NHS Funding Bill

Philip Hollobone Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

I will give way briefly before I conclude.

[Mr Philip Hollobone (Kettering) (Con)]

I thank the Secretary of State both for his commitment to fund the new £46 million urgent care hub at Kettering General Hospital and for including the hospital on the list for HIP2 funding from 2025 onwards. When will the hospitals on that shortlist get the seed funding to develop their plans?

[Matt Hancock]

The funding will be paid to the hospitals imminently, but it is definitely coming, so they can get on with planning for it.

Health and Social Care (Kettering)

Philip Hollobone Excerpts

Wednesday 23rd October 2019 Westminster Hall

[Mr Philip Hollobone (Kettering) (Con)]

I beg to move,

That this House has considered health and social care in Kettering constituency.

I welcome you to the Chair, Mr Wilson, and I thank Mr Speaker for granting this debate. I also welcome Northamptonshire colleagues who are here: my hon. Friends the Members for Wellingborough (Mr Bone) and for Northampton South (Andrew Lewer). If he is released from his important role in the Government Whips Office, my hon. Friend the Member for Corby (Tom Pursglove) hopes to be able to attend. Others with a local interest are also here, including my right hon. Friend the Member for Rutland and Melton (Sir Alan Duncan), who I welcome to his place.

I also welcome our excellent Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar). He is not only excellent in his own right, but he is super excellent because within just a few weeks of being appointed as hospitals Minister, he made a visit to Kettering General Hospital one of his very highest priorities. He did that on 7 October and met: the superb chairman of Kettering General Hospital, Alan Burns; our wonderful chief executive, Simon Weldon; the medical director, Andrew Chilton; the chief nurse, Leanne Hackshall; the chief operating officer, Joanna Fawcus; the director of strategy and transformation, Polly Grimmett; the director of finance, Nicola Briggs; the director of estates, Ian Allen; the clinical director of urgent care, Adrian Ierina; and the head of nursing in urgent care, Ali Gamby. All those magnificent people were there to meet the Minister because the hospital is absolutely determined to get the necessary funding for a new urgent care hub at the Kettering General Hospital site.

Kettering General Hospital is a much-loved local hospital. It has been on its present site for 122 years, and there cannot be many hospitals that have such a record. The problem at Kettering General Hospital is that the A&E department is full. It was constructed in 1994 to cope with 45,000 attendances each year. This year, we could well go through the 100,000 attendances mark, which is well over 150% of the department’s capacity. By 2045, 170,000 attendances are expected at the same site. The solution to that pressure is for an urgent care hub facility costing £46 million to be constructed on the site. It would be a two-storey, one-stop shop with GP services, out-of-hours care, an on-site pharmacy, a minor injuries unit, facilities for social services and mental health care, access to community care services for the frail elderly and a replacement for our A&E department. All the NHS organisations in Northamptonshire, as well as NHS Improvement regionally, agree that that is the No. 1 clinical priority for Northamptonshire. They are all saying the same thing to the Government, and I am delighted to support their campaign.

The A&E department at Kettering General Hospital was visited in 2016 by Dr Kevin Reynard of the national NHS emergency care improvement programme. He said:

“The current emergency department is the most cramped and limiting emergency department I have ever come across in the UK, USA, Australia or India. I cannot see how the team, irrespective of crowding, can deliver a safe, modern emergency medicine service within the current footprint.”

Despite some temporary modifications over recent years, including moving other patient services off the hospital site, detailed surveys show that no further opportunities remain to extend the department and that a brand-new building is required on the site. The hospital has developed a superb business case for a fit-for-purpose emergency care facility that will meet local population growth for the next 30 years. It has been developed with all the health and social care partners across the county so that patients can get a local urgent care service that meets all the Government guidance on good practice, ensuring that they get the care they need to keep them safely outside of hospital if necessary, and ensuring that if they come into hospital, they are seen by the right clinician at the right time, first time. The bid has been submitted to the Government. We have been pressing the case for the facility since 2012. It is about time that the Government listened to the concerns and responded by promising the funding.

The pressure on Kettering General Hospital is primarily being driven by very fast population growth locally. The Office for National Statistics shows that we are one of the fastest growing areas in the whole country, at almost double the national average. The borough of Corby is the fastest growing borough outside of London. The population served by the trust has grown by almost 45% since the A&E opened in 1994. The area is committed to at least 35,000 new houses over the next 10 years. That means a population rise of some 84,000, to almost 400,000 people locally. The A&E department now sees approximately 300 patients every single day in a department that is safely sized to see just 110. Every day, 87 patients are admitted into the inpatient wards from A&E, and over the next 10 years, the hospital expects the number of A&E attendances to increase by 30,000, equivalent to almost 80 extra patients every day. Bluntly, a solution is required immediately if the hospital is to have time to prepare and build for that.

[Andrew Lewer (Northampton South) (Con)]

I thank my hon. Friend for giving way. I recently visited A&E at Northampton General Hospital, which also has a space and crowding problem, particularly in paediatrics. Does he agree that investment there would assist Kettering with the problems it has and would lead to a whole Northamptonshire approach to solving some of these problems?

[Mr Hollobone]

I am delighted to take that intervention from my hon. Friend, who is a superb representative for his constituents in Northampton and is very much in touch with the importance of local healthcare issues to our constituents. He is absolutely right.

