That this House has considered unavoidably small hospitals.
Thank you very much, Mr Hollobone; as ever, it is a pleasure to serve under your chairmanship. I thank the Minister for being here, and I wish her luck in any coming reshuffle. I also thank colleagues from Yorkshire, Devon, Cornwall and other parts of the United Kingdom for being here. Indeed, we have two Members from Yorkshire—my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) and my right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak). It is a delight to see them both. I saw one quite recently on the Isle of Wight, but sadly not both.
The debate was originally granted prior to the covid pandemic. Clearly, much has changed since then, but I also wonder whether the fundamentals of unavoidably small hospitals have changed. The reason why I called the debate back then, and why I want it now, is that I fear they are still the poorer cousins of larger district general hospitals.
I will make two points. Clearly, I am going to talk specifically about St Mary’s Hospital on the Island, because it is in my constituency, but there are broader points to be made about unavoidably small hospitals throughout the United Kingdom. I want specifically to ask the Minister to put as much information as possible about the funding processes for unavoidably small hospitals in the public domain. We were talking prior to the debate, and she said that some of that information rests with the new integrated care boards. That may well be the case, and that is fair enough, but they are not elected bodies. We know that the NHS can be rather top down and bureaucratic in some of its behaviours, and the more information she can put in the public domain to help Members with unavoidably small hospitals understand the situation, the better.
Before I address that further, let me put on record my thanks not only to staff at St Mary’s but to GPs on the Isle of Wight and their staff, and to the pharmacists, the dentists and all the staff in care homes, who do a no less valuable job. Some of the problems we are facing are because of a lack of integration with our adult social care system; the inability to find a home for the elderly and vulnerable that that system looks after puts additional pressure on hospitals.
I congratulate my hon. Friend on securing this important debate. May I give an example of how the Government might calculate the figure? A hospital in my constituency in Scarborough is run by the York and Scarborough Teaching Hospitals NHS Foundation Trust, which tells me that it has to pay extra to get consultants to travel to Scarborough and stay overnight, as well as paying their hotel bills. However we factor this stuff in, we have to be able to make a calculation that allows those trusts properly to fund these hospitals.
I thank my hon. Friend for that valuable intervention. We have exactly the same problem. I will come on to how we are trying to solve it, but we have the same issue getting consultants over from Portsmouth, although we are very close to Portsmouth and Southampton. It is difficult for a consultant with a speciality to work in a small NHS trust, because there is no opportunity to practise that speciality effectively enough to keep their ticket to do their very valuable and worthwhile job.
Although I am delighted that the previous Conservative Government recognised the additional costs and gave the Isle of Wight nearly £50 million in additional capital expenditure, my trust assesses that the funds given are roughly half what is needed. I stress that we are not just sitting on the Island saying, “We want money.” We understand that we need to sort out these problems for ourselves. Our trust was in special measures and is now rated good, due to some fantastic hard work by Maggie Oldham and other health leaders, who have come in and turned our hospital around, really helping to make a difference. I thank everybody, from the cleaning staff to the most junior nurse and the most junior doctor, for the great work they have done.
We are now rated good and have been looking at ways to provide better services on the Island, without just waiting for the Government to provide funding. We are integrating. We have deepened our relationship with Portsmouth general hospital, our university hospital, the idea being that when it hires a consultant, we share that consultant for 10% or 25% of their time. A world-leading consultant in an area of medical expertise will therefore spend some of their time looking after folks on the Isle of Wight.
We have reformed our mental health services, and we are reforming our ambulance service too, to ensure that we have more ambulances out there to treat more people, more quickly. Along with everywhere else, we are integrating adult social care as part of the Government’s plans. We want to be pioneers in that. Because of our age demographic, we want to be at the front of the queue. I have sadly learned that, if the Island is not first, it tends to be last, because it comes as an afterthought. I always want to ensure that the Island gets to the front of the queue, so that when the Government look to test pilot schemes, they come to us first.
