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Barking, Havering and Redbridge University Hospitals NHS Trust

Volume 598: debated on Wednesday 15 July 2015

I beg to move,

That this House has considered the future of Barking, Havering and Redbridge University Hospitals NHS Trust.

I begin by declaring an interest: I was a patient at Queen’s hospital in January. My operation was cancelled at two hours’ notice, but despite that hiccup I was given excellent treatment a couple of weeks later. I want to place on the record the fact that despite being in a very busy department, the staff were working very well and had excellent morale, as far as I could see during my groggy recovery from my operation.

The Barking, Havering and Redbridge University Hospitals NHS Trust was established in the 1990s. It brings together two acute general hospitals—King George hospital in Ilford in my constituency and Queen’s hospital in Romford, which was a new-build private finance initiative hospital to replace the old church hospital.

Since 2006, there have been many pressures for reorganisation of services in north-east London. There was a misnamed project called “Fit for the Future”, which was scrapped because it was clinically unsound. Since then, there have been proposals that would have meant downgrading services at some hospitals, particularly King George hospital. To cut a long story short, an independent reconfiguration panel looked at the proposals, and eventually, in 2011, the then Secretary of State for Health, Andrew Lansley, gave the go-ahead to close the maternity and accident and emergency services at King George hospital in around two years. The maternity services were reconfigured in early 2013, but A&E is still at King George hospital.

The trust is very big. There are 750,000 people in its catchment and it covers three London boroughs—Barking and Dagenham, Redbridge, and Havering. Havering has an elderly population overall, but Barking and Dagenham and Redbridge have some very young people. There is a churning population, with lots of migrants, from both elsewhere in the UK and many other parts of the world. GP services and primary care services have been poor and inadequate for many years. There have always been pressures on the hospitals and trusts in north-east London. Those pressures have led to accumulated deficits and concerns about the quality of service.

In October 2013, the Care Quality Commission carried out an inspection of the services at the Barking, Havering and Redbridge trust. It concluded that the trust should be put into special measures. The press release put out on December 18 said:

“The NHS Trust Development Authority…today confirmed that Barking, Havering and Redbridge…will be placed into special measures. The move follows the CQC Chief Inspector of Hospital’s report…which concludes that while there have been signs of sustained improvements in some areas, the leadership of the Trust needs support to tackle the scale of the problems it faces. While aware of many of the issues raised by CQC around patient safety and patient care, attempts to address these issues have had insufficient impact.”

As a result, the trust was put into special measures and all the management were got rid of. It took a while to fill the various posts, but an interim chief executive was brought in and other posts were changed. I have been impressed with the chief executive, Matthew Hopkins. He and the team around him are doing their best to improve services in the area. However, fundamental, difficult problems remain.

The CQC’s 2013 report, which led to the involvement of the NHS Trust Development Authority, highlighted a number of areas of concern, and follow-up work was carried out. One underlying issue was the financial crisis, which remains at the trust. A new finance director, Jeff Buggle, was appointed in July last year, although he did not take up his job until December. The press release at the time he was appointed said that the trust had a £38 million deficit, with expenditure of somewhere around £400 million or more in 2013-14. I understand that the target for the deficit this year was £29 million, but that has not been met; the deficit remains at about the level it was a year ago. That is not surprising; the Health Service Journal from June 26 this year has an interesting statement from Richard Douglas, the former director general for finance at the Department of Health. He said that trusts placed in special measures

“tend to exit the regime with a financial position that had deteriorated”.

The reason is that there is so much pressure to improve services that the expenditure must continue.

It is a bit like the situation in Greece: we have an underlying deficit, a temporary troika, or body, comes in to sort out the problems and the trust is put into special measures. Fortunately, we do not have a far-left, far-right coalition running the hospitals. Nevertheless, we face fundamental difficulties.

The special measures, which were called for, have led to a number of changes. I wish to draw attention to the further inspection that the CQC carried out in March, the results of which were published only at the beginning of July. To the disappointment of the new leadership of the trust, the CQC says that BHRT must remain, for the next few months at least, in special measures. The CQC’s latest report says that although improvements have been made in a number of services, many are still rated as requiring improvement. Professor Sir Mike Richards concluded that significant improvement was still required, and therefore there will be a further inspection before the end of the year to see whether other changes have been introduced since that assessment was made in March.

Clearly I do not have time, even in an hour-long debate, to go through the voluminous reports—the general one and the one on each of the hospitals in the trust—but I will refer to some of the main points. I hope the Under-Secretary of State for Health can reassure me on some issues in his response.

First, I want to make it clear that anything I say here is not a criticism of the staff in my local hospitals. They face enormous pressures; we have a trust that faces huge demand and there are huge pressures on it. I will just give some figures. There are just over 1,000 beds in the two hospitals, of which 80 are maternity beds, 32 are critical care beds, and 972 are general and acute beds. There are 73,000 in-patient admissions, 592,000 out-patient attendances and 245,000 emergency department attendances each year. That figure of 245,000 is divided into 97,000 attendances at King George hospital in Ilford, which Andrew Lansley said in 2011 should be closed within about two years, with the rest—nearly 150,000 attendances —at Queen’s hospital in Romford.

