(7 years, 10 months ago)
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Graham Stringer (Blackley and Broughton) (Lab)
I beg to move,
That this House has considered the future of the Pennine Acute Hospitals NHS Trust.
It is a pleasure to serve under your chairmanship, Mr Streeter. We have a delicate path to tread in this debate. Over the past 10 years, there has undoubtedly been a scandalous failure of care within this NHS trust. It has been well documented; I will come to that in the middle of my comments. There has been a failure in the structure of the trust, a failure of management and, in individual cases, failure by clinicians, and people have suffered and died because of those failures.
That discussion and debate needs to be aired, while ensuring—this is the delicate balance—a solid and credible future for the hospitals in the trust, and particularly North Manchester general hospital in my constituency. The vast majority of clinicians, staff and employees in the trust are committed to the good care of patients, want the best for those patients and devote their careers and time to giving it to them. There is a delicate balance to be struck: I do not want any criticism of the trust to undermine morale further, but we have a responsibility to debate the issues. This is not about the present general debate on NHS cuts or the impact of the Health and Social Care Act 2012; it is specifically about the structures of the Pennine trust and some of its failures, and what we should do to secure its future.
Almost exactly 10 years ago, on 24 January 2006, I sponsored another debate on the Pennine Acute Hospitals NHS Trust; it can be found in Hansard at column 372WH. Shockingly, when I read that debate, I found that it covered almost exactly the same points that I believe we will discuss in this one. On the day of that debate, the front page of The Times highlighted misdiagnoses, with serious consequences, by the radiology teams at North Manchester general hospital, as well as at Trafford general hospital, which is not part of the Pennine trust. At the time, Professor George Alberti and Dr Joan Durose had written a report on the Pennine trust, which had been going for only three years, having been set up on 1 April 2002. The report found low staff morale, poor communications and poor administration, which is almost exactly what the Care Quality Commission’s current report found. The human resources director and medical director of the trust had already left, and after the 2006 debate, the chair and chief executive left.
We hoped for a better future and improvement through Professor Alberti’s 25 recommendations, but today we find that the chief executive of the trust has gone elsewhere and the current director of operations is on gardening leave. We are almost back where we were 10 years ago. In the meantime, there have been numerous warning signs that things have been going terribly wrong. One question on which I shall focus is why, even with all those red lights flashing all over the place for 10 years, with dire consequences for patients, the national organisation of the NHS and, more recently, the clinical commissioning groups did not notice them and sort out the situation.
The first strong warning sign that things were wrong came in a report from Channel 4’s “Dispatches” on 11 April 2011. “Dispatches” sent secret cameras into North Manchester and Royal Oldham hospitals in the Pennine trust, and found very poor care, amounting almost to low-level torture of some patients, who were shown not getting what they asked for. It was a terrible situation. At the time, I took up the case, and I am told that staff were disciplined.
Liz McInnes (Heywood and Middleton) (Lab)
Is my hon. Friend aware that the nurse who was dismissed as a result of “Dispatches” took her case to a tribunal, which instructed the trust to give her back her job?
Graham Stringer
I was not aware of that. There are obviously many technical details about the disciplinary situation of which I am not aware. However, I saw the programme, and the patients in that situation were undoubtedly treated appallingly. One cannot resile from what one sees directly.
Liz McInnes
I caution my hon. Friend against reading too much into the “Dispatches” programme. The tribunal overruled the trust. The reporters spent six months in the trust and managed to find two incidents, which they broadcast. When the case was heard by a tribunal, it ruled that the nurse in question should not have been dismissed.
Graham Stringer
As I just said to my hon. Friend, I will not go into the details, but I probably know more than she does about the situation from the patients’ side, because a relative was affected. I have no doubt that those patients were treated appallingly. I cannot comment on the details of personnel issues, but I can comment on the fact that patients have been badly treated. Given the technicalities of the situation and having watched the programme, I find it worrying that although one or two cases were found after six months, the nurses were re-employed.
After “Dispatches”, the CQC report found scandalous failings within the trust. It found that the safety and wellbeing of patients were inadequate, and that the trust’s responsiveness and effectiveness needed improving, but that the care of patients was good. That report was very worrying; the trust would have been put in special measures, if a new team had not already been put in place to deal with the situation.
As I say, the CQC report found that the care of patients was good, but within a very short time—and after excellent investigative work by Jennifer Williams of the Manchester Evening News and other journalists—an internal report on maternity care was made public, showing that the care provided by some individuals was very poor indeed.
It is worth reading out for the record an extract from that internal report, because we have now had a 13-year period of failure. It is also worth remarking that both that internal report and the CQC report relied on nothing but internal statements by the trust’s staff. A paragraph from the internal report really contradicts the CQC report, as it states:
“Staff attitude has been a feature of a significant number of incidents, from the most basic reports of staff relationship breakdowns, resulting in women and their families exposed to unacceptable situations, to an embedded culture of not responding to the needs of vulnerable women”.
The report went on to say of one woman that
“in one incident it is clear that the failure of the team to identify her increasing deterioration and hypoxia attributed her behaviour to mental health issues. Failure to respond to deterioration over a period of days resulted in her death from catastrophic haemorrhage.”
That means that, according to internal sources, the situation was actually worse than had been thought.
The report continued:
“A further example of staff attitude and culture has been experienced recently when a woman gave birth to her baby just before the legal age of viability (22 weeks and 6 days)…whilst no resuscitation would be offered to an infant of this gestation, compassionate care is essential. However, when the baby was born alive and went on to live for almost two hours, the staff members involved in the care did not find a quiet place to sit with her to nurse her as she died but instead placed her in a Moses basket and left her in the sluice room to die alone.”
That is inhuman treatment.
These failings are the failings of individuals, of management, who failed to sort things out, and of the structure of the Pennine trust itself. I could list a whole series of other cases. In fact, late last night I was contacted by constituents I know about another case. I do not know the details of that case, but my constituents wanted me to take it up, as they strongly believed that a misdiagnosis meant that proper therapeutic care had not been provided. So problems in the Pennine trust continue.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
My hon. Friend is making a very powerful speech and I share his absolute horror at some of the reports of the standard of care that some patients have received. Like me, he was at a meeting with staff last month, who also expressed their concerns about the quality of care being provided.
