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Teignmouth Hospital

Volume 690: debated on Tuesday 9 March 2021

I beg to move,

That this House has considered the future of Teignmouth Hospital.

It is a great pleasure to serve under your chairmanship, Sir Charles. This is the story of a hospital being closed by stealth. Teignmouth Hospital, which is in my constituency, was built in 1954. It was one of the first purpose-built NHS hospitals and offered a wide range of services. Even today, it has three community clinics, in audiology, physiotherapy and podiatry, which have largely been funded by the League of Friends. In addition, there are out-patient clinics dealing with abdominal aortic screening, anaesthetics, breast, cardiology, chronic fatigue—there are 23 of them in total, so I will not labour through all of them, in the interests of time and to allow a proper discussion of this issue. The hospital also has an operating theatre, which takes day cases relating to eye complaints and skin issues.

However, all of this was put into a quandary in 2014, when the local clinical commissioning group decided to look again at how health and care should be properly provided in Teignmouth and Dawlish. That is absolutely the right thing to do. However, my issue is with how it has been done, and with the evidence that has been collected and the way it has been evaluated.

The consultations took the following steps. First of all, they looked at removing two of the in-patient wards within Teignmouth Hospital. So, at a stroke in 2016 and after two consultations—one in 2014-15 and one in 2016—a decision was made to remove two whole wards. As anyone can imagine, the local community were not at all happy and the only thing that helped was the promise of 12 new rehabilitation beds to help in the community. That would have been very appropriate in a rural community with an ageing population, which mine is, and with a state-of-the-art physiotherapy unit paid for, as I have said, by the League of Friends. However, what was even worse was that those rehabilitation beds were never delivered. A unilateral decision was then taken in 2017 that there would be no rehabilitation beds. No evidence was produced and no consultation took place.

Then, in 2018 a further consultation looked at a reconfiguration of services. The creation of a new health hub, which was the core proposal, was and remains absolutely the right thing to do, and is in accordance with the NHS Long Term Plan. It would house the GPs in Teignmouth and an integrated care hub, with individuals from the voluntary sector, and the three community clinics. However, the out-patient clinics—all 23 of them—were to be relocated to another hospital in Dawlish. It is not that far away, but given our transport problems it is quite far enough away to be problematic for an ageing population.

The consequence suggested—but with no questions asked—because of the hub and the relocation of services to Dawlish, was that Teignmouth Hospital would necessarily close. There was no consultation. It seems to me that although there has been a consultation on reconfiguration, there has been no consultation on a hospital closure. It is my understanding that legally—never mind to ensure best care—such a consultation should take place.

I and a number of colleagues were very disquieted by all this. Indeed, the health scrutiny committee at Devon County Council was sufficiently concerned about the lack of evidence and the failure to consult that it went to the reconfiguration panel to take informal advice as to what it should do. It is only the health scrutiny committee, under current legislative provisions, that can, in effect, call in such a decision. It is my belief that, had it done that formally, the reconfiguration panel would have had to take a much more serious approach. Instead, its response to the request for advice was, frankly, a bit of a pat on the head: “Go and talk to the clinical commissioning group; I’m sure you can resolve your differences,” or words to that effect. I do not really think that is a responsible reply to a very urgent and well meant request for assistance, and my view would be, in the light of that response, that the county council, through its scrutiny committee, should now make a formal application.

The issue is that Teignmouth Hospital is to close, without any consultation at all. Why does that matter? It matters because there has been no assessment of the health and care outcomes for residents of Teignmouth. Without such a consultation, how can we be clear that health and care needs are being properly met? Worse, the consultation takes no account of what is happening in the landscape of social care. In Teignmouth there are no nursing care homes, so there is no fall-back; there are no other beds in the community that can be used.

Why are the health scrutiny committee and I so exercised about the flaws in the reconfiguration, which mean that closing Teignmouth Hospital without consultation is a real mistake? First, the decision is based on an assumption that all intermediary care can be undertaken at home, with the balance in nursing care homes. I contend that it is simply unrealistic to consider that all intermediate care can be undertaken in an individual’s home. There are lots of reasons for that. First, we do not have any nursing care homes in Teignmouth. Secondly, even if we did, rehabilitation is not what nursing homes are all about. Thirdly, some of these elderly people have to have help come to them from some distance, which makes it a challenge. We also have an acute lack of domiciliary care provision. That puts a very big question mark over the key assumption that underpins all the decision making.

