South Tyneside Hospital

Emma Lewell-Buck Excerpts

Thursday 14th December 2017 Commons Chamber

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I am grateful for having been granted this timely and important Adjournment debate.

I know that this Government, despite all their warm words and platitudes, do not really care for our NHS. The very principle and essence of it simply does not sit well with their ideologically driven privatisation agenda. We should judge this Government’s commitment to our NHS by their actions. The shambolic top-down reorganisation that began in 2012 has been followed by increasing competition, increased privatisation, and now the introduction of sustainability and transformation plans and accountable care organisations that are heralding the end of our NHS.

Here is how it works. The Government starve the NHS of the finances it needs and refuse to implement collaborative working structures inside and outside Parliament to come up with a long-term sustainable plan for properly financing our NHS. They then force local areas in England to come up with plans to make £22 billion of efficiency savings to compensate for the Government’s own neglectful incompetence. As local areas grapple with these cuts, services are inevitably transferred from one hospital to another. The receiving hospital cannot cope. It buckles under the strain, it closes, and private healthcare takes over.

In South Shields, the sustainability and transformation plans have been brought in under the guise of a path to excellence, and we have been placed in an arbitrarily created boundary footprint area of Northumberland-Tyne and Wear. By 2021, the health and social care system in that footprint area is projected to be £960 million short of the funds it needs to balance its books while maintaining the same levels of care for patients. Make no mistake: these plans are about cuts. They are nothing to do with transforming our NHS for the better. The NHS has been set an impossible task by the Government, and the endgame is to see it in private hands.

Over a year ago, the management teams of South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust merged, and work began in earnest on formulating these Government-led plans by local clinical commissioning groups that look after all the health services in our area, as well as the hospital trusts. The plans are scrutinised by a joint scrutiny committee of South Tyneside Council and Sunderland City Council, and the clinical commissioning group is accountable to the respective local authorities’ health and wellbeing boards.

The plans are officially supposed to be targeted at improving health and care, but people in Shields and right across England are discovering that they are actually about the biggest-ever programme from any Government to shut down our NHS once and for all. Alongside supposedly improving health and care, the Health Secretary has endorsed plans for cuts of up to £5 billion in our NHS. This is the man who has written about how to achieve full privatisation of the NHS, and who got the Chancellor, in the last Budget, to give £2.6 billion to help to embed these sustainability and transformation plans—in other words, using Government and taxpayers’ money to close down local hospitals.

Despite many people denouncing me and other campaigners for scaremongering, I have remained firm in my view that from the day the two management teams merged, the plan was to downgrade South Tyneside Hospital and move all our services to Sunderland. But I take no pleasure in being right about this. When the first phase of the consultation was launched, we were advised that the clinical teams’ preferred option was to move stroke services to Sunderland. Not only does having a preferred option fly in the face of the Gunning principles, but all our suspicions were confirmed when in October last year, without any public consultation, our stroke unit was closed and moved to Sunderland, with the promise that the measure was temporary and a response to staffing challenges. There is currently no option on the table that would allow the unit to come back to South Tyneside.

In relation to maternity services, gynaecological services, and children and young people’s urgent and emergency paediatrics, all the options presented lead to a drastic reduction in provision of acute services, in particular, for South Tyneside. Yet in October our A&E, inclusive of paediatrics, was found to be the second best in the country, and South Tyneside is one of the very few hospitals that has achieved the four-hour waiting time target.

I have been consistent in rejecting this consultation. I refuse to accept that a consultation that is predicated on a massive cuts agenda, against a backdrop of additional cuts to social care and other services, will do anything at all to improve the health and care that people in South Tyneside receive; in fact, it will do quite the opposite. I am not alone in that view. The trust and the clinical commissioning group state that the proposals before us were formulated by, and are supported by, clinicians and staff at our hospital, but many of those clinicians and staff have contacted me and provided me with evidence to show that they have, in fact, been actively blocked out of the formulation of these proposals. How on earth can the public be expected to trust a consultation that raises such serious questions about transparency and due process and that has lacked integrity from the outset?

I have been trying to get my local authority to refer the whole shambolic consultation to the Secretary of State, so that the smokescreen can be lifted and matters conducted properly, with due process. So far, to my abject disappointment and that of my constituents, that has not happened. Constituents have also raised with me their concerns about the potential conflicts of interest. Our council leader is a paid non-executive director of the trust and chairs the health and wellbeing board. The chair of the CCG is the vice-chair of the health and wellbeing board and a practising local GP.

