North Tees and Hartlepool NHS Foundation Trust

Andrew Stephenson Excerpts

Tuesday 27th February 2024 Westminster Hall

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to see you in the Chair, Sir Charles. I congratulate the hon. Member for Stockton North (Alex Cunningham) on securing this important debate. He has used it to raise important questions that are vital to NHS governance—localism, transparency and accountability. He is right that patients in his constituency and the wider region should be at the forefront of decision making about their healthcare. NHS England has found that shared leadership and group working arrangements between trusts can stabilise governance and align approaches to help improvement.

[Matt Vickers (Stockton South) (Con)]

I thought that those were very legitimate questions and concerns about the way forward with mergers—joint working—but one of the issues in our part of the world is that South Tees Hospitals NHS Foundation Trust was burdened by the last Labour Government with a huge PFI deal at James Cook Hospital that cost £1 million a week. That is what makes this contentious. That is what makes it so difficult to see joint working in our part of the world.

[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?