Doncaster and Bassetlaw NHS Trust STP

Lord Mann Excerpts

Monday 30th January 2017 Commons Chamber

[John Mann (Bassetlaw) (Lab)]

At this late hour, I rise to talk about the South Yorkshire and Bassetlaw sustainability and transformation plan. Sustainability and transformation plans are a huge part of the direction of travel in the NHS, but I find that the general public know nothing about them and that consultation is not reaching people—unlike their implications, including the cuts that they are disguising, which are reaching more and more people.

When I heard about the plans and met people to discuss them, it struck me that this was a chance for people in our area to have a vision of an NHS fit for today. I thought that it would enable us to move beyond the clapped-out buildings and outdated technologies into a new era, perhaps without all the funding in place, but with a vision of what would be there in 10 or 20 years’ time if that money became available. I find myself dismally disappointed.

I expected a vision across South Yorkshire and Bassetlaw of what a new surgical hospital of the future would look like. I recalled that, 25 years ago, my own company was working at Addenbrooke’s hospital. During a “live time” operation, we connected with consultants from Japan so that they could give their precise view on what should be done to a patient many thousands of miles away. I expected that—the best expertise and the most modern technologies—to be part of the vision. I expected tomorrow’s technology, but what I see is yesterday’s technology.

I expected to see, beyond smartphones, smart health. I expected that if someone of our age, Mr Deputy Speaker, should require paramedics, today’s smart technology would enable his medical records to be accessible to them immediately on their arrival. I expected screening, testing and all the real “before and afters” of any operation, and any highly specialised input, to become increasingly localised. I expected both our brilliant universities in Sheffield to be in the middle of the new future of the NHS. I expected an area that had been blighted by the impact of the coal and steel industries on the health of people and families to be able to look to the future, with a clear vision of how health services would be configured and how they would be linked to the super new health provision. That is what I expected from the plan.

I expected to be able to challenge my local communities to become engaged in prevention—in education, sport, recreation and healthy living—and to use the NHS less because they were fully involved in a modern plan for a modern health service. I expected to see mental health services that were a support, not a stigma, in the community. I expected to see the integration of social care and the NHS. Let me say to the Minister—I have said it before, but I will say it again now—that I am happy for Bassetlaw to be the first area to hand over the entire social care budget to the clinical commissioning group to put the two together. Working together but delivering from a single budget, they can be much more effective. I hope that the Minister will oblige by making our area the pathfinder for change of that kind.

This dismal plan is a smokescreen for cuts. But there is an opportunity, because of those cuts, to engage the population. The population does not know about the STP, but it certainly knows about the breast care unit that, behind the smokescreen of these changes, is being cut at Bassetlaw hospital, possibly never to be returned. It is a state-of-the-art system as good as that anywhere in the country, brilliantly put together by Mr Kolar and his team, but it is being dismantled at this moment. Women who, previously, from first appointment to consultant were seen, diagnosed and in treatment in 24 hours are now waiting weeks. It is a system that even in the olden days of the last two decades has been prompt and to the point, but it has now shifted back 30 years in its thinking. I hope the Minister will look at precisely how this dangerous cut is being done, because the people of Bassetlaw are not happy about it.

The management of the hospital—the chief executive went on Friday and is still to be replaced, and a new chair was appointed at the turn of the year—has decided to pick on the children’s ward of Bassetlaw hospital, which is perhaps not the smartest of moves. The STP gets nobody other than me and one or two officials to participate in its consultation, but then there is the parents’ Facebook campaign against the overnight closure and the video blog—fancy words—that I did to expose it. Some 9,000 people watched my video blog within the first 24 hours, and 7,000 have joined the Facebook group in the first 24 hours. So there is some consultation feedback for the NHS. The people of Bassetlaw, particularly the mothers and grandmothers, are saying, “We do not want this children’s ward shifting or closing, as it has been; we want that reversed.”

What is their vision, and my vision, of an NHS? Let me give the Minister the views of some of the real people—not the theory, not the stats, but the views of humans. Let me tell the Minister about the twins Leon and William, with autism spectrum disorder, milk allergies and other food intolerances, and learning difficulties, poor eyesight and sensory processing disorders. William has had eight chest infections since birth, with each one becoming more serious. What does his mother Kelli say? Her twins

“thrive on continuity of care and are routine driven and to take an unwell child who has no communication (non verbal) and understanding could be devastating.”

