The Parliamentary Under-Secretary of State for Health (Ben Gummer)
It seems appropriate that the final debate before Christmas is about maternity. It is appropriate in another way because it is about an area of the country that has too often been forgotten in the planning of services and where the people feel left out from the way in which the NHS has been formed in the past. The Government and I wish to address that. I am grateful to the hon. Member for Copeland (Mr Reed) for bringing his points to the House. He is a forthright campaigner for his constituents and cares passionately about his constituency, and he understands the needs and concerns of his patch. I listen with care, because I know he chooses his words with care. He would not have used the strong language he used in his speech were it not for the fact that he judged it necessary to do so.
I will begin where the hon. Gentleman ended—on the floods. I was glad that, despite the extraordinary amount of rainfall in Cumberland and Westmorland, the effect on NHS services was not as severe as it was in 2009 and 2005. That shows we are at least getting a bit better at resilience and planning. I would like to pay tribute to some of the people who stood out during the difficult period of the past few weeks. The NHS workers from across north Cumbria, many of them in his constituency, worked all hours to make sure people could access medication and receive treatment. It is a credit to them. The amount of work, commitment and vocational passion they bring to their jobs was reflected in the hon. Gentleman’s speech.
I will come on immediately to the problems in north Cumbria. They are well documented, although there is no agreement yet on how we address them. The fact is that north Cumbria is one of those rare things in England: a very remote area. We do not have them in our country in the way that others do. Our neighbouring country of Scotland has more remote areas and is able to understand the pressures that they put on health systems in a way that we do not. The Whip, my hon. Friend the Member for Hexham (Guy Opperman), also represents a remote and rural area. Rural areas pose particular challenges to a service that has grown out of an urban design for healthcare provision over many decades. We are seeing the pressures and difficulties posed by that structural conflict in north Cumbria.
To be blunt—the hon. Gentleman is cognisant of this—the care of patients in north Cumbria has fallen well short of where it should have been because of the structural failures in the way the NHS is set up in that area. That is why the hospitals were placed in special measures and why they have been there for so long. It is why they have not exited from special measures and why NHS England, together with Monitor and the trust development authority, has felt it necessary to place the whole of the health economy of north Cumbria into its so-called success regime. That is not a title I love very much, but I hope it points to the place we need to get to.
I will say from the outset that the success regime will be successful only if it comes up with a plan that is deliverable and has the support of local people and clinicians. The problem in the past has been that ideas have been proposed, normally from the centre, and placed on to local people. Completely understandably, they have said, “I am not having this. This doesn’t suit what we believe we need in terms of healthcare for our area and that’s not good enough.” Because the NHS is owned by local people, we will only win this if they feel any redesign will improve quality and services. We also have to be clear that it will pose difficult challenges to us as politicians, both as local representatives and Ministers. It is important we get behind the success regime when it concludes and are prepared to take difficult decisions. The one thing that will ensure that the poor state of patient care quality persists in north Cumbria for years and decades to come is if we do not take a decision. We have to take a decision. We have to make sure it is the right decision. We have to get behind it and make sure it happens.
Turning to some of the specific issues the hon. Gentleman raised, the issue of staffing really underlies all the problems in the various NHS bodies in north Cumbria. It is difficult to recruit to certain specialties in north Cumbria. That means the trusts and other NHS bodies depend on locums and agency staff. That is not the way to run the health economy either in north Cumbria or across the NHS. That is why we have taken wider action on staff agency costs and why we need specific help for north Cumbria. The success regime is looking specifically at this.
The hon. Gentleman mentioned the new medical school, led by the University of Central Lancashire, on the West Cumberland campus. I welcome its sense of innovation. It already provides very good non-medical healthcare courses, and I am glad it is reaching into new areas. I will be excited to see how it progresses and would like to see what it is doing for myself in the near future. I certainly endorse his plan for a rural health policy laboratory—it is the right way to go—which I hope will feed into the success regime and our understanding of how to learn from other areas of greater rurality and sparsity, such as Canada and Australia, and how they deal with, and provide exceptional care to, people in dispersed communities.
The hon. Gentleman mentioned nursing bursaries. I will not get into that debate now, but I hope he will be reassured by my announcement a few hours ago of a nursing apprenticeship route all the way to degree level to ensure that healthcare assistants can progress to registered nurses via an intermediate nursing associate position. In north Cumbria, it is much easier to recruit to healthcare assistant posts than to nursing posts. I hope he will understand where I am going with this. As in Hull and other parts of the country where it has been difficult to get nurses into post, it will allow us to give to our excellent, committed healthcare assistants, who have the values of the NHS right at the core of their being, a career progression route that they have not had so far. I hope he will take comfort from that initiative.
I understand that staff often work excessive hours just to keep things going in stressed areas such as north Cumbria. The NHS depends on their good will at such moments, but it is not something we should bank on, which is why we need to get it right for his constituents and the whole of north Cumbria.
The hon. Gentleman made two final points about the building programme at the West Cumberland and the transformation fund. I will certainly consider his request in respect of the West Cumberland, although it is probably best that Monitor comes to a final decision once the success regime diagnostic is at least concluded, which should be imminently, because it would be a mistake to embark on something that would be moderated by a joint decision within the success regime deliberations. I will ensure, however, that there is pace to that. It is important, if it is committed to, that it is delivered, but I assure him that I will look into the matter first thing in the new year.
The transformation fund is designed to stimulate the innovation we know there is in the NHS around clinical management and to bring efficiencies to bear across the hospital estate. It is not, I stress, a bail-out fund; it is designed to do what it says on the tin: to transform how we run our hospitals. Efficient care is good-quality care, as the hon. Gentleman understands better than most, which is why the hospitals delivering the best care in the country are also the best at looking after their finances. There is considerable talent within the management and clinical management core in the NHS, and we want to realise their ideas for making the NHS more efficient across the services it provides. That is the purpose of the fund. It is to help realise that innovation and to match their efforts. If we simply pour it into bailing out hospitals that are not doing their bit to transform and bring in efficiencies, it will be doing the wrong thing and we will be wasting money. However, I will certainly make his request clear to the leadership of NHS Improvement, which is concerned with this matter. He will be pleased to know that Jim Mackey, the exceptional new chief executive of NHS Improvement, is well acquainted with his part of the country and has its interests at heart.
It remains to me, as the last person to speak from the Floor this year, to thank the hon. Gentleman for bringing this important matter to the House. On this occasion, last is certainly not least, and I hope that Cumbria will be first in the new year in terms of the announcements we will make. I wish everyone still remaining in the Chamber—the Clerk, the Serjeant, the Whip, the Doorkeeper, the officials in the Box, the one or two determined visitors and you, Madam Deputy Speaker—a very happy Christmas.
Question put and agreed to.