Queen Elizabeth Hospital, King’s Lynn

Wednesday 23rd March 2022 Westminster Hall

16:00

[Stewart Hosie (in the Chair)]

I will call James Wild to move the motion and then call the Minister to respond. The Member in charge will not have the opportunity to wind up, as is the convention in 30-minute debates.

[James Wild (North West Norfolk) (Con)]

I beg to move,

That this House has considered quality of care and the estate at the Queen Elizabeth Hospital, King’s Lynn.

It is a pleasure to serve under your chairmanship, Mr Hosie. I am grateful to Mr Speaker for granting this important debate, which gives me the opportunity to highlight the significant improvements at Queen Elizabeth Hospital, while once again making the compelling case for it to be one of the new hospital schemes that the Government have committed to building. I also want to recognise the close interest that my hon. Friend the Minister has taken in QEH and to thank him for the many meetings and discussions we have had about it so far. Of course, I also encourage him to back the bid.

QEH serves 330,000 people across Norfolk, Lincolnshire and Cambridgeshire, providing a comprehensive range of specialist, acute and community-based services. It is a busy hospital, with 55,000 in-patient admissions, a quarter of a million out-patient appointments and 70,000 emergency department admissions last year. However, QEH has suffered from poor Care Quality Commission ratings and an historic lack of investment, and has therefore been in special measures for some time. However, under the leadership of Caroline Shaw, the chief executive, and the chairman, Steve Barnett—who is moving on shortly, having done a lot of good work—things have changed.

In the last three years, there have been significant improvements in care. However, you do not have to take my word for it, Mr Hosie; that was the verdict of the CQC’s report a month ago. The core services it inspected—medicine, urgent and emergency care, and critical care—were all rated good overall. Indeed, critical care was recognised as having outstanding elements in many areas. That means that QEH is now rated good in three domains: caring, well led and effective. The CQC found that

“Staff provided good care and treatment…treated patients with compassion and kindness, respected their privacy and dignity, took account of…individual needs…and made it easy for people to give feedback.”

The report shows how far QEH has come. As a result, the Care Quality Commission’s chief inspector of hospitals has recommended that QEH come out of special measures, which is very welcome for the area.

It is frankly remarkable that all this has been achieved during a period when covid posed such huge challenges to QEH and other hospitals, and to other parts of the health and social care sector. This has not happened by luck; it is due to the leadership, hard work and commitment of all the staff at QEH. I have seen that dedication at first hand when I have met doctors, nurses, the infection control teams, the porters and all the others who make up the hospital during my regular visits. I commend them for all that they have achieved in the report. As the CQC said, staff were

“passionate about…providing the best possible care for patients”,

and leaders understood

“the priorities and issues the trust faced”

and were

“visible and approachable…for patients and staff.”

Clearly further improvements are required, as the hospital recognises, but it is important that we acknowledge the huge step forward that has been taken, as reflected in the report.

Those improvements have been made despite the decaying and ageing buildings that staff and patients have to experience and operate in. As my hon. Friend the Minister knows, QEH is one of the best-buy hospitals and has major issues with reinforced autoclaved aerated concrete planks—which I think we should refer to as RAAC planks for the rest of the debate—which are structurally deficient. The hospital was built with a 30-year design life, but it is now in its 42nd year. Some 79% of hospital estate buildings have RAAC planks, and I am sorry to say that it is the most propped hospital in the country, with 470 steel and timber supports across 56 parts of the hospital.

Being in a ward or another part of the hospital, surrounded by props holding up the roof, is a poor experience for patients. It makes it harder for staff to care for them. It is not something that we should accept, and we do not. This is a serious situation, and the trust’s risk register has a red rating for direct risk to life and the safety of patients, visitors and staff, due to the potentially catastrophic risk of failure of the roof structure. Last year, the critical care unit had to close for some weeks due to precisely those safety issues. The urgent need for a new hospital, and the strength of that case, is underlined by the fact that over a third of all reported RAAC issues in the east of England were at QEH in the last year.

I know that my hon. Friend recognises the seriousness of the situation, and the £20.6 million of emergency capital funding that he approved last year is very welcome. That is making a difference: a new endoscopy unit is taking shape to modernise facilities, and to create space to enable installation of fail-safe roof supports. In addition, there is £3 million of funding for a west Norfolk eye centre, which along with other projects, including digital, means that QEH is currently delivering a more than £30 million capital programme.

[Duncan Baker (North Norfolk) (Con)]

I thank my hon. Friend for giving way and for securing this incredibly important debate. It is a very poor situation to have a hospital in Norfolk in this position, when it clearly needs a rebuild. I thank my hon. Friend for everything he has done; we would not be in this position without his tireless work to raise this matter with the Secretary of State. May I raise one point? We have three hospitals in Norfolk. We want a new hospital at QEH. That will benefit not just his constituents, but those all over Norfolk, particularly in my constituency of North Norfolk, who will also use its fantastic services when it is rebuilt.

