Unavoidably Small Hospitals

Philip Hollobone Excerpts

Tuesday 6th September 2022 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

Welcome to Westminster Hall, and to the debate on unavoidably small hospitals. I call Bob Seely to move the motion.

[Bob Seely (Isle of Wight) (Con)]

I beg to move,

That this House has considered unavoidably small hospitals.

Thank you very much, Mr Hollobone; as ever, it is a pleasure to serve under your chairmanship. I thank the Minister for being here, and I wish her luck in any coming reshuffle. I also thank colleagues from Yorkshire, Devon, Cornwall and other parts of the United Kingdom for being here. Indeed, we have two Members from Yorkshire—my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) and my right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak). It is a delight to see them both. I saw one quite recently on the Isle of Wight, but sadly not both.

The debate was originally granted prior to the covid pandemic. Clearly, much has changed since then, but I also wonder whether the fundamentals of unavoidably small hospitals have changed. The reason why I called the debate back then, and why I want it now, is that I fear they are still the poorer cousins of larger district general hospitals.

I will make two points. Clearly, I am going to talk specifically about St Mary’s Hospital on the Island, because it is in my constituency, but there are broader points to be made about unavoidably small hospitals throughout the United Kingdom. I want specifically to ask the Minister to put as much information as possible about the funding processes for unavoidably small hospitals in the public domain. We were talking prior to the debate, and she said that some of that information rests with the new integrated care boards. That may well be the case, and that is fair enough, but they are not elected bodies. We know that the NHS can be rather top down and bureaucratic in some of its behaviours, and the more information she can put in the public domain to help Members with unavoidably small hospitals understand the situation, the better.

Before I address that further, let me put on record my thanks not only to staff at St Mary’s but to GPs on the Isle of Wight and their staff, and to the pharmacists, the dentists and all the staff in care homes, who do a no less valuable job. Some of the problems we are facing are because of a lack of integration with our adult social care system; the inability to find a home for the elderly and vulnerable that that system looks after puts additional pressure on hospitals.

Let me also put on record my thanks to the Government for the £48 million additional capital spending on the Island. Indeed, I suspect that the former Chancellor, my right hon. Friend the Member for Richmond (Yorks), deserves thanks for that, as well as for the fair funding formula reference for the Isle of Wight. I am delighted and very grateful that he did both those things. That £48 million was part of getting a better deal for the Island, which is clearly an ongoing project.

In England and Wales, there are 12 unavoidably small hospitals, which are defined as hospitals that, due to their location and the population they serve, and their distance from alternative hospitals, are unavoidably smaller than the “normal” size of a district general hospital. In the Isle of Wight’s case, we are about half the size—about 55% to 60%—of the population needed for a district general hospital.

I would argue that the pressures on these small hospitals are greater than elsewhere. They are smaller, so they are more easily overwhelmed due to their size, and they are under greater economic pressure, because the NHS funding model—we recognise that there has to be a funding model—is designed for an average-sized, “normal” district general hospital, rather than an undersized one. You cannot give birth on a helicopter or a ferry; on the Island, we need to run our maternity services and our A&E 24 hours a day, seven days a week. However, our income is based on national tariffs that do not equate to the size of our population. As the Island’s trust says,

“the Island’s population is around half of that normally needed to sustain a traditional district general hospital.”

The third pressure on unavoidably small hospitals is because they exist outside of major population centres. Without a shadow of a doubt, they are in some of the loveliest parts of England and Wales, but because they are outside of those major population centres, recruitment and retention of staff becomes more difficult, which adds pressure on the staff who are there and adds costs in terms of locums and agency staff, which can have a highly significant effect on budgets. Ferries aside—with the partial exception of the Scilly Isles—the pressures at St Mary’s on the Isle of Wight are shared by other unavoidably small hospitals. I think that helps to explain why, in the last decade, a number of unavoidably small hospitals have been put in special measures or have sadly failed, despite the best efforts of those people who work there.

Our hospital, St Mary’s, is classed as 100% remote, which is unique even by unavoidably small hospital standards, because it is accessible only by ferry—although, as far as I can see, accessibility by sea is not a factor in the definition of an unavoidably small hospital. On the Island, our need for healthcare is arguably higher than elsewhere in the United Kingdom. We struggle to get the national standard, but our need for that national standard is greater because over a quarter of our resident population is aged over 65 and, by 2028, over-65s will be one third of the population. Indeed, we have a particularly large cohort of 80 to 84-year-olds.

All the evidence and common sense suggests that that has a disproportionate effect on healthcare: older people, and especially the very old and frail, need healthcare more than young people. We on the Island are struggling—as, potentially, are other USH areas—to provide quality for that ageing population. In addition, the Island’s population doubles over the summer, because we have lots of lovely visitors. That impacts demand, which means that our A&E can be close to overflowing at times, even as efficiently run as it is.

I suggest that there is an additional factor: the impact of high levels of social isolation. People retire to the Island as a couple and one sadly dies, leaving the other isolated from family and social networks because they lived most of their life in other parts of the United Kingdom. That leads to increased reliance on statutory services.

All this has been noted. The former Health Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock), confirmed his concerns to me in July 2019, telling the House:

“As for Island healthcare costs, my hon. Friend is right to say that the Isle of Wight is unique in its health geography, and that there are places in this country—almost certainly including the Isle of Wight—where healthcare costs are”—[Official Report, 1 July 2019; Vol. 662, c. 943.]

increased.

