Thérèse Coffey
Main Page: Thérèse Coffey (Conservative - Suffolk Coastal)Department Debates - View all Thérèse Coffey's debates with the Leader of the House
(12 years ago)
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Jim Dowd
Yes, I think that is part of the TSA’s agenda. The way the Department has engineered this situation is disgraceful, dishonourable, disreputable and downright dishonest—and if we have not had enough alliteration, I could add devious, as well as underhand and fraudulent.
Hon. Members will not be surprised to learn that I am no great supporter of what the TSA has done. The Department is attempting to pervert the process because the major impact of what the administrator in the adjoining trust is doing is on Lewisham hospital. The draft report is a considerable document that has cost an awful lot of money and made an awful lot of money for a number of consultants, including McKinsey, KPMG and PricewaterhouseCoopers—they always seem to do well out of these things. The public consultation on the draft report has closed and the Secretary of State is due to reach a decision. The final report from the TSA will be presented in early January and the Secretary of State will be making a decision in February. I appeal today for the Secretary of State to suspend the entire process, because it has been perverted in the way that I have outlined.
I do not hold the TSA personally responsible. I have met him on a few occasions and find him to be a reasonable and rational person. However, I know that the devastating impact of his report is on Lewisham hospital—the impact there is beyond anything that will happen at Queen Mary’s, the Princess Royal or the Queen Elizabeth. The report will result in the closure of the accident and emergency department, and all medical and surgical emergency care, all maternity services, all children’s services and all critical care will cease on the Lewisham hospital site.
I had an Adjournment debate on this subject a couple of weeks ago. My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friend the Member for Lewisham East (Heidi Alexander) both raised the issue in the Opposition-day debate on health just last week. If I were to raise this matter every day in this House, I could not adequately reflect the burning resentment and anger that it has caused in the community in Lewisham, as the injustice is so severe. The Department could not appoint a special administrator to look at Lewisham Hospital NHS Trust, because it is a solvent, well-managed trust meeting all its performance and financial targets. What the Department has done is appoint an administrator next door and then, under the bogus and completely facile assumption that everything connects with everything else, focused on Lewisham hospital. That is what is completely devious about this.
At the public meetings the TSA has held on the matter, he has shown a little film setting out what he is trying to do. It included him quoting this age-old homily, “If your domestic finances are in mess, clearly you have to do something about it.” I do not dispute that the finances of the South London Healthcare NHS Trust are in a mess. At the meeting in Sydenham one of my constituents said to him, “If your domestic finances are in a mess, you may well have to do something about it, but that does not include breaking into next door’s house and nicking all their stuff.” That is precisely what is happening under this system. This procedure is being used for the first time. If it is used in that way, the Department will set a template for the rest of the country. It will then, in theory, be able to appoint a TSA anywhere and his or her remit will be such that they can look anywhere; they will not just focus on the area or trust they have been established to look into.
The Prime Minister and the Secretary of State repeatedly parrot four tests for reorganisations and reconfigurations. The first is that they should have general practitioner and clinical commissioning group support. The second is that they should have public engagement. That is a strange use of the vague term “public engagement”; they do not specify “public support”. The third is that the proposals have to be clinically sound. The fourth is that they have to increase patient choice. None of those factors exists in the recommendations for Lewisham hospital, and the TSA does not even maintain that they do. He openly admits that the proposals will reduce patient choice sharply. The clinicians, the hospital board, the CCG, and various groups of GPs across Lewisham and beyond all say that the recommendations are a threat to the standard of care that the people of Lewisham can expect and all are opposed to the TSA’s proposals. I say to the Secretary of State, via the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), that he should abandon the scheme now, as the way it has been undertaken is clearly flawed, and he should protect the services that my constituents and people across south-east London have a right to expect.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
It is a great pleasure to speak in this debate on a particularly important topic, in which the Minister shares an interest, as we are neighbours. First, I wish to thank our front-line staff in the ambulance service, our paramedics, who work very hard. I also thank our volunteers, the community first responders, who do a great job and genuinely participate in helping to save lives in our communities. That is particularly important in the shires, as reaching someone in just a few minutes to provide life-saving treatment is crucial. I thank those people who give up their time.
A reorganisation is taking place in the east of England ambulance service, and I know that that is a concern to staff, who feel that patients will not get the treatment that they deserve. Change is always unsettling, but I genuinely believe that the management are trying to do this for the best reasons. One of the things we need to keep ensuring is that patient safety is the key priority.