I am trying to understand something. Is my hon. Friend saying that this poor care, as set out in the CQC report and other reports, is endemic and is found right across the Pennine Acute Hospitals NHS Trust? Also, does he recognise that the new leadership is playing an important role and that the site leadership teams will have an important role in turning this situation around?
Graham Stringer
What I am saying is that there have been failures from the very beginning of this trust, in that it has four hospitals that were jealous of each other. That caused administrative problems, which means the trust has never worked well, and there is also a structural problem. Secondly, there have been failures of management to deal with those issues of individual failure to care.
I have enormous confidence in Sir David Dalton and the team who are taking over the Pennine trust. Sir David’s record of developing Salford Royal hospital is exemplary, and I hope that he can do the same with North Manchester general hospital and the other hospitals within Pennine.
As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, along with my hon. Friend the Member for Heywood and Middleton (Liz McInnes) we met the trade unions in Pennine just before Christmas and, like the vast majority of the staff, they were committed to improving healthcare in the trust. Like my hon. Friend the Member for Oldham East and Saddleworth, I made the point that one has to acknowledge failures to ensure that there is improvement. One cannot just say that, just because so many staff are committed, that is good enough for the future. One also has to recognise the failure of the local clinical commissioning groups to deal with the problems, the fact that the board of the trust seems to have been paralysed and the fact that NHS Improvement has not dealt with the trust’s problems.
I have listed some of the cases that have caused public concern. One cannot put a financial cost on those cases, but if one reads the internal report on maternity care, one sees that the amount of money spent on compensation in the year 2014-15 was £58 million. I repeat— £58 million. Nearly £20 million went on three cases, which means that just over £6 million was spent on each one. In those cases, the people involved took legal action and at the end of the process were awarded that sum to look after severely handicapped patients.
There is no question but that, as I just said to my hon. Friend the Member for Oldham East and Saddleworth, Sir David Dalton has put in place a team who are committed to taking North Manchester general hospital out of Pennine and putting right what was a structural mistake.
It is worth reflecting on another point that was made in the Westminster Hall debate about 10 years ago, which is about why the Pennine trust was created. It was not created for good medical reasons. There was a public reason, which was given at the time by Billy Egerton, the then chair of the North Manchester health trust—I think that was what it was called. He said that he thought that if North Manchester general hospital had remained separate from the trust, it would have been prey to the predatory instincts of Manchester Royal infirmary and the major central hospitals in Manchester. First, I do not think that was a good idea—there could have been co-operation—and secondly, there were a number of chief executives in the trust who were retiring, which meant that three chief executives could be paid off and one chief executive found. Those three chief executives who were paid off came back and did consultancy work for the NHS. Unfortunately, that is the way that the NHS has dealt with problems. It has spent money, and wasted money.
The proposals for devolution will help to deal with the problem. The national structures have not worked. Having the combined authority, encompassing the 10 local authorities, taking decisions and examining these issues, with North Manchester general hospital being within the Manchester hospital schemes, is not a guarantee of success, but I generally believe that when decisions are taken closer to what is happening on the ground, they are more likely to be correct decisions than if they are left to a national body, which has clearly failed in this situation.
Mr Ivan Lewis (Bury South) (Lab)
I congratulate my hon. Friend on securing this incredibly important debate and on his years of attempting to highlight the dreadful failure of leadership—not of frontline staff, who do a remarkable job—in the trust. We have to hope that the future is better, but being dependent on the leadership of one individual in the long term is not always the best way to turn around an organisation.
In the light of my hon. Friend’s comments about local decision making, does he believe that at a time when accident and emergency at North Manchester general is under such tremendous pressure, it makes sense for Bury CCG to press ahead with its proposal to close the Prestwich walk-in centre? At a time when patients are being told not to go to accident and emergency services, it seems absolutely bonkers to close a walk-in centre that is so well used.
Graham Stringer
I agree with my hon. Friend about the closure of walk-in centres. There has always been a conflict of interest between GPs getting patients through their surgeries and walk-in centres. At a time when there is stress across the whole Greater Manchester NHS—indeed, across the NHS in the whole country—to increase that pressure by closing walk-in centres seems—my hon. Friend says “bonkers”, but I would use slightly tamer language—perverse.
I will finish with some questions for the Minister. Part of the plans that Sir David Dalton and his team have in place, which involve separate management teams for the three major hospitals—putting Rochdale in with Bury—will require investment in the short term in 24 new beds for intermediate care and hopefully, in the medium term, the demolition of more than half of North Manchester general, which is a 19th-century workhouse, to turn it into a completely modern hospital. What will help staff morale most is a commitment to the future of the hospital on that site, dealing with a community with some of the country’s worst mortality and morbidity statistics. The Minister might not be briefed on this because it happened relatively recently, but the paediatric audiology unit has failed its accreditation assessment. If he does not know about that—I would not necessarily expect him to—will he write to tell me what the response will be and whether paediatric audiology will continue on the site?
On 13 December 2016, in a statement on the NHS deaths review, the Secretary of State, while recognising the difficulty in doing so, committed to trying to understand which of the highlighted cases were avoidable deaths and which were not. It is important for both the families and the public to know which of them could have been avoided and which were, unfortunately, the kind of unavoidable hospital death that takes place when someone is very sick. Was it a mistake to remove 31 medical beds from the hospital just over 12 months ago? As a result, the number of people being admitted into North Manchester general is lower, because there simply are not enough beds. What is happening to the people who otherwise would have been admitted?
Those are the detailed questions. The real question for the future is whether the Minister will give a long-term commitment to the hospital and to its moving into the Manchester hospital system. Given the statistics showing that men from north Manchester are likely to have lives that are six years shorter than those of men in the rest of the country, and that women’s lives are likely to be about 4.4 years shorter, is there a commitment to quality care and investment in the hospital for the future, to ensure that those rather damning statistics are changed?
Several hon. Members rose—
Mr Gary Streeter (in the Chair)
Order. The winding-up speeches will begin no later than 10.40 am and four colleagues wish to catch my eye, so the maths does itself.
Mr David Nuttall (Bury North) (Con)
It is a pleasure to have you take charge of our proceedings, Mr Streeter. It is also a pleasure to follow the hon. Member for Blackley and Broughton (Graham Stringer). He was right about our membership of the European Union and he has been proved right again about the Pennine Acute Hospitals NHS Trust. I particularly appreciate the very considered and proportionate way in which he has approached what is clearly a difficult subject.
