West Cumbria Health Services

Wednesday 4th May 2016 Westminster Hall

11:00

[Mr Jamie Reed (Copeland) (Lab)]

I beg to move,

That this House has considered health services in West Cumbria.

I thank you, Mr Nuttall, for chairing this debate, which is on the particularly important subject of health services in west Cumbria and the ongoing work of the success regime process in my part of the world. I am pleased to see the Minister in his place. He responded to my debate concerning these matters in December last year, and he is well aware of the numerous difficult issues that I will raise with him today. He will know that any criticisms I make are not personal or even necessarily politically partisan. In all the years I have fought for this argument and this cause, I have represented thousands of constituents who do not vote for me or my party. I always have and always will place my constituency interests above any superficial party political interests. Most of all, I seek solutions in this debate for the ongoing problems facing the north, east and west Cumbrian health economy. The problems have persisted for too long. They have worsened and can no longer be allowed to defy resolution. The Minister has responded positively to my questions and requests in the past—I am exceptionally grateful for that—and I hope he can do so again today.

I will start by outlining the issues facing my constituents in accessing health services in west Cumbria. The problems facing the North Cumbria University Hospitals NHS Trust are well known. There is intense pressure on overworked and under-resourced staff. I am grateful for the work undertaken by The Cumberland News and the News and Star, particularly that of the journalists Emily Parsons and Pamela McGowan, in helping to illustrate the scale of the problems within the trust. I will return to those later.

In such a rural county with such dispersed areas of urban population, the pressures on ambulance services are enormous. There is unprecedented pressure on primary care and GP services as a result of doctor shortages and truly catastrophic cuts to adult social services as a result of the Government’s choice to cut Cumbria County Council’s budget. A new threat in the guise of the potential closure of beds in the area’s community hospitals has emerged to widespread anger and condemnation from every community that relies upon them.

Added to those problems are the problems—caused exclusively by Government, I fear—facing the success regime. In particular, I want to address the success regime and, despite the initial optimism, the manifest problems and difficulties the process has been presented with. Critically, I will talk about the consequences of the success regime’s failure, how we can avoid them and how we can solve the problems facing our health economy, which is undoubtedly the most challenged in Britain. I will also talk about the recent floods, the effects of which are still being keenly felt throughout the county. They have magnified the issues at the heart of the debate over health services in the area.

Finally, I will pose as many of the questions sent to me as I can before outlining the health needs of my community and those of neighbouring communities—those needs, after all, are what it comes down to. The key issue for decision makers, Government and Ministers is: what do the people of west Cumbria need from their health services and how can that be delivered? That is a very different question from, “What are the Government prepared to provide?” Make no mistake, at the heart of the issue is the question: is the national health service worthy of the name? When we answer those questions, we should have the humility and wisdom to recognise that the consequences of the decisions we take now will outlast the lifespan of this Government. They will certainly outlast my and the Minister’s political careers. That is the gravity, the reality and the privilege of the situation we find ourselves in.

The simple answer is that the people of west Cumbria need better access to health services, particularly the hospital services provided by the West Cumberland Hospital in Whitehaven. It serves a vast rural area with many tightly compacted urban communities, with all the attendant challenges that has. In that context, access can be defined in a number of ways. It means the actual services provided locally, ensuring that those services are staffed appropriately so that they are of a high quality, and empowering the community so that it is listened to when decisions about its services are taken. It also means proper planning for the significant population expansion forecast for the area. In west Cumbria, each area is immensely challenging and we must address that. It is what the success regime was meant to address.

At this point, I have to thank the hundreds of patients, medical professionals past and present and members of the public who responded to my request for questions or evidence relating to the success regime process and the condition of the local health service in general. Time limits mean that I will not be able to put every question to the Minister today, but those I cannot ask I will either table as parliamentary questions or I will write to the Secretary of State for Health expressing the concerns. I am particularly grateful to the Royal College of Nursing, the Joint League of Friends of Community Hospitals, West Cumbrians’ Voice for Health Care—it has undertaken phenomenal work—and healthcare campaigners in Millom, Keswick and right across Allerdale, Carlisle and Penrith and the Border. I hope the Minister will ensure that the Secretary of State replies honestly and at length.

The Minister will be well aware that in July 2013, Sir Bruce Keogh published his review into mortality rates at a number of hospital trusts around the country. North Cumbria University Hospitals NHS Trust was one of them. Along with 10 other trusts, it was placed in special measures. The trust had higher than average mortality rates and action to remedy that was obviously welcome and necessary. At the time, Ministers were unable to provide basic information about what special measures actually meant for the trust, but it was patently clear that the major reason for care failings at the trust was—it remains the case—a chronic staff shortage.