Average bed occupancy in the hospitals is consistently around 93%, 94% or 95%. There is almost no flexibility, and my own experience in January of having an operation cancelled at short notice is sadly repeated from time to time. We had a mild winter and yet operations were being cancelled in January. The same pressures will come each year in this area in outer north-east London, which has a young population and rapid population growth.

I will refer to some of the issues affecting the hospitals. I begin by quoting Mike Richards again:

“Despite considerable attention the trust is failing to meet waiting time targets in the emergency department. Outpatients and diagnostics can’t cope with demand and the children’s services do not meet local need.

I am particularly concerned at the large backlog of investigations into serious incidents, which suggests that safety has not been given the priority it requires and lessons are not being learnt as they should.

However, the new executive team has made significant improvement ensuring the overall culture of the trust was more open and transparent making it a much more positive place to work.”

The point I am making is that this trust needs support, and it needs that support to continue for a period of time.

The CQC report asked whether services at the trust were safe, effective and caring. The rating for all three was “Requires improvement”. It asked, “Are services at this trust responsive?” The rating was “Inadequate”, which is the red one on the traffic lights. It asked whether services were well led; the rating was “Requires improvement”. That is the overall rating for the trust—“Requires improvement”—and there are particular concerns about urgent and emergency services.

The CQC report covers a range of different services at the two hospitals, but the essence of the report is that there are major difficulties, and I will refer to just a few of them. First, the report says:

“The service planning for children’s services was not responsive to local needs.”

Secondly, it says:

“The trust faces significant capacity pressures which it has tried to address”.

Thirdly, it says:

“Across all core services there was limited evidence of learning from complaints and concerns being applied to service improvement. We identified areas where complaints response was slow leading to backlogs, lack of action planning and absence of thematic analysis.”

Fourthly—and this is very significant—it says, under the heading “Governance, risk management and quality measurement”:

“Amidst many improvements within the trust since our last inspection, governance, risk management and quality measurement is an area of significant concern as little improvement has been made…Previous cost reduction plans had significantly reduced the infrastructure to support governance and safety.”

This is a trust with a deficit of about £37 million or £38 million, and it has to eliminate that deficit. When it comes out of special measures—as it no doubt will, perhaps in a few months or maybe in a year, depending on what the next inspection says—it will still face these financial pressures. One of the reasons why it has had difficulties is that it has already had to subject itself to those pressures.

The CQC report continues:

“There is a heavy reliance on individuals and the use of short term interim staff.”

Recruitment and retention of staff have been major difficulties, and they have added to the cost pressures.

We face a difficult situation. We have a management—a leadership—who are trying to turn the trust round, and they are doing much better than their predecessors. They face enormous pressures, and those difficulties are perpetuated and even made worse by the cuts in social care at local authorities, the fact that we have inadequate GP services and the fact that many people just present themselves at accident and emergency rather than going to a GP. That is because they have been trying to get an appointment with their GP for two weeks, and, in the case of the Loxford polyclinic in my constituency, they have been phoning for hours but cannot get through because there is a problem with the switchboard. The same problems arise in a more intense way while the trust is dealing with this financial crisis.

What is the way forward? I will speak for just a few more minutes, to allow my colleagues the chance to contribute to the debate. The CQC report carries out a “Friends and Family test”, and I find the results for the trust extremely concerning. In the test, there is an assessment of the different departments. The report says:

“NHS Friends and Family test (July 2014)—average score for urgent and emergency care was 20%, which was worse”—

in fact, considerably worse—

“than the national average of 53%.”

The report continued:

“The average Friends and Family score for inpatients was 73, which is the same as the national average…The Friends and Family score for maternity…was 70, which was better than the England average of 62.”

So it is not all bad news.

However, the urgent and emergency care is a significant problem, yet the Government decided in 2011, based on the independent reconfiguration panel and the CQC report, that the A&E department at King George hospital should be closed and all A&E services should be relocated to Queen’s hospital. Queen’s cannot cope as it is. Consistently, the Queen’s A&E has had worse assessments than the King George A&E. Yet the sword of Damocles is still hanging over the A&E at King George, and there is this mass of 245,000 patients who go to the A&E departments at the two hospitals, which they cannot cope with.

Let us suppose that the assessment in December, or whenever it is, leads to the trust coming out of special measures next year. What will that mean? What will the consequence of that be? I will quote the summary of the CQC report on urgent and emergency services. The “Friends and Family test”, which I have just quoted, said those services were

“showing no signs of improvement over the 12 months prior to the inspection. The hospital had not achieved the national four-hour waiting target of 95% of patients seen within this timeframe for more than a year, and usually averaged around 90% of patients seen within this time. Patients often had waits of four hours or more in the department and were waiting for long periods of time to be moved to an appropriate bed once it has been decided they should be admitted.”

This is the key sentence:

“There was no clarity about the future of the department and when, or if, it might close in the future.”

This has been hanging over my local hospital since 2006. We have fought vigorous community campaigns and the issue is still hanging over it. There is no clarity. If, because of improved management, the situation improves later in the year and the trust comes out of special measures, will that mean—I suspect it will—that there will then be moves to close the A&E at King George because the trust is no longer in special measures? There is not the capacity at Queen’s to deal with that. It will take years, considerable cost, and millions of pounds of investment on the Queen’s hospital site before Queen’s hospital is ready to cope with this situation.

