Kettering General Hospital

Andy Sawford Excerpts

Tuesday 24th March 2015 Westminster Hall

[Mr Philip Hollobone (Kettering) (Con)]

It is a huge pleasure and privilege to serve under your chairmanship, Mr Gray. May I, through you, thank Mr Speaker for giving me the honour of debating what is an important subject for my constituents?

I welcome the Minister to his place. He has taken a keen personal interest in the future of Kettering general hospital. The hon. Member for Corby (Andy Sawford) and my hon. Friend the Member for Wellingborough (Mr Bone) are also here, and I hope they will make many interventions to stress the role they have played in working with me to secure the hospital’s future. Indeed, I am pleased to report that the three of us have been working closely together on a cross-party basis for the past few years, because we recognise that local people want party politics taken out of the future of our local hospital. It is a personal issue for the three of us, because we and our relatives use it, as do local people.

Kettering general hospital has been on its present site for 118 years. Local people have been born there and treated there, and they have died there. It is a much-loved district general hospital at the heart of the community of Kettering and north Northamptonshire. It is a key priority for local people that its future should be secure, so that it can continue to offer the best treatment to the increasing number of people living in the area. Kettering and north Northamptonshire are growing rapidly. Over the past decade the borough of Kettering had the sixth most rapid household growth out of 348 districts in the country, and that population increase is set to continue into the next decade.

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

I thank the hon. Gentleman for his kind remarks about our cross-party working, which our constituents throughout north Northamptonshire welcome. It has helped us in our approaches to the Minister and local health partners, and in bringing them together.

On the point about population, does the hon. Gentleman agree that we should emphasise the fact that as well as having, like most of the country, an ageing population, we also have one of the highest birth rates? Indeed, my constituency has the highest, but the birth rate is high throughout north Northamptonshire. There is demand at both ends of the population, as well as, of course, from people of working age.

[Mr Hollobone]

That is very pertinent. Demographic pressures are hitting us from every angle. There is a high birth rate in Corby and east Northamptonshire. Increasingly, in my constituency as well as the hon. Gentleman’s and that of my hon. Friend the Member for Wellingborough, the population is ageing. Whereas 30 years ago an elderly patient might go to hospital with a particular condition, now it is even older people who are going there, with multiple conditions needing treatment at the same time. Kettering general hospital, like all hospitals, must raise its game when treating such vulnerable members of the community. It is not only population numbers, but the number of young and old patients that creates a challenge.

Although Kettering general hospital has difficulties and challenges, it is raising its game, and that is due largely to the tremendous dedication of the doctors, nurses, ancillary staff, management and clerical staff at the hospital, who are in a joint endeavour to deliver the best care they can. There is extremely good news to report. The Department of Health tells me that in 2012-13 there were 85,497 in-patient finished consultant episodes at the hospital, compared with 84,602 in 2011-12. There has been a focus on accident and emergency waiting time targets, and in the past few years Kettering general hospital has moved from being one of the worst in the country to one of the best. All hospitals in the country have been under pressure this winter, but it would be wrong to give the impression that fewer people are being treated at Kettering A and E. The reverse is true. In 2010-11 76,099 people presented themselves to A and E. In 2012-13 the number was 84,055. Record numbers of people are being treated there.

[Andy Sawford]

The hon. Gentleman will have been struck, as I was, at being told that the accident and emergency department was built for 20,000 patient visits a year, given that recent figure of 84,000. I endorse his remarks about change and progress in the past few years. To what does he attribute that? He mentioned the staff, and I agree. There has also been a change in the leadership of the hospital. However, perhaps it is also to do with the way the local health partners and organisations, including the clinical commissioning groups, have come together with the hospital more effectively through the work that we have been involved in with them, particularly with a view to improving A and E.

[Mr Hollobone]

The hon. Gentleman is right, of course. He gives a tantalising flavour of the climax of my speech, which will be about the urgent care hub proposal for Kettering general hospital, on which he, I and my hon. Friend the Member for Wellingborough have been working together.

[Mr Hollobone]

Yes—not only have we three north Northamptonshire Members worked on a cross-party basis to secure the future of our local hospital, but we all dressed up in funny outfits on Sunday to walk around Wicksteed park in Kettering in support of Glennis Hooper and the marvellous work she does for Crazy Hats, which raises money for cancer treatment and care for our constituents. I suppose that it is part of an MP’s job on occasion to dress up in a funny costume and look silly for the benefit of constituents, and we are all pleased to do that.

