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Kettering General Hospital Urgent Care Hub

Volume 664: debated on Tuesday 3 September 2019

I beg to move,

That this House has considered the urgent care hub at Kettering General Hospital.

May I say what an unexpected pleasure it is to see you in the Chair, Mr Bone. I am sure that we will all benefit from your wise guidance and counsel. I thank the Speaker for granting me this debate and welcome the Minister to his place. We are joined today by Mr Simon Weldon, the outstanding chief executive of Kettering General Hospital, our very popular local hospital. Of course, you will know him as well as I do, Mr Bone.

Kettering General Hospital is an extremely popular and well-liked local hospital. It is 122 years old this year, and still occupies the site that it first occupied in 1897. There cannot be many hospitals in the country that are still based almost entirely in their original locations from more than a century ago.

Today, we are talking about the urgent need for an urgent care hub on the Kettering General Hospital site. We need the urgent care hub because the hospital is such a popular one that it simply cannot cope with the number of patients admitted to A&E at the moment. Everyone—all the local NHS professionals in every NHS organisation in Northamptonshire—agrees that the best solution to the challenges the hospital faces is £49 million for the development of an urgent care hub on the site, which the hospital needs.

An urgent care hub would basically be a one-stop shop for GP services and out-of-hours-care, an onsite pharmacy, a minor injuries unit, facilities for social services and mental health care, access to community care services for the frail elderly, and a replacement for our A&E department. The most crucial aspect of that is the A&E department, which was built 25 years ago in 1994 to cope with 40,000 attendances each year. Last year, 91,200 patients came through that very same A&E. This year, we are on track to pass the 100,000-mark for patient attendances, which is well over 150% of the department’s capacity. By 2045, 170,000 attendances are expected at the same site

It is not only Kettering General Hospital—A&Es across many constituencies suffer from similar problems. Does the hon. Gentleman agree that we would all benefit if, in A&Es—particularly that of Kettering General Hospital, which the debate is about—there were better patient care and a better working environment for health professionals? In A&Es, it is important that health professionals are happy in their work and feel that they can move forward in what is possibly the most stressful specialty. In the long run, the investment to which the hon. Gentleman referred will pay for itself in better patient outcomes and better staffing capacity.

I am most grateful for that unexpected contribution from Northern Ireland—it is always a delight to see the hon. Gentleman in his place, and I thank him for his support. Of course, I agree that A&E facilities across the country are under pressure, but that pressure is particularly acute in Kettering, not least due to the number of houses that are being built locally, the increase in the local population and the fact that—thank goodness—we are all living longer. In Northamptonshire, there has been a particular increase in the number of elderly patients who are served by the local hospital. I thank the hon. Gentleman for attending and for his support.

In 2016, Dr Kevin Reynard of the national NHS emergency care improvement programme visited Kettering’s A&E and concluded that:

“The current emergency department is the most cramped and limiting emergency department I have ever come across in the UK, USA, Australia or India. I cannot see how the team, irrespective of crowding, can deliver a safe, modern emergency medicine service within the current footprint.”

Simon Weldon is also extremely concerned about patient safety. He said to me that unless we get the situation sorted, sooner or later there would be a patient death in Kettering’s A&E.

An impact of the incredibly cramped department is that staff do not have clear lines of sight on some of the most unwell patients to monitor their conditions appropriately. Privacy and dignity for patients cannot be maintained due to overcrowding and cramped spaces. Patients wait longer than the national limits, as there is physically not enough space to treat the numbers coming through the door. Children have to wait in open corridors and go through adult areas to receive treatment. A lack of space to offload ambulances often results in long queues and inhibits ambulance response times to 999 calls. The A&E rooms do not comply with many current health building standards and there is a lack of natural daylight.

The Care Quality Commission and other inspections have consistently raised multiple concerns, for both adult and paediatric patients, about the size and limitations of the estate. Most importantly, as I have described, the number of patients has now reached a critical point and staff need to manage safety daily, patient by patient. For health professionals who take pride in their job, the challenges of working in Kettering A&E are becoming unbearable.

In the next 10 years, local population growth is expected to far exceed the national average and our catchment includes the fastest growing borough outside London, in our neighbouring constituency of Corby. In the last census, out of 348 districts across the country, Kettering was sixth for growth in the number of households and 31st for population increase, while Corby has the country’s highest birth rate. Our local area has been included as part of the Cambridge-Milton Keynes-Oxford corridor, in which there is a commitment to build 35,000 new homes in the next 10 years.

