Alexandra Hospital, Redditch

Rachel Maclean Excerpts

Wednesday 15th May 2019 Commons Chamber

[Rachel Maclean (Redditch) (Con)]

I am glad to be able to raise in the Chamber the issue of services at the Alexandra Hospital in Redditch. I hear concerns time and again in public meetings, and I thank the local groups, such as Save the Alex, that are campaigning on this matter.

In short, services at the Alex are inadequate. That is not my word, but the one used by the independent Care Quality Commission. It inspected Worcestershire Acute Hospitals NHS Trust, which includes the Alex Hospital in Redditch, in June last year and again found it to be inadequate. That represents no change since the last inspection. Indeed, in 16 areas that the CQC inspects, only one was rated good, none was outstanding, and half were rated inadequate, with the remaining requiring improvement. That is not good enough.

On being elected in 2017, I inherited a situation where the trust had already approved a new clinical model for future acute services to which centralisation was key. As a result, regrettably, a number of services, including maternity and paediatric care, were removed from the Alex and relocated to Worcestershire Royal Hospital. Our maternity unit closed in November 2015, and paediatrics was “temporarily” transferred in September 2016. The new plan, which was rubber-stamped in 2017, is intended to relieve pressure on both hospitals, improve patient safety and address staff shortages, but almost two years on from the removal of services and the approval of the new plan, it is clear to me that it has not had the intended outcome. The hospital is still inadequate, and the trust remains in special measures. Some services have got worse. Patients cannot access services when they need them, waiting times are poor and promised investments are not coming to fruition quickly enough. Pressure has not been relieved. Patient safety is being called into question, and staff shortages persist at both sites.

Since my election, I have given NHS bosses and management time to demonstrate to me and my constituents that the new clinical model is beneficial. I have done my best to explain to constituents why services were transferred, and I have visited the hospital time and again—along with my fellow Worcestershire MPs, who are here tonight—to keep a close eye on developments.

We have thousands of dedicated and fantastic staff in our hospital. I have spoken to many of them, and my constituents report time and again that the care they receive is fantastic. I thank every single member of staff at the hospital for their work. However, I do not believe I can continue in good faith to defend the new clinical model. It is not delivering for the people of Redditch. I secured this debate to press my constituents’ concerns on the Minister and call for a fresh approach. All options must remain on the table.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way; I spoke to her beforehand and explained the situation of some of my hospitals back home. I commend her efforts to retain services at the Alexandra Hospital. The recommendations of Redditch Borough Council health commission, which came out firmly against the clinical commissioning group proposals, must be given weight. The proposals must not progress to any lessening of services in the Alexandra. My own Ulster hospital is seeing proposals to redirect stroke services to a hospital that is over an hour away in traffic, which will certainly mean that damage cannot be fixed within the window of opportunity for recovery. Does she agree that money saving cannot trump life saving in any trust area?

[Rachel Maclean]

I thank the hon. Gentleman for his intervention. It sounds as though his experiences are very similar to ours in Worcestershire. I am sure he will continue to stand up for his constituents.

I have campaigned for improvements to local health services, and I welcome the investments coming on stream as a result. Upgrades in endoscopy, a new urgent care centre at the Alex and better infrastructure have all come on stream. A frailty unit has been transferred from Worcester, and a new ward has opened to improve the flow of patients in and out of A&E. Those are all making a difference.

[Mark Garnier (Wyre Forest) (Con)]

I echo my hon. Friend’s sentiment about the hard work of the stalwart staff of the Worcestershire Acute Hospitals NHS Trust. I can testify that, right now, my 11-year-old son is sitting in the A&E department having a sprained ankle attended to by nurses. I am sure he will be fine; he has obviously been hooning around when he should have been paying attention at school—I will talk to him when I get home.

One of the hospitals run by the trust that is not talked about much is Kidderminster treatment centre. Does my hon. Friend agree that we have to think coherently about all the services across the three hospitals? If we bring more services back to Redditch, we can also bring more long-term treatment services back to Kidderminster Hospital and have a much better service for all our constituents in Worcestershire.

[Rachel Maclean]

I thank my Worcestershire colleague for his intervention. I think we are all on the same page. We all want to see better services across the whole of our county of Worcestershire.

