Barking, Havering and Redbridge University Hospitals NHS Trust

(Limited Text - Ministerial Extracts only)

Wednesday 15th July 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a great pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Ilford South (Mike Gapes) for raising what is an important matter not only for his constituents, but for the whole health economy of east London, and for the measured way he presented his case. He has been a watcher of and campaigner on the matters in his constituency for a long time. This matter has been addressed and debated on several occasions in this Chamber, and I know he has raised it in the main Chamber too. The last time he raised it here was in January 2014, just after the trust had been put into special measures by the Care Quality Commission in December 2013.

The distance that has been travelled since then is quite considerable. I was able to see it for myself recently, as my first ministerial visit was to visit the Queen’s hospital site—albeit to hear about the trust as a whole. It was clear from talking to staff, which I was able to do without management being present, that the distance travelled over the past 18 months has been considerable and transformative not only for patient care, but for staff experience of the workplace—the two, as all Members will recognise, are coterminous. The most instructive moment came in the staff discussion, when a nurse explained that, the day before, a petition signed by 3,000 local people, which had not instigated by anyone at the hospital, had been delivered to say how much they valued staff efforts to turn around their hospital and how they felt that it was a different place from the one that had gained a mixed reputation in the many years before the hospital was put into special measures.

I will address each of the issues raised by hon. Members in turn, but I want first to set the context and add slightly to the narrative provided by the hon. Member for Ilford South in his recounting of the trust’s history. The key review in the matters that we are discussing was begun in 2009. The review took in the whole of Health for North East London and was conducted under the right hon. Member for Leigh (Andy Burnham), then the Secretary of State for Health and now the shadow Secretary of State. It began reporting just before the 2010 election and required an answer immediately after. The hon. Member for Ilford South will know the report’s conclusion, which is basically what we are still sitting with. It encompassed not only the health economy of north-east London, but the relationship with what is now the Barts Health NHS Trust, encompassing Whipps Cross university hospital, St Bartholomew’s hospital, Newham university hospital and the Royal London hospital.

Several hon. Members have discussed the Government’s intentions regarding reconfiguration, but the report was not led by the Government or Whitehall but was under the sensible regime set up by the previous Labour Government of clinically led reconfiguration panels. The principle behind it was a better organisation of A&E and urgent care in east and north-east London—in particular, being able to provide superior trauma care at fewer sites. That model has wide understanding across the House and is based on international evidence and, increasingly, the experience in the NHS. It has affected my constituency as much as it has others around the country.

I understand why hon. Members who are concerned about a hospital that will lose particular services—although King George hospital will retain a 24-hour urgent care service—will feel aggrieved by that change. When engaging with patients and constituents, however, I ask that we remind everyone that this was a clinically led decision that was set up under the previous Labour Government and that the recommendations were continued by the coalition Government as a result. However, none of that questions the fundamental reason why the hon. Member for Ilford South called for this debate, which was to ask, “How can you continue this reconfiguration when one part of the trust is in crisis?” Crisis is the correct word to use for a hospital that was put into special measures. It was not one of the Keogh trusts that were put into special measures due to adverse mortality; it was one of the first to be put in because of systemic and endemic problems at the trust, many of which the hon. Gentleman highlighted.

The change that has occurred over the past 18 months to two years—I am grateful to the hon. Member for Ilford North (Wes Streeting) for highlighting exactly what has gone on—has been one of culture. Another remark from a nurse with whom I spoke was that, since special measures, her comments about patient care were being noticed by management for the first time. That was the difference that the CQC inspection made. The change in culture has been recognised by local people and the result is much-improved family and friends figures. I do not recognise the figures provided by the right hon. Member for Barking (Margaret Hodge), but the most recent figures are close to the national average. I will receive those figures in a moment, but I believe the overall A&E figure for family and friends was up at 84%. That is not quite where it should be, but the in-patients figure had also risen to nearly the national average. The most recent family and friends figures showed an improvement in results.