I am delighted to welcome the Government’s commitment to include Kettering General Hospital on the list of hospitals that will be considered for health infrastructure plan 2—or HIP2—funding from 2025. That is important for Kettering, because the hospital has been there for 122 years, 70% of the buildings on the main hospital site are more than 30 years old and there is a maintenance backlog of £42 million. We need the reconstruction of many wards at the hospital. I welcome the Government’s commitment to investment in the hospital site from 2025 onwards, which could transform the whole of Kettering General Hospital. The point about the urgent care hub is that we need the money now to address the pressure on the A&E department.

The second part of the debate is about the need for us to use the opportunity of local government reorganisation in Northamptonshire to create in the county a combined health and social care pilot that will put responsibility for healthcare and social care under one organisation. Northamptonshire County Council has faced tremendous financial difficulties. The Government appointed an inspector, who concluded that it was not possible to turn around the organisation. The Government’s solution is to create two unitary councils in the county: a “north” council and a “west” council that will take over all the responsibilities of the eight different councils in the county from May 2021. We can use that once-in-a-generation opportunity to create a new organisation on a pilot basis to combine health and social care in Northamptonshire.

That is important for Kettering General Hospital because it has 531 beds; at any one time 110 of those beds—21%—are occupied by patients who should not be in hospital at all, but in a social care or other setting. In Government jargon, they are defined as super-stranded patients who have been in hospital for more than 21 days. If the hospital discharges 87 patients a day from the A&E department to the hospital, and 110 of the beds are occupied by patients who should be in a different setting, it creates huge problems for the A&E department, so finding a solution to the social care issue is also important for the A&E department.

[Mr Peter Bone (Wellingborough) (Con)]

I congratulate my hon. Friend on having led a seven-and-a-half-year campaign to get the expansion at Kettering General Hospital. It has been my great pleasure and that of my hon. Friend the Member for Corby (Tom Pursglove) to support him, but he has led this magnificent campaign and I hope that today he will succeed in his objective. Does he agree with me that the reorganisation he has talked about could possibly—hopefully—lead to an urgent care centre at the Isebrook Hospital in my constituency, which would reduce the number of people who go to Kettering A&E by 40%?

[Mr Hollobone]

I would be delighted to support my hon. Friend’s campaign. He is a very effective champion for his constituents. He, along with my hon. Friend the Member for Corby, has been an integral part of a joint effort to campaign for the urgent care hub at Kettering. I would be delighted to reciprocate, because health investment in our local constituencies is very important for our local residents.

My hon. Friend the Member for Wellingborough will join me in welcoming any proposals that the Government introduce to create a health and social care pilot in the county. We simply have to make sure that elderly, frail residents in hospital, who need not be there and should be in a social care setting, are given the social care that they need in the right place at the right time. With social care now the responsibility of Northamptonshire County Council, I am afraid it simply is not working.

Evidence shows that the longer an elderly person stays in hospital, the more they lose critical muscle mass and strength, which affects their ability to return to their home or social care setting without appropriate support. Patients with long lengths of stay in hospital become revolving door patients. They get better and could go to a community setting of care, but they become unwell again because they wait so long for an appropriate out-of-hospital placement, so we need to get that sorted out. Financially, it does not make sense, either. If a patient stays in hospital, it costs £2,500 a week. If they are put into a social care setting, the cost to the taxpayer is £700 a week. Not only is the setting more appropriate, but it is financially beneficial for our health and social care providers.

I am pleased that the Secretary of State for Health and Social Care, together with the appropriate Minister in the Ministry of Housing, Communities and Local Government, wrote to all Northamptonshire MPs on 24 July, encouraging Northamptonshire County Council and the local NHS providers to knock their heads together to thrash out an appropriate plan. The Secretary of State wrote:

“I agree that the unitarisation process offers an excellent opportunity to re-imagine the delivery of health and social care services across Northamptonshire. I believe that local leaders should be bold in their ambitions for integration”.

He stated that he and the Housing, Communities and Local Government Minister

“are happy to back a bolder plan for integrated services in Northamptonshire, learning from other areas that are further ahead in the integration journey”,

such as Greater Manchester. Since that letter of 24 July, my colleagues and I, as parliamentary representatives from Northamptonshire, have seen little evidence of any concrete proposals from the county council and the local NHS. It is time for the Government to knock heads together locally, because the Government will want a pilot to pioneer their reform of health and social care. We have a wonderful opportunity in Northamptonshire to be the first in a shire setting to get it right.

Local organisations are doing their best in the present circumstances—I declare my interest as a member of Kettering Borough Council. To give one example, Karen Clarke, a housing options adviser at Kettering Borough Council, has been working extremely hard to make sure that patients can come out of hospital and find appropriate accommodation if they have difficulties in doing so. She recently wrote:

“I think the majority of the public assume everyone goes in to hospital, receives their treatment and is discharged home, but what if that patient doesn’t have a home? Or what if their home is no longer accessible? What if someone needs more than just independent living? Where does the patient go then?”

Karen has seen more than 250 patients in the past two years. She has managed to return home, or to secure permanent accommodation for, approximately 7% of those referrals, and 25% have gone into some level of temporary accommodation. That pioneering initiative is at Kettering’s health and housing partnership, where Kettering Borough Council, the local mental health trust and Kettering General Hospital work together. It has been pioneered by John Conway, the inspirational head of housing at Kettering Borough Council. It is a superb initiative.

However, such local initiatives are not enough. We need one organisation, preferably NHS-led, to sort out health and social care provision in Northamptonshire. The Government have a golden opportunity to pioneer a pilot in the county, so I hope they will press ahead. There are two issues: we need £46 million for an urgent care hub at Kettering General Hospital, and we need the Government to seize the initiative, knock heads together locally, and make sure we can have a pilot for health and social care in Northamptonshire.

