North Tees and Hartlepool NHS Foundation Trust

Alex Cunningham Excerpts

Tuesday 27th February 2024 Westminster Hall

[Alex Cunningham (Stockton North) (Lab)]

I beg to move,

That this House has considered the governance of the North Tees and Hartlepool NHS Foundation Trust.

I am pleased to serve under your chairmanship, Sir Charles, for this short debate about the historic governance of the trust, and about how the management of NHS North East and Yorkshire has dealt with the formal inquiry that questioned the integrity and performance of the board over two years ago. The outcome of that inquiry remains a mystery, as NHS North East and Yorkshire has fought for the past two years to keep the report a secret—a fight that continues today, and not just through my speech.

Before I get into detail on the failures of NHS North East and Yorkshire and its leadership, I want the House to know that I was proud to serve as a non-executive director of the trust before I was elected to Parliament nearly 14 years ago. I was proud that the trust was recognised not just for sound finances and delivering for patients, but for innovation and a can-do, will-do attitude that continued long after I found myself in this place.

Much of the credit for performance being maintained goes to the non-executive directors, who gave a large part of their lives to the trust and provided a robust challenge to the executive. That ensured that the trust’s performance, finances and proposals for new projects were examined in detail, not simply signed off; they were forensically examined to ensure that they were all delivering for patients. We owe a tremendous debt of gratitude to those people and to all independent non-executive chairs and directors for the work they do across our country, often in the most difficult circumstances.

Sadly, two years ago, the trust went through a very difficult patch that included the resignation of several non-executive directors, a few of whom I put on the record as my friends. That happened after the NHS regional leadership launched an inquiry that questioned the integrity and performance of the trust’s board, and in particular its non-executives. This was a trust that was rated as good. The contents of the ensuing report remain shrouded in secrecy, sadly, although what can only be described as a well-edited but short summary was published in 2022.

The inquiry was launched after a robust challenge from the non-executive directors to a proposal from the then new joint chair of the North Tees and South Tees NHS foundation trusts, Professor Derek Bell, to have a joint chief executive on an accelerated timescale. I suspect to this day that this was being driven not by the chair of the trusts, but by officials in the regional office, led by the regional director for North East and Yorkshire and North West, Richard Barker. So much for local decision making! I do not name an official on the Floor of the House lightly, but—given his approach to the issues raised by the inquiry—I believe that in the interests of natural justice I have no other option.

It appeared to the non-executive directors that the proposal for the new joint chief executive in November 2021 was being rapidly pushed through without due process, including consultation with the health and wider community, and without proper papers or a business case for the idea. That meant that there were no answers to the robust challenges from the non-executive directors. I can capture their views and concerns in a few bullet points: the joint chair’s proposal was made without consultation or discussion with the NEDs or governors; principles of good governance and due process were ignored or sidelined; the proposed timetable was highly risky and unlikely to lead to a sound appointment of a joint CEO; any proposal to install a joint CEO and some form of amalgamation of management structures would require careful planning, options appraisal and scenario modelling, extensive consultation with the boards and governors, senior trust stuff and other stakeholders, and expert input from human resources and legal teams; and the timeline for a successful appointment of a joint CEO was likely to be 18 months to two years, not a matter of just a few weeks.

The non-executive directors summarised their concerns and objections in a formal document, with an outline of how to organise progress towards a joint CEO and potentially a joint management structure in a way that would minimise risks and maximise benefits. The joint chair’s response was, I am told, obdurate and unyielding. There was no offer to discuss the matter at full board or a meeting of the council of governors, or to consider an alternative to his proposal. Trust between the joint chair and the non-executive directors had been severely damaged by his actions. It was at that stage that the members of the board, concerned that there was no proper process and that they were being steamrollered into a decision, alerted me to what was going on. For me, that was the real reason for the inquiry.

I believe that NHS England’s influence on the joint chair’s proposal was palpable and unhelpful. In late December 2021, the joint chair, CEO, deputy chair and senior independent NED were called to a meeting at short notice with representatives of NHSE, including Richard Barker and national board directors Sir Andrew Morris and Sir David Sloman, as well as the chair of the North East and North Cumbria integrated care board, Sir Liam Donaldson. Although the NHSE representatives recognised that they had no formal powers to oblige the board of a foundation trust to change its organisational form, they were insistent that the joint chair’s original proposal should go ahead as quickly as possible. The trust was informed that it had until the end of January to agree a plan. The meeting ended with the NHSE representatives commenting, “Don’t tell us that it’s going to take two years,” and “Just get on with it.” Some would suggest that this was simply an exercise in bullying.

