Five Year Forward View

Tom Blenkinsop Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

I welcome the King James Bible reference. The independent Commonwealth Fund report that my right hon. Friend mentions contained one very startling fact, which Labour Members would do well to remember when they go on about the NHS—when they left office, we were seventh out of 11 countries on patient-centred care, whereas this year, now that we are in office, we came top. That is a huge improvement in patient-centred care. Under the new Care Quality Commission regime, his own hospital, John Radcliffe, got a “good” rating, which is an extremely impressive result.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

The ambulance trust in the north-east has quadrupled the use of private ambulances, increasing its costs, and South Tees Hospitals NHS Foundation Trust is in deficit. In my constituency, two urgent care wards and a minor injuries unit are to be closed. A medical centre in Skelton has been closed, a medical centre in Park End has been closed, and a medical centre in Hemlington is to be closed. Does the Secretary of State take any responsibility for any of these health services in my constituency or across England? Every single response we get from him, every single time, is that somebody else is to blame.

[Mr Hunt]

Not at all—I take full responsibility for the NHS. Given the pressures created by having nearly 1 million more over-65s than we had four years ago, and the fact that the Government have had to cope with the deepest recession since the second world war, I believe that the NHS is doing remarkably well, and this document gives it a blueprint for the future that we can all welcome.

Patient Safety

Tom Blenkinsop Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

Yes, and I would like to thank my hon. Friend for her superb work in supporting Basildon and Thurrock hospital through a very difficult period. I think that the chief executive there, Clare Panniker, is an exemplary one. She wrote an article in The Guardian pointing out that it is incredibly painful for trusts when they go into special measures, that it causes a lot of pressure in the local media, but that it also means that change can be made much more quickly when an urgency to solve these problems, many of which have been around for years and years, is created. I commend the staff of that hospital not just for coming out of special measures but for being rated “good” by the chief inspector of hospitals—a fantastic achievement.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Never mind the fact that this Government will not publish the risk register for a £3 billion top-down reorganisation; the Secretary of State and his Ministers will not meet me. If he wants to talk about accountability, why will he and his Ministers not meet me to talk about a minor injury unit in Guisborough being closed, a minor injuries unit in Brotton hospital being closed, a GP centre in Park End being closed and a walk-in and GP centre in Skelton being closed? All those units are in my constituency and they are all being closed, yet the Secretary of State and his Ministers will not meet me, which would represent genuine accountability.

[Mr Hunt]

Let me say to the hon. Gentleman that the accountability he talks about is precisely demonstrated by his ability to ask me questions right now as he has just done. He needs to be accountable and come clean with the House by saying that he has actually met my Ministers on a number of occasions on precisely the issues that he raised.

Health

Tom Blenkinsop Excerpts

Monday 9th June 2014 Commons Chamber

[Andy Burnham]

My hon. Friend is absolutely right—the deterioration in general practice has been marked during the past few years. There have been changes that have disadvantaged patients. Within weeks of taking office, the Government removed the guarantee that patients could have an appointment within 48 hours. That explains the situation that my hon. Friend describes, alongside cuts to funding of general practice to the point that some practices now say they are on the brink of deciding whether or not they can remain open. The Government have responsibility for that situation, but there is not a word from the Secretary of State about it and there is not an acknowledgement that people have severe problems in accessing their GP.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

In my constituency, the minor injuries unit at Guisborough hospital, the minor injuries unit at East Cleveland hospital in Brotton, a walk-in centre and medical centre in Skelton, and a medical centre in Park End—all primary or intermediary level facilities—will be closed, putting further pressure on the excellent but already outlying A and E unit at James Cook University hospital. When I write to Ministers to ask questions and for a meeting, I am told that I have already had too many discussions with them and that I cannot bring it up any further. Will my right hon. Friend please enlighten me about what he would do if he were in power?

[Andy Burnham]

I will move on to that point. Whenever there is a problem, we are told, “Speak to NHS England.” I am afraid that is not good enough. Up and down the country we are seeing services closed without adequate consultation. NHS walk-in centres continue to be closed, piling more pressure on A and E departments. It is just not good enough. We have seen top-down changes driven through, and the hospital closure clause is on the books, so sadly this will continue. It will only change when we have a Labour Government back in control—a Government committed to putting the public and patient voice at the very heart of the NHS.

I was talking about A and E and the reorganisation. We know that Ministers were explicitly warned about an A and E recruitment crisis by the College of Emergency Medicine a couple of years ago, but they said they were too absorbed with the reorganisation to listen or act. That brings me to the nub of the matter before the House: the root cause of the deterioration in the NHS is that reorganisation, which nobody wanted and nobody voted for. It threw the service into chaos just when it needed stability. As we warned, it has damaged standards of patient care. Four years ago the Government inherited a self-confident and successful NHS, with the lowest ever waiting times and the highest ever public satisfaction. Since then it has been destabilised, demoralised and reduced to an uncertain organisation that is increasingly fearful of the future.

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[Angus Robertson (Moray) (SNP)]

It is an honour to follow the hon. Member for Burnley (Gordon Birtwistle). The House was listening raptly to a speech full of humanity and compassion. I pay tribute, too, to the right hon. Member for Cynon Valley (Ann Clwyd), who read out a lot of examples of what everyone will agree was shocking treatment. I genuinely hope that Ministers listened closely to those speakers and to many others who have made important points.

