West Cumberland Hospital

Jamie Reed Excerpts

Monday 20th October 2014 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

I would like to thank your office, Madam Deputy Speaker, and the office of Mr Speaker, for the advice with which they have provided me in the lead-up to today’s debate. That a Member of Parliament could have been prevented from speaking on an issue that relates directly to his constituency and constituents owing to the decision of an individual Minister, is too absurd to contemplate. That would have made a mockery of our democratic process at a time when there is a growing dislocation between the public and Parliament. This Chamber exists precisely for the purpose of holding power to account and if any Minister in any Government believes they can be exempted from that then they are badly wrong. That said, I am exceptionally grateful to the Minister for granting me permission to speak. I would also like to extend my thanks to my hon. Friend the Member for Workington (Sir Tony Cunningham) for securing this debate and congratulate him on his richly deserved knighthood over 12 months ago now—this is the first chance I have had to do so in public.

My hon. Friend and I have campaigned consistently on behalf of West Cumberland hospital in a fight that will continue for as long as it is necessary. The Government must not try to shut down the debate, especially given that patients, the public and medical professionals across west Cumbria require clear and open discussion and genuine public engagement regarding the future of our hospital—the first new hospital built after the establishment of the national health service.

We need the support of the Government in ensuring that such engagement takes place. The Government’s health reforms, of which I am a long-standing critic, were billed as devolving decisions about local health services to the communities relying on them, but in Cumbria, which the previous Health Secretary said should be the template for the whole of the country—consider that for a minute—engagement could not be any worse. In my constituency and that of my hon. Friend, the Minister will find tens of thousands of people willing to engage with the Government—and with the trust, for that matter—on the future of their services, but their voices are being deliberately ignored.

Before I continue, I must declare my interest in this topic. I was born at West Cumberland hospital; my four children were born there; my wife was born there; and over the past few years, it has saved my life not once, but twice—which I appreciate sounds careless. I am indebted to its staff for all they have done for me and countless others from my part of the world. The hospital has been one of the main focuses of my efforts since I was elected to this place, and it will remain so for as long as I am here.

I do not wish to repeat what my hon. Friend said, but I want to echo my support for the We Need West Cumberland Hospital campaign group. These are local people exercised by what is happening to their national health service. They have created a group with passion and purpose, and it is time for decision makers to sit up and take notice of them—that means the Government as well as the trusts in question. The group exists only because the local health economy is in turmoil and because its members, like everyone else, are being purposely shut out of decisions relating to their hospital, as service decisions are made and increasingly removed by stealth.

As my hon. Friend pointed out, just a few weeks ago this group of concerned people organised a public meeting to discuss the future of services at West Cumberland hospital. About 4,000 people attended on a dark Monday evening at the recreation ground in Whitehaven. Had we held it on a summer weekend, only a few weeks earlier, more than 10,000 people—easily—would have attended.

My constituents are deeply concerned. The lack of engagement from the North Cumbria trust and other decision makers has fostered a feeling of toxic distrust. This simply is not conducive to establishing faith or trust, or to building the local services my constituents, the people of west Cumbria and the whole of the Cumbrian health economy need. I implore the Minister to intervene to stop this behaviour and ensure that an effective framework of meaningful public engagement is put in place before it is too late. I hope he can write to the North Cumbria trust to ensure this takes place.

Consultation is one thing, but meaningful engagement is another thing altogether. Rather than simply being consulted on a plan designed by the trust behind closed doors, it would be much more beneficial to have public involvement in what the plan should look like before it is consulted on. Surely that would make for a much easier, expedited consultation and a much easier, effective implementation. We did that locally prior to 2010 and we should do so again. I hope the Minister will address that point directly.

I want to address the concerns expressed about the services provided by West Cumberland hospital. The vacuum left by the lack of engagement from the trust means that local people are understandably worried about what their services will look like in the coming years, and the ability of the trust to engage with local people has been clearly and demonstrably worsened by the recent reorganisation of the NHS. However, the acquisition of North Cumbria by the Northumbria trust is also proving to be a significant problem. I hope the Minister will pay careful attention to this point. The acquisition cannot proceed unless both Monitor and the Care Quality Commission are satisfied that the trust is both financially and clinically sustainable.

