Pennine Acute Hospitals NHS Trust

Debbie Abrahams Excerpts

Tuesday 17th January 2017 Westminster Hall

[Graham Stringer]

As I just said to my hon. Friend, I will not go into the details, but I probably know more than she does about the situation from the patients’ side, because a relative was affected. I have no doubt that those patients were treated appallingly. I cannot comment on the details of personnel issues, but I can comment on the fact that patients have been badly treated. Given the technicalities of the situation and having watched the programme, I find it worrying that although one or two cases were found after six months, the nurses were re-employed.

After “Dispatches”, the CQC report found scandalous failings within the trust. It found that the safety and wellbeing of patients were inadequate, and that the trust’s responsiveness and effectiveness needed improving, but that the care of patients was good. That report was very worrying; the trust would have been put in special measures, if a new team had not already been put in place to deal with the situation.

As I say, the CQC report found that the care of patients was good, but within a very short time—and after excellent investigative work by Jennifer Williams of the Manchester Evening News and other journalists—an internal report on maternity care was made public, showing that the care provided by some individuals was very poor indeed.

It is worth reading out for the record an extract from that internal report, because we have now had a 13-year period of failure. It is also worth remarking that both that internal report and the CQC report relied on nothing but internal statements by the trust’s staff. A paragraph from the internal report really contradicts the CQC report, as it states:

“Staff attitude has been a feature of a significant number of incidents, from the most basic reports of staff relationship breakdowns, resulting in women and their families exposed to unacceptable situations, to an embedded culture of not responding to the needs of vulnerable women”.

The report went on to say of one woman that

“in one incident it is clear that the failure of the team to identify her increasing deterioration and hypoxia attributed her behaviour to mental health issues. Failure to respond to deterioration over a period of days resulted in her death from catastrophic haemorrhage.”

That means that, according to internal sources, the situation was actually worse than had been thought.

The report continued:

“A further example of staff attitude and culture has been experienced recently when a woman gave birth to her baby just before the legal age of viability (22 weeks and 6 days)…whilst no resuscitation would be offered to an infant of this gestation, compassionate care is essential. However, when the baby was born alive and went on to live for almost two hours, the staff members involved in the care did not find a quiet place to sit with her to nurse her as she died but instead placed her in a Moses basket and left her in the sluice room to die alone.”

That is inhuman treatment.

These failings are the failings of individuals, of management, who failed to sort things out, and of the structure of the Pennine trust itself. I could list a whole series of other cases. In fact, late last night I was contacted by constituents I know about another case. I do not know the details of that case, but my constituents wanted me to take it up, as they strongly believed that a misdiagnosis meant that proper therapeutic care had not been provided. So problems in the Pennine trust continue.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

My hon. Friend is making a very powerful speech and I share his absolute horror at some of the reports of the standard of care that some patients have received. Like me, he was at a meeting with staff last month, who also expressed their concerns about the quality of care being provided.

I am trying to understand something. Is my hon. Friend saying that this poor care, as set out in the CQC report and other reports, is endemic and is found right across the Pennine Acute Hospitals NHS Trust? Also, does he recognise that the new leadership is playing an important role and that the site leadership teams will have an important role in turning this situation around?

[Graham Stringer]

What I am saying is that there have been failures from the very beginning of this trust, in that it has four hospitals that were jealous of each other. That caused administrative problems, which means the trust has never worked well, and there is also a structural problem. Secondly, there have been failures of management to deal with those issues of individual failure to care.

I have enormous confidence in Sir David Dalton and the team who are taking over the Pennine trust. Sir David’s record of developing Salford Royal hospital is exemplary, and I hope that he can do the same with North Manchester general hospital and the other hospitals within Pennine.

As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, along with my hon. Friend the Member for Heywood and Middleton (Liz McInnes) we met the trade unions in Pennine just before Christmas and, like the vast majority of the staff, they were committed to improving healthcare in the trust. Like my hon. Friend the Member for Oldham East and Saddleworth, I made the point that one has to acknowledge failures to ensure that there is improvement. One cannot just say that, just because so many staff are committed, that is good enough for the future. One also has to recognise the failure of the local clinical commissioning groups to deal with the problems, the fact that the board of the trust seems to have been paralysed and the fact that NHS Improvement has not dealt with the trust’s problems.

