King George Hospital, Ilford
Philip Dunne Excerpts(7 years, 5 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
It is a pleasure to serve under your chairmanship, Mr Speaker, and to contribute to another debate introduced by the hon. Member for Ilford South (Mike Gapes). I congratulate him on his tenacity in keeping the subject of King George Hospital at the forefront of Health Ministers’ minds in recent years, not least during my tenure. As he rightly said, he and I had a meeting in February with my former colleague, David Mowat, to discuss many of the issues that he has raised this evening. I therefore hope that he will forgive me if he has heard some of my remarks before. I congratulate the hon. Member for Ilford North (Wes Streeting) on joining us. He obviously has experience of these matters as well, given his role in the local council.
I join the hon. Member for Ilford South in paying tribute to the achievement of all the staff and management involved at Barking, Havering and Redbridge University Hospitals NHS Trust in exiting special measures after what has undoubtedly been a long journey for them over the past three years. I was very pleased that they were able to exit special measures in March of this year. That is a huge tribute to everyone involved in ensuring that they were focused on the areas where the CQC had identified what was not best practice. They have focused on improving the deficiencies, and the fact that they were awarded an “improved” rating enabled us to take the decision we did. I also join him in congratulating the quality of management now substantively in place within the trust, at least one of whose members has himself been a beneficiary of treatment locally; I think it was for a different complaint from the one that the hon. Gentleman was treated for in the intermediate treatment centre. That was a very substantial experience, and all credit to that member of the executive team.
The hon. Gentleman touched on a couple of clouds, as he described them. The first was the intermediate treatment centre, which conducts elective and planned procedures provided by an independent provider, Care UK. As he will appreciate—in fact, this took place under the previous Labour Government, when the independent sector provided capacity to support the NHS in a number of areas—we have had a policy of allowing independent providers to be commissioned to undertake care, and it is a matter for the local commissioners in his area to do so; it is not for me to tell them who are the best providers to be able to undertake care. I am very pleased that he was a beneficiary of some of that care. It will be up to the commissioners, working with the NHS, to decide who is best to provide services in his area as they come up for renewal from time to time.
The hon. Gentleman referred to the social care challenge that exists in north-east London, as it does in many other parts of the country. That is why we decided in the Budget in March this year to inject an additional £1 billion into the adult social care budgets of local authorities across the country and a further £1 billion in the next financial year. Moreover, last week, we announced some measures to scrutinise the performance of local authorities in managing those budgets—in particular, so that they contribute to the patient flow challenge, which we experience in many of our hospitals, including the King George: patients occupying hospital beds in acute settings who have no medical reason to continue to be there, because of the challenge of providing placements in the community. It is important that there is closer integration with social care through the local authorities, but also, as he rightly identifies, through other NHS providers, particularly if they are co-located on the site. He mentioned what he describes as an opportunity for the North-East London NHS Foundation Trust to work alongside Barking, Havering and Redbridge University Hospitals NHS Trust to try to smooth the passage and find other opportunities in the community for more appropriate flow. That is very interesting and I hope he is engaging with the leadership of the sustainability and transformation plan and proposing imaginative ideas, in the hope that they will be assessed appropriately when consideration is given to the provision of the future pattern of healthcare in his area.
The hon. Gentleman focused mostly on the challenge to A&E at King George. I will spend most of the rest of my remarks addressing his concerns as best I can. He will appreciate that, across the country, the NHS is coming together, through the STPs published at the end of last year, to identify the right pattern of care across an individual NHS footprint. North-east London has come together with the STP for that area. Our view is that that is the right way to encourage a more holistic approach to the future provision of NHS services. It needs to be led by clinicians and those responsible for managing NHS organisations, and it needs to work in a collaborative and perhaps more open way than it has in the past with local authorities, which have a part to play, as I have said, in facilitating the passage beyond hospital and back into the community.
We are absolutely clear that any significant service change that arises out of the implementation of STPs, if they get to that stage, must be subject to full public consultation, and proposals must meet the Government’s four reconfiguration tests, which are support from clinical commissioners, clarity on the clinical evidence base, robust patient and public engagement, and support for patient choice. Additional NHS guidance means that proposed service reconfigurations should be tested for their impact on overall bed numbers in the area, which the hon. Gentleman has identified appears to be absent from the STP at present. I urge him to continue to challenge that in his area.
Wes Streeting
Will the Minister clarify whether he expects the STP process to now publicly consult on any future proposal to close the A&E at King George Hospital? Furthermore, were the STP to recommend to Ministers that the A&E should remain, will they heed that advice and agree that the STP process should not be constrained by the decision made in 2011by the then Secretary of State?
