North Middlesex University Hospital NHS Trust

David Burrowes Excerpts

Tuesday 12th July 2016 Westminster Hall

[Mr David Burrowes (Enfield, Southgate) (Con)]

It is a pleasure to take part in this debate, which is vital for my constituents and for all those around Enfield and Haringey. I pay tribute to the right hon. Member for Enfield North (Joan Ryan) for securing it and for presenting a comprehensive case for the need for urgent action and reassurance for our constituents about the sustainable future of North Middlesex hospital. She has tempted me on to a political path: plainly this is a cross-party concern and call for action, but mention was made of the outgoing Prime Minister. I remember reminding a previous outgoing Prime Minister, Mr Blair, at his last Prime Minister’s questions—those are now coming up for the current Prime Minister—that he had said that there were

“24 hours to save the NHS”,

but that his Government had decided to downgrade Chase Farm hospital. There is a lot of history to this, but I will avoid, if I can, being tempted down that route.

I believe that, because of the Government’s investment, Chase Farm and the Royal Free hospitals have a secure future that is not shackled by the private finance initiative deals that have severely affected Barnet and North Middlesex hospitals. In terms of resources, they are paying a big mortgage, and in relation to finances they have been chasing their tail. Sadly, A&E has been part of that tail. In April, the hospital was whacked with a £320,000 financial penalty, which made a significant dent in its finances and contributed significantly to the £8.3 million deficit with which it is struggling to deal.

The issue is with the A&E. I want reassurances from the Government that someone will take responsibility and action will be taken. Many of us have been expressing concern about local A&E provision for far too long. The concern is that responsibility has not been taken and there has been no proper action. In short, how bad does it have to get before someone takes responsibility and action is taken?

Like the right hon. Member for Enfield North, I pay tribute to staff. We all do. There are obviously great, dedicated staff. Many of us will know them—they are friends and people we know locally. They are as concerned about what is happening as anyone else. Later in my speech, I will say a little more about my experience as a patient in the A&E department two years ago. I saw things for myself, and there are regular reports. The Care Quality Commission made particular reference to the “caring and compassionate” work and service of staff. The current situation is letting them down.

Health Education England and the General Medical Council said that, as much as there was a duty of care to patients, there was a duty of care to doctors training at the hospital, which was why there was such profound, extraordinary, exceptional concern that they reached the point of threatening to pull doctors out. We know that that threat will not be realised, that a corner has been turned and action taken, but why did it take this long for such urgent, expensive crisis management to take place? There were earlier warning signals, so why was there no proper plan?

It is all very well having a new programme calling for “safer, faster, better” services, but for goodness’ sake our constituents expect a safer, faster, better service without a new programme having to be put together, no doubt in glossy print and at considerable expense. They expect a basic service, not a new programme. They have been expecting that for far too long and have been let down.

The 10-year context is important. Despite some interruptions, we can all testify to that 10-year journey. It is so very frustrating because the context is positive: the journey of the Barnet, Enfield and Haringey clinical strategy since 2005-06. We can have our criticisms and our campaigns, but the context is London’s biggest reorganisation of acute services in more than a decade, which was inevitably going to be a challenge. It inevitably needed a careful plan and serious clinical leadership—not just proper clinical leadership in secondary care and the appropriate number of consultants and middle-grade doctors, but the appropriate primary care. Those of us who were involved in the discussions heard the promises from Sir George Alberti, and the talk about bridging loans and the pump priming of primary care, which was also necessary. Sadly, we are seeing the lack of all those things at the same time.

Nevertheless, North Middlesex hospital has been physically transformed since 2009, when it was mostly old Victorian buildings that were not fit for purpose. Those buildings were demolished and a new £123 million modern hospital took shape. That was incredibly welcome, as was the added investment. Some £80 million of public funds was invested to provide the new facilities in line with the reorganisation in the BEH strategy. The plan was, quite properly, to modernise the older facilities, and the hospital has been visibly transformed. Sadly, though, the service that has been provided to constituents has not matched the modern facilities from which they are now able to benefit.

North Middlesex has become one of the busiest A&E departments in the capital, so it is plain that no one can afford it to close. I know the Minister can counter the suggestion that there is any risk of closure, and I am sure he will reassure us that it will not close in any way, that there will be no partial closure and that it will continue, with a long-term, sustainable future. Nevertheless, the concern is why, with all that investment having gone in—initially private finance initiative investment, then direct taxpayer-funded investment—it has taken until this point, so far down the line, for regulators to be able to tell everyone what we all knew far earlier.

