Mid Yorkshire Hospitals NHS Trust

Debate between Paula Sherriff and Yvette Cooper

Thursday 21st July 2016 Commons Chamber

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

I wish those Members departing the Chamber a good summer and thank you, Mr Speaker, for granting me the final debate before the summer recess. I also welcome the new Minister to the Dispatch Box.

I called this debate, following the one brought a few months ago by my hon. Friend the Member for Dewsbury (Paula Sherriff), because she, I and many Yorkshire Members are deeply concerned about the staffing levels not just at the Mid Yorkshire trust but at other hospitals across Yorkshire and the serious effect they are having on our health service. We have warned Ministers before about this, but we are deeply concerned that nothing is yet being done. Things will get worse if action is not taken.

Last year, I was contacted by a constituent, Mr Fanshawe, whose mother-in-law, Edith Cunningham, had recently died at the end of a short illness in Pinderfields hospital. As well as dealing with the grief and bereavement, Mr and Mrs Fanshawe were having to cope with the deep distress and anger caused by the way in which Mrs Fanshawe’s mother was treated and the care she received, in her final days and hours, because of serious staff shortages at the hospital.

Nursing staff were so overstretched that, at one point, Edith Cunningham had to wait two hours for a bed pan—two hours for an elderly lady in distress—and one weekend she had to wait 25 hours to see a doctor. It became clear to the Fanshawes that the staffing shortages on the ward were such that they could not leave her, so they stayed; they did her bed pans, they fed her, and when the pressure mattress they had requested was brought up, they changed it themselves, because there was no one else to do it.

I have met the Mid Yorkshire trust and the Fanshawes, and the chief nursing officer has given them a full apology and made it clear that it was an unacceptable level of care and that it was the result of staffing shortages on ward 43 at the time. Since then, the trust has continued to work on a wide range of recruitment and staffing initiatives to improve the situation.

[Paula Sherriff (Dewsbury) (Lab)]

I thank my right hon. Friend for calling this important debate. As she alluded to, I had a debate on this issue in March, but sadly it appears that little progress, if any, has been made. Last week, I attended a patient safety walkabout on ward 2 of Dewsbury hospital, and once again patients raised issues of short staffing. Several patients had been told not to ring their alarm bell at night because there was only one member of staff on duty. The number of beds on the ward had been increased from 24 to 30, but sadly no extra staff had been brought in to accommodate the extra patients. I plead with the Minister: we need tangible progress to ensure patient safety.

[Yvette Cooper]

My hon. Friend is exactly right. We hear continually from constituents often saying the same thing: the nursing staff are wonderful, look after them and work immensely hard, but are overstretched; there are simply not enough of them to do the job they want to do.

The trust has recruited not just locally but from across Europe and India, which has sometimes raised language issues. It is looking at new ways to recruit from the local area, and in some areas, the number of vacancies has fallen. It has also put in place processes to switch staff around to make sure that gaps are filled every day. I welcome the commitment by the chief nursing officer and the chief executive to do everything they can to fill the staffing gaps, but it is still not enough.

We agreed with the trust that the Fanshawes and the local health watch should be able to do an unannounced visit to ward 43, talk to parents and report on what they found. I quote from their report:

“Patients... reported kindness and very good care. Patients generally agreed that staff are lovely but are ‘run off their feet’”.

They found that staffing levels were better than last year,

“but it is still often a struggle and only rarely does the ward have the right quota of staff”.

Just this week, I received another email from another family with a relative in ward 43 raising serious alarms about the level of staffing on the ward and the level of care that their relative was being given. There were not enough healthcare assistants or nurses to provide the basic care and support needed. That fits with the findings last year of the Care Quality Commission, which also raised concerns about safe staffing levels. Once again, we cannot pay sufficient tribute to the kindness and hard work of the staff at the trust. However, when they are stretched in all different directions, it is in the end the patients who lose out and the staff who are deeply concerned because they are not able to provide the level of care that they want.

I am concerned, too, about the financial pressures on the Mid Yorkshire trust. It is not the only trust where the money received is simply not enough to meet rising demand. I suspect that the Minister will have been briefed on some of the financial pressures and the squeeze facing the Mid Yorkshire trust. There is a risk of services being cut not for sensible medical reasons, but simply because it does not have the funding or the staffing to provide them safely.

It is even worse than that. Even where the Mid Yorkshire trust has budgeted for the staff, it cannot recruit or retain enough to deliver the services in the way it wants and the way our communities need. The latest figures from the trust list 150 nursing vacancies: that includes healthcare assistants and safety support workers, and amounts to about 12% of budgeted posts. The vacancy rate for nursing staff in the theatre department is 17%, and it is 20% in intermediate care. If we take account of holidays, maternity leave, sick leave, stress, and temporary secondments to other departments, the gaps are bigger. Monitoring by department in May, which looked at the actual staffing relative to the planned levels wanted, showed cardiology at only 76%, stroke rehab at 65% and short stay at 70%.

The trust also measured unavailability, which encompasses the percentage of contracted hours lost owing to staff absence, including for sickness and stress. When some staff are working so hard, and some are also being moved around from one department to another in order to cope with gaps elsewhere, facing further stress and uncertainty, it leads to higher levels of absence.

