§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Dowd.]7.49 pm
§ Mr. Eric Pickles (Brentwood and Ongar)
I am grateful for this opportunity to raise an important constituency matter. I assure the Minister that I do not intend to speak for my allotted time of two and three quarter hours: I shall try to persuade him that the matter should be examined thoroughly without detaining him from sending letters to Santa Claus.
I speak on behalf of the whole community. All political parties are united against the threat posed to my constituents and their health. I have also received support from all the churches in the Brentwood and Ongar area. I am in an unusual position tonight, as the research for this debate has been conducted by Labour and Liberal Democrat as well as Conservative councillors. Perhaps that goes to prove that, in times of adversity, Brentwood and Ongar sticks together.
I have three concerns about community medicine in my constituency: first, the removal of beds from the Ongar War Memorial hospital; secondly, the closure of the minor injuries unit at Brentwood community hospital; and, thirdly, the closure of High Wood hospital services to the elderly. Those three measures are a response either to a lack of finance or to an overspending on budget, depending on one's point of view. The three hospitals have not contributed to the overspend, and the proposed savings are relatively small.
This debate is about the place of community or cottage hospitals in the modern health service and the disadvantages suffered by two small towns that are situated on the fringe of two health authorities. The Ongar War Memorial hospital was established in response to the first world war. Shock at the number of casualties from that conflict prompted communities throughout the land to seek ways of remembering the dead and of recognising the contributions of their neighbours and friends. Ongar decided upon a unique cenotaph—a living monument: a hospital. The money was raised by public donation. Hon. Members should understand that Ongar is not a particularly prosperous community, but it is a committed community that is tremendously proud of its hospital. That commitment continues today, and the hospital's League of Friends has raised almost £1 million—some £920,000—in 1996 prices over the past 17 years.
The hospital is held in high esteem by my constituents. It provides a variety of services, including speech and language therapy sessions, hearing and development checks, a baby clinic, ante-natal classes, relaxation classes, parentcraft classes, mental health services with the community psychiatric nurse, chiropody and podiatry. It offers day care and currently puts 16 beds to various uses.
I have received many letters from ex-patients of Ongar hospital or, more often, from their children. They talk of the enormous care and dedication of the staff and the importance of the hospital to the people of Ongar. I shall sum up that depth of feeling by quoting from one letter from a constituent. The impression is often created that 549 the hospital predominantly provides services to the elderly. While such services are important, they are just part of the role of that community hospital. My constituent Miss Karen Dunning writes:I spent a week in Ongar War Memorial as I am a diabetic and my GP thought it would be a good idea to place me in hospital for a week to try to get my diabetes under control. I was so pleased that Ongar Memorial found me a bed as it enabled me to not be too far away from my family. Up to this time I thought the hospital was mainly for the elderly—somewhere for people to die. I was very wrong—during that week I got involved with all sorts of people coming in and out of the hospital. It was a real eye opener. Not only does the hospital provide for the sick and dying it also provides a place for people with special needs to go for the day. Giving their family/guardians that much deserved break".Some 46 per cent. of beds are occupied by general practitioner admissions, 22 per cent. are dedicated to respite care, 12 per cent. are occupied by patients transferred from other hospitals, 8 per cent. are for terminal or palliative care, and 4 per cent. are dedicated to emergency psychiatric cases. As those figures and Miss Dunning's letter show, it is clear that the majority of patients are sent to the hospital by their GPs. Some 75 per cent. of patients come from North Essex health authority and 25 per cent. from South Essex health authority.
A large number of patients come from South Essex because of a historical accident in drawing up the boundaries of the health authority. Many of the old parishes in the former rural district council of Ongar fall within the boundaries of South Essex health authority. Hon. Members must understand that the hospital covers 100 square miles of rural Essex in my constituency, and serves not just the town of Ongar but the communities that surround it.
