North Middlesex University Hospital NHS Trust

David Lammy Excerpts

Tuesday 12th July 2016 Westminster Hall

[Mr David Lammy (Tottenham) (Lab)]

I hesitate to interrupt my right hon. Friend, who is laying out the story so comprehensively. Is she as concerned as I am that many health professionals knew what was going on, but that MPs in the three boroughs covered by the trust were kept in the dark?

[Joan Ryan]

That was exactly the case and I am very concerned. It is not an exaggeration to say we were kept in the dark. All of us across Enfield and Haringey have, over the past year, raised the issue of North Mid in the Chamber at a local level and with Ministers at various times. We received no information until a recent meeting with the Minister, who, I am pleased to say, is here today. Prior to that, there was almost no answer to the points that we raised, other than to brush them aside with answers such as how much better the NHS is doing now than ever before. The phrase “kept in the dark” absolutely covers the situation, with those in the know including the likes of NHS Improvement, NHS England, the General Medical Council, Health Education England and, no doubt, the Department of Health. However, but for the actions of the General Medical Council and Health Education England, the situation for patient safety could be even worse.

I have had a number of meetings with the senior leadership teams at North Mid and at the Enfield clinical commissioning group, and many of the problems I will discuss today were not thought noteworthy enough to bring to my attention. If they were brought to my attention, the exposure of those problems was minimal, such that they did not raise the alarm bells that they should have.

In May, the severity of the situation at the hospital was discussed at a high-risk summit, involving several north London hospital trusts, clinicians and other stakeholders. MPs were not even informed that the summit was happening, never mind informed of the outcomes. I would be interested to know whether the Minister thinks that that state of affairs is acceptable given that our constituents have to suffer the consequences of the failures at the hospital. Even as of today, despite numerous requests, we have received no minutes of the high-risk summit and no account of what was discussed in any detail whatever.

Would the Government be willing to bring in early warning measures to ensure that MPs and constituents are kept properly informed about impending healthcare crises in their communities, rather than being notified after the crisis has hit? To do our job on behalf of our constituents—to safeguard their safety and interests in the use of and access to one of the most important public services any of us can imagine—we need some kind of early warning system. It is clear that very many people knew about the situation, but nobody who is accountable to the public at a local level was properly informed. I look forward to the Minister’s response to that point.

I am pleased to see my hon. Friend the Member for Edmonton (Kate Osamor) in her place, as the hospital is just inside her constituency, although it serves a large number of my constituents and constituents from Hornsey and Wood Green. I think it also serves practically the whole of Tottenham—my right hon. Friend the Member for Tottenham (Mr Lammy) is in his place, as is the hon. Member for Enfield, Southgate (Mr Burrowes). I am pleased to say that we have been working cross-party on the issue. Frankly, I will work with anyone—other hon. Members involved would do the same—who is willing to put the hospital first.

The CQC’s damning report into North Mid was published on Wednesday 6 July, and its inspection of the emergency department and two medical wards at the hospital was in response to a

“number of serious incidents…which had raised concerns about the standards of care”.

Between March 2015 and March 2016, there were 22 cases at North Mid’s A&E department where patients experienced serious or permanent harm or alleged abuse, or where a service provision was threatened. The CQC found that people were waiting far too long to be assessed on first arriving at the hospital, to see a doctor and to be moved to specialist wards in the hospital. The main experience of anybody turning up at the hospital’s emergency department was to wait, wait and then wait again.

The report tells of a lack of respect and dignity in how patients were treated, including a time when there was only

“one commode available in the whole of the ED”—

emergency department—

“to serve over 100 patients.”

Most people reading this will find that shocking.

Resources had been so stretched that, by the time the CQC issued its warning notice to the hospital in June, only seven of 15 emergency department consultants were in post, and seven of 13 middle-grade emergency doctors. As a consequence, junior doctors and medical trainees have been left unsupported by senior staff in A&E at night, including in emergency paediatric care. Junior doctors have been asked to perform tasks for which they are not yet qualified, and there have even been reports of receptionists with no medical training being used to triage patients, at least to the extent of deciding whether they should go to urgent care or the emergency department.