In the limited time available, I should like to draw attention to the obvious point that this is the last Queen’s Speech before the historic and exciting independence referendum in Scotland on 18 September. It is worth making the point that this Queen’s Speech and Westminster governance—the choices that the Government have introduced—can and should be seen through that prism. There are 100 days left before people in Scotland are able to determine whether we should become a normal country making all the normal decisions that successful democracies make.

Today, we have been encouraged to speak about health, so I was pleased to find a recent international health watchdog report issued only a few days ago in Canada, which said:

“Imagine a land where a patients’ charter of rights and responsibilities is in place that includes wait-time guarantees; over 90% of patients requiring elective care are treated within 18 weeks from referral by a family physician to start of treatment/procedure including all diagnostic testing and specialist consultations. Over 98% of in-patient procedures and day-surgery cases are treated within 12 weeks of agreement to treat. Over 90% of patients are seen within four hours in the emergency department (i.e., admitted, transferred or discharged). Citizens can access the most appropriate member of their primary care team within 48 hours. Up-to-date statistics and reports on wait times and health system performance indicators are publicly available. In addition to providing timely access, this land has been successful in improving other dimensions of quality of care (e.g., significantly reducing levels of hospital acquired infections, reducing the level of inappropriate care), and performance in all of these dimensions is being tracked through the measurement and reporting of performance targets available for use by patients, providers and system managers alike. Fortunately, this land already exists—Scotland.”

That report was issued only a few days ago by the physicians watchdog in Canada.

I pay tribute, as did the Health Secretary, to the work of health professionals, who make a tremendous difference to people in the NHS system in England and, no doubt, to the NHS system in Wales and Northern Ireland. I pay tribute to all of them, and in particular to those who work in NHS Scotland. I am proud of the difference that the Scottish National party Government have made since taking power in 2007. Staffing has increased under the SNP by more than 6.7%.

[Tom Blenkinsop]

Will the hon. Gentleman give way?

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[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Over the space of a few weeks from this April, my constituency has been overwhelmed by a perfect storm of cuts and closures pushed through by NHS England and the local clinical commissioning group, all the result of this Government’s agenda.

People in the rural East Cleveland part of my constituency need NHS services and support seven days a week, and that is why the last Labour Government proudly introduced NHS Direct and walk-in centres, but East Cleveland now faces a triple whammy. The South Tees clinical commissioning group wants to end minor injuries provision at East Cleveland hospital and Guisborough hospital. It has also decided to cease walk-in provision at Skelton medical centre at the end of June, while NHS England wants to abolish GP provision at Skelton medical centre.

Ending minor injuries provision does not, in the words of the CCG consultation letter, provide

“better care for the vulnerable and elderly”,

and I fear that the CCG is trying to disguise cuts to vital minor injury provision. This leaves no urgent care services in East Cleveland.

That is particularly problematic for the villages of East Cleveland, where public transport links are poor and an ambulance service provided by the North East Ambulance Service trust “cannot cope”, as its chief executive admitted. Over six months last year, the North East Ambulance Service recorded 10,599 delays, 196 of which were for more than two hours. Paramedics are left unable to respond to waiting 999 calls, and a regional BBC programme only last week showed that the situation is worsening. I have raised this matter in the House on many occasions.

Both the two small hospitals I cited were once run by the local primary care trust, but after the coalition NHS reforms were pushed through they were passed on to the main hospital trust for our area, the South Tees Hospitals NHS Foundation Trust, which runs the excellent James Cook university hospital in Middlesbrough. The trust is already facing a £30 million to £50 million black hole in financing, having had only a £5 million deficit last year; it is being investigated by Monitor and has to make drastic cuts. It is little wonder that what might be seen as easy targets in ancillary units such as these two small local hospitals come up on the trust’s radar.

In addition, we have had the CCG and NHS England turning their big guns on another NHS facility in East Cleveland: they are looking at, and have announced as a fait accompli, the total closure of the Skelton health centre and medical walk-in centre. That proposal is part of a national coalition approach that has been targeting walk-in clinics set up by the last Labour Government. If the closure goes ahead, Skelton will lose one of its GP practices, a nurse practitioner clinic and the attached pharmacy. The clinic serves people from the poorer areas of the ward such as Hollybush, the Courts and north Skelton.

Like local people, I feel that NHS England is basing its views on old numbers which we feel are suspect. The provider, LivingCare, which owns the practice, is gobsmacked, as closure letters to people on the surgery list went out before they were told about the possibility of closure. In certain instances not enough letters were sent to people actually registered with the GP practice. Skelton as a town is undergoing vast expansion, with new housing going up and more planned. More than 1,000 new homes have been built in the past three years, with the new local plan indicating a further 400 homes on open land to the east of that new estate.

LivingCare was hit by a further blow when NHS England then announced the imminent closure of another GP facility it runs in my constituency. Unlike the earlier closures, this was not in rural East Cleveland, but in deep urban south Middlesbrough, on the Park End estate. I know the area well as my mother was for many years a teacher at the St Pius X Roman Catholic primary school on the estate, and I have relatives who still live there. The estate has profound social needs, with associated poverty and high indices of ill health. The cuts occurring locally in my constituency will increase the likelihood of people going to A and E, even when that is not appropriate. Our A and E has struggled to cope with demand over recent years, so these cuts are a false economy.