It is only right that I again take this opportunity to thank, on a personal level as a parent and on behalf of my constituents, the amazing staff who work tirelessly in trying conditions to provide high-quality care. Many work unpaid overtime because they care about their patients, their work and, by extension, the service they provide to my community. I and my constituents know that they work in extraordinary circumstances beyond their control, and we are so grateful for their work. I doubt that any community in the country prizes its medical professionals so highly.

The truth is that every part of the health economy in west, east and north Cumbria simply needs more staff in primary care, secondary care, acute care and across our preventive services. Government must intervene to ensure that the problem is resolved, assisting with local initiatives wherever possible. That request has fallen on deaf ears for too long. The most recent report on the North Cumbria University Hospitals NHS Trust by the Care Quality Commission, which was published in September 2015, illustrated the scale of the challenge. It stated:

“The recruitment of nursing staff also remained an on-going challenge. At the time of our inspection nurse staffing levels, although improved, were still of concern and there was a heavy reliance on staff working extra shifts and on bank and agency staff to maintain staffing levels. There were times when the wards were not appropriately staffed to meet the needs of patients.”

I am sure the Minister would agree that that simply is not acceptable. In 2013-14, the trust spent £16 million on agency staff. That is clearly a false economy. Agency staff are a short-term expensive solution to a long-term problem.

Stable, long-term recruitment is key to turning around the finances of the local health economy and the hospital trust in particular. If my local trust has to pay over the odds to secure services taken for granted in other parts of the country, it should be able to do that and be funded appropriately by the Department of Health. That must be accepted by the success regime and by Government. Sadly, that is not currently the case. Sadly, it is not a conflation of the issues to point out that the Secretary of State’s antagonistic and insulting behaviour towards junior doctors is severely worsening the recruitment problem in challenged health economies such as that in Cumbria.

In my constituency, I have been working with the trust and the University of Central Lancashire to bring a medical school to west Cumbria so that we can “grow our own medics”. It would be a long-term sustainable solution to one of the key problems we face. I am delighted to say that the new West Cumberland medical education campus now exists at the Westlakes science park, immediately adjacent to the new West Cumberland hospital in my constituency. So far that has succeeded without the support or involvement of Government, but I hope that the Government will be able to support the development, not just in spirit as I know the Minister does, but with practical assistance, including money.

In addition to growing our own medics in west Cumbria for the benefit of the entire Cumbrian health economy, we are providing the basis for policy solutions by becoming a rural health policy laboratory. The campus can and should become a crucible of innovation, providing solutions to the problems facing rural areas through the provision of high-quality, accessible, universal health services. The Minister has expressed support for that in the past, but the Government should now support it financially and in terms of policy. Will he request that Health Education England works with the University of Central Lancashire and the North Cumbria University Hospitals NHS Trust as a matter of urgency so that innovative models of healthcare training, such as earn-while-you-learn models, can be rolled out, not only in Cumbria but in other challenged health economies?

I hope that the Government will look again at nursing bursaries. The Chancellor’s decision to scrap those will only make it harder for us to train and recruit the medical staff that we need. The market will not deliver the workforce that the national health service requires; it will deliver only inefficiency and inequality. We need proper workforce planning right across the national health service.

On the subject of the local health workforce, will the Minister commit to looking into the morale issues affecting health professionals in the area covered by the success regime and undertake action to improve this?

In December, I told the Minister that sooner or later our luck would run out and that patients would pay the price. Tragically, as documented in the News and Star and The Cumberland News recently, the signs are that that is already happening. It was reported yesterday that in March a patient was transferred from the West Cumberland Hospital in Whitehaven to the Cumberland Infirmary in Carlisle, but died—according to the medics who have come forward—because specialist staff were not alerted to the patient’s arrival in Carlisle. The patient subsequently had a cardiac arrest and died. If that is true, it is not only a direct result and a damning indictment of policy, but the inevitable consequence of an overburdened, underfunded and understaffed system. I cannot imagine the despair that the family of the deceased must feel, and I cannot describe how angry I am that, in all likelihood, a constituent of mine has died as a result of being transferred from the West Cumberland Hospital to the Cumberland Infirmary.

The community has repeatedly warned of such an event. It has not been listened to and so I ask the Minister to commit as a matter of urgency to making a statement in the House about this and other so-called never events that occur across the North Cumbria University Hospitals NHS Trust. We need to solve these problems, and we need to determine accountability for them, too. I know that the medics and the new chief executive, Stephen Eames, are determined to get this right.

