We now move to the short debate. Can I ask Members to leave the Chamber quietly, please? Can I ask Members, please, not to conduct conversations in the Chamber?

We now move to the short debate and I call on Caroline Jones to speak on the topic that she has chosen.

Diolch, Dirprwy Lywydd. I'd like to give Suzy Davies and Dai Lloyd a minute of my time to speak in this debate. My debate is on the role of community hospitals in the twenty-first century.

On Thursday 5 July this year, the NHS will be 70 years old. Those 70 years have seen tremendous advances in care: the eradication of smallpox and polio, the world’s first liver, heart and lung transplants were performed, and diseases such as coronary heart disease, stroke and cancer are no longer a death sentence. As a result, we are all living much longer. In 1947 the average life expectancy was 64. Today, that has risen to around 82, and those born today are expected to live well into their 90s and beyond. King William will be sending rather more telegrams than his grandmother. In 20 years, there will be around 45 per cent more over-65s. However, old age rarely comes alone, and over the next decade, around a quarter of us will have a limiting long-term condition.

The NHS have cut bed numbers by a staggering 45 per cent. In 1990 there were nearly 20,000 beds in the Welsh NHS. Today, there are just over 10,000. Community hospitals across the country have shut, wards have been closed or merged, and plans have been unveiled for further closures. We have also seen a lack of investment and planning in the social care sector, which has accelerated under austerity, and in the last five years, per capita spending for social care has fallen by over 13 per cent. This has a knock-on effect on our hospitals, and in the last 10 years, there have only been slight improvements to delayed transfers of care, which month to month hover around 400 to 500.

Each month we have hundreds of patients who are unable to leave hospital, simply because there is no social care available. In December, we had 238 people who had been waiting for more than three weeks to leave hospital, and of those, 51 had been waiting between 13 and 26 weeks, and 25 people had been waiting for more than 26 weeks—25 people spending half a year longer in hospital than they need to, simply because there is no step-down care available. Hundreds of people are spending weeks in a hospital bed they don’t need to be in. Not only does this impair recovery, it also reduces our already limited bed numbers.

A hospital stay is estimated to cost an average of £400 per day, so the cost of these unnecessary stays is costing our NHS millions of pounds in care. This will place our health and social care services under a tremendous strain. Services are already at breaking point, and despite months of planning, millions of pounds of investment and assurances that the chaos of previous winters was a thing of the past, our NHS struggled to cope this winter. It was so bad that emergency consultants took the unprecedented step of writing to the First Minister to warn that they could no longer guarantee patient safety. Our top accident and emergency consultants told the First Minister that a lack of beds was hampering their ability to treat patients in a safe and timely manner. And despite all the innovations in NHS care over the last 70 years, one thing that hasn’t improved is the ability of those at the top to forward plan. Over the last three decades, our population has grown by over 10 per cent, yet those in charge of the NHS have cut the beds by a staggering 45 per cent.

In the past, we had the perfect solution for those patients who didn’t need acute care but were unable to go home for whatever reason. It was the community hospital, or cottage hospital, as we used to refer to them. The community hospital offered step-down care to those patients who no longer needed the same level of care provided at the district or general hospital. Unfortunately, many of these hospitals have closed, not because they didn’t provide excellent care or that we no longer needed to provide step-down care—many of our community hospitals closed because of poor planning, particularly workforce planning. Successive Governments have failed to recruit sufficient clinical staff for those hospitals. As a result, many of our community hospitals have been forced to close because a lack of staff has left the services unsafe and unsustainable. Short-term cost-saving decisions have led to a number of other closures.

Within my region, South Wales West, years before the closure of Fairwood Hospital, nurses warned that NHS managers were deliberately running down the service in order to justify its closure, because the health board needed to save money. Managers got their wish and Fairwood, indeed, did close. This has left a black hole in step-down care. Social services have been unable to pick up the slack in the system. I have dealt with a number of cases where constituents have left hospital without any care plan in place. The most recent case involved an elderly gentleman in his 80s who was sent home days after receiving bypass surgery. There was no step-down care, and without the help of friends and neighbours, the poor gentleman would have been unable to feed or, indeed, dress himself. This is totally unacceptable, and we shouldn’t expect care to be dependent upon the generosity of neighbours and friends.

It’s clear that we can't depend on local authority social services, who are facing unsustainable cuts to their budgets, and it's no wonder that we are seeing reports of patients spending years in hospital. Social services are also at breaking point and are unable to cope with the demand.

We had the answer in the past—the community hospital. My constituent would have been transferred to Fairwood for nurse-led care to give him the time to recuperate and be able to fend for himself. Unfortunately, bad planning and poor decisions led to Fairwood’s closure. So, today, the only choice is to keep him on an acute ward or turf him out to fend for himself.

This is not the NHS Aneurin Bevan envisioned nearly 70 years ago. We have made so many advances, but proper planning of care hasn’t been one of them. We have to stop taking short-term decisions based on financial pressures, and deliver an NHS with a complete care pathway—a pathway that involves step-down care at a community hospital.

