NHS Care of Older People

Neil Carmichael Excerpts

Thursday 27th October 2011 Westminster Hall

[Margot James]

I welcome that intervention because whenever one is preparing for a debate such as this, one is conscious of how much more there is to say than one has time for. I was not intending to draw too many conclusions on what needs to change in society. I was concentrating on what needs to change in the domain that we are discussing, but perhaps the hon. Lady would care to call for a debate on the topic to which she has referred. I am sure that we could fill an afternoon with such a discussion and I should be delighted to take part.

[Neil Carmichael (Stroud) (Con)]

One matter that needs to be thought about carefully in this debate if not elsewhere is, of course, the integration of the NHS and social care, because that will help the process along and deal with many of the issues to which my hon. Friend is referring.

[Margot James]

I thank my hon. Friend. That is a very good point. The integration of health and social care should, with the weight of joint commissioning behind it, make quite a difference. My speech has concentrated on care in hospitals, but I hope that other hon. Members will bring out issues to do with care at home and other aspects of what the NHS delivers.

I shall go through my list of recommendations briefly. On nutrition, the Age UK report, “Still Hungry to Be Heard”, advocated that ward staff needed to be “food-aware”. Training should include nutrition and the importance of assistance with meals when needed. I agree with these recommendations. Older people should be assessed for signs of malnourishment on admission, during their stay and on discharge. Hospitals should introduce protected mealtimes. Where they are using a red tray system, which involves a red tray being given to patients who require assistance with eating, staff should be trained in how to use it. It sounds as though that system works well where it is used properly.

--- Later in debate ---

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Stourbridge (Margot James) on securing the debate through the Backbench Business Committee, and all hon. Members who supported the call for it—as I did.

I do not pretend to be a health care professional, even though I use the title “Dr”. Nor do I profess expertise in that area. However, the care given to those older people who need it—I tend to use the word “elderly”, although it may not be politically correct—is important. Usually, the start and end of life is when we use NHS care the most, and those people should be given the best care possible. We should make sure failures are dealt with, and we should speak up about them in Parliament.

Given the time constraints, I had thought of spending a little time on talking about the terminally ill. Hon. Members may know that I have introduced a ten-minute rule Bill on the provision of hydration and nutrition. We have also had Westminster Hall debates about palliative care in eastern England, and I recognise the valuable work that is done. However, it is right to focus on the Care Quality Commission report and individual hospitals, so that our constituents know we are speaking up for them, and so that their voice is heard in Parliament.

My hon. Friend the Member for Stourbridge went into great detail about the CQC report, and the hon. Member for Worsley and Eccles South (Barbara Keeley) went into detail on a particular case. The view of representatives of the Royal College of Nursing, given in informal discussions, about evidence given or sentiments expressed in submissions to the Francis inquiry, was telling. There was concern about leadership and about how people would be treated if they stood up and spoke up for patients—that they would be ignored, or, worse, demoted. I am sure that that shocked the nursing profession and other people, and I recognise that attempts are being made to deal with that, so I do not mean to be condemnatory.

My constituency has the 15th highest proportion of pensioners. Some 55% of my constituents are over 55, so the issue we are discussing is important there. The constituency also covers two primary care trusts—NHS Suffolk, and Great Yarmouth and Waveney—and we have three hospitals that provide care. They are the Norfolk and Norwich university hospital, Ipswich hospital and James Paget university hospital. I am afraid that two of those were on the list of failing hospitals and, understandably, local residents were very upset. That is reflected in the number of complaints made to me, or copied to me, about people’s experiences when they are trying to get care.

As to Ipswich, after the first failure, I and my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) met the chairman and director of nursing. I was impressed straight away that the director of nursing recognised absolutely that there had been failings. That recognition and acceptance of failings was important to me. The suggestion was made at the time that not all the staff accepted, initially, that there were failings, and that the feedback was met with an element of rejection. However, every member of staff quickly recognised that things had to change.

An action plan of changes and improvements to local ward leadership was set out, and fresh training was provided. A high focus was put on that, including additional support for patients with dementia. The hospital was inspected on a second occasion and, although the report has not yet been formally issued, I understand that it will pass—it should be congratulated on that—that a marked improvement was noted and that patient satisfaction was much higher.

[Neil Carmichael]

It is worth distinguishing between acute and community hospitals. That would inform the debate, because, obviously, chronic and non-chronic conditions are different. It would be helpful to know which hospitals are which, and whether that will help us to think about the subject.