Mr Dunne
I am going to have to disappoint the hon. Gentleman, because I am not in a position to second guess the conclusions of the STP discussions and recommendations. It is appropriate for them to take into account clinical decisions made in the recent past, one of which is the decision about the A&E at King George. It is up to the STP management to decide whether to take that forward as the STP evolves. It is right that the STP management looks at health provision in the round. It will be responsible for delivering healthcare to local residents and it needs to take into account all the information sources available to it. I do not think it is right to say that it necessarily has to re-consult on certain issues. It needs to form a view on the right configuration and then use its available data sources and go through the processes.
I will try to explain to the hon. Gentleman the process that, as I understand it, is now under way in his area. Both hon. Gentlemen are right to say that, in 2011, on advice from the independent reconfiguration panel, which approved the proposal, the then Secretary of State took the decision that the north-east London scheme should be allowed to proceed. The Secretary of State made it clear at the time—it has since been repeated in response to questions about the health authorities in the area—that no changes were to take place until it was clinically safe to do so. I believe that remarks that the Secretary of State might have made when visiting the area recently must be considered in that context.
There have been a number of changes since the decision was made, and there are four elements to the process. First, the STP team is reviewing and revalidating the modelling used back in 2010 to ensure that the proposals that were made remain appropriate, as one would expect the team to do. Secondly, the governing members of the CCG board, the trust board and the STP board will need to agree the business case that arises from the STP recommendations. Thirdly, if that is achieved, NHS England and NHS Improvement will be required to approve the business case. Finally, it is envisaged that a clinically led gateway assurance team—an NHS construct —will manage a series of gateway reviews at different stages of the process from planning to implementation, as the project proceeds, to assure system readiness and patient safety at every step of the way, should the decisions necessary to get there be taken in the intervening period.
Mike Gapes
Does the Minister think that the whole process could be completed by 2019?
Mr Dunne
I will have to disappoint the hon. Gentleman, because it is not for me to prejudge how long the process would take. In all honesty, I think it is most unlikely that it would be completed in less than two years. It is conceivable that it would be concluded by the end of 2019, but a two-year process is likely to be required as a minimum.
In the meantime, CQC visits and reports will continue on a routine basis. Now that the trust is out of special measures, those visits will be somewhat less frequent than they were while the trust was in special measures. Any information coming out of that process will inform decisions taken by the trust and the STP area.
In my final comments, I want to reassure the hon. Gentlemen and their constituents that the proposals include a new urgent care centre at King George Hospital to provide emergency support to local residents for the majority of present A&E attendances. Blue-light trauma and emergency cases requiring full support from emergency medical teams would be taken to other hospitals in the area, but the majority of cases currently treated at King George would continue to be treated there. The new urgent care centre would benefit from several improvements, including more space and access for diagnosis, X-ray, blood tests and so on. I hope that that gives the hon. Gentlemen some reassurance that the facilities that remained at King George would continue to provide the majority of their constituents with the care that they would need in an emergency.
Wes Streeting
Is the Minister saying that the STP process should not be constrained by the 2011 decision if those in charge of the process think that that was the wrong decision?
Oral Answers to Questions
Philip Dunne Excerpts(7 years, 5 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
Health Education England is responsible for meeting the workforce requirements of the NHS in England. The number of dermatologists in the NHS continues to grow, with 18% more consultants and 13% more doctors in training since May 2010. HEE’s latest workforce plan shows a 2% increase in funded training places for dermatologists compared with the previous year. Dermatology remains a popular choice for doctors, and it typically enjoys 100% fill rates.
Rebecca Pow
I am pleased to say that, through a combined approach by the clinical commissioning group and Musgrove Park hospital in my constituency of Taunton Deane, it has been possible to prevent the long-term closure of the dermatology department and to put in place an interim service, with a full service reopening in 2018. Given the seriousness of the conditions of people coming through this department—including an increasing number of cases of skin cancer—will my right hon. Friend give further assurances about how we can ensure there is a sufficient supply of specialists in this area?
Mr Dunne
I know that my hon. Friend has campaigned actively to ensure that dermatology services at Musgrove Park hospital in her constituency have been retained following a consultant retirement, which prompted the temporary arrangements. I am pleased that, since the beginning of April, Somerset CCG has successfully commissioned regular dermatology clinics at Musgrove Park using specialists from Bristol, with a view to restoring a full service from next April. We recognise the important service that dermatology clinics provide and are committed to encouraging that specialty in Somerset and nationally.
