North Middlesex University Hospital NHS Trust

Debate between Joan Ryan and David Lammy

Tuesday 12th July 2016 Westminster Hall

[Mr David Lammy (Tottenham) (Lab)]

I hesitate to interrupt my right hon. Friend, who is laying out the story so comprehensively. Is she as concerned as I am that many health professionals knew what was going on, but that MPs in the three boroughs covered by the trust were kept in the dark?

[Joan Ryan]

That was exactly the case and I am very concerned. It is not an exaggeration to say we were kept in the dark. All of us across Enfield and Haringey have, over the past year, raised the issue of North Mid in the Chamber at a local level and with Ministers at various times. We received no information until a recent meeting with the Minister, who, I am pleased to say, is here today. Prior to that, there was almost no answer to the points that we raised, other than to brush them aside with answers such as how much better the NHS is doing now than ever before. The phrase “kept in the dark” absolutely covers the situation, with those in the know including the likes of NHS Improvement, NHS England, the General Medical Council, Health Education England and, no doubt, the Department of Health. However, but for the actions of the General Medical Council and Health Education England, the situation for patient safety could be even worse.

I have had a number of meetings with the senior leadership teams at North Mid and at the Enfield clinical commissioning group, and many of the problems I will discuss today were not thought noteworthy enough to bring to my attention. If they were brought to my attention, the exposure of those problems was minimal, such that they did not raise the alarm bells that they should have.

In May, the severity of the situation at the hospital was discussed at a high-risk summit, involving several north London hospital trusts, clinicians and other stakeholders. MPs were not even informed that the summit was happening, never mind informed of the outcomes. I would be interested to know whether the Minister thinks that that state of affairs is acceptable given that our constituents have to suffer the consequences of the failures at the hospital. Even as of today, despite numerous requests, we have received no minutes of the high-risk summit and no account of what was discussed in any detail whatever.

Would the Government be willing to bring in early warning measures to ensure that MPs and constituents are kept properly informed about impending healthcare crises in their communities, rather than being notified after the crisis has hit? To do our job on behalf of our constituents—to safeguard their safety and interests in the use of and access to one of the most important public services any of us can imagine—we need some kind of early warning system. It is clear that very many people knew about the situation, but nobody who is accountable to the public at a local level was properly informed. I look forward to the Minister’s response to that point.

I am pleased to see my hon. Friend the Member for Edmonton (Kate Osamor) in her place, as the hospital is just inside her constituency, although it serves a large number of my constituents and constituents from Hornsey and Wood Green. I think it also serves practically the whole of Tottenham—my right hon. Friend the Member for Tottenham (Mr Lammy) is in his place, as is the hon. Member for Enfield, Southgate (Mr Burrowes). I am pleased to say that we have been working cross-party on the issue. Frankly, I will work with anyone—other hon. Members involved would do the same—who is willing to put the hospital first.

The CQC’s damning report into North Mid was published on Wednesday 6 July, and its inspection of the emergency department and two medical wards at the hospital was in response to a

“number of serious incidents…which had raised concerns about the standards of care”.

Between March 2015 and March 2016, there were 22 cases at North Mid’s A&E department where patients experienced serious or permanent harm or alleged abuse, or where a service provision was threatened. The CQC found that people were waiting far too long to be assessed on first arriving at the hospital, to see a doctor and to be moved to specialist wards in the hospital. The main experience of anybody turning up at the hospital’s emergency department was to wait, wait and then wait again.

The report tells of a lack of respect and dignity in how patients were treated, including a time when there was only

“one commode available in the whole of the ED”—

emergency department—

“to serve over 100 patients.”

Most people reading this will find that shocking.

Resources had been so stretched that, by the time the CQC issued its warning notice to the hospital in June, only seven of 15 emergency department consultants were in post, and seven of 13 middle-grade emergency doctors. As a consequence, junior doctors and medical trainees have been left unsupported by senior staff in A&E at night, including in emergency paediatric care. Junior doctors have been asked to perform tasks for which they are not yet qualified, and there have even been reports of receptionists with no medical training being used to triage patients, at least to the extent of deciding whether they should go to urgent care or the emergency department.

In February, A&E staff were so overwhelmed that patients, many of whom had already been waiting for hours, were told that they should go home unless they thought their illness was life-threatening. How can anyone be expected to know how ill they are without seeing a doctor? We have self-service checkouts in our supermarkets, but self-service A&E? I think not.

--- Later in debate ---

[Mr David Lammy (Tottenham) (Lab)]

I am grateful to have the opportunity to speak in this debate. The hospital serves almost the entirety of the constituency of Tottenham and has done ever since the closure of the Prince of Wales hospital in my constituency in the 1980s. It is important to emphasise that North Middlesex hospital is located in a strategically essential area. It serves not only the boroughs of Enfield and Haringey, but some of Barnet and Waltham Forest. Many years ago, when I was a Minister for Health, a neighbouring hospital, Whipps Cross, was a general hospital that on occasion struggled considerably with its emergency department, so I cannot emphasise enough that it is critical for the broader health economy of north-east London that the North Middlesex survives, flourishes and does well.

The concern that has been raised in this Chamber is really about how the situation has got to this stage over such a length of time, with so many Members of Parliament ringing alarm bells in a context where all of us have privately said, “We must tread carefully. We don’t want to talk down the hospital.” We say, “The chief exec seems to be…” as we whisper among ourselves. We do not want to talk down the hospital, but it has now got to the point at which we have to be absolutely frank about what has been happening at that trust, as we have heard, and we must ask some very hard questions about what has been going on.

