Healthcare: North Staffordshire
At the heart of every community is a hospital, and a hospital such as north Staffordshire’s Royal Stoke is one that has many potential problems. As a result of previous occurrences, the trust has grown in size, and at the end of 2017-18, the hospital was predicted to have a deficit of £119 million. We know that the NHS is one of the things we are proudest of in our country, but we also know that it is one of the things in our country where spending squeezes have been greatest.
It was announced earlier this year that £29 million would be saved in-year by the hospital as part of the cost improvement programme. This hospital has one of the highest entry rates at accident and emergency, and it is also one of the places at which people routinely present themselves out of frustration at not being able to get a doctor’s appointment locally. The figure of £29 million in-year savings was increased in March to a target of £50 million, and further savings were projected for 2018-19 and 2019-20 of £35 million each, taking the total savings of the hospital to well in excess of £120 million.
After serious work, the hospital is now suggesting that it will be able to end the year with a deficit of £68.9 million. However, the deficit is dependent on two other funding arrangements that have yet to materialise relating to the County Hospital in the constituency of the hon. Member for Stafford (Jeremy Lefroy), and I am grateful to him for being in the Chamber. NHS England has promised £14.9 million towards the transitional fund to help Royal Stoke with the demands placed on it by the County Hospital and to help the people of Stafford to maintain the hospital that they want and so richly deserve, and a further £9.9 million was promised from the Department of Health, but that money has not materialised. That bill of about £25 million is one the University Hospitals of North Midlands NHS Trust needs and would like to have in order to secure the provision of health services for north Staffordshire.
I congratulate the hon. Gentleman on securing this debate. I absolutely agree with him that the work Royal Stoke has done to bring stability to County Hospital, Stafford, has been of great benefit to my constituents and the people of the whole of my part of Staffordshire. It is therefore absolutely vital that the trust and Royal Stoke should not suffer from having undertaken this very important work.
The hon. Gentleman is absolutely right. The trust in north Staffordshire should not suffer, and nor should his constituents in Stafford, who quite rightly want to have the hospital they have with the services it is providing, including an A&E service that is vital to relieving pressure in Royal Stoke A&E at peak times.
As I have said, the cost improvement programme in-year saving was raised to £50 million in March. Having already found itself with a £25 million hole, because money had not materialised from NHS England and the Department of Health, the trust decided to up the cost improvement programme savings by a further £10 million. That means the hospital is required to find £60 million in this financial year, on top of all the savings that are being made through the capped expenditure programme.
The hospital is aware of things it can do to help to alleviate its problem. For instance, it is investing £2 million in creating 45 additional beds to alleviate waiting times in A&E by taking out excess space in corridors and smaller bathrooms to use for beds. We would all agree that we do not want them to be in such a position, but it taking that risk and making that investment to try to improve the health service in Stoke-on-Trent and in north Staffordshire.
I pay tribute to Paula Clark, the chief executive of the trust, who has worked tirelessly with the former chair of the trust, John MacDonald, to try to overcome the problems the hospital has faced, not least the reputational issues that came with some of the incorrect information circulated under the—
As I was saying, I pay tribute to Paula Clark, the chief executive of the trust, and the former chair of the trust, John MacDonald, for the work they have done to bring the trust together, for taking on County Hospital when it was in a precarious position and for providing stability not just to the hospital in my constituency, but to the wider north Staffordshire healthcare economy.
Nationally, England, Wales and Northern Ireland have failed to meet one of their key targets for 18 months. I think in particular of the cancer waiting list. Northern Ireland has a non-functioning Assembly due to Sinn Féin’s intransigence—that is our reason. What does the hon. Gentleman think is the reason in Staffordshire?
