Thank you to Barry Fleetwood for sending me the below
Mike Gapes Adjournment Debate on BHRUT 0n 9th January-with Ministers Reply
Mike Gapes (Ilford South) (Lab/Co-op): Madam Deputy Speaker, I would like to ask you to convey my thanks to Mr Speaker for selecting this Adjournment debate today. On the last sitting day before Christmas, I asked for this debate because of what I considered to be the bad behaviour of the Secretary of State for Health. I was informed on 17 December that an announcement would be made the following day—embargoed until 2 pm—that would have profound implications for my constituents and the many other people in the London boroughs of Barking, Havering and Redbridge. That announcement, by the chief inspector of hospitals, Professor Sir Mike Richards, was that the Barking, Havering and Redbridge University Hospitals NHS Trust was to be put into special measures following inspections by the Care Quality Commission.
I attempted to raise the matter by intervening on the Secretary of State during a debate that took place following the announcement. I waited until after 2 o’clock so as not to break the embargo. I stood several times, but he did not accept my intervention. I therefore thought that the least I could do was to put in for an Adjournment debate on the subject, and I am grateful that it has now been chosen. I have also raised a point of order about this matter.
That was not the first time that I have found Ministers reluctant to engage with me directly on the question of the NHS trust that covers the King George hospital in my constituency as well as the Queen’s hospital in Romford. Nearly a year ago, on Thursday 7 February, I took part in a debate on accident and emergency provision in London. I asked the then Minister, the hon. Member for Broxtowe (Anna Soubry)—who has since been moved away from Health—to respond to my request to set aside the decision of the previous Secretary of State, the right hon. Member for South Cambridgeshire (Mr Lansley), in 2011. I also asked for the decision to plan for the closure of the accident and emergency department at King George hospital within two years of October 2011 to be reconsidered. The then Minister failed to respond or even to mention the King George or the Queen’s hospitals in her response to the debate.
I have tried on several occasions to get ministerial responses to my requests to reconsider that decision. It was clearly a strange decision, given that we are now in 2014 and that—for reasons I shall outline—the timetable and the absolute chaos of this failing NHS trust make it absolutely impossible to close the accident and emergency department at the hospital in my constituency. Sadly, in 2013, we lost our maternity services, which have been transferred to Queen’s hospital.
I asked the Secretary of State to reconsider this issue, but on 15 January 2013 he said:
“The decision has been taken”.
However, he also said that
“we have made it absolutely clear that we will not proceed with implementing it until there is sufficient capacity in the area, particularly at Queen’s hospital in Romford, to cope with any additional pressures caused by it, and that undertaking remains.”—[Official Report, 15 January 2013; Vol. 556, c. 734.]
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I asked him again in May, and I got a similar answer. I was told that it
“will not be closed until it is clinically safe to do so.”—[Official Report, 21 May 2013; Vol. 563, c. 1064.]
What is the current situation? The Care Quality Commission published its report in December. That report does not just deal with accident and emergency; it also raises issues relating to other departments in both Queen’s hospital and King George hospital. On Queen’s hospital’s accident and emergency department, it states:
“The service is not responsive enough to people’s needs. People were waiting too long to be either discharged or admitted. The trust is not dealing with enough people within the national four-hour target. The initial care pathway for children does not meet their needs, and unnecessarily delays their initial assessment.
Queen’s Hospital has consistently failed to achieve the 95% NHS target for the number of attendees that were discharged, admitted or transferred within four hours of arrival. Between the 1 April 2013 and 8 September 2013, 9,359…out of 59,038 patients were not seen within four hours of arrival. The department struggles to meet the target at all times, however, Mondays and Sundays provide the greatest difficulties. The A&E at Queen’s…performs significantly worse than at King George Hospital. These delays mean that patients are more likely to have poor outcomes.”
So the report said that there was “significantly worse” performance at Queen’s hospital, yet the Government are still planning the closure of the A and E at King George hospital, even though they know that Queen’s hospital has been failing, is failing and will continue to fail unless massive investment is made there, and that the King George is the better performing of the two hospitals in the trust. My constituency has a very young population with a large number of children. Some 30% of the people who go to A and E at the two hospitals in my local trust are children, yet the children in my constituency will have to move, with their parents, to the Queen’s hospital to attend A and E, rather than be treated in the better performing of the two hospitals in this failing trust.
