Healthcare: East Midlands

Debate between Karen Lee and Ruth George

Tuesday 30th April 2019 Westminster Hall

[Karen Lee (Lincoln) (Lab)]

I beg to move,

That this House has considered provision of local healthcare in the East Midlands.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am glad to have secured this crucial debate, which gives me and my east midlands colleagues a great opportunity to highlight the healthcare crisis in our constituencies, our region and across the country. I must stress in everything I say that I do not blame the hard-working and dedicated staff for any of it; the fault lies fairly and squarely with Government cuts. Our constituents deserve better than the past decade of under- funding, which has created a postcode lottery in local healthcare. It has had particularly detrimental implications for my constituency of Lincoln: local healthcare centres have been forced to shut, more general practitioners’ services are at risk of closure in the coming months, and local hospitals are in need of considerable funding and support.

Our healthcare infrastructure in the surrounding region of Lincolnshire has also been put under considerable pressure over the past nine years. In July last year, the chief inspector of hospitals recommended that United Lincolnshire Hospitals NHS Trust, which has a deficit estimated at £80 million, should remain in special measures. The latest figures show that the trust missed its A&E waiting time target by 32% and has not met the national standard since September 2014.

The east midlands reflects the national picture of a health service in crisis. The Government have spent nine years running down the NHS by imposing the biggest funding squeeze in its history, with massive cuts to public health services. Social care has been slashed by £7 billion since 2010. Our NHS is short of 100,000 staff, including 41,000 nurses and nearly 10,000 doctors. That has had a detrimental knock-on effect on performance: waiting lists are at 4.3 million, more than 500,000 patients are waiting more than 18 weeks for treatment, and 2.5 million people are waiting for more than four hours in A&E. That is a crisis.

It is clear that the underfunding, privatisation and inadequate staffing of our health service has had a devastating effect on healthcare provision in Lincoln and the east midlands. Government decisions have had terrible consequences for people who need care in the areas that I and many of my colleagues represent. That is typified by the recent announcement that the highly relied-on Skellingthorpe surgery may close.

For those who do not know it, Skellingthorpe is a beautiful village in my constituency. Its doctors surgery provides healthcare to more than 8,000 patients, many of whom are local residents. The national patient survey found that 81.9% of the surgery’s patients felt that their overall experience was good or very good. The Glebe Practice, which runs the surgery, is in the process of proposing its closure to the clinical commissioning group, and the practice’s patients are centralised in its Saxilby surgery. I acknowledge that there are pressures on the service—there could not fail to be, given the Government’s cuts—and that the practice is struggling to recruit clinicians, so centralising its service in Saxilby allows it to maintain quality in one surgery. However, centralising the service restricts my constituents’ access to care. They have told me that it is already very difficult to book a timely GP appointment there.

As many other hon. Members will know from their own constituencies, rural areas are often inaccessible because of limited transport links. If the Glebe Practice’s plan to transfer patients to its Saxilby practice is agreed to, it will mean patients having to travel on public transport—remember, not everybody can drive or has a car—or walk for 90 minutes from the Skellingthorpe surgery. Even the closest surgery is about a 40-minute walk away. Imagine elderly people having to walk for 40 minutes!

This is a shocking downgrade of my Skellingthorpe constituents’ access to care. The proposed alternatives do not offer an acceptable journey length to patients who are in need of health services. Many patients may struggle with mobility issues because of age or illness, while others may not be able to afford to travel other than by public transport.

[Ruth George (High Peak) (Lab)]

My hon. Friend is making an excellent speech that sets out the challenges to healthcare in rural areas such as Lincolnshire. Just this week, the wound service in one of our local clinics in High Peak has shut. Elderly patients with open wounds are having to travel for four hours each way, on three buses, to access the clinic that they are supposed to go to. Does my hon. Friend agree that that is absolutely unacceptable?

[Karen Lee]

Yes, I do. I hope that everybody in this Chamber would agree that that is really unacceptable.

Rather than reducing access to one-to-one healthcare, we should be outlining how we can help groups such as the Glebe Practice by implementing effective national programmes that incentivise recruitment in rural areas. There is a major workforce crisis: as a report co-authored by the Nuffield Trust, the King’s Fund and the Health Foundation has found, the NHS could be short of 7,000 GPs within five years. Rural areas will be the first to be hit. As access to GP services in the east midlands is reduced, I urge the Minister to take action to address the staffing crisis.