Mr Ben Bradshaw (Exeter) (Lab)
Dermatology is one of the specialisms that is particularly dependent on doctors from other EU countries. Is it not becoming clearer by the day, whether on the staffing crisis in the NHS or the threat to our pharmaceutical industry highlighted by the Health Secretary in his letter today, that the extreme hard Brexit being pursued by the Prime Minister is disastrous for our NHS? What are the Minister and the Secretary of State doing to pull the Prime Minister back from that damaging course?
Mr Speaker
Order. In relation to dermatologists is, I think, what the right hon. Gentleman had in mind.
Tom Brake (Carshalton and Wallington) (LD)
4. When he last discussed the future of St Helier Hospital with the Epsom and St Helier University Hospitals NHS Trust.
The Minister of State, Department of Health (Mr Philip Dunne)
The Secretary of State recently met the chief executive of Epsom and St Helier University Hospitals Trust and was impressed by the fantastic work staff are doing despite the surroundings and facilities, which are clearly in need of improvement, for which the right hon. Gentleman has been campaigning. Any significant service change must be subject to consultation with local people, be based on clinical evidence, consider patient choice and have support from GP commissioners.
Tom Brake
Indeed the Secretary of State did visit the hospital on the first day of the election campaign—nothing suspicious about that timing. The Minister will have heard that 43% of the estate is unsuitable for the delivery of modern healthcare yet, thanks to the hard work of staff, St Helier is one of the few hospitals that manages to keep on top of A&E waiting time targets. Would he like to be the bearer of good news and confirm that the Government will reinstate the £219 million that the Secretary of State cancelled to enable a new hospital to be built?
Mr Dunne
As the right hon. Gentleman knows, the south-west London sustainability and transformation plan area is in the process of turning its proposals into plans, with public consultation when appropriate. It has yet to make any recommendations. As he knows, it set up four local transformation boards to consider how best to transform services, including at both Epsom and St Helier hospitals, for the decade beyond 2020. It would therefore be wrong for me to prejudge those conclusions at this stage.
Paul Scully (Sutton and Cheam) (Con)
Rather than having empty political campaigns, does my hon. Friend have a sympathetic ear for an alternative, well thought-out plan for healthcare in Sutton which works clinically and financially and listens to all residents in Sutton?
Mr Dunne
My hon. Friend is right. We need to look to the proposals coming from the clinicians on the ground who are responsible for running acute services for the whole of south-west London. They have made it clear that they intend to consult the public once they have made their recommendations transparent. They intend to retain all five hospitals but to look at the configuration of services among them, and that needs to be led by clinicians.
Bridget Phillipson (Houghton and Sunderland South) (Lab)
5. What assessment he has made of the adequacy of the number of GPs.
Mr Marcus Fysh (Yeovil) (Con)
6. What steps are being taken to broaden routes into nursing.
The Minister of State, Department of Health (Mr Philip Dunne)
Developing new routes into nursing is a priority for the Government. That is why we launched, as the Secretary of State set out, both the new nursing associate role and the nursing degree apprenticeship earlier this year. They will open new routes into the registered nursing profession for thousands of people from all backgrounds and allow employers to grow their own workforce from their local communities.
Mr Dunne
Health Education England’s “Workforce Plan for England” for 2016-17 indicated an increase of more than 3% in the number of mental health nurse training places. It stated:
“The current level of mental health nurse training is the highest of any nursing branch as a percentage of the workforce it serves”,
which should allow for an increase of some 22% to more than 8,000 full-time equivalent staff members in the mental health workforce by 2020.
Wes Streeting (Ilford North) (Lab)
The fact is that when the Government chose to charge students record levels of tuition fees and scrap their NHS bursary, the Secretary of State and his Ministers were warned that that would lead to a fall in the number of applications, and what has happened since then? The number of applications for nursing degrees has fallen by 23%. Given that the Secretary of State has already acknowledged that we cannot continue our over-reliance on EU staff following Brexit, when will Ministers understand that the biggest challenge facing nursing recruitment is not our policy on the EU, but the Government’s own health policies?
Mr Dunne
The hon. Gentleman is right to draw attention to the fact that we continue to have a surplus of applicants for nursing degree courses in this country. The level of that surplus has fallen somewhat as a result of the change in funding structures. We shall have to see where it ends up, because at present universities are not recruiting directly outside the UCAS system, but we are confident that there will be more applicants than places this year by a ratio of some 2:1.
Jim Shannon (Strangford) (DUP)
Does the Minister agree that there are opportunities for more mature students to gain access to courses easily, and that more work must be done with adult learning institutions to provide courses that allow such direct access?
Mr Dunne
The hon. Gentleman is right to point out that the more mature workforce, particularly people resuming careers later in life—perhaps, in the case of women, after they have had children—is an important source of experienced professionals, and we need to do more than we have been doing to try to encourage such people to return to the workforce.
