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Shepton Mallet Community Hospital

Volume 631: debated on Tuesday 21 November 2017

I beg to move,

That this House has considered the temporary closure of in-patient beds at Shepton Mallet community hospital.

It is a pleasure to serve under your chairmanship, Mr Gray. I thank the Minister and her team not only for coming to respond today but because they, like me, have been speaking to local health authorities in Somerset in preparation for the debate.

There are two parts to today’s discussion: the temporary closure of the in-patient beds at Shepton Mallet and the longer-term future of the site—the redevelopment of existing facilities to create a community health campus.

The decision on temporary closure was announced very late indeed. Only about three weeks’ notice was given to patients and the community and, worst of all, to the staff. The reason given for temporary closure was that insufficient nurse cover was available. Understandably, that was very vigorously challenged by the staff at the hospital, who knew that the overall rota statistics for both day and night shifts were 100%. Shepton Mallet Community Hospital was fully manned, was running well and had some of the lowest agency costs in the entire county. Under scrutiny at an excellent public meeting held in Shepton Mallet two weeks ago, Somerset Partnership NHS Foundation Trust was forced to accept that actually, what it was seeking to do was to break up a team that was working well and was fully staffed, in a hospital that was fully operational and able to deliver all that it should in the beds that it had, in order to fix rotas elsewhere.

I do not know about you, Mr Gray, but I have always believed that “if it ain’t broke, don’t fix it” is a pretty good motto to live by, and that would appear to make the trust’s decision to close temporarily a hospital ward that was functioning well to try to fix the system elsewhere somewhat nonsensical, not least because when the temporary closure comes to an end—I am sure the Minister will agree that the local health authorities are adamant that the closure is temporary—the trust will have to reconvene those staff and get everything up and running again. What everyone is agreed on—it is important to emphasise this—is that this is not a financial measure. No one—we are told—is seeking to make a saving from it. Indeed, the chief executive of the Somerset clinical commissioning group told me on the telephone yesterday that if there was an option to just put more money into this he would have done so.

The reality is that there is a challenge with nursing availability elsewhere in the county; I understand that about 34 vacancies within the county need to be filled. That clearly cannot be sorted overnight. It does not excuse the temporary closure of Shepton just because it had a full rota, but I accept that there is a wider county issue and, if my disagreement with the decision over Shepton is lodged, there is clearly a challenge for the local health authorities, for NHS England and, indeed, for the Government in filling those nursing vacancies in the county as quickly as possible.

One area where there has been some disagreement, and where I think Shepton Mallet Community Hospital has been left unnecessarily vulnerable, is that for the past few years, urgent repairs to the fabric of the hospital building, including the boiler, have been postponed by NHS Property Services, under cover of an enthusiastic discussion about redevelopment on the site and the creation of a health campus. That would have meant the addition of a new build extension to the Shepton Mallet treatment centre, into which the in-patient ward, the out-patient clinics, a GP practice and some public health facilities would have gone. However, we are now in a really frustrating position where the outgoing chief executive of the trust said at the public meeting the other week that when the staff of the trust were looking at options for managing the shortage of nurses, they looked around and, as Shepton Mallet and Chard were small hospitals and the fabric of their buildings was causing them concern, they made the decision to close them, regardless of their success in filling their rotas.

My constituents’ anger is understandable. They know that NHS Property Services, which is responsible for the maintenance of the existing community hospital, knows that there is a big maintenance burden and has chosen not to maintain those buildings, on the basis that we were going to get a new hospital. In the process, however, that decision has meant that Shepton has been a soft target for temporary closure.

That leads me to my first ask. The Minister will hopefully agree that, from this moment on, no matter what the prospects for redevelopment into a community health campus, NHS Property Services should be required to get in there and urgently fix the buildings, as they are—the local health authorities have been clear that this is just a temporary closure and, therefore, an in-patient bed facility at Shepton Mallet Community Hospital is expected to resume in the near future. The conversation about redevelopment can go on concurrently, but repairs can no longer be postponed on the basis that something new might be built.

My second ask is that the nonsensical decision is challenged once more. I hope that the Minister might just go back and ask, as I have on a number of occasions, “Really?” There is an opportunity here to put back in place a team that was succeeding. The Minister will be keen to know, I am sure, about the excellent crowdfunding campaign in the town. It has raised thousands of pounds for a legal challenge, because there is a suggestion that the temporary closure may be illegal, in that it has not been properly consulted on. I encourage the Minister to go back and ask again whether the hospital can really be closed when it was succeeding so well.

