Stafford Hospital

Tuesday 20th December 2011 Westminster Hall

16:22

[Jeremy Lefroy (Stafford) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. It is also a pleasure to see the Minister in her place. I am expecting my colleagues from Staffordshire to come into the Chamber during this debate and to intervene if they so wish.

On 1 December this year, Stafford hospital started a temporary night-time closure of the accident and emergency department from 10 pm to 8 am. That happened principally as a result of a shortage of A and E specialists and the need to maintain a safe service. The hospital has been unable to recruit such specialists, partly as a result of a national shortage and partly owing to problems that Stafford has experienced. I wish to set out why it is important for the hospital’s A and E department to return to full-time working and to draw out some more general conclusions.

The hospital is part of the Mid Staffordshire NHS Foundation Trust, which also runs the non-acute Cannock hospital. Stafford serves a population of some 250,000 to 300,000 people in the middle and south-west of the county. As my intention is to highlight the importance of A and E, I will dwell only briefly on the Francis public inquiry, which is completing its work and will report next year. The inquiry is considering the lessons that can be learned from what happened. Certainly, lessons learned from the initial Francis investigation into the hospital have largely been put into practice. There continue to be major improvements, though clearly there is no complacency. It has been very encouraging to hear from constituents about the quality of care that they receive and their praise for staff.

I have heard some say that the Francis inquiry is not necessary, but I disagree profoundly. Let me simply report the words of a senior member of the Royal College of Physicians who said that that is the most important inquiry into the NHS in a generation. I am most grateful to the Government for their support for the hospital and the trust through a particularly difficult time for Stafford and the whole surrounding area. I ask for that support to continue, as the trust develops its plans to provide high-quality and financially sustainable services.

The importance that people in Stafford, Cannock, Rugeley and beyond place on the A and E department is shown by the more than 18,000 people who have signed petitions that support it. Stafford borough council has also shown strong support by passing a unanimous resolution at full council. Since the temporary night-time closure, a number of people have told me how concerned people, particularly the elderly, are that they no longer have a night-time emergency service relatively close to hand. We need to remember that, across the country, A and E departments not only treat people in medical need and save lives, but provide reassurance, whether to parents with a child who becomes sick in the middle of the night, or elderly people who have no transport of their own and are worried about imposing themselves by calling out an ambulance and overburdening the service. For them, an emergency service that is as local as possible is essential.

Let me make it clear that the closure was necessary. The decision was not taken lightly, but was made in the interests of patient safety. The temporary night-time closure is giving the hospital time to recruit the necessary staff and to improve training, which is difficult when one is overstretched.

I should like to thank the Minister and the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), as well as the Secretary of State for Health and the Department of Health for their help and support. I also thank the Ministers and staff of the Ministry of Defence for providing armed forces medical staff to assist for some 12 weeks. They have been invaluable both in providing additional cover and in helping with training.

I should like to thank the leadership and staff of the University hospital of North Staffordshire, New Cross hospital in Wolverhampton, Manor hospital in Walsall and Burton hospitals for taking the strain of additional patients during the temporary night-time closure. I also thank the staff of the West Midlands ambulance service for providing the necessary additional cover.

I should now like to turn to the reasons why Stafford requires a 24-hour A and E department. First, the population of the area is growing. Stafford itself is a growth point and expects to see another 15,000 to 20,000 people settle in the area in the coming 20 years, with 2,000 to 3,000 from the armed forces returning from Germany to MOD Stafford between 2015 and 2018. Cannock and Rugeley are also growing.

[Mr Aidan Burley (Cannock Chase) (Con)]

I congratulate my hon. Friend on securing this debate. He mentions Cannock, which is my constituency. Does he agree that the answer to all the problems that we have seen in Stafford is not to close Cannock but to impose a two-site solution, with services both at Stafford and at Cannock and an improved and more vibrant Cannock hospital? That is the only way forward and a solution on which we both agree as neighbouring constituency MPs.

[Jeremy Lefroy]

I entirely agree with my hon. Friend. It is essential that we have services both in Cannock and Stafford. Both hospitals are vital to their local communities, although they perform different services.

