Pennine Acute Hospitals NHS Trust

Justin Madders Excerpts

Tuesday 17th January 2017 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate my hon. Friend the Member for Blackley and Broughton (Graham Stringer) on securing this extremely important debate and on the knowledgeable way in which he introduced the subject. He set out the history of the concerns, which stretch back as far as the establishment of the trust. He made a powerful case about the need to give the people we represent in north Manchester the excellent health service they deserve.

My hon. Friend made the key point, which we should all reflect on, that life expectancy in that part of the world is much lower than in other parts of the country. We all want to see that improve. He said, and I agree, that there is a delicate balance between getting to the bottom of what has gone wrong and creating a credible plan for the trust’s future. I agree that the vast majority of clinicians at Pennine acute are highly committed and professional. He told us that he led a debate on the subject a decade ago. I have read extracts of the Hansard report of that debate, and many of the points that he raised then have been raised again today. We should all reflect on that. It is a completely unacceptable situation.

The hon. Member for Bury North (Mr Nuttall) said that the problems at Pennine acute are not all down to money, and that some of them date back to a time when the NHS was receiving record levels of investment, but I think that some of the staffing shortfalls are finance-driven—the Care Quality Commission report refers to the financial pressures. I agree that leadership is very much an issue, and that a period of stability is required.

My hon. Friend the Member for Heywood and Middleton (Liz McInnes) also spoke about having a period of stability, with great knowledge and experience from her long history of working in the NHS. She said with great eloquence that there seems to be a constant rollercoaster of change. She also pointed out that the trust is undergoing two initiatives, which seem to be pulling it and the staff in slightly different directions. She highlighted very well the anxiety that the staff feel about their future, and said that we need a period of stability. She also highlighted the maternity services’ funding issues, and said that they are dealing with about three times as many births as they receive funding for. If correct, that is an unsustainable situation.

My hon. Friend the Member for Oldham West and Royton (Jim McMahon) also has significant connections with the trust. He described it as a family, but he was right to say that that should not mean that we cannot ask difficult questions about what has gone on. He conveyed how demoralising it is for the staff who work there. He said that leadership is a key issue, as did the hon. Member for Rochdale (Simon Danczuk), who also said it is about capacity and resources. I think we all agree that leadership was lacking in the past, but most Members who spoke were positive about the new leadership.

I, too, pay tribute to everyone working at Pennine Acute Hospitals NHS Trust. As Members said, it is not an easy time for them. It is not an easy time for anyone working in the NHS, let alone for those who work in a trust that has been the subject of such negative coverage. We should be mindful of the fact that the crisis currently engulfing the whole of the NHS would be so much worse if it were not for the good will of the staff who go above and beyond the call of duty every day. As my hon. Friend the Member for Oldham West and Royton said, we should be extremely grateful for the contribution they make. I recognise how difficult it must be to work in a trust such as Pennine acute. As he said, it has sadly been in the headlines all too often for the wrong reasons. It is worth pointing out that the most recent CQC report into the trust rated the leadership inadequate, but rated the care good. Although we are deeply concerned about the reports about the trust, we recognise that the vast majority of staff are extremely dedicated and caring.

No one can read the CQC report or the other reviews that have been published without feeling deeply uncomfortable about what has gone on at Pennine acute. The report should be a wake-up call for the wider health service. It talks about low morale, severe staff shortages and, worryingly, a feeling among staff that until recently the culture focused on financial matters and operational delivery, rather than quality. We hear such concerns across the whole of the health service. I am not for a minute suggesting that the most concerning incidents at Pennine acute will be repeated, but we should recognise that the pressures that we hear about in Pennine acute can be found in many other trusts up and down the country. The history of this matter should act as a warning to us that such problems cannot be ignored and will not be resolved without effective interventions and leadership.

