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Access to Health Services: West Cumbria

Volume 603: debated on Thursday 17 December 2015

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

Thank you, Madam Deputy Speaker, for presiding over this Adjournment debate, the last parliamentary business of 2015.

The issue at hand is one that my constituents and people living across west Cumbria care a great deal about. I know that the Minister is well aware of the challenges. He has responded positively to my questions and requests in the past, for which I am exceptionally grateful to him, and I hope that he will do so again today.

I will first outline the issues facing my constituents with regard to their ability to access health services in west Cumbria, particularly hospital services at the West Cumberland hospital. The issues facing the North Cumbria University Hospitals NHS Trust, the pressures on ambulance services and the intense pressure on overworked and under-resourced staff are well documented, but despite that, little, if any, progress towards solving the problems would appear to have been made. I will then address the success regime and the opportunity it represents for health services in west Cumbria and therefore for our communities. The recent floods, the effects of which are keenly felt throughout the county, have magnified the issues at the heart of the debate on health services in west Cumbria, and I will also talk about that. I will conclude by outlining what I believe are the needs of the west Cumbrian community. After all, the key decision for decision makers, the Government, Ministers and NHS executives comes down to this: what do the people of west Cumbria want from their health and hospital services, and how can that be delivered? It must be said at the outset that that is a very different question from: what is the North Cumbria University Hospitals NHS Trust prepared to provide? The simple answer is that the people of west Cumbria need better access to health services, particularly in relation to hospital services provided by the West Cumberland hospital in Whitehaven.

In this context, the term “access” has myriad meanings. It means the actual services provided locally, and it means that those services must be staffed appropriately so that they can be provided to a high quality. It also means empowering communities so that when decisions are made about their services, they are listened to during the decision-making process. Access also means proper planning for the significant population expansion that is forecast for the area. In west Cumbria, each of those points are immensely challenging, and that is what we must address.

In July 2013, Sir Bruce Keogh, with whom I have a very good and effective working relationship, published his review of mortality rates at several hospital trusts around the country. North Cumbria University Hospitals NHS Trust, which serves my constituents, was one of the trusts and, along with 10 others, it was placed in special measures. The trust had higher than average mortality rates, and action to remedy that was justified and was welcomed.

At the time, Ministers were unable to provide basic information about what “special measures” meant for the trust. It was patently clear, however, that a major reason for the care failings at the trust was a chronic staff shortage. It is only right that I use this opportunity to thank, personally and on behalf of my constituents, the tremendous staff who are working tirelessly in trying conditions to provide high-quality healthcare. I know that many work unpaid overtime because they care about their patients, about the community and about the care they provide. It will be a tough winter and there will be huge pressures, but I want them all to know that I and my constituents understand that they are working in extraordinary circumstances.

The trust simply needs more staff, and the Government must intervene to ensure that it has more staff. Such a request has fallen on deaf ears for too long. The most recent report by the Care Quality Commission, published in September, showed the scale of the challenge:

“The recruitment of nursing staff also remained an on-going challenge. At the time of our inspection nurse staffing levels, although improved, were still of concern and there was a heavy reliance on staff working extra shifts and on bank and agency staff to maintain staffing levels. There were times when the wards were not appropriately staffed to meet the needs of patients.”

This simply is not acceptable.

In 2013-14, the trust spent £16 million on agency staff. That cannot be sustainable, and it is clearly a false economy. Agency staff are a short-term, expensive solution, and in my view the Government should be empowering trusts to achieve long-term, efficient solutions. Capping agency costs is a small, tentative step in the right direction, but it would be better all round if the Government provided funding to enable trusts to train and recruit for the long term. That would surely save money in the long run and enable predictable, stable, secure service design for the long term. Will the Minister therefore commit to making relief funding available to allow the trust to be more competitive in the recruitment market? If my local trust has to pay over the odds to secure services that are taken for granted in other parts of the country, it ought to be funded appropriately to do so.

In my constituency, I have been working with the trust and the University of Central Lancashire to bring a medical school to west Cumbria so that we can grow our own medics. That is a long-term sustainable solution to one of the key problems we are facing. I am delighted to say that the new West Cumberland medical education campus now exists at the Westlakes science park in my constituency, immediately adjacent to the new West Cumberland hospital. So far, it has succeeded without the support or involvement of the Government, but I hope that they will support the development not just in spirit, but through practical assistance, including money.