The hon. Gentleman asks the excellent question of what cause we attribute the situation to. I am hesitant to give an answer that points the finger of blame. One reason north Staffordshire and Staffordshire as a whole have failed to remedy the problem is that there has been a game of pass the buck in determining who is responsible for not achieving what. That means that nobody has taken responsibility. One issue in Staffordshire is industrial disease, which has caused us not to meet A&E waiting times because people who cannot get the secondary healthcare they want present to A&E with their problems. That means that we have missed both the four-hour and 12-hour A&E targets. Although we have met six of the seven targets on cancer waiting times, we are still short on one.
The hon. Gentleman’s question is pertinent because we have a hospital that already has a deficit and has been challenged to make £60 million of savings this year and a further £70 million in the next two years, and North Staffordshire and Stoke-on-Trent clinical commissioning groups have decided that the best way to help that hospital, when it is struggling to meet those targets, is to fine it an additional £10 million. I do not understand the logic of taking a fine of £10 million from an organisation that is already struggling to deliver the services with the cash that it has.
Does my hon. Friend agree that, in spite of all the efficiencies that are being made by the chief executive of our hospital, the reward is that the percentage cuts are deeper at Royal Stoke and University Hospitals of North Midlands than at any other hospital in the country? That is not a reward for the efforts that are being made to provide decent healthcare provision for our constituents.
I am usually pleased to see Stoke-on-Trent at the top of a leader board, but the one that my hon. Friend highlights is not one that we should be proud to top. She demonstrates the perverse and farcical nature of a funding system that targets those who have the least by penalising them further financially. That will simply compound the problem in the healthcare system in north Staffordshire, which will impact on the wider Staffordshire health economy and cause greater problems for her constituents, my constituents and the constituents of the hon. Member for Stafford.
To give credit where it is due, the Government have offered £530,000 of additional funding to help with the potential crisis this winter. Again, that shows the perverse nature of the funding situation. On the one hand, we are asked to make huge cuts in the tens of millions, yet the Government recognise that the winter will be challenging and offer half a million pounds back. It seems that money is circulated around the system, but those who need it most—the constituents we represent—are unable to get the support they need.
The problems with A&E in Stoke-on-Trent have been compounded by the loss of 168 community care beds at various community hospitals around north Staffordshire. The decision was made by the clinical commissioning group 18 or so months ago to move towards a “My Care, My Way—Home First” pathway, whereby people would be discharged from the hospital straight to their home, without the need for a step-down continuing care facility. We were told that that would revolutionise the way care was provided in north Staffordshire. However, we know that one of the things that is causing delays in our A&E and financial problems in our hospital is that the number of people who are declared medically fit for discharge but are unable to leave an acute bed because no care package is available in the community sector is growing. The hospital will tell us that. Stoke-on-Trent City Council is recruiting more care workers, but the package of care needed for those people is becoming more and more acute, and more and more difficult, meaning that private providers are simply turning away potential patients because they do not see them as profitable customers.
The community care bed scenario highlights what I think is a grave travesty in the way the health sector is now run. The Health and Social Care Act 2012 created clinical commissioning groups. In Staffordshire, we used to have three primary care trusts. They came to the conclusion that working as one cluster was the best way forward; that pooling their resources and working collectively for the greater good of the 1.1 million in our county and city was the way forward. The Health and Social Care Act then created six clinical commissioning groups, who have now decided that the best way forward is to have one accountable officer and to work together for the benefit of the 1.1 million residents who live in Stoke-on-Trent and Staffordshire. I ask the Minister how is it possible that we have gone from a system of three PCTs to one PCT and from six CCGs to one accountable officer for CCGs—with all the money spent on reforming those services—when clinicians, Members of Parliament, councillors and patient groups were telling the Minister and the Government that that was the best way forward?
We now have a situation where NHS England has decided that the original consultation on the closure of those beds was not up to standard and ordered it to be re-consulted on, meaning that 168 community care beds will sit mothballed this winter—not formally decommissioned, but mothballed—while a second consultation takes place on whether they should exist at all. At the same time, the Government recognise that there will be an acute pressure on A&E in Royal Stoke Hospital that requires a half a million pound investment.
