(3 years, 6 months ago)
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Mr Philip Hollobone (Kettering) (Con)
What a joy it is to see you in the Chair, Madam Deputy Speaker; thank you for staying for the Adjournment. I thank Mr Speaker for granting me this debate and welcome the Minister to his place. I also welcome my hon. Friend the Member for Corby (Tom Pursglove), who is a superb representative for his constituents, but who unfortunately, as he holds the high office of the Government Whip, is not allowed to speak in this place. I also thank all the staff at Kettering General Hospital, in particular Simon Weldon, the superb group chief executive, and Polly Grimmett, the director of strategy.
I thank the Minister for the personal interest that he has shown over a long period in Kettering General Hospital. He visited the hospital on 7 October 2019. He responded to an Adjournment debate on the hospital on 23 October 2019, when he announced £46 million of new funding for the proposed urgent care hub, and on 3 February this year he met with the hospital and my hon. Friends the Members for Wellingborough (Mr Bone) —who I welcome to his place—and for Corby. I would also like to thank the Prime Minister, who spent five hours on a night shift at Kettering General Hospital in February 2020.
I welcome the Government’s unprecedented investment in the NHS and their commitment to the hospital building programme, which has resulted in promised commitments to the hospital of £46 million for a new on-site urgent care hub, £350 million in health infrastructure plan 2 funding for 2025 to 2030, and a write-off last year of £167 million of trust debt at the hospital. However, promises are one thing and delivery is another. The problem that the hospital faces is that these two funding streams from the Government—£46 million for the urgent care hub and £350 million for the phased rebuild—are not being meshed together by the Health Department and HM Treasury. The danger is that, as a result, the promised investment in the hospital faces potentially serious delays.
The dilemma is this: if the hospital proceeds with the £46 million urgent care hub build as a stand-alone project, there will not be room on the site for the HIP2—health infrastructure plan 2—development post 2025. On the other hand, if the hospital waits for the HIP2 funding, it will lose its £46 million urgent care hub funding commitment, and the urgent replacement for the hospital’s overcrowded A&E may never happen.
I have four main asks of the Health Department and HM Treasury: first, permission for the hospital to draw down on the £46 million urgent care hub funding commitment so that work can start on the initial works required for the project; secondly, permission for the hospital to proceed with the preparation of its outline business case for the HIP2 investment expected after 2025; thirdly, an early advance of £52 million, spread over the next three years, from the £350m HIP2 commitment, so that the urgent care hub can be built not as a stand-alone project, but as the initial part of the phased hospital redevelopment; and, fourthly, that the Secretary of State for Health honours his welcome commitment made on the Floor of the House earlier today, in response to a question of my hon. Friend the Member for Wellingborough (Mr Bone), to meet the three hon. Members for north Northamptonshire to get the issues sorted out. The Secretary of State said: “Nothing gives me greater pleasure than making stuff happen, so I would be very happy to meet…to make sure we can get this project moving as soon as we can.”
Those four asks are not about asking for extra money over and above that which has already been promised. Instead, they outline a sensible, flexible and dovetailed approach to already given funding commitments, so as to maximise value for money for the taxpayer while also ensuring that local people get to see as soon as possible the badly needed improvements to our local hospital, which we have already been promised. Simply put, the problem is this: building the promised urgent care hub is no longer an option on a stand-alone basis. If it is built as a stand-alone project, there would not be enough room on the site for the subsequent HIP2 funding, so the value-for-money solution is to integrate the two funding streams.
Kettering General Hospital is ready to go. It owns the land, so no land deals are required, and no extra public consultation is needed. It has written support from local planners and the regional NHS. It is a phased approach that would deliver visible and real benefits. It is shovel ready and has far lower risks than other hospital build projects. In developing this whole-site plan—integrating the urgent care hub and HIP2 funding streams—the hospital has identified the best way of delivering value for money to get the buildings up and operating, serving local people.
Kettering hospital is unique among the 40 designated hospital rebuilds scheduled to be completed by 2030. First, it already has a Government commitment for a new £46 million urgent care hub. Therefore, its future funding is complicated as it comes from two separate funding pipelines. Secondly, it is ready to go, with an innovative, phased and value-for-money rebuild on land that it already owns, with no planning or consultative hold-ups. Thirdly, it serves one of the fastest growing areas in the whole country. Fourthly, it has one of the most congested A&Es of any hospital in the land, which needs addressing as a matter of urgency. I do not believe that any other hospital in the country has that unique set of circumstances.
Mr Peter Bone (Wellingborough) (Con)
Does my hon. Friend recall that this project in effect started before my hon. Friend the Member for Corby (Tom Pursglove) was elected in 2015? It has widespread cross-party support. If this were a business, without doubt a pre-payment would be made, because it would save money in the end and get things done. Are we just caught in a silo, with the Treasury here and the health service there? They must somehow mesh together.
