NHS Negligence Cases

Steve Barclay Excerpts

Tuesday 30th January 2018 Westminster Hall

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

As always, it is a pleasure to serve under your chairmanship, Mr Rosindell.

I begin by commending the hon. Member for Denton and Reddish (Andrew Gwynne) for securing this debate. Although he opened it by saying that it is perhaps unusual for a member of the shadow Cabinet to secure a debate such as this one, it is absolutely right that he is doing so on behalf of his constituent and bringing these matters before the House. I am very sorry to hear about Mr Hawkins’s experiences, which have clearly caused him distress.

As you are well aware, Mr Rosindell, the NHS complaints process operates independently of Government, to prevent political bias in the handling of individual complaints. However, a number of points arise from the hon. Gentleman’s remarks, in respect of his contention that Mr Hawkins was let down by a number of individuals and organisations within the NHS. Specifically, it is alleged by Mr Hawkins that the hospital failed him by prioritising then Government targets, which delayed his operation; that the clinician failed him through clinical error; that the duty surgeon failed him by falsely reporting that his wound had healed; that the hospital failed him by not correcting the alleged mistake and by instructing lawyers; that Hempsons solicitors failed to disclose full records; that his own solicitors failed him by not obtaining his records; that his own clinical medical expert failed him; that the hospital failed him, regarding his report; that the ombudsman failed him; and that the NHS Litigation Authority failed him.

Although the Department of Health does not comment on individual cases, and it is not for me to adjudicate whether all of those claims by Mr Hawkins are valid, it is worth noting that a very wide range of both individuals and organisations are alleged by Mr Hawkins either to have conspired against him or, indeed, to have failed him in this matter.

It is also worth placing on the record that NHS Resolution, which was formerly the NHS Litigation Authority, informs me that in January 2016 it first became aware of an independent medical report commissioned by Thompsons, Mr Hawkins’s own solicitors, which had not been previously disclosed to NHS Resolution in the course of Mr Hawkins making his claim. That medical report concluded that there was nothing to suggest that the operation in question had been performed anything but competently. Although I very much recognise that the hon. Gentleman’s constituent is of a different view, and he is perfectly entitled to be of a different view, it is worth placing on the record that his own medical expert, who reviewed this case, did not feel that the operation had been performed in the way that Mr Hawkins has claimed.

I note that Mr Hawkins referred this matter to the Parliamentary and Health Service Ombudsman, which is independent of both the NHS and Government, but the ombudsman ruled that the claim was out of time. Ombudsman decisions are final and there is no automatic right for them to be reviewed. However, the law provides for the ombudsman to consider whether to review a decision if it was demonstrated that the ombudsman made their decision based on inaccurate facts, or that there was new and relevant information that was not previously available, or that they had overlooked or misunderstood parts of the complaint or relevant information.

If a complainant believes that there has been maladministration in the handling of their complaint, they can apply to the courts for a judicial review. However, that must be done within three months of the conclusion of the complaints process.

[Andrew Gwynne]

The Minister hits the nail on the head there, and it is where the system has let Mr Hawkins down; Mr Hawkins will have been listening very attentively to the case that I set out. Mr Hawkins was denied that ability to apply for a judicial review because of the way that the hospital itself had delayed the process by not informing him that the case had been formally closed, so that by the time he was advised that the case was closed, the time limit by which he was able to take a legal route had passed.

[Stephen Barclay]

I very much recognise the point that the hon. Gentleman is making. Obviously, I do not want to get drawn into the specifics of this individual case, for the reasons that I have already set out, but within this case and within the claim made by Mr Hawkins a number of factors have been outlined, and I recognise that the hon. Gentleman’s point is one limb of the claim that Mr Hawkins has made.

What brings the various issues together is a question that I think applies to all of us, from all parties in the House: in the future, how do we collectively avoid cases such as Mr Hawkins’s case, and how do we improve the complaints process? That is an area where the Government have been particularly active, not least following “Hard Truths”, the report into Mid Staffordshire and the issues that arose there. The Department of Health has established the complaints improvement board to take forward a series of projects to improve the complaints process. So I hope that—irrespective of the specifics that we are discussing today—as part of the “closure” that the hon. Gentleman referred to, the improvements in the complaints process in the future will be a source of some comfort to Mr Hawkins.

