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Newark Hospital

Volume 556: debated on Monday 7 January 2013

Motion made, and Question proposed, That this House do now adjourn.—(Karen Bradley.)

I start by thanking the Speaker’s Office for granting this debate, the second debate on Newark hospital in the past couple of years. I thank the Minister for making himself available tonight, I thank colleagues on both sides of the House, and I thank my constituents who have come down here for this evening’s debate. I am most grateful to all of them.

As I said, we have already had one debate on Newark hospital. I do not wish to bore the Minister, but a little bit of history might be useful. I do not know how well he knows Newark, but I hope to enlighten him. We sit right on the border between Lincolnshire and Nottinghamshire, and we are bedevilled by dreadful roads and awful traffic, particularly as we move from east to west and west to east. Newark is a growing town and the population of over-65s is likely to have doubled by 2026. I shall explain later why that is so important.

Newark is a town that I fear suffers from the Nottinghamshire health care model, which has been in place for at least a decade and a half. Centres of excellence have been established in places such as Lincoln, Grantham and the King’s Mill hospital, but not in Newark. I am realistic about that, but it presents huge challenges for a growing town. The hospital delivers superb services, but is diminishing relative to the services offered in the recent past; in addition, with King’s Mill, it is saddled with a private finance initiative that has been in place for two years now but will be in place for 30 years.

The problem is not new. It has been a hot potato in the Newark constituency since at least 2004. We had a helpful visit from a Minister in the previous Government in 2004, and in 2010 the PFI project that I mentioned was put in place. Then, a couple of years ago, the A and E department was closed and replaced with a minor injuries unit.

I have to say that the more I see of the national health service, the more byzantine I find the organisation. I cannot understand how a department that called itself an A and E for the best part of 10 years was not an A and E—it did not qualify to be an A and E. It was always going to be painful when the department’s title was changed—in this case from A and E to minor injuries unit. The fact remains that the goalposts in the national health service seem constantly to change. If, for instance, Mr Speaker, you asked me how an anti-tank platoon was organised, I could tell you how many weapons, how many men and how many vehicles were involved. If you ask what an MIU looks like in one hospital and what an A and E looks like in another hospital, the answers are usually widely different. We definitely suffer from that problem in Newark.

Another point about the growing town is that it has been clear to me for at least the last five years, and was recently confirmed in the Monitor report, that there is no plan for the hospital to increase in size—no matter whether one is critical of the services it currently offers—to take into account the growth and the natural explosion of the population that is likely to occur.

I congratulate my hon. Friend on securing this debate. He makes a compelling case for the importance of the hospital to the people of Newark, but does he recognise that people in my Sherwood constituency also value the services that the hospital provides?

As my hon. Friend knows, I live right on the edge of my constituency and almost inside his, and my family and I unquestionably depend on Newark hospital—and, of course, on the East Midlands ambulance service—just as much as those in many parts of the Sherwood constituency.

Might it help the Minister if my hon. Friend told him where the nearest major road and rail routes to Newark are, and where the nearest A and E unit is?

The answer to that question is, of course, Lincoln, but it is by no means true that all the serious cases in Newark go there. I shall say more about that shortly.

Let me continue my brief history. Last autumn, Monitor delivered a devastating report on the private finance initiative and on Sherwood Forest Hospitals NHS Foundation Trust, which includes King’s Mill and Newark hospitals, drawing attention to serious financial problems. It pointed out that Newark hospital was underutilised by 55% at times, that it was closed for admissions after 6 pm, and that many members of the board had resigned as a result. There is no doubt that good has come of that, but on top of all those difficulties, East Midlands Ambulance Service NHS Trust has decided to close Newark ambulance station. I shall say more about that shortly as well.

Where does the problem lie at the moment? First, let me nail a couple of misapprehensions. I am sure that the Minister will not be surprised by my raising them. First, in certain malicious quarters in the town, rumours—more than rumours—have been stoked that the hospital will close. I do not believe that it will close; I see no reason for that to happen. Indeed, Chris Mellor, the new acting chief executive of Sherwood Forest Hospitals NHS Foundation Trust, has made it clear that if the hospital does close, it will be a liability for the next 28 years no matter what, because there can be no withdrawal from the PFI in which Newark hospital is engaged with King’s Mill. Secondly, we still hear forlorn and ill-informed voices talking about the reopening of an A and E unit. No one who understands the problem could think for a minute that Newark will have an A and E unit. That really is not the issue at hand, and, given that the subject will no doubt arise during our continuing conversations, I want to reassure the Minister that, in my opinion at least, it will not happen.