Jeremy Lefroy (Stafford) (Con)
7. What steps he has to secure the future of accident and emergency departments.
Paula Sherriff (Dewsbury) (Lab)
11. What steps he is taking to reduce the number of children admitted to hospital for dental surgery.
The Minister of State, Department of Health (Mr Philip Dunne)
Public Health England leads a wide-ranging programme to improve children’s oral health. Its oral health strategy, which was published last year, showed a marked improvement across the country in the proportion of children with no obvious tooth decay—it rose from 69% in 2008 to over 75% in 2015. NHS England is finalising plans for the “Starting Well” programme, which will operate in 13 high-needs areas to improve the oral health of under-fives.
Paula Sherriff
Prevention and early intervention are crucial, but no NHS dentists are accepting new patients in Dewsbury, which has the second-worst provision in the country. Children in Dewsbury have five times the national average level of tooth decay. I have asked for help on this for two years, but absolutely nothing has been done. Can you tell me why the dental health of children in Dewsbury is so unimportant to this Government?
Mr Speaker
I cannot, but I hope that the Minister can—preferably rather briefly.
Mr Dunne
I will try, Mr Speaker.
NHS England recognises the significant challenges in dentistry in Yorkshire, which was why it ran a pilot scheme from January until the last week of June to improve access to primary care dentistry in the Bradford City, Bradford Districts and North Kirklees CCG areas. The pilot will inform the wider work that the NHS is considering across Yorkshire.
Mr Speaker
New Members probably will not know that the hon. Gentleman is a dentist.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
13. What assessment he has made of the consistency and quality of GP services in (a) Newcastle and (b) England.
Nic Dakin (Scunthorpe) (Lab)
15. What steps are being taken to ensure that NHS Improvement provides timely and effective support to health communities to deliver consistently high-quality care.
The Minister of State, Department of Health (Mr Philip Dunne)
NHS Improvement offers tailored support to the organisations it oversees, particularly those that have gone into special measures as a result of a Care Quality Commission review. The Department, of course, has responsibility for holding NHS Improvement to account, and it does that through me.
Mr Dunne
We are clearly disappointed that Northern Lincolnshire and Goole NHS Foundation Trust has gone back into special measures. It is one of a very small number of trusts that have emerged from special measures and then reverted, so this is something in which we are taking a lot of interest. NHS Improvement has appointed an improvement director and is in the process of arranging for a nearby buddy trust to provide some support. I assure the hon. Gentleman that the Department is receiving weekly updates.
Bridget Phillipson (Houghton and Sunderland South) (Lab)
T1. If he will make a statement on his departmental responsibilities.
Edward Argar (Charnwood) (Con)
T4. Leicester and Leicestershire MPs, irrespective of party and led by the hon. Member for Leicester West (Liz Kendall), are united with local people, patients and medical professionals in opposition to NHS England’s badly thought out and, frankly, wrong proposals to close Glenfield hospital’s children’s heart unit. Can my right hon. Friend reassure me that he continues to appreciate the strength of feeling on this issue and that he will ensure that the eventual decision reflects the responses received to the consultation?
The Minister of State, Department of Health (Mr Philip Dunne)
My hon. Friend and other Leicestershire MPs have made their views very clear to me. I hosted a number of them, from both sides of the House, to discuss this issue. He is aware that the public consultation on congenital heart disease services continues until 17 July. Obviously, we will take all the comments made into account when we come to the conclusions from that report.
Barbara Keeley (Worsley and Eccles South) (Lab)
Today is the sixth anniversary of the publication of the Dilnot commission’s report on the funding of social care. In those six years, Ministers have legislated for a cap and a floor on care costs, and then abandoned those measures. They brought forward disastrous proposals in their manifesto for what became known as the “dementia tax”, and they appear to have abandoned those measures, too. Will the Secretary of State confirm that those policies have indeed been abandoned? Will he tell me, and more than 1 million people with unmet care needs, when he expects to have some new proposals for reform?
Rishi Sunak (Richmond (Yorks)) (Con)
T8. Last week I met doctors and nurses at the Friarage, an excellent small hospital serving a rural population spread over 1,000 square miles. Will my right hon. Friend urge South Tees Hospitals NHS Foundation Trust to do everything it can to ensure the continued provision of emergency care clinicians and anaesthetists at this vital local hospital?
Matthew Pennycook (Greenwich and Woolwich) (Lab)
T7. At the height of the recent election campaign, NHS England took forward plans to merge, in effect, six south London CCGs, including Greenwich CCG, under one single chief officer. Does the Minister agree that that would be a retrograde step, not only in terms of local accountability, but at a time when primary care has been devolved downwards and all the emphasis is on collaboration and integration at a local borough level?
