The Minister of State, Department of Health (Mr Philip Dunne)
I congratulate the hon. Member for South Shields (Mrs Lewell-Buck) on securing this debate about the future of South Tyneside Hospital. I pay tribute to the emotion she showed in standing up for her constituents, but I have to say that I was disappointed by the tone she adopted, particularly at the start of her remarks. Frankly, her allegation of conspiracy—trying to paint the issue as some kind of dastardly plot to privatise the health service, for which there is not a shred of evidence—is scaremongering that will undoubtedly alarm residents in her area. That rather undermined the force of her quite proper concern for her constituents, so I am sorry that she chose to characterise her position in that way.
I welcome, however, the hon. Lady’s support for the staff at her hospital and join her in congratulating them on their work. Despite significant pressures, South Tyneside NHS Foundation Trust is performing very well for the vast majority of patients under its care. She pointed out the performance in A&E. The trust is one of the few in the country to be performing at and above the four-hour waiting target, but that is not the only area in which it is performing well. It is also one of the few trusts across the country to be meeting all of the eight cancer targets, as well as the referral to treatment waiting time targets—again, that is unusual at present—and all the diagnostic targets. It is therefore one of the best-performing trusts in the country, and I think the hon. Lady and I will be on the same page on that.
The trust and its neighbour, the City Hospitals Sunderland NHS Foundation Trust, recently formed an alliance known as South Tyneside and Sunderland Healthcare Group. That is why the group is looking at a reconfiguration of services across the two trusts to remove unnecessary duplication and improve the sustainability of services to ensure that the local population’s healthcare needs are well looked after across the range of activities.
Ultimately, as the hon. Lady knows, any service changes at South Tyneside Hospital will be a matter for local health authorities. All proposed service changes should be based on clear evidence that they will deliver better outcomes for patients. The changes should also meet the four tests for service change: they have support from GP commissioners; they are based on clinical evidence; they demonstrate public and patient engagement; and they consider patient choice. In addition, NHS England introduced this year a test on the future use of beds that requires commissioners to assure it that any proposed reduction will be sustainable over the longer term and that key risks such as staff levels are addressed.
Mrs Lewell-Buck
The Minister says that both hospitals are working together to create safe healthcare for both populations. However, how does shutting down a maternity unit and a special care baby unit with hardly any notice at all help to create that environment? Surely they are failing the task they have been handed.
Mr Dunne
I am coming on to explain precisely why there was an emergency shutdown of that facility because the hon. Lady’s characterisation does not quite represent what happened. I will go into that in some detail to try to reassure her and her constituents about the reasons behind this sudden—and, we hope, temporary—closure.
On 30 November, as the hon. Lady pointed out, the delivery of high-risk births at South Tyneside District Hospital was suspended due to staffing pressures. A number of urgent safety protocols were put in place to accommodate a very small number of low-risk deliveries over the weekend of 2 and 3 December. Since 4 December, all maternity services have been temporarily suspended at South Tyneside Hospital on patient safety grounds. The trust did not take this decision on its own initiative. It sought advice from the Northern Neonatal Network and the heads of midwifery services for the north-east of England. Their unanimous clinical view, based on all the evidence available at that time, was that births should be temporarily suspended in the interests of the safety of mothers and babies.
The trust has about 70 hospital-based staff who are directly affected, who have all been asked to report for duty as normal. The staff are working with the trust to contact the 165 women currently affected to ensure that safe alternative arrangements are made. The trust has been in close contact with neighbouring units and has had overwhelming support from NHS partners across the system. Women have been choosing to deliver in Sunderland, Gateshead and Newcastle, with a number of women opting for a home birth.
The trust is working closely to make sure there is an individual plan for each patient and that there is clear communication between the healthcare professionals involved with their care. The trust aims to reopen the special care baby unit for low-risk births when a safe staffing level has been established.
I now want to dwell on the specific staffing challenges that have precipitated this action. South Tyneside NHS Foundation Trust has been contending with the challenge of safely staffing the special care baby unit over many years, so this situation has not just crept up on it. When the Care Quality Commission visited in May 2015 and rated the trust overall as requiring improvement, inspectors raised serious concerns about its special care baby unit staffing arrangements. Since 2015, the trust management has made relentless efforts to mitigate these staffing issues. Regular recruitment has taken place for permanent vacancies in the special care baby unit and paediatric emergency care over the past two years, with the latest round taking place only this month.
Contrary to the hon. Lady’s allegations of a long-standing conspiracy to compel the unit to close, I want to give her the facts about that unit as I understand them. In recent months, chronic staff sickness has reduced the six full-time equivalent specialist neonatal nurse workforce in the special care baby unit to just four full-time equivalent staff. That has resulted in an unsustainable situation, with the remaining nurses working many extra hours each week to ensure safe staffing on the unit. One of the four remaining nurses then became ill, exacerbated by work pressures, and that led to unsustainable staffing levels to keep the unit open. It has not been possible for the trust, however hard it has tried over the past two and a half years, to fill the rota. It has not been possible most recently to use bank and agency staff to do so, given the very specialised skills required by neonatal nurses in the special care baby unit. This decision, although difficult, was driven by very clear clinical advice that put the safety of mothers and babies first and foremost, and also took account of the health and wellbeing of hospital staff, to whom the trust also owes a duty of care.