These twins are

“not critically ill but suffer from an acute neurological condition so severe that they attend St Giles”

special school in Retford.

Kelli says:

“My boys know Bassetlaw Hospital and it is all they have ever known, if they have to go elsewhere this will have a detrimental effect on their mood and stress levels. This also may mask a real problem and when a child is non verbal you rely on the subtle hints they give. Even I”—

the mother—

“struggle to understand what their main cause of upset is when they are panicked.”

They need “continuity of care”, but what does this modern, new NHS offer us—this year, brought in two weeks ago? It does not offer continuity of care. If those twins go in in the daytime, they will go into Bassetlaw children’s ward, but if they go in overnight they are automatically transferred to another hospital, and asked to go back to Bassetlaw the next morning. I have already got mothers who are told to go to Sheffield or to Doncaster and arrive there and, after an hour or two—having spent the night getting there, waiting at Bassetlaw for an ambulance, going in an ambulance, getting transferred—are then told, “You need to get back to Bassetlaw.” What a farcical, 1960s health system we are now having imposed on my local hospital.

That is not good enough for the twins Leon and William, and it is not good enough for the six-year-old asthmatic who is admitted to the children’s ward two or three times a year when he is struggling to breathe and requires nebulisers, oxygen and steroids. His parents say:

“The service has…been efficient and relatively quick, which as you can imagine is paramount when you have a child who is fighting for breath…My son gets the treatment he needs without us having to bother the ambulance service. However if we have to travel to Doncaster, which is over 30 miles away and have the nightmare of parking there too it fills me with complete dread. It stops us being able to access home as easily when he has to stay in sometimes for 3 days but also takes the security and familiarity out of the stay for my son, who is already quite poorly”.

Distance is a crucial factor, and it is total nonsense that the distance their son has to travel should be determined by whether he is ill at night or in the daytime.

A four-year-old from Beckingham was treated three times in the children’s ward at Bassetlaw last year. Her mother says:

“The care was absolutely fantastic. I was really scared that she was so poorly, but all the staff were so kind and couldn’t do enough to help. Other mums I spoke to said exactly the same. The thought of having to drive to Doncaster with a sick small child, particularly my own, fills me with dread…I couldn’t have driven her to hospital on my own with her as she was at that age and I asked if we could have an ambulance but it was going to be well over an hour before one could be sent.”

We struggle to get ambulances at any time, never mind in the middle of the night. Ambulances cost money, yet in my area parents will be expected to get into ambulances and travel vast distances—in some cases 40 miles there and 40 miles back. That is not sensible planning in the modern national health service.

Another parent told me:

“My daughter was born 3 months premature in 2012. Due to this she has several health issues, in particular problems with her lungs which has caused her to be admitted on to the children’s ward at Bassetlaw hospital on many occasions.”

Her parents described an occasion when they were told that

“her organs were shutting down as her lungs were not getting enough oxygen. The children’s ward staff were amazing and gave her high dependency care on the ward as she was too unstable to move her to Doncaster hospital. If it had not been for them our daughter would have died.”

She was too unstable to be moved, yet now she would automatically be moved after 8 o’clock at night. That is an abomination, and there are many more.

Another example is 16-month-old Isla, who went to A&E twice in November. Her parents said that

“with her already being distressed with feeling so poorly we felt that the added ordeal of waiting for an overnight transfer by ambulance was added distress and unfair on our daughter. We had been warned we could wait up to three hours for an ambulance to be available and this was on top of the time we had already spent there. For such a young child to be subjected to a seven hour wait and an ambulance transfer in the middle of the night is grossly unfair and doesn’t fit with the ethics and duty of care we believe the NHS should stand for.”

This is not theoretical; it is actually happening.

Mylor, aged 10, was also born prematurely at Bassetlaw hospital. He suffered a brain injury, periventricular leukomalacia. He has quadriplegic cerebral palsy and is unable to sit or stand independently. He has had major hip surgery and has complex health needs. Rarely a week goes by without his needing an associated appointment related to his health needs. His parents say:

“It is of great comfort and reassurance to have a children’s hospital 8 miles from our home with staff who know Mylor and his medical background, a hospital he is familiar with. The decision to cut back admissions on the ward will greatly impact on disabled children and their families—families who already face enough challenges and worry caring for their loved ones.”

