Sir Robert Peel Hospital

Christopher Pincher Excerpts

Tuesday 1st April 2014 Commons Chamber

[Christopher Pincher (Tamworth) (Con)]

As our colleagues rush to watch the second half of the Manchester United match, I should like to raise an issue of somewhat greater importance to my constituents. Although the title of the debate is narrow and focuses on the effect on my Tamworth constituency, the wider implications for users of Burton Hospitals NHS Foundation Trust also affect the constituents of my hon. Friends the Members for Lichfield (Michael Fabricant), for North West Leicestershire (Andrew Bridgen), for South Derbyshire (Heather Wheeler) and for Burton (Andrew Griffiths)—I see that my hon. Friend the Member for Burton is in his place.

[Andrew Griffiths (Burton) (Con)]

I thank my hon. Friend for giving way and congratulate him on securing this debate and for being a doughty fighter on behalf of his constituents in the provision of health care. He will know that Queen’s hospital has a deficit of some £3.1 million. It has already saved £9.8 million but needs to save a further £10 million in 2013-14. Given that my own east Staffordshire clinical commissioning group inherited a deficit of £8 million—

[Andrew Griffiths]

I am grateful to you for that advice, Madam Deputy Speaker. I was just about to get to the crux of the matter. Given that the area is £12 million away from fairer funding, does my hon. Friend agree that the health care economy is incredibly fragile locally and that something needs to be done to help us bridge that gap in the short term?

[Christopher Pincher]

I quite agree with my hon. Friend and suggest that we find that way forward, in the first case by seeking a meeting with the Secretary of State to discuss our concerns about the trust.

In nearly four years as a Member of Parliament, this is the first Adjournment debate I have applied for in the Chamber. I hope that gives you, Madam Deputy Speaker, and those on the Treasury Bench some indication of the importance that I and my constituents attach to the subject.

The Sir Robert Peel community hospital at Mile Oak in my constituency provides services for people living in and around Tamworth including a round-the-clock minor injuries unit, an X-ray and ultrasound department, an endoscopy unit and out-patient and day surgery. It also provides award-winning rehabilitation services, care of older people and palliative care services. Indeed, the award to staff for their innovative work on rehabilitation was received only two weeks ago.

The hospital is an important and valued service in our community. Local residents are very attached to it and the medical support it offers to a growing town. They want to be a part of its future, yet as a result of a review that many feel was conducted behind closed doors, Burton Hospitals NHS Foundation Trust, which runs the Peel, has decided to close its day case theatre and surgical ward and is considering withdrawing its endoscopy service. A decision on that service will be made next month. The closure of the day case theatre alone will affect about 1,400 patients each year.

Although no institution, including the NHS, can be set in aspic and although hospitals can and must be prepared to adapt to meet the changing demands of NHS users—for example, the growth in the number of elderly patient means that hospitals need to make more provision for dementia and palliative care—I am concerned that the proposals for the Robert Peel are being hurried through without the fullest consultation and certainly without the fullest involvement of the local community in Tamworth and Fazeley. Although local people are now being invited to so-called listening events, they are about the options for future service provision and not the decisions that have already been made. It appears that the Burton trust has closed its ears to concerns about its plans for day surgery.

The trust has form. A year ago, it introduced parking charges at the Peel hospital with no public consultation and with very little notice. The system it introduced was ill-conceived and badly signed, resulting in a large number of unwarranted fines being levied on some of the most vulnerable people: the old and frail, concerned relatives and the lowest paid. Many of those fines have been overturned. More than 3,000 people signed my petition calling on the trust to rethink its parking proposals and the trust, to its credit, recognised public concern and is now in the process of developing a revised parking system, yet, like the Bourbons, it seems to have learned nothing and forgotten nothing from that experience.

On 5 February, staff at the Peel hospital were called to a meeting to be told that, following what was described as an “extensive review”, the surgical ward would be closed in as little as 12 weeks. They knew nothing of that review, and neither did anyone else—not me, not the local health scrutiny committee, and certainly not the wider community. The review took place between October and January behind closed doors and no one was told. The first the wider community knew was when the story was broken in the Tamworth Herald on 13 February. Yet it was not until 25 March that the trust answered detailed public questions at the Healthy Staffordshire scrutiny meeting, which took place not in Tamworth, but in Stafford. The impression left is that the trust has talked to itself, but not to anyone else.

