Improving Healthcare: Isle of Wight

Bob Seely Excerpts

Tuesday 1st October 2019 Westminster Hall

[Mr Bob Seely (Isle of Wight) (Con)]

I beg to move,

That this House has considered improving healthcare on the Isle of Wight.

It is a pleasure to serve under your chairmanship, Mr Betts. It is good to see the Minister here; I thank her very much for attending. This is an important debate for the Island; I will demonstrate that to the Minister with an example from just yesterday, when, by coincidence, a friend of a friend went into St Mary’s A&E, on a doctor’s recommendation. They were seen and assessed quickly, within 15 minutes, which is great; but they then sat there for nearly 10 hours, with a cannula sticking out of their arm, and with “urgent” written on their paperwork. One o’clock, 2 o’clock, 3 o’clock and 4 o’clock came and went, and they left at 10 pm.

This is not a criticism of NHS staff—quite the opposite. I have friends and acquaintances who work at St Mary’s and in the NHS on the Isle of Wight; I know their dedication and professionalism, and I am very grateful to them for it. Nor is this criticism of the leadership at the trust under our new executive, Maggie Oldham; I am a big fan of her leadership and her team, who are doing good work. We need that leadership on the Island; frankly, we have lacked it in recent years. What I wish to discuss with the Minister is the NHS funding system and how that relates to the Isle of Wight as an island.

The broader context for this debate is my proposal for an island deal that recognises the additional costs––which are not massive; sometimes they are small—of providing on the Island good public services equivalent to those on the mainland. I have had several conversations with the Prime Minister about my proposal for an island deal, and I am delighted that he has agreed to it in principle; he most recently talked of it in the House on 25 September, when he spoke of

“the island deal that we are going to do—I can assure him that we are, do not worry.”—[Official Report, 25 September 2019; Vol. 664, c. 803.]

I am delighted with that.

This is not us asking for something that we think we deserve because we feel that our need is greater; this is an assessed case, based specifically on the fact that the Isle of Wight is an island and so suffers from issues to do with economies of scale and distortions in the market. The additional cost of providing public services on islands, with their limited markets and fewer possible economies of scale, has long been recognised. If the Minister wishes, I can send her an extensive list of academic research on the subject, the most recent piece of which was done for the Isle of Wight by the University of Portsmouth.

The Scottish islands have the special islands needs allowance, which gives additional funding of about £6 million per Scottish island to recognise the additional costs and challenges of providing public services to isolated island communities. We have no equivalent in England, and because of that, we have been structurally underfunded for generations, no matter whether Labour or the Conservatives have been in government; that is how the formula was designed. I wish to look briefly at three key aspects of this.

There are probably five or six elements to the settlement under the island deal that I am discussing with the Prime Minister, but today, I am looking specifically at healthcare costs. In July, the Secretary of State for Health and Social Care said that the Isle of Wight is

“unique in its health geography, and that there are places in this country—almost certainly including the Isle of Wight—where healthcare costs are higher”—[Official Report, 1 July 2019; Vol. 662, c. 943.]—

by dint of isolation and, in its case, of being an island.

The 2019 sustainability plan of the Island’s NHS trust estimates the following costs, which I will discuss in slightly greater detail and then put some questions to the Minister. I know that she will want a decent amount of time to reply, so I will not speak for more than another 10 or 15 minutes, so I can listen as well. The trust estimates that the additional cost of providing acute services on 24 hours-a-day, seven-days-a-week wards is £8.9 million. It assesses the additional cost of providing ambulance services, including a coastguard helicopter ambulance, as £1.5 million and the cost of patient travel by ferry as £500,000, although I suspect it is slightly more, as I will come on to.

Those figures come from the need to provide a baseline service by law for a smaller population than average for the size of a district general hospital. As the Island’s NHS trust states,

“the Island’s population is around half of that normally needed to sustain a traditional district general hospital.”

Because of that smaller population, we do not have the throughput of people, which means that we generate fewer tariffs. To explain it to a layman, we have fewer people going through our hospital, so we claim less money for those procedures, but we still need to keep the wards open and up to the decent baseline standard that people expect.

It stuns me that I still have to explain this. I was having a conversation about the Island this summer with a friend of mine, a Secretary of State and someone I hold in high regard, who turned to me and said, “You have to get to it by ferry, don’t you?” The Isle of Wight is not an island like the Isle of Sheppey or Anglesey in the sense of being connected to the mainland and an island only in a quaint medieval cultural way. We are an island in a practical way: we are separated from the mainland.