I have read the trust’s minutes from 26 May, which state:

“Since the problems first surfaced last year, we have been open with our health partners about the challenges and have worked closely with them to tackle the many interlinked contributory factors, both internally and in the local health care system.”

Well, the problems did not first surface in 2015. I was a patient two years ago and saw for myself that there were problems when I was sitting on a trolley for 11 or 12 hours and was missed by very busy, overstretched staff who were dealing with so many patients. It was an ordinary summer’s day in June—not a winter’s day—and there were more than 400 patients. The staff were absolutely overstretched and missed my CT scan. Lo and behold, my appendix burst. It could have been fatal. That happened because no one was available to take any responsibility for what was happening.

There was real concern about the leadership of staff who were overstretched. I raised the alarm then, as did others. Indeed, the CQC happened to be inspecting the A&E on the very weekend I was sitting on that trolley and seeing for myself the huge challenges it faced. The CQC said that the A&E required improvements. Its report recognised that the hospital was fully embracing the reconfiguration of services, but also said:

“While the hospital had achieved much in absorbing increased numbers of patients, its infrastructure of staffing levels, training provision, complaints handling and governance had been stretched, and there had been an underestimate of the resources needed to maintain services at the current level.”

The warning signals had gone out. Why was prompt action not taken to provide sufficient numbers of consultants and middle-grade doctors?

On Chase Farm hospital, one of the bottom lines for the reconfiguration was the fact that, true to the Prime Minister’s words, we had a moratorium and delayed the previous Government’s plans. All options were looked at, but it came back to the unanimous clinical advice from the local doctors and others, who said that it was in the best interest of the patients for the reconfiguration to take place. Why? They referred particularly to the lack of consultants and middle-grade doctors. That meant that Chase Farm had to be downgraded and A&E patients referred to Barnet and to North Middlesex.

How can it have come to pass that, three years later, we are still hearing the same excuse—that there are not enough consultants or middle-grade doctors? It is completely unacceptable. Why is the system not reacting quicker? Whoever the system is—whether it is the chief executives of the trust or the ever-changing roll-call of interim managers and directors of NHS Improvement, NHS London or NHS England, or, indeed, Ministers themselves—why has it taken so long, with the regulators threatening to pull out doctors, for everyone to pull out their fingers and turn the corner that has now been turned? It is not good enough.

Without my permission—there was a leak—the Daily Mail did a big splash on my experience, and there has been tension ever since about other very serious incidents, some of which have already been mentioned. There was the awful example of someone who had died being left unattended for four hours. There were other shocking and deplorable incidents. Staff themselves see it as something that shames them as well. Managers say to me, “Why hasn’t more action been taken?”

Until July 2015, the A&E department, which is in a very challenging London hospital, was performing relatively well against the standard of seeing and admitting or discharging 95% of patients within four hours. In the first four months of 2015-16, the hospital continued at 94% to 95%. We have to recognise that it has undergone extraordinary growth. Compared with 2013, before the BEH changes were implemented, the hospital now has 25% more staff, cares for 19% more A&E patients, admits 44% more patients, undertakes 44% more surgical operations and procedures, sees 27% more patients in outpatients, and delivers 37% more babies. Yes, all of that is happening.

Of course, performance dipped in other trusts in the country and the downturn continued in January 2016, but when it reached a low of 66%—yes, it recovered slightly to 70%—why were those signals not heeded? How could it get to that level and no urgent action is taken? It was mentioned by hon. Members and others at the time, so why was urgent action not taken? Why was somebody not ready to seize it and say, “We are not going to wait for these regulators, the CQC, to come and tell us down the line that it is inadequate, or for the HEE and GMC to say it is not even safe for doctors, let alone for patients?” Why did it take so long? How bad does it have to get? Why does our health service have to get to this stage for prompt action to be taken?

Many of us could have said that it was not just about secondary care, but about primary care as well. The right hon. Member for Enfield North has made that point already. I referred to the issue of a tale of two health cities within London. Compared with the Camdens and Islingtons of this world, we are very much the poor relations. We are 25% poor. We have had meetings with Ministers about mental health provision, and we have pressed the Minister about the need to ensure fair funding for London. We must get that. We have got this sustainability and transformation plan. It is another siren call. There will be other problems down the line on mental health and other issues affecting our constituents unless the Government and NHS England London ensure that we get fair funding.

