Barking, Havering and Redbridge University Hospitals NHS Trust

Baroness Hodge of Barking Excerpts

Wednesday 15th July 2015 Westminster Hall

[Margaret Hodge (Barking) (Lab)]

I congratulate my hon. Friend the Member for Ilford South (Mike Gapes) and join him in commending and thanking the many staff who work under huge pressure in both King George hospital and Queen’s for the very good work they do, which I hear a lot about from my constituents.

I have been involved with BHRUT and its predecessors for over 20 years. I have seen six chief executives and 12 different chairs, men and women. Every new generation blames their predecessors for the problems that they inherit. I am perhaps a little more sceptical than my hon. Friend: I do not think that we have suddenly, magically got a new team that will solve many of the intransigent problems facing that trust. It has been co-operative and is trying hard, but we are now over a year into the new regime, and on many of the indicators I cannot see demonstrable improvements. The trust has been bankrupt for years; the deficit has not gone down for years and I cannot think that it will go down much in the coming period, given the pressures and the failures to deal with some of the intransigent problems.

Quality has been pretty poor for years. We finally got the CQC report that put the trust into special measures, but the most recent report shows that the necessary improvements that I wanted for my constituents and that would take the trust out of special measures have not been made. Although I share my hon. Friend’s hope, I am not confident that we will get there by the time the CQC comes back yet again.

Compared with all other trust areas throughout the country, ours is the eighth most deprived area in terms of health need. The NHS ought to be delivering equal access to high-quality care to people wherever they live, but it is not. I sincerely feel that that is the biggest battle for my constituents. Where I live, I get much better access to much better quality healthcare than my constituents in Barking and Dagenham who use both Queen’s hospital and King George hospital.

I should like some assurances from the Minister about the north-east London sector. Not only are we bankrupt in our neck of the woods, but Barts City—predictably, I have to say—is also in incredible deficit. One knows how these allocations of moneys go and how views are taken about the health service across the country. There is a real danger that salvaging the new Barts hospital, with its £1 billion PFI and the massive call of that on revenue funding there, will come at the expense of BHRUT and the hospital provision that we need locally. I seek assurances from the Minister that, in considering an undoubtedly difficult financial situation across the whole north-east London sector, he does not disadvantage our residents by putting everything into the much more powerful Barts and the Royal London Hospital NHS Trust.

I want to raise three other issues. First, I have been shocked in recent times by how much is spent on agency staff by BHRUT. For example, in 2013-14, it spent £27 million, and in June this year it spent £2.5 million. When Matthew Hopkins gave evidence at the Public Accounts Committee, when we were looking at the state of a number of vulnerable trusts, he talked about a 50% shortage of consultants in the A&E department and told us that he was spending £1,760 on one 16-hour shift of A&E consultants. After that session, I asked a consultant in A&E during one of my usual visits round the hospital whether he was an agency consultant or a full-time employee. He had been a full-time employee, but deliberately switched to being agency staff because as an agency member of staff he earned more and did less. His doing so put the trust in greater difficulties.

That sort of behaviour is simply an unacceptable waste of what we all understand is a very small amount of money that is not enough for local healthcare. According to the CQC’s most recent inspection, a third of the nurses on night duty on the first night of its inspection were agency nurses. I should like the Minister to talk a little bit about how he is going to tackle the use of agency staff, who provide poorer quality care, because they do not know the systems or the people and do not know their way around the hospital, and cost the hospital a lot of money.

Secondly, although I recognise that there have been improvements, particularly in maternity, where we were first alerted to quality really going wrong in Queen’s, on reading the report I was worried about radiology. There is still a huge bill—millions of pounds—to be paid to people now litigating against the hospital because of what happened to the mothers and children through poor maternity care there, but the original CQC report in 2010 highlighted that the radiology department was poor. There were delays in people having scans done and scans were not passed to the relevant consultant, so people with cancer were simply not being diagnosed in a proper, timely manner that would have allowed them to access the treatment they needed. The recent inspection still finds problems there: it is too short-staffed, with too many locums.

One of the incredible things I read was that on one day of the inspections, five radiologists were on leave. What sort of culture does a hospital have if it allows five radiologists to go on leave on the same day and so provides a poor service to patients? There is a large backlog of patients who have waited well over 18 weeks. During the inspection, the CT scanner kept breaking down and patients had to be transferred from Queen’s hospital to King George hospital. That is unacceptable. It is about more than money; it is about a culture in the management that was originally identified in 2010 and now, in 2015, the A&E is still appalling.

