Mid Yorkshire Hospitals NHS Trust

Philip Dunne Excerpts

Thursday 21st July 2016 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

May I start my remarks by saying what a pleasure it is to be here this evening for my first opportunity at the Dispatch Box in my new role at the Department of Health?

I congratulate the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) on securing this debate on a subject that I know is close to her heart and that of her neighbour, the hon. Member for Dewsbury (Paula Sherriff), who it is good to see here supporting her in the Chamber this evening. I congratulate the right hon. Lady in particular on securing this debate, the last opportunity to raise a subject in the House this side of September.

I am well aware that this is a matter of significance to Members of Parliament and obviously to the local populations they represent. I think the hon. Member for Dewsbury recently persuaded the Mid Yorkshire trust to have a public meeting to discuss these issues locally, and I congratulate her on doing that, and hope it was helpful in at least raising some of these issues.

The problem of staff shortages at Mid Yorkshire is well known, and it is recognised not just by local Members of Parliament, but was demonstrated by evidence recorded by the CQC through its inspections over recent years, not just the most recent one. Having said that, there are of course examples of good care within the trust, and I would like to add my voice to that of the right hon. Lady who acknowledged that from the comments of, I think, the Fanshawe family, who pointed out that the quality of care provided by the nursing and other staff in the hospital is very high where they are in a position to do that. I pay tribute to everyone who works in the trust—in the hospitals there—in the admittedly somewhat challenging circumstances they find. I draw attention in particular to the maternity services and children’s services, where the standards are acknowledged to be high.

There is no hiding the fact that there are problems, however, and I am not here to do so. Unsafe care was found in the most recent CQC inspection last summer, published in December last year. That is clearly the most potentially serious of its findings. This is a long way from being a high-performing trust, which is what we would all like our trusts to be. While the CQC report shows the trust had responded to previous staffing concerns and is actively trying to fill posts, there are acknowledged areas of significant nurse staffing shortage affecting patient care and treatment, particularly on the medical care wards and in community in-patient services and specialist palliative care.

The right hon. Lady may not appreciate hearing this, but the fact remains that responsibility for staffing in hospitals in her constituency sits squarely with the board of the Mid Yorkshire trust. Trusts have a duty to ensure they have the numbers and skill mix needed to deliver quality care, patient safety and efficiency, taking into account local factors such as acuity and case mix.

[Yvette Cooper]

But what if there just are not enough A and E doctors or neurology doctors to fill the posts? If they advertise them, charge around the country recruiting for them and they still cannot get the doctors in, what are they supposed to do?

[Mr Dunne]

I will come on to what we are doing nationally to try to make sure we have an adequate number of trained professional clinicians to meet the needs around the country.

It is important to recognise that while nationally some standards are set for safe staffing ratios, which were referred to by the hon. Member for Dewsbury, these are not a hard-and-fast rule and never have been. They are guidance rather than statutory requirements, and this position has not changed. Trusts have to use their judgment and focus on quality of care, patient safety and efficiency, taking into account local factors such as case mix rather than just numbers and staffing ratios. It is not a case of meeting a particular staffing ratio or getting to a particular figure and thinking that the matter is resolved. There must be enough staff—as both hon. Members are saying—to meet the needs of the patients, and it is a matter for the clinicians on the spot to make a judgment on that.

Nationally, demands on our staff across the NHS are rising, and more patients are being cared for than ever before. That is as true of Mid Yorkshire as it is of anywhere else in the NHS. Last year, across the Mid Yorkshire Hospitals NHS Trust, 232,966 patients were seen, compared with 194,119 in 2009-2010. That is an increase of more than 15% over the past six years. There were also some 4,685 more diagnostic tests carried out in May this year than in May 2010. Activity levels are therefore rising considerably.

[Paula Sherriff]

I thank the Minister for his constructive tone in responding to the debate. Does he acknowledge that the significant increase in the tendencies is partly down to a crisis in primary care in the area? That sector is struggling to attract GPs and practice nurses, and people are therefore sometimes attending A&E inappropriately, instead of being seen in primary care.

[Mr Dunne]

It is well recognised across the country that the tendencies in A&E include a significant proportion of people who should not be there and who should be being dealt with elsewhere in the system. The reasons for that are legion; it is not all down to pressures on GPs. Much of it is down to members of the public increasingly seeing their hospital as the place to go. We have a big educational job to do across the country on that, and it behoves all of us to help to relieve the pressure on A&E by encouraging patients to get their health needs seen to in the most appropriate place, whether through a pharmacy or a GP, or through other community services.

I want to touch on the question of funding. It is not all about money, but money plays a part. As a result of the funding settlement that we have secured for NHS England, the Wakefield clinical commissioning group will receive £488.8 million in 2016-17—the current fiscal year—which represents a cash increase of just over 3% compared with the previous year. In cash terms, that is a £21.7 million increase—a significant increase compared with previous years. For North Kirklees, the other CCG that commissions the work of the trust, there was also an increase in the current year to £237.1 million, representing a 2.49% increase compared with 2015-16, or just a shade under £12 million. That increase is substantially greater than the deficit reported by the Mid Yorkshire trust for last year. Of course, the commissioning funds do not all go to the trust, but the health economy in the area has received a significant cash injection.

Ensuring that we have the right number of nurses —I shall start with nurses—is a vital move towards achieving the Government’s objective of having a fully seven-day NHS by 2020. Nationally, we already have 11,800 more nurses, midwives and health visitors than we did in May 2010. The number of nurse training places has increased by 14% over the past three years alone, with further increases planned in the current year. More than 50,000 nurses are currently in professional training, which includes working and learning in hospitals through placements. However, the current funding system means that two out of every three people who apply to a university to do a nursing degree are not accepted for training. That is one of several reasons why trusts such as Mid Yorkshire find it difficult to recruit.

