North Middlesex University Hospital NHS Trust
(7 years, 10 months ago)
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Joan Ryan (Enfield North) (Lab)
I beg to move,
That this House has considered the performance of North Middlesex University Hospital NHS Trust.
It is a pleasure to serve under your chairmanship, Ms Vaz. North Middlesex University Hospital NHS Trust serves two thirds of my constituency and more than 350,000 people living in Enfield, Haringey and the surrounding areas. I am grateful for the opportunity to bring this important matter before the House.
The situation at the hospital is, frankly, a scandal. It operates the busiest emergency department in London, which is attended by more than 500 people a day, yet the Care Quality Commission has rated safety at the emergency department as inadequate. Medical care, including older people’s care, at the hospital also requires extensive and immediate improvement. The senior leadership team at the trust and the Government have serious questions to answer about how patient safety at North Mid has been allowed to have been put at grave risk.
What has been happening at the hospital has major implications for my constituents, for residents in north London and for health services across the capital and beyond. My speech will consider all those issues and the steps that need to be taken to ensure the safety of patients and the quality of care. I will call on the Government to give assurances that services at the hospital, including those provided by the accident and emergency department, will be protected and improved in the short and long term.
Before I get to the heart of the matter, I should make two important points. First, the many concerns and criticisms that I will raise about what has happened at the hospital are not directed at the front-line staff—the doctors, nurses and trainees who work there. They are overworked and under-resourced, and have been doing a challenging job in incredibly difficult circumstances. The CQC has made it clear that:
“Most staff were competent and endeavoured to provide good care and outcomes for patients.”
However, just like the patients, the front-line staff have been badly let down by poor management and a lack of leadership at the hospital, and by the Government’s health policies over the past six years, which have left the national health service on its knees.
My second point is one that I believe is shared by all London MPs whose constituents have been affected by the performance of the hospital. Although all of us have raised concerns about how North Mid has been operating, we were not made aware of the true extent of the crisis at the hospital until the CQC issued a warning notice at the beginning of June, requiring the trust significantly to improve the treatment of patients attending the A&E. That was almost two full months after its unannounced inspection of the hospital in April.
Many recent revelations about the chaos at North Mid have been exposed only because of the press via leaked documents, yet it appears that the terrible situation has been an open secret in health circles for a significant period of time.
Mr David Lammy (Tottenham) (Lab)
I hesitate to interrupt my right hon. Friend, who is laying out the story so comprehensively. Is she as concerned as I am that many health professionals knew what was going on, but that MPs in the three boroughs covered by the trust were kept in the dark?
Joan Ryan
That was exactly the case and I am very concerned. It is not an exaggeration to say we were kept in the dark. All of us across Enfield and Haringey have, over the past year, raised the issue of North Mid in the Chamber at a local level and with Ministers at various times. We received no information until a recent meeting with the Minister, who, I am pleased to say, is here today. Prior to that, there was almost no answer to the points that we raised, other than to brush them aside with answers such as how much better the NHS is doing now than ever before. The phrase “kept in the dark” absolutely covers the situation, with those in the know including the likes of NHS Improvement, NHS England, the General Medical Council, Health Education England and, no doubt, the Department of Health. However, but for the actions of the General Medical Council and Health Education England, the situation for patient safety could be even worse.
I have had a number of meetings with the senior leadership teams at North Mid and at the Enfield clinical commissioning group, and many of the problems I will discuss today were not thought noteworthy enough to bring to my attention. If they were brought to my attention, the exposure of those problems was minimal, such that they did not raise the alarm bells that they should have.
In May, the severity of the situation at the hospital was discussed at a high-risk summit, involving several north London hospital trusts, clinicians and other stakeholders. MPs were not even informed that the summit was happening, never mind informed of the outcomes. I would be interested to know whether the Minister thinks that that state of affairs is acceptable given that our constituents have to suffer the consequences of the failures at the hospital. Even as of today, despite numerous requests, we have received no minutes of the high-risk summit and no account of what was discussed in any detail whatever.
Would the Government be willing to bring in early warning measures to ensure that MPs and constituents are kept properly informed about impending healthcare crises in their communities, rather than being notified after the crisis has hit? To do our job on behalf of our constituents—to safeguard their safety and interests in the use of and access to one of the most important public services any of us can imagine—we need some kind of early warning system. It is clear that very many people knew about the situation, but nobody who is accountable to the public at a local level was properly informed. I look forward to the Minister’s response to that point.
I am pleased to see my hon. Friend the Member for Edmonton (Kate Osamor) in her place, as the hospital is just inside her constituency, although it serves a large number of my constituents and constituents from Hornsey and Wood Green. I think it also serves practically the whole of Tottenham—my right hon. Friend the Member for Tottenham (Mr Lammy) is in his place, as is the hon. Member for Enfield, Southgate (Mr Burrowes). I am pleased to say that we have been working cross-party on the issue. Frankly, I will work with anyone—other hon. Members involved would do the same—who is willing to put the hospital first.
The CQC’s damning report into North Mid was published on Wednesday 6 July, and its inspection of the emergency department and two medical wards at the hospital was in response to a
“number of serious incidents…which had raised concerns about the standards of care”.
Between March 2015 and March 2016, there were 22 cases at North Mid’s A&E department where patients experienced serious or permanent harm or alleged abuse, or where a service provision was threatened. The CQC found that people were waiting far too long to be assessed on first arriving at the hospital, to see a doctor and to be moved to specialist wards in the hospital. The main experience of anybody turning up at the hospital’s emergency department was to wait, wait and then wait again.
The report tells of a lack of respect and dignity in how patients were treated, including a time when there was only
“one commode available in the whole of the ED”—
emergency department—
“to serve over 100 patients.”
Most people reading this will find that shocking.
Resources had been so stretched that, by the time the CQC issued its warning notice to the hospital in June, only seven of 15 emergency department consultants were in post, and seven of 13 middle-grade emergency doctors. As a consequence, junior doctors and medical trainees have been left unsupported by senior staff in A&E at night, including in emergency paediatric care. Junior doctors have been asked to perform tasks for which they are not yet qualified, and there have even been reports of receptionists with no medical training being used to triage patients, at least to the extent of deciding whether they should go to urgent care or the emergency department.
In February, A&E staff were so overwhelmed that patients, many of whom had already been waiting for hours, were told that they should go home unless they thought their illness was life-threatening. How can anyone be expected to know how ill they are without seeing a doctor? We have self-service checkouts in our supermarkets, but self-service A&E? I think not.
Tulip Siddiq (Hampstead and Kilburn) (Lab)
I thank my right hon. Friend for securing the debate. Even though the hospital is not in my constituency, much of what she describes happens in hospitals in my constituency and just outside it. At Central Middlesex hospital, which is just outside my constituency but serves many of my constituents, healthcare provision has also been affected by cuts. A recent inspection by the CQC similar to the one that she is describing highlighted a lack of experienced medics for seriously ill patients. Does she agree that such staff shortages threaten patient safety?
