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University Hospitals of Morecambe Bay NHS Foundation Trust

Volume 558: debated on Tuesday 5 February 2013

I am pleased to have secured this debate. It is a pleasure to speak under your chairmanship, Mr Howarth.

I represent a community in shock, reeling from the suddenly announced intention to transfer Furness general hospital’s beloved special care baby unit and consultant maternity services out of the county, from 9 o’clock this morning, to Lancaster. Pleas to rethink that emergency transfer have so far been rebuffed, leaving expectant mums distraught at the prospect of a 50-mile trip in the back of ambulance if they suffer complications in labour. I will set out our concerns in detail and stress the areas in which we hope the Minister, who is of course an expert in the field, will agree to intervene, but first I will discuss the wider issues the area faces, which prompted my application for this debate.

There is the forthcoming review of hospital services, triggered by the need for significant budget reductions across the University Hospitals of Morecambe Bay NHS Foundation Trust. All of us here are acutely aware of the long-term threat that that might pose to key provision, such as the need to sustain a consultant-led maternity service and accident and emergency provision across more than one site in the area.

There is also the campaign against the removal of A and E, maternity and intensive care units at Royal Lancaster infirmary, on which the Downing street petition in the name of Matthew Hood already has thousands of signatures. I think that my constituency neighbour, the hon. Member for Westmorland and Lonsdale (Tim Farron) wants to do exactly that—move Lancaster’s A and E department to the Westmorland general hospital. Let me simply say that any attempt to question Barrow’s need for an A and E department would be met with horror not only by every single resident of the Furness area, but by the prized and highly regulated industries on which the nation depends.

The broader question facing the Morecambe Bay trust is how best to locate services when the population is far more spread out than in most areas of Britain, and when centres of population are often connected by a single road that winds through Cumbria’s unique landscape. In other areas, a trust for hundreds of thousands of residents might naturally be based around one A and E department and one maternity unit, but that would put an unacceptable strain on residents of Morecambe bay. People in pockets of severe deprivation in Barrow and families who, for whatever reason, just do not travel would be forced to go to another county and be completely cut off from their families. In an emergency, it would result in journey times of more than an hour on routes that are prone to become blocked by breakdowns.

I want to ask the Minister four questions about the four tests in the Government’s forthcoming consultation. His first test is the evidence base. Will he ensure that the options and risks are properly weighed, so that the risks inherent in long-distance ambulance travel are set alongside what might otherwise be the optimal configuration of services? The second test is whether there is the support of GP commissioners. The past 24 hours have shown the damaging shambles that can occur when a trust attempts to press on against the will of local commissioners. The Government back the new system, so will the Minister ensure that local GPs have the teeth to insist on the services that communities need? The third test is choice for patients. Will the Minister ensure that problems of isolation and lack of access to services are an integral part of the assessment when it arrives on the Secretary of State’s desk? It is hard to imagine the test of choice being passed if, for example, an isolated peninsula’s only consultant-led maternity unit were downgraded. The fourth test is strengthened public engagement. The trust needs to do much better than the mess of the past few days, which has left women desperately worried and confused. I shall say more on that in a moment, but the underlying point is that engaging means listening and acting. Of course, health professionals have a duty to present the options and a proper assessment of safety in each case, but if the public weigh that up and say that they want to keep the services they need close to home, the Government should listen to them.

Another major issue is the need for Ministers to ensure that our local hospitals and the wider national health service adequately learn the lessons of the significant and prolonged failings in hospital management at the Morecambe Bay trust. There have been tragedies about which people are still demanding answers and which apparently did not trigger sufficient improvements, despite laying bare shortcomings in areas such as maternity provision several years ago.

As usual, my hon. Friend is making an excellent case on behalf of his constituents. Many people in the south of my constituency use Furness general hospital, as well. Does he share the fear that some of them have expressed to me that the rapid removal of the special care baby unit heralds a stealth reconfiguration of services there?