Travel in the area is not easy, and not all patients have access to private cars. Many people must rely on public transport, which is sometimes non-existent in rural areas. There have been attempts to close Ongar War Memorial hospital in the past, and the hospital was saved last time by the late Richard Crosland when he was Secretary of State for Health. The hospital has grown since then and plays an increasingly important role in the community.
Only 18 months ago, Essex and Herts Community NHS trust considered the future of Ongar War Memorial hospital. Having stated its high regard for the hospital and recognised the high-quality care that it provides, it went on to consider the hospital's future. I emphasise the fact that the review was conducted only 18 months ago—the ink is still wet on the consultation document. The report states:The remit of small hospitals serving local communities varies considerably, but should address local health and community needs.Given the obvious challenges to be faced in the future, Essex and Herts Community NHS Trust together with local professional colleagues, agencies, the League of Friends and the local community, wish to firmly establish the future of Ongar Hospital as a unique and fundamental provider of locally based health care services in its own right.It is that fundamental nature of the health service in Ongar that it is so important to preserve.
That view should be shared by the House. What was true in 1995 must surely be true in 1997. The 1995 report took into account the fact that if beds are removed from one part of an area, pressure is put on beds in another part.
550 That process takes pressure off, for example, beds within Princess Alexandra hospital. The report stated that there waspotential for the transfer of patients from Princess Alexandra and other district general hospitals to Ongar War Memorial Hospital thereby helping to relieve pressure on acute beds in these former sites.No one knows how difficult this winter will be. We know, however, that beds in Ongar will play an important part in relieving pressure on the rest of the health service in the Essex area.
A working party has been considering the various options for the future of the hospital since July. Curiously, the figures have varied enormously. Surely the authority should know two basic figures: the cost of care and the cost of the savings that it is proposing. The figures have been revised almost weekly. They have the same consistency that the late Senator McCarthy produced in making claims about the number of communists within the State Department.
I could take the Minister through a long and convoluted route of how changes have taken place. However, I can see a look of despair in his eyes. Instead of taking that route, I shall summarise. We started with a total cost of care per year of £602,000. That figure fell to £545,000. It then dropped to £406,000. Eventually, it increased to £478,000. Similarly, savings have varied between £107,000 and £14,800. Surely, that is worrying. If a hospital is to lose its beds, there must be certainty about figures. Figures should not be produced on a whim.
It is curious that members of the working party tell me that the health authority has a rather strange way of organising its budget. The working party was told with great pride that the authority always under-budgeted. Apparently, it always submits a figure that is lower than the one that it thinks will succeed. It is not surprising, therefore, that the authority's budget is always exceeded. It is rather like those irritating people whom we occasionally meet in life, who insist on putting their watches ahead by five minutes so that they will never be late. Eventually, they begin to rely on those extra five minutes.
Once the authority's procedures are known, clinicians rely on the fact that the figures in the budget are not those that will actually be needed. They know that the overall figure will be lower. The result is that the budget will always be exceeded. Surely that is not a sensible approach. As a result, my constituents are having to face cuts.
There is a need to be certain about the figures. However, there is only one certainty, and that is that there is no certainty about the figures. Perhaps there is one certainty: the Deputy Prime Minister was right when he said that we have closed too many cottage hospitals in the past. That being so, the proposed closure of Ongar War Memorial hospital is a throwback to bad decisions in the past.
There is an alternative approach, which would make use of beds and fulfil the needs of all the clinics. It would be necessary to examine the protocols for general practitioners' admissions and to provide £65,000-worth of refurbishment. The local League of Friends has promised a substantial donation. Indeed, it has promised £47,000, which would go a considerable way to meeting the total cost.