I am not saying that we are the only place like that. There is isolation in other parts of the country, including Yorkshire, Cornwall, Devon and Cumbria, but in the Island’s case the situation is cut and dried because of our separation by sea from the mainland. In its January 2019 sustainability plan, the Isle of Wight NHS Trust estimated that the annual cost of providing a similar—I stress to the Minister that this is the critical element—standard of healthcare and provision of 24/7 acute services, including maternity and A&E, on the Island to that enjoyed by mainland residents would be an additional £9 million. These are 2019 figures.

The estimated cost of providing additional ambulance services, including coastguard helicopter ambulance services, was about £1.5 million. In the Scilly Isles, patient travel is funded out of the clinical commissioning group—now the ICB—budget. Ours is not. Our patient travel budget comes from ferry discounts and council contributions, and it was estimated to be £560,000. In total, one is looking at between £10 million and £12 million at 2019 figures.

Either because they were going to do so anyway or, hopefully, because of representations from myself and others, the Government have recognised since then that unavoidably small hospitals need a funding model that serves them, because there is no alternative but to keep those hospitals open to serve those populations in a way that is ethical and, frankly, legal nowadays.

I am proud of our efforts to highlight the plight of unavoidably small hospitals to the Government, and I thank them for listening and for trying to put in place a package of support for them. I say to the Minister that this is where I would welcome more facts being put in the public domain. I have trawled through NHS documents for the last couple of days, and the last figure I can see for the unavoidably small hospital uplift for St Mary’s on the Isle of Wight is that from 2019, when we received £5.3 million. That is roughly half of what we think we need to run a national level service, so we are grateful that the Government have recognised the need for an uplift for unavoidably small hospitals. Will the Minister please update me on how much money St Mary’s has had as an unavoidably small hospital since 2019, given that we have clearly had issues with covid?

According to page 13 of the NHS “Technical Guide to Allocation Formulae and Pace of Change” for 2019-20 to 2023-24, that money was given in 2019 due to

“higher costs over and above those covered by the”

market forces factor. I cannot see other figures in the public domain. I do not quite understand how the Government could calculate that figure in 2019 when the advisory committee said in January 2019 that it was

“unable to find evidence of unavoidable costs faced in remote areas that are quantifiable and nationally consistent such that they could be factored into allocations”.

That is from the NHS England document “Note on CCG allocations 2019/20-2023/24”.

The Government say that they cannot work out how much extra to give unavoidably small hospitals, while at the same time a different NHS document says, “We are going to do some calculations, and here is the rough calculation.” Can the Government work out the additional costs or can they not? They are basically saying the same thing in two separate documents.

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[Several hon. Members rose—]

[Mr Philip Hollobone (in the Chair)]

Order. The debate can last until 11 o’clock. I am obliged to call the Front-Bench spokespersons no later than 10.37 am, and the guideline limits are 10 minutes for Her Majesty’s Opposition and 10 minutes for the Minister. Bob Seely will then have two or three minutes at the end to sum up the debate. There are six highly distinguished colleagues seeking to contribute. I do not wish to impose a time limit, but if everybody limits their remarks to eight minutes, everybody will get in.

--- Later in debate ---

[Rishi Sunak (Richmond (Yorks) (Con)]

It is a pleasure to speak under your chairmanship, Mr Hollobone, and thank you for accommodating me at a late stage in the debate. I had not planned on speaking, but this morning I saw the Order Paper and it turned out that I had more time on my hands than I had anticipated! It is a pleasure to be here with my hon. Friend the Member for Isle of Wight (Bob Seely) to discuss this very important topic.

I am here to speak about the Friarage Hospital in Northallerton, in North Yorkshire, which is in my constituency. It is one of the smallest district general hospitals in the country, serving a rural population of over 100,000 people and covering an area of a thousand square miles, stretching from the North York Moors at one end to the central Pennines at the other, bordered by York in the south and Darlington in the north. When I was first elected in 2015 and when I was campaigning before that, I told my constituents that the hospital would be my No.1 priority.

The reason for that is simple. Of course the NHS is the country’s most prized public service but, as we have heard in all the contributions from hon. Members today, the accessibility of healthcare in rural areas specifically is an issue of acute anxiety and the pattern over several years had been in a negative direction. Indeed, as I was being elected, my local hospital had lost its consultant-led maternity unit. Shortly to follow was the loss of paediatrics. That had an enormous impact on the local community. They feared for the very future of our beloved local hospital and I committed to do everything I could to reverse the flow of services away from it to ensure a bright future for the Friarage.

As my constituency neighbour, my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), rightly pointed out, when healthcare organisations look at such things they tend to think about centralisation, because it looks very efficient on a spreadsheet wherever they might be sitting, but it does not work for our constituents. One thing I will say to the Minister is that she should send a strong message to trusts, particularly those that cover large urban centres and smaller rural hospitals in the same area, to always think about accessibility when they make their plans, which I do not believe they always do as well as they could. Secondly, I echo my hon. Friend’s recommendation about booking appointments. That is a simple, practical thing and trusts can do a good job of it when members of the public have the option to travel to smaller hospitals nearby or to others further away and to get the timing of those appointments right. That has an enormous impact on people’s ability to access the healthcare that they need.

Shortly after I was elected, I had to deal with a challenge that we have already heard about today—the downgrading of our A&E. However, that marked a turning point and I say to the Minister that what followed can serve as an example of what the future of small rural hospitals can look like. Under the leadership of Dr James Dunbar and his team, at the Friarage we pioneered an innovative new model of an urgent treatment centre that is open 24 hours a day and is consultant-led, with a clinical decisions unit. That means that it can provide a far greater range of healthcare to my constituents, including far more care for children than would typically be found. The unit is staffed superbly by nurse practitioners. It is working brilliantly and all I will say to the Department of Health and indeed to trusts where there is a similar challenge is to look at the model and see how it can be replicated around the country because, as I say, it is working brilliantly and has saved the loss of all emergency services at our hospital.

