North Middlesex University Hospital NHS Trust

Diane Abbott Excerpts

Tuesday 12th July 2016 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I congratulate my right hon. Friend the Member for Enfield North (Joan Ryan) on securing the debate and giving a masterful summation of the situation.

There have been some important speeches today, including from the hon. Member for Enfield, Southgate (Mr Burrowes), my right hon. Friend the Member for Tottenham (Mr Lammy) and my hon. Friend the Member for Hornsey and Wood Green (Catherine West). I also note the presence of my hon. Friends the Members for Hampstead and Kilburn (Tulip Siddiq), for Hammersmith (Andy Slaughter) and for Edmonton (Kate Osamor).

This debate is about more than an individual hospital such as Central Middlesex or North Middlesex. There are certain underlying issues, which I will touch on. One source of pressure on an accident and emergency department—whether it is in the North Middlesex hospital, the Central Middlesex hospital or any other hospital around London—is what is happening in social care. For years, local authorities, both Labour and Conservative, have said that they are struggling to meet social care need, and studies show that many of the people who turn up at A&E would not have to go there in the middle of the night to get the care they need if the social care system was functioning properly.

There is also the difficulty of getting GP appointments. The level of difficulty may vary from constituency to constituency, but in the City and Hackney area, for quite a long time now—for years, in fact—it has taken two weeks to get a GP appointment. I am afraid that means that many of my constituents take it upon themselves to go to A&E, because they know that, however long they wait there, they will ultimately be seen. Another problem is the lack of investment in public health, which could deal with some of the health conditions that people turn up to A&E with.

There is also the issue of alcohol abuse. On a Saturday night, too many people are in A&E as a consequence of alcohol abuse, and we must consider how we can deal with those cases and stop A&E departments being filled up.

On the issue of staff recruitment, I am not seeking to be particularly party political, but I cannot believe that the junior doctors dispute will make it easier to recruit staff. One thing that was manifest in the junior doctors’ refusal of a contract that the British Medical Association had recommended to them was the complete collapse in morale among doctors, and that will be reflected in the difficulty of recruiting staff.

Part of the problem with outer-London hospitals may be the changing demographics of the areas they serve. I said I would not be party political, but I campaigned for many of my right hon. and hon. Friends at the last general election, and I was struck by the situation in areas such as Enfield, Edmonton and parts of Hornsey. When I was a child, those areas were very much leafy suburbia, but now they have a much greater density of population, a much more complex demographic profile and much more complex health and social care needs.

As shadow Secretary of State for Health, I hope to look at that issue further. We should remember that outer London does not have many socially connected teaching hospitals such as those that exist in inner London. I am not sure whether the level of funding that outer-London areas get reflects the demographic and social changes in those areas that I have seen in my lifetime.

It is easy to talk about the issue abstractly, and to talk about reports and hieroglyphics, but it is about people. The tragedy at North Middlesex is a tragedy for patients. Who would want their mother to be dead on a trolley for four and a half hours and have no one come to look for her?

We also have to think about staff morale. People have congratulated the staff but, strikingly, the unpublished Health Education England report, for which 24 members of staff were anonymously interviewed, said that some doctors found working in the A&E unit so stressful that they cried when they finished their shifts. It stated:

“Foundation doctors had been reduced to tears by the sheer volume of patients they had to deal with, for example 200 patients and a six-hour wait, and they felt that they regularly had to send children home without having discussed their case with anyone senior…They often finished their shift and returned home full of anxiety that they had not been able to provide care at an appropriate level.”

This is about the patients and their families, but it is also about the staff who know that they are not providing the right level of care and are demoralised and upset.

As my right hon. and hon. Friends and the hon. Member for Enfield, Southgate have reminded us, we are told that North Middlesex is implementing a safer, faster, better programme to bring down waiting times and address the issues in the Care Quality Commission’s report. As the hon. Gentleman said, why should there have to be a shiny new programme to ensure that our constituents get safe, fast, high-quality treatment? It is good to hear that a new A&E clinical director—Turan Huseyin from Barnet A&E—has been appointed, and that there is a new A&E nursing lead and five additional middle-grade doctors and consultants on loan from other London trusts. It is also good to hear that in July the Care Quality Commission said that although North Middlesex was still inadequate, it had “turned a corner”.

I want to raise a few points with the Minister. One, which has already been made today, is that what happened could have been foreseen. The drop in both standards and performance at North Middlesex is intimately tied up with the closure of the A&E at Chase Farm in 2014. Members who are here today raised that point at the time. I would also like to hear from the Minister about how much support is being given to the emergency care intensive support team. In response to a parliamentary question asked by my right hon. Friend the Member for Tottenham we heard that the trust had requested such support, so what is happening?

