asking and lobbying for have a general application. From the Minister’s perspective, something that has a more general application will be much more acceptable.

We have an above average number of over-85s with complex co-morbidities, as do many other rural areas, because people like to retire to such places. We know that travel distances in Devon are particularly acute. We have been compared to Denmark in terms of the numbers of roads that we have.

It is absolutely right to raise the recruitment challenge, but it is not a simple question of not being able to get people; there simply are not enough people to get. Previous Governments have inadequately provided for training. In addition, we have the challenge of attracting people to work in a rural location. Rural locations are fine if someone is retiring there; young individuals want to live in cities; and that is the challenge. On top of that, the cost of living also makes a post in a rural area unattractive.

Perhaps the most difficult problem is the one-size-fits-all approach that previous Governments have focused on. The model for funding and for structures is built around an urban model where there are numbers and therefore productivity. The challenge we have is the lack of footfall, except in tourist times. We need to tick the box not only for the funding formula but for the new integrated models of care that look at integrating vertically and horizontally across primary and secondary care. The multi-specialty community provider and primary and acute care systems will simply not work where we are, which means that we cannot use the same solutions as other areas.

Devon is a prime example of all these problems. We have three different reviews going on. We have the success regime in north Devon; the consultation on primary care, which last year took place in south Devon and is now taking place in Northern, Eastern and Western Devon; and the sustainability and transformation plans, which have been relatively recently brought into play. As has already been mentioned, Angela Pedder, the leader of our STP, will look at combining all the reviews.

The real challenge that we face is the speed at which implementation of the changes is being considered. As other hon. Members have said, it makes it almost impossible to put in place the needed care in the community. Of more concern to me is the fact that nowhere have we really addressed the need for a proper strategy for rural healthcare. I have read the five-year plan, and the word “rural” appears three times. I have been frustrated, when I have written to the Minister’s predecessors to ask about a rural strategy, because they have told me that there is one, when the truth is that there is not. There is an urgent need for a proper review of examples from around the world—Australia and New Zealand. There are plenty of examples. Even China has a proper strategy, and other countries think about such things in a very different way. That, to me, is crucial.

The other day I attended a workshop with the Nuffield Trust, the ambulance service and a number of hospital trusts, looking at what is happening and what we need to do. In rural areas things are at crisis point. Care homes are closing and are not being replaced with new ones—at least not in rural areas. They tend to be developed in city areas. The result will be a change in the population mix in rural areas, which will lead to economic deprivation and then social deprivation. We need to accept that rural communities are different. They need to be supported; otherwise, the consequences will not be as simple as whether we lose a hospital. The taxes raised in this country are generated predominantly in the city, but we accept that they should be spent across the country; equally, that is how we should deal with our rural communities.

We should review and amend the funding formula. I am pleased to hear of the changes in allocation which are coming shortly. However, the issue is more fundamental than the funding formula. One of our challenges is the fact that the needs are different in each rural area, but training regimes have become increasingly specialised. There are many individuals who specialise, in a number of different specialisms; the current regime structure requires a certain number of specialists, in each of those specialisms, to get a tick in the box to say that an area is safe. We need more generalists, not more specialists. Several royal colleges are already considering the generalising of training, but we need conversations to happen not just within those royal colleges but between them, and Government should sponsor and support that. We also need to get acceptance within the trusts that recruit the individuals. If they will not accept the new generalists, we shall have a problem.

We need more generalists and we need more geriatricians. We also need to think carefully about how to deliver urgent care. Urgent care and accident and emergency are not entirely the same. Some of the models used in other parts of the world, such as Australia, are very interesting. It is wrong to say that if there cannot be an A & E department the hospital must go. There are many different ways to provide what we need, and we must look at that. We must also review the regulatory criteria. Regulators say, “You need a person with this job description and this expertise and training.” At the moment regulators will not allow an organisation to accept someone with the right skill mix but without the specific tick-the-box qualifications. That needs to change.

As to the care home sector, we clearly need hard measures, but we need soft measures too. The human side of social care is as important as the technical side. A challenge with respect to the agenda for integrating health and social care is to scrutinise the commissioning of social care in the same way as the commissioning of NHS care. At the moment that is not happening. I do not think I am wrong if I say that there is now a bit of a lottery, based on where people live, for how much money is allocated and therefore how good the care is.

