(6 years, 10 months ago)
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Mr Philip Hollobone (Kettering) (Con)
I am very grateful to you, Mr Speaker, for giving me permission to hold this important debate on the Floor of the House, because Kettering general hospital is perhaps the No. 1 issue for local people in Kettering.
This year, Kettering general hospital celebrates its 120th anniversary. It is one of the few hospitals that has been on the same site for 120 years. It is a much-loved local hospital. Thousands of local people have been born there, repaired there and, sadly, died there. Everyone has a special place in their heart for the hospital.
Some serious issues, however, need to be addressed. I welcome the Minister of State to his place to hear those concerns and respond. I am very grateful to him for making a personal visit to the hospital in April to meet the staff, including doctors and nurses, and also to my hon. Friends the Members for Wellingborough (Mr Bone) and for Corby (Tom Pursglove), whom I also welcome to their places in the Chamber. The Minister’s personal attention to Kettering general hospital is noted and much appreciated.
I thank all the staff at the hospital—the nurses, the doctors, the ancillary staff, the managers and the directors—for the wonderful work that they do. It is a massive team effort, with almost 4,000 people working on the site. There are just short of 600 beds in the hospital, and tens of thousands of patients go through the doors every year. Indeed, that is one of the issues that I want to remind the Minister about. Kettering general hospital is located in one of the fastest-growing parts of the country. In the last census, Kettering was sixth out of 348 districts for growth in the number of households and 31st for population increase. Just down the road, I believe Corby has the highest birth rate in the whole country. Thousands of houses are being built each year in Kettering, Corby and Wellingborough, in east Northamptonshire and over the border in Market Harborough, which means that there is growing pressure on the hospital.
The local population is not only growing in size but ageing rapidly. It is wonderful that we are all living longer, but the number of people over 75 in Northamptonshire is likely to go up by 33% in the next five years from 54,000 to 72,000. People over 75 bring with them a wealth of experience, but I think most of them would admit that they are not as young and fit as they used to be, and they require increasingly detailed medical interventions, often for multiple issues rather than just one. That is a real challenge for the hospital to get to grips with.
In the past 10 years, the number of in-patient consultant episodes in the hospital has gone up by 27%. Attendances at the accident and emergency department have gone up by 23% in the past five years, and some 83,000 people a year are now coming through the A&E, which was built 20 years ago to cope with an influx of 40,000 people a year—less than half the number who currently visit. Out-patient attendances at the hospital have risen by almost two thirds in the past 10 years.
Local people increasingly say to all three hon. Members from the area, “We love our local hospital, but what new investment and new facilities are being provided so that it can cope with the growth in the local population?” I ask the Minister that question directly this evening on behalf of those residents.
Our clinical commissioning group is still one of the most underfunded in the country. This year it crept up to 5% below the target funding. It has been worse in the past, but it is still pretty bad. Will the Minister urge those responsible to ensure that health funding is prioritised in areas of rapid population growth such as north Northamptonshire? Without that, we simply will not be able to cope.
The car parking situation at Kettering general hospital is critical, as the Minister experienced at first hand when he was caught in the traffic jam outside the hospital on his visit. It is good news that there will be 240 new spaces in the car park by the end of this November, and although that problem is difficult to fix, it is relatively straightforward compared with meeting the medical needs of the growing local population.
I must stress that, as the Minister will know, the hospital is now in special measures, which is not a happy situation. It is the result of a Care Quality Commission inspection in October, after which the CQC gave the hospital an “inadequate” rating in November, triggering the special measures. There have been a series of unannounced and focused inspections since—I think the last one was yesterday—and we await further news on when the CQC anticipates the hospital might come out of special measures. I welcome the special measures provisions provided by the Department. It is absolutely right to make sure that a hospital in some difficulty receives special attention. If that requires it being labelled “special measures” then so be it, but we must provide the help and assistance that such hospitals need.
It is not all bad news at Kettering general hospital. We must remember that it is treating a record number of local people with increasingly world-class treatments. It is hitting all its cancer targets. Its infection control, having some years ago been the very worst in the country, is now extremely good. The A&E target, which has been among the bottom 10 in the country, is now rapidly improving. I hope that figures to be announced soon will show that it is in the top third of type A A&Es.