Some further good news about Kettering general hospital, from Department of Health statistics, is that finished consultant episodes when any procedure took place in the hospital—which I think is bureaucracy-speak for the number of operations—went up from 49,638 in 2010 to 53,869 in 2013. I am told that there are 43 more hospital doctors and 55 more nurses than in 2010 and there is a 24% increase in diagnostic tests, a one third increase in the number of people treated for cancer and a 71% increase in the number of MRI scans performed. Of course just two years ago the £30 million foundation wing was opened. It has a 16-bed intensive care unit, a 28-bed cardiac unit and a 32-bed children’s unit. That was massive new investment in our local hospital.

It should not be forgotten—and we three Members of Parliament for the area do not forget—that increasingly Kettering general hospital offers our constituents world-class health care. The latest example of that is the cardiac investigations department, which has received national recognition for its high standards in heart ultrasound scanning. Every year 8,000 of our constituents are patients through that unit, which provides ultrasound scans of the heart. Those can reveal diseases such as heart failure and valve diseases.

[Andy Sawford]

That shows what huge progress has been made. A little over 10 years ago, my granddad had a heart attack and had to wait in a bed in Kettering general for six weeks to be transferred to Glenfield hospital in Leicester for a stent. Such operations can now be done as a day case at Kettering general.

[Mr Hollobone]

The hon. Gentleman is right. That is a good example of the way Kettering general hospital has raised its game to tackle local health needs. Increasingly, our constituents do not have to go to Glenfield, because they can get better care at their local hospital. In the case in question, that is because of the £300,000 investment in three state-of-the-art ultrasound scanners, which can show the heart in three dimensions. The 16-strong cardiac investigations team has been awarded accreditation by the British Society of Echocardiography, which is an affiliate of the British Cardiovascular Society. That accolade is not given lightly. Kettering hospital is one of only 38 in the country to have achieved that accreditation; some specialist centres, such as Glenfield, Papworth, John Radcliffe and Coventry, have not yet attained it.

The £4 million upgrade of the maternity department at Kettering general hospital started in December. An average of 10 babies per day are delivered at the hospital—including the babies of Members who are here today. It is part of an £18 million investment in the hospital.

In coming to the climax of my remarks, I want to talk about the innovative proposal for an urgent care hub at the hospital—my colleagues will appreciate this, because we have been working on it together. Over the past few months, the hospital has been liaising with partners and developing a strategic case for an urgent care hub on the hospital site to tackle long-term, urgent care pressure relating to population growth, about which we have spoken; age and acuity; and increasing public demand for prompt access to urgent care.

In December, the trust shared its strategic case with the foundation trust regulator, Monitor, which is currently considering the proposal. If Monitor approves the case, it will go on to an outline business case and finally a full business case for approval by Monitor, the Department of Health and the Treasury. The key to its success is that the hospital has been working in close collaboration with its health and social care partners. It is developing what is essentially a one-stop shop for our constituents who need urgent medical care.

The aim is to develop a £30 million urgent care hub on the hospital site that will combine secondary care, hospital A and E and urgent care assessment with primary care—in other words, GP services, minor injury care and social and community care services. The proposal has arisen because there has been significant growth in demand for that type of urgent care in the local health economy of our three constituencies, partly due to a 30% population growth over the past 19 years, with another 9% expected by 2020, and a rise in the population of older people, about which we have spoken. There has also been a massive 83% increase in the use of A and E over the past 20 years as a means of accessing urgent care.

[Mr Hollobone]

My hon. Friend has rightly made that issue a priority for his constituents, and he has led an effective campaign on it. That facility will be similar to the facility currently in operation in Corby. The idea is to treat people as locally as possible so they do not have to present themselves at Kettering’s A and E department. It is all part of making local health care delivery more efficient and effective, and my hon. Friend is right to highlight it.

[Andy Sawford]

Does the hon. Gentleman agree about one of the things we have made progress on—particularly through the cross-party campaign and the cross-working of the organisations involved? Although there are sometimes particular interests in individual towns and communities, we have looked at the bigger picture for the whole of our area. There are benefits for individual towns. The hon. Gentleman is right to say that I want to build on the success of the urgent care centre, but, in the end, when A and E—in particular, trauma services—is needed, it is going to be there relatively locally for everybody in north Northamptonshire.

[Mr Hollobone]

The hon. Gentleman is absolutely right. Although we want to see far more local delivery of efficient NHS services in particular constituencies, all three of us accept that the vital part of the local health economy is the success of Kettering general hospital. If it were not there—if it were in Northampton, Milton Keynes, Bedford or Luton—local NHS delivery for our constituents would be far worse. We have to make Kettering general hospital a success. We can help it along its way with the innovative establishment of success stories such as the urgent care centre in Corby and the new facility at Isebrook, but the key to success for all our constituents is to make Kettering general hospital a success story for the future.