As part of that process, the complaints improvement partnership was established by the Department and system partners, including NHS England, NHS Improvement, the Care Quality Commission, the Parliamentary and Health Service Ombudsman, and NHS Resolution. That partnership is currently examining options for delivering a more effective complaints management system, and better use of all forms of feedback to improve NHS services. That includes expanding the role of the “freedom to speak up” guardians, to give them powers to initiate whistleblower complaints processes where possible. My predecessor, the hon. Member for Ludlow (Mr Dunne), particularly championed that when he was a Minister, and he did a huge amount to progress it.

The complaints improvement partnership also engages with non-executive directors to explore options for them to have responsibility for monitoring the progress of complaints and serious incidents within trusts, and with Healthwatch England, to empower local healthwatch organisations. As constituency Members, I think we all work with and see the value of that body. Working with the ombudsman, the partnership also promotes best practice in the handling of complaints by providing information, advice and training. In addition, NHS Resolution has recently launched a service to increase the use of mediation in the NHS, to resolve issues at an earlier stage without the need for protracted litigation. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) has previously championed reducing the impact of lawyers when disputes arise.

It is important that patients receive the safest care possible from the NHS and that when things go wrong clinicians are open and honest, and able to learn from their mistakes. It is equally important that patients and their families are listened to and their concerns taken seriously and addressed.

[Andrew Gwynne]

That brings us back to the point made by the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). When Mr Hawkins complained that his Achilles tendon had adhered to the back of his foot again, it surely would have been better for Tameside General Hospital’s old management—the hospital has come a long way since it was in special measures—to investigate and put it right at that point, rather than immediately going down the legal route.

[Stephen Barclay]

The hon. Gentleman will appreciate that the events took place more than 11 years ago and that it is, therefore, not for me to comment on what the trust knew at that time or their actions accordingly. I think we all, across the House, recognise that resolving issues without recourse to litigation is preferable, where possible, to lawyers being involved at an early stage—and I say that as a former lawyer. That is why the Government seek to improve how complaints are handled, including improving the regulation. The Care Quality Commission now rigorously inspects all trusts and primary and adult care providers, and a duty of candour—a new protection for whistleblowers—encourages staff to speak up for safety and hence fosters greater transparency. There is also the development of a culture of learning, through patient safety collaboratives and the national Sign up to Safety campaign, and last April the healthcare safety investigation branch became a fully operational and independent branch of NHS Improvement, to investigate serious incidents in the NHS with a strong focus on system-wide learning.

[Dr Poulter]

I do not wish to distract from the main purpose of the debate, but my hon. Friend makes an important point about a culture of openness and transparency in dealing with complaints. How does he feel that the recent High Court judgment about a doctor being struck off by the General Medical Council might play into doctors’ and other healthcare professionals’ willingness to engage with such a culture? Might it be inhibitory, in that they would be concerned about the impact on their future careers of being open and willing to own up to mistakes?

[Stephen Barclay]

As a former Minister, my hon. Friend knows that there are conventions regarding Ministers of the Crown commenting on court judgments. The Secretary of State has already made clear his position on that matter, and this debate on a specific constituency issue is not the forum for moving beyond that scope.

It is important for us all that we improve the handling of complaints. In a system as large as the NHS, we all recognise that, with the best will in the world, things will go wrong and mistakes will be made. The latest Care Quality Commission annual “State of Care” report, published in October 2017, recognises that the vast majority of patients get good care and that many parts of the NHS have improved thanks to the hard work of the staff. The key issue that the hon. Member for Denton and Reddish has rightly brought before us today is how we learn from things going wrong and how, when a patient thinks something has gone wrong, the issues are aired and resolved.

I commend the hon. Gentleman for securing the debate, notwithstanding his elevated position in the shadow Cabinet, and for ensuring that his constituent’s issues have been aired before the House. The Government are committed to building a learning culture within the NHS that listens to patients and relatives and learns from mistakes, so that patients do not suffer avoidable harm. The Secretary of State deserves great credit for his championing of patient safety as a specific issue within his portfolio. We are also working to improve the complaints handling system so that it is more responsive and joined-up between organisations. I hope that the improvements that are in place will help Mr Hawkins to get some closure on the matters we have debated today.

North West Ambulance Service

Steve Barclay Excerpts

Monday 22nd January 2018 Commons Chamber

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

I congratulate the hon. Member for Rochdale (Tony Lloyd) on securing this debate. I know that he visited the North West Ambulance Service Trust in 2017 and has a long-standing interest in this area. He comes to the House as one of its most senior and experienced Members and a former chair of the parliamentary Labour party. I am happy to meet him to discuss his remarks in more detail in order to work collaboratively to take this forward, given the concerns he has set out, particularly concerning the delays that Ron and Pat experienced, and how we can address them.

