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Stafford Hospital

Volume 565: debated on Thursday 4 July 2013

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

Thank you, Madam Deputy Speaker, for this opportunity for a debate on Stafford hospital.

On 31 July, the administrators of the Mid Staffordshire NHS Foundation Trust will present their proposals for the future of health services at Stafford and Cannock hospitals. They, as well as Monitor, to which they report, and the Government, have a tremendous opportunity to show the way forward for the NHS as a whole, which celebrates 65 years this week. This trust special administration is the first under the Health and Social Care Act 2012 and is a chance to show how emergency, acute and maternity services can continue to be provided affordably, locally, safely and to the highest standards. We are also talking about the administration of a trust that has been the subject of intense scrutiny since the revelation of appalling standards of care in some parts of Stafford hospital in the period to 2009. Since then the improvement has been marked, as the Care Quality Commission has evidenced, although there is no complacency about that on our part.

When tens of thousands of people marched through Stafford on 20 April this year to a rally that I had the honour to address, along with the Bishop of Stafford, we were showing just how much we value the services provided at Stafford and Cannock. We were also expressing our concerns about the future—a future that the contingency planning team’s report, which came out earlier this year, said was unlikely to include the provision of most acute, emergency and maternity services in Stafford, even though our maternity services have some of the best outcomes in the country. When the trust special administrators produce their report, I hope they will provide us with complete access to the data on which they worked, as well as the assumptions made—something that did not happen with the contingency planning team.

We were also making it clear that we cannot see how other, neighbouring hospital trusts, which are already under so much pressure, could cope with substantial numbers of additional patients who would have to come for treatment, travelling considerable distances on routes that are not well served by public transport.

Does my hon. Friend agree that if we do not keep a strong core of services in Stafford and at Cannock, the consequence for other trusts could be a deterioration in the care they can give patients, which would be highly detrimental for patient care right across Staffordshire?

I entirely agree with my hon. Friend. Many people, including those with more experience of these matters than I have, have said the same.

The coincidence of the publication of the Francis report—which was commissioned by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), whom I am glad to see in his place—and Monitor’s contingency planning team report into the future of services at Stafford and Cannock was, I have to say, unfortunate. Both organisations were running to independent timetables, but the coincidence gave rise to the incorrect impression that the proposed downgrading of services at Stafford was somehow the direct consequence of the failures in care until 2009. Let us be absolutely clear: it is not. In fact, the financial problems of the trust are long standing. It should never have been granted foundation trust status by Monitor back in 2008.

However, the impression that exposing poor care somehow resulted in threats to services had a double effect. First, blame was completely unjustifiably put on those who spoke out. Secondly, the impression was given that if people speak out in future anywhere else, local services might be at risk. The result is that Stafford has experienced ups and downs in the last few months. They include the wonderful coming together of a community of all ages and a group supporting the services at the hospital working across the political divide. Sadly, however, we have also seen cases of threatening behaviour against Julie Bailey and members of Cure the NHS, who courageously brought the serious problems at Stafford to light. I will not mince my words: it has been heartbreaking to hear people—good people, with the welfare of the community at heart—on opposite sides of an argument that should never have happened.

At the same time, hundreds of people in the community have put in a huge amount of time and effort to support Stafford hospital. I want to mention some by name. They include Sue Hawkins, Cheryl Porter, Karen Howell, Brian Henderson, Diana Smith, James Cantrill, Chris Thomas, James Nixon, Councillors Mike Heenan, Rowan Draper and Ann Edgeller, and Ken Lownds—who has put in a huge amount of expert work—together with my hon. Friends the Members for Stone (Mr Cash), for Cannock Chase (Mr Burley) and for South Staffordshire (Gavin Williamson).

But I wish to focus on the future, and I am going to concentrate on Stafford hospital although Cannock, too, is vital. Stafford is one of the many small district general hospitals up and down the country that play a vital part in our emergency and acute infrastructure. The number of acute beds has fallen substantially in the past 20 years, including in Staffordshire. The new PFI-funded hospital that opened recently in Stoke has 250 fewer beds than its predecessor, although it is none the less a wonderful hospital. We all welcome the fact that the length of hospital stays has fallen sharply, to an average of less than four days, but a report from the Royal College of Physicians published last year pointed out that there is little room for further reduction. Indeed, as the population begins to age, the average length of stay might start to creep up again.

The only way to manage acute beds, even at the current capacity, is to ensure that people do not have to be admitted in the first place. I am sure that we all want to see that happen, but it will depend on expanded community provision and the better integration of health and social care. That will happen, but it is not happening yet. Even when it does, my firm belief is that although it might halt the increase in demand for acute services, it will not reduce it at this time of a rising and ageing population. The Government are listening to experts who say that we need substantially increased rail capacity by 2035, so I am sure that they will also listen to the experts who say that we cannot cut any further the local and regional capacity for emergency, acute and maternity care. I say to Monitor and to the Government that Stafford is ready to be a national leader in such integration, with patients and the provision of the highest quality of care put first. However, that demands time and co-operation.