Where I am going with this debate and the point I want to make is that the long-promised plan for the Alex to become a centre of excellence for planned surgery has not materialised, despite my pressing for it constantly and despite a £29.6 million funding pot. That funding is in the process of being delivered across the trust, and it was intended to help implement the new clinical model.

That is why I believe it is time to look again at where and how services are provided, and particularly to consider the return of a range of maternity and paediatric services to the Alex. We need to explore options for the local population to use services in Birmingham, which are more accessible than those in Worcester. We also need to continue investment in our communities and build a medical school in Worcester to create our own local NHS workforce, which would help to address the shortage of staff at the root.

The context has changed because the Prime Minister recently announced the Government’s intention to provide the NHS with an additional £20.5 billion by 2023-24—the largest, longest funding settlement in the history of the NHS. We hear that the four CCGs that cover our two counties could merge into one in the future. This is why I believe it is time to be honest with people and for bosses to say that plan A is not working.

[Nigel Huddleston (Mid Worcestershire) (Con)]

My hon. Friend is an excellent champion for her constituents on this and many other issues. On the funding point, does she agree with me that those of us in Worcestershire are arguing not for special treatment, but for fair treatment? Particularly when it comes to funding, because we all know we are relatively underfunded at CCG level and elsewhere, we just want our fair share, not special treatment. We would just like a fair share of the cash, please. We know it is coming, and we would like our share of it.

[Rachel Maclean]

My hon. Friend echoes my point. I absolutely agree. We know the NHS is world class and we know that more funding is coming on stream; we are just arguing for it to be distributed for our constituents’ benefit.

We need to act soon. Redditch is home to 85,000 people; the population has grown from 78,000 in 2001, and almost 90,000 people are expected to live locally by 2030. In neighbouring South Worcestershire, tens of thousands of new homes are planned and the population is going to grow rapidly. Redditch is a new town, and it has always attracted young families to move there and build a better life, away from the back streets of Birmingham and from all over the country. We are proud of our local environment and of much else, but I want to be able to promote the holistic experience of living in Redditch, and to say that this is a great place for people to come to and live, work, set up a business and raise their family. For that, we need to have all the facilities that young families expect, including excellent healthcare services. This is part of our campaign to unlock Redditch. It needs to be the best place in the midlands, and we deserve nothing less.

We were told that the reason for centralising maternity services away from Redditch is that the size of the population is not large enough to sustain a full maternity service safely, but that does not make sense to me and my constituents. I accept that safety has to be paramount and I know that the Meadow birth centre in Worcester does a brilliant job, but the truth is that we have a high proportion of young families, which is increasing the demand for maternity and children’s services. What the hon. Member for Strangford (Jim Shannon) said is the same for us: it can take over an hour to reach Worcester from some areas of the town, particularly in traffic. There is no direct bus or train link from Redditch, so my constituents who need to use public transport must travel to the hospital via Birmingham or Bromsgrove.

When we look around the other areas of the west midlands conurbation, we can see that there are maternity units with populations much smaller than Redditch’s: for example, in Oswestry, which has a population of 16,000; Bridgnorth, with 12,000; Burton-on-Trent, with 75,000; Hereford, with 63,000; and even Ludlow, with 11,000. I am calling on the CCG and the trust to publish those comparator statistics and justify why those towns should have their own maternity unit, but Redditch should not. Most people would understand that a higher risk birth would require more specialist services and that might not be possible in Redditch, but the vast majority of births can be catered for safely in a midwife-led maternity unit.

The centralisation has piled pressure on to Worcester. It cannot withstand that pressure and we have all voiced concerns in this Chamber. I talked about the ambulance handover delays at the Worcestershire Royal just before Christmas—they are amongst the worst in the country, with ambulances waiting for over an hour. I am very grateful that the Secretary of State visited Worcestershire Acute. He saw for himself—

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Motion made, and Question proposed, That this House do now adjourn.—(Mike Freer.)

[Rachel Maclean]

As I was saying, the Secretary of State visited Worcestershire Acute and saw the size of the emergency department, which constrains patient flow. Despite the incredible efforts of the staff triage and consultants, and even with the welcome recent investments and improvements, it is difficult to see how those problems can be solved in the short term. Surely, the answer is to let Redditch take some of the strain, particularly with paediatrics.

