Kettering General Hospital A and E

Andy Sawford Excerpts

Wednesday 26th June 2013 Westminster Hall

[Andy Sawford (Corby) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mrs Brooke. I am grateful for the opportunity to debate the future of Kettering General hospital’s accident and emergency services.

Kettering General hospital has served the people of my constituency for 115 years. It is where my children were born, and where my granddads received care at the end of their lives—where I said goodbye to them—and today it is a place that is relied on by my family and my constituents. I declare an interest in that it is where my mum, like many thousands of local people, works. Kettering General hospital is a huge part of the community, because of the care it provides and because it is one of the major local employers. Many of my constituents are employed there, as nurses, doctors and auxiliary staff, and I take this opportunity to thank them, in whatever capacity they work. Working in our health services is demanding and, for most health workers, not particularly well paid. The hours are long and the demands are great, but the overwhelming majority of my constituents receive good care, and for that we are all grateful.

However, we have to face some hard truths. The quality of care at the hospital is not good for everyone. It is not realistic to think that 100% of my constituents will get perfect care every time, but it is something for which we should surely strive. All the evidence shows that too many people do not get the care they need. Kettering General hospital employs more than 3,000 staff, and has more than 600 in-patient and day-case beds and 17 operating theatres. The hospital has a consultant-led level 2 trauma unit in its 24-hours-a-day, seven-days-a-week accident and emergency department, and there are currently two locums and five consultants who are on site until 11 o’clock in the evening and on call until 8 o’clock in the morning. Some cases, such as severe burns and head injuries, are transferred, often by air ambulance, to Coventry, which has a level 3 trauma facility, but Kettering General hospital is where most trauma patients go. It serves the accident and emergency needs of a wide population across north Northamptonshire.

The hospital’s location, right next to one of the busiest arteries in the midlands—the A14—makes it the most accessible accident and emergency for many people, not only in north Northamptonshire but across the whole county and in neighbouring counties, particularly Leicestershire. The core of the hospital’s patients, however, is from my constituency and that of my two neighbours, the hon. Members for Kettering (Mr Hollobone) and for Wellingborough (Mr Bone).

Today, I want to speak about the challenges that our accident and emergency services face, and to seek Government support in meeting them. The context is highly political, and the Minister and I will strongly disagree on some health policies, but I would much prefer us to have as constructive a debate as possible today. Much of what I have to say will be supported by the hon. Members for Kettering and for Wellingborough who are unable to be here, but with whom I am working closely and regularly in support of the hospital. We have formed a campaign group, consisting not only of the three of us, but of the local media, the local authorities and many other interested local organisations.

As three Members of Parliament, we meet regularly with the chair and the chief executive of the hospital, and I am pleased to say that, as of last night, we have a meeting arranged with the Minister’s colleague, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). We are also in dialogue with the local clinical commissioning groups. A and E services are our top priority.

The Minister will be aware of the Healthier Together proposals for the south midlands area. Last autumn, there was a hurried timetable and inadequate consultation on the proposals. The public gradually became aware of them, the thrust of which was for five hospitals to go into three for some of the services, particularly full accident and emergency, obstetrics and maternity, and in-patient paediatrics. The detailed model underpinning the proposals stated that the best option, according to their criteria, was that Kettering lose its full accident and emergency.

I am pleased to say that, in response to a strong cross-party community campaign, Healthier Together and all those involved, including the clinical commissioning groups and the hospitals, recognised that communities in my constituency and across the north of Northamptonshire would not support the proposals. Our nearest accident and emergency would be at Northampton general, and anyone who knows the county and understands its geography will recognise that that is not acceptable. We do not need the independent experts—as they were called—employed by the Healthier Together team to tell us that it is almost impossible to get from Corby to Northampton along the A43 during peak times without coming to a standstill. There is no rail link between the towns in the north of the county and Northampton, and the bus service is intermittent.

The Department says that it expects proposals for local health service changes to meet four key criteria: support from GPs; strengthened public and patient engagement; sound clinical evidence; and that the proposals support patient choice. I do not believe, nor do the hon. Members for Kettering and for Wellingborough, that those four criteria were met in the Healthier Together work. And it is not just in my area. Councillor Hannah O’Neill, the deputy leader of the Labour group on Milton Keynes council, told me that Healthier Together caused uncertainty across Milton Keynes, that neither communities nor the council was properly consulted, and that they were left with no information about the future of the programme for their hospital. A critical issue for the whole south midlands Healthier Together area is that we do not know where the proposals will take us next.

The final Healthier Together report, published in March, states:

“Current A&E staffing levels do not meet national guidance, which recommends a minimum of ten consultants for a medium-sized A&E department.”

It also raises concerns about the long-term viability of retaining five acute surgical rotas:

“Concentrating A&E and general surgeons onto fewer sites could improve sustainability, but there would still be a need to recruit further A&E consultants to provide consultant presence.”