In addition to growing our own medics in west Cumbria for the benefit of the entire Cumbrian health economy, every part of which faces similar challenges, we are providing the basis for policy solutions by becoming a rural health policy laboratory. The campus can and should become the crucible of innovation that provides the solutions to the problems facing rural areas in respect of the provision of high-quality, accessible, universal health services. I hope that the Minister will express the support of the Government and the Department for that today.

I hope that the Government will look again at nursing bursaries, as I fear that their new policy will make it harder to train and recruit the medical staff that we all know we need. On 14 December, the chief executive of the Royal College of Nursing said that the decision to cut bursaries that was announced in the Chancellor’s autumn statement is having a negative impact on people who are considering a career in the profession. It is all well and good pledging to increase the number of training places, but the impact is wasted if the mechanism that we adopt turns people away.

The NHS staff survey shows the current strain on medical staff in north and west Cumbria. There has been a big increase in the proportion of staff who suffer work-related stress and, unforgivably, the prevalence of staff experiencing bullying from other staff is increasing. Staff are working extra hours unpaid. The people in west Cumbria rely on the services provided by those hard-working people. Much like the expensive agency bills, overworking staff simply is not sustainable. Will the Minister commit to seeing what action the Department can take to improve the situation? Sooner or later, our luck will run out. The good will of the medical professionals, who are exhausted and demoralised in so many ways, will run out too. It is patients who will pay the price.

At the beginning of the year, I wrote to the NHS’s chief executive, Simon Stevens. I asked him to visit Cumbria to see for himself the geographical challenges and to speak with patients and staff. I asked him to work with me and other stakeholders to develop a comprehensive recovery plan for the Cumbrian health economy. Nowhere in the country is quite like our county. The health inequalities, the demographic differences, the challenging geography and the contrast between the affluent and those who are less well-off all present unique challenges in designing and providing hospital services and health services in the round.

What is provided should be broadly the same in every community in the country. A national health service should ensure that there is equality of standards and accessibility in the health service, but how that is delivered must be flexible enough to accommodate unique local circumstances.

The success regime is the response to my request for a comprehensive recovery plan. The new regime is intended to develop a locally tailored solution to the problems we face. I support the success regime fully, but I have doubts about the support of the North Cumbria University Hospitals NHS Trust for the process.

Over recent years, actions by the trust’s executive team have led to the public being understandably worried about the prospect of key services being removed from West Cumberland hospital without a rationale. In September 2013, the trust moved some out-of-hours surgery services from the West Cumberland to the Cumberland infirmary in Carlisle, over 40 miles away. The public were not consulted on the change. Crucially, the modelling and assumptions underpinning the move were flawed. Much greater numbers of patients have had to travel than was either anticipated by the trust or told to the public. Either it was a lamentable failure properly to model the effects of service change or it was a lie. That raises serious questions about either the honesty or competence of the trust.

The trust’s attitude on a number of other issues since then has done little to reassure those who are concerned about its intentions with regard to the provision of services at the new West Cumberland hospital. I was present at a meeting—I think it was in October—with Simon Stevens on the success regime, in which the local hospital trust was told categorically that the “asset stripping” of services from West Cumberland hospital must not continue. It was an exceptionally uncomfortable meeting. Days later it was reported that senior managers at the trust had told staff that the accident and emergency department would be downgraded. That is unacceptable. The trust must abandon any preconceived plans to strip services. Those services must be provided at West Cumberland hospital, and the success regime must be allowed to complete its work.

I welcome the recent statement from the NHS in Cumbria, which set out in a public letter that the accident and emergency department, and other services, must remain at the West Cumberland hospital. That is the bare minimum that my community would expect, yet the trust had to be shamed into making such a basic commitment.

With regret, if the trust does not abandon its preconceived ideas about service reconfiguration and reduction, and if it tries to ride roughshod over the work of the success regime programme before it has a chance to develop its plan, I will be left with no option but to pursue the removal of the current trust management. I would be grateful if the Government would support what is clearly an effort of last resort. I take no pleasure in that, but unless the trust management can commit fully to the terms of reference of the success regime, it should have no part in the future of healthcare service design in north and west Cumbria.

