The debate lasted about half an hour, Richard Foord received a lot of support while the Minister wriggled.
From Hansard
Richard Foord (Tiverton and Honiton) (LD)
I would like to welcome the new Secretary of State for Health and Social Care, the hon. Member for Louth and Horncastle (Victoria Atkins), to her place.
I rise to raise the pressing situation facing the community hospital at Seaton in the part of east Devon that I represent. I am very grateful for the opportunity to outline why plans to strip away a whole wing of the hospital pose a serious risk to the long-term viability of the hospital, and how small actions by the Government can unlock this space and provide huge benefits for the local communities.
Seaton Hospital is one of 12 community hospitals that provide vital services in my corner of Devon which were given over to NHS Property Services in 2016. Seaton Hospital provides a range of services and clinics that enable people to be cared for closer to home in their own community. I would like to take a moment to give hon. and right hon. Members an idea of the range of services that the hospital currently provides. They include a dedicated Chime audiology service, aneurysm screening, bladder and bowel treatments, and child and adolescent mental health services—we heard a lot about that in today’s health debate—as well as access to a dietician, ear, nose and throat specialists, general medicine, orthoptists, support for those with Parkinson’s, physiotherapy, podiatry, retinal screening, speech and language therapy, and stoma treatments. I could go on.
The hospital also acts as a hub for the growing number of so-called at-home care services. We appreciate that community hospitals have been increasingly moving over to services provided in the community at home. That includes provision for those who are frail and need regular care, or are reaching the end of their life. Indeed, the Seaton & District Hospital League of Friends supports the hospice at home professionals, who provide care to people and their families in those most difficult times of a person’s life or in a family’s life.
Jim Shannon (Strangford) (DUP)
I commend the hon. Gentleman for securing this debate. When someone evaluates what a community hospital does, they find that it is about much more than finance and making sure that the books balance. It is about all the things the hon. Gentleman has referred to. The community hospital in my constituency is where my three children were born some 30-plus years ago. It is where I took my youngest son when he broke his arm. It is where I took my other boy when he put his hand through a glass window and had to go to hospital for surgery. That is what a community hospital is about, and that feeling is replicated by every one of my constituents. When the hon. Gentleman speaks about his local community hospital, I am quite sure that he has the same passion, belief and commitment to that hospital, because it is part of the community, and that is how it is measured, not by finance.
Richard Foord
I am grateful to the hon. Gentleman for his intervention. His anecdotes about what that hospital has done for his family and community are absolutely the same sort of thing as I hear from constituents every time I speak to them.
Seaton Hospital was built in 1988 to provide better local access to medical care and treatment for people across the Axe valley. It serves people not only in Seaton but in Colyton, Colyford, Beer, Axmouth and other villages dotted around the east Devon countryside. Originally, the plan was that people would not have to travel so far for their treatment. Given that the Royal Devon and Exeter Hospital is perhaps 30 miles away—20 miles at least—people felt that acute provision was on their doorsteps, which is what they wanted.
Simon Jupp (East Devon) (Con)
The hon. Member is making a stand for a community hospital used by people in both our constituencies, and I congratulate him on having secured the debate. I live less than 10 miles from Seaton Hospital. So many residents raised funds to build the wing, which first opened back in 1991. Does the hon. Member agree that it would be so wrong for local residents to have to pay twice for a building that they helped to fundraise for and build?
Richard Foord
The hon. Member makes an excellent point. It is exactly right that Seaton Community Hospital was built by local people. Let me expand on that important point, because a lot of people have talked to me about this and I want to relay to the House the feelings they have spoken to me about at recent local community meetings.
The hospital was built over two storeys and updated in 1990 with an acute wing, which was funded not just 50% by the local community but 100% by local donations. The important thing to note is that the construction would not have been possible at all were it not for the contributions by local individuals. For example, the Seaton & District Hospital League of Friends had a scheme called “Be a brick: donate to Seaton Hospital”. People could make a small contribution—whatever they could afford—and get a little brick as a memento to demonstrate that they had contributed to Seaton Community Hospital. The charity is still a vocal champion of the hospital to this day. The project would not have happened had it not been for the generosity of the local people. What comes with that is a sense of ownership that I cannot really stress enough. There is a really strong feeling that the hospital does not belong to some amorphous NHS: it is their hospital. They paid for it, they were treated in it and it belongs to them.
Several weeks ago, I was contacted by the League of Friends charity after it learned from the Devon NHS that the plan is to hand over the two-storey wing from the Devon NHS to NHS Property Services. The charity was concerned that this could lead, eventually, to the selling off of the hospital wing, and even to its demolition. As soon as I heard that, alarm bells were set ringing for me. It is clear that Devon’s integrated care board is keen to wash its hands of the facility as quickly as it can. In essence, the facility is in special measures, and in a financially dire place. The wing is costing the Devon NHS about £300,000 a year, billed by NHS Property Services.