The report proposes an alternative model of four fully supported accident and emergency sites, with the fifth being a “warm” site, managing and transferring some patients under protocols. In the north of Northamptonshire, the worst case scenario is that we would have to assume, based on the previous detailed proposals, that Kettering would be in line to be that “warm” accident and emergency. That is simply not on, not just because of the geography, but because of the demand from the area that Kettering serves.

We recognise, however, that there is a challenge to improve accident and emergency at Kettering. The hospital had to save £11 million last year, and has to save a further £12 million next year, but the answer lies not in taking away our proper accident and emergency and maternity services but in improving the health system. We need a more integrated health and social care system. I will study the detail of today’s spending review announcements, and if they reflect the integration policies that my right hon. Friend the Member for Leigh (Andy Burnham) and my hon. Friend the Member for Leicester West (Liz Kendall) have been championing, they will have my support.

We need local authorities to act more quickly to get elderly patients out of hospital once they have been treated, so that they can have the care they need in the community and so that hospital beds are freed up. That happened just last year with my nan, after she had a stroke. A critical issue is how primary and acute care will work together in the future. It is also about prevention, about which I heard the Minister speak last week at an event organised by Cambridge Manufacturing, a great Corby-based company that exports across the world and helps people become fitter. If the Minister is wondering, the event was at the National Obesity Forum, and Cambridge Manufacturing was the partner organisation. The issue is also about the hospital itself becoming as efficient and effective as possible.

I am sorry to tell the Minister that instead of moving towards an improved service, there are very serious issues at Kettering A and E. This is a very worrying time. The hospital simply cannot cope with demand; we have rising demand, and an ageing and growing population. There are issues relating to the local doctor services and the out-of-hour services, and twice this year the general hospital had to close the doors of the A and E to patients other than those arriving by ambulance, announcing it to the media and asking local Members of Parliament to tell patients not to turn up. We have been told that the principal factor in that was the 111 changes.

Corby is the fastest-growing town in the UK and has the highest birth rate, but there is population growth right across north Northamptonshire. The number of people attending the A and E department at Kettering General has doubled over the past 20 years, from 40,000 in 1992 to 80,000 in 2012. That 100% increase is far greater than the rate of population growth, and growth continued last year. We have continued growth in Northamptonshire’s elderly population, so an increase in acuity, for example, is to be expected, with more people with more complex problems who really do need A and E care. The trust’s emergency department was not designed to see that many patients. In the hospital’s own words, it is now “not fit for purpose”: it is too small and does not have enough rooms to provide appropriate care.

There are significant issues around the inappropriate use of accident and emergency. A recent patient education project in Northamptonshire showed that 70% of patients did not try to contact out-of-hours GP services before going to A and E. The trust is currently investigating and pricing ways in which it could expand its emergency care department’s footprint to make it more suitable for patients and to make it more efficient to help reduce waiting times.

On accident and emergency waiting times, there has been a dramatic increase in the number of people waiting for more than four hours. In April 2012, 262 people waited more than four hours, but in April 2013 that figure stood at 1,530 people. A year on, we can see how significant the rise in the number of people waiting for more than four hours is. Breaches of the target are largely because of patients waiting in A and E for hospital beds to become available. Kettering General hospital’s bed base runs very hot: 95% to 100% of beds are full. It is therefore often bed availability in the whole hospital, rather than issues in A and E, that leads to breaches of the transit time.

The hospital has launched a transformation programme, which local MPs support, by creating new direct access services for GPs, putting in a new discharge team to improve discharges and expanding the A and E department—for example, with an observation bay for patients needing short-term observation and tests. The hospital is investigating the creation of more of its own step-down facilities in the community.

There are other positive developments. The Corby urgent care centre has improved facilities, particularly for my constituents in Corby. It is not the hospital that Corby people really wanted, but it brings many services closer to my constituency. It is open from 8 am to 8 pm, and it reduces the need for patients to travel to A and E. It is only now coming fully into use, so it will be some time before it takes significant pressure off A and E at Kettering.

I went to the opening of the new foundation wing at Kettering, which is a fantastic new facility. It will improve some of the problems in the hospital, and it increases the number of beds. The hospital is to be congratulated on developing the proposals for that wing. It has been 10 years in the making, and there was a delay in its opening, but it is a significant improvement.

In a few weeks, with the hon. Members for Kettering and for Wellingborough, I will meet the local clinical commissioning groups to discuss GP out-of-hours services. A key issue relates to people using a GP where appropriate, rather than presenting at accident and emergency.

I hope that the Minister will comment on the seriousness of the Care Quality Commission report published in March. It stated that action is needed on cleanliness and infection control, on supporting workers and, in particular, on assessing and monitoring the quality of service provision. In fact, so severe were its findings that it has taken enforcement action against the hospital.

