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Mid Yorkshire Hospitals NHS Trust

Volume 613: debated on Thursday 21 July 2016

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

I wish those Members departing the Chamber a good summer and thank you, Mr Speaker, for granting me the final debate before the summer recess. I also welcome the new Minister to the Dispatch Box.

I called this debate, following the one brought a few months ago by my hon. Friend the Member for Dewsbury (Paula Sherriff), because she, I and many Yorkshire Members are deeply concerned about the staffing levels not just at the Mid Yorkshire trust but at other hospitals across Yorkshire and the serious effect they are having on our health service. We have warned Ministers before about this, but we are deeply concerned that nothing is yet being done. Things will get worse if action is not taken.

Last year, I was contacted by a constituent, Mr Fanshawe, whose mother-in-law, Edith Cunningham, had recently died at the end of a short illness in Pinderfields hospital. As well as dealing with the grief and bereavement, Mr and Mrs Fanshawe were having to cope with the deep distress and anger caused by the way in which Mrs Fanshawe’s mother was treated and the care she received, in her final days and hours, because of serious staff shortages at the hospital.

Nursing staff were so overstretched that, at one point, Edith Cunningham had to wait two hours for a bed pan—two hours for an elderly lady in distress—and one weekend she had to wait 25 hours to see a doctor. It became clear to the Fanshawes that the staffing shortages on the ward were such that they could not leave her, so they stayed; they did her bed pans, they fed her, and when the pressure mattress they had requested was brought up, they changed it themselves, because there was no one else to do it.

I have met the Mid Yorkshire trust and the Fanshawes, and the chief nursing officer has given them a full apology and made it clear that it was an unacceptable level of care and that it was the result of staffing shortages on ward 43 at the time. Since then, the trust has continued to work on a wide range of recruitment and staffing initiatives to improve the situation.

I thank my right hon. Friend for calling this important debate. As she alluded to, I had a debate on this issue in March, but sadly it appears that little progress, if any, has been made. Last week, I attended a patient safety walkabout on ward 2 of Dewsbury hospital, and once again patients raised issues of short staffing. Several patients had been told not to ring their alarm bell at night because there was only one member of staff on duty. The number of beds on the ward had been increased from 24 to 30, but sadly no extra staff had been brought in to accommodate the extra patients. I plead with the Minister: we need tangible progress to ensure patient safety.

My hon. Friend is exactly right. We hear continually from constituents often saying the same thing: the nursing staff are wonderful, look after them and work immensely hard, but are overstretched; there are simply not enough of them to do the job they want to do.

The trust has recruited not just locally but from across Europe and India, which has sometimes raised language issues. It is looking at new ways to recruit from the local area, and in some areas, the number of vacancies has fallen. It has also put in place processes to switch staff around to make sure that gaps are filled every day. I welcome the commitment by the chief nursing officer and the chief executive to do everything they can to fill the staffing gaps, but it is still not enough.

We agreed with the trust that the Fanshawes and the local health watch should be able to do an unannounced visit to ward 43, talk to parents and report on what they found. I quote from their report:

“Patients... reported kindness and very good care. Patients generally agreed that staff are lovely but are ‘run off their feet’”.

They found that staffing levels were better than last year,

“but it is still often a struggle and only rarely does the ward have the right quota of staff”.

Just this week, I received another email from another family with a relative in ward 43 raising serious alarms about the level of staffing on the ward and the level of care that their relative was being given. There were not enough healthcare assistants or nurses to provide the basic care and support needed. That fits with the findings last year of the Care Quality Commission, which also raised concerns about safe staffing levels. Once again, we cannot pay sufficient tribute to the kindness and hard work of the staff at the trust. However, when they are stretched in all different directions, it is in the end the patients who lose out and the staff who are deeply concerned because they are not able to provide the level of care that they want.

I am concerned, too, about the financial pressures on the Mid Yorkshire trust. It is not the only trust where the money received is simply not enough to meet rising demand. I suspect that the Minister will have been briefed on some of the financial pressures and the squeeze facing the Mid Yorkshire trust. There is a risk of services being cut not for sensible medical reasons, but simply because it does not have the funding or the staffing to provide them safely.

