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Health and Social Care (Kettering)

Volume 666: debated on Wednesday 23 October 2019

I beg to move,

That this House has considered health and social care in Kettering constituency.

I welcome you to the Chair, Mr Wilson, and I thank Mr Speaker for granting this debate. I also welcome Northamptonshire colleagues who are here: my hon. Friends the Members for Wellingborough (Mr Bone) and for Northampton South (Andrew Lewer). If he is released from his important role in the Government Whips Office, my hon. Friend the Member for Corby (Tom Pursglove) hopes to be able to attend. Others with a local interest are also here, including my right hon. Friend the Member for Rutland and Melton (Sir Alan Duncan), who I welcome to his place.

I also welcome our excellent Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar). He is not only excellent in his own right, but he is super excellent because within just a few weeks of being appointed as hospitals Minister, he made a visit to Kettering General Hospital one of his very highest priorities. He did that on 7 October and met: the superb chairman of Kettering General Hospital, Alan Burns; our wonderful chief executive, Simon Weldon; the medical director, Andrew Chilton; the chief nurse, Leanne Hackshall; the chief operating officer, Joanna Fawcus; the director of strategy and transformation, Polly Grimmett; the director of finance, Nicola Briggs; the director of estates, Ian Allen; the clinical director of urgent care, Adrian Ierina; and the head of nursing in urgent care, Ali Gamby. All those magnificent people were there to meet the Minister because the hospital is absolutely determined to get the necessary funding for a new urgent care hub at the Kettering General Hospital site.

Kettering General Hospital is a much-loved local hospital. It has been on its present site for 122 years, and there cannot be many hospitals that have such a record. The problem at Kettering General Hospital is that the A&E department is full. It was constructed in 1994 to cope with 45,000 attendances each year. This year, we could well go through the 100,000 attendances mark, which is well over 150% of the department’s capacity. By 2045, 170,000 attendances are expected at the same site. The solution to that pressure is for an urgent care hub facility costing £46 million to be constructed on the site. It would be a two-storey, one-stop shop with GP services, out-of-hours care, an on-site 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. All the NHS organisations in Northamptonshire, as well as NHS Improvement regionally, agree that that is the No. 1 clinical priority for Northamptonshire. They are all saying the same thing to the Government, and I am delighted to support their campaign.

The A&E department at Kettering General Hospital was visited in 2016 by Dr Kevin Reynard of the national NHS emergency care improvement programme. He said:

“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.”

Despite some temporary modifications over recent years, including moving other patient services off the hospital site, detailed surveys show that no further opportunities remain to extend the department and that a brand-new building is required on the site. The hospital has developed a superb business case for a fit-for-purpose emergency care facility that will meet local population growth for the next 30 years. It has been developed with all the health and social care partners across the county so that patients can get a local urgent care service that meets all the Government guidance on good practice, ensuring that they get the care they need to keep them safely outside of hospital if necessary, and ensuring that if they come into hospital, they are seen by the right clinician at the right time, first time. The bid has been submitted to the Government. We have been pressing the case for the facility since 2012. It is about time that the Government listened to the concerns and responded by promising the funding.

The pressure on Kettering General Hospital is primarily being driven by very fast population growth locally. The Office for National Statistics shows that we are one of the fastest growing areas in the whole country, at almost double the national average. The borough of Corby is the fastest growing borough outside of London. The population served by the trust has grown by almost 45% since the A&E opened in 1994. The area is committed to at least 35,000 new houses over the next 10 years. That means a population rise of some 84,000, to almost 400,000 people locally. The A&E department now sees approximately 300 patients every single day in a department that is safely sized to see just 110. Every day, 87 patients are admitted into the inpatient wards from A&E, and over the next 10 years, the hospital expects the number of A&E attendances to increase by 30,000, equivalent to almost 80 extra patients every day. Bluntly, a solution is required immediately if the hospital is to have time to prepare and build for that.