I have listed some of the cases that have caused public concern. One cannot put a financial cost on those cases, but if one reads the internal report on maternity care, one sees that the amount of money spent on compensation in the year 2014-15 was £58 million. I repeat— £58 million. Nearly £20 million went on three cases, which means that just over £6 million was spent on each one. In those cases, the people involved took legal action and at the end of the process were awarded that sum to look after severely handicapped patients.

There is no question but that, as I just said to my hon. Friend the Member for Oldham East and Saddleworth, Sir David Dalton has put in place a team who are committed to taking North Manchester general hospital out of Pennine and putting right what was a structural mistake.

It is worth reflecting on another point that was made in the Westminster Hall debate about 10 years ago, which is about why the Pennine trust was created. It was not created for good medical reasons. There was a public reason, which was given at the time by Billy Egerton, the then chair of the North Manchester health trust—I think that was what it was called. He said that he thought that if North Manchester general hospital had remained separate from the trust, it would have been prey to the predatory instincts of Manchester Royal infirmary and the major central hospitals in Manchester. First, I do not think that was a good idea—there could have been co-operation—and secondly, there were a number of chief executives in the trust who were retiring, which meant that three chief executives could be paid off and one chief executive found. Those three chief executives who were paid off came back and did consultancy work for the NHS. Unfortunately, that is the way that the NHS has dealt with problems. It has spent money, and wasted money.

The proposals for devolution will help to deal with the problem. The national structures have not worked. Having the combined authority, encompassing the 10 local authorities, taking decisions and examining these issues, with North Manchester general hospital being within the Manchester hospital schemes, is not a guarantee of success, but I generally believe that when decisions are taken closer to what is happening on the ground, they are more likely to be correct decisions than if they are left to a national body, which has clearly failed in this situation.

--- Later in debate ---

[Mr Nuttall]

I am grateful to the hon. Gentleman for raising walk-in centres. I was going to mention them later, but I will deal with the issue now. I met with representatives from the Bury CCG some months ago, before all this was announced, and they took me through what they were planning. They convinced me that it was in the best interests of my constituents. It would be easy for me to say the popular thing, which is, “I think we should oppose it.” I entirely appreciate why the good folk of Prestwich do not want their walk-in centre to be closed. I can see that there is a likelihood that it would increase pressure on the A&E. That highlights the point I was making, which is that there are good arguments to be made on both sides of the debate as to whether to have walk-in centres or a more community-based approach to delivering services. That is where Bury CCG was coming from.

Following the devolution of healthcare in Greater Manchester, since last April, we have been in an entirely new situation. We have an opportunity to make a reality of the joining up of health and social care, which has long been argued for.

I want to make three points this morning. First, I do not accept that the problems that have been identified at Pennine acute are all down to a lack of funding. To be fair, I think the hon. Member for Blackley and Broughton accepted that the questions went much wider than funding. It is an easy get-out to simply blame a lack of funding.

[Debbie Abrahams]

Does the hon. Gentleman accept that the NHS estimates a shortfall of £1 billion for the Greater Manchester health economy by 2020 under the devolution deal? Does he also accept the differences between the consolidation of different sites into specialist units and the huge shortfall that has meant that Pennine acute has not been able to recruit staff?

[Mr Nuttall]

There are two separate points there. On the first, I have been involved in politics for getting on for the best part of 40 years, and I have never come across a time when it has been claimed that the NHS is not short of money. I cannot remember a time when the parties have all agreed that the NHS was getting all the money it needed. In every general election that I have ever been involved in, there has always been this claim that the Conservative party is about to privatise the NHS and the NHS is short of money. We are not very good at it—if we had been, we would have privatised it years ago, were that the Conservative party’s intention. The fact of the matter is that Pennine acute alone is a huge organisation, with a budget of more than half a billion pounds. Even with our small part of the NHS, such sums of money are difficult to comprehend, never mind the totality of it.

We can all argue that our particular part of the NHS should be given more funding, but in reality the NHS will always be competing with all the other calls on the public purse. If we are to stick with the current funding model, we will only ever be able to increase spending on the NHS significantly if we have a strong and growing economy. I do not want to get bogged down in the broader questions about our NHS, however, because the specific issue this morning is the future of Pennine Acute Hospitals NHS Trust.

