The Parliamentary Under-Secretary of State for Health (Ben Gummer)
I thank the hon. Member for Dewsbury (Paula Sherriff) for bringing this matter to the House and for her powerful introduction to her constituents’ concerns. I also thank the hon. Member for Batley and Spen (Jo Cox), who intervened. They make a powerful double act for Mid Yorkshire. I have felt the pressure of the concerns they have quite rightly raised with me privately, and I hope that they will be able to do so again in the next couple of weeks.
I very much like the fact that the hon. Member for Dewsbury ended by mentioning this important anniversary. We are a few weeks away from the 70th anniversary of the Second Reading of the National Health Service Bill, as it then was, on 30 April. At that time, Nye Bevan made two points about the introduction of the NHS. The first is the one we all know, and of which we are equally proud, which is that it should be a service free at the point of need.
However, Nye Bevan made another point, which for him was as important in the establishment of a national health service—it has been forgotten by politicians on both sides during the past 70 years—which is the principle of universalising the best. He made a very powerful argument at the time, which was that the reason for a universal NHS was to ensure not just that people could approach the service without having to worry about money, but that someone from a part of the country that traditionally did not have good hospital care could rely on the same quality of service that they would expect in a wealthier or better served part of the country.
In establishing the first part of Nye Bevan’s dream, we have done well, but in establishing the second part, we have not yet succeeded. The hon. Lady’s constituents have, in part, been at the rough end of that. For years, under Governments of all kinds, we have not done well enough in universalising the best across the service. As we discussed when we had our meeting, there are hospitals not far from hers that are delivering exceptionally good and consistent levels of nursing care. They have been able to do so while under similar pressures to those in her own hospital—as she has correctly identified, similar pressures apply across the service.
Clearly, there are historical problems in Mid Yorkshire, and they will be difficult to grapple with. I completely understand why the hon. Lady feels that commissioners might not yet have a full enough grasp of the problems in her area. That is why she questions the basis of the reconfiguration. I understand that the assurance exercise into the reconfiguration is nearing its end, and we will publish that at some point in the near future. I hope that that will provide assurance that the accelerated reconfiguration can take place. I take into account the completely legitimate points that the hon. Lady made about the readiness of the reconfiguration of social care services in the area, but I think we should cross that bridge when we get to it. I am mindful of the fact that I have no power to change reconfiguration decisions—and neither does the Secretary State.
Jo Cox
As the Minister will be aware, the Mid Yorkshire Hospitals NHS Trust has the third highest number of admittances to A&E in the country. In that context, I share the concern of my hon. Friend the Member for Dewsbury (Paula Sherriff) about the planned reorganisation and downgrade of the Dewsbury hospital. It is a serious matter for local residents and some of my constituents. It would be wonderful to have a commitment further to discuss whether now is the time to move forward with that plan.
Ben Gummer
Of course I understand why it is a matter of concern. I must say what I have also said privately, which is that I must respect the opinion of clinicians and commissioners. That is why I want to hear what they say. Ultimately, there is the approval process that this reconfiguration has already gone through—namely, that of the Independent Reconfiguration Panel. I will, of course, speak to the hon. Lady whenever she wishes. It is not kindness on my part, but my duty to her as a Minister responding to an elected representative.
I spoke today to the director of nursing at the Mid Yorkshire Hospitals NHS Trust and also to representatives of the local trust development authority, and I was glad to be assured on some points. I was pleased to hear that they were co-operating with Lord Carter’s review of safe staffing ratios, which should provide a promising foundation for ensuring that we have the right kind of staffing ratios at the appropriate acuity of patients. This will be good in every hospital where it eventually applies, but for those with very challenged staffing ratios at the moment, the ability to look carefully at the rostering of staff across the service with the kind of skills and international experience that Lord Carter will bring will, I think, be helpful. Unfortunately, I was not made aware of the meeting that the hon. Lady had with the chief executive. I am disappointed about that because she clearly had a robust discussion. I have seen the contents of the letter that she sent to the Secretary of State.
Paula Sherriff
Given that Ernst & Young’s services were used, at some considerable cost, and that some of the matters it considered were staffing issues and staff forecasts, it is relevant to point out the contract has now ended after about four or five years. Does the Minister agree that it is quite worrying to find ourselves in this position after spending somewhere in the region of £15 million?
Ben Gummer
As a constituency MP, I, too, have been frustrated by consultancy contracts, both before and after the 2010 election. Across the service, we have managed to bear down on consultancy spend considerably. It is for the hon. Lady and her consultants to determine whether the trust has got good value for money. It is not for me to pass comment on that, except for the fact that all hospitals should account to their local people and to the trust and local authority responsible for making sure that money is being spent wisely.
I completely agree with the hon. Lady in that behind the statistics of poor performance that she identified, there are people who are not receiving the care they require. That was picked up by Professor Sir Mike Richards in his report into the quality of care provided at the hospital. He was very clear about it, saying
“we found medical care, end of life services and community inpatients either hadn’t improved or had deteriorated since our last inspection.”
He found areas of significant staffing shortages affecting patient care, especially on the medical care wards, community in-patient services and in the specialist palliative care team. He said that there was a shortage of medical staff for end of life services. He came to the same conclusion as the hon. Lady did.
