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Health Services in Staffordshire

Volume 596: debated on Wednesday 3 June 2015

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

Thank you very much indeed, Madam Deputy Speaker, for calling me to speak, and I congratulate you on your re-election, which is much deserved. I welcome the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), to his post, which is also greatly deserved.

With your permission, Madam Deputy Speaker, I will take interventions from colleagues, as the subject of the debate affects their constituents.

Staffordshire and Stoke-on-Trent face some serious challenges in the provision of healthcare in the coming months and years. Although some of these issues concern the County hospital in my constituency of Stafford, which, together with Cannock Chase hospital, was the subject of a trust special administration, I also want to examine the broader situation. I will touch on emergency and acute services, community provision, cancer and end-of-life care, general practice and the financing of the health service.

Accident and emergency services in Staffordshire have been under the spotlight in recent days, with reports of pressure on the A&E department in the Royal Stoke University hospital and statistics showing that the hospital has had the highest number of 12-hour waits in recent months. At the same time, the A&E department at the County hospital in Stafford has been treating patients in under four hours more than 95% of the time in many of the most recent weeks.

It has seemed both necessary and clear to my constituents for a long time that returning the County hospital’s A&E department to a 24-hour service would both relieve some of the pressure on the Royal Stoke University hospital and improve overnight services for the 300,000 people in the County hospital’s catchment area. So I welcome the Secretary of State’s support in this House yesterday for restoring the 24/7 A&E service

“as soon as we can find a way of doing it that is clinically safe”.—[Official Report, 2 June 2015; Vol. 596, c. 439.]

Safety, of course, is paramount; I am the sponsor of the Health and Social Care (Safety and Quality) Act 2015, and it is absolutely right that safety is paramount. Therefore, will the Minister say what steps have already been taken and when we can expect to see progress on this issue?

However, the problems at the Royal Stoke are not simply the result of additional patients from the Stafford area. As I understand it, they also arise from the long-term trend in rising emergency admissions, particularly of older people, and difficulties in discharging patients to their home or to community beds.

I understand that last week’s report about the possible closure of up to 100 community beds in north Staffordshire is not accurate. Nevertheless, there are real concerns about the future of our community hospitals. Any reduction in beds is likely to lead to further delays in the discharge of patients and have a knock-on impact on the A&E department at the Royal Stoke, which would affect my constituents as well as those of other hon. Members.

I commend my hon. Friend for securing this debate and I share his concerns, particularly because these issues also affect my constituents in Congleton. One of them has written to me expressing concern that cardiac patients needing to be urgently

“transferred to The Royal Stoke immediately on arrival at our local hospital A&E, Leighton”

can be at serious risk as a result of the additional pressures on services. Indeed, he says that if this issue is not resolved

“fatalities may be the consequence.”

I thank my hon. Friend. She makes a point that I think will be echoed by other hon. Members in the area.

The reason given for the potential closure of the community beds was that more care would be provided at home, but how precisely will that be done? I have to declare an interest in that my wife works as a GP in Stoke-on-Trent. From what I hear, community nursing teams sometimes have difficulty in managing the workloads they have at the moment, so where will the extra capacity come from? Surely it would be more sensible, before those beds disappear—if indeed they are scheduled to disappear—to ensure that the extra community nurses are in place and to show that there is a clear reduction in the need for such beds. I urge the Minister to question any proposed reduction in community beds—even if it is not of the order mentioned in the press last week—at a time when they seem to be most in need.

I will now turn to acute services in general. The University Hospitals of the North Midlands Trust has recently announced the closure of in-patient oncology and haematology at the County hospital. In future, there will be outpatient chemotherapy treatment, but in-patients will be seen in the Royal Stoke hospital. This move was not dealt with in any detail during the public consultation on the proposals of the trust special administrator, nor was it mentioned by the NHS in its information about the changes in services provided to my constituents or to those of my hon. Friends the Members for Cannock Chase (Amanda Milling) and for Stone (Sir William Cash), and my right hon. Friend the Member for South Staffordshire (Gavin Williamson) who are affected.

From a visit to a patient on the oncology unit at the County hospital last week, it was clear to me that the service was not only very busy, but greatly appreciated. Constituents have written to me saying how important it was to have the unit relatively close, so that they could be with their family through stays which were very difficult and often lengthy. Why move what is appreciated and working well? I understand that there are staffing problems, but surely those could be tackled. I ask the Minister to look at this again.

Does my hon. Friend welcome the statement made by the Secretary of State for Health the day before yesterday regarding the question of agencies and the absolute necessity to make sure they do not rip off the health service? May I also congratulate him not only on his splendid victory, but on the fact that he has just collected the Act of Parliament that he so successfully piloted last year?