Kettering General Hospital expects a 21% increase in over-80s and 10,000 more A&E attendances in the next five years alone. Despite some temporary modifications over recent years, including moving other patient services off the hospital site to accommodate delivering safe emergency care, detailed surveys show that there now remain no further opportunities to extend the current department and that a new building is required on the site.

Following those safety reviews and surveys, the hospital has developed a business case for a fit-for-purpose emergency care facility that will meet local population growth for the next 30 years. It was developed with all health and social care partners across Northamptonshire, so that patients can get a local urgent care service that meets all government guidance on good practice, ensuring that they get the care they need to keep them safely outside of hospital and that they are cared for by the right clinician at the right time, first time.

The urgent care hub would be a central cog in a whole-system approach to delivering urgent care services to meet the needs of the population, and it would work alongside GP, mental health, community and social care services. The hub continues to be identified as the highest clinical safety priority across the whole of the county by Northamptonshire sustainability and transformation partnership. It was also approved by the NHS Improvement midlands and east regional team as the highest priority submission for central capital funding.

We are talking about £49 million and about Northamptonshire being the only one of all 44 STP areas in the country not to receive any capital funding at all in the past four waves of such funding from the Department. Why is that the case? If the Minister were to agree to the urgent hub proposal, he would put that wrong right. The trust can access only £3.5 million annual capital through its own funding, and the county, Northamptonshire, has only £20 million, but that is used simply to maintain essential equipment and to repair heating and lighting systems. Kettering General Hospital therefore requires central funding or some form of private financing to build the facility.

A bid has been submitted as the highest clinical priority for funding across the whole of the NHS in Northamptonshire, and for NHS Improvement regionally, but Government capital allocation announcements over the past few weeks have not included the urgent care hub, nor any other moneys for Northampton or our local region. I simply do not understand why Kettering General Hospital has been missed off the list. The national NHS Improvement team has indicated that no further STP capital funding will be announced until spring 2020, although I understand that the Government are now reviewing all spending allocations across all Departments in the comprehensive spending review expected later this week. Local people will be very surprised if Kettering General Hospital is not included somewhere in that review.

Given the clear patient safety concerns at Kettering that have been recognised locally, regionally and nationally by NHS experts, what process did the Government follow to award schemes the central NHS capital allocations in recent weeks? Why was Kettering not included? Why were some awards made to areas with no apparent clear and worked-up business case, when Kettering has such a case? Given the lack of access to further NHS capital funding, what are the alternatives for Kettering General Hospital without a central grant of funding from the Department of Health? Furthermore, how are the Government correlating healthcare decisions with the locations of planned growth in housing?

I do my humble best as the local elected representative to express such concerns. The chief executive of the hospital, Simon Weldon, would have made a far better job in this debate than me, but I will quote some of the dedicated healthcare professionals in our local hospital. They will outline the challenges that they face far better than anyone else.

The head of children’s safeguarding at the hospital, Tabby Tantawi-Basra, said:

“Children have to wait in corridors alongside seriously unwell, drunk or mentally unwell adults. This causes a serious safeguarding concern as our staff are not always able to have line of sight on them.”

Sarah Parry, who is a nurse in end-of-life care at the hospital, said:

“When a patient is brought into A&E dying or already passed away, there is no space where relatives can sit quietly to receive the news and grieve. We can’t even make them a cup of tea—they have to share a facility with the staff room!”

Jacquie Barker, the head of adult safeguarding, said:

“We know from the Winterbourne View scandal that the lack of privacy and dignity for vulnerable adults seriously impacts their mental wellbeing. Sadly our facilities mean even our most vulnerable adults are looked after in very cramped conditions, sometimes next to disruptive or aggressive other adult patients.”

Claire Beattie, the head of nursing medicine at the hospital, said:

“Our staff work tirelessly to keep patients safe under the most difficult of conditions. The way the treatment areas are configured means they struggle to easily communicate or ask for help, and if patients are deteriorating then it isn’t always easy to see that quickly and give the urgent help they need.”

Leanne Hackshall, the director of nursing, said:

“Patients are so close together they can almost hold hands. And if someone is being sick or coughing badly in the next space then every other patient worries about who they are so close to.”