The CQC report identified major problems with the leadership of the organisation. Like the hon. Member for Blackley and Broughton, I have every confidence that Sir David Dalton and his new team will bring a fresh approach and outlook to the trust. The one worry I have is that we are perhaps expecting too much of that gentleman. He is clearly a very talented man, but we are all limited by the fact, no matter what our particular talents may be, that there are only 24 hours in the day. I have heard anecdotal stories that he is pulled from pillar to post because he has so many demands on his time. That is understandable; it is not in any way a criticism. It is just a fact of life that he is being asked to do an awful lot. I wish him every success in the world. I hope he can deliver, and I am confident that he will but, if I have one concern, it is that he is perhaps being asked to do too much. I understand that he is focusing on trying to have a more decentralised approach to management to bring management closer to those the trust seeks to manage, and I hope that that will improve matters.

My second point is the issue of maternity services. The removal of children’s services and the closure of the maternity department and the special care baby unit at Fairfield occupied much of my time for years when I first moved to the Bury North constituency. Almost everyone thought that the services at Fairfield were excellent. At the time, my constituents and I were told that things would be even better—even safer—if services were closed at Fairfield and moved to North Manchester and Bolton hospitals. I made it clear that I had doubts about that, as did my constituents. I do not want to quote again from the CQC report, but I want to put on the record this particular quote from it:

“We found poor leadership and oversight in a number of services, notably maternity services, urgent care (particularly at North Manchester Hospital) the HDU at Royal Oldham hospital and in services for children and young people.

In all of these services leaders had not led and managed required service improvements robustly or effectively.”

My constituents could be forgiven for saying, “We told you so.” They can understandably feel vindicated on the stance they took. Incidentally, I understand from a councillor who serves on the Pennine acute scrutiny committee that it was told that the trust was liaising with Newcastle hospitals to learn best practice for maternity services. However, some little time later, when the scrutiny committee asked how that was going and followed up on that idea, it was told, “Sorry, it never went ahead. We are not proceeding with that now.” That little anecdote perhaps gives some idea as to why the CQC discovered problems.

In conclusion, I will make a quick third point. I believe that what Pennine acute would benefit from most in the months and years ahead is a period of stability. It seems to me that part of the problem at Pennine is the constant chopping and changing of leadership. No sooner does one team settle in than they move on and someone else takes over. The difficulty is the resultant lack of accountability. When things go wrong, it can always be blamed on someone else, whether that is to do with a lack of funding or decisions made by a previous management. My constituents and I need to see an end to the changes; we need to see some continuity. My constituents want Pennine acute to be a success. Other NHS trusts are successful, so there is no reason why, with the right leadership in place, Pennine acute cannot be as successful.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure, Mr Streeter, to serve under your chairmanship in such a well-attended debate. I congratulate the hon. Member for Blackley and Broughton (Graham Stringer) on securing the debate and on encouraging so many of his neighbours, who clearly have an interest in healthcare in the area served by the Pennine trust, to attend and to make such powerful contributions. Everyone has spoken from the heart and with true sensitivity.

As the hon. Gentleman said at the start of the debate, it is difficult to strike the right balance between drawing attention to trusts’ obvious failings, which need to be brought into the public domain and dealt with, and not seeking to lay blame on individuals. We all recognise that the individuals who work in the trust, as we heard so powerfully from the hon. Member for Heywood and Middleton (Liz McInnes), who worked at the trust for many years, give of their best and wish to provide the best possible care for their patients. Often the systems and structures around the individuals can inhibit that good intent.

I applaud the hon. Member for Blackley and Broughton for highlighting some dreadful examples of very poor care in the trust over many years, but especially those that came to light last year. As he well knows, the problems at Pennine go back many years. The trust is 16 years old, as other Members have said. Within three years of its creation, consultants at the trust had passed a vote of no confidence in its then management, as the hon. Member for Heywood and Middleton reminded us.

The hon. Member for Ellesmere Port and Neston (Justin Madders) pointed out that, in the days before the CQC, Sir George Alberti was asked to report on what was happening. Much of last year’s CQC report, however, echoes the findings of the 2005 Alberti report, as the hon. Gentleman said in his constructive contribution. We must try therefore not only to learn the lessons, but to implement them; they clearly have not been in the past few years. I will touch on some key findings of the CQC report before I develop my remarks on what we are doing to respond to the findings and shortcomings.