Thirdly, I hope that the Minister will direct NHS England and her colleagues in UK Visas and Immigration to make it as easy as possible for the immediate needs of the staffing rotas for nurses in Somerset as a whole to be met by migrant nurse labour as urgently and quickly as possible. Of course, we would like to say that it would be great to bring British nurses who have left the career back into service, but the reality, in trusts all over the country I believe, is that the most immediate way to supply nurses at short notice is to go overseas. I understand that the Government have previously been able to expedite the visa process and I hope that the Minister will be able to assist in that.

Fourthly, if the temporary closure decision must stand, will the Minister agree to work with me to ensure that, first, the local health authorities are required to give us, in writing, a clear timeline for the reopening of the beds in Shepton Mallet? Secondly, will she agree to meet me in early January and again in early February, after speaking to the Somerset Partnership NHS Foundation Trust, so that she and I may take stock of the progress the trust is making in filling the vacancies, and so that we may satisfy ourselves that the temporary closure will end on the date to which the trust has committed? Will she ask the Secretary of State to agree to a meeting in March, shortly after the date on which I believe the trust says the temporary closure will come to an end? I would hope that such a meeting would not be needed, but at least it would focus minds, and should the ward not reopen on the agreed date, all those responsible for the failure could come up and explain to the Secretary of State why the deadline had not been met.

As I said in starting this speech, with the temporary closure of the ward—as frustrating as it is and as much work as there is to do to ensure that it is genuinely temporary and as short term as possible, so that the ward is reopened as early as possible—there is a wider discussion about the future of the Shepton Mallet Community Hospital. The vision for a Shepton Mallet health campus is exciting. While I was campaigning for election in 2013, the Secretary of State visited Shepton Mallet Community Hospital and met with the league of friends. He was excited about the plans they and local health authorities had for a health campus on the site. There have been years of meetings to discuss that vision.

The idea was that there would be a GP surgery, out-patient clinics, public health and a pharmacy on site in addition to the hugely successful Shepton Mallet treatment centre, which is run by Care UK and does elective procedures as commissioned by the health authorities. The idea also included two ambulatory care beds, two assessment beds and eight in-patient ward beds. That was the vision. All of that made it into Somerset’s sustainability and transformation plan, and we were hugely pleased to have that vision there. Since then, the GP practice has fallen by the wayside because there are issues over releasing the GP practice from its mortgage on its current site. That is a private business issue for the GP practice and NHS England, and it has been frustrating that that has not been unlocked. I hope that the clouds may part and the sun will shine and it will somehow still happen, but that is a separate issue, which I do not want to labour today.

Other than the GP practice, everything else was still in the plans. As recently as January, I sat down with the hospital director for Shepton Mallet treatment centre and the then chief executive of the Somerset clinical commissioning group, and I was shown the plans for this amazing health campus. It looked fantastic. It felt so close that you could smell the freshly painted corridors, Mr Gray. The problem is that since then things have gone horribly wrong for Somerset clinical commissioning group. From nowhere, it is now forecasting a significant deficit, which has brought with it the requirement for a change in leadership. Worse still, it turns out that after years of work, the STP needs to be revised because NHS England has reservations about the strategy underpinning it. I understand that when Simon Stevens visited a couple of weeks ago, there was not much coffee being served at the meeting.

The situation is a very bitter pill to swallow for me and for those in the community who have been working so hard to secure the vision of a health campus. I now understand that everything is back under review. I look forward to resuming the debate with local health authorities about what that health campus should look like. Nothing has changed, in that the vision is obviously for community hubs to deliver healthcare. I accept that there is some discussion about the validity of in-patient beds, but with a population as sparse and a demographic as challenging as Somerset’s—along with the acute pockets of deprivation within the county—the demand for beds in Somerset has perhaps been higher than elsewhere, and those occupancy levels might indicate why Somerset has maintained a higher level of in-patient beds than some other places.

After so many years of discussion, the situation is disappointing. So many hours have been spent in committee developing first the STP and then the plans for a community health campus in Shepton Mallet. First, because of the nursing shortage, which must have been known about months and months ago by the Somerset Partnership NHS Foundation Trust, a successful and winning team at Shepton will be broken up to try to plug gaps elsewhere in the county. Secondly, the plans we had for a health campus in Shepton were hugely exciting. It is surely the model we should be transitioning to for a community-based healthcare system that keeps people out of acute hospital facilities and facilitates their discharge from acute hospitals as quickly as possible. That is not to mention the fact that the geography of my constituency lends itself to such community facilities, because I have no significant hospital in or very near my constituency. My constituents divide in equal measure between Weston-super-Mare and Bristol to the north-west, the Royal United Hospital in Bath to the north-east, Yeovil to the south-east and Taunton to the south-west. Having those community facilities when hospitals are all 20 miles or so distant in each direction is an important part of maintaining the right health network for my community and ensuring that we get people out of acute hospitals or stop them going there in the first place.