My hon. Friend is absolutely right that that is indeed the great fear. It is up to the trust, and ultimately to Ministers and the Government, to demonstrate that that is not the case, but there are still questions to be answered.

The need for lessons to be learned has been shown by such problems as the basic lack of grip in key areas in recent years—for example, the failure of new computer systems designed to remind patients about repeat appointments, which has clearly put lives at risk. A police investigation into a number of deaths is ongoing. There is also a lack of openness at the trust.

I pay tribute to the hard work of the staff in the maternity unit and across Furness general hospital. They are dedicated people, who come to work wanting to help others and to save lives. There have been real improvements of late, and we should recognise the immense strain placed on staff by the ongoing spotlight on the hospital and the longer-term uncertainty over their future. None the less, families are still grieving because of past mistakes made in a poorly managed system. The Minister was good enough to write to me in response to a letter from my constituent James Titcombe, and again recently on the need for a genuinely independent inquiry into the lessons for the wider NHS of management failings at Furness general hospital.

I congratulate the hon. Gentleman on securing this debate and, as I know from having worked with him, on his concern for his constituents. Does he not think that we constantly go round the roundabout in relation to the Morecambe Bay trust? To the centre, Morecambe bay sounds as though it is a natural unit, but in fact it is a barrier. I suggest that we need to look at the fundamental geography, which might mean challenging the boundaries of the Morecambe Bay trust, if we are ever to get some balance between the demands of Furness, Kendal and Lancaster.

The hon. Gentleman makes an interesting point, for which I am grateful. I am sure that Ministers will want to consider that, but I think it must not come at the expense of local MPs’ taking our eye off the ball in the forthcoming consultation.

The Minister was good enough to write to me about James Titcombe and other grieving families. In the first letter, he said that he would keep the issue under review. I hope that, when he has time to look at the matter further, the Minister will agree that the trust’s commitment to an independently chaired but internally managed inquiry, although it is a welcome step forward, will not be sufficient to give confidence and ensure that lessons are learned, not only in this individual hospital, but in the entire NHS. Most of all, I hope that he will join me today in sending a message, loud and clear, that the need to be accountable for past mistakes must never be used by the trust as an excuse to remove services that our community clearly needs.

The final part of my speech relates to the crisis caused by the trust’s shock decision to transfer, apparently temporarily, the special care baby unit and consultant maternity services out of Furness general to Royal Lancaster infirmary due to increased sickness absence levels at the trust.

Let me deal first with the shambolic process that has left expectant women unsure about where they can give birth—even now, as we speak, two hours after the transfer was due to take place—because of genuine fears about a lack of ambulance cover. The decision was taken unilaterally by the trust, with no consultation or warning given to the public, the obstetric consultants who work at Furness general, or the GPs responsible for commissioning the services. The option of transferring staff from the Royal Lancaster infirmary was not put to the board. Although there can be no doubt that staffing levels are low at Furness general, there was no detailed risk assessment of the dangers of transferring mums in labour by ambulance. Most alarmingly, no attempt was made to engage the North West ambulance service—this was confirmed to me by the service last night—until last Wednesday evening, leaving that organisation unable to find the extra unit that it estimates will be necessary to cope with the increased demand on an already stretched operation. This is an appalling and potentially dangerous shambles that has greatly increased the anxiety of pregnant women in my constituency, on top of the worry they already felt at the news, during what is naturally one of the most worrying times in their life anyway.

Will the Minister intervene personally to impose order on the chaos? Will he confirm that the regional health authority’s gold command is meeting today to escalate the situation? Will he meet me to ensure that we have the best chance of getting the services we need back as soon as possible? Let me be clear: families in my constituency and beyond will be devastated if we lose consultant-led maternity services permanently. The Minister is a practising obstetrician and will know better than I that the removal of the clinician-led special care baby unit will result in women who expect complicated deliveries or who experience complications during birth facing a transfer to Lancaster, involving a journey time of about one hour along a road that, less than a fortnight ago, became almost impassable due to heavy snow—in fact, journeys between Barrow and Lancaster were taking up to 10 hours. Trying to transfer a mother who needs consultant care in such conditions is hard to imagine.