Rather than wasting millions of pounds and causing more difficulties for several years, would it not be better if the sword of Damocles was taken away, thereby ending the uncertainty and lack of clarity mentioned in the CQC report? Then we could deal with the problems of recruiting sufficient specialist doctors and having adequate cover at all times, and maybe work out a plan for a relationship between the two acute and emergency departments whereby there would not be a closure, but perhaps a rethink about how services were run.

Clearly, Queen’s cannot cope today. However, it is still the Government’s plan to close King George. I have asked Ministers about this for several years and the answer has never changed. There is still uncertainty. What will the future of King George be? It is time to end the uncertainty, to give a sense of clarity and, as the trust improves, to take away the threat to close the A&E department at King George.

I congratulate my hon. Friend the Member for Ilford South (Mike Gapes) and join him in commending and thanking the many staff who work under huge pressure in both King George hospital and Queen’s for the very good work they do, which I hear a lot about from my constituents.

I have been involved with BHRUT and its predecessors for over 20 years. I have seen six chief executives and 12 different chairs, men and women. Every new generation blames their predecessors for the problems that they inherit. I am perhaps a little more sceptical than my hon. Friend: I do not think that we have suddenly, magically got a new team that will solve many of the intransigent problems facing that trust. It has been co-operative and is trying hard, but we are now over a year into the new regime, and on many of the indicators I cannot see demonstrable improvements. The trust has been bankrupt for years; the deficit has not gone down for years and I cannot think that it will go down much in the coming period, given the pressures and the failures to deal with some of the intransigent problems.

Quality has been pretty poor for years. We finally got the CQC report that put the trust into special measures, but the most recent report shows that the necessary improvements that I wanted for my constituents and that would take the trust out of special measures have not been made. Although I share my hon. Friend’s hope, I am not confident that we will get there by the time the CQC comes back yet again.

Compared with all other trust areas throughout the country, ours is the eighth most deprived area in terms of health need. The NHS ought to be delivering equal access to high-quality care to people wherever they live, but it is not. I sincerely feel that that is the biggest battle for my constituents. Where I live, I get much better access to much better quality healthcare than my constituents in Barking and Dagenham who use both Queen’s hospital and King George hospital.

I should like some assurances from the Minister about the north-east London sector. Not only are we bankrupt in our neck of the woods, but Barts City—predictably, I have to say—is also in incredible deficit. One knows how these allocations of moneys go and how views are taken about the health service across the country. There is a real danger that salvaging the new Barts hospital, with its £1 billion PFI and the massive call of that on revenue funding there, will come at the expense of BHRUT and the hospital provision that we need locally. I seek assurances from the Minister that, in considering an undoubtedly difficult financial situation across the whole north-east London sector, he does not disadvantage our residents by putting everything into the much more powerful Barts and the Royal London Hospital NHS Trust.

I want to raise three other issues. First, I have been shocked in recent times by how much is spent on agency staff by BHRUT. For example, in 2013-14, it spent £27 million, and in June this year it spent £2.5 million. When Matthew Hopkins gave evidence at the Public Accounts Committee, when we were looking at the state of a number of vulnerable trusts, he talked about a 50% shortage of consultants in the A&E department and told us that he was spending £1,760 on one 16-hour shift of A&E consultants. After that session, I asked a consultant in A&E during one of my usual visits round the hospital whether he was an agency consultant or a full-time employee. He had been a full-time employee, but deliberately switched to being agency staff because as an agency member of staff he earned more and did less. His doing so put the trust in greater difficulties.

That sort of behaviour is simply an unacceptable waste of what we all understand is a very small amount of money that is not enough for local healthcare. According to the CQC’s most recent inspection, a third of the nurses on night duty on the first night of its inspection were agency nurses. I should like the Minister to talk a little bit about how he is going to tackle the use of agency staff, who provide poorer quality care, because they do not know the systems or the people and do not know their way around the hospital, and cost the hospital a lot of money.

Secondly, although I recognise that there have been improvements, particularly in maternity, where we were first alerted to quality really going wrong in Queen’s, on reading the report I was worried about radiology. There is still a huge bill—millions of pounds—to be paid to people now litigating against the hospital because of what happened to the mothers and children through poor maternity care there, but the original CQC report in 2010 highlighted that the radiology department was poor. There were delays in people having scans done and scans were not passed to the relevant consultant, so people with cancer were simply not being diagnosed in a proper, timely manner that would have allowed them to access the treatment they needed. The recent inspection still finds problems there: it is too short-staffed, with too many locums.

One of the incredible things I read was that on one day of the inspections, five radiologists were on leave. What sort of culture does a hospital have if it allows five radiologists to go on leave on the same day and so provides a poor service to patients? There is a large backlog of patients who have waited well over 18 weeks. During the inspection, the CT scanner kept breaking down and patients had to be transferred from Queen’s hospital to King George hospital. That is unacceptable. It is about more than money; it is about a culture in the management that was originally identified in 2010 and now, in 2015, the A&E is still appalling.