My final plea is about the long-term plan. With increasing development and population—whatever happens about immigration—we need to ensure that we plan. At the moment, the NHS is not a statutory consultee in the planning process; and that needs to be rectified.

It is great to serve under your chairmanship, Mrs Main. I thank my right hon. Friend the Member for East Devon (Sir Hugo Swire) for obtaining this debate, which is very timely.

Consultation should be about consultation. The CCG has presented four options: in option A Tiverton has 32 beds, Seaton 24 and Exmouth 16; in option B Tiverton has 32, Sidmouth 24 and Exmouth 16; in option C Tiverton has 32, Seaton 24 and Exeter 16; and in option D Tiverton has 32, Sidmouth 24 and Exeter 16. There is no sign of Okehampton or Honiton hospitals on the consultation. Beds there are simply said to be closed. Is that consultation? In our original reforms of the health service we said that local people must be consulted. Angela Pedder did exactly the same in Axminster, two years ago, as is being done now; she just came and said the beds were to be closed. There were no alternatives or consultation—just “We have made the decision, we know best, and we will overrule anybody who says any different.”

I tell the Minister that that is not consultation; we must make sure that consultation happens. Honiton is a great hospital. It currently has 18 beds and offers midwife-led births, a minor injuries unit, therapies, outpatients, X-ray and GP-allocated primary care services. It has an outstanding reputation and is often referred to locally as the Honiton Hilton, because it provides such great services. People in Honiton have supported it for generations, and that is what is so essential. We have an ageing population in Devon. My constituency starts in Uplyme. My hon. and learned Friend the Member for Torridge and West Devon (Mr Cox) has Great Torrington in his constituency up in the north-west. Lifton is down in one corner of the county, and it goes right up to beyond Ilfracombe. The county is massive, and it is being suggested that community hospitals should be closed. The Royal Devon and Exeter hospital will be under great pressure to keep its acute beds free. Yet we are closing down community hospitals that could ease the pressure on acute hospitals. That seems to be taking things in totally the wrong direction.

I welcomed the Minister’s intervention on my hon. Friend the Member for North Devon (Peter Heaton-Jones) about the reallocation of funds. Are not the consultations therefore premature? Do they not exclude whole hospitals from being considered at all, and should not that be reviewed? Can the Minister ask for that? The independent health service review looked at the case of Torrington and said that it should not have been closed. As to Axminster, we still do not have a proper facility and we do not know how it will be engaged. Not only are the CCGs taking beds away from community hospitals; they are not putting anything in their place.

I make a plea to the Minister: what are we to do? We have an ageing population; the age profile of Axminster is probably what the whole country’s will be in 2035. Our population is healthy but growing older. We want to help people in their own homes. I am pleased for that to happen, and I think it is right, but we also need community hospitals. Honiton has excellent communications so it is easy to bring people in and out of the hospital, and it is a quick journey from the Royal Devon and Exeter to Honiton hospital if people need to be brought back to relieve the pressure on beds. I cannot see how it is possible to go forward with a consultation when a hospital is completely taken out. I am sure that the Minister will say that it is up to local people and organisations to decide; but there is a problem if, when local consultation comes along, a hospital is removed from the list. Also, when it comes to staffing, it does not help in getting staff for a local hospital if that hospital is threatened with closure.

I really feel that all our MPs across the whole of Devon need to unite, because over the last two years the number of beds in our community hospitals has been halved. I rather fear that we will be standing here in two years’ time saying that they have been halved again. Rather than fighting between each other over which hospitals are kept open and which are closed, let us fight all the closures across Devon. Otherwise we are just being picked off one by one, Minister, and this is not the way to run a health service in Devon.

The problem with North Devon district hospital has for decades—certainly for as long as I have been in politics in Devon—been quite simple: it is a general hospital that is far out on a limb of sustainability, in terms of the range of services it offers. For decades, there has been a decision begging to be taken, but it has never had the proper, honest and frank discussion that it really needs.