My hon. Friends the Members for Wellingborough and for Corby would agree with me that one of the key priorities at the hospital is the provision of an urgent care hub. This is a fairly simple concept that requires funding of £20 million to £30 million. The idea is this: to have on one site, at Kettering general hospital, a one-stop shop for GP services and out-of-hours care, an on-site pharmacy, a minor injuries unit, facilities for social services and mental health care, access to community care services for the frail elderly, and a replacement for the A&E department, which, as I have said, is now more than 20 years old. Those services in a one-stop shop urgent care hub on site would enable the rapid assessment, diagnosis and treatment by appropriate health and social care professionals. Patients would be streamed into appropriate treatment areas to minimise delays and reduce the need for admissions. This is an example of best practice across the NHS and it is what we would like to see introduced at Kettering to relieve pressure on clinicians in the A&E department.
Mr Hollobone
Well, it is very difficult for me to choose, but since our younger and fitter colleague was faster on his feet I am going to give way first to my hon. Friend the Member for Corby (Tom Pursglove).
Tom Pursglove
I am very grateful to my hon. Friend for giving way. I entirely share his sentiment about the importance of developing a new urgent care hub at Kettering. Would he be keen to visit the Corby urgent care centre with me and, I hope, my hon. Friend the Member for Wellingborough (Mr Bone)? Given that this is a first-class facility, clear lessons could be learned and taken forward when we move towards trying to develop the new urgent care hub. It is a class-leading facility that is hugely popular with local people. I would love him to come and visit it with me.
Mr Hollobone
I am very grateful for that most kind invitation. I have visited the urgent care centre and I would be happy to do so again. I offer my hon. Friend my 100% support as he advances the importance of the urgent care centre with local funding bodies. He knows that he can always rely on me to support him in his endeavours. I am happy to give way to my hon. Friend the Member for Wellingborough (Mr Bone).
Mr Bone
I am very grateful to my hon. Friend for giving way to the older and more experienced Member from Northamptonshire. I congratulate him enormously on securing the debate and on how he is speaking so powerfully for Kettering hospital. The one bit of the triangle that is not there is an urgent care centre or minor injuries unit at the Isebrook hospital in Wellingborough. That is part of the plan approved by several Ministers from the Department of Health. I have great trouble getting commissioners to engage with that, but we need it to relieve pressure on the A&E at Kettering.
Mr Hollobone
As so often in this place, my hon. Friend speaks words of great wisdom and insight. He represents his constituents extremely well in repeating that point. The current draft sustainability and transformation plan for Northamptonshire is simply not good enough, because it does not place enough emphasis on developing the facilities my hon. Friend is speaking about. Effectively treating people nearer to where they live so they do not have to come into Kettering general hospital makes sense. It would be better for the patients, it would mean that they received more appropriate treatment closer to home, it would be more cost-effective and it would relieve pressure on Kettering general hospital. I therefore urge the Minister, with the contacts he has with NHS England, to pay close attention to the development of the STP in Northamptonshire, which is not good enough yet. It needs to place more emphasis on primary care, urgent care centres and local facilities, as my hon. Friends the Members for Corby and for Wellingborough have both mentioned.
The A&E department at Kettering general hospital is under huge pressure, the bulk of which comes from the lack of bed space. Ninety-eight per cent. of people who present at Kettering A&E with minor injuries are seen within the target, while 96% of those who are not admitted to the hospital are seen within the four-hour target. However, somewhere between only 60% and 90% of those who require admission to the hospital are hitting the target. The problem is the number of beds occupied by people whose treatment has been completed but who have not yet been moved to rehabilitative or local social care.
There have been problems with that in Northamptonshire, which I have raised before on the Floor of the House. However, I am pleased to say that I understand that closer co-operation between the hospital and the local county council is likely to mean that the better care funds allocated by the Government will be used more effectively, so that people can be moved more quickly out of the hospital and into more appropriate care in their local communities. This is an urgent priority, but I understand that we are about to see some rapid improvement.
Having said that, even if Kettering general hospital does everything right, I have to tell the Minister that I am being told that it has a structural deficit of £10 million a year. That means that even if it does everything right and meets all the targets that the Government set, the way in which the health service is structured in Northamptonshire means that it can do no better every year than to have a deficit of £10 million. In 2015-16 the deficit was £11 million and in 2016-17 it was £25 million. This year it is likely to be £20 million, so things have clearly not worked as they should have, but I have to tell the Minister directly that even if everything worked right, there would be a structural deficit of £10 million, which is clearly not sustainable. That needs to be looked at.