It is even worse than that. Even where the Mid Yorkshire trust has budgeted for the staff, it cannot recruit or retain enough to deliver the services in the way it wants and the way our communities need. The latest figures from the trust list 150 nursing vacancies: that includes healthcare assistants and safety support workers, and amounts to about 12% of budgeted posts. The vacancy rate for nursing staff in the theatre department is 17%, and it is 20% in intermediate care. If we take account of holidays, maternity leave, sick leave, stress, and temporary secondments to other departments, the gaps are bigger. Monitoring by department in May, which looked at the actual staffing relative to the planned levels wanted, showed cardiology at only 76%, stroke rehab at 65% and short stay at 70%.

The trust also measured unavailability, which encompasses the percentage of contracted hours lost owing to staff absence, including for sickness and stress. When some staff are working so hard, and some are also being moved around from one department to another in order to cope with gaps elsewhere, facing further stress and uncertainty, it leads to higher levels of absence.

I shall try to be briefer in this intervention. I was recently contacted by Dewsbury hospital, and was told that, on any given day, the minimum staffing level in the A&E department is eight qualified nurses and four healthcare assistants or unqualified nurses. On this occasion, there were three nurses and one healthcare assistant. I think that speaks for itself; clearly, it will have an impact on patient safety.

My hon. Friend is right, and these are the sort of individual examples that we increasingly hear about from our constituents—from both staff and patients. I have heard from staff in intensive care and in paediatrics who are deeply worried about the pressures and responsibility on them lest something should go wrong on their watch as a result of understaffing. They are deeply concerned that they will be unable to provide the care that is needed and are worried about the implications.

The trust’s planning guidance suggests that it can cope with up to 22% of the contracted hours not being provided and still provide a safe service. Beyond that, it shows that significant problems are likely to be encountered in delivering the right level of care. Overall, however, the gap is not 22%, but 26% for registered nurses and 30% for registered midwives. In A&E, the average shortfall in contracted hours is 30% and there is a similar 30% shortfall in children’s services. On some wards, the proportion of temporary staff from agencies and the NHS banks is particularly high. On acute assessment wards, 20% of the nursing staff are agency staff. On the short-stay wards, 11% of the nursing staff and 33% of the healthcare assistants are from agencies and the bank.

It is not just about the pressures on nursing staff. Senior staff at the Mid Yorkshire trust say that they are doing a huge amount of work to address the nursing shortages, but they are even more worried about the shortage of doctors—not just at Mid Yorks, but across Yorkshire. According to the Royal College of Physicians, 14% of the consultant posts at the Mid Yorkshire trust are vacant. In A&E and neurology, there is a particular problem, and there are regular and significant gaps in the contract rota for junior doctors. Some 15% of the acute medicine rota is not filled by contracted staff, and it is 18% for the emergency medicine rota, 20% for the anaesthetics rota and 20% for the surgery rota.

In practice, the trust is having to fill the rotas either with consultant staff acting down in more junior posts, or with locum staff. It is a choice between doing that and cancelling operations, or turning ambulances away. The trust is, of course, is committed to providing the best service that it can provide and not letting patients down, but locum care means that medical staff do not have the relationships or the knowledge of the system that would enable them to do the best possible job, and it costs far more as well. Because the trust cannot recruit enough contracted staff, its average spend on agency doctors in the first three months of the current financial year was £1.5 million a month—and, as we know, it is a trust that faces significant financial pressures. So what is it supposed to do?

However, this does not apply only to Mid Yorkshire Hospitals NHS Trust. In the country as a whole, two in five vacant consultant posts went unfilled last year, according to the Royal College of Physicians. In the north of England, there are serious staff shortages in our hospitals. That is what we hear from our constituents. My hon. Friend the Member for Dewsbury spoke of appointments being cancelled and waiting times being affected. What troubles me particularly is the fact that there is now a 20-week wait for the pain clinic. Because of staffing problems, patients who are suffering pain and could be supported and helped are having to wait 20 weeks to be seen.

