NHS Provision (Brighton and Hove)

Debate between Peter Kyle and Philip Dunne

Monday 24th October 2016 Commons Chamber

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

I congratulate the hon. Member for Brighton, Pavilion (Caroline Lucas) not just on securing this debate but on doing so on a day that enabled her to get through her entire speech and take interventions from the hon. Member for Hove (Peter Kyle) and my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton)—a considerable achievement.

The hon. Lady has a long-standing interest in health outcomes for her constituents, as we all do in the House. I would like to join her at the outset by highlighting the excellent work carried out every day by all those who work in the NHS, not just in her constituency but equally in my own and across the country. Before addressing the specific points that she made, I should like to give the House an overview of the NHS in her constituency. Brighton and Hove clinical commissioning group covers a geographical area of approximately 34 square miles, with a patient population of some 300,000. It commissions a wide range of healthcare services including from the main local acute trust, Brighton and Sussex University Hospitals NHS Trust, with a regional teaching hospital working across two sites in Brighton and Haywards Heath. I understand that the trust treats over three quarters of a million patients every year, and it recognises its growing role as a developing academic centre.

The hon. Lady has asked, not for the first time, for more funding to improve services and facilities in Brighton. I am pleased that she recognised the capital investment of more than half a billion pounds that is under way at the Royal Sussex County Hospital, replacing some very old buildings, as she said, and supporting the service quality improvements planned by the trust. I was a bit disappointed that, in his intervention, which came around the time that she referred to that capital investment, the hon. Member for Hove did not acknowledge that that is a significant investment in the facilities at the heart of health provision in Brighton.

The Government created the Care Quality Commission to shine a light on good and bad healthcare up and down the country. Its independent inspection teams provide a vital function on behalf of patients and everyone in England in challenging how hospitals, GP surgeries, care homes and all other healthcare providers are delivering to the standards we should all expect.

The CQC has identified that the local NHS in the hon. Lady’s constituency faces some challenges. I acknowledge that the confluence of inspection reports—they have come at around the same time to several of the different providers and commissioners in her area—is an unusual challenge to correct for the benefit of local residents. In stark contrast, as my hon. Friend the Member for East Worthing and Shoreham said, next door, there is the outstanding-rated Western Sussex Hospitals NHS Foundation Trust, which serves residents of West Sussex. As she pointed out, Brighton and Sussex University Hospitals NHS Trust was rated inadequate earlier this year by the CQC. To support its recovery, NHS Improvement placed the trust into special measures.

[Peter Kyle]

I am grateful to the Minister for giving way so early in his speech. He mentions that there has been an unusual confluence of reports. I would suggest that the unusual thing is that each of the reports indicates extreme failure in many different parts of our health system in Brighton and Hove, from the ambulance trust and six GP surgeries, as was brilliantly outlined by the hon. Member for Brighton, Pavilion (Caroline Lucas), right through to the hospital trust—all in special measures, and the hospital in financial special measures. That is the unusual thing. I suggest that the health economy in Brighton and Hove is now bankrupt.

I suggest to the Minister that he does not do his thinking on his feet now, but would he consider arranging for his Department to appoint someone to our city who can take an overview of what is right and what is wrong in our city, of the funding and of the relationship between the different health bodies and the local authority? Let us bring together all the health systems, figure out what is wrong and how we can bring them together to solve all the problems. The fractures have got too much.

[Mr Dunne]

I will not take up the hon. Gentleman’s invitation to think on my feet, but I will refer later to the sustainability and transformation plan, to which the hon. Lady referred, which is providing a forum for much closer collaboration across the NHS within an area. Clearly, it is a much larger area than Brighton itself, but it is going some way towards meeting the kind of analysis that he is looking for. I will also touch on the individual trust support that is being offered by wider NHS groups to provide additional qualified medical and managerial support to help to solve the problems.

