Queen Elizabeth Hospital, King’s Lynn

Debate between Jerome Mayhew and James Wild

Wednesday 23rd March 2022 Westminster Hall

[James Wild]

I am grateful to my hon. Friend for his support and words. He is absolutely right; I think his constituency has the oldest average age in the country, and that poses particular needs. My constituency and that of my hon. Friend the Member for Broadland (Jerome Mayhew), who has joined to support the debate, also have challenges, so we need to ensure that the care is in place. There is also a lot of planned housing growth in the area. The demand is strong across our constituencies, and in Lincolnshire and Cambridgeshire, which is why it is important to show the strength of support for the hospital across Norfolk and beyond.

When compared with the turnover, the level of capital programme is significant, and it is important to acknowledge that the programme is being managed well. QEH has submitted a further bid for £18 million for an orthopaedic centre, as part of the funding to tackle the backlog. Given that it is the area with one of the longest waiting lists for QEH, I strongly endorse that bid, and encourage the Minister to approve it when it comes to his desk. Seeing is believing. When the Secretary of State visits QEH—which he has agreed to and I hope will happen soon—he will see those improvements, but he will also see the props and the very real need for investment. My hon. Friend the Member for North Norfolk (Duncan Baker) will be able to join him on that occasion or another, as he will be very welcome.

As well as the structural issues, the hospital has outgrown its footprint. The emergency department sees 70,000 patients a year—more than double what it was designed for. The layout of the hospital does not meet modern care pathways, with too few consulting rooms, and wards well below the recommended size.

[Jerome Mayhew (Broadland) (Con)]

I am grateful to my hon. Friend for giving way. I wish to add my voice to the support he received from my hon. Friend the Member for North Norfolk (Duncan Baker), and to highlight the importance of this hospital as a regional centre of excellence. It does not support only the constituency of my hon. Friend the Member for North West Norfolk (James Wild), but also those of North Norfolk, Broadland and further afield.

I pose this question: what impact does receiving care in a building where the ceiling is maintained by acrow props have on the patient’s confidence in the care received?

[James Wild]

My hon. Friend gets to the nub of the issue, which is the impact of this situation on patients. The previous Secretary of State for Health came to the hospital, saw that and spoke to patients in those beds. They made light-hearted remarks, but they were concerned about the safety of the building after seeing props and timber supports. Of course, the trust is doing all that it can to manage that risk, but the risk of catastrophic failure remains, which is why it is rated red on the risk register.

The hospital cannot cope with the current demand. NHS modelling shows a 64% increase in overall floor space is needed to maintain services and meet future demand, with lots of housing planned in the area. In short, QEH needs to be replaced. The case is compelling to take this once-in-a-generation opportunity to have a hospital fit for the future. QEH has submitted proposals to the new hospitals programme for a single-phase new build on the existing site to meet current and future demand. The plans put forward would eliminate RAAC, and transform and modernise local healthcare, integrating primary, community, mental health, acute, social care and the third sector in a health and wellbeing village.

However, this is not about having shiny new buildings for their own sake; it is about delivering better health outcomes in some of the most deprived areas in the country that the Government have recognised as priority 1 areas for levelling up. It is also about an anchor institution—the QEH in west Norfolk—combining with the new school of nursing studies, which will be funded through the Government’s town deal, to help the NHS workforce by boosting local opportunities to develop skills and careers in our healthcare sector. It is also about promoting sustainability by using modern methods of construction and net zero principles, and maximising the use of digital technology.

It is important to recognise that the trust going from inadequate to good in the well-led domain in this inspection is a significant achievement, which provides confidence that this is a trust capable of delivering the new hospital that the patients and staff in west Norfolk need. A lot of hard work and engagement has gone into developing the plans and the scheme is highly deliverable, with a strategic outline case well advanced and on track to go to the June board meeting.

QEH’s bid is backed by 4,000 staff at the hospital. Stuart Dark—the leader of West Norfolk Borough Council—as well as all the councillors and the county council are supportive, as is the Norfolk and Waveney integrated care system, and at least seven right hon. and hon. Members, including my hon. Friends the Members for North Norfolk and for Broadland. The Prime Minister’s Chief of Staff—the Chancellor of the Duchy of Lancaster, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay)—and the Foreign Secretary also back the bid, and it enjoys local support, with more than 15,000 people having signed a petition backing a new hospital. It is essential that we have an acute hospital in this geographic area. The plans that have been put forward would deliver major improvements to care, patient outcomes and staff experiences. An alternative multi-phase approach has also been put forward. It would, of course, be an improvement on the status quo, but it would not deliver the same benefits or value for money as a single-phase build and would not be delivered in the required timeframe.