I appreciate that changes such as this will take time and involve many layers of management, but it is my job to ensure that the people who are making these decisions take into account the experience of my constituents. We are lucky to live in a country with free healthcare, free at the point of use. Investment in health pays off multiple times in both financial and wellbeing terms. Other trusts in the country have managed to recover from poor performance, but we in Worcestershire seem to be struggling on with one of the worst trusts in the country, and it is my constituents who pay the price. I am extremely frustrated that we are no closer to the green shoots of improvement than when I was elected, and there has been a high turnover of people in senior positions, which does not help.

I think that a practical solution to relieve pressure on the overloaded site at Worcester is to provide more care for children and families at Redditch, so I would really like to hear from the Minister what other plans there are to turn this around. What evidence does she have that improvements will take place under the current structure? How long are we expected to wait? What options are there for working more closely with the University Hospitals Birmingham NHS Foundation Trust, for example—a high-performing trust, which is rated “good” by the Care Quality Commission, with much better transport and strong historical links to Redditch?

I thank the Minister for coming here to reply to the debate. I very much look forward to hearing her response.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I really thank my hon. Friend the Member for Redditch (Rachel Maclean) for the passionate, articulate pitch she made on behalf of her constituents and the health services that they deserve, because obviously we all deserve good-quality health services. As the Minister responsible, it is my job to give challenge to ensure that we are delivering the best services we can. Obviously, they are not always as good as we would like them to be, but I can reassure my hon. Friend of my determination to make sure that we continue with the constant campaign for improvements, and for the best possible services. All our constituents, as taxpayers, are paying for those services, and they all deserve an equivalent service.

I thank my other hon. Friends from Worcestershire—my hon. Friends the Members for Wyre Forest (Mark Garnier) and for Mid Worcestershire (Nigel Huddleston)—for showing their support. The issues that my hon. Friend the Member for Redditch raises are clearly of concern across the wider area. Indeed, my right hon. Friend the Member for Bromsgrove (Sajid Javid) has also lobbied me about this, notwithstanding the wider interests that he has in this place.

My hon. Friend the Member for Redditch raised several important points and areas of concern, which I will seek to address. She raised a number of points about maternity services. She is absolutely right that we must ensure that we have the safest possible environment in which people have their children. Obviously, having safer births is very much a national priority, so that issue is of particular concern to me. As my hon. Friend is aware, the decision to move maternity and children’s services from the Princess Alexandra Hospital to the Worcestershire Royal was implemented in 2017, and it was clearly controversial—many changes are, and this is no exception. That is why we need to continue to give appropriate scrutiny—my hon. Friend is absolutely right to do that—to ensure that we are serving all our constituents as well as we possibly can. She is also right to say that challenges remain. The trust continues to be scrutinised closely by the Care Quality Commission and in this House.

My hon. Friend asks how long we have to wait. Quite often, changes can be achieved very quickly. Sometimes, however, whether cultural or behavioural changes, they take much longer than any of us are happy with. I say to her that in my experience, constant scrutiny by the CQC does deliver results. I encourage her to continue her discussions with local interest groups and the CQC to ensure that all the constant scrutiny and challenge drives improvement. I do not know how many times I have said it in this place, but sunlight is the best disinfectant. Accountability will drive improvement and change.

All that said, we should recognise that there has been some important progress in the service at the trust. The CQC looked at the maternity in-patient survey for February 2017, which found that the Worcestershire Royal rated well against other maternity services in all aspects of care and scored among the best in the country in partner engagement and involvement in the appropriate length of stay in hospital. In addition, following the reconfiguration of services the neonatal rota is now fully staffed and recruitment is going in the right direction; the maternity doctors’ rota is fully staffed; and the trust has avoided a lot of the cancellation of antenatal or gynaecology clinics that was previously seen. I know that people will be concerned because of the historical record, but the scrutiny of the CQC shows that there are improvements.

According to the most recent CQC report, maternity and gynaecology services at the Alex are rated “good” for caring and “responsive” and “requires improvement” for other domains. Worcestershire Royal is rated “requires improvement” for safety and “good” in all other categories. The CQC recognised that the Worcestershire Royal’s maternity service was especially caring and responsive to parents who had suffered a pregnancy loss, such as miscarriage, stillbirth or neonatal death, and was committed to continually improving the care and services it provided for bereaved parents. That shows that there are some areas where the leadership are making an impact, but we clearly need to keep the situation under review.