I have met the chief executive and the operations manager at the Burton Hospitals NHS Foundation Trust and they have assured me that the Robert Peel will not close, that minor injury services will be unaffected, and indeed that new services, such as pressure ulcer clinics, may be run out of the hospital. However, I am concerned that the very thing my hon. Friend the Minister was at pains to stress during the debate on amendments to the Care Bill on 11 March—indeed, he made the point directly to me during my intervention—that proper patient and community consultation must take place before decisions are made, is just not happening at the Peel hospital. As a result, patients, staff, hospital users, local councillors and the local community feel that changes are being done to them rather than along with them after recognising their concerns and their advice.

Burton Hospitals NHS Foundation Trust says that demand for the day case theatre has dropped by 30% in the last five years and that 40% of current capacity can be dealt with in GP surgeries. That may well be true. It may also be true that commissioning services in GP surgeries is cheaper and more convenient for my local clinical commissioning group. However, I remain concerned that if this decision is hurried through without proper consideration and consultation, the problems the hospital discovered with its car parking arrangements could be replicated on a far more serious level—that of patient care. We cannot be sure that all local GPs have the necessary equipment, experience and time to undertake all the new procedures they may be called upon to deliver. We need to be sure that Queen's hospital in Burton and the Good Hope in Birmingham have the scope to add to their already demanding schedules without affecting patient waiting times. At the very least it means some people may need to travel further, and spend more on their journey, for their scheduled minor surgery. For an operation at Queen's hospital in Burton, that means travelling some 18 miles along the A38, which, when it is blocked, tends to stay blocked.

I hope my hon. Friend will agree with me that if Burton Hospitals NHS Foundation Trust believes that services at the Robert Peel must be adapted to meet changing needs in the community it serves, it must make those changes having first clearly and openly discussed its proposals with the wider community. A handful of local councillors, important as they undoubtedly are, simply is not good enough, and it must be careful to analyse and accept the sensible advice of the community, including the friends of the local hospital who do so much good work with it. Making its decision at the start of the consultation process, rather than at its end, does nothing to engage public confidence; indeed, it makes a mockery of any consultation.

I hope that my hon. Friend is prepared to send a clear message to Burton Hospitals NHS Foundation Trust, and to others, that while they must continually monitor their services so that they remain relevant to and focused on need and so that they deliver the very best patient care, decisions made behind closed doors long before anyone is asked their view are not acceptable. The trust board must agree to the widest local consultation, must collate and publish feedback from its consultation and must be prepared to act on the considered advice of all local stakeholders. Only then will people believe that their local hospital is truly their own.

--- Later in debate ---

[Dr Poulter]

I will be delighted to meet my hon. Friends to talk further about local issues. There are long-standing concerns, not least the processes triggered by the Keogh review in the trust and the wider health economy.

I turn to the local reconfiguration process. To ensure that the foundation trust would continue to provide the best level of service to the local population, the trust commissioned a report from Deloitte in December 2012. The intention was to address the long-term challenges faced by the trust by refocusing community services, such as those provided at the Sir Robert Peel community hospital, and concentrating on the most vulnerable patient groups.

The Deloitte report set out a number of options. However, as we are all aware, in 2013 the trust was inspected under the Keogh review, which we took forward following the Francis report on Mid Staffordshire foundation trust. Burton was inspected because it had higher than expected mortality rates. The Keogh review was not reassured by what it found. As a result of the inspection, the foundation trust was placed in special measures by Monitor, the regulator of foundation trusts. Monitor continues to work with foundation trusts in special measures to ensure that they return to safe and efficient services as soon as possible. The Keogh review made six urgent recommendations for Burton. Those recommendations have been the drivers for the changes at Burton and at the Sir Robert Peel community hospital.

Sir Bruce Keogh challenged the foundation trust on what its long-term plans would be for the community hospitals. For example, patient activity at both sites in Lichfield and Tamworth has been decreasing across minor injuries, in-patient and out-patient services for a number of years, and is, I understand, on a steadily decreasing trend. There is a need to make changes because, as well as the higher than expected mortality rates, the trust and its local commissioners believe that the health needs of the population they serve are changing.

As a nation, we face changing challenges in health care—for example, the demographic pressures imposed by an ageing population. As the health needs of the population change, it is right that the services provided at local hospitals and in the local health economy also change and that a more integrated approach is taken between local authorities and the NHS in delivering more personalised care, particularly for the frail elderly, and more care in people’s homes and communities.

The foundation trust has already responded to the Keogh review challenge, although much is still to be done. I understand that the reconfiguration to which my hon. Friend the Member for Tamworth refers follows on from and continues the response to the Keogh review. Certainly, the aims are the same—to ensure that health care services are of high quality and meet the needs of local patients.

The Keogh review has affected the Sir Robert Peel community hospital, which currently offers local services for people living in and around Tamworth—including, for example, a 24/7 minor injuries unit, in-patient, X-ray and ultrasound department, and an out-patient service. There is one ward providing rehabilitation, care of older people, general medical care and palliative care. Consultant and nurse-led clinics accommodate consultations, investigations, minor procedures, post-treatment follow-up and health promotion.

