West Cumberland Hospital

Tony Cunningham Excerpts

Monday 20th October 2014 Commons Chamber

[Sir Tony Cunningham (Workington) (Lab)]

West Cumberland hospital is used by thousands of my constituents who rely on the services it provides on a daily basis. The future of the hospital is an issue close to my heart and that of my hon. Friend the Member for Copeland (Mr Reed), whose constituency is next to mine. The hospital is based in his constituency, and with the prior agreement of the Minister, whom I thank, and of Mr Speaker, it is right for him to contribute to the debate.

Based in Whitehaven but relied on by people throughout west Cumbria, including tens of thousands of my constituents, the hospital is one of two sites that make up North Cumbria University Hospitals NHS Trust. The trust currently remains in special measures and in limbo over a delayed acquisition by Northumbria Healthcare NHS Foundation Trust. Reports by Sir Bruce Keogh, the Care Quality Commission and others have revealed serious problems with the trust, from a shortage of staff to governance and management issues. Through the hard work and commitment of clinical and non-clinical staff, improvements are being made—although slowly—and I add my personal and genuine thanks to all the staff who work so incredibly hard at West Cumberland hospital. However, the trust is still in special measures after more than a year.

I pay tribute to the fantastic work done by the We Need West Cumberland Hospital group to raise public awareness. It organised a meeting recently to discuss services at the hospital, which was held in a sports stadium because no indoor facility was big enough to cater for the 4,000 local residents from Allerdale and Copeland who turned up to show support for their hospital.

My hon. Friend and I have worked closely with the group and will continue to do so. Its work has clearly shown the strength of feeling throughout west Cumbria, and the willingness of our communities to engage with the decision-making process when it comes to services at our local hospital. The crux of the issue is that the unwillingness of the hospital trust to engage with communities and local people has meant that all trust has broken down. People want a say in what their local health services do and should look like, yet the door is being shut—slammed in their faces. Because of that lack of openness from the trust, feelings of distrust have grown.

My hon. Friend has repeatedly said that the issues highlighted by Sir Bruce Keogh and the Care Quality Commission must not be used as an excuse to strip services away from west Cumbria, and particularly West Cumberland hospital. However, when decisions are made behind closed doors, that is exactly what the community, my hon. Friend and I fear is happening. Representatives of the trust were present at the recent public meeting, but they did not reassure the local people who attended one iota. Engagement has increased recently, but it feels a bit like reluctant engagement. That cannot, and must not, continue.

The nearest other hospital is more than 40 miles away from the West Cumberland hospital. The Cumberland infirmary in Carlisle faces many of the same problems, but stripping services from the hospital in Whitehaven to relocate them to Carlisle is in my view, and in the view of my hon. Friend, a recipe for absolute disaster. Taking ambulances out of service to transport patients in need of care more than 40 miles, a journey that takes at least one hour, creates unnecessary and unacceptable risks to patients. Brand-new facilities are about to open in Whitehaven at the West Cumberland hospital which will provide our constituents with a first-class hospital. Surely hospital services should be delivered in the hospital that has been purpose-built to provide them. I will repeat that so that there is no misunderstanding: surely hospital services should be delivered in the hospital that has been purpose-built to provide them.

The high degree of uncertainty surrounding services has been fostered by the lack of engagement from the trust. There seems to be uncertainty about particular services, especially consultant-led maternity services. The atmosphere in which any engagement has been conducted to date has led local residents to believe that the trust is hiding its intentions. If the services at the West Cumberland hospital are not under threat, why has the trust not made that clear? The fact that it has not suggests that the services could indeed be under threat. We cannot, and must not, allow a situation to develop where the lives of mothers and their unborn children are put in danger in the back of an ambulance on the long journey to Carlisle. It is difficult to do a caesarean section in the back of an ambulance.

I understand that members of staff from the trust were not allowed to attend the recent public meeting. That is also totally unacceptable. The trust needs to promote meaningful engagement, rather than shutting down reasonable debate. It is clear that many medical professionals within the trust have concerns about the how the trust is acting. This must change. There is deep concern within the medical community, and their views must be heard.

There is a great strength of feeling within our communities. People who use these services on a day-to-day basis, people who rely on these services when they get ill and the people who will use these services in the future deserve a say in how these services are provided. There is a willingness to engage by the people of west Cumbria. People want to see their services improved and strengthened, and they want to be part of that process. The trust’s lack of engagement cannot continue. It must be willing to engage with all the people of west Cumbria, staff and local residents alike, and the Government must ensure that this happens.