The CQC report is absolutely damning. It points out:
“The trust faces significant difficulties in recruiting medical staff for A&E, and has done since 2011.”
Of course, October 2011 was when the Government decided that King George hospital would be run down and that this trust would have only one hospital in around two years. I do not think that date is a coincidence. The reality is that there is a damaging impact on morale and on the future of the services in my borough and the neighbouring ones as a result of this decision.
The report also states:
“The College of Emergency Medicine recommends that, for the number of patients seen in the A&E at Queen’s Hospital, it should have 16 consultants to provide cover 16 hours a day, seven days a week.”
A separate part of the report reveals that about 10 consultants would be needed at King George hospital, yet:
“The trust has eight consultants in post out of an establishment of 21 to cover both A&E departments at Queen’s and King George Hospitals. The heavy reliance on locum staff is putting patients at risk of receiving suboptimal care. Joint work with other trusts has not achieved the desired results and additional work is underway, including recruiting staff from overseas.”
Will the Daily Mail, the Daily Express, the UK Independence party and Ministers please note that the
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suggestion is to recruit staff from overseas to deal with the crisis caused by a lack of consultants in NHS trusts in north-east London?
The report criticises the inadequate record-keeping. It talks about the need for significant management improvements. I do not have time in this short Adjournment debate to go into the great detail that is in the report, but I will say that there are hard-working and dedicated members of staff and good practice in some departments in the trust.
I must declare an interest. This week, I was an out-patient in the ear, nose and throat department at King George hospital. I was seen quickly and before my appointment time and I was dealt with in an efficient manner. I want to place it on the record that the morale of the staff in the two hospitals remains remarkably high, but they are to some extent lions led by donkeys. They are suffering from years, perhaps decades, of problems in the health service in north-east London. I have been an MP for 21 years and have seen a succession of chief executives and significant reorganisations, and yet the fundamental problem is that the trust has a deficit of £100 million, which is clearly one of the driving forces in the reorganisation, and, at the same time, it has a massive catchment area of between 700,000 and 800,000 people. It is one of the largest trusts in the country with a huge, diverse population, a lot of churn and movement of people, and, as a result, some inadequate GP and primary care services and problems at the A and E. The fundamental issues are not being solved by whatever reorganisation is happening.
Let me make a few more remarks before the Minister responds. The report says:
“There was widespread concern from staff that the trust has not fully supported the A&E”
when concerns were raised. One member of staff said:
“We never see any of the management over here and all the important meetings are held at Queen’s.”
The larger of the two hospitals, the hospital built for 90,000, now has 140,000 admissions in a year. The report went on to say:
“The staff also felt that they were not kept up to date on the planned closure of the A&E at King George Hospital by senior management in the trust. One nurse told us, ‘There is a lot of unrest about the closure; we feel they are doing it by the back door. It makes it more difficult to recruit and keep staff.’”
The problems we face at the King George and Queen’s hospitals cannot be resolved even by a change of management. I understand that the current chief executive has indicated that she will be leaving in a couple of months. Having been involved in the reorganisation and running down of Chase Farm, she has now done her job at King George hospital and will no doubt be moving on to some other unfortunate trust. I also understand, although it is not yet quantified, that there will be some form of special new management structure and things associated with special measures. Perhaps the Minister can clarify what special measures mean as regards the day-to-day running of the organisation.
Will there be additional financial support? Will there be additional resources? The Barking, Havering and Redbridge clinical strategy document—I have the presentation for stakeholders, patients and the public in my hand, as well as the document itself—contains interesting phrases. For example, it says that areas of
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King George hospital will be “liberated” for use by other services and facilities. I thought when I read that that it was some sort of Maoist cult trying to have a people’s liberation army of consultants and NHS bureaucrats coming in to seize the stable base areas in the centre of my constituency. The NHS bureaucracy’s jargon sometimes amazes me. What is being talked about is running down services in Ilford and transferring facilities out of other buildings in the borough or elsewhere that will then be sold off, presumably for use as housing to add to the population demanding services from the trust while the total number of beds is run down drastically from 1,250 to about 800 to 900.