Joan Ryan
I do indeed, and I am grateful to my hon. Friend for that intervention. One point that I argue most strongly is that, although the MPs concerned are banding together to defend our hospital and fight for adequate and safe service, it is obvious that this is not just about North Mid—North Mid is just the first point where the crisis has hit. This is an issue around outer London, across London and probably nationally, particularly for district general hospitals.
Andy Slaughter (Hammersmith) (Lab)
I am delighted that my right hon. Friend has secured this debate, which resonates across London and probably outside it. We recognise the point about waiting, especially in ambulances outside hospitals. People are waiting for up to four hours and then being admitted just before the four-hour mark, so that it is not registered against the time limit, and then waiting again. That is happening even before the planned closures of accident and emergency departments. As one clinician said to me just today, there is no credible clinical evidence that out-of-hospital services can deliver on the scale necessary, but that is all we are being offered as an alternative.
Joan Ryan
I agree with my hon. Friend. Again, that demonstrates that this is not just about North Mid; it is just that North Mid has reached the crisis point before anywhere else.
The CQC has also raised concerns about the lack of equipment within the department, from missing monitors and missing leads for cardiac machines to trolleys in resuscitation rooms that are not fully equipped. I cannot imagine the distress of a patient with chest pains who is connected to a cardiac machine to monitor their progress, only to find that the staff member cannot connect it up to get an instant read-out because the leads are not there. Even a chute meant to carry specimens from the emergency department to the pathology unit was out of operation for six whole weeks. According to the CQC,
“this caused major delays to the speed in which results were returned to the department, thus slowing down the time in which some patients could be treated.”
That is unacceptable.
All those problems have been exacerbated by a lack of effective clinical leadership and a culture of bullying at the hospital, meaning that staff do not feel confident in raising concerns and have even
“stopped reporting incidents of staff shortage as management had not responded to them in the past”.
A quality visit report by Health Education England from March 2016 found that none of the medical trainees interviewed would recommend the emergency department to their family and friends for treatment, principally because they felt that the department was unsafe. The postgraduate trainee junior doctors at the hospital would not themselves recommend the hospital or the emergency department to their family and friends—what an indictment.
The General Medical Council, which oversees the standard of training for doctors, has threatened to ban North Mid from providing postgraduate training because standards have been so poor. The loss of junior doctors would leave the A&E so badly understaffed that it would effectively close. The future of North Mid’s emergency department is at risk.
I note that the chief inspector of hospitals—Professor Sir Mike Richards, whom a number of us are due to meet tomorrow—has said that since the CQC’s inspection in April, “some progress” has been made to improve the situation, although there is
“still much more that needs to be done.”
A new clinical leadership team has been put in place, and there have been moves to appoint more senior doctors. However, in almost every instance, the new appointments are short-term, with the doctors taken on loan from other hard-pressed local hospitals for up to six months. The situation is safe at the moment, given the number of doctors in the A&E, but the measures are only a sticking plaster, as many of the doctors are on a three to six-month loan. What measures are the Government willing to put in place to support North Mid and ensure that it has the consultants and doctors it requires on a permanent, long-term basis?
The CQC also states that North Middlesex University Hospital NHS Trust
“has supplied an action plan setting out the steps it will take to address the concerns identified in the Warning Notice and report.”
Does the Minister agree that the action plan should be published in full and updated regularly with the measures taken to improve patient safety at the hospital?
Tellingly, the CQC says that previous serious incident investigations and subsequent action plans at the hospital have not always been shared with staff in a timely manner, which has
“meant that in certain circumstances, reports were received when actions should already have been taken in order to mitigate against a future occurrence.”
Given the analysis of how things have been kept in the dark, which we have explored, and that statement from the CQC, the Minister will understand why I ask for a fully published action plan and regular reports on progress. This is about implementation and outcomes.
Surely the Minister will understand that without full transparency, many of my constituents and those of my colleagues who are here today will have little confidence that the required improvements have been made and are being sustained. As I said earlier, the trust’s shocking mismanagement and poor leadership have played a big part in creating the mess at North Mid, but the chief executive, who I understand is stepping down, is not solely responsible for what has happened. The Government cannot be let off the hook when they have done so much to undermine healthcare provision in Enfield.
The tipping point for the crisis at North Mid was the closure of the A& E department at Chase Farm hospital in my constituency. In 2007, the then Leader of the Opposition—the current Prime Minister, for now—posed outside Chase Farm hospital and promised to protect the emergency department on site. By 2013, his Conservative-led Government had ripped the heart out of the hospital, closing both the A&E unit and the maternity services. It went from a 480-bed hospital to one with 48 surgical beds. Those of us who campaigned against the closure at the time said that the decision would put huge pressure on North Middlesex hospital, Barnet hospital, our ambulance services and GP surgeries right across Enfield. We were right.
Andy Slaughter
My right hon. Friend describes exactly our experience in west London, where two A&E departments have closed and two more are intended to close, despite assurances having been given that they would not. We have heard nothing at all since February 2013 about what those plans will be. I was told just this week that the next report is not going to be in September, so until another report is done we will not know exactly what services there will be. People are waiting in limbo for years, and meanwhile there is a drain of staff and expertise from hospitals, so their closure becomes a self-fulfilling prophecy.
Joan Ryan
And that is exactly what happened at Chase Farm hospital. It was under threat for so long that it had no stability and it was no longer an attractive place for staff because they had no security. I hope I am wrong, but my fear is that in cases such as my hon. Friend outlines, no news is definitely not good news.
One year after the closure of Chase Farm’s A&E department, the CQC reported that services at North Mid were struggling with the additional workload. We know now that the hospital has had to manage an increase in A&E patients of between 20% and 25% as a result. That is unmanageable and unsustainable for an A&E department; many would bend, if not break, if put under such strain. The situation was so bad that by February 2016 only 67% of patients were seen and treated within the national four-hour target at North Mid, compared with an average of 88% across England.
Our local health services and the emergency department at North Mid would have been better placed to cope with the closure of Chase Farm’s A&E department if other promises to improve primary care had been fulfilled. In November 2013, the Prime Minister stood at the Dispatch Box and said:
“Enfield is…getting an increase in primary care funding. That is part of our plan of not cutting but expanding our NHS.”—[Official Report, 20 November 2013; Vol. 570, c. 1226.]
But many people in Enfield find it really hard to get a doctor’s appointment when they need one. Over the last six years, 12 doctors’ surgeries in Enfield have closed and only one new practice has opened. That is why, even though Enfield is now the fourth-biggest borough in London, we have fewer GPs per head than almost anywhere in the capital. That situation is not sustainable.
Will the Minister join me in calling for a proper plan for at least 84 more GPs in Enfield over the next four years, as recommended by the Royal College of General Practitioners? Will he support my calls to improve health funding across the board in Enfield? As he will know, Barnet, Enfield and Haringey Mental Health Trust anticipates a £13 million deficit by 2016-17; Enfield Council needs to deliver a saving of £24 million in adult social care by 2020 because of reductions in funding from central Government; and per capita spending on public health in Enfield is only £43 this year, far lower than the average across London and in England. Given that cutting preventive services piles pressure on hospitals, does he seriously believe that allowing the current situation to continue will take the strain off North Mid—or will it in fact do the exact opposite?
