The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I congratulate the hon. Member for Workington (Sir Tony Cunningham) on securing this evening’s debate, and I commend him for his interest in local health matters affecting his constituents, and for his clear advocacy of the needs of local patients.
We all understand that the configuration of local health services is an important issue for many Members—and for many of our constituents—particularly those who represent the more rural parts of the country such as Cumbria. We all agree that patients should receive high-quality care, regardless of where they live.
These are challenging times for the West Cumberland hospital. There have been difficult decisions to face up to, following the Keogh review, and the hospital has been put on special measures, following concerns about some aspects of patient care. I will say a little more later about that and about the importance of patient and public engagement in all decisions affecting the reconfiguration of local health care services.
First, I want to provide hon. Members with some reassurance about the future of local health services. It is important to note that for the first time in more than 50 years significant investment is being made under this Government in health care facilities in west Cumbria. The West Cumberland hospital is being redeveloped at a cost of £95 million, with this Government providing £70 million of that funding. The improved hospital will offer high-quality services and facilities fit for the 21st century, including significant local elective surgical services for the benefit of local patients.
The local doctors in the Cumbria clinical commissioning group are committed to keeping West Cumberland hospital clinically and financially viable, with the majority of Whitehaven patients continuing to access services, including A and E, at that hospital. I would also like to reassure the hon. Gentleman that it is the local doctors and nurses who run the clinical commissioning group—not me or anyone in Whitehall—who will make the decisions about health care in Whitehaven and Cumbria.
Before I move on to the specifics of the issues raised by the hon. Gentleman, it is worth noting the long-running issues at North Cumbria University Hospitals NHS Trust and the progress that has been made towards addressing them. Because of a history of high mortality rates—which means that more people were dying at the trust than should have been the case—the trust was placed into special measures in July 2013 as a result of Sir Bruce Keogh’s review. The trust is now working towards a merger with Northumbria Healthcare NHS Foundation Trust, which will further ensure that it can offer safe, high quality and sustainable patient services.
The trust has continued to work hard to tackle its long-running problems with recruitment of medical staff. It has recently implemented a nurse practitioner work force model to replace trainee doctors, who are currently not being placed at the trust due to long-standing difficulties in ensuring the necessary levels of senior medical training support. A recent positive development is that the trust has increased its consultant medical staff by 17%, as well as introducing a new nursing structure, which is helping to ensure safe nurse staffing levels on every ward.
Sir Tony Cunningham
Why does the Minister think there is such a shortage of doctors?
Dr Poulter
This has been a long-standing shortage; the trust has not been an attractive place for junior doctors to work for many years—probably for the past decade. However, the trust is now looking at ways in which it can better incentivise doctors to work there. That is an important step forward. If we want junior doctors to return to the trust—given that they have been removed from it because they were not getting the high-quality training they needed in order to become consultants—we must ensure that we incentivise the recruitment of more senior doctors to the trust. The hospital is now looking much more seriously at that than it has done in the past.
As I just outlined, recent measures have resulted in the consultant medical staff being increased by 17%, which is a positive step forward. Measures are also being put in place to ensure that nurse practitioners will be better used, where appropriate, to treat patients. The trust can be proud and pleased with the progress that it is making in that respect. An important aspect of looking after patients is to ensure that there is a full rota of junior doctors on site, and I am sure that if the progress in increasing the amount of consultant cover is maintained, that will become available again in the future.
On performance, the trust has put in place a recovery plan to meet waiting time targets from the end of 2014. It is currently working to reduce its backlog of patients who have been waiting for more than 18 weeks from referral to treatment, and it has received additional funding to support that. As hon. Members have pointed out, however, the trust has been financially challenged for some time. Last year, it reported a deficit of £27.1 million. The Department of Health provided significant financial support to the trust in 2013-14, as it has in previous years. The trust received £11.5 million from the Department, alongside support from the trust development authority and the clinical commissioning group, and £6.3 million in private finance initiative funding support. As we have discussed, however, that position is not sustainable in the long term. That is why further discussions about foundation trust status are being held.
Other critical challenges remain. Most significantly, some services at West Cumberland hospital remain fragile due to difficulties recruiting specialists and consultants and to the current heavy reliance on locums. However, I hope that that issue will be addressed in the near future if the trust can continue to recruit more consultants.
The Care Quality Commission inspection report published in July 2014 rated the safety of acute medical and outpatients services at the West Cumberland hospital “inadequate”. That reflects the difficulties that the hospital has faced for many years, and continues to face, in recruiting adequate staff to run some of its services safely and effectively. However, the trust has made significant progress in addressing the many challenges it faces. The CQC inspection acknowledged that, giving it an overall rating of “good” for providing a caring service to patients.
Another CQC inspection is expected to take place in early 2015, and I understand that the trust is working hard to make improvements ahead of that. For example, the outpatients service has greatly improved the availability of patient notes, an issue highlighted at the previous inspection. As I understand it, patients’ notes were not available when they came for an appointment. That is not helpful in providing an understanding of their previous history, which disadvantages the staff who are looking after the patient and trying to provide the best possible care. The trust has taken that issue on board and I understand that it is making good progress to address it.