I thank my hon. Friend. He has been a huge support in all these matters, which have at times been extremely difficult. He is absolutely right. I have come across cases of agency workers charging absolutely extortionate fees. I could give the Minister in private—he would be shocked to hear them—one or two examples of what I consider to be close to blackmail.

Another question is raised: if these important services are moving, without mention in the information to my constituents, are other moves planned of which we have no information? The loss of emergency surgery, consultant-led maternity, full level 3 critical care and in-patient paediatrics was—even if most were the wrong decisions—at least clearly set out and communicated with my constituents. These acute in-patient services were not. What we therefore need, and what I have been asking for since last summer, is a clear summary of exactly what services will be available and where.

Of course, this is primarily the responsibility of the UHNM Trust. However, it is grossly unfair to place this burden entirely on it. It has been asked to do a huge job in bringing together two acute hospitals, one of which has been the subject of a major public inquiry. It needs the full support of the NHS through the NHS Trust Development Authority and NHS England. I am asking the Minister to make it his responsibility to do precisely that.

I will now turn to the tender for cancer and end-of-life services throughout the west of Staffordshire and Stoke-on-Trent. The proposal has been developed by NHS England, the four clinical commissioning groups covering North Staffordshire, Stoke-on-Trent, Stafford and surrounds, and Cannock Chase, and Macmillan Cancer Care. The objective is clear: to improve cancer outcomes, which are currently below the average for England and well below the European best, so that survival rates are among the best in England by 2025 and subsequently among the best in Europe.

I commend my hon. Friend for securing this debate and for the fantastic work he has done over the last five years, both for his constituents and for people across Staffordshire. We welcome the work he does, and I am sure he would join me in thanking the doctors, nurses and clinical staff across Staffordshire who have worked so hard to get improved care across our county. Does he agree that we still have a fragile healthcare economy in Staffordshire? I managed to secure £8 million for East Staffordshire CCG thanks to the help of the previous Health Minister, but that is for just one year, so does my hon. Friend agree that we need to move towards fairer funding in Staffordshire?

I entirely agree with my hon. Friend and reiterate his remarks about the excellent work done in my constituency by staff at the County hospital to recover the situation, which a few years ago was extremely difficult, to one where the quality of care offered is of a very high standard.

To return to cancer and end-of-life services, the real concern has been over the method being used. To quote Macmillan:

“We think a procurement process is the best way to integrate the fragmented cancer and end of life services we have in Staffordshire. A procurement process is needed because at the moment there is no one organisation with overall control of cancer or end of life services.”

My argument has always been: in that case, what are CCGs for? They are there to commission, so why can they not commission? In the last Parliament, we gave them the ability to work together to procure services, so why cannot the four CCGs involved, together with Macmillan, simply make that happen? The answer I was given at the time was that the constraints on CCGs’ own administration costs—a reducing amount of funding per head—meant that it was impossible. Sometimes I am puzzled. We see this all over Government and have done for many years and across many Departments: we constrain spending on so-called bureaucracy and then, in order to get necessary things done, pay large sums of money to consultants to do precisely the kind of bureaucratic work that we forbid the experts from doing—in this case the CCGs—but, because it is called consultancy or programme work rather than overheads, it is allowed. There is a problem that needs to be solved—I do not deny that—and it affects the lives of my constituents and those of other Members, so it must be solved.

Macmillan says about the first two years of the contract:

“The main responsibility of the integrator will be to address the current inadequate data about pathway activity and the real cost of this activity. Much increased investment over the last decade has arguably been wasted by poor contract accountability and a lack of reliable data and analytics.”

That is important, but it is a research and advisory role. I have no problem with the CCGs calling in experts to offer them such research and advice, whether it is a private company, university or, indeed, another arm of the NHS. A fee will be paid for that work. Again, I have no problem with that, but I would like the Minister to say how much it is likely to be. As local MPs, we have a right to know, on behalf of our constituents, or at least have a rough idea.

According to Macmillan, after 18 months the integrator —I would say consultant—will be expected to

“present a more detailed strategy as to how they expect to achieve improved service outcomes. If the evidence is robust, arrangements will be made for all contracts to be transferred to the Service Integrator from the beginning of year 3. If not, the contract with the Integrator could be terminated and the Service integrator will be required to repay all (or a significant part) of their fee to date.”

That is where I do not see the logic. What makes an organisation that is good at research and advice the right body to run cancer services for our constituents? Why can it not simply be thanked for its advice and that advice, if it is good, be followed by the CCGs, working in co-operation with the providers? The risk is that the vital work that patients, the CCGs and Macmillan have done, with the very best of intentions, will be damaged by contractual arrangements that do not make sense and may put a private organisation with a somewhat different ethos in charge of commissioning NHS providers for services, rather than the other way round.