A general hospital generally requires something around a third of a million people to sustain it. The population of northern Devon, including Torridge and the hospital’s catchment area, is some 80,000 or 90,000 people short of the figure that generally sustains a general hospital. However, historically, it has been universally accepted that Barnstaple requires a general hospital. We cannot provide health services to the population of northern Devon unless we have an acute hospital in Barnstaple. We are therefore faced with a clear and stark choice: either make a special case for funding it in the way that a rural hospital that otherwise could not survive needs to be funded, and make it an exception to the principles that apply to general hospitals for which the population is sufficient; or see it slowly wither on the vine, dying by a thousand cuts, and by weasel words used by clever civil servants and others to justify one saving after another. Those savings really mean services reduced, and patients redirected over 40, 50, 60 or 80 miles away, with some expected to travel into the heart of Somerset for treatment that other residents enjoy on their doorstep.

I endorse what my hon. Friend the Member for North Devon (Peter Heaton-Jones) said; there are red lines for Devon’s Members of Parliament. Of course we accept that the current model of healthcare cannot be preserved in aspic. There must be change and transformation, but we cannot put accountants’ methodology over the interests of patients and the citizens we represent.

I say to my hon. Friend the Minister that I know the green and pleasant lands of Shropshire well. What a fine county it is. It, too, has had its battles on this score; I know, because I have family who live there. Let him come to Devon and see the wide distances. I do not believe that in Shropshire there is a place over 70 miles from a main conurbation, as many communities in my constituency are. Travelling 70 miles to, say, have a child delivered puts at risk and prejudices the interests of those who are to be treated.

A decision must be taken on health services in north Devon. It is the same with hospitals in the far north of Scotland; they are highly rural, deeply isolated and not sustainable unless a special formula and a special approach are taken. Words such as “care closer to home” are all well and fine, but the difficulty is that communities see an historic legacy of underfunding that has left the health authorities in our area with an £80 million annual deficit. That deficit has built up over decades of accounting measures, and of conjuring with accounts. On the one hand, communities see this vast deficit, and on the other, they hear words such as “care closer to the community,” or, “Cut your beds and we will provide you with a service that is just as good, and that better fulfils the needs of patients.” Of course we can listen to the logic and rationality of that argument, but while it is all the time moved by the spectre of deficit, they will suspect that it is being made for one reason only: to reduce the budget.

My plea is for fairness. It is a plea to be heard, made on behalf of a neglected, extraordinarily rural area—possibly one of the most rural in England. It is a plea for a special look at this problem in northern, eastern and western Devon. The language coming from well-meaning and, I accept, wholly sincere health administrators has an Orwellian flavour to it while it is governed by this shadow of deficit that hangs over it.

I welcome the news from my hon. Friend the Minister that there has been allowance for rurality in the 2016-17 budget, but one or two minor tweaks do not reverse the legacy of decades. The truth is that the health services we represent—of the people we represent—are being seen to perpetrate a grave injustice. For example, public health spending alone—spending on the prevention of ill health—in the county of Devon is less than half the national average. On any analysis, the funding we receive in Devon is wholly inadequate to deal with its wide disparities and distances, its ageing population, and the other factors that affect Devon.

My simple plea to the Minister today is to hear the voice of those whom we represent, and to hear them pleading with him. Until the deficit is addressed and there is fair funding for rural health services, we will not believe the assurances from well-meaning administrators that our health services are safe. They are not safe. We need a major amendment to the rural health funding formula; we need to improve on what has been done this year; and we need to assuage the anxieties of our constituents by a proper, demonstrably fair health funding formula.

I thank the right hon. Member for East Devon (Sir Hugo Swire) for tabling a debate on this important issue. It is heartening to see Members for Devon coming together with a unified voice on this subject. I, too, will mention Members who are not here today: the hon. Member for Totnes (Dr Wollaston), who has been mentioned, and my right hon. Friend the Member for Exeter (Mr Bradshaw). As we speak, they are questioning the Secretary of State for Health on finance for the NHS—a subject that cannot be totally separated from the issue at hand.

The healthcare challenges that Devon faces are immense, but I disagree with some of the points that hon. Members have made. I do not believe that the challenges are limited to this region; I believe they are systemic. Demand for NHS services is increasing nationally faster than ever before, fuelled in part by an increase in social deprivation and an ageing population. The need to address the increased demand, together with the need to keep pace with new technologies, is placing hitherto unseen financial pressures on NHS providers.