In January 2022, it became clear to the non-executive directors that they could not approve a proposal that was not supported by a full and proper case, but within a month Mr Barker ordered the investigation into whether the board was acting in a unitary fashion, and into its behaviour and leadership. On 18 February, five of the six NEDs resigned with immediate effect, as they felt that they were being prevented from doing the job they believed they had been appointed to do, and that NHSE and the joint chair would steamroller their way to the desired outcome regardless of any advice to the contrary. I suspect that that is exactly what the powers that be wanted: the removal of people who were not sticking to the line or doing what the officials wanted, but were instead maintaining their independence and putting patients first.

There was an allegation that the non-executive directors were somehow deliberately delaying the proposal for a joint chief executive. Were they supposed to roll over and not do their job of scrutiny properly? I am sure that the Minister will understand that the non-executive directors were insisting on due process and consultation with the trust’s wide range of partners. I believe to this day that they were right to ensure that others were aware of what was going on. They were concerned, as I was, that it was the start of a merger process for the two trusts. One of the trusts, North Tees, was considered high-performing at the time; the other, South Tees, was struggling and under considerable scrutiny from the Care Quality Commission. Happily, there have been improvements since then.

Non-executive directors are required to be independent and put the interests of patients first. Their robust challenge was clearly not appreciated by the chair and regional bosses. Those non-executive directors were local. They knew their community and wanted to do their best for them. I would like to put it on the record that not one of the new non-executive directors lives in the general area served by the trust—a completely opposite picture to the one before. It took me several attempts to find out where the new people hail from. Only when I issued a request under the freedom of information system was I told the answer: the new non-executive team come from Stafford, Hexham, Newcastle, Middlesbrough, which is quite nearby, Crook and Northallerton. I hope that the Minister will acknowledge that the idea of local trusts is just that—local—and that local people best know the needs of their community.

The outcome of the inquiry remains a mystery to all, including those who were investigated. The full report is being kept under wraps by NHS North East and Yorkshire executives, despite Richard Barker sitting in my office in Stockton and assuring me that it would be made public. What on earth have they all got to hide? Perhaps it is the fact that their actions were being questioned or that they had needlessly mounted an inquiry because the non-executive directors wanted to understand why a joint chief executive was being proposed and would not just roll over.

When Mr Barker refused to publish the report in full as he promised, I wrote to him several times, but I had to resort to the FOI request, which was ignored for some considerable time. I did think I had finally persuaded them when I eventually got a copy of the report, but it was so heavily redacted by Mr Barker and his team as to render it useless. The excuse that individuals had to be protected was far from satisfactory.

We still do not know whether the report showed that the non-executive directors were failing in their duty, or whether NHS North East and Yorkshire was even justified in mounting the inquiry. As I say, the fight for the full report continues. Although I contested the decision to make the redactions, I decided, on learning that one of the former non-executive directors was pursuing it through the Information Commissioner, to allow that action to take its course. That is still in play. Today I am asking the Minister to save the Information Commissioner a job and order Mr Barker—who commissioned the report, but then blocked its publication—to publish it now.

The Minister should also find out why this sorry mess was allowed in the first place. The decision to mount the inquiry called into question the integrity of people of long-standing service, yet not even they have been allowed to see it. They remain damaged by what has gone on, and they deserve to know what the report says—a report that cost tens of thousands of pounds. They want to see whether it is critical of them or not.

I suspect that the report remains under wraps because it may be critical of others in this sorry saga; in fact, I know that to be the case. In my Stockton office, when Mr Barker promised me full transparency and publication of the report, he said that it would be critical of the chair’s role in the scandal. That was omitted from the short summary report published by the regional officials and is not obvious from the redacted report. Mr Barker also acknowledged that the region could have handled the matter better, and I suspect that the report does too. He, too, now needs to be held accountable; I have, in the past, called for his resignation. I have no doubt that the regional officials have some questions to answer about the appalling way in which they have handled this matter.