It should come as no surprise that I and many of my constituents have very little faith that the NHS is safe in the Government’s hands. The financial crisis in the NHS is a major reason why North Mid did not have enough equipment, consultants, doctors and nurses to cope with demand. The inability to recruit permanent staff has meant that many hospitals, including North Mid, have been forced to drain their resources on expensive agency workers and locums. One might have thought that, in the light of such circumstances, the Government would be bending over backwards to encourage people to join the medical profession—but no. Instead we are witnessing the sorry situation of a Government fighting with junior doctors over contracts and removing bursaries for nurses. What a slap in the face for the future front-line staff we so desperately need.
The Government also plan to make £22 billion of efficiency savings by 2020. I know that savings must be found, particularly in back-office services, but efficiencies on such a scale simply cannot be achieved without putting patient care at risk. I am also concerned that the Government’s methods to implement those cuts—described using woolly phrases like “the rationalisation of clinical facilities”, “the consolidation of trusts” or “the introduction of transformation and sustainability plans”—will result in takeovers, mergers and the downgrading of services. Even before the crisis at North Mid was revealed, plans were already afoot to launch an NHS pilot programme, involving the Royal Free London NHS Trust, to look at options to link hospitals including North Mid together and to merge clinical and support services. At the same time that it was announced that the chief executive of North Mid was going on leave, we learned that an acting chief executive was being appointed from the trust and that David Sloman, the trust’s chief executive—a very good chief executive, I might add—would be taking on the role of accountable officer on an interim basis. I fear for the future of service provision at North Mid as a consequence.
Local residents remember to their cost that the A&E and maternity units at Chase Farm were shut only a few months before the Royal Free London NHS Trust took over Barnet and Chase Farm hospitals in 2014. Chase Farm has been left as little more than a cottage hospital. North Mid cannot suffer the same fate; that would have terrible consequences for health services across North London. Think how much further people in Enfield would have to travel to get emergency hospital treatment, and how much pressure it would put on A&E departments at hospitals such as University College hospital in Euston, Barnet hospital and the Royal Free hospital in Hampstead.
What assurances will the Minister give my constituents, first that North Middlesex hospital will not be taken over by the Royal Free London NHS Trust by stealth, using this crisis as the back door to a merger; secondly, that constituents will be consulted fully on all future proposals for North Mid; and thirdly and most importantly, that its key services will be protected and improved in the short and long term? The performance of North Middlesex University Hospital NHS Trust must be a wake-up call for the Government. I urge the Minister to use every tool at his disposal to help North Mid make the immediate improvements required in the quality of care provided to patients. The Government must ensure that the hospital and our health services have the funding and support they need so that this situation never happens again. I look forward to the Minister’s response.
Mr David Burrowes (Enfield, Southgate) (Con)
It is a pleasure to take part in this debate, which is vital for my constituents and for all those around Enfield and Haringey. I pay tribute to the right hon. Member for Enfield North (Joan Ryan) for securing it and for presenting a comprehensive case for the need for urgent action and reassurance for our constituents about the sustainable future of North Middlesex hospital. She has tempted me on to a political path: plainly this is a cross-party concern and call for action, but mention was made of the outgoing Prime Minister. I remember reminding a previous outgoing Prime Minister, Mr Blair, at his last Prime Minister’s questions—those are now coming up for the current Prime Minister—that he had said that there were
“24 hours to save the NHS”,
but that his Government had decided to downgrade Chase Farm hospital. There is a lot of history to this, but I will avoid, if I can, being tempted down that route.
I believe that, because of the Government’s investment, Chase Farm and the Royal Free hospitals have a secure future that is not shackled by the private finance initiative deals that have severely affected Barnet and North Middlesex hospitals. In terms of resources, they are paying a big mortgage, and in relation to finances they have been chasing their tail. Sadly, A&E has been part of that tail. In April, the hospital was whacked with a £320,000 financial penalty, which made a significant dent in its finances and contributed significantly to the £8.3 million deficit with which it is struggling to deal.
The issue is with the A&E. I want reassurances from the Government that someone will take responsibility and action will be taken. Many of us have been expressing concern about local A&E provision for far too long. The concern is that responsibility has not been taken and there has been no proper action. In short, how bad does it have to get before someone takes responsibility and action is taken?
Like the right hon. Member for Enfield North, I pay tribute to staff. We all do. There are obviously great, dedicated staff. Many of us will know them—they are friends and people we know locally. They are as concerned about what is happening as anyone else. Later in my speech, I will say a little more about my experience as a patient in the A&E department two years ago. I saw things for myself, and there are regular reports. The Care Quality Commission made particular reference to the “caring and compassionate” work and service of staff. The current situation is letting them down.
Health Education England and the General Medical Council said that, as much as there was a duty of care to patients, there was a duty of care to doctors training at the hospital, which was why there was such profound, extraordinary, exceptional concern that they reached the point of threatening to pull doctors out. We know that that threat will not be realised, that a corner has been turned and action taken, but why did it take this long for such urgent, expensive crisis management to take place? There were earlier warning signals, so why was there no proper plan?
It is all very well having a new programme calling for “safer, faster, better” services, but for goodness’ sake our constituents expect a safer, faster, better service without a new programme having to be put together, no doubt in glossy print and at considerable expense. They expect a basic service, not a new programme. They have been expecting that for far too long and have been let down.
The 10-year context is important. Despite some interruptions, we can all testify to that 10-year journey. It is so very frustrating because the context is positive: the journey of the Barnet, Enfield and Haringey clinical strategy since 2005-06. We can have our criticisms and our campaigns, but the context is London’s biggest reorganisation of acute services in more than a decade, which was inevitably going to be a challenge. It inevitably needed a careful plan and serious clinical leadership—not just proper clinical leadership in secondary care and the appropriate number of consultants and middle-grade doctors, but the appropriate primary care. Those of us who were involved in the discussions heard the promises from Sir George Alberti, and the talk about bridging loans and the pump priming of primary care, which was also necessary. Sadly, we are seeing the lack of all those things at the same time.
Nevertheless, North Middlesex hospital has been physically transformed since 2009, when it was mostly old Victorian buildings that were not fit for purpose. Those buildings were demolished and a new £123 million modern hospital took shape. That was incredibly welcome, as was the added investment. Some £80 million of public funds was invested to provide the new facilities in line with the reorganisation in the BEH strategy. The plan was, quite properly, to modernise the older facilities, and the hospital has been visibly transformed. Sadly, though, the service that has been provided to constituents has not matched the modern facilities from which they are now able to benefit.
North Middlesex has become one of the busiest A&E departments in the capital, so it is plain that no one can afford it to close. I know the Minister can counter the suggestion that there is any risk of closure, and I am sure he will reassure us that it will not close in any way, that there will be no partial closure and that it will continue, with a long-term, sustainable future. Nevertheless, the concern is why, with all that investment having gone in—initially private finance initiative investment, then direct taxpayer-funded investment—it has taken until this point, so far down the line, for regulators to be able to tell everyone what we all knew far earlier.