The acquisition was meant to provide certainty and stability, yet years later the process has provided neither. In fact, the uncertainty is only worsening matters. There are justifiable fears that financial sustainability will be achieved by reducing, and only by reducing, the amount of services provided at the West Cumberland hospital, under the guise of “clinical sustainability”. Will the Minister agree today to stop any further progress of the acquisition of North Cumbria by Northumbria unless a comprehensive public consultation on the future of services provided by the West Cumberland hospital is undertaken prior to an acquisition? The people of west and north Cumbria need the Government’s help with that, which is the least the Government could do.

We have already seen some services move from the West Cumberland hospital to the Cumberland infirmary at Carlisle, itself a hospital in serious difficulty. People are worried that more services will follow and they are especially worried about consultant-led maternity services being transferred from West Cumberland to Carlisle.

[Sir Tony Cunningham]

The journey between West Cumberland and Carlisle is 40 miles, but some people have to go to Newcastle—for example, for chemotherapy. Just think of the anguish when children have to have chemotherapy as far away as Newcastle, which is almost 100 miles away.

[Mr Reed]

My hon. Friend makes an absolutely pivotal point. This is about not just the effectiveness and efficacy of the clinical solutions provided by the NHS; it is about the patient experience and the best outcomes for patients, and not just those 40 miles from Carlisle and further afield. The 40-mile point is Whitehaven, but it is actually much further south than that: it is Egremont, Cleator Moor, Seascale, Wasdale, Eskdale and so on. It is the people there who, perhaps more than others, are disadvantaged by these moves.

Childbirth is one of the biggest moments in any parent’s life, but the elation and happiness that surrounds a new family at this time can all too often turn to stress, worry and fear. Any complications can have a catastrophic effect—I have seen this recently with close friends. If there are complications during a labour, it is just not feasible for an expectant mother—particularly one in difficulty—to be transferred 40 miles from Whitehaven and further afield south, on a journey that, as my hon. Friend said, takes well over an hour at the best of times and considerably longer in heavy traffic. On occasion, the roads will become impassable in bad weather. In fact, only this year, after a visit to my constituency, a Minister wrote to one of his colleagues, a Minister in the Department for Transport, pointing out the inadequacy of the A595, bemoaning the state of the road infrastructure. If the roads are not good enough for visiting Ministers, they are certainly not good enough to be transporting patients at the time of their greatest need.

The truth is that a one-hour journey for a mother in labour means more than 90 minutes, bed to bed. That is indefensible. Also, studies have shown that an increase in straight-line ambulance journey distances is associated with an increased risk of death and that an increase of 10 km in straight-line distance is associated with an absolute increase of around 1% in mortality. Consider that for a moment. The centralisation of some services from the West Cumberland hospital in Whitehaven to Carlisle will increase the mortality risk for west Cumbrians much further afield than Whitehaven.

Between 2007 and 2008, the local primary care trust, as it then was, undertook a consultation on local services, to which it received 140,000 responses. As a result, the people of west Cumbria were told that they would receive a new hospital, built on the site of the West Cumberland hospital. The new hospital would retain services, including consultant-led maternity services, and also develop specialisms not catered for at Carlisle. The deal struck was also set to provide newly built cottage hospitals in Millom, Keswick and Maryport, to complement the existing new one built in my hon. Friend’s constituency in Workington.

When the Government took office in 2010, they scrapped the funding for the new hospital, as they did for all other existing new build hospital projects. It is only through perseverance, hard work and a lot of lobbying by me, my hon. Friend and others that the Prime Minister acquiesced and returned some of the money, for which we are very grateful indeed. However, the full funding was not returned and funds had to be found elsewhere. The Minister will know that to this day I am still consistently making the case—through the trust development authority, NHS England and other bodies—for extra funding. Now that the new hospital site is almost completed, it is only right that the other promises that were made are honoured.