Before the surgery closes, Lincolnshire West CCG intends to hold a public consultation—but the people of Lincoln have been there before, very recently. Lincoln’s walk-in centre on Monks Road closed last year after an allegedly meaningful public consultation, 94% of respondents to which were opposed to the closure. Protests were held outside Lincoln County Hospital and along the high street. Both Conservative-led Lincolnshire County Council and Labour-controlled City of Lincoln Council formally objected to the closure, as did I, but not a bit of notice was taken—the centre was still closed. The justification was similar to the one being given now for the Skellingthorpe closure: we were told that there would be sufficient alternative provision to ensure the same level of care. After researching that claim, we found that no substitution would come anywhere near the accessibility of the walk-in centre, so I am afraid that my constituents’ faith in any local consultation is pretty limited.

Appointment-only slots will not meet the needs of my constituents who rely on short-notice, timely access to care. Inevitably, they will only add to the pressure on the overworked A&E department at Lincoln County Hospital and East Midlands ambulance service.

I am very concerned that a trend is emerging: the implementation of cuts to healthcare services, in direct opposition to local people’s wishes and needs. It is deeply worrying that CCGs are not listening to residents’ concerns before closing local health services. I completely acknowledge that there have been sustained budgetary pressures on the healthcare system over the past nine years, and that it is the CCGs that are expected to deliver large-scale cuts, but in a transparent health governance system we cannot allow cuts to be rubber-stamped against such clear local opposition.

I ask the Minister to consider these cases and contact me to provide substantial reasoning to explain why another closure in my constituency is considered acceptable. The information that I and my constituents have been afforded has led us to the opinion that neither the walk-in centre nor the Skellingthorpe surgery should have been considered for closure. I am sorry, Minister, but passing the buck to the CCG is not good enough for my constituents.

It is not just local GP practices and health centres that have been put under debilitating pressure over the past decade. In my constituency, Lincoln County Hospital serves the city of Lincoln and the north Lincolnshire area. Due to funding and staffing pressures, the latest Care Quality Commission inspection has found that Lincoln County Hospital is below the national standard and requires improvement. It is important to stress that, as is the case in hospitals throughout the UK, this substandard performance is in no way the fault of the dedicated and hard-working staff. I speak from experience: when I was a nurse there, we often used to stay up to an hour late. In theory we got our time back, but in practice we did not.

The staff give a lot—it is not their fault. I worked as a nurse at Lincoln County Hospital for 14 years and I know how much energy and care all the staff, from porters to doctors, put into their challenging work. That is supported by the CQC report, which concluded that the hospital requires improvement in four out of five areas: safety, effectiveness, responsiveness and management. The only area rated as good was the caring nature of the hospital. As the report states repeatedly:

“Patients were treated with compassion, dignity and respect.”

I pay credit to the hard-working staff for that, but they are being let down by a Government who have consistently neglected our health services. I have been through their cuts myself.

The inspection found that nurse staffing numbers were often insufficient to keep people protected from avoidable harm and that the hospital relied heavily on agency and locum staff. I know that at first hand: my friends who are still nurses there tell me that that is true even now. Most worrying was the fact that adequate levels of nurses were observed on only four of the 28 days that the CQC reviewed. It is hardly surprising that there are such drastic staffing shortages. Since 2010, there has been a 19% real-terms fall in weekly earnings for full-time nurses. Nursing degree applications have dropped by one third since the Government scrapped nursing bursaries, without which I would not have been able to train. I go on and on about the nursing bursary, and I will not stop. We need to bring it back; we will not have enough nurses until we do.

The Health Foundation has also found that the number of nurses quitting because of a poor work-life balance almost tripled between 2011 and 2018. Our NHS staff should be celebrated and supported. Their kindness and commitment should not be taken advantage of by a Government who strip away the security of their profession. Lincoln County Hospital demonstrates the devastating way in which avoidable staffing shortages affect vulnerable patients in our communities.

The CQC report also found that patients could not always access care and treatment in a timely way. Waiting times were worse than the England average and did not meet the national standard. Some 60% of ambulance handovers were delayed by 30 minutes or more, and 47% of patients in A&E waited longer than the recommended 15 minutes to be triaged. I went out with an ambulance crew about a year ago, and I saw that at first hand.

That shows how hard-working, committed NHS staff in Lincoln are being put under intolerable pressure by decisions made in Whitehall. That is not unique to Lincoln. In July last year, England’s chief inspector of hospitals recommended that United Hospitals Lincolnshire NHS Trust should remain in special measures after visits to Lincoln County Hospital, Pilgrim Hospital, County Hospital Louth and Grantham and District Hospital. Pilgrim Hospital in Boston, which serves my constituents, is a particularly worrying case. It received an overall rating of “inadequate” in this year’s CQC inspection. The report found that there was no allocated corridor nurse. Corridor nurse—really? Should people be in corridors on trolleys? One nurse was caring for up to 21 patients at one time. When I was a nurse, the average was about six or eight. On a bad day, if someone did not come in, it could be 10 or 12, but 21—really?