I have read the trust’s minutes from 26 May, which state:
“Since the problems first surfaced last year, we have been open with our health partners about the challenges and have worked closely with them to tackle the many interlinked contributory factors, both internally and in the local health care system.”
Well, the problems did not first surface in 2015. I was a patient two years ago and saw for myself that there were problems when I was sitting on a trolley for 11 or 12 hours and was missed by very busy, overstretched staff who were dealing with so many patients. It was an ordinary summer’s day in June—not a winter’s day—and there were more than 400 patients. The staff were absolutely overstretched and missed my CT scan. Lo and behold, my appendix burst. It could have been fatal. That happened because no one was available to take any responsibility for what was happening.
There was real concern about the leadership of staff who were overstretched. I raised the alarm then, as did others. Indeed, the CQC happened to be inspecting the A&E on the very weekend I was sitting on that trolley and seeing for myself the huge challenges it faced. The CQC said that the A&E required improvements. Its report recognised that the hospital was fully embracing the reconfiguration of services, but also said:
“While the hospital had achieved much in absorbing increased numbers of patients, its infrastructure of staffing levels, training provision, complaints handling and governance had been stretched, and there had been an underestimate of the resources needed to maintain services at the current level.”
The warning signals had gone out. Why was prompt action not taken to provide sufficient numbers of consultants and middle-grade doctors?
On Chase Farm hospital, one of the bottom lines for the reconfiguration was the fact that, true to the Prime Minister’s words, we had a moratorium and delayed the previous Government’s plans. All options were looked at, but it came back to the unanimous clinical advice from the local doctors and others, who said that it was in the best interest of the patients for the reconfiguration to take place. Why? They referred particularly to the lack of consultants and middle-grade doctors. That meant that Chase Farm had to be downgraded and A&E patients referred to Barnet and to North Middlesex.
How can it have come to pass that, three years later, we are still hearing the same excuse—that there are not enough consultants or middle-grade doctors? It is completely unacceptable. Why is the system not reacting quicker? Whoever the system is—whether it is the chief executives of the trust or the ever-changing roll-call of interim managers and directors of NHS Improvement, NHS London or NHS England, or, indeed, Ministers themselves—why has it taken so long, with the regulators threatening to pull out doctors, for everyone to pull out their fingers and turn the corner that has now been turned? It is not good enough.
Without my permission—there was a leak—the Daily Mail did a big splash on my experience, and there has been tension ever since about other very serious incidents, some of which have already been mentioned. There was the awful example of someone who had died being left unattended for four hours. There were other shocking and deplorable incidents. Staff themselves see it as something that shames them as well. Managers say to me, “Why hasn’t more action been taken?”
Until July 2015, the A&E department, which is in a very challenging London hospital, was performing relatively well against the standard of seeing and admitting or discharging 95% of patients within four hours. In the first four months of 2015-16, the hospital continued at 94% to 95%. We have to recognise that it has undergone extraordinary growth. Compared with 2013, before the BEH changes were implemented, the hospital now has 25% more staff, cares for 19% more A&E patients, admits 44% more patients, undertakes 44% more surgical operations and procedures, sees 27% more patients in outpatients, and delivers 37% more babies. Yes, all of that is happening.
Of course, performance dipped in other trusts in the country and the downturn continued in January 2016, but when it reached a low of 66%—yes, it recovered slightly to 70%—why were those signals not heeded? How could it get to that level and no urgent action is taken? It was mentioned by hon. Members and others at the time, so why was urgent action not taken? Why was somebody not ready to seize it and say, “We are not going to wait for these regulators, the CQC, to come and tell us down the line that it is inadequate, or for the HEE and GMC to say it is not even safe for doctors, let alone for patients?” Why did it take so long? How bad does it have to get? Why does our health service have to get to this stage for prompt action to be taken?
Many of us could have said that it was not just about secondary care, but about primary care as well. The right hon. Member for Enfield North has made that point already. I referred to the issue of a tale of two health cities within London. Compared with the Camdens and Islingtons of this world, we are very much the poor relations. We are 25% poor. We have had meetings with Ministers about mental health provision, and we have pressed the Minister about the need to ensure fair funding for London. We must get that. We have got this sustainability and transformation plan. It is another siren call. There will be other problems down the line on mental health and other issues affecting our constituents unless the Government and NHS England London ensure that we get fair funding.
The Government have put in a new fair funding formula, but it is taking far too long. We do not need to listen to the Public Accounts Committee to tell us it is taking too long—we can listen to patients, to this debate now and to the regulators. Although in the round our health economy is not all about resources, they have a big impact, particularly in primary care. Why does the health trust have to go through a financial penalty system? Another £130,000 was taken away in April, so more money is taken away from the system when there is a cry for help.
The chief executive, who has gone on leave or has left, made a plea for help over many years. We were all making a plea for help. Why has the NHS not done more about it? It is totally unacceptable for us to be in this position here with this debate. I know from our meetings that the Minister is holding the NHS to the fire now, but why were feet not held to the fire years ago to ensure that people took responsibility? Yes, they could have lost their jobs, but there could have been proper clinical leadership that did not let down our patients in Enfield.
I look forward to the Minister giving us every assurance that there is, as I believe there is, a long-term sustainable future for the A&E at North Middlesex. We cannot afford to lose it and I am sure we will not. The CQC tells us that a corner has been turned, but it was far too long in coming. I want the Minister’s assurance on consultants, although I understand there is a national crisis in getting consultants on the ground, particularly in emergency departments. I want to ensure that the Government will fix it to ensure there is every financial incentive for the right number of consultants and middle-grade doctors to come to Enfield to ensure we have the A&E service that our constituents need and deserve.
Mr David Lammy (Tottenham) (Lab)
I am grateful to have the opportunity to speak in this debate. The hospital serves almost the entirety of the constituency of Tottenham and has done ever since the closure of the Prince of Wales hospital in my constituency in the 1980s. It is important to emphasise that North Middlesex hospital is located in a strategically essential area. It serves not only the boroughs of Enfield and Haringey, but some of Barnet and Waltham Forest. Many years ago, when I was a Minister for Health, a neighbouring hospital, Whipps Cross, was a general hospital that on occasion struggled considerably with its emergency department, so I cannot emphasise enough that it is critical for the broader health economy of north-east London that the North Middlesex survives, flourishes and does well.
The concern that has been raised in this Chamber is really about how the situation has got to this stage over such a length of time, with so many Members of Parliament ringing alarm bells in a context where all of us have privately said, “We must tread carefully. We don’t want to talk down the hospital.” We say, “The chief exec seems to be…” as we whisper among ourselves. We do not want to talk down the hospital, but it has now got to the point at which we have to be absolutely frank about what has been happening at that trust, as we have heard, and we must ask some very hard questions about what has been going on.
