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Health Care Provision (Newark)

Volume 590: debated on Wednesday 7 January 2015

I start by thanking Mr Speaker for granting the debate and the Minister for replying this morning. I am also grateful for the attention of the Secretary of State, who visited Newark hospital last year. I thank my constituents and the Newark Advertiser, who have come here for the debate, and I thank my constituency neighbour, my hon. Friend the Member for Sherwood (Mr Spencer). Rather like the film “Groundhog Day”, the last debate on the subject was held two years ago to the day. The matter has moved on somewhat since then and progress has been made, to which I will refer shortly, but concerns remain. That is the reason why I return to the subject today.

I do not want to bore the Minister, but a little bit of history might be useful. I know that she visited Newark three times in May last year, but let me briefly guide her. We sit on the border between Lincolnshire and Nottinghamshire, and despite excellent north-south road and rail links, the community is relatively remote and rural, and it is bedevilled by poor roads and awful traffic. Newark is a growing town, with applications for thousands of new homes being considered as we speak and many more to follow, according to local growth plans. We have an older population, and the number of over-65s is likely to have doubled by 2026. I fear that Newark 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 created in places such as Lincoln, Nottingham and King’s Mill hospital, but not in Newark. For reasons of population scale, Newark hospital was linked to King’s Mill hospital some years ago. They were, and remain, uneasy bedfellows, because there are few natural connections and poor transport links between the two.

I congratulate my hon. Friend on securing this important debate. In the two years that have elapsed since the previous debate, one thing that has changed is the transfer of more than £80 million in private finance initiative payments from Sherwood Forest hospitals trust to its PFI holder. What impact is that having on Newark hospital and Sherwood Forest hospitals trust?

I thank my hon. Friend for his campaigning on PFI and Sherwood Forest hospitals trust. I will return to that question later in my remarks, because it is one of the central issues affecting the trust’s ability to deliver good-quality health care not only for my constituents, but for his and for people throughout Nottinghamshire.

To return to my brief history lesson, the hospital delivers superb services, and it always has done, but those services have diminished relative to those that were offered in the recent past. In addition, as we have heard, King’s Mill is saddled with a devastating PFI that will be in place for 30 years. The problem is not new; it has been a hot potato in the Newark area since at least 2004, and there is a history of declining services including the loss of maternity care in the increasingly distant past. The PFI was put in place, and in 2010—bridging the previous and current Governments—the A and E department was replaced with a minor injuries unit. I say that, but the classifications in the NHS seem byzantine to us amateurs, and even if they are not designed to confuse us, they undoubtedly have that effect. The department called itself an A and E for the best part of 10 years, but it did not qualify to be one. It was always going to be extremely painful to change the department’s title and inform the community that the back-up available at the hospital was insufficient to be safely called an A and E and to have ambulances directed to it for the commensurate range of emergency situations.

In 2012, Monitor delivered an extremely critical report on the PFI and the trust, which includes King’s Mill and Newark hospitals. The report pointed out that Newark hospital was, at times, underutilised by some 55%, and it was closed for admissions after 6 pm. Good has come from that report, including new management and significant improvements at the trust. However, the trust, as the Minister knows, remains in special measures, with a corresponding impact on recruitment, retention and the reputation of the trust and its hospitals among my constituents and those of my hon. Friend the Member for Sherwood.

To return to the hospital and bring us closer to the present day, some services, including those related to hips and knees, have been removed in recent years following the Keogh report and the imperative, we were told, to ensure that services are matched to appropriate levels of staffing and back-up. The trust is in the process of refocusing Newark on day case services and diagnostics. We all understand that the transformation of services takes time to implement, and the period of change has seen some underutilisation. I suspect that that period has gone on too long. Furthermore, there have been problems about directing patients to the appropriate hospital and ensuring that that hospital is Newark if the services are still available. I have lost count of the number of times that constituents have told me that they were not offered Newark hospital or had to ask for it specifically, when we know that the hospital delivers the necessary services. That contributes to underutilisation and must be resolved once and for all.