At the beginning of 2015, I wrote to the NHS chief executive, Simon Stevens, and asked him to visit Cumbria to see for himself the geographical challenges; to speak to patients and staff; and to work with me to develop a comprehensive recovery plan for the Cumbrian health economy. Nowhere in the country is quite like Cumbria. The health inequalities, the demographic differences, the challenging geography and the contrast between the affluent and those who are less well-off all present unique challenges with regard to providing services—right across the board, not just in the health service.

The national health service should ensure equality of standards and accessibility of services, but how that is delivered must be flexible enough to accommodate unique local circumstances such as those in Cumbria. The success regime is the response to my request for a comprehensive recovery plan. That new regime was intended to develop a locally tailored solution to the problems that we face. I was a shadow Health Minister at the time I made the request. Sadly, it is unusual for an Opposition spokesperson to ask Ministers in the Department that they cover to work together on an issue of joint concern for the greater good.

In December, I expressed my concerns about the then management team at the hospitals trust. I pointed out how it had attempted to defy the NHS chief executive and sabotage the work of the success regime. The appointment of Stephen Eames and his team has changed all that to date, but the public are still understandably worried about the prospect of key services being removed from the West Cumberland Hospital.

I was present at a meeting with Simon Stevens and the success regime when the trust management was told categorically that the continued “asset-stripping”—that was the precise phrase—of services from the West Cumberland Hospital should not continue. It was an uncomfortable meeting, but a welcome one in which the primacy of the success regime in determining what services would be provided where was asserted.

In December, I told the Minister that unless the previous trust management committed fully to the success regime process, it should have no part to play in the future of healthcare service design in west, north and east Cumbria. Information now coming from many people from within the success regime process is that the process is not working and that the reason for that is Government intransigence, a refusal to listen to the experts on the ground and a refusal to grant the additional resources that the process requires to succeed.

In the rest of the country, the Government and the NHS would be hard pushed to find more committed, willing, well-informed and passionate communities when it comes to health services than the communities of west, north and east Cumbria. We want the success regime to work and the people within the success regime want it to work, but right now the Government are stopping it working. I am told, from within the process, that the success regime and the people in it know what they need to do to put the health economy right, but that, as soon as ideas are put forward, they are knocked down.

I have been asked to ask the Minister whether the Government recognise that a premium is required to continue to enable the people of west Cumbria to access certain acute services at the West Cumberland Hospital. Do the Government recognise that centralising services in Carlisle is about service cost, not service quality, and that this will lead to worse outcomes for patients? Again, I am told from within the success regime that the exercise is now becoming one that is not as has been advertised. Rather than a process of investigation and improvement, it has become a cost-management tool and the people within the process do not want it to be that way, yet the Government insist that cuts, not quality, are king. I have been asked, again from within the success regime, what happened to the Prime Minister’s promise of a bare-knuckle fight for district general hospitals and maternity services, because it either has not materialised or was a knowing deception.

There are more questions, all of which I will forward to the Secretary of State, but the most incredible intervention in the work of the success regime was recently made by the Cumbria Partnership NHS Foundation Trust. In an open letter to the success regime, governors of the trust have given notice of their intention not to approve the work of the success regime, accusing its emerging options proposals of lacking logic, transparency, financial evidence and meaningful detail. The letter states:

“Our problem is that on every significant issue, the Success Regime appears to us to be shrouded in impenetrable fog.”

The letter adds that the success regime’s vision is

“woefully lacking in sensitivity to the health-related implications of geography and demography in Cumbria.”

Nowhere can this be seen more than in the unjustifiable proposals to remove beds from community hospitals. They deserve better in Millom, Keswick, Maryport, Workington, Brampton and Alston. This demonstrates precisely what we risk destroying here: a process that the people, public and medical professionals of Cumbria supported with optimism at the outset, but that now risks collapse and failure because the Government have changed the remit of the success regime as its work has progressed.

The point underpinning all of this is relatively simple: access to a full and comprehensive range of acute hospital services for the people of west Cumbria is non-negotiable, and the success regime requires freedom from Government interference to complete its work. The work requires additional funding. If the success regime is to succeed, it has to be funded to succeed. Let us not pretend that that is not the case.

The recent flooding in the county has shown that if services were transferred from the West Cumberland Hospital, in times of emergency patients simply would not be able to access them as they would not be able to get to the Cumberland Infirmary. Again, that is not acceptable. In times of emergency, the people of west Cumbria need to be able to access their services, and that can be assured only by retaining the services in their local hospital—the West Cumberland Hospital—a fantastic new facility that the Minister knows I have campaigned for for more than 10 years, and which should now become a model for how we provide care in non-metropolitan communities in the 21st century.