There are 280,000 people in Devon living with one or more long-term conditions, such as asthma, diabetes, hypertension and cancer; 150,000 people have a mental illness; and there are 40,000 people with cancer who need rapid access to high-quality services. Alongside that increased demand, there have been cuts to adult social care, and to public health and prevention budgets. If we are just to stand still, funding needs to be increased by an extra 2.6% above inflation. I am interested to see whether the Minister’s promised extra funding matches that; I doubt that it will. If no changes are made by 2020, the NHS in Devon will face a deficit in excess of £440 million.

In 2015, the Northern, Eastern and Western Devon success regime was introduced by Simon Stevens, the chief executive of NHS England, in an attempt to address the rising deficit and the failure to meet important health targets, including cancer waiting times. There is no doubt, as I am sure hon. Members agree, that there is a compelling case for change. Change is desirable; it would indeed be better for care to be more patient-centred, and of course it would be better to have more care needs met in the community. It is also true that the majority of patients receiving end-of-life care would prefer to die at home.

But, and it is a big “but”, change on this scale—massive, transformational change—needs leadership, transparency, a whole system change and, above all, investment. Making changes of this order—closing community hospitals with no proven plan for care in place—is downright reckless. That is why so many GPs in Devon are opposing the proposals, and have stated that they have

“grave concerns over patient safety.”

They say:

“we are concerned that the untried, untested closures of so many community hospital beds in this area could prove dangerous for a significant population of patients who might need to rely on community beds”.

The well-respected Chair of the Health Committee, the hon. Member for Totnes, has declared that she also cannot support the plans without an assurance that services will improve as a result of the changes.

People the length and breadth of Devon have expressed their concerns. The very active women’s institute in Devon has raised objections, as have communities across Devon. As we have heard from Members today, the consultation process has been woefully inadequate; there have been undersized rooms, and an online consultation. Frankly, it is not good enough.

Everybody is right to be worried. Only last week, the Care Quality Commission published its report, entitled, “The state of health care and adult social care in England”. The report states that

“the sustainability of adult social care is approaching a tipping point”.

In addition to the financial pressures, the sector is also experiencing massive problems with recruitment and retention of staff. The people of Devon are being asked to place their trust in a system that is on already on the brink and, quite understandably, they are not going to—and nor should they.

Local GPs have described the proposals as a “hasty cost improvement process”. This is the crux of the matter: the proposals as they stand, without adequate funding for alternative care, will save money, but they will not improve patient care, and may even compromise patient safety. I agree with the right hon. Member for East Devon that the cart is being put before the horse; that absolutely hits the nail on the head. Local NHS trusts in Devon are on their knees, desperately crying out for more funding to enable them to plan for the increased demand and changing needs of the population in the 21st century. This is not just about extra funding, but about making the kind of transformational change that is needed to deliver high-quality, excellent healthcare in the 21st century. It needs proper planning and proper systems in place, and that cannot be achieved on the cheap.

I am shocked that in this context, the Prime Minister is refusing to give the health and social care sectors more funding, which they desperately need. We have one of the lowest percentages of health and social care funding, as a proportion of our GDP, in the entire region of Europe. That cannot be right. I urge the Minister to use whatever influence he has with the Prime Minister to get her to revisit this issue, for the sake of the people of Devon, and for people across the country. This situation is not unique to Devon; we face many of the same problems in my region of Lancashire and, as I know from my work with the Health Committee, across the country.

I also ask that the consultation process be firmed up, and that people be offered a full, transparent and real consultation, rather than lip service being paid to having one. During Health questions the other day, the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), promised to visit Devon and to listen at first hand to stakeholders. I urge this Minister to take that away with him, and to look at making sure that the Government listen properly to the voices of Devon and the very legitimate concerns being raised in this debate. No one is trying to say that change is not needed, but one system cannot be taken away until there is a fully proven plan in place.

I call the Minister. If possible, could you leave a minute or two at the end for the right hon. Member for East Devon (Sir Hugo Swire) to respond, Minister?

I am grateful to you for taking the Chair this afternoon, Mrs Main, and for encouraging me to leave some time for my right hon. Friend the Member for East Devon (Sir Hugo Swire) to respond, which I will endeavour to do. I congratulate him not only on securing this debate, which has been very well supported by his colleagues from across the county, but if I may—this is the first opportunity for me to do so publicly—on the recognition that he received of his time in Government from the previous Prime Minister.

