NHS Care of Older People

Thérèse Coffey Excerpts

Thursday 27th October 2011 Westminster Hall

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Stourbridge (Margot James) on securing the debate through the Backbench Business Committee, and all hon. Members who supported the call for it—as I did.

I do not pretend to be a health care professional, even though I use the title “Dr”. Nor do I profess expertise in that area. However, the care given to those older people who need it—I tend to use the word “elderly”, although it may not be politically correct—is important. Usually, the start and end of life is when we use NHS care the most, and those people should be given the best care possible. We should make sure failures are dealt with, and we should speak up about them in Parliament.

Given the time constraints, I had thought of spending a little time on talking about the terminally ill. Hon. Members may know that I have introduced a ten-minute rule Bill on the provision of hydration and nutrition. We have also had Westminster Hall debates about palliative care in eastern England, and I recognise the valuable work that is done. However, it is right to focus on the Care Quality Commission report and individual hospitals, so that our constituents know we are speaking up for them, and so that their voice is heard in Parliament.

My hon. Friend the Member for Stourbridge went into great detail about the CQC report, and the hon. Member for Worsley and Eccles South (Barbara Keeley) went into detail on a particular case. The view of representatives of the Royal College of Nursing, given in informal discussions, about evidence given or sentiments expressed in submissions to the Francis inquiry, was telling. There was concern about leadership and about how people would be treated if they stood up and spoke up for patients—that they would be ignored, or, worse, demoted. I am sure that that shocked the nursing profession and other people, and I recognise that attempts are being made to deal with that, so I do not mean to be condemnatory.

My constituency has the 15th highest proportion of pensioners. Some 55% of my constituents are over 55, so the issue we are discussing is important there. The constituency also covers two primary care trusts—NHS Suffolk, and Great Yarmouth and Waveney—and we have three hospitals that provide care. They are the Norfolk and Norwich university hospital, Ipswich hospital and James Paget university hospital. I am afraid that two of those were on the list of failing hospitals and, understandably, local residents were very upset. That is reflected in the number of complaints made to me, or copied to me, about people’s experiences when they are trying to get care.

As to Ipswich, after the first failure, I and my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) met the chairman and director of nursing. I was impressed straight away that the director of nursing recognised absolutely that there had been failings. That recognition and acceptance of failings was important to me. The suggestion was made at the time that not all the staff accepted, initially, that there were failings, and that the feedback was met with an element of rejection. However, every member of staff quickly recognised that things had to change.

An action plan of changes and improvements to local ward leadership was set out, and fresh training was provided. A high focus was put on that, including additional support for patients with dementia. The hospital was inspected on a second occasion and, although the report has not yet been formally issued, I understand that it will pass—it should be congratulated on that—that a marked improvement was noted and that patient satisfaction was much higher.

[Neil Carmichael]

It is worth distinguishing between acute and community hospitals. That would inform the debate, because, obviously, chronic and non-chronic conditions are different. It would be helpful to know which hospitals are which, and whether that will help us to think about the subject.

[Dr Coffey]

Ipswich hospital is a district general hospital, if that helps my hon. Friend. It provides acute care, and is not just focused on community care. I want to say thank you and well done to the director of nursing and all the medical teams at the hospital for the changes they have made.

In contrast, James Paget hospital, in the constituency of my hon. Friend the Member for Great Yarmouth (Brandon Lewis), has failed a second inspection. The second report showed improvements, but not consistent improvements. There were still minor concerns in several areas, and continued moderate concerns on meeting nutritional needs and the management of medicines. The second report is complimentary about staff and training, and, as my hon. Friend the Member for Stourbridge has already mentioned, the hospital was cited in a Nursing and Midwifery Council report as having good training levels. To reinforce that point, the CQC suggested that patients’ needs were generally met. At times it was possible that not all the staff were available or deployed in the most effective way, but generally patients had the staffing appropriate to their needs. The third inspection has taken place. Its outcome is not yet formally known, and the hospital has not received the draft report, but I have not heard positive vibes so far.

As to my interaction with the leadership, I must say at the outset that I recognise that it was limited. My hon. Friends the Members for Waveney (Peter Aldous) and for Great Yarmouth have taken a much greater role, because a relatively small number of patients from my constituency go to the hospital in question. After the first inspection, however, I was assured that the failures were just a blip, and that things were already under way. Doubt was cast on the quality of the inspection carried out by the CQC—that was said to me by the chairman of the hospital trust. I did not accept that, because those CQC inspections are intended to be a snapshot and to take a view. Frankly, if one patient experiences bad care, that is an automatic failure. I think that hon. Members would recognise that.