The report makes mixed reading. Most patients seen by the CQC generally commend the hospital. As I said at the outset, most people’s experience is good, but where it is not good, it can be very disappointing. For example, because of that huge rise in demand in accident and emergency, the CQC found open storage of needles and syringes, containers overflowing with syringes, and noisy and rusty bins in areas of the department, and it observed that the public toilets were dirty and that floors appeared dirty and stained.

As the CQC has stated, that situation was not because the hospital staff were not working incredibly hard—it observed that the staff were working with clear protocols and trying to do the right thing—but the facility is now frankly too small for what is really needed to serve the north of Northamptonshire. It is cramped, which really affects the quality of care.

The CQC specifically mentioned long waiting times. I have heard cases of people waiting up to 10 hours, which is clearly unacceptable. Not only are there the waits in accident and emergency, but, having been seen in A and E, there are the waits to be transferred to wards in the hospital. There are also knock-on effects. The CQC highlighted issues in orthopaedic and surgical wards, where other medical admissions from A and E have become a way of life, because the beds are needed, but those wards do not have the staff, the expertise or the capacity to meet the needs of the patients transferred.

I want to hear from the Minister an understanding of the pressures facing us in Kettering General hospital’s accident and emergency, and support for initiatives that the local chair, chief executive, trust and staff are taking and which we are trying to support. We want to support this incredibly important hospital. We also want a commitment to capital improvements in accident and emergency. Whether that comes from what I understand is a dedicated fund in the Department of Health for capital improvements for A and E that is underspent or from the general NHS underspend, I hope that we will hear about it today. I also hope that she will comment on the issues about how the health system works locally.

--- Later in debate ---

[Anna Soubry]

I am sorry.

The hon. Member for Corby has raised important issues about accident and emergency services, although I will not be dealing with the national situation. As we know, there have been some issues and problems in emergency departments throughout the country, many of which have been well rehearsed in this place.

Underlying themes and problems are often common to all our accident and emergency departments. Undoubtedly, many of the problems at Kettering’s accident and emergency are exactly the same as those that have caused so much difficulty in other A and E departments in this country. I am pleased that huge progress has been made and that overall performance is improving across the country as might be expected, especially given my Department’s efforts.

The hon. Gentleman has pointed out how health services are under pressure in his constituency and having a knock-on effect at Kettering, and those pressures are being experienced across the whole system. He quite properly identified that the reasons for that are complex. Dealing with those pressures means looking at the underlying causes, which the Department has been doing by working with NHS England.

The hon. Gentleman pointed out that Kettering General Hospital NHS Foundation Trust is experiencing many of the issues that I have highlighted. I am aware that, as he told us, the trust has not met the A and E standard. It has struggled with that difficulty for some time. He will know that Monitor, as the regulator of foundation trusts, has unfortunately found that the trust is in breach of its licence in relation to its A and E performance, as well as wider financial and governance issues. That will cause concern not only to the people who use the hospital, but to its outstanding staff.

Monitor has required the trust to implement an urgent care action plan to ensure that it can return to compliance against the A and E standard. The deadline for that is 1 July, so it will not be long before the trust has to implement it. Monitor is working with local commissioners and NHS England to support the trust to meet that requirement.

I appreciate that the hon. Gentleman feels that further investment is needed to expand facilities at the trust to improve its position. It is right that, as I understand it, he has had meetings with the chair of the trust and other Members of Parliament, and that letters have been written, to request assistance in securing extra capital funding. Some £5 million to £10 million has been requested, so that the trust can redevelop and expand its A and E department.

Of course it is for NHS foundation trusts to develop and take forward their own capital investment proposals, and trusts such as Kettering can apply to the Department for a capital investment loan. We understand that the trust has allocated some of its capital budget this year to make improvements within A and E, and it has worked with commissioners to redesign what we call pathways to improve flow. Hot clinics and ambulatory pathways have been developed, which divert patients away from A and E and avoid GP admissions, which, as we know, often stack up in the Department.

On the matter of whether Kettering has ever closed its doors, I am told that its accident and emergency department has never done so, and it is important to put that on the record. I am told that there was a period in February when the hospital trust effectively advised members of the public—I think that this sounds like a sensible piece of advice—to ensure that they only went to A and E if they had had an accident or an emergency. In other words, to use the jargon, they were told to use the department appropriately, because the trust had become aware of a sudden and acute rise in people using A and E. Actually, that is a good message for all of us to take back to our constituents. The department is not called “accident and emergency” for no good reason; it is for accidents and emergencies.

When we had a debate on A and E in the main Chamber, Members from both sides told stories about people presenting at A and E when they could have gone to the pharmacy or just taken a paracetamol. The point I am making is that, often for understandable reasons, people attend A and E when they cannot get the appointment they want at the GP surgery. There is this wider issue that perhaps we do not do what we used to do in the past, which was to self-administer, take advice from our brilliant pharmacies or ring the GP surgery for advice before simply turning up at A and E.