Since the new team has taken over—and I appreciate that it is only a temporary team—some refreshing views have been expressed following the hammer blows of last autumn’s Monitor report. For instance, Eric Morton, who is running the administration of the hospital, albeit temporarily, has responded to a request from me and others for Newark’s minor injuries unit to receive further resources, so that it can at least provide level 2 critical care and become a sort of MIU-plus or A and E-minus—the terms are confusing—and we can be seen as comparable with smaller towns and, indeed, towns of similar size, such as Worksop and Grantham. I have suggested that if a clinical case can be made, there is no reason why such a system should not be introduced at Newark—why, in other words, our services should not be improved.

The GPs with whom I have had some interesting friction over the last couple of weeks—constructive friction, I hope; I say that with the greatest respect to those GPs—have a rather different view. They think that the system would be extremely difficult to implement. I do not know; I cannot judge. I am not a doctor, a clinician or a medical man of any sort. I should greatly appreciate it if the Minister gave me his unequivocal but detached view on exactly how realistic the proposal is, bearing in mind all that I have said about the increasing size of the town, the fact that there seem to be no plans to increase the size of the hospital in line with that, and the fact that it sits on major routes, both rail and road, which are always susceptible to the mass casualties which we see frequently during the year.

I congratulate the hon. Member for Newark (Patrick Mercer), whose tenacity on this issue is well worth the effort and appreciated by many of us who reside in the area covered by the Sherwood Forest trust. I have been closely involved with the trust for many years, and his description and analysis are honest and probably mostly correct. I believe that the Newark part of the trust has been let down badly in recent years by the reorganisation, and his description of the situation that led to the resignation of most of the trust’s board some time ago was an exact and correct one. I assure him that I and other colleagues in the north of the county will do whatever we can to support his effort not only to keep Newark hospital open, but to build on the services that are required for the growing population in that part of Nottinghamshire.

I am most grateful to my hon. Friend who sits on the Opposition Benches. His view is always valued by me and certainly by the people of Newark. I have tried to keep politics out of this, and my stand has been consistent under the last Government and this Government. I really appreciate his comments, because this issue, more than anything else, stands above party politics.

One of the benefits of having an upgraded minor injuries unit is that more cases could be dealt with in Newark. GPs and others would be more willing to send patients to Newark, rather than hospitals some way away from the town, and this will have a direct effect on availability of the ambulances—their reaction times and their number—needed to cover Newark and the rural areas. For instance, if we ensured that the transfer times for all green 1 to 4 and urgent minor emergencies could be covered locally, the effect would be felt by East Midlands ambulance service right the way across Nottinghamshire.

That brings me neatly on to the point about EMAS and the service it provides, particularly in Newark town and the rural area. As well as all the other difficulties I have mentioned, which the Minister will recognise, we are currently going through a consultation about exactly how the ambulance service in Newark should be reconfigured. The ambulance service’s boss, Mr Phil Milligan, has helpfully admitted that the ambulance service is not performing to the necessary standard and that there are difficulties with EMAS, particularly in the Nottinghamshire area. The details are there to be seen.

I ask the Minister to look carefully at the need, or otherwise, for a hub inside or adjacent to Newark and at the positioning of the two community ambulance points that we are being promised, again either in or adjacent to Newark. We can have the best hospital in the world in Newark, but, unless we have an ambulance service that can take people with whom it cannot deal quickly, effectively and properly to other hospitals, the health care model will not work. That lies at the heart of the two issues here: the upgrading of the MIU and provision of further critical services, and the improvement —not continuation of the status quo—of the ambulance service. Those two major issues, with all their interlocking threats, lie at the heart of the problem of health care across the Newark area.