The attitude displayed by the trust, whether deliberate or not, has meant that many in the local community simply do not believe a word it says. Its lack of willingness to engage with the public who use or rely on the services provided at our hospital means that many feel disconnected from a key service—the key service—in their community. The service reconfiguration of September 2013 was done without public engagement, and the development of the trust’s future clinical options did little to assuage legitimate concerns. The document showed the stripping of key services from West Cumberland hospital which, I repeat, is unacceptable.

Last year, in front of a crowd of almost 5,000 people at the recreation ground—the home of Whitehaven rugby league football club—trust representatives assured an anxious crowd that no decision on service reconfiguration would be made. However, the publication of the future clinical options appraisal in October 2014 showed that the plans had been in development for a year. It is easier to deal with Iran!

The duplicitous nature of the trust’s public statements, the covert actions that seek to pursue in private the opposite of what it states it wishes to do in public, and the public distrust that it has singularly managed to establish is staggering. It is truly breathtaking. Too often, the trust acts as a rogue trust, seemingly beyond any accountability to anyone and beyond the influence of the Cumbrian public. Will the Minister commit to examine the behaviour of the trust? Senior local medics, patients, local civic society, trade unions, and local representatives of all parties all doubt that any eventual consultation designed by the trust will be genuine or honest. Progress will not be possible within that climate of distrust.

Hopefully, many of the trust’s preconceived ideas about service reconfiguration will be superseded by the work of the success regime. In the rest of the country the Government and NHS would be hard pushed to find a more committed, willing, well-informed and passionate community when it comes to health services than the community of west Cumbria. A campaign group set up to fight for services, “We Need West Cumberland Hospital”, has garnered much public support and I pay tribute to its work, as I do to the fantastic work of Siobhan Gearing, Carol Woodman, Lee Butterworth, Rachel Holliday, my hon. Friend the Member for Workington (Sue Hayman) and so many others.

Does the Minister agree that if the trust was committed to rebuilding trust within the community, it should involve the local public in open and transparent discussions about local services, instead of defying the NHS chief executive, deliberately undermining staff, raising doubts about services about which there should be no doubt, and acting like thieves in the night?

The recent local floods did not cause the underlying issues inherent in the north and west Cumbrian health economy. Nor did they cause lasting damage to the ability of the NHS in Cumbria to deliver services. What the recent floods did, among many other things, is prove beyond doubt the sheer folly of removing services from the West Cumberland hospital and putting them in the Cumberland infirmary in Carlisle, more than 40 miles away.

The floods meant that roads were impassable. Ambulances and other emergency services, which were already struggling more in Cumbria than anywhere else in the north-west, were under intense pressure. Power was cut to the Cumberland infirmary, which had to rely on back-up generators. I am told that there were no clean sheets or bedding. The laundry service failed and doctors and nurses could not get to work. The impact on patients was severe.

Getting from west Cumbria to Carlisle at the best of times is difficult. If the weather does not beat you, the tractors or the sadly routine road traffic accidents and diversions will. I am campaigning for serious improvements to the A595, but because of the floods over that weekend and the following days it was simply impossible to get from west Cumbria to Carlisle—not difficult, not unlikely, but impossible. The levels of the flooding could not be anticipated, but there are things that we can do to ensure access to, and the resilience of, our key services. Rain in the Lake district should never come as a surprise—it should never lead international news bulletins—but severe weather should not create a health emergency because access to services has been cut off.

I have been inundated with numerous examples of the situations people found themselves in, but the underpinning point is relatively simple: access to a full and comprehensive range of hospital service is, for the people of west Cumbria, essentially non-negotiable. The recent flooding showed that, if services are transferred from the West Cumberland hospital, in times of emergency, patients simply would not be able to access them because they would not be able to get to the Cumberland infirmary in Carlisle.

I repeat that that cannot be acceptable. In times of emergency, the people of west Cumbria need to be able to access their services. That can be assured only by retaining their services in their local hospital—the West Cumberland hospital—which is a fantastic new facility for which I have campaigned for more than 10 years. I make two specific requests of the Minister with regard to the hospital. Will he please move to unblock the funding for phase 2 of the hospital new build programme? The money has been allocated but is not yet accessible. I ask that that be done as soon as possible so as to provide confidence and help to build public trust. If, as is suggested by some, Monitor will shortly be able to allocate a fund £1.8 billion to the most challenged health economies in the country, will the Minister ensure that north Cumbria is at the top of that list?