551 Discussions took place with the county council, which inspected the hospital and was very impressed. I have a letter from Mr. Robin Rennie, who is the head of community care services of Essex county council. He visited the hospital and was most impressed with what he saw. He wrote:A project involving joint commissioning for Older Peoples Services are, in my view, long overdue in Essex and there may be a considerable attractiveness in considering such a project in the Ongar area. I have also ensured that there will be a specific section in the new Community Care Plan which highlights particular difficulties in rural areas and the sort of imaginative solutions that might be considered to overcome these local difficulties.It is my view, and it appears to be Mr. Rennie's, that that is exactly the imaginative proposal that should be applied to projects for the care of the elderly within the Ongar area of my constituency.
What is said about the Ongar area of my constituency is also true about Brentwood. The minor injuries unit at the community hospital was described in one of the local newspapers as the "town's best kept secret". The unit relieves pressure on the accident and emergency unit. There is only one small sign on the main road directing my constituents to a modern, clean and brightly decorated unit, which is run well by an efficient staff.
A mere 7,000 patients a year come to the unit—it has really only just started. That number represents only a fraction of what could be achieved. Many people are not aware of the unit's existence. Those who are come into contact with it only when they receive an injury.
The accident and emergency unit at Harold Wood hospital is currently closed. The alternative, for my constituents, is a difficult and long journey to the inaccessible A and E unit at Oldchurch hospital. When the new minor injuries unit was opened, it was hailed as the coming thing. It was said that it represented the future. We were told that such units would take pressure off serious A and E cases and would reduce working time. It was claimed that they would offer help where a simple dressing, a splint or a stitch was necessary. It was said that they would offer an alternative to which general practitioners could refer.
Any of us who have visited an A and E unit know that the hard truth is that the majority of people who go to them should not have done so and instead should have gone to their general practitioner or sought medical help elsewhere. It is often frustrating to see people with minor injuries, nevertheless painful, having to wait for long periods because more serious cases are coming through. That is why the minor injuries unit was so useful.
It appears that someone in the south Essex area does not like minor injuries units. There are two other units, one at Purfleet and the other at Orsett. They are well used and will remain open for the time being. However, their opening hours will be reduced. Indeed, they will be open only when GPs' surgeries are closed. I cannot help but feel that that is a cynical manoeuvre.
If we create uncertainty about the opening hours of minor injuries units and reduce the number of people who are involved, it might well be said this time next year, "The minor injuries units in Purfleet and Orsett are not being used." The fate of Brentwood today could well be that of Purfleet and Orsett next year.
Running through the closure of Ongar and the minor injuries unit, and the problems at High Wood, is the impression that minds are already made up; that, 552 despite fairly expensive consultation and full-page advertisements in a local newspaper, people are just going through the motions. Meetings on closures are held in rooms that are deliberately small, so that people who are concerned cannot get in. We have a meeting tomorrow in Brentwood to consider the minor injuries unit and High Wood hospital. The meeting was arranged for the last weekend before Christmas, with the feeling that the public would not turn up. I think that we shall be surprised tomorrow night.
Brentwood, which is bearing the bulk of the proposed closures—two of the units are within my constituency—feels strongly that if better use were made of the minor injuries unit, it would relieve an enormous amount of pressure on the national health service and reduce waiting time. The suggested savings of £132,000 seem small in comparison to the overall budget. Indeed, all the closures do not amount to very much. I have to agree with Councillor David Gottesmann—a Liberal Democrat—the leader of Brentwood council, thatthe options concern a reduction in services rather than in bureaucracy.At High Wood hospital, the proposals include the closure of Magnolia ward, Laurels ward and Brambles day centre, with 50 in-patient beds. It is not surprising that Mrs. Queenie Bishop, the chairman of Brentwood Age Concern, says:residents are shocked and unhappy at the news.The consultation document says that the aim is to
achieve the closure of the High Wood site.Since the outcry, South Essex health authority has backpedalled on that. Julie Garbutt, the director of health care development for South Essex health authority, told a recent meeting of the community health council that the original document listing the options for saving money was "not accurate" when it stated that the aim was to achieve the closure of the High Wood site. She went on to say:We are not talking about the whole closure, we are talking about beds".That is an interesting idea on how to create a more efficient hospital: do not close the hospital, just get rid of the beds. It saves on linen and also waiting times. I cannot help but feel that views on a hospital without beds are the same. The Ongar War Memorial hospital campaign group has a saying: "No beds equals no hospital."
