Barking, Havering and Redbridge NHS Hospitals Trust
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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 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 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 £1.4 million 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.