Secondly, we have an increasing elderly population who rely on local accident and emergency services. Increasing life expectancy is welcome, but when the elderly become ill, they tend to be more acutely ill. The combination of population growth and more elderly people will inevitably lead to more demand for emergency and acute services. Successive Governments have tried, with varying degrees of success, to persuade people who are not seriously ill to use alternatives to A and E. That is important—I welcome the Government’s moves in that direction—but it will only relieve a small part of the pressure on these departments.

Thirdly, Stafford’s accident and emergency department is extremely busy. The admissions for the past 12 months, up to November 2011, numbered 52,255. That is some two thirds of the number of admissions to Manor hospital in Walsall and slightly more than half of the admissions to the University hospital of North Staffordshire and New Cross hospital in Wolverhampton.

[Gavin Williamson (South Staffordshire) (Con)]

I congratulate my hon. Friend on securing this debate. He touches on an important point, especially at this time of peak demand for hospitals. New Cross hospital and hospitals in Walsall and Stoke-on-Trent are under a lot of pressure. It is vital that we ensure that this closure is only temporary and that we resume full-time, 24-hour accident and emergency services.

[Jeremy Lefroy]

I am most grateful to my hon. Friend for making that point. I reiterate my thanks to those hospitals for taking on the extra patients in the night-time hours during this difficult time in the winter. Stafford accounts for 14% of the entire number of A and E admissions for the whole region, which includes Staffordshire, Wolverhampton and Walsall.

Fourthly, with Stafford being shut at night, most patients have to travel considerably further for emergency care. The University hospital of North Staffordshire in Stoke is 19 miles away, New Cross in Wolverhampton is 18 miles away, Manor hospital in Walsall is 19 miles away and the hospital in Burton is 27 miles away. The absence of Stafford, even for 10 hours at night, leaves a very large hole in accident and emergency provision for the region. It is a matter not only of distance, but of the amount of traffic on the roads. Night-time travel is usually reasonable in the area, but congestion can be substantial during the day, particularly when the M6 is closed between junctions 12 and 14 and all motorway traffic is diverted through the middle of Stafford.

It has only been possible to cope with the temporary night-time closure with the use of several additional ambulances and increasing staff cover. Such facilities are expensive. Indeed, they are more expensive than keeping the A and E department open 24/7, which emphasises the fact that the decision was taken for reasons not of cost but of patient safety.

It is essential that Stafford hospital has a full-time accident and emergency service, but not every emergency can be treated there. Given the advances in medical science and treatment, it makes sense for some of the most serious emergencies to be treated by top specialists who will only be in the largest hospitals. Patients with major trauma, severe strokes or major heart attacks already go to regional centres such as UHNS. That is understood and generally accepted. However, a district general hospital should be able to respond safely to a number of emergency conditions and provide a minimum set of services, such as acute medical, including rheumatology and geriatric; acute surgical and orthopaedic; paediatric; maternity; and mental health, particularly for overdoses. In some cases, hospitals may have to stabilise a patient before they can be transferred to a specialist centre.

Retaining a core set of emergency services in district general hospitals is important to protect their viability. As John Donne said:

“No man is an island.”

That can equally be said of many acute services. It is not possible to retain acute medicine, which provides the lion’s share of the income of an acute hospital, without having access to surgical opinion on the spot. Any emergency service also needs the full-time support of critical care units and radiology, to name but two. That is not to say that there can be no change—there must be changes to make district general hospitals financially sustainable in a difficult climate—but we must not put so much pressure on them that their only option is to close their doors to emergencies from the communities that they serve, forcing people to travel considerable distances for all but minor injuries.

Changes must be thought through and discussed openly with those communities. There should be no sudden changes and nothing hidden in the small print. The NHS is paid for by the British people and is a service that gives us great reassurance, even if we are fortunate enough rarely to need it.

I have set out clearly why Stafford hospital needs a full-time accident and emergency service. I am making the argument from the point of view not of the hospital itself, the bricks and mortar, but of the patients—my constituents and those of my hon. Friends the Members for Cannock Chase (Mr Burley), for Stone (Mr Cash) and for South Staffordshire (Gavin Williamson), many of whom rely on its services.

Stafford hospital provides a first-class service to many people in our area. The management, the staff, my parliamentary colleagues and I are not complacent; we recognise that there is more to be done. None of us will be satisfied until our hospital is known nationally, as I believe it will be, for its high-quality treatment and care and it has the confidence of all those whom it serves.