My other recommendation to the Minister and the Department is on recruitment and staffing issues, which we have heard a lot about already. It was clear during the work that I did that often the guidance from the royal colleges exacerbates some of the issues that we have heard about. My hon. Friend the Member for Thirsk and Malton said that anaesthetists are a case in point. A specialisation has occurred over decades, whereby anaesthetists used to be generalists and now we have sub-specialties. It is very difficult for small hospitals to accommodate those sub-specialties, and we need to look with the royal colleges at what safe staffing models might work to ensure the sustainability of our services.

I must commend the South Tees trust, because after repeated efforts from my hon. Friend the Member for Thirsk and Malton and me, it has focused fully on ensuring the future of the Friarage. I thank Simon Stevens for visiting the hospital in his previous capacity and understanding the challenges, and the pervious Health Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock). Since then, thanks to the philanthropy of the late Sir Robert Ogden, we have a new Macmillan cancer centre, which is providing fantastic care, a new diagnostic centre, an MRI scanner, a dialysis unit and an ophthalmology unit, all of which save my constituents a round trip of up to four hours to the much larger James Cook hospital. They are all delivering fantastic care closer to home.

I will give the Minister another example of innovation from the local team. James Dunbar came up with a new ambulatory care unit, which means that we can do emergency treatment on the same day. In the first year of its operation, it saved over 4,000 overnight stays, so it is not just a model for rural hospitals but a beacon for how the NHS can work more broadly to reduce the pressure on our bed capacity.

Most recently, I am delighted that the Government and the Minister responded to my long-running campaign to get new investment in our operating theatres. They date back to the second world war and are in urgent need of refurbishment, so I am delighted that the Government have said that they will provide £30 million of investment to refurbish all the operating theatres to the latest and greatest standards. That will have several benefits. Most importantly, it will send a very strong signal to my community about the future of the Friarage. It is very clear that the Friarage is not going anywhere and people can have confidence in its future, which helps with recruitment and retention, as we have heard. People are attracted towards working at smaller hospitals when they know that their career will be something they can bank on and that there is interesting work to do. This investment will absolutely secure that and ensure that we can attract the nurses, doctors and other staff that we need.

The Friarage also serves as a model for how we will tackle the backlogs more generally, because the hospital will be a new surgical hub with all the associated auxiliary services that are required. That means that we can now double the amount of elective surgery and do it closer to people’s homes. In the scheme of what the NHS spends, that investment will provide a very high rate of return by increasing the amount of surgical throughput. The doctors and nurses I saw just the other day—chief medical officer Dr Mike Stewart, chief surgeon Matt Clarke, and theatre nurse Sarah Baker—are all incredibly invigorated by what they can now do for our community, and that will help more broadly serve us to get the backlogs down faster, which I know is a Government priority.

I say to the Minister that it is important that small hospitals are recognised, which is something that is said very clearly in the five-year plan. It is important that the NHS continues to deliver on that. My experience locally is that that is happening, and I ask her to take on board some of my suggestions. I will close by paying tribute to the incredible doctors, nurses and staff at the Friarage, and to the Friends of the Friarage charity. I said to them when I was first elected that they would be my No. 1 priority, and they will continue to have my full support.

[Mr Philip Hollobone (in the Chair)]

We now come to the Front-Bench speeches. I call Feryal Clark for Her Majesty’s Opposition.

Urgent and Emergency Care

Philip Hollobone Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

We are putting in additional funding, whether that is the additional £1.5 billion put into GP capacity in 2020, the £450 million to upgrade A&E facilities across 120 trusts, the extra £150 million specifically put into the ambulance service, the £30 million put into the St John Ambulance contract over the summer, or the further £50 million that has gone into call handling to boost the 111 service. Significant additional funds are going in as part of the support for the significant pressure that we recognise there has been over the summer.

[Mr Philip Hollobone (Kettering) (Con)]

I thank my right hon. Friend the Health Secretary for visiting Kettering General Hospital in July and for his subsequent confirmation in August that the hospital has won £38 million, as a 10% down payment, to start the redevelopment of the hospital. During his visit, he visited the A&E department, which is one of the most overcrowded in the country, and saw the ambulances waiting outside. What is his assessment of the current state of play at Kettering General Hospital and its prospects for the future?

[Steve Barclay]

First I acknowledge on the record the campaigning that my hon. Friend and colleagues have done for a new hospital at Kettering. They particularly demonstrated the urgency of addressing issues with the energy plant, so I was pleased that we were able to get that enabling work done. All A&E facilities have been under pressure over the summer, which is why we have announced the additional funding. It is about boosting capacity in call centres, looking at how we address variation in performance among ambulance trusts, particularly on conveyancing, and looking at how we get more flow into hospitals. That is why, along with the hospital, I also visited a care home in my hon. Friend’s constituency, in order to look at how we better address the issue of delayed discharge.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 1st March 2022 Commons Chamber

[Gillian Keegan]

Very much so. Young people should be protected from inappropriate and excessive caring responsibility, and adult and children’s services need to work together better. We recognise, though, the lack of hard data and evidence on outcomes for young carers. That is where we are and that is why we have made the commitment, with the Department for Education, to amend the school census. We intend to introduce that as early as 2022-23 and each year thereafter. The data will be collected at primary school and secondary school, so we will be able to look at all kinds of outcomes for this particular cohort and take actions.

[Mr Philip Hollobone (Kettering) (Con)]

19. If he will ensure that the NHS new hospital programme team complete approval processes by summer 2022 to allow the preparation of the full business case for the redevelopment of Kettering General Hospital by the local NHS trust.

