HCRG Care Group: Performance in the South-west
(1 day, 17 hours ago)
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Emma Lewell (in the Chair)
I remind hon. Members that they may make a speech only with the prior permission of the Member in charge of the debate and the Minister. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates. I call Sarah Gibson to move the motion.
Sarah Gibson (Chippenham) (LD)
I beg to move,
That this House has considered the performance of HCRG Care Group in the south-west.
It is a pleasure to serve under your chairmanship, Ms Lewell. I am grateful for having secured this debate about the performance of HCRG in the south-west, and Wiltshire in particular. Over recent months, a growing number of constituents, carers and healthcare professionals have contacted me. I want to open by thanking the staff who have stuck their heads above the parapet and asked their elected representatives to put HCRG’s performance on the Minister’s radar. Some of those staff are sitting in the Gallery, and I thank them for coming.
The communities served by the HCRG contract are diverse: Bath and North East Somerset, Swindon and Wiltshire. Each has its own challenges, demographics and patterns of service use. The issue is not whether one area matters more than another; it is whether local circumstances are properly understood. District nurses covering rural Wiltshire face challenges very different from those of nurses working in more urban areas, yet many of the staff who contacted me feel that those differences have not been properly recognised.
Wiltshire is a large, rural county, where patients can live miles from healthcare facilities. Community nursing teams often spend significant amounts of the day travelling between appointments. Aggregate figures for a large contract area tell part of the story, but they can also obscure local pressures and problems. A successful service model is one that understands those differences and responds to them. I am afraid that I have concluded that HCRG does not understand those differences.
When responsibility for community health services was awarded to HCRG in October 2024, patients were promised more joined-up care, easier access to services and simpler overall experiences.
Will Stone (Swindon North) (Lab)
I also thank the members of staff who have taken the time to come here and put themselves forward. Does the hon. Lady agree that HCRG’s promise of improving services through a single access point has been a historic failure and that, if it does not manage to get back on track, we should look at re-evaluating its contracts?
Sarah Gibson
The hon. Member is absolutely right. There is serious concern about what was promised and what has been delivered. The central part of that vision and delivery was the single point of access. As he has highlighted, that is an attractive idea on paper but the reality is completely different. Constituents repeatedly tell me about the long waits on phones, missed callbacks, referrals that are difficult to track and urgent cases not reaching the right team quickly enough.
Brian Mathew (Melksham and Devizes) (LD)
Does my hon. Friend agree that one of the most disruptive changes for frontline staff and patients has been the loss of dedicated admin support in favour of the so-called single point of access—or SPA—that simply does not work? If HCRG is serious about improving services, restoring adequate admin support for clinical teams must surely be part of the solution. Time spent on admin by clinical staff is time spent away from patients.
Sarah Gibson
I absolutely agree with my hon. Friend and will come to that point. The biggest concern for staff is patient safety, which they have clearly highlighted to us. One Chippenham resident told me they waited an hour to get through to the single point of access, only to be told to expect a callback, which did not arrive until the following day. A constituent from Calne described spending a week making calls, leaving messages and sending emails simply to secure a podiatry appointment. I understand that, in the end, he was so desperate that he just went into the offices, but not everyone can do that. I appreciate that the integrated care board, the commissioner, has the single point of access under surveillance. But as I will return to later, being under surveillance is just not enough for our residents.
Many of the concerns raised with me have come not only from patients but from staff. I have heard concerns about growing caseloads, vacancies, the loss of experienced staff and, as my hon. Friend the Member for Melksham and Devizes (Brian Mathew) mentioned, the reduction of administrative support.
One nurse reported that what had previously been 10 visits per day had increased to approximately 15. Another described seeing 14 patients during a shift that overran by 90 minutes. Staff speak of chronic understaffing, excessive workloads, and concerns about the impact that the pressures are having on patients and the workforce.
Jim Shannon (Strangford) (DUP)
I commend the hon. Lady for securing this debate. The HCRG took over a substantial NHS contract to run the community health service in the south-west of England. I share her concerns about the long delays faced by patients: similar issues have come up in my constituency in Northern Ireland, where the group struggles to provide services due to worker shortages and lack of funding. Does the hon. Lady agree that the ability of private care providers to deliver NHS-contracted services effectively and reliably must be more thoroughly assessed before the contracts are handed out?