[James Wild]

I am grateful to my hon. Friend for his support and words. He is absolutely right; I think his constituency has the oldest average age in the country, and that poses particular needs. My constituency and that of my hon. Friend the Member for Broadland (Jerome Mayhew), who has joined to support the debate, also have challenges, so we need to ensure that the care is in place. There is also a lot of planned housing growth in the area. The demand is strong across our constituencies, and in Lincolnshire and Cambridgeshire, which is why it is important to show the strength of support for the hospital across Norfolk and beyond.

When compared with the turnover, the level of capital programme is significant, and it is important to acknowledge that the programme is being managed well. QEH has submitted a further bid for £18 million for an orthopaedic centre, as part of the funding to tackle the backlog. Given that it is the area with one of the longest waiting lists for QEH, I strongly endorse that bid, and encourage the Minister to approve it when it comes to his desk. Seeing is believing. When the Secretary of State visits QEH—which he has agreed to and I hope will happen soon—he will see those improvements, but he will also see the props and the very real need for investment. My hon. Friend the Member for North Norfolk (Duncan Baker) will be able to join him on that occasion or another, as he will be very welcome.

As well as the structural issues, the hospital has outgrown its footprint. The emergency department sees 70,000 patients a year—more than double what it was designed for. The layout of the hospital does not meet modern care pathways, with too few consulting rooms, and wards well below the recommended size.

[Jerome Mayhew (Broadland) (Con)]

I am grateful to my hon. Friend for giving way. I wish to add my voice to the support he received from my hon. Friend the Member for North Norfolk (Duncan Baker), and to highlight the importance of this hospital as a regional centre of excellence. It does not support only the constituency of my hon. Friend the Member for North West Norfolk (James Wild), but also those of North Norfolk, Broadland and further afield.

I pose this question: what impact does receiving care in a building where the ceiling is maintained by acrow props have on the patient’s confidence in the care received?

[James Wild]

My hon. Friend gets to the nub of the issue, which is the impact of this situation on patients. The previous Secretary of State for Health came to the hospital, saw that and spoke to patients in those beds. They made light-hearted remarks, but they were concerned about the safety of the building after seeing props and timber supports. Of course, the trust is doing all that it can to manage that risk, but the risk of catastrophic failure remains, which is why it is rated red on the risk register.

The hospital cannot cope with the current demand. NHS modelling shows a 64% increase in overall floor space is needed to maintain services and meet future demand, with lots of housing planned in the area. In short, QEH needs to be replaced. The case is compelling to take this once-in-a-generation opportunity to have a hospital fit for the future. QEH has submitted proposals to the new hospitals programme for a single-phase new build on the existing site to meet current and future demand. The plans put forward would eliminate RAAC, and transform and modernise local healthcare, integrating primary, community, mental health, acute, social care and the third sector in a health and wellbeing village.

However, this is not about having shiny new buildings for their own sake; it is about delivering better health outcomes in some of the most deprived areas in the country that the Government have recognised as priority 1 areas for levelling up. It is also about an anchor institution—the QEH in west Norfolk—combining with the new school of nursing studies, which will be funded through the Government’s town deal, to help the NHS workforce by boosting local opportunities to develop skills and careers in our healthcare sector. It is also about promoting sustainability by using modern methods of construction and net zero principles, and maximising the use of digital technology.

It is important to recognise that the trust going from inadequate to good in the well-led domain in this inspection is a significant achievement, which provides confidence that this is a trust capable of delivering the new hospital that the patients and staff in west Norfolk need. A lot of hard work and engagement has gone into developing the plans and the scheme is highly deliverable, with a strategic outline case well advanced and on track to go to the June board meeting.

QEH’s bid is backed by 4,000 staff at the hospital. Stuart Dark—the leader of West Norfolk Borough Council—as well as all the councillors and the county council are supportive, as is the Norfolk and Waveney integrated care system, and at least seven right hon. and hon. Members, including my hon. Friends the Members for North Norfolk and for Broadland. The Prime Minister’s Chief of Staff—the Chancellor of the Duchy of Lancaster, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay)—and the Foreign Secretary also back the bid, and it enjoys local support, with more than 15,000 people having signed a petition backing a new hospital. It is essential that we have an acute hospital in this geographic area. The plans that have been put forward would deliver major improvements to care, patient outcomes and staff experiences. An alternative multi-phase approach has also been put forward. It would, of course, be an improvement on the status quo, but it would not deliver the same benefits or value for money as a single-phase build and would not be delivered in the required timeframe.

My constituents in North West Norfolk are frustrated by the delays in the timelines for the new hospital selection process, as am I. That will not come as any surprise to my hon. Friend the Minister; I confess publicly to bugging him and my right hon. Friend the Secretary of State repeatedly for decisions on the shortlisting of these hospitals. I press the Minister today: when can we expect to hear a decision on the hospitals that will go through to the next phase of the programme? What implications does the delay have for the final decision on the eight schemes to be selected, and for getting design and construction under way? I encourage him to do all he can to move this process forward as rapidly as possible.

