Accident and Emergency Services: Merseyside and Cheshire

Rosie Cooper Excerpts

Tuesday 22nd November 2016 Westminster Hall

[John Pugh]

Precisely. I am going on to some brief analysis of the problems of A&E, but it is certainly the line in the sand that we must defend.

Elderly people are obviously the major clients for A&E, and Southport by any analysis has an enormous number—a very high percentage—of people who will require A&E. Moreover, as the ambulance service says, and as the hospital will confirm, when people arrive at A&E these days they are iller than ever before. The reason for that is that access to GPs and to social care is worsening—social care has suffered extensive cuts, and has done so in my area, and is struggling.

To make matters worse, one reason for A&E throughput being a little slow is that, more than ever, people going to A&E are not being turned around and sent home, but need to be admitted, so beds are needed for them, although previous reports recommended ward closures in Southport hospital. Furthermore, discharging people from existing wards is a slower process, because social services are, frankly, struggling. The system is getting logjammed, with ambulances at one end and people not being discharged at the other.

To add to the problem is a matter that the hon. Member for West Lancashire (Rosie Cooper) will wish to bring up: the CCGs have taken the community care contract off Southport hospital, where I thought it was well placed, and given it to two organisations new to the field. How that is supposed to help integration, I do not know.

[Rosie Cooper (West Lancashire) (Lab)]

There is a serious problem in West Lancashire and the Southport conurbation. The local population has been excluded from all these decision-making processes. There is a serious need for the NHS bosses to explain what they mean by “downgrading”, as their perception of A&E can vary quite significantly from my community’s understanding. Simply sharing information without any explanation leads to anxiety and serious distress about the future of health services. I come back to the point that the hon. Gentleman has just been making: in the face of the fact that it will destabilise the hospital, the CCG—that is the local GPs—has just awarded the contract for urgent and community services to Virgin Care, which has no real track record. We do not have a real assessment of what is going on, and my constituents are being put at risk.

[John Pugh]

I thank the hon. Lady for that clarification and amplification. There really is a problem with integration, and I do not know how that will be better solved by bringing more organisations—particularly untried organisations—into the fray.

We are all exasperated by watching people make a hash of things and create rather than solve problems. CCGs are neither accountable nor always reasonable, and frankly sometimes have their own agendas. They are often tough on hospitals but less so on GPs. They are of course GP-led organisations, which is a weakness in how they are structured. I have a letter from the biggest surgery in my patch complaining about abuse received by receptionists. Hon. Members will be able to guess what that abuse is about. It is not excusable, but the rationale for that abuse is that people are having real difficulty making appointments in a timely and effective way, and as a result they are going to A&E, sometimes in desperation. Surveys that I have done over time have shown GP access to be as much of an issue in my constituency as A&E waiting times. As the hon. Lady just said, NHS bosses collectively are either deliberately or accidentally causing the destabilisation and unbalancing of provision in the area, and no one can stop them.

[John Pugh]

I am not sure whether that is the deliberate intent, but that is certainly a possible result.

[Rosie Cooper]

CCGs are nominally accountable to the Secretary of State or NHS England. Will the Minister address who actually guarantees that CCGs will provide really good service? The incompetent CCG in Liverpool that presided over the unholy mess at Liverpool Community Health NHS Trust has been allowed to preside over future services and new contracts in Liverpool. It is the same incompetent organisation. How is that okay?

[John Pugh]

The hon. Lady reinforces the point that I was going to make next. No one in the NHS locally is in a position to bang heads together and say, “Hang on, what do the public actually want or expect here?” The CCGs speak to NHS England and the Secretary of State. They are the decision makers. It seems to me that one of the coalition Government’s biggest mistakes was abolishing the regional strategic arms of the NHS—the bodies accountable for integrating and making things work together and making services across an area work effectively. Instead, we have groups of special interests—the big providers on one side and wholly unaccountable CCGs on the other—and, frankly, a recipe for chaos.

[John Pugh]

There was actually an attempt to make clear in that legislation where responsibility lay. I am very familiar with that debate and do not want to re-engage with it at the moment.

There is an absence of a genuine force for integration at a local level. We all know that there are institutions in any local environment that will be shored up at all costs, regardless of the clinical benefits to the population. Like the banks, a big private finance initiative such as the Royal Liverpool hospital will never be allowed to fail, because when PFIs fail, they revert to the Government’s books. Such services therefore tend to attract neighbouring services, whether or not it is a good idea for those neighbouring services to be attracted and regardless of the practicalities or the patients.

To come to some sort of conclusion, without a 24/7 A&E in Southport and all that follows from that—a great deal follows from that in terms of what other services may then go—people will suffer longer and more anxious journeys. I shudder to think what would happen if there were an incident at a big event in Southport, such as the flower show, the air show or the musical fireworks, and we did not have a 24/7 A&E. For better or worse, Southport is on the periphery of Merseyside and the hospital is also used by large parts of Lancashire. Southport straddles the boundary between Sefton and West Lancashire. The local hospital trust has to interact with two CCGs that face different ways. As it stands, the hospital is massively convenient for patients but inconvenient for those who like symmetry in the NHS. Precisely because of that, we are in constant danger of being overlooked and not championed, which is why Sefton Council recently passed a motion drawing attention to its concerns, particularly about the A&E.