Health Infrastructure Plan

Philip Hollobone Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

I am grateful to the right hon. Gentleman. He is absolutely right to highlight the challenges about Midland Metropolitan Hospital. I know, in the spirit of bipartisan sentiment, how hard he has been working on that issue on behalf of his constituents, and I also know how hard Toby Lewis has been working on this as well in running that hospital trust. I have looked into the matter recently. I am very happy to meet him to talk through with him where we are and what the next steps are because, like him, I am keen that we get things moving.

[Mr Philip Hollobone (Kettering) (Con)]

Record numbers of patients are being treated at Kettering General Hospital with increasingly world-class treatments. The difficulty that we have at Kettering General Hospital is the A&E department, which, when it was constructed 25 years ago, was designed to cope with 45,000 visitors and is expected to go through 100,000 attendances this year. The solution is an urgent care hub. There is already a fully worked-up business plan in place. May I welcome the addition of Kettering General Hospital on the list of future projects and ask: when can the hospital expect the money and when can it expect to start to build the new urgent care hub?

[Edward Argar]

I am grateful to my hon. Friend for his question. He is right to highlight the importance of design, particularly in A&E and emergency departments, for the ability of staff to manage increasing demand and increasingly complex cases. As he highlights, Kettering General Hospital NHS Foundation Trust is included in HIP 2 for the seed funding to develop that business case and its proposal. I am happy to work with him and I hope that he will work with the trust to develop the business case in accordance with the criteria for bidding against future funds.

Kettering General Hospital Urgent Care Hub

Philip Hollobone Excerpts

Tuesday 3rd September 2019 Westminster Hall

[Mr Philip Hollobone (Kettering) (Con)]

I beg to move,

That this House has considered the urgent care hub at Kettering General Hospital.

May I say what an unexpected pleasure it is to see you in the Chair, Mr Bone. I am sure that we will all benefit from your wise guidance and counsel. I thank the Speaker for granting me this debate and welcome the Minister to his place. We are joined today by Mr Simon Weldon, the outstanding chief executive of Kettering General Hospital, our very popular local hospital. Of course, you will know him as well as I do, Mr Bone.

Kettering General Hospital is an extremely popular and well-liked local hospital. It is 122 years old this year, and still occupies the site that it first occupied in 1897. There cannot be many hospitals in the country that are still based almost entirely in their original locations from more than a century ago.

Today, we are talking about the urgent need for an urgent care hub on the Kettering General Hospital site. We need the urgent care hub because the hospital is such a popular one that it simply cannot cope with the number of patients admitted to A&E at the moment. Everyone—all the local NHS professionals in every NHS organisation in Northamptonshire—agrees that the best solution to the challenges the hospital faces is £49 million for the development of an urgent care hub on the site, which the hospital needs.

An urgent care hub would basically be a one-stop shop for GP services and out-of-hours-care, an onsite pharmacy, a minor injuries unit, facilities for social services and mental health care, access to community care services for the frail elderly, and a replacement for our A&E department. The most crucial aspect of that is the A&E department, which was built 25 years ago in 1994 to cope with 40,000 attendances each year. Last year, 91,200 patients came through that very same A&E. This year, we are on track to pass the 100,000-mark for patient attendances, which is well over 150% of the department’s capacity. By 2045, 170,000 attendances are expected at the same site

[Jim Shannon (Strangford) (DUP)]

It is not only Kettering General Hospital—A&Es across many constituencies suffer from similar problems. Does the hon. Gentleman agree that we would all benefit if, in A&Es—particularly that of Kettering General Hospital, which the debate is about—there were better patient care and a better working environment for health professionals? In A&Es, it is important that health professionals are happy in their work and feel that they can move forward in what is possibly the most stressful specialty. In the long run, the investment to which the hon. Gentleman referred will pay for itself in better patient outcomes and better staffing capacity.

[Mr Hollobone]

I am most grateful for that unexpected contribution from Northern Ireland—it is always a delight to see the hon. Gentleman in his place, and I thank him for his support. Of course, I agree that A&E facilities across the country are under pressure, but that pressure is particularly acute in Kettering, not least due to the number of houses that are being built locally, the increase in the local population and the fact that—thank goodness—we are all living longer. In Northamptonshire, there has been a particular increase in the number of elderly patients who are served by the local hospital. I thank the hon. Gentleman for attending and for his support.

In 2016, Dr Kevin Reynard of the national NHS emergency care improvement programme visited Kettering’s A&E and concluded that:

“The current emergency department is the most cramped and limiting emergency department I have ever come across in the UK, USA, Australia or India. I cannot see how the team, irrespective of crowding, can deliver a safe, modern emergency medicine service within the current footprint.”

Simon Weldon is also extremely concerned about patient safety. He said to me that unless we get the situation sorted, sooner or later there would be a patient death in Kettering’s A&E.

An impact of the incredibly cramped department is that staff do not have clear lines of sight on some of the most unwell patients to monitor their conditions appropriately. Privacy and dignity for patients cannot be maintained due to overcrowding and cramped spaces. Patients wait longer than the national limits, as there is physically not enough space to treat the numbers coming through the door. Children have to wait in open corridors and go through adult areas to receive treatment. A lack of space to offload ambulances often results in long queues and inhibits ambulance response times to 999 calls. The A&E rooms do not comply with many current health building standards and there is a lack of natural daylight.