The trust has made significant progress in other respects, most notably, and perhaps most importantly, in reducing high mortality rates. That means that patients in Cumbria who would have died had these changes not been introduced are alive today. Having been one of the highest in the country, the trust’s mortality rates are now within national confidence limits, and the trust and its staff must be commended for that turnaround. Further progress has also been made in, for instance, the meeting of the four-hour A and E standard, the implementation of a new patient experience programme, and a reduction in clostridium difficile infection rates. However, changes must continue to be made to secure a sustainable future, and to enable the trust to keep building on the good progress that it has made so far. It is important for the local NHS to be supported in that work to secure safe, high-quality patient care.
Dr Poulter
I do not have the local knowledge that would enable me to understand why that happened, but what is important is the need for action to be taken in cases in which there is a history of higher than expected standardised mortality rates—cases in which patients have died when they should not have died. That is why the Government asked Sir Bruce Keogh to investigate this trust, and, indeed, many other trusts, as a result of which some were put into special measures.
Although a number of challenges remain, and the trust must address them, it appears to be making good progress in terms of standardised mortality rates, which means that—as I said earlier—patients who might have died in the past are now surviving. That is testimony to the hard work of the trust’s front-line staff. I know that Members will be pleased, and that, more importantly, local patients and their families will be very grateful.
The subject of reconfiguration was raised. The issues affecting west Cumbria were discussed during a debate secured in 2012 by the hon. Member for Copeland (Mr Reed), and I know that the future of services at the hospital is a matter of continuing concern to both him and the hon. Member for Workington. As I said earlier, the local NHS is committed to ensuring that West Cumberland hospital has a viable and successful future, and that west Cumbrian patients continue to receive treatment there. That is why £95 million—£70 million of it from the Government—is being made available to improve its facilities. The money will allow it to offer 21st-century facilities, including seven new operating theatres, four of which will have full laminar flow, which will make them suitable for use in any operation. That will allow the hospital to offer a wide range of surgical services, and to become a centre of excellence for elective surgical procedures.
The hon. Member for Workington asked what excellence would be provided at the hospital. I can tell him that the investment in new facilities will allow patients to receive elective surgical procedures of a much higher quality, which will hugely benefit the local population. That investment is supported by additional investment in other local health care facilities, including, not far away, the new £11 million Cockermouth community hospital—which was officially opened in August 2014—and the new health centre at Cleator Moor.
Alongside the financial investment in the hospital, there are continuing efforts to attract and recruit new clinicians to North Cumbria University Hospitals NHS Trust. International recruitment campaigns have already taken place, and financial incentives are now available to support recruitment to the posts that are the most difficult to fill. That point arose earlier in the debate. Hospitals often have the flexibility to offer incentives in the event of recruitment challenges and difficulties, and I am pleased that the local trust is taking advantage of the opportunity to offer such incentives to attract new consultants and permanent staff.
To build on the progress that is already being made, clinicians are working towards changes that offer the best opportunities for better outcomes to be given to patients suffering from the most serious illnesses. No changes will take place unless there is clear clinical evidence that they will result in better outcomes.
Understandably, people have concerns when any change to local health care services is being discussed, but it is important that such concerns are not exploited for any political or other purpose, and that all changes that take place are in the best interests of local patients. The five-year plan for the local health service being developed by local doctors and clinical commissioners is looking at how services can be delivered safely and sustainably in the future. In developing the plan, I expect the local NHS to give important consideration to the distance patients need to travel to access services, particularly emergency services. As we have discussed, rural areas are very different from urban areas, and the distance patients may have to travel to access services is an important factor in determining what is safe for patients. Local commissioners need to take note of that.
Dr Poulter
That actually may have to happen in my constituency, for example, in cases where my local hospital does not have the right support for a very premature baby in utero once it is born. Neonatal services are not always as well developed at every hospital, and some areas tend to have a regional centre of excellence for neonatal care. As the hon. Gentleman said, there may be a regional centre of excellence for cardiovascular services, heart surgery or other specialist services. We want to ensure that bread and butter, day-to-day medical services are always provided by local hospitals—that is particularly important in rural areas—but we have to ensure when taking these decisions that where there is a clinical case for better patient care to be delivered at a centre of excellence, that case is made and communicated effectively. So, for example, although I would want to ensure, as I have done, that in Suffolk patients are able to receive the best possible care from the local NHS, if they needed super-specialist services and other services that are better provided at a specialist centre, they receive that care from those centres. I have always advocated that important case on clinical grounds.
This is about seeking to provide high-quality day-to-day services, while recognising that some services have to be provided at specialist locations. So when dealing with the potential birth of a very premature baby, it is important that the right support after birth is available, and that is provided by more specialist neonatal intensive care units—for example, Brighton is a regional centre for the south of England for some of those services. It is also important that, where possible, an intrauterine transfer takes place to make sure that the right care is available upon birth and after delivery.