I absolutely agree with the sentiment expressed by the hon. Member for West Lancashire (Rosie Cooper) about the need for an open culture, and I am happy to work with her, as I have done in the past, in fostering such a culture.

[Norman Lamb]

The Secretary of State has been very good, post Francis, at being very clear that there has to be an open culture and that staff must feel free to speak out when there are patient safety risks that concern them. Will the Minister use this opportunity to re-enforce the message to the management of trusts, including ambulance trusts, across the country that they must allow their staff to speak out when they have genuine and legitimate concerns of this sort?

[Stephen Barclay]

I certainly will take this opportunity to do exactly that. As the right hon. Gentleman will be aware, like him, I myself, during my time in the House, have frequently spoken out on behalf of whistleblowers, particularly in my former role as a member of the Public Accounts Committee. I know he has other concerns that, with the leave of the House, I might touch on at the end of my remarks, but, as I am sure he will appreciate, I want to address the issues of the North West Ambulance Service in particular.

As Members on both sides of the House will know, the NHS is busier than ever. The ambulance service is dealing with unprecedented demand, with 11 million calls each year and almost 7 million face-to-face responses in 2016-17, which was a 14% increase on the previous five years. Overall, it is worth noting, on the concerns about workforce that the hon. Member for Rochdale set out, that the North West Ambulance Service has a strong record on recruitment, having recruited an extra 167 paramedics in 2017. As a result, its vacancy rate, at just 2.4%, is now one of the lowest in the country.

The hon. Gentleman is right, however, that on performance there is an issue and that the service does need to improve. As I will set out in my remarks, that is why work is under way with NHS England and NHS Improvement, working with the commissioners and the trust, to address that, as part of the wider national initiatives. It also needs to be set in the context of the pressures within the health service. About 3,000 patients are currently in hospital beds with flu and about 700 with the norovirus, so there are clearly winter pressures affecting handovers, but he is absolutely right that how we address the delays in handovers is a key area, and certainly a key ministerial focus of mine, as I will come on to in due course.

The hon. Gentleman set out several concerns about the trust’s performance. It is worth drawing the House’s attention to the fact that six ambulance liaison officers are now in place at A&Es across Greater Manchester to support handovers and address delays. The Treasury is investing £100,000 in the trust in February and March to boost operational capacity, and procedural solutions are being introduced to improve the efficiency of call handling. Under Sir Bruce Keogh’s review of the NHS urgent and emergency care system, ambulance services are being transformed to increase the use of “hear and treat” and “see and treat” and ensure the better prioritisation of patients so that those with the highest need are seen most urgently. The aim is to avoid what we all recognise was an issue in the past—where, in order to meet targets, often two, three or four ambulances were being sent in response to the same call. People had concerns about that across the House, but that is one of the improvements that has been brought in.

In 2016-17, the North West Ambulance Service treated and discharged over one quarter more patients at the scene and 92% more patients over the telephone compared with 2011-12, so although I recognise that there are challenges and areas that require improvement, it is important, in the interests of balance, also to recognise the progress the trust has made in recruiting more paramedics—as part of the 3,000 more paramedics nationally—its low vacancy rate and the steps it has taken to treat more patients at the scene.

Additionally, in July last year, the Secretary of State approved a revision of the operational performance standards for ambulances. Those improvements have been rolled out to all mainland ambulance trusts, which will mean better prioritisation of calls. The framework brings all patients under a national response standard for the first time and improves the efficiency and resilience of the ambulance service in the face of rising demand.

We recognise that the performance of the North West Ambulance Service against those standards is not good enough, and that is why NHS Improvement, NHS England and commissioners are closely engaged with the trust to ensure that it adapts successfully to the new performance framework. If the hon. Gentleman has specific concerns about the openness of the trust, I will be very happy to discuss those points and take them forward with him in a collaborative spirit.

I understand that the hon. Gentleman has raised concerns about workforce directly with the trust. As I said earlier, 3,000 more paramedics have been recruited nationally compared with 2010—an increase of more than 30%—so there are more paramedics than there were.

[Tony Lloyd]

I know that the Minister is trying to be helpful, but one thing is bound to concern constituents. At the time of the A&E closure in Rochdale, a commitment was made that there would be paramedic cover as routine, but that is being breached regularly. Even if there has been some increase in the number of paramedics, and I concede that there has been, it has not kept pace. Nor has the North West Ambulance Service even tried to honour the commitment that was made—perhaps it should not have been made—in order to deliver the closure of the A&E. The phrase “sleight of hand” comes to mind, and we have to do better.