[The Minister for Health (Edward Argar)]

The joint DHSC and NHSE/I—NHS England and NHS Improvement —programme team is working closely with all schemes in the programme, including Kettering, on how and when new hospitals will be built across the decade. That is to maximise the potential benefits that the programme’s approach can bring for all the new hospitals. We will continue to support all trusts in the programme, including Kettering, to ensure that there is the swift approval of all business cases—including, in this case, for early enabling works—but that will always be in line with due process to ensure that there is value for money, as my hon. Friend would expect.

[Mr Hollobone]

I thank the hospitals Minister very much for his visit to Kettering General Hospital on 17 February. Specifically, can we have feedback from the new hospital team on the strategic outline case for the hospital by the end of April, so that the hospital can submit its outline business case for the next stage in July?

[Edward Argar]

It was a pleasure to visit my hon. Friend’s constituency. He is a forceful advocate for that constituency and for his hospital, as indeed—if I may slightly crave your indulgence, Mr Speaker—was the late Sir David Amess. Today is the day that Southend-on-Sea officially becomes a city, so I just wanted to shoehorn that into the record. On my hon. Friend’s point, we will do everything we can to expedite the approval of business cases while ensuring that due process is followed to make sure that there is value for money.

Integration White Paper

Philip Hollobone Excerpts

Wednesday 9th February 2022 Commons Chamber

[Edward Argar]

I am grateful to the hon. Lady for her comments and for highlighting the situation Lynn and Andy find themselves in. What we seek to do, through what I said about care records, is exactly what she and I think they would wish to see, which is to reduce the number of unnecessary or duplicative interactions with the system.

She touches on workforce. I set out in my remarks earlier that since 2010, under this Government, there have been over 30,000 more doctors and 38,000 more nurses. In just the past year, we have seen a huge increase in the number of nurses—I think 11,000—and an increase of about 5,000 doctors. We continue to grow the workforce and we are already working to do so. My right hon. Friend the Member for South West Surrey (Jeremy Hunt), who is no longer in his place, set a lot of that in motion. We have also commissioned from Health Education England and NHS England, now that we have announced their merger, the long-term 10-year workforce strategy, which I look forward to with interest.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering General Hospital and Northampton General Hospital have between them 1,100 beds, 300 of which are occupied mainly by elderly patients who have completed their medical treatment and await discharge either into a care home or a domiciliary care setting. Meanwhile, adult social care is provided by the two unitary authorities, which contract with over 80 different domiciliary care providers. Would the Minister welcome ambitious proposals from Northamptonshire along the lines of those already being pursued by Northumbria Healthcare NHS Foundation Trust, whereby the NHS itself provides domiciliary care? Unless we get those 300 patients into an appropriate setting out of hospital, our hospitals will for ever be clogged up.

[Edward Argar]

I am grateful to my hon. Friend, who quite rightly never misses an opportunity to pay tribute to his local hospital trust. As he knows, I am always happy—as is my hon. Friend the Minister for Care and Mental Health—to hear any ideas for innovation that may improve outcomes for patients and communities.

Elective Treatment

Philip Hollobone Excerpts

Tuesday 8th February 2022 Commons Chamber

[Sajid Javid]

I thank my hon. Friend for reminding the House that the Labour party voted against additional investment in the NHS. He is right to talk about the impact on urgent care, particularly for ambulance services and especially during the recent omicron wave. We invested an additional £55 million in ambulance services over the winter. A lot more needs to be done to support urgent care, but the plans that we will shortly set out for the integration of healthcare with social care will certainly help to relieve many of those pressures.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering General Hospital performed heroically during the pandemic and is now gearing up with determination to increase its elective surgery capacity by 30%. Does the Secretary of State take on board the point that in addition to having to clear the covid backlogs, areas such as Kettering and north Northamptonshire are seeing a very steep rise in the local population, with tens of thousands of new houses being built, and are expecting a very sharp rise in the next five years in the number of people aged 80 or over? Will he ensure that Kettering General Hospital gets all the resources it needs?

[Sajid Javid]

I join my hon. Friend in thanking the staff at Kettering General Hospital for everything they have been doing, especially over the past two years. Of course, challenges remain. I understand that my hon. Friend the Minister for Health will visit Kettering General Hospital shortly; I look forward to hearing about it. I can assure my hon. Friend the Member for Kettering (Mr Hollobone) that when we look at funding and directional resources, we will certainly take account of not just the current population, but the forecast population.

Covid-19: Military aid to Civil Authorities

Philip Hollobone Excerpts

Tuesday 8th February 2022 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

Before we begin, I remind Members that Mr Speaker encourages all to observe social distancing and to wear masks.

[Chris Loder (West Dorset) (Con)]

I beg to move,

That this House has considered requests for military aid to civil authorities during the covid-19 outbreak.

It is a pleasure to serve under your chairmanship today, Mr Hollobone. I am grateful to the House for allowing time for this important debate.

Coronavirus has created pressures on all public services the likes of which we have never seen before. When those services are critical for preserving life, the pressures—increased absenteeism and greater demand—are significantly more noticeable. Many constituents have had awful experiences of waiting four, eight or even 10 hours for an ambulance for either themselves or a relative. I applied for this debate because constituents—many of whom are relatives of vulnerable people—have recently been in touch to share their despair over having to wait many hours for an ambulance, even in urgent circumstances.

One constituent had to stay by the side of his late father’s body for nine hours before an ambulance was able to attend to his father and take him away. The shock of finding his father unexpectedly dead at home would have been enough—I cannot imagine having to sit beside a deceased loved one for many hours, waiting for help that just does not turn up. Another constituent in her 80s waited for an ambulance for 10 hours after she broke her hip at home. Another was identified as having a stroke by a doctor who lived nearby; because they could not wait for an ambulance, the doctor kindly drove her directly to the hospital.