Order. The debate can last until 11 o’clock. I am obliged to call the Front-Bench spokespersons no later than 10.37 am, and the guideline limits are 10 minutes for Her Majesty’s Opposition and 10 minutes for the Minister. Bob Seely will then have two or three minutes at the end to sum up the debate. There are six highly distinguished colleagues seeking to contribute. I do not wish to impose a time limit, but if everybody limits their remarks to eight minutes, everybody will get in.
May I say what a pleasure it is to speak in this debate? I thank the hon. Member for Isle of Wight (Bob Seely) for raising the issue for his constituents in a commendable way and with passion. He has illustrated the necessity of having a good local hospital or small hospital, as the title of the debate suggests. I share his concerns about St Mary’s Hospital in his constituency, which is completely isolated by water. It is of major importance that, for the sake of his constituency, his local hospital is funded correctly, to encourage people to use the services available there and to enhance those services, as the hon. Gentleman has suggested. I was pleased to read about recent plans to innovate and improve the service at St Mary’s; it is great to be back in Westminster Hall, in this parliamentary term, to discuss that.
May I say how pleased I am to see the Minister in her place? She has a real understanding of health issues and I am sure her response will encourage us all, and particularly the hon. Member for Isle of Wight. I am also pleased to see the shadow Minister, the hon. Member for Enfield North (Feryal Clark), in her place and look forward to her contribution.
I always give a Northern Ireland perspective: the title of the debate is “Unavoidably Small Hospitals” and I certainly have one of those in my constituency. The importance of that hospital should never be underestimated. Back home in Northern Ireland, most of our major hospitals are in the County Antrim area, near Belfast city, where the majority of the population tends to live. In my rural constituency of Strangford we have two hospitals. The main hospital in Ulster is on the edge of my constituency. It is the biggest hospital and is very important because it provides acute services and can take in almost every emergency that comes its way. The other hospital, Ards Community Hospital, is in Newtownards, where my main office is. It used to be a major hospital, but things have changed in recent times. Hospitals have centralised their services and many services that used to be provided by Ards Community Hospital have moved to the Ulster Hospital.
It is a pleasure to speak in this debate with you in the Chair, Mr Hollobone. I thank my hon. Friend the Member for Isle of Wight (Bob Seely) for tenaciously following up on this very important issue, which I and my right hon. Friends the Members for Scarborough and Whitby (Sir Robert Goodwill) and for Richmond (Yorks) (Rishi Sunak) have been following closely over the years.
My hon. Friend concluded in exactly the right place. The issue is not hard numbers in terms of cash, deficits or whatever; this is about patients and patient care. We have experienced two challenges in respect of Scarborough Hospital and the Friarage Hospital in Northallerton in particular. Yes, as my hon. Friend set out, there is the issue of funding and the extra costs of delivering services in places such as Scarborough, but there is also the fact that these hospitals are run by trusts that run a number of hospitals, and the small hospitals are, of course, not necessarily their largest hospitals. Because the trusts are faced with the extra costs of running the smaller hospitals, there is a natural tendency for them to try to centralise care in one of the other hospitals. When they talk to the public—they tend to talk to their customer base before they make changes—they ask them, “Would you be prepared to travel for better health outcomes?” Who would not say yes to that? Of course! But it is a leading question.
I have a couple of examples of how it works in practice. A number of my constituents have written to me. One of them had to go to York Hospital from Scarborough. They did not have transport—they did not have a car—and they had to go for an appointment at 7.30 in the morning for treatment for a brain tumour, and were then discharged at 11 o’clock that night, without transport. It is not just that people have to travel for extra care and that they are deprived of local care for treatment that would have been available at Scarborough at one point; it is the fact that there is no real consideration of some of the challenges of living in a rural area. Some of my constituents have had to travel to York from Scarborough on the east coast—from Filey in my patch—to stay in a hotel overnight because there is no public transport to get to early morning appointments in York Hospital. Those are direct consequences of centralisation.
The problem is clearly significant in my hon. Friend’s patch, but does he understand that when people are separated by sea from the mainland it becomes an even greater problem? There are even greater logistics if people need a car and then a ferry to the bus and so on.
My hon. Friend is absolutely right. His challenge may be even greater than ours in rural parts of North Yorkshire.