I have no problem at all with a private organisation producing a much better plan for cancer and end-of-life services, nor do I have a problem with social enterprises or private providers being involved in delivering certain elements of that plan, as they do now and have done under Labour, coalition and Conservative Governments. However, I do not see the logic in the organisation producing that plan becoming another bureaucratic tier between the CCGs, providers and patients. I therefore ask the Minister to take up the proposed contract with the CCGs.

The state of general practice is gradually becoming critical in our area. Many GPs are retiring or approaching retirement. I welcome the Government’s plans to train more GPs, but we will also have to train more medical students or rely on recruiting from overseas.

In Health questions this week, an issue close to my heart was raised about GP numbers and how many doctors are choosing to become GPs. We have similar issues in Northern Ireland. The difficulties in Staffordshire have been outlined, but they are mirrored across the whole of the United Kingdom, and particularly in Northern Ireland. Could any steps be taken to encourage more doctors to become GPs, thus dealing with the problem of the massive number of patients that each doctor has, because we are getting to the stage where doctors will not be able to cope?

I am grateful to the hon. Gentleman, who hits the nail on the head. It is vital to increase the number of medical students and those training as GPs. I know that the Government want to do that and are committed to it, but I believe they need to expand the number of medical school places.

What plans do the Government have for expanding the number of medical school places and ensuring that those trained stay and work in the NHS, particularly in those areas that are running short of GPs? A seven-day personalised service is an ideal, but those GPs who take the care of their patients extremely seriously—and that is the vast majority of them—are already working extraordinarily hard. The European working time directive most certainly does not apply to GPs, even if it does to the rest of the NHS, and if it were to apply, our family doctor service would fall apart.

Finally, I wish to address the financing of the NHS in Staffordshire. All parts of it are under strain. The KPMG report showed, although some of its solutions have rightly not been accepted, that there is a serious problem. The answer is not to be found in short-term fixes, whether they be in Staffordshire or elsewhere. The NHS England 2020 plan—tough though it is—gives us the opportunity to think long term. Yesterday, I argued in this place for a cross-party commission, including the medical professions, on the future of health and social care and its provision and financing for the 20 or 30 years beyond 2020. I repeat that call today, and I urge the Minister and his colleagues to take up the challenge.

It is a great pleasure to serve in this, your first Adjournment debate of the new Parliament, Madam Deputy Speaker. I am delighted that you have found your seat again. It is a great pleasure, too, to respond to my hon. Friend the Member for Stafford (Jeremy Lefroy), who has been a model for many of us in the 2010 intake in his advocacy of local health issues. He was rightly recognised for so doing in the election, and I am delighted that he, like so many of my hon. Friends, was returned with such a considerable mandate as a result of his hard work. I congratulate him, too, on securing this important Adjournment debate, which continues the battle he has fought on behalf of his constituents over the last Parliament.

Let me say first that the initial meetings I have had in my new position have in large part centred on the issues raised as a result, both directly and indirectly, of the terrible events that befell the Mid Staffordshire trust. My hon. Friend’s bringing of this Adjournment debate is timely in that sense.

I shall first address some of the specific issues my hon. Friend raised about the procurements recently spoken about in the press before moving on to deal with the more general issues. None of this has been particularly helped by some of the comments in the local media. Looking at the CCG’s proposals to improve the organisation of cancer and end-of-life services, which my hon. Friend raised first, I would like to announce to him and the House today that a public-private consortium led by two NHS trusts is now the sole remaining bidder and is in the final stages of talks with the CCG to manage the cancer care pathway. This is an innovative model. I know my hon. Friend has some reservations about it, but it is the first of its kind and it should greatly help to improve and develop services for patients. It is one of the outcomes we wanted to see from the changes in his county, so that health excellence emerges out of the terrible events that occurred. I know we share a common position on that.

Four CCGs are in the process of procuring this consortium to act as a service integrator for the wide range of organisations in the area providing cancer care and to improve the journey of patients in the county and their experience of the care they receive. Dialogue will now continue.

My hon. Friend asked about the role of advisers, consultants and the associated costs. I cannot give him the details now, but I will ensure that they are provided to him. I will ensure also that all officials, including those in the CCG, have the discussion about the role of consultants and advisers in order to satisfy him—or not—on that matter.

Let me now deal with some more general points about the health economy in which my hon. Friend’s constituency sits. It is challenged, and it has been challenged for a long time. Last year, Staffordshire was identified as one of the 11 most challenged local health economies in England. The healthcare organisations in those areas need intensive support to ensure that, as a minimum, services are clinically and financially sustainable over the next five years.

Many of the problems faced by Staffordshire have lain unaddressed for years. Recruitment and retention problems are not unique to the county—other parts of the country experience them as well—but, as my hon. Friend will know, they contributed to the dreadful events on which he has become an expert. Change is needed, not just in the hospitals but in the local health economy as a whole.