On top of those difficulties, East Midlands ambulance service received a concerning inspection report by the CQC at the beginning of 2013, which found it to be underperforming in four of the six central measures. As medical professionals agree that the most serious emergency situations are best treated by fully staffed and equipped general hospitals, the imperative becomes greater to have an ambulance service in north Nottinghamshire with the capacity to respond swiftly and meet the appropriate timings for our constituents. Furthermore, residents complain about the length of time taken to repatriate those who are no longer critical but who require rehabilitation or some further care closer to home. That is made all the worse and more onerous by the long journeys and expensive bus fares required for relatives to visit.

To bring my history lesson to a close, I want to report some positive developments of late. In 2013, a new 13-bed ward, the Fernwood recuperation and rehabilitation unit, opened. The Bramley children’s unit, new cardiac services and an endoscopy suite have all opened. The CT scanner at the hospital, which had reached the end of its natural life, is—admittedly after some pressure—to be replaced. The trust has appointed a new director, Mrs Jacqueline Totterdell, with the specific objective of bringing Newark hospital up to full capacity in the range of services that it provides. This week, the trust and the clinical commissioning group have announced a capital investment of more than £500,000 to enhance the facilities of the minor injuries unit, providing a better patient experience and more consultation rooms, and integrating the MIU with out-of-hours GP services. That development is the successful result of an application to the Prime Minister’s challenge fund.

Those developments are refreshing and should be celebrated. They confirm that the old rumours in the town that the hospital was to close are unfounded. The trust has made that clear. They also suggest a welcome degree of focus on the hospital by the trust and the CCG, which I hope will continue and which must intensify. I praise the clinical leader of the CCG, a respected Newark doctor named Dr Mark Jefford, for his role in that.

Where do we go from here? My objective, which I am sure that my hon. Friend the Member for Sherwood shares, is to ensure that Newark and north Nottinghamshire have health care provision of the highest possible quality delivered as close to home as is safe. I gave this debate the title “Health Care Provision (Newark)”, as distinct from the previous debate, to emphasise the fact that my interest is precisely that. My interest is not in bricks and mortar, and it is not driven by nostalgia or false science.

I return to the emergency provision. We still hear forlorn voices talking about the reopening of an A and E unit, but no one who understands the problem could think for a minute that Newark will have an A and E unit. I want to make it clear that that really is not the issue at hand. The issue is whether the present MIU or urgent care centre—whatever one wishes to call it—adequately reflects the fundamental remoteness of Newark and the surrounding area of Nottinghamshire, and whether anything can safely be done to provide a higher degree of emergency provision. Again, terminology gets in the way but, for the sake of argument, let me call it MIU-plus—in other words, providing sufficient support to enable Newark hospital to take a greater proportion of the so-called green cases. One can argue about what the proportion might be but, clearly, any material increase in the types of cases that paramedics could safely bring to Newark hospital, or that the hospital accepts from those walking into the MIU, would result in a range of benefits: shorter journeys to hospital for those in Newark and rural areas; less pressure on the ambulance service; and greater convenience for patients and their relatives. The benefits would surely be felt throughout Nottinghamshire and Lincolnshire and would take pressure off overstretched A and E departments.

In my time as a Member of Parliament, I have argued that, if a clinical case can be made, there is no reason why such an MIU-plus should not be introduced at Newark hospital. I have sought the advice of the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who, without detailed knowledge of the circumstances, pointed me in the direction of a hospital in Hexham where GPs, local authorities and the hospital trust have integrated to a degree to preserve and enhance services in a remote area.

Members of the management and leadership of the trust and CCG with whom I have discussed the matter over the past couple of months take a different view. They think the system would be extremely difficult to implement safely. I would be grateful if the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison) gave me her view, today or in the future, on exactly how realistic the proposal is. Members of the public seeking an outcome not wholly dissimilar to the one I have described have written to various authorities, including Ministers and NHS England, but have been unable to gain their opinion on that route. I admit to banging on about this, continuing a line of argument that has been made unsuccessfully for some time, but I raise it again because it is strongly felt by my constituents. I seek the Minister’s guidance and, of course, the ear of the trust and the CCG.

As I have already described, the heart of the problem in Newark and Nottinghamshire is the interlocking concern about the adequacy of the MIU and the performance of our ambulance service. East Midlands ambulance service has new leadership, a new chair in Mrs Pauline Tagg and acting chief executive in Mrs Sue Noyes. The ageing fleet, which I have seen myself, will be upgraded, including with welcome new vehicles for north Nottinghamshire. The trajectory appears to be upwards, which is welcome. Any support that the Minister and her Department can give to EMAS and its leadership would be greatly appreciated.