The hub concept developed by the trust and supported by all three of us is a partnership with the bodies that purchase NHS services, such as the clinical commissioning groups, the Northamptonshire Healthcare NHS Foundation Trust and the social care provider, Northamptonshire county council. If successful, the urgent care hub would effectively provide a one-stop shop for GP services and out-of-hours care; an on-site pharmacy; a minor injuries unit; facilities for social services and mental health care; access to community care services for the frail elderly; a replacement for the hospital’s A and E department, which is now 20 years old; and a new A and E services area, which will provide even better acute emergency care and integrated assessment to ensure that patients see the right specialists right away.

The three of us have been to see the Minister with the hospital and the CCGs, so the Minister knows that we are all as one in believing that the urgent care hub concept is the right one for the health economy in north Northamptonshire. It mirrors the way in which NHS England would like to see pioneering health care delivered in the future. As David Sissling, the chief executive of the hospital, said,

“This integrated approach is also something that NHS England has highlighted is an important principle in its Five Year Forward View for the NHS and it also fits with”

the collaborative programme happening in Northampton- shire.

I hope that when the Minister responds to this debate, in which all three MPs have sung from the same hymn sheet and said with one voice that we need the urgent care hub for the betterment of our constituents’ health, he will reiterate his support for the proposal. Whoever wins the election in our three constituencies and whoever forms the next Government, this important proposal must happen, for all our constituents.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate. I also commend him and our colleagues in the Chamber—my hon. Friend the Member for Wellingborough (Mr Bone) and the hon. Member for Corby (Andy Sawford)—for their consensual and cross-party approach to tackling the challenges of the local health economy and addressing the needs of local patients. It is working together, as a group of MPs, that has helped to deliver success for the local hospital. That cross-party consensus is an example of what should be done. My hon. Friend the Member for Kettering is right that good health care is not political; it is about doing the right thing by patients, and that is the approach that hon. Members here today have taken in addressing local health concerns.

A number of the points raised today are ones we have talked about in meetings at the Department of Health. I have taken a keen interest in supporting Kettering in its future ambitions and in supporting my hon. Friend in his strong advocacy of the needs of local patients and his local hospital. As he rightly outlined, this is a part of the country with a growing population, due to increasing housing growth and the plans to increase housing growth in the future. As in all parts of the country, there is increased pressure on medical services from an ageing population with complex health care needs. By 2018, we will have 3 million patients with not one or two, but three long-term medical conditions—it could be diabetes, dementia, heart disease or chronic obstructive pulmonary disease.

Caring for patients with complex medical needs is a challenge for our whole country, and I know it has been one of the main drivers of increased admissions to A and E in Kettering. The acuity, which is the severity of the illness or medical admission, is a key issue that has been picked up by the A and E consultants and doctors with whom I have discussed the challenges faced locally by the trust. Supporting a better way of caring for people with long-term conditions and the frail elderly is at the heart of the proposals for the care hub that my hon. Friend outlined.

I want to take this opportunity to recognise the outstanding work done by NHS staff up and down the country. On this occasion, it is appropriate to draw attention to NHS staff working in and around Kettering—not only in the hospital, but in general practice, community mental health teams and palliative care teams. The commitment across the board in Kettering to delivering the highest-quality patient care is an example of what the NHS is all about, and it is right to recognise the dedication of front-line staff in the Kettering area.

I want to take the opportunity also to commend formally my hon. Friend for the outstanding interest that he has shown in standing up for the best interests of local patients throughout this Parliament and for his dedication in never missing an opportunity to raise questions in this Chamber and in the main Chamber during Health questions or to raise the case of his constituents in the Department of Health with me as the responsible Minister. It has been a pleasure to do all I can to support him, his constituents and Kettering hospital.

My hon. Friend is right to highlight the recent investment in the hospital. That is due in no small part to his advocacy and that of other hon. Members in consistently raising the needs of Kettering hospital and the local population. My hon. Friend will recall that when we met in January to discuss health services in his constituency and the plans that his local NHS has to deal with some of the pressures that it faces, we talked about some promising ideas. I will discuss those in more detail in a moment.

Before I do so, it would be appropriate to say a few words more generally about the pressures that the health service has faced during a difficult winter, how they have been handled and what we have done to support the health service both in Kettering and more generally. We know that parts of the NHS can and have come under pressure because of unprecedented demand, linked to the challenges of our ageing population. Compared with four years ago, every day the NHS sees 16,000 more hospital out-patients, performs 10,000 more diagnostic tests and carries out 3,500 more operations, and there are 2,000 extra ambulance journeys. Every year, 1.3 million more people visit accident and emergency departments.

Despite the extra demand, our NHS is performing well and treating the vast majority of people quickly. It is particularly important that it is dealing with the most unwell patients first. That is possible because we have taken, even in difficult economic times, the decisions that have allowed us to increase the NHS budget by £12.7 billion over this Parliament. Of course, that has allowed us to support Kettering hospital with local investment, which my hon. Friend outlined.