I thank my hon. Friend for giving way. I recently visited A&E at Northampton General Hospital, which also has a space and crowding problem, particularly in paediatrics. Does he agree that investment there would assist Kettering with the problems it has and would lead to a whole Northamptonshire approach to solving some of these problems?

I am delighted to take that intervention from my hon. Friend, who is a superb representative for his constituents in Northampton and is very much in touch with the importance of local healthcare issues to our constituents. He is absolutely right.

I am delighted to welcome the Government’s commitment to include Kettering General Hospital on the list of hospitals that will be considered for health infrastructure plan 2—or HIP2—funding from 2025. That is important for Kettering, because the hospital has been there for 122 years, 70% of the buildings on the main hospital site are more than 30 years old and there is a maintenance backlog of £42 million. We need the reconstruction of many wards at the hospital. I welcome the Government’s commitment to investment in the hospital site from 2025 onwards, which could transform the whole of Kettering General Hospital. The point about the urgent care hub is that we need the money now to address the pressure on the A&E department.

The second part of the debate is about the need for us to use the opportunity of local government reorganisation in Northamptonshire to create in the county a combined health and social care pilot that will put responsibility for healthcare and social care under one organisation. Northamptonshire County Council has faced tremendous financial difficulties. The Government appointed an inspector, who concluded that it was not possible to turn around the organisation. The Government’s solution is to create two unitary councils in the county: a “north” council and a “west” council that will take over all the responsibilities of the eight different councils in the county from May 2021. We can use that once-in-a-generation opportunity to create a new organisation on a pilot basis to combine health and social care in Northamptonshire.

That is important for Kettering General Hospital because it has 531 beds; at any one time 110 of those beds—21%—are occupied by patients who should not be in hospital at all, but in a social care or other setting. In Government jargon, they are defined as super-stranded patients who have been in hospital for more than 21 days. If the hospital discharges 87 patients a day from the A&E department to the hospital, and 110 of the beds are occupied by patients who should be in a different setting, it creates huge problems for the A&E department, so finding a solution to the social care issue is also important for the A&E department.

I congratulate my hon. Friend on having led a seven-and-a-half-year campaign to get the expansion at Kettering General Hospital. It has been my great pleasure and that of my hon. Friend the Member for Corby (Tom Pursglove) to support him, but he has led this magnificent campaign and I hope that today he will succeed in his objective. Does he agree with me that the reorganisation he has talked about could possibly—hopefully—lead to an urgent care centre at the Isebrook Hospital in my constituency, which would reduce the number of people who go to Kettering A&E by 40%?

I would be delighted to support my hon. Friend’s campaign. He is a very effective champion for his constituents. He, along with my hon. Friend the Member for Corby, has been an integral part of a joint effort to campaign for the urgent care hub at Kettering. I would be delighted to reciprocate, because health investment in our local constituencies is very important for our local residents.

My hon. Friend the Member for Wellingborough will join me in welcoming any proposals that the Government introduce to create a health and social care pilot in the county. We simply have to make sure that elderly, frail residents in hospital, who need not be there and should be in a social care setting, are given the social care that they need in the right place at the right time. With social care now the responsibility of Northamptonshire County Council, I am afraid it simply is not working.

Evidence shows that the longer an elderly person stays in hospital, the more they lose critical muscle mass and strength, which affects their ability to return to their home or social care setting without appropriate support. Patients with long lengths of stay in hospital become revolving door patients. They get better and could go to a community setting of care, but they become unwell again because they wait so long for an appropriate out-of-hospital placement, so we need to get that sorted out. Financially, it does not make sense, either. If a patient stays in hospital, it costs £2,500 a week. If they are put into a social care setting, the cost to the taxpayer is £700 a week. Not only is the setting more appropriate, but it is financially beneficial for our health and social care providers.

I am pleased that the Secretary of State for Health and Social Care, together with the appropriate Minister in the Ministry of Housing, Communities and Local Government, wrote to all Northamptonshire MPs on 24 July, encouraging Northamptonshire County Council and the local NHS providers to knock their heads together to thrash out an appropriate plan. The Secretary of State wrote:

“I agree that the unitarisation process offers an excellent opportunity to re-imagine the delivery of health and social care services across Northamptonshire. I believe that local leaders should be bold in their ambitions for integration”.