--- Later in debate ---

[Mr Dunne]

I thank the hon. Lady for her intervention. I am going to move on, but I acknowledge her point. I hope that, in part, the STP will focus the attention of the wider area to support the new trauma centre that is being established. That is part of the purpose of the STP, although, like her, I have yet to see the full details.

I think we all recognise that patients deserve the highest quality care and we expect the trust to take action to ensure the root causes of the CQC concerns are addressed. NHS Improvement has confirmed that the trust has developed a recovery plan and as part of a package of support for the trust for being in special measures, NHS Improvement has appointed an improvement director and a board adviser.

We should also acknowledge along with the trust’s challenges the fact that there are good things going on in Brighton. We should praise the team that delivers services for children at the Royal Alexandra children’s hospital in Brighton as the CQC rated them as outstanding for being innovative and well led.

Emergency care services at the trust are not as we would expect, as the hon. Member for Brighton, Pavilion identified. With support from the national emergency care improvement programme, a clinically led initiative that offers intensive practical help to trusts looking to improve their emergency services, NHS Improvement is working closely with local clinicians to make a difference for the people of Brighton and Hove seeking emergency care. The trust is also developing plans to create capacity to support delivery of the planned care standards.

As the hon. Lady said, on Monday of last week NHS Improvement announced that the trust has entered financial special measures, a programme launched by the regulator that provides a rapid turnaround package for trusts and foundation trusts that have either not agreed savings targets with local commissioners or planned to make savings but deviated significantly from this plan in their quarterly returns. As part of financial special measures, the trust will agree a recovery plan with NHS Improvement. The trust will also get support from and is held accountable by a financial improvement director.

The hon. Lady also referred to the challenges faced by the ambulance services in her constituency and the area. In addition, South East Coast ambulance service was recommended for special measures by the CQC in its inspection report published last month. NHS Improvement acknowledges that there are wide-ranging problems across the trust, including in governance structures and processes, culture, performance and emerging financial issues. NHS Improvement has agreed a support package for the trust, which was formalised on 9 August this year, and includes a formal peer support relationship with a neighbouring ambulance trust that is rated good by the CQC.

As part of the support package, NHS Improvement has also appointed an interim chair and will appoint an improvement director in due course.

[Peter Kyle]

For the second time, I am extremely grateful to the Minister for giving way. We focus the onus for improvement on the delivery bodies in the Brighton and Hove area. NHS Improvement and the CQC have been outlining plans and their responsibility is to instigate this improvement, but does he accept that NHS Improvement is also under scrutiny in how it unfolds this improvement programme and that if improvements do not happen fast enough it will also be culpable? Some of the dates for improvement have already passed without the improvements being made.

[Mr Dunne]

The hon. Gentleman will recognise that NHS Improvement only came together in April of this year when the two previous regulators, Monitor and the NHS Trust Development Authority, were combined. It is to a degree finding its feet in working out how best to assist trusts that get into difficulty. It has introduced a number of different schemes for different types of challenge, and we have touched on the care challenge and the financial special measures challenge. It is also undertaking a five-point A&E improvement plan to focus particularly on challenges in emergency care. It is fair to say that it is early days in seeing how NHS Improvement undertakes its functions, but we have every confidence that it will be able to assist trusts in dealing with these challenges.

Finally on the South East Coast ambulance service, NHS Improvement is also undertaking a capability and capacity review and will provide the trust with support with its finances. The hon. Lady mentioned the problems with the non-urgent patient transport service provider. This has clearly been a very difficult time for its staff and for some patients, as she has highlighted. My understanding is that the High Weald Lewes Havens CCG has overseen the implementation of plans to ensure continuity of service, and has recently appointed a specialist transport adviser to look into the resilience of the contract and to explore options to strengthen this further.

The provision of the services is, quite rightly, a matter for the local NHS. The hon. Lady asked who is responsible for monitoring contracts. The reality is that the CCG is the statutory NHS body with responsibility for the integrity of the procurement, as well as for managing the contract. It has powers within the standard NHS contract to intervene where a contractor’s performance falls below what is expected.