The Cabinet Secretary is working on a long-term plan for health and social care, and I hope that he doesn’t make the same mistakes as his predecessors. We have to stop closing community hospitals and hope that local authorities will provide the step-down care. We know that this is not happening. Community hospitals are not an anachronism of nineteenth and twentieth-century care. They have a key role to play in our twenty-first century NHS.

I urge the Cabinet Secretary to stop local health boards from closing any further community hospitals and plan for the reopening of hospitals like Fairwood that were wrongly closed. Events of the past few months have shown us how wrong the decisions to cut beds were, and it’s time we reversed those decisions if we are to have any hope of celebrating the NHS’s one hundredth birthday. Diolch yn fawr. Thank you.

Thank you, Caroline, for bringing the short debate to the Chamber today. I think you could argue that the health service has been characterised in this way—that hospitals are very difficult to get into, and then it's very difficult to get out of them again. One of the reasons we lost our community beds was because of the risk of institutionalisation, and I think all of us, as Caroline has mentioned, really, are seeing more and more cases where individuals are getting institutionalised in the acute expensive beds in district general hospitals rather than in the local beds.

Having said that, the parliamentary review gives us some scope for hope here. My main concern with that remains that social care—or let's just call it 'care' because, actually, you're confusing that with medical care—I think it's sometimes our difficulty—and concentrate a little bit more on where care can be carried out more locally, which I know is the principle behind the review, and in the meantime not necessarily look to spare spaces in care homes as the step-down provision, as we're seeing a lot at the moment. Because, as you know, some individuals who go to the care home for step-down care never leave. Thank you.

This, really, is to celebrate the phenomenal success of the NHS, actually. Let's set all this in context: back in 1950, King George VI, I think it was then, signed 250 birthday cards for people who were 100 years old—there were 250 centurions throughout the whole of the United Kingdom then. Fast-forward 40 years to 1990, Queen Elizabeth II had to sign 2,500 birthday cards for centurions in 1990. Fast-forward to two years ago, she had to sign 13,700, and last year, another 14,500 birthday cards for centurions. So, if nothing else, the phenomenal success has implications for the work-life balance of the monarch.

Obviously, that means that there are an awful lot of people in our towns and villages walking around who are older and more frail than they used to be, and that's why we need more beds in our communities. It can be in a care home, and, yes, community hospitals. Yes, we've been there with Fairwood, Hill House Hospital, and Cwmdonkin hospital in Swansea—yes, I am that old. [Laughter.] But there is a category of people now, because we are all living longer, who are just too ill to be left in their homes, even with the most surprising amount of domiciliary care packages, but they're also not ill enough to justify being on an acute medical and surgical emergency ward bed. We need that creative thinking involving community beds. Diolch yn fawr.

Thank you. I now call the Cabinet Secretary for Health and Social Services to reply to the debate. Vaughan Gething.

Thank you, Deputy Presiding Officer. As you know, the Welsh Government's aim is for people to have access to the right care, at the right time, and in the right place, and for that to be as close to home as possible. Our planning guidance to health boards each year reinforces this. To deliver on that aim, we need to challenge and break down the traditional medical model of health, with its focus on illness and hospitals. We need to do even more to construct and deliver a social model of health and well-being, with its focus on an integrated response from public services, and the third and community sector working collaboratively within our communities.

The needs of the population of the twenty-first century are changing, usefully highlighted by Dai Lloyd's reminder of the increasing number of centenarians—I think that's the phrase—from the accession of the current monarch to now. And we expect that to continue in the future. We expect more and more of us to live longer. And I think most of us, maybe not all of us, would like to live to a ripe old age, and perhaps live to an old age where we have dignity and be able to make choices—and we know that old age doesn't come alone.

But I do recognise that the issue of community hospitals is sensitive. Local communities can often be very attached to their community hospitals. You see either defence committees or league of friends committees that raise funds, that are very attached and proud of the care that is provided. And trying to change any service in a local hospital can be seen as an attack on that community, as opposed to a genuine attempt to reform, change and improve health and care services. All plans for service change need to meet needs now and in the future, and they must be grounded in evidence, informed, and shaped by effective involvement from the people who deliver those services and, of course, the wider public. And I expect health boards and their partners to have genuinely robust arrangements to involve everyone in the conversation where there is a case for change and options for providing the best solution that will meet the needs of the population, in the today, but also in the future.

And of course, all health boards have established primary care clusters. We had a debate in this place about the role of primary care clusters, again mentioned positively by the parliamentary review's final report. And there are collaborative arrangements that are beginning to mature, and part of the challenge in the cluster report was about how we do more with them, not do less, about how we try and enhance and accelerate that maturity and the way in which they can plan and deliver a range of local health and care services.

I do expect them increasingly to drive the planning and delivery of the right care at the right time, and in the right place, as close to home as possible. And these are groups of people who understand the communities they're in. We are trying to make sure we align some of the planning processes to make sure that we're not planning on the one hand here in primary care, in those local clusters, and then having something different come with the integrated medium-term plans from health boards. And I do want to see all of those partners be creative in how they make effective use of community services, and for this to develop the concept of hubs to integrate a clinical and a social response to the needs of the community that they serve.