It is not all doom and gloom. I visit the hospital regularly—I there last on Christmas day and shall be there again on Friday—and am always impressed by the nurses, doctors, support staff, ambulance drivers and clinicians who deal in Newark. Anybody treated in Newark will say that we have an excellent hospital and that the services it provides are second to none, but we must not allow it to dwindle. When I visit, I am always impressed to find people from Lincolnshire and Derbyshire who are electing to be dealt with in that hospital. That raises the question why, when King’s Mill hospital runs out of beds, as it has over the past couple of months, it is not the customary practice for patients to be taken straight to Newark hospital. Surely if the money follows the patient, too many Newark patients are being taken “abroad”, with the money being paid out to different health trusts around and adjacent to ours, including to King’s Mill. Why does the arrangement not work properly in the other direction? That is exactly the point Chris Mellor made to me when he took over in his new job.

There is no doubt that improvements have been made: a bus service now runs between our hospital and King’s Mill; and we have reopened what used to be called the Friary ward, providing extra beds, particularly for the elderly. Those good things have to be celebrated, not sneered at, as certain individuals in the town have done. I look forward to such improvements being replicated throughout the hospital and in the different authority—the different aegis—of the East Midlands ambulance service.

I also look forward to the meeting that the Minister has kindly agreed to have with me on 4 February—it might be on 5 February, but we will tie the date down. I am grateful to him for that, and I have no doubt that we will talk and talk about these issues. However, I hope I can leave him in absolutely no doubt about the isolation that many of my constituents feel in respect of the hospital. The resources of the hospital and its ability to cope with the sick, the halt, the lame, the deaf and the blind have been seriously diminished over the past couple of years and perhaps even longer. To that end, I ask him not only to address these specific points, but, if he has the time, to visit Newark. I would like him to talk to not only the staff of the hospital and the ambulance service, but to the people of Newark, so that he can gauge for himself how strongly we feel about the hospital, how close it is to our hearts and how we hope it will continue to improve in the future.

I congratulate my hon. Friend the Member for Newark (Patrick Mercer) on securing this debate and on his continued, long-standing dedication to and strong advocacy for his constituents, and his local health care services and all the patients who use them. It was good to hear interventions from hon. Members on both sides of the House; we heard from my hon. Friends the Members for Sherwood (Mr Spencer) and for Lincoln (Karl MᶜCartney), and the hon. Member for Mansfield (Sir Alan Meale). That shows that on important issues such as local hospitals we can put party differences aside to come together for the benefit of the people who matter most in the NHS—local patients. I was pleased to hear that party politics had been put aside today and I was glad to hear the hon. Member for Mansfield say that he will continue to do so in the future for the benefit of patients in Nottinghamshire.

As has been articulately outlined by my hon. Friend the Member for Newark, Newark hospital provides an extensive range of consultant-led out-patient services and does so with short waiting times. It provides many high-quality day-case procedures, and diagnostic and other services. It also has a high-quality minor injuries unit and urgent care centre. Some 35 beds are available across two medical wards, with 21 more beds in the surgical ward. As my hon. Friend rightly outlined, one challenge that faces the NHS as a whole and patient provision in Newark is the fact that many people are now living longer and need high-quality, close-to-home community health care services. That is exactly what is provided at his hospital.

We also know that a new 12-bed facility is to open in Newark hospital in February 2013. The Fernwood community unit will be a specialist unit of single-sex bays and private rooms that will meet the needs of the growing number of elderly patients we have discussed, ensuring that people have the right to recuperation and recovery in an appropriate intermediate care setting before they return to their own homes.

The hospital receives full back-up from the teams at King’s Mill and the services provided by the two hospitals are compatible and work well in synergy. I want to put on record my congratulations on and gratitude for the dedication and hard work of all the NHS staff who work on the King’s Mill site and at Newark and who do excellent work to look after patients to a very high standard. I will be happy to take up my hon. Friend’s offer of a visit to Newark hospital when time permits later in the year, so that I can meet the staff and see first hand the excellent care provided there.

It is worth highlighting that there was a local agreement on Newark services, which was signed off on 18 December. Newark and Sherwood district council agreed across party lines to work with the Newark and Sherwood clinical commissioning group and the Sherwood Forest Hospitals NHS Foundation Trust to maintain what they see as essential elements for local services. When looking after older people, it is good to have cross-agency integrated care and working and a commitment to those principles from not only the NHS but local authorities, which play such an important part in the care of older people through housing and social services.