I have a specific request for the Minister. Will he move to unblock the funding for phase 2 of the West Cumberland Hospital new build programme? I have been told that the money has been allocated but is not accessible. I ask that this is done as soon as possible so as to provide confidence and help build trust. Will the Minister tell my constituents that this will be done soon as a central part of the success regime process, and will he confirm that this project is not included among those deferred capital spending programmes identified in the Health Service Journal this week? There can be no agreement of any kind without this money being unlocked.

West Cumbria is home to one of the most nationally and strategically important sites in the shape of Sellafield. Over the coming years, with new nuclear reactors at Moorside, thousands of jobs will be created, and my constituency will become one of the fastest growing regional economies in the country. This is due to the plan I developed in 2005: the plan that my community has worked towards ever since. As a result, the local population will grow significantly and quickly.

The people who live in west Cumbria now need better access to the health services they rely on, but it is simply mind-boggling that when a local population is growing, anyone should believe it is sensible to move services 40 miles along a road in need of serious upgrading and subject to frequent closure.

The local NHS must take into account strategic infrastructure and the local population of host communities when planning services. The Minister has been unequivocal about this in the past, and I thank him again for that. Will he ensure that the local population growth and the national obligation owed to my community as a result of its strategic importance is addressed prominently and clearly as part of the work of the success regime?

The fundamental principles in this debate are straightforward. Moving services 40 miles away from the West Cumberland Hospital is the antithesis of the principles that underpin a truly national health service. I said in December that unless the patients and taxpayers of my community can access the same level of healthcare routinely provided by the NHS in other communities, the NHS exists in name only. Forty miles is not a reasonable distance to ask people in need of medical care to travel, particularly when that 40 miles is served by such inadequate infrastructure. Mothers giving birth do not want to sit in an ambulance on the A595 hoping that they do not get stuck behind a tractor or encounter a road traffic accident.

A fully operational A&E department, supported by associated departments, consultant-led maternity services and paediatric services, must remain at West Cumberland hospital. If we need to adopt a flexible approach to achieve that, that is what we must do. Fully functioning community hospitals with the beds that they have provide an invaluable service in the communities of west, north and east Cumbria. Those services should be built upon, expanded and improved in the face of growing demand, not cut. The Government must allow the success regime the freedom and finances to make that happen.

The Government and local authority partners in Cumbria recently attempted to reach an agreement on a devolution deal. The deal was appalling, but local partners tried hard, on a cross-party basis, to make it work. Negotiations continued right up until the eve of the Budget, so keen was the Chancellor to include the deal in his Budget statement, but they collapsed because the Government refused to accommodate the wishes of local partners with regard to the NHS in Cumbria. Will the Minister tell me whether the Department was consulted, or whether the deal was driven purely by the Treasury?

I have today written to the Secretary of State to invite him to my constituency to listen to local people, hear their concerns and answer their questions. He will be accountable for this process, come hell or high water. To summarise, will the Minister commit to giving the success regime the freedom it needs, and the west, east and north Cumbrian health economy the additional resources it requires? Will he commit to making a statement to the House on the recent never events in the local hospitals trust, how they happened and who is responsible? Will he commit to retaining existing acute services at the West Cumberland hospital? Will he commit to supporting the west Cumbria medical campus with both funding and assistance from Health Education England? Will he commit to releasing the funds for phase 2 of the West Cumberland hospital new build?

I want the success regime process to work and the Minister wants it to work, but it will do so only if the Government work with my community, not against it. There is no doubt in my mind that we can solve the problems, but the Government have to want to solve them and they have to let the process work. The choice is clear: together, we can produce something truly special, groundbreaking and innovative, or we can watch a hollowed-out, under-funded, fraudulent process break the notion of a truly national health service. The NHS is our country’s religion; what happens next in Cumbria will demonstrate whether the Government believe in it.

11:05

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

It is very kind of you to oversee this debate, Mr Nuttall. I thank the hon. Member for Copeland (Mr Reed) for his kind words and I of course accept the fact that he speaks on behalf of all his constituents—he has a fine track record of doing so. It is good to see the hon. Member for Workington (Sue Hayman) by his side, and to see here present my hon. Friend the Member for Carlisle (John Stevenson), who has also taken a profound interest in this intractable and difficult matter. I do not have much time, so I will address the points that the hon. Member for Copeland raised in turn.

The hon. Gentleman said that the NHS is our national religion. One of his great forebears, the creator of the NHS, Nye Bevan, said that socialism is the religion of priorities. I know that the hon. Gentleman understands the nonconformist antecedents of the British Labour party, perhaps better than some of the party’s current leadership. He will also know that we need to get priorities right in Cumbria. That is something that neither we nor our predecessors in Government have achieved for many years.