My constituents in North West Norfolk are frustrated by the delays in the timelines for the new hospital selection process, as am I. That will not come as any surprise to my hon. Friend the Minister; I confess publicly to bugging him and my right hon. Friend the Secretary of State repeatedly for decisions on the shortlisting of these hospitals. I press the Minister today: when can we expect to hear a decision on the hospitals that will go through to the next phase of the programme? What implications does the delay have for the final decision on the eight schemes to be selected, and for getting design and construction under way? I encourage him to do all he can to move this process forward as rapidly as possible.

Over the last three years, there have been real changes at QEH and patients are getting better care. The leadership has demonstrated that it can drive sustained improvements, and move to a position where staff feel supported and valued, and where there is a strong focus on improved patient care and outcomes. Now we have an opportunity to build—literally—on that progress, to provide the major investment to modernise the hospital, to improve care further and to support the trust’s strategy to be the best rural district general hospital.

The Government and the Department of Health have already committed to removing deficient RAAC from the estate by 2035. However, experts on RAAC have said that for QEH the end-of-life deadline is 2030 and that the risk will only worsen. There comes a point where it no longer makes sense or represents value for money to keep propping up the roof. I would contend that we are past that point. Indeed, in the report that set out the significant improvements needed to QEH, the CQC said that

“The trust’s most substantial risk was the safety of the roof structure”

and that there is a

“need for long term solutions to the estate problems.”

As well as having serious structural issues, the current hospital cannot meet the current or future demand. The only long-term solution is a new hospital to deal with the RAAC issues, meet demand and serve patients. By selecting QEH as one of the eight new hospital schemes, that inevitable need for replacement will become part of a funded programme, rather than an unplanned demand requiring repeated emergency funding. I urge the Government to include QEH as one of the schemes. The people of North West Norfolk and beyond deserve nothing less.

Cawston Park Hospital: Norfolk Safeguarding Adults Board Review

Debate between Jerome Mayhew and James Wild

Tuesday 21st September 2021 Commons Chamber

[Jerome Mayhew (Broadland) (Con)]

We are here this evening because of Joanna, Jon and Ben. Joanna had autism and was epileptic, Jon was autistic too, and Ben had Down’s syndrome. Their learning disabilities led to mental health difficulties, and they were consequently sectioned under the Mental Health Act 1983 and sent to the private Jeesal Cawston Park Hospital in my constituency. It is an assessment and treatment unit, and assessment and treatment is exactly what was meant to happen to these people: they were meant to be assessed and then treated, the objective being their discharge back into community care. But that did not happen.

Joanna was kept in the hospital for 11 months before she died in April 2018. Jon was kept in the hospital for 24 months before he died in October 2019. Ben was kept in the hospital for 17 months before he, too, died, in July 2020. All of them were in their early 30s, and all of them suffered from neglect. They were neglected through uncontrolled weight gain, through a lack of meaningful physical or mental activities, and through a lack of effective treatment through continuous positive airway pressure—CPAP—machines, which help people to sleep at night. The staff neglected the raising of concerns by members of their families; and, worst of all, they neglected even to attempt to resuscitate them when resuscitation was desperately needed.

Joanna was found unresponsive in her bed. A nurse and five carers—all of them trained—attended, but not a single one attempted resuscitation. Joanna died. Jon had swallowed a piece of a plastic cup. He told staff:

“I cannot breathe. I am dying.”

The CCTV footage proves that the staff just stood there for several minutes without attempting resuscitation. He died.

The day before Ben died, it was obvious that he was extremely unwell. He had blue lips and blue nails because of a lack of saturated oxygen in his blood. His mother was there on a visit and she raised the alarm. She demanded that an ambulance be called, but the hospital refused. Even later that day when Ben’s oxygen saturation levels were measured and found to be 35%, no ambulance was called. He died. The hospital neglected the families, and neglected to use their expertise and experience.

The families describe indifferent, harmful hospital practices, excessive use of restraint and seclusion by unqualified staff, and overmedication. A mother has contacted me in the past week to describe her child’s matted hair, her uncut fingernails and toenails, and the soiled clothing piled in a corner of the room. By chance, CCTV footage reviewed after Ben’s death uncovered a casual physical assault on him by a carer on the day he died. He was pulled down by his arms and then slapped around the head. What have we not seen?

This was supposed to be a specialist assessment and treatment unit, yet records were not even kept by the hospital for prolonged periods. Joanna was at the hospital for 11 months, but there are no records for 179 days of those 11 months. Ben was there for 17 months, but for an amazing 450 days during that 17-month period, no records were kept. So what assessment was undertaken? What treatment was given? My first request of the Minister is this: we need to acknowledge the scale of this scandal and its impact on real people, the most vulnerable in our society. We also need to acknowledge that we should all be ashamed.