I was not all that familiar with NHS Property Services a year ago. I had heard of it, but I was under the impression that it was just another division of the NHS. I looked into it a bit further, and I found that it is responsible for the maintenance and support of most local NHS facilities. I was surprised to find that it is a Government-owned company, legally owned by one shareholder. The single shareholder for NHS Property Services is the Secretary of State for Health and Social Care. As of today, the hon. Member for Louth and Horncastle can congratulate herself on taking on NHS Property Services as her new holding. How can it be the case that a hospital built with the generous support of local people is now owned directly by NHS Property Services, rather than those local people?
In 2016, the Government transferred that facility over to NHS Property Services and implemented a consolidated charging policy to levy charges for rent, maintenance and service charges. Some of those charges are extortionate. We are talking about £300,000 a year, which is £247 a square metre. On paper, it might seem prudent to organise the NHS with some commercial expertise in charge of some of these facilities. However, we have to bear it in mind that the people running NHS Property Services are not necessarily thinking about it through the lens of health and social care; they are thinking about how they can maximise the utility of space and make savings to put money back into budgets.
That is worrying, because what I am hearing is that the offer being made to NHS Devon is, “If you wash your hands of this facility, you will receive 50% of the proceeds of the sale”—that will be to the NHS Devon integrated care board—“and 50% of the proceeds will go back into central coffers, back to Whitehall and back into the very large pot that is the NHS.” The House can imagine what that is like for an individual constituent in my part of east Devon, who has contributed perhaps tens or hundreds of pounds—as much as they could afford—in decades gone by, perhaps through a direct debit or regular payment, to maintain the facility. To hear that those decades of investment will be put back into a big pool in London, a long way away, is pretty sickening.
There has been an understandable backlash from people right across my corner of Devon. I have been to a couple of public meetings in recent weeks since the news broke. At Colyford Memorial Hall a couple of weeks ago, there were more than 200 people. It is a cliché to say there was standing room only, but there was no standing room—there was a long queue of people outside in the rain wanting to get into the meeting. People had one overriding feeling that they wanted to convey to me, and that they wanted me to convey to the Minister and to others gathered here this evening: they created this hospital and they are deeply offended by the idea that it might be taken away. What put salt into those wounds was the idea that that should happen with zero public consultation.
Wendy Chamberlain (North East Fife) (LD)
My hon. Friend is making a passionate speech on behalf of his community. What strikes me is that when the community came forward and made those contributions or bought those bricks, they did not do so to save the hospital at that point. I am pretty sure, like the hon. Member for Strangford (Jim Shannon), that they made that contribution to maintain the hospital for future generations. I am not surprised that it feels like a betrayal to my hon. Friend’s constituents.
Richard Foord
I very much thank my hon. Friend for her contribution. She is exactly right. I point to two specific conversations I have had with constituents recently.
The first was with someone who lives in Seaton, who was close enough to the hospital that she could walk there. Her husband died in the hospital and she was able to go and see him in his final days. She welled up—more than that, tears rolled down her cheeks—as she told me about her husband, who she was able to see in his final days.
Now we have moved to a situation in which patients are cared for at home. Of course, that means that some of the staff previously based out of the community hospital are driving to people’s driveways and providing that care in their homes. That works for some individuals, but the other day I had a lady in my surgery who was almost shaking with nervousness because her husband, whom she loved dearly, had just been discharged from the acute hospital in Exeter and she was charged with looking after him but did not feel able to look after his needs, as he was overcoming his operation towards the end of his life. We are putting some of our constituents in a really difficult situation that they do not feel equipped for.
The reason for the beds being removed from the hospital in 2017 related to so-called workforce issues. There was a substantial consultation of local people in 2017 when beds were removed from local hospitals, but I fear that following that consultation, which showed the outrage and indignation of local people, the NHS does not want to get involved such a consultation exercise again, hence the desire for the ICB to get shot of the building as soon as possible.
The ICB was talking about getting shot of it by the end of this calendar year, although that has gone to Devon County Council’s health scrutiny committee, so it may be pushed into next year. What we need tonight is an intervention from the Minister in relation to NHS Property Services, which is charging a clinical rate for a space that has not been used for acute medicine—it has not had clinical beds in it—since 2017. Organisations are coming forward with a desire to use it not for clinical use but as a care hub to provide other services.