The mess of the Tory-Lib Dem NHS reorganisation, and the human tragedy it brings in its wake, deepens by the day. The coalition has already wasted £3 billion on a reorganisation and £1.4 billion on redundancies, and it is leaving the NHS weakened and confused. Locally, through this consultation, we are beginning to see the consequences on our constituents’ doorsteps. The approach being taken flies in the face of the call by NHS England’s new chief, Simon Stevens, for a marked change in policy and a shift away from big centralised hospitals. The health service chief executive says that we need new models of care built around smaller local hospitals and that, combined with comprehensive walk-in and GP care, is what my constituents need, deserve and rightly demand.

I have not been idle on these issues, but all my efforts have been stymied by a combination of bureaucratic blocking and ministerial indifference, resulting in Ministers’ responding to my requests for meetings with refusals, despite earlier friendly patter. Despite an outcry from local people, a full-page protest poster in the local newspaper Coastal View & Moor News and a massive petition, I managed to organise a meeting with NHS authorities that was unhelpful to say the least. Instead of a commitment to examine the clinical arguments and the issue of closures putting more pressure on the A and E unit at James Cook university hospital—a hospital with one of the longest waiting times for A and E in the region, if not the country—the NHS reps at the meeting retreated behind the protection of contractual timetabling, based on funding cuts issued by the Department of Health, because the “Darzi clinics”, as they were at the time, are coming to the end of their five-year contracts. I can say now, without equivocation, that such an approach will inflame my constituents, as I have seen already on the doorstep.

I still want to offer Ministers the option to meet me to talk about this issue, because I really fear the consequences for East Cleveland, and for Park End in particular, of these services being taken away. There is absolutely nothing in the consultation offering the individuals there any other option. There is no plan to put people in other GP practices. My fear is that we will have a time lag, and about 2,000 to 4,000 people not knowing where to go for primary care and ultimately ending up in the A and E unit—again.

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[Norman Lamb]

That is equivalent to about 6,000 nurses a year. The right hon. Gentleman has to demonstrate how that would be paid for. The fact is that there is an average wage increase of 3% as a result of annual pay increments under Agenda for Change. We have ensured that at least everyone will get a 1% increase. If he is arguing for something different, he has to say where the money would come from to pay for it and how he would cope with 6,000 fewer nurses, which would be the result of his action.

For the first time, it is this Government who have made decisive moves to join up the care and health system and focus more on preventing ill health. Contrary to the shadow Secretary of State’s claims, the better care fund has been widely welcomed, and it has initiated action across the country to join up a very fragmented system. We have sent out the signal that we encourage innovation and change, driven by clinicians from the bottom up, not from the top down. Brilliant pioneers across the country are ending this fragmented system that has interrupted patient care for so long and failed patients. Those pioneers are combating loneliness, which my hon. Friend the Member for Burnley (Gordon Birtwistle) spoke passionately about. It is so far removed from the caricature offered by the shadow Secretary of State and the tired old refrain about privatisation. It was, after all, a Labour Government who mortgaged the future of the NHS to the tune of billions of pounds with their private finance initiative programme, giving massive windfall profits to private consortiums—a scandal of historic proportions. Yet Labour Members continue to argue that the Government are privatising—an argument that is based on thin air, not substance.

[Tom Blenkinsop]

Will the Minister tell the House at what point the provisions of the Competition Act 1998 were introduced into the Bill that became the Health and Social Care Act 2012? I think it was this Government who did that. In the Public Bill Committee, I commented on the fact that they were exposing the NHS and undermining the category B status of the European competition regulations by putting the Competition Act at the very heart of the Bill.

[Norman Lamb]

I am sorry to disappoint the hon. Gentleman, but it was under the Labour Government that it was made clear that competition law applied to the health care system. Indeed, the Labour Government’s guidelines on the NHS replicated exactly the regulations under section 75 of the Competition Act that this Government have introduced. Time and again, we hear false claims by Labour Members.

This Government have developed a new health and care system that is totally patient-centred, led by health professionals, and focused on delivering world-class health outcomes. The difficult decisions that we have made on public finances have meant that we have been able to protect the NHS budget. The shadow Minister spoke as though the Government have had to face no financial challenge at all. She knows that across Europe, Governments have slashed pay for health workers and introduced co-payments. We have done none of that. We have protected the budget for the NHS, and we are proud of doing so; Labour did not commit to that in its manifesto at the last election. The truth is that the NHS is doing extremely well under a great deal of pressure.

This Government have laid solid foundations to transform our NHS to help it to meet the challenges of an ageing population, drive up standards, and focus absolutely on compassionate care. My hon. Friend the Member for Mid Worcestershire (Sir Peter Luff) spoke movingly about his experience of the importance of compassionate care. We have introduced tough, robust inspections overseen by new chief inspectors of hospitals, of social care, and of general practice. We have introduced ratings of hospitals, care homes and GP practices so that people know how good their local services are. We have introduced, for the first time, fundamental standards and the ability to prosecute—to hold to account organisations and directors who seriously fail patients. We have introduced a fit and proper person test for directors; for the first time, compulsory training for health and care assistants; and—I am particularly proud of this—a statutory duty of candour to ensure that there is openness when things go wrong in the NHS or the care system.

Ambulance Resources and Response Times

Tom Blenkinsop Excerpts

Wednesday 14th May 2014 Westminster Hall

[Mr Wright]

We should have that system already, but it is simply not working in the north-east and in other parts.