Deciding on the best and most efficient way to organise our national health service is a problem that has long occupied the intellect of many able minds. I think it is fair to say that both the Conservative party and the Labour party have struggled over the years with how best to manage such an enormous organisation. That is not a political point; it is a matter of fact that there are different ways to organise huge bodies and everyone wants to do it in the best way possible to deliver the best possible service for all our constituents. I want the NHS to be organised in any way that delivers the best service for my constituents in Bury, Ramsbottom and Tottington. They rely on our NHS. They rely on Bury CCG and on the Pennine acute. Frankly, they are not too bothered about precisely where a management committee sits or meets, but they are bothered about whether they can get their appointments on time and, crucially, whether, when they have to use NHS services, they are safe.
Mr Nuttall
I will give certainly way to my neighbour, the hon. Member for Bury South.
Mr Lewis
The hon. Gentleman and I have always sought to work together in the interests of Bury and to put party political differences to one side. Does he agree that the decision being pressed ahead with, to close the walk-in centres in Prestwich and Bury, is perverse—or bonkers, depending on how one wants to look at it? Will he join me in ensuring that, when the formal consultation begins, we fight that decision? Given the pressures on the existing accident and emergency departments at North Manchester and Fairfield general hospitals, that decision would make the situation far worse.
Mr Nuttall
I am grateful to the hon. Gentleman for raising walk-in centres. I was going to mention them later, but I will deal with the issue now. I met with representatives from the Bury CCG some months ago, before all this was announced, and they took me through what they were planning. They convinced me that it was in the best interests of my constituents. It would be easy for me to say the popular thing, which is, “I think we should oppose it.” I entirely appreciate why the good folk of Prestwich do not want their walk-in centre to be closed. I can see that there is a likelihood that it would increase pressure on the A&E. That highlights the point I was making, which is that there are good arguments to be made on both sides of the debate as to whether to have walk-in centres or a more community-based approach to delivering services. That is where Bury CCG was coming from.
Following the devolution of healthcare in Greater Manchester, since last April, we have been in an entirely new situation. We have an opportunity to make a reality of the joining up of health and social care, which has long been argued for.
I want to make three points this morning. First, I do not accept that the problems that have been identified at Pennine acute are all down to a lack of funding. To be fair, I think the hon. Member for Blackley and Broughton accepted that the questions went much wider than funding. It is an easy get-out to simply blame a lack of funding.
Debbie Abrahams
Does the hon. Gentleman accept that the NHS estimates a shortfall of £1 billion for the Greater Manchester health economy by 2020 under the devolution deal? Does he also accept the differences between the consolidation of different sites into specialist units and the huge shortfall that has meant that Pennine acute has not been able to recruit staff?
Mr Nuttall
There are two separate points there. On the first, I have been involved in politics for getting on for the best part of 40 years, and I have never come across a time when it has been claimed that the NHS is not short of money. I cannot remember a time when the parties have all agreed that the NHS was getting all the money it needed. In every general election that I have ever been involved in, there has always been this claim that the Conservative party is about to privatise the NHS and the NHS is short of money. We are not very good at it—if we had been, we would have privatised it years ago, were that the Conservative party’s intention. The fact of the matter is that Pennine acute alone is a huge organisation, with a budget of more than half a billion pounds. Even with our small part of the NHS, such sums of money are difficult to comprehend, never mind the totality of it.
We can all argue that our particular part of the NHS should be given more funding, but in reality the NHS will always be competing with all the other calls on the public purse. If we are to stick with the current funding model, we will only ever be able to increase spending on the NHS significantly if we have a strong and growing economy. I do not want to get bogged down in the broader questions about our NHS, however, because the specific issue this morning is the future of Pennine Acute Hospitals NHS Trust.
The CQC report identified major problems with the leadership of the organisation. Like the hon. Member for Blackley and Broughton, I have every confidence that Sir David Dalton and his new team will bring a fresh approach and outlook to the trust. The one worry I have is that we are perhaps expecting too much of that gentleman. He is clearly a very talented man, but we are all limited by the fact, no matter what our particular talents may be, that there are only 24 hours in the day. I have heard anecdotal stories that he is pulled from pillar to post because he has so many demands on his time. That is understandable; it is not in any way a criticism. It is just a fact of life that he is being asked to do an awful lot. I wish him every success in the world. I hope he can deliver, and I am confident that he will but, if I have one concern, it is that he is perhaps being asked to do too much. I understand that he is focusing on trying to have a more decentralised approach to management to bring management closer to those the trust seeks to manage, and I hope that that will improve matters.
My second point is the issue of maternity services. The removal of children’s services and the closure of the maternity department and the special care baby unit at Fairfield occupied much of my time for years when I first moved to the Bury North constituency. Almost everyone thought that the services at Fairfield were excellent. At the time, my constituents and I were told that things would be even better—even safer—if services were closed at Fairfield and moved to North Manchester and Bolton hospitals. I made it clear that I had doubts about that, as did my constituents. I do not want to quote again from the CQC report, but I want to put on the record this particular quote from it:
“We found poor leadership and oversight in a number of services, notably maternity services, urgent care (particularly at North Manchester Hospital) the HDU at Royal Oldham hospital and in services for children and young people.
In all of these services leaders had not led and managed required service improvements robustly or effectively.”
My constituents could be forgiven for saying, “We told you so.” They can understandably feel vindicated on the stance they took. Incidentally, I understand from a councillor who serves on the Pennine acute scrutiny committee that it was told that the trust was liaising with Newcastle hospitals to learn best practice for maternity services. However, some little time later, when the scrutiny committee asked how that was going and followed up on that idea, it was told, “Sorry, it never went ahead. We are not proceeding with that now.” That little anecdote perhaps gives some idea as to why the CQC discovered problems.
In conclusion, I will make a quick third point. I believe that what Pennine acute would benefit from most in the months and years ahead is a period of stability. It seems to me that part of the problem at Pennine is the constant chopping and changing of leadership. No sooner does one team settle in than they move on and someone else takes over. The difficulty is the resultant lack of accountability. When things go wrong, it can always be blamed on someone else, whether that is to do with a lack of funding or decisions made by a previous management. My constituents and I need to see an end to the changes; we need to see some continuity. My constituents want Pennine acute to be a success. Other NHS trusts are successful, so there is no reason why, with the right leadership in place, Pennine acute cannot be as successful.