I want to make hon. Members aware of how those clinical beds got removed in the first place. In 2017, there was deep concern that the removal of the beds was an arbitrary decision made following a last-minute intervention by the then right hon. Member for East Devon, Hugo, now Lord Swire. In fact, it is revealed in a book by his wife, Sasha, that Seaton Hospital was to be kept open, with its beds maintained, but, because of that last-minute intervention by Hugo Swire, the bed closures moved to Seaton and the Sidmouth Hospital beds remained.
As a result of that decision, there was no additional funding to set up extra services at Seaton. Instead, the ICB began charging this exceedingly high rent for an empty space. What we really need to do is reduce that rental fee from its clinical rate to one that acknowledges that there are community alternatives. The palliative care nursing team can operate out of this space, and organisations such as Restore and hospice at home carers can work out of it, too. The friends of Seaton and District Hospital are coming up with a strong business plan, but they do need more time to develop it and a concessionary rate—not the clinical rate—to operate from it. If no solution is found, the ward is most likely to be either sold off or demolished. Again—I cannot stress this enough—we need to do this for the people who feel that they paid for the hospital.
There is a precedent for it, and I am grateful to the hon. Member for St Ives (Derek Thomas) for letting me know that the hospital in Cornwall was saved from the jaws of NHS Property Services. However, there is a big difference between what I am proposing for Seaton and what happened at St Ives. St Ives hospital was paid for by a single philanthropist. As we have heard, Seaton Hospital was paid for with contributions—or subscriptions —from thousands of people.
Jim Shannon
The widow’s mite.
Richard Foord
Exactly.
Finally, when it comes to healthcare infrastructure in rural areas such as mine, it is so much harder to rebuild something once it has been removed than to maintain it. We saw in coastal and rural communities such as mine the damage that the closure of cottage hospitals caused, and the impact of removing beds from community hospitals. We must put a stop to that, before our rural healthcare centres are left empty skeletal shells of their former selves, where they were once hubs of love and care. I am looking forward to the Minister’s response and hope that she will agree to work constructively with me, as Seaton’s MP, to ensure a fair deal for local people and to protect our hospital for the people who bought and contributed to it.
The Minister for Social Care (Helen Whately)
I congratulate the hon. Member for Tiverton and Honiton (Richard Foord) on securing this debate. I appreciate his interest and concern about the future of Seaton community hospital. As he said, it was built only as a result of a huge fundraising campaign in the local community, which was matched pound for pound by the NHS. It therefore holds a lot of importance for the hon. Member’s constituents. I fully understand his interest in making best use of the facilities. I know that my hon. Friend the Member for East Devon (Simon Jupp) also wants to see this situation resolved, and I met him earlier to talk about it. I remind the hon. Member for Tiverton and Honiton that decisions about the use of NHS property such as this community hospital are taken at a local level—as they should be—and not by a Minister in Whitehall.
It may be helpful to recap some of the history, as the hon. Member covered in his speech. Between 2015 and 2017, the then NHS clinical commissioning group—CCG—undertook a recommissioning of community services in Devon. That was about introducing a new model of care—more integrated and more community based, with more people receiving care at home. I heard him raise concerns about that model and the shift to getting care closer to the community. My ministerial brief includes supporting the discharge of people from acute hospitals to try to care for more people in their own homes. Some patients spend longer in hospital than is good for their recovery, so for many people it is much better that, when they are declared fit for discharge, they recover and receive care at home.
Returning to the situation of this particular community hospital, as part of the commissioning change there was a change of lead NHS trust as the provider of services in local community hospitals. That meant that ownership of 12 community hospitals, including Seaton, was transferred from the former NHS provider trust to NHS Property Services, as the hon. Member spoke about. NHS Property Services’ model of charging a market rent for properties is to build an incentive to make good long-term decisions about the use of buildings. NHS Property Services then invests that income into those properties and the services that they provide.
At the point of transfer, many community hospitals in Devon had a large amount of empty space. The transfer happened on the basis that the NHS commissioning body—now the ICB—would be responsible for the full cost of that space. The costs include the recovery of the market rent and service charges, such as energy, rates, cleaning and maintenance. Over the past seven years, progress has been made to identify sustainable, alternative healthcare uses for vacant spaces in other community hospitals in Devon, such as in Axminster and Ottery St Mary’s. However, I understand that Seaton and some others still have significant amounts of vacant space. In addition, the ICB and NHS Property Services have worked closely with the voluntary sector, and have supported local initiatives in some properties, such as the Waffle café at Seaton Hospital. However, it is for the local commissioners—not NHS Property Services—to determine the best use of the healthcare spaces that they are responsible for.