The Care Quality Commission and other inspections have consistently raised multiple concerns, for both adult and paediatric patients, about the size and limitations of the estate. Most importantly, as I have described, the number of patients has now reached a critical point and staff need to manage safety daily, patient by patient. For health professionals who take pride in their job, the challenges of working in Kettering A&E are becoming unbearable.

In the next 10 years, local population growth is expected to far exceed the national average and our catchment includes the fastest growing borough outside London, in our neighbouring constituency of Corby. In the last census, out of 348 districts across the country, Kettering was sixth for growth in the number of households and 31st for population increase, while Corby has the country’s highest birth rate. Our local area has been included as part of the Cambridge-Milton Keynes-Oxford corridor, in which there is a commitment to build 35,000 new homes in the next 10 years.

Kettering General Hospital expects a 21% increase in over-80s and 10,000 more A&E attendances in the next five years alone. Despite some temporary modifications over recent years, including moving other patient services off the hospital site to accommodate delivering safe emergency care, detailed surveys show that there now remain no further opportunities to extend the current department and that a new building is required on the site.

Following those safety reviews and surveys, the hospital has developed a business case for a fit-for-purpose emergency care facility that will meet local population growth for the next 30 years. It was developed with all health and social care partners across Northamptonshire, so that patients can get a local urgent care service that meets all government guidance on good practice, ensuring that they get the care they need to keep them safely outside of hospital and that they are cared for by the right clinician at the right time, first time.

The urgent care hub would be a central cog in a whole-system approach to delivering urgent care services to meet the needs of the population, and it would work alongside GP, mental health, community and social care services. The hub continues to be identified as the highest clinical safety priority across the whole of the county by Northamptonshire sustainability and transformation partnership. It was also approved by the NHS Improvement midlands and east regional team as the highest priority submission for central capital funding.

We are talking about £49 million and about Northamptonshire being the only one of all 44 STP areas in the country not to receive any capital funding at all in the past four waves of such funding from the Department. Why is that the case? If the Minister were to agree to the urgent hub proposal, he would put that wrong right. The trust can access only £3.5 million annual capital through its own funding, and the county, Northamptonshire, has only £20 million, but that is used simply to maintain essential equipment and to repair heating and lighting systems. Kettering General Hospital therefore requires central funding or some form of private financing to build the facility.

A bid has been submitted as the highest clinical priority for funding across the whole of the NHS in Northamptonshire, and for NHS Improvement regionally, but Government capital allocation announcements over the past few weeks have not included the urgent care hub, nor any other moneys for Northampton or our local region. I simply do not understand why Kettering General Hospital has been missed off the list. The national NHS Improvement team has indicated that no further STP capital funding will be announced until spring 2020, although I understand that the Government are now reviewing all spending allocations across all Departments in the comprehensive spending review expected later this week. Local people will be very surprised if Kettering General Hospital is not included somewhere in that review.

Given the clear patient safety concerns at Kettering that have been recognised locally, regionally and nationally by NHS experts, what process did the Government follow to award schemes the central NHS capital allocations in recent weeks? Why was Kettering not included? Why were some awards made to areas with no apparent clear and worked-up business case, when Kettering has such a case? Given the lack of access to further NHS capital funding, what are the alternatives for Kettering General Hospital without a central grant of funding from the Department of Health? Furthermore, how are the Government correlating healthcare decisions with the locations of planned growth in housing?

I do my humble best as the local elected representative to express such concerns. The chief executive of the hospital, Simon Weldon, would have made a far better job in this debate than me, but I will quote some of the dedicated healthcare professionals in our local hospital. They will outline the challenges that they face far better than anyone else.

The head of children’s safeguarding at the hospital, Tabby Tantawi-Basra, said:

“Children have to wait in corridors alongside seriously unwell, drunk or mentally unwell adults. This causes a serious safeguarding concern as our staff are not always able to have line of sight on them.”

Sarah Parry, who is a nurse in end-of-life care at the hospital, said:

“When a patient is brought into A&E dying or already passed away, there is no space where relatives can sit quietly to receive the news and grieve. We can’t even make them a cup of tea—they have to share a facility with the staff room!”

Jacquie Barker, the head of adult safeguarding, said:

“We know from the Winterbourne View scandal that the lack of privacy and dignity for vulnerable adults seriously impacts their mental wellbeing. Sadly our facilities mean even our most vulnerable adults are looked after in very cramped conditions, sometimes next to disruptive or aggressive other adult patients.”

Claire Beattie, the head of nursing medicine at the hospital, said:

“Our staff work tirelessly to keep patients safe under the most difficult of conditions. The way the treatment areas are configured means they struggle to easily communicate or ask for help, and if patients are deteriorating then it isn’t always easy to see that quickly and give the urgent help they need.”

Leanne Hackshall, the director of nursing, said:

“Patients are so close together they can almost hold hands. And if someone is being sick or coughing badly in the next space then every other patient worries about who they are so close to.”

Polly Grimmett, the director of strategy, said:

“As Director on call in August, we had over 100 patients in the department for most of the night and it’s only safely meant to fit 40—there were 10 ambulances with patients queuing. This is meant to be our quietest month so who knows how bad it will be in December!”

Nicola Briggs, the director of finance, said:

“If we stopped spending any money at all on necessary things like replacing light bulbs or fixing equipment, then it would still take us nearly 15 years to save up enough money ourselves.”

The urgent care hub is, as far I am concerned, the No. 1 priority for local people in Kettering. The general hospital is much loved, and we need more investment to cope with the growth in the local population and to care for our increasingly aged population. I invite the Minister to visit the hospital and to see the A&E department for himself. If he does so, he will follow in the footsteps of two previous Ministers with responsibility for hospitals and the previous Secretary of State.