On 30 November, a press release was issued, advising that the special care baby unit was closing with immediate effect. The reason given for the closure was staffing issues. That closure, coincidently, sits neatly with all the proposed options put forward by the CCG and trust. The safety and wellbeing of babies and parents should, of course, always be a priority, but subsequent events indicate that this is yet another development in the managed decline of South Tyneside Hospital. On 3 December, after the local media had been advised, staff from the maternity unit were invited to a meeting to be told that from 8 am the following morning, the maternity unit would be closing as a result of staffing issues. That happened after the trust had discussed matters with regional groups—not local ones, and not staff.

We have now reached the stage at which no more babies are being born in South Tyneside, but the maternity unit has the full complement of staff present, as it did when it was fully and safely operational. The staff presented the trust with a workable rota system to keep the unit delivering, so there is no reason for the closure to continue. Right now, instead of delivering babies, these trained, professional and dedicated midwives are doing admin and transferring mams to neighbouring hospitals.

I have been advised that expectant mams are having to find, on average, £40 for each round-trip journey to another hospital in the region when they thought they were due to deliver. One woman was sent home after being told she was not in labour by a neighbouring hospital. Once home, and very much in labour, she ended up having a home birth because she simply could not afford another taxi, and ambulance waiting times were too long. The situation is dangerous and completely unsustainable for my constituents, and it takes away a woman’s right to choose where she gives birth.

From day one of this process, the trust and clinical commissioning group have given us one version of events, but the evidenced facts from the clinicians and other staff at the hospital tell a different story. The dedicated hard work and professionalism of clinicians and staff is being denigrated, their morale reduced as they work under the veiled threat that if they speak with me they will be risking their jobs.

There remains a multitude of unanswered questions—questions critical to the whole process that have been asked repeatedly. What capacity does Sunderland Royal Hospital have to take the extra patients from South Tyneside? What will happen to the staff at South Tyneside? What transport arrangements will be put in place, bearing in mind that car ownership in the area is among the lowest in the entire country? Does the North East Ambulance Service have the capacity for the increased emergency demand that will be created by the options?

What are the proposals for the next phases of the consultation? This is only the first phase of a consultation that has another two phases to go. We cannot continue with a situation in which those tasked with providing the very best healthcare scenarios for my constituents are acting outwith that remit and not promoting good, safe, equitable healthcare. Choice has been removed from my constituents: their health needs—in fact, their lives—are deemed secondary to those of others in the region. I am asking the Minister to support the taking of some serious steps. NHS England must step in, investigate and, if necessary, remove the clinical commissioning group’s powers, and NHS Improvement must take investigative action against the trust.

Things have become very nefarious in Shields; people have misunderstood my representing and relaying of my constituents’ views and laying out of the facts as personal attacks. I remind those who have tried to silence me, and who have stated publicly that I am a liar and tried to bully me into toeing their line, that I put myself forward for public office not to cosy up to others or bow to those in power or vested interests, but to represent the people of Shields no matter how uncomfortable for some that may be. No amount of threats or bullying will stop me from doing the job I was elected and entrusted to do.

I end by paying tribute to all the amazing staff in our hospital and those in South Tyneside who have wholeheartedly joined the fight to save it—especially Roger Nettleship and Gemma Taylor, who have worked tirelessly leading the Save South Tyneside Hospital campaign and are currently crowdfunding to raise money for a potential judicial review. Please, if anyone is listening, donate and help us—this process does not begin and end with our hospital. The Government are coming for our entire NHS.

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

I congratulate the hon. Member for South Shields (Mrs Lewell-Buck) on securing this debate about the future of South Tyneside Hospital. I pay tribute to the emotion she showed in standing up for her constituents, but I have to say that I was disappointed by the tone she adopted, particularly at the start of her remarks. Frankly, her allegation of conspiracy—trying to paint the issue as some kind of dastardly plot to privatise the health service, for which there is not a shred of evidence—is scaremongering that will undoubtedly alarm residents in her area. That rather undermined the force of her quite proper concern for her constituents, so I am sorry that she chose to characterise her position in that way.

I welcome, however, the hon. Lady’s support for the staff at her hospital and join her in congratulating them on their work. Despite significant pressures, South Tyneside NHS Foundation Trust is performing very well for the vast majority of patients under its care. She pointed out the performance in A&E. The trust is one of the few in the country to be performing at and above the four-hour waiting target, but that is not the only area in which it is performing well. It is also one of the few trusts across the country to be meeting all of the eight cancer targets, as well as the referral to treatment waiting time targets—again, that is unusual at present—and all the diagnostic targets. It is therefore one of the best-performing trusts in the country, and I think the hon. Lady and I will be on the same page on that.