Centralisation is a natural tendency for any organisation, of course. A person sat in a larger hospital in York will think, “Let’s have all the services over here. It is easier and cheaper to employ consultants over here.” Centralisation is easier, but it is much worse for patients. It is not fair on them, given the complexity of travel and the effect on local communities.
The principal trust that runs the hospitals in my area is the York and Scarborough Teaching Hospitals NHS Foundation Trust, which runs Malton Community Hospital, Scarborough General Hospital and St Monica’s Easingwold, which is a small cottage hospital. It is easier for the management to centralise things, and it is cheaper, given that it is more expensive to provide healthcare in more remote locations. I said earlier that because remote hospitals have difficulty recruiting people, they tend either to close services down or provide additional remuneration for the consultants who work there, so there is a double whammy of cost.
The other issue in my constituency is that it is 40 miles from Scarborough Hospital to York, and on a good day it takes an hour to travel on the A64 all the way to York as it is a single carriageway for most of its stretch and is often logjammed with traffic. The dualling of that carriageway has been the subject of many pleas to the former Chancellor, my right hon. Friend the Member for Richmond (Yorks), and many others, and hopefully we will get that in the not-too-distant future. This is serious stuff, of course, for anyone who needs emergency treatment.
The stroke unit at Scarborough was relocated to York some time ago, so if someone has a stroke in Scarborough, they have to get to York, and they might be in an ambulance for two hours on that road. It is unfair. I understand that they may get better treatment at the hyper-acute stroke unit at York, but nevertheless there are potentially direct impacts on people’s healthcare when services are centralised in distant locations.
It is always a pleasure to serve under your chairmanship, Mr Hollobone. Although I may be a Liberal Democrat, if I lived on the Isle of Wight I could be tempted to vote for the hon. Member for Isle of Wight (Bob Seely), because he is assiduous in the pursuit of issues that are important to his constituents. He has repeatedly raised the issue of St Mary’s, and he has my every sympathy.
When listening to the contributions so far, I could have shut my eyes and imagined that I was standing on the high street in Wick, in the far north of Scotland—the far north of this United Kingdom—because the issues are the same there as have been outlined. Recruitment and retention is the deadly issue in the north of Scotland, much as it is on the Isle of Wight. I will say, as the hon. Member for Strangford (Jim Shannon) said, that health is devolved; as he also said, health matters to everyone in the United Kingdom. What I am about to say about the situation in my own constituency is pertinent to the rest of the United Kingdom.
Some years ago, Caithness General Hospital in Wick had a consultant-led maternity service. There was a battle to retain that and it was won by the local people. More recently, the highland health board, NHS Highland, used retention and recruitment as the reason not to have consultants located in the far north of Scotland and to downgrade the service to a midwife-led maternity service. That means that mothers have to travel more than 103 miles from Wick to Inverness to give birth. In the middle of winter, if the A9 road blocks, which it does on occasion, and the air ambulance has been called to a road traffic accident somewhere in Morayshire or West Sutherland, then what is going to happen? We are faced with a very dangerous situation indeed. I give credit to the NHS in Scotland: at long last a dialogue has started between the residents of Caithness and Sutherland and the powers that be. I hope that dialogue will eventually be fruitful.
It is a pleasure to serve under your chairmanship, Mr Hollobone, and I thank my hon. Friend the Member for Isle of Wight (Bob Seely) for securing this important debate.
My hospital is the second most remote on the list, and the most remote on the UK mainland. Obviously, as the representative of North Devon, I would not have to go to hospital by boat, although constituents of my neighbour, my right hon. and learned Friend the Member for Torridge and West Devon (Sir Geoffrey Cox), who live on Lundy do go by boat or fly to hospital. Most of my constituents in beautiful North Devon travel to hospital on a road that is described as the longest no-through-road in the country, and we are not only rural, but coastal. As Professor Chris Whitty has highlighted, coastal communities’ health outcomes are particularly poor.