The cuts are not about improving health services. They are not even about changes in health service needs in my constituency. Rather, they are about shifting resources from one area at the borders of two health authorities. The net result will be a reduction in services for the elderly and in community health services. It will increase bed blocking in my part of Essex, as well as the pressure on acute services.
The Government have a number of health service policies that I support. I agree broadly with the shift towards primary care, and with close partnership between GPs and local hospitals. Small cottage hospitals have a vital part to play in the overall team. I ask the Minister to spell out where community or cottage hospitals fit into the modern health service.
§ The Minister of State, Department of Health (Mr. Alan Milburn)
I congratulate the hon. Member for Brentwood and Ongar (Mr. Pickles) on securing this debate. The issues that he raised are of concern to many of his constituents. Indeed, some of them have written to me, so I am personally aware of the difficulties in his area.
I echo one or two of the things that the hon. Gentleman said about the efforts of staff to maintain services in the NHS, particularly at this time of year. The truth—as we all recognize—is that, without the dedication and enthusiasm of health service staff, the NHS would simply grind to a halt. I know that they face many daunting tasks this year, but I have no doubt that they will undertake them commendably and with enthusiasm.
I can assure the hon. Gentleman that the Government share his aim of providing high-quality health care to the people of this country, wherever they live. He will be aware that, just last week, we published a White Paper on the future of the national health service, which set out the steps that we intend to take. We propose a 10-year programme of modernisation to ensure that the NHS is both modern and dependable.
I am pleased that the hon. Gentleman shares the Government's aim of switching resources from bureaucracy to front-line patient care. I do not think that many can argue with that proposition. I can assure him that, during this Parliament, we will move approximately £1 billion out of bureaucracy and into front-line patient services, which is arguably where it should have been in the first place.
The changes that we want to make will ensure a more responsive and dependable service to every community in this country. Community hospitals have a very important part to play in many parts of the country in a modern national health service. Indeed, the hon. Gentleman will be aware from the White Paper that community hospitals feature within the framework of the new NHS that we seek to fashion.
I hope that the hon. Gentleman is pleased with the Government's proposals, particularly to strengthen the links between primary care and the community health services that are provided by community and cottage hospitals in many parts of the country. That is where the future of community hospitals lies, in ensuring a stronger and better relationship between community health care and primary health care than perhaps has been the case.
The hon. Gentleman raised a number of specific concerns about current and future consultation exercises. I think that it is fair to say that he is suffering from a bout of consultations. Most of the hospitals that serve his constituents are subject to consultation of one form or another. To the west, Harold Wood hospital serves the residents of the Brentwood area; to the east is Basildon; while within Brentwood are located Brentwood Community hospital, High Wood and Little High Wood hospitals, and Warley hospital. Finally, in the Ongar part of his constituency is the Ongar War Memorial hospital.
This whole area is one of significant challenges for the national health service. All the local health authorities face difficult decisions about how best to use finite resources. As the hon. Gentleman is aware, two are involved in consulting on "Options for Change".
As the hon. Gentleman rightly said, the future of Ongar War Memorial hospital is being consulted on by the North Essex health authority. I have listened to what he and 554 other hon. Members have had to say about this hospital. As he is probably aware, I have had communications from members of the local community across the political divide about this matter. Let me stress from the outset the importance that the Government attach to ensuring that plans for service development are determined in an open manner, and that any changes that might happen should be implemented sensitively and appropriately.
As the hon. Gentleman is aware, the consultation period ends on 14 January 1998. Therefore, there is still time for those with concerns or suggestions about the proposals to make their thoughts known to the health authority. Only in that way can the health authority ensure that local ideas and suggestions are properly considered. That is true not just for Ongar War Memorial hospital but for all the other proposals that the health authority is considering.