Does my hon. Friend agree that one of the most ludicrous parts of the game that has gone on with our community health beds is that the nursing staff who provide the services have been made redundant in advance of the end date of the consultation? Even if the consultation finds that the beds are necessary, the staff have been redundant in advance of the decision. That is a ludicrous way to treat the workforce.
My hon. Friend is absolutely right. I could not agree more. As a former trade union official with Unison, I think the way the staff have been treated is simply unacceptable. It is also an additional cost burden. Staff have been made redundant at a cost to the clinical commissioning groups, who may find that the work they were doing is brought back into use if the consultation suggests the beds should exist. Again, I ask the Minister to provide some rationale as to why that is an effective use of public money in a healthcare system that we all agree is overspending and needs to find a way of closing its budget gap.
It is all too easy to point at Royal Stoke Hospital and say, “The hospital is the problem; fix the hospital and everything else will sort itself out”. That is partly true, but there are also issues around our capped expenditure programme. Over the next two years, Staffordshire is being asked to take £160 million out of its broader healthcare economy spending. An sustainable and transformation plan identified a deficit of almost half a billion pounds by 2022, yet the way to deal with that appears to be a disjointed approach to solving little problems in little areas without any reasonable thought about the way forward and how this can be redressed.
I go back to the community care beds. They provided a platform whereby people who were in an acute expensive setting could be discharged, at a point of being considered medically fit for discharge, to a provision that was designed to give them the care they needed before they transitioned to their home, a private care provider or a council-run care facility. That allowed them to make the change without the prospect of them re-presenting, at the expense of the acute system, because they had been discharged too quickly. Again, this is money circulating around a system that is identifiable as waste in many people’s considerations of what waste is, while at the same time it is being manufactured by the decisions of the CCG.
The CCG’s decision on community care beds was referred to the Minister under paragraph 29(6) of the 2013 regulation almost a year ago. Letters from myself and my hon. Friend the Member for Stoke-on-Trent North (Ruth Smeeth), which were countersigned by my hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly), Baroness Golding and the former Member for Stoke-on-Trent South, Mr Flello, have gone unanswered. I have raised the issue here as a point of order and at business questions, and I have asked the Secretary of State directly when we will get that response, but to date we still have had none. That is almost a year of referrals from the two tier 1 authorities and of unanswered parliamentary requests. It is creating an unacceptable level of uncertainty in the economics of the health service in Staffordshire.
I recognise that there are significant financial challenges, particularly around the hospital, but North Staffordshire Combined Healthcare NHS Trust, for example, has made significant improvements in the wider health economy. Does the hon. Gentleman agree that the main financial challenges are with the hospital and that, if we can address those, we can help the wider health economy?
The hon. Gentleman, like me, wants the best for the constituents of Stoke-on-Trent, but it is far too easy simply to blame the hospital for our wider concerns about the health economy in Stoke-on-Trent and north Staffordshire. He is right about the combined trust making great headway—for example, in dealing with mental health—but he, like me, will still have people coming to his surgery to complain that they have to wait four, five or six months for a referral to the child and mental health adolescent support team; that they ring the access and crisis number and it rings out; or that they have been unable to find a bed with a mental healthcare provider. In Staffordshire, the latter is virtually impossible; in the west midlands, possibly slightly easier. Either way, this is a national issue that is not being addressed and which is not of the making of the hospital in Stoke-on-Trent.
To take the hon. Gentleman’s point slightly further, the CCG in north Staffordshire currently has a programme of slashing and burning all those support services and peripheral services that keep people from having to go to hospital in the first place. There is now no support for drug and alcohol services as a result of decisions by county councils, city councils and the CCG. Previously, these people were not presenting with acute problems in hospitals, but they now have no recourse to support and will end up presenting in A&E, in expensive treatment centres, getting the wrong sort of help for their conditions.