The hon. Lady referred to the consultation that has taken place in recent months over the path to excellence.
Mrs Lewell-Buck
I thank the Minister for giving way again, but I am really disappointed. I can see that he has the official lines from the trust and the CCG, but did he not listen to what I said? Regional groups made this decision, not local groups. The unit is now at the full staff complement at which it has been historically. In short, there is no staffing problem there right now. Midwives are sitting doing admin work when they could be delivering babies.
Mr Dunne
I was referring to the special care baby unit. My understanding is that the staffing levels at the neonatal unit are as I have just described to the hon. Lady. If she has other information, I will happily go back to the trust tomorrow to ask whether it has managed to fill those slots. There is no intention of keeping the maternity unit for normal births suspended for any longer than is necessary.
I will touch on an area that the hon. Lady did not mention specifically, because a similar situation occurred in relation to stroke services in the region. I want to put that into context to help her to understand why the decision was taken.
Since December 2016, any patient requiring acute care for a stroke has been taken to Sunderland. This decision was taken to ensure patient safety because South Tyneside also had a significant staffing challenge in its stroke unit. In fact, it had only one part-time physician, who was single-handedly assessing and treating incoming stroke patients. The stroke unit faced significant pressures in maintaining a sufficiently staffed nursing rota to support that clinician to maintain the patient safety required for stroke patients.
The benefits of centralising high acuity stroke care have been shown in Manchester, London and other parts of the country where reduced mortality and a more efficient use of resources have resulted in better care for patients. Most other parts of the country have either implemented similar changes or have plans to do so. Centralising stroke care into a smaller number of larger units provides the opportunity to ensure that there are specialist nurses and doctors available to manage patients at all times, and to provide access to imaging and other investigatory facilities immediately as they are required. I will illustrate what that means to patients, who are at the heart of these changes.
Across the NHS in England, 84% of stroke patients now spend the majority of their hospital stay in a specialist stoke unit, compared with 60% in 2010. This has led to excellent progress in the treatment of stroke over recent years. More than 93% of stroke patients across England now receive a brain scan within 12 hours of their arrival at hospital, with more than 50% screened within one hour. That is a huge improvement since 2010, when 70% of patients waited up to 24 hours for a scan. The concentration of stroke services and specialist units has helped to save lives.
The workforce challenges experienced by South Tyneside Hospital are being proactively addressed in the long term through the path to excellence programme that the hon. Lady mentioned. This is a five-year transformation programme for healthcare services in South Tyneside and Sunderland, and a localised response to the Northumberland, Tyne and Wear and North Durham STP of which she was so critical. The public consultation for the path to excellence programme ran from 5 July to 15 October. The areas of service under consultation were maternity and women’s healthcare services, including the special care baby unit; stroke care services; and children and young people’s urgent and emergency services. Before the CCGs make their decision, they will consider all the feedback gathered during the consultation from all stakeholders, including the hon. Lady and other hon. Members. The CCGs are also holding a number of public engagement sessions between now and February, in which I strongly encourage her to participate. An extraordinary meeting of the CCG’s governing bodies will be held in February 2018, in public, for the two CCGs to make their final decisions.
The hon. Lady mentioned the Save South Tyneside Hospital group. I am aware that the group is active in campaigning against any reconfiguration of healthcare services between the two hospitals. I hope that I have helped to clarify to her that no decisions will be made on reconfiguration until the responses to the path to excellence consultation have been thoroughly analysed.
Mrs Lewell-Buck
The Minister’s analysis of the Save South Tyneside Hospital campaign is incorrect. We want safe, decent healthcare for people in South Tyneside. We are campaigning for equitable, safe healthcare.
Mr Dunne
I am sure that that is the objective. It is also the objective of the trust to ensure that sustainable, high-quality services are available to the populations of the areas served by both hospitals.
The South Tyneside NHS Foundation Trust now faces a challenging task in ensuring that the two hospital trusts, through the path to excellence process, remove any unnecessary duplication and improve sustainability. It is important that the trusts work well together, with the local community and with their commissioning groups, to ensure that any plans that they have are communicated clearly to local populations. [Interruption.] The hon. Lady says that that is not happening. It is incumbent on the trusts to engage properly with their local communities. I am sure that they will be watching this debate and taking note of the comments that she and I are making. There should be full public engagement, and as I have identified, that will continue right up until the decision of the CCGs in February.
I conclude by simply saying that it is incumbent on all of us who represent our local communities to get engaged —the hon. Lady is doing this with her campaign group—with the people who are responsible for making decisions. That is the local NHS in her area. [Interruption.] She indicates that she is engaged with her local NHS. I am pleased to hear that, and I ask her to encourage all other MPs to get engaged in a constructive way, to find the best solution for their local residents that will put patient safety at the top of the list.
Question put and agreed to.