Urgent and Emergency Care Recovery Plan

Helen Morgan Excerpts

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

In a former role, when I was Chief Secretary to the Treasury, I signed off a significant expansion of A&E facilities. I hope that reassures my hon. Friend of my commitment to putting more capacity into emergency departments, not least because they need a certain level of capacity to be able to ensure same-day access, triage and ways of getting flow into the system. As for the wider site proposal, clearly the ICB for his area will want to prioritise that.

[Helen Morgan (North Shropshire) (LD)]

The urgent care and ambulance crisis has been brewing since autumn 2021 in Shropshire, and it has worsened since. Last week, a doctor went on the record to say that the emergency department was “like a war zone” and expressed her fear that, in a fire, not everyone would get out alive. In a six-week period to 12 January, the category 2 response time in the Oswestry area was two hours and 10 minutes. Will the Secretary of State acknowledge that in some areas the crisis is worse than in others? Will he agree to meet me and the other MPs representing Shropshire to discuss how we progress Shropshire further along this track to solve the urgent care crisis that is so serious there?

[Steve Barclay]

I am very happy to meet with the hon. Lady and colleagues to discuss this further. I think most people recognise that, since the huge pressures from flu over the Christmas period, the flu numbers have come down, but of course there is continued pressure in the system.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 24th January 2023 Commons Chamber

[Steve Barclay]

My hon. Friend raises two important themes. The first relates to how many are in training, and I think it is around 4,000. We have boosted the number of GP training places and we have looked at medical schools as a specific issue. Also, he will have seen some of the changes being made around pensions in order to better retain staff, mindful of those clinicians who are leaving the profession, and further discussions are taking place with Treasury colleagues in that regard.

[Helen Morgan (North Shropshire) (LD)]

In Shropshire there are 14% fewer GPs and 29% fewer GP partners than in 2019, yet in the period from April to November 2022, they provided 6% more appointments. It is this additional workload that is causing burnout in GP practices and a flight from the profession. What is the Secretary of State doing to improve the retention of GPs as well as recruitment?

[Steve Barclay]

It is important to look at the number of doctors in general practice, and those numbers are up. There are 2,298 more than there were in September 2019, so we are increasing the number of doctors. What is also important is getting the right care at the right time within primary care, which is about the wider workforce—the paramedics, the mental health support and others working in primary care—and there are an extra 21,000 there. This is enabling GPs to see more patients a day and allowing more patients to get the right primary care, perhaps not from a doctor but from others who can offer specialised support.

NHS Winter Pressures

Helen Morgan Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

My hon. Friend has raised the £8 million capital request with me previously, and it is something we are looking at. She is right about how capital needs to be looked at in the context of getting flow into a local system and of where triaging can be unlocked. In response to her point about 5 pm, there are two points. First, part of the reason for looking at discharge lounges is that if we have something that is 7 am to 7 pm, there is a cultural change for the patient in going into the discharge lounge in the morning and being off the ward. Looking at other health systems around the world, we see that that can be beneficial in accelerating discharge, rather than there being a point in the day after which suddenly it is easier to leave discharging the patient until the next day.

The second point on 5 pm is that we need to look at what support care homes need to have the confidence to take the patient. To be fair to them, it is not simply a question of whether they are refusing to take the patient after 5 pm; it is also about us looking at the wider wraparound care package, so that care homes are confident in taking that risk not just after 5 pm on weekdays, but at weekends, when there is often a significant drop in the number of patients taken.

[Helen Morgan (North Shropshire) (LD)]

One of the key issues in Shropshire is a shortage of staff across every discipline and at every level. It is one of the reasons for the horrifying ambulance wait times that I raised in this place on my first day, 5 January 2022—this is not a new issue for 2023. What is the Minister’s plan to improve staff retention, because staff recruitment on its own will not plug this gap? It has not plugged it in Shropshire, and there are no signs of it plugging the gap across the rest of the country either.

[Steve Barclay]

We are expanding staff numbers—that is why there are 3% more doctors and 2% more nurses than last year—but it is about more than simply looking at that. We also need to look at the fact that we have more elderly patients, who are presenting with multiple conditions, which in turn changes the demands from a system that has traditionally been more about individual specialties. Now we are looking at treating those patients with multiple conditions, and that then needs to be factored into the skills the workforce have. That is why the point from my hon. Friend the Member for Brigg and Goole (Andrew Percy) is so important. We need to think about what upskilling can be offered to particular roles and how they can take on a wider set of responsibilities. There is also the role of technology in that. For example, many nurses in hospitals currently take time looking for beds. Operational control centres with a different cohort of staff, as is already the case in some hospitals, not only automate much of that process, which is far quicker in getting beds back into use, but free up a lot of nursing time to be used for what nurses would prefer to be doing, which is focusing on the clinical side and taken away from some of those administrative roles.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 6th December 2022 Commons Chamber

[Neil O’Brien]

I am always keen to work constructively with the Scottish Government. This sounds like a serious problem. My right hon. Friend the Secretary of State set out how we are using our health and capital spend more efficiently, and unfortunately this is an example of where it is not happening in Caithness.

