University Hospitals of Morecambe Bay NHS Foundation Trust

Jamie Reed Excerpts

Tuesday 5th February 2013 Westminster Hall

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

I am pleased to have secured this debate. It is a pleasure to speak under your chairmanship, Mr Howarth.

I represent a community in shock, reeling from the suddenly announced intention to transfer Furness general hospital’s beloved special care baby unit and consultant maternity services out of the county, from 9 o’clock this morning, to Lancaster. Pleas to rethink that emergency transfer have so far been rebuffed, leaving expectant mums distraught at the prospect of a 50-mile trip in the back of ambulance if they suffer complications in labour. I will set out our concerns in detail and stress the areas in which we hope the Minister, who is of course an expert in the field, will agree to intervene, but first I will discuss the wider issues the area faces, which prompted my application for this debate.

There is the forthcoming review of hospital services, triggered by the need for significant budget reductions across the University Hospitals of Morecambe Bay NHS Foundation Trust. All of us here are acutely aware of the long-term threat that that might pose to key provision, such as the need to sustain a consultant-led maternity service and accident and emergency provision across more than one site in the area.

There is also the campaign against the removal of A and E, maternity and intensive care units at Royal Lancaster infirmary, on which the Downing street petition in the name of Matthew Hood already has thousands of signatures. I think that my constituency neighbour, the hon. Member for Westmorland and Lonsdale (Tim Farron) wants to do exactly that—move Lancaster’s A and E department to the Westmorland general hospital. Let me simply say that any attempt to question Barrow’s need for an A and E department would be met with horror not only by every single resident of the Furness area, but by the prized and highly regulated industries on which the nation depends.

The broader question facing the Morecambe Bay trust is how best to locate services when the population is far more spread out than in most areas of Britain, and when centres of population are often connected by a single road that winds through Cumbria’s unique landscape. In other areas, a trust for hundreds of thousands of residents might naturally be based around one A and E department and one maternity unit, but that would put an unacceptable strain on residents of Morecambe bay. People in pockets of severe deprivation in Barrow and families who, for whatever reason, just do not travel would be forced to go to another county and be completely cut off from their families. In an emergency, it would result in journey times of more than an hour on routes that are prone to become blocked by breakdowns.

I want to ask the Minister four questions about the four tests in the Government’s forthcoming consultation. His first test is the evidence base. Will he ensure that the options and risks are properly weighed, so that the risks inherent in long-distance ambulance travel are set alongside what might otherwise be the optimal configuration of services? The second test is whether there is the support of GP commissioners. The past 24 hours have shown the damaging shambles that can occur when a trust attempts to press on against the will of local commissioners. The Government back the new system, so will the Minister ensure that local GPs have the teeth to insist on the services that communities need? The third test is choice for patients. Will the Minister ensure that problems of isolation and lack of access to services are an integral part of the assessment when it arrives on the Secretary of State’s desk? It is hard to imagine the test of choice being passed if, for example, an isolated peninsula’s only consultant-led maternity unit were downgraded. The fourth test is strengthened public engagement. The trust needs to do much better than the mess of the past few days, which has left women desperately worried and confused. I shall say more on that in a moment, but the underlying point is that engaging means listening and acting. Of course, health professionals have a duty to present the options and a proper assessment of safety in each case, but if the public weigh that up and say that they want to keep the services they need close to home, the Government should listen to them.

Another major issue is the need for Ministers to ensure that our local hospitals and the wider national health service adequately learn the lessons of the significant and prolonged failings in hospital management at the Morecambe Bay trust. There have been tragedies about which people are still demanding answers and which apparently did not trigger sufficient improvements, despite laying bare shortcomings in areas such as maternity provision several years ago.

[Mr Jamie Reed (Copeland) (Lab)]

As usual, my hon. Friend is making an excellent case on behalf of his constituents. Many people in the south of my constituency use Furness general hospital, as well. Does he share the fear that some of them have expressed to me that the rapid removal of the special care baby unit heralds a stealth reconfiguration of services there?