Liz McInnes (Heywood and Middleton) (Lab)
It is a pleasure to serve under your chairmanship, Mr Streeter. I am an ex-employee of Pennine acute. I worked for Pennine acute and its predecessor trust from 1987 for 27 years before I was elected to this place. I come to this debate very much from the Pennine acute staff point of view and our experiences of working there.
We have always worked against a background of change. Ever since I started work in the NHS, I cannot remember a time when there was not a new scheme coming up. It was always couched in the same language and everything was going to be different under the latest proposals. That has been my experience of working for the NHS in a 33-year career. There was always a new scheme on the horizon that promised the earth. We would try to give it a go and work with the new system, but systems were never given time to bed in. Just as we were getting used to a different way of working, a new system would come along promising the earth and everything was going to be wonderful under the new system. We all wondered what was so wrong with the old system that we had been told would be so good and solve all our problems. That, in a nutshell, is my experience as a member of staff working in the NHS.
Listening to the views of my hon. Friend the Member for Blackley and Broughton (Graham Stringer) and the hon. Member for Bury North (Mr Nuttall) was very interesting. They have been MPs in the area for a long time. My hon. Friend the Member for Blackley and Broughton said that Pennine acute was formed from four trusts that were jealous of each other, but I feel that is a misinterpretation. He was partially right in quoting Bill Egerton: the trust was formed because North Manchester general was worried about being swallowed up by Central Manchester. That was a fear shared by the staff as well, because none of the four hospitals that form the Pennine Acute Hospitals NHS Trust are teaching hospitals. There was a real concern among the staff that North Manchester general, a local hospital, might be swallowed up by teaching hospitals in central Manchester and disappear. Patients were also concerned that their local hospital would disappear. The trust treats a disadvantaged area, as has already been highlighted. The fact that life expectancy is low in that region is more to do with the quality of life rather than the standard of hospital care there.
Pennine acute was formed in 2002 from a merger of four existing trusts that I think merged to support each other. It was very much a banding together of four non-teaching hospitals that wanted to work together and make a success of Pennine acute. Obviously, any change is difficult, and the merger was a major change, but when Pennine was formed there was a real spirit to make it work. It was one of the biggest trusts in the country with 10,000 staff.
Graham Stringer
I am glad my hon. Friend agrees with me about the reason for the formation. Does she recall that within three years of the formation of the trust the consultants and the unions had an unprecedented vote of no confidence in the management? All the different hospital sites believed they were going to be closed at the expense of another site. Within three years the formation was not working.
Liz McInnes
I was coming to that point because my hon. Friend referred to the chief executive leaving. I inferred from his speech that that was as a result of a debate my hon. Friend had held in Parliament, but the chief executive left because the doctors had a vote of no confidence. The trade unions similarly expressed concern about the way in which the trust was being managed, but, as I recall, the trade unions did not have a vote of no confidence. Unless my memory is not serving me well, I do not recall the trade unions voting on that. I was heavily involved in the trade unions and I have no recollection of our having a vote of no confidence. That came purely from the doctors, who were concerned about the direction the trust was going in. It was as a result of that vote that Chris Appleby resigned from the trust. I was heavily involved in trade union activities as I was a workplace rep for Unite the union while I worked at the trust.
I want to highlight the issues involved in constant reorganisation and relocation. With the single hospital service proposal and with Healthier Together, we have two proposals running concurrently now, both of which seem to have different aims with different groups of hospitals working together. Healthier Together relies on the four Pennine acute hospitals working together and the single hospital service review, commissioned last year, proposes that North Manchester general should now work with Central Manchester and South Manchester. To add to the background of the constant confusion of reorganisations, we now have two different schemes that do not seek the same outcomes. I am sure everybody can understand how confusing and worrying such uncertainty is for the staff.
During the formation of Pennine acute, as a union rep I dealt with many staff who struggled with suddenly being told that their job was moving to another site and that they would be expected to relocate. Very little attention seemed to be paid to staff’s caring responsibilities. I dealt with several staff with disabilities, who had real issues about suddenly being told their job at North Manchester general no longer existed and that they were now expected to get themselves to Oldham at the same time in the morning, even though they had an extra six or seven miles to travel. There were real issues in dealing with staff and relocation in a sensitive manner. Such issues lead to uncertainty for staff and also make Pennine acute look an unattractive place to work.
In the meeting that we had with staff, they were very concerned about the maternity report that had been reported in the Manchester Evening News and the detrimental effect that it would have on staff who wanted to work there. At the meeting we heard from a representative from the Royal College of Midwives that a scheme had been put in place for improvements. The scheme is ongoing and midwives are now being recruited. There was an anomaly with the grade on which midwives were employed. They were being employed one band lower than they should have been, but that has been remedied. So there is an improvement plan in place and we need to be careful about extrapolating from dreadful incidents and saying that the whole of the trust is failing. I caution against that.
I have spoken about Healthier Together and the single hospital service running simultaneously, but seemingly both requiring different outcomes. The staff at Pennine are concerned about the single hospital service and the proposal that Central Manchester, South Manchester and Pennine acute should begin working together. Unfortunately, a lot of staff have been through it all before. They have been through the assurances that their jobs will be safe and that they will not have to move, but they have seen those promises eroded over time. Many are concerned about the prospect of having to journey right across central Manchester to go to work at Wythenshawe. That will be a lot of commuting for staff and they are very concerned about the proposal. The single hospital service review makes a virtue of staff being transferable—that is quoted in the document—and yet, at the moment, staff are being assured that they will not have to move.
On maternity care, the hon. Member for Bury North said that it is not a funding issue, but the appalling report on maternity services highlighted the lack of funding. In the past, there was a proposal to improve maternity services, called “Making It Better.” That was based on an annual birth rate of 3,500. The trust is now dealing with 10,000 births per year on the amount of funding that was settled on 3,500 births, so the funding issue obviously needs to be addressed.
The building stock at North Manchester is a real issue, as my hon. Friend the Member for Blackley and Broughton already mentioned. In my understanding, it was never a workhouse and has always been a hospital, but it was built to serve the workhouse that was built next door. The state of the building stock was always the reason that Pennine acute could not get foundation trust status.