There has recently been a problem with referral to treatment targets. In the past, waiting list data have not been recorded correctly at the hospital. Everyone is agreed about that, and I am pleased that the Care Quality Commission is investigating and has referred the matter to NHS Protect. I think everyone agrees that the data are now being collected correctly, but historically they have been inaccurate, and patients may have been harmed as a result. I therefore ask the Minister directly whether he is satisfied that the issue is being investigated appropriately and that the investigation will be concluded as speedily as possible, so that local people can get to the bottom of what has been a historical problem.
Kettering general hospital is perhaps the most important facility to local people in Kettering. I know that it is important to my hon. Friends the Members for Wellingborough and for Corby as well, and we will not let any opportunity go by in this place without reminding Her Majesty’s Government how important the hospital is to local people. All is not well with the hospital, and these things can be put right. There has been a problem of the chief executive changing too often. We have lost some good people and replacements have not stayed for too long. The Minister has met Fiona Wise, the acting interim chief executive, but she will not be there for too much longer, because a more permanent replacement is being sought. There have also been leadership issues at the hospital in the past, which we need to tackle. The chairman, Graham Foster, is doing his level best—I commend him for his efforts—and there is tremendous team spirit at the hospital. It got extremely good marks in the CQC inspection for the quality of the care that all staff provide to local patients.
All is not well, however, and we need the Minister’s continuing attention to ensure that we can address the issues involved. In particular, will he urge NHS Improvement to prioritise its analysis of the urgent care hub proposals? I understand that NHSI, which used to be called Monitor, has now approved the funding for the preparation of the business case for the hub. That is likely to be submitted to NHSI in September, and I hope that it will be at the top of its in-tray so that we can get a move on with a project that everyone—the Government, the hospital, the patients and the CCG—agrees is the key development that needs to take place if we are to continue the distinguished history of a hospital that has been going for 120 years.
The Minister of State, Department of Health (Mr Philip Dunne)
Let me start by congratulating you, Madam Deputy Speaker, on the resumption of your rightful place in the Chamber. It is a delight to serve under you in what I think is the first Adjournment debate that you have chaired in the new Parliament. I am delighted that you are looking after our proceedings this evening.
Let me also join in the congratulations of all who have spoken in the debate—apart from his usual modest self—to my hon. Friend the Member for Kettering (Mr Hollobone), who has been so gracious in encouraging me to take a personal interest in the hospital in his constituency. He was forthright in inviting me to join him last year when we previously debated the hospital, and I was pleased to be able to take up his invitation. Invitations have been flowing around the Chamber once more this evening from his neighbours, who show a consistent and collegiate approach to managing health issues in their constituencies and Northamptonshire in general.
When I visited Kettering in April, I was delighted to see my hon. Friends the Members for Corby (Tom Pursglove) and for Wellingborough (Mr Bone) taking such a close interest in the primary acute facility serving their constituents. I feel that the area is well represented by its Members of Parliament, who take such an active interest in health.
One thing that disappointed me about the speech made by my hon. Friend the Member for Kettering was the fact that his detailed grasp of the issues confronting the hospital was almost as good as that of the officials who helped me to prepare my speech. I therefore may not tell him too much that he does not know already, but it is a tribute to his perspicacity that he has such a good grip.
My hon. Friend raised a number of detailed issues relating to Kettering general hospital, and I shall try to address as many of them as possible in the time that is available to me. He concluded his remarks by making it clear that his No. 1 priority was to see progress on securing funds for the development of an urgent care hub at the hospital. I am pleased to join him in welcoming the progress that has been made since our debate last October. In particular, the foundation trust has secured funds from the Department of Health, with agreement from NHS Improvement, to enable the production of an outline business case, which, in the NHS approval system, is a necessary precursor of any significant capital investment.
A mobilisation meeting was held only last week to discuss the preparation of the outline business case, which is a welcome development. The initial draft of the outline business case is expected to be shared with NHS Improvement in August. The current intention is for the trust board to approval a final outline business case by the end of the year, provided it is satisfied with the progress that has been made, before a formal submission is made to NHS Improvement. I hope that that gives my hon. Friend some idea of the pace of the process. I am talking about a period of months, but I am afraid that that is the nature of the world we are in. It must be ensured that all appropriate internal procedures are followed correctly in order to give the proposition the best prospect of success.