As my hon. Friend has already explained, the county hospital in Stafford is now part of the new University Hospitals of North Midlands NHS Trust—in alliance with services in Stoke—but that in itself is not enough to ensure that patients get a better service. That is about much more than a change of management. A solution often used by the NHS involves concentrating services on a single site, so that professional skills are maximised and patients receive much better care.

Although there is a need to reorganise, reorganisation is not just a switch of management location; services themselves must change. That process must be led by local clinicians, working in a partnership between hospital and community, and taking the views of patients into account. The eventual structure cannot be imposed from the outside, nor can there be a “one size fits all” answer. Stafford’s geography, population distribution, transport links and distance to nearby towns and cities, for example, are all relevant to a decision on how services should be set up. Any solution must take account of those factors, as well as others such as disease prevalence and age profile, which are, perhaps, more obviously health-related.

Let me—briefly—remind my hon. Friend that people in the deep rural parts of my constituency are served by the county hospital and the University Hospitals of North Midlands NHS Trust. It is important to ensure that, when there is a lack of easy communication on the motorway, they too are specially looked after.

That is precisely the point that I made to the clinical commissioning groups when I spoke to them yesterday. I appreciate its importance, and not just on the basis of my own experience of representing an urban seat in a largely rural county.

My hon. Friend the Member for Stafford raised the issue of community beds. I need not advise him to exercise caution when it comes to believing everything that he reads in the press. However, there will be consultation about any changes that do take place, and I know that the Trust Development Authority and the commissioners will work together to ensure that they take place in a coherent fashion. Following my forthcoming meeting with chief executives and the TDA commissioners, I shall be happy to meet my hon. Friend and others to discuss changes in services if that will help to allay his concerns.

I have had detailed discussions with commissioners and NHS England about haematology and oncology services. Although there was a thought that they had been mentioned in original documents, I must say that I, too, found such mentions to be lacking. I am afraid problems of that kind are often encountered in the NHS, and that, in the past, consultations have not been as full or as pertinent as they should have been. I have asked the NHS again to consult specifically on those services, and also to engage in a full and proper consultation with patients and local groups. The same will apply to any other services that may come into question. I take my hon. Friend’s point about the need for a list of services, and I will pass it on to the CCGs, because I think it is important.

I am most grateful to the Minister. It is very good news that there will be proper, extra consultation. As I said earlier, last week I visited a patient whom I know, and saw the excellent service that is currently being provided. It would be a real loss—more than that, a tragedy—were that service to be moved.

I stress that it is not for me to design the outcome of that consultation, because the whole point of what we are trying to do is to allow clinicians to make that decision, but they must consult properly. The same pertains for A&E. My right hon. Friend the Secretary of State has said that round-the-clock A&E services—I know he has made this point specifically to my hon. Friend—could return to Stafford if clinically safe to do so.

There is a need for quality services to be delivered immediately, however, and that is why I am concerned also about the situation at Stoke, where issues clearly need to be addressed in the immediate term. I wrote yesterday to the chief executive of the University Hospitals of North Midlands NHS Trust to arrange a meeting with him, local commissioners and the TDA to see what can be done immediately to help improve the emergency services at Stoke. I will of course speak to my hon. Friend following that meeting to bring him up to date on the conclusions of that discussion.

I also understand from the local NHS that the plans are resilient and will deliver better services, and that the work is being led by CCGs and local authority commissioners. They are redesigning the Staffordshire health and social care economy to ensure that patients enjoy the benefits of a safe, high-quality and financially sound service in the long term. That is their assurance to me. My job, and my hon. Friend’s, is to ensure that they fulfil their promise.

My hon. Friend brought up two separate issues more generally about agency nurses and consultants, and he will have seen the announcements made by my right hon. Friend the Secretary of State yesterday and today about them. Both go to the heart of the matter my hon. Friend raised and demonstrate how we in this Government are prepared to move rapidly on the matters facing the NHS in the early days of this Parliament to ensure that we can deliver the excellence in healthcare that we know our constituents deserve and wish for.

The Minister for Community and Social Care, sitting beside me, has heard my hon. Friend’s comments on GP numbers. That is a challenge throughout England and in my constituency, and one that we hope to address in part by the 5,000 additional general practitioners whom we hope to recruit in the next five years. We will, however, bring forward a range of measures to ensure that general practice not only survives but flourishes in the years to come.

In conclusion, I thank once again my hon. Friend for bringing so carefully and diligently these important matters to the House’s attention. It has allowed us to explore some of the wider issues facing the national health service. I hope I have provided him with a few points of consolation and also reassurance on how the Government and local health commissioners will proceed with the matters that he has raised. If he has any further complaints, problems, wishes or desires about his local health service, he should come to me. That invitation extends to his colleagues in the county of Staffordshire as well.

Question put and agreed to.

House adjourned.