Jim McMahon (Oldham West and Royton) (Lab)
It is a pleasure to serve under your chairmanship, Mr Streeter, and I congratulate my hon. Friend the Member for Blackley and Broughton (Graham Stringer) on securing this important debate. This subject has been the source of much stress for members of the community and staff who live in the area.
My approach is usually to be supportive of local institutions, particularly because my first proper job was as an apprentice at North Manchester general hospital, or Crumpsall as we call it locally. It is where I was born. The Royal Oldham hospital is where my eldest son and my partner were born; Fairfield is where my youngest son was born. We are very much part of the community infrastructure, so naturally I feel protective of it—it is like a family—and that is right and proper, but it does not mean that we defend the indefensible. Things have taken place that have affected people’s lives. Deaths that could have been avoided have occurred. Family members who have tried to get answers have been frustrated and have been met with a culture of closing down and restricting information. Usually, people just want to get answers to help the grieving process and to find out what has taken place.
I very much share the view of my hon. Friend the Member for Heywood and Middleton (Liz McInnes) on the Healthier Together programme, which runs on one stream, and a separate desire, with different drivers, to take the North Manchester hospital away from the Pennine trust. There are different forces at play in the background. The clinician approach, Healthier Together, is about making sure the infrastructure in place meets the demands of the community. Then there is a power game at play, which is about taking North Manchester hospital out and making an enlarged Manchester trust that covers the city boundaries. I am yet to be convinced that that is being done with patients in mind, rather than other things—although, of course, I want to be convinced, because those patients are my constituents, my family members and my friends too, so it is important.
When I speak to staff, I see an organisation where people are working hard, trying to make a difference—people who came into public service because they wanted to be good public servants—but who feel that they are waiting for the next criticism. They are waiting to be named and shamed in the local paper; they are waiting for the next inspection to take place that says they are not doing what they need to do. The vast majority of the 9,000 staff are doing a good job. They came into public service in the NHS because they wanted to be good public servants and we need to bear that in mind—we owe most of those people a debt of gratitude. People have been let down, but lives have also been saved—there are people who would not be here today if not for the work that the hospitals have done and babies who have been born into the world who perhaps would not be here if not for the people who work in that place—but there is no doubt that there are issues of culture, leadership and resources.
The culture needs to be more open and transparent. It needs to be more of a learning trust that is open about when mistakes are made and learns from them, rather than being defensive and withholding information, which is my experience from supporting constituents.
Leadership needs to be visible and proactive. It needs to give people a sense that the future is better than the past. If all people see is a constant cycle of criticism, downgrading and talking down, that will not create the conditions to improve the hospital, which is not good for anybody. I welcome the appointment of Sir David Dalton, who has a good track record, but building the capacity and support in the organisation to make sure that it can improve in the way that it needs to goes beyond him. There is a body of staff—our constituents, our family members and our friends—who really want to see that place turned round, but capacity and resources are really important.
I am not saying that all of the issues in the trust are about money, because they run far deeper than that, but resources are important. There is a reason why the trust has an over-reliance on agency staff, why it struggles to recruit and retain high-quality clinicians and staff and why it is not able to get the surety that it needs in the longer term—it is resourcing, and it is also the estate.
A transformation plan has been submitted to Government—we know that there will be a plan in place to improve leadership and culture, but in places, the estate, particularly at the Royal Oldham hospital, is not fit for purpose. Some of it dates back to its opening in 1870 as a workhouse hospital. There have been improvements since then, but in some places the estate, as a place to manage and organise, is just not fit for purpose. It requires cash investment and I plead with the Minister to make sure that money is made available to ensure that the hospital can be all it can be.
My final plea, which chimes with the points made by my hon. Friend the Member for Heywood and Middleton, is that we all have a duty to be part of the solution to turn the trust round and to make sure that each of the hospitals performs to the best of its ability. We will not do that if all we do is focus on the past. The past is important for context, and in order to get answers for people who have had bad treatment and need those answers, but it is not a foundation for positive progress, which is what the hospitals need. We need to work across parties on this issue—it is beyond party politics—to make sure that resourcing is right and the proper challenge and leadership is in place. That is an open offer, from my point of view, and from that of other Members here today, and I hope it is taken up.
Simon Danczuk (Rochdale) (Ind)
It is a pleasure to serve under your chairmanship, Mr Streeter. I thank my hon. Friend the Member for Blackley and Broughton (Graham Stringer) for securing this very important debate. In many respects it is overdue, but it is also timely, not least because of the recent Manchester Evening News exposé of the trust, and particularly of the maternity units. I put on record the excellent journalism that Jennifer Williams carried out at the Manchester Evening News, which shone a light on the issue and held power to account. That is what journalism should be about.
We have all seen the crisis in the national health service and the suffering that has been caused, the lack of funding and the cuts to social care, but as colleagues have pointed out, this debate is not about funding. It is about leadership, or a lack of leadership, within the trust, which has gone on for quite some time. As others have said, it is about not the leadership of Sir David Dalton, who has just taken up some responsibilities for the trust, but the poor leadership of people such as Gillian Fairfield and indeed John Saxby, her predecessor. They failed to lead the organisation effectively and properly.
We have all read the reports of diverted ambulance services, chronic understaffing and serious incidents going unreported, but as colleagues have pointed out, as MPs, we have also seen behind the headlines. With people coming into our surgeries, we see on a regular basis the real upset and worry that is caused by the failure within the trust.
Last year, I was contacted by Mr Hall, the brother of my constituent Mrs Doreen Malone, who passed away on 22 July. Doreen had diabetes and suffered from kidney disease, and as a result was completely dependent on the local health service. When she fell ill on 20 July, the care she received from Royal Oldham hospital A&E and the North West Ambulance Service was quite simply appalling. I was told by Doreen’s brother that her ambulance was diverted and collected her only after a two or three-hour delay. I was also told that she waited for four hours in A&E, and that she returned home just before midnight without having been seen. Pennine acute’s own assessment acknowledges that
“it was approximately three hours between her arrival and a doctor being available.”
That is
“a longer time than expected for a patient with a priority 3 triage.”
Normally, such cases should be seen within one hour.
