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NHS: Community Hospitals

My Lords, I was going to thank the noble Earl and the noble Baroness, Lady Barker, for their support for this proposal, but, as the noble Baroness went on and on, her support seemed to be extremely grudging. This is a strategic document. It sets out very clearly that there is a new direction in which parts of the NHS can travel, consistent with our White Paper. Some of the noble Baroness’s remarks suggested that there were not already community hospitals doing some of the things that are set out in this document. We are responding to the concerns of people in the NHS about being given support to take forward this agenda. I was at Edgware General Hospital yesterday, where services have already been taken out of acute buildings and provided in a community setting, with specialists working in that community hospital and doing operations there that were previously carried out in an acute hospital. The guidance contains many examples of where people have put partnerships together but have found that capital is a blockage to making progress in this area. We are responding to what people say that they need locally. They wanted encouragement to take forward a community hospital agenda. We have given them that encouragement in this document. I have to say to the noble Baroness, Lady Barker, that we feel that people are mature and can make many of these local judgments for themselves. We have set out the range of services that it is possible to provide. We do not need to set out guidance that prescribes in every detail what people locally need to provide in their communities. We are trying to create a flexible capability for people to respond to their local services. We are not like the Liberal Democrats, wanting to try to control this from the centre. It is absolutely clear that there is no need to change the GP referral systems with community hospitals. They are working perfectly well now, and I do not agree with the noble Baroness that we need more guidance on this issue. I turn to the questions and comments of the noble Earl, Lord Howe. I agree that some parts of the NHS are finding it difficult to manage their revenue allocations, but it is worth bearing in mind that the allocations this year are about 9.5 per cent higher than they were last year and that next year they will be another 9.5 per cent or so higher than this year. I remind the noble Earl that not all primary care trusts are in deficit. Many of them are creating surpluses so that they can develop their services. In this document, we are responding to their concerns by taking forward an agenda of moving services closer to home. We have put this document into the public arena because we know that a number of trusts now have proposals to take forward particular projects, and we want to give them the opportunity to do so. The noble Earl asked whether there was a subtle change in the population range for community hospitals. The answer is no. We have repeated the figure of 100,000 but we want to be a bit more flexible here by saying that there may be circumstances in which smaller communities can have a facility that meets their local needs. There is no significance to the figure other than providing a bit more flexibility. I am grateful for the noble Earl's support on partnerships. What he said is very much our view. With this document, we are trying to encourage people to think widely about the number of people and services with which they might involve themselves in these projects. We have tried to create a model in the form of a flexible community venture so that other public sector organisations, such as the local authority, may bring some of their patterns of revenue and capital into play. Voluntary organisations may wish to join these ventures and private sector organisations may also have something to offer. We know that as we sit here today projects are being developed with people coming forward in a wide range of partnerships. The noble Earl rightly asked about the tariff. The tariff can already be unbundled if people choose to separate the components. We will be providing more guidance for the year 2007-08. The big, more formal, change on unbundling is likely to take place in 2008-09. People in the NHS have told us that they can use capital to help to re-engineer services in order to lower costs and revenue expenditure. Part of the reason for making the funding available is to enable them to do that. Finally, when you put services closer to people, people get quicker access. With regard to the suggestion that community hospitals are closing, the Community Hospitals Association website states that for every closure in recent years, a new hospital has been opened. This body has responsibilities in relation to community hospitals and I do not think that it views the situation in quite the gloomy way that the noble Earl and the noble Baroness have done.