Doncaster and Bassetlaw NHS Trust STP

Philip Dunne Excerpts

Monday 30th January 2017 Commons Chamber

[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.