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Musgrove Park Hospital Surgical Centre

Volume 634: debated on Thursday 18 January 2018

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

I am delighted to have secured this debate, which gives me the opportunity to bring Musgrove Park Hospital—located in Taunton and serving the whole county of Somerset—under the microscope. More particularly, I am focusing on the need to replace some of the oldest buildings, which are providing care to some of the most critically ill patients, with a brand-new £79.5 million surgical centre.

At the outset, I want to be clear that Musgrove Park Hospital is rated by the Care Quality Commission as good overall and as outstanding for care. That rating was announced following inspections in January 2016, and in August and September 2017. I particularly want to place on record my thanks and appreciation to all the hard-working and dedicated staff across the board at Musgrove and all those who link into it, because without them it would not be the place it is today. The hospital is very much respected locally.

I want to thank those who have inputted into and informed this speech, including the chief executive, Peter Lewis, and Dr Sam Barrel before him; Dr Stuart Walker, the chief medical officer; and Dr James Sidney. I also thank my London team, but particularly my parliamentary assistant, Katherine Toone, who is moving to pastures new, so this is very much her swansong. I also thank my Taunton team.

So why am I calling for a new theatre complex at Musgrove and supporting the bid that has recently been submitted to the NHS transformation body? Well, first, like so many people in my constituency, I have a personal link to the hospital. I have lived locally for almost 30 years, and Musgrove has seen my family through a lot. For example, all my three children were born there. The dramatic emergency operation I went through during the birth of my first child will remain in my mind forever but, thanks to the quick reactions of the staff and the professional team, all went well. In all the years that have followed, we, like so many other local families, have been in and out of that hospital for one reason or another, and that is still the case. There is always a personal link that people feel with their local hospital.

That first experience of the Musgrove Hospital’s operating theatre was 25 years ago. Today, the self-same operating theatres are being used, but even more poignant is the fact that five of the 14 theatres in the hospital have been in use not for 25 years, but for 70 years. They were built in the 1940s by the American forces based in Taunton as a temporary evacuation hospital for the D-day landings. They are still in constant use. They could almost qualify as a museum, but they are still functioning.

Members might therefore understand why a new complex that will house more up-to-date theatres and associated facilities is urgently needed. Basically, the current theatres are not fit for the demands now being placed on them, and that has been brought home to me following a number of tours of the premises. I have seen staff in the critical care unit having to work in the most cramped conditions imaginable—tiny, narrow corridors where it is tricky to manoeuvre equipment and move beds round. There is also an extreme lack of storage space—I could hardly get in, with all the stuff packed in there. The storage systems seem to have come out of the Ark—there are dank cupboards. It is also a constant juggling act to fit patients in, because there simply is not enough space, and there are not enough isolation rooms.

Now, Madam Deputy Speaker, let me take you on to the roof, where I have literally been with the estates manager. Up here is located the unbelievably antiquated air conditioning unit, which is housed in what I can only describe as a deteriorating shack. It is so old that there are still notes from electricians on the walls about what they did last time. We do these things digitally now, but there are little scribbled pencil notes—it is historic. The sky is also showing through the crumbling wall at one end, and the hospital has difficulties with the insulation. This system alone is well past its sell-by date.

The report produced by the CQC following its recent inspection made reference to the environment in the surgery department. The report stated that the premises were not always suitable and noted that some operations were cancelled due to the air conditioning failing in the theatre environment.

Just clambering across the roof was quite a precarious process, criss-crossed as it is with a complex network of pipes. Members can imagine the wear and tear involved and the maintenance issues, especially when it is cold and snowy. In most modern hospitals, of course, such pipes would be enclosed.

The 1940s flat roof housing the five theatres at the heart of this debate is key to some of the problems. The roof is in constant need of repair to keep it watertight, which is costly and time consuming. I kid you not, Madam Deputy Speaker: rain water comes through the roof and into the ceilings below, and is often collected in buckets. A couple of years ago, I found myself witness to that as a patient, when I had to go in for an op. It was a dark and stormy day, and as I was wheeled along on the trolley, there were literally buckets collecting water in the corridors. I was a little alarmed. The next thing I knew, as I lay in the operating theatre waiting to go under, I was surrounded by masked figures, who were obviously quite well aware of who I was. In the nicest but firmest possible way, they drew my attention to the dire state of the fabric of the building and urged me to do something about it when I got out. And who could blame them for not taking advantage of that opportunity, pinned as I was to the slab, as they say?