There are many such stories. I am sure West Dorset is not the only area in the United Kingdom experiencing such difficulty, and I am sure I am not the only MP hearing such stories. In this debate, my intention is not to pile criticism on the South Western Ambulance Service. In West Dorset and across the wider south-west, our ambulance service has been working to absolute capacity until it simply cannot do any more. Diligent MPs cannot stand by and allow this situation to go on without proper scrutiny. It is clear that something needs to change.

These failures are caused not by incompetence or inefficiency, but by a greater demand upon our health systems than they are capable of handling without further back-up. A lack of social care options for people fit for discharge has caused a backing up throughout the hospital system that has ultimately compounded this situation. Ambulances often need to queue outside A&E for hours, with patients having to wait so long that they are triaged in the ambulance.

Ambulance drivers are in frequent close contact with vulnerable people. They have needed to be even more vigilant than the rest of us about self-testing and isolating when required so that they do not infect their patients. While that sense of care and responsibility is their duty, it has resulted in higher levels of absenteeism than the ambulance workforce has been able to manage.

The compounding of those issues—with absenteeism and capacity pressures in hospitals resulting in ambulances queuing at A&E, unable to leave until they have safely transferred their patients into the care of hospital staff—has meant the ambulance service is unable to respond to the next call. The result at home in West Dorset is a lack of ambulances available and people waiting for hours, sometimes in great pain and distress.

When our civilian services are in this situation, during a national crisis or not, the last step of escalation is to the Government, for assistance from the Ministry of Defence.

Covid-19: Purchasing Effort

Philip Hollobone Excerpts

Thursday 3rd February 2022 Commons Chamber

[Edward Argar]

I pay tribute to the hon. Gentleman for, as ever, dextrously mentioning his Bill. I think he has done that to me once before when I have been at the Dispatch Box discussing similar issues. I am sure that Ministers, and indeed the Leader of the House, will read it very carefully.

[Mr Philip Hollobone (Kettering) (Con)]

In the early months of the pandemic, getting PPE to Kettering General Hospital and local care homes was the absolute No. 1 priority. A very sophisticated distribution network had to be established involving the Army to ensure PPE was delivered to the right place at the right time, as best as possible. I believe that, starting from scratch, only 1% of certain PPE products were actually made in this country and over the course of the pandemic that has been increased to 70%-plus. Can my hon. Friend the hospitals Minister assure me that, God forbid, were we ever to have a pandemic again, we could source most of our PPE requirements from British manufacturers and that we now have a robust and resilient supply and distribution chain?

[Edward Argar]

I am grateful to my hon. Friend and join him in paying tribute to the work of his local healthcare system during the pandemic. He makes a couple of points. First, he is absolutely right to highlight that this was ramped up at pace. Initially, the NHS supplied PPE directly to about 250 hospital trusts and other trusts. In the early months of the pandemic, that was ramped up to supplying it to well over 50,000 different settings. That is a phenomenal ramping up of logistics and distribution capabilities. To his second point, he is absolutely right that, from about 1% of PPE being manufactured in the UK before the pandemic, we now have the capacity to manufacture about 70% of the PPE it is currently assessed we need in this country. That is a great British success story.

Kettering General Hospital

Philip Hollobone Excerpts

Wednesday 2nd February 2022 Westminster Hall

[Derek Twigg (in the Chair)]

Before we begin, I remind Members to observe social distancing and wear masks. I will call Philip Hollobone to move the motion and then the Minister to respond. There will not be an opportunity for the Member in charge to wind up. That is the convention for 30-minute debates, as I know the Member is well aware.

[Mr Philip Hollobone (Kettering) (Con)]

I beg to move,

That this House has considered the redevelopment of Kettering General Hospital.

It is a delight to see you in the Chair, Mr Twigg.

I thank Mr Speaker for granting me this debate, and I welcome the Hospitals Minister to his place. I also welcome my hon. Friend the Member for Northampton South (Andrew Lewer), who is kindly here to support the calls for the redevelopment of Kettering General Hospital. I thank the very hard-working, dedicated and loyal workforce at Kettering General Hospital for all they do to address the healthcare needs of the local population across Northamptonshire, particularly north Northamptonshire—in particular, Simon Weldon, the group chief executive, and Polly Grimmett, the director of strategy at Kettering hospital.

The Hospitals Minister knows Kettering hospital well and has always been extremely attentive and courteous to the healthcare needs of the local population in Kettering and beyond. He kindly visited the hospital on 7 October 2019, and he has responded to Adjournment and Westminster Hall debates on the hospital on 23 October 2019, 8 June 2021 and 10 September 2021. We have had regular meetings with him, most recently on 17 January this year.

I welcome the Government’s unprecedented investment in the NHS as a whole, and their commitment to the national hospital building programme. It has resulted in commitments to Kettering hospital of £46 million for an on-site urgent care hub, £350 million in health infrastructure plan 2 funding for 2025-30 and a write-off in 2020 of all the hospital’s £167 million trust debt. That is a total investment package for the hospital of a staggering £563 million, which is the biggest ever investment in Kettering General Hospital.

Kettering hospital is 125 years old this year. It has been on the same site ever since its inception in 1897. It is a much-loved local hospital that I hope will have a bright future. Let me reassure the Minister that I am not asking for more money. I welcome his recent decision that the two funding streams—the £46 million for the urgent care hub and the £350 million HIP2 funding—be meshed together, so that a synthesis of investment can be provided to the hospital. I have said this to the Minister before, and I repeat it today: promises are one thing, but delivery is quite another, and we now need the cash. The hospital needs the £46 million in cash so that works can continue.