16:36

[Mr William Cash (Stone) (Con)]

I will be fairly brief. I congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) on securing this debate. Since becoming the Member of Parliament for Stafford, he has transformed the attitudes and policy towards Stafford hospital. I pay tribute to the work that he does on behalf of the hospital and all his constituents. The issue has a direct bearing on my constituency, as well as those of my hon. Friends the Members for Cannock Chase (Mr Burley) and for South Staffordshire (Gavin Williamson). Indeed, it also has a bearing on other parts of Staffordshire where the hospital is used by constituents from neighbouring areas.

I endorse everything that my hon. Friend the Member for Stafford has said, but I should like to add another factor, which is highly relevant to a constituency such as mine. The Stafford part of my constituency has some deeply rural areas, such as High Offley, that are very much more remote than the streets of Stafford and other towns with good arterial connections to the M6. I have heard figures quoted about how quickly people can get to UHNS and other hospitals. I simply make the point that somebody might have a stroke, or a farmer might be caught in some dreadful tragedy in a dark field in a remote area.

My hon. Friend is completely right when he says that we need a full accident and emergency service. At the moment, we are going through a hiatus, but let it not remain long because we need a proper full service, especially for those deeply rural areas, as well as for the more built-up areas in the urban parts of Stafford and the adjacent areas.

[Mr Philip Hollobone (in the Chair)]

Order. This debate is clearly important for Stafford and the surrounding area. I call the Minister to respond.

16:39

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

Thank you very much, Mr Hollobone, for calling me to respond to the debate. It is a pleasure to serve under your chairmanship today; I do not think that I have done so before.

I congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) on securing this debate and of course I join him in paying tribute to the staff of Stafford hospital, the staff of the local ambulance service and indeed the staff of the neighbouring hospitals for all that they are doing to provide local people with good accident and emergency services. I particularly pay tribute to them at this time of year. When many people will be enjoying their Christmas lunch, there will be many NHS staff working over the Christmas period and it is always important to acknowledge their contribution and the work that they do.

My hon. Friend raised a number of issues about the overnight closure of the A and E department at Stafford hospital, which is a measure that will naturally be a cause for concern for his constituents. I know that all of them have been through quite a tough time, but I also know that he will agree—in fact, he did agree—that the safety of patients must always come first. However safety can be protected, that is always the best course of action, so I must support clinicians at Stafford hospital in their request for the overnight closure, which they made so that standards of care in the A and E department can be kept high.

My hon. Friend mentioned A and E staff, but it is also important to note that this issue is not always about numbers. A certain number of staff are needed in an A and E department, but that department also needs expertise; it not only needs staff in the right quantity but staff with the right skills and competencies.

I also want to remind hon. Members who are in Westminster Hall today—it is a pleasure to see so many of them here—that for some time now the NHS at Stafford hospital has been routinely diverting all of the most critical patients, including those suffering from major trauma, heart attacks and strokes, to the larger hospitals to the north and south of Stafford. That is not because of the suspension of overnight A and E at Stafford but because the larger hospitals in the area are better able to cope with life-threatening emergencies. My hon. Friend pointed that out, but it is worth repeating it for the record.

The change at Stafford A and E is down to staffing levels; I understand that financial pressures do not come into it. Mid Staffordshire NHS Foundation Trust has the funding for the posts that it needs to fill, but it has found it difficult to find the staff to fill them. My hon. Friend mentioned the importance of reassuring the local community. The available health services need to reassure people; that is one of their important roles. They must also engender trust among those people who they are there to serve. That is a very important role that the NHS must play.

Since the summer of 2010, permanent staffing—both medical and nursing—at Stafford A and E has been low. The trust and the wider NHS in the midlands have been trying to get enough medical cover to keep standards at the right levels. It is also important to acknowledge the support from the neighbouring University Hospital of North Staffordshire. Without it, the situation would have been considerably worse. However, that regional support could never be kept going indefinitely. To buy some time to work out longer-term solutions, Sir Bruce Keogh, the NHS medical director, arranged the short-term loan of four members of staff—two doctors and two nurses—from Defence Medical Services to help at the trust. My hon. Friend paid tribute to those staff and it is always good to see organisations working together to deliver the best possible solutions for patients. As my hon. Friend pointed out, that arrangement started on 17 October and it is now coming to an end; again, it could not be kept going for an indefinite period of time. However, let us place on record our thanks to the members of staff involved and to the DMS for providing them. I know that everyone at the trust welcomed the expertise that the DMS staff brought with them.