Consultant-led maternity services cannot be removed from the West Cumberland hospital, and the Government must surely intervene to ensure that this does not happen. Before the election, the then Leader of the Opposition and now Prime Minister promised a “bare-knuckle fight” to stop maternity services moving, yet that fight has never appeared. Around the country, people wonder whether it will ever appear. However, can the Minister confirm that there is set to be a nationwide maternity services review? Will he explain when that will begin and end?

I believe that the local CCG in Cumbria wants to commission the consultant-led maternity services at the West Cumberland hospital, but that the North Cumbria trust does not wish to do so. I have submitted a series of freedom of information requests to the trust, seeking its internal proposals for removing consultant-led services; to date, I have received no response. Can the Minister help in that regard? Can he impress on the trust the urgency of the matter and the need for full candour? I hope he will be able to do so in writing.

Report after report by Sir Bruce Keogh and by the Care Quality Commission has shown that there are real issues, as my hon. Friend said, that need to be addressed not only in north Cumbria, but right across the Cumbrian health economy. Staff shortages are having a major impact on the services—not just the type but the quality—that can be delivered. Will the Minister commit himself today to investigate the recruitment practices of the North Cumbria trust? Will he commit himself to assist with recruitment, with financial incentives for potential new staff? This is critical. I am inundated with complaints from staff about the poor quality of recruitment advertising, cancelled interviews for applicants and much more. As a result, we have one of the highest locum spends in the whole country. The Minister will be only too aware of the effect on the trust’s ability to provide, in some cases, even the most basic front-line services.

In the people of west Cumbria, this Government—any Government—the trust and the regulators will find a willing partner for constructive discussions about what services should and could look like. They have been through these issues year after year; they are well versed in them and up to speed with the realities of modern clinical practice—and commissioning decision making, too.

More than that, however, with the brand new hospital being built, we should be able to develop a new model of health care for health economies such as Cumbria’s that is exciting, attractive and sustainable. We should be able to attract top-class medical professionals to our hospitals, and we should be able to support them. As Bruce Keogh points out, there is excellence at the North Cumbria trust. These issues are genuinely—we can say this without exaggeration—matters of life and death.

I have asked the Minister a series of questions. There will doubtless be many more, and if he cannot answer them today—I again express my gratitude for being allowed to speak in this debate—I hope he will answer them in writing. In addition, I hope he will agree to meet a delegation of hospital campaigners—from my constituency and that of my hon. Friend—in the Department of Health as soon as possible. Most of all, I hope he will listen to the clear voice of the people of west Cumbria. We need the West Cumberland hospital and the services it provides, and we will fight to the finish to secure the hospital services we deserve and the hospital we were promised. Future generations of west Cumbrians deserve nothing less.

--- Later in debate ---

[Dr Poulter]

This has been a long-standing shortage; the trust has not been an attractive place for junior doctors to work for many years—probably for the past decade. However, the trust is now looking at ways in which it can better incentivise doctors to work there. That is an important step forward. If we want junior doctors to return to the trust—given that they have been removed from it because they were not getting the high-quality training they needed in order to become consultants—we must ensure that we incentivise the recruitment of more senior doctors to the trust. The hospital is now looking much more seriously at that than it has done in the past.

As I just outlined, recent measures have resulted in the consultant medical staff being increased by 17%, which is a positive step forward. Measures are also being put in place to ensure that nurse practitioners will be better used, where appropriate, to treat patients. The trust can be proud and pleased with the progress that it is making in that respect. An important aspect of looking after patients is to ensure that there is a full rota of junior doctors on site, and I am sure that if the progress in increasing the amount of consultant cover is maintained, that will become available again in the future.