It is also important to stress that in designing and working through what the right patient services are, and in putting together the local five-year plan in Cumbria, certain guarantees and reassurances have been made to the local population. I spoke just now about important day-to-day medical services, and a commitment has been given that there will continue to be an accident and emergency department at West Cumberland hospital. That is part of what I was just speaking about: high-quality, immediate services available for patients in more rural and remote areas. An independent review is looking at maternity services across Cumbria and will feed into work locally to find the best possible solution to providing safe and sustainable maternity care in the future.
While the five-year plan outlines the direction of travel for the local health service, no definite proposals have yet been put forward, and work remains at an early stage. In developing its proposals, I expect the local NHS to ensure that patient safety is a key focus, and that any movement or change of services is based on clear clinical evidence of better outcomes for patients.
I wish to make some important points about public engagement, which was raised by both hon. Gentlemen. It is important that people who use NHS services get a say in any changes to those services. We are very clearly committed to that as a Government, and it is important that local clinical commissioning groups, and the doctors and nurses who run them, properly engage with the public when they are making the case for the future shape of local health care services. I encourage local patients to continue to engage with the NHS as plans for west Cumbria are developed.
I understand that Cumbria CCG has met local MPs and the local campaign group to discuss their concerns and is happy to maintain that dialogue and continue to meet to discuss issues of concern in the weeks and months ahead.
The local NHS held a period of engagement to inform the development of the five-year plan. Both the CCG and the trust are committed to undertaking more engagement and communication with local people in the coming months.
Any proposals put forward for significant changes to local health services will be subject to a full public consultation in which patient and public views can be fully engaged in helping to shape future health care services. That is an important reassurance to give Members. No decisions will be made without that full public consultation if and when any changes to services are proposed.
In conclusion, I know that local people care deeply about the future of West Cumberland hospital—that has come across clearly from the contributions this evening. The provision of health care services affects all members of the community. We have only to look at the example of 10-year-old Maddy Snell who last week received a reply from the Prime Minister to her letter about potential changes to local health care services to see how the whole community in west Cumbria wants to be involved in the future of its hospital.
Patients should keep up that engagement with the local NHS and make their opinions known to those developing proposals for the future of local health care services. I also want to encourage the people of Whitehaven to listen to the reasoning behind any proposals that their local doctors bring forward for improvements in the way in which people are cared for in the local area.
I should like to reiterate that local health services in west Cumbria have a strong future. There is a commitment from the local CCG, led by doctors and nurses, for a continuing accident and emergency service, and the Government support a £95 million investment in health care facilities at West Cumberland hospital.
Mr Reed
The Keogh report makes it very clear that meaningful engagement with the staff both at the Cumberland infirmary, Carlisle, and the West Cumberland hospital is nothing like it should be. That is one of the key reasons the trust entered special measures. All of us from all parts of the House want to see the hospital trust emerge from special measures as quickly as possible. However, latterly, that engagement internally has demonstrably worsened. How can we get out of special measures if these behaviours persist?
Dr Poulter
Part of the challenge may well be challenging some of the existing work practices at the hospital. I accept what the hon. Gentleman has said about the quality and commitment of local NHS staff. In my experience, I have never found a member of the NHS who has been engaged in health care with anything but the best intentions and the wish to help people. That is why I am a doctor and why many people go into health care; they want to provide compassionate care for people and to improve the human condition. I know that that is what drives local staff in Cumbria. Sometimes when profound issues have to be faced, such as higher than expected local mortality rates, challenging conversations have to take place. Such issues are the result of not a lack of commitment or dedication from the staff, but the fact that some working practices need to be improved. Additional training and support may need to be put in place to improve those working practices. It is important that that is done in a way that brings staff along in a collaborative working environment.
When things go wrong in health care, it is rare that there is one single causal factor, although sometimes there is; sometimes it is the negligent act of one person. Often, however, it is the system in a hospital that has let someone fall through the gaps. This is about challenging working practices, and as far as possible, that has to be done collaboratively. Clearly, there have been huge improvements in the way health care is delivered locally. Mortality rates have fallen, and patients are being looked after in the way we would all expect. That is down to the hard work of the staff who are facing up to some of the challenges, and making sure that they put right what may have been wrong.
It is important that when there are discussions about reconfiguring, changing or developing health care services, local clinical commissioners engage effectively with the hospital and properly with hospital staff. Part of the broader consultation and engagement exercise needs to be focused on proper engagement between the clinical commissioning group and the clinicians and other dedicated staff who work at the trust. From what hon. Members are saying, there may be more work to do in that area. I urge the clinical commissioning group to put right any issues, because it is important that everybody signs up to dealing with future challenges.
As I have said, I am confident in the local clinical commissioning group’s commitment to supporting a viable A and E at the hospital. The Government have provided investment to develop facilities further, particularly facilities for surgical procedures, in the hospital and the local area. With that investment, there is a strong future for local hospital services. It is important that local clinical commissioners continue to engage with staff at the trust, and particularly with local patients. After all, if we want a health service that is fit for purpose in Cumbria and elsewhere, it has to be based on the needs of local patients. It is to them, more than anybody else, that local commissioners need to listen.
Question put and agreed to.