The trust and its neighbour, the City Hospitals Sunderland NHS Foundation Trust, recently formed an alliance known as South Tyneside and Sunderland Healthcare Group. That is why the group is looking at a reconfiguration of services across the two trusts to remove unnecessary duplication and improve the sustainability of services to ensure that the local population’s healthcare needs are well looked after across the range of activities.

Ultimately, as the hon. Lady knows, any service changes at South Tyneside Hospital will be a matter for local health authorities. All proposed service changes should be based on clear evidence that they will deliver better outcomes for patients. The changes should also meet the four tests for service change: they have support from GP commissioners; they are based on clinical evidence; they demonstrate public and patient engagement; and they consider patient choice. In addition, NHS England introduced this year a test on the future use of beds that requires commissioners to assure it that any proposed reduction will be sustainable over the longer term and that key risks such as staff levels are addressed.

[Mrs Lewell-Buck]

The Minister says that both hospitals are working together to create safe healthcare for both populations. However, how does shutting down a maternity unit and a special care baby unit with hardly any notice at all help to create that environment? Surely they are failing the task they have been handed.

[Mr Dunne]

I am coming on to explain precisely why there was an emergency shutdown of that facility because the hon. Lady’s characterisation does not quite represent what happened. I will go into that in some detail to try to reassure her and her constituents about the reasons behind this sudden—and, we hope, temporary—closure.

On 30 November, as the hon. Lady pointed out, the delivery of high-risk births at South Tyneside District Hospital was suspended due to staffing pressures. A number of urgent safety protocols were put in place to accommodate a very small number of low-risk deliveries over the weekend of 2 and 3 December. Since 4 December, all maternity services have been temporarily suspended at South Tyneside Hospital on patient safety grounds. The trust did not take this decision on its own initiative. It sought advice from the Northern Neonatal Network and the heads of midwifery services for the north-east of England. Their unanimous clinical view, based on all the evidence available at that time, was that births should be temporarily suspended in the interests of the safety of mothers and babies.

The trust has about 70 hospital-based staff who are directly affected, who have all been asked to report for duty as normal. The staff are working with the trust to contact the 165 women currently affected to ensure that safe alternative arrangements are made. The trust has been in close contact with neighbouring units and has had overwhelming support from NHS partners across the system. Women have been choosing to deliver in Sunderland, Gateshead and Newcastle, with a number of women opting for a home birth.

The trust is working closely to make sure there is an individual plan for each patient and that there is clear communication between the healthcare professionals involved with their care. The trust aims to reopen the special care baby unit for low-risk births when a safe staffing level has been established.

I now want to dwell on the specific staffing challenges that have precipitated this action. South Tyneside NHS Foundation Trust has been contending with the challenge of safely staffing the special care baby unit over many years, so this situation has not just crept up on it. When the Care Quality Commission visited in May 2015 and rated the trust overall as requiring improvement, inspectors raised serious concerns about its special care baby unit staffing arrangements. Since 2015, the trust management has made relentless efforts to mitigate these staffing issues. Regular recruitment has taken place for permanent vacancies in the special care baby unit and paediatric emergency care over the past two years, with the latest round taking place only this month.

Contrary to the hon. Lady’s allegations of a long-standing conspiracy to compel the unit to close, I want to give her the facts about that unit as I understand them. In recent months, chronic staff sickness has reduced the six full-time equivalent specialist neonatal nurse workforce in the special care baby unit to just four full-time equivalent staff. That has resulted in an unsustainable situation, with the remaining nurses working many extra hours each week to ensure safe staffing on the unit. One of the four remaining nurses then became ill, exacerbated by work pressures, and that led to unsustainable staffing levels to keep the unit open. It has not been possible for the trust, however hard it has tried over the past two and a half years, to fill the rota. It has not been possible most recently to use bank and agency staff to do so, given the very specialised skills required by neonatal nurses in the special care baby unit. This decision, although difficult, was driven by very clear clinical advice that put the safety of mothers and babies first and foremost, and also took account of the health and wellbeing of hospital staff, to whom the trust also owes a duty of care.

The hon. Lady referred to the consultation that has taken place in recent months over the path to excellence.

[Mrs Lewell-Buck]

I thank the Minister for giving way again, but I am really disappointed. I can see that he has the official lines from the trust and the CCG, but did he not listen to what I said? Regional groups made this decision, not local groups. The unit is now at the full staff complement at which it has been historically. In short, there is no staffing problem there right now. Midwives are sitting doing admin work when they could be delivering babies.