We lack a fixed link, which would cost between £2 billion and £3 billion. If the Government ever wish to discuss that, I would be delighted, but until such time, we are separated by water, so primarily, almost exclusively, people travel to the Island by ferry, which changes the dynamics of the hospital and our economy in many different ways. For example, we need to run an accident and emergency service 24 hours a day, seven days a week. It is the same with the maternity ward, because people cannot give birth on a ferry or in a helicopter, and the helicopters do not run in all weathers nor the ferries overnight.

We have a baseline legal requirement to have a hospital on the Isle of Wight, but we have half the usual population for a district general hospital, so everything costs more, because we do not have the tariff-per-head throughput. Our A&E runs seven days a week, but our income is based on a national tariff for a much larger population. We must have a four-cot special care baby unit as part of the maternity unit cover, but a lot of the time, I am delighted to say, it has no babies in it, because the births are healthy. That is wonderful, but we still need to run it, which costs quite a lot of money, even when it is empty, because we have half the population. The same applies to other wards, such as the dementia ward, and to intensive care.

For all those units and wards, we have to provide a baseline service with significantly less income from NHS England because we do not have the tariff, so it costs more to provide the same standard of service. Historically, therefore, we have been underfunded, which has had an impact on the quality of the service that we offer. For example, we are meant to have eight consultants in A&E, but we have four, which is why people wait for 10 hours rather than two—as happened yesterday.

It also costs more to attract permanent staff due to isolation, because of the island factor, so we tend to spend more on agencies and specialist services. Our use of agency and locum staff is frankly bad. We need to find solutions to it, and we are having to do so. To get a locum to come to the Island, we may have to offer to pay the ferry fare, because our ferries are probably the most expensive per mile on the planet. The use of locums and temporary staff also has a knock-on effect on training for our young doctors and nurses. The General Medical Council found issues with foundation training due to inconsistent supervision, up to and including earlier this year.

That is the first point, on acute services; I will speed up, because I want to get as much in as possible. Secondly, our ambulance service has suffered, too. Why? Because we cannot use an overlay of ambulance. When someone is taken ill and needs an ambulance and they are on the Hampshire-Sussex border, if there is not a Hampshire ambulance willing to take them, we can pretty much guarantee that there will be a Sussex ambulance coming along.

We cannot have that. We do not have that on the Island, because it would take an hour and a bit for a Hampshire ambulance to get on the ferry to come over. We cannot call on out-of-area ambulance services from Sussex, Hampshire, Dorset or Cornwall to support us. At busy times, when we are taking folks to the mainland, the additional overtime and manning costs stack up very quickly as soon as there is a slight pressure on our ambulance service. We estimate that cost to be £1.5 million, and I am very happy to discuss that, along with the £8.9 million and the £500,000 for patient travel. This is not based on people being poor and earning a bit less than the national average; they are specific costs associated with islands.

Finally, there is patient travel. In 2017-18, there were 31,314 episodes of planned care—sorry for the bureaucratic terminology—on the mainland relating to Isle of Wight patients, which translates to 44,608 related journeys from the Isle of Wight to the mainland. Through our plan to improve quality of care on Isle of Wight, with the use of telemedicine and better-integrated IT, we hope to reduce the amount of travel to the mainland, but I believe that NHS England should be funding some of that patient travel.

At the moment, the council funds £60,000-worth of chemotherapy visits; the ferries, to their credit, subsidise others, but I want the ferries to spend that subsidy money on other things and I want NHS England to pay for this. I look at the Scilly Isles as an example: the National Health Service (Travel Expenses and Remission of Charges) Regulations 2003 set out that any Scilly Isles resident not entitled to free NHS travel will pay a maximum of £5 for their travel costs. I ask for that £5 maximum return fare to be funded as part of this Isle of Wight settlement and for NHS England to take on the cost of patient travel to the mainland, such as for chemotherapy and other specialist services, which is estimated at £500,000 per annum, or maybe a little bit more, depending on how it is calculated. I would like NHS England to fund that cost. That would also act as a spur to improve IT integration and telemedicine, because the Island wants to become a model.

I am delighted that we got the £48 million from the Department of Health and Social Care recently—thank you very much indeed. It was a fantastic bid put in by Maggie and her team, which I was delighted to support and meet Ministers about. Some of that money is for improving A&E, but some of it is for telemedicine.