Polly Grimmett, the director of strategy, said:

“As Director on call in August, we had over 100 patients in the department for most of the night and it’s only safely meant to fit 40—there were 10 ambulances with patients queuing. This is meant to be our quietest month so who knows how bad it will be in December!”

Nicola Briggs, the director of finance, said:

“If we stopped spending any money at all on necessary things like replacing light bulbs or fixing equipment, then it would still take us nearly 15 years to save up enough money ourselves.”

The urgent care hub is, as far I am concerned, the No. 1 priority for local people in Kettering. The general hospital is much loved, and we need more investment to cope with the growth in the local population and to care for our increasingly aged population. I invite the Minister to visit the hospital and to see the A&E department for himself. If he does so, he will follow in the footsteps of two previous Ministers with responsibility for hospitals and the previous Secretary of State.

The problems are well known in the Department of Health, and I simply do not understand why £49 million—not very much in the context of the size of the whole NHS budget—cannot be allocated to fund the badly needed urgent care hub at Kettering General Hospital. All the local NHS bodies agrees that the hub is the answer to the difficulties and challenges faced by the hospital.

More patients are being treated at Kettering General Hospital than ever before. Their treatment is increasingly world-class, and I thank all the dedicated NHS professionals in our local hospital for their magnificent work. In order to help them face the challenges ahead, we urgently require £49 million from the Government for this badly needed urgent care hub facility.

It is an honour to serve under your chairmanship, Mr Bone, in my first debate as the new Minister of State for health.

I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate on the proposed urgent care hub at Kettering General Hospital. This is an important issue for not only my hon. Friend but his constituents in the wider Kettering community, and it is one on which he campaigns tirelessly. I congratulate him on his diligence and determination to continue that, bringing it before the House today.

Kettering General Hospital, as my hon. Friend mentioned, has stood on the same site for nearly 122 years. It plays a vital role in the community, and he set out eloquently the importance of the hospital to that community. In January this year, my predecessor, my hon. Friend the Member for Wimbledon (Stephen Hammond), discussed the urgent care hub proposal with my hon. Friend the Member for Kettering and visited the hospital, following the foundation trust’s unsuccessful £45.7 million sustainability and transformation partnership bid in July 2018. My hon. Friend set out clearly the need to cope with rising demand, with which the urgent care hub could assist.

Given the unsuccessful bid, I am sure that my hon. Friend is aware that the sustainability and transformation partnership programme has been the main funding route for strategic capital development projects. Under that programme, capital has been allocated to more than 170 STP schemes since July 2017, which now amounts to about £3.3 billion. STP investments will modernise and transform NHS buildings and services across the country, including new urgent care centres, integrated care hubs that bring together primary and community services, and investment in new mental health facilities.

On 5 August this year, the Government announced a £1.8 billion increase in NHS capital spending, on top of the additional £3.9 billion announced in the 2017 spring and autumn budgets. Of the increase in NHS capital spending, £1 billion will allow existing upgrade programmes to proceed, to tackle the most urgent infrastructure projects. Some £850 million will allow 20 new hospital upgrades to start as soon as possible. Those hospitals were chosen because they applied for funding in tranche 4 of the sustainability and transformation partnerships, but narrowly missed out. I will set out the short process that we go through to designate the waves, whereby the 20 hospitals that narrowly missed out on upgrades previously will receive funding this time.

Kettering General Hospital narrowly missed out on previous funding allocations. Northamptonshire is the only one of the 44 STPs in the country never to have received any capital funding in the four waves that have taken place. I find that staggering, given the overwhelming support from the local NHS for the urgent care hub proposals.

NHS Improvement and NHS England follow an independent assessment process. Previous waves, and the allocation of the 20 hospital upgrades that were announced last month, were assessed on the following six criteria: deliverability; patient benefit and demand management; service need and transformation; financial sustainability that delivers savings to both the organisation and the sustainability and transformation partnership; value for money, including return on investment; and estates.

As well as the top-scoring schemes, a number of schemes of critical service importance have been included, such as mental health and learning disability schemes, drawing on the advice from sustainability and transformation partnerships and national and regional NHS leadership. Together, the schemes demonstrate that they will deliver clear improvements to services. That may not be the answer that my hon. Friend wants to hear, but let me reassure him that I am happy for NHS England and NHS Improvement to discuss how the process and the scoring of requirements operate in greater detail with the chief executive, Simon Welden, who is sitting in the Public Gallery. If the trust would like to have that meeting, I will happily help to arrange that feedback for the hospital and my hon. Friend.