In 2014, the last full year for which I have statistics, universities were forced to turn down 37,000 nursing applicants. As a result, the NHS suffers from a limited supply of nurses and must rely on expensive agency staff and overseas workers, as referred to earlier. That is one reason why, earlier today, the Government announced their response to the public consultation on plans to place trainee nurses in the same system as all other students, including teachers and doctors. That response has been placed in the Library.

[Yvette Cooper]

I thank the Minister for his generosity in giving way. Will he confirm that the reason universities were forced to turn down so many would-be nurses was that the Government did not fund enough places? I realise that he is new to the Department and will not have had a huge amount of time to investigate staffing levels around Yorkshire, but when he goes back to the Department I urge him to look at whether there could be a Yorkshire action plan on recruitment. We have a regional problem that is worse than the national problem—although it will be replicated in other regions.

[Mr Dunne]

I will come to how we will respond when I conclude my remarks, but the right hon. Lady is quite right to point out that the problem is not unique to this particular trust and must be seen in a regional context.

[Paula Sherriff]

I also thank the Minister for his generosity. I just want him to know that the public meeting unfortunately did not go ahead owing to the tragic death of our colleague from Batley and Spen. However, given the staffing crisis and the fact that Mid Yorkshire is still undergoing a significant downgrade programme that will see Dewsbury hospital reduced to a minor injuries unit and many patients having to go to Pinderfields Hospital in Wakefield, will the Minister please reconsider the plans?

[Mr Dunne]

The short answer is yes. I intend to honour a commitment to meet the local trust—I would be happy to facilitate a meeting for the local MPs as well—to talk about the reconfiguration plans that are afoot.

I am conscious that I am in the unusual position of winding up an Adjournment debate at this stage of the parliamentary calendar and in danger of running out of time, so I will turn to the reconfiguration plans before I conclude.

We have to look at staffing issues, wherever they are, and at all the nursing specialisations in the hospital that were referred to earlier in the context of the wider reconfiguration of services currently going on within the trust and the sustainability transformation plans within the region later this year. The reconfiguration is driven by the need to address long-term systemic problems, some of which I touched on earlier. The current service changes were agreed back in 2013 and were supported by the Secretary of State in 2014 following the advice of the Independent Reconfiguration Panel.

Implementation of the agreed service changes at the trust is a matter for the local NHS, which is undertaking detailed work to assess fully the benefits and risks of bringing the changes forward. The process will look primarily at safety and quality, as well as capacity across the system, and will take local stakeholder views into account. Local commissioners will make the decisions about precisely what is to happen, and it is for the local NHS to keep all service change under review in line with its role in ensuring that the services provided are high quality, safe and sustainable. Staffing levels at the trust, particularly in nursing, remain a concern, and are regularly identified by the trust’s regulators and commissioners.

The trust has taken some action to address those concerns, including recruitment of additional nurses and non-qualified support staff as well as strengthening safe staffing policies and increasing board level scrutiny. Clearly, that has not solved the problem, as we have heard so graphically this evening, and more needs to be done.

The trust believes that benefits could be realised in bringing forward implementation of the service changes with improved clinical safety, efficiency and patient flow. I am aware that concerns are being expressed about the knock-on effects of the proposal for changes nearby in Calderdale, of which the hon. Ladies will be aware, and that is currently under consultation.

Change at each of these trusts should not be looked at in isolation, particularly in an area such as this with so many interdependencies and challenging geography and local public transport. Following the meeting of my predecessor, my right hon. Friend the Member for Ipswich (Ben Gummer), with the hon. Member for Dewsbury (Paula Sherriff) and the late hon. Member for Batley and Spen (Jo Cox) earlier this year, he agreed to facilitate a meeting in September with the regulators—NHS Improvement, the CQC and the NHS providers and commissioners. I will undertake to ensure that that meeting goes ahead.

Question put and agreed to.

Healthcare Education

Philip Dunne Excerpts

Thursday 21st July 2016 Written Statements

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am publishing today, following a 12-week public consultation, a Government response on how we will implement the healthcare education funding reforms. A copy can be found online.

The reforms, which are for England only, will mean that from 1 August 2017, all new undergraduate nursing, midwifery and allied health professional students on pre-registration courses will receive their student support through the standard student support system for fee loans and living costs support, rather than course fees and NHS bursaries for living costs paid by Health Education England. These students will therefore be subject to the same general student finance arrangements that apply to other undergraduate students in 2017-18.

Overall, the Government response will set out that the majority of these students, including those with children, will have access to more funds under the student loans system while at university; they will have access to at least 25% more living cost support and we are making additional offers on childcare, travel, dual accommodation and provision, in appropriate circumstances, for exceptional hardship funding.

The Government response also sets out transitional arrangements for pre-registration part time students, pre-registration postgraduate courses and dental hygiene and therapy courses applicable for new students commencing their studies in the academic year 2017-18.

The changes will mean we are able to accept more applicants for pre-registration nursing, midwifery and allied health degree courses who get the right grades than we have in the past. Currently two thirds of people who apply to university to become a nurse are not offered a place for training.

We have responded to feedback from key stakeholders, who took part in a constructive consultation, by providing extra funding to help cover additional expenses like travel and more support for students with children. We will work with nursing bodies, universities, hospitals and other partners in taking this forward.

These changes are only part of our plan to expand the NHS workforce—we are also opening up new routes into nursing support roles through apprenticeships for example, the new nursing associate role to widen access further to these professions. The Government are determined to ensure the NHS can adapt to the changing needs of our population, train more nurses in England and reduce the reliance on agency and overseas staff.

Attachments can be viewed online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-07-21/HCWS126/.

[HCWS126]