Doreen was frustrated with waiting, and had eaten only a sandwich in the space of 12 hours, which is obviously highly problematic for a diabetic. She called her brother to let him know that she was going to visit the infirmary in the morning, and she went home without having been seen. The following day, three police cars, a fire engine and a passenger ambulance turned up at Doreen’s house, because she had been found to be in a critical condition. An ambulance was called at 11 o’clock. Once again, Doreen was left waiting. At 12.15 pm, the ambulance eventually arrived, and she was taken to Fairfield hospital, where she sadly died the following day. Pennine acute attributed the delays to the high number of patients arriving at accident and emergency. This was not during the winter crisis; it was the middle of July. It is no surprise that none of what Pennine acute had to say was of any comfort to Doreen’s family. That tragedy could have been avoided, not least because lessons should have been learned much earlier.
I would appreciate it if the Minister could outline what steps are being taken to hold failing senior managers at Pennine acute to account. What assurances can he give that such people are not able to get jobs elsewhere in the national health service?
Justin Madders (Ellesmere Port and Neston) (Lab)
It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate my hon. Friend the Member for Blackley and Broughton (Graham Stringer) on securing this extremely important debate and on the knowledgeable way in which he introduced the subject. He set out the history of the concerns, which stretch back as far as the establishment of the trust. He made a powerful case about the need to give the people we represent in north Manchester the excellent health service they deserve.
My hon. Friend made the key point, which we should all reflect on, that life expectancy in that part of the world is much lower than in other parts of the country. We all want to see that improve. He said, and I agree, that there is a delicate balance between getting to the bottom of what has gone wrong and creating a credible plan for the trust’s future. I agree that the vast majority of clinicians at Pennine acute are highly committed and professional. He told us that he led a debate on the subject a decade ago. I have read extracts of the Hansard report of that debate, and many of the points that he raised then have been raised again today. We should all reflect on that. It is a completely unacceptable situation.
The hon. Member for Bury North (Mr Nuttall) said that the problems at Pennine acute are not all down to money, and that some of them date back to a time when the NHS was receiving record levels of investment, but I think that some of the staffing shortfalls are finance-driven—the Care Quality Commission report refers to the financial pressures. I agree that leadership is very much an issue, and that a period of stability is required.
My hon. Friend the Member for Heywood and Middleton (Liz McInnes) also spoke about having a period of stability, with great knowledge and experience from her long history of working in the NHS. She said with great eloquence that there seems to be a constant rollercoaster of change. She also pointed out that the trust is undergoing two initiatives, which seem to be pulling it and the staff in slightly different directions. She highlighted very well the anxiety that the staff feel about their future, and said that we need a period of stability. She also highlighted the maternity services’ funding issues, and said that they are dealing with about three times as many births as they receive funding for. If correct, that is an unsustainable situation.
My hon. Friend the Member for Oldham West and Royton (Jim McMahon) also has significant connections with the trust. He described it as a family, but he was right to say that that should not mean that we cannot ask difficult questions about what has gone on. He conveyed how demoralising it is for the staff who work there. He said that leadership is a key issue, as did the hon. Member for Rochdale (Simon Danczuk), who also said it is about capacity and resources. I think we all agree that leadership was lacking in the past, but most Members who spoke were positive about the new leadership.
I, too, pay tribute to everyone working at Pennine Acute Hospitals NHS Trust. As Members said, it is not an easy time for them. It is not an easy time for anyone working in the NHS, let alone for those who work in a trust that has been the subject of such negative coverage. We should be mindful of the fact that the crisis currently engulfing the whole of the NHS would be so much worse if it were not for the good will of the staff who go above and beyond the call of duty every day. As my hon. Friend the Member for Oldham West and Royton said, we should be extremely grateful for the contribution they make. I recognise how difficult it must be to work in a trust such as Pennine acute. As he said, it has sadly been in the headlines all too often for the wrong reasons. It is worth pointing out that the most recent CQC report into the trust rated the leadership inadequate, but rated the care good. Although we are deeply concerned about the reports about the trust, we recognise that the vast majority of staff are extremely dedicated and caring.
No one can read the CQC report or the other reviews that have been published without feeling deeply uncomfortable about what has gone on at Pennine acute. The report should be a wake-up call for the wider health service. It talks about low morale, severe staff shortages and, worryingly, a feeling among staff that until recently the culture focused on financial matters and operational delivery, rather than quality. We hear such concerns across the whole of the health service. I am not for a minute suggesting that the most concerning incidents at Pennine acute will be repeated, but we should recognise that the pressures that we hear about in Pennine acute can be found in many other trusts up and down the country. The history of this matter should act as a warning to us that such problems cannot be ignored and will not be resolved without effective interventions and leadership.
The CQC report made it clear that the issues it outlined are not new. To paraphrase it, they appear to be part of the culture at Pennine acute. As my hon. Friend the Member for Blackley and Broughton said, there is a strong resemblance between the CQC report and a 2005 report by Sir George Alberti, which was very critical of the trust. The only real difference between those reports is that the severity of the criticism has grown. During that decade, there was inaction, patients and staff were let down, and there was a lack of leadership. Although there are concerns about a number of services, the most serious issues appear to be with maternity services, where the CQC said it found
“a poor culture with deeply entrenched attitudes where some staff accepted sub optimal care as the norm…and specific needs were not appropriately considered or met.”
As we have said several times already, this is about leadership. Although it is not right to point a finger at individuals on this occasion, it seems that there have been repeated failures over many years and at many levels, and a failure to drive the changes needed to improve outcomes for patients. I was particularly concerned by the statement that not all reportable incidents were reported on the system because
“there was often no managerial response or feedback.”
The CQC report also says:
“Incidents and risks were not escalated in a timely way or at times not escalated at all; consequently they did not gain robust executive scrutiny or the required response from managers and the senior team.”
Although the report says that only some departments failed to respond correctly, it is deeply troubling that it happened at all. We can see why some of those incidents happened: there was a culture in which reports were not acted upon.
There were other warnings. Between 2010 and 2015, the trust paid the highest number of compensation claims of any trust within the NHS Litigation Authority. As my hon. Friend the Member for Blackley and Broughton said, in one year the compensation totalled £58 million. Compensation levels in maternity claims obviously tend to be extremely high, but no one could claim that those figures did not require further investigation and more action. However, only after the CQC inspection of February 2016 was decisive action taken.
In July last year the Manchester Evening News learned from a whistleblower that an internal review had been carried out into maternity services at North Manchester general and Royal Oldham hospitals. Unfortunately, the newspaper’s requests for a copy of the review were repeatedly sidestepped, until eventually, in August, the trust stated that the review did not exist. It was handed over only after further requests to the trust and the intervention of the Information Commissioner. What does denial of the report’s existence say about the trust’s defensiveness, secrecy and unwillingness to learn from mistakes?