I want to thank the fantastic team at North Devon District Hospital. They are remarkable, and I am delighted that the Minister has had the opportunity to come and meet some of them. We visited the first covid catch-up ward in the country. My hospital might be small, but it is pretty perfectly formed. It was the recipient of £1.9 million last December for a covid catch-up elective ward, which was opened in time for the jubilee. It is named the Jubilee ward and the staff are conducting—seven days a week—hip and knee replacement surgery with most patients going home the same day. That is a truly remarkable achievement, which was delivered by some of the Nightingale teams.
I made a plea to the Minister then that I will repeat today. My hospital is highlighted as one of the 40 that are due a rebuild. The plans are written, this is a modular build, and the team have demonstrated that they can deliver on time and on budget. They can also show the need for the improvement to the facilities at the site, so, if the Minister is not in post next week—I very much hope she is—will she leave a note on the way out to let people know that North Devon District Hospital is ready to start the building programme if the funds are released?
The hon. Member is making a very good speech indeed. Does she agree that it might be a good idea to revisit the taxation regime that covers the remuneration for mileages for some health workers who have to drive? They have been penalised rather and perhaps the number of miles could be raised. It would not attract taxation.
Indeed, I agree in many ways. My right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak) and I had similar conversations in a previous life. Much could be done, and personally I want to give social care workers electric cars, so they are taken out of that and can decarbonise at the same time.
As the new Administration comes in, I hope that there will be some revisiting of how to tackle the challenges of social care without the ringfenced money if that plan is to go ahead. We need to look after everybody who is unwell in our society. When visiting a social care organisation over the recess, it was frustrating to hear that they have the work for so many extra people. They can recruit internationally and they are. They advertised six jobs and overnight they had 70 applicants. They could take all 70, but there is nowhere for them to live. Until we in northern Devon find a way to address our housing challenges, I will work tirelessly here to tackle them. As a community, we need to find a way to ensure that people who need to work and live in our community can afford to do so before the situation gets worse as we head into the winter.
Talking about the winter and seasonality, I want to highlight the remarkable work that goes on within A&E at North Devon District Hospital. Unlike many hospitals that have a big winter peak, my population increases fivefold during the summer months. My A&E is busy all year round, which has its benefits in that we do not have those peaks and troughs, but I am not sure that the funding truly reflects the seasonal influx of those visitors and the changes. Obviously, the injuries people secure on a beach are quite different to the issues that affect my elderly population. I think there is some work to be done to understand the rurality, seasonality and locality of the fabulous North Devon District Hospital. My parting comment to the Minister is that quick reminder that we are one of the 40 and we are ready to go.
10:17 am
20 of 35 shown
Let me also put on record my thanks to the Government for the £48 million additional capital spending on the Island. Indeed, I suspect that the former Chancellor, my right hon. Friend the Member for Richmond (Yorks), deserves thanks for that, as well as for the fair funding formula reference for the Isle of Wight. I am delighted and very grateful that he did both those things. That £48 million was part of getting a better deal for the Island, which is clearly an ongoing project.
In England and Wales, there are 12 unavoidably small hospitals, which are defined as hospitals that, due to their location and the population they serve, and their distance from alternative hospitals, are unavoidably smaller than the “normal” size of a district general hospital. In the Isle of Wight’s case, we are about half the size—about 55% to 60%—of the population needed for a district general hospital.
I would argue that the pressures on these small hospitals are greater than elsewhere. They are smaller, so they are more easily overwhelmed due to their size, and they are under greater economic pressure, because the NHS funding model—we recognise that there has to be a funding model—is designed for an average-sized, “normal” district general hospital, rather than an undersized one. You cannot give birth on a helicopter or a ferry; on the Island, we need to run our maternity services and our A&E 24 hours a day, seven days a week. However, our income is based on national tariffs that do not equate to the size of our population. As the Island’s trust says,
“the Island’s population is around half of that normally needed to sustain a traditional district general hospital.”