Independent support services in north Staffordshire for people presenting in hospital for domestic violence are also being looked at and could be lost. The north Staffordshire users group, which recently changed its name to Voice, has had all its funding withdrawn by the CCG, meaning that people with mental health conditions can no longer advocate or receive support to advocate for the help and support they need. Again, that will compound the situation in our acute setting, but small, lower cost interventions from the community or the third sector could have prevented such people presenting.
Furthermore—I know this is not unique to north Staffordshire—the social care system in Staffordshire is a problem, not least because getting people out of hospital into social care is a problem. The Royal Stoke, Stoke-on-Trent City Council and Staffordshire County Council routinely have unacceptable wait times in hospital, and more and more people are having temporary arrangements put in place and having their care packages changed while they are being delivered, which we all accept is not good for patients, for providers or for our overall health economy, because every change will cost money.
I know that the Minister has received numerous substantive briefings from healthcare providers across north Staffordshire—I know that mainly because they have told me and partly because I would not tell them what I was going to say today so they had to cover a multitude of areas. To save the Minister having to regurgitate facts already shared with MPs, I have prepared what I hope are simple questions which, if he can answer them, will provide us with an opportunity to move the debate forward. Everybody, irrespective of party politics, wants to move forward. We want a hospital that has the funding it needs; community care provision that meets the needs of people in our communities; a mental health system that not only responds to people when they hit crisis point, but actively works with them to ensure they do not get to crisis point in the first place; and a social care system that allows people who need care at home to receive it.
Will the Minister commit himself to providing a full response to the community care bed referrals from Staffordshire County Council and Stoke-on-Trent City Council, and respond to the letters from the Members whom I mentioned earlier? Will he do that as a matter of courtesy, if nothing else, even if his response is “We are rejecting the referrals”? At present those beds are mothballed, and the consultation is being rerun. The Minister has an opportunity to ensure that 168 community care beds are returned to our health economy this winter, which would significantly reduce pressures on A&E departments.
I ask the Minister to use whatever powers he has to intervene between the University Hospital of North Midlands Trust and the clinical commissioning groups to ensure that the £10 million of fines are waived, because they constitute the difference between our hospital’s getting through the next 12 months and its crawling through the next 12 months on its knees. It does not make financial sense to penalise a hospital further for not meeting targets that it has struggled to meet because of its funding crisis. That is perverse economics by anyone’s standards.
I should be grateful if the Minister would guarantee that the £9.9 million from the Department of Health and the £14.9 million from NHS England which were promised to Royal Stoke University Hospital so that it could cope with taking on the responsibilities and, dare I say, the burdens of the county hospital for a short time as part of the trust special administrator model will be handed over to Staffordshire as a matter of urgency. That money is already budgeted for in Royal Stoke’s plans, and is part of the amount that would enable it to reduce its deficit from £119 million to £69 million. Without it, we shall face a winter of absolute crisis.
Would the Minister consider convening a meeting to reassess the 2018-19 and 2019-20 cost improvement programme figures of £35 million each? Asking the hospital to take a further £70 million out of its operating budgets over the next two years is akin to asking someone with no money to pay a huge fine. It will just rack up more debt, and will end up being fined for not meeting its financial targets and fined further for not meeting its medical targets. This is a vicious and horrible circle, and I hope that, if the Minister cannot do so himself, the Secretary of State will use his powers to halt it so that we can have a little breathing space in which to try to solve the problems in our hospital.
Will the Minister intervene to ensure that the £19.5 million that is owed to Staffordshire County Council for the better care fund to help relieve the pressure on local authorities that are trying to deliver social care can be handed over? NHS England should have handed over that money, but it has not done so, and the delay has caused the better care fund to have a deficit. If the money is released, the discharge assessment programme that was meant to alleviate some of the hospital’s problems with discharging may be able to continue, but without it we shall be storing up problems for the future.