[Helen Morgan (North Shropshire) (LD)]

It is well documented that people in rural areas have worse health outcomes than people in urban areas. One driver is that the most vulnerable people lack access to the services they need. Will the Minister consider working with his colleagues in the Department for Transport to figure out how the most vulnerable people can access the healthcare they need?

[Neil O’Brien]

We are rolling out community diagnostic centres to bring services closer to those who need them, and we are investing in 21,200 extra people working in general practice to make sure that rural services, as well as services in the rest of the country, are improved.

Baby Loss and Safe Staffing in Maternity Care

Helen Morgan Excerpts

Tuesday 25th October 2022 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Hartlepool (Jill Mortimer) for securing this important debate and for speaking so movingly about her experience.

I draw Members’ attention to the fact that I am the vice-chair of the APPG on baby loss and a member of the APPG on maternity. I joined those APPGs shortly after my election last December because in Shropshire the issue of avoidable baby loss is extremely raw. Although neither of the Shrewsbury and Telford NHS Trust hospitals are located in my constituency, the vast majority of families in North Shropshire welcome their new arrivals in one of those maternity wards.

I did not have my baby in Shropshire as I lived in Buckinghamshire at the time. When he arrived in 2009 by emergency caesarean, making his feelings about the indignity of the situation known to everyone in the theatre at an enormously high volume, I never once worried that either of us were likely to be unsafe. The idea that things might go tragically wrong did not even cross my mind. Although the birth of my baby did not go to plan, I felt brilliantly cared for at all times. When I moved to Shropshire four years later, I realised that, tragically, that is not always the case. Friends with experiences similar to mine told of near misses, blue babies being resuscitated and long stays in special care baby units. A close friend told me she did not realise until many years later that flashbacks to the trauma of the birth were not normal.

We now know, thanks to the bravery of many families and the detailed review of Donna Ockenden and her team, that there were serious and systemic failings at Shrewsbury and Telford over a long period of time. The tragic stories include those of constituents and personal friends. I know of many other women who did not come forward, either because their baby did not suffer any long-term consequences or they did not want to revisit painful tragedies. It sometimes seems that everyone of my age in Shropshire knows a family who lost a baby.

The causes are multiple and this is not the time to discuss them, but safe staffing was fundamental in that tragedy. In the executive summary to the report, Donna Ockenden states:

“It is absolutely clear that there is an urgent need for a robust and funded maternity-wide workforce plan, starting right now, without delay and continuing over multiple years.”

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

The APPG’s report on staffing shortages found that hospital staff feel that post-natal care has suffered the most from cuts, with most aftercare being devolved to healthcare workers who do not hold the same level of qualification as a midwife. That will impact on the health of mother and baby—for example, if they do not have access to breastfeeding support because resources are stretched too thin. Does the hon. Member agree that post-natal care needs urgent attention?

[Helen Morgan]

I agree. Many of us have experience of less than brilliant post-natal care, and the staff shortages are well documented. The Health and Social Care Committee report recommendation that £200 million to £350 million a year is required to be invested immediately in maternity services speaks to that issue. On Wednesday 30 March, the then Health Secretary, the right hon. Member for Bromsgrove (Sajid Javid), confirmed that £222 million had already been committed but was not guaranteed for the future, although he would keep it under review. That was two Health Secretaries ago.

On 1 September, the next Health Secretary argued that, given how stretched the NHS was, services such as maternity might no longer be a priority. I seek reassurance from the Minister that that is not the case. Maternity services have been treated as a Cinderella service for years and we have been left with shocking scandal after shocking scandal, with thousands of families devastated by poor care at a time when they were supposed to be at their happiest. I am at a loss to understand the deprioritising of maternity services—the one service that every one of us will need at least once in our lives.

The workforce gap of 2,000 midwives and 500 new consultants has been referred to, but it is estimated that nearly 700 midwives have left the profession in the past year, and eight out of 10 report that they do not have enough staff on their shift to provide a safe service. Will the Minister commit to increasing funding to meet the £200 million to £350 million-a-year recommendation, for a specified period of time, and to developing a fully costed, multi-year workforce plan?

The safe staffing report produced by the baby loss and maternity APPGs, on which I serve, has already been referred to. I draw particular attention to the need for more bereavement midwives. The pressure and increased likelihood of failure, and the sheer exhaustion that overworked maternity staff feel, must be a cause of some of the other issues we have seen at Shrewsbury and Telford NHS Trust, and at the other trusts that face challenges.