This is not unique. We have heard this before. It sounds familiar, and that is because exactly the same thing happened at Winterbourne View Hospital back in 2012. We have had the report. This was another assessment and treatment unit where people with learning disabilities or autism were abused. The 2012 report criticised the development of assessment and treatment units, saying that they were

“not part of current policy, and certainly not recommended practice…Containment rather than personalised care and support has too easily become the pattern in these institutions.”

Of course lessons were learned. Department of Health reports described the abuse of people at Winterbourne View Hospital as “horrifying”. A Department of Health programme of action was agreed, and I have it with me today. Following the statement:

“We the undersigned commit to a programme for change”,

the very first undertaking is that

“Health and Care Commissioners will review all current hospital placements and support everyone inappropriately placed in hospital to move to community-based support as quickly as possible and no later than 1 June 2014.”

That did not happen. Today, in 2021, more than 2,000 patients are still contained in assessment and treatment units. I use the word advisedly: they are “contained”.

This is my second request to the Minister. Will she, on behalf of the Government, recommit this evening to the needed closure of all assessment and treatment units? That is what the coalition Government committed to doing in 2012, but by 2014 it had still not been done. We need to do it now. Why do we need to do it? There is a monumental conflict of interest for these private hospitals. Beyond being merely inhumane, there is a huge commercial incentive to maintain residency, because each of these patients comes with a fat cheque of £26,000 per month.

We can see where the conflict lies and why one family member, when they went to Cawston Park Hospital, was handed a piece of paper on which was written the address of a firm of solicitors. Her statement said:

“Once people are in Cawston Park Hospital you can’t get them out.”

Patients did not leave Cawston Park Hospital, and the problem is structural. If a hospital is paid £26,000 a month to assess and treat a patient, is it surprising that the hospital does not release them?

We have had another review of this latest scandal, and the Norfolk Safeguarding Adults Board’s review of Cawston Park Hospital is excellent. I have read it. It is 105 pages long and there are 13 recommendations. I recommend it wholeheartedly to the Minister, and the Government should apply all the recommendations.

The report has been followed by the usual handwringing responses from the agencies. Action plans have been created and there have been multidisciplinary stakeholder reviews. Profound apologies have been given, and I believe they are profound apologies. Lessons have been learned, but in my submission they have not really been learned, because without a profound culture change in residential care, we will be back here again. We all know it and the public know it.

[James Wild (North West Norfolk) (Con)]

I am grateful to my hon. Friend for securing this debate on the tragic events in Norfolk and for the powerful case he is making.

One of the most alarming elements of this very shocking report is the final hours of Ben, which my hon. Friend mentioned. Ben’s mum, Gina, said:

“If you ill-treat an animal, you get put in prison. But people ill-treated my son and they’re still free.”

That is completely unacceptable, and the police and the authorities should look again at all the leads and all the evidence to hold those people to account.

[Jerome Mayhew]

My hon. Friend is absolutely right that management teams and owners should personally fear prison as a response to a culture failure. If a culture of neglect is tolerated by their acts or, more likely, by their omissions, there needs to be personal liability. People need to fear prison, because there will be no change without individuals being held personally to account for allowing this culture of indifference. I profoundly hope that the most rigorous investigations are undertaken by the police and the Care Quality Commission, with a focus on individual prosecutions if justified by the evidence. There have been no prosecutions to date.

More generally, and widening the conversation away from the individual, directors need to be held to account if we are to restore public trust in the system. The Law Commission is aware of this, and it is undertaking a consultation on the issue of corporate criminal liability. It is consulting on how we can make improvements primarily, in the first instance, in economic crime, but how much more important is it to get equity where the victims are the most vulnerable in society, people in care, people who cannot argue their own case because of their age, because of illness or because of their condition?

The current rules on the definition of a controlling mind are often too narrow for individual prosecutions to succeed. The legislation has been on the statute book since about 2007, and there have been hardly any successful prosecutions because of that narrow definition. This needs to be changed.

I am meeting the Law Commission in October, along with the authors of the Safeguarding Adults Board review, to press the case for a widening of the definition to make the people who run such hospitals fear personal prosecution, because that is how we will change the culture.

That leads me to my third request of the Minister. If she really wants to prevent a repeat, will her Department commit to making a submission to the Law Commission consultation on criminal corporate liability so that we strengthen the personal responsibility for providers of residential care? The Chinese general Sun Tzu, who is very famous now, said “Kill one, terrify 1,000”, and he was right. The problem is that families of patients are concerned; they are the ones who are fearful and have no confidence in the current system. They fear the consequences and we need to change that; it should be the directors of care businesses. If they allow abuse and neglect, they should be fearful—they should pay with the fear of a prison sentence. Only then will we get change.