What are the Government doing about this? All too often Ministers shrug their shoulders and think that it is someone else’s problem, or that someone else will sort it out. I contacted the Secretary of State in 2010 and 2011 saying that the training numbers that were being set by the Yorkshire and Humber Deanery, particularly for A & E, were not enough, and were certainly not enough to meet rising demand, but nothing was done. Given the scale of rising demand for healthcare and given our ageing population, far too few doctors are being trained. There is also a significant and serious regional disparity, with bigger shortages in the north and the midlands.

It is incomprehensible, given all those pressures, that the Government should choose this moment to pick a major fight with junior doctors that ends up demoralising them, and drives many of them to consider either going abroad or leaving the profession altogether at a time when we need every doctor we can get.

The Department of Health is also taking a massive risk when it comes to nursing staff. It is ending nursing bursaries, although in areas like ours that means that many people who could have become great nurses will be put off because they are worried about the debts that they will incur, and about not being able to afford the training. It is also refusing to give a proper assurance to the thousands of European Union citizens who work in the NHS—our trust has often recruited such people because of the shortages at home—that they can stay and fill those crucial posts.

Referring to nurse training, the Minister who responded to the debate initiated by my hon. Friend the Member for Dewsbury a few months ago said:

“Within the current spending envelope…it is simply not going to be possible to achieve the numbers that we wish to see.”—[Official Report, 21 March 2016; Vol. 607, c. 1354.]

That is not good enough. We need enough nurses, and enough doctors, to provide the care that our constituents need and deserve. That cannot simply be left to Mid Yorkshire Hospitals NHS trust, or to any individual trust in the country.

So many of the issues are linked, whether we are talking about the training numbers on which the deaneries decide or decisions made by the Department of Health that have an impact on morale, pay or incentives throughout the country. We now need a regional action plan setting out what the Government are going to do, and what NHS England is going to do, to address the serious shortages of both nurses and doctors in Yorkshire, because unless something is done, something serious will happen to patient care. I do not want to warn again about this, as I did some years ago, but it still has not been sorted out, and that is not fair on patients in Yorkshire and throughout our area.

In the case raised by Mr Fanshawe, Edith Cunningham had a family who stepped in and looked after her while she was in hospital, but many more patients do not have families who can fill the gaps and step in. So for the sake of all of those patients, and for all of those who we—all of us in all parts of the House—will want to get the best possible care, I urge Health Ministers to get a grip on this and get us the regional action plan we need, before patient safety is affected.

May I start my remarks by saying what a pleasure it is to be here this evening for my first opportunity at the Dispatch Box in my new role at the Department of Health?

I congratulate the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) on securing this debate on a subject that I know is close to her heart and that of her neighbour, the hon. Member for Dewsbury (Paula Sherriff), who it is good to see here supporting her in the Chamber this evening. I congratulate the right hon. Lady in particular on securing this debate, the last opportunity to raise a subject in the House this side of September.

I am well aware that this is a matter of significance to Members of Parliament and obviously to the local populations they represent. I think the hon. Member for Dewsbury recently persuaded the Mid Yorkshire trust to have a public meeting to discuss these issues locally, and I congratulate her on doing that, and hope it was helpful in at least raising some of these issues.

The problem of staff shortages at Mid Yorkshire is well known, and it is recognised not just by local Members of Parliament, but was demonstrated by evidence recorded by the CQC through its inspections over recent years, not just the most recent one. Having said that, there are of course examples of good care within the trust, and I would like to add my voice to that of the right hon. Lady who acknowledged that from the comments of, I think, the Fanshawe family, who pointed out that the quality of care provided by the nursing and other staff in the hospital is very high where they are in a position to do that. I pay tribute to everyone who works in the trust—in the hospitals there—in the admittedly somewhat challenging circumstances they find. I draw attention in particular to the maternity services and children’s services, where the standards are acknowledged to be high.

