Jeremy Lefroy (Stafford) (Con)

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In September 2012 the Royal College of Physicians published a report, “Hospitals on the edge? The time for action”, which sets out starkly the challenges facing our acute hospitals. It begins:

“All hospital inpatients deserve to receive safe, high-quality, sustainable care centred around their needs and delivered in an appropriate setting by respectful, compassionate, expert health professionals. Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions.”

It highlights the consequences of failing to meet the challenges and refers to the history of my own trust. When the public inquiry reports next month, we will have the opportunity to consider its implications for the NHS. Today I wish to concentrate on the Monitor review of my trust in the light of the continuing rise in pressure on acute services that the Royal College of Physicians highlights.

There are three common themes that I hear in the NHS these days. The first is that we need to do much more in the community and at home and much less in acute hospitals, and that we must therefore close acute hospital beds and use the money in the community. Although I agree with the premise, I dispute the conclusion. Community care is essential, but it must work before it results in a reduction in admissions and lengths of stay. The fact that admissions are rising and, according to the RCP, the fall in length of stay has flatlined in the past three years, even rising for patients over 85, indicates to me that the shift to the community either is not happening fast enough or indeed will not happen as expected.

The conclusion also seems to ignore demography. In the area served by the Mid Staffordshire Trust, the population is expected to rise by some 10% in the coming 23 years. The number of people over 60 will rise by nearly half, and the number of those 75 and older—those most likely to need acute services—will double. I suspect that is the situation in many parts of the country.

Increasing admissions, rising and ageing population, flatlining length of stays—all of these indicate an increased demand for acute services in the coming 20 years, yet the talk is, and has been for many years, of further reductions in acute beds. It makes little sense to do that until community services and other medical advances mean that those beds are proved to be no longer necessary. In Stafford, there is a shortage of step-down beds, so rather than closing acute beds altogether why not keep them as community beds on the same site, leaving the door open for increasing acute services in the future, if and when the need arises?

The second theme is that we need to integrate primary and secondary care more closely. I agree, yet actions sometimes have the opposite effect. The previous Government took away the responsibility for providing 24/7 primary care cover from GPs. I regret that, as it detracts from integration. It may also be responsible for placing a greater burden on accident and emergency departments at night. If out-of-hours care is not to be the responsibility of GPs, let it be centred, where geographically possible, on acute and community hospitals. This makes better use of NHS premises and, by being adjacent to A and E or other emergency units, can help take the pressure off them while providing the hospital with extra income. That would certainly work at Stafford and Cannock.

Tariffs can produce strange results. The University Hospital of North Staffordshire has a block contract for A and E admissions. For any admission in excess of that, it receives only 30% of the tariff, so what is it supposed to do—reject emergency admissions on the basis that they will be loss-making? Of course not. I would propose that emergency departments are funded at what it costs to provide that service safely. In Stafford, the emergency department has a deficit of some £2 million per year based on throughput and tariff. The number of patients attending—more than 50,000—could not possibly be safely accommodated elsewhere. Surrounding hospitals are already at capacity, so it makes little sense to impose a national tariff, which inevitably results in a loss and which in turn puts pressure on the hospital to prove that it is sustainable.

The third theme is that medicine is becoming increasingly specialised, so most work will inevitably migrate to large specialist units. There is truth in this belief, but there is also danger. There are 61 approved medical specialties in the UK, compared with 30 in Norway. As the RCP says, this has

“rendered the provision of continuity of care increasingly difficult.”

For older people, who often have complex and multiple needs, this can result in poorly co-ordinated care. This has not been helped by the introduction of shift-based systems under the new deal and the European working time directive, to replace the teams that took responsibility for individual patients. Specialisation also means that there is a much smaller pool of staff from which to select for each post.

If we were to design from scratch a hospital where those who will need it most— the elderly, as the statistics show—will receive safe and caring care for their complex needs as close to home and loved ones as possible, integrated into primary and community care, we would end up with something pretty much like the district general hospitals and community hospitals up and down the country, such as Stafford and Cannock.

This is not an argument for no change. I believe there must be much closer working between the larger and smaller trusts, for instance, and much more sharing of common services than at present. But it is a warning that national tariffs are not impartial arbiters. They generally work, I believe, against acute care.

Jeremy Lefroy

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I thank the hon. Gentleman for his intervention. I am not convinced that that is the case at all. I believe Ministers are listening and are considering matters very carefully, but there is a danger, of course, that a template will be inflicted. The hon. Gentleman and I both earnestly trust that that will not be the case.

As I said, I believe that national tariffs are not impartial arbiters. They generally work against acute care, and there is a risk that the constant pressure which they are placing on acute care, particularly in district general hospitals, will make much of the sector unsustainable, yet without it, we do not have an NHS.

Finally, I wish to raise a specific point about Monitor’s review of Mid Staffordshire. Clearly, the population served by the trust is a very important consideration. The trust’s 2011-12 report said that it was around 276,000, yet I have heard reports that the Monitor team considers it to be as low as 220,000 and therefore potentially too small to sustain certain services. The facts that I have clearly support the trust’s figure, not the one that I have heard rumoured.

I have spoken much today about figures, because they are an important part of the Monitor review, but more important is the quality of services, for which Monitor also has a legal responsibility. Early next year, the Secretary of State will bring to the House the report of Robert Francis QC from his public inquiry into Mid Staffordshire. Julie Bailey and the Cure the NHS group, who from their own experiences brought to light the harm that was done, have set out radical and clear ideas for turning the NHS the right way up, with the patient at the top, not the bottom—right first time with zero harm to each and every patient. That is something which caring, hard-working staff in our NHS in Stafford and Cannock—where waiting times and mortality rates are improving, although there is much to be done—and right across the country went into the NHS to provide.

The NHS, as the right hon. Member for Wentworth and Dearne (John Healey) said, and the nursing and medical professions must make it clear that there is no place for anyone for whom quality patient care does not come above all else. The regulations must show that.

The Monitor review is an opportunity for Stafford and Cannock hospitals to become a model of how to provide sustainable high quality emergency, acute and community care to a mid-sized population. If Monitor succeeds in achieving this there and elsewhere, as the hon. Member for Lewisham West and Penge (Jim Dowd) mentioned, it will have done the nation a great service, and I am sure the Minister will be remembered as someone who played a major part in improving our NHS. I urge Monitor to rise to the challenge.