The east of England ambulance service is hitting its targets—it has a regional target. Given that our region is so vast, it is no surprise that by focusing on certain cities it is relatively straightforward to hit targets. However, when we break down the performance by county, we start to see a very different story. I know that my colleagues from Suffolk and, indeed, my hon. Friend the Member for North Norfolk (Norman Lamb) have long been campaigning on that issue to try to raise it up the agenda, and it is vital that we do so. The presence of a new interim chief executive may start to help us to tackle that. We need to work hard to keep the chair and the board of the ambulance service on their toes, so that they recognise that saying that they have hit a regional target does not mean that the issue will go away—it will not.
One of the things I call on the board to do is think carefully about its responses to Members of Parliament when we are asking for greater transparency on performance. Belatedly—I am pleased that it has done this—there is an agreement that it will start to publish county by county performance details on a monthly basis. I believe that the board should and can go further. We already know that it provides performance data by postcode to the primary care trusts, and I believe those data should be published—they should certainly be available. Instead of getting into freedom of information exchanges, we need to ensure that, in line with what Sir David Nicholson told the Public Accounts Committee, every Member of Parliament should be able to get access to the data they need easily in order to monitor what is happening for their constituents and not be caught in a bureaucratic nightmare. As we all know, sunlight often brings a change in performance. Somebody trying to get to a village such as Shingle Street finds that it takes 10 minutes to get there just from the main road. When I say “main road” I am referring to a single track road. I recognise that not everybody will be able to do that, but it is still important that we try to get the postcode data published.
Earlier this year, after a successful meeting with my right hon. Friend the Member for Chelmsford (Mr Burns), a Health Minister at the time, I was under the impression that there would be a contract with the county performance targets built into it. Indeed, that was important for the paying of bonuses. Disappointingly, the contract that was agreed with the ambulance service by the person agreeing it on behalf of the primary care trusts in the east of England contained an added caveat about hospital handover times. We know that that is an issue, but another thing that Members of Parliament are doing is putting the spotlight on where there are those problems as well. Ultimately, we want the best ambulance service for our patients. We should not have to put up with sub-standard performance simply because the county is rural.
One disappointing thing about the contract, from which we expected so much, was that there seemed to be a lot of wriggle room. The new interim chief executive knows that well, as he negotiated the contract on behalf of the primary care trusts. He knows the issues our ambulance services face and I shall press him to ensure that the contracts this time make it clear what percentage of people in Suffolk should expect to see an ambulance within the regulated time.
Another thing that went wrong was the complaints process, although I am delighted that the chair of the ambulance trust has fixed that. I pay tribute to her and her staff for sorting that out. All these problems together have led me to voice my opposition—I will continue to do so—to the trust’s being allowed to have foundation status before a quality service is delivered consistently across the region. Simply placing ambulances close to Cambridge, Ipswich, Norwich, Luton and so on—near the big conurbations—is not fair on our rural areas. I point those people who say, “Well, it is a rural area,” to the example of the north-west. Cumbria has very similar characteristics as a pretty rural area with some big towns, yet the service there manages consistently to hit its targets.
Is there light at the end of the tunnel? I hope so. It is clear that MPs from Suffolk and across the east of England will not let up on the issue and I hope that we will have a step change in performance when we meet again in February.
Health care is very important to the people of Suffolk, but I also want to take this opportunity to thank my staff for all the hard work they have done in the last year. They have been extraordinary in helping my constituents tackle all sorts of issues and have also been very helpful this week, as we have sent out a mailshot of nearly 4,000 letters on Sizewell C—another issue that I share with my hon. Friend the Minister—and the impact that could have in the future. On that note, Mr Deputy Speaker, I wish you a happy Christmas.
John Healey (Wentworth and Dearne) (Lab)
I wish to take the unusual step of telling the House and the Minister about the individual case of little Vinny Duggan to highlight a wider problem that the Government can solve by making legal changes so that other patients and other parents such as Andy and Andrea Duggan do not have to go through what this family has gone through in the past two and a half years. As Andrea has said to me, this is their fight, but it is also a fight for other people in their position.
I have been involved with the parents in the quest for information for only 10 months, whereas Mr and Mrs Duggan have been battling since Vinny was born nearly two and half years ago. At times, Vinny has fought for life. He is now a little lad who is full of life. I was with the family on Saturday, and he was smiling, laughing, climbing on the sofa and climbing on me, but he has a very serious congenital heart and lung condition. He has brain damage, likely to have been caused by a lack of oxygen, and he is unlikely ever to be able to speak. His parents have told me that they are very proud of Vinny and very grateful that they still have him here.