The evidence that was presented is inadequate in quality and in quantity. There was a lot of data; I am drowning in data, but I have very little genuine information and very little genuine analysis. On that basis, I am very unhappy with what I have seen. It is fundamentally desk-based research by the clinical senate and the University of Plymouth—two outstanding institutions. However, the information that they have used is simply records of beds and their use, whether in a hospital setting or otherwise. It looks at discharge and delayed discharge, but because there are no beds at the moment in Teignmouth Hospital, there is nowhere for people to go other than home, or a care home outside Teignmouth, so is it surprising that we find an argument being made that those beds that were in Teignmouth Hospital are not needed? It seems to me that a negative cannot prove a positive.

Of more concern is the fact that there is no research whatever on the patient experience. Given the lack of domiciliary care provision, that is a crucial omission. People should bear it in mind that, at this point in time, the hospital’s beds have been closed for two years. Why has no evidence been gleaned as to the quality and quantity of the care provided to people in their homes? That seems to me a glaring error, which must be resolved.

It also seems to me that the evidence is definitely defective. It takes no account of this new, post-covid world. I accept that the consultation started before covid, but it has lasted through covid, and for me that has made one thing clear: the old system we had, which was very much just in time, is no longer the way forward. We must have a resilient care system. That means taking into account the impact of covid. We know long covid is following covid. We know that that specifically requires a lot of rehabilitation care. I raised that with the clinical commissioning group, who believed it was inappropriate to take account of the figures for 2020-21 because those covid figures were unrepresentative. I find that strange, because, if those are unrepresentative of the real need, surely the figures for 2019 are equally not representative. That causes me real concern.

I will turn to the proposal in relation to the other services, not beds in Teignmouth Hospital. That care is to continue to be provided in Dawlish Hospital. Dawlish is, effectively, to take double the number of referrals—23 out-patient clinic patients on top of its existing load of patients. The “building works”, which I would not really call building works, will simply reconfigure the maternity room into two consulting rooms. It is a bit like moving the deckchairs on the Titanic. There is no evidence of any real effort to ensure that Dawlish is properly configured to meet what will be an increasing demand.

As for the hub itself, there is no evidence that it will have the capacity to take all the GPs, all the community service clinics, the integrated care hub and the voluntary sector representatives. Yes, planning permission has been put in for and, indeed, granted. It is clear how the rooms will be configured in the new hub, but not how they will be used, and until they are used we simply do not have evidence that they will be sufficient for the need.

What is the way forward? It seems to me—because we have two years during which the hub is to be built—that the first priority is to collect the missing data. Let us collect the data for 2020-21, and look properly at bed occupancy and why it is as it is. Let us look at discharge, readmissions and waiting lists. Let us look particularly at the impact that long covid will have in that period on rehabilitation care and growing need. Let us also undertake some research on the quality and quantity of home-based care. There is no evidence about either of those in anything that has been presented by the clinical commissioning group. Worse, there is nothing on the patient experience at all. When all the data has been gathered, let us have a separate consultation on Teignmouth Hospital—not only after the data has been gathered but after the hub has been opened and we can see whether it is adequate, and Dawlish has taken on its additional work.

To be clear about the impact of the reconfiguration on Teignmouth residents, all those things must be taken into account. That is right and responsible. If we get the decision wrong, we could well find that we are closing a facility only to spend money on reopening something else to meet the rehabilitation need that is not met. That is lose-lose. I would be the first to agree that it is an ageing hospital, but it could be improved—not to become state of the art, and I am not looking for that; but it would cost just over £600,000 to get it to a position where it could continue to provide the services that are needed.

My ask of the Minister and the Secretary of State is, first, to intervene to stop this automatic closure of Teignmouth Hospital, as the Secretary of State did to stop the closure of Chorley hospital accident and emergency department in Lancashire. I quote regional director Bill McCarthy:

“We have received instruction from both the secretary of state for health and the minister of state for health, to work with the integrated care system and local leadership to develop an option that provides safe, high quality care, that continues to include Chorley”

emergency department. That was reported in “North by Northwest” in February this year, not many weeks ago.