I have two final points for consideration. We keep being told that one reason for change is to create specialisms. For example, if a patient in west Cumbria has heart problems—perhaps they need a triple heart bypass—they may well need to go to a specialist unit such as the one in Middlesbrough. I, and the community, understand that, but perhaps the Minister could tell me what specialism is being planned for the new refurbished West Cumberland hospital, because it needs one.

Finally, my hon. Friend and I are to hold a meeting of interested bodies soon, including some not in the process, such as the university of Central Lancashire and Allerdale borough council, whose leader Alan Smith spoke to me this morning. Will the Minister encourage the relevant bodies to attend such a meeting so that we can provide the hospital that the people of west Cumbria deserve?

[Mr Jamie Reed (Copeland) (Lab)]

I would like to thank your office, Madam Deputy Speaker, and the office of Mr Speaker, for the advice with which they have provided me in the lead-up to today’s debate. That a Member of Parliament could have been prevented from speaking on an issue that relates directly to his constituency and constituents owing to the decision of an individual Minister, is too absurd to contemplate. That would have made a mockery of our democratic process at a time when there is a growing dislocation between the public and Parliament. This Chamber exists precisely for the purpose of holding power to account and if any Minister in any Government believes they can be exempted from that then they are badly wrong. That said, I am exceptionally grateful to the Minister for granting me permission to speak. I would also like to extend my thanks to my hon. Friend the Member for Workington (Sir Tony Cunningham) for securing this debate and congratulate him on his richly deserved knighthood over 12 months ago now—this is the first chance I have had to do so in public.

My hon. Friend and I have campaigned consistently on behalf of West Cumberland hospital in a fight that will continue for as long as it is necessary. The Government must not try to shut down the debate, especially given that patients, the public and medical professionals across west Cumbria require clear and open discussion and genuine public engagement regarding the future of our hospital—the first new hospital built after the establishment of the national health service.

We need the support of the Government in ensuring that such engagement takes place. The Government’s health reforms, of which I am a long-standing critic, were billed as devolving decisions about local health services to the communities relying on them, but in Cumbria, which the previous Health Secretary said should be the template for the whole of the country—consider that for a minute—engagement could not be any worse. In my constituency and that of my hon. Friend, the Minister will find tens of thousands of people willing to engage with the Government—and with the trust, for that matter—on the future of their services, but their voices are being deliberately ignored.

Before I continue, I must declare my interest in this topic. I was born at West Cumberland hospital; my four children were born there; my wife was born there; and over the past few years, it has saved my life not once, but twice—which I appreciate sounds careless. I am indebted to its staff for all they have done for me and countless others from my part of the world. The hospital has been one of the main focuses of my efforts since I was elected to this place, and it will remain so for as long as I am here.

I do not wish to repeat what my hon. Friend said, but I want to echo my support for the We Need West Cumberland Hospital campaign group. These are local people exercised by what is happening to their national health service. They have created a group with passion and purpose, and it is time for decision makers to sit up and take notice of them—that means the Government as well as the trusts in question. The group exists only because the local health economy is in turmoil and because its members, like everyone else, are being purposely shut out of decisions relating to their hospital, as service decisions are made and increasingly removed by stealth.

As my hon. Friend pointed out, just a few weeks ago this group of concerned people organised a public meeting to discuss the future of services at West Cumberland hospital. About 4,000 people attended on a dark Monday evening at the recreation ground in Whitehaven. Had we held it on a summer weekend, only a few weeks earlier, more than 10,000 people—easily—would have attended.

My constituents are deeply concerned. The lack of engagement from the North Cumbria trust and other decision makers has fostered a feeling of toxic distrust. This simply is not conducive to establishing faith or trust, or to building the local services my constituents, the people of west Cumbria and the whole of the Cumbrian health economy need. I implore the Minister to intervene to stop this behaviour and ensure that an effective framework of meaningful public engagement is put in place before it is too late. I hope he can write to the North Cumbria trust to ensure this takes place.

Consultation is one thing, but meaningful engagement is another thing altogether. Rather than simply being consulted on a plan designed by the trust behind closed doors, it would be much more beneficial to have public involvement in what the plan should look like before it is consulted on. Surely that would make for a much easier, expedited consultation and a much easier, effective implementation. We did that locally prior to 2010 and we should do so again. I hope the Minister will address that point directly.