The business case is intended to create a long-term solution for the hospital: a 10 to 15-year proposition that will take into account the significant increase in house building envisaged in the local plans, and the accompanying population growth to which my hon. Friend referred. In the meantime, the trust has put in place as a temporary facility a modular unit—a Portakabin —which we visited a couple of months ago. The outline business case will include plans to replace it with a permanent structure in due course.
More immediately, I am delighted to join my hon. Friend in welcoming the solution to the current challenge, which was very evident to me when I visited, that faces staff and patients trying to gain access to the hospital. The challenge of finding somewhere to park for anyone arriving by car was such that I had to be plucked out of the queue waiting to get into the car park by the chief executive herself, who had come to find me. Otherwise I might have spent my entire allotted time for the visit trying to get into the car park. The good news, as my hon. Friend has identified, is that work begins next week on the construction of the second level of the car park. The additional tier will provide an extra 240 spaces. I am told that the work will be completed by mid-November, which sounds like pretty pacey progress. This will cost some £1.3 million over five years, and the funding has been found by the trust from its own resources, which is very welcome.
My hon. Friend made reference to various pressures affecting the hospital. NHS England is working closely with the two local clinical commissioning groups to ensure that local care homes, general practices and the ambulance service are supported to care for patients outside the hospital, when that is appropriate. That is designed to help to reduce pressure on the hospital, and it was referred to in the interventions from my hon. Friends the Members for Corby and for Wellingborough.
In the longer term, the draft Northamptonshire sustainability and transformation plan, which was published last December, proposes an early focus on improving the urgent care system to reduce the pressures on A&E. Part of that will include introducing more front-door clinical streaming at Kettering general, with plans to put in place a seven-day discharge capability to help patient flow through the hospital. However, I have heard the comments in this debate about the quality of the STP, particularly from my hon. Friend the Member for Wellingborough. The STPs are being assessed by the Department of Health, and we will be making some comments before the summer recess on their relative attributes. We will see where Northamptonshire comes out in the context of the others.
Tom Pursglove
As part of that work in the Department, will the Minister take away from this debate the significance of the Corby urgent care centre to our local health economy, particularly in the context of how it relieves the pressure on Kettering A&E? Will he also acknowledge that there are significant healthcare needs in the Corby community that that facility helps to address?
Mr Dunne
I was not going to allow my hon. Friend the Member for Corby to leave without passing comment on the Corby urgent care centre, so I shall do that now, as he raised the matter so specifically. As we have heard, the STP does not perhaps place as much emphasis on what is to happen outside the acute hospital setting as hon. Members would like, and I shall take that away.
One of the issues that we need to address is the urgent care centre in Corby. As I understand it, the current service expires at the end of September. A new contract will be let as a caretaker arrangement for the ensuing 12 months to ensure that the existing facility continues, thereby allowing time for the CCG to engage with the public about the future shape of urgent care services in Corby, which will help to inform the development of the STP plan for the long term. The intent is that public engagement will lead to a proposal for an enduring longer-term contract to be procured in the next calendar year—during 2018—which will take into account the additional population around Corby. As we have already heard, the population is extensive around Kettering, but that is not unique to that part of north Northamptonshire. I am reassured by the CCG that the temporary arrangement will continue to provide the highest standards of patient care and safety for Corby’s population. My hon. Friend should not be concerned; this is a short-term contract extension that is facilitating a much longer-term solution.
My hon. Friend the Member for Kettering referred to the better care fund and how services are being provided in the community beyond the acute setting. As he knows, the fund supports programmes not only at Kettering general, but at Northamptonshire general. The better care fund and what we are describing as the improved better care fund—a similar pot of funding for the current financial year—are being used to fund both non-elective admissions and discharge to support at Kettering general, which is aimed at relieving pressure on the hospital.
My hon. Friend mentioned the special measures regime, which was the immediate trigger for my visit in April, the time of the publication of the CQC report that rated the trust as inadequate. I was pleased that he welcomed the introduction of special measures, because they provide an opportunity for focus across the NHS on areas that have been rated as not performing as we would all like. The evidence thus far is that trusts that go into special measures get considerably more attention not only from NHS Improvement, but from right across the NHS and up to a ministerial level. Special measures have a significant impact on improving performance within a hospital. I see that as a positive step, and I was pleased that he welcomed it. NHS Improvement has agreed an initial package of support. It has allocated an improvement director who will be working with the trust from next month. NHSI is also setting up “buddy trust” arrangements with highly rated trusts.