In February, A&E staff were so overwhelmed that patients, many of whom had already been waiting for hours, were told that they should go home unless they thought their illness was life-threatening. How can anyone be expected to know how ill they are without seeing a doctor? We have self-service checkouts in our supermarkets, but self-service A&E? I think not.

--- Later in debate ---

[Mr David Lammy (Tottenham) (Lab)]

I am grateful to have the opportunity to speak in this debate. The hospital serves almost the entirety of the constituency of Tottenham and has done ever since the closure of the Prince of Wales hospital in my constituency in the 1980s. It is important to emphasise that North Middlesex hospital is located in a strategically essential area. It serves not only the boroughs of Enfield and Haringey, but some of Barnet and Waltham Forest. Many years ago, when I was a Minister for Health, a neighbouring hospital, Whipps Cross, was a general hospital that on occasion struggled considerably with its emergency department, so I cannot emphasise enough that it is critical for the broader health economy of north-east London that the North Middlesex survives, flourishes and does well.

The concern that has been raised in this Chamber is really about how the situation has got to this stage over such a length of time, with so many Members of Parliament ringing alarm bells in a context where all of us have privately said, “We must tread carefully. We don’t want to talk down the hospital.” We say, “The chief exec seems to be…” as we whisper among ourselves. We do not want to talk down the hospital, but it has now got to the point at which we have to be absolutely frank about what has been happening at that trust, as we have heard, and we must ask some very hard questions about what has been going on.

I hope that the Minister will assist me on this point. There have been successive risk summits, meetings have been held, and the chief exec has asked for support, but I am not clear why support was not provided. In the old days, Members of Parliament would have been able to contact the strategic health authority and there would have been a clear line of leadership. We literally had two bodies to deal with: the strategic health authority and the chief executive of the trust. Frankly, chief executives went if they were not up to the job, and emergency teams were brought in to run the hospital. I did that as a Minister responsible for emergency care. I saw it happen in a range of trusts across the country as, under the Tony Blair Government, we pushed for the first targets of four-hour waits. I am struggling to understand how things have got to this level.

Life expectancy in a constituency such as mine is among the lowest in the country: men reach 74, six years behind the average life expectancy. We have homelessness and we have had two riots in a generation. The issues are clear, but what is not clear is who was in strategic charge? Why were meetings held in successive years? What is the role of NHS Improvement? Is it ever the case that anyone there would contact a Member of Parliament to say what they are doing to improve a trust? What is the role of NHS England’s London office? The individuals there are paid a hell of a lot of money—hundreds of thousands of pounds. Have they got a responsibility to contact a Member of Parliament to ask for a meeting or a conference call to speak to us about what is happening in the trust?

What is the role of Health Education England, which has been concerned about training and qualifications? We know the role of the General Medical Council, but has it been nobbled not to withdraw doctors by NHS England or any other body? What we have are numerous quangos. I have not even mentioned the clinical commissioning group. We have CCGs, HEE, NHS Improvement, NHS England London and the chief executive. The Government came into office determined to reduce the number of bureaucrats, but—my God!—each of us has at least 10 or 12. Then there are all the staff that work under them. Meetings have been held, but what has been done?

I have done the Minister’s job, so I feel for him. When I did his job, we did a lot of the running of the NHS from Whitehall. The Minister’s party came in and I understand why they said they could not run it from Whitehall, but we now have all these bodies and I am not clear what they have done. As a former Minister, I want to hear more of what they have been up to. I hope that the Minister will answer the question asked by my right hon. Friend the Member for Enfield North (Joan Ryan). Given that there have been CQC reports—the one that we had on the 6th is not the first—and risk summits, what is the obligation to inform Members of Parliament and therefore our constituents? At what point does that kick in? Or is it expected that that should be done solely by the trust? If it is, that is problematic if it is a failing trust in which the chief executive has been put on emergency leave. I have the CQC report before me and it says that safety at the hospital is inadequate, and so is responsiveness. As to whether it is well led—leadership is also inadequate, which is presumably why the chief executive has been put on emergency leave. Overall the hospital is inadequate. Under the headings of caring and effectiveness, it requires improvement. That is pretty damning. It does not get much worse than that.