I want to address the concerns expressed about the services provided by West Cumberland hospital. The vacuum left by the lack of engagement from the trust means that local people are understandably worried about what their services will look like in the coming years, and the ability of the trust to engage with local people has been clearly and demonstrably worsened by the recent reorganisation of the NHS. However, the acquisition of North Cumbria by the Northumbria trust is also proving to be a significant problem. I hope the Minister will pay careful attention to this point. The acquisition cannot proceed unless both Monitor and the Care Quality Commission are satisfied that the trust is both financially and clinically sustainable.

The acquisition was meant to provide certainty and stability, yet years later the process has provided neither. In fact, the uncertainty is only worsening matters. There are justifiable fears that financial sustainability will be achieved by reducing, and only by reducing, the amount of services provided at the West Cumberland hospital, under the guise of “clinical sustainability”. Will the Minister agree today to stop any further progress of the acquisition of North Cumbria by Northumbria unless a comprehensive public consultation on the future of services provided by the West Cumberland hospital is undertaken prior to an acquisition? The people of west and north Cumbria need the Government’s help with that, which is the least the Government could do.

We have already seen some services move from the West Cumberland hospital to the Cumberland infirmary at Carlisle, itself a hospital in serious difficulty. People are worried that more services will follow and they are especially worried about consultant-led maternity services being transferred from West Cumberland to Carlisle.

[Sir Tony Cunningham]

The journey between West Cumberland and Carlisle is 40 miles, but some people have to go to Newcastle—for example, for chemotherapy. Just think of the anguish when children have to have chemotherapy as far away as Newcastle, which is almost 100 miles away.

[Mr Reed]

My hon. Friend makes an absolutely pivotal point. This is about not just the effectiveness and efficacy of the clinical solutions provided by the NHS; it is about the patient experience and the best outcomes for patients, and not just those 40 miles from Carlisle and further afield. The 40-mile point is Whitehaven, but it is actually much further south than that: it is Egremont, Cleator Moor, Seascale, Wasdale, Eskdale and so on. It is the people there who, perhaps more than others, are disadvantaged by these moves.

Childbirth is one of the biggest moments in any parent’s life, but the elation and happiness that surrounds a new family at this time can all too often turn to stress, worry and fear. Any complications can have a catastrophic effect—I have seen this recently with close friends. If there are complications during a labour, it is just not feasible for an expectant mother—particularly one in difficulty—to be transferred 40 miles from Whitehaven and further afield south, on a journey that, as my hon. Friend said, takes well over an hour at the best of times and considerably longer in heavy traffic. On occasion, the roads will become impassable in bad weather. In fact, only this year, after a visit to my constituency, a Minister wrote to one of his colleagues, a Minister in the Department for Transport, pointing out the inadequacy of the A595, bemoaning the state of the road infrastructure. If the roads are not good enough for visiting Ministers, they are certainly not good enough to be transporting patients at the time of their greatest need.

The truth is that a one-hour journey for a mother in labour means more than 90 minutes, bed to bed. That is indefensible. Also, studies have shown that an increase in straight-line ambulance journey distances is associated with an increased risk of death and that an increase of 10 km in straight-line distance is associated with an absolute increase of around 1% in mortality. Consider that for a moment. The centralisation of some services from the West Cumberland hospital in Whitehaven to Carlisle will increase the mortality risk for west Cumbrians much further afield than Whitehaven.

Between 2007 and 2008, the local primary care trust, as it then was, undertook a consultation on local services, to which it received 140,000 responses. As a result, the people of west Cumbria were told that they would receive a new hospital, built on the site of the West Cumberland hospital. The new hospital would retain services, including consultant-led maternity services, and also develop specialisms not catered for at Carlisle. The deal struck was also set to provide newly built cottage hospitals in Millom, Keswick and Maryport, to complement the existing new one built in my hon. Friend’s constituency in Workington.

When the Government took office in 2010, they scrapped the funding for the new hospital, as they did for all other existing new build hospital projects. It is only through perseverance, hard work and a lot of lobbying by me, my hon. Friend and others that the Prime Minister acquiesced and returned some of the money, for which we are very grateful indeed. However, the full funding was not returned and funds had to be found elsewhere. The Minister will know that to this day I am still consistently making the case—through the trust development authority, NHS England and other bodies—for extra funding. Now that the new hospital site is almost completed, it is only right that the other promises that were made are honoured.

