I beg to move,
That this House has considered the future of Teignmouth Hospital.
It is a great pleasure to serve under your chairmanship, Sir Charles. This is the story of a hospital being closed by stealth. Teignmouth Hospital, which is in my constituency, was built in 1954. It was one of the first purpose-built NHS hospitals and offered a wide range of services. Even today, it has three community clinics, in audiology, physiotherapy and podiatry, which have largely been funded by the League of Friends. In addition, there are out-patient clinics dealing with abdominal aortic screening, anaesthetics, breast, cardiology, chronic fatigue—there are 23 of them in total, so I will not labour through all of them, in the interests of time and to allow a proper discussion of this issue. The hospital also has an operating theatre, which takes day cases relating to eye complaints and skin issues.
However, all of this was put into a quandary in 2014, when the local clinical commissioning group decided to look again at how health and care should be properly provided in Teignmouth and Dawlish. That is absolutely the right thing to do. However, my issue is with how it has been done, and with the evidence that has been collected and the way it has been evaluated.
The consultations took the following steps. First of all, they looked at removing two of the in-patient wards within Teignmouth Hospital. So, at a stroke in 2016 and after two consultations—one in 2014-15 and one in 2016—a decision was made to remove two whole wards. As anyone can imagine, the local community were not at all happy and the only thing that helped was the promise of 12 new rehabilitation beds to help in the community. That would have been very appropriate in a rural community with an ageing population, which mine is, and with a state-of-the-art physiotherapy unit paid for, as I have said, by the League of Friends. However, what was even worse was that those rehabilitation beds were never delivered. A unilateral decision was then taken in 2017 that there would be no rehabilitation beds. No evidence was produced and no consultation took place.
Then, in 2018 a further consultation looked at a reconfiguration of services. The creation of a new health hub, which was the core proposal, was and remains absolutely the right thing to do, and is in accordance with the NHS Long Term Plan. It would house the GPs in Teignmouth and an integrated care hub, with individuals from the voluntary sector, and the three community clinics. However, the out-patient clinics—all 23 of them—were to be relocated to another hospital in Dawlish. It is not that far away, but given our transport problems it is quite far enough away to be problematic for an ageing population.
The consequence suggested—but with no questions asked—because of the hub and the relocation of services to Dawlish, was that Teignmouth Hospital would necessarily close. There was no consultation. It seems to me that although there has been a consultation on reconfiguration, there has been no consultation on a hospital closure. It is my understanding that legally—never mind to ensure best care—such a consultation should take place.
I and a number of colleagues were very disquieted by all this. Indeed, the health scrutiny committee at Devon County Council was sufficiently concerned about the lack of evidence and the failure to consult that it went to the reconfiguration panel to take informal advice as to what it should do. It is only the health scrutiny committee, under current legislative provisions, that can, in effect, call in such a decision. It is my belief that, had it done that formally, the reconfiguration panel would have had to take a much more serious approach. Instead, its response to the request for advice was, frankly, a bit of a pat on the head: “Go and talk to the clinical commissioning group; I’m sure you can resolve your differences,” or words to that effect. I do not really think that is a responsible reply to a very urgent and well meant request for assistance, and my view would be, in the light of that response, that the county council, through its scrutiny committee, should now make a formal application.
The issue is that Teignmouth Hospital is to close, without any consultation at all. Why does that matter? It matters because there has been no assessment of the health and care outcomes for residents of Teignmouth. Without such a consultation, how can we be clear that health and care needs are being properly met? Worse, the consultation takes no account of what is happening in the landscape of social care. In Teignmouth there are no nursing care homes, so there is no fall-back; there are no other beds in the community that can be used.
Why are the health scrutiny committee and I so exercised about the flaws in the reconfiguration, which mean that closing Teignmouth Hospital without consultation is a real mistake? First, the decision is based on an assumption that all intermediary care can be undertaken at home, with the balance in nursing care homes. I contend that it is simply unrealistic to consider that all intermediate care can be undertaken in an individual’s home. There are lots of reasons for that. First, we do not have any nursing care homes in Teignmouth. Secondly, even if we did, rehabilitation is not what nursing homes are all about. Thirdly, some of these elderly people have to have help come to them from some distance, which makes it a challenge. We also have an acute lack of domiciliary care provision. That puts a very big question mark over the key assumption that underpins all the decision making.
The evidence that was presented is inadequate in quality and in quantity. There was a lot of data; I am drowning in data, but I have very little genuine information and very little genuine analysis. On that basis, I am very unhappy with what I have seen. It is fundamentally desk-based research by the clinical senate and the University of Plymouth—two outstanding institutions. However, the information that they have used is simply records of beds and their use, whether in a hospital setting or otherwise. It looks at discharge and delayed discharge, but because there are no beds at the moment in Teignmouth Hospital, there is nowhere for people to go other than home, or a care home outside Teignmouth, so is it surprising that we find an argument being made that those beds that were in Teignmouth Hospital are not needed? It seems to me that a negative cannot prove a positive.