The NHS is also on track to deliver up to £20 billion in efficiency savings over this five-year period. That challenge was outlined by the former chief executive of the NHS, Sir David Nicholson, in 2009. Even to stand still and even with increased investment going into the NHS, it needed to make greater efficiencies. As a result of reforms and modernisation, we expect to save £4.9 billion over this Parliament and £1.5 billion a year from 2014 onwards. All of that will go directly back into front-line care in Kettering and elsewhere.

[Andy Sawford]

I thank the Minister for generously giving way, especially as the debate was secured by the hon. Member for Kettering. The Minister makes a point about efficiencies, but will he comment on the issue of geography, which we have not really touched on? We have talked about demand, but this is a critical issue for north Northamptonshire. The geography of our area is such that for people to have to rely on a hospital other than Kettering would mean considerable travel time. As someone who represents a rural area, I can say that that is an efficiency that we would not want to make. We would prefer to say, “Look, we want our local hospital. We recognise that there are challenges in sustaining a local hospital, but the geography of our area is such that we want to keep hold of it.”

[Dr Poulter]

The hon. Gentleman makes a very important and valid point. As well as improving the way our NHS buys goods and services—improving procurement practice, an issue that we discussed with members of the local health care team from Kettering when they visited me in the Department of Health—improving estate management and taking other measures of obvious efficiency, there is a need, outlined clearly in NHS England’s “Five Year Forward View”, to radically transform the way we deliver care. My hon. Friend the Member for Kettering made that point. It is now a priority to care better for frail elderly people through better integrating health services. I am talking about using the hospital potentially as a hub for vertical integration of services, particularly in more rural areas. That will mean that other health services—community health services, general practice and mental health services—can be supported and integrated with the hospital service as a hub-and-spoke model of care.

Crucial to that as well is integrating what the social care service does at the same time and having an approach that joins up what health and social care have to offer. Taking advantage of the better care fund that has been set up at local level, so that the local authority can work more collaboratively with the NHS, is very important. It is often very difficult to define where social care ends and health care begins, because staff are dealing with the same person, with the same care needs, but traditionally a silo approach has been taken to the delivery of care. We need to break down institutional silos and deliver more personalised care. That is at the heart of integrating care—at the heart of the hub-and-spoke model built around Kettering hospital. It draws on the importance of joining up what the local authority does with what the NHS does. That is particularly important in more rural areas, such as the one that the hon. Member for Corby represents.

As I said, I have followed developments in Kettering with keen interest. It is worth saying that since October 2012, when Monitor found the trust to be in breach of its licence in relation to consistently poor A and E performance, considerable progress has been made. That is in no small part down to the work of the local NHS and the local health care teams. To date, in 2014-15—I am now bringing the House up to date—the Department has provided £7.4 million of revenue support and £5 million of emergency capital to the trust. Over the winter, the trust fully activated its winter plans, building on initiatives that proved successful in previous years.

That work included an enhanced weekend discharge team, detailed plans allowing escalation when there was a busy period, and appropriate use of short-stay facilities, including an observation unit and ambulatory care unit. Those short term measures are designed to ensure that services continue in times of pressure, but the intention, quite rightly—building on the point about better integrating health and social care and what happens in the community with what happens at the hospital—is to move to a position whereby there is the ability to cope with pressure all year round and not just during the winter. The urgent care hub has that integrated delivery model at its heart.

The hub, as my hon. Friend the Member for Kettering outlined, would incorporate existing A and E services and facilities, but also include, for example, GP services and out-of-hours care, an on-site pharmacy, a minor injuries unit, facilities for social services, facilities for mental health care—that is particularly important and sometimes overlooked, but not in this case—and access to community care services for the frail elderly. Those services would facilitate rapid assessment, diagnosis and treatment by appropriate health and social care professionals. Patients would be streamed into appropriate treatment areas to minimise delays and reduce the need for admissions.

The hub’s location is, I am told, still being finalised, but options include clearing and redeveloping existing areas of the hospital or developing a new build on the site. The local NHS envisages that a capital investment of approximately £30 million, as my hon. Friend outlined, will be required. However, that figure will be subject to further detailed assessment as part of the business planning process.

The principle of the hub is absolutely the right way forward for the local NHS. It is the type of integrated care model that we need elsewhere in the country, particularly where the NHS is servicing a broad population. In this case, it is servicing not just Kettering, but a partially rural county and rural area. This is a model that I am sure hon. Members will continue to support and that I will continue to have a keen interest in supporting. I hope the plans will be successful at making the improvements that patients in my hon. Friend’s constituency and the area surrounding Kettering want. There are encouraging signs. The improvements envisaged are significant and would ensure that the local area had a resilient and high-quality health care system to deliver the highest-quality patient care. I again thank my hon. Friend the Member for Kettering for securing the debate.