I hope that the Minister will assist me on this point. There have been successive risk summits, meetings have been held, and the chief exec has asked for support, but I am not clear why support was not provided. In the old days, Members of Parliament would have been able to contact the strategic health authority and there would have been a clear line of leadership. We literally had two bodies to deal with: the strategic health authority and the chief executive of the trust. Frankly, chief executives went if they were not up to the job, and emergency teams were brought in to run the hospital. I did that as a Minister responsible for emergency care. I saw it happen in a range of trusts across the country as, under the Tony Blair Government, we pushed for the first targets of four-hour waits. I am struggling to understand how things have got to this level.
Life expectancy in a constituency such as mine is among the lowest in the country: men reach 74, six years behind the average life expectancy. We have homelessness and we have had two riots in a generation. The issues are clear, but what is not clear is who was in strategic charge? Why were meetings held in successive years? What is the role of NHS Improvement? Is it ever the case that anyone there would contact a Member of Parliament to say what they are doing to improve a trust? What is the role of NHS England’s London office? The individuals there are paid a hell of a lot of money—hundreds of thousands of pounds. Have they got a responsibility to contact a Member of Parliament to ask for a meeting or a conference call to speak to us about what is happening in the trust?
What is the role of Health Education England, which has been concerned about training and qualifications? We know the role of the General Medical Council, but has it been nobbled not to withdraw doctors by NHS England or any other body? What we have are numerous quangos. I have not even mentioned the clinical commissioning group. We have CCGs, HEE, NHS Improvement, NHS England London and the chief executive. The Government came into office determined to reduce the number of bureaucrats, but—my God!—each of us has at least 10 or 12. Then there are all the staff that work under them. Meetings have been held, but what has been done?
I have done the Minister’s job, so I feel for him. When I did his job, we did a lot of the running of the NHS from Whitehall. The Minister’s party came in and I understand why they said they could not run it from Whitehall, but we now have all these bodies and I am not clear what they have done. As a former Minister, I want to hear more of what they have been up to. I hope that the Minister will answer the question asked by my right hon. Friend the Member for Enfield North (Joan Ryan). Given that there have been CQC reports—the one that we had on the 6th is not the first—and risk summits, what is the obligation to inform Members of Parliament and therefore our constituents? At what point does that kick in? Or is it expected that that should be done solely by the trust? If it is, that is problematic if it is a failing trust in which the chief executive has been put on emergency leave. I have the CQC report before me and it says that safety at the hospital is inadequate, and so is responsiveness. As to whether it is well led—leadership is also inadequate, which is presumably why the chief executive has been put on emergency leave. Overall the hospital is inadequate. Under the headings of caring and effectiveness, it requires improvement. That is pretty damning. It does not get much worse than that.
Many hon. Members are concerned—and my right hon. Friend the Member for Enfield North, the hon. Member for Enfield, Southgate (Mr Burrowes) and I certainly are, having been around for a few years. We campaigned to get the PFI that put millions—I think it was £150 million—into building a brand new hospital. It is therefore deeply frustrating that we now have such an uphill struggle. Chase Farm has been mentioned and I will not discuss it again, but the Minister will recognise that we all rang alarm bells about the implications of closing emergency there. Money was put into the trust; yet it has got to its present situation.
I heard yesterday about the case of Mrs Alice Morfett, a 92-year-old lady who still went shopping in Morrisons. She had a heart operation in Barts and she was recuperating on the T3 ward. In the morning she told her daughter about her concern about a male nurse’s behaviour; she could not understand why he kept wanting to touch her chest. Her daughter said she did not believe Mrs Morfett and thought the anaesthetic had not worn off, but her mother complained about the nurse rubbing against her chest. After that Mrs Morfett was scared to ask for help. No one was summoned to help her. The next day, after an hour of asking for someone to take her to the toilet, Mrs Morfett tried to get out of bed herself and she fell. She ended up with huge open wounds; my constituent sent me a photo of the terrible wounds her mother suffered. Mrs Morfett died a couple of weeks later, and her daughter believes that she died as a result of her injuries. Mrs Morfett said to her daughter, “Please don’t let them get away with it; they have to pay for what they’ve done to me.” I do not lightly raise constituency case work in this way. I have used this letter because it is the latest one I have in a stream of letters from constituents about what is happening in the trust.
Joan Ryan
Such incidents are what the CQC calls “never” events because they should never happen: a patient dies, and it is not necessarily from medical issues or natural causes. I am sure that my right hon. Friend knows that the CQC report notes that one patient lay dead in a cubicle for four and a half hours last December because there were not enough doctors even to do the hourly rounds. It does not get much worse than that.
Mr Lammy
No, it does not, and that cuts to the critical issue of safety at the hospital. In fact, the problems at the hospital have been going on for well over two years. What happened to the hon. Member for Enfield, Southgate, who lay in the hospital with a burst appendix and who frankly would not be here but for a stroke of luck, says it all. How have we got to the situation where the local Member of Parliament is about to die of a medical emergency after waiting without being seen for 11 hours? He has been friendly—[Interruption.] Well, that is what happens with a burst appendix. The hon. Gentleman is looking well, but he is not that young. People die of a burst appendix if they are not treated.
Mr Burrowes
Perhaps it is an issue of profile, but they did not know I was the Member of Parliament. I kept it quiet and was there as an ordinary patient—which is the point. It was only when they found out 11 hours on, following some communication that I was the Member of Parliament, that, lo and behold, the seniors all came down and had a look, and saw what was going on. It was actually my mother who was banging on the desk saying, “Why aren’t you getting a scan for my son?” That is what it takes—it is the ordinary experience of any patient, who, sadly, may not have their mother there to badger the staff for them. That is the patient safety concern.
Mr Lammy
The hon. Gentleman took the business of mystery shopping a little far, but his encounter was well reported locally, and at that time alarm bells were being rung. By my recollection it was a good couple of years ago.
The CQC report confirms what we all long feared—that the closure of the emergency department at Chase Farm hospital in December 2013 had a significant impact on demand at North Middlesex hospital. Concerns were also raised about doctors training in anaesthetics, and they were removed from training in the hospital in April 2015, and have never returned to it because the GMC was so concerned. I wrote to the Secretary of State for Health on 22 March—four months ago. I did not get a reply. I am grateful to have seen the Minister eventually, a couple of weeks ago; but he can see why I am concerned when, after failures of the kind we have heard about in the debate, the Secretary of State did not reply to me in March. I will gently say that a hospital where alarm bells are ringing about such issues would have commanded the attention of the Secretary of State in the past, under successive Governments. Certainly MPs and local authority leaders would have been called together and the issue would have been addressed. I raise the matter in the gentlest of ways, because I am concerned about it.
Many issues have been raised and other hon. Members want to contribute; and we want to hear from the shadow Minister, too. The bottom line is that we are very concerned that the hospital has reached the state it has, given the investment that has gone into it. Week after week there are complaints from constituents. Yes, the leadership has now changed. It is important that local governance and the hospital’s relationship with Enfield and the London Borough of Haringey should be retained; but we want to hear from the Minister that such things cannot happen again. It is a question of who is accountable, and when, and of how Members of Parliament could have been heard much more constructively. Given all that happened at Mid Staffordshire, it is a matter of deep concern that although things are clearly not quite at that stage, they could have reached it had leaks not been published in The Guardian and had MPs such as my hon. Friend the Member for Edmonton (Kate Osamor) and my right hon. Friend the Member for Enfield North not rung alarm bells as they have in the past few weeks.