Andrew Bridgen (North West Leicestershire) (Con)
Funding our national health service to meet the needs of UK residents is one proposition; funding an international health service open to the world is another proposition entirely. Are there any indications that advance charging for non-emergency treatment for overseas patients is putting more money into our NHS?
Mr Dunne
My hon. Friend is a doughty campaigner for ensuring that non-resident visitors to this country contribute for healthcare received here. We put in place a number of measures to enhance the appropriate charging structures and increased the funding received by the NHS from £89 million to £289 million in 2015-16. We expect similar action to result in a further increase.
Karin Smyth (Bristol South) (Lab)
NHS Property Services has just signed a £1 million lease on a central London location. May I suggest that other properties were available? Would the Secretary of State like me to inquire in my constituency, where NHS Property Services increased Knowle West Health Park’s rent threefold? Better value for the taxpayer is available.
Kettering General Hospital
Philip Dunne Excerpts(7 years, 5 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
Let me start by congratulating you, Madam Deputy Speaker, on the resumption of your rightful place in the Chamber. It is a delight to serve under you in what I think is the first Adjournment debate that you have chaired in the new Parliament. I am delighted that you are looking after our proceedings this evening.
Let me also join in the congratulations of all who have spoken in the debate—apart from his usual modest self—to my hon. Friend the Member for Kettering (Mr Hollobone), who has been so gracious in encouraging me to take a personal interest in the hospital in his constituency. He was forthright in inviting me to join him last year when we previously debated the hospital, and I was pleased to be able to take up his invitation. Invitations have been flowing around the Chamber once more this evening from his neighbours, who show a consistent and collegiate approach to managing health issues in their constituencies and Northamptonshire in general.
When I visited Kettering in April, I was delighted to see my hon. Friends the Members for Corby (Tom Pursglove) and for Wellingborough (Mr Bone) taking such a close interest in the primary acute facility serving their constituents. I feel that the area is well represented by its Members of Parliament, who take such an active interest in health.
One thing that disappointed me about the speech made by my hon. Friend the Member for Kettering was the fact that his detailed grasp of the issues confronting the hospital was almost as good as that of the officials who helped me to prepare my speech. I therefore may not tell him too much that he does not know already, but it is a tribute to his perspicacity that he has such a good grip.
My hon. Friend raised a number of detailed issues relating to Kettering general hospital, and I shall try to address as many of them as possible in the time that is available to me. He concluded his remarks by making it clear that his No. 1 priority was to see progress on securing funds for the development of an urgent care hub at the hospital. I am pleased to join him in welcoming the progress that has been made since our debate last October. In particular, the foundation trust has secured funds from the Department of Health, with agreement from NHS Improvement, to enable the production of an outline business case, which, in the NHS approval system, is a necessary precursor of any significant capital investment.
A mobilisation meeting was held only last week to discuss the preparation of the outline business case, which is a welcome development. The initial draft of the outline business case is expected to be shared with NHS Improvement in August. The current intention is for the trust board to approval a final outline business case by the end of the year, provided it is satisfied with the progress that has been made, before a formal submission is made to NHS Improvement. I hope that that gives my hon. Friend some idea of the pace of the process. I am talking about a period of months, but I am afraid that that is the nature of the world we are in. It must be ensured that all appropriate internal procedures are followed correctly in order to give the proposition the best prospect of success.
The business case is intended to create a long-term solution for the hospital: a 10 to 15-year proposition that will take into account the significant increase in house building envisaged in the local plans, and the accompanying population growth to which my hon. Friend referred. In the meantime, the trust has put in place as a temporary facility a modular unit—a Portakabin —which we visited a couple of months ago. The outline business case will include plans to replace it with a permanent structure in due course.
More immediately, I am delighted to join my hon. Friend in welcoming the solution to the current challenge, which was very evident to me when I visited, that faces staff and patients trying to gain access to the hospital. The challenge of finding somewhere to park for anyone arriving by car was such that I had to be plucked out of the queue waiting to get into the car park by the chief executive herself, who had come to find me. Otherwise I might have spent my entire allotted time for the visit trying to get into the car park. The good news, as my hon. Friend has identified, is that work begins next week on the construction of the second level of the car park. The additional tier will provide an extra 240 spaces. I am told that the work will be completed by mid-November, which sounds like pretty pacey progress. This will cost some £1.3 million over five years, and the funding has been found by the trust from its own resources, which is very welcome.
My hon. Friend made reference to various pressures affecting the hospital. NHS England is working closely with the two local clinical commissioning groups to ensure that local care homes, general practices and the ambulance service are supported to care for patients outside the hospital, when that is appropriate. That is designed to help to reduce pressure on the hospital, and it was referred to in the interventions from my hon. Friends the Members for Corby and for Wellingborough.