Mr Hollobone
My hon. Friend is quite right. This is not a difficult problem to solve. It requires a political solution and it requires a decision by Health and Treasury Ministers acting together.
Kettering General Hospital is a much loved local hospital. With 500 beds, it has been on its present site in the heart of the town of Kettering since 1897—that is 124 years. There cannot be many hospitals that have such a record. Most of the residents in the parliamentary constituencies of Kettering, Corby and Wellingborough were born there—as my hon. Friend the Member for Corby was—have been repaired there or, sadly, passed away there. There can be very few local residents who have not accessed the hospital at some point during their lives. It also has a fantastically dedicated, talented and loyal workforce.
The pressure on the hospital is being driven primarily by very fast local population growth. The Office for National Statistics has shown that we are one of the fastest growing areas in the whole country, at almost double the national average. The borough of Corby is the fastest growing borough outside London. In the last census, out of 348 districts across the country, Kettering was No. 6 for growth in the number of households and 31st for population increase, while Corby has the country’s highest birth rate.
Kettering General Hospital expects a 21% increase in over-80s in the next five years alone. The area is committed to at least 35,000 new houses over the next 10 years. That means a local population rise of some 84,000 to almost 400,000 people. The A&E department, which is sized to see 110 people a day safely, now sees up to 300 patients every single day. Every day, 90 patients are admitted to the in-patient wards from A&E, and the hospital expects the number of A&E attendances to increase by 30,000 over the next 10 years, which is equivalent to almost 80 extra patients every day. That is why the promised improvements are desperately needed.
The big problem at Kettering General Hospital is that the A&E department is full. It was constructed in 1994 to cope with 45,000 attendances each year. It now has around 100,000 attendances a year, which is well over 150% of the department’s capacity, and by 2045, 170,000 attendances are expected at the same site. The solution to that pressure is for an urgent care hub facility, costing £46 million, to be constructed on the site. It would be a two-storey, one-stop shop with GP services, 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 our A&E department. All the NHS organisations in Northamptonshire, as well as NHS Improvement regionally, agree that that is the No. 1 clinical priority for Northamptonshire.
The A&E department at the hospital was visited five years ago by Dr Kevin Reynard of the national NHS emergency care improvement programme. He said:
“The current emergency department is the most cramped and limited emergency department I have ever come across in the UK, USA, Australia or India. I cannot see how the team, irrespective of crowding, can deliver a safe, modern emergency medicine service within the current footprint.”
I am glad that the Government have recognised the hospital’s superb business case for this fit-for-purpose emergency care facility that will meet local population growth for the next 30 years. It has been developed with all the health and social care partners across the county so that patients can get a local urgent care service that meets all the Government guidance on good practice, ensuring both that they can get the care that they need to keep them safely outside hospital if necessary, and that if they come into hospital, they are seen by the right clinician at the right time and first time.
In announcing the award of £46 million for the new urgent care hub in the debate on 23 October 2019, the Minister said:
“My officials and NHS England will be in touch with the trust to discuss further details, in order to ensure that funds are released and that work starts on the project as swiftly as possible. I am conscious of the urgency that my hon. Friend the Member for Kettering highlighted.”—[Official Report, 23 October 2019; Vol. 666, c. 31WH.]
That announcement was 20 months ago, and the hospital has still not had permission to draw down that funding. That is why my first ask of the Government is to grant permission for the funding to be drawn down so that the project can start.
I warmly welcome the Government’s inclusion of Kettering General Hospital on the list of 40 hospitals for health infrastructure plan 2—HIP2—funding from 2025. That is important for Kettering, because 70% of the buildings on the main hospital site are more than 30 years old, and there is a maintenance backlog of £42 million. Some 60% of the hospital estate is rated as either poor or bad.
The hospital plan for the redevelopment of the hospital site as part of the HIP2 programme offers a phased approach over a number of years, with the extra ward space provided by this funding to be built on top of the urgent care hub. That is in contrast with a number of other hospitals in the HIP2 programme that are seeking all-in-one-go funding packages. The hospital is not asking for its HIP2 allocation in an up-front £350 million all-in-one-go lump sum. Instead, it is seeking a modular annual funding requirement for what would be a phased and value-for-money rebuild up to 2030. Surely, out of a £3.7 billion national hospital rebuild programme, providing just £6 million to the hospital this year to get the project started and £29 million next year is not beyond the wit of man.