My next request involves a personal interest. As I am sure the Minister will know from his briefings, Staffordshire was a pilot area for a cancer care contract undertaken by Marcus Warnes of the CCG. The CCG hoped to procure a provider to deliver cancer care services, and £890,000 of public money was spent to that end—including staff time, the total came to nearly £3 million—only for the contract never to be let, and the process to be aborted. I appreciate that we cannot go back in time and rewrite the process, but what we can do is learn the lessons from Staffordshire to ensure that no other CCGs go through such an appalling and bungled procedure that wastes taxpayers’ money. I should be grateful if the Minister would consider convening a meeting that would enable us to learn the lessons and share them with other CCGs so that we, and they, do not make the same mistakes in the future.
Let me end on a convivial note. Nearly 18 months ago my predecessor, Mr Tristram Hunt, invited the Secretary of State to visit the hospital. During the by-election that I fought in February, the Secretary of State came to Stoke-on-Trent, but did not go to the hospital. On my own behalf and that of my hon. Friend and neighbour the Member for Stoke-on-Trent North (Ruth Smeeth), I invite the Minister, or one of his colleagues, to come to Stoke-on-Trent, not so that we can have a stand-up row about the future of our hospital, but so that we can actually start the process of healing it. No one in Staffordshire wants to see our hospital fail, but we are currently walking down that road blindfolded.
All I ask is for the Minister to address the seven simple questions that I have put to him, and if he were to take up the offer to visit us, he would be most welcome.
I congratulate the hon. Member for Stoke-on-Trent Central (Gareth Snell) on securing this debate, and on securing the support of neighbours and colleagues from both sides of the House, who clearly share his interest in ensuring that we have high-quality healthcare for the residents of north Staffordshire.
The hon. Gentleman gave a wide-ranging account of several of the challenges facing healthcare provision in Staffordshire, and I shall frame my remarks in the context of the NHS plan for resolving them. The hon. Gentleman did not mention it, but he will be aware that Staffordshire and Stoke-on-Trent’s sustainability and transformation partnership is the vehicle through which all these issues are being brought together, to try to provide a sustainable, financially viable future of high-quality healthcare for the residents of Staffordshire. It is a complex area, and the rating given to the STP by the NHS earlier this summer reflects an understanding of the challenges being faced across Staffordshire, because it was rated in the lowest category. A number of steps are being taken to try to help leaders in Staffordshire come to grips with the challenges that they face.
The area contains two local authorities, six clinical commissioning groups—as the hon. Gentleman mentioned—and five NHS trusts. Together, they provide services to more than 1.1 million people in Staffordshire. The hospital the hon. Gentleman invited me to visit, and on which he began his remarks, the Royal Stoke, also serves patients from Shropshire, including in my constituency, as it is one of the leading trauma centres for the area. I have yet to visit that hospital, and I would be delighted at some appropriate point to take up his invitation; so at the outset I can give him that reassurance in answer to one of his questions.
We in the Department, and the Secretary of State in particular, are acutely aware that some of the pattern of provision in Staffordshire is coloured by the tragic events of Mid Staffs, and the importance of eradicating the poor care that the people in Staffordshire experienced because of the problems in that hospital at that time. Much has already been done to address the challenges that arose earlier in this decade, and I pay tribute to the NHS staff across Staffordshire, who have been working tirelessly to improve the way care is delivered. Just one year after the Mid Staffs inquiry, we saw a real shift in priorities, with new inspection regimes, additional nurses and a stronger voice for patients, leading to tangible improvements in the way care is delivered, but it is right for me to acknowledge, as the hon. Gentleman has in this debate, that the NHS in Staffordshire remains under significant pressure. The acute hospitals have been, and still are, struggling to meet quality standards and demand.
The STP has publicly stated that if the way services are delivered is not transformed, the majority of organisations across Staffordshire and Stoke-on-Trent will be in deficit by 2020, and many of them already are. Clearly, Staffordshire has long-standing local issues that need addressing. None of the organisations in the area can do that by themselves. Instead, they need to work together to deliver wide-ranging transformation. The STP is the vehicle to do this. It brings together the local population, NHS organisations and local authority bodies to propose how, at a local level, they can improve the way that their local health and care is planned and delivered. The plan published in December last year set out the scale of the area’s ambition, identifying five particular areas that, if implemented, will help to achieve that.