[Stephen Barclay]

I take that concern seriously, and I discussed it with officials earlier today. Compared with 2010-11, when the local “Healthy Futures” reconfiguration took place, there has been a 33% increase in vehicle hours assigned to the Rochdale and Bury area, with an associated staff resource increase of 43 full-time equivalent. So there has been improvement.

The North West Ambulance Service also aims to include a paramedic on board every ambulance. Although there are seven paramedic vacancies in the Rochdale area, nine paramedics are due to be assigned over the next 10 weeks and the trust is confident that the area will have a full complement of paramedic staff by April this year. I hope that that brings some comfort to the hon. Gentleman’s constituents about the direction of travel.

It is worth bearing in mind that, alongside those paramedics, the North West Ambulance Trust has recruited 24 graduates to operate as emergency medical technicians, and they are awaiting registration as paramedics. That will further improve the position. The trust has made it easier for emergency medical technicians to embark on paramedic training courses and worked with local universities to increase the rate of paramedic qualification. Where emergency medical technicians crew ambulances and respond to calls, they are heavily supported to do so safely, with direct access to advice from advanced paramedics and the trust’s clinical hub.

Handover delays were mentioned in several interventions. We recognise the challenge of delayed patient handovers to emergency departments. Delayed handovers tie up ambulance resources and adversely affect the trust’s capability to respond quickly to new calls. We are clear that handovers must take place within the agreed timeframes, and NHS England and NHS Improvement are supporting hospitals to ensure that improvements are made. Such work includes improved monitoring and daily review by national and regional winter operations teams, targeted assistance to challenged hospital trusts to improve their performance and the issuing of revised handover guidelines that focus responsibility on the wider system to address handover delays, including a clear escalation process. Locally, there are initiatives in place such as the placement of hospital ambulance liaison officers within emergency departments.

The trust is implementing a number of procedural solutions to improve the efficiency of the call-taking staff, including the use of post-dispatch scripts, which inform callers of the expected arrival time of a resource. In other trusts, that has minimised duplicate calls and reduced ambulance attendances by 4.6%.

To conclude on the comments of the hon. Member for Rochdale—with the leave of the House, I will then address the concerns of the right hon. Member for North Norfolk (Norman Lamb)—his concerns about performance are pertinent, and there is work ongoing to address that issue as part of the wider initiative. However, it is also important to recognise the progress that has been made, which has seen the recruitment of additional paramedics and the training of staff, with the progression of which the hon. Gentleman spoke, which allows people to progress their career into the role of paramedics. There are also further measures in terms of prioritisation, which will address a number of the concerns he set out.

On whistleblowers, that is an issue on which I, as a constituency Member of Parliament, have long campaigned. I hope my record on that speaks for itself, and the issue is something the right hon. Gentleman and I have previously discussed.

The right hon. Gentleman has also raised concerns, as has the hon. Member for Norwich South (Clive Lewis), regarding the East of England Ambulance Service. On receipt of the right hon. Gentleman’s letter, I instructed officials in my Department to share copies with the Care Quality Commission—the independent regulator of all health and social care services in England—to ensure that it is fully aware of the issues being raised. I discussed these concerning allegations directly with the chief executive of NHS England and the chief executive of NHS Improvement this morning, and asked them to confirm to me the actions they will be taking. They have subsequently confirmed that they will be holding a joint risk summit regarding the trust in the next week. The CQC will be in attendance.

[Norman Lamb]

First, I am really grateful to the Minister for addressing these issues this evening, given that this is a debate about the North West Ambulance Service. Would he be willing to meet me, given the level of concerns in the east of England?

[Stephen Barclay]

I would be very happy to meet the right hon. Gentleman. As a fellow east of England Member of Parliament, but also as a former Health Minister, he brings great experience to these issues, so of course I will.

In conclusion, I pay tribute to the hon. Member for Rochdale for raising this issue this evening. I am happy to work with him in our common interest to address the areas of performance that need to improve. However, at the same time, it is important that we recognise the progress that has been made on recruitment and reducing the vacancy level by the North West Ambulance Service, which gives a positive sign of the progress that is being made as we address the challenges being faced across the NHS.

Question put and agreed to.