The difference here is that I hope we have made progress since the Mid Staffs tragedy that the hon. Lady identified, and are now able to be more open about this. There will not be a culture of denial from the Government Benches about problems where they exist. Clearly, there is a problem here; it has been identified by the Care Quality Commission. The distressing story of the hon. Lady’s constituent that she raised with the Secretary of State in the Chamber and in the letter and again just now has been supplemented with additional stories that her colleagues have brought to the attention of the Department, and these make it clear that things need to be done in Mid Yorkshire.
What, then, is the solution to the problems that the hon. Lady has identified? The first is a local one, and all these problems have to be addressed locally, but I of course take the hon. Lady’s point that the Department has to take a degree of responsibility. Of course the Secretary of State and I take responsibility for everything that happens in the health service—that is ultimately our duty—but we cannot micromanage every hospital. It is for the local team to ensure that they are universalising the best and implementing the kinds of changes in their trust that have made such a success of hospitals not very far from the hon. Lady’s own. If they are able to do that, they will already be able to bring considerable improvements to the quality of the care that they can provide.
I can obviously do additional things as a Minister to give the local team the tools to do the job, as I can for other hospitals across the country. That includes ensuring that they have the best guidance to enable them to roster their staff properly. Lord Carter’s review is being conducted with the Care Quality Commission and with NHS Improvement. It is a tripartite review of safe staffing ratios that will give hospitals cutting-edge support to roster their staff according to the acuity of their patients to ensure maximum safety and efficiency, learning from best practice across the globe. Salford Royal Infirmary has already been looking at this particular model in one guise.
Paula Sherriff
My hon. Friend the Member for Batley and Spen (Jo Cox) and I share considerable concerns about the senior leadership at the trust. We have regular monthly meetings, but we were made aware only at the last meeting—we now have an interim chief executive—of some of the chaotic things that were going on at the trust, although we had been aware of anecdotal stories. We would therefore appreciate some support from the Department of Health team to ensure that communication channels between us as elected Members are as effective as possible.
Ben Gummer
I shall certainly impress that upon NHS Improvement, which will be taking over the functions of the NHS Trust Development Authority in the next few days. I expect that it will keep an even beadier eye on the quality of management than has been the case so far. It will do so under the watchful eye of Jim Mackey, its chief executive, who ran one of the best hospitals not only in England but in the world. He is now running NHS Improvement and I know that he will be able to provide the support that the hon. Lady wishes to see. I will tell him later this week about the discussion that we have had tonight and I will ensure that he provides hon. Members with the kind of resource that they are asking for so that they can ensure that their local leadership is doing the right thing.
On the wider issue of staffing, the fact is that the nursing numbers in the service, which were found wanting at the time of the Mid Staffs scandal, could have been addressed only by significant changes in commissioning levels not two, three or four years ago but 10, 15 or 20 years ago. The service has failed under successive Administrations to predict the number of staff that it needs for the future. One of the more extraordinary functions that I possess is to have to sign off every year the commissioning of staff that will be required in 20 or 30 years’ time. My officials are a wise and brilliant group of people, but no one can behave like Nostradamus and expect to know what the service will require after that period of time.
That is why we have come to the conclusion that we need to increase significantly the number of places commissioned. Within the current spending envelope, however, it is simply not going to be possible to achieve the numbers that we wish to see. I think that Governments from both sides would have found that very difficult—in fact, impossible. That is why we came to the conclusion that we should release those places by transferring nurse graduates on to a loan system. I know that that is unpopular with Labour Members, but I hope that they will understand the rationale behind our doing so. It will allow us to add 10,000 additional places between now and the end of this Parliament. Those are 10,000 places that we will then be able to feed into additional nursing places, which will in time solve the underlying issues that parts of the country such as the hon. Lady’s have suffered for decades.
One final aspect that I wish to bring to the hon. Lady’s attention, which I hope she will be pleased with, is that of the new role of nursing associate. It is supported by the Royal College of Nursing and to some extent by Unison, although it has reservations—a consultation is starting soon on this. It will provide a ladder of opportunity to healthcare assistants to move through an apprenticeship level up to the midway point of a nursing associate, and then on to being a full registered nurse. At present that is a course that healthcare assistants cannot take; it is not open to them.
I know that other parts of Yorkshire have no problem at all hiring healthcare assistants, but find it very difficult to hire registered nurses. That is a particular local difficulty. What I have proposed is a mechanism to give an opportunity to healthcare assistants to progress themselves, which they have many times missed out on because they did not have access to the decent formal education that we aim to provide now under the reformed education system. We are now offering, through an apprenticeship route that would not be open to them otherwise, a ladder of opportunity to a much wider group of people in the NHS, and at the same time helping to solve staffing issues where there are traditional, historical difficulties in hiring nurses.
I hope that with those general measures we will be able to do far more in the long term to solve the issue that the hon. Lady has identified. On the specific issues, I will ensure that she gets the reassurance she requires, not just on the reconfiguration, but on the leadership of her trust. I thank her and her colleague for bringing this important matter to the attention of the House.
Question put and agreed to.