The first area was a focus on shifting from reactive care to prevention. That means increasing the proportion of care delivered in the community, rather than in hospitals. Some £24 million has already been invested in community services by two CCGs in the STP area, including the CCG covering the hon. Gentleman’s constituency, through changing the way local services are delivered. Further investments are being made to increase the capacity of primary and community care, which will, in turn, significantly reduce the pressures on A&E.
I want to push the point about community care if I may. The 168 community care beds are not only in my constituency; they are in Bradwell in Newcastle, and in Leek in the Culture Secretary’s constituency. Will the Minister answer the point about referrals specifically?
I specifically will; I will come to that point very shortly.
It is important that we get the right balance between primary, community and secondary care. NHS leaders believe that they can significantly reduce the 30% of patients who are currently being treated in Staffordshire in the wrong setting. Clearly, patients sometimes have to go to our acute settings. We have recognised that the Royal Stoke, having reviewed its emergency department, is under-bedded. There is currently a plan for 46 beds to be added over the winter to help to relieve the pressure on the acute services. I will come to the question of the community beds in a second.
I want to raise the point about acute beds as well, because it is a significant issue. It particularly relates to the design of the hospital, which does not have enough acute beds. Does the Minister agree, however, that some of these issues predate this Government?
I am sure that my hon. Friend is right, but I am not going to get into a dispute about that just at the moment. I would like to deal with the question of community beds that the hon. Member for Stoke-on-Trent Central raised. He has referred to the request by two local authorities concerning the community bed closures, seeking a referral to the independent reconfiguration panel. He suggested that there had been no response to that request, unless I have misunderstood him. I think that the hon. Member for Stoke-on-Trent North, who is sitting next to him, received a letter in February. The local authority received a letter to confirm that the referral request had been received, and the referral has been transmitted to the independent reconfiguration panel. We are currently awaiting the results of that referral and the panel’s report and recommendations. The hon. Gentleman will therefore understand that it would be inappropriate for me to pre-empt the panel’s conclusions by commenting on this specific case.
I want to touch on the financial challenges that the hon. Gentleman has referred to. I recognise some of the figures that he has referenced and questioned. We believe that Staffordshire needs to get into a financially sustainable position. At the moment, some areas of Staffordshire receive significantly more funding per capita than the rest of the county and than England as a whole. The Stoke-on-Trent CCG receives an allocation that is some 9% greater than the average for England per capita, reflecting the needs and challenges of that community. The NHS recognises that parts of Staffordshire are more challenged and need more money, but equally, the hon. Gentleman needs to recognise that each area of England needs to live within the budget that it has been set.
One of the challenges that Staffordshire has at present is that, for historical reasons that have not been addressed over the years—going back to the point made by my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton)—the pattern of provision and the models of care have not developed in the way that they have in some other areas. This has meant that the cost of providing care—in some cases, in settings that are no longer as relevant as they could be—is resulting in Staffordshire running unsustainable deficits. It is unfair that other parts of the UK should provide even more funding into Staffordshire, resulting in their not having sufficient funding to look after their own populations.
The hon. Member for Stoke-on-Trent Central referred in particular to the better care fund. I understand that concerns are shared across the House about the funding that was pledged in the Budget. It was made clear to local authorities that as a condition of that funding they would need to make progress in reducing the delayed transfers of care. North Staffordshire has made huge strides in doing that and it currently has roughly zero delayed transfers of care, which is one of the best performances in the country. We need to see that improvement across the county as a whole. I know that there was a meeting last week to discuss that, and we will see how that progresses in the future.
Question put and agreed to.
Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)
Motion lapsed (Standing Order No. 9(3)).
Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)