I will raise a couple of other issues that I think are relevant and which my hon. Friend alluded to. The first is GP services. If we cannot sort out primary care, demand on acute and hospital services will continue to exceed their ability to respond. Barking and Dagenham has the highest number of GPs aged over 60 in the country: a third of our GPs are over 60. We have been completely open—we will try any experiment on the ground. We have had salaried GPs, private practice GPs and GPs linked to universities in an attempt to provide some training. We will do anything to attract and get more and a better cadre of GPs in our patch, but we have failed. We are still the eighth in London in terms of concentration of single-person practices. I raise this issue all the time with the powers that be in the health service locally. One in five of our GP practices remains single-handed. We know that that does not provide an adequate service to local people, yet there is not any sort of energy or urgency in the actions of the local health service officials to sort that out. They ought to be able to do so and to apply much greater pressures on some of the GP services, so that we get better primary care.

People cannot get appointments. We have done a survey of our residents—it is not a proper survey; I do it when people attend my very regular coffee afternoons. However, those surveys show that 50% of our residents had to wait more than a week to get access to their GP. Some 30% went to A&E because they could not get access to the GP. Nearly half said that they had found it difficult to get an appointment. The typical story is, “I ring up at half-past 6 to see the GP the next morning. I am told to ring the next morning. When I ring the next morning, it is engaged and engaged, and in the end I give up and go to the A&E.” Unless there is a forceful, determined attempt to sort out the failures of our primary care system, we will not make progress in the acute sector.

One of the little things we did was run a campaign on the use of premium phone numbers. From constituents who came to see me, we uncovered in 2013 that 10 GP practices in the constituency had 084 numbers. One constituent had spent £10 trying to get an appointment, because ringing such numbers from a mobile costs 41p or 42p a minute. Another constituent spent £30 trying to get an appointment for her son because she had to hang on until she was dealt with. She got through to the system, but the call was not answered by anyone to secure an appointment. We have run a tough campaign on that, but two and a half to three years on, we still have one GP practice—Castleberry medical centre—that is refusing to put in a landline, and three others that have a landline but have kept their premium phone line, and my bet is that patients cannot get through on the landline and have to use the premium phone line. Access to GPs is important. I thought we had halted the use of premium phone numbers after another PAC inquiry, but it has not happened.

My final plea is on access to the hospital for the poorest people in my constituency. They live in the most south-western part of my constituency, in Thames ward. Getting to Queen’s hospital from there takes three buses. I did the journey during the election period, and it took me about two hours. If someone has to go for regular chemotherapy or kidney treatment—whatever it is—that four-hour journey every day means that the person does not go and so does not get that treatment and therefore dies younger. I have been pleading with the Mayor and the transport authorities to ease that just by diverting the No. 5 bus so that it goes straight to the hospital. That would save people one change—they would get two buses, not three—but I have completely failed so far. I have been fobbed off. I urge the Minister to join me and write to the relevant authorities to ensure that while at least keeping those hospitals there, trying to get them properly funded, sorting out the financial mess and improving the quality, we also allow people to get there easily, particularly those who need the hospital services the most and are most dependent on public transport.

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for Ilford South (Mike Gapes) on securing this important debate and on opening it in the way he did, setting out the chequered history of the trust and the particular challenges we face right across our borough of Redbridge and the wider north-east London health economy.

I will not repeat the points made by my hon. Friend and my right hon. Friend the Member for Barking (Margaret Hodge). I want to express my concern about the outstanding problem that the CQC has identified with the trust and the impact that is having on patient care in a wide variety of areas. I share the concerns expressed by both my colleagues that the CQC inspectors rated the trust as “requires improvement” on most measures, and the responsiveness of service at the trust was deemed “inadequate”, but it is also important to highlight some of the areas that were identified as having outstanding practice—in particular, the values of the trust and how they have been embedded in the culture of the staff.

Like my colleagues, I congratulate the NHS staff who work in the trust on the hard work they do in difficult circumstances. I commend the fact that the radiotherapy unit was one of the top five in the country. There are good outcomes for stroke, and the genito-urinary medicine clinic had

“excellent service with appropriate protocols”.

Significant improvements have been made, so while it is disappointing that the trust remains in special measures, the improvements described in the report are encouraging and reflect well on the NHS staff and the reinvigoration of the trust leadership. They can take genuine pride in their teamwork. I have no doubt that the trust will emerge from special measures sooner rather than later.

My right hon. Friend spoke about the high level of agency spend. One of the problems that the trust has suffered from for a number of years—frankly, some of the trust’s challenges were well known before the inspectors put the trust into special measures—is that when a trust has a poor reputation, it is hard to recruit and retain the best staff. While I am disappointed that we are not yet out of the woods, I hope that when people are thinking about their careers, they identify not only that the trust requires improvement, but that it is improving and is a good place for good people to be at this point in its journey.

I want to speak briefly about the wider north-east London health economy. Until May, I was chair of the Redbridge health and wellbeing board, deputy leader of Redbridge Council and the cabinet member for health and wellbeing. It is fair to say that the challenges in the north-east London health economy—the challenge in primary care has already been touched on—are not just restricted to the trust. I was the first chair of the primary care transformation board, which is trying to change how primary care is delivered and bring about genuine service improvements. In the very first meeting, I asked GPs about their experiences, and they described primary care as being in crisis. They know that they are not providing a good enough service to their patients. They work hard to do so, but the pressures are immense. That relates to the quantity and quality of GP provision. My right hon. Friend talked about the wider concerns about the number of GPs who are past or nearing retirement and the workforce pipeline. Combined with the fact that Redbridge has one of the lowest levels of public health spending in London, that gives me cause for great concern. I am concerned not only about the level of public health funding but about the fact that the Government are seeking to give councils new responsibilities —for example, for health visiting—without sufficient funding. The in-year cut that my council will experience will place even greater pressure on services. On that note, I should probably declare that I am still a member of Redbridge Council, albeit an unpaid one.