In October, the Care Quality Commission issued a warning notice regarding the quality of care provided by the Stafford A and E department. The CQC’s concerns centred on nursing staff levels, which at the time of inspection were badly depleted because of staff sickness and the overall difficulty of filling vacancies. On 9 November, the trust decided to close its A and E department overnight, starting from 1 December. That decision was not made lightly. As my hon. Friend pointed out, people want A and E facilities close to where they live, so, as I say, such decisions are never made lightly, and they need to be taken locally; it is not appropriate for the Department of Health to interfere with them. It goes without saying that the trust is paying the closest possible attention to the situation at Stafford A and E. It believes that that situation cannot be improved quickly, however frustrating that is for hon. Members.

[Mr Cash]

Does the Minister agree that there is also a question that may be a national issue, of which Stafford may or may not be an example? That is the need to ensure that consultants are always available, as and when necessary, because I think that that issue is all part of the hierarchy of the problem.

[Anne Milton]

Yes, and I thank my hon. Friend for raising that important issue, which is one of delegation and cover. It is of concern to the Department of Health; I think that there have been a number of newspaper articles and some television programmes about it. It is important at all times that care is delivered safely. That sometimes requires cover, but it also requires appropriate levels of delegation. However, what must be uppermost in everybody’s mind is that patients’ safety is always preserved, and the Department of Health will obviously work with the NHS to ensure that nationally we have schemes to ensure that patients’ safety is maintained.

For that reason, it would be unwise to return to 24-hour opening at Stafford A and E department before it is safe to do so. To minimise risk, I understand that the trust has set criteria that must be met before overnight operating can resume, and I also understand that there are regular staff meetings to check progress against those criteria. Those meetings are an important means of reassuring staff and those criteria will become critical. They mean that staff will be aware of the current situation and fully up to speed with the progress that is being made.

At present, I understand that patients needing A and E treatment are being diverted by ambulance to A and E departments in Wolverhampton, Walsall, Burton and Stoke, every one of which has been fully involved in planning for the overnight closure at Stafford. West Midlands Ambulance Service has established a divert policy to deal properly with patients coming to the trust, and to alternative A and E departments, at night. To help to manage those arrangements, the trust has appointed a “repatriation co-ordinator” to ensure close co-operation between Mid-Staffordshire NHS Foundation Trust hospitals and the other hospitals affected. The thing that struck me as quite extraordinary is the amazing job titles that the NHS can come up with at times. However, that “repatriation co-ordinator” will be important, to ensure close co-operation between hospitals.

To date, very few patients have turned up at Stafford A and E at night, which is a testament to how well the trust has publicised the current arrangements. That is another important point; explaining the reason for the closure, and how and where to get help when Stafford A and E is closed, is vital. My hon. Friend the Member for Stafford mentioned older people in his speech. As I say, the fact that few people are turning up at Stafford A and E at night means that the message that the department is closed overnight has got through, even to older people, who of course often attend A and E departments.

[Mr Cash]

On a purely practical level, diversion signs are important. My hon. Friend is referring to the importance of getting the message through, but however much we try to get the message through, I suspect that people will still turn up anyway. Therefore, the most important thing at that point is to know that the signing system—as provided by the highways authorities, or whoever—will actually provide the right information to help people to get to the other hospitals. Does my hon. Friend agree?

[Anne Milton]

I agree entirely, and I am sure that my hon. Friends the Members for Stone (Mr Cash) and for Stafford are in touch with the local authorities, because it is extremely important, as my hon. Friend the Member for Stone rightly pointed out, that diversion signs are clear to people and that people do not turn up at an A and E department that is closed. It is actually quite extraordinary how resilient people are to those diversion signs. Information needs to be given to people in words of one syllable, so that they are quite clear that the A and E department is not open for business at the moment.