Let me cite another case. A constituent of mine from the Headland part of Hartlepool, which is an urban area, contacted me to say:

“My dad has kidney failure and has only 12% of his kidneys working. Just over three weeks ago, my mam rang me concerned about dad. When I arrived at their house, I could see he was very, very ill. I rang immediately for an ambulance. A nurse rang me back for an assessment of dad. No ambulance. I rang again, another assessment, no ambulance. I rang again, another assessment, (the 4th one), this time stressing that I was angry because he was dying and the family would be driving dad to the hospital if they didn’t come, even though this was impossible. After two hours ten minutes, the ambulance finally arrived. In each phone call that I made, I stressed the fact that dad had kidney failure, which results in potassium build up, which results in a heart attack.”

Thankfully, my constituent’s father went to hospital and, almost against the odds, is slowly improving. As my constituent stated to me:

“He is still weak but my dad has always been a hard worker and a tough, strong man. He is at home but missing going to his allotment! There is no doubt the wonderful nurses and doctors saved dad’s life.”

I want the Minister to respond to and take action on a number of points raised by the examples that I and my hon. Friends have given. First and foremost is that stark admission from a manager within the NEAS that the service does not have the resources to meet demand, and that that is a national problem. As my right hon. Friend the Member for Oxford East (Mr Smith) said, demand is clearly rising. Since the 2010 general election, emergency calls to ambulance services in England have increased by about 12%, and calls in the north-east have gone up by about 13%. An ageing population will only increase demand further. In the next decade, this country will need more ambulance resources, not less.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

My hon. Friend has secured an excellent debate. We know from the NEAS itself that it had an expectation of 415,000 call-outs in the financial year 2012-13, yet it was funded for only 376,000 calls. Also, the use of private ambulances has gone up ninefold, with an initial cost of £96,000 in 2009-10 rising to £754,461 in 2012-13.

[Mr Wright]

I know that my hon. Friend has spoken in the House about this issue before, and I praise him for that. The use of private ambulances is taking resources away from our having a sustainable public service, which all our constituents want. As a result of that, the ambulance services are not able to invest in their work force, and something needs to be done about it. I hope that the Minister will respond directly to my hon. Friend about that issue, because the use of private ambulances is simply unacceptable.

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[Mr Wright]

As a north-east collective, we work closely to ensure that our constituents get the best possible services.

Let me move on to average response times. In the north-east, the average response time increased from five minutes and 16 seconds in 2011 to five minutes and 48 seconds last year. The east of England saw a 90-second increase in response times. Only one ambulance trust actually reduced the average emergency response time. Those figures reinforce what the senior management from the North East Ambulance Service confirmed at Mr Gouldburn’s inquest, namely that ambulance services do not have the resources to meet demand, that it is a national problem and that response times are suffering as a result. There has been an admission from a senior manager in the ambulance service that resources are not keeping up with demand. Response times, in particular for more serous cases, are deteriorating and lives are being threatened, if not tragically lost. Will the Minister therefore pledge this afternoon to provide more resources to ambulance services in Hartlepool, the north-east and across England to meet rising demand?

I also want to question the assessment process used to screen calls and prioritise response times. Given Mr Gouldburn’s history of heart problems, his age and the fact that he had recently undergone surgery and had seen the doctor that same day, why on earth was he not prioritised as an emergency case and provided with an eight-minute response time? Why did it take seven calls to escalate the case to an emergency? The Minister must accept that that is simply unacceptable. Is there pressure from the Government to downgrade the priority of emergency calls due to inadequate resources?

This week, I received a letter from the Health Minister Earl Howe stating in response to Mr Gouldburn’s case that

“the 999 call was triaged correctly, although some of the questioning could have been better.”

Why was it not better? Why is the questioning not relevant and efficient in every case? The constituent whose father had kidney problems said to me:

“Phone assessments should be changed. In each assessment they asked me did dad have a rash and could he put his chin on his chest! Words like kidney failure and potassium should be taken note of. Because I’m not a rude person I didn’t react angrily, but wish I had because dad could have died. We realise that there is a shortage of ambulances and this can’t go on. We are a rich country. Shortages of ambulances are something you read about in poor countries. It shouldn’t be happening here.”

Assessment and prioritisation seem to be failing and the right questions are not being asked during initial screening. What will the Minister do to address that?

The third issue is that ambulances were delayed because of a problem in admitting patients to North Durham hospital due to a lack of available beds. That seems to show both a lack of joined-up thinking on hospital admissions and the fact that ambulance and NHS resources are hanging by a thread. Is it really acceptable, as seems to have happened in Mr Gouldburn’s case, that because of a delay at a single hospital in County Durham due to insufficient beds, the whole ambulance service for the north-east, or certainly the south of the region, grinds to a halt? The Minister surely cannot find that acceptable. Are resources being spread so thinly that services are not being provided to my constituents?

Hospital services in my area have gone through dramatic changes in the past few years, as my hon. Friend the Member for Easington (Grahame M. Morris) knows all too well. Hartlepool’s A and E closed in August 2011, much to the town’s concern, on the grounds of clinical safety and the specialisation and centralisation of appropriate medical skills. There is a mismatch between the Momentum programme of centralising services and the Government’s failure either to commit to funding a new hospital or to provide resources to reinstate services at the existing Hartlepool hospital. If there are fewer A and Es across the country and ambulances have to travel greater distances to a smaller number of centres, will that not increase the handover and turnaround times of patients between the ambulance service and hospital staff? Ambulance crews—my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) has been strong on this—are queuing up outside fewer hospitals, making handover and turnaround times worse. Does that not reduce the amount of time for which ambulance staff can be in a position to respond to emergency calls?