Those people need not have worried—I thank them, by the way, for the great care I got—because it was already in my mind to try to help, because I had been made aware of the issue before my election and had determined that if I ever got to this place, I would try to do something about it. I raised it with the then—and thankfully current—Secretary of State when he came to Taunton Deane before my election in 2015. I have broached the subject with him many times since arriving here, so I know it is on his radar, and I hope it will also be on the radar of the Minister, whom I thank for his interest so far.

 I reiterate that, despite the challenges presented by the fabric of the buildings, Musgrove continues to deliver the best possible care. Recent figures from the Intensive Care National Audit and Research Centre show that mortality rates in Musgrove’s intensive treatment unit are the lowest among 20 similar units throughout the UK, so we do not want to worry people on that score. However, I stress that the buildings I am highlighting today were never intended to provide modern and complex hospital care, and they certainly were not intended to cope with the throughput that the hospital faces. Moreover, the critical care section is where the most seriously ill patients are treated, and it includes the operating theatres, where patients undergo a range of operations—general surgery for the local population, as well as more specialist surgery for a much wider population.

The current facilities simply cannot provide the support required for the provision of 21st-century healthcare, and demands are ever-increasing, as I am sure the Minister knows, especially in a county such as Somerset, given our elderly population. The baby boomers are hitting their 70s and, with Somerset being such a glorious county, people choose to retire there. Although they are welcome, the influx puts even more pressure on our health services. It is a tribute to our health service that on average people can look forward to a longer life, but that brings with it more complex medical issues, and that puts more pressure on our theatres.

Musgrove, by the way, does not draw its clientele, if I can call them that, just from the county. Owing to the high level of expertise it has developed—this is a great accolade to the hospital—Musgrove has acquired strategic importance to healthcare in the wider south-west. People come from much further afield for its specialist services. For example, vascular surgery patients regularly travel quite long distances for treatment at Musgrove.

I want to give a few numbers. The trust undertakes approximately 4,000 operations a year, and that figure is growing by 5% each year. As demand escalates, the trust is struggling to keep up. That is already having the unfortunate consequence that many residents of Taunton Deane and further afield are inevitably experiencing longer waiting times, with patients having to be transferred to other providers where possible. Having spoken to many people who have used Musgrove, I know how inconvenient and upsetting it is when people cannot go to their local hospital and suddenly have to transfer much further afield, away from friends and relatives, who find it hard to visit. That adds a lot more stress to the whole situation.

Let me turn to the practicalities. The call for a new theatre complex is not just based on demand. There are real practical limitations to the current system that need to be addressed. Unfortunately, that can result in the patient experience being compromised—which, I must continue to add, in no way reflects on the staff.

Musgrove currently has the highest bed occupancy in the south-west. Most of the time the rate is 90%, and best practice is generally recognised as about 70%. In the critical care unit there are 12 beds: six in the high-dependency unit, which is close to the intensive care unit; and six in intensive care. What is needed, and what is in the bid, is capacity for 22 beds: 18 at levels 2 and 3 —level 3 being for those who require the most care—and four at level 1. The idea is to make them flexible, so that they can be swapped from one level to the other when necessary, which cannot be done at present and which would really help. That is almost double the current capacity, which illustrates just what the hospital has been up against.

At present, bed numbers and space are the limiting factor when it comes to the number of people who can be treated, which I would suggest is pretty unacceptable. As demand for critical care capacity grows, more patients are inevitably in the undesirable position of having major surgery cancelled because the trust cannot guarantee access to a critical care bed following their procedure. For the staff, trying to sort out the bed space is a constant juggling act that must put unnecessary strain on their already pressurised daily lives. I have talked to them, and while they are awfully nice about it, I know that they are under a lot of pressure.

