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Maidstone and Tunbridge Wells NHS Trust

Volume 465: debated on Tuesday 23 October 2007

I am glad to have the opportunity to follow the oral statement made by the Secretary of State for Health last week. Indeed, he was forced to make it, following the urgent question by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), whom I am glad to see in his place.

Like other Members of Parliament representing the area covered by the Maidstone and Tunbridge Wells NHS Trust, I have received a number of letters from constituents whose relatives and nearest and dearest have been afflicted by hospital infections. As appalling and grim as these letters were to read—obviously, I took appropriate action on them—they did not prepare me and, I suspect, many others for the magnitude and severity of the criticism that came from the Healthcare Commission.

This is a scandal in which some 90 people have died directly, or most probably, because of Clostridium difficile. It is also a scandal because the treatment of individual patients in some cases can only be described as absolutely abominable. I should like to take this opportunity to put on the record this quote from the Healthcare Commission’s report:

“They told us that when patients rang the call bell because they were in pain or needed to go to the toilet, it was not always answered, or not in time. A particularly distressing practice reported to us was of nurses telling patients on some occasions to “go in the bed,” presumably because this was less time-consuming than helping a patient to the bathroom. Some patients were left, sometimes for hours, in wet or soiled sheets, putting them at increased risk of pressure sores. Families claimed that tablets or nutritional supplements were not given on time, if at all, or doses of medication were missed. Wards, bathrooms and commodes were not clean and patients had to share equipment such as zimmer frames which were not cleaned between use.

I cannot think of a more disgraceful account of a part of the NHS than what has come out in this report revealing grossly inadequate management. I shall give just one example:

“Policies for the control of infection were on the trust’s intranet, but they were nearly all out of date and not all staff could gain access to the intranet.”

And there are some pretty strong criticisms of doctors:

“Areas of concern included infrequent reviews of patients by doctors, the lack of systematic monitoring of whether the patients were recovering from C. difficile, and the failure, in many cases, to change antibiotic treatment for C. difficile when a patient had failed to respond to the initially prescribed therapy.”

Now, of course, we have a Kent police investigation into possible criminal offences.

Against this outrageous, appalling background, there have been just two resignations: the immediate, totally warranted, resignation of the chief executive and the further resignation—somewhat belatedly and reluctantly, I felt—of the chairman of the board of the trust. I must put it to the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), and to the Secretary of State: is it right that, following such an appalling scandal, there should have been only two resignations from this trust?

That brings me to the Government’s policy on severance payments for those who have fallen down on their job in the NHS. In my view, the former chief executive of the Maidstone and Tunbridge Wells NHS Trust should not be receiving one single penny in severance payments. Yet here we have the ludicrous position of the trust board having taken legal advice—I have a copy of the strictly private and confidential letter sent by the former chairman to the Secretary of State for Health confirming that—on the basis of which it is on one hand offering a very substantial sum to the outgoing chief executive while, on the other hand, the Secretary of State is desperately seeking to intervene to prevent the payment being made, which is wholly unacceptable.

I put it to the Minister that, surely, it is high time that the Government issued clear guidance to boards of NHS trusts about some of the basic terms of contract that they should be offering to the top management. A key element of those basic terms of contract should say, “If you succeed, you do well—you get recompensed financially, accordingly—but if you fall down on the job, do not expect to be bailed out with a significant sum at the taxpayer’s expense. Failure means no financial pay-out.” That should be the key watchword for the Government. I do not understand why such a policy has not been conveyed throughout the NHS.

So where do we go from here? We need to start right at the top of the Maidstone and Tunbridge Wells NHS Trust. We have in place a new chief executive. Obviously, I wish him well in respect of an immense challenge facing him. I hope that he will hit it off distinctly better with the staff of the trust and, indeed, with patients than his predecessor did and I hope that he achieves infinitely greater success. However, I have to say that the chief executive’s first public utterances in his new role were not wholly comforting. They were as follows:

“My name is Glenn Douglas and I was appointed as acting Chief Executive on Monday. My normal job is as Chief Executive of Ashford and St. Peter’s Hospitals NHS Trust in Surrey.”

So here we have an acting part-time chief executive put into the Maidstone and Tunbridge Wells NHS Trust, which has suffered an appalling calamity for patients and now needs to be put on the road to recovery.