In the longer term, the draft Northamptonshire sustainability and transformation plan, which was published last December, proposes an early focus on improving the urgent care system to reduce the pressures on A&E. Part of that will include introducing more front-door clinical streaming at Kettering general, with plans to put in place a seven-day discharge capability to help patient flow through the hospital. However, I have heard the comments in this debate about the quality of the STP, particularly from my hon. Friend the Member for Wellingborough. The STPs are being assessed by the Department of Health, and we will be making some comments before the summer recess on their relative attributes. We will see where Northamptonshire comes out in the context of the others.
Tom Pursglove
As part of that work in the Department, will the Minister take away from this debate the significance of the Corby urgent care centre to our local health economy, particularly in the context of how it relieves the pressure on Kettering A&E? Will he also acknowledge that there are significant healthcare needs in the Corby community that that facility helps to address?
Mr Dunne
I was not going to allow my hon. Friend the Member for Corby to leave without passing comment on the Corby urgent care centre, so I shall do that now, as he raised the matter so specifically. As we have heard, the STP does not perhaps place as much emphasis on what is to happen outside the acute hospital setting as hon. Members would like, and I shall take that away.
One of the issues that we need to address is the urgent care centre in Corby. As I understand it, the current service expires at the end of September. A new contract will be let as a caretaker arrangement for the ensuing 12 months to ensure that the existing facility continues, thereby allowing time for the CCG to engage with the public about the future shape of urgent care services in Corby, which will help to inform the development of the STP plan for the long term. The intent is that public engagement will lead to a proposal for an enduring longer-term contract to be procured in the next calendar year—during 2018—which will take into account the additional population around Corby. As we have already heard, the population is extensive around Kettering, but that is not unique to that part of north Northamptonshire. I am reassured by the CCG that the temporary arrangement will continue to provide the highest standards of patient care and safety for Corby’s population. My hon. Friend should not be concerned; this is a short-term contract extension that is facilitating a much longer-term solution.
My hon. Friend the Member for Kettering referred to the better care fund and how services are being provided in the community beyond the acute setting. As he knows, the fund supports programmes not only at Kettering general, but at Northamptonshire general. The better care fund and what we are describing as the improved better care fund—a similar pot of funding for the current financial year—are being used to fund both non-elective admissions and discharge to support at Kettering general, which is aimed at relieving pressure on the hospital.
My hon. Friend mentioned the special measures regime, which was the immediate trigger for my visit in April, the time of the publication of the CQC report that rated the trust as inadequate. I was pleased that he welcomed the introduction of special measures, because they provide an opportunity for focus across the NHS on areas that have been rated as not performing as we would all like. The evidence thus far is that trusts that go into special measures get considerably more attention not only from NHS Improvement, but from right across the NHS and up to a ministerial level. Special measures have a significant impact on improving performance within a hospital. I see that as a positive step, and I was pleased that he welcomed it. NHS Improvement has agreed an initial package of support. It has allocated an improvement director who will be working with the trust from next month. NHSI is also setting up “buddy trust” arrangements with highly rated trusts.
Kent & Canterbury Hospital
Philip Dunne Excerpts(7 years, 6 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
It is a pleasure to serve under your chairmanship as Deputy Speaker, Sir David. I hope that that will not necessarily be as temporary as suggested by Mr Speaker when he sought the leave of the House to appoint you. It is also a pleasure to respond to my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), who has been on her toes in securing Mr Speaker’s consent to have this debate so early in the parliamentary Session. I am pleased that she has secured the support of many of her constituents, some of whom have come to witness her championing their interests in relation to Kent & Canterbury hospital. She has done that not just this evening, but consistently over the past few months with our mutual friend Sir Julian Brazier, who is sadly no longer with us in the House. However, I congratulate his replacement, the new hon. Member for Canterbury (Rosie Duffield).
I worked closely with Sir Julian when we were Ministers in the Ministry of Defence, and both he and my hon. Friend the Member for Faversham and Mid Kent have been doughty champions of the population of mid- Kent, particularly those in the areas surrounding Canterbury, in fighting for healthcare services given the challenges that she quite properly describes at Canterbury hospital. I pay tribute to them for that, and they are doing the right thing in ensuring that such issues are brought to Ministers’ attention. I know that she wrote to the Secretary of State only last week, and I am pleased to hear her arguments, which were so eloquently put today. I will say what I can in response to the questions and challenges that she posed, but I must say at the outset that I do not stand here tonight with all the answers to all the questions because, as she will appreciate, many of the things that she is calling for are decisions that will be taken and led by clinicians in Kent. It is not for Ministers to prescribe the provision of services in Kent. Many such decisions will take place over a period of time; it will not be instant decision making.