The problems are well known in the Department of Health, and I simply do not understand why £49 million—not very much in the context of the size of the whole NHS budget—cannot be allocated to fund the badly needed urgent care hub at Kettering General Hospital. All the local NHS bodies agrees that the hub is the answer to the difficulties and challenges faced by the hospital.

More patients are being treated at Kettering General Hospital than ever before. Their treatment is increasingly world-class, and I thank all the dedicated NHS professionals in our local hospital for their magnificent work. In order to help them face the challenges ahead, we urgently require £49 million from the Government for this badly needed urgent care hub facility.

[The Minister for Health (Chris Skidmore)]

It is an honour to serve under your chairmanship, Mr Bone, in my first debate as the new Minister of State for health.

I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate on the proposed urgent care hub at Kettering General Hospital. This is an important issue for not only my hon. Friend but his constituents in the wider Kettering community, and it is one on which he campaigns tirelessly. I congratulate him on his diligence and determination to continue that, bringing it before the House today.

Kettering General Hospital, as my hon. Friend mentioned, has stood on the same site for nearly 122 years. It plays a vital role in the community, and he set out eloquently the importance of the hospital to that community. In January this year, my predecessor, my hon. Friend the Member for Wimbledon (Stephen Hammond), discussed the urgent care hub proposal with my hon. Friend the Member for Kettering and visited the hospital, following the foundation trust’s unsuccessful £45.7 million sustainability and transformation partnership bid in July 2018. My hon. Friend set out clearly the need to cope with rising demand, with which the urgent care hub could assist.

Given the unsuccessful bid, I am sure that my hon. Friend is aware that the sustainability and transformation partnership programme has been the main funding route for strategic capital development projects. Under that programme, capital has been allocated to more than 170 STP schemes since July 2017, which now amounts to about £3.3 billion. STP investments will modernise and transform NHS buildings and services across the country, including new urgent care centres, integrated care hubs that bring together primary and community services, and investment in new mental health facilities.

On 5 August this year, the Government announced a £1.8 billion increase in NHS capital spending, on top of the additional £3.9 billion announced in the 2017 spring and autumn budgets. Of the increase in NHS capital spending, £1 billion will allow existing upgrade programmes to proceed, to tackle the most urgent infrastructure projects. Some £850 million will allow 20 new hospital upgrades to start as soon as possible. Those hospitals were chosen because they applied for funding in tranche 4 of the sustainability and transformation partnerships, but narrowly missed out. I will set out the short process that we go through to designate the waves, whereby the 20 hospitals that narrowly missed out on upgrades previously will receive funding this time.

[Mr Hollobone]

Kettering General Hospital narrowly missed out on previous funding allocations. Northamptonshire is the only one of the 44 STPs in the country never to have received any capital funding in the four waves that have taken place. I find that staggering, given the overwhelming support from the local NHS for the urgent care hub proposals.

[Chris Skidmore]

NHS Improvement and NHS England follow an independent assessment process. Previous waves, and the allocation of the 20 hospital upgrades that were announced last month, were assessed on the following six criteria: deliverability; patient benefit and demand management; service need and transformation; financial sustainability that delivers savings to both the organisation and the sustainability and transformation partnership; value for money, including return on investment; and estates.

As well as the top-scoring schemes, a number of schemes of critical service importance have been included, such as mental health and learning disability schemes, drawing on the advice from sustainability and transformation partnerships and national and regional NHS leadership. Together, the schemes demonstrate that they will deliver clear improvements to services. That may not be the answer that my hon. Friend wants to hear, but let me reassure him that I am happy for NHS England and NHS Improvement to discuss how the process and the scoring of requirements operate in greater detail with the chief executive, Simon Welden, who is sitting in the Public Gallery. If the trust would like to have that meeting, I will happily help to arrange that feedback for the hospital and my hon. Friend.

On future capital funding, an extra £1.8 billion was announced in August. That money, to enable investments in critical infrastructure, was not previously available, and gives new spending power to the NHS to fund new projects. The £1.8 billion is a brand-new capital injection on top of money announced in previous Budgets and spending reviews. The Department’s capital spending limit has increased accordingly: following the announcement on 5 August, the capital spend on health for 2019-20 has gone up from £5.92 billion to £7.02 billion. It is important to make that clear, given some wish to look for bad news in any good news announcement. It is important to recognise that the £1 billion boost, and the £100 million of the £850 million allocated this year, will be spent on that capital allocation.

[Mr Hollobone]

I join the Minister in welcoming the £1.8 billion of extra capital funding for the NHS and the £1 billion wave of funding at the end of 2018. That is all very good news, but given there is almost £3 billion of extra capital injection, we simply cannot understand why £49 million of that could not find its way to Kettering, particularly as there is already a worked-up business case, to get the project up and running quickly.

[Chris Skidmore]

As a new Health Minister, I have found that the wave approach to the sustainability and transformation partnerships programme has highlighted a wider issue with NHS capital. My hon. Friend’s point about geographical distribution applies not just to bricks and mortar but to diagnostic equipment. We must make sure that our national health service is truly national, by giving every trust equal opportunities to apply for and receive funding. That is why the Secretary of State recently set out that, as a Government, we will establish a new health infrastructure plan. The plan will mean that we take a strategic approach when looking at hospitals that need upgrades, and how that will fit into a wider strategy that will be organised in the Department, taking into account local needs and NHS clinical requirements.