Musgrove Park Hospital Surgical Centre

Steve Barclay Excerpts

Thursday 18th January 2018 Commons Chamber

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

I congratulate my hon. Friend the Member for Taunton Deane (Rebecca Pow) on securing this debate, and I am pleased to be able to join her in discussing a matter of great importance to both her constituency and her family. She powerfully set out her personal links with Musgrove Park and its importance to the community as a whole.

The Government recognise the real concerns—which the House got a full flavour of—about Musgrove Park and we are working to address the concerns that my hon. Friend set out. The hospital’s theatres and critical care facilities are housed in pre-war buildings that are at risk of critical infrastructure failure because of their age and condition, and she gave us a clear sense of the urgency of the need to respond to that.

It is clearly crucial that NHS facilities are as well maintained and up to date as possible. In this case, I am sure my hon. Friend will agree that decisions should be driven by what is best clinically, what is best for the health service in the area, and what is of most benefit to the greatest number of people in the area. It is right that we address these matters at a level where the local healthcare needs are best assessed, rather than doing so solely in Whitehall.

The Government recognise that Musgrove Park Hospital’s theatres and critical care facilities need to be improved significantly, but that due to the foundation trust’s financial position it is unable to fund the improvements itself. The trust has therefore proposed to invest £79.6 million in the development of modern, fit-for-purpose operating theatres, a critical care unit and an endoscopy unit. The trust is bidding for funds made available through the sustainability and transformation plan capital bidding process.

As my hon. Friend is aware, the Taunton and Somerset NHS Foundation Trust was informed that it was unsuccessful in its application under the wave 2 capital bidding process, but perhaps it will be encouraged by the fact that it was asked to develop a case with a view to submitting another bid under the wave 3 process, which is now under way. The latest bid submission process was announced in late December 2017 and closes on 31 January. The trust is being supported by the regional NHS Improvement team to ensure that it submits a comprehensive bid.

The Somerset clinical commissioning group has given its highest priority to the redevelopment of the surgical block at Taunton’s Musgrove Park Hospital. Running in parallel to the process for securing funding, the NHS Improvement regional team is supporting the trust to develop the business cases required for the development of the surgical facilities. I am pleased to learn that Musgrove Park Hospital’s surgical block capital bid has now been submitted and has received support, in principle, from NHS England and NHS Improvement, and will be considered for the next round of announcements for capital. Should its bid be successful, money will then be made available to start work on a new surgical centre at Musgrove Park Hospital. I join my hon. Friend in recognising that lead times for construction work are often very long. That is an area that I am keen for the Department to focus its attention on.

On the long-term plans for Somerset hospitals, the Somerset CCG is developing a clinical services review that will consider the views of patients before developing a series of service proposals with the aim of ensuring that family doctors and community hospital and district hospital services are joined up with social care services to provide financially sustainable and high-quality care. I know that my hon. Friend shares the Government’s desire to ensure that we take a more integrated approach to commissioning our services.

The Taunton and Somerset NHS Foundation Trust was rated as good by the Care Quality Commission in its December 2017 report. That is a tribute to the staff working there. It was rated as outstanding for caring, and rated as good for being effective, responsive and well-led. Surgical services are rated as good overall, having been rated as requiring improvement in the previous report. This followed action being taken to address and resolve issues with theatre safety and surgical site infections. NHS Improvement has no significant clinical quality concerns, and there have been no recent theatre or estate-related significant incidents. However, the latest CQC report mentioned that inspectors had heard of operations being cancelled due to the theatre environment and the air conditioning issues that my hon. Friend mentioned. This highlights the need for improved surgical facilities.

In closing, I recognise that Musgrove Park Hospital’s theatres and critical care facilities require significant improvement, and I pay tribute to my hon. Friend for the manner in which she set out such a powerful case for that improvement. Somerset clinical commissioning group has given its highest priority to the redevelopment of the surgical block at Taunton’s Musgrove Park Hospital. I am pleased to learn that the hospital’s surgical block capital bid has been submitted and has received support, in principle, from both NHS England and NHS Improvement. Should the bid be successful, money will then be made available to start work on a new surgical centre at Musgrove Park Hospital. I am sure that my hon. Friend will agree that decisions should be driven locally, and I know that she is particularly focused on that.

In securing this Adjournment debate, my hon. Friend, as she so often does, has put the case for Taunton Deane. As the Minister responsible, I recognise the importance of the issue both to her and to the community, and I look forward to continued discussions with her as we seek to progress the situation and ensure the best possible care for Taunton Deane and the surrounding area.

Question put and agreed to.