As we have heard from Members today, the report painted a deeply concerning picture of a chronically understaffed service unable to provide patients with the level of care that they deserve. We have heard of incidents such as a mother dying of a catastrophic haemorrhage after her symptoms were attributed to mental illness; a baby who died because staff failed to identify the mother’s rare blood type; and a patient who was left with a colostomy because her condition was missed three times.
My hon. Friend the Member for Blackley and Broughton read out the most distressing of those reports, which was the case of a premature baby. It is incredibly difficult for us to comprehend just how distressing that must have been. I agree with him that that incident was inhuman. We cannot undo that terrible event, but we can do our best to prevent it from being repeated and to ask the pertinent question of why the warning signs, which occurred over a number of years, did not bring about more effective change. Only after the CQC got involved did change begin.
It is also deeply concerning that only the diligence of a single journalist at the Manchester Evening News pushed the issue of the internal review into maternity services. When the Minister responds, will he agree that steps should be taken to unearth the full extent of what happened at the trust, so that we may learn the right lessons for the future?
Members who have spoken in the debate have recognised that the leadership of Sir David Dalton since April has been received positively. The CQC has recognised the improvements made since his appointment. As the hon. Member for Bury North said, even an individual of Sir David’s ability, however, cannot be expected to lead two trusts, as large as they are, as well as carrying out his other responsibilities. I will welcome any comments the Minister might have about the long-term leadership at the trust.
The CCG has, I understand, been able to invest an extra £9 million, but the Government have not allocated any additional funds to the trust, as would usually be the case with a turnaround effort of that nature. The Secretary of State acknowledged that improving Pennine acute would be “incredibly difficult”, but suggested that it was possible after citing the example of the Frimley Health Foundation Trust. According to the Health Service Journal, however, Frimley Health will receive £90 million in revenue support, as well as £130 million of capital funding. Is the Minister therefore satisfied that the trust has the resources not only to maintain services in an incredibly challenging climate, but to drive through the improvements that are clearly needed?
Over the years, many opportunities to turn the trust around have been missed. I hope that the Minister will be able to satisfy us that this is a turning point and that we will not be back here in 10 years’ time with another set of patients and staff who have been let down badly.
The Minister of State, Department of Health (Mr Philip Dunne)
It is a pleasure, Mr Streeter, to serve under your chairmanship in such a well-attended debate. I congratulate the hon. Member for Blackley and Broughton (Graham Stringer) on securing the debate and on encouraging so many of his neighbours, who clearly have an interest in healthcare in the area served by the Pennine trust, to attend and to make such powerful contributions. Everyone has spoken from the heart and with true sensitivity.
As the hon. Gentleman said at the start of the debate, it is difficult to strike the right balance between drawing attention to trusts’ obvious failings, which need to be brought into the public domain and dealt with, and not seeking to lay blame on individuals. We all recognise that the individuals who work in the trust, as we heard so powerfully from the hon. Member for Heywood and Middleton (Liz McInnes), who worked at the trust for many years, give of their best and wish to provide the best possible care for their patients. Often the systems and structures around the individuals can inhibit that good intent.
I applaud the hon. Member for Blackley and Broughton for highlighting some dreadful examples of very poor care in the trust over many years, but especially those that came to light last year. As he well knows, the problems at Pennine go back many years. The trust is 16 years old, as other Members have said. Within three years of its creation, consultants at the trust had passed a vote of no confidence in its then management, as the hon. Member for Heywood and Middleton reminded us.
The hon. Member for Ellesmere Port and Neston (Justin Madders) pointed out that, in the days before the CQC, Sir George Alberti was asked to report on what was happening. Much of last year’s CQC report, however, echoes the findings of the 2005 Alberti report, as the hon. Gentleman said in his constructive contribution. We must try therefore not only to learn the lessons, but to implement them; they clearly have not been in the past few years. I will touch on some key findings of the CQC report before I develop my remarks on what we are doing to respond to the findings and shortcomings.
The CQC report was based on an inspection in February and March last year, which rated the Pennine Acute Hospitals NHS Trust overall as inadequate. In particular, the trust was rated inadequate for safety and leadership. As the hon. Gentleman pointed out, however, it was rated good for care, which is a visible tribute to the quality of care provided by the dedicated staff in the main.
The report found other problems: shortages in nursing, midwifery and medical staff, which have been touched on by other hon. Members; a lack of understanding of key risks at departmental, divisional or board level; problems in services, including in A&E, maternity, and children’s and critical care; key risks were not recognised, escalated or mitigated effectively; and there was inconsistent performance reporting and concern about the quality of data to support performance reporting.
In addition, the CQC identified low morale in a number of services, in particular maternity, and described a poor culture with deeply entrenched attitudes. Regrettably, some staff accepted suboptimal care as the norm, and patients’ individual and specific needs were neither appropriately considered nor met.
Those were the CQC findings. In contrast to what has happened following previous problems and subsequent actions, the new CQC regime is introducing beneficial change—which I hope is recognised by the hon. Member for Heywood and Middleton—and improvement. An inadequate rating by the CQC would normally result in the trust being put into special measures, but in this case a different remedy is being used to turn the trust around and, in particular, to address the obvious challenge of leadership, which almost every contributor to the debate has identified as an historical failing at the trust.
In April last year, the management team of the neighbouring Salford Royal, led by Sir David Dalton and Jim Potter, took over the chief executive and chair roles at Pennine acute on an interim basis. That team is in the process of guiding a management contract for the long term to continue providing the strong leadership needed to drive the improvements that we all recognise. The new management team at the Pennine trust got to work immediately. In July last year, the Salford team completed a diagnostic assessment of the issues facing Pennine and developed a short and long-term improvement programme based on patient safety, governance, workforce, leadership and operational performance.
Debbie Abrahams
Given the Pennine trust’s current position and the staff shortfalls that the Minister has also mentioned, what additional funding support can he offer Pennine acute?
Mr Dunne
I will not be drawn too far down that route at this point, because I would like to develop my overall response. This is not all about funding, as many hon. Members have said. Staff shortages are not necessarily driven by funding either; they are often driven by a trust’s difficulties making it an unattractive place to work. I do not have in my head the number of applicants for vacancies, or the number of vacancies, but I will tell the hon. Lady in a moment how many staff have joined the trust—what increase there has been—under its new leadership.