Despite sincere efforts from the ICB, I understand that no sustainable healthcare use has been identified for the former ward space at Seaton, which adds up to about half the hospital space. I know the hon. Member’s constituents are frustrated by this situation. Local community groups have expressed an interest in taking on some of the empty ward space, but they see the level of charges as an insurmountable barrier. The ICB has explored a range of potential healthcare uses with NHS providers, but the proposals have not yet come to fruition, so I know the situation is not satisfactory for them either.
The costs to the system of the vacant space are a pressure on the health budget. Clearly, having unused space is not a good use of resources and, ultimately, taxpayers’ money.
Helen Whately
It is important to note that NHSPS operates on a cost recovery basis. That means any reduction in its charges counts as a loss to the health budget if it is not directly offset by actual cost reductions in the facilities. As the hon. Member mentioned, the annual charges for the vacant space in this facility are approximately £300,000, of which £140,000 is the rental charge. The rest is spent on a share of the utilities, business rates, maintenance and cleaning costs for the property.
Richard Foord
I am grateful to the Minister for explaining the charge-back system. Could she explain why the NHS is charging the NHS and hence the NHS cannot have this space, and why it cannot be used for health purposes? Could she explain the charging mechanism a little bit more please?
Helen Whately
The hon. Gentleman says it cannot be used for health purposes. What I understand is that what is being looked at is what healthcare it can be used for, albeit recognising the shift of more care into the community and the changing model of care. On the way the system works, in essence the philosophy behind NHSPS is to ensure that best possible use is made of property. If there are no charges associated with the use of buildings, we could get lots of buildings sitting empty and there is not the same incentive to ensure the best possible use of facilities and resources. That is the philosophy behind having this kind of system. I think he mentioned in his speech bringing specific expertise together as part of the organisation that is NHSPS. I hope that addresses his query.
Helen Morgan (North Shropshire) (LD)
Will the Minister give way?
Helen Whately
I will make a bit of progress, if that is all right.
As I outlined, the ICB is required to pay for the costs and it is not sustainable for the ward space to remain empty for a further lengthy period of time. When an ICB decides there is no long-term healthcare use for an asset, it will usually be sold to allow the funds to be reinvested elsewhere. I have been told that that is not the plan in the case of Seaton community hospital, not least because half the building is an operational health facility and the ICB is fully committed to keeping those services open. I also appreciate that a huge fundraising effort was put in by the local community to build the wing at the hospital in the first place, a point that my hon. Friend the Member for East Devon (Simon Jupp) made when he intervened earlier, and so selling the facility would not be what the community wants.
We know that providing high-quality care and support in the community benefits patients, and their carers and families, helping people to stay well and independent for longer. Across the country, we have achieved a lot as part of our commitment to move more care out into the community. For example, urgent community response services are doing a great job of helping to keep people out of hospital when they are at risk of a crisis. Virtual wards or hospital-at-home services are providing hospital-level care in people’s own homes, helping to avoid admissions to hospital and allowing earlier discharge, and ensuring extra support is there if somebody is concerned about being discharged home, or, as I heard the hon. Member mention, is concerned about a family member being discharged home.
Richard Foord
I am grateful to the Minister for raising the concept of the virtual ward in this context. It reminds me a little of conversations that I have had with constituents in recent months about the virtual shopping experience, the virtual rail ticket purchasing experience, and the difficulty that they are having in dealing with humans. I think that the last thing people want when it comes to health and social care is “virtual”. They want the human touch.
Helen Whately
I can only encourage the hon. Gentleman to visit a team that supports a virtual ward, and speak to some patients who have been cared for through hospital at home or virtual wards. I have done both, and the feedback from patients is phenomenally positive. If someone is concerned about being discharged and supported in this way, it does not happen, but many people would much rather recover in their own homes with that support than be in a hospital where it is hard to get a good night’s sleep because there so much going on around them. Moreover, while people recover in their own homes, beds are freed up for people who really need acute hospital care on site.
A third model that is doing very well in helping people to receive care close to home is the proactive care model delivered by multidisciplinary neighbourhood teams. These are real game-changers, helping people to live independently and stay out of hospital. The teams consist of—among others—doctors, nurses, care workers, allied healthcare professionals, all coming together to ensure that people have the care that they need in order not to be going in and out of hospital, as sometimes happens when people become unwell.
While I fully understand the hon. Gentleman’s frustration, I have been assured that the integrated care board, local providers and NHS Property Services are working together to resolve the situation at Seaton Hospital to ensure that facilities—and, indeed, funds—are put to good use for patients.
1 Cranford Close Exmouth EX8 2HRRef. No: 23/2353/FUL | Validated: Fri 03 Nov 2023 | Status: Awaiting decision
East Devon Watch 