Shropshire is not the only area of the country to have suffered a crisis in its maternity services, with Morecambe Bay, East Kent and Nottingham all facing serious issues. Far too many families have faced tragedy. I ask the Minister to ensure that their experiences are not in vain, and that the Government will act on unsafe staffing.

Urgent and Emergency Care

Helen Morgan Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

As I said in my statement, additional funding has been put in to boost A&E capacity. There was some £450 million of funding in the spending review in 2020, which has been applied across 120 trusts. Of course, the ICSs will look at the commissioning priorities in particular areas, and the NHS England taskforce is looking at trusts where there is acute pressure.

[Helen Morgan (North Shropshire) (LD)]

I am concerned that people across England and Wales, including in Shropshire, have died as a result of the ambulance delays we have seen for a long period. I have raised the issue a number of times in this place. I welcome the improvement in the response times of the west midlands ambulance service, but I am worried that the regional data masks huge differences between rural areas such as Shropshire and densely populated urban areas. Will the Secretary of State consider the Ambulance Waiting Times (Local Reporting) Bill, which my hon. Friend the Member for St Albans (Daisy Cooper) tabled earlier this year, so that the disparity between urban and rural response times can be properly understood and tackled?

[Steve Barclay]

The hon. Lady makes an important point about variation not just between regions but within regions. As a rural Member of Parliament, I get the point that there is often significant variation within a region. That has been a key area of focus. The federated data platform, which is due to come on stream in April, will give her local ICS much better data on what is happening and on what community capacity there is. Over the summer, we have worked with ambulance trusts to look at operational performance data on a much more granular level. That is why I have flagged to the House the issue that a small number of trusts are driving a large proportion of the handover delays. That is exactly the sort of variation that we are looking at.

Ambulance Pressures

Helen Morgan Excerpts

Monday 18th July 2022 Commons Chamber

[Steve Barclay]

I am happy to look at that, and I thank my hon. Friend for his service locally. I am keen to follow up on his point, because it is absolutely right. From the feedback from ambulance trusts so far, it seems that category 2 average response times were broadly stable at the weekend, but how we triage, how we categorise calls, and what additional support can be given by considering the skills mix are all factors in improving performance.

[Helen Morgan (North Shropshire) (LD)]

I also attended the meeting on Friday morning about Shropshire’s health crisis, and I echo the comments of the right hon. Member for Ludlow (Philip Dunne) on that. Quite apart from this week’s heatwave, there is increased demand on Shropshire’s ambulance service, and the local team are clearly working hard to find solutions, but I did not feel reassured that they had any quick fixes for this crisis. One of their big problems is with recruiting social care workers; the team say that they have never seen a market like it. What is the Secretary of State doing to address the critical workforce problem in social care, not only in rural areas but across the country?

[Steve Barclay]

Through initiatives such as the better care fund and the £2.6 billion of investment, we are looking at how to allocate funds in an integrated way. That requires better integration of data between the care sector and the NHS, and that is an area that I am keen to explore.

Ambulance Services and National Heatwave Emergency

Helen Morgan Excerpts

Wednesday 13th July 2022 Commons Chamber

[Mr Speaker]

I granted the urgent question because the shadow Secretary of State tabled it and normally we would expect a Secretary of State to come. I recognise that they may be busy in other areas, but it is something we ought to be aware of. More and more, we are seeing fewer Secretaries of State across all Departments, not just this one.

[Helen Morgan (North Shropshire) (LD)]

Last Friday, I passed by Royal Shrewsbury Hospital. It is in a neighbouring constituency, but it serves my constituents. It was not a particularly bad day, but there were eight ambulances with their doors open in the heat, waiting to transfer patients. This is not a new situation and I have repeatedly raised the issue in this place: on my first day in Parliament with the Prime Minister; with the Secretary of State for Health in an Adjournment debate; and in a Westminster Hall debate with the hon. Member for Charnwood (Edward Argar). All those people have now resigned. Shrewsbury and Telford Hospital Trust has declared its fifth critical incident this year. When will the Government end the chaos and infighting, and start taking steps to prevent avoidable deaths in Shropshire and across the country?

[Maria Caulfield]

I can reassure the hon. Lady that the hon. Member for Telford (Lucy Allan) has been working very hard behind the scenes to get more investment into that local hospital. We will be making announcements shortly on future funding for hospital trusts.