[John Woodcock]

My hon. Friend is absolutely right that that is indeed the great fear. It is up to the trust, and ultimately to Ministers and the Government, to demonstrate that that is not the case, but there are still questions to be answered.

The need for lessons to be learned has been shown by such problems as the basic lack of grip in key areas in recent years—for example, the failure of new computer systems designed to remind patients about repeat appointments, which has clearly put lives at risk. A police investigation into a number of deaths is ongoing. There is also a lack of openness at the trust.

I pay tribute to the hard work of the staff in the maternity unit and across Furness general hospital. They are dedicated people, who come to work wanting to help others and to save lives. There have been real improvements of late, and we should recognise the immense strain placed on staff by the ongoing spotlight on the hospital and the longer-term uncertainty over their future. None the less, families are still grieving because of past mistakes made in a poorly managed system. The Minister was good enough to write to me in response to a letter from my constituent James Titcombe, and again recently on the need for a genuinely independent inquiry into the lessons for the wider NHS of management failings at Furness general hospital.

--- Later in debate ---

[Dr Poulter]

Absolutely. There will be a full response to the Mid Staffordshire inquiry tomorrow, so I will not pre-empt it or go into detailed discussion of that issue. However, it is absolutely right that we must encourage staff who have concerns about patient care to raise those concerns and air them in an open way. Moreover, when we know that there have been long-standing failings at a trust about the quality of care provided to patients and concerns raised about those failings—although Morecambe Bay NHS Foundation Trust, for example, has made some good progress in recent months, there are some long-standing issues there—it is important that, when an investigation is carried out, it is carried out in a transparent, open and independent way; there must be a great degree of independence involved.

If a trust sees fit to launch an investigation and a review of what has happened, it is important that the investigation and review pass the test of transparency. There may well be a role for local MPs and other interested parties in that process, and when the hon. Member for Barrow and Furness and I meet, that is an issue that I will be very keen to discuss further, to ensure that we can discuss with the local trust ways in which we can ensure that there is that transparency and independence in the process. That is very important to ensure that those patients, and their families who have had problems in the past—in some cases, there have been deaths at the trust—feel that the investigation addresses their allegations.

Obviously, this debate is not just about maternity services at the Morecambe Bay NHS Foundation Trust; there have been other issues around the trust, and any investigation will need to take account of all those issues. I understand that that is what will happen.

[Mr Jamie Reed]

I am very grateful to the Minister for his considered and thoughtful response to the debate. I agree with him wholeheartedly on the importance of transparency and openness. However, where there are different clinical groups commissioning services from a single trust that operates a number of different hospitals, who actually holds the ring and decides which services are commissioned where?

[Dr Poulter]

The hon. Gentleman asks a very good and thoughtful question. It is the duty of the commissioning groups to work collaboratively for the best interests of patients. They obviously have responsibility for their own budgets and, as I say, they all ought to work collaboratively for the benefit of patients. However, if there are concerns about that, there is also a role in this process for the commissioning board, which will have some oversight over the process, to help to ease it through. In many parts of the country, there is already good evidence that the emerging local commissioning groups are working together collaboratively in just the way that I have described. I hope that that is reassuring for the hon. Gentleman.

We know that the Morecambe Bay NHS Foundation Trust has had a very long and troubled history. We also know that it serves a very important purpose in looking after people throughout north Lancashire and Cumbria. My hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) made clearly the good point that the configuration of the trust geographically is challenging. We, as a group, are going to meet together to talk through some of these issues and the troubled history of the trust, to ensure that we can do our best to work through these issues.

There have been problems in the past with the trust and local patients have not been treated properly, and they and their families have suffered. There have been long-standing concerns over local care quality issues. That may mean that we have to redesign the way that services are delivered; that may be an inevitable consequence of improving patient care in the long run. Nevertheless, the driver of this process must be delivering high-quality local health care within the envelope of providing improved patient care with better outcomes and safer care for patients. However, the only way that we will achieve that is if all the commissioners are working collaboratively with the trust in a more integrated approach to care. The failure to do that is where things have gone wrong in the past, and that is what needs to change in the future.