It has been touch and go at times. He was born on 20 August 2010 at Doncaster royal infirmary. He was full term and was a healthy 7 lb 9 oz. However, within the first day his mum, in particular, became concerned that he was very blue, that he was not feeding properly and that he was very sleepy. The following day, he was diagnosed with a heart murmur and the day after that he was discharged against the parents’ wishes, as they were concerned and wanted tests done before he was discharged. He was at home for two days and after that time, when he had not properly woken up or properly fed and had stopped wetting his nappies, they phoned the hospital and were advised to take him to the children’s observational unit, where they arrived at 7 o’clock that evening.
Within the first hour, they were assessed by a triage nurse as non-urgent—green, in other words—and had to wait almost another five hours before a doctor saw them. During that night, Vinny was put on a heart monitor and given the tests he needed. He had a very high heart rate and was transferred rapidly to the specialist unit at Leeds general infirmary. He was diagnosed as having a very serious life-threatening heart and lung condition. He was given open heart and major lung surgery and spent five months in Leeds hospital, six weeks of that in intensive care and 10 weeks in the high-dependency unit.
The internal investigation at Doncaster hospital afterwards concluded that there were “no real concerns” about the standard of care in Vinny’s case, despite the fact that there were many chances to notice that he was unwell, to do the tests that could have been required and to listen to Mr and Mrs Duggan’s concerns. There remain important discrepancies between the evidence of the parents and that of some of the staff and the hospital in the investigation. It took two years and a new chief executive before, six weeks ago, Mr and Mrs Duggan received a welcome letter from the new acting chief executive, Mike Pinkerton, who ended by saying:
“The care that Vinny received fell below the standard you have a right to expect from us and I do sincerely apologise.”
Like so many other parents, Mr and Mrs Duggan had principally wanted an explanation—not retribution or compensation. However, like many parents, they were driven down the route of trying to get answers through the courts, and that is what they are having to do. They also rightly turned to the professional body, the Nursing and Midwifery Council, which is responsible for regulating Britain’s 670,000 nurses and midwives. Mrs Duggan submitted a complaint in September 2011, which was turned down in January 2012. She challenged it, which caused the council to look again at the argument that there was no case to answer, and the internal review concluded that the case should be referred back to the investigating committee for reconsideration.
The Nursing and Midwifery Council, however, has limited powers to review its decisions and that has been reinforced and restricted further by a High Court judgment in May in the case of R(B) v. NMC 2012. In other words, the NMC does not have the legal powers it needs to review its own decisions. The chief executive, Jackie Smith, was good enough to meet me in the summer and to agree to commission independent legal advice on Vinny’s case and on the NMC’s restrictions. That independent legal advice came from Mark Shaw QC, who concluded:
“The Order and Rules makes it plain that the NMC has no statutory power to review, re-open or reverse a disciplinary decision (in particular, a decision of the Investigating Committee that a registrant has no case to answer) beyond the specific circumstances stipulated in rule 7, namely: receipt of a fresh allegation within three years of the dismissal of a previous allegation against the same registrant.”
He went on to point out:
“Typically, other professional regulators have wider review powers, granted explicitly by secondary legislation.”
Those other professional bodies include the General Medical Council, which is responsible for regulating Britain’s 250,000 registered doctors. The GMC’s powers were rightly extended in 2004, so it has the power to review and reopen a complaint, to take a view that its earlier decisions might be flawed, to take new evidence into account and to act. It is considering a review of the complaint lodged with it about a doctor involved in this case and we expect a decision imminently.
The General Optical Council and the General Pharmaceutical Council have similar powers; the General Dental Council does not. At a time when complaints from patients are rising and pressures on staff are increasing, if we are to maintain trust and confidence in our health professionals and the NHS, we must have a better and more open system of complaints and we must have regulators with the powers to do the job they are set up to do: safeguard professional standards and safeguard patients and the public, too.
I know the Law Commission is reviewing the common enabling legislative framework for all health regulators. That could take three years, so I want the Minister to confirm today that he knows that there is a problem and that in the meantime, in advance of the Law Commission’s report, he will act to change the operating rules and orders so that those professional bodies can do the job. Otherwise, many other patients and parents will face the same fight for the truth—