[Tom Blenkinsop]

Such cases will only increase in my constituency, where it is proposed to close two minor injury units and the walk-in centre in Skelton. That all comes on the back of a recent development at the South Tees Hospitals NHS Foundation Trust, which could have a £50 million deficit. My main problem is that we have been refused meetings with Health Ministers to discuss such matters.

[Mr Wright]

It is wrong for any Minister to refuse a meeting request from a Member of Parliament, in particular on something as important as ambulance response and handover times.

Will the Minister respond to my point about the trade-off between the specialisation and centralisation of services, which is how the NHS is going, and the impact on the distances travelled by ambulances and their subsequent response and return-to-road times? Those are links in the chain that will ensure a seamless and high-quality NHS service, but they do not seem to be as locked together as they should. What is the Minister doing to address that? Will she commit to monitoring handover times to ensure a better and more responsive service for all patients?

At times of emergency and crisis for themselves or their loved ones, the public expect a responsive and professional ambulance service, but as we have heard from those working at a senior level within the North East Ambulance Service, resources are not matching demand, response times are worsening and lives are being threatened. Will the Minister act to ensure that in Hartlepool, the north-east and across the country we have ambulance provision that meets demands, is professional and is the best in the world?

Oral Answers to Questions

Tom Blenkinsop Excerpts

Tuesday 1st April 2014 Commons Chamber

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

The Francis report highlighted the importance of ward sisters in properly managing wards, so why has the number of band 8 nurses in the north-east fallen by 87 since the general election?

[Mr Jeremy Hunt]

The number of nurses overall is up by 1,600 since the general election. Let me be absolutely clear that I do not believe in a system where the Secretary of State is micro-managing precisely how many nurses there are in every ward in every hospital in the country. Because we have protected funding that Labour wanted to cut, there are more doctors and more nurses than there were when it was in government.

Oral Answers to Questions

Tom Blenkinsop Excerpts

Tuesday 14th January 2014 Commons Chamber

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

At the excellent James Cook University hospital between 19 December and 1 January, 49 ambulances were delayed for more than 30 minutes, 168 beds were blocked and 82% of admitted patients had been treated within 18 weeks, rather than the Government target of 90%. Why does the Secretary of State think that that is the case?

[Mr Hunt]

Because there is sustained pressure throughout the NHS. Across the NHS, hospitals and ambulance services are doing very well in the circumstances. I am happy to look at the hon. Gentleman’s specific concerns to make sure that his local NHS trust is doing everything it should.

Accident and Emergency

Tom Blenkinsop Excerpts

Wednesday 18th December 2013 Commons Chamber

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

I wish to discuss two topics. First, I want to raise the issue of funding for the North East Ambulance Service NHS trust, the rising use and cost of private ambulances and other ambulance pressures, and, secondly, I want to raise with the Minister the ongoing Monitor investigations into the two foundation trusts, that serve my constituents, the South Tees Hospitals NHS Foundation Trust and the Tees, Esk and Wear Valleys NHS Foundation Trust.

Over the past 18 months, the A and E department at the James Cook university hospital, which serves my constituency, has come under considerable pressure. In particular, in the run-up to last winter, there were problems with handover times, with ambulances and paramedics waiting up to two and a half hours to admit patients, despite the national target time being 15 minutes. I raised this matter last year with the Secretary of State for Health, who agreed that the situation was completely unacceptable, and with the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter),in a Westminster Hall debate on A and E provision in the north-east on 13 February 2013.

In addition to the issues I raised with the Secretary of State, it became evident that James Cook’s A and E department struggled to manage with the pressure that winter placed on it. In January and February, South Tees Hospitals NHS Foundation Trust failed to meet its target of seeing 95% of A and E patients within four hours. With James Cook so clearly overstretched, I was surprised to discover in September that the Secretary of State decided not to award it, or any other hospital trust in the north-east, funding to alleviate pressures on A and E. It struck me as beyond belief that of the £250 million he awarded to 53 trusts, not a penny was to reach the north-east. Thankfully, following pressure from the Opposition, including in my Westminster Hall debate on north-east NHS services on 5 November, the South Tees trust is to receive £2.1 million, as announced earlier this month.

For weeks and weeks, however, I have received recurrent expressions of concern about the increasing use of private and voluntary ambulances in response to 999 calls in my constituency. I wrote to the North East ambulance service about two of these incidents. From its reply, it became clear that central Government funding cuts were eroding the blue-light service. It wrote:

“Each year we have discussions with our commissioners on the forecast number of incidents in the forthcoming year. The outcomes of these discussions for 2013-14 were that commissioners felt it necessary to set our income on activity for the next 12 months at a level less than we were forecasting... So for 2013-14, we have been contracted to respond to 376,000 incidents, although we are forecasting activity at an estimated 415,000. This means that any incidents above 376,000 will be funded on a one-off basis rather than as recurrent annual income. These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries”.

[Mr Dave Watts (St Helens North) (Lab)]

Is there not an element almost of secrecy taking over the NHS, with trusts not allowed to talk to MPs or tell them the facts and trusts’ financial details not being published? Does my hon. Friend agree that that is not healthy for the NHS?

[Tom Blenkinsop]

For that reason, I had to put in a freedom of information request to the trust to get the information I shall now detail.