I was reassured, however, by the expectation of changes, which were under way; but, as I have mentioned, the second inspection continued to find failings in dealings with older patients. I did not meet the hospital manager and chairman after the inspection, but my colleagues did and I was not reassured by the report of that meeting. Yet again it seemed that doubt was being cast on the validity of the CQC inspection by the chairman of the trust—though not, I understand, by the chief executive.

We three MPs have together agreed a course of action to press the hospital on its improvements for our constituents, and it has responded. As I said, a third inspection has been held, and I am highly concerned that a third failure will be reported. Monitor has now issued a red governance rating, which I believe is automatic, but I understand that it has also had conversations with the leadership. I have received copies of constituents’ complaints, and seen a whistleblowing letter from GPs from the consortium Health East. The letter says:

“As a group of concerned GPs we have been forced to pursue this whistle blowing option, because we are concerned that our new GP consortium ‘Health East’ may fail to be successful due to the failings of our main, acute provider the James Paget University Hospitals NHS Foundation Trust.

Health East will be depending on the Trust to provide the acute care for most of our patients and we have lost confidence in the ability of its leadership to correct its current failings. Please act quickly before we have yet another Mid Staffs on our hands.”

It ends:

“We apologise once again for having to take this whistle blowing option, but we need you to put pressure on appropriate organisations to put the issues right before our patients suffer.”

I do not suggest that someone going into the hospital will automatically suffer poor care, but that is the reaction of GPs who are expected to work with patients to ensure that they receive the best care.

In the circumstances, it is my role to press the leadership of the James Paget hospital on constituents’ behalf. In particular, the chairman of the hospital trust should consider his position. I appreciate that the financial risk at the hospital is low, and that that may reflect good financial governance, but patient care is key. The chairman has provided useful leadership, but—after two failed care inspections and with the possibility of a third—it is time for him to step aside and allow new leadership to come forward.

I will apologise to the chairman of the trust, because although I sent him a communication about what I would say in this debate, I could not speak to him personally. I should also say that I do not make my suggestion on behalf of my hon. Friends the Members for Waveney—who is in his place—and for Great Yarmouth. I do not make such a call lightly, but there is concern that patients may be reluctant to go to that hospital. Perhaps that is not a widely-experienced feeling, but often people worry about going to a particular hospital because of the perception of concern. We cannot afford that, and must not stand quietly by without expressing a view.

I have spoken for 10 minutes and understand that others want to speak. There are other issues, such as community care and confidence in that. My hon. Friend the Member for Central Suffolk and North Ipswich and others, including myself, have pressed the case about ambulance services and response times. Some of our constituents live more than an hour from the nearest hospital, so concerns about failure to respond within the eight-minute target are appropriate. I am meeting Ministers another time to discuss that matter.

I do not make the request that I made about the James Paget hospital in Parliament lightly, but I believe that it is necessary for the safety, well-being and protection of patients in Suffolk Coastal.

--- Later in debate ---

[Alison McGovern (Wirral South) (Lab)]

I congratulate the hon. Member for Stourbridge (Margot James) on securing the debate and thank the Backbench Business Committee for timetabling it. There are few issues that mean more to me or make me more angry than the poor treatment of older people, especially by our NHS. Therefore, it is highly important that we focus on that today.

I shall begin where other hon. Members might not have had time to go—by questioning our values. The hon. Member for Stourbridge listed societal problems as being one of the causes of indignity in hospitals and, when I intervened to ask her about that, she said that she did not have enough time to go into the subject. I hope I can assist her by taking us on that journey.

I am afraid that I shall start by disagreeing with the hon. Lady. I find it hard to believe that there is a lack of moral value or preference in society. Part of the problem is that those values are not made explicit often enough. We have talked much about dignity today. That word is often used, but rarely explored. I question and doubt the point made by the hon. Member for Truro and Falmouth (Sarah Newton) about older people being treated differently in other countries. If that is the case, it is incumbent upon us as politicians to make our values absolutely clear. In many ways, the national health service is, for Britain, an expression of our moral choices and preferences. Whether or not we talk about the NHS in those terms, that is what it is.

Let us begin by asking what we mean by “dignity.” It means inherently respecting the other person because of their humanity. In practice, that means demonstrating they are listened to, cared for and thought of, no matter who they are or what their personal circumstances are. Let me quote from the CQC report to give an example of what I mean and why it is so important that we make that absolutely explicit. In the report’s overview by Dame Jo Williams, she mentioned that they found cases where they believed that staff stripped patients of their dignity. She says:

“People were spoken over, and not spoken to…left without call bells, ignored for hours on end, or not given assistance to do the basics of life.”