The last point I should like to address is the short-sightedness of the trust’s desire to move services. West Cumbria is home to one of the most nationally strategic points in the shape of Sellafield. Over the coming years, with new nuclear reactors at Moorside, which is adjacent to Sellafield, thousands of jobs will be created, and my constituency will become one of the fastest-growing regional economies anywhere in the United Kingdom. As a result, the local population will grow significantly and quickly. The people who live in west Cumbria need better access to the health services on which they rely, but it is simply mind-boggling that, when the local population is growing, the trust thinks it is possible and perhaps even desirable to move services more than 40 miles up the road. The Minister has been unequivocal about that in the past and I thank him once again for that. The local NHS must take into account strategic infrastructure and the local population of host communities when planning services, so will he commit to write to North Cumbria University Hospitals NHS Trust to ensure that it publicly acknowledges that? Will he today, at the Dispatch Box, urge the trust to factor that population growth and strategic need into its future plans?

The fundamental principle in the debate is absolutely straightforward. Moving services more than 40 miles away from the West Cumberland hospital is the antithesis of the principles that underpin a truly national health service. I would go as far to say that, unless patients and taxpayers in my community can access the same level of healthcare routinely provided by the NHS in other communities, the national health service exists in name only. Forty miles is not a reasonable distance to ask people who are in need of medical care to travel, particularly when that 40 miles is served by such inadequate infrastructure. Mothers giving birth do not want to sit in an ambulance on the A595 hoping beyond hope that they do not get stuck behind a tractor.

A fully operational accident and emergency department supported by associated departments, consultant-led maternity services and paediatric services must remain at the West Cumberland hospital, for which I have much to be grateful for, both as an individual and as a recent parent. If we need to adopt a flexible approach in order to achieve that, that is what we must do. It must be accompanied by what will in many ways be nothing short of a new model of healthcare. The trust should know that the people of west Cumbria will stand for nothing less. The trust may be a provider of services but, after all, the NHS belongs to all of us.

I fully support the success regime, but I ask the Minister today to tell the trust in unequivocal terms that, unless it listens and responds to the west Cumbrian community, it will face a fight the likes of which it has never seen.

It seems appropriate that the final debate before Christmas is about maternity. It is appropriate in another way because it is about an area of the country that has too often been forgotten in the planning of services and where the people feel left out from the way in which the NHS has been formed in the past. The Government and I wish to address that. I am grateful to the hon. Member for Copeland (Mr Reed) for bringing his points to the House. He is a forthright campaigner for his constituents and cares passionately about his constituency, and he understands the needs and concerns of his patch. I listen with care, because I know he chooses his words with care. He would not have used the strong language he used in his speech were it not for the fact that he judged it necessary to do so.

I will begin where the hon. Gentleman ended—on the floods. I was glad that, despite the extraordinary amount of rainfall in Cumberland and Westmorland, the effect on NHS services was not as severe as it was in 2009 and 2005. That shows we are at least getting a bit better at resilience and planning. I would like to pay tribute to some of the people who stood out during the difficult period of the past few weeks. The NHS workers from across north Cumbria, many of them in his constituency, worked all hours to make sure people could access medication and receive treatment. It is a credit to them. The amount of work, commitment and vocational passion they bring to their jobs was reflected in the hon. Gentleman’s speech.

I will come on immediately to the problems in north Cumbria. They are well documented, although there is no agreement yet on how we address them. The fact is that north Cumbria is one of those rare things in England: a very remote area. We do not have them in our country in the way that others do. Our neighbouring country of Scotland has more remote areas and is able to understand the pressures that they put on health systems in a way that we do not. The Whip, my hon. Friend the Member for Hexham (Guy Opperman), also represents a remote and rural area. Rural areas pose particular challenges to a service that has grown out of an urban design for healthcare provision over many decades. We are seeing the pressures and difficulties posed by that structural conflict in north Cumbria.

To be blunt—the hon. Gentleman is cognisant of this—the care of patients in north Cumbria has fallen well short of where it should have been because of the structural failures in the way the NHS is set up in that area. That is why the hospitals were placed in special measures and why they have been there for so long. It is why they have not exited from special measures and why NHS England, together with Monitor and the trust development authority, has felt it necessary to place the whole of the health economy of north Cumbria into its so-called success regime. That is not a title I love very much, but I hope it points to the place we need to get to.