According to that letter, our ambulance service will see more cuts, more private ambulances and possibly a less responsive service. It is not me saying this, but the chief operating officer of the North East Ambulance Service. In 2008-09, private ambulances attended 865 call-outs in our region, costing £86,118. In 2009-10, there were 1,816 call-outs, costing £151,112. In 2010-11, however, there were 6,429 such call-outs, costing £477,575. In 2011-12, there were 9,034 of these call-outs, costing £639,819, and in 2012-13, there were 13,524 call-outs of private and voluntary ambulances, costing £754,461. Since Labour left office, therefore, a fivefold cost increase in private ambulances has occurred in the north-east—these are funds going to private contract firms. It is obvious that from 2010 onwards an explosion of private ambulance usage by the trust has occurred, costing a huge amount of taxpayer funds. As the chief executive states:

“These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

The police and crime commissioner for Cleveland, Barry Coppinger, has said:

“The bottom line is that police officers are not medical professionals and should not be put in the position of having to transport patients to hospital. Police vehicles are unsuitable and unequipped; it not only puts undue stress on the patient, but also the officer who should be able to continue to fulfil policing duties on the ground… The downward trend in incidents from September to October relates to a policy change by senior officers”—

not the NHS—

“within the Force and a directive issued that officers should not transport patients to hospital unless there is an immediate risk to life. However, there have been five occasions in November of officers being forced to take patients for urgent medical treatment due to ambulance delays.”

I hope for a response from the Secretary of State or a Health Minister. I would be more than willing to talk to them about this subject, because it is a massive concern, particularly in the east Cleveland part of my constituency.

NHS Funding (North-East and Teesside)

Tom Blenkinsop Excerpts

Tuesday 5th November 2013 Westminster Hall

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

This is an important opportunity to discuss concerns that my north-east colleagues and I have. I hope that the Minister takes our points on board, and takes the necessary steps to rectify the issues in the region’s health service.

I will discuss four topics this afternoon. The first is the funding provided by central Government to the region’s accident and emergency departments, particularly in the south Tees area. The second is the funding of the North East Ambulance Service NHS Foundation Trust, and the rising use and cost of private ambulances. The third is the ongoing Monitor investigations into the two foundation trusts—the South Tees Hospitals NHS Foundation Trust and the Tees, Esk and Wear Valleys NHS Foundation Trust—that serve my constituents. Finally, I will seek reassurance from the Minister on future funding allocations to north-east clinical commissioning groups.

Over the past 18 months, the accident and emergency department at James Cook university hospital, which serves my constituency, has come under particular pressure. In the run-up to winter last year, there were problems with handover times; ambulances and paramedics waited up to two and a half hours to admit patients, despite the national target time being 15 minutes. I raised that last year with the Secretary of State for Health, who agreed that the situation was completely unacceptable, and I raised it with the Minister on 13 February 2013 in a Westminster Hall debate on A and E provision in the north-east. In addition to the issues that I raised with the Secretary of State, it has become evident that the James Cook hospital’s A and E department struggled to manage with the pressure caused by winter.

In January and February 2013, the South Tees Hospitals NHS Foundation Trust failed to meet its target of seeing 95% of A and E patients within four hours. With James Cook hospital so clearly overstretched, I admit that I was surprised to discover in September 2013 that the Secretary of State decided not to award it, or any hospital trust in the north-east, funding to alleviate the pressure on A and E departments. It is beyond belief that, of the £250 million awarded by the Secretary of State between 53 trusts, not a penny will reach the north-east, particularly as we live in a region that suffers from some of England’s harshest winter weather and has some of the harshest local government cuts in the country. I hope that the Minister reconsiders that allocation, or at the very least clarifies why the Secretary of State made such a seemingly absurd and regionally disparate decision.

Recurrently, over many weeks, I have received expressions of concern from constituents about the increasing use of private ambulances in response to 999 calls in my constituency. I corresponded with the North East Ambulance Service on two such incidents, and its reply made it clear that central Government funding cuts are eroding that blue-light service:

“Each year we have discussions with our commissioners on the forecast number of incidents in the forthcoming year. The outcome of these discussions for 2013-14 were that commissioners felt it necessary to set our income on activity for the next 12 months at a level less than we were forecasting… So for 2013-14, we have been contracted to respond to 376,000 incidents, although we are forecasting activity at an estimated 415,000. This means that any incidents above 376,000 will be funded on a one-off basis rather than as recurrent annual income. These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

[Ian Swales (Redcar) (LD)]

The hon. Gentleman is making a powerful speech. Is he aware that Cleveland police vehicles and staff are also being increasingly used as unofficial ambulances?

[Tom Blenkinsop]

Yes, the police, and particularly the police and crime commissioner for Cleveland, have raised that with me in private meetings on first responder calls. They have funding worries about what will happen if such practices continually recur.

The NEAS letter shows that there will be more cuts, more private ambulances and possibly a less responsive service. It is not me saying that, but the chief operating officer of the North East Ambulance Service. The figures are stark. In 2008-09, 865 call-outs were attended by private ambulances in our region, costing £86,000. In 2009-10, some 1,816 call-outs were attended by private ambulances, costing £151,000. In 2010-11, however, 6,429 call-outs were attended by private ambulances, costing £477,000, which is a huge jump. In 2011-12, there were 9,000 call-outs attended by private ambulances, costing £639,000. In 2012-13, 13,524 call-outs were attended by private ambulances, costing £754,000. So since 2010, there has been a fivefold increase in private ambulance costs in the north-east, with the funds going to private contract firms. It is obvious that from 2010 onwards, there has been an explosion of private ambulance usage by the trust, costing a huge amount of taxpayers’ funds. The chief executive states:

“These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

A third issue of particular concern to my constituents is that both the NHS trusts that serve them—the South Tees Hospitals NHS Foundation Trust, and the Tees, Esk and Wear Valleys NHS Foundation Trust—have found themselves under investigation by Monitor in the past 12 months. Since May 2010, the South Tees trust has failed on seven occasions to meet its referral-to-treatment target, most recently between March and August. That has resulted in the Monitor investigation, because the trust has failed to ensure that 90% of patients commence treatment within 18 weeks of referral. Furthermore, there has been an increase in reported “never” events at the trust, and an increase in the incidence of clostridium difficile.