I recently spent time with paramedics and was hugely impressed. They face the challenge of operating in a large geographic area. A and E is under strain, and a contributing factor is the very limited circumstances in which paramedics are able to take patients to Newark. Whatever one’s view on that, there is a lack of clarity on those circumstances. I am told by one source that a lad breaking his arm on a football pitch, suffering no other major symptoms, could be taken to Newark, but I am aware of plenty of cases in which paramedics could not take such patients there or have been turned away. I am told that the number of circumstances in which paramedics may take patients to Newark has increased, yet I have seen a crib sheet in ambulances that appears to show that the number has decreased by two. I do not know the rights or wrongs—I am not a clinician, so I cannot say—but that must be cleared up urgently. Fundamentally, the rurality of Newark and north Nottinghamshire needs to be addressed with adequate ambulance capacity,

Finally, I will address the PFI debt, which my hon. Friend the Member for Sherwood mentioned. Monitor expressed concern about the financial situation of Sherwood Forest Hospitals NHS Foundation Trust. The trust signed its £320 million PFI deal for the redevelopment of King’s Mill hospital in November 2005, and in 2012-13 the trust’s PFI cash outflow was £42.5 million, which equates to 17% of the trust’s income. If ever we needed an example of a terrible PFI deal and debt, this is it.

The trust operates with one hand tied behind its back. In December, my hon. Friend and I asked the Secretary of State for Health whether he would review the trust’s finances as it is both in special measures and suffering the consequences of a disastrous PFI deal. He agreed to do so, and I ask the Minister to make good on that promise. PFI contracts are complex and the options available to the trust to reduce the current burden—whether that be some form of refinancing, the buying back of debt or addressing parts of the contract not yet or inadequately executed—are complex and require analysis. The trust has limited resources to devote to the analysis required, which would presumably require the help of outside specialists. Are the Minister and the Department willing to sponsor, by which I mean pay for and support with advice, a full review of the PFI deal, with the objective of presenting options to the trust that can be reviewed and, I hope, implemented? I make that request with the full support of the trust’s chief executive. Such support would make a difference to the trust, my constituents, my hon. Friend’s constituents and the constituents of many other north Nottinghamshire Members who have not been able to join us this morning.

In addition to my specific questions, I leave the Minister in absolutely no doubt of the importance to my constituents of Newark hospital and of health care provision in north Nottinghamshire. Newark hospital is much loved. I was there on Christmas morning, and patients and their relatives had the utmost respect for the wonderful staff. My constituents, and people across Nottinghamshire, want an inspiring vision of what their health care provision will look like, but a vision without substance is an illusion. My constituents now want a credible plan in which they can believe, a plan that ensures that health care continues to improve for them and for future generations in this growing and rural community. That, in essence, is what we seek today.

It is a pleasure to serve under your chairmanship, Mr Turner. I apologise for being a stand-in for the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). I know he has previously debated these issues with my hon. Friend the Member for Newark (Robert Jenrick), whom I congratulate on securing this debate. It was a pleasure to go to Newark to campaign for him during the by-election. Literature that we all delivered told us that he would be a doughty campaigner, with health at the heart of his campaigning and his representations on behalf of his constituents. He has evidently made good on that promise in his relatively short time in the House. I am very aware of his dedication to ensuring that the health needs of his constituents are met. It is also a pleasure to see my hon. Friend the Member for Sherwood (Mr Spencer), who is another assiduous local Member and a valued colleague who has the health concerns of his constituents at heart.

This debate is a welcome chance to discuss local health care matters. I know both my hon. Friends regularly meet local health leaders, which is right. The depth of knowledge that comes across from both Members this morning is the result of that engagement. I encourage such engagement because it allows Members to be best placed to bring their constituents’ concerns to the House.

I recognise, as does my hon. Friend the Member for Newark, the hard work and dedication of NHS staff in his and other constituencies. He rightly describes them as wonderful, and it is excellent to hear that he was with them over the Christmas break. More than 4,000 staff are employed by Sherwood Forest Hospitals NHS Foundation Trust alone, in addition to the thousands who work in primary care. We thank them for their service at a time when we know they are under pressure.