Hon. Members recounted figures suggesting that the A&E performance was poor. It is true that the A&E department has failed to hit its required standard for a long time, but the most recent figures are encouraging. Performance for the first quarter of this year was 93.39%—just under the 95% target—compared with the figure for the first quarter of the previous year of 85.62%. That is like for like. Despite the problems encountered across the NHS over last winter, that hospital showed a sustained improvement in the first quarter of this year.

I second the remarks made by several hon. Members about the quality of the new chief executive and the team he has built around him. I have spoken to him, and although he was not going to make predictions, his confidence about going into winter, as well as the place the hospital was in, was significantly different from where he and his team were this time last year.

Let me clarify the A&E figures before I get upbraided. I believe that the figures are that 96% of in-patients would recommend the service to their family and friends, and 1% would not; in A&E, 84% would recommend and 10% not; in maternity, 98% would recommend; in antenatal, 95%; in postnatal wards, 93%; and in postnatal community, 97%. Those figures are roughly around the averages in national FFTs—family and friends tests—which is a significant and marked improvement, showing that local people are responding to the changes made in the hospital and to what needs to happen.

None the less, despite all the improvements, it is true that the A&E is not in a sustainable position to receive the services from King George hospital, either physically—I saw its buildings for myself—or in terms of the new rotas and rosters, although recruiting is now much better managed than in the past. I understand from local commissioners that there is no intention to move these services from the King George to the Queen’s site until the physical and staff changes have been made to the satisfaction of the commissioners and the provider—the trust itself. I understand also from the commissioners that the time limit they have imposed means that that cannot happen even within the next two years, because they need to see a degree of sustainability before they can have the confidence to make the changes.

[Mike Gapes]

Does the Minister accept that, given that the A&E will be closed, whether in two, three or four years’ time, there is a level of uncertainty? The CQC report comments on that. Is it not better for the sword of Damocles to be lifted and for us to go ahead on the basis of having two A&Es that work together?

--- Later in debate ---

[Ben Gummer]

I understand the hon. Gentleman’s points. I accept that uncertainty is created at the King George site and that the effect of that is potentially destabilising, especially when the hospital and the trust have had to endure the whole process of special measures. His solution, however, is a false one in two senses.

First, the decision was clinically led in the first place, so to go against it would be to go against a clinical decision after several reviews. The hon. Gentleman is therefore suggesting that we make a political intervention against a decision made by doctors about the best distribution of trauma centres and urgent and emergency care centres according to population. Decisions have been made on a similar basis throughout the country. I do not believe that he really feels that that would be an acceptable route to take. Secondly, even were we to do that, it would not remove uncertainty, because there would still need to be some sort of reconfiguration in future in order to get the best outcomes for patients. So the uncertainty would remain.

The hon. Gentleman’s point is valid to an extent. If the situation were to occur again—clearly none of us would have wished things to proceed as they have done —we need to make it clear that reconfigurations can happen only when we have the correct sustainability in receiver organisations. That should be something we think about as we go ahead. However, we are where we are now with his trust, and to proceed on the basis that he suggests would not give either the patient outcomes or the certainty that he desires, whether for staff or his constituents.

[Margaret Hodge]

The Minister referred to a decision that was initiated in about 2009. That is correct, but circumstances change. Our area is the most rapidly expanding in London. I do not know the figures for Redbridge, but those for Barking and Dagenham show, potentially, another 30,000 to 35,000 houses being built over the next 10 to 15 years. That is massive expansion. I put it to the Minister that not only is the number of houses increasing, but the nature of the households is changing. What used to be a house lived in by a couple with perhaps two kids now tends to be lived in by intergenerational families with many more people. What regard has he paid to those changes? Should he not pay regard to them and review his decision in the light of them?

[Ben Gummer]

It is not ultimately my decision. It is the decision of the Secretary of State, but only on the advice of the Independent Reconfiguration Panel. The IRP takes a view over a long horizon, so it takes population growth into account in the original decisions—

[Margaret Hodge]

It did not.

[Ben Gummer]

I will come back to the right hon. Lady with a final comment, but that is what I understand. In the end, such decisions are left to local commissioners, who are the experts in buying the right kind of health provision for their patient groups. If their decision changes, that should be reflected in the IRP’s final decision, but the commissioners remain certain that that is the correct way to go for east and north-east London, and while that remains the case, we as politicians should support that clinical decision.