The third pressure on unavoidably small hospitals is because they exist outside of major population centres. Without a shadow of a doubt, they are in some of the loveliest parts of England and Wales, but because they are outside of those major population centres, recruitment and retention of staff becomes more difficult, which adds pressure on the staff who are there and adds costs in terms of locums and agency staff, which can have a highly significant effect on budgets. Ferries aside—with the partial exception of the Scilly Isles—the pressures at St Mary’s on the Isle of Wight are shared by other unavoidably small hospitals. I think that helps to explain why, in the last decade, a number of unavoidably small hospitals have been put in special measures or have sadly failed, despite the best efforts of those people who work there.
Our hospital, St Mary’s, is classed as 100% remote, which is unique even by unavoidably small hospital standards, because it is accessible only by ferry—although, as far as I can see, accessibility by sea is not a factor in the definition of an unavoidably small hospital. On the Island, our need for healthcare is arguably higher than elsewhere in the United Kingdom. We struggle to get the national standard, but our need for that national standard is greater because over a quarter of our resident population is aged over 65 and, by 2028, over-65s will be one third of the population. Indeed, we have a particularly large cohort of 80 to 84-year-olds.
All the evidence and common sense suggests that that has a disproportionate effect on healthcare: older people, and especially the very old and frail, need healthcare more than young people. We on the Island are struggling—as, potentially, are other USH areas—to provide quality for that ageing population. In addition, the Island’s population doubles over the summer, because we have lots of lovely visitors. That impacts demand, which means that our A&E can be close to overflowing at times, even as efficiently run as it is.
I suggest that there is an additional factor: the impact of high levels of social isolation. People retire to the Island as a couple and one sadly dies, leaving the other isolated from family and social networks because they lived most of their life in other parts of the United Kingdom. That leads to increased reliance on statutory services.
All this has been noted. The former Health Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock), confirmed his concerns to me in July 2019, telling the House:
“As for Island healthcare costs, my hon. Friend is right to say that the Isle of Wight is unique in its health geography, and that there are places in this country—almost certainly including the Isle of Wight—where healthcare costs are”—[Official Report, 1 July 2019; Vol. 662, c. 943.]
increased.
I am not saying that we are the only place like that. There is isolation in other parts of the country, including Yorkshire, Cornwall, Devon and Cumbria, but in the Island’s case the situation is cut and dried because of our separation by sea from the mainland. In its January 2019 sustainability plan, the Isle of Wight NHS Trust estimated that the annual cost of providing a similar—I stress to the Minister that this is the critical element—standard of healthcare and provision of 24/7 acute services, including maternity and A&E, on the Island to that enjoyed by mainland residents would be an additional £9 million. These are 2019 figures.
The estimated cost of providing additional ambulance services, including coastguard helicopter ambulance services, was about £1.5 million. In the Scilly Isles, patient travel is funded out of the clinical commissioning group—now the ICB—budget. Ours is not. Our patient travel budget comes from ferry discounts and council contributions, and it was estimated to be £560,000. In total, one is looking at between £10 million and £12 million at 2019 figures.
Either because they were going to do so anyway or, hopefully, because of representations from myself and others, the Government have recognised since then that unavoidably small hospitals need a funding model that serves them, because there is no alternative but to keep those hospitals open to serve those populations in a way that is ethical and, frankly, legal nowadays.
I am proud of our efforts to highlight the plight of unavoidably small hospitals to the Government, and I thank them for listening and for trying to put in place a package of support for them. I say to the Minister that this is where I would welcome more facts being put in the public domain. I have trawled through NHS documents for the last couple of days, and the last figure I can see for the unavoidably small hospital uplift for St Mary’s on the Isle of Wight is that from 2019, when we received £5.3 million. That is roughly half of what we think we need to run a national level service, so we are grateful that the Government have recognised the need for an uplift for unavoidably small hospitals. Will the Minister please update me on how much money St Mary’s has had as an unavoidably small hospital since 2019, given that we have clearly had issues with covid?
According to page 13 of the NHS “Technical Guide to Allocation Formulae and Pace of Change” for 2019-20 to 2023-24, that money was given in 2019 due to
“higher costs over and above those covered by the”
market forces factor. I cannot see other figures in the public domain. I do not quite understand how the Government could calculate that figure in 2019 when the advisory committee said in January 2019 that it was
“unable to find evidence of unavoidable costs faced in remote areas that are quantifiable and nationally consistent such that they could be factored into allocations”.