The CQC report was based on an inspection in February and March last year, which rated the Pennine Acute Hospitals NHS Trust overall as inadequate. In particular, the trust was rated inadequate for safety and leadership. As the hon. Gentleman pointed out, however, it was rated good for care, which is a visible tribute to the quality of care provided by the dedicated staff in the main.

The report found other problems: shortages in nursing, midwifery and medical staff, which have been touched on by other hon. Members; a lack of understanding of key risks at departmental, divisional or board level; problems in services, including in A&E, maternity, and children’s and critical care; key risks were not recognised, escalated or mitigated effectively; and there was inconsistent performance reporting and concern about the quality of data to support performance reporting.

In addition, the CQC identified low morale in a number of services, in particular maternity, and described a poor culture with deeply entrenched attitudes. Regrettably, some staff accepted suboptimal care as the norm, and patients’ individual and specific needs were neither appropriately considered nor met.

Those were the CQC findings. In contrast to what has happened following previous problems and subsequent actions, the new CQC regime is introducing beneficial change—which I hope is recognised by the hon. Member for Heywood and Middleton—and improvement. An inadequate rating by the CQC would normally result in the trust being put into special measures, but in this case a different remedy is being used to turn the trust around and, in particular, to address the obvious challenge of leadership, which almost every contributor to the debate has identified as an historical failing at the trust.

In April last year, the management team of the neighbouring Salford Royal, led by Sir David Dalton and Jim Potter, took over the chief executive and chair roles at Pennine acute on an interim basis. That team is in the process of guiding a management contract for the long term to continue providing the strong leadership needed to drive the improvements that we all recognise. The new management team at the Pennine trust got to work immediately. In July last year, the Salford team completed a diagnostic assessment of the issues facing Pennine and developed a short and long-term improvement programme based on patient safety, governance, workforce, leadership and operational performance.

[Debbie Abrahams]

Given the Pennine trust’s current position and the staff shortfalls that the Minister has also mentioned, what additional funding support can he offer Pennine acute?

[Mr Dunne]

I will not be drawn too far down that route at this point, because I would like to develop my overall response. This is not all about funding, as many hon. Members have said. Staff shortages are not necessarily driven by funding either; they are often driven by a trust’s difficulties making it an unattractive place to work. I do not have in my head the number of applicants for vacancies, or the number of vacancies, but I will tell the hon. Lady in a moment how many staff have joined the trust—what increase there has been—under its new leadership.

[Debbie Abrahams]

rose—

[Mr Dunne]

I am afraid, unless the hon. Lady can give me some figures on vacancies that will help my understanding—

[Debbie Abrahams]

Maintained vacancies have caused significant pressure on, for example, middle-grade clinicians in the A&E department. Vacancies have been maintained to try to save money, and that has been a real issue.

[Mr Dunne]

I am grateful to the hon. Lady for her intervention. I will come on to staff issues in a few moments.

As several hon. Members have said, local political leaders have broadly welcomed Sir David Dalton’s appointment as the chief executive of the Salford Royal trust, which is one of the finest trusts in the country and was one of the first to be rated outstanding by the CQC. He is listening to staff and, where appropriate, deploying Salford’s systems and experience to help to support staff in Bury, Rochdale, Oldham and North Manchester to deliver the high standards of service that we all want. I welcome the support that has been expressed for Sir David’s efforts by everyone who has spoken in this debate, in particular the hon. Member for Blackley and Broughton.

Sir David believes that all the evidence shows that staff are best placed to know what needs to be improved in their ward or department. He has introduced a system—tried and tested in Salford—that involves staff and supports them to test their ideas for improvement. Ideas that are shown to work will be replicated across the whole hospital. That approach turns on its head the idea that people in senior management positions always know what is best for patients on a ward, and instead recognises that frontline staff have expertise in spades and supports them. It will help to develop the culture change that was called for in particular by the hon. Member for Oldham West and Royton (Jim McMahon), who rightly identified that as a fundamental problem in the Pennine acute trust.

As my hon. Friend the Member for Bury North (Mr Nuttall) called for, Sir David Dalton at the beginning of this month introduced new site-based leadership teams in each of the four hospitals. For the first time since the creation of the trust 15 years ago, each hospital site and place-based team will consist of a medical director, a nursing director and a managing director, each dedicated to the daily oversight of that hospital. Together, they will manage the services of a care organisation. That site-based arrangement will give leadership teams a clearer focus and enable them to offer staff better support and engagement and take operational decisions for each site. Those leaders will also have the benefit of being in post on site to strengthen local relationships and promote joint working with other partners in the health economy, including local authorities and commissioners.

