The Minister of State, Department of Health (Mr Philip Dunne)
It is a pleasure to serve under your chairmanship as Deputy Speaker, Sir David. I hope that that will not necessarily be as temporary as suggested by Mr Speaker when he sought the leave of the House to appoint you. It is also a pleasure to respond to my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), who has been on her toes in securing Mr Speaker’s consent to have this debate so early in the parliamentary Session. I am pleased that she has secured the support of many of her constituents, some of whom have come to witness her championing their interests in relation to Kent & Canterbury hospital. She has done that not just this evening, but consistently over the past few months with our mutual friend Sir Julian Brazier, who is sadly no longer with us in the House. However, I congratulate his replacement, the new hon. Member for Canterbury (Rosie Duffield).
I worked closely with Sir Julian when we were Ministers in the Ministry of Defence, and both he and my hon. Friend the Member for Faversham and Mid Kent have been doughty champions of the population of mid- Kent, particularly those in the areas surrounding Canterbury, in fighting for healthcare services given the challenges that she quite properly describes at Canterbury hospital. I pay tribute to them for that, and they are doing the right thing in ensuring that such issues are brought to Ministers’ attention. I know that she wrote to the Secretary of State only last week, and I am pleased to hear her arguments, which were so eloquently put today. I will say what I can in response to the questions and challenges that she posed, but I must say at the outset that I do not stand here tonight with all the answers to all the questions because, as she will appreciate, many of the things that she is calling for are decisions that will be taken and led by clinicians in Kent. It is not for Ministers to prescribe the provision of services in Kent. Many such decisions will take place over a period of time; it will not be instant decision making.
I will start my response by providing a little context for what has happened over the past few years, and this week in particular. As my hon. Friend pointed out, the board of East Kent Hospitals University NHS Foundation Trust agreed to relocate some services from its Canterbury site, Kent & Canterbury Hospital, this Monday. The change happened overnight from Sunday into Monday and came in response to legitimate concerns raised by both the General Medical Council and Health Education England over a period stretching back to as early as 2014, when they raised concerns about the standard of training available at the Canterbury site, in particular the quality and safety of junior doctor training.
The situation was brought to a head following a visit in March this year. The recruitment and retention of key medical staff has been an ongoing challenge for the trust, and there is a shortage of consultants to provide the required training and supervision of junior doctors posted to Kent & Canterbury hospital. On Sunday 18 June, 38 junior doctors were reallocated from Kent & Canterbury to other sites operated by the trust. The removal of these junior doctors has required the trust to relocate some of the services it provides, to ensure safe and sustainably staffed services for patients.
My hon. Friend’s constituents will still receive good service provision. The clinical commissioning group has facilitated this development by acquiring some 40 additional care packages to support effective discharge from the Ashford and Margate sites, to free up some 75 beds to allow for this temporary service change to take place, along with an additional 20 ambulances, supplied through SECAmb—the South East Coast Ambulance Service NHS Foundation Trust—to cover the additional journey times from the Canterbury area. Replacement services at nearby hospitals in Ashford and Margate are being monitored to ensure that they are safe and effective, given the additional pressure on those hospitals from the move.
Unfortunately, I cannot say today how long this temporary closure will last. The GMC has made it clear that
“if there is evidence that appropriate and sustainable action has been taken to make the Urgent Care Centre a safe environment for doctors in training once more, HEE will review reallocating trainees to the site”.
No decision has been made about the long-term future of the service and no decision will be made without full public consultation. I can give my hon. Friend that reassurance.
Helen Whately
My hon. Friend mentions that there is monitoring of the provision of care for the services that have been moved to William Harvey and Queen Elizabeth the Queen Mother hospitals. May I ask him to take a personal interest in that monitoring? I have heard reports from staff who are really worried about how care is being provided following the transfer of the services. They are very concerned that patients might be at risk.
Mr Dunne
One of my ministerial responsibilities is to support the Secretary of State in having an oversight of trusts that are in special measures. The East Kent trust has been in special measures and is currently in financial special measures, so I take a close interest in what is happening in that trust. In view of my hon. Friend’s request and the events that have happened this week, I assure her that I will take a particular interest to ensure that the existing facilities at Ashford and Margate are up to scratch to cope with the increased demand they will undoubtedly have to manage.
I want to make it clear to the House and to the representatives on both sides who look after constituents in Kent that this issue is about maintaining the supervision of junior medical staff and ensuring that we have safe staffing levels for patients from central Kent; it is not about clinical practice or the competence of the hard-working staff in the hospital. I have been assured that before taking this decision every effort was made to identify appropriate senior staff cover from neighbouring trusts. The challenge has been to ensure that an adequate number of consultants were on duty at Kent & Canterbury hospital to allow junior doctors to have senior colleagues to refer to in the event of issues they felt uncomfortable dealing with. The problem that the trust has had is that it has been over-reliant on locum consultant cover in the hospital and there has been an inability to recruit to substantive posts in the hospital over a prolonged period, which has given rise to this concern on the part of HEE and the GMC that the training conditions for junior doctors were not adequate. That is what has led to this decision, rather than any criticism of the individual doctors or other staff members in the hospital.
I am also assured that the concerns of both HEE and the GMC are being addressed as quickly as possible. That will form part of any public consultation that follows from the development of the STP that is being worked up for the area.