Consultant-led maternity services cannot be removed from the West Cumberland hospital, and the Government must surely intervene to ensure that this does not happen. Before the election, the then Leader of the Opposition and now Prime Minister promised a “bare-knuckle fight” to stop maternity services moving, yet that fight has never appeared. Around the country, people wonder whether it will ever appear. However, can the Minister confirm that there is set to be a nationwide maternity services review? Will he explain when that will begin and end?

I believe that the local CCG in Cumbria wants to commission the consultant-led maternity services at the West Cumberland hospital, but that the North Cumbria trust does not wish to do so. I have submitted a series of freedom of information requests to the trust, seeking its internal proposals for removing consultant-led services; to date, I have received no response. Can the Minister help in that regard? Can he impress on the trust the urgency of the matter and the need for full candour? I hope he will be able to do so in writing.

Report after report by Sir Bruce Keogh and by the Care Quality Commission has shown that there are real issues, as my hon. Friend said, that need to be addressed not only in north Cumbria, but right across the Cumbrian health economy. Staff shortages are having a major impact on the services—not just the type but the quality—that can be delivered. Will the Minister commit himself today to investigate the recruitment practices of the North Cumbria trust? Will he commit himself to assist with recruitment, with financial incentives for potential new staff? This is critical. I am inundated with complaints from staff about the poor quality of recruitment advertising, cancelled interviews for applicants and much more. As a result, we have one of the highest locum spends in the whole country. The Minister will be only too aware of the effect on the trust’s ability to provide, in some cases, even the most basic front-line services.

In the people of west Cumbria, this Government—any Government—the trust and the regulators will find a willing partner for constructive discussions about what services should and could look like. They have been through these issues year after year; they are well versed in them and up to speed with the realities of modern clinical practice—and commissioning decision making, too.

More than that, however, with the brand new hospital being built, we should be able to develop a new model of health care for health economies such as Cumbria’s that is exciting, attractive and sustainable. We should be able to attract top-class medical professionals to our hospitals, and we should be able to support them. As Bruce Keogh points out, there is excellence at the North Cumbria trust. These issues are genuinely—we can say this without exaggeration—matters of life and death.

I have asked the Minister a series of questions. There will doubtless be many more, and if he cannot answer them today—I again express my gratitude for being allowed to speak in this debate—I hope he will answer them in writing. In addition, I hope he will agree to meet a delegation of hospital campaigners—from my constituency and that of my hon. Friend—in the Department of Health as soon as possible. Most of all, I hope he will listen to the clear voice of the people of west Cumbria. We need the West Cumberland hospital and the services it provides, and we will fight to the finish to secure the hospital services we deserve and the hospital we were promised. Future generations of west Cumbrians deserve nothing less.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I congratulate the hon. Member for Workington (Sir Tony Cunningham) on securing this evening’s debate, and I commend him for his interest in local health matters affecting his constituents, and for his clear advocacy of the needs of local patients.

We all understand that the configuration of local health services is an important issue for many Members—and for many of our constituents—particularly those who represent the more rural parts of the country such as Cumbria. We all agree that patients should receive high-quality care, regardless of where they live.

These are challenging times for the West Cumberland hospital. There have been difficult decisions to face up to, following the Keogh review, and the hospital has been put on special measures, following concerns about some aspects of patient care. I will say a little more later about that and about the importance of patient and public engagement in all decisions affecting the reconfiguration of local health care services.

First, I want to provide hon. Members with some reassurance about the future of local health services. It is important to note that for the first time in more than 50 years significant investment is being made under this Government in health care facilities in west Cumbria. The West Cumberland hospital is being redeveloped at a cost of £95 million, with this Government providing £70 million of that funding. The improved hospital will offer high-quality services and facilities fit for the 21st century, including significant local elective surgical services for the benefit of local patients.

The local doctors in the Cumbria clinical commissioning group are committed to keeping West Cumberland hospital clinically and financially viable, with the majority of Whitehaven patients continuing to access services, including A and E, at that hospital. I would also like to reassure the hon. Gentleman that it is the local doctors and nurses who run the clinical commissioning group—not me or anyone in Whitehall—who will make the decisions about health care in Whitehaven and Cumbria.