King’s College Hospital

Steve Barclay Excerpts

Tuesday 16th January 2018 Westminster Hall

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

It is a pleasure to serve under your chairmanship once again, Mr Hollobone, albeit in a different role. I begin by paying tribute to the hon. Member for Dulwich and West Norwood (Helen Hayes) for securing the debate and for the powerful case she set out on behalf of her constituents. I recognise the importance of King’s not just to her family but to the community she serves, to other hon. Members present, and more widely.

In her remarks, the hon. Lady drew out three specific points, suggesting that the Government have responded to this situation as if it had arisen suddenly, that it is reflective of other hospitals and that the roots go back to the Princess Royal decision in 2013. I will seek to address each of those in the course of my remarks, but at the heart of this matter is the concern that the board and King’s have lost or eroded the confidence of the regulator by the manner in which the deficit target has significantly deteriorated, and the concern that the cost improvements are an outlier when pitched against comparable trusts. That is really the crux of the issue.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) brought the value of experience both as a clinician and as a former Health Minister. I was very taken by his remarks. Specifically, on the point he raised about the PFI debt, it is helpful to remind colleagues that support was agreed by the Department at the time, in 2013-14, for the additional costs of that PFI financing. That was taken into consideration by the board, which agreed to it at that point. It is not the case that the PFI has been a material contributor to the current deficit.

[Dr Poulter]

My hon. Friend makes a fair point, although it is difficult for a board that has effectively had a merger foisted on it to appreciate fully how a hospital will run across two sites—or even three sites, with Orpington as well. I am sure the Minister will go away and think about that in the context of the PFI and whether something more could be done to help with the PFI debt.

[Stephen Barclay]

Indeed, I am happy to give consideration to the point my hon. Friend makes, although if one looks at the deficit for this year, which I will come on to in my remarks, one will see that the bulk of the deficit is not from the Princess Royal but from the other sites, so it does not pertain to the 2013 decision. I will come on to that more fully as I develop the case.

I will also say to the right hon. and learned Member for Camberwell and Peckham (Ms Harman), who recognised that the staff at King’s want to deliver, that I agree with her on that point. It is not about apportioning blame to those members of staff. Indeed, the financial special measures are about giving additional assistance to King’s to address those points, rather than seeking to blame them. I think there is a shared desire from both sides of the House to get the right outcome for King’s. I am very happy to agree with her on that.

It is a fact that King’s is a challenged organisation. We are putting a lot of effort into supporting it. King’s is receiving substantial financial support from the Department. The trust has received more than £100 million of support to maintain frontline services, the second-highest level of support to any individual trust across England. Placing King’s in special measures for financial reasons is a regulatory action to bring about swift improvement and address the trust’s financial challenges. NHSI is working with the trust to undertake a rapid review and agree a financial recovery plan.

Under the financial special measures programme, the trust will receive extra help and oversight, with the appointment of a financial improvement director. The organisation will also be required to draw up and deliver a plan to improve its finances, which NHSI will closely monitor. That will include support from peer providers where appropriate. On top of those special measures, NHS Improvement has also appointed Ian Smith as a new and experienced interim chair for King’s, to take control of the organisation’s position. He was appointed, as I am sure the hon. Member for Dulwich and West Norwood is aware, on 21 December and took up that role with immediate effect.

It is a fact that some profound financial issues at the trust need to be addressed. The trust agreed a budget deficit of £38.8 million in May 2017, yet just five months after the board had agreed that deficit it submitted a re-forecast deficit of £70.6 million, and a further two months later, in December 2017, the trust informed NHS Improvement that its current mid-case projection had worsened again to around £92 million. So, an agreed board position of a deficit of £38.8 million had within seven months gone up to a deficit of £92 million. That is really at the heart of this. When measured, that level of deterioration is an outlier, which is why the chief financial officer and chief operating officer both resigned in November 2017, and the chair resigned, as hon. Members have pointed out, in December 2017.

When announcing the financial special measures, Ian Dalton, the chief executive of NHSI, noted of other hospitals that

“none has shown the sheer scale and pace of the deterioration at King’s. It is not acceptable for individual organisations to run up such significant deficits when the majority of the sector is working extremely hard to hit their financial plans, and in many cases have made real progress.”

[Helen Hayes]

The extent of the financial challenge facing King’s is well documented, and I recognise the figures that the Minister quotes. However, he has not yet recognised the extent of financial savings that King’s was already making. It is not an organisation that had been resisting the need to make savings; it has been making, on average, double the level of savings of any other trust in the country. That points to a situation in which the level of resource afforded to the trust is simply not enough to deliver the day-to-day responsibilities of keeping patients safe. Will the Minister recognise the extent of the effort that has gone into saving significant amounts of money out of the trust’s finances?

