Unavoidably Small Hospitals

Jamie Stone Excerpts

Tuesday 6th September 2022 Westminster Hall

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

It is always a pleasure to serve under your chairmanship, Mr Hollobone. Although I may be a Liberal Democrat, if I lived on the Isle of Wight I could be tempted to vote for the hon. Member for Isle of Wight (Bob Seely), because he is assiduous in the pursuit of issues that are important to his constituents. He has repeatedly raised the issue of St Mary’s, and he has my every sympathy.

When listening to the contributions so far, I could have shut my eyes and imagined that I was standing on the high street in Wick, in the far north of Scotland—the far north of this United Kingdom—because the issues are the same there as have been outlined. Recruitment and retention is the deadly issue in the north of Scotland, much as it is on the Isle of Wight. I will say, as the hon. Member for Strangford (Jim Shannon) said, that health is devolved; as he also said, health matters to everyone in the United Kingdom. What I am about to say about the situation in my own constituency is pertinent to the rest of the United Kingdom.

Some years ago, Caithness General Hospital in Wick had a consultant-led maternity service. There was a battle to retain that and it was won by the local people. More recently, the highland health board, NHS Highland, used retention and recruitment as the reason not to have consultants located in the far north of Scotland and to downgrade the service to a midwife-led maternity service. That means that mothers have to travel more than 103 miles from Wick to Inverness to give birth. In the middle of winter, if the A9 road blocks, which it does on occasion, and the air ambulance has been called to a road traffic accident somewhere in Morayshire or West Sutherland, then what is going to happen? We are faced with a very dangerous situation indeed. I give credit to the NHS in Scotland: at long last a dialogue has started between the residents of Caithness and Sutherland and the powers that be. I hope that dialogue will eventually be fruitful.

The point has been made that there is an additional cost for locums—the stand-ins and so on. That is absolutely true, and it hits us as much as it hits the Isle of Wight or Yorkshire. There is also an issue whereby the change of locum and personnel can be disadvantageous to the patient, because they have to go back through the same old story with a new person—the patient tends to repeat themself. In the highlands of Scotland, that issue is particularly acute on the mental health front. I have heard horror stories of people having to see a variety of different professionals and repeat themselves again and again before anything can be done. That is extremely worrying.

The solution is partly money. Like the hon. Member for Strangford, I urge the Minister, or Her Majesty’s Government—as they run the health service in England—to exchange best practice, as and when we have it, with the Scottish Government. We can learn from each other about how things can best be done.

I have outlined the mental health issue. There is a final point. The hon. Member for Isle of Wight made the point that there are double standards. It was recently proposed that the maternity service in Morayshire, which is based in Dr Gray’s Hospital in Elgin, in the constituency of the leader of the Scottish Conservatives, the hon. Member for Moray (Douglas Ross), should be downgraded. There was a huge outcry about that and the Scottish Government eventually said they would look again at the situation and see whether there is a solution whereby people do not have to travel from Morayshire to either Inverness—a distance of 38 miles from Elgin—or Aberdeen.

That sits ill with what I have just described in Caithness and Sutherland. The distance from Wick to Inverness is 103 miles, yet the Scottish Government have not agreed to look again at maternity services. However, there is a dialogue now—thank heavens. I pay tribute to Caithness Health Action Team—known as CHAP locally—and to one councillor in particular, Ron Gunn, and his colleagues, who have been absolutely instrumental in ensuring that this issue is never off the top of the agenda.

It is a fact that every citizen of the United Kingdom should deserve an equal right to health services, regardless of where they live. It is a fact that unavoidably small hospitals in England face the same problems as hospitals of the same size in Wales, Northern Ireland and Scotland. The bottom line is that health matters hugely to us all. I sincerely hope that the new members of the UK Government, both in the Cabinet and as junior Ministers, can look at the issue as a matter of absolute urgency. My telephone is always switched on. Ministers can call me, and I will again and again bang the drum on behalf of my constituents in Caithness and Sutherland, who deserve rather better than they are getting at the moment.

[Selaine Saxby (North Devon) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and I thank my hon. Friend the Member for Isle of Wight (Bob Seely) for securing this important debate.

My hospital is the second most remote on the list, and the most remote on the UK mainland. Obviously, as the representative of North Devon, I would not have to go to hospital by boat, although constituents of my neighbour, my right hon. and learned Friend the Member for Torridge and West Devon (Sir Geoffrey Cox), who live on Lundy do go by boat or fly to hospital. Most of my constituents in beautiful North Devon travel to hospital on a road that is described as the longest no-through-road in the country, and we are not only rural, but coastal. As Professor Chris Whitty has highlighted, coastal communities’ health outcomes are particularly poor.