It has been suggested that air ambulances could be used to speed up transfer times in the event of Furness general hospital’s maternity unit being downgraded, but serious questions need to be answered about the practicality of that proposal. The Great North air ambulance service is a fantastic organisation that helps to save many lives each year, but it has just three helicopters to cover not only Cumbria, but the whole of north-east England and North Yorkshire. We cannot simply assume that the answer lies in the air.

I am immensely proud to be backing the “Thousand Voices” campaign in my constituency, which comprises mums who got together to make themselves heard when they saw the crisis coming. I know that I cannot use props, Mr Howarth, so I will not, but I urge all hon. Members to go to to hear the stories being shared. People are going out and using camera phones to get video clips from mums and dads, wherever they can find them. Let me read just one such story on the site, which reflects the views of hundreds. Mum of three, Christina Pickering, said:

“Due to extreme circumstances in my third pregnancy, I was sent to the Royal Preston hospital to deliver my daughter and that’s got to be one of the most terrifying experiences of my life, being in an unknown hospital, on my own, to deliver my baby. I don’t want this to happen to any mums—it doesn’t have to. Downgrading our maternity services at Furness general would not only be detrimental to mums and babies, but to the whole community. We’ve got to stop this happening.”

Let me end with the Minister’s own words from before he was promoted, which I wholeheartedly endorse. In a Westminster Hall debate in September 2010, he said that,

“generally speaking, if we consider the example of”

other hospitals,

“we see that the push has been to have a low-risk, midwifery-led unit alongside a higher-risk unit. We in obstetrics know that a greater number of women—rising to about 30%—are giving birth by Caesarean section, and that number is going up year on year. Many births that we initially think uncomplicated end up being much more complicated.”—[Official Report, 14 September 2010; Vol. 515, c. 230WH.]

The Minister summed it up perfectly. Families in Furness want the security of knowing that they can have their babies in Barrow with specialist help on hand. They pay for their health services with their taxes and they are speaking with one voice. They need the Government to listen.

I thank you for calling me in this debate, Mr Howarth, as it is one that will be closely watched in my constituency. For some weeks, the local press has been awash with allegations about both maternity and accident and emergency services at our NHS trust. I am concerned not about services changing but about the scare stories surrounding the matter. I have a letter from the chief executive of the trust that confirms that it will not shut the A and E at Royal Lancaster infirmary. The Minister also has this letter, but I will quote from it:

“The A and E at the Royal Lancaster Infirmary serves the population of Lancaster and surrounding areas and treats in the region of 50,000 people each year. Whilst it would be wrong of me to second guess the future, I personally find it hard to imagine Lancaster not having emergency services. Let me be clear, we do not have any plans to shut the Accident and Emergency department in Lancaster. We are deeply concerned that these continual rumours are undermining confidence and frightening the public. We will continue to work with the public, staff and stakeholders to better understand the review of services to help allay these concerns.”

Jackie Daniel, the CEO of the trust, is saying there that not only does she have no plans to close the A and E, but she cannot even imagine a scenario in which anyone would close it, not least because it serves 50,000 people a year.

However, a concerted Labour campaign has been mounted by local party members who actually work in the NHS to make people believe that the A and E is likely to close. The campaign involves press briefings, an online petition, a Facebook group and even people walking round the centre of Morecambe with clipboards inviting people to join. I want the e-petition removed from Directgov and have written to the Cabinet Secretary to ask for him to intervene. We cannot have this dishonest campaign fought through the Directgov e-petition platform. If the A and E is not under threat, it must be concluded that Labour is frightening people for its own political advantage, which is morally wrong.

