Acute Hospital Services

Part of Opposition Day — [6th Allotted Day] – in the House of Commons at 4:25 pm on 21st February 2007.

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Photo of Howard Stoate Howard Stoate Labour, Dartford 4:25 pm, 21st February 2007

I welcome today's debate, not just because it gives us an opportunity to discuss the process and nature of hospital reconfiguration, but because it provides us with the opportunity to consider the wider question of what kind of role the acute general hospital ought to play in the 21st-century NHS.

I shall quote briefly from the NHS Confederation briefing, which states:

"Reconfiguration is needed to improve health outcomes. Changes are necessary whether or not there are NHS deficits. Indeed, in some cases the reason why trusts have run up deficits in the first place is because these decisions were not made earlier."

The briefing goes on to say:

"We must start judging the NHS by the number of people we make better and keep well, not by the number of beds."

That, to me, is perfect common sense. Much of the debate on reconfiguration tends to dwell, quite understandably, on the potential loss of local hospital services and the perceived reduction in the quality of local health care. That diverts attention from what ought to be our primary area of inquiry—why we continue to admit so many patients unnecessarily to hospital, and what we can do to prevent it.

As I have said on many occasions in the House, the vast majority of hospital admissions should be seen as a failure of health policy. Every day thousands of patients are admitted to hospital not because they are desperately ill or because they need the support that only a hospital can provide, but because we often do not have anywhere else to treat them. In most cases patients enter hospital as a direct consequence of our failure to spot potential problems, to prevent people from becoming ill in the first place, and to put in place effective care packages that would allow them to be treated properly at home.

One in four emergency admissions consists of people with chronic conditions who yo-yo in and out of hospital three or sometimes four times in a single year. That adds up to 1 million unnecessary hospital admissions each year, costing the NHS in excess of £2 billion. This catastrophic waste of money rarely does patients any particular good. Not only do patients not want to be in hospital, but in many cases they would make a quicker and more complete recovery in their own homes and certainly in their own communities, supported by an appropriate care package close to where they live.

Most policy makers and commentators understand that and sometimes even talk about the need to reduce unnecessary hospital admissions, yet progress is painfully slow, given the sensitive nature of reform. As we have heard this afternoon, too often the reason is thinly veiled political self-interest on the part of Members who understandably but, in my view, misguidedly try desperately to talk up their own area and their own interest, often to the detriment of the wider health service. We must try to redress that tendency.

We are making some progress. Patients are discharged back into the community far more quickly than they would have been a generation ago, thanks to the increased use of less invasive procedures and the huge increase in day surgery. Today's hospitals require far fewer beds, as we have heard in the debate, and patients requiring minor procedures are increasingly being treated elsewhere. However, I believe that the model of acute care that we had in place is no longer fit for purpose, and we need to rethink radically the way in which the acute system, and the district general hospital in particular, is operated.

We should start by asking which services must be provided at acute district hospital level. Although there is a range of services to which patients in each area need access, including trauma, accident and emergency, orthopaedics, paediatrics, obstetrics, gynaecology and many others, there is no reason why all these specialties should be provided at each and every acute hospital in a particular region.