The new plan also encompasses new facilities for the endoscopy unit. The current premises are outdated and unacceptable. This is a very hard-working department, of which I have had a great deal of experience when family members have had to use it. The unit does not comply with current regulatory healthcare environmental standards, and it does not have the capacity to cope with the existing demands of the diagnostic screening programme, let alone the future growth that we are likely to see. It is great that more people are being called for screening—we are always talking about such things in Parliament—as early diagnosis tends to lead to better outcomes, but that is of no use if the system cannot cope. The crux of the matter is that the long-term sustainability of the complex, providing emergency surgical care, diagnostic screening services and critical care in Somerset, now depends entirely on the replacement of an outdated estate that is no longer fit for purpose—so no pressure there for the Minister!

Bearing in mind the stark reality of the pressing situation which I hope I have made clear, Musgrove Park has submitted its outline business case for a new £79.5 million phase 2 surgical centre to the NHS transformation body for consideration. I believe that the timing is right. It coincides with the welcome announcement in the autumn budget of £3.5 billion of capital funding for just such projects, which will enable NHS organisations to deliver on their transformation schemes, helping to meet demands for local services, to deliver more integrated care for patients and to reduce waiting times. Other sites have already been redeveloped across the Musgrove estate and are working well.

The proposed new complex would go a long way towards bringing the entire site up to date. The new surgical centre would be placed in a more central location on the hospital site and would optimise proximity to other clinical services. It would consist of six endoscopy rooms, patient recovery and clinical support areas, eight operating theatres—including two interventional radiology theatres—clinical support and the 22 critical care beds that I mentioned earlier, all specified for the various levels of care. Those new facilities would allow a better patient experience and more efficient working, and would provide sufficient capacity to sustain services. That would have a positive impact on the health and care system in Somerset and beyond.

There is another reason why the redevelopment is so important, which has been mentioned to me a number of times in the hospital. A spanking, brand-new, state-of-the-art facility would boost morale. It would also help to improve recruitment prospects. I know it is hard to believe, but it is quite tricky to attract bright young talent to Taunton—that beautiful glorious rural area. If we had this wonderful new facility, I think talented young people would be rushing to take up our jobs, and they would be welcomed. I have spoken to the Secretary of State about this issue and the issue of attracting GPs as well, and he thoroughly understands it, so I hope that that will also be considered in assessing the bid.

I hope I have outlined a clear case for the need for a new surgical centre at Musgrove. In allocating funds, value for money to the taxpayer is also extremely important. Extensive studies have illustrated this. The Minister might say, “Why don’t you just improve the outdated facilities that are there?” But that simply does cut the mustard. Those facilities would not provide a long-term sustainable solution, and they would present very poor value for money. Money spent on basic refurbishment of the existing life-expired facilities cannot address the capacity constraints and would not enable compliance with current standards of healthcare provision or improve the patient experience. Consideration of the Somerset sustainable transformation plan relating to a range of options for sustaining these services for the long term has concluded that the best option is to re-provide the services in a new, modern, high-quality, adaptable building that can meet the needs of patients as medicine and healthcare make further advances.

So, not to put too stark a point on it, Minister, if these facilities are not updated, there is a risk of critical infrastructure failing. Those are strong words and they are not mine: they come from Musgrove Park. The risk of this occurring would be all but eliminated, together with the threat it might pose to the continuity of services to the patients of Somerset, if the new centre were built. Modern facilities will also provide a better patient experience, enable more efficient working and provide sufficient capacity to sustain services, with a positive impact for the Somerset care system.

Minister, the good people of Somerset have waited for far too long for this facility and the staff have soldiered on in less than desirable conditions for far too long. This is the only hospital in the south-west not to have such an upgrade. Should the bid be successful—which I sincerely hope it will be for the myriad reasons I have outlined—this project must be started with some urgency because it could take five to six years and that would mean it would not be ready for use until 2023 at the earliest. Therefore, speed is of the essence and that would be most appreciated.

I am sure that the Minister, and Madam Deputy Speaker, will agree that this is a most deserving case for the £80 million—just £80 million—of the £3.5 billion that this Government have earmarked, which we so welcome, for such projects. The money could not be better spent and the impact could not be greater. The sooner the new surgical centre is started, the sooner it will be finished and the sooner the deserving people of Taunton, and indeed the whole of Somerset and the wider south-west, will be able to start benefiting from it.

