Stafford Hospital

Anne Milton Excerpts

Tuesday 20th December 2011 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

Thank you very much, Mr Hollobone, for calling me to respond to the debate. It is a pleasure to serve under your chairmanship today; I do not think that I have done so before.

I congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) on securing this debate and of course I join him in paying tribute to the staff of Stafford hospital, the staff of the local ambulance service and indeed the staff of the neighbouring hospitals for all that they are doing to provide local people with good accident and emergency services. I particularly pay tribute to them at this time of year. When many people will be enjoying their Christmas lunch, there will be many NHS staff working over the Christmas period and it is always important to acknowledge their contribution and the work that they do.

My hon. Friend raised a number of issues about the overnight closure of the A and E department at Stafford hospital, which is a measure that will naturally be a cause for concern for his constituents. I know that all of them have been through quite a tough time, but I also know that he will agree—in fact, he did agree—that the safety of patients must always come first. However safety can be protected, that is always the best course of action, so I must support clinicians at Stafford hospital in their request for the overnight closure, which they made so that standards of care in the A and E department can be kept high.

My hon. Friend mentioned A and E staff, but it is also important to note that this issue is not always about numbers. A certain number of staff are needed in an A and E department, but that department also needs expertise; it not only needs staff in the right quantity but staff with the right skills and competencies.

I also want to remind hon. Members who are in Westminster Hall today—it is a pleasure to see so many of them here—that for some time now the NHS at Stafford hospital has been routinely diverting all of the most critical patients, including those suffering from major trauma, heart attacks and strokes, to the larger hospitals to the north and south of Stafford. That is not because of the suspension of overnight A and E at Stafford but because the larger hospitals in the area are better able to cope with life-threatening emergencies. My hon. Friend pointed that out, but it is worth repeating it for the record.

The change at Stafford A and E is down to staffing levels; I understand that financial pressures do not come into it. Mid Staffordshire NHS Foundation Trust has the funding for the posts that it needs to fill, but it has found it difficult to find the staff to fill them. My hon. Friend mentioned the importance of reassuring the local community. The available health services need to reassure people; that is one of their important roles. They must also engender trust among those people who they are there to serve. That is a very important role that the NHS must play.

Since the summer of 2010, permanent staffing—both medical and nursing—at Stafford A and E has been low. The trust and the wider NHS in the midlands have been trying to get enough medical cover to keep standards at the right levels. It is also important to acknowledge the support from the neighbouring University Hospital of North Staffordshire. Without it, the situation would have been considerably worse. However, that regional support could never be kept going indefinitely. To buy some time to work out longer-term solutions, Sir Bruce Keogh, the NHS medical director, arranged the short-term loan of four members of staff—two doctors and two nurses—from Defence Medical Services to help at the trust. My hon. Friend paid tribute to those staff and it is always good to see organisations working together to deliver the best possible solutions for patients. As my hon. Friend pointed out, that arrangement started on 17 October and it is now coming to an end; again, it could not be kept going for an indefinite period of time. However, let us place on record our thanks to the members of staff involved and to the DMS for providing them. I know that everyone at the trust welcomed the expertise that the DMS staff brought with them.

In October, the Care Quality Commission issued a warning notice regarding the quality of care provided by the Stafford A and E department. The CQC’s concerns centred on nursing staff levels, which at the time of inspection were badly depleted because of staff sickness and the overall difficulty of filling vacancies. On 9 November, the trust decided to close its A and E department overnight, starting from 1 December. That decision was not made lightly. As my hon. Friend pointed out, people want A and E facilities close to where they live, so, as I say, such decisions are never made lightly, and they need to be taken locally; it is not appropriate for the Department of Health to interfere with them. It goes without saying that the trust is paying the closest possible attention to the situation at Stafford A and E. It believes that that situation cannot be improved quickly, however frustrating that is for hon. Members.

[Mr Cash]

Does the Minister agree that there is also a question that may be a national issue, of which Stafford may or may not be an example? That is the need to ensure that consultants are always available, as and when necessary, because I think that that issue is all part of the hierarchy of the problem.

[Anne Milton]

Yes, and I thank my hon. Friend for raising that important issue, which is one of delegation and cover. It is of concern to the Department of Health; I think that there have been a number of newspaper articles and some television programmes about it. It is important at all times that care is delivered safely. That sometimes requires cover, but it also requires appropriate levels of delegation. However, what must be uppermost in everybody’s mind is that patients’ safety is always preserved, and the Department of Health will obviously work with the NHS to ensure that nationally we have schemes to ensure that patients’ safety is maintained.

For that reason, it would be unwise to return to 24-hour opening at Stafford A and E department before it is safe to do so. To minimise risk, I understand that the trust has set criteria that must be met before overnight operating can resume, and I also understand that there are regular staff meetings to check progress against those criteria. Those meetings are an important means of reassuring staff and those criteria will become critical. They mean that staff will be aware of the current situation and fully up to speed with the progress that is being made.

At present, I understand that patients needing A and E treatment are being diverted by ambulance to A and E departments in Wolverhampton, Walsall, Burton and Stoke, every one of which has been fully involved in planning for the overnight closure at Stafford. West Midlands Ambulance Service has established a divert policy to deal properly with patients coming to the trust, and to alternative A and E departments, at night. To help to manage those arrangements, the trust has appointed a “repatriation co-ordinator” to ensure close co-operation between Mid-Staffordshire NHS Foundation Trust hospitals and the other hospitals affected. The thing that struck me as quite extraordinary is the amazing job titles that the NHS can come up with at times. However, that “repatriation co-ordinator” will be important, to ensure close co-operation between hospitals.