King George hospital serves a population that includes some of the poorest people in north-east London. I worry about the long-term implications. We were told—this has been repeated in various trust documents—that the original plan was to wait for about two years, until new facilities had been established at Queen’s hospital, for the A and E at King George to be run down. That has obviously slipped, as we are now two and a half years on. I was told informally a few months ago that they were talking about the end of 2014 to the early part of 2015, yet the clinical strategy reveals that the new facilities at Queen’s hospital will not be ready until the middle or the autumn of 2015. One document says that the plan is to:
“Move all emergency medicine and surgery to Queen’s Hospital by mid 2015”,
whereas another says that that will be done by early 2016.
The whole process is still uncertain. Given the uncertainties, the problems, the management issues that have arisen and the poor morale of the staff, there should be a moratorium with a review. My ideal solution would be to go back to having a trust that would run the hospital in Ilford—the better performing of the two A and Es—and keep an accident and emergency department in Redbridge, as we have had since 1931. That would mean that the people of my borough, which at that time had a population of 85,000, would today, with a population approaching 300,000, have a hospital to serve them when they need it to meet their emergency needs.
I hope that the Government will seriously reconsider the situation, given the unprecedented action of the CQC—this is the first time an NHS trust has been put into special measures in this way—recognise the serious problems and recognise the dysfunctional nature of the Barking, Havering and Redbridge trust.
The Parliamentary Under-Secretary of State for Health (Jane Ellison): I congratulate the hon. Member for Ilford South (Mike Gapes) on securing the debate. I have heard him raise this issue in the House before, and it is clearly one of enormous interest and importance to his constituents. Like him, I wish to pay tribute to NHS staff in his area, particularly in the trust, as it has faced significant financial and performance challenges over recent years, as he outlined, including substantial problems with recruitment and retention. It is therefore particularly important to pay tribute to those front-line staff who have endeavoured—with some success, it sounds—to
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deliver an acceptable level of patient care in the face of a difficult situation. We thank and pay tribute to them for that.
I do not have a huge amount of time, so will give an undertaking now to get in touch with the hon. Gentleman after the debate if there are any issues that I cannot respond to or that I have not picked up on. It is worth saying—he will be disappointed, but it is better to say it straight away—that there has been no change in the position on the reconfiguration plans as laid out by the Secretary of State in the most recent official correspondence. I will therefore focus my remarks on the special measures situation and some of his questions about it, as I have some more detailed information to put across.
As we have heard, the NHS Trust Development Authority has decided to place the trust in special measures. The decision was not taken lightly; it follows the findings of an inspection by the Care Quality Commission’s chief inspector of hospitals, which demonstrated unacceptable failings in the trust. The chief inspector acknowledged that the trust has demonstrated improvements in some areas, such as the maternity service, but that good work has not been replicated throughout the trust. He highlighted that long-standing difficulties in the two A and E departments are clearly affecting patients and that attempts by the trust to address the problems have not had the hoped-for impact.
I share the hon. Gentleman’s disappointment that the much-needed improvements to A and E have not been achieved. All our constituents—I am a fellow London Member—deserve the best health care that we can provide. I recognise his characterisation of the local catchment area, as I see many of the same characteristics in my constituency. London is an extremely challenging health economy. The city’s diversity brings both exciting challenges and big pressures, so I understand what he is alluding to. Those are some of the reasons why the chief inspector recommended that the trust should be placed in special measures, whereby the trust’s leadership can get the support it needs to tackle the scale of the problems it faces.
Special measures provide an open and transparent way for the trust to take swift action to improve the quality of the services it provides for local people, which is what we want to see. I have been informed that the TDA has set out an intensive and focused programme of support. It includes the development of an improvement plan by the trust, which the TDA expects to see implemented over the next 12 months, and the appointment of an improvement director to support the development and delivery of the trust’s improvement plan. I recognise that the hon. Gentleman feels that he has seen people come and go with that objective in mind, but clearly it is extremely important that the improvement director is appointed, grasps the situation and makes a real difference.