To go back to the central issue, neither the non-executive directors nor I were opposed to the idea of a joint chief executive. In fact, I placed it on record that I was not even opposed to the two trusts one day becoming one, provided that our local hospital services were maintained and even improved. Yes, the regional officials did get their way in the end, but it was a genuine pleasure for me—I mean that honestly—to meet the new joint chief executive recently when the mayor of Stockton-on-Tees, Jim Beall, held his charity ball. Only time will tell whether a joint chief executive is the right decision. I sincerely hope that it is.

I reiterate my request to the Minister to order the publication of what should never have been a secret report. It is in the interests of natural justice, it is the right thing to do and it will give those affected the chance to move on with their lives. I provided the Minister’s office with the gist of the issues that I wanted to raise today, and I can provide him with a much fuller timeline that was too detailed for me to put on the record today. I look forward to a positive response that can help us to draw a line under this whole sorry matter.

--- Later in debate ---

[Andrew Stephenson]

I thank my hon. Friend for making that point. I recognise that they are two trusts with very different characteristics. He is right about the eye-watering legacy in one trust—I think it is £57 million a year of PFI debt—which can make joint working controversial. However, as I will come on to say, I have been assured that the two trusts want to work together with joint arrangements, but not merge. I hope we can set the record clearly: in doing the research behind this speech, I have heard that this is not the prelude to a merger through the back door; rather, it is about trusts wanting to work together to address the healthcare needs in the area.

It is right that any decisions about shared leadership arrangements are made in Stockton, not Westminster. However, where an NHS trust is facing performance challenges, the Government back targeted interventions by NHS England, bringing the trusts together to properly diagnose the problem and develop an improvement plan, which could include shared leadership. Any leadership changes should be kept under constant review to ensure that they are effectively delivering for patients and the local area. The point is to help challenged trusts to improve and take ownership of local issues. External evaluations of NHS England’s leadership interventions have found them to be effective.

I will address the current leadership arrangements of the North and South Tees trusts. Up and down the country, trust governance fits a variety of different frameworks. As the hon. Member for Stockton North knows, putting a round peg in a square hole is pointless. However, although we support a diversity of models, I am crystal clear that every arrangement should be geared towards building a faster, simpler and fairer NHS that works for both patients and staff. I am happy to assure him that, in this instance, I have been assured that the shared leadership and joint working arrangements are not in any way a precursor to trust mergers or acquisitions. In other words, both trusts intend to remain statutory organisations in their own right.

NHS England promotes those models of working to maintain consistency within trusts and to ensure that everyone is on the same page when lessons are being learned. However, for over 10 years now, North and South Tees trusts have been discussing how to work together to provide a better offer for the people of Stockton.

[Alex Cunningham]

The Minister may like to acknowledge that the North Tees and Hartlepool trust and the South Tees trust have worked together for many years. It is not a case of how they can do it in the future; they have been doing it for many years.

[Andrew Stephenson]

They have been doing it for many years. There are shared challenges in the area that they need to work on together, and this model of operation has worked in many parts of the country. I hope that what the hon. Gentleman describes is very much a bump in the road rather than something that characterises the past 10 years of joint work, most of which seems to have been constructive and conducted through local consensus.

In September 2021, the trusts appointed a joint chair. Just over a year later, they announced plans to form a group model to strengthen health services in the local area. That model was intended to improve recruitment and retention of specialist doctors and nurses, ensure join-up with local communities and partners, and secure capital investment to rebuild and upgrade hospital facilities. To deliver that new way of working, I understand that North Tees and South Tees foundation trusts engaged extensively with partners in the local area.

There is now strong collaborative work taking place across the Tees Valley, in the long-term interest of patients. The North Tees foundation trust is one of the best performing providers across the country for urgent and emergency care. The area’s NHS urgent care services will now be run by an alliance of four health organisations, including the North Tees and South Tees foundation trusts. Together, the partnership will oversee minor injuries and illnesses across the Tees Valley, including urgent care centres at the University Hospital of Hartlepool, the University Hospital of North Tees, and Redcar Primary Care Hospital.

I am delighted that the new urgent treatment centre at the James Cook University Hospital opened in March. We are backing the centre with a £9 million investment in urgent care services on Teesside, which will integrate services, provide patients with care close to home, and ease pressures on A&E. We should also celebrate the new Government-funded Tees Valley community diagnostic centre, which will open in Stockton town centre later this year. The centre will offer rapid scans, tests and checks for a number of major conditions. It will help thousands of people to access simpler services, with easily accessible life-saving tests and faster treatment.