I know that the Treasury is currently completing a commercial strategy for all the hospital rebuilds so as to standardise hospital redesign, secure key commercial efficiencies in procurement across the country and address digital and sustainability requirements. Kettering General Hospital is fully committed to those Treasury objectives. Value for money is extremely important in delivering the hospital rebuild programme across the country, and if Kettering General Hospital’s innovative and sensible approach was matched with sufficient flexibility in applying the relevant funding streams from the Department of Health and Social Care and the Treasury, Kettering General Hospital could be an exemplar hospital redevelopment that others could follow.
I am using this debate to urge the Government—both the Department of Health and Social Care and HM Treasury—to do the sensible thing: dovetail the two presently separate funding streams for Kettering General Hospital so as to not only optimise value for money for the taxpayer but deliver sooner rather than later the urgent improvements at the hospital that all local residents need and wish to see.
The Minister for Health (Edward Argar)
I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate about the redevelopment of Kettering General Hospital. I know that it is an incredibly important subject for his constituents and, therefore, for him. He is nothing if not a strong champion for the people of Kettering, as Ministers forget to their cost. He works tirelessly on not only this but many other local matters.
I should also highlight the interest in and passion for this subject of my hon. Friend the Member for Wellingborough (Mr Bone)—who remains a friend, despite him seeking to slightly pre-empt and constrain me today by asking a question of my boss, the Secretary of State, a few hours ago in the Chamber—and my hon. Friend the Member for Corby (Tom Pursglove). As my hon. Friend the Member for Wellingborough rightly said, due to his elevated position as a senior Government Whip, my hon. Friend the Member for Corby is unable to speak in the debate, but I know from the interactions and conversations I have had with him on many occasions just how passionate he is about this hospital project on behalf of his constituents. I can reassure his constituents that, while he may not be speaking in the debate, I have had many lengthy discussions with him, and I suspect that I will be hearing from him many times in the future—although, hopefully, if I can offer some reassurance to my hon. Friend the Member for Kettering, he may be slightly less vociferous in pursuing me on this matter.
I join my hon. Friend the Member for Kettering in paying tribute to the chief executive and the team at Kettering General Hospital for the amazing work they do. They have worked tirelessly throughout this pandemic for his constituents and those of my hon. Friend the Member for Corby, as they do day in, day out, year in, year out for the people who live in that area. It has been a pleasure to take a very close interest in this matter. As my hon. Friend the Member for Kettering knows through his experience in the House, it is sometimes very difficult to say no to him, which can get Ministers into trouble; he is extremely persuasive.
Turning to the substance of the debate, I am delighted that the rebuild of the Kettering General Hospital part of the foundation trust is part of our plans to build 48 new hospitals by 2030—the biggest hospital building programme in a generation. To kick-start the scheme, Kettering General Hospital NHS Foundation Trust has already received £3.7 million of seed funding to develop its plans for the rebuilding of Kettering General Hospital.
Before I turn to the urgent care hub, my hon. Friend the Member for Wellingborough highlighted that plans for that had been mooted, discussed and possibly even agreed before 2015—before my hon. Friend the Member for Corby and I joined this House. The difference, I would suggest, is that on that occasion there was no budget allocated to the trust. For the urgent care hub, there is a budget allocated to it now, following our announcement in 2019, which followed lobbying by my hon. Friend the Member for Kettering. That funding will help transform the provision of urgent and critical care in this area. As he says, £46 million has been allocated for that project.
My hon. Friend asks why it is that, 20 months on since that debate and that visit—I remember them well and I will turn to them in a moment—the money has not been fully drawn down. This is in no way a criticism, but I would say that that is because of the announcement of the new hospital programme and the fact that the trust has, quite rightly, changed what it would like as a result. Therefore, discussions have had to take place about how those two funding streams can be meshed together. I will turn to that in a moment.
As my hon. Friend mentioned, the urgent care hub and the new hospital that are to be built share a set of common enabling works that have been factored into the new hospital development. As he and his trust have requested, we have shown flexibility and agreed to mesh the two projects together if an appropriate way of doing so, including the funding, can be found. As a result, the trust is seeking to incorporate the urgent care hub delivery into the wider redevelopment of the site. That means that the UCH may now be part of the first stage of building the new hospital, but he rightly highlights how approaching this in a more holistic way than a “phase 1 and 2” approach provides opportunities and synergies for achieving better value for money. He has made that point to me and to others.
On the drawdown of funding, the £46 million is available, subject to business case approvals and how those two funding streams can be meshed together in a single project. On drawing down from the new hospital programme fund more broadly, we have a one-year spending settlement from the Treasury. Therefore, if we wish to start drawing down from future years funding and make commitments, that is a matter for the Treasury and a future spending review. My hon. Friend quite rightly highlights, as I expected he would, the need for a synergistic approach between the Department of Health and Social Care and Her Majesty’s Treasury.