He stated that he and the Housing, Communities and Local Government Minister

“are happy to back a bolder plan for integrated services in Northamptonshire, learning from other areas that are further ahead in the integration journey”,

such as Greater Manchester. Since that letter of 24 July, my colleagues and I, as parliamentary representatives from Northamptonshire, have seen little evidence of any concrete proposals from the county council and the local NHS. It is time for the Government to knock heads together locally, because the Government will want a pilot to pioneer their reform of health and social care. We have a wonderful opportunity in Northamptonshire to be the first in a shire setting to get it right.

Local organisations are doing their best in the present circumstances—I declare my interest as a member of Kettering Borough Council. To give one example, Karen Clarke, a housing options adviser at Kettering Borough Council, has been working extremely hard to make sure that patients can come out of hospital and find appropriate accommodation if they have difficulties in doing so. She recently wrote:

“I think the majority of the public assume everyone goes in to hospital, receives their treatment and is discharged home, but what if that patient doesn’t have a home? Or what if their home is no longer accessible? What if someone needs more than just independent living? Where does the patient go then?”

Karen has seen more than 250 patients in the past two years. She has managed to return home, or to secure permanent accommodation for, approximately 7% of those referrals, and 25% have gone into some level of temporary accommodation. That pioneering initiative is at Kettering’s health and housing partnership, where Kettering Borough Council, the local mental health trust and Kettering General Hospital work together. It has been pioneered by John Conway, the inspirational head of housing at Kettering Borough Council. It is a superb initiative.

However, such local initiatives are not enough. We need one organisation, preferably NHS-led, to sort out health and social care provision in Northamptonshire. The Government have a golden opportunity to pioneer a pilot in the county, so I hope they will press ahead. There are two issues: we need £46 million for an urgent care hub at Kettering General Hospital, and we need the Government to seize the initiative, knock heads together locally, and make sure we can have a pilot for health and social care in Northamptonshire.

I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate on health and social care in Kettering. It is testament to his strong commitment to the issue on behalf of his constituents that we hold this debate today, around six weeks after he secured a debate on his local hospital. I had the privilege, as he mentioned in his speech, of visiting his local hospital a couple of weeks ago. His constituents can be in no doubt of his tenacity and persistence in this place on their behalf—something all too familiar to numerous Ministers—and they are lucky to have him as a strong local voice fighting their corner here in Westminster.

The local context for health and social care in Northamptonshire, and in Kettering specifically, was well set out by my hon. Friend. The area has seen considerable population growth. On the basis of projections, the wider area is set to see further significant growth in population in the coming years, with circa 35,000 new homes over the next 10 years, as he set out. That will in turn see additional demand for health and social care services. The presence of my right hon. Friend the Member for Rutland and Melton (Sir Alan Duncan) emphasises the fact that not only Kettering and Northamptonshire residents are served by the hospital, but so are many of his constituents in Rutland as well.

If we overlay on this the broader national picture of an ageing population—a positive we should be proud of as we are all living for longer, but one that brings with it the need for additional support and care for people to live independent, fulfilling lives for longer—we see a clear need for new integrated models of care, addressing the increase in demand in numerical terms; the greater number of older people requiring support; and the young families that the new development and housing will bring with them. Working towards greater integration of health and social care services in Northamptonshire is a critical part of the journey towards local government reorganisation in the county.

On the establishment of the two unitary councils, I know my right hon. Friend the Secretary of State for Housing, Communities and Local Government is working hard to ensure that legislation can be considered by the House as soon as practicable. I know that my hon. Friend the Member for Kettering has, in that context, raised the proposition, as he did today, of trialling or piloting a new integrated health and social care system in Northamptonshire. That proposal was also highlighted to me compellingly by members of the hospital team and trust during my recent visit, and I understand it has been discussed with the Health Secretary and the Secretary of State for Housing, Communities and Local Government. Following that discussion, local council and NHS stakeholders have held further discussions on an outline proposal around system design principles and governance, as a precursor to any possible formal integration.