That is not the full range of services that one would expect at larger NHS hospitals. However, having close-to-home community-based facilities is an important part of meeting the challenge of looking after older people in their own homes. Some such facilities are found at Sir Robert Peel community hospital. I am sure that the local population welcome that and believe it important in delivering high-quality health care in the months and years ahead.

There are currently discussions about the relocation of day case surgery and there is a review of endoscopy. I understand that that would affect about 30 patients a week, with services moving to local GP surgeries, Good Hope hospital at Sutton Coldfield about eight miles away, or the main trust site at Burton.

I understand that further changes are being considered in response to Keogh. However, planning is at a very early stage. I understand that the trust board will be receiving an outline paper this coming Thursday and that no decisions have yet been taken. I am sure that my hon. Friend will agree that it would be highly inappropriate for me to speculate about what option or options might be considered or chosen by the local NHS. I would certainly not want to suggest that there is a Government-preferred option that should be followed; I am not in a position to do that. Whitehall micro-management of the local NHS invariably leads to bad things happening; that is what we have tried to avoid through the health reforms that we instigated in 2012. As I said a few minutes ago, such decisions are local decisions and must be seen to be taken by the local NHS and local commissioners, in consultation with local patients.

[Christopher Pincher]

Of course my hon. Friend is absolutely right. These are local decisions for local communities and their local NHS. It is not for Ministers to dictate what services should or should not be provided for any particular hospital; it is for the local community to determine that, based on need. Does he agree, however, that when the local community decides, it should be based on proper consultation, and that listening exercises should be based on what people want and not what the clinical professionals and managers want?

[Dr Poulter]

My hon. Friend makes an important point. Of course clinical leadership in the NHS is important in designing services, but he is absolutely right that it is important that patients and the public locally are properly consulted in decisions about health care services. That is something that we believe in. Far too often in the past, patients have felt that decision making is done to them rather than their being involved in it. That is exactly why we introduced new tests for the reconfiguration of services that put patient and public consultation at the very heart of designing how medical and health care needs are addressed in the future.

As I am sure my hon. Friend agrees, the heart of the matter—this is certainly my reading of the situation from what he has said—is that there is a need for good communication from the foundation trust. That means proper engagement by the trust with local communities, patients and the public and local commissioners in all decisions. It is understandable that people will respond negatively to speculation in the media, and sometimes by word of mouth, about any change or improvement to services unless there is proper communication. It seems that in this case that communication has not been of the highest standard, and that has led to some of the concerns raised by my hon. Friend. I know that he has recently met the chair and chief executive of the trust, and I encourage him to build on that contact. I am sure that the local NHS would welcome the opportunity further to share its thinking with him. That would be very desirable for all hon. Members, including my hon. Friend the Member for Burton (Andrew Griffiths).

I hope that the trust and local GP commissioners will continue to work together to explain clearly what they are doing and why. Elected representatives also play a strong leadership role in helping to work with trusts. It is in the interests of trusts to work with local MPs to ensure that there is a proper understanding of what they are trying to achieve in the way that they deliver health care to the local community.

I was pleased to hear that my hon. Friend has received reassurances from the trust about a strong future for Sir Robert Peel hospital; that is good news. However, there is clearly a need for the trust to focus on improving its communications in future to ensure that the people of Tamworth and surrounding areas fully understand that delivering high-quality health care is about listening to the public. The public must feel that their views are being listened to and properly responded to when health care services are designed. To be absolutely clear, as my hon. Friend said, this is about making sure that patients and public in Tamworth do not feel that decisions are being done to them but that they are making decisions on their own behalf and are fully engaged in the process with local commissioners in deciding on the future health care needs of the local area. Hospital reconfiguration and good health care means listening to patients and the public and making sure that hospital services are improved and delivered in a better way.

That is all the more important in this case because of the consequences of the Keogh review. I know that my hon. Friend will go back from this debate and further engage with the local trust. As I said, I am very happy to meet him and my hon. Friend the Member for Burton to ensure that we can help to achieve better engagement with local health care commissioners and the trust.

I am glad to have had the opportunity to place on record this Government’s support for the local NHS in taking forward the difficult challenge of responding to the Keogh review. We would also like to put on record our gratitude to the local front-line staff who work very hard at the Burton trust. I am sure that as a result of their work and this debate, we will be in a much better position to make sure that the trust engages more fully with the public in Tamworth and surrounding areas when it comes to making decisions about future health care services.

Question put and agreed to.