Many hon. Members are concerned—and my right hon. Friend the Member for Enfield North, the hon. Member for Enfield, Southgate (Mr Burrowes) and I certainly are, having been around for a few years. We campaigned to get the PFI that put millions—I think it was £150 million—into building a brand new hospital. It is therefore deeply frustrating that we now have such an uphill struggle. Chase Farm has been mentioned and I will not discuss it again, but the Minister will recognise that we all rang alarm bells about the implications of closing emergency there. Money was put into the trust; yet it has got to its present situation.

I heard yesterday about the case of Mrs Alice Morfett, a 92-year-old lady who still went shopping in Morrisons. She had a heart operation in Barts and she was recuperating on the T3 ward. In the morning she told her daughter about her concern about a male nurse’s behaviour; she could not understand why he kept wanting to touch her chest. Her daughter said she did not believe Mrs Morfett and thought the anaesthetic had not worn off, but her mother complained about the nurse rubbing against her chest. After that Mrs Morfett was scared to ask for help. No one was summoned to help her. The next day, after an hour of asking for someone to take her to the toilet, Mrs Morfett tried to get out of bed herself and she fell. She ended up with huge open wounds; my constituent sent me a photo of the terrible wounds her mother suffered. Mrs Morfett died a couple of weeks later, and her daughter believes that she died as a result of her injuries. Mrs Morfett said to her daughter, “Please don’t let them get away with it; they have to pay for what they’ve done to me.” I do not lightly raise constituency case work in this way. I have used this letter because it is the latest one I have in a stream of letters from constituents about what is happening in the trust.

[Joan Ryan]

Such incidents are what the CQC calls “never” events because they should never happen: a patient dies, and it is not necessarily from medical issues or natural causes. I am sure that my right hon. Friend knows that the CQC report notes that one patient lay dead in a cubicle for four and a half hours last December because there were not enough doctors even to do the hourly rounds. It does not get much worse than that.

[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.

[Catherine West (Hornsey and Wood Green) (Lab)]

It is an honour to serve under your chairmanship, Ms Vaz. I congratulate my right hon. Friend the Member for Enfield North (Joan Ryan) on securing the debate. It feels a bit like mark 2 for her, I think, given the earlier experiences with Chase Farm. I am pleased about the cross-party nature of the debate; it was interesting to hear the personal experience of the hon. Member for Enfield, Southgate (Mr Burrowes) of care at the hospital.

Like my right hon. Friend the Member for Tottenham (Mr Lammy), I am at a loss; I attended the annual general meeting a couple of weeks ago and have written letters to Ministers—indeed, the Minister present today has been kind enough to have a meeting with us. We have had press reports and urgent questions. We have asked questions at Prime Minister’s questions. We have had Adjournment debates, and the Mayor of London has raised the matter with NHS London. I am at a loss to know what we should do next, and which levers can be pulled.

I am pleased that management action has been taken, and that Mr Sloman has now taken an interest and is the accountable officer. I am equally pleased that Ms McManus has been brought in to take over on an emergency basis while the leadership of the hospital is being looked at. However, I have concerns for the long term about a situation in which decision makers in Hampstead would make decisions about a north London hospital whose area is Edmonton, Tottenham, Wood Green, Enfield and Haringey. I am concerned about how remote and out of touch they might be. I look forward to hearing in the spring what the management arrangements will be for the medium to long term. We must ensure that there is proper representation of local people at board level and a proper voice for our area in the hospital management and governance structure.

I will briefly raise two constituency cases. One is about medicines training, which was referred to in the Care Quality Commission’s report. I understand from a constituent that when her father was discharged from the hospital, somehow his name had got mixed up with another patient’s name, and when she got home she had the incorrect medicine for him. That is a basic error, and the wrong medicine could have been fatal for an elderly and frail man.

