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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate. I also commend him and our colleagues in the Chamber—my hon. Friend the Member for Wellingborough (Mr Bone) and the hon. Member for Corby (Andy Sawford)—for their consensual and cross-party approach to tackling the challenges of the local health economy and addressing the needs of local patients. It is working together, as a group of MPs, that has helped to deliver success for the local hospital. That cross-party consensus is an example of what should be done. My hon. Friend the Member for Kettering is right that good health care is not political; it is about doing the right thing by patients, and that is the approach that hon. Members here today have taken in addressing local health concerns.
A number of the points raised today are ones we have talked about in meetings at the Department of Health. I have taken a keen interest in supporting Kettering in its future ambitions and in supporting my hon. Friend in his strong advocacy of the needs of local patients and his local hospital. As he rightly outlined, this is a part of the country with a growing population, due to increasing housing growth and the plans to increase housing growth in the future. As in all parts of the country, there is increased pressure on medical services from an ageing population with complex health care needs. By 2018, we will have 3 million patients with not one or two, but three long-term medical conditions—it could be diabetes, dementia, heart disease or chronic obstructive pulmonary disease.
Caring for patients with complex medical needs is a challenge for our whole country, and I know it has been one of the main drivers of increased admissions to A and E in Kettering. The acuity, which is the severity of the illness or medical admission, is a key issue that has been picked up by the A and E consultants and doctors with whom I have discussed the challenges faced locally by the trust. Supporting a better way of caring for people with long-term conditions and the frail elderly is at the heart of the proposals for the care hub that my hon. Friend outlined.
I want to take this opportunity to recognise the outstanding work done by NHS staff up and down the country. On this occasion, it is appropriate to draw attention to NHS staff working in and around Kettering—not only in the hospital, but in general practice, community mental health teams and palliative care teams. The commitment across the board in Kettering to delivering the highest-quality patient care is an example of what the NHS is all about, and it is right to recognise the dedication of front-line staff in the Kettering area.
I want to take the opportunity also to commend formally my hon. Friend for the outstanding interest that he has shown in standing up for the best interests of local patients throughout this Parliament and for his dedication in never missing an opportunity to raise questions in this Chamber and in the main Chamber during Health questions or to raise the case of his constituents in the Department of Health with me as the responsible Minister. It has been a pleasure to do all I can to support him, his constituents and Kettering hospital.
My hon. Friend is right to highlight the recent investment in the hospital. That is due in no small part to his advocacy and that of other hon. Members in consistently raising the needs of Kettering hospital and the local population. My hon. Friend will recall that when we met in January to discuss health services in his constituency and the plans that his local NHS has to deal with some of the pressures that it faces, we talked about some promising ideas. I will discuss those in more detail in a moment.
Before I do so, it would be appropriate to say a few words more generally about the pressures that the health service has faced during a difficult winter, how they have been handled and what we have done to support the health service both in Kettering and more generally. We know that parts of the NHS can and have come under pressure because of unprecedented demand, linked to the challenges of our ageing population. Compared with four years ago, every day the NHS sees 16,000 more hospital out-patients, performs 10,000 more diagnostic tests and carries out 3,500 more operations, and there are 2,000 extra ambulance journeys. Every year, 1.3 million more people visit accident and emergency departments.
Despite the extra demand, our NHS is performing well and treating the vast majority of people quickly. It is particularly important that it is dealing with the most unwell patients first. That is possible because we have taken, even in difficult economic times, the decisions that have allowed us to increase the NHS budget by £12.7 billion over this Parliament. Of course, that has allowed us to support Kettering hospital with local investment, which my hon. Friend outlined.
The NHS is also on track to deliver up to £20 billion in efficiency savings over this five-year period. That challenge was outlined by the former chief executive of the NHS, Sir David Nicholson, in 2009. Even to stand still and even with increased investment going into the NHS, it needed to make greater efficiencies. As a result of reforms and modernisation, we expect to save £4.9 billion over this Parliament and £1.5 billion a year from 2014 onwards. All of that will go directly back into front-line care in Kettering and elsewhere.
