Worcestershire Acute Hospitals NHS Trust

Steve Brine Excerpts

Tuesday 11th July 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Thank you very much, Mr Hollobone. First, I apologise to my hon. Friend the Member for Redditch (Rachel Maclean); the Minister of State, my hon. Friend the Member for Ludlow (Mr Dunne), who is responsible for hospitals, is on the Front Bench in the main Chamber taking part in the important debate on contaminated blood, to which she rightly referred. He has sent me in his place, so I hope I will do.

I will attempt to answer many, if not all, of the questions that my hon. Friend asked in the 15 minutes or so that I have. I congratulate her on securing the debate and on her recent election. I knew her predecessor well, and as she graciously said in her maiden speech, she is some act to follow. She is a lovely person and I hope that she is doing well—I am sure that my hon. Friend is in touch with her.

Most of all, I congratulate my hon. Friend on the way she has tackled this issue in the short time she has been here and brought what she said on the campaign trail into the House of Commons and its various Committees—hitting the ground running would be an understatement. That is exactly why the people of Redditch placed their trust in her, and she is already a credit to them. I was in the House for her maiden speech, so I heard her refer to these issues and to the Alex in great detail. It reminded me of someone not so far from where I am standing now, who came to this House seven years ago and said that the future of Winchester’s hospital would be his priority. I have tried to stick to that, as I am sure she will to hers. I have not seen a family quite so proud as hers, sitting up top to watch her make her maiden speech. I think her children and partner were there, and it was great to see.

I understand that my hon. Friend is deeply concerned about the performance of local health services at Worcestershire Acute Hospitals NHS Trust, which has been in special measures since December 2015. On her first key question, I can reassure my hon. Friend and her constituents that Ministers keep a very—I emphasise “very”—close watch on performance at this trust and all trusts through the role of the chief inspector of hospitals, Sir Mike Richards. The Secretary of State put that in place, and it has made an enormous difference. My hon. Friend will know that, as she was able to join the Minister of State on his recent visit to the Alexandra Hospital during the campaign.

The recent CQC inspection report is clearly of great concern to my hon. Friend and to us, but I understand that the Minister of State was reassured to meet the trust’s new chief executive twice since her arrival from Australia at the end of March. She now has a substantive team in place for the first time in many years, and we know from experience that strengthening the leadership team is a significant step towards taking any trust out of special measures.

NHS Improvement has taken active steps to help drive improvement at the trust. That includes bringing in Birmingham Children’s Hospital, South Warwickshire NHS Foundation Trust and Coventry and Warwickshire Partnership NHS Trust to help address key areas of weakness and provide strategic, mentoring and practical support. An improvement director is also in place. That is the very least we expect, and I am pleased to report that it is happening.

Let me turn now to winter pressures. The Department has agreed to Worcestershire Acute NHS Trust’s bid for £920,000 of capital funding for primary care streaming in A&E. That funding is intended to ensure that the trust has appropriate facilities in place for this winter, and I strongly encourage the trust to spend the funding as quickly as possible, within the constraints of good governance, so that it is ready for when the weather turns.

That capital investment is one part of the urgent and emergency care plan being implemented across the NHS this year to recover A&E performance during 2017-18. The intention of the national plan is to redirect patient activity to primary and community care through GP streaming, GP weekend and evening appointments, and supported discharge and re-ablement in people’s homes. Worcestershire Acute Hospitals NHS Trust will benefit from these efforts to improve performance on delayed transfers of care—DTOC is one of the acronyms I have had to get to grips with in the past three years—as will other trusts.

Let me set the review of acute services, which my hon. Friend rightly mentioned, in the context of the Herefordshire and Worcestershire sustainability and transformation partnership. This represents a landmark attempt to address long-standing challenges to the provision of emergency care across the county, and to ensure sustainable A&E services and all other health services, because—we do not say this often enough—we are one NHS for the long-term future. The review of acute services has been incorporated within the STP, which is right. A draft was published in November 2016 and public consultation ran between January and March 2017. I will briefly outline the proposals.

The revised model would see 95% of patients experiencing no change in the way they access services in Worcestershire and all three of the county’s acute hospitals remaining open. Worcestershire Acute Hospitals NHS Trust would also retain its two A&E departments at Worcester and Redditch and the minor injuries unit at Kidderminster. Worcestershire Royal Hospital would become a specialist centre to support emergency and complex care, and the Alex in Redditch would provide more planned care.