It is clear that at the local, regional and national level, healthcare provision is not working. Vulnerable people who need care in Lincoln, the east midlands and across the UK have a right to access the health provision that they need. That requires a properly funded and staffed NHS service, from local GPs to county hospitals. Although I welcome the Government’s planned funding increase for the NHS, most health experts agree that it is barely enough to keep the NHS afloat, let alone reverse nine years of severe funding cuts. Areas such as Lincoln and the east midlands need and deserve much more than a plan that will barely keep afloat a system operating on a shoestring budget.

As someone whose job used to be to provide local healthcare, I am lifted by the fact that everyone can access healthcare as a human right in this country, but that universal right is threatened by policies that do not enable an effective health service in which everyone can access care based on their need, not on the austere policy decisions of the Government of the day.

East Midlands Ambulance Service

Debate between Karen Lee and Ruth George

Wednesday 21st February 2018 Westminster Hall

[Ruth George]

We can always seek to manage resources better, but East Midlands ambulance service has been seeking to manage resources for a very long time, working with Unison and the unions there.

[Karen Lee (Lincoln) (Lab)]

Does my hon. Friend agree that the closure of Lincoln’s walk-in centre, despite the fact that 94% of the people who responded to the consultation said that they did not want it to close, cannot fail to have a further impact on EMAS and local services? We are told by the clinical commissioning group that it will not have an impact and that there will be other provision, but the local ambulance teams—I will come to this point when I give my speech—told me that it will absolutely have an impact. I wonder what her thoughts are on that.

[Ruth George]

Walk-in centres were established by the last Labour Government to reduce the demand on the ambulance services and to give people the services that they actually needed on their doorstep. Every cut of every walk-in centre is hugely worrying, both for patients and the ambulance service.

--- Later in debate ---

[Ruth George]

The fact is that walk-in centres are open late in the evenings and at weekends, and in most GP practices it is not possible to get an urgent appointment without phoning at 8 am exactly. In my constituency, people have to wait at least two weeks to get an appointment.

[Karen Lee]

When I went out with the ambulance team, one of the people who called and got an ambulance was an elderly gentleman of 91 who had breathing problems. He called an ambulance because he could not get a GP appointment or get to the walk-in centre at that point. It is not always people who are desperately ill who call ambulances; lots of people call ambulances in sheer desperation because they cannot get anything else.

[Ruth George]

That illustrates the point completely. We have seen a lack of primary care services, and doctors’ appointments are far harder to get than the 48 hours it took under a Labour Government. In consequence, we have a hugely overburdened ambulance service.

Now we come to funding. East Midlands ambulance service is already one of the most efficient in all the regions. In spite of the relatively sparse population and demanding geography, EMAS’s costs per face-to-face response are the third-lowest of all the regions—9% lower than the average across England. The costs per call are, again, the third lowest and more than 10% below the average.

By any measure, East Midlands ambulance service is very efficient, with 99% of its staff working on the frontline. Almost all managers take shifts so that they know exactly what is going on. It has cut all that it can, and it has had to make cuts, because EMAS has the second-lowest funding of all the regions—8% lower than the average across England. Only the North East ambulance service, which serves a more densely populated area, has lower funding than the East Midlands ambulance service.

The funding has not kept pace either with inflation or with the increased demand—in fact, it has barely increased at all in the last six years. In 2010-11, EMAS received £160 million for patient care activities. By 2016-17, we had seen over 16% inflation and a 50% increase in activity. Funding should be at least two thirds higher—£105 million extra would be the proportionate cost. Instead, East Midlands ambulance service received less than £5 million extra compared with 2011. That is less than 3% extra funding when it needed 66%.

East Midlands ambulance service has never been well funded—our region has always been the poor relation, as colleagues on both sides of the House often concur—but the cuts over the last seven years have made it impossible for it to meet its targets, and to deliver the right standard of service and care to some of the most sick and injured people, and the most at risk. That is what the Nottinghamshire coroner concluded in May 2016. In an urgent case review, she said:

“Demand is clearly greater than the resources they have most of the time”.

That is not the fault of any of the staff at EMAS. Last summer, the Care Quality Commission found that although the service was in need of improvement, it was caring and responsive—but it could not be safe or effective. The report states that there were

“caring, professional staff delivering compassionate, patient focussed care in circumstances that were challenging due to the continued demand placed on the service.”

The increased demand for primary care, emergency care and ambulance services is not being resourced. Our ambulance service is on the frontline. Our crews do their very best, but it is tough. Yes, staff sickness is slightly higher than average at EMAS, but I am not surprised. It is not just what the crews deal with; it is the constant stress and pressure, and the distress and anger that they sometimes face when they can finally arrive.