I start by highlighting some of the excellent work carried out every day by all those who work in the NHS, not only in my right hon. Friend’s constituency but in mine and those of all the others who have spoken today. I will attempt to address some of the specific points that have been raised, particularly by my right hon. Friend, but I shall first provide the House with a little context and background regarding health services in Devon.

Devon is a leader in many areas of the health service—perhaps to the surprise of some hon. Members who have spoken—relative to other parts of the country. Not least, the Torbay and South Devon NHS Foundation Trust was the first trust in England to join up hospital and community care with social care. A plea to do that was made by my right hon. Friend and it is already happening in South Devon. The trust operates as a single organisation, working with partners to improve the way it delivers safe, high-quality health and social care. The trust is showcasing exactly the kind of joined-up, patient-centred care that we want the NHS to provide to meet the needs of the ageing population.

I also pay tribute to the staff at the Royal Devon and Exeter NHS Foundation Trust, who last month celebrated their fifth anniversary since the last incident of hospital- acquired MRSA. That remarkable accomplishment comes as the result of continuous improvements at the trust over the last 10 years. The trust is now considered a national leader in infection control, being the only general hospital in the whole of England to have avoided any MRSA infections in the last five years.

However, I absolutely recognise that the region is facing difficulties. NHS staff across the region are working hard to provide good care to patients, but services are not keeping pace with the changing needs of local people. It is becoming increasingly difficult to make sure that local people have access to consistently high-quality care that is affordable and sustainable.

As my right hon. Friend said, in June 2015, NHS England announced that north, east and west Devon would be one of the three areas in the country to take part in a success regime. That is designed to improve health and care services for patients in local health and care systems that are struggling with financial or quality problems. Following intense diagnostic work, the north, east and west Devon success regime published, in February this year, the “Case for Change” report, which was referred to earlier. The report sets out the underlying challenges facing the area and the opportunities to improve access to services and ensure clinical and financial stability. The work concluded that if nothing was done, Northern, Eastern and Western Devon would have a system deficit of £398 million by 2020/21, as has been referenced by a couple of hon. Members, including the hon. Member for Burnley (Julie Cooper).

As well as the financial challenge, the work identified significant health inequalities and some clinical services that will be unsustainable in their current form. There are good reasons for that. As we have heard from hon. Members, people in north, east and west Devon are living longer successfully, particularly in areas of the constituency of my right hon. Friend the Member for East Devon and in Torbay.

People are living with increasingly complex care needs and require more support from health and social care services. More than one in five people in north, east and west Devon are over the age of 65, and that figure will be almost one in four by 2021. Some 40% of local people use almost 80% of health and social care services. There are 280,000 local people, including 13,000 children, living with one or more long-term conditions such as asthma, diabetes, hypertension, cancer and mental illness.

Although Devon is regarded from the outside as generally affluent, we are all aware—hon. Members have explained this—that there are areas of significant deprivation. There are big differences in health outcomes between some areas, particularly in Plymouth. There are also spending disparities between different parts of the county.

More than 10% less for each person is spent on healthcare in west Devon compared with north and east Devon, even when age and deprivation is taken into account, as my hon. Friend the Member for North Devon (Peter Heaton-Jones) emphasised. Somebody living in Ilfracombe Central is statistically likely to die almost 15 years earlier than a person living a two-hour drive away in Newton Poppleford.

Inequalities need to be reduced, and the spread of health and social care across north, east and west Devon needs to be made more equal. I am sure that my right hon. Friend the Member for East Devon agrees that his constituents should have access to the same high-quality healthcare services as those in the rest of Devon, let alone the rest of the country. He referred to the success regime consultation as being at fault. I gently remind him that it was only published on 7 October. I am sure that comments made today about the lack of available paper copies of the consultation will be taken into account by the organisers, and that we can respond to that.

I want to press the Minister on the success regime’s consultation. Is it right for a hospital to have its beds taken away as part of that consultation? Surely a consultation should be for people to have a say on a public decision.