I understand that the health authority's principal purpose in consulting on these changes is to improve the quality, effectiveness and efficiency of care by reconfiguring services across north Essex.
As this consultation is still in progress, it would be inappropriate for me to speak in any detail about it. The hon. Gentleman will be aware that, if the consultation is contested by any of the local community health councils, it will be for Ministers to make the final decision. Until then, I shall keep an open mind. However, I have listened extremely carefully to the hon. Gentleman.
It is particularly important when such proposals are being considered that the views and needs of local people are properly taken into account. We have a statutory responsibility to consult publicly and weigh the results fairly and carefully. When I say "we", I mean not just the Government but the local health authority as well.
The hon. Gentleman then discussed some of the changes recently mooted by the South Essex health authority affecting the Brentwood part of his constituency. I am aware that there is a particular problem in south Essex to do with the anticipated financial position of the health authority in the next financial year beginning on 1 April. South Essex has continued to be funded above the average for England. That has been true for a number of years, and it will be true next year as well. The health authority will receive a real-terms increase of around 2.3 per cent.
In addition, the Government have invested about £2 million this winter to deal with some of the particular pressures to which the hon. Gentleman alluded. Approximately two thirds of the money that has been made available for the winter months will be transferred directly to social services, particularly to deal with some of the issues that the hon. Gentleman addressed, such as bed blocking and ensuring that discharge arrangements are in place. Such arrangements will be particularly beneficial to elderly patients in the hon. Gentleman's constituency.
However, as we know, resources are finite, and the health authority has put in train a process which is aimed at making services reflect the level of need, while keeping within the overall amount available to it.
South Essex health authority is conducting an informal consultation on the subject of change to acute and community services. Some of the health authority's proposals for change would affect the hon. Gentleman's constituents. I have seen a copy of the health authority's 555 public consultation timetable which was agreed with the local community health councils, which have played a constructive role.
As the hon. Gentleman rightly said, on 5 December a leaflet in the form of a newspaper wrap-round, conveying a number of health service options, was distributed to every household in south Essex. Residents will have until 16 January to make known their views on the present options. That can be done by attending public meetings, returning one of the questionnaires or phoning a free phone line.
On 22 January, the health authority will consider the feedback to enable it to determine the proposals to put out for formal public consultation. The second stage of the exercise will begin in February, and will last until the end of March. The health authority then proposes to meet in April to make its final decision. I hope that setting out the process that is to take place will be helpful.
As the informal consultation is still in progress, the same conditions apply to the review being carried out by the North Essex health authority. Again, I am not in a position to comment at this stage. It is unusual for Ministers to come to the Dispatch Box and have little to say, but I am bound by convention and by my obligation to ensure that, if the results of the consultation are contested, I can continue to demonstrate that I have an open mind and will consider the issue fairly and squarely.
556 I was concerned to hear the hon. Gentleman's remarks about the nature of some of the informal consultation exercises which have taken place thus far. However, there is no question whatever of anyone simply going through the motions. I expect it to be a proper consultation, and it will be. I have noted carefully the hon. Gentleman's concerns, along with those of the local council and others about the informal consultation, and I expect the South Essex health authority to take those concerns into account in considering its response to the formal consultation.
Consultations give rise to strong local feeling. Local people may feel that the proposals will have an adverse effect on the provision of health care in their area. That is not why consultations are undertaken. They are carried out to make substantial improvements, and should be for the benefit of local people.
I share the hon. Gentleman's determination to ensure that high-quality treatment and care are available to the people in the Brentwood and Ongar area. I am sure that the local NHS trusts, as well as the local health authorities, share that commitment. I strongly urge all interested parties in the local community to pass on their thoughts and comments on the proposals that are currently out to consultation.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-five minutes past Eight o'clock.