Despite the seriousness of those issues, Health Ministers have taken no action. My constituents would at the very least expect Ministers to have had conversations with Monitor and the trust on the issue, and on what support the Department of Health can provide, yet the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), confirmed to me in a written answer that

“No such discussions have taken place with Ministers.”—[Official Report, 22 October 2013; Vol. 569, c. 83W.]

Will the Minister please assure me that he will closely monitor the situation and have discussions with both Monitor and the South Tees trust on how the Department can provide support, including additional funding if necessary?

My final point is on allocations to the north-east’s clinical commissioning groups.

A recent working paper issued by NHS England on allocation and indicative target allocation outlines proposals that will reduce per-capita funding for CCGs across the north-east. People in Sunderland will each face a £146 cut, people in south Tyneside a £124 cut, people in Gateshead a £104 cut, and people in my constituency a £60 cut.

[Ian Lavery (Wansbeck) (Lab)]

Is it not perverse that deprivation and health inequality indicators are not part of the overall calculation, as regards the funding allocation for the north-east? That will potentially result in the north-east losing up to £230 million of NHS funding per annum.

[Tom Blenkinsop]

Yes, the cumulative effect of all the funding allocations in different areas is very worrying. If those allocations are all reduced, my genuine worry for my constituents, and for constituents across the north-east, is that all the hard work and financial effort in Teesside in the past 15 years to reduce cardiac risk, bad outcomes for cancer, and other problems will be undermined, and we will not build on the momentum gathered over the past 15 years.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Is that not all the more outrageous because a former Health Minister, the right hon. Member for Chelmsford (Mr Burns), gave a clear assurance at Health Question Time on the Floor of the House that the importance of the deprivation part of the calculation would not be downgraded? We asked for a clear assurance, and we were given a clear assurance. That assurance is not compatible with the current consultation.

[Tom Blenkinsop]

My right hon. Friend predicts the final part of my speech. I hope the Minister will take the opportunity to put our fears to rest. Unfortunately, the information that I have received to date does not reassure me.

[Grahame M. Morris (Easington) (Lab)]

I compliment my hon. Friend on securing such a timely and important debate. I completely agree that one of the most worrying aspects is the potential changes to the funding of clinical commissioning groups. Easington would lose £62 a head. Does he agree that that could be seen as political gerrymandering, with the poorest areas deprived of funding and the wealthiest, such as east Hampshire, getting increases of as much as £164 a head? The areas with the best health outcomes will get the biggest increases in resources.

[Tom Blenkinsop]

My hon. Friend has mentioned that in Health questions and in the Select Committee on Health, of which he is a doughty member who provides a lot of input. Someone from a poorer socio-economic background has a lower likelihood of reaching the age at which they would receive more funds under the allocation—it would probably never happen. This becomes a self-defeating, vicious circle of a lack of investment in people who might need it the most.

As I was saying, the proposals in a recent working paper issued by NHS England on the allocation and the indicative target allocation would have led to a per capita reduction in funding for CCGs throughout the north-east, and my constituents would have lost out. Meanwhile, CCGs in the south would have had a per capita increase; for example, those covered by Coastal West Sussex CCG would each gain £115, those in Hailsham £136, and those covered by South Eastern Hampshire CCG £164. That is clearly not a one-nation NHS. I received ministerial assurances that that formula was not ultimately used for 2013-14, but a response to a parliamentary question that I asked confirmed that

“No proposals or decisions regarding allocations for 2014-15 have yet been made.”—[Official Report, 22 October 2013; Vol. 569, c. 76W.]

The hon. Member for Stockton South (James Wharton), who is in the Chamber, told the Evening Gazette on 23 October that it was indeed “right” that NHS England was considering reducing health funding for his constituents and the north-east, but—

[James Wharton (Stockton South) (Con)]

The hon. Gentleman has either misread or misremembered, or perhaps the Evening Gazette did not give a full account of my comments. What I said was right was having an independent funding body that makes decisions based on a formula that is consulted on, and it is right that age should be a factor. That does not mean that deprivation should not be a factor. I recognise and welcome the debate, and the effort that hon. Members in all parties are making to put the case that deprivation has an impact on health outcomes and should be considered as part of the funding formula. I recognise, however, the independence of NHS England, and I support it being an independent body. Does he recognise its independence?

[Tom Blenkinsop]

I recognise the health outcomes and needs of my local constituents; as their representative, I will voice those views and needs vociferously. I take on board, however, the hon. Gentleman’s comments and his desire to see deprivation recognised in the allocation of funds. On the future allocation for CCGs, I hope that he will advocate to the Minister on behalf of those of his constituents who share the same socio-economic background as me, in the way that we Labour Members do. I take his intervention in favour of those funds in a spirit of common north-eastern friendship.