What is the position on the board? Two of my constituents who are consultants in the trust rang me yesterday. I asked them the same question: “Who is now the chairman of the board?” They gave me the same answer, saying: “We have no information as to who is now the chairman of the board.” One of those consultants added, “The trust is rudderless.” The Secretary of State must get in and grip this situation. We cannot have this trust left with a part-time chief executive and no chairman in its present plight. Will the Secretary of State look urgently, today, at the need for a full-time, razor-sharp chief executive and a truly effective chairman?

I now turn to the relationship between beds and infection control. I thought that what used to be called—and apparently still is called—hot-bedding went out with the Factory Acts in Victorian times. Well, I was wrong. Hot-bedding is still alive and well, although that is not a very appropriate term to use in reference to the Maidstone and Tunbridge Wells NHS Trust. It is still very much in use.

I noted the interesting comments in The Sunday Telegraph last Sunday about the relationship between hot-bedding and infection. The article said:

“Experts say that ‘hot-bedding’, with beds filled again soon after they have been vacated, does not leave enough time to clean them properly, while a lack of spare beds makes it hard to isolate infected patients.”

It went on to refer to an important report that is being produced by Professor Barry McCormick, the Department of Health’s chief economist. That report apparently shows that

“when a hospital’s bed occupancy rate passes 90 per cent., the risk of MRSA rises by 42 per cent.”

The article goes on:

“Prof McCormick’s final report is also expected to show that C. difficile spreads most quickly when hospitals are crowded.”

Rather worryingly, the article went on to report that the Government do not seem to be keen that the report should see the light of day.

However, 90 per cent. is the danger threshold. What do we have in the Healthcare Commission’s report on the Maidstone and Tunbridge Wells NHS Trust? It states:

“The trust’s bed occupancy rates were consistently over 90 per cent. in the medical wards at both Maidstone Hospital and Kent and Sussex Hospital”

with all the consequent dangers of infection. The particular scandal in our area—I have to put it that strongly—that I want to draw to the Minister’s attention is that on the one hand the acute trust, the Maidstone and Tunbridge Wells NHS Trust, is hot-bedding, while on the other hand, in the same area, the West Kent primary care trust had half the beds in its four community hospitals shut down in the whole of last year, which was one of the most absurd and short-sighted false economies in the NHS that could possibly be made.

Happily, West Kent PCT has finally woken up to the idiocy of shutting down the beds in its community hospitals. It is at least reopening the beds in three out of the four. The one where the beds are not being reopened at the moment is Tonbridge Cottage hospital in my constituency. Half the beds remain shut. I have received no respectable medical justification for keeping those beds in Tonbridge Cottage hospital shut. I wish through the Minister to urge the Secretary of State to issue a direction to the chairman and chief executive of the West Kent PCT to reopen the beds in Tonbridge Cottage hospital forthwith. That trust, at the moment, in my view, is failing in its duty of care to patients. There is no good reason for keeping those beds closed. They should be opened immediately.

I now want to turn to debt and its relationship to infection. I looked closely at and listened to what the Secretary of State for Health said last week, and he gave an extraordinary answer to my hon. Friend the Member for St. Albans (Anne Main). He said that there was “no correlation” between debt and C. difficile. Eradicating C. difficile costs money—it has to be funded. The Secretary of State himself, at the end of his statement, drew attention to the fact that he was spending an extra £50 million on dealing with C. difficile.

I bring to the Minister’s attention the extraordinary situation that we have with debt in the Maidstone and Tunbridge Wells NHS Trust. The trust is a victim of what the Government choose to call the resource accounting and budgeting, or RAB, system. The idiocy and unfairness of the system for the Maidstone and Tunbridge Wells NHS Trust is that having paid off a historical debt of £17 million, under RAB it is required to pay off that same amount a second time over. It is intolerable that the trust should be put in that position, which is directly detrimental to patients.

My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) and my hon. Friends the Members for Tunbridge Wells (Greg Clark) and for Sevenoaks (Mr. Fallon) and I wrote not once, not twice but three times to the previous Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), urging her to remove the debt burden from the trust. I urge the Minister and the Secretary of State to wipe out the totally unjustifiable debt that the trust is having to make economies to try to pay off a second time.