The first element of co-operation involves a larger acute trust. In the case of Stafford, the obvious partner is the University Hospital of North Staffordshire in Stoke. Working with UHNS as one team will bring advantages to both hospitals and both communities. For Stafford, the chance to become part of a university hospital will be an exciting prospect. We already welcome third, fourth and fifth-year medical students from Keele university medical school, and they report that they value the experience of working in a busy district general hospital. For the clinical staff at Stafford and at Stoke, the chance to work as a much bigger team across two sites would bring greater opportunities for them to develop their skills and experience. Frankly, for Stafford, it would also ensure that there was much less chance of a return to the complacent culture of the past that the Francis report identified as a major problem in parts of the hospital. For Stoke, which is already under considerable pressure as a result of the reduction in beds and has had to reopen up to 100 old ones, coming together with Stafford would offer welcome additional capacity. It would also create a larger catchment area, which would make some specialties that are currently marginal at Stoke much more viable.

But this would not be easy, as UHNS also has a substantial deficit and a PFI cost that is frankly unsustainable. I urge the Government to do everything within their power to cut the cost of UHNS’s PFI so that the 750,000 and more people who would rely on a combined major acute trust—whether in Stoke, Newcastle-under-Lyme, Leek Stafford, Cannock or further afield—can continue to have access to services delivered as locally as possible.

I congratulate my hon. Friend on securing this timely debate as we await the final report from Monitor at the end of this month. We must oppose any serious downgrading of Stafford hospital, but the other hospital that was poorly managed by the former Mid Staffordshire NHS Foundation Trust was Cannock Chase hospital, which has been mismanaged to the point that 50% of its hospital buildings are currently lying empty. There is therefore a threat to its future. Does my hon. Friend agree that any solution provided in the report at the end of the month must involve Cannock hospital being fully utilised, and Stafford hospital not being downgraded?

I entirely agree with my hon. Friend, and I congratulate him on the huge amount of work that he has put into ensuring that Cannock Chase hospital can be better utilised.

The second part of co-operation involves community services. Instead of seeing acute hospitals as buildings into which people disappear and then re-emerge at some point, let us make them a full partner in community services. In fact, they should be a hub for those services. Stafford, Stoke and Cannock can be groundbreakers in this, and set an example to the rest of the country. In Stafford, we long for the chance to show the country that we provide the highest standards of care, and that we will never again let patients be treated in the shocking way that many experienced in the past.

I thank my hon. Friend for giving way, and I commend him for bringing this issue to the Floor of the House. Does he agree that we have a national health service, and that any loss of services at Stafford could send out ripples that would affect services at Burton-on-Trent—also in Staffordshire, and also a hospital under some financial pressure that services a large proportion of the medical needs of my constituents in North West Leicestershire?

As usual, my hon. Friend makes a powerful point—that this debate is not just about a relatively small district general hospital, because it will have ripple effects. We have a pretty efficient national health service, but it does run on tight margins, so that if we take one acute hospital out, it could have effects right across the whole region. Local clinical commissioning groups have a vital part to play, and I want to pay tribute to the good work they are doing in developing community services in Stafford.

The third element of co-operation comes from Monitor itself. Under the Health and Social Care Act 2012, Monitor now has responsibility for setting tariffs, including those for emergency and acute services. It would be rather strange if Monitor were to continue the programme introduced in 2009 of constant 4% year-on-year real cuts in tariffs, and then be forced to pick up the pieces of acute foundation trusts around the country that fall into deficit as a result of the tariff cuts it has made. Monitor has the chance to challenge the assumption that acute services can continue to squeeze out annual efficiencies—in some cases, and not just in Stafford—of up to 7% a year, while elective services enjoy a relative feast.

Monitor has the opportunity to ensure that the necessary changes to the provision of acute services are done in such a way that will allow acute services to continue to be provided locally. Monitor itself could become an excellent example of joined-up government, and in doing so carry out its legal requirement under section 62 of the Health and Social Care Act 2012 to promote the

“provision of health care services which…is economic, efficient and effective, and…maintains or improves the quality of the services.”

Finally, the national Government have a vital role to play in co-operation.