[Mr Dunne]

I was referring to the special care baby unit. My understanding is that the staffing levels at the neonatal unit are as I have just described to the hon. Lady. If she has other information, I will happily go back to the trust tomorrow to ask whether it has managed to fill those slots. There is no intention of keeping the maternity unit for normal births suspended for any longer than is necessary.

I will touch on an area that the hon. Lady did not mention specifically, because a similar situation occurred in relation to stroke services in the region. I want to put that into context to help her to understand why the decision was taken.

Since December 2016, any patient requiring acute care for a stroke has been taken to Sunderland. This decision was taken to ensure patient safety because South Tyneside also had a significant staffing challenge in its stroke unit. In fact, it had only one part-time physician, who was single-handedly assessing and treating incoming stroke patients. The stroke unit faced significant pressures in maintaining a sufficiently staffed nursing rota to support that clinician to maintain the patient safety required for stroke patients.

The benefits of centralising high acuity stroke care have been shown in Manchester, London and other parts of the country where reduced mortality and a more efficient use of resources have resulted in better care for patients. Most other parts of the country have either implemented similar changes or have plans to do so. Centralising stroke care into a smaller number of larger units provides the opportunity to ensure that there are specialist nurses and doctors available to manage patients at all times, and to provide access to imaging and other investigatory facilities immediately as they are required. I will illustrate what that means to patients, who are at the heart of these changes.

Across the NHS in England, 84% of stroke patients now spend the majority of their hospital stay in a specialist stoke unit, compared with 60% in 2010. This has led to excellent progress in the treatment of stroke over recent years. More than 93% of stroke patients across England now receive a brain scan within 12 hours of their arrival at hospital, with more than 50% screened within one hour. That is a huge improvement since 2010, when 70% of patients waited up to 24 hours for a scan. The concentration of stroke services and specialist units has helped to save lives.

The workforce challenges experienced by South Tyneside Hospital are being proactively addressed in the long term through the path to excellence programme that the hon. Lady mentioned. This is a five-year transformation programme for healthcare services in South Tyneside and Sunderland, and a localised response to the Northumberland, Tyne and Wear and North Durham STP of which she was so critical. The public consultation for the path to excellence programme ran from 5 July to 15 October. The areas of service under consultation were maternity and women’s healthcare services, including the special care baby unit; stroke care services; and children and young people’s urgent and emergency services. Before the CCGs make their decision, they will consider all the feedback gathered during the consultation from all stakeholders, including the hon. Lady and other hon. Members. The CCGs are also holding a number of public engagement sessions between now and February, in which I strongly encourage her to participate. An extraordinary meeting of the CCG’s governing bodies will be held in February 2018, in public, for the two CCGs to make their final decisions.

The hon. Lady mentioned the Save South Tyneside Hospital group. I am aware that the group is active in campaigning against any reconfiguration of healthcare services between the two hospitals. I hope that I have helped to clarify to her that no decisions will be made on reconfiguration until the responses to the path to excellence consultation have been thoroughly analysed.

[Mrs Lewell-Buck]

The Minister’s analysis of the Save South Tyneside Hospital campaign is incorrect. We want safe, decent healthcare for people in South Tyneside. We are campaigning for equitable, safe healthcare.

[Mr Dunne]

I am sure that that is the objective. It is also the objective of the trust to ensure that sustainable, high-quality services are available to the populations of the areas served by both hospitals.

The South Tyneside NHS Foundation Trust now faces a challenging task in ensuring that the two hospital trusts, through the path to excellence process, remove any unnecessary duplication and improve sustainability. It is important that the trusts work well together, with the local community and with their commissioning groups, to ensure that any plans that they have are communicated clearly to local populations. [Interruption.] The hon. Lady says that that is not happening. It is incumbent on the trusts to engage properly with their local communities. I am sure that they will be watching this debate and taking note of the comments that she and I are making. There should be full public engagement, and as I have identified, that will continue right up until the decision of the CCGs in February.

I conclude by simply saying that it is incumbent on all of us who represent our local communities to get engaged —the hon. Lady is doing this with her campaign group—with the people who are responsible for making decisions. That is the local NHS in her area. [Interruption.] She indicates that she is engaged with her local NHS. I am pleased to hear that, and I ask her to encourage all other MPs to get engaged in a constructive way, to find the best solution for their local residents that will put patient safety at the top of the list.

Question put and agreed to.