Catherine West (Hornsey and Wood Green) (Lab)
It is an honour to serve under your chairmanship, Ms Vaz. I congratulate my right hon. Friend the Member for Enfield North (Joan Ryan) on securing the debate. It feels a bit like mark 2 for her, I think, given the earlier experiences with Chase Farm. I am pleased about the cross-party nature of the debate; it was interesting to hear the personal experience of the hon. Member for Enfield, Southgate (Mr Burrowes) of care at the hospital.
Like my right hon. Friend the Member for Tottenham (Mr Lammy), I am at a loss; I attended the annual general meeting a couple of weeks ago and have written letters to Ministers—indeed, the Minister present today has been kind enough to have a meeting with us. We have had press reports and urgent questions. We have asked questions at Prime Minister’s questions. We have had Adjournment debates, and the Mayor of London has raised the matter with NHS London. I am at a loss to know what we should do next, and which levers can be pulled.
I am pleased that management action has been taken, and that Mr Sloman has now taken an interest and is the accountable officer. I am equally pleased that Ms McManus has been brought in to take over on an emergency basis while the leadership of the hospital is being looked at. However, I have concerns for the long term about a situation in which decision makers in Hampstead would make decisions about a north London hospital whose area is Edmonton, Tottenham, Wood Green, Enfield and Haringey. I am concerned about how remote and out of touch they might be. I look forward to hearing in the spring what the management arrangements will be for the medium to long term. We must ensure that there is proper representation of local people at board level and a proper voice for our area in the hospital management and governance structure.
I will briefly raise two constituency cases. One is about medicines training, which was referred to in the Care Quality Commission’s report. I understand from a constituent that when her father was discharged from the hospital, somehow his name had got mixed up with another patient’s name, and when she got home she had the incorrect medicine for him. That is a basic error, and the wrong medicine could have been fatal for an elderly and frail man.
The second case arose after an anonymous phone call to my office reporting on the condition of an elderly patient. The caller was very distressed, as the patient was his elderly wife. He said, “I’m so worried to tell you, because I am afraid that they actually might kill her if I tell you her name.” There is a level of desperation, and that call was made not so long ago; it was within the last month.
There are some general lessons to be learned from this specific situation about the lack of leadership and lack of quality control in our public services. The first is about the recruitment and retention of properly qualified staff. We desperately need to tackle the low morale of staff, which has been exacerbated by the poor handling of the junior doctors dispute. Morale is low not only at senior level or consultant level but at the middle level, and even at the level of junior doctors. Once the hospital lost the contract for the training of junior doctors, everything went downhill from there. We need to get that training back, and we need to work very hard and very quickly to get back the doctors and experts who want to serve, learn and train in a university hospital.
The second lesson to learn is about the crucial issues in our health economy, one of which is the problems with primary care. I understand that there are immense problems with the current Enfield primary care arrangements. The clinical commissioning group is not in a good place. I would like to hear about any associated issues, and I would like to know what levers the Minister can pull to ensure that proper primary care arrangements are put in place for Enfield and that primary care in Haringey is strengthened.
I understand that Haringey has done some very good things, including putting some extra general practitioners into the accident and emergency department to educate people about where to go when they first come into hospital, and about how they can go and see their GP in the local community. I would be happy to hear about an evaluation of that programme and whether it has been helpful. Rather than rushing in with a band-aid solution, can we hear back about that programme? What has the evaluation been, and what do the experts think? Has that programme stopped the flow of people coming—perhaps incorrectly—to A&E, and has it helped the primary care health economy?
It is well known that Members including my right hon. Friend the Member for Tottenham secured a debate in the main Chamber on mental health in Haringey. At St Ann’s hospital in Haringey, the acute care places are really overloaded, which has led to greater demand for beds at North Middlesex hospital. Once the health economy becomes unbalanced, that can put more strain on A&E departments from general patients who do not have mental health problems.
Furthermore, there is an ambulance crisis. Police officers have told me that there are not enough ambulances and that they have to take patients to the North Middlesex hospital themselves because the ambulances cannot cope. Of course, we know that once the ambulances get to hospital, people are being treated inside the ambulances, which is completely unacceptable.
Mr Lammy
My hon. Friend will also appreciate that a major criticism in the CQC report was that after patients have left the ambulance, they are treated solely by nurses at grade 5, with no doctors in sight and no consultants available after 11 o’clock at night. How can there be an emergency department when there are no consultants available on a Friday or Saturday night?
Catherine West
My right hon. Friend makes an excellent point about an issue that must be monitored. I look forward to the Minister reporting back on the lack of the leadership and clinical excellence that we expect on behalf of our constituents.
The cuts to public health provision will have an extra impact. I will give just one example, which many Members here have pursued—basic HIV/AIDS care. We are not doing the preventive work, and we are unnecessarily cutting back the public health budget, which will eventually lead to more people turning up at A&E or acute care departments in crisis. These issues in the health economy are all linked, and we need to do much more about all of them.
We are all aware that litigation accounts for a quarter of NHS expenditure. Why do we not get better at doing the proper work first, so that the money we spend on lawyers and expensive court cases when we get things wrong does not add up to so much? The situation is absolutely desperate. We need more investment, and we need to stop making mistakes so that we do not have to pay for litigation and so that instead of litigation there can be front-loading of resources into prevention, mental health and good-quality primary care and basic services. People accessing the NHS could then have confidence that their local service is as good as we should expect it to be.
Finally, we know that in London, there are a number of issues with the cost of living, the cost of transport and the cost of childcare for medical practitioners and nursing staff. Those issues are linked to the others that I have mentioned, and I would like to see a more robust approach from the NHS around London to the needs of those working in our hospitals and our public services. London is not like other areas, where it is cheaper to rent homes and so on. We are unable to recruit the medical practitioners and nurses we need because they cannot afford to live in the area, and we should examine that issue more energetically and not just in a theoretical way.
Thank you very much, Ms Vaz, for calling me to speak. I look forward to hearing the Minister’s conclusions.
Valerie Vaz (in the Chair)
I point out to the Front-Bench spokespersons that the wind-ups are starting now, and we are expecting a Division in the House at around ten to 4.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
I congratulate my right hon. Friend the Member for Enfield North (Joan Ryan) on securing the debate and giving a masterful summation of the situation.
There have been some important speeches today, including from the hon. Member for Enfield, Southgate (Mr Burrowes), my right hon. Friend the Member for Tottenham (Mr Lammy) and my hon. Friend the Member for Hornsey and Wood Green (Catherine West). I also note the presence of my hon. Friends the Members for Hampstead and Kilburn (Tulip Siddiq), for Hammersmith (Andy Slaughter) and for Edmonton (Kate Osamor).
This debate is about more than an individual hospital such as Central Middlesex or North Middlesex. There are certain underlying issues, which I will touch on. One source of pressure on an accident and emergency department—whether it is in the North Middlesex hospital, the Central Middlesex hospital or any other hospital around London—is what is happening in social care. For years, local authorities, both Labour and Conservative, have said that they are struggling to meet social care need, and studies show that many of the people who turn up at A&E would not have to go there in the middle of the night to get the care they need if the social care system was functioning properly.