I am most apologetic about arriving late to this debate and not having the opportunity to hear the opening part of the hon. Gentleman’s speech. To find a long-term solution for health care in Mid Staffordshire and in North Staffordshire, it is vital that the Minister refers in his reply to the best way of ensuring that the emergency services and all the other services that people want can be retained. That can be achieved only if we have a proper collaboration between the University hospital of North Staffordshire, which must be at the front of—

Order. Had the hon. Lady been here from the beginning, she would have heard what the hon. Member for Stafford (Jeremy Lefroy) said about that. Her intervention was rather long, and we are running out of time.

I would like to place on record my thanks to the hon. Member for Stoke-on-Trent North (Joan Walley) for her co-operation on this issue. She has really been of great help.

As I was saying, the national Government have a vital role to play in co-operation. Well distributed emergency and acute care is part of our national health infrastructure; it cannot be left entirely to local or even regional bodies to determine what is provided. My constituency and those of my hon. Friends the Members for Stone, for Cannock Chase and for South Staffordshire host the M6, the M6 toll road and both routes of the west coast main line and are also scheduled to host HS2. Stafford’s critical care unit provides a value supplement to the larger ones in Stoke, Wolverhampton and Walsall, in case they are under great pressure. There is a strong argument for such vital infrastructure to be funded nationally rather than being dependent on local CCGs, which, in the case of those in South Staffordshire, the Government have recognised receive considerably less than their fair funding share.

The administration of Mid Staffordshire is a great chance for Monitor, through the administrators, to show that it is listening to and acting on the concerns of my constituents about the need for vital emergency, acute and maternity services to remain at Stafford. This provides, too, an excellent opportunity for the Government to show first how they have responded to the Francis report by putting patients first, and secondly how the 2012 Act is not, as some would have it, about fragmentation and privatisation, but about co-operation and quality of care for the patients who must be at the heart of the NHS.

I pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy) for his tireless work in relation to Stafford hospital. I myself campaigned vigorously and successfully for a public inquiry, and was able to give evidence to it. However, the Government have still not arranged a debate on the Francis report, although it was published many months ago, in February. That is completely unacceptable. I know that the Secretary of State for Health wants a debate, so, for heavens sake, will the Government get on with it? Will they have their discussions, so that we can debate the matter and establish the root causes of what went wrong?

If the discussions do not produce the results which, as my hon. Friend said, are absolutely necessary, the national health service itself will not be able to live up to what people have claimed that it can produce. It could stand or fall on the basis of the results of those discussions. As we know from the media, many people are questioning the workings of the national health service, and with some justification. If the Government get this right, the health service as a whole will benefit enormously. I urge them to act.

Let me also say that the Prime Minister himself has expressed his concern about the treatment given to Julie Bailey, and we are following that up with the police.

Finally, I ask the Government and the Minister to make certain that Stafford hospital is given an opportunity not only to prove itself, but to prove that the national health service can work properly.

It is a great pleasure to reply to the debate. Let me begin by congratulating my hon. Friend the Member for Stafford (Jeremy Lefroy), and expressing my great admiration for the work that he has done so tirelessly during his time in the House. He has been a tremendous advocate for all his constituents, for the hard-working staff at the trust who are doing their best in very difficult circumstances, for all the people who have rightly spoken out about earlier problems at the trust, and for the patients. He is an example to us all of what a hard-working and dedicated constituency Member should be.

I also congratulate my hon. Friend the Member for Stone (Mr Cash), who has been raising this matter tirelessly for many years. It is a tribute to the efforts of both my hon. Friends that we have got to where we are today.

I can reassure my hon. Friend the Member for Stone that the findings of the Mid Staffordshire inquiry are at the forefront of the Government’s mind. As he will recall, our response to the Francis report set in train a number of important pieces of work. First, we asked Sir Bruce Keogh, medical director of NHS England, to look into 14 hospitals where there had been two years of higher than standardised mortality ratio indicators. That work is now reaching fruition. Following a report as damning as the Francis report, which looked into the culture of the NHS, we thought it right to investigate other hospitals that could give rise to concern, and we now think it right to examine the findings of Sir Bruce Keogh’s report before we report back to the House. We also set in train Camilla Cavendish’s review of nursing and Don Berwick’s inquiry into a minimum-harm and no-harm culture in the NHS. All those inquiries have formed part of our response to the Francis inquiry, and they have all been independent of Government. We shall have the reports in the next few weeks, and we shall then be able to arrange the more considered debate on the Floor of the House for which my hon. Friend has rightly called.

My hon. Friend the Member for Stafford was right to highlight the fact that the health care challenges in more rural areas, where travelling distances are longer, are by definition different from the health care challenges in urban areas. He was also right to highlight the fact that, throughout the NHS, in Stafford and elsewhere, we face the challenge, in both human and financial terms, of better looking after an ageing population and better providing dignity in elderly care.