We will put in place a long-term strategy to upgrade and improve our NHS. That will deliver a major strategic hospital rebuilding programme that will provide the necessary health infrastructure across the country. I cannot go into any further detail, apart from to say that the shape of that will be confirmed in due course. To offer a comparison, the road investment strategy—RIS 1 and RIS 2—has a longer term process by which we can move away from a succession of waves. We have waves 1, 2, 3 and 4 of funding as part of the STP processes: some of those projects are further along and more developed than others; some have more advanced business cases than others, as my hon. Friend mentioned. It is important to take a strategic approach for the future.

I understand that my hon. Friend was disappointed that Kettering General Hospital was not selected for funding this time. However, as he mentioned, the trust secured £6 million in emergency capital funding this year, to deal with safety-related estates work. In addition, between 2017-18 and 2018-19, the trust received more than £14 million in capital to fund improvements to the hospital, including £12 million to tackle the urgent capital backlog and other essential capital expenditure. It received £2.4 million for winter pressures and £820,000 for electronic prescribing. That does not make up for what my hon. Friend recognises as an important development and improvement to the estate, but in Kettering the trust has improved enormously and has made great strides in recent years.

I note that while the Care Quality Commission rated the hospital as “needs improvement” after its inspection earlier this year, the trust has been taken out of special measures for quality following the CQC report published in May 2019. I am pleased that, despite the rising demand my hon. Friend mentioned, it is still providing patients with safe and good quality care and is focused on embedding a culture of continuous quality improvement. I am delighted that Kettering General Hospital is participating in a national urgent and emergency care standards pilot, and I await information and learnings on that this year.

[Mr Hollobone]

I am glad that the Minister highlights the huge improvements made at the hospital and the superb leadership we now have in place. Will he accept an invitation to visit the hospital and see the A&E department at first hand?

[Chris Skidmore]

I thank my hon. Friend for that invitation; I would be delighted to visit the hospital. I pay tribute to the staff at Kettering General Hospital, who continue to work hard and who contributed to the hospital’s receiving a good rating for care. I hope we will continue discussions during my visit.

I hope that, if my hon. Friend and the trust are willing, I can arrange the meeting to go through the criteria for STP wave 4 in finer detail. I hope that he understands that we are looking at setting up a new process by which capital infrastructure projects will be delivered. The Government have made significant investments in the NHS as part of their long-term plan. We recognise that we need to mirror that investment in NHS capital. I thank my hon. Friend for raising this important issue, and I look forward to working with him.

Question put and agreed to.

Drug Treatment Services

Philip Hollobone Excerpts

Tuesday 16th July 2019 Westminster Hall

[Jeff Smith]

The hon. Gentleman makes an excellent point. I absolutely agree that we need regulation and control. Personally, I am not sure about royal commissions, because they tend to kick things into the long grass a bit, but perhaps a parliamentary commission or some other way of looking at the problem, trying to come to a consensus and taking the politics out of it—stop people weaponising drugs as a political issue—is the way forward. We need to look at that, because our system is not working. This is not a debate about wider drug policy but, clearly, that policy is not working, and it is resulting in the kind of problems that we face—addicts need the kind of drug treatment services that this debate is about.

I will try to be quick, because other people want to contribute to this short debate. On innovative models of service delivery, naloxone is a life-saving medication that can be used to reverse opioid overdose. However, coverage across England remains poor and the guidance is confusing. If we cannot convince the Government to increase funding for naloxone treatment by implementing a national naloxone programme, they should at least offer national support and guidance for local authorities and prisons. Finally, on drug safety testing, the Home Office refuses explicitly to sanction drug safety testing, which is a simple measure that could save lives and result in fewer people needing treated for drug harms.

We therefore need a refocus of our spending priorities. Funding constraints are curbing the effectiveness of proven treatment and harm reduction measures at the same time as we spend fortunes on drug law enforcement. In 2014-15, for example, an estimated £1.6 billion was spent on drug law enforcement, compared with only £541 million on drug treatment and harm reduction services over the same period. However, while we know that treatment services are cost-effective and save money, the Home Office’s own evaluation of its last drug strategy could not demonstrate value for money in drug law enforcement or enforcement-related activities.

The Government, unfortunately, are preoccupied with trying to stop people from taking drugs—something no one has managed to do in centuries of human behaviour—instead of focusing on harm reduction and treatment. Problematic drug users are stigmatised by our policies and treated as criminals, leaving them less likely to access the life-saving drug treatment services that they need, for fear of arrest. Meanwhile, the services that are available—as we heard earlier—have had their funding slashed and continue to be squeezed.

I need to conclude with some proposals. First, the one consistent message from all stakeholders who have been in touch and care about the issue is that we need to reverse the cuts to our struggling drug and alcohol treatment system. We need to reinvest in those services. The Camurus report released today states:

“The evidence shows that we are fast approaching a point at which we risk doing irreparable damage to our hard-won recovery system, leaving services unable to meet the scale of need that exists.”

The Government must therefore use the upcoming spending review to increase spending on drug treatment services. They need to provide local authorities with additional funding towards those services, without which the ability of services to meet demand will continue to decline.

Among other proposals I suggest the Government should consider guaranteeing the delivery of substance misuse services by making them a statutory, mandated service to end the ambiguity about their delivery and to underline importance of protecting budgets. The Government should also look at the commissioning regime—the consensus among many stakeholders is that it is not working and is too variable—to see whether it is fit for purpose. A 2017 report by the Advisory Council on the Misuse of Drugs asked whether the constant re-procurement of addiction services creates unnecessary instability in the system, resulting in poorer recovery outcomes, which is something I have seen on a small scale in the area of south Manchester I represent. Finally, we need to remove barriers to overdose prevention centres and drug safety testing to encourage faster use of heroin-assisted treatment. Such proposals can stop deaths and reduce the numbers going into treatment. We are looking at a public health emergency, and we need to act.