Reconfiguration was also raised in the exchange with the Secretary of State last week. I thought that he gave a very strange answer to my hon. Friend the Member for Faversham and Mid-Kent (Hugh Robertson). He said that as far as the Maidstone reconfiguration proposal was concerned:

“If it is referred to me, I will refer it to the independent reconfiguration panel, which is clinician-led, so that there is a clinical argument for any change.”—[Official Report, 15 October 2007; Vol. 464, c. 569-70.]

I appreciate that the Secretary of State has not been long in his job, but reconfiguration for Maidstone has already been referred to him and he, in turn, has referred it to the independent reconfiguration panel, which is due to report to him on 30 November. The matter is before the Secretary of State, who will have to take a decision on it in a few weeks’ time. I ask the Minister whether it makes sense, given the C. difficile scandal, for reconfiguration to be approved now to transfer services from Maidstone hospital to the antiquated buildings in the Kent and Sussex hospital and the Pembury hospital. Surely consideration should be given to delaying that reconfiguration until the new hospital is built.

My right hon. Friend is making a powerful speech, as ever. Will he confirm our understanding that the new hospital is absolutely imperative, if we are to have a long-term solution to these problems? Does he welcome the Secretary of State’s assurance that no expenditure on infection control will stand in the way of that? Does he share my concern that the Treasury holds the purse strings and will ultimately approve the new hospital? Will he join me in urging the Minister to urge her right hon. Friend the Chancellor to approve the hospital without delay whatever the final year balance of the new hospital?

My hon. Friend has correctly anticipated my concluding remarks. I have been somewhat critical of the answers given by the Secretary of State for Health last week, but I should like to finish by saying that I wholly agreed with the Secretary of State’s reply to my hon. Friend, when he put that question to him last week. The Secretary of State gave a clear assurance that he was committed to the new hospital and that the case for the new hospital was made even stronger by the appalling experiences that we have suffered from the C. difficile outbreak.

My constituents, and those of my hon. Friend, of my right hon. Friend the Member for Maidstone and The Weald and of my hon. Friend the Member for Sevenoaks, have suffered grievously through the delay in the arrival of the new hospital. They have had to endure mixed-sex wards, antiquated buildings, antiquated layouts, and now that terrible infection. I urge the Secretary of State to approve our new Pembury hospital and to approve it forthwith.

I congratulate the right hon. Member for Tonbridge and Malling (Sir John Stanley) on securing this important debate. I appreciate the comments that he and other hon. Members have made, and, in particular, the seriousness of the tone with which they have been expressed. Other Members from the area who are not in the Chamber today have also made their voices clear to me and to the Secretary of State.

I want to take the opportunity to offer my sincere condolences to all who have been affected by the tragic deaths that have occurred at the trust. Of course, that is not sufficient for grieving relatives and families. I have always acknowledged that since the announcement of the report, which is as serious as it gets. It showed a lack of management across the spectrum, from the wards to the board. There is no excuse for that at any level—from professional clinical staff, nurses, medical and biochemistry staff, to cleaners and managers. We have failed people across the health service spectrum. I have acknowledged that on previous occasions, and can do so again today, although it gives me no pleasure to say that to the right hon. Gentleman.

The report found that the trust board was unaware of the high infection rates, and did not spend enough time considering infection control. The report makes recommendations for action by the trust, including a review of the trust board’s leadership, prioritising of infection control at board level, risk management, clinical guidance, staffing levels and training. The right hon. Gentleman referred to a report by Professor McCormick, which will be updated and published, I believe, at the end of this year. We note that and look forward to his report back.

On other leadership matters in the trust, I accept totally the right hon. Gentleman’s comments about with whom the buck should stop. I personally think that that goes across the clinical field, and I know that a leadership review is taking place, which will report back shortly.

It is now nearly two weeks since the report was published, but still people are employed by the trust who were directly criticised in it, including non-executives, with the exception of the chairman, who approved, we are told, the pay-off to the former chief executive. That seems to be an unconscionable delay. Under section 66 of the National Health Service Act 2006, the Secretary of State has the power to serve an intervention order to remove individuals. Will he make use of those powers?

The Secretary of State has made it very clear that he is taking legal advice. Sadly, that is not going as fast as people in the Department, and certainly Ministers would like. However, the Secretary of State is taking advice and meeting regularly with the strategic health authority and chief executives to address all of the other concerns that the right hon. Member for Tonbridge and Malling rightly raised in his contribution.

