Worcestershire Acute Hospitals NHS Trust

Tuesday 11th July 2017 Westminster Hall

[Mr Philip Hollobone in the Chair]

15:59

[Rachel Maclean (Redditch) (Con)]

I beg to move,

That this House has considered the future of the Worcester Acute NHS Trust.

It is a great pleasure to be here under your chairmanship, Mr Hollobone. I am grateful for the opportunity to raise this matter, a cause of deep concern and worry for the people of Redditch and the surrounding area.

As this is a day on which health is being discussed in this place, I take the opportunity to pay tribute to the hon. Member for Kingston upon Hull North (Diana Johnson) for her tireless work on behalf of the victims of the contaminated blood scandal. I have a constituent in Redditch who has contacted me, even in my first few weeks of serving as a Member of Parliament, and I know that they and other victims will welcome the inquiry announced today.

The Worcestershire Acute Hospitals NHS Trust caters for a population of between 420,000 and 800,000 people. Referrals from GP practices outside of Worcestershire currently make up 13% of the trust’s market share. That clearly shows that the trust is under immense pressure to provide care to a huge number of widely dispersed people.

I will focus on the Alexandra Hospital in my constituency of Redditch. It serves approximately 200,000 people, is the county’s centre for urology services, and has eight operating theatres, MRI and CT scanners and cancer unit status. It may appear on paper that the hospital is well resourced. However, the Care Quality Commission’s most recent report, published in June this year, rated the Alex and the trust overall as inadequate, which is clearly a highly distressing situation. As a result, the trust is in special measures until further review, a status it has remained in since its initial inspection in November 2015.

Despite that status, I welcome that the trust is rated as good overall for its care. Feedback from patients, their families and friends is exceptionally positive in terms of their being treated with kindness, dignity and respect. My constituents in Redditch have often told me of their great personal experiences at the Alex.

[Nigel Huddleston (Mid Worcestershire) (Con)]

I congratulate my hon. Friend on securing the debate. As a fellow Worcestershire MP, I agree wholeheartedly with her comments. While there are many concerns about our local hospitals, not a week goes by in which I do not get letters and calls from people saying how positive their experiences at them were. While a lot of things need to change, we should also recognise the hard work and dedication of many of the staff, who provide excellent service much of the time.

[Rachel Maclean]

I wholeheartedly agree with my hon. Friend’s remarks. I am grateful to the Minister for his generosity in giving up his time to attend today, but I have some key questions for him. While a number of factors led to the trust being in this situation—the debate does not have the scope to allow me to describe them all—what is important to my constituents is what the Department and other responsible bodies are doing to plan for the future. We want the trust to come out of special measures as quickly as possible.

A related but somewhat separate issue is the consultation on the future of acute hospital services in Worcestershire. The review of services in the trust began in January 2012 when clinicians across Worcestershire raised concerns about whether they could safely deliver services due staff shortages. Those shortages meant that services had to be concentrated and centralised, owing to the provision being too small at each of the Worcestershire hospitals. Initial temporary emergency changes—births, complex emergency surgery, in-patient children’s services, emergency surgery on children and emergency gynaecology moved from the Alex to the Worcestershire Royal Hospital—have now become permanent. Those changes will be the subject of the consultation proposals put to the board of the three Worcestershire clinical commissioning groups for approval tomorrow.

As hon. Members will understand, those two wide-ranging issues when taken together have been highly emotive for my constituents, as well as for Members for the rest of Worcestershire. The “Save the Alex” campaign in my constituency has gained huge community support, and I have nothing but respect for the dedication and commitment of those campaigners, led by Neal Stote and many others, who have campaigned extremely hard for more than 11 years. They have kept the Alex at the forefront of public debate in our area, and I look forward to working closely with them in future in the best interests of the people of Redditch and the whole community.

In their proposals, the CCGs told us that there are not enough staff or local demand to maintain services at the Alex. I understand that the Worcestershire Royal is a busy, modern hospital with an interesting caseload that is attractive to consultants and specialist neonatal nurses who want to develop their skills. I have also learned that the Meadow Birth Centre at Worcestershire Royal is fantastic. Since the transfer of maternity services, emergency C-section rates have dropped from 32.6% to less than 25%, meaning fewer expectant mums being rushed down corridors and more relaxed births. Having given birth four times myself, and having been a National Childbirth Trust worker, I am somewhat of an expert on birth, and I know that local women are fortunate to have access to that wonderful care.