Finally, I want to talk about A&E. Since January, there have been some improvements in A&E performance at both King George and Queen’s. In January, King George’s performance standard was 92.67% and at Queen’s it was 79.15%. As of June, King George had improved, up to 96.56%, but Queen’s was still lagging behind at 93.31%. I have seen absolutely nothing in either the CQC’s inspection report or the performance data for our local A&E departments to alter my view that the loss of the A&E department at King George hospital would be a disaster for patients.

Since the decision to close the A&E department at King George, much has changed in terms of both the population pressures and the immense strain on the whole health economy in our part of London, which I have already described. In that context, it is really not unreasonable to ask Ministers to intervene, to look at the A&E closure with a fresh pair of eyes, and to ask the clinical commissioning group to reopen the A&E closure decision and reconsider its position. Previously—this always happens at the height of elections, particularly local elections—my local Conservative association put out a statement claiming that there had been some sort of reprieve and the A&E would not be closing, but nothing of the sort has happened. Thousands of residents across Redbridge will never forgive the Conservatives if they do not at least look at this matter with a fresh pair of eyes.

We all heard what my right hon. Friend the Member for Barking said about the financial issues at the trust. There is absolutely no doubt in my mind that those issues and the difficulties in recruiting staff across two A&E departments are what are really driving the closure of King George’s A&E. It is being driven not by what is in the best interests of patients or what good A&E configuration in our part of London would look like, but by the inability to get the right staff and to rescue the trust from its very difficult and precarious financial position. That is not good enough. I hope that, when he responds, the Minister will at least assure residents that the Government will look at this matter with a fresh pair of eyes and ask the CCG to do the same.

I will be brief, given that I want to leave sufficient time for the shadow Minister and the Minister to respond. I congratulate my hon. Friend the Member for Ilford South (Mike Gapes) on securing this debate.

From the contributions so far, I think we would all agree on what politicians tend to call the challenging environment that the trust has existed in for many years—including the initial Care Quality Commission report, which contained a lot of criticism, specifically on A&E and maternity. A whole host of other issues were raised, leading to the placing of the trust into special measures in December 2013 and the improvement plan of 12 months ago.

We know that there are huge demographic pressures on the trust, reflected in the number of emergency patients, of which there were 220,000 across Queen’s and King George last year. That illustrates the pressure from footfall. All speakers so far have mentioned the huge budgetary pressures, in terms of both the debt overhang from the private finance initiative and the management’s ability to secure the in-year budget. The deficit was some £38 million last year, and it is estimated to be the same this year.

There have been huge management changes across the trust, and I, too, support Matthew Hopkins’s work. As my right hon. Friend the Member for Barking (Margaret Hodge) mentioned, there has been a squeeze on Barts, on the west side, and also on the Essex trust, on the east side, meaning that there is a danger in the distribution of resources: we could be squeezed between the two trusts on the western and eastern borders of our trust.

The CQC report was a bit of a mixed package. There were positive outcomes for radiotherapy, strokes, nurse-led oral chemotherapy and the humane end-of-life care service, and there was increased cleanliness and good infection control across the trust, which compares well with some of our experiences a few years ago. However, the report also consistently pointed to issues relating to clinical governance and waiting times, especially for A&E.

The in-patient survey results mentioned improvements in single-sex placements, the decline in changes to admission dates and the offering of alternative hospital placements to patients. It also mentioned the need for improvements in waiting times for beds, doctor communication and the number of nurses on duty. I acknowledge, however, that in 2015-16 there will be £5.8 million of extra spending on improved nursing care, which will amount to some 80 additional nurses.

On the broader issues that have been raised, I echo a number of points mentioned by colleagues about the pressures on primary care, the age profile of the GPs, the number of single-handed practices and the fact that we have waited for a promised new integrated health centre in Dagenham East for 10 years—it has still not been delivered. Similarly, the Rainham practices desperately need new facilities. Getting appointments is becoming more difficult, putting more and more pressure on the acute sector because of people rolling up to A&E.

Overall, there have been improvements—we all support the management—but there is a long way to go. As we, hopefully, move out of special measures, it is especially important that we remove what my hon. Friend the Member for Ilford South called the sword of Damocles that is hanging over King George. I hope for a positive response from the Minister on that specific point.

It is a pleasure to serve under your chairmanship, Mr Davies.

I pay tribute to my hon. Friend the Member for Ilford South (Mike Gapes) for securing this important debate. His speech highlighted the very real danger of closing his local A&E department while the trust is, sadly, in the protracted throes of special measures.

I also pay tribute to my right hon. Friend the Member for Barking (Margaret Hodge) and my hon. Friends the Members for Ilford North (Wes Streeting) and for Dagenham and Rainham (Jon Cruddas) for their contributions. All have been champions for patients at the Barking, Havering and Redbridge University Hospitals NHS Trust for a number of years. Like my right hon. and hon. Friends, I pay tribute to the staff at the trust who, in very difficult circumstances, are working hard to deliver high standards of care to patients.