I will start my response by providing a little context for what has happened over the past few years, and this week in particular. As my hon. Friend pointed out, the board of East Kent Hospitals University NHS Foundation Trust agreed to relocate some services from its Canterbury site, Kent & Canterbury Hospital, this Monday. The change happened overnight from Sunday into Monday and came in response to legitimate concerns raised by both the General Medical Council and Health Education England over a period stretching back to as early as 2014, when they raised concerns about the standard of training available at the Canterbury site, in particular the quality and safety of junior doctor training.
The situation was brought to a head following a visit in March this year. The recruitment and retention of key medical staff has been an ongoing challenge for the trust, and there is a shortage of consultants to provide the required training and supervision of junior doctors posted to Kent & Canterbury hospital. On Sunday 18 June, 38 junior doctors were reallocated from Kent & Canterbury to other sites operated by the trust. The removal of these junior doctors has required the trust to relocate some of the services it provides, to ensure safe and sustainably staffed services for patients.
My hon. Friend’s constituents will still receive good service provision. The clinical commissioning group has facilitated this development by acquiring some 40 additional care packages to support effective discharge from the Ashford and Margate sites, to free up some 75 beds to allow for this temporary service change to take place, along with an additional 20 ambulances, supplied through SECAmb—the South East Coast Ambulance Service NHS Foundation Trust—to cover the additional journey times from the Canterbury area. Replacement services at nearby hospitals in Ashford and Margate are being monitored to ensure that they are safe and effective, given the additional pressure on those hospitals from the move.
Unfortunately, I cannot say today how long this temporary closure will last. The GMC has made it clear that
“if there is evidence that appropriate and sustainable action has been taken to make the Urgent Care Centre a safe environment for doctors in training once more, HEE will review reallocating trainees to the site”.
No decision has been made about the long-term future of the service and no decision will be made without full public consultation. I can give my hon. Friend that reassurance.
Helen Whately
My hon. Friend mentions that there is monitoring of the provision of care for the services that have been moved to William Harvey and Queen Elizabeth the Queen Mother hospitals. May I ask him to take a personal interest in that monitoring? I have heard reports from staff who are really worried about how care is being provided following the transfer of the services. They are very concerned that patients might be at risk.
Mr Dunne
One of my ministerial responsibilities is to support the Secretary of State in having an oversight of trusts that are in special measures. The East Kent trust has been in special measures and is currently in financial special measures, so I take a close interest in what is happening in that trust. In view of my hon. Friend’s request and the events that have happened this week, I assure her that I will take a particular interest to ensure that the existing facilities at Ashford and Margate are up to scratch to cope with the increased demand they will undoubtedly have to manage.
I want to make it clear to the House and to the representatives on both sides who look after constituents in Kent that this issue is about maintaining the supervision of junior medical staff and ensuring that we have safe staffing levels for patients from central Kent; it is not about clinical practice or the competence of the hard-working staff in the hospital. I have been assured that before taking this decision every effort was made to identify appropriate senior staff cover from neighbouring trusts. The challenge has been to ensure that an adequate number of consultants were on duty at Kent & Canterbury hospital to allow junior doctors to have senior colleagues to refer to in the event of issues they felt uncomfortable dealing with. The problem that the trust has had is that it has been over-reliant on locum consultant cover in the hospital and there has been an inability to recruit to substantive posts in the hospital over a prolonged period, which has given rise to this concern on the part of HEE and the GMC that the training conditions for junior doctors were not adequate. That is what has led to this decision, rather than any criticism of the individual doctors or other staff members in the hospital.
I am also assured that the concerns of both HEE and the GMC are being addressed as quickly as possible. That will form part of any public consultation that follows from the development of the STP that is being worked up for the area.
I will not go into any great detail about the specifics of what has happened over the last few days as my hon. Friend the Member for Faversham and Mid Kent has already done so, but our expectation is that this temporary relocation is likely to affect approximately 50 of the 900 patients who visit Kent & Canterbury hospital each and every day. It is important to recognise that there has not been a full A&E unit at Kent & Canterbury hospital since 2005, when services at the trust were reconfigured, and it was established as an emergency care centre. Trauma and general surgical emergency cases had already been sent to sites in Margate and Ashford for some time prior to the recent temporary changes, and I believe it was in 2016 that the emergency care centre itself was turned into an urgent care centre, which again had an impact on services at that time.