I accept that the Worcestershire Royal provides the safest and best care for the women of Redditch and their babies, but we cannot ignore the fact that Worcestershire is a rural county and that Redditch has a very low level of car ownership. In fact, it is one of the lowest in the country, with one in five Redditch households having no access to a vehicle. Not owning a car or driving will be a cause of great stress in times of emergency, and for those who want to visit loved ones who have just given birth in Worcester, it will present difficulties if travelling with young children in tow. Additionally, I have heard from my constituents that, when they arrive at Worcestershire Royal, the facilities are sometimes not quite set up for their needs.

During the general election campaign, and now as a newly elected MP, I have talked to thousands of local people who have brought up the Alex time and again—I have received numerous messages, emails, phone calls and comments on my Facebook and Twitter channels on this topic. Hon. Members will be able to imagine that, at every door I knocked on, the constituent said, “Let me tell you what the number one issue in Redditch is.” I already knew the answer: the Alex.

One young mum broke down in tears during my visit. She said that she had moved to Redditch specifically for the Alex, and had given birth to her first son there—a young lad who was now four. She suffers from a condition that means she is at high risk when in labour, needing almost immediate access to maternity services or her life would be at risk. She is therefore unwilling to fall pregnant again, even though she would like a second child. I find that situation tragic. While I have reassured her that our West Midlands Ambulance Service is the best in the country and would be able to transport her safely if needed, I would be grateful for confirmation from my hon. Friend the Minister that conditions such as hers have been taken into account in the clinical decision-making process.

Another problem that people raise with me is the rate of growth of Redditch as a town—it grew by more than 7% between 2001 and 2011. There must be something in the water in Redditch, because in 2012 there were 18,800 children, which is more than 22% of Redditch’s total population. It is a young and growing town with a lot of young people and children. On top of that, there are plans for new houses in areas such as Webheath. People are naturally worried that services at both the Alex and the Worcestershire Royal will not be able to cope in future, so I would be grateful if my hon. Friend the Minister confirms that he has considered the projected rise in the population when making decisions on commissioning services in Redditch, which serve the populations of both Redditch and Worcester.

Specifically, will the Minister tell me at what level of population, and births-per-head in the population, he would review maternity service provision in an area? I have also questioned the Secretary of State on that point. Will the Minister commit to call for a review when the population reaches that level? Can he also give examples of comparable areas in the country that have successfully transferred maternity services to a neighbouring town or area, so that the people of Redditch do not get the sense that they are being unfairly singled out? My constituents would particularly like to know why services were centralised in Worcester instead of Redditch, and whether that process was carried out fairly and with all due process.

Another extremely worrying fact is the winter pressures faced in Worcester. The BBC reported in January 2017 that three patients died at Worcestershire Royal over the winter period after waiting on trollies for lengthy periods, which has been quoted back to me many times by residents. I heard, and continue to hear, many stories of people waiting on trollies in corridors for lengthy periods and in dirty conditions. I join my hon. Friend the Member for Mid Worcestershire (Nigel Huddleston) in recognising the dedication of our NHS staff—the hard-working doctors and nurses doing their absolute best in such conditions—but the root cause of this problem lies not with them, but with a failure of leadership that goes back some time. That is not good enough. I call on my hon. Friend the Minister to provide much-needed assurances that robust and effective plans are in place to provide much better care for next winter.

As I previously alluded to, transport to Worcester is of huge concern to my constituents—my hon. Friend the Minister will find it challenging to drive between Worcester and Redditch on the M5 if he is unlucky enough to be stuck in traffic. What assurances can he give me that, if an ambulance providing transport in the event of an emergency transfer from Redditch to Worcester is unlucky enough to be held up in traffic, it will be able to care for a critically ill patient, baby, child or mum in labour? That is a priority for me and my constituents.

Although I am delighted that there is a free shuttle bus from the Alex to the Worcester Royal, I would like the Minister to join me in calling on the responsible authorities to ensure the sustainability and extension of that service. It could then serve more areas by making more stops over the diverse area that our county covers, as well as being more flexible and publishing its services more effectively. A lot of people in Redditch do not know about that valuable service, as I saw for myself when I knocked on doors in the election campaign.