The impact on those young disabled children is enormous. They know the children’s ward. They know the staff.

Courtney has autism and learning difficulties. The family said

“we have always been allowed an open door policy if Courtney has ever been very ill. It has been of great comfort to our family to have the reassurance of the excellent medical staff at Bassetlaw. The staff have got to know Courtney and her condition, and her illness has quickly been addressed and this—“

the open-door policy—

“has often prevented her condition from getting worse.”

Dr Leonard Williams, a paediatrician at Bassetlaw for 30 years, pioneered this open-door policy. Most parents do not even go through A&E; they go straight into the children’s ward, technically through the back door, with their children and their conditions known. All of that has been thrown out of the window in the last two weeks. Charlotte has many issues and

“contracted pneumococcal meningitis at 4 weeks of age which left her severely disabled, profoundly deaf and epileptic to name some of her conditions. She has spent many days/weeks on the Children’s Ward at Bassetlaw and the care has always been fantastic. We have always been allowed an open door policy if Charlotte has ever been very ill. It has been of great comfort to our family to have the reassurance of the excellent medical staff at Bassetlaw.”

There is a lot of repetition, but each of these is a different case.

Ollie is six. He has Hirschsprung’s disease and has had a colostomy. He has multiple problems and has had multiple surgeries. His family said

“you never know when you may need the hospital and it’s absolutely vital we have a local one accessible 24/7. It also is very distressing for families and children to be far away from loved ones when members of the family are poorly. Having a local hospital is very important”

to them. I can go on and on with example after example.

Chloe is a 13 year old with a huge number of issues. She has been to Sheffield children’s hospital because she has so many conditions, but she also regularly attends Bassetlaw, where she has grown to trust the staff. Being in hospital for her is not a one-off. Chloe has been treated in the children’s ward for more than a decade, and her mother says it is

“how we live our lives.”

Emily has an extremely rare condition. She has seizures and

“often stops breathing while having them.”

She frequently stays at the children’s ward for one or two nights. Her mother said:

“We moved into this area to be close to the hospital for this reason and Emily’s illness has always been quickly addressed at Bassetlaw and this has often prevented her condition from getting worse.”

There is a three-year-old with chronic asthma who is severely disabled, profoundly deaf and epileptic. There is a 10-month-old, born prematurely, whose father’s employment means that he will not be able to be there if she does not go to Bassetlaw. Zac was the one for whom we launched the campaign. He is three years old. He is blind. He is permanently in a wheelchair and cannot speak. Zac’s father is an industrial worker who works nights. How is he meant to get in with his son if he does not even know which hospital he is going to on his regular admissions to the children’s ward? Those are just some of the children. There are many, many more.

The staff say that seven hours for a non-blue light ambulance is the norm. We have seen cases already of kids waiting six or seven hours at night for a transfer after already waiting all day. There was case in which a blue-light ambulance arrived at Bassetlaw at 8 pm, just missing the deadline, which means a blue-light transfer and the child still going through A&E in Doncaster at midnight—four hours later. In Bassetlaw that would have been minutes, not hours.

We know about the financial black hole across South Yorkshire and Bassetlaw. We are aware of the massive black holes in some of the health trusts and that not enough money is being put in. We are also aware of the additional cuts, with the latest one being the cutting of health visitors in Bassetlaw. Mothers have been told in the last week that they have to weigh their own baby. There have been eye tests in schools since the inception of the NHS—stopped in the last week. Height tests in school—stopped in the last week. Those are major and significant cuts, and they are going to have to be reversed. “Weigh your own baby in the current national health service because we haven’t got any health visitors, and when they’re ill you can’t go into the children’s ward.” “There is no ambulance waiting for you. Drive your own kid to another hospital.” That is what families in my area are being told.

The STP states:

“Improving our population’s health and wellbeing…means re-imagining, re-designing and re-forming our public services and public budgets to improve the health and wellbeing of our population.”

Those changes and this plan are not forward-looking, they are old-fashioned, unimaginative and consultant-focused. It is a 1960s solution to the health service, not critical interventions in the right place, not key operations by specialist surgeons and not decentralised local services. For the young, the old and the seriously ill, it is already traumatic.