It is perhaps time to admit the truth: the trust is getting better under this Government. A new and better management was brought in by the previous Secretary of State for Health. A new minor injuries unit was opened in my constituency by the Minister only a few weeks ago. A new health centre in Heysham, costing £20 million, was opened last year. We have four new wards just opened. All of that was paid for by the 2.8% increase in funding for the NHS.

It is a great pleasure to serve under your chairmanship, Mr Howarth. It is not the first time, but nevertheless it is a pleasure.

I pay tribute to the hon. Member for Barrow and Furness (John Woodcock) for his advocacy on behalf of his constituents and all those in Cumbria who are looked after by the local trust and to my hon. Friend the Member for Morecambe and Lunesdale (David Morris), whose constituency I recently had the pleasure of visiting, for his advocacy on the behalf of his constituents. I have indeed received a copy of the letter sent to him by the chief executive of the NHS trust, which says:

“Whilst it would be wrong of me to second guess the future, I personally find it hard to imagine Lancaster not having emergency services.”

I hope that that is reassuring to him and his constituents.

On the main issues raised in the debate, I have already paid tribute to the strong advocacy on behalf of his constituents by the hon. Member for Barrow and Furness. He was very kind to brand me an expert in obstetrics. I would not go quite that far, but he is right to say that I have considerable understanding of the issues involved and of the importance of ensuring that we provide safe and comfortable environments in which women can give birth. He is also right to read out the case that I advocated in a debate here in Westminster Hall some time ago, and it is important that we recognise that uncomplicated deliveries can become more complicated. We know that for women in some parts of the country, particularly those in more deprived areas, there are often higher risk rates of prematurity. These are all issues that need to be taken fully into account whenever services for the safe delivery of babies, and for the safe care of women during pregnancy, delivery and the period afterwards, are examined.

The hon. Gentleman is also right to highlight that there are geographical considerations in Cumbria, as in many rural areas, including the fact that there is only one main road and the problems that presents in respect of allowing the local trust to transfer patients effectively and safely from one site to another. It potentially creates difficulties at certain times of day if the road is busy, as he is aware. However, it also requires the availability of ambulances, and he was right to point that out.

When decisions are made about changing services, whatever the reason may be for changing them, they cannot be taken in isolation. In this case––I will discuss this further later––I believe that the decision was made in good faith, although I share some of the concerns that the hon. Gentleman raised, given that we know that there have been a lot of problems at the trust with maternity services as well as the safety concerns he outlined. Those decisions cannot be taken in isolation. They need to be taken in collaboration and after discussion with local commissioners and indeed with the ambulance service, if they are to be made correctly and for the benefit of patients.

The hon. Gentleman was also right to outline the four tests for reconfiguration. In particular, he was right that reconfiguration must be clinically led, based upon evidence and always in the best interests of patients. Reconfiguration should never happen for cost reasons alone, and he was absolutely right to highlight that. Reconfiguration also needs to have the support of local GP commissioners. However, from what he has said today it appears that there are local concerns about the proposed changes, and that there has not been an integrated, joined-up approach in relation to this decision.

We have also discussed the concerns over the need to integrate ambulance transfers into any local decisions because of the travelling distance from Barrow to Lancaster. That is one of the issues that should have been take into account when these decisions about reconfiguration were being made, and I am very concerned to hear the hon. Gentleman say that he does not believe that they were taken into account and that local commissioners also have concerns about this matter.

I am very happy to meet the hon. Gentleman again in the very near future to discuss this; that would be very desirable. It is vital to ensure, as the hon. Member for Copeland (Mr Reed) said, that we do not see service reconfiguration by stealth or via the back door. We should have an integrated, joined-up approach to local decision making, particularly in view of what can only be described as the deficiencies of the past at the trust and the very sad cases that the hon. Member for Barrow and Furness and I have corresponded about, as well as the police investigations that are going on. He is aware that it would be inappropriate for me to comment directly on those.

There is a need to ensure that in the future decisions are made in a holistic way and in the best interests of patient safety. Such decisions are not just for the trust to make alone but must be made in conjunction with the local commissioners and the ambulance service, if we want to ensure patient safety. The hon. Gentleman and I can discuss that further when we meet.