The Minister will understand that one of the most difficult and emotive subjects is the treatment of critically ill children. Given the removal of accident and emergency care services for under-16s at Redditch, can he confirm that the new urgent care centre proposed for Redditch will be staffed 24 hours a day? What type of conditions will be treated there, and which cases will need to be transferred to Worcester? Can he confirm that, if children need to be treated in the urgent care centre, there will be enough fully trained staff to treat children, given that they are mainly serving an adult A&E population? Can he give any idea of the timescale for opening that urgent care centre?

One key problem identified by the CQC was leadership. I am very pleased that the trust has a new permanent leadership team, including a new chairman and a new chief executive. My Worcestershire colleagues—my hon. Friends the Members for Mid Worcestershire, for West Worcestershire (Harriett Baldwin), for Wyre Forest (Mark Garnier) and for Worcester (Mr Walker), and my right hon. Friend the Member for Bromsgrove (Sajid Javid)—and I will meet regularly with the trust’s new chief executive, Michelle McKay, whom I have already met.

I welcome the reaffirmed commitments that the Minister of State, Department of Health, my hon. Friend the Member for Ludlow (Mr Dunne) and the Secretary of State made to me of a £29 million investment in the Worcester and Alex Hospital sites, if the business case is approved this week by the CCG board. I would be most grateful to have more detail on what that will involve, when we will see it and what benefits it will deliver to Redditch.

What conversations has the Minister had with, and what support has he given to, the trust’s leadership team to ensure that the new chief executive can swiftly transition the trust out of special measures? Specifically, can he confirm what conversations his Department has had on the critical issue of staff morale? Low staff morale has in the past led to high staff attrition at the Alex, as I heard at first hand during the election campaign from a number of former and current staff members at the Alex. That has a knock-on effect on service delivery. I know from my experience of running a business that if staff are not happy and do not feel valued, it is impossible to achieve a good outcome in an organisation, no matter how much investment and resources are put into it.

[Nigel Huddleston]

I thank my hon. Friend for giving way again. Does she agree that low morale and any hospital being in special measures has a knock-on effect on recruitment, because people are a bit more reluctant to start or pursue their careers in those hospitals? The challenges that that brings need to be addressed.

[Rachel Maclean]

My hon. Friend touches on the key point of recruitment, which my colleagues and I, and himself, have raised with the new trust leadership. The trust has brought forward some interesting and exciting measures to address that, such as a new Facebook recruitment video. We look forward to seeing how that progresses and delivers more staff into this much-needed trust.

I am extremely grateful for the Minister’s interest in this matter and for being granted the time to discuss it. I am especially grateful for the commitment shown during the general election campaign by his colleague the Minister of State, who visited me in Redditch. I call on him to lay to rest the pernicious rumour circulating in Redditch that our hospital is at risk of further downgrades or even closure. I am aware, as are some of my constituents, of the Naylor report, which contains in its numerous pages—they are too numerous to mention—proposals for selling unused NHS land to build affordable housing for NHS workers. That seems to me to be an eminently sensible suggestion, given the shortage of affordable housing in our country and the need for affordable homes for our public sector workers.

Some of my constituents have found suggestions in the report’s pages—suggestions that I have not personally been able to find, despite assiduous reading over a number of hours, which I can confirm is a great insomnia cure, should the Minister be interested—that the Alex Hospital might be sold off for building land. I would be grateful for his confirmation that no suggestion is hidden in the small print of the report or elsewhere in any Government document that the Alex Hospital faces that fate.

As the Minister has been so generous in attending this debate, I would like him to go further by guaranteeing my constituents that Redditch will have a hospital that serves its population and is fit for the size of the town both now and in the future. Thank you, Mr Hollobone, for allowing me time to make my points. I look forward to hearing from the Minister.

[Mr Philip Hollobone (in the Chair)]

It was a pleasure, and I congratulate the hon. Lady on her address. I call the Minister.

16:16

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Thank you very much, Mr Hollobone. First, I apologise to my hon. Friend the Member for Redditch (Rachel Maclean); the Minister of State, my hon. Friend the Member for Ludlow (Mr Dunne), who is responsible for hospitals, is on the Front Bench in the main Chamber taking part in the important debate on contaminated blood, to which she rightly referred. He has sent me in his place, so I hope I will do.

