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NHS: Community Hospitals

My Lords, I, too, thank the Minister for repeating the Statement made in another place. Given that I have on a number of occasions in debates in your Lordships’ House talked about the need to move services away from acute hospitals to settings that are more advantageous and afford easier access to patients, he will not be surprised that when I woke up this morning to the press coverage of this announcement I felt rather hopeful. Like the noble Earl, Lord Howe, my hopes were somewhat dashed when I looked at the contents of the Statement and the supporting documentation. The noble Earl was right; this is an announcement of up to £150 million a year for five years only and there is no revenue funding attached. It is capital only. I echo the noble Earl in asking where this money comes from and what will not be purchased as a result that otherwise would have been. When one turns to the detail in the document, the only advice given by the Department of Health on the matter of revenue funding is a series of different funding mechanisms such as LIFT and community enterprises, but there are no actual resources. This is being announced at a time when primary care trusts are shedding jobs right, left and centre. One of the PCTs in the area in which I live is in the process of shedding one in six of its staff. According to this announcement, PCTs have until the end of this financial year to put in yet another bid for one piece of central government funding. There is too little time to work out the optimum healthcare system for those patients they are trying to treat. PCTs and strategic health authorities are at the moment undergoing a massive reorganisation, which is driven wholly and solely by the need to meet stringent financial targets. I do not understand who will have the time to carry out the consultation required before they get to the point of submitting business plans to establish the new community entities. It seems that, once again, the Government have fallen into an obvious trap—that of equating standards of healthcare with standards of buildings. Healthcare is not about buildings, but about staff and the access by patients to those staff. Lacking in all this is any indication of how these new centres will relate either to acute hospitals, which are undergoing a huge transformation and shedding many of the services that they used to provide, or to enhanced GP practices. Nowhere in this documentation is there any mention of crucial matters such as what the referral and decision-making systems for patients will be. One comes to the conclusion that, while the new premises that may result from this announcement may well be attractive and well equipped, there is no guarantee whatever that patients will have quicker access to appropriate services from clinicians who are capable of making correct decisions on the basis of their diagnosis. There seems to have been almost no research into, or thought given to, the impact of the establishment of these new services on acute centres, patient referral, or GP surgeries, which in many cases are working hard to get themselves ready for the new PBC—practice-based commissioning—regime but simply do not have adequate premises in which to offer enhanced services. Like the noble Earl, I too wish to know what advice will be given to PCTs and strategic health authorities about the optimum configuration for acute facilities, ISTCs, walk-in centres and some of the new community hospitals. Finally, at a time when old community hospitals, which have served their populations well and which have adapted to changing healthcare needs, are closing, this announcement is not only short-term, but is highly inappropriate and comes without an evidence base. The last thing that the NHS needed today was another centralised, short-term announcement of small amounts of competitive funding. This is not a strategic response to changing healthcare needs and, therefore, is a missed opportunity.