There is no hiding the fact that there are problems, however, and I am not here to do so. Unsafe care was found in the most recent CQC inspection last summer, published in December last year. That is clearly the most potentially serious of its findings. This is a long way from being a high-performing trust, which is what we would all like our trusts to be. While the CQC report shows the trust had responded to previous staffing concerns and is actively trying to fill posts, there are acknowledged areas of significant nurse staffing shortage affecting patient care and treatment, particularly on the medical care wards and in community in-patient services and specialist palliative care.

The right hon. Lady may not appreciate hearing this, but the fact remains that responsibility for staffing in hospitals in her constituency sits squarely with the board of the Mid Yorkshire trust. Trusts have a duty to ensure they have the numbers and skill mix needed to deliver quality care, patient safety and efficiency, taking into account local factors such as acuity and case mix.

But what if there just are not enough A and E doctors or neurology doctors to fill the posts? If they advertise them, charge around the country recruiting for them and they still cannot get the doctors in, what are they supposed to do?

I will come on to what we are doing nationally to try to make sure we have an adequate number of trained professional clinicians to meet the needs around the country.

It is important to recognise that while nationally some standards are set for safe staffing ratios, which were referred to by the hon. Member for Dewsbury, these are not a hard-and-fast rule and never have been. They are guidance rather than statutory requirements, and this position has not changed. Trusts have to use their judgment and focus on quality of care, patient safety and efficiency, taking into account local factors such as case mix rather than just numbers and staffing ratios. It is not a case of meeting a particular staffing ratio or getting to a particular figure and thinking that the matter is resolved. There must be enough staff—as both hon. Members are saying—to meet the needs of the patients, and it is a matter for the clinicians on the spot to make a judgment on that.

Nationally, demands on our staff across the NHS are rising, and more patients are being cared for than ever before. That is as true of Mid Yorkshire as it is of anywhere else in the NHS. Last year, across the Mid Yorkshire Hospitals NHS Trust, 232,966 patients were seen, compared with 194,119 in 2009-2010. That is an increase of more than 15% over the past six years. There were also some 4,685 more diagnostic tests carried out in May this year than in May 2010. Activity levels are therefore rising considerably.

I thank the Minister for his constructive tone in responding to the debate. Does he acknowledge that the significant increase in the tendencies is partly down to a crisis in primary care in the area? That sector is struggling to attract GPs and practice nurses, and people are therefore sometimes attending A&E inappropriately, instead of being seen in primary care.

It is well recognised across the country that the tendencies in A&E include a significant proportion of people who should not be there and who should be being dealt with elsewhere in the system. The reasons for that are legion; it is not all down to pressures on GPs. Much of it is down to members of the public increasingly seeing their hospital as the place to go. We have a big educational job to do across the country on that, and it behoves all of us to help to relieve the pressure on A&E by encouraging patients to get their health needs seen to in the most appropriate place, whether through a pharmacy or a GP, or through other community services.

I want to touch on the question of funding. It is not all about money, but money plays a part. As a result of the funding settlement that we have secured for NHS England, the Wakefield clinical commissioning group will receive £488.8 million in 2016-17—the current fiscal year—which represents a cash increase of just over 3% compared with the previous year. In cash terms, that is a £21.7 million increase—a significant increase compared with previous years. For North Kirklees, the other CCG that commissions the work of the trust, there was also an increase in the current year to £237.1 million, representing a 2.49% increase compared with 2015-16, or just a shade under £12 million. That increase is substantially greater than the deficit reported by the Mid Yorkshire trust for last year. Of course, the commissioning funds do not all go to the trust, but the health economy in the area has received a significant cash injection.

Ensuring that we have the right number of nurses —I shall start with nurses—is a vital move towards achieving the Government’s objective of having a fully seven-day NHS by 2020. Nationally, we already have 11,800 more nurses, midwives and health visitors than we did in May 2010. The number of nurse training places has increased by 14% over the past three years alone, with further increases planned in the current year. More than 50,000 nurses are currently in professional training, which includes working and learning in hospitals through placements. However, the current funding system means that two out of every three people who apply to a university to do a nursing degree are not accepted for training. That is one of several reasons why trusts such as Mid Yorkshire find it difficult to recruit.