The support of my neighbour, the hon. Member for Newark (Robert Jenrick), for the children’s ward and breast care unit is on the record, in the traditions of his predecessor, and I thank him for his cross-party work in Bassetlaw and in this place to save our NHS, but there are a few local politicians who seem to think that they are cleverer than the rest of the world. Well, their ignorance is no excuse, and my message to each and every one of them is: “Will you hold your head up high and proud by joining us in fighting these appalling changes and this appalling plan?”

This month and this year, these children have been given a third-class ticket. My constituents and I demand that the children are given a first-class ticket and an equal chance to all other children in this country. They are being denied that chance. Every child in Bassetlaw will benefit from keeping the children’s ward fully functional and fully operational 24 hours a day, seven days a week. The kids in Bassetlaw are united, and if the kids are united, they will not be defeated.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I start by paying tribute to the passion with which the hon. Member for Bassetlaw (John Mann) laid his case before us this evening, and I share his welcome to my hon. Friend the Member for Newark (Robert Jenrick), who joins him here.

The hon. Gentleman’s remarks are clearly timely, and he started his contribution by laying out his vision for innovative technology to be brought to bear for the people of South Yorkshire and Bassetlaw through the emerging sustainability and transformation plan. He drew on his experience from across the world in his previous life to try to bring innovation to bear, and I will touch on the STP towards the end of my remarks.

The hon. Gentleman spent most of his contribution talking about the more immediate issue of the challenge of maintaining a 24-hour children’s ward in Bassetlaw hospital. He has given us many examples of the impact of the current closure—or the fear of the impact of the closure—on families in his constituency and their children who have had experience in the ward. He did so with considerable empathy and conviction, and I am sure his constituents will be grateful for that.

I wish to start my remarks by setting out the facts as they have been presented to me in preparing for this debate. It is the case that Bassetlaw hospital stopped providing an overnight children’s service today. Children who would have been treated at Bassetlaw overnight will now be treated at the Doncaster royal infirmary or Sheffield children’s hospital. The closure is being undertaken by the trust on safety grounds, as there are workforce shortages for both paediatric medical and nursing staff, despite attempts to fill the gaps with locum staff. This is a patient safety issue; the current situation does not offer a safe and sustainable service, which the hon. Gentleman would expect for his constituents. That is the fundamental premise on which this decision has been taken. The replacement service will be monitored to ensure it is safe and effective prior to any decision in October about the long-term future of the service.

In December 2016, the trust identified an emerging issue with safely staffing children’s nursing, as there were gaps of six whole-time-equivalent registered children’s nurses. The trust has attempted to source children’s nurses through locum agencies but has been unsuccessful. Additionally, there is currently a three-person gap on the junior doctor rotation at the trust. I am advised that the trust has undertaken an overseas recruitment drive for medical staffing through an agency, but this has also, unfortunately, not been successful.

The situation with the workforce and the unpredictability of the locum doctor cover has resulted in the ward being temporarily closed at night to new admissions on many occasions in recent months, but children admitted earlier in the day who are stable have remained on the ward overnight. To put this into context, between 1 November and last Friday the trust had transferred 23 children out of the ward, averaging two per week. The total number of children remaining in the ward overnight from 1 September was 452, an average of three per night. I want to assure the hon. Gentleman that the trust appreciates that some children are admitted to the ward regularly—he gave us such examples from constituents’ emails—but due to the nature of their illness it is impossible to predict when this will be. The trust is contacting regular users of the children’s ward individually to discuss their particular care needs and how these can be best delivered under the new system. The trust will continue to provide a seven-day “hot clinic” service for ill children who need to be seen quickly for clinical diagnosis but are unlikely to need an admission for assessment. I understand that this clinic will also invite children discharged from the assessment unit on the previous day for a consultant review, if clinically necessary. This will offer parents confidence about their child’s progress if they have been in the assessment unit the day before.

The service that has become operational as of today is a consultant-led paediatric assessment unit, providing services seven days a week. The intention is that this will run from 8 am to 10 pm, with a cut-off time for the last admitted child for assessment of 8 pm each day. At the moment, the cut-off time for assessment is 7 pm, and that will move to 8 pm following a review after the new model has been operational for two months. As ever, the paramount consideration is the safety of the children.

