Healthcare on English Islands

Justin Madders Excerpts

Wednesday 27th June 2018 Westminster Hall

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

It is, as always, a pleasure to serve under your chairmanship, Mr Hanson. I congratulate the hon. Member for Isle of Wight (Mr Seely) on securing the debate and on his very knowledgeable presentation of his constituents’ concerns and views. It is clear that health services on the Isle of Wight face challenges that, as he eloquently set out, are unique and require a tailored approach. However, there are similarities between the experiences that he reported and people’s experiences with health services throughout England.

When we think of the geography of England, there can be too little appreciation of the fact that England covers just five eighths of Great Britain, and includes more than 100 islands. Those islands are an intrinsic part of our nation, as you will know, Mr Hanson. Not too far from both our constituencies is Hilbre Island, which, although it has no resident population, is an important part of our area’s history and culture. Like Hilbre, the vast majority of islands do not have a permanent population. Most of those that do are connected to the mainland by road—examples are Canvey Island in Essex and Portsea Island in Hampshire—and, as a result, their healthcare services are very integrated with those of the surrounding areas.

As we have heard, however, there are islands, including the Isle of Wight, the Isles of Scilly and Holy Island, that are accessible only by sea and air, and they do not benefit from such ease of access. That poses serious challenges, particularly for the smaller islands, especially in emergencies, which of course cannot be planned for.

Before discussing the points made by the hon. Gentleman about the Isle of Wight, I will touch on the situation on some of the other islands in England. Many do not have their own medical facilities providing emergency care, because of their smaller populations. With the exception of the Isle of Wight, all our islands are served by NHS organisations based on the mainland. For those with road access, ambulances from the mainland can reach patients without undue difficulty. However, those without access have had to develop local approaches to providing support. Much of that support comes from volunteer community first responders, who reach patients before an ambulance can arrive to provide first aid.

On behalf of the Opposition, I pay tribute to all those who give their time to such services. They provide a vital lifeline in their communities. We do not speak enough about the role that volunteers play in our health service. I have seen for myself during a stint at my local ambulance station how volunteer responders can play an important role in assisting paid professionals. On that occasion, it was in a rural location, but the principles about access and timely intervention also apply there.

I understand that last year a volunteer first responder group was launched on Holy Island, which as we all know is inaccessible at high tide. Supported by the North East Ambulance Service, the group plays an extremely valuable role. There are similar groups across many of our islands.

In the time that I have served on the Front Bench, I have been privileged to visit several air ambulance services. They, too, play an extremely valuable role in providing urgent care in isolated areas. Again, much is down to efforts by volunteers and to fundraising, as they are of course charities. There was a reception at Parliament yesterday for the various regional air ambulances, and I was very pleased to see a great many parliamentarians attend to show their support. It is concerning to consider what the position would be for our island communities if those volunteer organisations were not involved.

Aside from the Isle of Wight, the Isles of Scilly are our most populous islands that can be accessed only by air or sea. Despite five of those islands being inhabited, there is just one minor injuries unit, at St Mary’s, so the island is hugely reliant on the five ambulance all-terrain vehicles that serve the island. Many non-emergency procedures have to take place on the mainland because of the need to access specialised treatment for conditions. The cost of accessing that treatment is usually met by the patient, when they are not in receipt of qualifying benefits. That can cause problems for a number of individuals.

As the hon. Member for Isle of Wight said, for those who live on the Isles of Scilly, a £5 concessionary fare on the Skybus to the mainland is available, but that covers the cost of the journey only from St Mary’s to Land’s End; there is the additional cost of the remainder of the journey. However, that is still a better situation than the hon. Gentleman’s constituents enjoy—or not, as the case may be. It was perfectly reasonable for him to raise that anomaly, which he described as an inequitable situation. He was also right to raise the issue of families travelling to the mainland. It is important that those faced with an extended stay in hospital have the support of family and friends.

The hon. Member for Isle of Wight set out three main arguments to show that his constituents are in a different position. He believes that the Isle of Wight is underfunded generally when it comes to health services. He made the point that it is the only English island separated from the mainland by sea that is without any kind of subsidy for patient travel. He also expressed a desire to integrate public services, particularly health and social care. He raised a point about the extra cost of providing public services on the Island, because of reduced capacity; that was no surprise to hon. Members. He said that services such as A&E and maternity are needed on the Island, because it is not possible to travel to the mainland in every emergency. He set out very well how that sometimes creates diseconomies of scale, and problems that require more working with mainland providers.