I will attempt to answer many, if not all, of the questions that my hon. Friend asked in the 15 minutes or so that I have. I congratulate her on securing the debate and on her recent election. I knew her predecessor well, and as she graciously said in her maiden speech, she is some act to follow. She is a lovely person and I hope that she is doing well—I am sure that my hon. Friend is in touch with her.

Most of all, I congratulate my hon. Friend on the way she has tackled this issue in the short time she has been here and brought what she said on the campaign trail into the House of Commons and its various Committees—hitting the ground running would be an understatement. That is exactly why the people of Redditch placed their trust in her, and she is already a credit to them. I was in the House for her maiden speech, so I heard her refer to these issues and to the Alex in great detail. It reminded me of someone not so far from where I am standing now, who came to this House seven years ago and said that the future of Winchester’s hospital would be his priority. I have tried to stick to that, as I am sure she will to hers. I have not seen a family quite so proud as hers, sitting up top to watch her make her maiden speech. I think her children and partner were there, and it was great to see.

I understand that my hon. Friend is deeply concerned about the performance of local health services at Worcestershire Acute Hospitals NHS Trust, which has been in special measures since December 2015. On her first key question, I can reassure my hon. Friend and her constituents that Ministers keep a very—I emphasise “very”—close watch on performance at this trust and all trusts through the role of the chief inspector of hospitals, Sir Mike Richards. The Secretary of State put that in place, and it has made an enormous difference. My hon. Friend will know that, as she was able to join the Minister of State on his recent visit to the Alexandra Hospital during the campaign.

The recent CQC inspection report is clearly of great concern to my hon. Friend and to us, but I understand that the Minister of State was reassured to meet the trust’s new chief executive twice since her arrival from Australia at the end of March. She now has a substantive team in place for the first time in many years, and we know from experience that strengthening the leadership team is a significant step towards taking any trust out of special measures.

NHS Improvement has taken active steps to help drive improvement at the trust. That includes bringing in Birmingham Children’s Hospital, South Warwickshire NHS Foundation Trust and Coventry and Warwickshire Partnership NHS Trust to help address key areas of weakness and provide strategic, mentoring and practical support. An improvement director is also in place. That is the very least we expect, and I am pleased to report that it is happening.

Let me turn now to winter pressures. The Department has agreed to Worcestershire Acute NHS Trust’s bid for £920,000 of capital funding for primary care streaming in A&E. That funding is intended to ensure that the trust has appropriate facilities in place for this winter, and I strongly encourage the trust to spend the funding as quickly as possible, within the constraints of good governance, so that it is ready for when the weather turns.

That capital investment is one part of the urgent and emergency care plan being implemented across the NHS this year to recover A&E performance during 2017-18. The intention of the national plan is to redirect patient activity to primary and community care through GP streaming, GP weekend and evening appointments, and supported discharge and re-ablement in people’s homes. Worcestershire Acute Hospitals NHS Trust will benefit from these efforts to improve performance on delayed transfers of care—DTOC is one of the acronyms I have had to get to grips with in the past three years—as will other trusts.

Let me set the review of acute services, which my hon. Friend rightly mentioned, in the context of the Herefordshire and Worcestershire sustainability and transformation partnership. This represents a landmark attempt to address long-standing challenges to the provision of emergency care across the county, and to ensure sustainable A&E services and all other health services, because—we do not say this often enough—we are one NHS for the long-term future. The review of acute services has been incorporated within the STP, which is right. A draft was published in November 2016 and public consultation ran between January and March 2017. I will briefly outline the proposals.

The revised model would see 95% of patients experiencing no change in the way they access services in Worcestershire and all three of the county’s acute hospitals remaining open. Worcestershire Acute Hospitals NHS Trust would also retain its two A&E departments at Worcester and Redditch and the minor injuries unit at Kidderminster. Worcestershire Royal Hospital would become a specialist centre to support emergency and complex care, and the Alex in Redditch would provide more planned care.

Under NHS England’s proposals, both A&E departments, at the Alex and at Worcestershire Royal, would remain open 24 hours a day. However, due to the transfer of in-patient children’s beds, the A&E at the Alex would be for adults only. Both the Alexandra and Worcestershire Royal Hospitals would have new 24-hour co-located urgent care centres, which would treat adults and children with minor and moderate illnesses and injuries.