In announcing the award of £46 million for the new urgent care hub in the debate on 23 October 2019, the Minister himself said:

“My officials and NHS England will be in touch with the trust to discuss further details, in order to ensure that funds are released and that work starts on the project as swiftly as possible. I am conscious of the urgency that my hon. Friend the Member for Kettering highlighted.”—[Official Report, 23 October 2019; Vol. 666, c. 30WH.]

I welcomed those words, but that was over two years ago. While we have been promised £46 million, the hospital has not yet received the cash.

My first main ask is for the imminent provision to KGH of the £46 million sustainability and transformation partnership wave 4b funding, which was first pledged in the debate here in October 2019, so that the initial enabling works for the redevelopment of the hospital can continue to 2023-24. Secondly, I reinvite the Minister to visit Kettering hospital. He has kindly visited before and has promised to visit again. I hope that that visit will take place soon.

Thirdly, can we have confirmation that the NHS’s new hospitals programme team will approve, and give feedback on, the hospital’s strategic outline case for its redevelopment, which was submitted early last year, so that the hospital can develop the next stage—an outline business case—in May 2022? Fourthly, can the Minister confirm that he will look favourably on Kettering hospital’s eligibility for £53 million of slippage from other more complicated and larger hospital development schemes—such slippage will inevitably occur across the redevelopment of 40 hospitals—so that work can continue on the Kettering site all the way through to the 2025 to 2030 HIP2 period?

The hospital is straining at the leash to get the redevelopment project under way. Initial work has already commenced, but the hospital must go through various approval processes to fulfil the NHS’s investment requirements. Essentially, there is a three-stage business case approval process: a strategic outline case, an outline business case and a final business case.

The hospital submitted its SOC early last year, but it has not yet received feedback from the new hospitals programme team to inform the outline business case, which it is keen to submit in May this year. Once the OBC is achieved, feedback is required for the final business case. The big risk is that these various business case approval processes are extended too long, which will mean that substantial development on site will be held up.

The second risk is that the hospital needs the cash from the £46 million to allow the initial enabling work to continue. That work covers things such as the reprovisioning of car parking, clinical and office spaces to create construction space for the redevelopment itself, as well as road and utility diversions and site clearance. Without the cash from the £46 million, the risk is that those enabling works will have to stop, and that would be of extreme concern to local people.

The third risk is that the trust does not receive any slippage money from the other 40 hospital building programmes around the country. The Kettering scheme is relatively small, compared with some of the very large hospitals being rebuilt, but it is flexible. It can respond extremely well to receiving any slippage money from those other projects.

[Andrew Lewer (Northampton South) (Con)]

My hon. Friend is giving a remarkably impressive run-through of some of the complex bureaucracy and procedures. I want to pick up on his point about integration. Does he agree that Northampton General Hospital and Kettering General Hospital working together more efficiently provides some promising opportunities? While I cannot join him in saying that I will not ask the Minister for more money, because Northampton General Hospital is in the next stage of needing this sort of funding, I join him in asking the Minister to come and look at Northampton General Hospital and Kettering General Hospital as soon as possible.

[Mr Hollobone]

I thank my hon. Friend for his helpful intervention. How about this as a constructive suggestion? Would it not be wonderful if, on visiting Kettering, the Minister was able to call in at Northampton on the way? We are only 18 miles apart. Northampton and Kettering hospitals work together under the same NHS trust umbrella, and there is a lot of close working between the two hospitals. I recognise the need for more investment in Northampton hospital as well. I congratulate my hon. Friend on all his work for his constituents, which I know is hugely appreciated.

The risk is that, if Kettering hospital is not allowed to begin work on its full business case approval process this summer, the hospital will miss its 2023 target date for substantial construction on the site. The hospital continues to work towards a timetable that sees construction start on site in 2023. This is an accelerated timeline, because the hospital is eager to go on what is a relatively low-risk project. The hospital does not need to do any land deals; it owns all the land. There is strong local support among health system partners and planners. The hospital is keen to use repeatable designs from other hospital projects that have worked well elsewhere.

Can we have feedback from the new hospital programme team on the business case and designs for the hospital, so that the hospital can incorporate national thinking on programme priorities such as digital, net zero carbon and modern methods of construction? Can we have, as early as possible, the selection by the new hospital programme team of an appointed construction partner to work with the trust on developing the final scheme details, and can the hospital have the funding to cover the fees associated with this stage of the design? The risk is that, unless this support from the new hospital programme team is forthcoming, work on the hospital’s main scheme may have to come to a stop, with key resource being stood down and reassigned. I am sure the Minister wants to avoid that.

It is welcome news that the trust has received confirmation that the £46 million can be combined with the £350 million, so that it is a united programme. However, at present, there is no process in place to allow the hospital to start accessing these funds once existing programme budgets run out in March this year. Unless the trust is able to access these funds this year, early enabling work required to prepare the site for construction in 2023 will not be completed and the main build will not be possible on time.

One thing that keeps the chief executive awake at night is the power plant at Kettering hospital: £25 million of the money required for enabling work relates to the need for a new energy centre on site to replace the temporary plant and life-expired distribution system. This is an immediate risk to patient safety due to ongoing shutdowns caused by testing and repair work. If the Minister were kind enough to agree to visit the hospital, I am sure the trust would want to show him the power plant, which is in urgent need of attention. If we get the £46 million, the scheme can progress, enabling works can continue and the hospital will be on track for early construction work beginning in 2023.