On performance, the trust has put in place a recovery plan to meet waiting time targets from the end of 2014. It is currently working to reduce its backlog of patients who have been waiting for more than 18 weeks from referral to treatment, and it has received additional funding to support that. As hon. Members have pointed out, however, the trust has been financially challenged for some time. Last year, it reported a deficit of £27.1 million. The Department of Health provided significant financial support to the trust in 2013-14, as it has in previous years. The trust received £11.5 million from the Department, alongside support from the trust development authority and the clinical commissioning group, and £6.3 million in private finance initiative funding support. As we have discussed, however, that position is not sustainable in the long term. That is why further discussions about foundation trust status are being held.

Other critical challenges remain. Most significantly, some services at West Cumberland hospital remain fragile due to difficulties recruiting specialists and consultants and to the current heavy reliance on locums. However, I hope that that issue will be addressed in the near future if the trust can continue to recruit more consultants.

The Care Quality Commission inspection report published in July 2014 rated the safety of acute medical and outpatients services at the West Cumberland hospital “inadequate”. That reflects the difficulties that the hospital has faced for many years, and continues to face, in recruiting adequate staff to run some of its services safely and effectively. However, the trust has made significant progress in addressing the many challenges it faces. The CQC inspection acknowledged that, giving it an overall rating of “good” for providing a caring service to patients.

Another CQC inspection is expected to take place in early 2015, and I understand that the trust is working hard to make improvements ahead of that. For example, the outpatients service has greatly improved the availability of patient notes, an issue highlighted at the previous inspection. As I understand it, patients’ notes were not available when they came for an appointment. That is not helpful in providing an understanding of their previous history, which disadvantages the staff who are looking after the patient and trying to provide the best possible care. The trust has taken that issue on board and I understand that it is making good progress to address it.

The trust has made significant progress in other respects, most notably, and perhaps most importantly, in reducing high mortality rates. That means that patients in Cumbria who would have died had these changes not been introduced are alive today. Having been one of the highest in the country, the trust’s mortality rates are now within national confidence limits, and the trust and its staff must be commended for that turnaround. Further progress has also been made in, for instance, the meeting of the four-hour A and E standard, the implementation of a new patient experience programme, and a reduction in clostridium difficile infection rates. However, changes must continue to be made to secure a sustainable future, and to enable the trust to keep building on the good progress that it has made so far. It is important for the local NHS to be supported in that work to secure safe, high-quality patient care.

[Mr Reed]

Will the Minister explain why mortality rates increased sharply immediately after the summer of 2010?

[Dr Poulter]

I do not have the local knowledge that would enable me to understand why that happened, but what is important is the need for action to be taken in cases in which there is a history of higher than expected standardised mortality rates—cases in which patients have died when they should not have died. That is why the Government asked Sir Bruce Keogh to investigate this trust, and, indeed, many other trusts, as a result of which some were put into special measures.

Although a number of challenges remain, and the trust must address them, it appears to be making good progress in terms of standardised mortality rates, which means that—as I said earlier—patients who might have died in the past are now surviving. That is testimony to the hard work of the trust’s front-line staff. I know that Members will be pleased, and that, more importantly, local patients and their families will be very grateful.

The subject of reconfiguration was raised. The issues affecting west Cumbria were discussed during a debate secured in 2012 by the hon. Member for Copeland (Mr Reed), and I know that the future of services at the hospital is a matter of continuing concern to both him and the hon. Member for Workington. As I said earlier, the local NHS is committed to ensuring that West Cumberland hospital has a viable and successful future, and that west Cumbrian patients continue to receive treatment there. That is why £95 million—£70 million of it from the Government—is being made available to improve its facilities. The money will allow it to offer 21st-century facilities, including seven new operating theatres, four of which will have full laminar flow, which will make them suitable for use in any operation. That will allow the hospital to offer a wide range of surgical services, and to become a centre of excellence for elective surgical procedures.

The hon. Member for Workington asked what excellence would be provided at the hospital. I can tell him that the investment in new facilities will allow patients to receive elective surgical procedures of a much higher quality, which will hugely benefit the local population. That investment is supported by additional investment in other local health care facilities, including, not far away, the new £11 million Cockermouth community hospital—which was officially opened in August 2014—and the new health centre at Cleator Moor.