[Stephen Barclay]

I am happy to recognise the hon. Lady’s point that significant savings have been made. However, the regulators found that there had been an over-reliance on non-recurring savings, rather than on delivering the cost improvement programme. For example, King’s has the highest cleaning costs per square metre, at £71, compared with the median of £41 per square metre. Indeed, in her remarks the hon. Lady talked about the cost of bringing in consultants such as McKinsey, which the King’s board itself brought in. The concern is the slow pace at which those cost savings and efficiencies have been delivered on the back of those reports.

The trust has also been in breach of its licence for financial governance since April 2015. That followed an investigation by Monitor in March 2015 after the trust was unable to resolve long-standing problems at the Princess Royal University Hospital, which it took over, as Members have pointed out, in October 2013. As part of Monitor’s enforcement action, the trust was required to produce and implement an effective short-term recovery plan and a longer-term plan to ensure that patient services were improved and that they were provided in a sustainable way for the future.

The trust does not routinely report its financial performance by site, but analysis shows that the trust confirms that the losses by service are across many services and across both main sites. As I remarked in my opening, while the deficits at the Princess Royal are proportionally, as a percentage, higher than at Denmark Hill, in absolute terms the majority of the deficit is at Denmark Hill. That speaks to the point raised by my hon. Friend the Member for Central Suffolk and North Ipswich, who is not in his place, about the legacy from the Princess Royal.

The trust also faces a number of other challenges. King’s has not met the referral to treatment standard—RTT—since January 2015, at which point the board took a decision to suspend its performance data reporting. The trust resumed reporting of the RTT performance data again in March 2016. Following the deterioration in performance throughout 2016-17, NHSI undertook an investigation into the RTT governance and the drivers of the deterioration, which was completed in July 2017. An action plan based on recommendations from that investigation was subsequently developed by the trust and agreed by NHSI. Again, while the hon. Member for Dulwich and West Norwood says that this is a sudden, late intervention by the Government, a chronology of action and support can be shown.

Taken together, these challenges are the reason why NHSI has invested a lot of time and effort in supporting the organisation. It has provided a member of staff on secondment to the trust for two days per week to support the delivery of the action plan and to strengthen governance around RTT performance and reporting. Delivery against the action plan is monitored by NHSI through its formal monthly provider oversight meetings with the trust, and it is working closely with the trust to agree an appropriate timeframe for the sustainable return to compliance.

King’s has received more than £350 million-worth of working capital since 2015-16, and was also successful in securing a £47 million capital loan in April 2017 relating to Windsor Walk. Along with other trusts, King’s has also benefited from £21 million of public dividend capital funding since 2013, covering many central programmes including cyber security and digital care. In the last three years, King’s has invested in new capital assets in excess of the level needed just to maintain their asset base and above the average across all foundation trusts and NHS trusts.

The Department of Health commissioned Deloitte to review the trust special administrator’s analysis of the split of South London’s deficit, pertaining to when the Princess Royal came within the trust, and to provide an updated view of the split of the forecast out-turn deficit for 2013-14. Its assessment of the Princess Royal University Hospital’s share of the deficit for the full year was approximately £22 million. The trust reported deficits in the three subsequent years, despite significant other integration cost and bridging support revenues. It brought in PwC in the autumn of 2014, and appointed a turnaround director to initiate a financial recovery plan process. The trust then had McKinsey in during 2016-17 to drive a transformation programme, which has been very slow to yield the significant benefits that were promised.

The trust has been subject to enhanced financial oversight since March 2017, which includes the following support from NHSI: a senior financial adviser embedded at the trust; monthly financial oversight meetings with NHSI; participation in the financial improvement wave 2 programme; and, since April 2017, the trust has also received dedicated support from NHSI’s transformation and turnaround team as part of its enhanced financial oversight. More recently, in 2017-18, the trust has had external support from PwC, Ward 20/20, and Bailey & Moore. We need to be clear about what has caused the recent problems at King’s, including its recent rapid deterioration, and what has not, but it is not a lack of support and consultancy.