As we have heard, the trust is facing particularly profound challenges. It is one of the largest in the country, serving a huge and diverse population. There is a lot of churn and movement of people and, as a result, things are even more difficult for GP and primary care services, which, as we know from elsewhere in the country, have been under intense pressure in recent years. My right hon. Friend the Member for Barking made some particularly pertinent points on that: if someone cannot see their GP, the pressure is moved on to local hospital services. When those services are already in difficulty and struggling to cope, they could well do without the added pressure of extra demand.

I hope the Minister will accept that the trust needs real support, because it has been hit hard by certain decisions. The trust itself must bear some responsibility, but I am afraid that some of the previous Government’s policies came at the wrong time. Last winter, as we heard, the trust suffered its worst quarterly A&E performance since records began. In January, more than one in four patients were waiting longer than the recommended four hours in A&E—some were even waiting longer than 12 hours.

In December 2013, the trust was placed in special measures following a Care Quality Commission report that raised serious concerns about patient safety and care, particularly in A&E. The report said that staff at the A&E at King George

“did not have confidence in the trust leadership to make the necessary improvements in A&E.”

Although some of the problems at the trust are deep-seated, the CQC report was clear that many of the problems, such as the difficulty in recruiting staff to the emergency department, have either become worse or emerged in recent years. The report also suggested, for example, that staff were concerned about the wide range of locum doctors turning up to shifts. They felt that there was no problem when they were assigned locums with whom they had worked before, but they were clear that the lack of permanent staff posed a risk to patients.

The trust is in a difficult financial situation. As my right hon. Friend the Member for Barking said, and she was echoed by other Members, that is not helped by its having to spend £27 million on agency staff last year because of a shortage of qualified staff. The trust has also been forced to recruit nurses from overseas because not enough home-grown nurses are being trained. It is well worth remembering that, despite what Ministers claim, the NHS now contains fewer nurses per head than in 2010.

The future of A&E services at King George hospital obviously remains in doubt. I remind the Minister that the 2010 Conservative manifesto promised to

“stop the forced closure of A&E and maternity wards”.

Since then, the maternity ward at King George hospital has closed. The plan to close the A&E unit and relocate it to Queen’s hospital has been delayed, but not abandoned. The Minister can, hopefully, update us on those plans and address the valid concerns not only of local MPs, but of the local communities that they represent on the capacity issues that have been mentioned.

Clearly, many of these challenges cannot be tackled in isolation and require working across London and, indeed, considerable support from the Department of Health, but I hope the Minister has listened carefully to the assessment of the problems laid out by my hon. Friend the Member for Ilford South. I also hope that he is prepared to take on board some of my right hon. and hon. Friends’ suggestions. What they have said is eminently reasonable. With the right support from central Government, I know that their constituents can receive the standard of care that they deserve.

It is a great pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Ilford South (Mike Gapes) for raising what is an important matter not only for his constituents, but for the whole health economy of east London, and for the measured way he presented his case. He has been a watcher of and campaigner on the matters in his constituency for a long time. This matter has been addressed and debated on several occasions in this Chamber, and I know he has raised it in the main Chamber too. The last time he raised it here was in January 2014, just after the trust had been put into special measures by the Care Quality Commission in December 2013.

The distance that has been travelled since then is quite considerable. I was able to see it for myself recently, as my first ministerial visit was to visit the Queen’s hospital site—albeit to hear about the trust as a whole. It was clear from talking to staff, which I was able to do without management being present, that the distance travelled over the past 18 months has been considerable and transformative not only for patient care, but for staff experience of the workplace—the two, as all Members will recognise, are coterminous. The most instructive moment came in the staff discussion, when a nurse explained that, the day before, a petition signed by 3,000 local people, which had not instigated by anyone at the hospital, had been delivered to say how much they valued staff efforts to turn around their hospital and how they felt that it was a different place from the one that had gained a mixed reputation in the many years before the hospital was put into special measures.

I will address each of the issues raised by hon. Members in turn, but I want first to set the context and add slightly to the narrative provided by the hon. Member for Ilford South in his recounting of the trust’s history. The key review in the matters that we are discussing was begun in 2009. The review took in the whole of Health for North East London and was conducted under the right hon. Member for Leigh (Andy Burnham), then the Secretary of State for Health and now the shadow Secretary of State. It began reporting just before the 2010 election and required an answer immediately after. The hon. Member for Ilford South will know the report’s conclusion, which is basically what we are still sitting with. It encompassed not only the health economy of north-east London, but the relationship with what is now the Barts Health NHS Trust, encompassing Whipps Cross university hospital, St Bartholomew’s hospital, Newham university hospital and the Royal London hospital.

Several hon. Members have discussed the Government’s intentions regarding reconfiguration, but the report was not led by the Government or Whitehall but was under the sensible regime set up by the previous Labour Government of clinically led reconfiguration panels. The principle behind it was a better organisation of A&E and urgent care in east and north-east London—in particular, being able to provide superior trauma care at fewer sites. That model has wide understanding across the House and is based on international evidence and, increasingly, the experience in the NHS. It has affected my constituency as much as it has others around the country.