I congratulate my hon. Friend the Member for Taunton Deane (Rebecca Pow) on securing this debate, and I am pleased to be able to join her in discussing a matter of great importance to both her constituency and her family. She powerfully set out her personal links with Musgrove Park and its importance to the community as a whole.

The Government recognise the real concerns—which the House got a full flavour of—about Musgrove Park and we are working to address the concerns that my hon. Friend set out. The hospital’s theatres and critical care facilities are housed in pre-war buildings that are at risk of critical infrastructure failure because of their age and condition, and she gave us a clear sense of the urgency of the need to respond to that.

It is clearly crucial that NHS facilities are as well maintained and up to date as possible. In this case, I am sure my hon. Friend will agree that decisions should 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. It is right that we address these matters at a level where the local healthcare needs are best assessed, rather than doing so solely in Whitehall.

The Government recognise that Musgrove Park Hospital’s theatres and critical care facilities need to be improved significantly, but that due to the foundation trust’s financial position it is unable to fund the improvements itself. The trust has therefore proposed to invest £79.6 million in the development of modern, fit-for-purpose operating theatres, a critical care unit and an endoscopy unit. The trust is bidding for funds made available through the sustainability and transformation plan capital bidding process.

As my hon. Friend is aware, the Taunton and Somerset NHS Foundation Trust was informed that it was unsuccessful in its application under the wave 2 capital bidding process, but perhaps it will be encouraged by the fact that it was asked to develop a case with a view to submitting another bid under the wave 3 process, which is now under way. The latest bid submission process was announced in late December 2017 and closes on 31 January. The trust is being supported by the regional NHS Improvement team to ensure that it submits a comprehensive bid.

The Somerset clinical commissioning group has given its highest priority to the redevelopment of the surgical block at Taunton’s Musgrove Park Hospital. Running in parallel to the process for securing funding, the NHS Improvement regional team is supporting the trust to develop the business cases required for the development of the surgical facilities. I am pleased to learn that Musgrove Park Hospital’s surgical block capital bid has now been submitted and has received support, in principle, from NHS England and NHS Improvement, and will be considered for the next round of announcements for capital. Should its bid be successful, money will then be made available to start work on a new surgical centre at Musgrove Park Hospital. I join my hon. Friend in recognising that lead times for construction work are often very long. That is an area that I am keen for the Department to focus its attention on.

On the long-term plans for Somerset hospitals, the Somerset CCG is developing a clinical services review that will consider the views of patients before developing a series of service proposals with the aim of ensuring that family doctors and community hospital and district hospital services are joined up with social care services to provide financially sustainable and high-quality care. I know that my hon. Friend shares the Government’s desire to ensure that we take a more integrated approach to commissioning our services.

The Taunton and Somerset NHS Foundation Trust was rated as good by the Care Quality Commission in its December 2017 report. That is a tribute to the staff working there. It was rated as outstanding for caring, and rated as good for being effective, responsive and well-led. Surgical services are rated as good overall, having been rated as requiring improvement in the previous report. This followed action being taken to address and resolve issues with theatre safety and surgical site infections. NHS Improvement has no significant clinical quality concerns, and there have been no recent theatre or estate-related significant incidents. However, the latest CQC report mentioned that inspectors had heard of operations being cancelled due to the theatre environment and the air conditioning issues that my hon. Friend mentioned. This highlights the need for improved surgical facilities.

In closing, I recognise that Musgrove Park Hospital’s theatres and critical care facilities require significant improvement, and I pay tribute to my hon. Friend for the manner in which she set out such a powerful case for that improvement. Somerset clinical commissioning group has given its highest priority to the redevelopment of the surgical block at Taunton’s Musgrove Park Hospital. I am pleased to learn that the hospital’s surgical block capital bid has been submitted and has received support, in principle, from both NHS England and NHS Improvement. Should the bid be successful, money will then be made available to start work on a new surgical centre at Musgrove Park Hospital. I am sure that my hon. Friend will agree that decisions should be driven locally, and I know that she is particularly focused on that.

In securing this Adjournment debate, my hon. Friend, as she so often does, has put the case for Taunton Deane. As the Minister responsible, I recognise the importance of the issue both to her and to the community, and I look forward to continued discussions with her as we seek to progress the situation and ensure the best possible care for Taunton Deane and the surrounding area.

Question put and agreed to.

House adjourned.