Sarah Gibson
The hon. Member is quite right. We are seeing promises not being delivered; whether that is because HCRG is a private service or because of the management of the system is not for me to say. I hope that the Minister will be able to look into the matter.
I personally spend a lot of time in the NHS—not out of choice, but as a patient and a carer for my husband. The frontline staff are fabulous. They go above and beyond to support the patient, regardless of whether that patient happens to be their MP. But as their MP, I do find that the staff tend to approach me in confidence to say that they fear using the formal channels for feedback. Patients and staff working across the community-based healthcare system are raising the same issues with me: delays, difficulty navigating the referral pathway and concerns about whether requests always reach the right clinical team. I think Ministers have a responsibility to take those concerns as seriously as the Members sitting next to me.
Patient safety is my chief concern since HCRG took over. One community nurse described families contacting nursing teams because a loved one approaching the end of life was experiencing severe pain despite being told that help would be available. The nurse reported instances of when no referral appeared to have reached the community nursing team at all. Visits were eventually arranged, but the patient spent several hours without adequate pain relief. A former community nurse separately described trying to obtain additional medication for palliative patients and not being able to get it. Nobody approaching the end of their life should spend hours in avoidable pain because the system is inadequate.
I have also heard concerns about delayed wound care, time-critical medication and urgent catheter issues. One district nurse described attending a patient whose leg wounds had leaked through his dressing. His daughter had contacted the service twice over the weekend without receiving assistance. By the time the nurse arrived, the patient had resorted to wrapping plastic bags around his legs—and I understand that the same problem occurred the following weekend.
The concerns I have received are not limited to community nursing. A physiotherapist working in Chippenham hospital described concerns about the introduction of the new referral system. According to the information, staff noticed that referrals were dropping dramatically under the new system. But when those delayed referrals were eventually identified and processed, clinicians faced a sudden influx of cases, including urgent post-operative patients.
We are talking about knee replacements not being seen in a timely manner, in which case they will end up being re-done. That is a cost for no reason. Clinicians describe patients waiting around eight weeks after knee replacement surgeries, despite the treatment being expected much sooner. The concerns raised are not simply about waiting times, but about the possibility of avoidable deterioration and long-term impacts on recovery. They are not simply administrative inconveniences; they are potentially about patient safety.
I want to touch briefly on wheelchair services. I understand that Wiltshire currently has one wheelchair technician, although it had originally been intended to have four. One constituent from Calne told me that she was supplied with an unsuitable wheelchair without being properly measured. She raised concerns about the difficulty, her safety and the fact that she could not get on to the bus. Despite repeated attempts over months to resolve the matter, she is getting nowhere. Another constituent reported from Chippenham that their replacement battery and updated seating did not arrive, which meant that they were unable to get to college. When repair and maintenance services are not functioning as they should, the consequences for the patient are immediate and profound.
Something that particularly troubled me was a comment made to me by some patients who were no longer bothering to complain because they had become accustomed to the delays and difficulties. Sometimes, the absence of formal complaints reflects a loss of confidence rather than anything else. That is particularly concerning when we think about older patients, disabled patients and those already struggling to navigate a complex health system. The people who find it the hardest to access services are often the people least likely to make their voices heard. That is why scrutiny and transparency matter.
When constituents raise concerns about HCRG services, they expect clear, simple answers. Who is responsible? We have an ICBC contract oversight group that reports to the ICBC collaborative oversight forum. We have the BSW community delivery group, which oversees transformation across the system. We have joint contract oversight groups, quality boards and safeguarding groups that all scrutinise performance, but many of the same organisations sit across multiple levels of that oversight. The integrated care board, the local authority commissions and the HCRG itself are involved throughout that governance structure. The organisations commissioning the contract and managing the contract are also scrutinising the contract—all of them seem to be on the same table. Frankly, even we elected representatives struggle to work out who is accountable.
When everyone is involved in the oversight, it can be remarkably difficult to identify who is responsible for acting when problems emerge. There is a risk that organisations end up marking their own homework, with concerns passing between governance groups rather than being subject to genuinely independent challenge. Patients deserve a system in which responsibility is visible, understandable and transparent from the outset. Where persistent concerns are being raised about access to care, referral pathways and patient safety, it is entirely reasonable to ask whether the Care Quality Commission should take a closer look. We should not worry about independent scrutiny; we should welcome it, because it will lead to improvements.