I look forward to seeing the outcome of those discussions as swiftly as possible. However, although effective, seamless integration is vital to patients and, as my hon. Friend set out, to the overall health ecosystem in his county, I must turn to the heart of his speech and to another key element of the health and social care landscape in Kettering—Kettering General Hospital and the challenges that it faces, particularly around urgent and emergency care provision.

Following the Secretary of State’s announcement of the health infrastructure plan—HIP—which set out a clear plan for strategic investment in our NHS, ensuring that it has the capital investment that it needs to progress and improve for many decades, atop the £33.9 billion annual funding increase for the NHS in the long-term plan, I had the privilege of visiting Kettering General Hospital with my hon. Friend. I received a very warm welcome and had the opportunity to speak with the amazing team of staff, led by the chief executive, Simon, as well as with patients. Equally importantly, I was able to see for myself conditions that I may read about in briefing papers, or be briefed about by my hon. Friend, and see for myself the real need.

As he has today, my hon. Friend and the hospital team set out to me compellingly the challenge facing an emergency department that opened in 1994 for around 40,000 patients a year and that, last year, had more than 90,000 and is forecast to have more than 100,000 this year. It is one thing to be briefed on something; it is another to see the problem for myself, despite the amazing work, which I also saw, by all staff—day in, day out—to ensure patient safety and care. I pay tribute to those staff for playing a central role in the trust’s removal from special measures for quality reasons in May this year.

Despite that amazing work every day to ensure that patients get the care they need, this is a real challenge that needs a long-term resolution. The trust has proposed an urgent care hub—an earlier bid to the sustainability and transformation programme having been unsuccessful —and my hon. Friend is a key part of the trust’s overall larger plans to address that need. I pay tribute to my hon. Friend, and my hon. Friends the Members for Wellingborough (Mr Bone) and for Corby (Tom Pursglove), for their commitment to campaigning for the hospital, and to all Northamptonshire MPs. I recognise my hon. Friend the Member for Northampton South (Andrew Lewer) in that context.

My hon. Friends have not given up. They have been clear that the proposal represents an effective long-term way to solve existing issues and to meet future need. They have pressed their case with eloquence and charm, but with determination. That is why I was delighted that the major scheme for Kettering General Hospital was selected, as part of the HIP2 announcement, to receive seed funding to develop its plan and investment case to deliver its proposals for a rebuild of the hospital. The trust and my hon. Friend the Member for Kettering fully welcomed that, but made a strong case that aspects of those plans were already well advanced and ready to proceed, and that all the preparatory work had been done on those aspects. When I visited, not only was that argument made compellingly to me, but the need to proceed swiftly with respect to urgent and emergency care provision was clear.

That is why I can go further: I am delighted to inform the House that, in the next capital review, Kettering General NHS Foundation Trust’s £46 million project for a new urgent care hub has been approved by Her Majesty’s Government. My officials and NHS England will be in touch with the trust to discuss further details, in order to ensure that funds are released and that work starts on the project as swiftly as possible. I am conscious of the urgency that my hon. Friend the Member for Kettering highlighted. I know that that news will be welcomed by all my hon. Friends in the Chamber and their constituents. It is a reflection not only of our commitment to delivering on the announcement that we made at the start of the month, but of the work of the trust and that of my hon. Friend and other hon. Friends in their campaign for the investment.

That investment is only one part of the health and social care landscape in Kettering and Northamptonshire, but it is a vital part, and further demonstrates our commitment to the NHS—to our NHS. The investment will, I believe, make a huge difference to the people of Kettering and beyond; having visited and heard my hon. Friend’s arguments, and those of the clinical staff, it is a pleasure to announce it in the House today. I conclude by paying tribute to my hon. Friend not only for securing the debate but for his central role in securing this investment for his constituents and his community.

Question put and agreed to.

Sitting suspended.