The Government have put in a new fair funding formula, but it is taking far too long. We do not need to listen to the Public Accounts Committee to tell us it is taking too long—we can listen to patients, to this debate now and to the regulators. Although in the round our health economy is not all about resources, they have a big impact, particularly in primary care. Why does the health trust have to go through a financial penalty system? Another £130,000 was taken away in April, so more money is taken away from the system when there is a cry for help.

The chief executive, who has gone on leave or has left, made a plea for help over many years. We were all making a plea for help. Why has the NHS not done more about it? It is totally unacceptable for us to be in this position here with this debate. I know from our meetings that the Minister is holding the NHS to the fire now, but why were feet not held to the fire years ago to ensure that people took responsibility? Yes, they could have lost their jobs, but there could have been proper clinical leadership that did not let down our patients in Enfield.

I look forward to the Minister giving us every assurance that there is, as I believe there is, a long-term sustainable future for the A&E at North Middlesex. We cannot afford to lose it and I am sure we will not. The CQC tells us that a corner has been turned, but it was far too long in coming. I want the Minister’s assurance on consultants, although I understand there is a national crisis in getting consultants on the ground, particularly in emergency departments. I want to ensure that the Government will fix it to ensure there is every financial incentive for the right number of consultants and middle-grade doctors to come to Enfield to ensure we have the A&E service that our constituents need and deserve.

--- Later in debate ---

[Mr Lammy]

No, it does not, and that cuts to the critical issue of safety at the hospital. In fact, the problems at the hospital have been going on for well over two years. What happened to the hon. Member for Enfield, Southgate, who lay in the hospital with a burst appendix and who frankly would not be here but for a stroke of luck, says it all. How have we got to the situation where the local Member of Parliament is about to die of a medical emergency after waiting without being seen for 11 hours? He has been friendly—[Interruption.] Well, that is what happens with a burst appendix. The hon. Gentleman is looking well, but he is not that young. People die of a burst appendix if they are not treated.

[Mr Burrowes]

Perhaps it is an issue of profile, but they did not know I was the Member of Parliament. I kept it quiet and was there as an ordinary patient—which is the point. It was only when they found out 11 hours on, following some communication that I was the Member of Parliament, that, lo and behold, the seniors all came down and had a look, and saw what was going on. It was actually my mother who was banging on the desk saying, “Why aren’t you getting a scan for my son?” That is what it takes—it is the ordinary experience of any patient, who, sadly, may not have their mother there to badger the staff for them. That is the patient safety concern.

[Mr Lammy]

The hon. Gentleman took the business of mystery shopping a little far, but his encounter was well reported locally, and at that time alarm bells were being rung. By my recollection it was a good couple of years ago.

The CQC report confirms what we all long feared—that the closure of the emergency department at Chase Farm hospital in December 2013 had a significant impact on demand at North Middlesex hospital. Concerns were also raised about doctors training in anaesthetics, and they were removed from training in the hospital in April 2015, and have never returned to it because the GMC was so concerned. I wrote to the Secretary of State for Health on 22 March—four months ago. I did not get a reply. I am grateful to have seen the Minister eventually, a couple of weeks ago; but he can see why I am concerned when, after failures of the kind we have heard about in the debate, the Secretary of State did not reply to me in March. I will gently say that a hospital where alarm bells are ringing about such issues would have commanded the attention of the Secretary of State in the past, under successive Governments. Certainly MPs and local authority leaders would have been called together and the issue would have been addressed. I raise the matter in the gentlest of ways, because I am concerned about it.

Many issues have been raised and other hon. Members want to contribute; and we want to hear from the shadow Minister, too. The bottom line is that we are very concerned that the hospital has reached the state it has, given the investment that has gone into it. Week after week there are complaints from constituents. Yes, the leadership has now changed. It is important that local governance and the hospital’s relationship with Enfield and the London Borough of Haringey should be retained; but we want to hear from the Minister that such things cannot happen again. It is a question of who is accountable, and when, and of how Members of Parliament could have been heard much more constructively. Given all that happened at Mid Staffordshire, it is a matter of deep concern that although things are clearly not quite at that stage, they could have reached it had leaks not been published in The Guardian and had MPs such as my hon. Friend the Member for Edmonton (Kate Osamor) and my right hon. Friend the Member for Enfield North not rung alarm bells as they have in the past few weeks.