I will not go into any great detail about the specifics of what has happened over the last few days as my hon. Friend the Member for Faversham and Mid Kent has already done so, but our expectation is that this temporary relocation is likely to affect approximately 50 of the 900 patients who visit Kent & Canterbury hospital each and every day. It is important to recognise that there has not been a full A&E unit at Kent & Canterbury hospital since 2005, when services at the trust were reconfigured, and it was established as an emergency care centre. Trauma and general surgical emergency cases had already been sent to sites in Margate and Ashford for some time prior to the recent temporary changes, and I believe it was in 2016 that the emergency care centre itself was turned into an urgent care centre, which again had an impact on services at that time.
I am advised that local NHS leaders have fully explored the risks of temporarily relocating services and have put in place mitigating action and contingency plans when required. The decision has been an exercise in the balance of risk: it is clearly not desirable, and nor is it either common or unique, for the regulators to take action such as this when they have concerns about both patient and staff safety, and it is not a decision taken lightly or comfortably, but the trust has come to the view that the risk to patient safety outweighed maintaining the status quo and seeking to continue with, frankly, unsustainable levels of senior support.
My hon. Friend rightly raised concerns that this might presage a future closure of the site, and I want to try to reassure her: the trust board has been left in no doubt whatsoever that it should not regard this as a step on the road to a permanent solution and that it needs to consider the requirements of the population of mid-Kent in the round when looking at the provision for the future to be undertaken through the STP. The hon. Lady raised a perfectly reasonable concern that the STP horizon of five years is not long enough. If the STP were to consider a more wide-ranging reconfiguration, that absolutely would have to look at the long-term horizon for healthcare provision in the area and not just at meeting the immediate objectives of the next five years.
Charlie Elphicke
I thank the Minister for making this important speech, but may I gently press him on the issue of a new hospital? Is there not a cost-benefit analysis between the efficiency savings to be had from a new, state-of-the-art hospital, which can operate much more efficiently and do much more with much better use of resources, versus the cost in capital? How would the Minister and his Department strike that balance, and can they carry forward a feasibility study to look at the very interesting case being put by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately)?
Mr Dunne
I was going to come on to the suggestion of my hon. Friend the Member for Faversham and Mid Kent about both allocation of capital and the possibility of a new hospital. I was starting to develop the point that this matter needs to be assessed in the light of the overall requirements of the healthcare economy of mid-Kent and the East Kent trust through the STP process. Capital is currently constrained throughout the NHS. As hon. Members will know, in the March Budget we announced a capital allocation of some £325 million over the next three years to support the first phase of STPs. Fairly shortly, we should have made sufficient progress in deciding which of the STP proposals should be supported to secure that capital. Other capital pots are available to the NHS for what we refer to as business as usual, and there are always opportunities for trusts to make capital proposals to the NHS.
Right now, it is not appropriate for me to explain the basis on which future capital allocation decisions will be made. One can look to the recent past to identify some significant new hospital builds that are now in progress. There is currently a significant capital investment not far around the coast from Kent, in Brighton, and there is another closer to my constituency, in Sandwell in Birmingham. Such builds are few and far between, and bearing in mind the kind of major capital investment we are talking about, I think both my hon. Friends from different parts of Kent are arguing for space to undertake a study to consider whether a major build is appropriate to meet the needs of the mid-Kent population.
Generally, as can be identified from the two significant builds that are currently under way, which have been allocated hundreds of millions of pounds of capital each, a certain density of population is required to be served. Such builds are therefore most likely to occur in major cities rather than in less densely populated areas. That said, it is not for me to make suggestions as to what would or would not be appropriate. I urge my hon. Friend the Member for Faversham and Mid Kent to discuss the matter, as I know she has already, with her STP leaders. If there is a desire among Kent MPs and the Kent community to consider whether in future a more holistic approach to satisfying healthcare needs should be taken in the county as a whole, perhaps my hon. Friend should work in conjunction with other hon. Members.
The right forums are the STPs, which are bringing together NHS providers and commissioners from throughout their regions to try to arrange provision to meet the future healthcare needs of their populations. Whether or not my hon. Friend is successful in persuading the STP that a new hospital in Canterbury is the right solution, that is a matter for her to take forward with the STP. Such an effort would carry more weight were it supported by other colleagues from the area.
Helen Whately
It needs to come from the top that, when a bid is put forward that makes the case for significant investment, capital will be forthcoming. That message is currently not coming through and it is deterring people from making that case. It needs to shift.
Mr Dunne
I am conscious that I am close to running out of time, and I want to address the other point my hon. Friend raised, but I will say that capital is allocated by the Department of Health on the basis of the strength of the proposals, which need to meet the criteria on meeting the needs of local populations. That has to be balanced against the amount of capital that is available throughout the country, where there are competing needs.
My hon. Friend also raised the idea of a medical school, which she has discussed with me previously. She is aware of the consultation the Department ran on allocating new medical school places. That consultation has completed and we are considering our response. I am grateful to her for her submission. We wish to encourage some development of new medical schools, but again, that is subject to regulatory approval by the General Medical Council and other bodies. Any universities that wish to establish a new school need to meet the regulators’ criteria. I encourage my hon. Friend to see what progress is being made in that direction.
In conclusion, I again congratulate my hon. Friend on securing this debate and reassure her that I will be taking a close interest in how events unfold in the East Kent trust. I expect we will have an opportunity to discuss this matter again before too long.
Question put and agreed to.