The CQC report made it clear that the issues it outlined are not new. To paraphrase it, they appear to be part of the culture at Pennine acute. As my hon. Friend the Member for Blackley and Broughton said, there is a strong resemblance between the CQC report and a 2005 report by Sir George Alberti, which was very critical of the trust. The only real difference between those reports is that the severity of the criticism has grown. During that decade, there was inaction, patients and staff were let down, and there was a lack of leadership. Although there are concerns about a number of services, the most serious issues appear to be with maternity services, where the CQC said it found

“a poor culture with deeply entrenched attitudes where some staff accepted sub optimal care as the norm…and specific needs were not appropriately considered or met.”

As we have said several times already, this is about leadership. Although it is not right to point a finger at individuals on this occasion, it seems that there have been repeated failures over many years and at many levels, and a failure to drive the changes needed to improve outcomes for patients. I was particularly concerned by the statement that not all reportable incidents were reported on the system because

“there was often no managerial response or feedback.”

The CQC report also says:

“Incidents and risks were not escalated in a timely way or at times not escalated at all; consequently they did not gain robust executive scrutiny or the required response from managers and the senior team.”

Although the report says that only some departments failed to respond correctly, it is deeply troubling that it happened at all. We can see why some of those incidents happened: there was a culture in which reports were not acted upon.

There were other warnings. Between 2010 and 2015, the trust paid the highest number of compensation claims of any trust within the NHS Litigation Authority. As my hon. Friend the Member for Blackley and Broughton said, in one year the compensation totalled £58 million. Compensation levels in maternity claims obviously tend to be extremely high, but no one could claim that those figures did not require further investigation and more action. However, only after the CQC inspection of February 2016 was decisive action taken.

In July last year the Manchester Evening News learned from a whistleblower that an internal review had been carried out into maternity services at North Manchester general and Royal Oldham hospitals. Unfortunately, the newspaper’s requests for a copy of the review were repeatedly sidestepped, until eventually, in August, the trust stated that the review did not exist. It was handed over only after further requests to the trust and the intervention of the Information Commissioner. What does denial of the report’s existence say about the trust’s defensiveness, secrecy and unwillingness to learn from mistakes?

As we have heard from Members today, the report painted a deeply concerning picture of a chronically understaffed service unable to provide patients with the level of care that they deserve. We have heard of incidents such as a mother dying of a catastrophic haemorrhage after her symptoms were attributed to mental illness; a baby who died because staff failed to identify the mother’s rare blood type; and a patient who was left with a colostomy because her condition was missed three times.

My hon. Friend the Member for Blackley and Broughton read out the most distressing of those reports, which was the case of a premature baby. It is incredibly difficult for us to comprehend just how distressing that must have been. I agree with him that that incident was inhuman. We cannot undo that terrible event, but we can do our best to prevent it from being repeated and to ask the pertinent question of why the warning signs, which occurred over a number of years, did not bring about more effective change. Only after the CQC got involved did change begin.

It is also deeply concerning that only the diligence of a single journalist at the Manchester Evening News pushed the issue of the internal review into maternity services. When the Minister responds, will he agree that steps should be taken to unearth the full extent of what happened at the trust, so that we may learn the right lessons for the future?

Members who have spoken in the debate have recognised that the leadership of Sir David Dalton since April has been received positively. The CQC has recognised the improvements made since his appointment. As the hon. Member for Bury North said, even an individual of Sir David’s ability, however, cannot be expected to lead two trusts, as large as they are, as well as carrying out his other responsibilities. I will welcome any comments the Minister might have about the long-term leadership at the trust.

The CCG has, I understand, been able to invest an extra £9 million, but the Government have not allocated any additional funds to the trust, as would usually be the case with a turnaround effort of that nature. The Secretary of State acknowledged that improving Pennine acute would be “incredibly difficult”, but suggested that it was possible after citing the example of the Frimley Health Foundation Trust. According to the Health Service Journal, however, Frimley Health will receive £90 million in revenue support, as well as £130 million of capital funding. Is the Minister therefore satisfied that the trust has the resources not only to maintain services in an incredibly challenging climate, but to drive through the improvements that are clearly needed?

Over the years, many opportunities to turn the trust around have been missed. I hope that the Minister will be able to satisfy us that this is a turning point and that we will not be back here in 10 years’ time with another set of patients and staff who have been let down badly.