I would be grateful if the Minister addressed two specific points. First, will she ask BSW’s ICB and the HCRG to publish some comparable pre-transformation and post-transformation performance data that includes call waiting times, callback performance, referral processing times, complaints and patient outcome, broken down where possible to a local level? In that way, patients and parliamentarians will be able to see whether the promised improvements have actually been delivered a year and a half into the contract, despite the fact that the group had six months before the contract started to provide for the transition.
Secondly, will the Minister engage with the Care Quality Commission about a case for further independent scrutiny of HCRG’s Wiltshire services and clarify what further regulatory action may be available if the persistent concerns about access, referrals and patient safety continue, as was referenced by my hon. Friend the Member for Melksham and Devizes?
Patients do not really care how many committees or meetings are called; they want answers. Their concern is whether they are getting the care they need, when they need it.
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairship, Ms Lewell. I thank the hon. Member for Chippenham (Sarah Gibson) for securing this debate and for her well-informed and considered set of proposals about a contract of which I am aware. I will try to address most of her points. The contract was signed just after the general election, but it was on my radar before then, partly as a local MP. As I think the hon. Lady said, there are staff here today, and I am conscious that this remains a concern for staff and some of the trade unions—not least because my hon. Friend the Member for Swindon North (Will Stone) has kept it on my radar. I am absolutely aware of the genesis of the process by which this contract came forward, and I want to make sure that people know that. I will not rehearse it, however; we are where we are now.
As I think the hon. Lady said, now we need to make sure that what was promised is delivered. That is what we all want to see for the people of her community and across the wider ICB. I want to be clear on our general expectations of community services: they are really vital to the left shift, particularly in rural areas. A wide range of services is delivered under that umbrella—from district nurses to services provided by allied health professionals, such as physiotherapy and occupational therapy—for adults and children where they live, in local communities. They also provide really good local jobs.
Those services are vital to supporting our ambitions for neighbourhood health, which is why we set out clear ambitions for them in our medium-term planning framework. For the first time, we have set a target for systems to reduce long waits for community health services: by 2028-29, at least 80% of activity delivered by community health services should take place within 18 weeks, bringing community health services in line with targets for elective care. We have also published guidance outlining the core components of community health services for children, young people and adults that ICBs should provide. That guidance is hugely important for many of the issues that the hon. Member for Chippenham has raised today. We know that there is variation in the services available across the country, and that people are waiting too long to access community health services. That is why this Government are taking action to reduce unwarranted variation, cut waits and improve access to high-quality community services. That is where we want to get to.
Moving on to HCRG Care Group’s performance, as we know, it has taken on the contract to bring together more than 130 community health and care services across the ICB area. It is a large-scale “transformation” programme, as it is called. Since the contract was awarded, the ICB has obviously had to work very closely with it. The ICB is responsible for managing the contract, and I met it in advance of this debate to hear from it as well. As I understand it, the ICB has arrangements in place—the hon. Lady alluded to how many there are—to oversee quality, safety and performance across all those commissioned services, and performance is regularly monitored. I recognise the concerns about delays, callbacks and referrals across the teams, and about getting people through the single point of access. Single points of access have been worked on for many years under many different contracts. Generally, they should do what they say on the tin and actually help people move forward, so HCRG does need to make its work.
I understand that, as a result of some of the issues that have been raised, the ICB is increasing its oversight, bringing together the provider and the system to support improvement. It is really important that that work also brings together patients, carers, the local community, staff and other stakeholders as it develops. The ICB assures me that it remains committed to engaging openly with those communities, with MPs and with Healthwatch throughout the delivery and development of those community services.
Sarah Gibson
Does the Minister agree that the complexity of the oversight system, with the same people in every single one of its groups, does not help staff or patients to feel that there is genuine, independent scrutiny of what is happening? We are getting the same answers from the same people.
Karin Smyth
I will come on to some of that, because it is also tied up with the Health Bill and the things that we are proposing to do for the future. The hon. Lady also touched on one of my favourite subjects: the accountability of local health systems.
