Healthcare: North Staffordshire

Baroness Anderson of Stoke-on-Trent Excerpts

Monday 23rd October 2017 Commons Chamber

[Gareth Snell]

The hon. Gentleman asks the excellent question of what cause we attribute the situation to. I am hesitant to give an answer that points the finger of blame. One reason why north Staffordshire and Staffordshire as a whole have failed to remedy the problem is that there has been a game of pass the buck in determining who is responsible for not achieving what. That means that nobody has taken responsibility. One issue in Staffordshire is industrial disease, which has caused us not to meet A&E waiting times because people who cannot get the secondary healthcare they want present to A&E with their problems. That means that we have missed both the four-hour and 12-hour A&E targets. Although we have met six of the seven targets on cancer waiting times, we are still short on one.

The hon. Gentleman’s question is pertinent because we have a hospital that already has a deficit and has been challenged to make £60 million of savings this year and a further £70 million in the next two years, and North Staffordshire and Stoke-on-Trent clinical commissioning groups have decided that the best way to help that hospital, when it is struggling to meet those targets, is to fine it an additional £10 million. I do not understand the logic of taking a fine of £10 million from an organisation that is already struggling to deliver the services with the cash that it has.

[Ruth Smeeth (Stoke-on-Trent North) (Lab)]

Does my hon. Friend agree that, in spite of all the efficiencies that are being made by the chief executive of our hospital, the reward is that the percentage cuts are deeper at Royal Stoke and University Hospitals of North Midlands than at any other hospital in the country? That is not a reward for the efforts that are being made to provide decent healthcare provision for our constituents.

[Gareth Snell]

I am usually pleased to see Stoke-on-Trent at the top of a leader board, but the one that my hon. Friend highlights is not one that we should be proud to top. She demonstrates the perverse and farcical nature of a funding system that targets those who have the least by penalising them further financially. That will simply compound the problem in the healthcare system in north Staffordshire, which will impact on the wider Staffordshire health economy and cause greater problems for her constituents, my constituents and the constituents of the hon. Member for Stafford.

To give credit where it is due, the Government have offered £530,000 of additional funding to help with the potential crisis this winter. Again, that shows the perverse nature of the funding situation. On the one hand, we are asked to make huge cuts in the tens of millions, yet the Government recognise that the winter will be challenging and offer half a million pounds back. It seems that money is circulated around the system, but those who need it most—the constituents we represent—are unable to get the support they need.

The problems with A&E in Stoke-on-Trent have been compounded by the loss of 168 community care beds at various community hospitals around north Staffordshire. The decision was made by the clinical commissioning group 18 or so months ago to move towards a “My Care, My Way—Home First” pathway, whereby people would be discharged from the hospital straight to their home, without the need for a step-down continuing care facility. We were told that that would revolutionise the way care was provided in north Staffordshire. However, we know that one of the things that is causing delays in our A&E and financial problems in our hospital is that the number of people who are declared medically fit for discharge but are unable to leave an acute bed because no care package is available in the community sector is growing. The hospital will tell us that. Stoke-on-Trent City Council is recruiting more care workers, but the package of care needed for those people is becoming more and more acute, and more and more difficult, meaning that private providers are simply turning away potential patients because they do not see them as profitable customers.

The community care bed scenario highlights what I think is a grave travesty in the way the health sector is now run. The Health and Social Care Act 2012 created clinical commissioning groups. In Staffordshire, we used to have three primary care trusts. They came to the conclusion that working as one cluster was the best way forward; that pooling their resources and working collectively for the greater good of the 1.1 million in our county and city was the way forward. The Health and Social Care Act then created six clinical commissioning groups, who have now decided that the best way forward is to have one accountable officer and to work together for the benefit of the 1.1 million residents who live in Stoke-on-Trent and Staffordshire. I ask the Minister how is it possible that we have gone from a system of three PCTs to one PCT and from six CCGs to one accountable officer for CCGs—with all the money spent on reforming those services—when clinicians, Members of Parliament, councillors and patient groups were telling the Minister and the Government that that was the best way forward?

We now have a situation where NHS England has decided that the original consultation on the closure of those beds was not up to standard and ordered it to be re-consulted on, meaning that 168 community care beds will sit mothballed this winter—not formally decommissioned, but mothballed—while a second consultation takes place on whether they should exist at all. At the same time, the Government recognise that there will be an acute pressure on A&E in Royal Stoke Hospital that requires a half a million pound investment.

[Ruth Smeeth]

Does my hon. Friend agree that one of the most ludicrous parts of the game that has gone on with our community health beds is that the nursing staff who provide the services have been made redundant in advance of the end date of the consultation? Even if the consultation finds that the beds are necessary, the staff have been made redundant in advance of the decision. That is a ludicrous way to treat the workforce.

[Gareth Snell]

My hon. Friend is absolutely right. I could not agree more. As a former trade union official with Unison, I think the way the staff have been treated is simply unacceptable. It is also an additional cost burden. Staff have been made redundant at a cost to the clinical commissioning groups, which may find that the work they were doing is brought back into use if the consultation suggests the beds should exist. Again, I ask the Minister to provide some rationale as to why that is an effective use of public money in a healthcare system that we all agree is overspending and needs to find a way of closing its budget gap.

It is all too easy to point at Royal Stoke Hospital and say, “The hospital is the problem; fix the hospital and everything else will sort itself out”. That is partly true, but there are also issues around our capped expenditure programme. Over the next two years, Staffordshire is being asked to take £160 million out of its broader healthcare economy spending. A sustainability and transformation plan identified a deficit of almost half a billion pounds by 2022, yet the way to deal with that appears to be a disjointed approach to solving little problems in little areas without any reasonable thought about the way forward and how this can be redressed.

I go back to the community care beds. They provided a platform whereby people who were in an acute expensive setting could be discharged, at a point of being considered medically fit for discharge, to a provision that was designed to give them the care they needed before they transitioned to their home, a private care provider or a council-run care facility. That allowed them to make the change without the prospect of them re-presenting, at the expense of the acute system, because they had been discharged too quickly. Again, this is money circulating around a system that is identifiable as waste in many people’s considerations of what waste is, while at the same time it is being manufactured by the decisions of the CCG.

The CCG’s decision on community care beds was referred to the Minister under paragraph 29(6) of the 2013 regulation almost a year ago. Letters from myself and my hon. Friend the Member for Stoke-on-Trent North (Ruth Smeeth), which were countersigned by my hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly), Baroness Golding and the former Member for Stoke-on-Trent South, Mr Flello, have gone unanswered. I have raised the issue here as a point of order and at business questions, and I have asked the Secretary of State directly when we will get that response, but to date we still have had none. That is almost a year of referrals from the two tier 1 authorities and of unanswered parliamentary requests. It is creating an unacceptable level of uncertainty in the economics of the health service in Staffordshire.