The hon. Gentleman made comparisons with the funding increases for other CCGs in recent years. He expressed a desire for his constituency to become a national leader in integrating local services. He will be aware that up and down the country there are a great many plans at various stages of development. It is clear that many communities are heading in the direction of greater integration between health and social care. On that point, I would be grateful if the Minister could indicate in his response whether he believes there is any need for legislation to bolster this development, particularly in terms of safeguards around governance and standards.

Earlier this year, the Labour party conducted a coastal communities consultation, which extended to the islands. The issues we have discussed this morning are exactly the kind of things that a future Labour Government would be keen to look at. We have heard that the Isle of Wight is a unique island in our nation, with such a large population being dependent on ferries to get to the mainland. As the hon. Member for Isle of Wight set out, the Island’s unique status has led to a unique response, in terms of the configuration of health services. The Isle of Wight NHS Trust is the only integrated acute, community, mental health and ambulance healthcare provider in England. The hon. Gentleman wants to increase integration further. As we also heard, in addition to the geographical challenges, there are demographic issues on the Isle of Wight. Its proportion of residents aged 80-plus is above the national average. That has an additional impact on health and social care costs. The proportion of patients with dementia is double the national average.

In response to some of the unique challenges the Island is facing, a service reconfiguration is being planned through the Hampshire and Isle of Wight sustainability and transformation partnership. That involves 89% of current hospital-based care remaining on the Island, with 11% of more complex and specialist treatments being provided on the mainland. It is clear that the hon. Gentleman would like as many of those treatments as possible to be dealt with directly on the Island, and for his constituents not to have to travel to the mainland to access them. I appreciate that that will not always be achievable, but I seek the Minister’s assurances that he will consider the measures that can be put in place to support those patients who will have to travel, and will often be in a vulnerable condition as a result of that. Will he confirm that the changes proposed are based on clinical, rather than financial, priorities? Will he also confirm that proposals will not lead to a reduction in the overall number of beds on the Isle of Wight? The STP document states:

“There would be no change in capacity at St Mary’s until actual changes in activity are put in place”.

That suggests that there may be some reduction in bed numbers.

The Isle of Wight NHS Trust was again rated inadequate by the Care Quality Commission as recently as April, and it remains in special measures. No fewer than 233 incidents were reported in which the NHS was found to be failing to meet its obligations to residents of the Island. I would be grateful if the Minister said what he is doing to improve the trust’s performance. The report recognised that there were some improvements, although those can never come quickly enough.

Finally, while many of the challenges facing our health service on the islands are unique, there are also many similarities in the challenges we face. One of those similarities is in the financial pressures trusts are facing as a result of the longest and most sustained period of financial constraint the NHS has ever faced. As a result of that, performance has deteriorated. Take the example of the four-hour A&E target, which the Secretary of State described as being critical for safe care. In 2010-11, 99% of patients were seen within four hours on the Isle of Wight, whereas today that figure has fallen to 88%. Some 22% of Isle of Wight cancer patients wait more than two months for treatment, which, again, represents a significant deterioration. That is not uncommon within other parts of the NHS.

The financial challenges faced by the Isle of Wight NHS Trust are deeply concerning, as the hon. Member for Isle of Wight set out, and I believe that they can be directly traced to years of austerity. As we have heard, the trust and the CCG will end the year in a significant deficit. The trust is having to take out more than £1.5 million in loans each month, which will have to be repaid. We have heard reference to the additional funding announcements made by the Prime Minister last week. We should acknowledge that those funding announcements, if they are delivered on, will represent nothing more than a standstill position, rather than an improvement on the current situation. It has also been confirmed that social care, capital spending and public health are excluded from that announcement.

In conclusion, I thank the hon. Member for Isle of Wight for the impressive way he set out the issues facing his constituents, and the unique challenges that face those on the Isle of Wight and our other islands. Giving the NHS the funding that it needs is at the core of all that.