I must emphasise that no decision has yet been made regarding these proposals. As my hon. Friend said, the governing bodies of the three Worcestershire clinical commissioning groups will hold a meeting in public tomorrow, when they will each consider the decision-making business case and then make a decision on the recommendations. Depending on the outcome of that meeting—I have a funny feeling my hon. Friend will attend—the next step would be for the trust to go to NHS Improvement for approval of its outline business case. If successful, the next stage would be to commence procurement for the work and to take forward implementation of the clinical model. Suffice it to say, it would of course have to have clinical support in line with the five tests that we and NHS England have now set out for any service change.

I am encouraged to learn that the trust is progressing its plans for a £29 million investment in improved facilities at Worcester and Redditch Hospitals, in addition to the almost £1 million awarded following the Budget to improve patient streaming for those attending A&E. It is proposed that this money should be used to improve the operating theatres at the Alex so that the hospital can be developed into a centre of excellence for planned surgery, to develop a women’s centre at the Alex, to increase the number of beds at Worcestershire Royal, to provide a new children’s outpatient department at the Alex, to improve endoscopy facilities at the Alex and to improve the ever-thorny problem of car parking at Worcestershire Royal. I believe that the Worcester and Redditch are strong contenders for that proposed new investment funding, and my hon. Friend has made an extremely strong case for her constituency.

Let me touch on the Naylor report, which my hon. Friend mentioned—I have quite a lot of reading at the moment, but I will take seriously her advice about the insomnia cure that it provides. I assure her that I am not aware of any plans to dispose of the Alexandra Hospital. It does not propose closing any specific hospitals; it merely refers to where space and land can be released while continuing to deliver services. As my hon. Friend knows, the Naylor review was independent. Its report was prepared for the Department of Health and published in March 2017. As she would expect, my hon. Friend the Minister of State is considering its recommendations carefully and will respond fully in due course on behalf of the Government.

My hon. Friend rightly mentioned staff recruitment and retention, so I will touch on the problems that the trust has faced in recruiting staff, especially at senior levels, and its resulting reliance on interim and agency staff. The trust has a new chief executive and leadership team in place. We have found from the experience of many other hospitals that have been in special measures that low morale and high levels of attrition are usually never about staff commitment; they are about getting the right leadership in place, which is why I place such emphasis on the new chief executive and her team. My right hon. Friend the Secretary of State saw outstanding commitment from the trust’s staff when he visited the Alex and the Royal last month.

Let me turn to my hon. Friend’s concern about maternity services, which always touch the heart strings more than other hospital services. I of course recognise the strength of feeling in Redditch and, in particular, the concern about travel times to Worcestershire Royal. All hospital births in Worcestershire were moved on a temporary emergency basis from the Alex to the Worcestershire Royal in 2015 due to staff shortages. The safety of patients must rightly be our prime concern and I understand that the trust ran extensive recruitment campaigns for additional staff before this temporary decision was made. Worcestershire’s maternity services form part of the review of acute services, which must be right.

The CCGs’ published decision-making business case makes it clear that Worcestershire Acute Hospitals NHS Trust must review the scheduling of its outpatient appointments and operations to take account of patients’ travel needs and individual circumstances, and that the CCGs and the trust should work together with community transport providers in Worcestershire to provide an enhanced transport service between the Alex and the Worcestershire Royal. Decisions regarding those proposals are expected to be made by the governing bodies of the three CCGs at tomorrow’s meeting. I encourage my hon. Friend—I do not think I need to encourage her too much—to support the CCGs to agree a plan at that meeting.

Engagement with staff and local people must continue to influence and refine plans at every stage of the process. That is a key principle in the local reconfiguration of services, and it is dead right that the process is guided by those who best know and understand the local area, which of course includes the clinical support I mentioned.

In conclusion, I totally appreciate the concerns that my hon. Friend has set out so eloquently today, and I commend her once again for her work in such a short time in the House on local healthcare issues affecting her constituents and her own family, as she said in her maiden speech. I encourage her and her constituents to maintain an open dialogue with the local NHS, which they are doing, and I assure her that Ministers will continue to monitor the trust’s performance very closely.

Question put and agreed to.