The case for change that the parliamentary review recognised, indeed, is that some of that is in how people take responsibility for their own health and well-being, and the way they use and access care and support. We can't duck this as a challenge. I remember when I first became an Assembly Member, we had a report from the Bevan Foundation, and one of its key principles was about people taking more responsibility for their own health and care, their own sense of well-being, things they could and should do for themselves. Then, actually I think it was within the last year or two, NHS England produced a report that said something very similar to that. It was headline news on network channels, as opposed to a conversation we'd already had in this place several years previous. The challenge always is not just about saying the right thing, but how we help people to make those choices.

But preaching on the right thing to do often doesn't reach the people we want it to. So, we have to get alongside communities and individuals and help them to make their own choices. There's a role of leadership for people like me, of course, and for everyone else in the Chamber, including those who've departed, health and care professionals, but actually people within their communities, peers, and the way in which children are educated now, that should make a real difference in developing attitudes. That case for change, again, as I said, was articulated in the parliamentary review's outcome.

We then come back to community hospitals, and when people complain about the closure of community hospitals they almost always say that loved facilities that have provided a good service were removed. The accusation always is that nefarious NHS managers deliberately ran down the service, and it was all about cost. Money is always a factor in any service that we deliver. Ultimately we give services a finite amount of money to deliver a service, and particularly so—remember, we're in the eighth year of austerity here, and that has a very real impact on the services that we can deliver. But the case for change isn't really just about saying, 'We have to close services because of money.' The case for change is about: can we deliver a better service with a better experience and better outcomes for people? A number of the community hospitals have closed in recent years because they're no longer capable of providing the levels of care that each of us should expect and demand for our communities. I think that's what the challenge always is, if you are in a position like mine, otherwise you're saying to one local community, 'If you're really attached to that care then that's okay, that's good enough for you, but it wouldn't be acceptable for my constituency.' There's a challenge about getting around and through and understanding that debate, which in itself is not an easy one to have.

So, some did close due to safety concerns about staffing levels and the inability to recruit to older models of care, and that's a challenge in the mainstream hospital sector, actually, as well—about having models of care that will attract the right staff with the right experience to run and deliver effective care. And others were just about the physical state of buildings. If they're no longer able to comply with fire regulations, you shouldn't say to people, 'If you put up a big enough fight, then actually your health and safety doesn't matter anymore.' So, there are very practical reasons to want to do that as well.

But in redesigning services for this century, there has to be a combination of more nearby modern community facilities and enhanced care at home or in the community. So, the term 'community hospital' may no longer be appropriate. It usually brings up the image of a local hospital with beds, doctors and nurses, and we actually think that, in many cases, that isn't what the future's going to look like in every single instance. We'll look at that more dispersed view on community care. We'll still see smaller hospitals with doctors and nurses in them, and I'll go on to talk about some of those shortly, but I think we need to have our focus on creating the sort of integrated health and care service, the seamless care system, that the parliamentary review suggested should be our future vision.

If you think about those services, some of them will be physical, some of them will be virtual. Yesterday we had a debate about digital technology. We heard quite a lot about digitalisation and what that will do in sharing records, but also the ability to communicate remotely, and to deliver a service remotely, where someone either doesn't need to leave their own home or potentially goes to a local centre and not have to travel further, with the inconvenience that often produces for people, but to go to a very local facility to have access to different sorts of care. That will have an impact on people—not just our ability to stay healthy, but their physical and mental health, too.

An excellent example of the sort of thing I'm talking about is the Ystradgynlais Community Hospital, which has been reinvented, describing itself as a 'community hub'. It has in-patient care for older people's mental health, day care, therapy, including for dietary, occupational therapists and physiotherapist care. It also has x-ray and ultrasound services, minor injuries and a minor ailment service. There are also social care staff and third sector providers on site. That is not what you would think was a traditional community hospital, and that's the model I think we should be investing in in the future.

Another example is the Flint integrated health and social care centre due to open in the coming weeks—a matter of some controversy within Flint, about the plans for it to happen. And yet the centre is adjacent to a care home and it will provide accommodation for services transferred out of secondary care, with consulting and treatment rooms being supported by telemedicine. In addition there will be community, third sector, social care services and mental health care and support on site as well. So, we're able to do more in remodelling our service, and that's why we're going to direct our capital resources in that way in local healthcare.

I recently announced, in October, that I've earmarked £68 million for an initial pipeline of facilities for integrated health and care services right across the country—19 different projects in the north, south, east and west to try and do exactly what I've been describing and talking about. I think that's where the future is, because the advances in clinical and social care practice, together with advances in technology, should allow us to change the way, positively, that we plan and deliver more and better integrated care to support people in their own homes and communities. That's what we'll continue to do in working alongside our partners in health, social care and beyond to do just that.

Thank you very much, and that brings today's proceedings to a close. Thank you.

The meeting ended at 17:55.