In October 2018, the trust’s professional development team won the workforce team of the year award at the prestigious Nursing Times awards, which celebrate excellence in supporting the nursing and midwifery workforce. We congratulate them on that award. We should not be complacent, however. There is still very much more to do. I look forward to further discussions with my hon. Friend in the light of further investigations. We will do our best to support the entire community by making sure that performance is improved.

My hon. Friend raised the wider challenges facing the trust. It has been in special measures since December 2015. The latest CQC inspection judged the hospital as inadequate, with key concerns in urgent and emergency care, surgery and outpatients. I say again that scrutiny is the first catalyst to achieving improvement. It is worth noting that the trust achieved a “good” rating for the caring inspection domain in the latest CQC report, so in terms of patient experience there is clearly some improvement. However, nobody should be complacent about the scale of the task. As she says, her constituents really should not be expected to wait an undue length of time to achieve the quality of service that patients in other parts of the country receive.

I assure my hon. Friend that both the Government and national NHS bodies are committed to providing both the support and investment needed to help the trust make progress. I will be ensuring that we use our levers at a national level to give that appropriate challenge and support. Support currently in place for the trust includes a support package focusing on culture, risk and governance. That is very important. We always find, when a trust is going through the journey from requiring improvement to good, that leadership is crucial. I cannot overstate the importance of making sure that we are getting the right leaders in and mentoring them to deliver that. That support is crucial.

There is a quality improvement director, and there is a nurse retention collaborative programme to reduce turnover. There is a suggestion that that is starting to bear fruit. There will be emergency care support from the emergency care intensive support team and a peer support buddying arrangement with the Royal Wolverhampton NHS Trust. We have seen such buddying arrangements achieve real change, more than anything else by giving local leaders the confidence to be innovative and imaginative and really give additional challenge.

Local commissioners are closely involved in working with the trust to ensure that the quality of children’s and maternity services improves. Given the concerns my hon. Friend has expressed, I encourage her to engage with local commissioners to discuss how they are interpreting reviews of monthly divisional data and what they are doing to assure themselves of the quality of service. As a Minister, I can stand at the Dispatch Box and make promises, but ultimately I rely on local commissioners to do their bit to give challenge too. In giving me challenge, I encourage her also to give them challenge and have those discussions. The spirit of co-operation across the whole system is there to achieve improvements.

My hon. Friend rightly made her pitch for her constituents’ share of the increased funding for the NHS. While improvement is about more than just money, investment is clearly part of the picture. We will make the appropriate investments to support the trust. Recent examples of investments we have made are an award of £3.96 million for a breast imaging improvement plan, which will improve breast screening at the Alex; the development of a maternity hub to serve the Redditch area; and £3 million for a link bridge between the main hospital building and an outer building to be in place for the winter to assist with winter pressures.

I am confident that this will not be the last discussion my hon. Friend and I have about her local health services. I am grateful to her for bringing her concerns to me and putting them on the record. As I say, sunlight is the best disinfectant when it comes to inspection and challenge on the ground, but the opportunity to raise things here on the Floor of the House gives a signal to the entire health system that where we think things are not good enough and need to improve, we will not be shy in our determination to achieve that improvement.

[Rachel Maclean]

I thank the Minister for her comments and share her view that sunlight is a great disinfectant. May I press her? We have been undergoing this journey for four years, which is a long time. I had not been a Member of Parliament before and have never seen a trust turn around, so I would be grateful for some indication of how long she thinks it is reasonable for us to wait, with me as the local MP explaining to people, “You have to keep waiting.” Has she any examples of how it can happen and at what pace?

[Jackie Doyle-Price]

I will answer my hon. Friend’s question, but I will answer a different one too. She asks how long it is reasonable to wait. It is not reasonable to have to wait at all, because we should be delivering services of an appropriate quality. How long will people have to wait? We should be entirely honest when an institution requires improvement. She is right that four years seems like a long time. When my local trust went into special measures, it came out within two years, and the crucial ingredient was getting the right leader in at the top. Other trusts wait longer because other challenges can come into play that mean they are judged to require improvement—some trusts still struggle to get the right personnel, for example. We need to look in detail at exactly where the weaknesses are. My challenge to the system is to come up with a good plan to help get out of it. I would expect the buddying system with the Wolverhampton trust to start to deliver that more effectively, because there is no better driver of speed than external challenge.

With that in mind, I would like to close this excellent debate. The points made here should be considered very seriously by the local health system.

Question put and agreed to.