I hope that the hon. Gentleman does not mind if I start by refuting his central contention that the success regime has been perverted in its course. That is absolutely not the case. The success regime has had no further instruction from its co-sponsors, NHS England and NHS Improvement, since its foundation. I have certainly made no intervention, other than to listen carefully to Sir Neil McKay when he came to see me a few weeks ago so that I could understand the challenges that he has in bringing the success regime to a conclusion.

I am as frustrated as the hon. Gentleman is about the time the success regime is taking to formulate a plan, and I expressed that frustration to Sir Neil. He is going through the proper consultation process, which in Cumbria above all places needs to be done properly, given the failure of previous consultations either to be done properly or to result in a conclusion. That is why I understand why he feels he needs to go through the process as rigorously as possible, but I do want to see a conclusion. We need to see a proper clinical resolution to the problems. It is not for me to say what that clinical resolution will be, so I cannot comment on the hon. Gentleman’s specific questions about service delivery at West Cumberland hospital and its relationship with Carlisle, or, for that matter—he did not mention this—with other partners in the north, be they the Northumbria NHS Foundation Trust or other possible partners for the trusts in Cumbria.

We will give Cumbria all the means to be able to achieve what it needs to achieve, whether they be financial or representative. I hope the hon. Gentleman will understand that the 3% funding increase for the clinical commissioning group in Cumbria this year alone shows our commitment to ensuring that Cumbria has the funds it requires to achieve the changes it needs to make. Nevertheless, those changes will not come just from more money; there will need to be reform, which is why I urge him to look at the success regime’s emerging thoughts on integrated care communities. Those thoughts have been brought together not by me, NHS England or NHS Improvement bureaucrats—I count myself as a bureaucrat in that sense—but by local clinicians who understand the problems on the ground.

I cannot comment on the devolution deal, which is a matter for the Treasury, but I can assure the hon. Gentleman that I will ensure that he has an answer from the correct person on the recent never events, of which I was informed. He should know that the Secretary of State keeps in his office a board of never events throughout the NHS. He takes a keen interest in them and in their reduction. I hope that I can ensure that the hon. Gentleman gets a proper answer to those questions.

I have previously endorsed the moves by the University of Central Lancashire that the hon. Gentleman mentioned, and I will of course ask Health Education England to engage with that process as fully as possible. I disagree with him about the impact of nurse bursaries. It is exactly by reforming health education funding that we can release 10,000 additional places in nurse training school. Those places will mean that we can staff areas of the country that have been difficult to staff in the past. We cannot provide such massive expansion by the traditional means, and nor could the Labour party have promised to do so, because the costs involved are so considerable. It is by that reform that we will achieve the ends he wants to see. I want to be outlining more items of medical education reform in the next few months, and I hope that they will be to the advantage of places such as the University of Central Lancashire. In the meantime, I shall ensure that Health Education England takes a keen interest in that work—I know that it already is.

On the second phase of funding for the West Cumberland hospital A&E department, it is incumbent on me to say that £90 million has already been spent. That shows our commitment to ensuring that services in West Cumberland are of a consistent and proper level. Nevertheless, I will find out what the blockage is. I know there is a problem with increased costs and the fact that, as anticipated, the budget has been broken. We cannot have a situation anywhere in the NHS where, just because a budget is broken, we pay for capital increases, but I shall ensure that that particular matter is addressed as quickly as possible and that that is not part of the success regime reasoning, as it is part of a phased deal for that hospital.

Finally, the hon. Gentleman raised the issue of GPs. I know that he will have noted NHS England’s announcement last week about the improved deal for GPs: there will be in excess of £2 billion over the Parliament to increase support for GPs. A lot of that will be going into under-doctor areas and those areas into which it is hard to recruit. Those are subtly different things, but both apply to Cumbria. I hope that, over the next few years, he will see the impact as the 5,000 additional GPs that the Government have committed to providing feed through to improved services on the ground.

West Cumbria and Cumbria as a whole are indeed a mark of whether we get the NHS to be a national service. Bevan coined the term “universalise the best”, but that also means universalising the best that we learn from elsewhere in the world. We must learn from elsewhere in the world about how to deal with scarcely populated areas and make sure that we have specific solutions for places such as Cumbria. We have not yet done that successfully, which is why I want the success regime to be concluded as quickly as possible, and with community buy-in, so that we can have the results that Members present want to see.

Motion lapsed (Standing Order No. 10(6)).

11:05

Sitting suspended.