All of the new hospitals that will be delivered as part of the programme, including Kettering, are working with the central programme team, with the support of regional, system and local trust leaderships, to design and deliver their hospital in keeping with this approach. The central programme team and the new senior responsible officer, Natalie Forrest, who joined the team and took over its leadership at the beginning of this year, are working closely with the trust on the new build at Kettering and considering all the options currently on the table. I understand that they have had productive meetings, and I look forward to their having further productive meetings.
The programmatic approach will need to be carefully applied to these proposals, as for any other hospital in the new hospital programme, to see how we can best ensure value for money for the taxpayer through standardisation of design and the use of modern methods of construction, without unnecessarily constraining the ambitions of the trust’s plans, in so far as that is possible. The central team, as I have said, will engage with trusts to maximise the application of these approaches to ensure that the scheme has manageable, realistic and, indeed, affordable costs. Funding discussions for these projects are ongoing, and final amounts will be determined through the established business case and Treasury processes.
To stray slightly from the central theme, as my hon. Friend will know—as, indeed, he said in his remarks—Kettering General Hospital NHS Foundation Trust also received £1 million pounds as part of the £450 million investment to help upgrade A&Es and to help the NHS respond to winter pressures and the risks of further outbreaks of coronavirus. That funding was used to support compliance with social distancing and infection prevention and control at Kettering.
On interactions and conversations with the trust, as I have alluded to, the senior responsible officer, Natalie Forrest, met the trust on 2 March for a bilateral roundtable with its senior leadership team to discuss its proposed plans for the build. I understand that those discussions were productive, and they are ongoing. I, too, met the trust in February, with the SRO, to discuss the plans for a new build at Kettering General Hospital. As my hon. Friend mentions, I was fortunate enough to visit the hospital in September 2019 to see for myself, and to be shown by him at his most persuasive, what the case for investment was. As he mentioned, I also had the pleasure of answering a Westminster Hall debate last October on the need for the urgent care hub being funded and built in Kettering, during which I also had the pleasure of confirming the funding, following on from the announcement and promise made by my right hon. Friend the Prime Minister to my hon. Friend. Today’s debate is probably not the right time to discuss this, but I know that all three of my hon. Friends have highlighted the wider opportunities of combining health and social care for vulnerable adults in Northamptonshire.
Our ambitious programme to build 40 new hospitals by 2030 has confirmed funding of £3.7 billion at this point. That is an important and extremely positive start, but we continue to work with Her Majesty’s Treasury on future funding for the whole programme, including for Kettering, and the profiling of the availability of that funding. That is not the reason I am not, at this Dispatch Box, being gently lured by my hon. Friend into a clear commitment today on firm profiling of financial allocations for Kettering at this stage; rather, it is because deciding the funding level for a project of this scale, at this early stage in the process, before full design, exploration or scoping is complete, would not be the most appropriate approach, although I take his point about, for want of a better way of putting it, the need for speed.
Our experience of Government projects and, specifically, the lessons learned from the early work of the Chancellor’s Project Speed taskforce and from the experts in the Government’s Infrastructure and Projects Authority tell us that confirming funding for large, complex projects too early, before all parties are fully agreed on the future approach, can put the project and its overall cost at risk. I am not in any way questioning the ability of my hon. Friend’s local hospital trust to come up with a costed and extremely effective project plan, but it is important, as he would expect, that we are conscious of the need to ensure that we get value for money and the best outcomes for his constituents.
In conclusion, I pay tribute to my hon. Friend, and to my hon. Friends the Members for Wellingborough and for Corby, for the work they are doing to support the redevelopment of Kettering General Hospital. I know that my right hon. Friend the Secretary of State gave the commitment to my hon. Friend the Member for Wellingborough that he would meet him, and I know that he will honour that. I reiterate my commitment that if any point, on perhaps at a more detailed or granular level, my hon. Friend the Member for Kettering wishes to meet me or the SRO again, I am happy to do that. Perhaps as we see progress made in opening up our country again, I might be able to enjoy the pleasure of returning to Kettering to see him and his hospital trust in person. I look forward to continuing to work with him to making sure that this ambitious and innovative approach to building new hospitals is a success.
My hon. Friend is, rightly, incredibly proud of his team in Kettering. He and his colleagues have done a fantastic job of gently inducting me into quite how fantastic the team are and what is needed to get this project going. It was one of the first visits I made when I became a Minister holding this role, so I have a particular affection for that area—I am an east midlands MP, so I know it well. I hope that we will continue to be able to work hand in hand with his trust, the national programme and Her Majesty’s Treasury to move this programme forward at pace. I know it is what he wants, but most importantly I know it is what his constituents would want and expect of us.
Question put and agreed to.