Alongside the financial investment in the hospital, there are continuing efforts to attract and recruit new clinicians to North Cumbria University Hospitals NHS Trust. International recruitment campaigns have already taken place, and financial incentives are now available to support recruitment to the posts that are the most difficult to fill. That point arose earlier in the debate. Hospitals often have the flexibility to offer incentives in the event of recruitment challenges and difficulties, and I am pleased that the local trust is taking advantage of the opportunity to offer such incentives to attract new consultants and permanent staff.

To build on the progress that is already being made, clinicians are working towards changes that offer the best opportunities for better outcomes to be given to patients suffering from the most serious illnesses. No changes will take place unless there is clear clinical evidence that they will result in better outcomes.

Understandably, people have concerns when any change to local health care services is being discussed, but it is important that such concerns are not exploited for any political or other purpose, and that all changes that take place are in the best interests of local patients. The five-year plan for the local health service being developed by local doctors and clinical commissioners is looking at how services can be delivered safely and sustainably in the future. In developing the plan, I expect the local NHS to give important consideration to the distance patients need to travel to access services, particularly emergency services. As we have discussed, rural areas are very different from urban areas, and the distance patients may have to travel to access services is an important factor in determining what is safe for patients. Local commissioners need to take note of that.

[Mr Reed]

The Minister represents a rural constituency. Notwithstanding his medical expertise and knowledge, would he be happy for constituents of his who were in labour and showing complications to have to travel for more than 90 minutes, bed to bed?

[Dr Poulter]

That actually may have to happen in my constituency, for example, in cases where my local hospital does not have the right support for a very premature baby in utero once it is born. Neonatal services are not always as well developed at every hospital, and some areas tend to have a regional centre of excellence for neonatal care. As the hon. Gentleman said, there may be a regional centre of excellence for cardiovascular services, heart surgery or other specialist services. We want to ensure that bread and butter, day-to-day medical services are always provided by local hospitals—that is particularly important in rural areas—but we have to ensure when taking these decisions that where there is a clinical case for better patient care to be delivered at a centre of excellence, that case is made and communicated effectively. So, for example, although I would want to ensure, as I have done, that in Suffolk patients are able to receive the best possible care from the local NHS, if they needed super-specialist services and other services that are better provided at a specialist centre, they receive that care from those centres. I have always advocated that important case on clinical grounds.

This is about seeking to provide high-quality day-to-day services, while recognising that some services have to be provided at specialist locations. So when dealing with the potential birth of a very premature baby, it is important that the right support after birth is available, and that is provided by more specialist neonatal intensive care units—for example, Brighton is a regional centre for the south of England for some of those services. It is also important that, where possible, an intrauterine transfer takes place to make sure that the right care is available upon birth and after delivery.

It is also important to stress that in designing and working through what the right patient services are, and in putting together the local five-year plan in Cumbria, certain guarantees and reassurances have been made to the local population. I spoke just now about important day-to-day medical services, and a commitment has been given that there will continue to be an accident and emergency department at West Cumberland hospital. That is part of what I was just speaking about: high-quality, immediate services available for patients in more rural and remote areas. An independent review is looking at maternity services across Cumbria and will feed into work locally to find the best possible solution to providing safe and sustainable maternity care in the future.

While the five-year plan outlines the direction of travel for the local health service, no definite proposals have yet been put forward, and work remains at an early stage. In developing its proposals, I expect the local NHS to ensure that patient safety is a key focus, and that any movement or change of services is based on clear clinical evidence of better outcomes for patients.

I wish to make some important points about public engagement, which was raised by both hon. Gentlemen. It is important that people who use NHS services get a say in any changes to those services. We are very clearly committed to that as a Government, and it is important that local clinical commissioning groups, and the doctors and nurses who run them, properly engage with the public when they are making the case for the future shape of local health care services. I encourage local patients to continue to engage with the NHS as plans for west Cumbria are developed.