The argument that the cause of King’s problems can be found in the merger with Princess Royal, which several Members raised as a contributory factor behind the subject of the debate, does not stand up to scrutiny. In October 2013, King’s College Hospital Foundation Trust completed a transaction to acquire Princess Royal University Hospital and Orpington Hospital on the back of the trust special administrator’s recommendations regarding South London Healthcare Trust. The trust also took over responsibility for additional services at Beckenham Beacon, Sevenoaks Hospital and Queen Mary’s Hospital, Sidcup.

In the summer of 2013, King’s presented a five-year integration plan that showed small net surpluses of £2 million to £4 million in each year from 2013-14 onwards. The plan was assessed to be of medium risk by Monitor’s assessment team, but was none the less plausible thanks to generous support funding agreed by the Department of Health and NHS England at the time. The trust’s current financial problems reflect, as I said earlier, a continued overreliance on non-recurring savings, instead of delivering recurring benefits through cost improvement programmes and especially a failure to improve medical productivity at both the Denmark Hill and Princess Royal sites.

Model Hospital data, which is available to the trust, suggests that the trust has significant opportunities for efficiencies in areas such as orthopaedics. NHSI is supporting the trust to develop its cost improvement plan programme for 2018-19, which includes developing schemes based on validating those potential opportunities.

While there is never a single cause in such cases, and while we have acknowledged the pressures being felt across the system, the clear conclusion to draw from the evidence is that King’s was an outlier in financial terms and had lost its grip of its finances in recent months. I spoke with the trust’s chief executive yesterday and he acknowledged that there had been a serious problem with the trust’s financial planning process. Defects in the way the trust’s plan was put together eroded the regulator’s confidence in the trust, and it is for that reason that the trust has entered into special measures for its finances. The financial special measures regime has a proven track record of success in supporting trusts, as shown with North Bristol NHS Trust, which recently exited the special measures regime.

In losing control of its finances in the way that it has, King’s has effectively taxed others in the NHS, which is why it is right that NHSI took action in the way that it did. This organisation got itself into a very bad financial position and now needs a great deal of help and support. As the right hon. and learned Member for Camberwell and Peckham set out, we can agree on both sides of the House that King’s needs support. It is for that reason that the regulator has intervened to put it into special measures.

[Helen Hayes]

I thank the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who is not in his place, for bringing his experience to the debate. I am pleased that, having looked at the issue in some considerable detail when he was a Minister, he recognises, as the Minister seems not to, the problems that the merger of King’s with the Princess Royal and Orpington Hospital has caused for the trust.

The fact of the matter remains that the trust’s finances were stable and it was performing well on every measure until that merger took place. It has never been the same since. The combination of the drop-off in the increase of funding year on year, which has affected the finances at Denmark Hill and the organisation’s resilience to carry across costs to the Princess Royal and Orpington, with the irresponsible lack of a review mechanism for the funding settlement post-merger has, in my view, played a major role in destabilising the finances.

I thank my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), who has been a formidable champion for King’s for more than 35 years. She knows very well from direct experience exactly how bad things have been in the past at Denmark Hill, and how close we are to seeing once again those terrible circumstances of patients waiting far too long in A&E to receive the treatment they need so badly.

In summing up, I want to highlight two points on which I disagree with the Minister’s analysis. First, notwithstanding the support that the Government are putting in, they maintain a punishing approach to the finances of NHS trusts that are in financial difficulty. A system for funding our NHS that takes a trust that is already under financial strain, fines it and charges it additional interest for failing to meet impossible targets is a system that makes no sense at all. A system for funding our NHS that funds on a block grant basis emergency admissions, the volume of which hospitals have no control over, and then cancels elective operations, which deliver the revenue into our hospitals when pressures come through the front door of accident and emergency, is a system that makes no sense. The Minister has not addressed that conflict and the perversity in the funding system for the NHS.

Finally, I urge the Minister to consider very carefully the need for substantial capital investment in King’s at Denmark Hill. I am concerned that when staff at King’s hear talk about failures in efficiencies, and when the Minister talks about the failure to improve medical productivity, the inference is that staff are somehow not working hard enough.

[Stephen Barclay]

To clarify, that is absolutely not the point. The point is about billing and how rotas are managed. It is not about whether staff are working hard or not. We very much recognise that they are.

[Helen Hayes]

I am grateful for that clarification, but that needs to be communicated very clearly to staff, who are feeling the pressure of this crisis. When we talk about efficiencies at King’s, they are in a lack of buildings, ward capacity and fit-for-purpose facilities to deliver when facing the challenges that are coming through its front door every single day. That matter urgently needs to be addressed as part of this turnaround process.

Question put and agreed to.

Resolved,

That this House has considered King’s College Hospital finances.