The hon. Gentleman raised another important issue: the ongoing investigations at the trust. He was right to do so. As we know, tomorrow the Mid Staffordshire report will be published, which makes these sorts of issues all the more poignant and important. The NHS has sometimes had a history of covering up bad things that have happened to patients, and that is completely unacceptable. The result of that is bad care for patients, and cultural problems in trusts and hospitals. Those sorts of things cannot go on. When there are investigations, they need to be carried out transparently and openly, so that people feel the issues have been fully aired. It is also vital that those investigations have a degree of independence, as he suggested.

I thank the Minister for giving way, and for the excellent and considered way that he is responding to my points. He referred to the Mid Staffordshire situation. Does he accept that that started as an internal inquiry, which was found to be insufficient to get to the bottom of the issues and required a greater degree of independence to be established? We are worried that the same thing may be apparent in Furness.

Absolutely. There will be a full response to the Mid Staffordshire inquiry tomorrow, so I will not pre-empt it or go into detailed discussion of that issue. However, it is absolutely right that we must encourage staff who have concerns about patient care to raise those concerns and air them in an open way. Moreover, when we know that there have been long-standing failings at a trust about the quality of care provided to patients and concerns raised about those failings—although Morecambe Bay NHS Foundation Trust, for example, has made some good progress in recent months, there are some long-standing issues there—it is important that, when an investigation is carried out, it is carried out in a transparent, open and independent way; there must be a great degree of independence involved.

If a trust sees fit to launch an investigation and a review of what has happened, it is important that the investigation and review pass the test of transparency. There may well be a role for local MPs and other interested parties in that process, and when the hon. Member for Barrow and Furness and I meet, that is an issue that I will be very keen to discuss further, to ensure that we can discuss with the local trust ways in which we can ensure that there is that transparency and independence in the process. That is very important to ensure that those patients, and their families who have had problems in the past—in some cases, there have been deaths at the trust—feel that the investigation addresses their allegations.

Obviously, this debate is not just about maternity services at the Morecambe Bay NHS Foundation Trust; there have been other issues around the trust, and any investigation will need to take account of all those issues. I understand that that is what will happen.

I am very grateful to the Minister for his considered and thoughtful response to the debate. I agree with him wholeheartedly on the importance of transparency and openness. However, where there are different clinical groups commissioning services from a single trust that operates a number of different hospitals, who actually holds the ring and decides which services are commissioned where?

The hon. Gentleman asks a very good and thoughtful question. It is the duty of the commissioning groups to work collaboratively for the best interests of patients. They obviously have responsibility for their own budgets and, as I say, they all ought to work collaboratively for the benefit of patients. However, if there are concerns about that, there is also a role in this process for the commissioning board, which will have some oversight over the process, to help to ease it through. In many parts of the country, there is already good evidence that the emerging local commissioning groups are working together collaboratively in just the way that I have described. I hope that that is reassuring for the hon. Gentleman.

We know that the Morecambe Bay NHS Foundation Trust has had a very long and troubled history. We also know that it serves a very important purpose in looking after people throughout north Lancashire and Cumbria. My hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) made clearly the good point that the configuration of the trust geographically is challenging. We, as a group, are going to meet together to talk through some of these issues and the troubled history of the trust, to ensure that we can do our best to work through these issues.

There have been problems in the past with the trust and local patients have not been treated properly, and they and their families have suffered. There have been long-standing concerns over local care quality issues. That may mean that we have to redesign the way that services are delivered; that may be an inevitable consequence of improving patient care in the long run. Nevertheless, the driver of this process must be delivering high-quality local health care within the envelope of providing improved patient care with better outcomes and safer care for patients. However, the only way that we will achieve that is if all the commissioners are working collaboratively with the trust in a more integrated approach to care. The failure to do that is where things have gone wrong in the past, and that is what needs to change in the future.

Sitting suspended.