I do not have an opinion as to whether that was the right decision, but the Secretary of State said expressly in the very recent latest White Paper—which will lead to an NHS Bill—that he intends to enable power to be given to him to call in decisions such as the Teignmouth one and to remove the reconfiguration panel. From the experience I have had, that panel is not fit for purpose.

My second ask is that the Secretary of State and the Minister instruct the reconfiguration panel that no closure of any hospital or facility should be made going forward without the impacts of covid having been taken into account and a proper impact assessment having been made.

My third ask is for the Secretary of State and the Minister to instruct the clinical commissioning group to put in hand a separate consultation specifically on the closure of Teignmouth Hospital, after the data I referred to have been collected, and to mandate the CCG to collect the necessary evidence on patient experience, on the impact of Dawlish Hospital and on the adequacy of the new hub at Teignmouth. The group should then review the data collected and analyse it properly.

Teignmouth Hospital deserves better and the people of Teignmouth deserve the Secretary of State’s support. I ask the Minister in his place to grant that support and to do what he and the Secretary of State are more than capable of doing, so setting an example of how important health and care are to him and to us. That would set a marker that covid has changed the game and that covid, and long covid in particular, must influence and guide future decisions on hospital closures. I thank you for your indulgence, Sir Charles, and I look forward to the Minister’s response.

It is a pleasure to serve under your chairmanship, Sir Charles, in a sense for the second time. In my first Committee post in the House, when I was first elected, I served under your chairmanship on the Procedure Committee.

I congratulate my hon. Friend the Member for Newton Abbot (Anne Marie Morris) on securing this debate on such an important subject, and one that I know she has taken a close and long-standing interest in on behalf of her constituents, for whom she is a very strong local voice. From the outset, I pay tribute—I suspect with her—to the amazing work during the pandemic that has been done by not only all those working in our NHS but those in her local trust and hospital. I hope I might prevail on her to pass on my thanks to her local team.

As my hon. Friend set out, Teignmouth Community Hospital is part of Torbay and South Devon NHS Foundation Trust and provides health and care services to patients across Teignmouth and Dawlish. She set out their work very clearly in her speech, alongside a very helpful exposition of the broader health and social care context in the area in which she serves as the Member of Parliament. She recognised it, quite rightly—I hear her plea—as a whole system, and the broader picture, rather than as individual siloed parts of a health system. In the past, she and I have had the pleasure of discussing what she cares deeply about, which is the future evolution of health and social care as a coherent single model. I hope that it will not be too long before we can have those conversations in person again in this place.

As part of its work on ensuring that services across Devon are, as the CCG sees it, fit for the future and fully address the aspirations of the NHS long-term plan, the CCG, as my hon. Friend says, has been reviewing how services are provided and how to best integrate services in order to make improvements for the most vulnerable people in the communities that it serves. Considerable progress has been made in this area, for which I highlight the work of the CCG.

However, the ongoing review process has highlighted that three main cases for change remain, in the view of the CCG: that the joined-up community care now provided means that, in the CCG’s view, the 12 rehabilitation beds previously promised for Teignmouth community hospital are no longer needed, and my hon. Friend made very clear her views on that on behalf of her constituents; that there is a pressing need to safeguard the future of primary care across the entirety of the area she represents; and that both the national local strategies to integrate care further make the best use of the NHS estate.

The CCG’s reviews of the need for rehabilitation beds at Teignmouth hospital led it to believe that the health and wellbeing team was successfully meeting the needs of local patients without them, but my hon. Friend set out clearly her concerns about that conclusion and the reasons why she has those concerns. I will mention at this point an important contextual point. While hopefully many things we have seen in the past year relating to covid will become things of the past soon, it is highly likely that covid has changed the nature of how we look at the provision of healthcare, and that there are lessons to learn there for the long term and for the future. I think I heard her clearly saying that we should not lose that by virtue of something that was begun before covid not being able to scoop up and learn those lessons for the future—i.e. future-proofing the services that her constituents rely on. I am sure that the CCG will have heard her message loud and clear on that particular point.

My hon. Friend talked about the consultation and the decision-making process in some detail. Clearly, as I gather from that and from a letter she has recently written to the Secretary of State, which I will turn to in a moment when I conclude, she has undertaken a lot of work in looking at these consultation processes, the history of them, the genesis of them and how over time they have changed what they have been looking at.