I understand that Cumbria CCG has met local MPs and the local campaign group to discuss their concerns and is happy to maintain that dialogue and continue to meet to discuss issues of concern in the weeks and months ahead.

The local NHS held a period of engagement to inform the development of the five-year plan. Both the CCG and the trust are committed to undertaking more engagement and communication with local people in the coming months.

Any proposals put forward for significant changes to local health services will be subject to a full public consultation in which patient and public views can be fully engaged in helping to shape future health care services. That is an important reassurance to give Members. No decisions will be made without that full public consultation if and when any changes to services are proposed.

In conclusion, I know that local people care deeply about the future of West Cumberland hospital—that has come across clearly from the contributions this evening. The provision of health care services affects all members of the community. We have only to look at the example of 10-year-old Maddy Snell who last week received a reply from the Prime Minister to her letter about potential changes to local health care services to see how the whole community in west Cumbria wants to be involved in the future of its hospital.

Patients should keep up that engagement with the local NHS and make their opinions known to those developing proposals for the future of local health care services. I also want to encourage the people of Whitehaven to listen to the reasoning behind any proposals that their local doctors bring forward for improvements in the way in which people are cared for in the local area.

I should like to reiterate that local health services in west Cumbria have a strong future. There is a commitment from the local CCG, led by doctors and nurses, for a continuing accident and emergency service, and the Government support a £95 million investment in health care facilities at West Cumberland hospital.

[Mr Reed]

The Keogh report makes it very clear that meaningful engagement with the staff both at the Cumberland infirmary, Carlisle, and the West Cumberland hospital is nothing like it should be. That is one of the key reasons the trust entered special measures. All of us from all parts of the House want to see the hospital trust emerge from special measures as quickly as possible. However, latterly, that engagement internally has demonstrably worsened. How can we get out of special measures if these behaviours persist?

[Dr Poulter]

Part of the challenge may well be challenging some of the existing work practices at the hospital. I accept what the hon. Gentleman has said about the quality and commitment of local NHS staff. In my experience, I have never found a member of the NHS who has been engaged in health care with anything but the best intentions and the wish to help people. That is why I am a doctor and why many people go into health care; they want to provide compassionate care for people and to improve the human condition. I know that that is what drives local staff in Cumbria. Sometimes when profound issues have to be faced, such as higher than expected local mortality rates, challenging conversations have to take place. Such issues are the result of not a lack of commitment or dedication from the staff, but the fact that some working practices need to be improved. Additional training and support may need to be put in place to improve those working practices. It is important that that is done in a way that brings staff along in a collaborative working environment.

When things go wrong in health care, it is rare that there is one single causal factor, although sometimes there is; sometimes it is the negligent act of one person. Often, however, it is the system in a hospital that has let someone fall through the gaps. This is about challenging working practices, and as far as possible, that has to be done collaboratively. Clearly, there have been huge improvements in the way health care is delivered locally. Mortality rates have fallen, and patients are being looked after in the way we would all expect. That is down to the hard work of the staff who are facing up to some of the challenges, and making sure that they put right what may have been wrong.

It is important that when there are discussions about reconfiguring, changing or developing health care services, local clinical commissioners engage effectively with the hospital and properly with hospital staff. Part of the broader consultation and engagement exercise needs to be focused on proper engagement between the clinical commissioning group and the clinicians and other dedicated staff who work at the trust. From what hon. Members are saying, there may be more work to do in that area. I urge the clinical commissioning group to put right any issues, because it is important that everybody signs up to dealing with future challenges.

As I have said, I am confident in the local clinical commissioning group’s commitment to supporting a viable A and E at the hospital. The Government have provided investment to develop facilities further, particularly facilities for surgical procedures, in the hospital and the local area. With that investment, there is a strong future for local hospital services. It is important that local clinical commissioners continue to engage with staff at the trust, and particularly with local patients. After all, if we want a health service that is fit for purpose in Cumbria and elsewhere, it has to be based on the needs of local patients. It is to them, more than anybody else, that local commissioners need to listen.

Question put and agreed to.