There is also the difficulty of getting GP appointments. The level of difficulty may vary from constituency to constituency, but in the City and Hackney area, for quite a long time now—for years, in fact—it has taken two weeks to get a GP appointment. I am afraid that means that many of my constituents take it upon themselves to go to A&E, because they know that, however long they wait there, they will ultimately be seen. Another problem is the lack of investment in public health, which could deal with some of the health conditions that people turn up to A&E with.
There is also the issue of alcohol abuse. On a Saturday night, too many people are in A&E as a consequence of alcohol abuse, and we must consider how we can deal with those cases and stop A&E departments being filled up.
On the issue of staff recruitment, I am not seeking to be particularly party political, but I cannot believe that the junior doctors dispute will make it easier to recruit staff. One thing that was manifest in the junior doctors’ refusal of a contract that the British Medical Association had recommended to them was the complete collapse in morale among doctors, and that will be reflected in the difficulty of recruiting staff.
Part of the problem with outer-London hospitals may be the changing demographics of the areas they serve. I said I would not be party political, but I campaigned for many of my right hon. and hon. Friends at the last general election, and I was struck by the situation in areas such as Enfield, Edmonton and parts of Hornsey. When I was a child, those areas were very much leafy suburbia, but now they have a much greater density of population, a much more complex demographic profile and much more complex health and social care needs.
As shadow Secretary of State for Health, I hope to look at that issue further. We should remember that outer London does not have many socially connected teaching hospitals such as those that exist in inner London. I am not sure whether the level of funding that outer-London areas get reflects the demographic and social changes in those areas that I have seen in my lifetime.
It is easy to talk about the issue abstractly, and to talk about reports and hieroglyphics, but it is about people. The tragedy at North Middlesex is a tragedy for patients. Who would want their mother to be dead on a trolley for four and a half hours and have no one come to look for her?
We also have to think about staff morale. People have congratulated the staff but, strikingly, the unpublished Health Education England report, for which 24 members of staff were anonymously interviewed, said that some doctors found working in the A&E unit so stressful that they cried when they finished their shifts. It stated:
“Foundation doctors had been reduced to tears by the sheer volume of patients they had to deal with, for example 200 patients and a six-hour wait, and they felt that they regularly had to send children home without having discussed their case with anyone senior…They often finished their shift and returned home full of anxiety that they had not been able to provide care at an appropriate level.”
This is about the patients and their families, but it is also about the staff who know that they are not providing the right level of care and are demoralised and upset.
As my right hon. and hon. Friends and the hon. Member for Enfield, Southgate have reminded us, we are told that North Middlesex is implementing a safer, faster, better programme to bring down waiting times and address the issues in the Care Quality Commission’s report. As the hon. Gentleman said, why should there have to be a shiny new programme to ensure that our constituents get safe, fast, high-quality treatment? It is good to hear that a new A&E clinical director—Turan Huseyin from Barnet A&E—has been appointed, and that there is a new A&E nursing lead and five additional middle-grade doctors and consultants on loan from other London trusts. It is also good to hear that in July the Care Quality Commission said that although North Middlesex was still inadequate, it had “turned a corner”.
I want to raise a few points with the Minister. One, which has already been made today, is that what happened could have been foreseen. The drop in both standards and performance at North Middlesex is intimately tied up with the closure of the A&E at Chase Farm in 2014. Members who are here today raised that point at the time. I would also like to hear from the Minister about how much support is being given to the emergency care intensive support team. In response to a parliamentary question asked by my right hon. Friend the Member for Tottenham we heard that the trust had requested such support, so what is happening?
My final point is about doctors being kept in the dark. I want to avoid crudely party political points, but I spent three years in the Opposition health team dealing with the health Bill, and we were concerned about transparency and accountability. When there is a crisis in a hospital, despite all the different organisations that my right hon. Friend told us about, there seems to be no simple method of ensuring accountability to local representatives, and therefore to local people. Something is lacking in accountability, and we need to consider that. The fact that the collapsing performance at North Middlesex hospital was an open secret among the health service professionals but none of my hon. Friends knew about it—except anecdotally from constituents—is alarming.
This is about more than North Middlesex. There are systemic issues. There might be a systemic issue with NHS funding failing to keep up with changes in local demographics, and there is a systemic issue in social care. I am sure we will return to that in this Chamber, because local authorities have been flagging it up for some years now.
In closing, I can only repeat what the hon. Member for Enfield, Southgate asked: how bad does it have to get? It is troubling if our constituents, who pay their taxes and rates, cannot get a basic level of care when they go to A&E. For most of them, that is their engagement with hospital care. They are getting almost a third-world service. I do not say that lightly—someone being on a trolley for four and a half hours after they have died, and there being only one commode between 100 people, is more like a third-world than a first-world standard of healthcare. How bad does it have to get? Will the Minister assure us that we will not have a situation again in which a collapsing service at a major hospital is an open secret within the professional health services but not made apparent to Members of Parliament and the wider community?
The Parliamentary Under-Secretary of State for Health (Ben Gummer)
I thank the right hon. and hon. Members who have given such thoughtful, considered, well-researched and knowledgeable speeches, and also the hon. Member for Hackney North and Stoke Newington (Ms Abbott) who provided such a thoughtful reflection from the shadow Front Bench. Members will be pleased to know that I agree with much of what they have said. I will come on to how I think the NHS has let Members and their constituents down and what we will do to try to fix the situation.
If Members do not mind, I will first set the issue in a bit of context. North Middlesex hospital was classed by the Care Quality Commission as requiring improvement for reasons that have been mentioned. The quality of care was not consistent enough and there were concerns about patient safety. It was not one of the worst hospitals in London, or in the country, but it was certainly not one of the best. Until July 2015, it was largely meeting its institutional standards. The 95% waiting time target for A&E was being met most months, even though the department is one of the larger ones in the capital, and in spite of the reorganisations that were discussed at length by the right hon. Member for Enfield North (Joan Ryan).
We need to be careful, therefore, with causality, and I will not give a definitive reason why the problems came about. A direct connection between the reorganisation of Chase Farm, which began under the Government before the coalition, and the problems experienced at North Middlesex over the past year, cannot be made with great surety because the hospital was dealing with the A&E caseload within the required timelines, albeit with a standard of care that was not at the level it should have been.
Nor is this about money. It is important to point out that organisations across the NHS, as the shadow Minister knows well, have reported deficits in the past year and this is one of the smaller ones. The posts that are established in the hospital are fully funded; the problem is trying to get the right people into them. I do not deny that the hospital has a staffing problem—I will come on to that in a second—but it is not connected with funding.
Let us get to the core cause of the problems that Members have noticed and brought to the attention of the House. I am afraid that I am not able to give a complete answer at this stage, but Members are entirely right to ask why this happened. We need a better explanation. This morning, I agreed with officials and NHS England that we will look in detail at the reasons within the hospital why the performance standards slipped so significantly in the middle of last year, and why the training routines and practices slipped as well. That is the first part of the review.