The hon. Member for Blackley and Broughton and my hon. Friend the Member for Bury North highlighted poor maternity care. The newly appointed director for women’s and children’s services led an internal review of maternity services under the new management arrangements. That review dug deeper and revealed even more than the CQC was able to. Some of the instances of poor care that were revealed are truly shocking, and I express my sincere regret to everyone affected by those tragic incidents, some of which the hon. Member for Blackley and Broughton highlighted. As an immediate result of those reviews, an improvement plan and a new management team for maternity services have been put in place at North Manchester general hospital. Central Manchester University Hospitals NHS Foundation Trust maternity staff are working alongside Pennine staff to develop a clinical leadership and staffing support programme.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) asked about staffing. I am advised that between March 2016, when the new management team came into place, and December 2016, the number of people employed on a full-time or part-time basis by the trust increased by more than 300. I think that is 300 more full-time equivalents. That includes seven doctors, 133 registered nurses and 58 midwives and is a net addition to the trust.

The A&E departments remain under pressure, not least given the winter pressures that have been common across the NHS in the past couple of weeks. That is particularly true at North Manchester, but that department has been stabilised and measures have been put in place to support staff, including direct GP and primary care input into the A&E department from Manchester GPs. Those GPs are supporting the department seven days a week and seeing around 30 patients a day, taking pressure off the service and ensuring that patients see the right professionals and receive the right care. Similarly, the local NHS in Oldham is piloting embedding enhanced primary care support in the A&E and urgent care system. Two GPs a day work between 11 am and 11 pm to support that system.

Measures have also been taken to stabilise children’s services; there has been a temporary reduction in beds at the Royal Oldham and North Manchester hospitals to reflect the workload that staff, given their current numbers, can deal with safely. Those measures are having an impact on turning around the performance of the hospitals in the trust. Additionally—the hon. Member for Ellesmere Port and Neston asked about funding—extra financial support of £9.2 million was secured in year to enable the trust to put in place immediate and short-term measures to stabilise services.

The hon. Members for Blackley and Broughton and for Oldham West and Royton asked about avoidable deaths and the culture of silence when problems arose. The new management have been determined to change that culture. Since April 2016, the trust has investigated and closed down 489 serious incident cases, and the average investigation time has been reduced from 156 days to 90 days. Considerable progress has been made on changing the culture of how problems and complaints are dealt with.

Hon. Members talked about the future and expressed concern, particularly from a staff perspective, about yet another change happening. As all Members are aware, NHS England is in the midst of implementing sustainability and transformation proposals and turning those into plans for 44 areas across the country. Greater Manchester’s five-year plan, “Taking charge of our Health and Social Care”, predates the request for STPs, but NHS England has agreed that that plan meets the STP requirements and they are now effectively one and the same thing. There is, therefore, a real opportunity for healthcare in Manchester, with devolution of control to the council and opportunities for the local authority to work with the NHS to improve services for all the people of Manchester, to become a model for the rest of the country.

The NHS in Manchester has been looking at how acute services can best be organised to deliver benefits, including operational financial efficiency, for quality of care, patient experience and the workforce. As has been said, the proposal is to create a single acute provider for Manchester, with the Wythenshawe hospital and the North Manchester general hospital joining the Central Manchester foundation trust. That is an ambitious proposal, and the organisational change it requires is complex, but we believe that the potential benefits are considerable and offer a real chance for care to be standardised across the city. I know that hon. Members will be concerned about what that means for the Pennine trust. If that proposal proceeds, services at North Manchester general hospital will be combined with those at the other hospitals in Manchester, but the intention is for the remaining hospitals in the Pennine acute trust to continue to work with Salford Royal in a new relationship, which is under active consideration.

Hon. Members mentioned resources for estates. Like any trust, the Pennine acute trust needs better-quality, flexible and fit-for-purpose buildings. I have little time in which to outline what is happening but, as some hon. Members will be aware, construction has begun of a brand new, purpose-built 24-bed community intermediate care unit on the grounds of North Manchester hospital. That unit will cost £5 billion and will take 12 months to build. The Royal Oldham hospital, which includes the old workhouse, is being developed into a high acuity centre to serve the population of north-east Manchester.

Motion lapsed (Standing Order No. 10(6)).