Health Care Provision (Newark)

Jane Ellison Excerpts

Wednesday 7th January 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Turner. I apologise for being a stand-in for the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). I know he has previously debated these issues with my hon. Friend the Member for Newark (Robert Jenrick), whom I congratulate on securing this debate. It was a pleasure to go to Newark to campaign for him during the by-election. Literature that we all delivered told us that he would be a doughty campaigner, with health at the heart of his campaigning and his representations on behalf of his constituents. He has evidently made good on that promise in his relatively short time in the House. I am very aware of his dedication to ensuring that the health needs of his constituents are met. It is also a pleasure to see my hon. Friend the Member for Sherwood (Mr Spencer), who is another assiduous local Member and a valued colleague who has the health concerns of his constituents at heart.

This debate is a welcome chance to discuss local health care matters. I know both my hon. Friends regularly meet local health leaders, which is right. The depth of knowledge that comes across from both Members this morning is the result of that engagement. I encourage such engagement because it allows Members to be best placed to bring their constituents’ concerns to the House.

I recognise, as does my hon. Friend the Member for Newark, the hard work and dedication of NHS staff in his and other constituencies. He rightly describes them as wonderful, and it is excellent to hear that he was with them over the Christmas break. More than 4,000 staff are employed by Sherwood Forest Hospitals NHS Foundation Trust alone, in addition to the thousands who work in primary care. We thank them for their service at a time when we know they are under pressure.

It is all too easy to overlook primary care’s essential contribution to health care provision. The local GP or pharmacist is the key health care provider for many people. I will talk about the local hospital in a moment, but that foundation of good primary care is important. I am delighted that, through the Prime Minister’s challenge fund, Newark and Sherwood CCG is working with the hospital, local GP practices and Central Nottinghamshire Clinical Services, the out-of-hours provider, to improve access, reduce complexity for patients and ensure a sustainable staffing model. Given the pressure on the system over the Christmas and new year period, we can see only too well the importance of that work and the challenge fund in finding new ways to provide primary care access. In 2014, Mansfield and Ashfield CCG and Newark and Sherwood CCG were awarded a total of just over £1.8 million from the Prime Minister’s challenge fund, which was part of a £5.2 million collaborative funding bid that was spent in this financial year.

My hon. Friend is right to make Newark hospital the heart of his speech. Although there is legitimate concern, much of the worry caused for patients and the public in Newark has simply been unnecessary. I know he realises this but, for the record, the number of patients being treated is increasing. In 2012, the number was about 131,600; it increased to almost 133,500 in 2013. There is also more day care surgery, as my hon. Friend mentioned. The number of out-patients’ appointments is increasing and the number of specialities offering appointments at Newark is up. There is also improved provision for children.

I quite understand, however, why my hon. Friend wants to emphasise the need to keep building on that progress. He focused much of his speech on the minor injuries unit and urgent care centre. I can only sympathise with him with regard to navigating a way through terminology, because I am well aware that some terms mean different things in some parts of the country and that our health economy, because of its sophistication, is sometimes quite complex. It is therefore incumbent on all of us—Ministers, local health leaders and so on—to try to cut through that complexity as much as possible to make clear to local people what they can expect to get in a particular facility, what they would go there for, and where that facility fits into the local health economy, as well as the fact that it is part of a plan.

Newark provides consultant-led out-patients’ services, planned in-patient treatments, day-case procedures, diagnostic and therapy services and the MIU-UCC. My hon. Friend spoke about the need to increase the range of services. He is right to do so and to put forward his constituents’ concerns. As he outlined, there are plans to enhance the services offered at Newark hospital through the Newark strategy. He gave a history lesson at the beginning of his speech; I am well aware that there have been a number of strategies, but the current Newark strategy is being implemented, and I am encouraged by what I heard, in preparing for the debate, from local senior leaders. However, he is right to say that progress must be maintained.

The strategy includes Newark hospital being a centre of excellence for a broad range of services, including diagnostic, rehabilitation and so on. A number of new developments are already in place and a £500,000 development to make structural changes to the MIU is planned, which will make urgent care simpler and increase the range of Newark-based services.

As I said, I will take this debate as an chance to emphasise that if there is a lack of clarity locally—I can understand that there might be—local health leaders and all of us who work in and around the health system must work hard to ensure that the public, who are the users and end recipients of our excellent NHS services, really understand what is being offered. It is vital that they do.

The plans I mentioned include provision of additional consulting rooms, so that health care staff, including hospital staff and GPs, can work alongside each other instead of at separate locations. Building for that should start in April, which is really encouraging and testimony to my hon. Friend’s efforts to keep this a front-foot issue. Such evidence of the hospital’s long-term future is extremely welcome and should be reiterated.