As my hon. Friend said, the CCG undertook a formal consultation from 1 September to 26 October 2020—I caveat that with the point that my hon. Friend and I made earlier, which is that that was mid covid and not after the covid pandemic—which proposed to move high-use community clinics from Teignmouth community hospital to a health and wellbeing centre in Teignmouth; to move specialist outpatient clinics from Teignmouth community hospital to Dawlish community hospital, four miles away; to move day-case procedures from Teignmouth community hospital to Dawlish community hospital, which she picked up on clearly in her speech at the opening of the debate; to continue with that model of community-based intermediate care; and to reverse the decision to establish 12 rehabilitation beds at Teignmouth community hospital, as advocated by the CCG and, it asserts, as supported by previous public engagement in 2018 on the success of the service provision without the beds.

I understand that NHS England’s position is that the consultation in 2020 set out that a likely consequence of the reconfiguration was that the requirement for those beds in Teignmouth would no longer be there for the local NHS. However, I hear what my hon. Friend says; she highlighted that, in her view and that of her constituents, that is worthy of a more discrete and focused consultation.

The consultation was overseen by the independent Healthwatch for Devon, Plymouth and Torbay, which analysed the just over 1,000 responses received, finding that 61.3% of respondents were in favour of the overall proposals. The equality impact assessment undertaken indicated that, overall, the impact on people using the services affected by this proposal was deemed by them to be of benefit, while the EIA indicated that, overall, the impact on people using the services affected by this proposal was neutral or of benefit.

Following a review of both consultation feedback and the quality and equality impact assessments, the steering group approved the consultation and agreed to make a recommendation to the CCG governing body that all four elements of the consultation proposal be approved. The Teignmouth steering group approved the consultation and the local NHS plans to continue to review the proposed model of care in light of potential changes in levels of need within the local area, as well as—they have related to my office—the impact of covid-19 on ways of working. I will turn to that in a minute, as well as an offer that I will make to my hon. Friend when I conclude.

I am aware that, as she has said, local councillors recently wrote to the independent reconfiguration panel to seek informal advice on this reconfiguration, and have been advised to continue to work co-operatively with the CCG to find a local resolution. My understanding is that the IRP is constrained in what it can or cannot do and how it can engage where it is not a formal referral, but I understand from what my hon. Friend said that that remains a possibility, so I will be a little cautious about prejudging whether that may or may not happen. She asked a number of specific questions—for example, about Chorley, and then her asks at the end of her speech. What I would say about Chorley is that we do not have the power to instruct in the context of reconfiguration at this point, hence the legislative proposals that she talked about. We requested that they look at this, which they accepted, but I add the slight caveat that, as I understand it, we do not have the legal power to instruct the local CCG to do x or y at this point in the reconfiguration.

However, what I can offer to her within that legal constraint, which may be of help to her, is that first, of course, I will endeavour to reply to her letter swiftly, with responses to the detailed points she has raised in it. Secondly, although the legal powers available to me in the name of the Secretary of State are limited until and unless an IRP referral is received and the advice is then given, I am always delighted to meet with my hon. Friend if she feels that would be helpful. It may be helpful to her if I arrange to meet with her outwith this debate, to discuss with her in more detail some of the process points and legal constraints, but also to listen in more detail than she is perhaps able to set out in a debate of this sort. I would expect her CCG to have heard her voice in the House today loud and clear, as I suspect it does in her capacity as the local Member of Parliament on the ground in Newton Abbot.

It is right that all reconfiguration decisions are taken in the best interests of patients and the local population following the due process, and it is that due process that slightly constrains what I can say or do in this context. However, the Government are committed to ensuring that the appropriate resources are available to the NHS in Devon to support patients, and to continue to provide the people of Devon and of her constituency with the best possible care, so the people affected by these changes need to be involved in making the key decisions—including my hon. Friend, of course, as their elected voice. I would hope and expect that the CCG will set out a clear plan to engage proactively with her and with the local population, and would encourage all of her constituents to be involved in that process.

I will reiterate two things on the record. First, I will of course reply to my hon. Friend’s letter. Secondly, I repeat my offer to meet with her separately to discuss in more detail what is and is not possible within the legal constraints around the reconfiguration process, and also to learn more about Teignmouth Hospital. I hope that in more normal times, when such things are possible, I might be able to come down and see my hon. Friend in sunny Devon, to visit that hospital with her.

Question put and agreed to.

Sitting suspended.