Of more concern is the fact that there is no research whatever on the patient experience. Given the lack of domiciliary care provision, that is a crucial omission. People should bear it in mind that, at this point in time, the hospital’s beds have been closed for two years. Why has no evidence been gleaned as to the quality and quantity of the care provided to people in their homes? That seems to me a glaring error, which must be resolved.
It also seems to me that the evidence is definitely defective. It takes no account of this new, post-covid world. I accept that the consultation started before covid, but it has lasted through covid, and for me that has made one thing clear: the old system we had, which was very much just in time, is no longer the way forward. We must have a resilient care system. That means taking into account the impact of covid. We know long covid is following covid. We know that that specifically requires a lot of rehabilitation care. I raised that with the clinical commissioning group, who believed it was inappropriate to take account of the figures for 2020-21 because those covid figures were unrepresentative. I find that strange, because, if those are unrepresentative of the real need, surely the figures for 2019 are equally not representative. That causes me real concern.
I will turn to the proposal in relation to the other services, not beds in Teignmouth Hospital. That care is to continue to be provided in Dawlish Hospital. Dawlish is, effectively, to take double the number of referrals—23 out-patient clinic patients on top of its existing load of patients. The “building works”, which I would not really call building works, will simply reconfigure the maternity room into two consulting rooms. It is a bit like moving the deckchairs on the Titanic. There is no evidence of any real effort to ensure that Dawlish is properly configured to meet what will be an increasing demand.
As for the hub itself, there is no evidence that it will have the capacity to take all the GPs, all the community service clinics, the integrated care hub and the voluntary sector representatives. Yes, planning permission has been put in for and, indeed, granted. It is clear how the rooms will be configured in the new hub, but not how they will be used, and until they are used we simply do not have evidence that they will be sufficient for the need.
What is the way forward? It seems to me—because we have two years during which the hub is to be built—that the first priority is to collect the missing data. Let us collect the data for 2020-21, and look properly at bed occupancy and why it is as it is. Let us look at discharge, readmissions and waiting lists. Let us look particularly at the impact that long covid will have in that period on rehabilitation care and growing need. Let us also undertake some research on the quality and quantity of home-based care. There is no evidence about either of those in anything that has been presented by the clinical commissioning group. Worse, there is nothing on the patient experience at all. When all the data has been gathered, let us have a separate consultation on Teignmouth Hospital—not only after the data has been gathered but after the hub has been opened and we can see whether it is adequate, and Dawlish has taken on its additional work.
To be clear about the impact of the reconfiguration on Teignmouth residents, all those things must be taken into account. That is right and responsible. If we get the decision wrong, we could well find that we are closing a facility only to spend money on reopening something else to meet the rehabilitation need that is not met. That is lose-lose. I would be the first to agree that it is an ageing hospital, but it could be improved—not to become state of the art, and I am not looking for that; but it would cost just over £600,000 to get it to a position where it could continue to provide the services that are needed.
My ask of the Minister and the Secretary of State is, first, to intervene to stop this automatic closure of Teignmouth Hospital, as the Secretary of State did to stop the closure of Chorley hospital accident and emergency department in Lancashire. I quote regional director Bill McCarthy:
“We have received instruction from both the secretary of state for health and the minister of state for health, to work with the integrated care system and local leadership to develop an option that provides safe, high quality care, that continues to include Chorley”
emergency department. That was reported in “North by Northwest” in February this year, not many weeks ago.
I do not have an opinion as to whether that was the right decision, but the Secretary of State said expressly in the very recent latest White Paper—which will lead to an NHS Bill—that he intends to enable power to be given to him to call in decisions such as the Teignmouth one and to remove the reconfiguration panel. From the experience I have had, that panel is not fit for purpose.
My second ask is that the Secretary of State and the Minister instruct the reconfiguration panel that no closure of any hospital or facility should be made going forward without the impacts of covid having been taken into account and a proper impact assessment having been made.
My third ask is for the Secretary of State and the Minister to instruct the clinical commissioning group to put in hand a separate consultation specifically on the closure of Teignmouth Hospital, after the data I referred to have been collected, and to mandate the CCG to collect the necessary evidence on patient experience, on the impact of Dawlish Hospital and on the adequacy of the new hub at Teignmouth. The group should then review the data collected and analyse it properly.
Teignmouth Hospital deserves better and the people of Teignmouth deserve the Secretary of State’s support. I ask the Minister in his place to grant that support and to do what he and the Secretary of State are more than capable of doing, so setting an example of how important health and care are to him and to us. That would set a marker that covid has changed the game and that covid, and long covid in particular, must influence and guide future decisions on hospital closures. I thank you for your indulgence, Sir Charles, and I look forward to the Minister’s response.