Stafford is taking, and it will continue to take, GP-referred maternity, paediatric and medical patients 24 hours a day, seven days a week, which will be of some reassurance to local people. I know that my hon. Friend the Member for Stafford has visited Stafford A and E department several times since the overnight closure came into effect, and I am pleased to hear that he is satisfied that the measures that have been put in place will ensure patient safety and good access to A and E services. I know that some of his constituents are concerned about the impact of increased demand on neighbouring A and E departments. The situation is being closely monitored and the local NHS is content that the arrangements are working well.

Of course at this time of year, the pressure on A and E departments gets greater. We have not suffered particularly severe weather in the south of the country, but some places have done so. Such weather always takes its toll on the NHS, and therefore the monitoring of how things go is very important.

As I have said, the closure took place on the advice of clinicians with the aim of ensuring patient safety. The trust continues in its efforts to recruit additional staff, and patients can be assured that it will not reopen its A and E department full time before it is safe to do so. The trust, the Staffordshire PCT cluster, emerging clinical commissioning groups and others are looking at a range of options to achieve a clinically safe and financially sustainable service, and will present their report on the way forward to the NHS Midlands and East strategic health authority cluster at the end of January next year.

I will say a word about emergency medicine nationally. The number of emergency medicine consultants has risen by more than half in the past five years, but we agree that it must continue to increase and we are working with the College of Emergency Medicine on how best to make that happen. In the short term, some trusts have been employing more GPs in A and E. GPs are primary care experts, so their presence in A and E allows emergency specialists to concentrate on the cases for which their skills are needed. We are, however, looking at a number of areas, because this matter is of national concern. We are considering revising the person specification for training in emergency medicine to make entry more accessible, and redirecting into emergency medicine some of the doctors who cannot secure other higher specialty training posts.

My hon. Friend the Member for Stafford pointed out the importance of specialist services, and what I have said about the national situation highlights exactly why they are so important. As my hon. Friend the Member for Stone mentioned, the particular needs of people in rural communities, for whom travelling long distances causes additional problems, must also be taken into account. It has long been the case that specialist services need to be provided in specialist centres, and during my own working life as a nurse we had regional neurosurgical centres for the specialties that required highly skilled and specific care. That is important, because we are always balancing patient safety with the accessibility of local services.

[Jonathan Lord (Woking) (Con)]

I join colleagues in commending the thoughtful leadership role that my hon. Friend the Member for Stafford (Jeremy Lefroy) has taken. May I ask the Minister two things? Can we be reassured that the awful lessons of Stafford have been learned nationally? If I may crave the indulgence of my Staffordshire colleagues, I have happy memories of fighting with the Minister during the previous Parliament, when I was chairman of her association, to save the A and E at the Royal Surrey, so perhaps she would care to extend her warm words to all the medical staff who will be working there over Christmas and the new year holiday, just as she did to those at the Stafford hospital and elsewhere in Staffordshire.

[Anne Milton]

I thank my hon. Friend for his imaginative use of this debate to point out that I joined with him to fight a long, hard battle to save our hospital in the Guildford constituency. It is important, of course, to extend our thanks and tributes to staff working not only in our own constituencies, but across the country. On the first question, there is no doubt that lessons need to be learned, and I think that we sometimes feel that the NHS is slow to learn the lessons it should.

Work is being carried out nationally to address the skills mix, by developing non-medical roles within A and E departments. Enhanced nursing roles have genuine potential, and in countries with very remote populations, such as Canada and the USA, they are an extremely important part of the general skills mix. Emergency nurse practitioners who can look at the minor injuries and illnesses that in most departments account for 40% of the work load can be a major contribution to ensuring that A and E services remain available for local people, and advanced clinical practitioners, such as nurses and paramedics, can therefore treat many more of the major conditions.

I thank my hon. Friend the Member for Stafford for securing this debate, and other hon. Members for attending on the last day before recess. A number of Staffordshire MPs have met with the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), and I know that he will continue to keep in close touch, but should any new concerns arise I am sure that my hon. Friend the Member for Stafford will raise them with him. That leaves to me just to wish you, Mr Hollobone, and all the House of Commons staff a very happy Christmas and a prosperous and safe new year.

[Mr Philip Hollobone (in the Chair)]

I thank all Members for taking part in this debate and I, too, wish everyone a very merry Christmas.

Question put and agreed to.

16:50

Sitting adjourned.