I understand why hon. Members who are concerned about a hospital that will lose particular services—although King George hospital will retain a 24-hour urgent care service—will feel aggrieved by that change. When engaging with patients and constituents, however, I ask that we remind everyone that this was a clinically led decision that was set up under the previous Labour Government and that the recommendations were continued by the coalition Government as a result. However, none of that questions the fundamental reason why the hon. Member for Ilford South called for this debate, which was to ask, “How can you continue this reconfiguration when one part of the trust is in crisis?” Crisis is the correct word to use for a hospital that was put into special measures. It was not one of the Keogh trusts that were put into special measures due to adverse mortality; it was one of the first to be put in because of systemic and endemic problems at the trust, many of which the hon. Gentleman highlighted.

The change that has occurred over the past 18 months to two years—I am grateful to the hon. Member for Ilford North (Wes Streeting) for highlighting exactly what has gone on—has been one of culture. Another remark from a nurse with whom I spoke was that, since special measures, her comments about patient care were being noticed by management for the first time. That was the difference that the CQC inspection made. The change in culture has been recognised by local people and the result is much-improved family and friends figures. I do not recognise the figures provided by the right hon. Member for Barking (Margaret Hodge), but the most recent figures are close to the national average. I will receive those figures in a moment, but I believe the overall A&E figure for family and friends was up at 84%. That is not quite where it should be, but the in-patients figure had also risen to nearly the national average. The most recent family and friends figures showed an improvement in results.

Hon. Members recounted figures suggesting that the A&E performance was poor. It is true that the A&E department has failed to hit its required standard for a long time, but the most recent figures are encouraging. Performance for the first quarter of this year was 93.39%—just under the 95% target—compared with the figure for the first quarter of the previous year of 85.62%. That is like for like. Despite the problems encountered across the NHS over last winter, that hospital showed a sustained improvement in the first quarter of this year.

I second the remarks made by several hon. Members about the quality of the new chief executive and the team he has built around him. I have spoken to him, and although he was not going to make predictions, his confidence about going into winter, as well as the place the hospital was in, was significantly different from where he and his team were this time last year.

Let me clarify the A&E figures before I get upbraided. I believe that the figures are that 96% of in-patients would recommend the service to their family and friends, and 1% would not; in A&E, 84% would recommend and 10% not; in maternity, 98% would recommend; in antenatal, 95%; in postnatal wards, 93%; and in postnatal community, 97%. Those figures are roughly around the averages in national FFTs—family and friends tests—which is a significant and marked improvement, showing that local people are responding to the changes made in the hospital and to what needs to happen.

None the less, despite all the improvements, it is true that the A&E is not in a sustainable position to receive the services from King George hospital, either physically—I saw its buildings for myself—or in terms of the new rotas and rosters, although recruiting is now much better managed than in the past. I understand from local commissioners that there is no intention to move these services from the King George to the Queen’s site until the physical and staff changes have been made to the satisfaction of the commissioners and the provider—the trust itself. I understand also from the commissioners that the time limit they have imposed means that that cannot happen even within the next two years, because they need to see a degree of sustainability before they can have the confidence to make the changes.

Does the Minister accept that, given that the A&E will be closed, whether in two, three or four years’ time, there is a level of uncertainty? The CQC report comments on that. Is it not better for the sword of Damocles to be lifted and for us to go ahead on the basis of having two A&Es that work together?

I understand the hon. Gentleman’s points. I accept that uncertainty is created at the King George site and that the effect of that is potentially destabilising, especially when the hospital and the trust have had to endure the whole process of special measures. His solution, however, is a false one in two senses.

First, the decision was clinically led in the first place, so to go against it would be to go against a clinical decision after several reviews. The hon. Gentleman is therefore suggesting that we make a political intervention against a decision made by doctors about the best distribution of trauma centres and urgent and emergency care centres according to population. Decisions have been made on a similar basis throughout the country. I do not believe that he really feels that that would be an acceptable route to take. Secondly, even were we to do that, it would not remove uncertainty, because there would still need to be some sort of reconfiguration in future in order to get the best outcomes for patients. So the uncertainty would remain.

The hon. Gentleman’s point is valid to an extent. If the situation were to occur again—clearly none of us would have wished things to proceed as they have done —we need to make it clear that reconfigurations can happen only when we have the correct sustainability in receiver organisations. That should be something we think about as we go ahead. However, we are where we are now with his trust, and to proceed on the basis that he suggests would not give either the patient outcomes or the certainty that he desires, whether for staff or his constituents.

The Minister referred to a decision that was initiated in about 2009. That is correct, but circumstances change. Our area is the most rapidly expanding in London. I do not know the figures for Redbridge, but those for Barking and Dagenham show, potentially, another 30,000 to 35,000 houses being built over the next 10 to 15 years. That is massive expansion. I put it to the Minister that not only is the number of houses increasing, but the nature of the households is changing. What used to be a house lived in by a couple with perhaps two kids now tends to be lived in by intergenerational families with many more people. What regard has he paid to those changes? Should he not pay regard to them and review his decision in the light of them?

It is not ultimately my decision. It is the decision of the Secretary of State, but only on the advice of the Independent Reconfiguration Panel. The IRP takes a view over a long horizon, so it takes population growth into account in the original decisions—

I will come back to the right hon. Lady with a final comment, but that is what I understand. In the end, such decisions are left to local commissioners, who are the experts in buying the right kind of health provision for their patient groups. If their decision changes, that should be reflected in the IRP’s final decision, but the commissioners remain certain that that is the correct way to go for east and north-east London, and while that remains the case, we as politicians should support that clinical decision.