Andy Sawford
I thank the Minister for generously giving way, especially as the debate was secured by the hon. Member for Kettering. The Minister makes a point about efficiencies, but will he comment on the issue of geography, which we have not really touched on? We have talked about demand, but this is a critical issue for north Northamptonshire. The geography of our area is such that for people to have to rely on a hospital other than Kettering would mean considerable travel time. As someone who represents a rural area, I can say that that is an efficiency that we would not want to make. We would prefer to say, “Look, we want our local hospital. We recognise that there are challenges in sustaining a local hospital, but the geography of our area is such that we want to keep hold of it.”
Dr Poulter
The hon. Gentleman makes a very important and valid point. As well as improving the way our NHS buys goods and services—improving procurement practice, an issue that we discussed with members of the local health care team from Kettering when they visited me in the Department of Health—improving estate management and taking other measures of obvious efficiency, there is a need, outlined clearly in NHS England’s “Five Year Forward View”, to radically transform the way we deliver care. My hon. Friend the Member for Kettering made that point. It is now a priority to care better for frail elderly people through better integrating health services. I am talking about using the hospital potentially as a hub for vertical integration of services, particularly in more rural areas. That will mean that other health services—community health services, general practice and mental health services—can be supported and integrated with the hospital service as a hub-and-spoke model of care.
Crucial to that as well is integrating what the social care service does at the same time and having an approach that joins up what health and social care have to offer. Taking advantage of the better care fund that has been set up at local level, so that the local authority can work more collaboratively with the NHS, is very important. It is often very difficult to define where social care ends and health care begins, because staff are dealing with the same person, with the same care needs, but traditionally a silo approach has been taken to the delivery of care. We need to break down institutional silos and deliver more personalised care. That is at the heart of integrating care—at the heart of the hub-and-spoke model built around Kettering hospital. It draws on the importance of joining up what the local authority does with what the NHS does. That is particularly important in more rural areas, such as the one that the hon. Member for Corby represents.
As I said, I have followed developments in Kettering with keen interest. It is worth saying that since October 2012, when Monitor found the trust to be in breach of its licence in relation to consistently poor A and E performance, considerable progress has been made. That is in no small part down to the work of the local NHS and the local health care teams. To date, in 2014-15—I am now bringing the House up to date—the Department has provided £7.4 million of revenue support and £5 million of emergency capital to the trust. Over the winter, the trust fully activated its winter plans, building on initiatives that proved successful in previous years.
That work included an enhanced weekend discharge team, detailed plans allowing escalation when there was a busy period, and appropriate use of short-stay facilities, including an observation unit and ambulatory care unit. Those short term measures are designed to ensure that services continue in times of pressure, but the intention, quite rightly—building on the point about better integrating health and social care and what happens in the community with what happens at the hospital—is to move to a position whereby there is the ability to cope with pressure all year round and not just during the winter. The urgent care hub has that integrated delivery model at its heart.
The hub, as my hon. Friend the Member for Kettering outlined, would incorporate existing A and E services and facilities, but also include, for example, GP services and out-of-hours care, an on-site pharmacy, a minor injuries unit, facilities for social services, facilities for mental health care—that is particularly important and sometimes overlooked, but not in this case—and access to community care services for the frail elderly. Those services would facilitate rapid assessment, diagnosis and treatment by appropriate health and social care professionals. Patients would be streamed into appropriate treatment areas to minimise delays and reduce the need for admissions.
The hub’s location is, I am told, still being finalised, but options include clearing and redeveloping existing areas of the hospital or developing a new build on the site. The local NHS envisages that a capital investment of approximately £30 million, as my hon. Friend outlined, will be required. However, that figure will be subject to further detailed assessment as part of the business planning process.
The principle of the hub is absolutely the right way forward for the local NHS. It is the type of integrated care model that we need elsewhere in the country, particularly where the NHS is servicing a broad population. In this case, it is servicing not just Kettering, but a partially rural county and rural area. This is a model that I am sure hon. Members will continue to support and that I will continue to have a keen interest in supporting. I hope the plans will be successful at making the improvements that patients in my hon. Friend’s constituency and the area surrounding Kettering want. There are encouraging signs. The improvements envisaged are significant and would ensure that the local area had a resilient and high-quality health care system to deliver the highest-quality patient care. I again thank my hon. Friend the Member for Kettering for securing the debate.