To date, very few patients have turned up at Stafford A and E at night, which is a testament to how well the trust has publicised the current arrangements. That is another important point; explaining the reason for the closure, and how and where to get help when Stafford A and E is closed, is vital. My hon. Friend the Member for Stafford mentioned older people in his speech. As I say, the fact that few people are turning up at Stafford A and E at night means that the message that the department is closed overnight has got through, even to older people, who of course often attend A and E departments.

[Mr Cash]

On a purely practical level, diversion signs are important. My hon. Friend is referring to the importance of getting the message through, but however much we try to get the message through, I suspect that people will still turn up anyway. Therefore, the most important thing at that point is to know that the signing system—as provided by the highways authorities, or whoever—will actually provide the right information to help people to get to the other hospitals. Does my hon. Friend agree?

[Anne Milton]

I agree entirely, and I am sure that my hon. Friends the Members for Stone (Mr Cash) and for Stafford are in touch with the local authorities, because it is extremely important, as my hon. Friend the Member for Stone rightly pointed out, that diversion signs are clear to people and that people do not turn up at an A and E department that is closed. It is actually quite extraordinary how resilient people are to those diversion signs. Information needs to be given to people in words of one syllable, so that they are quite clear that the A and E department is not open for business at the moment.

Stafford is taking, and it will continue to take, GP-referred maternity, paediatric and medical patients 24 hours a day, seven days a week, which will be of some reassurance to local people. I know that my hon. Friend the Member for Stafford has visited Stafford A and E department several times since the overnight closure came into effect, and I am pleased to hear that he is satisfied that the measures that have been put in place will ensure patient safety and good access to A and E services. I know that some of his constituents are concerned about the impact of increased demand on neighbouring A and E departments. The situation is being closely monitored and the local NHS is content that the arrangements are working well.

Of course at this time of year, the pressure on A and E departments gets greater. We have not suffered particularly severe weather in the south of the country, but some places have done so. Such weather always takes its toll on the NHS, and therefore the monitoring of how things go is very important.

As I have said, the closure took place on the advice of clinicians with the aim of ensuring patient safety. The trust continues in its efforts to recruit additional staff, and patients can be assured that it will not reopen its A and E department full time before it is safe to do so. The trust, the Staffordshire PCT cluster, emerging clinical commissioning groups and others are looking at a range of options to achieve a clinically safe and financially sustainable service, and will present their report on the way forward to the NHS Midlands and East strategic health authority cluster at the end of January next year.

I will say a word about emergency medicine nationally. The number of emergency medicine consultants has risen by more than half in the past five years, but we agree that it must continue to increase and we are working with the College of Emergency Medicine on how best to make that happen. In the short term, some trusts have been employing more GPs in A and E. GPs are primary care experts, so their presence in A and E allows emergency specialists to concentrate on the cases for which their skills are needed. We are, however, looking at a number of areas, because this matter is of national concern. We are considering revising the person specification for training in emergency medicine to make entry more accessible, and redirecting into emergency medicine some of the doctors who cannot secure other higher specialty training posts.

My hon. Friend the Member for Stafford pointed out the importance of specialist services, and what I have said about the national situation highlights exactly why they are so important. As my hon. Friend the Member for Stone mentioned, the particular needs of people in rural communities, for whom travelling long distances causes additional problems, must also be taken into account. It has long been the case that specialist services need to be provided in specialist centres, and during my own working life as a nurse we had regional neurosurgical centres for the specialties that required highly skilled and specific care. That is important, because we are always balancing patient safety with the accessibility of local services.

[Jonathan Lord (Woking) (Con)]

I join colleagues in commending the thoughtful leadership role that my hon. Friend the Member for Stafford (Jeremy Lefroy) has taken. May I ask the Minister two things? Can we be reassured that the awful lessons of Stafford have been learned nationally? If I may crave the indulgence of my Staffordshire colleagues, I have happy memories of fighting with the Minister during the previous Parliament, when I was chairman of her association, to save the A and E at the Royal Surrey, so perhaps she would care to extend her warm words to all the medical staff who will be working there over Christmas and the new year holiday, just as she did to those at the Stafford hospital and elsewhere in Staffordshire.

[Anne Milton]

I thank my hon. Friend for his imaginative use of this debate to point out that I joined with him to fight a long, hard battle to save our hospital in the Guildford constituency. It is important, of course, to extend our thanks and tributes to staff working not only in our own constituencies, but across the country. On the first question, there is no doubt that lessons need to be learned, and I think that we sometimes feel that the NHS is slow to learn the lessons it should.

Work is being carried out nationally to address the skills mix, by developing non-medical roles within A and E departments. Enhanced nursing roles have genuine potential, and in countries with very remote populations, such as Canada and the USA, they are an extremely important part of the general skills mix. Emergency nurse practitioners who can look at the minor injuries and illnesses that in most departments account for 40% of the work load can be a major contribution to ensuring that A and E services remain available for local people, and advanced clinical practitioners, such as nurses and paramedics, can therefore treat many more of the major conditions.

I thank my hon. Friend the Member for Stafford for securing this debate, and other hon. Members for attending on the last day before recess. A number of Staffordshire MPs have met with the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), and I know that he will continue to keep in close touch, but should any new concerns arise I am sure that my hon. Friend the Member for Stafford will raise them with him. That leaves to me just to wish you, Mr Hollobone, and all the House of Commons staff a very happy Christmas and a prosperous and safe new year.

[Mr Philip Hollobone (in the Chair)]

I thank all Members for taking part in this debate and I, too, wish everyone a very merry Christmas.

Question put and agreed to.