I am advised that local NHS leaders have fully explored the risks of temporarily relocating services and have put in place mitigating action and contingency plans when required. The decision has been an exercise in the balance of risk: it is clearly not desirable, and nor is it either common or unique, for the regulators to take action such as this when they have concerns about both patient and staff safety, and it is not a decision taken lightly or comfortably, but the trust has come to the view that the risk to patient safety outweighed maintaining the status quo and seeking to continue with, frankly, unsustainable levels of senior support.
My hon. Friend rightly raised concerns that this might presage a future closure of the site, and I want to try to reassure her: the trust board has been left in no doubt whatsoever that it should not regard this as a step on the road to a permanent solution and that it needs to consider the requirements of the population of mid-Kent in the round when looking at the provision for the future to be undertaken through the STP. The hon. Lady raised a perfectly reasonable concern that the STP horizon of five years is not long enough. If the STP were to consider a more wide-ranging reconfiguration, that absolutely would have to look at the long-term horizon for healthcare provision in the area and not just at meeting the immediate objectives of the next five years.
Charlie Elphicke
I thank the Minister for making this important speech, but may I gently press him on the issue of a new hospital? Is there not a cost-benefit analysis between the efficiency savings to be had from a new, state-of-the-art hospital, which can operate much more efficiently and do much more with much better use of resources, versus the cost in capital? How would the Minister and his Department strike that balance, and can they carry forward a feasibility study to look at the very interesting case being put by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately)?
Mr Dunne
I was going to come on to the suggestion of my hon. Friend the Member for Faversham and Mid Kent about both allocation of capital and the possibility of a new hospital. I was starting to develop the point that this matter needs to be assessed in the light of the overall requirements of the healthcare economy of mid-Kent and the East Kent trust through the STP process. Capital is currently constrained throughout the NHS. As hon. Members will know, in the March Budget we announced a capital allocation of some £325 million over the next three years to support the first phase of STPs. Fairly shortly, we should have made sufficient progress in deciding which of the STP proposals should be supported to secure that capital. Other capital pots are available to the NHS for what we refer to as business as usual, and there are always opportunities for trusts to make capital proposals to the NHS.
Right now, it is not appropriate for me to explain the basis on which future capital allocation decisions will be made. One can look to the recent past to identify some significant new hospital builds that are now in progress. There is currently a significant capital investment not far around the coast from Kent, in Brighton, and there is another closer to my constituency, in Sandwell in Birmingham. Such builds are few and far between, and bearing in mind the kind of major capital investment we are talking about, I think both my hon. Friends from different parts of Kent are arguing for space to undertake a study to consider whether a major build is appropriate to meet the needs of the mid-Kent population.
Generally, as can be identified from the two significant builds that are currently under way, which have been allocated hundreds of millions of pounds of capital each, a certain density of population is required to be served. Such builds are therefore most likely to occur in major cities rather than in less densely populated areas. That said, it is not for me to make suggestions as to what would or would not be appropriate. I urge my hon. Friend the Member for Faversham and Mid Kent to discuss the matter, as I know she has already, with her STP leaders. If there is a desire among Kent MPs and the Kent community to consider whether in future a more holistic approach to satisfying healthcare needs should be taken in the county as a whole, perhaps my hon. Friend should work in conjunction with other hon. Members.
The right forums are the STPs, which are bringing together NHS providers and commissioners from throughout their regions to try to arrange provision to meet the future healthcare needs of their populations. Whether or not my hon. Friend is successful in persuading the STP that a new hospital in Canterbury is the right solution, that is a matter for her to take forward with the STP. Such an effort would carry more weight were it supported by other colleagues from the area.
Helen Whately
It needs to come from the top that, when a bid is put forward that makes the case for significant investment, capital will be forthcoming. That message is currently not coming through and it is deterring people from making that case. It needs to shift.
Mr Dunne
I am conscious that I am close to running out of time, and I want to address the other point my hon. Friend raised, but I will say that capital is allocated by the Department of Health on the basis of the strength of the proposals, which need to meet the criteria on meeting the needs of local populations. That has to be balanced against the amount of capital that is available throughout the country, where there are competing needs.
My hon. Friend also raised the idea of a medical school, which she has discussed with me previously. She is aware of the consultation the Department ran on allocating new medical school places. That consultation has completed and we are considering our response. I am grateful to her for her submission. We wish to encourage some development of new medical schools, but again, that is subject to regulatory approval by the General Medical Council and other bodies. Any universities that wish to establish a new school need to meet the regulators’ criteria. I encourage my hon. Friend to see what progress is being made in that direction.
In conclusion, I again congratulate my hon. Friend on securing this debate and reassure her that I will be taking a close interest in how events unfold in the East Kent trust. I expect we will have an opportunity to discuss this matter again before too long.
Question put and agreed to.