That is from the NHS England document “Note on CCG allocations 2019/20-2023/24”.
The Government say that they cannot work out how much extra to give unavoidably small hospitals, while at the same time a different NHS document says, “We are going to do some calculations, and here is the rough calculation.” Can the Government work out the additional costs or can they not? They are basically saying the same thing in two separate documents.
We are looking at chances to pilot new schemes. We did it with Test and Trace, and we are adopting telemedicine as fast as we can. We are working with the University of Southampton to pilot using drones to deliver cancer care. The drone testing started during covid and, as of a couple of months ago, it is now a regular service that brings just-in-time cancer medicine to the Isle of Wight. That is a really good way to see that advanced technology is helping folks on the Island and, indeed, helping the NHS to provide a better-quality service.
I will round up, as I am mindful that other people want to speak on this issue and it is important that the Minister hears other voices. In January 2019, the NHS long-term plan set out a 10-year strategy for the NHS in England. For smaller acute hospitals such as St Mary’s, the plan stated that the NHS will
“develop a standard model of delivery”.
It would be great to hear from the Minister what has happened to that plan for a standard model of delivery. Is that now the funding formula that is included in the new integrated care boards? If so, will the Minister please outline how that funding formula works and is calculated, as my hon. Friend the Member for Thirsk and Malton and I have asked? It is in the public interest that the formula is as transparent as possible.
Will the Minister please explain why, if someone travels from the Scilly Isles to the mainland for care, it is paid for out of a central budget? If someone has prostate cancer or another form of cancer, they often need to be treated in Portsmouth or, occasionally, Southampton. That funding does not come from the Government. Why is that? Why is there a double standard that affects the Isle of Wight negatively?
Finally, the Minister mentioned before the debate that the funding formula details are held by the new integrated care boards. For the 20 Members of Parliament in England and Wales who are within the remit of an unavoidably small hospital, those figures should not be held at ICB level but should be shared between Ministers and interested Members, so that we can all see how these very important institutions in our communities are funded. By doing so, I hope that we can increase the funding for them or at least increase the Government’s understanding that just because such hospitals are the smaller cousins of larger district general hospitals, they should not be treated worse but should be given extra care and attention to make sure that folks in our communities can have the same standard of care as other people throughout the rest of England and Wales.
My three boys—they are now young men, are married and have their own families—were all born at Ards Community Hospital, so I have a fondness for that hospital and for Adair House, as the maternity section was then. The hospital has changed—I understand why—and we now have a hospital that is not able to provide all the services that it once did. I want to put on record, as the hon. Member for Isle of Wight did in respect of his local hospital, my thanks to all the staff at Ards Community Hospital, the Ulster Hospital and elsewhere for their commendable and industrious work, their energy and passion, and their commitment to making lives better. That is something we can never fully understand, but we do understand that the part they play is so very important.
I understand the arguments about isolation, in terms of both where the hospital is situated and where my constituents live. To receive some services, my constituents are referred to the bigger hospital—the Ulster Hospital—where a significantly larger number of services are available, including a cancer centre. That is very important to us in Northern Ireland, where cancer impacts nearly one in every two people, just as it does in the rest of the UK.
For my most rural constituents, in villages such as Portaferry and Cloughey on the Ards peninsula—I live between Greyabbey and Kircubbin, but they live even further down the Ards peninsula—patients seeking medical care must have the reassurance that their nearest hospital can provide them with at least a basic assessment and service, despite the size of the population where they reside. That emphasises the importance of properly funding smaller hospitals such as Ards Community Hospital. Although I understand that our health services are devolved and therefore not the responsibility of the Minister present, the principle of health treatment is the same across the whole of the United Kingdom. Hopefully, I will be encouraged by what the Minister says and can send a copy of the debate to the Minister in the Northern Ireland Assembly to ensure that they take these matters on board.
I make a plea for the air ambulance, which I asked a question about in yesterday’s statement on urgent and emergency care. In Strangford, the air ambulance deals with life and death situations every day and is so very important for our rural community. Last year, Air Ambulance Northern Ireland had its busiest year ever.