I will raise a couple of other issues that I think are relevant and which my hon. Friend alluded to. The first is GP services. If we cannot sort out primary care, demand on acute and hospital services will continue to exceed their ability to respond. Barking and Dagenham has the highest number of GPs aged over 60 in the country: a third of our GPs are over 60. We have been completely open—we will try any experiment on the ground. We have had salaried GPs, private practice GPs and GPs linked to universities in an attempt to provide some training. We will do anything to attract and get more and a better cadre of GPs in our patch, but we have failed. We are still the eighth in London in terms of concentration of single-person practices. I raise this issue all the time with the powers that be in the health service locally. One in five of our GP practices remains single-handed. We know that that does not provide an adequate service to local people, yet there is not any sort of energy or urgency in the actions of the local health service officials to sort that out. They ought to be able to do so and to apply much greater pressures on some of the GP services, so that we get better primary care.

People cannot get appointments. We have done a survey of our residents—it is not a proper survey; I do it when people attend my very regular coffee afternoons. However, those surveys show that 50% of our residents had to wait more than a week to get access to their GP. Some 30% went to A&E because they could not get access to the GP. Nearly half said that they had found it difficult to get an appointment. The typical story is, “I ring up at half-past 6 to see the GP the next morning. I am told to ring the next morning. When I ring the next morning, it is engaged and engaged, and in the end I give up and go to the A&E.” Unless there is a forceful, determined attempt to sort out the failures of our primary care system, we will not make progress in the acute sector.

One of the little things we did was run a campaign on the use of premium phone numbers. From constituents who came to see me, we uncovered in 2013 that 10 GP practices in the constituency had 084 numbers. One constituent had spent £10 trying to get an appointment, because ringing such numbers from a mobile costs 41p or 42p a minute. Another constituent spent £30 trying to get an appointment for her son because she had to hang on until she was dealt with. She got through to the system, but the call was not answered by anyone to secure an appointment. We have run a tough campaign on that, but two and a half to three years on, we still have one GP practice—Castleberry medical centre—that is refusing to put in a landline, and three others that have a landline but have kept their premium phone line, and my bet is that patients cannot get through on the landline and have to use the premium phone line. Access to GPs is important. I thought we had halted the use of premium phone numbers after another PAC inquiry, but it has not happened.

My final plea is on access to the hospital for the poorest people in my constituency. They live in the most south-western part of my constituency, in Thames ward. Getting to Queen’s hospital from there takes three buses. I did the journey during the election period, and it took me about two hours. If someone has to go for regular chemotherapy or kidney treatment—whatever it is—that four-hour journey every day means that the person does not go and so does not get that treatment and therefore dies younger. I have been pleading with the Mayor and the transport authorities to ease that just by diverting the No. 5 bus so that it goes straight to the hospital. That would save people one change—they would get two buses, not three—but I have completely failed so far. I have been fobbed off. I urge the Minister to join me and write to the relevant authorities to ensure that while at least keeping those hospitals there, trying to get them properly funded, sorting out the financial mess and improving the quality, we also allow people to get there easily, particularly those who need the hospital services the most and are most dependent on public transport.

--- Later in debate ---

[Ben Gummer]

I understand the hon. Gentleman’s points. I accept that uncertainty is created at the King George site and that the effect of that is potentially destabilising, especially when the hospital and the trust have had to endure the whole process of special measures. His solution, however, is a false one in two senses.

First, the decision was clinically led in the first place, so to go against it would be to go against a clinical decision after several reviews. The hon. Gentleman is therefore suggesting that we make a political intervention against a decision made by doctors about the best distribution of trauma centres and urgent and emergency care centres according to population. Decisions have been made on a similar basis throughout the country. I do not believe that he really feels that that would be an acceptable route to take. Secondly, even were we to do that, it would not remove uncertainty, because there would still need to be some sort of reconfiguration in future in order to get the best outcomes for patients. So the uncertainty would remain.

The hon. Gentleman’s point is valid to an extent. If the situation were to occur again—clearly none of us would have wished things to proceed as they have done —we need to make it clear that reconfigurations can happen only when we have the correct sustainability in receiver organisations. That should be something we think about as we go ahead. However, we are where we are now with his trust, and to proceed on the basis that he suggests would not give either the patient outcomes or the certainty that he desires, whether for staff or his constituents.

[Margaret Hodge]

The Minister referred to a decision that was initiated in about 2009. That is correct, but circumstances change. Our area is the most rapidly expanding in London. I do not know the figures for Redbridge, but those for Barking and Dagenham show, potentially, another 30,000 to 35,000 houses being built over the next 10 to 15 years. That is massive expansion. I put it to the Minister that not only is the number of houses increasing, but the nature of the households is changing. What used to be a house lived in by a couple with perhaps two kids now tends to be lived in by intergenerational families with many more people. What regard has he paid to those changes? Should he not pay regard to them and review his decision in the light of them?