I heard my hon. Friend mention the lack of reference to Okehampton and Honiton. I gently draw attention to the fact that the option to retain community beds in both those hospitals was considered as part of the 15 options in the document. The option was rejected as one of the four recommended for consultation, but that does not prevent him, his constituents or local representatives in those areas from putting those alternative options forward.

My right hon. Friend the Member for East Devon asked whether there was a “none of the above” option. I think he may have been referring to page 42 of the consultation document, on which the organisers say that they

“welcome all views and will carefully consider all responses and analyse these against the decision making criteria. That will include options which are not currently in the consultation document”.

They are open for proposals to be made by others, but those need to be looked at in the context of the criteria.

I am grateful for that clarification. Presumably, that does not alter the fact that Tiverton—that rather expensive private finance initiative that we have inherited—stays part of any outcome.

My right hon. Friend would not expect me to be drawn on any of the specific options. I would not want to be seen to be influencing the consultation prematurely or, indeed, at all until we see the recommendations that come out of it.

It has come out of the investigations leading up to the consultation that every day more than 500 people in north, east and west Devon are being cared for in a hospital bed who do not need to be there. That is at the heart of the challenge that we face not just in Devon but across the country, as the hon. Member for Burnley mentioned.

The system is keeping people in community beds or acute beds longer than they need to be because of discharge challenges. That gets back to the initial remarks of my right hon. Friend the Member for East Devon about whether we are integrating the consultation properly with improvements to social care. It is important, when we come to look at the recommendations arising from the consultation, that we take into account the capacity that will need to be created in social care to provide alternative models of care if the number of beds is reduced.

The formal consultation concludes on 6 January. As I have said, I will not comment on specifics while that is under way, but I strongly encourage my right hon. Friend, all other hon. Members who have spoken in the debate, and those who were not able to because they are elsewhere in the House today to ensure that their views are taken into account. The next phase of the success regime will look at how services are provided in acute hospital settings, as my hon. Friend the Member for North Devon highlighted, as did my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox) in his characteristically robust contribution. I am sure that they will make their views known in the consultation that we anticipate will follow next summer, and the clinicians involved with the acute services will be preparing their recommendations.

My right hon. Friend the Member for East Devon is aware that the success regime plans are part of a broader sustainability and transformation plan that covers the whole of Devon. That creates the opportunity for health and local authorities—not just NHS bodies but local authorities with responsibility for social care—to work together to try to formulate plans that give care packages the kind of integration and coherence that hon. Members have sought for Devon. It will build on the work that has been done by north, east and west Devon’s success regime and on the “Case for Change” published by South Devon and Torbay CCG in September. The latest iteration of the plan is due to be submitted to NHS England this Friday.

Before I conclude, I can confirm that I will write to my right hon. Friend on the Exmouth out-of-hours service. I understand that he has a meeting with the Minister responsible for NHS property services later this month, so he will be able to take up his concerns then. On other challenges that were mentioned, we recognise that there is pressure on recruitment and retention of clinicians in rural areas. Hon. Members will be aware of the announcement made by my right hon. Friend the Secretary of State to try to recruit 25% more doctors over the next few years; of our plans to recruit up to 10,000 more nurses over this Parliament; and of the announcement, last week, that we will be introducing a new category of nursing associate to provide more capability. We are acutely aware of those needs.

It is the responsibility of local NHS organisations to determine how local services are delivered. Hon. Members have made some important points, and I urge them to do so as part of the consultation. I hope that we will have another opportunity to discuss the forthcoming recommendations.

I am grateful for an interesting and mature debate. The Minister has an invidious job of trying to reconcile the competing demands across the country, to say nothing of the competing demands across God’s own county of Devon. I can think of no better man to attempt to do that. If the consultation is a genuine opportunity, and is not an excuse to reduce levels of care, the Minister will find us supportive. He will find us supportive if, as I suspect, the consultation is an opportunity to deliver a fully integrated hospital, and a community care and social care system, that is fit for the 21st century.

I am pleased to remember a conversation I had with the Secretary of State, who repeated his commitment to community hospitals. I leave the Minister with one thought: as the previous Prime Minister freely admitted, it was the Conservative party in the south-west that delivered a victory at the last general election. The Minister has seen how formidable we can be when we come together, and come together we will to protect our vital services for our constituents across the county of Devon.

Motion lapsed (Standing Order No. 10(6)).