I will respond to some of the other points made by hon. Members. The finances of the hospital were brought up several times. It is true that it has had a sustained poor financial performance, but it is unlike other hospitals which have become indebted or are lifting up. The hospital’s position is a sustained one involving a large number—£38 million, which includes a very large figure for agency workers. That figure is now declining as the new management gets a grip on recruitment, and I heard some good stories about the improvement in recruitment when I went there only a couple of weeks ago. There is also £60 million annual provision for PFI payments, which is a problem in many trusts around the country, but there is no point rehearsing those issues, which the right hon. Member for Barking looked at many times in her previous role.

The chief executive is clear about the deficit. He shares my view and that of the Secretary of State that financial performance and quality go hand in hand. No hospital in this country offers outstanding care but has poor financial performance. We cannot get efficient care anywhere if the books are not being looked after at the same time, because the two work together. The chief executive understands that getting the trust into a decent financial position is central to providing the kind of consistently high-quality care that he wants to see across the trust, and not only in the specific areas rightly highlighted by the hon. Members for Dagenham and Rainham (Jon Cruddas) and for Ilford North.

The hon. Member for Ilford South was right to talk about capacity. There was a serious lack of capacity because of the failure to discharge patients and to get people through the system, which caused problems at the front end, in A&E. Remarkable change has been achieved in the past six months through the new measures put in place by the new management, but it is true that there is a great deal more to do. I heard a different story from the one the hon. Gentleman recounted: actually, they thought that the last CQC judgment was completely realistic; the action points highlighted were in large part already being addressed and needed to be done. The new management recognised that special measures was a regime that had to be exited once a sustainable improvement over time had been shown. That was gratifying to hear, because when it is heard from the shop floor, the management and the CQC, that shows that the whole team understands the problems and how they need to be addressed.

Several Members mentioned the problems in primary care, and I am aware of the acute issues in east and north-east London. They are the reason why my right hon. Friend the Secretary of State launched the new deal for GPs a couple of weeks ago. NHS England is now mapping hotspots of GP shortage across the country. It will use that information to target resources to make sure we are putting the new GPs being recruited into the right places and using every possible incentive to make sure that under-doctored areas are brought up to parity. Members will know that this is a historical problem and it will take a great deal of heavy lifting from all of us to change it. It is not simply about sheer numbers of GPs; we must have new models of delivering care and new diversity, so that we can deliver primary care appropriately rather than in a way that is based on a model that does not fit.

The right hon. Member for Barking raised understandable concerns that the existing system for the Barts trust was set up to finance one PFI deal. She is not alone in those concerns. I am taking a deep interest in the progress of the special measures regime at Barts. The financial performance and accounting procedures at that hospital and trust when it went into special measures were frankly shocking. They have now been changed, and we will be reviewing the situation on a weekly basis. I hope that if she discusses the matter with the CQC and the trust, she will understand better that it is not that the trust is subsidising one PFI but that there are systemic financial problems across the trust. I take her point completely, however. As we address the financial problems in east London we must reassure everyone that mergers have not happened simply to prop up one organisation at the expense of another.

Finally, I welcome the constructive approach and fair questions of the hon. Member for Denton and Reddish (Andrew Gwynne). I hope I have answered the majority of his questions, but I question the idea that Government policy has made the situation worse. The reason we are debating here is that the CQC gave an inadequate rating to the Barking hospital trust and put it into special measures. The ratings and the special measures regime were a creation of the previous Government. They have provided transparency and clarity that we did not have before and allowed us to have an honest discussion about what is wrong and what is right. I can now stand up and say where the problems are and accept responsibility for what needs to change. None of that was possible when we could not say that anything was wrong and had to pretend there were no problems, because there was a culture of denial rather than one of transparency and openness.

We are not at the acme. We have a great deal of distance still to make up, but we are in a much better place than we were back in 2013, when the trust was put in special measures, or in 2010, when the review was completed. We now have clarity about what we need to do and the process for doing it. I believe that we will soon have a much better health economy in north-east London than the one that Members have had to endure so far.