Debbie Abrahams
Maintained vacancies have caused significant pressure on, for example, middle-grade clinicians in the A&E department. Vacancies have been maintained to try to save money, and that has been a real issue.
Mr Dunne
I am grateful to the hon. Lady for her intervention. I will come on to staff issues in a few moments.
As several hon. Members have said, local political leaders have broadly welcomed Sir David Dalton’s appointment as the chief executive of the Salford Royal trust, which is one of the finest trusts in the country and was one of the first to be rated outstanding by the CQC. He is listening to staff and, where appropriate, deploying Salford’s systems and experience to help to support staff in Bury, Rochdale, Oldham and North Manchester to deliver the high standards of service that we all want. I welcome the support that has been expressed for Sir David’s efforts by everyone who has spoken in this debate, in particular the hon. Member for Blackley and Broughton.
Sir David believes that all the evidence shows that staff are best placed to know what needs to be improved in their ward or department. He has introduced a system—tried and tested in Salford—that involves staff and supports them to test their ideas for improvement. Ideas that are shown to work will be replicated across the whole hospital. That approach turns on its head the idea that people in senior management positions always know what is best for patients on a ward, and instead recognises that frontline staff have expertise in spades and supports them. It will help to develop the culture change that was called for in particular by the hon. Member for Oldham West and Royton (Jim McMahon), who rightly identified that as a fundamental problem in the Pennine acute trust.
As my hon. Friend the Member for Bury North (Mr Nuttall) called for, Sir David Dalton at the beginning of this month introduced new site-based leadership teams in each of the four hospitals. For the first time since the creation of the trust 15 years ago, each hospital site and place-based team will consist of a medical director, a nursing director and a managing director, each dedicated to the daily oversight of that hospital. Together, they will manage the services of a care organisation. That site-based arrangement will give leadership teams a clearer focus and enable them to offer staff better support and engagement and take operational decisions for each site. Those leaders will also have the benefit of being in post on site to strengthen local relationships and promote joint working with other partners in the health economy, including local authorities and commissioners.
The hon. Member for Blackley and Broughton and my hon. Friend the Member for Bury North highlighted poor maternity care. The newly appointed director for women’s and children’s services led an internal review of maternity services under the new management arrangements. That review dug deeper and revealed even more than the CQC was able to. Some of the instances of poor care that were revealed are truly shocking, and I express my sincere regret to everyone affected by those tragic incidents, some of which the hon. Member for Blackley and Broughton highlighted. As an immediate result of those reviews, an improvement plan and a new management team for maternity services have been put in place at North Manchester general hospital. Central Manchester University Hospitals NHS Foundation Trust maternity staff are working alongside Pennine staff to develop a clinical leadership and staffing support programme.
The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) asked about staffing. I am advised that between March 2016, when the new management team came into place, and December 2016, the number of people employed on a full-time or part-time basis by the trust increased by more than 300. I think that is 300 more full-time equivalents. That includes seven doctors, 133 registered nurses and 58 midwives and is a net addition to the trust.
The A&E departments remain under pressure, not least given the winter pressures that have been common across the NHS in the past couple of weeks. That is particularly true at North Manchester, but that department has been stabilised and measures have been put in place to support staff, including direct GP and primary care input into the A&E department from Manchester GPs. Those GPs are supporting the department seven days a week and seeing around 30 patients a day, taking pressure off the service and ensuring that patients see the right professionals and receive the right care. Similarly, the local NHS in Oldham is piloting embedding enhanced primary care support in the A&E and urgent care system. Two GPs a day work between 11 am and 11 pm to support that system.
Measures have also been taken to stabilise children’s services; there has been a temporary reduction in beds at the Royal Oldham and North Manchester hospitals to reflect the workload that staff, given their current numbers, can deal with safely. Those measures are having an impact on turning around the performance of the hospitals in the trust. Additionally—the hon. Member for Ellesmere Port and Neston asked about funding—extra financial support of £9.2 million was secured in year to enable the trust to put in place immediate and short-term measures to stabilise services.
The hon. Members for Blackley and Broughton and for Oldham West and Royton asked about avoidable deaths and the culture of silence when problems arose. The new management have been determined to change that culture. Since April 2016, the trust has investigated and closed down 489 serious incident cases, and the average investigation time has been reduced from 156 days to 90 days. Considerable progress has been made on changing the culture of how problems and complaints are dealt with.
Hon. Members talked about the future and expressed concern, particularly from a staff perspective, about yet another change happening. As all Members are aware, NHS England is in the midst of implementing sustainability and transformation proposals and turning those into plans for 44 areas across the country. Greater Manchester’s five-year plan, “Taking charge of our Health and Social Care”, predates the request for STPs, but NHS England has agreed that that plan meets the STP requirements and they are now effectively one and the same thing. There is, therefore, a real opportunity for healthcare in Manchester, with devolution of control to the council and opportunities for the local authority to work with the NHS to improve services for all the people of Manchester, to become a model for the rest of the country.
The NHS in Manchester has been looking at how acute services can best be organised to deliver benefits, including operational financial efficiency, for quality of care, patient experience and the workforce. As has been said, the proposal is to create a single acute provider for Manchester, with the Wythenshawe hospital and the North Manchester general hospital joining the Central Manchester foundation trust. That is an ambitious proposal, and the organisational change it requires is complex, but we believe that the potential benefits are considerable and offer a real chance for care to be standardised across the city. I know that hon. Members will be concerned about what that means for the Pennine trust. If that proposal proceeds, services at North Manchester general hospital will be combined with those at the other hospitals in Manchester, but the intention is for the remaining hospitals in the Pennine acute trust to continue to work with Salford Royal in a new relationship, which is under active consideration.
Hon. Members mentioned resources for estates. Like any trust, the Pennine acute trust needs better-quality, flexible and fit-for-purpose buildings. I have little time in which to outline what is happening but, as some hon. Members will be aware, construction has begun of a brand new, purpose-built 24-bed community intermediate care unit on the grounds of North Manchester hospital. That unit will cost £5 billion and will take 12 months to build. The Royal Oldham hospital, which includes the old workhouse, is being developed into a high acuity centre to serve the population of north-east Manchester.
Motion lapsed (Standing Order No. 10(6)).