The shadow Health Secretary, my hon. Friend the Member for Leicester South (Jonathan Ashworth), has talked movingly about his experience of alcoholism in his family. He has promised that a future Labour Government will reverse the decline in the drug and alcohol treatment sector. I fully support him in that endeavour, but we cannot wait. We need the Government to act to safeguard our drug treatment services and, most importantly, to safeguard those who use them.

[Mr Philip Hollobone (in the Chair)]

The debate can go on until 5.30 pm. I am obliged to call the Front Benchers from no later than seven minutes past five o’clock. The guideline limits are five minutes for the SNP, five minutes for Her Majesty’s Opposition and 10 minutes for the Minister, and Jeff Smith has two or three minutes at the end to sum up the debate. Five Back Benchers are seeking to contribute, so there will need to be a time limit, which is four minutes each, and then everyone will get in.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate the hon. Member for Manchester, Withington (Jeff Smith) on securing the debate. I agree with everything he said. I draw the attention of Members to my declaration of interest as a practising NHS psychiatrist and as someone who has worked in drug addiction, or drug treatment, services.

I do not intend to rehearse the discussion on the lack of, or reduction in, funding for the treatment of addiction services since the commissioning moved to local authorities, because that argument has been well established. The challenge we face is how to encourage more people to engage with addiction services and how to improve the quality of care available to those who are drug and alcohol-dependent. In my view—this is increasingly the consensus—commissioning by local authorities has probably been the single biggest failure of health legislation under our Government, and we need to revisit that if we want to improve the quality of care available to the patients we are looking after.

Between 2009-10 and 2016-17, the number of people with opiate addiction who access services has reduced by about 16%. Heroin deaths are on the rise; the number of people presenting with alcohol-related illness, pathology and morbidity is rising; and alcohol-related deaths are rising. Our current approach to additions is not working, which appears to be that the NHS will patch you up as best it can. We are not doing a good job of preventing people from appearing in A&E or in the acute hospital because the commissioning of addiction service is not right. While I do not believe that local authorities are in the right place to commission services, the lack of funding they receive has been a contributing factor.

There are five key challenges and problems with commissioning by local authorities. The first is the quality of patient care delivered. There is poor integration of services between the NHS and the providers that often are commissioned by the local authority, be they in the private sector or the charitable sector. Historically, NHS services have had a good integrated approach between physical healthcare and addictions care. NHS providers have a joined-up approach to treating people with hepatitis, HIV and other physical health problems, or older addicts who may need support for physical health needs, such as cardiac or respiratory problems they may develop as a result of their addictions, particularly if they smoke heroin. That does not happen when there is fragmented commissioning by private-sector providers and local authorities. That needs to change for the benefit of many patients.

Secondly, all private sector providers operate under their own IT systems that have no integration with the NHS whatsoever, so an NHS doctor does not know necessarily what care those private providers are giving. That is dangerous because there is no continuity of healthcare and it is fragmented, to the extent that one part of a supposed health system cannot see what is happening elsewhere.

[Mr Philip Hollobone (in the Chair)]

Order.

NHS Long-Term Plan: Implementation

Philip Hollobone Excerpts

Monday 1st July 2019 Commons Chamber

[Matt Hancock]

I am not sure what specific case the hon. Gentleman is referring to, but I will tell him this about privatisation: I support the NHS being free at the point of delivery so that everybody can use it, and the most important principle at stake is how to deliver the best possible services for our constituents. That is what I will keep doing.

[Mr Philip Hollobone (Kettering) (Con)]

The success of the NHS long-term plan in Northamptonshire will depend on urgent short-term reform of the combined health and social care system in the county. There are 1,400 hospital beds in the two hospitals in Northamptonshire; 900 are occupied today by stranded and super-stranded patients as a result of delayed transfers of care. This is the worst situation in the country. The number of patients staying more than seven days in a hospital bed is twice the national average. Northamptonshire’s over-65 population is the fastest growing in the county. We need to take advantage of local government reform to establish an integrated health and social care pilot, but this requires the personal attention of the Secretary of State. Without that, we will not make any progress. Will he meet Members of Parliament from the county this month to get this under way?

[Matt Hancock]

Yes, and I suggest we meet also with the Secretary of State for Communities and Local Government. I have met the Northants MPs to progress this, and I have also meet the Communities Secretary about it. My hon. Friend is dead right. There is a serious problem, but there is also an opportunity for much more integrated health and social care. If Northants MPs, the Communities Secretary and I can find an opportunity to meet, perhaps we will be able to crack through this one.

Electromagnetic Fields: Health Effects

Philip Hollobone Excerpts

Tuesday 25th June 2019 Westminster Hall

[Dr Drew]

I agree. My hon. Friend’s work on air quality is very important. Politicians in general are at last beginning to take note of the threats. It seems lamentable that, now that we understand the threats to air quality through pollution from cars, incineration and other things, another technology is coming in that could be as damaging. Maybe we will not see its effects for years, but will in decades unless we understand what it can do to people. It may not affect everybody—it may be down to genetic susceptibility—but we ought to listen to what is happening to those people.