As I have said, meetings have taken place, and, as I understand it, the trust has been working with local commissioners in the way that I have described. The hon. Gentleman mentioned the new Corby urgent care centre. I think I saw it before I was in this position—I was there for other reasons which I am sure the hon. Gentleman will understand—when it was in the process of being constructed. I am delighted that it is now open. It is called an urgent care centre. To be frank, we do not always use the best language when it comes to naming places where patients can go. In fact, the review, which is being conducted in the Department of Health, is looking at the sort of language that should be used, so that people understand where they have to go when they have a particular problem. I am delighted that the centre has opened in Corby and is providing additional urgent care services to the hon. Gentleman’s constituents, which should help to ease the unnecessary attendances at the A and E department of Kettering General.

I also want to mention the East Midlands Ambulance Service NHS Trust, because it is of concern to all of us who represent seats in the east midlands. I know that the hon. Gentleman has rightly talked about how problems with EMAS have affected services in his constituency.

[Andy Sawford]

I wanted to cover more issues in my opening remarks. The Minister is absolutely right to say that EMAS is a huge concern for all MPs across the region. I am sure that she is aware that the proposal is for the hub that would serve my constituents now to be at Kettering and for the level of service to be reduced at Corby, which is a concern for us.

[Anna Soubry]

Indeed, and it is right that the hon. Gentleman should raise that concern. I think I am right in saying that Earl Howe, who is the Minister with responsibility for the ambulance service, has agreed to meet the hon. Gentleman. If he has not agreed that, then he just has. In any event, Earl Howe will be more than happy to meet the hon. Gentleman to talk about the various issues.

The hon. Gentleman will also be aware that the NHS Trust Development Authority has intervened at the East Midlands Ambulance Service NHS Trust and is working with local commissioners to ensure that it has robust turnaround plans in place to improve its performance. The fact that the ambulance service has not been meeting the high standards that we all expect of it has been a long-standing problem in the east midlands. It is now implementing proposals to improve the way it delivers services across the east midlands through its “being the best” programme. That includes the replacement of some ambulance stations, including the one in Corby. It is creating 108 community ambulance posts, 19 ambulance stations and nine purpose-built hubs or superstations to enable ambulances to be dispatched from strategic points across the region to meet demand. I know that the “being the best” proposals have been referred to the Secretary of State by Lincolnshire county council. I do not know whether Northamptonshire will now take the same course, but it may not need to as Lincolnshire has already made the referral. As a result, the Independent Reconfiguration Panel is due to advise in the next few days, so it would not be right for me to make any further comments on that matter.

I will conclude now unless of course the hon. Gentleman wants to intervene again, which I am more than happy about because we still have four minutes.

[Andy Sawford]

I thank the Minister for giving way again and I am delighted to take up the opportunity to use up a little more of the time we have available. It is of course very welcome news that those proposals have been referred to the Independent Reconfiguration Panel. However, I must say to her that, irrespective of how those proposals proceed, I have no confidence in the trust board of the East Midlands Ambulance Service NHS Trust or in its leadership and management.

I will be interested to hear the Minister’s comments about what role, if any, the Department of Health can play in intervening when there are concerns about the management of an ambulance trust. I know that hon. Members from across the eastern region ambulance service, which also serves some of my constituency, have—frankly—successfully changed the leadership of that service. I feel that we may need to make some progress in that regard ourselves.

[Anna Soubry]

The diplomatic answer to that is to say that, yes indeed, east of England MPs have quite rightly taken their concerns to the highest level and there has been some serious intervention. There has been a report; we had a 90-minute debate here in Westminster Hall only yesterday on it. I have to say that apparently most members of the board of that ambulance service still remain in place, but the board has a new chair. There has been a full report into the service and there is hope that many of the report’s recommendations will now be put forward.

I must say that the Care Quality Commission, notwithstanding some of the comments that were made last week, can play a hugely important role in looking at the performance of ambulance trusts. I speak now as a constituency MP when I say that I myself have been in contact with the CQC and I urge the hon. Gentleman perhaps to take the same course, because the CQC can really play an important role in ensuring that ambulance services and indeed many other providers of health care are absolutely up to standard and providing the services that they should be providing. That may be of some assistance, but I must say that I think things have improved.

[Andy Sawford]

The Minister says that there are issues at Kettering General hospital’s A and E department that are in common with those in other hospitals. Finally, I draw her attention to the exceptional case for investment in Kettering General hospital, because of the growth in population locally. Corby has the highest birth rate in the country; it is the fastest growing town in the country; and the Northamptonshire area is one of the fastest growing areas in the country, so this is an exceptional case.