Under NHS England’s proposals, both A&E departments, at the Alex and at Worcestershire Royal, would remain open 24 hours a day. However, due to the transfer of in-patient children’s beds, the A&E at the Alex would be for adults only. Both the Alexandra and Worcestershire Royal Hospitals would have new 24-hour co-located urgent care centres, which would treat adults and children with minor and moderate illnesses and injuries.

I must emphasise that no decision has yet been made regarding these proposals. As my hon. Friend said, the governing bodies of the three Worcestershire clinical commissioning groups will hold a meeting in public tomorrow, when they will each consider the decision-making business case and then make a decision on the recommendations. Depending on the outcome of that meeting—I have a funny feeling my hon. Friend will attend—the next step would be for the trust to go to NHS Improvement for approval of its outline business case. If successful, the next stage would be to commence procurement for the work and to take forward implementation of the clinical model. Suffice it to say, it would of course have to have clinical support in line with the five tests that we and NHS England have now set out for any service change.

I am encouraged to learn that the trust is progressing its plans for a £29 million investment in improved facilities at Worcester and Redditch Hospitals, in addition to the almost £1 million awarded following the Budget to improve patient streaming for those attending A&E. It is proposed that this money should be used to improve the operating theatres at the Alex so that the hospital can be developed into a centre of excellence for planned surgery, to develop a women’s centre at the Alex, to increase the number of beds at Worcestershire Royal, to provide a new children’s outpatient department at the Alex, to improve endoscopy facilities at the Alex and to improve the ever-thorny problem of car parking at Worcestershire Royal. I believe that the Worcester and Redditch are strong contenders for that proposed new investment funding, and my hon. Friend has made an extremely strong case for her constituency.

Let me touch on the Naylor report, which my hon. Friend mentioned—I have quite a lot of reading at the moment, but I will take seriously her advice about the insomnia cure that it provides. I assure her that I am not aware of any plans to dispose of the Alexandra Hospital. It does not propose closing any specific hospitals; it merely refers to where space and land can be released while continuing to deliver services. As my hon. Friend knows, the Naylor review was independent. Its report was prepared for the Department of Health and published in March 2017. As she would expect, my hon. Friend the Minister of State is considering its recommendations carefully and will respond fully in due course on behalf of the Government.

My hon. Friend rightly mentioned staff recruitment and retention, so I will touch on the problems that the trust has faced in recruiting staff, especially at senior levels, and its resulting reliance on interim and agency staff. The trust has a new chief executive and leadership team in place. We have found from the experience of many other hospitals that have been in special measures that low morale and high levels of attrition are usually never about staff commitment; they are about getting the right leadership in place, which is why I place such emphasis on the new chief executive and her team. My right hon. Friend the Secretary of State saw outstanding commitment from the trust’s staff when he visited the Alex and the Royal last month.

Let me turn to my hon. Friend’s concern about maternity services, which always touch the heart strings more than other hospital services. I of course recognise the strength of feeling in Redditch and, in particular, the concern about travel times to Worcestershire Royal. All hospital births in Worcestershire were moved on a temporary emergency basis from the Alex to the Worcestershire Royal in 2015 due to staff shortages. The safety of patients must rightly be our prime concern and I understand that the trust ran extensive recruitment campaigns for additional staff before this temporary decision was made. Worcestershire’s maternity services form part of the review of acute services, which must be right.

The CCGs’ published decision-making business case makes it clear that Worcestershire Acute Hospitals NHS Trust must review the scheduling of its outpatient appointments and operations to take account of patients’ travel needs and individual circumstances, and that the CCGs and the trust should work together with community transport providers in Worcestershire to provide an enhanced transport service between the Alex and the Worcestershire Royal. Decisions regarding those proposals are expected to be made by the governing bodies of the three CCGs at tomorrow’s meeting. I encourage my hon. Friend—I do not think I need to encourage her too much—to support the CCGs to agree a plan at that meeting.

Engagement with staff and local people must continue to influence and refine plans at every stage of the process. That is a key principle in the local reconfiguration of services, and it is dead right that the process is guided by those who best know and understand the local area, which of course includes the clinical support I mentioned.

In conclusion, I totally appreciate the concerns that my hon. Friend has set out so eloquently today, and I commend her once again for her work in such a short time in the House on local healthcare issues affecting her constituents and her own family, as she said in her maiden speech. I encourage her and her constituents to maintain an open dialogue with the local NHS, which they are doing, and I assure her that Ministers will continue to monitor the trust’s performance very closely.

Question put and agreed to.