I will say from the outset that the success regime will be successful only if it comes up with a plan that is deliverable and has the support of local people and clinicians. The problem in the past has been that ideas have been proposed, normally from the centre, and placed on to local people. Completely understandably, they have said, “I am not having this. This doesn’t suit what we believe we need in terms of healthcare for our area and that’s not good enough.” Because the NHS is owned by local people, we will only win this if they feel any redesign will improve quality and services. We also have to be clear that it will pose difficult challenges to us as politicians, both as local representatives and Ministers. It is important we get behind the success regime when it concludes and are prepared to take difficult decisions. The one thing that will ensure that the poor state of patient care quality persists in north Cumbria for years and decades to come is if we do not take a decision. We have to take a decision. We have to make sure it is the right decision. We have to get behind it and make sure it happens.

Turning to some of the specific issues the hon. Gentleman raised, the issue of staffing really underlies all the problems in the various NHS bodies in north Cumbria. It is difficult to recruit to certain specialties in north Cumbria. That means the trusts and other NHS bodies depend on locums and agency staff. That is not the way to run the health economy either in north Cumbria or across the NHS. That is why we have taken wider action on staff agency costs and why we need specific help for north Cumbria. The success regime is looking specifically at this.

The hon. Gentleman mentioned the new medical school, led by the University of Central Lancashire, on the West Cumberland campus. I welcome its sense of innovation. It already provides very good non-medical healthcare courses, and I am glad it is reaching into new areas. I will be excited to see how it progresses and would like to see what it is doing for myself in the near future. I certainly endorse his plan for a rural health policy laboratory—it is the right way to go—which I hope will feed into the success regime and our understanding of how to learn from other areas of greater rurality and sparsity, such as Canada and Australia, and how they deal with, and provide exceptional care to, people in dispersed communities.

The hon. Gentleman mentioned nursing bursaries. I will not get into that debate now, but I hope he will be reassured by my announcement a few hours ago of a nursing apprenticeship route all the way to degree level to ensure that healthcare assistants can progress to registered nurses via an intermediate nursing associate position. In north Cumbria, it is much easier to recruit to healthcare assistant posts than to nursing posts. I hope he will understand where I am going with this. As in Hull and other parts of the country where it has been difficult to get nurses into post, it will allow us to give to our excellent, committed healthcare assistants, who have the values of the NHS right at the core of their being, a career progression route that they have not had so far. I hope he will take comfort from that initiative.

I understand that staff often work excessive hours just to keep things going in stressed areas such as north Cumbria. The NHS depends on their good will at such moments, but it is not something we should bank on, which is why we need to get it right for his constituents and the whole of north Cumbria.

The hon. Gentleman made two final points about the building programme at the West Cumberland and the transformation fund. I will certainly consider his request in respect of the West Cumberland, although it is probably best that Monitor comes to a final decision once the success regime diagnostic is at least concluded, which should be imminently, because it would be a mistake to embark on something that would be moderated by a joint decision within the success regime deliberations. I will ensure, however, that there is pace to that. It is important, if it is committed to, that it is delivered, but I assure him that I will look into the matter first thing in the new year.

The transformation fund is designed to stimulate the innovation we know there is in the NHS around clinical management and to bring efficiencies to bear across the hospital estate. It is not, I stress, a bail-out fund; it is designed to do what it says on the tin: to transform how we run our hospitals. Efficient care is good-quality care, as the hon. Gentleman understands better than most, which is why the hospitals delivering the best care in the country are also the best at looking after their finances. There is considerable talent within the management and clinical management core in the NHS, and we want to realise their ideas for making the NHS more efficient across the services it provides. That is the purpose of the fund. It is to help realise that innovation and to match their efforts. If we simply pour it into bailing out hospitals that are not doing their bit to transform and bring in efficiencies, it will be doing the wrong thing and we will be wasting money. However, I will certainly make his request clear to the leadership of NHS Improvement, which is concerned with this matter. He will be pleased to know that Jim Mackey, the exceptional new chief executive of NHS Improvement, is well acquainted with his part of the country and has its interests at heart.

It remains to me, as the last person to speak from the Floor this year, to thank the hon. Gentleman for bringing this important matter to the House. On this occasion, last is certainly not least, and I hope that Cumbria will be first in the new year in terms of the announcements we will make. I wish everyone still remaining in the Chamber—the Clerk, the Serjeant, the Whip, the Doorkeeper, the officials in the Box, the one or two determined visitors and you, Madam Deputy Speaker—a very happy Christmas.

Question put and agreed to.

House adjourned.