NHS and Social Care Funding

Baroness Hayman of Ullock Excerpts

Wednesday 11th January 2017 Commons Chamber

[Sue Hayman (Workington) (Lab)]

The Government say that their success regime for the NHS in Cumbria is about transforming health and social care to create a

“centre of excellence for integrated health and social care provision in rural, remote and dispersed communities.”

That sounds fantastic—it sounds like exactly what we need. If that is the case, though, why are local people are so concerned about the actual proposals that there is a petition for a vote of no confidence in the regime? Why did the Secretary of State himself say earlier in the debate that he has profound concerns about the quality of care in Cumbria?

West Cumbria is set to see rapid population growth, owing to the proposed nuclear new build at Moorside, alongside proposed coal mining and tidal energy projects. There are concerns that none of this is being taken into account. Nevertheless, I shall focus on my particular concerns about the proposals for maternity services and community hospitals.

First, on maternity, the highly skilled and experienced midwives in west Cumbria have told me that the success regime’s preferred maternity option is not their preferred option. The idea behind the success regime is to

“bring more care closer to home”,

with a model that would

“ensure provision of safe, high quality care and provide a first class experience”.

But the midwives ask how that can be achieved through the proposals to change maternity care at West Cumberland hospital when the success regime’s preferred option sees the choice of birthplace removed from hundreds of women and would potentially see severe delays in women and babies receiving life-saving assistance. The clinical outcomes and satisfaction rates at West Cumberland hospital under the current maternity care system are excellent and show that safe, high-quality care is being provided. The proposed changes would bring inequality, preventing fair access to maternity services across the county, and discriminate against west Cumbrian women who would no longer have a choice in maternity care, particularly those who are vulnerable owing to deprivation and social isolation.

The proposals will mean that around 700 additional women will deliver their babies at Carlisle every year, but where will they be cared for? The Cumberland infirmary in Carlisle already struggles with its current workload. West Cumbrian mothers need proper answers on this. In addition, a proposed new garden village is to be built south of Carlisle with 12,000 new homes. How on earth is the Cumberland infirmary expected to cope?

I am particularly disappointed that there is no option in the current consultation document to keep beds at Maryport and Wigton community hospitals. All the proposals remove all the beds at those hospitals. This will be particularly difficult for the relatives of patients who are having end-of-life care, because they may be elderly and have their own medical conditions. With no transport of their own, travelling to visit family members can be particularly arduous.

Both hospitals serve areas with considerable deprivation and very poor local transport links. Patients and families in Maryport may have to travel to the community hospitals or the acute hospitals. Journey times would be long with poor bus links, making it difficult for elderly and disabled people.

The people of Maryport feel very strongly about the changes and have run a passionate campaign to show people involved in the success regime just how much the community hospital means to them and how it is an integral part of the local community. They are deeply upset at the removal of the beds.

It is imperative that all services are delivered as close to people’s homes as possible. This must include the retention of beds at all our community hospitals and the retention of consultant-led maternity services at West Cumberland hospital.

I shall finish with a very personal experience, which relates in particular to beds in community hospitals. Not long before Christmas, my father was taken seriously ill. We managed to get him transferred from the acute hospital to his local community hospital, which was within walking distance of his home. He knew the staff at the hospital, and the district nurse was able to call in to see him. When it became clear that he was at the end of his life, we tried very hard to get him moved home—we had a hospital bed set up in the living room. Unfortunately, the move was not possible. However, unlike the experience of my hon. Friend the Member for Chesterfield (Toby Perkins), my father had a good death in his community hospital. All my constituents should have the same opportunity that my family had. We were able to be with my father at the local community hospital where he knew the staff and the district nurse who came to see him. If we remove palliative care from our community hospitals, we will be making a terrible mistake.

--- Later in debate ---

[Dr Allin-Khan]

Many people who go to A&E know that they should not be there. I have had elderly patients saying to me, “I’m so sorry, doctor, for wasting your time.” But what other option are the Government leaving them? That is what we are debating today. The Secretary of State wants an honest conversation—well, let us have it. Let us talk about the impact that the current state of the national health service, which he has been in charge of for four years, is having on accident and emergency departments and throughout hospitals in this country. Let us talk about rock-bottom staff morale. Let us talk about the breakdown of staff marriages, a rise in depression among staff and the fact that waiting times are not the responsibility of patients. They are not to blame.

Rising waiting times are the Secretary of State’s responsibility, yet he blames them on the number of people going to A&E since the target was set. It is his responsibility to lead a national health service that can meet the needs of its people, but again he pleads innocence. He says that no other countries have such stringent targets, suggesting that it is unfair that we do. The meeting of the A&E target in particular, not watered down but in full, is what establishes the NHS as the best health service in the world, and one that we can, should and would be proud of under a Labour Government. After all, emergency departments’ ability to meet the four-hour target is directly related to the health of the NHS itself. It is simple: more people go to A&E when they have no other options available.

[Sue Hayman]

On those options, the use of A&E in my area of Cumbria is entirely down to the lack of GPs. With so many GPs reaching retirement age, the situation is only going to become more acute. Does my hon. Friend agree that the Government need to tackle this matter urgently?

[Dr Allin-Khan]

I wholeheartedly agree with my hon. Friend. She makes an eloquent point about the lack of GPs and the problems we will face when more retire. Three GPs in my constituency contacted me this week to say that they had been offered jobs that were subsequently retracted due to financial pressures.

The Secretary of State pleads innocence. He says no other countries have such stringent targets. We should not compare ourselves to the worst; we should be leading as the best. The explosion of waiting times is his failure and a sign of the dangerous erosion of one of the country’s greatest institutions. As we saw last week when the British Red Cross had to be drafted in to our hospitals, our NHS is in crisis. Yet instead of listening to doctors and fixing the systemic problems they have created, our Government are repackaging the A&E four-hour target to try to save face and take attention away from the real challenges: the challenge of social care packages not being in place, prohibiting flow through A&E departments; the lack of access to GPs across the country, making A&E the only resort; the chronic underfunding and significant cuts in funding at local authority level; doctors and nurses being forced to miss breaks, as we heard earlier today, and working 14 hours, some without a break, sleep-deprived and unsafe to practise clinical work; and an NHS staff who do not feel supported, encouraged or motivated by the Government. None of these things will be addressed by a watered down four-hour target.

Having spoken to the Royal College of Emergency Medicine, those working on the frontline at all levels, and those who are training our junior doctors, I would like to put forward questions for the Secretary of State to think about. Why has it been decided that the four-hour target will now be downgraded? Who has been consulted on that? Which body said it would be beneficial to patients and A&E staff across the trusts? How will he define major and minor health problems? How are doctors and nurses magically meant to know, at first sight without proper assessment, whether it is a major or minor health problem? Who is responsible if a seemingly minor condition is actually life-threatening? Will it be him? Who will be responsible? How will the Government explain that we will be going back to the days when patients could wait over 12 hours if they were not considered ill enough?

The Secretary of State must recognise the impact of this systemic crisis on A&E rooms across the country in his words and in this decision. In downgrading the target, the Secretary of State does neither, instead placing blame on patients and putting patients at risk. Let me tell it straight: I have been an A&E specialist doctor under a Labour Government and under a Conservative Government. There has been a change under this Government—and for sure it has not been for the better.