I will respond to some of the other points made by hon. Members. The finances of the hospital were brought up several times. It is true that it has had a sustained poor financial performance, but it is unlike other hospitals which have become indebted or are lifting up. The hospital’s position is a sustained one involving a large number—£38 million, which includes a very large figure for agency workers. That figure is now declining as the new management gets a grip on recruitment, and I heard some good stories about the improvement in recruitment when I went there only a couple of weeks ago. There is also £60 million annual provision for PFI payments, which is a problem in many trusts around the country, but there is no point rehearsing those issues, which the right hon. Member for Barking looked at many times in her previous role.

The chief executive is clear about the deficit. He shares my view and that of the Secretary of State that financial performance and quality go hand in hand. No hospital in this country offers outstanding care but has poor financial performance. We cannot get efficient care anywhere if the books are not being looked after at the same time, because the two work together. The chief executive understands that getting the trust into a decent financial position is central to providing the kind of consistently high-quality care that he wants to see across the trust, and not only in the specific areas rightly highlighted by the hon. Members for Dagenham and Rainham (Jon Cruddas) and for Ilford North.

The hon. Member for Ilford South was right to talk about capacity. There was a serious lack of capacity because of the failure to discharge patients and to get people through the system, which caused problems at the front end, in A&E. Remarkable change has been achieved in the past six months through the new measures put in place by the new management, but it is true that there is a great deal more to do. I heard a different story from the one the hon. Gentleman recounted: actually, they thought that the last CQC judgment was completely realistic; the action points highlighted were in large part already being addressed and needed to be done. The new management recognised that special measures was a regime that had to be exited once a sustainable improvement over time had been shown. That was gratifying to hear, because when it is heard from the shop floor, the management and the CQC, that shows that the whole team understands the problems and how they need to be addressed.

Several Members mentioned the problems in primary care, and I am aware of the acute issues in east and north-east London. They are the reason why my right hon. Friend the Secretary of State launched the new deal for GPs a couple of weeks ago. NHS England is now mapping hotspots of GP shortage across the country. It will use that information to target resources to make sure we are putting the new GPs being recruited into the right places and using every possible incentive to make sure that under-doctored areas are brought up to parity. Members will know that this is a historical problem and it will take a great deal of heavy lifting from all of us to change it. It is not simply about sheer numbers of GPs; we must have new models of delivering care and new diversity, so that we can deliver primary care appropriately rather than in a way that is based on a model that does not fit.

The right hon. Member for Barking raised understandable concerns that the existing system for the Barts trust was set up to finance one PFI deal. She is not alone in those concerns. I am taking a deep interest in the progress of the special measures regime at Barts. The financial performance and accounting procedures at that hospital and trust when it went into special measures were frankly shocking. They have now been changed, and we will be reviewing the situation on a weekly basis. I hope that if she discusses the matter with the CQC and the trust, she will understand better that it is not that the trust is subsidising one PFI but that there are systemic financial problems across the trust. I take her point completely, however. As we address the financial problems in east London we must reassure everyone that mergers have not happened simply to prop up one organisation at the expense of another.

Finally, I welcome the constructive approach and fair questions of the hon. Member for Denton and Reddish (Andrew Gwynne). I hope I have answered the majority of his questions, but I question the idea that Government policy has made the situation worse. The reason we are debating here is that the CQC gave an inadequate rating to the Barking hospital trust and put it into special measures. The ratings and the special measures regime were a creation of the previous Government. They have provided transparency and clarity that we did not have before and allowed us to have an honest discussion about what is wrong and what is right. I can now stand up and say where the problems are and accept responsibility for what needs to change. None of that was possible when we could not say that anything was wrong and had to pretend there were no problems, because there was a culture of denial rather than one of transparency and openness.

We are not at the acme. We have a great deal of distance still to make up, but we are in a much better place than we were back in 2013, when the trust was put in special measures, or in 2010, when the review was completed. We now have clarity about what we need to do and the process for doing it. I believe that we will soon have a much better health economy in north-east London than the one that Members have had to endure so far.

I am pleased to have got some injury time, Mr Davies. I emphasise to the Minister and his officials that the problems in north-east London and in my borough of Redbridge in particular are serious. He referred to the Barking and Havering trust and the Barts trust. Every single resident of Redbridge now has to use a hospital that is in special measures, as Whipps Cross hospital is part of the Barts and Royal London agglomeration and King George hospital is part of the Barking and Havering trust. In that borough people cannot go to a hospital that is not in special measures. Some of the constituents of my hon. Friend the Member for Ilford North (Wes Streeting) go to Whipps Cross rather than to the King George.

The reality is that the situation is a fundamental challenge to a population that is growing rapidly. The Mayor of London has just agreed to invest £55 million to build 2,000 new dwellings in the heart of Ilford. A young, dynamic and largely migrant population is moving to Ilford. That means we have to deal with these problems soon—they must not become long-term issues. I am conscious that the people of north-east London—of Redbridge, Barking, Dagenham and Havering—will expect decisions to be taken in their interests. I and my colleagues will continue to fight for them.

Question put and agreed to.


That this House has considered the future of Barking, Havering and Redbridge University Hospitals NHS Trust.

Sitting adjourned.