[Paula Sherriff]

I shall try to be briefer in this intervention. I was recently contacted by Dewsbury hospital, and was told that, on any given day, the minimum staffing level in the A&E department is eight qualified nurses and four healthcare assistants or unqualified nurses. On this occasion, there were three nurses and one healthcare assistant. I think that speaks for itself; clearly, it will have an impact on patient safety.

[Yvette Cooper]

My hon. Friend is right, and these are the sort of individual examples that we increasingly hear about from our constituents—from both staff and patients. I have heard from staff in intensive care and in paediatrics who are deeply worried about the pressures and responsibility on them lest something should go wrong on their watch as a result of understaffing. They are deeply concerned that they will be unable to provide the care that is needed and are worried about the implications.

The trust’s planning guidance suggests that it can cope with up to 22% of the contracted hours not being provided and still provide a safe service. Beyond that, it shows that significant problems are likely to be encountered in delivering the right level of care. Overall, however, the gap is not 22%, but 26% for registered nurses and 30% for registered midwives. In A&E, the average shortfall in contracted hours is 30% and there is a similar 30% shortfall in children’s services. On some wards, the proportion of temporary staff from agencies and the NHS banks is particularly high. On acute assessment wards, 20% of the nursing staff are agency staff. On the short-stay wards, 11% of the nursing staff and 33% of the healthcare assistants are from agencies and the bank.

It is not just about the pressures on nursing staff. Senior staff at the Mid Yorkshire trust say that they are doing a huge amount of work to address the nursing shortages, but they are even more worried about the shortage of doctors—not just at Mid Yorks, but across Yorkshire. According to the Royal College of Physicians, 14% of the consultant posts at the Mid Yorkshire trust are vacant. In A&E and neurology, there is a particular problem, and there are regular and significant gaps in the contract rota for junior doctors. Some 15% of the acute medicine rota is not filled by contracted staff, and it is 18% for the emergency medicine rota, 20% for the anaesthetics rota and 20% for the surgery rota.

In practice, the trust is having to fill the rotas either with consultant staff acting down in more junior posts, or with locum staff. It is a choice between doing that and cancelling operations, or turning ambulances away. The trust is, of course, is committed to providing the best service that it can provide and not letting patients down, but locum care means that medical staff do not have the relationships or the knowledge of the system that would enable them to do the best possible job, and it costs far more as well. Because the trust cannot recruit enough contracted staff, its average spend on agency doctors in the first three months of the current financial year was £1.5 million a month—and, as we know, it is a trust that faces significant financial pressures. So what is it supposed to do?

However, this does not apply only to Mid Yorkshire Hospitals NHS Trust. In the country as a whole, two in five vacant consultant posts went unfilled last year, according to the Royal College of Physicians. In the north of England, there are serious staff shortages in our hospitals. That is what we hear from our constituents. My hon. Friend the Member for Dewsbury spoke of appointments being cancelled and waiting times being affected. What troubles me particularly is the fact that there is now a 20-week wait for the pain clinic. Because of staffing problems, patients who are suffering pain and could be supported and helped are having to wait 20 weeks to be seen.

What are the Government doing about this? All too often Ministers shrug their shoulders and think that it is someone else’s problem, or that someone else will sort it out. I contacted the Secretary of State in 2010 and 2011 saying that the training numbers that were being set by the Yorkshire and Humber Deanery, particularly for A & E, were not enough, and were certainly not enough to meet rising demand, but nothing was done. Given the scale of rising demand for healthcare and given our ageing population, far too few doctors are being trained. There is also a significant and serious regional disparity, with bigger shortages in the north and the midlands.

It is incomprehensible, given all those pressures, that the Government should choose this moment to pick a major fight with junior doctors that ends up demoralising them, and drives many of them to consider either going abroad or leaving the profession altogether at a time when we need every doctor we can get.

The Department of Health is also taking a massive risk when it comes to nursing staff. It is ending nursing bursaries, although in areas like ours that means that many people who could have become great nurses will be put off because they are worried about the debts that they will incur, and about not being able to afford the training. It is also refusing to give a proper assurance to the thousands of European Union citizens who work in the NHS—our trust has often recruited such people because of the shortages at home—that they can stay and fill those crucial posts.

Referring to nurse training, the Minister who responded to the debate initiated by my hon. Friend the Member for Dewsbury a few months ago said:

“Within the current spending envelope…it is simply not going to be possible to achieve the numbers that we wish to see.”—[Official Report, 21 March 2016; Vol. 607, c. 1354.]

That is not good enough. We need enough nurses, and enough doctors, to provide the care that our constituents need and deserve. That cannot simply be left to Mid Yorkshire Hospitals NHS trust, or to any individual trust in the country.

So many of the issues are linked, whether we are talking about the training numbers on which the deaneries decide or decisions made by the Department of Health that have an impact on morale, pay or incentives throughout the country. We now need a regional action plan setting out what the Government are going to do, and what NHS England is going to do, to address the serious shortages of both nurses and doctors in Yorkshire, because unless something is done, something serious will happen to patient care. I do not want to warn again about this, as I did some years ago, but it still has not been sorted out, and that is not fair on patients in Yorkshire and throughout our area.

In the case raised by Mr Fanshawe, Edith Cunningham had a family who stepped in and looked after her while she was in hospital, but many more patients do not have families who can fill the gaps and step in. So for the sake of all of those patients, and for all of those who we—all of us in all parts of the House—will want to get the best possible care, I urge Health Ministers to get a grip on this and get us the regional action plan we need, before patient safety is affected.