Before I move on to the specifics of the issues raised by the hon. Gentleman, it is worth noting the long-running issues at North Cumbria University Hospitals NHS Trust and the progress that has been made towards addressing them. Because of a history of high mortality rates—which means that more people were dying at the trust than should have been the case—the trust was placed into special measures in July 2013 as a result of Sir Bruce Keogh’s review. The trust is now working towards a merger with Northumbria Healthcare NHS Foundation Trust, which will further ensure that it can offer safe, high quality and sustainable patient services.

The trust has continued to work hard to tackle its long-running problems with recruitment of medical staff. It has recently implemented a nurse practitioner work force model to replace trainee doctors, who are currently not being placed at the trust due to long-standing difficulties in ensuring the necessary levels of senior medical training support. A recent positive development is that the trust has increased its consultant medical staff by 17%, as well as introducing a new nursing structure, which is helping to ensure safe nurse staffing levels on every ward.

[Sir Tony Cunningham]

Why does the Minister think there is such a shortage of doctors?

[Dr Poulter]

This has been a long-standing shortage; the trust has not been an attractive place for junior doctors to work for many years—probably for the past decade. However, the trust is now looking at ways in which it can better incentivise doctors to work there. That is an important step forward. If we want junior doctors to return to the trust—given that they have been removed from it because they were not getting the high-quality training they needed in order to become consultants—we must ensure that we incentivise the recruitment of more senior doctors to the trust. The hospital is now looking much more seriously at that than it has done in the past.

As I just outlined, recent measures have resulted in the consultant medical staff being increased by 17%, which is a positive step forward. Measures are also being put in place to ensure that nurse practitioners will be better used, where appropriate, to treat patients. The trust can be proud and pleased with the progress that it is making in that respect. An important aspect of looking after patients is to ensure that there is a full rota of junior doctors on site, and I am sure that if the progress in increasing the amount of consultant cover is maintained, that will become available again in the future.

On performance, the trust has put in place a recovery plan to meet waiting time targets from the end of 2014. It is currently working to reduce its backlog of patients who have been waiting for more than 18 weeks from referral to treatment, and it has received additional funding to support that. As hon. Members have pointed out, however, the trust has been financially challenged for some time. Last year, it reported a deficit of £27.1 million. The Department of Health provided significant financial support to the trust in 2013-14, as it has in previous years. The trust received £11.5 million from the Department, alongside support from the trust development authority and the clinical commissioning group, and £6.3 million in private finance initiative funding support. As we have discussed, however, that position is not sustainable in the long term. That is why further discussions about foundation trust status are being held.

Other critical challenges remain. Most significantly, some services at West Cumberland hospital remain fragile due to difficulties recruiting specialists and consultants and to the current heavy reliance on locums. However, I hope that that issue will be addressed in the near future if the trust can continue to recruit more consultants.

The Care Quality Commission inspection report published in July 2014 rated the safety of acute medical and outpatients services at the West Cumberland hospital “inadequate”. That reflects the difficulties that the hospital has faced for many years, and continues to face, in recruiting adequate staff to run some of its services safely and effectively. However, the trust has made significant progress in addressing the many challenges it faces. The CQC inspection acknowledged that, giving it an overall rating of “good” for providing a caring service to patients.

Another CQC inspection is expected to take place in early 2015, and I understand that the trust is working hard to make improvements ahead of that. For example, the outpatients service has greatly improved the availability of patient notes, an issue highlighted at the previous inspection. As I understand it, patients’ notes were not available when they came for an appointment. That is not helpful in providing an understanding of their previous history, which disadvantages the staff who are looking after the patient and trying to provide the best possible care. The trust has taken that issue on board and I understand that it is making good progress to address it.

The trust has made significant progress in other respects, most notably, and perhaps most importantly, in reducing high mortality rates. That means that patients in Cumbria who would have died had these changes not been introduced are alive today. Having been one of the highest in the country, the trust’s mortality rates are now within national confidence limits, and the trust and its staff must be commended for that turnaround. Further progress has also been made in, for instance, the meeting of the four-hour A and E standard, the implementation of a new patient experience programme, and a reduction in clostridium difficile infection rates. However, changes must continue to be made to secure a sustainable future, and to enable the trust to keep building on the good progress that it has made so far. It is important for the local NHS to be supported in that work to secure safe, high-quality patient care.