The argument for good, well-developed community healthcare facilities is easily made, and I am disappointed that after years of trying to develop such facilities at Shepton Mallet, the Somerset clinical commissioning group appears to have failed. I am disappointed that the STP is now up for revision, especially when we had won the argument over having eight plus two plus two beds in a redeveloped Shepton Mallet health campus. I hope very much that the Minister will join me in applying as much pressure as she can to the Somerset clinical commissioning group to ensure that the STP is revised as quickly as possible, and that Shepton Mallet does not lose out in that process.

It is a pleasure to serve under your chairmanship, Mr Gray. It is also a pleasure to respond to my hon. Friend the Member for Wells (James Heappey), who has brought the required amount of passion to this argument. He is doing exactly what he should do to stand up for his constituents after the local health establishment made a very rapid decision regarding his hospital. It certainly came out of the blue for many people, but I would like to give some explanation as to why the decision was made and perhaps a message about where we may go in the future.

In the short term, we have the closure, but what happens beyond that is very much up for review. I commend my hon. Friend on the constructive way in which he has engaged with local health practitioners while still giving them a challenge. That is always the way to go with these debates. As we all know, the challenged situation we are facing is not only in terms of money. As he acknowledged, in this case the issue is not money; it is workforce across the trust. The challenged situation means that we will have to make some difficult decisions, and we should make them on the basis of constructive dialogue, not who shouts loudest. I certainly agree to his request to have more discussions on this matter in January. Although the decision-making process is independent, we as Ministers will want to satisfy ourselves that processes are being properly followed and representations are being properly heard.

The reality is that any decision of this kind has to be taken with full transparency and full accountability. Robust argument will withstand challenge. I look forward to taking the dialogue with my hon. Friend further. I also welcome the forward-looking points he made about the future campus and looking at future needs. All too often in such debates we look at the immediate short-term challenges without addressing the long-term ones. If we looked more at the long term, we might come to better decisions, rather than short-term ones.

I understand my hon. Friend’s concern about the impact that changes at Shepton Mallet Community Hospital will have on his constituents. I reassure him that changes will always be in the best interests of patients and the local community. Decisions must be driven by what is best clinically, what is best for the health service in the area and what is of most benefit to the greatest number of people in the area. He asked me to direct the trust to reverse the closure. We are very much of the opinion that it is right that such matters are addressed at the level where the local healthcare needs are best understood, rather than in Whitehall. I give him the assurance that I will join him in holding local decision makers to account to ensure that their decision making has been properly accountable and robust.

It is worth reiterating that all proposed service changes should meet the four tests for service change: they should have support from GP commissioners, be based on clinical evidence, demonstrate public and patient engagement, and consider patient choice. In addition, NHS England introduced a new test applicable from 1 April 2017 for the future use of beds. It requires commissioners to assure NHS England that the proposed reduction is sustainable over the longer term and that key risks, such as staff levels, have been addressed.

I will first outline what led Somerset Partnership NHS Foundation Trust to announce on 11 October the temporary closure of in-patient wards at two of its 13 community hospitals across the county. As my hon. Friend has pointed out, the decision was not financial; it was based on patient safety. Overall, Somerset Partnership provides 222 community hospital beds, spread out over 13 community hospitals. Plans drawn up for an expected increase in patients over this winter made it clear that although sufficient funding was in place to maintain services, the trust was facing vacancies in a quarter of its registered nursing posts, meaning that the trust nursing workforce was spread far too thinly at the time. Following a review, it was found not to be sustainable to continue to safely deliver in-patient services across all 13 sites.

To address safety concerns, the trust made the decision to move 10 beds at Shepton Mallet hospital and 14 beds at Chard hospital, along with their staff, to other community hospitals in Somerset. I fully appreciate the case that my hon. Friend has made about the services at Shepton Mallet being robust. I understand why the move feels particularly unfair, but we will have to address that in consultation as we take the matter forward.

The trust has said that the two in-patient wards are likely to be temporarily closed until at least the end of March 2018, but that the current total of 222 community beds and all current services across Somerset will be maintained. Somerset CCG has endorsed the move and is in the process of considering community hospital services and provision as part of a wider clinical services review across the county next year.

We talked earlier about criteria and how trusts should come to decisions: in full openness and consultation with staff and the public. I understand that the trust communicated with a wide range of staff and stakeholders on its plans to temporarily close the wards, including with the local county council, which supported the action taken by the trust on the grounds of patient safety. I am also pleased to say that the trust held all day face-to-face drop-in sessions with members of the public, as well as a public meeting organised by the League of Friends of Shepton Mallet Community Hospital, which was attended by 120 people, including my hon. Friend and local councillors.