The second case arose after an anonymous phone call to my office reporting on the condition of an elderly patient. The caller was very distressed, as the patient was his elderly wife. He said, “I’m so worried to tell you, because I am afraid that they actually might kill her if I tell you her name.” There is a level of desperation, and that call was made not so long ago; it was within the last month.

There are some general lessons to be learned from this specific situation about the lack of leadership and lack of quality control in our public services. The first is about the recruitment and retention of properly qualified staff. We desperately need to tackle the low morale of staff, which has been exacerbated by the poor handling of the junior doctors dispute. Morale is low not only at senior level or consultant level but at the middle level, and even at the level of junior doctors. Once the hospital lost the contract for the training of junior doctors, everything went downhill from there. We need to get that training back, and we need to work very hard and very quickly to get back the doctors and experts who want to serve, learn and train in a university hospital.

The second lesson to learn is about the crucial issues in our health economy, one of which is the problems with primary care. I understand that there are immense problems with the current Enfield primary care arrangements. The clinical commissioning group is not in a good place. I would like to hear about any associated issues, and I would like to know what levers the Minister can pull to ensure that proper primary care arrangements are put in place for Enfield and that primary care in Haringey is strengthened.

I understand that Haringey has done some very good things, including putting some extra general practitioners into the accident and emergency department to educate people about where to go when they first come into hospital, and about how they can go and see their GP in the local community. I would be happy to hear about an evaluation of that programme and whether it has been helpful. Rather than rushing in with a band-aid solution, can we hear back about that programme? What has the evaluation been, and what do the experts think? Has that programme stopped the flow of people coming—perhaps incorrectly—to A&E, and has it helped the primary care health economy?

It is well known that Members including my right hon. Friend the Member for Tottenham secured a debate in the main Chamber on mental health in Haringey. At St Ann’s hospital in Haringey, the acute care places are really overloaded, which has led to greater demand for beds at North Middlesex hospital. Once the health economy becomes unbalanced, that can put more strain on A&E departments from general patients who do not have mental health problems.

Furthermore, there is an ambulance crisis. Police officers have told me that there are not enough ambulances and that they have to take patients to the North Middlesex hospital themselves because the ambulances cannot cope. Of course, we know that once the ambulances get to hospital, people are being treated inside the ambulances, which is completely unacceptable.

[Mr Lammy]

My hon. Friend will also appreciate that a major criticism in the CQC report was that after patients have left the ambulance, they are treated solely by nurses at grade 5, with no doctors in sight and no consultants available after 11 o’clock at night. How can there be an emergency department when there are no consultants available on a Friday or Saturday night?

[Catherine West]

My right hon. Friend makes an excellent point about an issue that must be monitored. I look forward to the Minister reporting back on the lack of the leadership and clinical excellence that we expect on behalf of our constituents.

The cuts to public health provision will have an extra impact. I will give just one example, which many Members here have pursued—basic HIV/AIDS care. We are not doing the preventive work, and we are unnecessarily cutting back the public health budget, which will eventually lead to more people turning up at A&E or acute care departments in crisis. These issues in the health economy are all linked, and we need to do much more about all of them.

We are all aware that litigation accounts for a quarter of NHS expenditure. Why do we not get better at doing the proper work first, so that the money we spend on lawyers and expensive court cases when we get things wrong does not add up to so much? The situation is absolutely desperate. We need more investment, and we need to stop making mistakes so that we do not have to pay for litigation and so that instead of litigation there can be front-loading of resources into prevention, mental health and good-quality primary care and basic services. People accessing the NHS could then have confidence that their local service is as good as we should expect it to be.