It is all too easy to overlook primary care’s essential contribution to health care provision. The local GP or pharmacist is the key health care provider for many people. I will talk about the local hospital in a moment, but that foundation of good primary care is important. I am delighted that, through the Prime Minister’s challenge fund, Newark and Sherwood CCG is working with the hospital, local GP practices and Central Nottinghamshire Clinical Services, the out-of-hours provider, to improve access, reduce complexity for patients and ensure a sustainable staffing model. Given the pressure on the system over the Christmas and new year period, we can see only too well the importance of that work and the challenge fund in finding new ways to provide primary care access. In 2014, Mansfield and Ashfield CCG and Newark and Sherwood CCG were awarded a total of just over £1.8 million from the Prime Minister’s challenge fund, which was part of a £5.2 million collaborative funding bid that was spent in this financial year.

My hon. Friend is right to make Newark hospital the heart of his speech. Although there is legitimate concern, much of the worry caused for patients and the public in Newark has simply been unnecessary. I know he realises this but, for the record, the number of patients being treated is increasing. In 2012, the number was about 131,600; it increased to almost 133,500 in 2013. There is also more day care surgery, as my hon. Friend mentioned. The number of out-patients’ appointments is increasing and the number of specialities offering appointments at Newark is up. There is also improved provision for children.

I quite understand, however, why my hon. Friend wants to emphasise the need to keep building on that progress. He focused much of his speech on the minor injuries unit and urgent care centre. I can only sympathise with him with regard to navigating a way through terminology, because I am well aware that some terms mean different things in some parts of the country and that our health economy, because of its sophistication, is sometimes quite complex. It is therefore incumbent on all of us—Ministers, local health leaders and so on—to try to cut through that complexity as much as possible to make clear to local people what they can expect to get in a particular facility, what they would go there for, and where that facility fits into the local health economy, as well as the fact that it is part of a plan.

Newark provides consultant-led out-patients’ services, planned in-patient treatments, day-case procedures, diagnostic and therapy services and the MIU-UCC. My hon. Friend spoke about the need to increase the range of services. He is right to do so and to put forward his constituents’ concerns. As he outlined, there are plans to enhance the services offered at Newark hospital through the Newark strategy. He gave a history lesson at the beginning of his speech; I am well aware that there have been a number of strategies, but the current Newark strategy is being implemented, and I am encouraged by what I heard, in preparing for the debate, from local senior leaders. However, he is right to say that progress must be maintained.

The strategy includes Newark hospital being a centre of excellence for a broad range of services, including diagnostic, rehabilitation and so on. A number of new developments are already in place and a £500,000 development to make structural changes to the MIU is planned, which will make urgent care simpler and increase the range of Newark-based services.

As I said, I will take this debate as an chance to emphasise that if there is a lack of clarity locally—I can understand that there might be—local health leaders and all of us who work in and around the health system must work hard to ensure that the public, who are the users and end recipients of our excellent NHS services, really understand what is being offered. It is vital that they do.

The plans I mentioned include provision of additional consulting rooms, so that health care staff, including hospital staff and GPs, can work alongside each other instead of at separate locations. Building for that should start in April, which is really encouraging and testimony to my hon. Friend’s efforts to keep this a front-foot issue. Such evidence of the hospital’s long-term future is extremely welcome and should be reiterated.

With regard to the suggestion that more ambulance patients might be taken to Newark hospital, I understand that the local NHS has identified safety concerns with that. The level of emergency care was reviewed locally in 2013 as part of the development of the Newark strategy. As I know that my hon. Friend will appreciate, a patient’s diagnosis will not always be clear when the ambulance crew first arrives at the scene, so more comprehensive diagnostics are required—diagnostics that often need to be done in a main centre before a serious condition can be excluded.

I am told by the local NHS that the conveyance of all green ambulance calls to Newark would result in a limited improvement in ambulance response times, but I hope that it has looked at that carefully, has heard what my hon. Friend said today, and is giving proper weight to that. I know that for both my hon. Friends, the safety of their constituents is a paramount concern. They will know that for the Secretary of State for Health, the safety and quality of our health system is a touchstone issue in this Parliament, and we have debated significant safety concerns in recent years. When local clinicians believe that there are safety risks, it is important that their opinions carry weight and that we listen to those concerns closely.