The trust has also organised a workshop event in the town for key local stakeholders on 30 November to seek the views of patients and carers while the ward is temporarily closed, and has developed a wider consultation document to inform its next board meeting on 6 February. I urge my hon. Friend and his constituents to engage in that process and make their voices heard. I want to reassure him that Somerset CCG has not put the trust under any financial pressure to temporarily close the wards at Shepton Mallet Hospital.

As my hon. Friend has pointed out, the issue is not about money. It is solely down to the issues around nurse recruitment, and the trust is working hard to improve on that. It has recruited two specialists who have extensive experience of specialised nursing recruitment. It is also offering more intensive support for potential recruits to increase the rate at which they take up posts. It is also working with Yeovil District Hospital to recruit nurses from the Philippines. I am pleased to learn that already there is a large number of interested nursing staff, which the trust hopes will be recruited and in post from April 2018. Furthermore, the trust is revisiting its current golden hello bonus of £1,000 to see how it can be better tailored to individual needs and it is looking at how else it can attract nurses to the trust.

Owing to staffing issues, the CCG supports the closure on the basis that, as my hon. Friend has pointed out, it is temporary and has been made on patient safety grounds, not on financial ones. It has been made clear that there can be no permanent closure of the wards at the community hospitals without prior patient and public engagement and formal public consultation. The CCG fully expects the beds to be reopened after the winter.

By taking planned measures now, the CCG is reassured that that represents the safest way of avoiding the potential risk of disruption to patient care should we see severe winter weather or the predicted higher than average levels of sickness from flu.

There is some concern locally about what the consultations look like. The Minister, briefed by local health authorities, has relayed that a “consultation” was conducted in the last few weeks of November ahead of the temporary closure. The reality is that that, including the agreement of Somerset County Council, was done after the solution was presented as a fait accompli. Can the Minister reassure me that the health authorities will be explicit with the community and all other stakeholders when having such a consultation about permanent closure and that the discussions going on right now about the temporary closure will not in due course be dressed up as the consultation leading to permanent closure?

My hon. Friend has the nub of the issue completely. To inspire confidence among his constituents, we as decision makers need to be very clear about the basis on which the decision was made and how future decisions will be made. The short-term consultation was about a decision made purely to get us through winter for patient safety reasons. For any long-term closure there would have to be a full consultation, fully transparent and fully accountable. I know he will hold me as well as his local trust to that. I do not think I can be firmer. We inspire confidence in the public and in patients who use the services only if we are fully transparent in making decisions. It is unfortunate that the speed with which this particular decision had to be made in order to get us through the winter will have undermined confidence. Of that there is no doubt, but rest assured I will continue to engage with him to make sure we can restore public confidence among his constituents in future.

As I have mentioned, the decision taken has allowed the trust to consolidate beds and staff into fewer hospitals, but larger wards. Closing the wards has reduced the number of unfilled shifts by 60 shifts a week: the equivalent of 13 nurses. Regrettably, since the closure, three Shepton Mallet patients have been admitted to surrounding community hospitals—one patient is in West Mendip and two are in Wincanton. I am advised that, as a result of the temporary closures, the trust has provided support budgets to enable carers and relatives who need financial assistance to visit patients. I should also add that all of Somerset CCG community hospitals have free car parks, so if people are visiting their loved ones, they will not have to pay. I should point out that that is not a privilege enjoyed by many other areas.

My hon. Friend talked about the long-term plans for a health campus. Both Chard and Shepton Mallet have been assessed as requiring significant redevelopment. Chard Community Hospital infrastructure was assessed as not fit for purpose by a 2015 Care Quality Commission inspection. As he pointed out, Somerset CCG is developing a clinical services review that will take into consideration the views of patients before developing a series of service proposals, which will ensure that family doctors, community hospital and district hospital services are joined up with social care services and provide financially sustainable and high quality care. It expects to engage with the public on those proposals in the new year. I know he will engage in that process.

The decision to temporarily close wards at the hospital is an important issue and the decision was not taken lightly. However, the decisions made by the trust have not been made because of financial concerns, but because of nurse recruitment issues. I know that the decision will cause concern to the residents of Chard and Shepton Mallet and the surrounding villages, but I urge my hon. Friend to encourage his constituents to attend the trust’s local public meetings and listen to what is said about addressing the issues that have caused the temporary ward closures, as well as making sure their voice is heard. We will all understand each other better with that dialogue. The people affected by the changes need to be involved in expressing their views and making key decisions.

Our starting point for discussing service change is that no permanent changes to the services that people currently receive will be made without formal public consultation. I reiterate that strongly to my hon. Friend. I conclude by encouraging him to continue to engage with Somerset Partnership Trust, Somerset CCG and me in the new year as the proposals are brought forward.

Question put and agreed to.

Sitting suspended.