Finally, we know that in London, there are a number of issues with the cost of living, the cost of transport and the cost of childcare for medical practitioners and nursing staff. Those issues are linked to the others that I have mentioned, and I would like to see a more robust approach from the NHS around London to the needs of those working in our hospitals and our public services. London is not like other areas, where it is cheaper to rent homes and so on. We are unable to recruit the medical practitioners and nurses we need because they cannot afford to live in the area, and we should examine that issue more energetically and not just in a theoretical way.

Thank you very much, Ms Vaz, for calling me to speak. I look forward to hearing the Minister’s conclusions.

--- Later in debate ---

[Ben Gummer]

I promised to explain to the House what we will do to correct the situation. There are two parts to this. First, the short-term rescue plan has been put in place by Health Education England, NHS England and NHS Improvement, with the approval of the General Medical Council, to ensure resilience in the A&E department and for paediatric services. Two consultants have gone on secondment to the department, and a further five are coming this month. The GMC is happy that that will provide the rota resilience we need in the short term.

If we think that will fix things, however, we will quickly end up in the same situation. That is why we need to look at a far more robust plan for the next few years, so that the North Middlesex can become the centre of excellence that hon. Members and I certainly want it to be. A new improvement director will be in place to deliver an improvement plan, which I will ensure is shared with hon. Members. So the plan that the right hon. Member for Tottenham (Mr Lammy) requested will be available for other hon. Members to see. It will have the transparency that has been lacking so far.

I must answer a particular point made by the right hon. Gentleman about the General Medical Council. I do not think that it was silenced in any way. Genuinely, this is more muck-up than conspiracy, and I hope that it will not be repeated, as I have already assured hon. Members.

On the long-term plan, the hon. Member for Hackney North and Stoke Newington was entirely right: the North Middlesex is like many hospitals on the periphery of London, which not only are seeing rapid demographic change, but suffer from the fact that they are not the attractive training places that the central London hospitals are—we have to be blunt about that. I think that is wrong, because many of the challenges that aspiring doctors want are in those hospitals, which are diverse with an extraordinary range of clinical conditions. However, because of the history of the NHS, which I cannot change, a glamour is attached to the central metropolitan hospitals, and that causes challenges for district general hospitals throughout the country, as well as those on the periphery of London.

I want to change that, but we cannot do it by fiddling around. That is why I am excited by the link-up with the Royal Free. That kind of branding, which the right hon. Member for Enfield North pointed to, the strong leadership, which will provide stability, and, I hope, the ability to move consultants and senior nursing points around—some people recruited already into the Royal London and Barts will also work at the North Middlesex—will result in the diversity of career opportunities necessary to attract the kind of clinicians that the right hon. Lady and her colleagues have requested for their hospital.

[Mr Lammy]

To press the Minister on a bit of detail, the CQC’s press release stated:

“We have strongly encouraged the trust to engage with other organisations across the local health and social care system to resolve this challenging issue...there are moves to appoint more senior doctors—and I note that the trust is calling on consultants from other departments within the hospital to provide the routine daily support to A and E which is so badly needed.”

That was on 6 July and, clearly, the CQC did not feel that the hospital had got there. Will the Minister therefore confirm what the required number is? If he cannot tell us that, it would be helpful for him to come back to us. What is the golden number that should comfort us? Will he also confirm, because this is important, that nurses are not still reviewing patients who arrive by ambulance, because that is seriously inadequate, and we want to ensure that patients are seen by doctors?

[Ben Gummer]

I reassure the right hon. Gentleman that NHS England has a live rota stream from the hospital to give it the reassurance that every single junior doctor has a consultant supervisor in place at all times—precisely to ensure that the reported lapses of supervision do not recur. When the right hon. Gentleman meets the chief inspector at the CQC tomorrow, I hope that he hears something similar to what I have heard: things are not good, but they are better than they were, and the trajectory is in the right direction.

Nevertheless, we will not fix this without looking at fundamental reform of local health services, which requires changes to primary care, of the kind that we discussed when I met local Members of Parliament last week. I hope to meet them again, in a few weeks or months, and to be able to talk about progress and the plans for the future, so that right hon. and hon. Members will be satisfied that things are getting better at the North Middlesex.