There will also be a review of the capability of the trust’s board and senior management team, to be undertaken this month by Sir Ian Carruthers. It aims to ensure that the organisation has the capacity and capability to respond to the chief inspector’s report and deliver the improvement plan. I hope that it will report very soon after this month’s assessment so that it can be one of the building blocks on which the trust can move forward.
The trust’s plan will also need to identify the support it needs from partner organisations to improve services, including its commissioners and local authorities. I
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understand that the relationships are not as good as they could be and that there have been problems for some time. Work is already under way to identify partners to support the trust in recruiting and retaining staff. I recognise that the figures on vacancies that the hon. Gentleman set out, particularly for A and E, which were given to me in the briefing for this debate, are not acceptable. That is a real challenge, and one that the trust needs to respond to.
I can reassure the House that the trust’s plan will be published on the NHS Choices website and will be freely available to the public. We also expect regular updates to demonstrate how the trust is progressing. I believe that progress will be posted against that plan in a transparent way as the period for improvement progresses. The TDA will keep close to the trust as it works to make the necessary improvements and will hold board-to-board meetings with the trust. It has also arranged to buddy-up and provide support, as appropriate, with a high-performing foundation trust. Special measures are designed to produce results quickly. The trust will have one year to improve sufficiently, as judged by the chief inspector of hospitals, in order to exit special measures.
As the hon. Gentleman said, the safety of A and E departments is very important. The trust has been subject to an external clinical review of the safety of its A and E services commissioned by the local clinical commissioning groups and undertaken by the London Clinical Senate. I understand that this was in response to a request from local CCGs following concerns raised about potentially unsafe levels of medical staffing within the A and E units, as we have discussed. The TDA has confirmed to me that this review, which published interim findings in September 2013, concluded that neither the A and E at King George hospital nor the A and E at Queen’s hospital was unsafe, but it made a number of recommendations to improve the service. It has also been made clear to me that the A and E review was very much independent of the chief inspector of hospitals’ inspections at the trust and the TDA’s decision to put the trust into special measures.
Let me touch on some of the support that has been put in for A and E. We have provided further support to the trust through the funds available to respond to winter pressures. The local health economy in the hon. Gentleman’s area has received about £7 million, while the trust itself has received £3 million. Some £4 million
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has been earmarked for A and E recruitment, and another £4 million was allocated throughout the local health economy by the urgent care working group responsible for the area. That money was allocated based on clinical need and went to a range of organisations, including the local mental health trust, the London ambulance service, and the local authority.
There is no time to talk about this in detail now, but the Government are taking longer-term action with regard to reducing demand at A and Es. Some of that falls within my own portfolio of public health in seeing what health and wellbeing boards can do to reduce demand as regards people going to A and E when that is not the appropriate place for them to be. Of course, the extension of GPs’ opening hours through new contractual arrangements is highly relevant in a population that is, as the hon. Gentleman described, to a large extent young, highly mobile, highly diverse, and often working in London’s 24-hour economy.
I strongly recommend that the hon. Gentleman and other hon. Members on both sides of the House who have expressed concern about the situation for some time should continue to engage with the trust at every opportunity—clearly, there have sometimes been challenges in the relationship—and with their local health and wellbeing board. The challenges facing the trust cannot be tackled alone and will best be tackled by the local NHS and all the partners—local authorities and so on—working together. It is absolutely vital to get that right.
The priority now is to make sure that the trust is able rapidly to improve the care that it provides to the hon. Gentleman’s constituents. The TDA will work closely with the trust to help it to improve and will take every necessary action to make sure that the issues raised in the chief inspector’s report are addressed. I will meet the London team within NHS England shortly. I will raise the issues highlighted in this debate, among others, and I will continue to keep the hon. Gentleman and other hon. Members who are interested in the situation informed as we go through this important year for his local NHS.
Question put and agreed to.