Will the Minister assure us that he will urge NHS England to consider deprivation and regional health inequalities when determining funding formulae? Furthermore, will he guarantee that any funding formula used to determine allocations in 2014-15 will not leave the north-east comparatively worse off, and will not widen the north-south health divide? I thank the Minister for his time, and I hope that he will be able to provide the clarifications and assurances that my colleagues and I have sought this afternoon.

--- Later in debate ---

[Dr Poulter]

I will not give way again.

The hon. Member for Middlesbrough South and East Cleveland is being very disingenuous in the points that he is making, and I have put the record straight: health care funding has increased under the present Government. If I give way again, perhaps he will explain why the shadow Secretary of State said it would be irresponsible to increase the health care budget in real terms. We all think that would be irresponsible in the current environment.

I turn to local services in the hon. Gentleman’s constituency. When we discussed the matter earlier this year, he raised specific concerns about Guisborough, East Cleveland and Redcar hospitals. He did not put on the record the fact that matters have improved considerably since that meeting with me and local commissioners. Guisborough urgent care centre is open from 9 to 5 on Mondays to Fridays and from 8 to 8 at weekends. East Cleveland urgent care centre is open from 9 to 5 on Mondays to Fridays and from 8 to 8 at weekends, and Redcar urgent care centre is open 24/7. There are currently no vacancies for clinical staff that affect opening hours, which have been aligned to match service and patient need. The centres will continue to evaluate the situation.

It is worth highlighting that three additional nurses were recruited to support the urgent care centres in June 2013, and they are now at full complement, apart from one vacant clinical lead post to which the trust is continuing to try to recruit. It is looking at better ways to manage staffing. In response to concerns raised by the hon. Gentleman, there are now fully functioning urgent care centres. There is a 24/7 service in Redcar and additional staff working at those centres. That is good progress and it is disingenuous of him to suggest otherwise.

[Tom Blenkinsop]

rose—

[Dr Poulter]

I hope that when I give way, the hon. Gentleman will put on the record the fact that considerable progress has been made by local commissioners for the benefit of local patients.

[Tom Blenkinsop]

I thank the Minister for giving way during a response to a speech I made in February, although I deliberately did not mention those points because they were not part of what I wanted to talk about today. The Minister says that South Tees NHS trust is successful, so why is it under investigation by Monitor?

[Dr Poulter]

The hon. Gentleman has raised issues of health care funding, and I am making the point that there has been considerable investment in local health care services, the very services that he said earlier this year had received no investment. He is also raising urgent care services and other services at his local hospital trust. I am reassuring him that considerable investment has been made locally, and it is worth highlighting the fact that further investment has been made. He is incredibly disingenuous to stand here and run down his local health service when considerable steps have been made to improve patient care services. For his benefit, I will outline a few more improvements that have been made, so that they are firmly on the record.

[Tom Blenkinsop]

Will the Minister give way?

[Dr Poulter]

I will not give way because the hon. Gentleman should listen to the answers to some of his questions and realise that his local health care services are improving thanks to the Government’s increased investment in the health service—[Interruption.] Hon. Members have been incredibly political in everything they have said today, and I am putting answers on the record. If the hon. Gentleman does not want to hear them, he should not have raised the debate.

The latest data for 27 October 2013 show that South Tees Hospitals NHS Foundation Trust’s performance against the 95% standard for A and E waits is 96.8%. Over the last 23 weeks, it has met the national 95% target for A and E four-hour waits. The local trust is performing very well in treating patients in a timely way when they arrive at A and E. That is contrary to the points that the hon. Gentleman was trying to make.

At James Cook university hospital, the acute admissions unit is adjacent to the A and E department, so enabling the trust better to manage the flow of patients and to ease pressure on A and E. The trust has recruited two additional consultants and six additional junior doctors to the acute medicine departments, so easing pressure on the A and E department. Considerable investment is being made, and additional nursing staff have been recruited to support 50 more acute hospital beds that will be in place this winter. The hon. Gentleman must be aware that there is a lot of investment locally, with more beds, more staff and better care. It is a pity that he could not acknowledge that in his speech. I am putting it on the record, so that his constituents are aware of it.

Accident and Emergency Departments

Tom Blenkinsop Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

I absolutely agree. It is really important that we recognise those challenges in rural areas, and indeed semi-rural areas such as my constituency, where we have had similar issues. I can assure my hon. Friend that when we make structural changes, we take those issues closely into account.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

How many walk-in centres have been closed since May 2010?

[Mr Hunt]

I do not have the figure at my fingertips, but I will happily write to the hon. Gentleman.

Hospital Mortality Rates

Tom Blenkinsop Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

That open relationship between hon. Members and their local NHS trusts is extremely important and useful. We all have to recognise that sometimes we have to speak up publicly when there are problems at our local NHS trust, because we have to represent our constituents, and that is part of the change due to this process. In the end, the most important thing is to give people confidence that, when there are problems, we are a Government who are committed to sorting them out.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Page 22 of the Keogh report clearly states:

“Contrary to the pre-visit data, when the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas. The reported data did not provide a true picture of the numbers of staff actually working on the wards.”

It goes on to say that that

“was compounded by an over-reliance on unregistered staff and temporary staff”.

Given that the Government have sacked more than 1,000 people in front-line nursing roles in seven of the trusts involved, what conclusion does the Secretary of State draw from that paragraph?

[Mr Hunt]

It is funny how Labour Members like to accuse Government Members of making party political points, but then misrepresent the reality that there are 8,000 more clinical staff throughout the NHS than when their Government were in power.