I turn now to the investigation that the hon. Member for Stockton North raised. I understand that NHS England looked into the proposed appointment of a joint chief exec, as well as the actions and behaviours of the board. It aimed to find out whether these concerns amounted to breach of the trust licence. The investigation determined that the trust board had not acted consistently in relation to moving to a single chief executive appointment for South Tees. This constituted evidence suggesting a breach of a provider licence by the North Tees and Hartlepool Trust, which would normally lead to formal regulatory action being taken. After careful consideration, however, NHS England decided that the trust should implement the recommendations on a voluntary basis.

[Alex Cunningham]

Does the Minister recognise that the non-executive directors had moved on by then? They had actually resigned from their posts in protest at the lack of due process. Does the Minister, or maybe even the region, accept that this matter could have been handled a lot better?

[Andrew Stephenson]

I hope the hon. Gentleman recognises that there are local government arrangements, and also that these are very much operational matters for NHS England and for the region. Certainly, given the concerns that he has outlined, it is quite clear that things could have been done better to take people with them, rather than alienating people. I also echo the tributes he paid to people who serve as non-exec directors on trust boards across the length and breadth of the country. They play a vital role in local NHS governance, and it is therefore regrettable to see a large number of non-execs resign for any reason.

I think that looking at the reasons behind this and investigating the best way forward is something best delivered by the NHS, and not dictated centrally by Ministers. The recommendations arising from the report were that a summary of it should be presented at the next board meeting and that an action plan for the next steps should be agreed, which has now been completed. It was also recommended that proper consultation between board members of both organisations should take place in future, so that they can reach the best collective decision for better services for Stockton. I hope that the trusts are now able to move forward with these new arrangements, especially with a new joint partnership board, establishing a clear chain of accountability going forward to address their challenges during this troubled period.

In wrapping up, I would like to thank the hon. Gentleman for bringing this debate forward.

[Alex Cunningham]

The Minister has just indicated that he is wrapping up, but the central question here is whether or not that report will be published. I have a heavily redacted report, which has more black ink than white paper. Does he accept that those people have the right to understand what judgments were made on the accusations against them? They should see the full report, not a version from the person who ordered it and then refused to publish it.

[Andrew Stephenson]

I hope the hon. Gentleman will appreciate that the NHS commissions a large number of reports on a whole range of services. When those reports are published internally, we expect all participants to be frank and open with investigations. They do so on the basis that they are internal reports to improve the governance of the organisation. It is not expected, and it is not the normal course, for such a report to be published. My understanding is that, following the hon. Gentleman’s freedom of information request, the report will be published in a heavily redacted fashion, as he said. The redactions were made by NHS England, in accordance with its policies. It is not a report that I am privy to and, to the best of my knowledge, it has not even been shared with the Department. It is an NHS England report that, as I say, has been published in accordance with its usual practices.

[Alex Cunningham]

Frankly, I find it amazing that a Minister cannot even get access to a report that questioned the integrity of five long-standing non-executive directors, who then resigned because of the lack of due process in the appointment system. I remind the Minister that, as I said in my speech, Mr Barker sat in my office and told me, face to face, that he would publish the report and that I would get to see it. He has reneged on that promise. Does the Minister think he should fulfil that promise?

[Andrew Stephenson]

Unfortunately, I will just reiterate the point that a summary of the recommendations emerging from this investigation were published; they were shared with the board. They are accessible by anyone who wishes to see them. Through his own endeavours, the hon. Gentleman has been able to secure a copy of the redacted full version of the report. As far as I can see from the investigations that I have made, the report has been published fully in accordance with NHS England’s normal practices.

Clearly, this is something that has led to a rocky period for the trust, but I believe that the recommendations that have been shared with the board are now being implemented and that the group model of working, as I have said today, is not a merger by the back door. I know that, in securing this debate, the hon. Gentleman wanted to give greater impetus to the trust to get its act together and resolve these issues. I am absolutely sure that the issues he has mentioned today will have been heard by members of the trust’s board—I am absolutely sure they have been listening. I urge them to work with him and other local MPs to ensure that any other concerns that he has raised, and any other concerns that other hon. Members may have, are addressed in due course.

[Alex Cunningham]

Can I wind up, Sir Charles?

[Sir Charles Walker (in the Chair)]

No, not in a half-hour debate.

Question put and agreed to.