My final point is about doctors being kept in the dark. I want to avoid crudely party political points, but I spent three years in the Opposition health team dealing with the health Bill, and we were concerned about transparency and accountability. When there is a crisis in a hospital, despite all the different organisations that my right hon. Friend told us about, there seems to be no simple method of ensuring accountability to local representatives, and therefore to local people. Something is lacking in accountability, and we need to consider that. The fact that the collapsing performance at North Middlesex hospital was an open secret among the health service professionals but none of my hon. Friends knew about it—except anecdotally from constituents—is alarming.

This is about more than North Middlesex. There are systemic issues. There might be a systemic issue with NHS funding failing to keep up with changes in local demographics, and there is a systemic issue in social care. I am sure we will return to that in this Chamber, because local authorities have been flagging it up for some years now.

In closing, I can only repeat what the hon. Member for Enfield, Southgate asked: how bad does it have to get? It is troubling if our constituents, who pay their taxes and rates, cannot get a basic level of care when they go to A&E. For most of them, that is their engagement with hospital care. They are getting almost a third-world service. I do not say that lightly—someone being on a trolley for four and a half hours after they have died, and there being only one commode between 100 people, is more like a third-world than a first-world standard of healthcare. How bad does it have to get? Will the Minister assure us that we will not have a situation again in which a collapsing service at a major hospital is an open secret within the professional health services but not made apparent to Members of Parliament and the wider community?

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank the right hon. and hon. Members who have given such thoughtful, considered, well-researched and knowledgeable speeches, and also the hon. Member for Hackney North and Stoke Newington (Ms Abbott) who provided such a thoughtful reflection from the shadow Front Bench. Members will be pleased to know that I agree with much of what they have said. I will come on to how I think the NHS has let Members and their constituents down and what we will do to try to fix the situation.

If Members do not mind, I will first set the issue in a bit of context. North Middlesex hospital was classed by the Care Quality Commission as requiring improvement for reasons that have been mentioned. The quality of care was not consistent enough and there were concerns about patient safety. It was not one of the worst hospitals in London, or in the country, but it was certainly not one of the best. Until July 2015, it was largely meeting its institutional standards. The 95% waiting time target for A&E was being met most months, even though the department is one of the larger ones in the capital, and in spite of the reorganisations that were discussed at length by the right hon. Member for Enfield North (Joan Ryan).

We need to be careful, therefore, with causality, and I will not give a definitive reason why the problems came about. A direct connection between the reorganisation of Chase Farm, which began under the Government before the coalition, and the problems experienced at North Middlesex over the past year, cannot be made with great surety because the hospital was dealing with the A&E caseload within the required timelines, albeit with a standard of care that was not at the level it should have been.

Nor is this about money. It is important to point out that organisations across the NHS, as the shadow Minister knows well, have reported deficits in the past year and this is one of the smaller ones. The posts that are established in the hospital are fully funded; the problem is trying to get the right people into them. I do not deny that the hospital has a staffing problem—I will come on to that in a second—but it is not connected with funding.

Let us get to the core cause of the problems that Members have noticed and brought to the attention of the House. I am afraid that I am not able to give a complete answer at this stage, but Members are entirely right to ask why this happened. We need a better explanation. This morning, I agreed with officials and NHS England that we will look in detail at the reasons within the hospital why the performance standards slipped so significantly in the middle of last year, and why the training routines and practices slipped as well. That is the first part of the review.

The second part is on why the system did not react with the speed it needed to when concerns were first expressed about a year ago. Here, I offer an apology to Members on behalf of NHS organisations. Members were not informed at the pace and the time they should have been, and for that I offer regret. Members are right to say that they should have been the first to know there were problems so that they could properly represent their constituents and hold local leaders to account.

I offer that apology within the context of a much better story across the NHS of what happens when hospitals fail. A warning notice was issued—that was the first reason that the right hon. Member for Enfield North knew something was going wrong—because of a change to the law under the coalition Government in 2014 on when the CQC was able to issue warning notices.

[Ms Abbott]

Will the Minister give way?

[Ben Gummer]

I will in a second. The whole system of CQC Ofsted-style inspection ratings, which are designed to be user-friendly so that non-clinicians can understand how well hospitals are performing, was instituted by the Secretary of State because we wanted to shine a light on the performance and quality of care in hospitals. Through two and a half years of having special measures routines and regimes for hospitals, we have a much better understanding of why things go wrong and can put them right far more quickly. Most importantly, we have a process for engaging Members of Parliament right at the beginning. That did not happen in this instance, and I will explain why after I have taken the right hon. Lady’s intervention.

[Ms Abbott]

The Minister may be coming to this, but I wanted to ask who Members should look to inform them of a catastrophic drop in standards. They should not have to wait for the CQC to issue a warning.

[Ben Gummer]

Ideally, if things are going wrong and that has been noted within the hospital, the hospital chief executive or commissioners should inform local people, but in the past—and over the two and a half to three years since we instituted the special measures regime—it has taken a Care Quality Commission investigation to highlight poor standards of care so inadequate that the hospital needs to be placed under special measures. At that point, before the public are informed, Members of Parliament are informed by the CQC and what was Monitor and the Trust Development Authority, but is now NHS Improvement.