NHS Winter Crisis

Debate between Philip Dunne and Yvette Cooper

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

My hon. Friend is a consistent champion of efforts to improve health facilities in her constituency. I am acutely aware of the challenge of medical training places in Canterbury, which was one of the reasons that we met last year to discuss what could be done to encourage medical students to come to Kent. I am not able to give her any specific guidance on the allocation of new medical training places because that recommendation will be coming to me over the next few months from Health Education England. We look forward to making decisions on that, and I specifically included in the criteria that rural and coastal areas should have good representation.

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

The Minister will have seen the images of patients at Mid Yorkshire Hospitals NHS Trust sleeping on the floor because they could not even get a trolley, never mind a bed. We have had over 95% bed occupancy rates and a shortfall of over 200 nursing vacancies, and we will have a multimillion-pound budget shortfall by the end of this year. The Health Secretary and the Prime Minister have been repeatedly warned about this by nurses and doctors at Mid Yorkshire trust and across the country, by the public and by the NHS chief executive, yet they still decided to deny him the funding he needed at the Budget. How many more patients will have to sleep on the floor before this Government act?

Mid Yorkshire Hospitals NHS Trust

Debate between Philip Dunne and Yvette Cooper

Thursday 21st July 2016 Commons Chamber

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

May I start my remarks by saying what a pleasure it is to be here this evening for my first opportunity at the Dispatch Box in my new role at the Department of Health?

I congratulate the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) on securing this debate on a subject that I know is close to her heart and that of her neighbour, the hon. Member for Dewsbury (Paula Sherriff), who it is good to see here supporting her in the Chamber this evening. I congratulate the right hon. Lady in particular on securing this debate, the last opportunity to raise a subject in the House this side of September.

I am well aware that this is a matter of significance to Members of Parliament and obviously to the local populations they represent. I think the hon. Member for Dewsbury recently persuaded the Mid Yorkshire trust to have a public meeting to discuss these issues locally, and I congratulate her on doing that, and hope it was helpful in at least raising some of these issues.

The problem of staff shortages at Mid Yorkshire is well known, and it is recognised not just by local Members of Parliament, but was demonstrated by evidence recorded by the CQC through its inspections over recent years, not just the most recent one. Having said that, there are of course examples of good care within the trust, and I would like to add my voice to that of the right hon. Lady who acknowledged that from the comments of, I think, the Fanshawe family, who pointed out that the quality of care provided by the nursing and other staff in the hospital is very high where they are in a position to do that. I pay tribute to everyone who works in the trust—in the hospitals there—in the admittedly somewhat challenging circumstances they find. I draw attention in particular to the maternity services and children’s services, where the standards are acknowledged to be high.

There is no hiding the fact that there are problems, however, and I am not here to do so. Unsafe care was found in the most recent CQC inspection last summer, published in December last year. That is clearly the most potentially serious of its findings. This is a long way from being a high-performing trust, which is what we would all like our trusts to be. While the CQC report shows the trust had responded to previous staffing concerns and is actively trying to fill posts, there are acknowledged areas of significant nurse staffing shortage affecting patient care and treatment, particularly on the medical care wards and in community in-patient services and specialist palliative care.

The right hon. Lady may not appreciate hearing this, but the fact remains that responsibility for staffing in hospitals in her constituency sits squarely with the board of the Mid Yorkshire trust. Trusts have a duty to ensure they have the numbers and skill mix needed to deliver quality care, patient safety and efficiency, taking into account local factors such as acuity and case mix.

[Yvette Cooper]

But what if there just are not enough A and E doctors or neurology doctors to fill the posts? If they advertise them, charge around the country recruiting for them and they still cannot get the doctors in, what are they supposed to do?

[Mr Dunne]

I will come on to what we are doing nationally to try to make sure we have an adequate number of trained professional clinicians to meet the needs around the country.

It is important to recognise that while nationally some standards are set for safe staffing ratios, which were referred to by the hon. Member for Dewsbury, these are not a hard-and-fast rule and never have been. They are guidance rather than statutory requirements, and this position has not changed. Trusts have to use their judgment and focus on quality of care, patient safety and efficiency, taking into account local factors such as case mix rather than just numbers and staffing ratios. It is not a case of meeting a particular staffing ratio or getting to a particular figure and thinking that the matter is resolved. There must be enough staff—as both hon. Members are saying—to meet the needs of the patients, and it is a matter for the clinicians on the spot to make a judgment on that.

Nationally, demands on our staff across the NHS are rising, and more patients are being cared for than ever before. That is as true of Mid Yorkshire as it is of anywhere else in the NHS. Last year, across the Mid Yorkshire Hospitals NHS Trust, 232,966 patients were seen, compared with 194,119 in 2009-2010. That is an increase of more than 15% over the past six years. There were also some 4,685 more diagnostic tests carried out in May this year than in May 2010. Activity levels are therefore rising considerably.

[Mr Dunne]

It is well recognised across the country that the tendencies in A&E include a significant proportion of people who should not be there and who should be being dealt with elsewhere in the system. The reasons for that are legion; it is not all down to pressures on GPs. Much of it is down to members of the public increasingly seeing their hospital as the place to go. We have a big educational job to do across the country on that, and it behoves all of us to help to relieve the pressure on A&E by encouraging patients to get their health needs seen to in the most appropriate place, whether through a pharmacy or a GP, or through other community services.

I want to touch on the question of funding. It is not all about money, but money plays a part. As a result of the funding settlement that we have secured for NHS England, the Wakefield clinical commissioning group will receive £488.8 million in 2016-17—the current fiscal year—which represents a cash increase of just over 3% compared with the previous year. In cash terms, that is a £21.7 million increase—a significant increase compared with previous years. For North Kirklees, the other CCG that commissions the work of the trust, there was also an increase in the current year to £237.1 million, representing a 2.49% increase compared with 2015-16, or just a shade under £12 million. That increase is substantially greater than the deficit reported by the Mid Yorkshire trust for last year. Of course, the commissioning funds do not all go to the trust, but the health economy in the area has received a significant cash injection.

Ensuring that we have the right number of nurses —I shall start with nurses—is a vital move towards achieving the Government’s objective of having a fully seven-day NHS by 2020. Nationally, we already have 11,800 more nurses, midwives and health visitors than we did in May 2010. The number of nurse training places has increased by 14% over the past three years alone, with further increases planned in the current year. More than 50,000 nurses are currently in professional training, which includes working and learning in hospitals through placements. However, the current funding system means that two out of every three people who apply to a university to do a nursing degree are not accepted for training. That is one of several reasons why trusts such as Mid Yorkshire find it difficult to recruit.

In 2014, the last full year for which I have statistics, universities were forced to turn down 37,000 nursing applicants. As a result, the NHS suffers from a limited supply of nurses and must rely on expensive agency staff and overseas workers, as referred to earlier. That is one reason why, earlier today, the Government announced their response to the public consultation on plans to place trainee nurses in the same system as all other students, including teachers and doctors. That response has been placed in the Library.

[Yvette Cooper]

I thank the Minister for his generosity in giving way. Will he confirm that the reason universities were forced to turn down so many would-be nurses was that the Government did not fund enough places? I realise that he is new to the Department and will not have had a huge amount of time to investigate staffing levels around Yorkshire, but when he goes back to the Department I urge him to look at whether there could be a Yorkshire action plan on recruitment. We have a regional problem that is worse than the national problem—although it will be replicated in other regions.

[Mr Dunne]

I will come to how we will respond when I conclude my remarks, but the right hon. Lady is quite right to point out that the problem is not unique to this particular trust and must be seen in a regional context.