I hope that the Minister will assist me on this point. There have been successive risk summits, meetings have been held, and the chief exec has asked for support, but I am not clear why support was not provided. In the old days, Members of Parliament would have been able to contact the strategic health authority and there would have been a clear line of leadership. We literally had two bodies to deal with: the strategic health authority and the chief executive of the trust. Frankly, chief executives went if they were not up to the job, and emergency teams were brought in to run the hospital. I did that as a Minister responsible for emergency care. I saw it happen in a range of trusts across the country as, under the Tony Blair Government, we pushed for the first targets of four-hour waits. I am struggling to understand how things have got to this level.

Life expectancy in a constituency such as mine is among the lowest in the country: men reach 74, six years behind the average life expectancy. We have homelessness and we have had two riots in a generation. The issues are clear, but what is not clear is who was in strategic charge? Why were meetings held in successive years? What is the role of NHS Improvement? Is it ever the case that anyone there would contact a Member of Parliament to say what they are doing to improve a trust? What is the role of NHS England’s London office? The individuals there are paid a hell of a lot of money—hundreds of thousands of pounds. Have they got a responsibility to contact a Member of Parliament to ask for a meeting or a conference call to speak to us about what is happening in the trust?

What is the role of Health Education England, which has been concerned about training and qualifications? We know the role of the General Medical Council, but has it been nobbled not to withdraw doctors by NHS England or any other body? What we have are numerous quangos. I have not even mentioned the clinical commissioning group. We have CCGs, HEE, NHS Improvement, NHS England London and the chief executive. The Government came into office determined to reduce the number of bureaucrats, but—my God!—each of us has at least 10 or 12. Then there are all the staff that work under them. Meetings have been held, but what has been done?

I have done the Minister’s job, so I feel for him. When I did his job, we did a lot of the running of the NHS from Whitehall. The Minister’s party came in and I understand why they said they could not run it from Whitehall, but we now have all these bodies and I am not clear what they have done. As a former Minister, I want to hear more of what they have been up to. I hope that the Minister will answer the question asked by my right hon. Friend the Member for Enfield North (Joan Ryan). Given that there have been CQC reports—the one that we had on the 6th is not the first—and risk summits, what is the obligation to inform Members of Parliament and therefore our constituents? At what point does that kick in? Or is it expected that that should be done solely by the trust? If it is, that is problematic if it is a failing trust in which the chief executive has been put on emergency leave. I have the CQC report before me and it says that safety at the hospital is inadequate, and so is responsiveness. As to whether it is well led—leadership is also inadequate, which is presumably why the chief executive has been put on emergency leave. Overall the hospital is inadequate. Under the headings of caring and effectiveness, it requires improvement. That is pretty damning. It does not get much worse than that.

Many hon. Members are concerned—and my right hon. Friend the Member for Enfield North, the hon. Member for Enfield, Southgate (Mr Burrowes) and I certainly are, having been around for a few years. We campaigned to get the PFI that put millions—I think it was £150 million—into building a brand new hospital. It is therefore deeply frustrating that we now have such an uphill struggle. Chase Farm has been mentioned and I will not discuss it again, but the Minister will recognise that we all rang alarm bells about the implications of closing emergency there. Money was put into the trust; yet it has got to its present situation.

I heard yesterday about the case of Mrs Alice Morfett, a 92-year-old lady who still went shopping in Morrisons. She had a heart operation in Barts and she was recuperating on the T3 ward. In the morning she told her daughter about her concern about a male nurse’s behaviour; she could not understand why he kept wanting to touch her chest. Her daughter said she did not believe Mrs Morfett and thought the anaesthetic had not worn off, but her mother complained about the nurse rubbing against her chest. After that Mrs Morfett was scared to ask for help. No one was summoned to help her. The next day, after an hour of asking for someone to take her to the toilet, Mrs Morfett tried to get out of bed herself and she fell. She ended up with huge open wounds; my constituent sent me a photo of the terrible wounds her mother suffered. Mrs Morfett died a couple of weeks later, and her daughter believes that she died as a result of her injuries. Mrs Morfett said to her daughter, “Please don’t let them get away with it; they have to pay for what they’ve done to me.” I do not lightly raise constituency case work in this way. I have used this letter because it is the latest one I have in a stream of letters from constituents about what is happening in the trust.

[Joan Ryan]

Such incidents are what the CQC calls “never” events because they should never happen: a patient dies, and it is not necessarily from medical issues or natural causes. I am sure that my right hon. Friend knows that the CQC report notes that one patient lay dead in a cubicle for four and a half hours last December because there were not enough doctors even to do the hourly rounds. It does not get much worse than that.

[Mr Lammy]

No, it does not, and that cuts to the critical issue of safety at the hospital. In fact, the problems at the hospital have been going on for well over two years. What happened to the hon. Member for Enfield, Southgate, who lay in the hospital with a burst appendix and who frankly would not be here but for a stroke of luck, says it all. How have we got to the situation where the local Member of Parliament is about to die of a medical emergency after waiting without being seen for 11 hours? He has been friendly—[Interruption.] Well, that is what happens with a burst appendix. The hon. Gentleman is looking well, but he is not that young. People die of a burst appendix if they are not treated.