I reiterate that Kettering hospital is a much-loved local hospital. It serves all the residents of Kettering, Wellingborough, Corby and others, sometimes including patients form Northampton. We live in one of the fastest-growing areas in the country. Corby has the country’s highest birth rate, and Kettering hospital expects a 21% increase in the number of over-80s in the local area in the next five years alone. The area has committed to at least 35,000 new houses over the next 10 years. The local population is set to rise by some 84,000, to almost 400,000 people. The A&E now sees up to 300 patients every single day in a department that is sized to safely see just 110. Over the next 10 years, the hospital expects the number of A&E attendances to increase by 30,000, up from 100,000; that is the equivalent of almost 80 extra patients every day.

The A&E is full. It was constructed in 1994 to cope with just 45,000 attendances each year. By 2045, 170,000 attendances are expected. Seventy per cent. of the buildings on the main site are more than 30 years old, and there is a maintenance backlog of £42 million. Sixty per cent. of the hospital estate is rated as either poor or bad. Local people know that this investment is needed. The Government have also accepted that the investment is needed. What we need now is the cash to make sure that the works can start on time in 2023.

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate. By my tally, this is the fourth debate I have responded to that he has secured on the future of Kettering General Hospital and its redevelopment. That fact reflects his commitment to this issue on behalf of his constituents, and his typically courteous but tenacious approach to the matter. I will put on record, as they are unable to be here, the work done by my hon. Friends the Members for Wellingborough (Mr Bone) and for Corby (Tom Pursglove) in this respect. I welcome the intervention from my hon. Friend the Member for Northampton South (Andrew Lewer).

The topic is not a new one for this House to discuss, but it is an extremely important one. I hope that I might move matters a little bit further forward in this debate for my hon. Friend the Member for Kettering. It was a pleasure to meet him, my hon. Friends the Members for Wellingborough and for Corby and Simon Weldon on 17 January to discuss Kettering General Hospital and receive an update on its plans. I join my hon. Friend the Member for Kettering in paying tribute to Simon and all of the team at Kettering General Hospital and at Northampton General Hospital for the work they have done, not only in the past two years, but day in, day out every year, to support the local community and provide first-class care.

My hon. Friend the Member for Kettering made, as ever, a generous offer to visit Kettering General Hospital with him. It was a pleasure to do so in 2019, when he gave me a very warm welcome in Kettering. I also take his suggestion of visiting Northampton at the same time. Without setting a specific date, my aim is to try to visit him during the February recess—I will discuss this with him. It is not a long haul for me from my constituency in Leicestershire to his in Kettering or Northampton, so that is what I will hope to do, subject to that working for the trust. Ministers are often surplus to operational requirements in a busy trust at busy times, but I suspect that Simon will welcome me to explain what progress he has made. That is my commitment to my hon. Friend.

As my hon. Friend set out, Kettering General Hospital is part of the broader foundation trust, and continues to work closely with the central programme team in taking forward the rebuild of Kettering General as a new hospital for his community. It is part of the broader programme to build 40 new hospitals by 2030. On 13 January, Natalie Forrest, who is the senior responsible owner for the new hospital programme, and officials attended a virtual meeting with the chief executive and staff from Kettering General to discuss progress and provide an update on the scheme in the context of the programme. As my hon. Friend knows, Kettering General Hospital NHS Foundation Trust has received £4.4 million of funding to develop its plans for the rebuilding of Kettering General Hospital. They were successful in securing funding back in 2019, at that stage for a new urgent care hub, which would transform the provision of urgent and critical care in the area. I know that officials are in discussion with the chief executive of the hospital trust regarding the trust’s plans for enabling works on the Kettering General Hospital site and have set out what will be required for these proposals to be assessed as quickly as possible, once business cases are received from the trust, which is in line with what my hon. Friend would expect of appropriate processes for spending public money.

I will provide a little background. The Department wrote to the chief executive on 16 June last year to confirm that, at his request, the urgent care hub and new hospital programme schemes could be brought together as a single pot of money, to maximise the benefits that local people could derive.

Essentially, my hon. Friend asked why things have not progressed since 2019. That is largely because the trust changed its plans. That money was ringfenced for an urgent treatment centre. We had discussions about that with the trust and accepted its proposal to merge the two pots of money. That then necessitated their coming forward with proposals about how they would spend that money as part of the enabling works for a broader scheme. If changes are made, it is right that those changes are justified, in the context of the appropriate stewardship of public money.

The hub and the new hospital that are to be built both share a set of common enabling works, which have been factored into the new hospital development plans. As a result, the trust is incorporating the urgent care hub delivery into that broader plan. It means that the hub will now be part of the first stage of the building of the new hospital, enabling the more efficient use of resources to deliver better results.

In respect of the business case for that plan—I know that my hon. Friend is keen that there is progress on that as swiftly as possible—my officials have been in touch with the trust recently, most recently yesterday and before that on 26 or 27 January, asking the trust to put forward its proposals for those enabling works. We need those to progress the business case. My officials continue to nudge the trust gently, saying, “Please submit your proposals for that and the business case for it”. My commitment is that my officials will consider those proposals as swiftly as they can, once they have received them. As I understand it, given the scale of the enabling works, they would not need to go through the full internal approvals process, but the trust needs to submit a business case for that element.

The second element, which I know my hon. Friend and the trust are keen to see being advanced as swiftly as possible, is the new boiler room and power plant. Essentially, that would have to go through the full approvals process, but I understand that the board of the trust is due to meet in April to agree and finalise its proposal and business case on that work. As soon as it submits that, I can commit to my hon. Friend that—assuming that it is up to scratch, which I am sure it will be—it will go before the first joint investment committee of the Department following its submission, so that it can be considered as swiftly as possible.