In 2014, the last full year for which I have statistics, universities were forced to turn down 37,000 nursing applicants. As a result, the NHS suffers from a limited supply of nurses and must rely on expensive agency staff and overseas workers, as referred to earlier. That is one reason why, earlier today, the Government announced their response to the public consultation on plans to place trainee nurses in the same system as all other students, including teachers and doctors. That response has been placed in the Library.

I thank the Minister for his generosity in giving way. Will he confirm that the reason universities were forced to turn down so many would-be nurses was that the Government did not fund enough places? I realise that he is new to the Department and will not have had a huge amount of time to investigate staffing levels around Yorkshire, but when he goes back to the Department I urge him to look at whether there could be a Yorkshire action plan on recruitment. We have a regional problem that is worse than the national problem—although it will be replicated in other regions.

I will come to how we will respond when I conclude my remarks, but the right hon. Lady is quite right to point out that the problem is not unique to this particular trust and must be seen in a regional context.

I also thank the Minister for his generosity. I just want him to know that the public meeting unfortunately did not go ahead owing to the tragic death of our colleague from Batley and Spen. However, given the staffing crisis and the fact that Mid Yorkshire is still undergoing a significant downgrade programme that will see Dewsbury hospital reduced to a minor injuries unit and many patients having to go to Pinderfields Hospital in Wakefield, will the Minister please reconsider the plans?

The short answer is yes. I intend to honour a commitment to meet the local trust—I would be happy to facilitate a meeting for the local MPs as well—to talk about the reconfiguration plans that are afoot.

I am conscious that I am in the unusual position of winding up an Adjournment debate at this stage of the parliamentary calendar and in danger of running out of time, so I will turn to the reconfiguration plans before I conclude.

We have to look at staffing issues, wherever they are, and at all the nursing specialisations in the hospital that were referred to earlier in the context of the wider reconfiguration of services currently going on within the trust and the sustainability transformation plans within the region later this year. The reconfiguration is driven by the need to address long-term systemic problems, some of which I touched on earlier. The current service changes were agreed back in 2013 and were supported by the Secretary of State in 2014 following the advice of the Independent Reconfiguration Panel.

Implementation of the agreed service changes at the trust is a matter for the local NHS, which is undertaking detailed work to assess fully the benefits and risks of bringing the changes forward. The process will look primarily at safety and quality, as well as capacity across the system, and will take local stakeholder views into account. Local commissioners will make the decisions about precisely what is to happen, and it is for the local NHS to keep all service change under review in line with its role in ensuring that the services provided are high quality, safe and sustainable. Staffing levels at the trust, particularly in nursing, remain a concern, and are regularly identified by the trust’s regulators and commissioners.

The trust has taken some action to address those concerns, including recruitment of additional nurses and non-qualified support staff as well as strengthening safe staffing policies and increasing board level scrutiny. Clearly, that has not solved the problem, as we have heard so graphically this evening, and more needs to be done.

The trust believes that benefits could be realised in bringing forward implementation of the service changes with improved clinical safety, efficiency and patient flow. I am aware that concerns are being expressed about the knock-on effects of the proposal for changes nearby in Calderdale, of which the hon. Ladies will be aware, and that is currently under consultation.

Change at each of these trusts should not be looked at in isolation, particularly in an area such as this with so many interdependencies and challenging geography and local public transport. Following the meeting of my predecessor, my right hon. Friend the Member for Ipswich (Ben Gummer), with the hon. Member for Dewsbury (Paula Sherriff) and the late hon. Member for Batley and Spen (Jo Cox) earlier this year, he agreed to facilitate a meeting in September with the regulators—NHS Improvement, the CQC and the NHS providers and commissioners. I will undertake to ensure that that meeting goes ahead.

Question put and agreed to.

House adjourned.