[Dr Coffey]

Ipswich hospital is a district general hospital, if that helps my hon. Friend. It provides acute care, and is not just focused on community care. I want to say thank you and well done to the director of nursing and all the medical teams at the hospital for the changes they have made.

In contrast, James Paget hospital, in the constituency of my hon. Friend the Member for Great Yarmouth (Brandon Lewis), has failed a second inspection. The second report showed improvements, but not consistent improvements. There were still minor concerns in several areas, and continued moderate concerns on meeting nutritional needs and the management of medicines. The second report is complimentary about staff and training, and, as my hon. Friend the Member for Stourbridge has already mentioned, the hospital was cited in a Nursing and Midwifery Council report as having good training levels. To reinforce that point, the CQC suggested that patients’ needs were generally met. At times it was possible that not all the staff were available or deployed in the most effective way, but generally patients had the staffing appropriate to their needs. The third inspection has taken place. Its outcome is not yet formally known, and the hospital has not received the draft report, but I have not heard positive vibes so far.

As to my interaction with the leadership, I must say at the outset that I recognise that it was limited. My hon. Friends the Members for Waveney (Peter Aldous) and for Great Yarmouth have taken a much greater role, because a relatively small number of patients from my constituency go to the hospital in question. After the first inspection, however, I was assured that the failures were just a blip, and that things were already under way. Doubt was cast on the quality of the inspection carried out by the CQC—that was said to me by the chairman of the hospital trust. I did not accept that, because those CQC inspections are intended to be a snapshot and to take a view. Frankly, if one patient experiences bad care, that is an automatic failure. I think that hon. Members would recognise that.

I was reassured, however, by the expectation of changes, which were under way; but, as I have mentioned, the second inspection continued to find failings in dealings with older patients. I did not meet the hospital manager and chairman after the inspection, but my colleagues did and I was not reassured by the report of that meeting. Yet again it seemed that doubt was being cast on the validity of the CQC inspection by the chairman of the trust—though not, I understand, by the chief executive.

We three MPs have together agreed a course of action to press the hospital on its improvements for our constituents, and it has responded. As I said, a third inspection has been held, and I am highly concerned that a third failure will be reported. Monitor has now issued a red governance rating, which I believe is automatic, but I understand that it has also had conversations with the leadership. I have received copies of constituents’ complaints, and seen a whistleblowing letter from GPs from the consortium Health East. The letter says:

“As a group of concerned GPs we have been forced to pursue this whistle blowing option, because we are concerned that our new GP consortium ‘Health East’ may fail to be successful due to the failings of our main, acute provider the James Paget University Hospitals NHS Foundation Trust.

Health East will be depending on the Trust to provide the acute care for most of our patients and we have lost confidence in the ability of its leadership to correct its current failings. Please act quickly before we have yet another Mid Staffs on our hands.”

It ends:

“We apologise once again for having to take this whistle blowing option, but we need you to put pressure on appropriate organisations to put the issues right before our patients suffer.”

I do not suggest that someone going into the hospital will automatically suffer poor care, but that is the reaction of GPs who are expected to work with patients to ensure that they receive the best care.

In the circumstances, it is my role to press the leadership of the James Paget hospital on constituents’ behalf. In particular, the chairman of the hospital trust should consider his position. I appreciate that the financial risk at the hospital is low, and that that may reflect good financial governance, but patient care is key. The chairman has provided useful leadership, but—after two failed care inspections and with the possibility of a third—it is time for him to step aside and allow new leadership to come forward.

I will apologise to the chairman of the trust, because although I sent him a communication about what I would say in this debate, I could not speak to him personally. I should also say that I do not make my suggestion on behalf of my hon. Friends the Members for Waveney—who is in his place—and for Great Yarmouth. I do not make such a call lightly, but there is concern that patients may be reluctant to go to that hospital. Perhaps that is not a widely-experienced feeling, but often people worry about going to a particular hospital because of the perception of concern. We cannot afford that, and must not stand quietly by without expressing a view.

I have spoken for 10 minutes and understand that others want to speak. There are other issues, such as community care and confidence in that. My hon. Friend the Member for Central Suffolk and North Ipswich and others, including myself, have pressed the case about ambulance services and response times. Some of our constituents live more than an hour from the nearest hospital, so concerns about failure to respond within the eight-minute target are appropriate. I am meeting Ministers another time to discuss that matter.

I do not make the request that I made about the James Paget hospital in Parliament lightly, but I believe that it is necessary for the safety, well-being and protection of patients in Suffolk Coastal.