At the moment, if I may put it this way, the ball is in the trust’s court, for it to send its proposal and business case over. However, my commitment is that as soon as the trust does so, I will task officials with considering them as swiftly as possible.

[Mr Hollobone]

I thank the Minister for his very helpful comments. I think that the ball, in part, may be in the trust’s court, but there is perhaps another ball with the new hospitals programme team. I say that because the hospital submitted its strategic outline case to the NHS a year ago and what the trust requires is feedback on that, to inform the development of its outline business case. So would the Minister be kind enough to look at that feedback?

[Edward Argar]

I am happy to look at that. The point I am making to my hon. Friend is that for the moneys that he and the trust wish to draw down from the £46 million, we do not have the business cases from the trust that would enable that work. I suspect that they will be winging their way to the Department pretty swiftly following this debate and as soon as they arrive we will look at them. Regarding the broader business case for the overall scheme, I will turn to that, if I may, in just a moment.

All the new hospitals that will be delivered as part of the programme, including Kettering, are required to work with the central team and, with the support of regional and local trust leadership, to design and deliver their hospitals in keeping with a consistent and standardised national approach. This collaborative approach is intended to help each trust to get the most from its available funding, while avoiding repetition of work and design, and ensuring that adherence to the principles, which my hon. Friend alluded to, of repeatable design, modern methods of construction and net carbon zero, is embedded from the outset, to maximise the potential benefits of the programmatic approach, as well, of course, as providing better value for money for the taxpayer.

All the projects that are part of that 40-hospital programme need to ensure that their approach is consistent with the programme, which that has been developed over the past year and has reached a greater level of maturity. Therefore, there will be individual conversations with trusts about where they align with the programme, or where they may need to adapt to meet that national approach.

My hon. Friend touched on the trust’s desire to go faster and begin the main project construction in 2023. In the spirit of openness, my only caveat to that is that, in the nature of funding through multiple spending review periods, it is not the case that a pot of money is earmarked for each programme and is just waiting to be drawn down; there is a profiling of moneys made available by the Treasury. I appreciate the trust’s eagerness to go faster, and I appreciate my hon. Friend’s clear steer that he believes it is capable of going further and faster, but we need to look at it in the context of all the other schemes and the availability and profile of moneys being made available. I just sound that slight note of caution, so I will not commit to a date, much though he tempts me to do so.

[Mr Hollobone]

I appreciate the Minister’s comments. I would just highlight that there are some very large new hospital programmes out there that will not be achieved on time. Kettering is a relatively small, flexible and modular scheme that is perfectly placed to pick up on any slippage from some of the larger schemes.

[Edward Argar]

I am grateful to my hon. Friend, because I was about to turn to his final ask, which was whether the Department would look favourably on Kettering’s scheme if there was slippage from other schemes in the course of the spending review period. Although I cannot prejudge in this place that Kettering will be top of the list, he makes a strong case. It is absolutely right that we look at schemes and have a list of schemes that we believe could fill the gap if moneys are not going to be spent in year. It is important that that contingency is built in, and my hon. Friend makes a strong case for Kettering to be one of the hospitals that is considered for acceleration if it is ready and the moneys become available. I will not prejudge the advice that I will be given by officials as to which schemes are most mature, but he makes his case clearly and forcefully on the Floor of the Chamber.

I am grateful to my hon. Friend not only for the opportunity to discuss and debate Kettering General Hospital, but for the opportunity to visit Kettering. On my last visit, I received a very warm welcome from him and the team at the hospital. In what I have said today, I hope I have ensured that I get an equally warm welcome when I come and see him this month. Like him, I am keen to see all these schemes progress, and I am keen to see the benefits that the schemes will realise.

In the context of Kettering General Hospital, my hon. Friend continues to be an incredibly powerful advocate for the interests of his constituents and those in the wider area of Northamptonshire who are served by the hospital. I look forward to continuing to work with him very closely in the future, as well as with the trust’s chief executive and team, other hon. Friends from Northamptonshire and my team in the Department, to help progress these very exciting and important plans, which will make a huge difference to his constituents’ lives in the years ahead.

Question put and agreed to.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 18th January 2022 Commons Chamber

[Sajid Javid]

Throughout the pandemic especially we have been providing more and more support, quite rightly, across the care sector, including for domiciliary care in care homes and unpaid carers. We have made £3.3 billion of extra funding and support available since March 2020.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering General Hospital is a 500-bed medium general hospital, and I am afraid that too many, mainly elderly, people who have completed their medical treatment still await discharge back into the community in a safe way. Will the Secretary of State ensure that the national taskforce is sent to Northamptonshire to help us deal with this issue?

[Sajid Javid]

My hon. Friend is right to raise this issue. It is of increasing concern, especially as we have seen hospitalisations rise because of the omicron wave. I believe that the national taskforce is already looking at Northamptonshire. If it is not, I will certainly make sure it does.

Covid-19 Update

Philip Hollobone Excerpts

Monday 6th December 2021 Commons Chamber

[Sajid Javid]

I thought it was going to be a serious question.

[Mr Philip Hollobone (Kettering) (Con)]

I have a constituent who is stuck in South Africa and due to come back on Thursday. He has been given a medical exemption from hotel quarantine, so he has to have managed quarantine at home for 10 days, but there is a problem with Corporate Travel Management, because it will not let him book his PCR test for day two and day eight unless he also books a hotel quarantine package. Will the Secretary of State help to unblock the problem with Corporate Travel Management?

[Sajid Javid]

Yes, there are in certain cases, as my hon. Friend points out, medical exemptions to the hotel quarantine system. The problem that he points out should not be happening, so I will be happy to look at that case with some urgency.