In respect of per head services, we can never predict how serious any incident may be, but I believe that we underfund smaller and more remote hospitals because of that factor. In my constituency, we have to take into account both the fishing village of Portavogie, which is an economic and industrial centre, and the many remote places across the Ards peninsula from which it is just as critical to get to a hospital in time. There are also issues with the cost of medical services, based on the location of the hospital. That means that smaller and more isolated hospitals in certain areas face higher costs due to the decreased likelihood that a particular service may be utilised.
The community services formula, which was introduced in 2019 and to which the hon. Member for Isle of Wight referred, recognised that some rural and coastal areas tend, on average, to have an older population, which means there are higher needs for community services. In the Ards peninsula, the population of older people is growing. Many people come from other parts of the Province and move out to rural villages where houses are perhaps that wee bit cheaper so they can use the money they have to buy a house. They look on the area as a place where they will be for the rest of their lives, so the numbers of elderly people are increasing in my constituency.
The need for community services was assessed in England, and I encourage the Minister to engage with Health Minister Robin Swann back home on a similar strategy for Northern Ireland, to enable improved district healthcare for communities. I would be indebted to the Minister if she would take that forward. I will do my bit, but maybe the Minister might be able to do the same with the Minister in Northern Ireland. What I love about these debates is that we can all share things from all parts of this great United Kingdom of Great Britain and Northern Ireland, and we can use those things for the betterment of us all. Today’s debate does just that.
In the short time I have left, let me say briefly that in rural areas there tends to be less access to public transport in the evenings, which exacerbates the problems with the use of hospitals. Our own local hospital and other smaller hospitals may not even be open at certain times, and sometimes not until the early morning. It is crucial that that is taken into account in the funding of smaller hospitals.
To conclude, I echo the comments of the hon. Member for Isle of Wight, who introduced the debate, and very much look forward to the contributions of others. We must ensure that small hospitals are properly funded, for the sake of our constituents, friends, families and loved ones, and avoid the clear delays in funding opportunities. The NHS is a wonderful service. We depend on it and it must be protected. We must also give thanks and gratitude to all nurses and healthcare workers in our small hospitals who do their very best to work with what they have available and to ensure that our people—our constituents—are looked after in the healthy way that they deserve.
It is not just stroke care that has been centralised in other hospitals, but outpatient physiotherapy, dermatology and pain clinics. Breast cancer oncology was moved away from Scarborough some time ago owing to the difficulties of recruitment. It is easier to employ consultants in a hospital that has more money than to incentivise them to go to more remote locations. The A&E unit at the Friarage Hospital in Northallerton, in the patch of my right hon. Friend the Member for Richmond (Yorks)—he will talk more about it—was downgraded to urgent care treatment, and we were told that one of the reasons was that it was difficult to recruit anaesthetists.
Services are being closed down. The Lambert Hospital in Thirsk in my constituency, which provided respite and elderly care, was completely closed down because it could not recruit in that location. Our suspicion was that the trust did not really try all that hard to recruit people because it is more difficult to run services in remote locations.
On costs, I can give my hon. Friend the Member for Isle of Wight a direct comparison. When the York and Scarborough Teaching Hospitals NHS Foundation Trust took over Scarborough back in 2012, it was given £10 million a year for the extra costs of providing services in that location. That ended in 2018. A small amount has been provided to make up for the loss of £10 million—£2.6 million of funding through the clinical commissioning group—but, as a consequence, services are diminishing.
There is some good news: my right hon. Friend the Member for Scarborough and Whitby and I campaigned, and the Health Ministers were very supportive. There has been £40 million of extra investment in the A&E at Scarborough, but nevertheless there are some real concerns about the services, which are reduced as a consequence of underfunding. I would like to hear from the Minister exactly what we are doing about it now and what we will do in the future to improve the situation.
