3.31 pm
Mr. Philip Dunne (Ludlow) (Con): I congratulate my hon. Friend the Member for Gosport (Peter Viggers) on securing this debate; it is the second in which I have participated that emphasises the importance of our community hospitals.
In January, I joined the trustee group of community hospitals acting nationally together, which is chaired by my hon. Friend the Member for Beverley and Holderness (Mr. Stuart); a number of other hon. Members have also joined. The group identified that of 322 hospitals in England, 80 were at risk of service cuts or closure at the point when it did that work. Three of those hospitals were in my constituency, and I want to draw the Minister's attention to what has happened in them so that he gets a picture of what is going on in some of the more remote parts of the country, where the issues are particularly relevant.
As we have heard, the Government publishedtheir White Paper in February. It gave considerable comfort to those of us who are concerned aboutour community hospitals, as it suggested thatthe Government were listening to the concerns of the people who used those hospitals. Many of the arguments that we had put forward in the months leading up to the White Paper's publication coincided with those of the Government, so we had some sense that our message was getting through. It was disappointing, to say the least, that very little of the Government's message seemed to filter down to the bureaucrats who run strategic health authorities and primary care trusts that are responsible for running our community hospitals.
David Taylor: I endorse the hon. Gentleman's remarks about the initiative taken by the hon. Member for Beverley and Holderness (Mr. Stuart), on which I congratulate him, to ensure that fragmented voices were turned into an organised chant.
Some months ago, we were reassured about the apparent new direction for community hospitals; effectively, 5 per cent. of general hospital expenditure was to be transferred over 10 years. However, there is, was and will be a risk that the finances of those acute hospitals will be destabilised by the proposal. Perhaps the funds should not be top-sliced from their expenditure. Does the hon. Gentleman agree?
Mr. Dunne: Actually, the experience in Shropshire has been the reverse: the primary care trusts are helping to fund the acute hospital deficits. In Shropshire, the deficits have been created in the acute trusts. To repair their budgets, they are looking to extract money from the primary care trusts.
In March, the primary care trust in my area eventually announced that it would not close any of the three hospitals in my constituency. That was a great relief to the community. The primary care trust then produced a document at the beginning of May. As I said directly to the trust when it presented the document to the overview and scrutiny committee, the service plan for Shropshire County primary care trust is a thin, weak document. It fails both to give the context in which the savings are supposed to be made and to provide any clear guidance about whether the proposed savings will be sufficient to meet the deficits that it seeks to identify.
Bridgnorth community hospital has had a great deal of investment by the NHS over the previous 12 months and is currently in the process of being rebuilt, which is welcome. The document said that it would be saved and that it would face no job or bed cuts. That is a great tribute to the people of Bridgnorth, who campaigned actively to save it. The leader of Bridgnorth district council is listening to this debate, and I pay tribute to Councillor Elizabeth Yeomans for the work that she and many others did to save their hospital. That is the good news.
The bad news relates to the other two hospitals. Ludlow community hospital is threatened with the closure of two of its wards, with the loss of more than 30 beds and many jobs-as yet, the detail has not been enunciated by the PCT. The hospital is faced with the closure of the final mental health ward in the Shropshire community, with the exception of a small number of beds in Whitchurch in north Shropshire. Bishop's Castle community hospital-the third hospital-will close; at least, there are plans for that to happen. The site will be handed over to a nursing home operator who currently operates on part of the site. The number of NHS-funded beds will be reduced from 24 this time last year to 12.
The mental health aspect particularly worries me and many of my constituents in Ludlow. The primary argument is that this is a value-for-money exercise, as the mental health ward has not been operated in Ludlow at full capacity and should therefore be closed. The director of mental health in Shropshire County PCT has admitted in public meetings that it is not his preference to have to close the ward and that the decision is entirely driven by efficiency savings required by the PCT to help shore up the financial deficits in the remainder of the Shropshire health economy.
One of the reasons why the mental health divisionin the PCT has operated so successfully within budget in recent years is that its primary provision is at the Shelton hospital. I understand that it is the second to last Victorian mental health asylum still operating in the UK, and it will be the last remaining one, because there are no plans to redevelop it for some time. While its staff do the best that they can, the provision is acknowledged to be substandard. The impact on patients who require acute care of going to that facility is likely to be significant and the impact on the carers who look after them is likely to be even more so, because the geography involved in travelling from the Ludlow catchment area to Shrewsbury is significant.
I shall briefly illustrate that point. Yesterday, a group of concerned residents led by John Nash undertook a journey from Ludlow to Shelton for a theoretical one-hour visit by public transport. The six of them caught the 435 bus from Ludlow to Shrewsbury at 11.50 am. They had to change in Shrewsbury to catch the bus to take them to the hospital at Shelton. One of the group is a frail lady in her 80s who is a former physiotherapist, and she got home to Ludlow at5.40 pm, which represents a journey of almost six hours for a one-hour visit. She would currently be able to walk around the corner to her local community hospital. The ability for the carers of our most vulnerable mental health patients to continue to provide such family contact, as it were, will be severely reduced.
I should like to dwell briefly on the impact of the closure of the other rehabilitation wards. The NHS has argued that it should justify the closures on the basis of an equity audit. The equity profile of primary care and community services for Shropshire County PCT, published in May 2005, argues that
"NHS improvement, expansion and reform should narrow the health gap by ensuring that service planning is performed by an equity audit."
The equity audit that has supposedly been carried out to justify the reduction of rehabilitation beds has not been made public. It has been argued that attempts are being made to provide a fairer allocation of beds across the county, which is why beds are being cut in Ludlow and Bishop's Castle. Yet the document also covers the question of need, which was not addressed in the PCT's latest analysis, among the 18 catchment areas in Shropshire. Four of them serve the Ludlow community hospital area, and they all have a higher need for the 65 to 74-year-olds, as identified in the summary, and all bar one are in the higher category for the 75-plus group. Three of the four catchment areas have the highest dependency ratio per catchment area in Shropshire. Three of the four have the lowest ratio of GPs per head of population in Shropshire, and two of the four have the lowest number of patients per practice nurse.
There is a clear need for beds to be available in Ludlow, and for long-term beds in Bishop's Castle. I have been pressing the PCT to commit itself to a 10-year contract for NHS-funded beds. Experience elsewhere in Shropshire shows that it will commit to much shorter contracts, but that once they end, the number of beds is cut. That salami slicing cannot continue, or our community hospitals will all be closed within a short time.