On future capital funding, an extra £1.8 billion was announced in August. That money, to enable investments in critical infrastructure, was not previously available, and gives new spending power to the NHS to fund new projects. The £1.8 billion is a brand-new capital injection on top of money announced in previous Budgets and spending reviews. The Department’s capital spending limit has increased accordingly: following the announcement on 5 August, the capital spend on health for 2019-20 has gone up from £5.92 billion to £7.02 billion. It is important to make that clear, given some wish to look for bad news in any good news announcement. It is important to recognise that the £1 billion boost, and the £100 million of the £850 million allocated this year, will be spent on that capital allocation.

I join the Minister in welcoming the £1.8 billion of extra capital funding for the NHS and the £1 billion wave of funding at the end of 2018. That is all very good news, but given there is almost £3 billion of extra capital injection, we simply cannot understand why £49 million of that could not find its way to Kettering, particularly as there is already a worked-up business case, to get the project up and running quickly.

As a new Health Minister, I have found that the wave approach to the sustainability and transformation partnerships programme has highlighted a wider issue with NHS capital. My hon. Friend’s point about geographical distribution applies not just to bricks and mortar but to diagnostic equipment. We must make sure that our national health service is truly national, by giving every trust equal opportunities to apply for and receive funding. That is why the Secretary of State recently set out that, as a Government, we will establish a new health infrastructure plan. The plan will mean that we take a strategic approach when looking at hospitals that need upgrades, and how that will fit into a wider strategy that will be organised in the Department, taking into account local needs and NHS clinical requirements.

We will put in place a long-term strategy to upgrade and improve our NHS. That will deliver a major strategic hospital rebuilding programme that will provide the necessary health infrastructure across the country. I cannot go into any further detail, apart from to say that the shape of that will be confirmed in due course. To offer a comparison, the road investment strategy—RIS 1 and RIS 2—has a longer term process by which we can move away from a succession of waves. We have waves 1, 2, 3 and 4 of funding as part of the STP processes: some of those projects are further along and more developed than others; some have more advanced business cases than others, as my hon. Friend mentioned. It is important to take a strategic approach for the future.

I understand that my hon. Friend was disappointed that Kettering General Hospital was not selected for funding this time. However, as he mentioned, the trust secured £6 million in emergency capital funding this year, to deal with safety-related estates work. In addition, between 2017-18 and 2018-19, the trust received more than £14 million in capital to fund improvements to the hospital, including £12 million to tackle the urgent capital backlog and other essential capital expenditure. It received £2.4 million for winter pressures and £820,000 for electronic prescribing. That does not make up for what my hon. Friend recognises as an important development and improvement to the estate, but in Kettering the trust has improved enormously and has made great strides in recent years.

I note that while the Care Quality Commission rated the hospital as “needs improvement” after its inspection earlier this year, the trust has been taken out of special measures for quality following the CQC report published in May 2019. I am pleased that, despite the rising demand my hon. Friend mentioned, it is still providing patients with safe and good quality care and is focused on embedding a culture of continuous quality improvement. I am delighted that Kettering General Hospital is participating in a national urgent and emergency care standards pilot, and I await information and learnings on that this year.

I am glad that the Minister highlights the huge improvements made at the hospital and the superb leadership we now have in place. Will he accept an invitation to visit the hospital and see the A&E department at first hand?

I thank my hon. Friend for that invitation; I would be delighted to visit the hospital. I pay tribute to the staff at Kettering General Hospital, who continue to work hard and who contributed to the hospital’s receiving a good rating for care. I hope we will continue discussions during my visit.

I hope that, if my hon. Friend and the trust are willing, I can arrange the meeting to go through the criteria for STP wave 4 in finer detail. I hope that he understands that we are looking at setting up a new process by which capital infrastructure projects will be delivered. The Government have made significant investments in the NHS as part of their long-term plan. We recognise that we need to mirror that investment in NHS capital. I thank my hon. Friend for raising this important issue, and I look forward to working with him.

Question put and agreed to.

Sitting suspended.