The commitments made in the agreement were that there should be high-quality primary and secondary health care for the people of Newark and Sherwood; a strong and positive future for Newark hospital within Sherwood Forest Hospitals NHS Foundation Trust; and accessible and safe health care services for patients across Newark and Sherwood district that are as close to people’s homes as possible. As has been outlined throughout the debate, it is important that we ensure that older people do not have to travel many miles to receive high-quality care and that they receive that care, if not in their own homes, as close to their homes as possible. That is why I am confident that Newark hospital will always have a strong and viable future as a setting for the provision of high-quality care for many older people and for all the other patients it looks after so well.

My hon. Friend also raised the question of the PFI debt at the hospital trust and he was right to do so. Monitor, the independent regulator of foundation trusts, recently expressed concern about the financial situation at Sherwood Forest Hospitals NHS Foundation Trust. The trust signed its £320 million PFI deal in November 2005 for the redevelopment of King’s Mill, and in 2012-13 the trust’s PFI cash outflow is £42.5 million, which equates to 17% of the trust’s income—a very large PFI debt, with 17% of the income spent on PFI repayments. If we were not already aware of the great damage inflicted on our NHS by PFI agreements, which were sometimes signed in haste and which we have often lived to regret, that agreement would make the case very clearly.

On 21 September, Monitor published a breach of compliance report which referenced a McKinsey’s report it had commissioned. The report concluded that the trust’s PFI commitments were affordable only with additional activity from the local health economy. That means it does not qualify for Department of Health national PFI support. The report outlined the fact that the trust has potential for additional health care activity, which would benefit it financially and put it on a more stable financial footing. The emphasis on additional activity in the report seems to suggest that more can be done potentially at Newark to develop services for the benefit of local patients. That could bring revenue and income into the trust and would do more better to serve the needs of a growing population and its future health care demand.

To answer one of the points my hon. Friend raised, enhancing facilities in the minor injuries unit could play a part in putting the trust on to a more stable financial footing. The new chief executive is keen to look into the issues, as my hon. Friend said, and he is right to highlight the fact that good, dynamic leadership can turn around the trust’s financial fortunes, notwithstanding the massive PFI debt repayments. There are clearly further opportunities to develop what the hospital can do to put itself on a stable financial footing while doing more to look after local patients better. I know that the chief executive and the team at the trust are listening to the debate, and that they will take on board what I have said and the concerns that my hon. Friend raised.

My hon. Friend talked about ambulance services in the Newark area. It is worth pointing out the distances that some patients have to travel to reach a fully functioning, 24-hour A and E service. King’s Mill hospital, one of the acute settings, is 23 miles away, which is about 42 minutes by road. The Queen’s Medical Centre in Nottingham is 22 miles away, a 50-minute road journey, and Lincoln county hospital is 20 miles away, which is 45 minutes from Newark by car. Those are average journey times; there may be busy times and road congestion.

There are particular challenges in making sure that in an emergency patients can get to an appropriate A and E care setting in a timely manner. My hon. Friend pointed out that according to East Midlands Ambulance Service NHS Trust figures, in the years 2009-10 and 2010-11 and in the first quarter of 2012-13, Nottinghamshire did not reach its A8 response targets. Sometimes, those targets are skewed: they can be better in urban areas, such as Nottingham, but worse in more rural settings. I am sure my hon. Friend will want to take things further with the ambulance service and drill into the data for Newark by postcode, to compare response times in a more rural area, where there is a long distance to travel to an A and E, with those in some of the more urban settings in Nottinghamshire. It is obviously unacceptable to all of us if patients in rural communities have to wait a long time for an ambulance and life-saving treatment.

In the ambulance service review and the consultation on its proposals, it is vital that rurality and travel distances to A and Es and other urgent care settings are taken into account in any changes to the service. From the figures I referred to, we already know about the challenge the ambulance service in Nottinghamshire faces, because it is not meeting response targets. If we break down those targets by postcode and by area, we may find that rural areas are even further behind. When the review takes place, it is important that the rurality of Newark is properly taken into account so that patients in rural areas have the same quality of ambulance response as those in more urban settings.

In conclusion, I am pleased to confirm that there is a strong and viable future for services for local patients at Newark hospital. I very much look forward to taking the discussions further with my hon. Friend in early February, and to visiting the hospital later in the year.

Question put and agreed to.

House adjourned.