The second part is on why the system did not react with the speed it needed to when concerns were first expressed about a year ago. Here, I offer an apology to Members on behalf of NHS organisations. Members were not informed at the pace and the time they should have been, and for that I offer regret. Members are right to say that they should have been the first to know there were problems so that they could properly represent their constituents and hold local leaders to account.
I offer that apology within the context of a much better story across the NHS of what happens when hospitals fail. A warning notice was issued—that was the first reason that the right hon. Member for Enfield North knew something was going wrong—because of a change to the law under the coalition Government in 2014 on when the CQC was able to issue warning notices.
Ben Gummer
I will in a second. The whole system of CQC Ofsted-style inspection ratings, which are designed to be user-friendly so that non-clinicians can understand how well hospitals are performing, was instituted by the Secretary of State because we wanted to shine a light on the performance and quality of care in hospitals. Through two and a half years of having special measures routines and regimes for hospitals, we have a much better understanding of why things go wrong and can put them right far more quickly. Most importantly, we have a process for engaging Members of Parliament right at the beginning. That did not happen in this instance, and I will explain why after I have taken the right hon. Lady’s intervention.
Ben Gummer
Ideally, if things are going wrong and that has been noted within the hospital, the hospital chief executive or commissioners should inform local people, but in the past—and over the two and a half to three years since we instituted the special measures regime—it has taken a Care Quality Commission investigation to highlight poor standards of care so inadequate that the hospital needs to be placed under special measures. At that point, before the public are informed, Members of Parliament are informed by the CQC and what was Monitor and the Trust Development Authority, but is now NHS Improvement.
Ben Gummer
Before I take the right hon. Lady’s intervention, I will explain why Members were not informed, and it is by no means an excuse. The core problem around emergency medicine and paediatrics was to do with the training places and the relationship between the General Medical Council, which looks at and regulates the quality of training, Health Education England and NHS Improvement. Because this case did not go through the traditional special measures route, which is governed by the CQC and NHS Improvement, things did not happen at the pace I would have expected and nor were Members talked to when they should have been.
The first thing I want to ensure, once we have receipt of the review I asked for this morning, is that we have a similar standard approach, were this to happen again. We have to assume that it might, because things in a large system do go wrong. We need to learn from this scenario over the past year, where Members have been let down, and ensure that it does not happen again. We can move with greater celerity and ensure that Members are informed at the earliest possible opportunity.
Joan Ryan
I appreciate the Minister’s expression of regret and his acknowledgement that something went badly wrong, but I take issue. A CQC report in 2014 noted added pressures in A&E that we are all aware of. I only came back into Parliament in May 2015, and over the past year a number of Members, including me, have raised the issue several times in the Chamber. We were given no information. The CQC report is very welcome, but for it to take more than three months to be published means it is of no use as a warning note with any detail. [Interruption.]
Valerie Vaz (in the Chair)
Before the Minister responds, there is a Division.
Ben Gummer
I will answer the right hon. Lady directly. Of course there is more to do, but we are much further ahead than 10 years ago. There is no blame on any particular Government—we are further ahead than 20 or 30 years ago. The Care Quality Commission is a respected regulator that comes down with tough judgments and makes Members aware. When we come back after the Division, I will explain what we will do.
Ben Gummer
I promised to explain to the House what we will do to correct the situation. There are two parts to this. First, the short-term rescue plan has been put in place by Health Education England, NHS England and NHS Improvement, with the approval of the General Medical Council, to ensure resilience in the A&E department and for paediatric services. Two consultants have gone on secondment to the department, and a further five are coming this month. The GMC is happy that that will provide the rota resilience we need in the short term.
If we think that will fix things, however, we will quickly end up in the same situation. That is why we need to look at a far more robust plan for the next few years, so that the North Middlesex can become the centre of excellence that hon. Members and I certainly want it to be. A new improvement director will be in place to deliver an improvement plan, which I will ensure is shared with hon. Members. So the plan that the right hon. Member for Tottenham (Mr Lammy) requested will be available for other hon. Members to see. It will have the transparency that has been lacking so far.
I must answer a particular point made by the right hon. Gentleman about the General Medical Council. I do not think that it was silenced in any way. Genuinely, this is more muck-up than conspiracy, and I hope that it will not be repeated, as I have already assured hon. Members.
On the long-term plan, the hon. Member for Hackney North and Stoke Newington was entirely right: the North Middlesex is like many hospitals on the periphery of London, which not only are seeing rapid demographic change, but suffer from the fact that they are not the attractive training places that the central London hospitals are—we have to be blunt about that. I think that is wrong, because many of the challenges that aspiring doctors want are in those hospitals, which are diverse with an extraordinary range of clinical conditions. However, because of the history of the NHS, which I cannot change, a glamour is attached to the central metropolitan hospitals, and that causes challenges for district general hospitals throughout the country, as well as those on the periphery of London.
I want to change that, but we cannot do it by fiddling around. That is why I am excited by the link-up with the Royal Free. That kind of branding, which the right hon. Member for Enfield North pointed to, the strong leadership, which will provide stability, and, I hope, the ability to move consultants and senior nursing points around—some people recruited already into the Royal London and Barts will also work at the North Middlesex—will result in the diversity of career opportunities necessary to attract the kind of clinicians that the right hon. Lady and her colleagues have requested for their hospital.
Mr Lammy
To press the Minister on a bit of detail, the CQC’s press release stated:
“We have strongly encouraged the trust to engage with other organisations across the local health and social care system to resolve this challenging issue...there are moves to appoint more senior doctors—and I note that the trust is calling on consultants from other departments within the hospital to provide the routine daily support to A and E which is so badly needed.”
That was on 6 July and, clearly, the CQC did not feel that the hospital had got there. Will the Minister therefore confirm what the required number is? If he cannot tell us that, it would be helpful for him to come back to us. What is the golden number that should comfort us? Will he also confirm, because this is important, that nurses are not still reviewing patients who arrive by ambulance, because that is seriously inadequate, and we want to ensure that patients are seen by doctors?
Ben Gummer
I reassure the right hon. Gentleman that NHS England has a live rota stream from the hospital to give it the reassurance that every single junior doctor has a consultant supervisor in place at all times—precisely to ensure that the reported lapses of supervision do not recur. When the right hon. Gentleman meets the chief inspector at the CQC tomorrow, I hope that he hears something similar to what I have heard: things are not good, but they are better than they were, and the trajectory is in the right direction.
Nevertheless, we will not fix this without looking at fundamental reform of local health services, which requires changes to primary care, of the kind that we discussed when I met local Members of Parliament last week. I hope to meet them again, in a few weeks or months, and to be able to talk about progress and the plans for the future, so that right hon. and hon. Members will be satisfied that things are getting better at the North Middlesex.
Mr Charles Walker (in the Chair)
I thank the Minister—my constituents in Broxbourne will be following the outcome of this debate closely.
Question put and agreed to.
Resolved,
That this House has considered the performance of North Middlesex University Hospital NHS Trust.