[Ben Gummer]

It is not ultimately my decision. It is the decision of the Secretary of State, but only on the advice of the Independent Reconfiguration Panel. The IRP takes a view over a long horizon, so it takes population growth into account in the original decisions—

[Margaret Hodge]

It did not.

[Ben Gummer]

I will come back to the right hon. Lady with a final comment, but that is what I understand. In the end, such decisions are left to local commissioners, who are the experts in buying the right kind of health provision for their patient groups. If their decision changes, that should be reflected in the IRP’s final decision, but the commissioners remain certain that that is the correct way to go for east and north-east London, and while that remains the case, we as politicians should support that clinical decision.

I will respond to some of the other points made by hon. Members. The finances of the hospital were brought up several times. It is true that it has had a sustained poor financial performance, but it is unlike other hospitals which have become indebted or are lifting up. The hospital’s position is a sustained one involving a large number—£38 million, which includes a very large figure for agency workers. That figure is now declining as the new management gets a grip on recruitment, and I heard some good stories about the improvement in recruitment when I went there only a couple of weeks ago. There is also £60 million annual provision for PFI payments, which is a problem in many trusts around the country, but there is no point rehearsing those issues, which the right hon. Member for Barking looked at many times in her previous role.

The chief executive is clear about the deficit. He shares my view and that of the Secretary of State that financial performance and quality go hand in hand. No hospital in this country offers outstanding care but has poor financial performance. We cannot get efficient care anywhere if the books are not being looked after at the same time, because the two work together. The chief executive understands that getting the trust into a decent financial position is central to providing the kind of consistently high-quality care that he wants to see across the trust, and not only in the specific areas rightly highlighted by the hon. Members for Dagenham and Rainham (Jon Cruddas) and for Ilford North.

The hon. Member for Ilford South was right to talk about capacity. There was a serious lack of capacity because of the failure to discharge patients and to get people through the system, which caused problems at the front end, in A&E. Remarkable change has been achieved in the past six months through the new measures put in place by the new management, but it is true that there is a great deal more to do. I heard a different story from the one the hon. Gentleman recounted: actually, they thought that the last CQC judgment was completely realistic; the action points highlighted were in large part already being addressed and needed to be done. The new management recognised that special measures was a regime that had to be exited once a sustainable improvement over time had been shown. That was gratifying to hear, because when it is heard from the shop floor, the management and the CQC, that shows that the whole team understands the problems and how they need to be addressed.

Several Members mentioned the problems in primary care, and I am aware of the acute issues in east and north-east London. They are the reason why my right hon. Friend the Secretary of State launched the new deal for GPs a couple of weeks ago. NHS England is now mapping hotspots of GP shortage across the country. It will use that information to target resources to make sure we are putting the new GPs being recruited into the right places and using every possible incentive to make sure that under-doctored areas are brought up to parity. Members will know that this is a historical problem and it will take a great deal of heavy lifting from all of us to change it. It is not simply about sheer numbers of GPs; we must have new models of delivering care and new diversity, so that we can deliver primary care appropriately rather than in a way that is based on a model that does not fit.

The right hon. Member for Barking raised understandable concerns that the existing system for the Barts trust was set up to finance one PFI deal. She is not alone in those concerns. I am taking a deep interest in the progress of the special measures regime at Barts. The financial performance and accounting procedures at that hospital and trust when it went into special measures were frankly shocking. They have now been changed, and we will be reviewing the situation on a weekly basis. I hope that if she discusses the matter with the CQC and the trust, she will understand better that it is not that the trust is subsidising one PFI but that there are systemic financial problems across the trust. I take her point completely, however. As we address the financial problems in east London we must reassure everyone that mergers have not happened simply to prop up one organisation at the expense of another.

Finally, I welcome the constructive approach and fair questions of the hon. Member for Denton and Reddish (Andrew Gwynne). I hope I have answered the majority of his questions, but I question the idea that Government policy has made the situation worse. The reason we are debating here is that the CQC gave an inadequate rating to the Barking hospital trust and put it into special measures. The ratings and the special measures regime were a creation of the previous Government. They have provided transparency and clarity that we did not have before and allowed us to have an honest discussion about what is wrong and what is right. I can now stand up and say where the problems are and accept responsibility for what needs to change. None of that was possible when we could not say that anything was wrong and had to pretend there were no problems, because there was a culture of denial rather than one of transparency and openness.

We are not at the acme. We have a great deal of distance still to make up, but we are in a much better place than we were back in 2013, when the trust was put in special measures, or in 2010, when the review was completed. We now have clarity about what we need to do and the process for doing it. I believe that we will soon have a much better health economy in north-east London than the one that Members have had to endure so far.