Children admitted during the day who have been assessed by a consultant as “acutely unwell” will be rapidly transferred to a centre such as the Doncaster royal infirmary or Sheffield’s children’s hospital. I understand that the new model of care for the trust is consistent with Royal College of Paediatric and Child Health guidance, and represents the latest and safest national guidance.

The hon. Gentleman referred to long waits for non-urgent patient transport, and I can provide some reassurance on that. The trust and the CCG have, from today, jointly commissioned a dedicated urgent transport facility to be available from 4 o’clock in the afternoon to 2 o’clock in the morning, seven days a week, specifically to cater for any necessary children’s transfers. The trust is committed to providing the highest-quality care for children, as recently demonstrated when it invested around £250,000 to build the assessment unit and new children’s out-patient area.

We should remember that the decisions on how to provide safe care for children, which come into force today, are a matter for the local NHS. It is right for these issues to be addressed at a local level, where the local healthcare needs and demands are thoroughly understood and considered. The local NHS makes decisions to ensure the safety and welfare of patients. Although the decision may cause upset and disruption for patients and families, it is for the local NHS to ensure that the services provided are of the highest quality possible and are safe and sustainable. Above all, parents with sick children need to have confidence that their child will be treated at the safest level and by the most appropriately qualified staff. I am sure the hon. Gentleman will agree that that is paramount.

Nottinghamshire County Council’s scrutiny committee has been informed of the service changes, and I understand that no decision was made to refer the changes to the Secretary of State.

[John Mann]

Part of the weakness of the structure is that not a single person from Bassetlaw sits on Nottinghamshire County Council’s scrutiny panel. Not a single person from Bassetlaw has been consulted, including none of the staff who work at the trust. Is it not time that the people of Bassetlaw, including the staff, were listened to? At my public meetings on Saturday, there will be an opportunity for the trust to come along and hear precisely what parents, staff and others have to say.

[Mr Dunne]

I understand that the hon. Gentleman has already held a meeting for the public to discuss this matter. I am also aware that, as would be expected, he has been in touch with the trust and the CCG to make his representations directly. I am sure that if he has not yet had the opportunity to discuss this matter with the scrutiny committee at the local authority, he will have every opportunity to do so.

The South Yorkshire and Bassetlaw sustainability and transformation plan covers an area that has funding in the current year of £2.7 billion. Under the current plans, funding will rise over the remainder of this Parliament by £400 million to 2021—a cash increase of just under 14%. The plan is one of 44 STPs that are being developed by local NHS leaders and local authorities, with providers, commissioners and other health and care services coming together to propose how, at local level, they can improve the way that health and care is planned and delivered in a more person-centred and co-ordinated way. That is the ambition, and one that I think the hon. Gentleman shared in his hope that the STP will generate an NHS fit for the future.

For all STPs, there will be no changes to the services that people currently receive without local engagement. If plans propose service changes, formal consultation will follow in due course, in line with legislative requirements and procedures. The Government are clear that all service changes should be based on clear evidence that they will deliver better outcomes for patients. Any changes proposed should meet four tests: they should have support from GP commissioners; they should be based on clinical evidence; they should demonstrate public and patient engagement; and they should consider patient choice. I am also aware of a consultation that is currently under way on children’s surgery and anaesthesia services in South Yorkshire, Mid Yorkshire, Bassetlaw and North Derbyshire.

I reassure the hon. Gentleman that the changes happening in the children’s ward at Bassetlaw hospital are unrelated to the STP or to the current consultation on changes to children’s surgery and anaesthetic services, which are not currently conducted at Bassetlaw. The decision was taken as a result of insufficient staffing to maintain patient safety.

In conclusion, I fully appreciate the concerns that the hon. Gentleman expresses on behalf of his constituents, particularly the families of the young children who have been used to the service being provided 24 hours a day in Bassetlaw. I encourage him and his constituents—he has told us he is doing this—to maintain a proper, open dialogue over the coming weeks and months with Doncaster and Bassetlaw Hospitals NHS Foundation Trust, and the Bassetlaw clinical commissioning group to ensure that there continues to be a safe and sustainable service for the children of Bassetlaw. That service should be provided in the hospital during the day and, for those who are stable, overnight. However, children who have an urgent problem that needs attention overnight must go somewhere safe for that service.

Question put and agreed to.