I want to thank the fantastic team at North Devon District Hospital. They are remarkable, and I am delighted that the Minister has had the opportunity to come and meet some of them. We visited the first covid catch-up ward in the country. My hospital might be small, but it is pretty perfectly formed. It was the recipient of £1.9 million last December for a covid catch-up elective ward, which was opened in time for the jubilee. It is named the Jubilee ward and the staff are conducting—seven days a week—hip and knee replacement surgery with most patients going home the same day. That is a truly remarkable achievement, which was delivered by some of the Nightingale teams.

I made a plea to the Minister then that I will repeat today. My hospital is highlighted as one of the 40 that are due a rebuild. The plans are written, this is a modular build, and the team have demonstrated that they can deliver on time and on budget. They can also show the need for the improvement to the facilities at the site, so, if the Minister is not in post next week—I very much hope she is—will she leave a note on the way out to let people know that North Devon District Hospital is ready to start the building programme if the funds are released?

The facilities team at North Devon—owing to the size of the hospital and the problems with issues that have been spoken about, such as recruitment and retention, as well as the fact that the site is in need of work—is innovative and creative. We are fortunate to have linked up with Exeter, and in many ways that link has secured the site. It gave us the opportunity to establish virtual wards, which are now running, so consultants from Exeter and North Devon can share the patch among them. However, the age profile of the population, which has been mentioned, changes the nature of the hospital—for example, there is more demand for certain services, and less demand for others, such as maternity, which are used much less. Therefore, it is much harder to attract consultants in some of the specialisms.

My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) spoke about distance to be travelled, and in North Devon people make choices about their cancer treatment based on the distance they would have to travel. Most people have to travel 60 miles to Exeter Hospital, and if they have to travel daily or weekly for radiotherapy, a journey of 120 miles might be a choice they decide not to make. As we look to how to tackle the issue of health outcomes in remote rural communities, I hope we can ensure that patients have access to the best care, rather than the care nearest to them.

The rurality of North Devon is a driver in the struggle people have to come and work there: we had a recruitment issue in North Devon long before the pandemic, and one nursing post in five is now vacant. Not only is it hard to get to North Devon; it is hard to move and live there. My hon. Friend the Member for St Ives (Derek Thomas), who represents the Isles of Scilly, and I spend a lot of time talking about housing and the housing challenges in the south-west of England, and we find that it is almost impossible to buy a house in North Devon. The rental market has also collapsed, so it is near impossible for public sector workers and those who work in many other jobs, such as hospitality, to move there.

That situation is now overlaid by the situation in social care. My fantastic hospital has more beds full of patients who could go home than it would normally have at this time of year. That is not because the social care teams in North Devon are not also fantastic, but it is just very hard to recruit, and the costs of providing social care have escalated hugely with the increased costs of energy. For those fantastic teams who travel around and look after mostly elderly people in their homes, the cost of getting there has now shot up. There are also the issues around recruitment, and we are paying far more in that sector to attract and retain those great individuals who do such valuable work.

[Jamie Stone]

The hon. Member is making a very good speech indeed. Does she agree that it might be a good idea to revisit the taxation regime that covers the remuneration for mileages for some health workers who have to drive? They have been penalised rather and perhaps the number of miles could be raised. It would not attract taxation.

[Selaine Saxby]

Indeed, I agree in many ways. My right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak) and I had similar conversations in a previous life. Much could be done, and personally I want to give social care workers electric cars, so they are taken out of that and can decarbonise at the same time.

As the new Administration comes in, I hope that there will be some revisiting of how to tackle the challenges of social care without the ringfenced money if that plan is to go ahead. We need to look after everybody who is unwell in our society. When visiting a social care organisation over the recess, it was frustrating to hear that they have the work for so many extra people. They can recruit internationally and they are. They advertised six jobs and overnight they had 70 applicants. They could take all 70, but there is nowhere for them to live. Until we in northern Devon find a way to address our housing challenges, I will work tirelessly here to tackle them. As a community, we need to find a way to ensure that people who need to work and live in our community can afford to do so before the situation gets worse as we head into the winter.

Talking about the winter and seasonality, I want to highlight the remarkable work that goes on within A&E at North Devon District Hospital. Unlike many hospitals that have a big winter peak, my population increases fivefold during the summer months. My A&E is busy all year round, which has its benefits in that we do not have those peaks and troughs, but I am not sure that the funding truly reflects the seasonal influx of those visitors and the changes. Obviously, the injuries people secure on a beach are quite different to the issues that affect my elderly population. I think there is some work to be done to understand the rurality, seasonality and locality of the fabulous North Devon District Hospital. My parting comment to the Minister is that quick reminder that we are one of the 40 and we are ready to go.