With regard to the suggestion that more ambulance patients might be taken to Newark hospital, I understand that the local NHS has identified safety concerns with that. The level of emergency care was reviewed locally in 2013 as part of the development of the Newark strategy. As I know that my hon. Friend will appreciate, a patient’s diagnosis will not always be clear when the ambulance crew first arrives at the scene, so more comprehensive diagnostics are required—diagnostics that often need to be done in a main centre before a serious condition can be excluded.

I am told by the local NHS that the conveyance of all green ambulance calls to Newark would result in a limited improvement in ambulance response times, but I hope that it has looked at that carefully, has heard what my hon. Friend said today, and is giving proper weight to that. I know that for both my hon. Friends, the safety of their constituents is a paramount concern. They will know that for the Secretary of State for Health, the safety and quality of our health system is a touchstone issue in this Parliament, and we have debated significant safety concerns in recent years. When local clinicians believe that there are safety risks, it is important that their opinions carry weight and that we listen to those concerns closely.

My hon. Friend the Member for Newark has already discussed with the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, whether hospitals elsewhere might provide helpful examples for both Sherwood Forest Hospitals NHS Foundation Trust and Newark hospital. Hexham was mentioned as one such example. While parallels can be drawn, an exact comparison cannot, as my hon. Friend the Member for Newark acknowledged. There are some similarities between the services offered at those sites, but Hexham is a larger site with a more remote community. I note, however, what he said about his constituency being mixed, with some areas being much harder to get to owing to their road services.

GP services are offered at Hexham, and the new extension at Newark will enable that to happen in my hon. Friend’s constituency, which will be welcome. As he is also aware, decisions on local services, including urgent and emergency services, are a matter for local NHS leadership because they are the people, working with elected representatives, who know the local community best. The local NHS is clear that decisions about services will be based on patient safety and sustainability, which, having seen some of the problems uncovered in this Parliament in cases such as Mid Staffs, is what we all want as the foundation on which we build.

[Mr Spencer]

It is good to hear that progress is being made, but the elephant in the room remains the £40 million a year in PFI payments. Until we solve that problem, the challenges will remain. In the time remaining, will the Minister discuss that?

[Jane Ellison]

I will; in fact, that is on my next page. My hon. Friend is right to bring me to that. On the trust’s financial position, as my hon. Friends have mentioned, Monitor assessed Sherwood Forest Hospitals NHS Foundation Trust in 2012 and identified issues that had contributed to its deteriorating financial performance. The trust signed its £326 million PFI deal under the previous Government in November 2005 for the redevelopment of King’s Mill hospital. The trust’s PFI cash outflow equates to some 17% of its annual income, which is clearly a substantial amount. The operating costs for that scheme are inflating with the retail prices index by about £1.5 million a year. My colleagues are therefore right to raise that considerable concern.

The trust has received ongoing financial support directly from the Department of Health: it received £28 million in 2013-14 and £26 million in 2014-15. However, as my hon. Friends realise, it is important that I emphasise that such funding is not sustainable as it takes resources away from other areas. We therefore clearly need a better solution.

The trust forecast a financial deficit this year, but Monitor does not have any immediate concerns about the sustainability of services at Newark hospital. I put that on the record as a note of reassurance for my hon. Friend the Member for Newark. The trust recognises the challenge that its PFI payments present—that has come out clearly in my discussions—and it accepts that the solution lies in the full involvement of all partners in the local health economy. The Better Together programme for Nottinghamshire goes some way towards achieving sustainability, and local commissioners continue to work with Monitor and NHS England, as they need to, to find a solution.

I am aware that there have been suggestions locally that Sherwood Forest Hospitals NHS Foundation Trust should look at the route taken by Northumbria Healthcare NHS Foundation Trust and buy out its contract. However, the overall PFI deal for Sherwood Forest is much bigger than Northumbria’s, so a similar buy-out would incur a far greater cost. That is a note of caution.

The Department and the Treasury have discussed a range of options to reduce the cost of PFI projects in general, using public sector capital, including buying senior debt and terminating contracts completely. It is however for individual trusts to be clear about what options they have considered and to bring proposals forward.

Looking around the country, it is clear that the individual schemes have complexities, in terms of when they were signed, effective pricing and risk profile, so it is important both that such matters are looked at carefully at a local level and that the Department is engaged early on by trusts and foundation trusts when they develop their proposals, which will then be considered carefully by the Department of Health and the Treasury—and Monitor, if required—on a case-by-case basis for value for money and affordability. That is what happened in Hexham.

In the time left, I want to assure my hon. Friend the Member for Newark that my right hon. Friend the Secretary of State, as he said last year, will be happy to consider any proposals brought forward. We are very much open to that.

I am left with little time to comment on the ambulance services, other than to say that although we acknowledge that there are some big challenges, a resilience plan is in place and we will monitor that carefully. I end by congratulating my hon. Friends the Members for Newark and for Sherwood on bringing this important topic once again to Ministers’ attention.