My hon. Friend was right to highlight the fact that we need to support people such as Julie Bailey, who was treated appallingly in the light of her great courage and conviction. We must support people inside and outside the NHS who have the courage to speak up when there are concerns. We have made that clear in our initial response to the Francis inquiry report. That is why we have set up a whistleblowing hotline and are tackling the cultural issues in the NHS. We will support staff who want to raise concerns, so they can do so free of fear and intimidation. That is absolutely the right thing to do.

It is admirable that local people have continued to come out in full support of their hospital through the Support Stafford Hospital campaign. That was demonstrated by the 50,000 people who marched through Stafford with my hon. Friend in April and by other local events such as the Night of Light event in May. I am sure that we all agree that it is vital that the trust special administrator, currently in place at the trust, develops the right proposals for the future of services at the hospital to provide high-quality, affordable and sustainable services. I will return to that later.

The NHS is about to celebrate its 65th anniversary and its 65th year has perhaps been its most challenging. In that year, we have perhaps questioned some of the things that we held dear. I work in the NHS, I believe in it and I believe that our NHS should be and is one of the very best health services in the world, but when things have gone so badly wrong it is right that we learn lessons from what has happened, that we ensure that we put them right and that we support staff when they raise concerns. It is right that we drill into how to ensure that we listen to staff in learning how to put things right in local hospitals. We must also ensure that we create a culture in which trust managers always listen to what front-line staff tell them. In my experience, when things go wrong in front-line patient care, it is often because there is a disconnect between management and front-line staff. That is why the Government, through the Health and Social Care Act 2012, are embedding in the NHS a culture of clinical leadership, which will benefit patients massively.

On the future of Stafford hospital and the issues raised in the debate, the events that took place led Monitor to intervene and, over the past few years, there has been a whole health economy approach to improving services at the trust. That has led us to where we are today. Monitor, as the regulator of foundation trusts, appointed a TSA at the trust in April 2013 to determine the future provision of services at the trust. As we know, that process is ongoing.

I should be clear that, while the TSA is developing its proposals, I cannot discuss that in much detail. Nor is it known what the TSA is likely to propose. It is right that that process is free of political interference. However, what I would expect, and I am sure that my hon. Friend would agree, is that the TSA fully engages with key stakeholders during that process, including clinical commissioning groups, local health care providers, local authorities and local MPs, which I have been assured is the case. The TSA is legally bound to consult on its proposals and I would expect that any proposals meet the four tests for any service change and reconfiguration, which were set by the former Secretary of State for Health, now the Leader of the House of Commons.

Can the Minister assure me that, following publication of the report by the trust special administrator, as well as the people and communities in Stafford, the people and communities in North Staffordshire will be consulted? There are wider concerns about how any further collaboration will affect health care, which has to be improved in North Staffordshire as well as in Stafford.

I thank the hon. Lady for her question. As I highlighted earlier, it is absolutely right that the TSA will look at the whole health and care sector in Staffordshire, and of course the implications of any potential change for neighbouring hospitals. That is implicit in the work that the TSA is doing. This is, of course, not an issue I can dictate from the Dispatch Box or the Secretary of State determines. It is for the TSA to decide what its own work is, and it is important that that is done without political interference, so the right decision for local patients in Stafford and surrounding areas can be reached. I am sure the hon. Lady will agree about that.

I appreciate the concerns of my hon. Friend the Member for Stafford that acute services should remain at Stafford hospital. However, the TSA is independent of Monitor and therefore it would not be appropriate for Monitor—or, indeed, Ministers or the Department of Health—to seek to influence this process. My hon. Friend is aware that, at the request of the TSA, Monitor granted an extension to the period in which it can develop its proposals and the consultation period. I understand that the TSA is expected to consult on its proposals between August and October 2013, and I am sure my hon. Friend and his constituents will play an active role in that, and that the views expressed in the House today will be listened to as a part of the deliberations of the TSA and in the consultation process that follows.

I appreciate my hon. Friend and his constituents will experience uncertainty while the TSA develops its proposals. However, the TSA is engaging widely with the broader health economy as these proposals are developed and I understand that includes speaking with my hon. Friend and the Stafford Hospital Working Group. I would, therefore, encourage my hon. Friend to continue this dialogue with the TSA to ensure that his views and those of his constituents are fully taken into account as proposals for the future of Stafford hospital emerge.

I pay tribute to the work of my hon. Friend and my hon. Friend the Member for Stone, because if it were not for their work, we would not be where we are today and the people of Stafford and Staffordshire would be much more poorly represented. Their record speaks for itself and they have our full support in the work they are doing as advocates for their constituents. I look forward to continuing to support them in my role as a Minister, and the Government stand ready to support Stafford hospital.

Question put and agreed to.

House adjourned.