The hospital at home services are also important—as it says on the tin—to keep people out of hospital when they do not need to be there and to support early discharge. They remain an important part of the community services offer across Bath and North East Somerset, Swindon and Wiltshire ICB. There have been changes to the service provision and I am assured by the ICB that there are no plans to reduce capacity or withdraw the hospital at home service—I am sure that the hon. Lady will correct me if that is wrong. The ICB is currently undertaking a review of the services following concerns raised, and will continue to monitor the impact of those changes to ensure that safe and effective care is maintained. Again, that is absolutely the direction of travel in that we want to see those services change and improve.
Sarah Gibson
At the risk of delaying her, will the Minister give way on that point?
Emma Lewell (in the Chair)
Order. Will the hon. Member refrain from shouting out, please?
Karin Smyth
Industrial relations are also important. We cannot run a health and care service without good staff who are well supported, nor without maintaining good industrial relations at a local level. That is a matter primarily for the group, its employers and recognised trade unions. The ICB needs to continue to monitor that and go through those established processes for doing so. It needs to keep working with them and we certainly support that at a national level.
On the wider issues about supporting ICB performance, I sympathise. I have spoken many times in Opposition and Government about the frustrations of local Members of Parliament in understanding the very fragmented system left under the Lansley reforms. I appreciate what the hon. Lady is saying from her position in Chippenham, and that may be different from other positions—it is a large geographic area. That is one of the issues that we need to get right. We are working closely on it in the Health Bill, where we are devolving responsibility and accountability for commissioning and providing services at a local level. That is the right thing to do. We also need to get right the link to neighbourhoods and place through local authorities while strengthening health and wellbeing boards. That is the direction of travel in the Bill and what we are currently trying to make happen.
ICBs are held to account nationally for delivering for patients. The oversight framework provides a transparent approach for assessing performance. Another thing that we have changed since coming into power is that from 2026-27 every ICB will be placed in a delivery segment based on national performance measures. That will help to identify when greater support, scrutiny or intervention is needed at the national level. That will be complemented by an annual assessment of how effectively each ICB is discharging its statutory functions. Where performance is falling short, oversight can be increased and support can be targeted at the areas of challenge and, where necessary, formal intervention powers are available. That brings ICBs into line with other providers.
At the same time we are strengthening ICBs’ commissioning capability, partly through the Health Bill. We have the strategic commissioning framework setting out what effective strategic commissioning looks like, and the strategic commissioning development programme provides targeted support to strengthen those capabilities in local systems. We recognise that there is variability across the country. To be clear: ICBs are responsible for assuring the quality, effectiveness and value of the services that they commission, while NHS England oversees the performance of ICBs through the oversight framework, including consideration of how effectively they discharge those commissioning responsibilities.
Finally, we have heard about issues with palliative and end-of-life care. Patients approaching the end of life and those important to them—their closest friends and family—should absolutely receive compassionate, dignified and personalised care in an appropriate environment. That is why the Government are committed to improving access to high-quality palliative and end-of-life care, and to shifting more care from hospitals into the community and, where appropriate, the home. NHS England requires ICBs to commission appropriate palliative and end-of-life care to meet the needs of their local populations. To support ICBs in that duty, NHS England has published statutory guidance and service specifications.
In addition, we are developing a modern service framework for palliative and end-of-life care, which will be a clinically led, evidence-based framework to support sustained improvement in outcomes for patients and carers, including identifying, measuring and reducing health inequalities, and reducing unwarranted variation in access, experience and outcomes.
We continue to work hard to strengthen community care services and shift care closer to home. As the hon. Lady said, what was promised to her population and the wider ICB area must be delivered. All too often, community health services do not get the attention that they deserve, and staff on the ground do not get the recognition that they deserve. This debate has raised some important questions about how we hold organisations delivering and commissioning services to account.
The hon. Lady asked two questions about comparable data. If anyone has not read the transformation and opportunity packs that I sent all MPs last year about their local systems, I recommend that they do that. I will continue to get information on their local systems to them. The hon. Lady probably knows that we cannot compare like for like, but she should have that information; we are getting it on stream. I am happy to write to her with details of what is or might be made available.
The hon. Lady asked about the CQC. As she knows, it is an independent regulator, but I will ensure we write to her about it. I thank her and other Members who contributed to the debate.
Question put and agreed to.