North Middlesex University Hospital NHS Trust
(Limited Text - Ministerial Extracts only)
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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.
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.