It would be useful for the Government to put the studies, and their responses to them, on the record. As my hon. Friend the Member for Gower says, one problem is that, now we are into 5G, there is a view that existing masts can be added to or that additional technology can be used. I put it to the Minister that the biggest worry is that there is a view, certainly in Stroud, that lamp posts will be seen as a perfectly acceptable substitute and that, instead of putting up new masts, the technology could be added to existing infrastructure.

It would be useful to know what powers exist, because I understand that the electronic communications code has granted virtually unlimited powers to companies to construct, maintain or develop the current infrastructure without any planning permission. It is all done under delegated responsibility, which means that the general public do not even know what is going on, because normally these things are not publicised. There is little recourse unless the public take court action to stop it, but the means of doing so are limited. Even a private landowner has little authority to stop it. The matter needs to be looked into and properly investigated.

I ask the Government to look at how they can consult the public, because the public are getting worried. The scare stories may not have the full scientific rigour that they should have, but the public know no more than what they have been told by various experts in the field, and there are always experts on either side of the argument. Our case is that, at the very least, there should be an open, honest and transparent investigation of the health and biological impact of the new technology.

Driving forward 5G is about financial interests. It is not being done for altruistic reasons, but because an awful lot of money stands to be made out of it in a very short period. We need to look at that. It exacerbates the digital divide. As I have said, I would be satisfied with 3G my constituency.

Having listened to my hon. Friend the Member for Gower, I hope the Minister will be able to say what plans the Government have to investigate the impact on the ecosystem, which is as important as human beings. We need to keep our bugs, birds and other fauna in the state they are in, given that they are under enormous attack. We talked about that yesterday in relation to the climate change statutory instrument that we passed. We are not just talking about our own survival but the survival of other species. It would be a tragedy if we have done things to protect them and yet we let 5G come in. There are allegations that 5G has an impact on other species, particularly in rural areas where we see many living creatures.

My final point is that part of the problem is that the new technology is coming through without much questioning, or even recourse for people to question it. The biggest problem is the speed at which it is being introduced. There is no way that communities that are at best uncertain about the impact of that technology on their children, their schools and their wider community can do anything.

I ask the Government to look at this carefully, as my hon. Friend the Member for Gower said, so that we consider the implications both for individuals’ health and the wider ecosystem, and that we also take time and recognise that the precautionary principle is as important in this area as it is in general about air quality.

[Mr Philip Hollobone (in the Chair)]

We now come to the Front-Bench spokespersons, the first of which will be from the Scottish National party.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 18th June 2019 Commons Chamber

[Mr Philip Hollobone (Kettering) (Con)]

The electronic prescription service is now used by more than 90% of GP practices, and more than 70% of prescriptions are issued in that way. As well as providing a better patient experience, how much money has this saved for the NHS?

[Matt Hancock]

My hon. Friend is dead right to say that this provides a better service and saves money. I do not have the figure at my fingertips, but I will write to him with the answer and ensure that it is published for the whole House to see.

--- Later in debate ---

[The Minister for Care (Caroline Dinenage)]

The Care Act 2014 gives councils a responsibility to provide residents with a choice of quality care options in a local area. More broadly, we are backing up councils with increased funding. Over the last three years, we have increased funding in real terms by 8%. That has given councils access to about £10 billion to help ensure that there is provision in local areas.

[Mr Philip Hollobone (Kettering) (Con)]

T7. Will the Secretary of State assure my constituents in Kettering that taking advantage of the local government reorganisation in the county to establish a combined health and social care pilot is one of his Department’s very top priorities?

[The Minister for Health (Stephen Hammond)]

The House will not be surprised to know that the hon. Gentleman has raised this with me and my right hon. Friend the Secretary of State on a number of occasions. I am happy to reconfirm to him that we do consider it a top priority to make sure that all of his constituents get the care they need.

Listeria: Contaminated Sandwiches

Philip Hollobone Excerpts

Monday 17th June 2019 Commons Chamber

[Matt Hancock]

Yes, of course. Millions of meals are served in NHS hospitals each year. While we regret any death, especially a death that could have been avoided, the overall food in hospitals absolutely is safe.

[Mr Philip Hollobone (Kettering) (Con)]

The NHS is a pioneer of and, increasingly, an international authority on the new science of genomics. Will the Minister confirm that without this NHS expertise, the source of the outbreak would not have been identified nearly as quickly and that we could well have been looking at far more deaths than in fact occurred?

[Matt Hancock]

My hon. Friend makes an incredibly important point—even more than he says. Without genomics, which the UK is the world leader in, it would have been impossible to link the different listeria deaths. They would have looked like individual cases in separate, individual hospitals. It is only because through genomics it could be worked out that the exact strain of listeria was the same in cases in different hospitals that we could then work out that there must have been a factor at work that was not internal to the hospital. When it was then identified that the food provider provided food to many different hospitals, that link could be made, too. Science and scientific progress are saving lives here.

Cambridgeshire and Peterborough CCG: Funding Pressures

Philip Hollobone Excerpts

Tuesday 11th June 2019 Westminster Hall

[Heidi Allen]

Am I allowed to intervene?

[Mr Philip Hollobone (in the Chair)]

Order. You are allowed to rise at any moment, but the Minister does not have to accept your intervention.

[Heidi Allen]

Thank you, Mr Hollobone. Forgive me—I have not led a Westminster Hall debate before. I accept all that the Minister has said, and it is a difficult matter, but the statistics are flawed. The Minister said that he accepts that the growth is 0.6% above the England average; the Office for National Statistics is working on its being 0.1% below. Something is therefore going a little astray.