My hon. Friend the Member for Newark has already discussed with the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, whether hospitals elsewhere might provide helpful examples for both Sherwood Forest Hospitals NHS Foundation Trust and Newark hospital. Hexham was mentioned as one such example. While parallels can be drawn, an exact comparison cannot, as my hon. Friend the Member for Newark acknowledged. There are some similarities between the services offered at those sites, but Hexham is a larger site with a more remote community. I note, however, what he said about his constituency being mixed, with some areas being much harder to get to owing to their road services.

GP services are offered at Hexham, and the new extension at Newark will enable that to happen in my hon. Friend’s constituency, which will be welcome. As he is also aware, decisions on local services, including urgent and emergency services, are a matter for local NHS leadership because they are the people, working with elected representatives, who know the local community best. The local NHS is clear that decisions about services will be based on patient safety and sustainability, which, having seen some of the problems uncovered in this Parliament in cases such as Mid Staffs, is what we all want as the foundation on which we build.

It is good to hear that progress is being made, but the elephant in the room remains the £40 million a year in PFI payments. Until we solve that problem, the challenges will remain. In the time remaining, will the Minister discuss that?

I will; in fact, that is on my next page. My hon. Friend is right to bring me to that. On the trust’s financial position, as my hon. Friends have mentioned, Monitor assessed Sherwood Forest Hospitals NHS Foundation Trust in 2012 and identified issues that had contributed to its deteriorating financial performance. The trust signed its £326 million PFI deal under the previous Government in November 2005 for the redevelopment of King’s Mill hospital. The trust’s PFI cash outflow equates to some 17% of its annual income, which is clearly a substantial amount. The operating costs for that scheme are inflating with the retail prices index by about £1.5 million a year. My colleagues are therefore right to raise that considerable concern.

The trust has received ongoing financial support directly from the Department of Health: it received £28 million in 2013-14 and £26 million in 2014-15. However, as my hon. Friends realise, it is important that I emphasise that such funding is not sustainable as it takes resources away from other areas. We therefore clearly need a better solution.

The trust forecast a financial deficit this year, but Monitor does not have any immediate concerns about the sustainability of services at Newark hospital. I put that on the record as a note of reassurance for my hon. Friend the Member for Newark. The trust recognises the challenge that its PFI payments present—that has come out clearly in my discussions—and it accepts that the solution lies in the full involvement of all partners in the local health economy. The Better Together programme for Nottinghamshire goes some way towards achieving sustainability, and local commissioners continue to work with Monitor and NHS England, as they need to, to find a solution.

I am aware that there have been suggestions locally that Sherwood Forest Hospitals NHS Foundation Trust should look at the route taken by Northumbria Healthcare NHS Foundation Trust and buy out its contract. However, the overall PFI deal for Sherwood Forest is much bigger than Northumbria’s, so a similar buy-out would incur a far greater cost. That is a note of caution.

The Department and the Treasury have discussed a range of options to reduce the cost of PFI projects in general, using public sector capital, including buying senior debt and terminating contracts completely. It is however for individual trusts to be clear about what options they have considered and to bring proposals forward.

Looking around the country, it is clear that the individual schemes have complexities, in terms of when they were signed, effective pricing and risk profile, so it is important both that such matters are looked at carefully at a local level and that the Department is engaged early on by trusts and foundation trusts when they develop their proposals, which will then be considered carefully by the Department of Health and the Treasury—and Monitor, if required—on a case-by-case basis for value for money and affordability. That is what happened in Hexham.

In the time left, I want to assure my hon. Friend the Member for Newark that my right hon. Friend the Secretary of State, as he said last year, will be happy to consider any proposals brought forward. We are very much open to that.

I am left with little time to comment on the ambulance services, other than to say that although we acknowledge that there are some big challenges, a resilience plan is in place and we will monitor that carefully. I end by congratulating my hon. Friends the Members for Newark and for Sherwood on bringing this important topic once again to Ministers’ attention.

Sitting suspended.