I have met some of the guys and girls doing the telemedicine work: we have 42 nursing homes on the Island, and in, I think, 18 we now have a little blue box so that residents in the nursing home can have their vital statistics checked on an almost daily basis, which saves money and time and means that their information is sent every morning to the GP or district nurse so that they can be checked up on. It is much more proactive. This is the future; it is really good and very exciting, and we want to be in the forefront of that. It would make not only ethical and medical, but economic sense for us to do that, because there would be fewer trips to the mainland, lower costs, fewer trips to St Mary’s and even fewer trips to GP surgeries.

Those are the three areas I am focusing on: the cost of acute services, £8.9 million; the cost of ambulance, £1.5 million, including coastguard and air ambulance; and the cost of patient travel. I stress that this is not related to wider problems. We have problems with deprivation on the Island, which sometimes surprise people. Areas of Newport and Ryde are among the 10% most deprived in England. Our disease prevalence is significantly higher than the national average for dementia, stroke, learning disabilities, arthritis and some cancers. I am not yet making a case for additional funding for those things, because the priority is for the Government to recognise the additional costs of providing healthcare on the Isle of Wight.

We are doing our own thing. I stress to the Minister that we are not covering up for a poor-quality NHS trust. It is in special measures, but we have new leadership, we are turning it around and we are going in the right direction. Again, I pay tribute to the leadership of the NHS team on the Island. We know that we need to do more to improve our productivity. We had 149 nurse vacancies earlier this year. By the new year, we expect that figure to be under 90—by getting Filipino nurses in, for sure, but also by training up Islanders and giving them jobs as nurses. We have new models of care, particularly in mental health and acute services, which in the past have been too—I think the word is paternalistic. We are significantly improving those fields, especially mental health, which is still seen to be inadequate and failing.

We are also sharing consultants more. This is the way ahead. We cannot afford specialists on the Island, given our size, but by working with Southampton or, more likely, Portsmouth, we can afford to share those specialists. We are about to sign a memorandum of understanding with Portsmouth, so that we make greater use of efficiencies, sharing consultants, specialisms and specialists, so that when they are not working in Portsmouth, they can jump on the ferry and come over to St Mary’s, or wherever they are needed on the Island, and support us.

As we know, there have been recent failings, which is why we are in special measures on the Island. Some recent episodes that concern me include patients leaving hospital without a discharge summary. That has been happening too often—it was raised in a coroner’s court recently—and it is not good practice.

I cannot make things in the past right, but I can do my utmost to make sure they do not happen in future. I am trying, in my role as Member of Parliament for the Island, to be a critical friend to Maggie and her team. When I hear complaints from my fellow Islanders about certain things, I will pass them on to her, in the hope that she can focus on them, while I understand the importance of supporting the new leadership team. What I ask in return from that team is honesty, to ensure that we are transparent about any past or current failings—not to lay blame or have a go at people, but to work collectively towards raising our standards and giving Islanders the quality of healthcare that, frankly, we deserve and that I want to see for the Island. Until that time, what we have will not be good enough, because the Government have never taken into account the additional costs of being an island.

Overall, things are getting better. I am delighted about the £48 million, and I have discussed telemedicine and IT, so I will not go over them again. To sum up, we face special circumstances—severance by sea—hence the need for an island deal, which I have discussed with the Prime Minister. In this debate, I am looking at healthcare and additional costs in three specific areas: acute, at £8.9 million; ambulance, including coastguard helicopter, at £1.5 million; and patient travel, at half a million. Those are what we accurately and honestly assess to be the additional costs.

I am hugely grateful to the Minister for being here. I hope that she is not missing conference on my account—or perhaps she is very happy to be; I am not quite sure nowadays. My questions to her, finally, are these. Will NHS England accept our costings for the additional costs of providing services on the Isle of Wight that are due to the requirement for baseline services, yet with fewer people coming through and therefore less funding? Or will NHS England provide its own costings, and if so, on what basis? I would like to know whether NHS England disputes our figures and when we can expect official comment. I am not trying to bounce the Minister into a decision today, as well she knows. The most important thing is that we get a considered response and that the conversation now begins, so that I can deliver what I need to deliver for my people.

Can the Minister please outline for the public record, or write to me if need be, a route by which the Island and NHS England can work together to identify the additional costs of providing healthcare on the Island and look at the timeframe for decision making? Finally, where does she feel the additional healthcare pressures figure in the overall funding for the Island? I ask that because we have additional costs that are associated not only with being an island, but with being slightly more deprived in some areas. We have higher dementia, cancer and arthritis rates on the Island, so we are not only dealing with some acute and chronic diseases that have rates higher than the national average, but we are dealing with the island factor as well. I thank the Minister for her time.