Ambulance and Emergency Department Waiting Times

Helen Morgan Excerpts

Wednesday 6th July 2022 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I am grateful to my hon. Friend the Member for Bath (Wera Hobhouse) for securing the debate. On 25 May this year, the nursing director of the West Midlands Ambulance Service, Mark Docherty, said that the ambulance trust would face a “Titanic moment” and collapse entirely this summer. He gave the specific date of 17 August. Mark went on to say that patients were “dying every day” from avoidable causes created by ambulance delays. That was 42 days ago. He predicts that we now have another 42 days before the ambulance service in my community collapses.

I have had an Adjournment debate with the Minister on that subject, and a meeting with the former Secretary of State for Health, the right hon. Member for Bromsgrove (Sajid Javid), yet this Government still have not got a grip on the problem. As a proud resident of North Shropshire, I was aware of our ambulance crisis before I was elected in December, and before I started campaigning in November. However, on the campaign trail, and since being elected, it has become evident that the scale of the crisis is absolutely shocking.

Just last week, I was contacted by a constituent whose 85-year-old mother, who suffers from dementia, had fallen and suffered a suspected broken hip. Her son called the ambulance, but she sat in agonising pain in their living room for 18 hours before the ambulance arrived at her home. Everyone in this Chamber will agree that this should not be happening in this country, or in this century. It is one of many stories I have received. Many other people are attended by the ambulance crew in fairly reasonable time, but then wait 12 or 13 hours in the ambulance before being transferred into the hospital.

The focus of this debate should be on solutions to the problem, but it is also crucial to understand how we got here. Ambulance service delays are a symptom of wider issues plaguing the NHS and health services across the country, and the issue of staff shortages is critical to that, as colleagues have alluded to today. So far, the Government have failed to address that. They have thrown our hard-working doctors and nurses pretty much under the bus. We are short of nurses, carers, GPs and decision-making doctors in A&E. In February, the all-party parliamentary group for rural health and care published a report concluding that the 10 million people who live in rural and coastal areas in the UK deserve better healthcare outcomes. Colleagues here representing rural constituencies know from first-hand accounts that it is not just access to healthcare that is compromised but, in the words of the APPG report,

“the very determinants of health itself.”

That is why our ambulance crisis is even worse than in some of Britain’s more urban areas. Worse still, it is hidden by the published data. West Midlands Ambulance Service reports some of the better response times in the country, but a decent outcome in Birmingham and the black country conurbation is masking a deep crisis in the countryside.

How are the hard-working professionals in our NHS to deal with another significant rise in covid admissions? They are struggling to deal with the broken social care service, a hospital bed crisis and people who cannot access a GP and so are turning up at A&E. I know those professionals have the best will in the world, but they simply cannot deal with that. That is why Shrewsbury and Telford Hospital NHS Trust has declared yet another critical incident this week. I have lost count of the number of times that has happened this year—I think it is the fourth or fifth—but a summer incident is unprecedented. The winter is coming at us fast, and now we need to understand what we can do to fix the problem.

We know there is no quick fix, but one thing the Government could do now to understand the problems and come up with effective recommendations is commission the Care Quality Commission to investigate delays in the ambulance service and their underlying causes. In my Adjournment debate before easter, the Minister said it was open for me, or others, to raise that with the CQC. However, they have subsequently written to my hon. Friend the Member for St Albans (Daisy Cooper)—the Liberal Democrat health spokesperson—to confirm that that is not the case. It is clear that while the Health Secretary has the power to commission the CQC, unfortunately I do not. Crucially, Mark Docherty, the nursing director of West Midlands Ambulance Service, has also called for the CQC to investigate the issue. I would like to take this opportunity to urge the newly appointed Health Secretary to commission the CQC to conduct an investigation to identify the measurable actions we need to take to resolve the issues that we face across the country.

The Government could also adopt the recommendations of my hon. Friend the Member for St Albans by commissioning ambulance waiting times by postcode, so that we can direct the resource where it is needed and not just over large regions. They could also act on the recommendations of the APPG’s February report to deal with the health inequalities faced by the one fifth of our population who live living in rural or coastal communities. There are positive steps that can be taken to fix this crisis. I would like the Minister to say exactly what is going to happen now.

North East Ambulance Service

Helen Morgan Excerpts

Monday 23rd May 2022 Commons Chamber

[Maria Caulfield]

First responders do have an important role but they are not a substitute for paramedics. We have 3,000 paramedic graduates trained nationally per annum and we have increased our ambulance and support staff by 38%, so we are making that investment in the ambulance service.

[Helen Morgan (North Shropshire) (LD)]

I have been struck by the similarities between this case and the failings in maternity care at the Shrewsbury and Telford Hospital NHS Trust that were in part due to a toxic management culture—as outlined by Donna Ockenden earlier this year—in which staff were afraid to raise concerns. Given the similarities, will the Minister commit to ensuring that we have a system where staff can whistleblow to an independent organisation and where they feel safe to admit that they have made a mistake?