Hon. Members will have gathered that I do not have entire confidence in the transformation process. None of us will say that we are not aware of the need to work more smartly and in a more integrated fashion to make the health pound work a lot harder, but the record will show that this is not the first time that I and the hon. Member for West Lancashire have brought the affairs of this hospital and this health service patch to the House’s attention. I fought off a previous attempt to get rid of our A&E when that was mooted by consultants on the usual ground that if the NHS ceases to do anything, it will cease to cost anything. The public have campaigned vigorously for an urgent care centre in Southport, and a succession of Ministers have been lobbied in this place about that plan, only for it to be scuppered by behind-the-scenes NHS politics. I have no reason to feel any confidence at all in this process—not when I see the hospital trust itself make a complete hash of whistleblowing charges against senior management and protract the process through its own simple incompetence.

[Rosie Cooper]

rose—

[John Pugh]

The hon. Member for West Lancashire is positively bursting to get in.

[Rosie Cooper]

Does the hon. Gentleman agree that STPs are in danger of becoming a managerial exercise in contingency and risk planning, where the NHS speaks to itself? Several years ago, in the Health Committee, I put to Bruce Keogh the charge that where we were going, there would be 30-plus trauma centres in this country and every A&E would be downgraded. With STPs, the NHS is talking to itself, not the communities it serves, and it will come up with that very same plan. I can see that happening in front of me right now.

[Sir Roger Gale (in the Chair)]

Order. I have to make the point that these half-hour debates are specifically the property of the Member in charge. Mr Pugh is entitled to give way to whomever he chooses, but interventions should be interventions, not speeches, and every moment that is taken curtails the opportunity for the Minister to respond.

--- Later in debate ---

[Mr Dunne]

I am not going to get into a prolonged debate about the CQC report, but it rates the entire trust as “requires improvement”. We have confidence in the overall reporting, and looking at A&E in that context reflects an accurate impression of the current status of the trust. For example, three of the trust’s seven A&E consultant posts are filled by locums or agency staff. That mix of staffing is not sustainable for any A&E department. I am aware that the trust and its commissioners are looking to address that.

Several hon. Members referred in interventions on the hon. Member for Southport to the NHS sustainability and transformation plans. I emphasise to the House that STPs are collaborative plans designed to help local organisations deliver on the “Five Year Forward View”. They are formed by CCGs, providers and local authorities working together in an area to develop a plan. Some have also involved other stakeholders who will be affected by changes in their area and can contribute to improvements. The true test will be whether a revised healthcare system really improves matters for patients.

We are still at an early stage in the process. The local NHS describes the plan for Cheshire and Merseyside as a plan for a plan at this stage. I will not therefore pass judgement today on the STP process or the content of the Cheshire and Merseyside STP. I am not in a position to do so. I do not know the local position as well as the local clinicians who have drawn up the plan; no one in Westminster or Whitehall does. Local clinicians must ensure that they involve the public and patients—and Members, as the hon. Gentleman called for in his closing remarks—and explain what they think is best for each local area. I reject the charge that the plan will not involve the local communities; it absolutely needs to involve local communities to be taken forward. It is a central tenet of the approval of the plans that there is public engagement.

[Rosie Cooper]

rose—

[Mr Dunne]

I am afraid I have very little time, and the hon. Lady will have an opportunity to pick my brains directly on anything I do not address in my remarks, because we are meeting next week. I am happy to talk to her. We have had a dialogue over some of the health issues that are of most concern to her, and I thank her for her efforts in bringing those to my attention.

The STP process is not run by or for the Department of Health. It is run by the NHS for patients of the NHS. Design of health services, including front-line health services and A&E, is a matter for the local NHS. The reforms that my noble Friend Lord Lansley made when he was in post have put clinicians in charge of the care people receive and how it is delivered to serve their populations best. Local authorities are vital in helping set the direction of health and social care development locally. Guidance on STPs from NHS England has been clear about the importance of local authorities in partnership arrangements and of the NHS working with local authorities to deliver prevention and public health improvements. It is crucial that the NHS and local authorities work closely to ensure the key aims of the STP process can be delivered: better health, better patient care and improved NHS efficiency.

The STP for Cheshire and Merseyside was published a week ago, on 15 November. As I said, the NHS described it as a plan for a plan. In the area represented by the hon. Member for Southport, it builds on the “Shaping Sefton” local delivery system, which I understand had considerable public engagement. It is disappointing that the leaking of an early and incomplete draft of the STP led to speculation and some concern. I hope that the publication of the formal document will dispel some of those fears. I assure the hon. Gentleman that no changes to the services people currently receive will be made without local engagement. When and if final plans propose service change, formal consultation will follow in due course.

Motion lapsed (Standing Order No. 10(6)).