We cannot take this matter more seriously, because the most serious errors have taken place in Maidstone and Tunbridge Wells NHS Trust. I assure Members that the Secretary of State is working very closely, on a daily basis, with everybody, in order to bring these very sorry events to a conclusion, and to move on in the most positive way possible.

Many measures have been put into place in Maidstone to improve systems for monitoring all infections, which of course have to be in place in all trust and primary care trusts. In particular, I take note of the right hon. Gentleman’s comments about community trusts and community beds. I assure him that I shall go back to the Department and check up on that. I would be very happy to discuss my findings with him.

We have reviewed nurse staffing levels and are recruiting to enlarge nurse staffing numbers on wards. As a former nurse, it is beyond my comprehension how such a level of infection could take place in 2007. I accept that they are operating in very poor conditions, and I accept the point about the speed of the reconfiguration, and emphasised it to the Secretary of State, who is working very hard to address it.

We have extended cleaning in all clinical areas. Of course, we have relaunched the “Clean Your Hands” campaign. I am aghast that we have to do that, but we do, across the board, from the most senior medical consultants down to the most junior members of staff.

I, too, am a former nurse, and I remember the smell of cleanliness in hospitals. Is the Minister aware that, in 1982, 170,520 ancillary staff worked in NHS hospitals in England, but, by 1995, that number had fallen to 66,760? At the same time, there was a corresponding increase in MRSA and other infections that have been highlighted. Does she agree that it is time that we got back to the domestic levels of cleanliness in hospitals that we had in 1982, prior to compulsory competitive tendering?

I agree. Of course, given that we both worked in hospitals back then, we know how important domestic staff are to the well-being of patients and of the contribution that they make to the team. If they are designated to be in one ward or clinical area, they take pride, and always have done, in their work, and feel as responsible for the cleanliness and infection rates of their hospitals as any member of the professional team.

I agree with the right hon. Member for Maidstone and The Weald (Miss Widdecombe), whom I met this morning, and who said, in her own way, that an air of carbolic is required in our hospitals once again. However, we must look at individual practice in the case before us, which we have said was unacceptable. Now we have to look to the future and help to restore community confidence in the Maidstone and Tunbridge Wells area, and I know that hon. Members will work with us to help with that.

Targets have been mentioned, but the Healthcare Commission pointed out that targets in themselves did not create this problem, because other organisations meet targets while keeping patient safety as paramount at all times. Complaints must be taken seriously. In this instance, for those of us concerned with health care professionals, one complaint would have been one too many. We also need to look to how we manage C. difficile infection in the future. It has always been an infection in its own right, and the medical care of patients and the appropriate use of antibiotics is paramount, as well as the cleaning. We must take a team approach to this difficult infection. In many areas of microbiology, other countries are now looking to us to see how we can assist them.

We must not forget the hard work and dedication of our NHS staff who feel the anger and shame of what has taken place in Maidstone and Tunbridge Wells. We all understand that the public expect to be cared for in clean hospitals, which is why the Prime Minister announced the big spring or autumn clean—whenever it takes place— but that is just one thing. It is not sufficient, but it will start to give the public the confidence that they always had in the cleanliness of our hospitals. The way in which clinical matters are managed and run needs to be looked at again.

I could, of course, go back a few years when it was unheard of to have such a busy stream of people in and out of wards and clinical areas, and to see our hospitals used by so many people in so many different ways at the most inappropriate times. I have asked the chief nursing officer to look at that. Pilot projects taking place in parts of our hospitals are showing huge signs of saying, “We will have rules and all the clinical staff will obey them.” However, in this case, that is not enough. Senior people across the board will be, and have been, called to account. The Secretary of State and I want to work with a new chairman and chief executive, and to get round the table with all the hon. Members concerned to look at how best to do that.

My door is open to all hon. Members in order to get this right and to see how best to work with constituents so that we can restore confidence in the NHS, in which we still have great pride. That is a serious issue. We can balance books and meet targets, which have helped patients, but we also need future targets to reduce infection rates and to adhere to a very strict code of practice. The chief executive, David Nicholson, has sent out a very strong message to all NHS managers saying that an atmosphere of being unable to report situations and of complaints not being taken seriously will not be acceptable at any level. All members of staff must feel that they operate in an open and safe environment, and patients and communities must always feel that about our beloved NHS.