When we talk about dignity, that is what we really mean. I find it hard to believe that we live in a Britain where most people would walk past, look the other way or not consider the needs of somebody who is extremely vulnerable and stripped of the basic necessities of life. The vast majority of people in our country would consider that situation to be utterly intolerable.

The question is: what is going on in the health service that leads us to see cases in our surgeries and examples among our families where people are bereft of their dignity? Given that we set such high moral value by the appropriate respect given to people because of their inherent dignity, what is going on in the health service that allows such a situation to occur? I accept other hon. Members’ points about the level of frequency and the commitment of staff by and large, and I was also most taken by the remarks of my hon. Friend the Member for Nottingham South (Lilian Greenwood), who is no longer in her place, about the best practice demonstrated to her. Given that we know what the right answer is, we need to consider what happens when there is a failure.

[Dr Coffey]

I strongly endorse what the hon. Lady is saying. What is even more extraordinary is how there are such different experiences within a single hospital. That is why local leadership is absolutely critical to getting this right.

[Alison McGovern]

I thank the hon. Lady, who spoke so well and so bravely earlier, for her intervention. I will come on to describe the differences within hospitals—a point at the heart of the debate.

Last year, the Wirral University Teaching Hospital Trust experienced some of the worst staff survey results in England. They were awful. The percentage of people who would recommend our local hospital to a member of their family was disturbingly low. I know I speak for other hon. Members in the area when I say that we are extremely concerned about this. The trust has a plan of action to try and put this right and there are many examples of the best quality of care being given to my constituents. However, some wards have been very poor. What we have observed locally relates exactly to the point raised by the hon. Member for Suffolk Coastal (Dr Coffey). Some wards are very good and some are extremely poor, and the CQC report also found that. Some of the places of most concern also had very good practice, so this is a problem.

We ought to ask the following questions about staff in the NHS, and I think that they should ask the same questions of themselves. The first question relates to the point that I started with: do they have the right values? Do they make the right moral choices? Do they have the right preferences? By and large, I think our answer would be yes. I do not believe that people in this country somehow just do not care—I think that that is wrong. The second question is: are NHS staff empowered to make choices in line with those values—the basic right to dignity and sense of humanity that we want them to? Are they empowered? Finally, in line with the points that have just been made, are they accountable if that does not happen? That is a crucial point.

The Front Line Care report is an important report written under the previous Government about the future of nursing. There is, perhaps, a missed opportunity. It covers, in detail, many of the questions that we have about nursing care. My mother was a nurse. Her line on nursing is that a nurse’s job is whatever the patient needs. That coheres entirely with both the Front Line Care report and the CQC report, which points out the problem alluded to by other hon. Members. Dame Jo Williams states that care seems to be:

“focusing on the unit of work, rather than the person who needs to be looked after.”

We need staff who are empowered to provide person-led care that looks at the needs of each person, and delivers for them what they need in the health service.

There is, of course, the question of targets. The Government have moved towards dropping some of the waiting list targets that were in place under the previous Government. Is this the kind of thing we can have targets for? I am not sure. However, I know that we know good quality when we see it. If the model of staffing for the dignified and respectful care of people is right, then that will drive up the quality of experience they receive. Leaving aside whether we have targets, quality of experience can definitely be monitored. There are some difficulties relating to monitoring older people, not least people who die in hospital. It can be very difficult to ask for feedback about the death of a loved one, but we need to find a way of asking. A good death is at the heart of what it means to be a dignified person. I encourage all hospitals to think carefully about how they ask for feedback from the relatives of a patient who has died. Even in the case of an older person with dementia, how do we get feedback on how the NHS has treated them?

As politicians, we need to back nursing staff and doctors. At the beginning of my speech, I tried to be very clear about the values that we espouse and I hope that they are shared across the Chamber. Those values give people absolute faith about what is expected. We can be clearer about the standards of care that we expect. I have concerns about systems, such as the red tray one, which rely on a tick-box culture, rather than saying, “Here is the standard that we expect people to live up to and it is your responsibility to do so”. How people in different wards meet those standards would be different, but they must meet them.

I would set the following test for the NHS. I believe in the NHS not merely through custom and practice, but as an article of my political faith. It is a fundamental expression of our values that everybody should be looked after if, through no fault of their own, they become unwell. Everybody should be taken care of. That means that if one person is not taken care of in the NHS—whether they are related to us, or nothing to do with us—in the way that we would expect for a member of our family, then that is not good enough. We should articulate that value. I hope—and know, in my case—that local leaders of hospitals share the belief that we should care for people in the NHS as though they were members of our family and give them the dignity to which they have an absolute moral right. We need to articulate those values and then make people empowered and accountable to living up to them in the NHS.