The point has been made that there is an additional cost for locums—the stand-ins and so on. That is absolutely true, and it hits us as much as it hits the Isle of Wight or Yorkshire. There is also an issue whereby the change of locum and personnel can be disadvantageous to the patient, because they have to go back through the same old story with a new person—the patient tends to repeat themself. In the highlands of Scotland, that issue is particularly acute on the mental health front. I have heard horror stories of people having to see a variety of different professionals and repeat themselves again and again before anything can be done. That is extremely worrying.
The solution is partly money. Like the hon. Member for Strangford, I urge the Minister, or Her Majesty’s Government—as they run the health service in England—to exchange best practice, as and when we have it, with the Scottish Government. We can learn from each other about how things can best be done.
I have outlined the mental health issue. There is a final point. The hon. Member for Isle of Wight made the point that there are double standards. It was recently proposed that the maternity service in Morayshire, which is based in Dr Gray’s Hospital in Elgin, in the constituency of the leader of the Scottish Conservatives, the hon. Member for Moray (Douglas Ross), should be downgraded. There was a huge outcry about that and the Scottish Government eventually said they would look again at the situation and see whether there is a solution whereby people do not have to travel from Morayshire to either Inverness—a distance of 38 miles from Elgin—or Aberdeen.
That sits ill with what I have just described in Caithness and Sutherland. The distance from Wick to Inverness is 103 miles, yet the Scottish Government have not agreed to look again at maternity services. However, there is a dialogue now—thank heavens. I pay tribute to Caithness Health Action Team—known as CHAP locally—and to one councillor in particular, Ron Gunn, and his colleagues, who have been absolutely instrumental in ensuring that this issue is never off the top of the agenda.
It is a fact that every citizen of the United Kingdom should deserve an equal right to health services, regardless of where they live. It is a fact that unavoidably small hospitals in England face the same problems as hospitals of the same size in Wales, Northern Ireland and Scotland. The bottom line is that health matters hugely to us all. I sincerely hope that the new members of the UK Government, both in the Cabinet and as junior Ministers, can look at the issue as a matter of absolute urgency. My telephone is always switched on. Ministers can call me, and I will again and again bang the drum on behalf of my constituents in Caithness and Sutherland, who deserve rather better than they are getting at the moment.
The facilities team at North Devon—owing to the size of the hospital and the problems with issues that have been spoken about, such as recruitment and retention, as well as the fact that the site is in need of work—is innovative and creative. We are fortunate to have linked up with Exeter, and in many ways that link has secured the site. It gave us the opportunity to establish virtual wards, which are now running, so consultants from Exeter and North Devon can share the patch among them. However, the age profile of the population, which has been mentioned, changes the nature of the hospital—for example, there is more demand for certain services, and less demand for others, such as maternity, which are used much less. Therefore, it is much harder to attract consultants in some of the specialisms.
My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) spoke about distance to be travelled, and in North Devon people make choices about their cancer treatment based on the distance they would have to travel. Most people have to travel 60 miles to Exeter Hospital, and if they have to travel daily or weekly for radiotherapy, a journey of 120 miles might be a choice they decide not to make. As we look to how to tackle the issue of health outcomes in remote rural communities, I hope we can ensure that patients have access to the best care, rather than the care nearest to them.
The rurality of North Devon is a driver in the struggle people have to come and work there: we had a recruitment issue in North Devon long before the pandemic, and one nursing post in five is now vacant. Not only is it hard to get to North Devon; it is hard to move and live there. My hon. Friend the Member for St Ives (Derek Thomas), who represents the Isles of Scilly, and I spend a lot of time talking about housing and the housing challenges in the south-west of England, and we find that it is almost impossible to buy a house in North Devon. The rental market has also collapsed, so it is near impossible for public sector workers and those who work in many other jobs, such as hospitality, to move there.
That situation is now overlaid by the situation in social care. My fantastic hospital has more beds full of patients who could go home than it would normally have at this time of year. That is not because the social care teams in North Devon are not also fantastic, but it is just very hard to recruit, and the costs of providing social care have escalated hugely with the increased costs of energy. For those fantastic teams who travel around and look after mostly elderly people in their homes, the cost of getting there has now shot up. There are also the issues around recruitment, and we are paying far more in that sector to attract and retain those great individuals who do such valuable work.