Over the last three years, there have been real changes at QEH and patients are getting better care. The leadership has demonstrated that it can drive sustained improvements, and move to a position where staff feel supported and valued, and where there is a strong focus on improved patient care and outcomes. Now we have an opportunity to build—literally—on that progress, to provide the major investment to modernise the hospital, to improve care further and to support the trust’s strategy to be the best rural district general hospital.

The Government and the Department of Health have already committed to removing deficient RAAC from the estate by 2035. However, experts on RAAC have said that for QEH the end-of-life deadline is 2030 and that the risk will only worsen. There comes a point where it no longer makes sense or represents value for money to keep propping up the roof. I would contend that we are past that point. Indeed, in the report that set out the significant improvements needed to QEH, the CQC said that

“The trust’s most substantial risk was the safety of the roof structure”

and that there is a

“need for long term solutions to the estate problems.”

As well as having serious structural issues, the current hospital cannot meet the current or future demand. The only long-term solution is a new hospital to deal with the RAAC issues, meet demand and serve patients. By selecting QEH as one of the eight new hospital schemes, that inevitable need for replacement will become part of a funded programme, rather than an unplanned demand requiring repeated emergency funding. I urge the Government to include QEH as one of the schemes. The people of North West Norfolk and beyond deserve nothing less.

16:13

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Hosie, and to respond to this debate, which was secured by my hon. Friend the Member for North West Norfolk (James Wild), about the quality of care and the estate at Queen Elizabeth Hospital, King’s Lynn.

As my hon. Friend has already alluded to, this is an important subject for him. It is rare that I pass him in the corridors of this place without him gently but firmly drawing me aside to raise this issue with me. I know that he does so because it matters hugely to his constituents. Indeed, as my hon. Friend the Member for Broadland (Jerome Mayhew) said, it also matters hugely to other people living in the region—the wider Norfolk area—and beyond.

My hon. Friend the Member for North West Norfolk rightly highlights the close interest that a large number of right hon. and hon. Members take in this subject. Indeed, I am conscious that even some Members in their lordships’ House take a close interest in this issue. I am grateful to my hon. Friend the Member for North Norfolk (Duncan Baker) for his words. He is absolutely right to highlight the dedication of our hon. Friend the Member for North West Norfolk to this cause. His constituents and, indeed, those represented by all hon. Members here today are lucky to have them, as they continue forcefully and firmly to argue the cause of the Queen Elizabeth Hospital, King’s Lynn.

As my hon. Friend the Member for North West Norfolk will be aware, the Government are backing our NHS with a significant capital settlement that will create a step change in the quality and efficiency of care up and down the country, including in Norfolk. We are pleased to confirm that an initial £3.7 billion has been provided over a four-year period—this spending review period—to begin making progress on delivering 48 new hospitals by 2030, with 30 of the hospitals already announced to be built outside London and the south-east. I am pleased that six of the 48 hospitals are already in construction and one has already been completed. Of course, this hospital building programme is in addition to the 70 upgrades, worth £1.7 billion, that are part of the wider programme of capital investment. Those commitments will result in outdated infrastructure being replaced by facilities for staff and patients that are at the cutting edge of modern technology, innovation and sustainability.

My hon. Friend the Member for North West Norfolk is, as always, passionate in putting the case for his local hospital to be among the next eight to be announced—I will turn to the process and timelines for that shortly. As he highlights, the Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust has been provided in recent times with significant national funding, including £5 million in 2021-22 from our targeted investment fund for the establishment of an eye care unit at the Queen Elizabeth and a modular endoscopy unit, and £2.65 million in 2020-21 for the emergency department expansion works and to address backlog maintenance across its locations. My hon. Friend advocated for both those investments.

Let me turn to a point that I know is a significant concern for my hon. Friend. We remain publicly committed to eradicating reinforced autoclaved aerated concrete from the NHS estate by 2035-36—I note my hon. Friend’s point highlighting that in his view and the view of others, that needs to happen more swiftly—and to protecting patient and staff safety in the interim period. As he said, we awarded the Queen Elizabeth £20.7 million this financial year as part of SR20 £110 million ring-fenced funding to address the most serious and immediate risks posed by reinforced autoclaved aerated concrete. In addition, further funding confirmed in the autumn Budget and spending review will allow for the continuation of this remediation work in the Queen Elizabeth Hospital and, indeed, on the wider NHS estate.

Let me turn to the next eight new hospitals. The proposal for trusts to submit an expression of interest to be one of the next eight was announced last year and, as my hon. Friend knows, his local hospital submitted its expression of interest. We have been reviewing all submissions against our robust assessment process, to identify a longlist of schemes to progress to the next phase. We will communicate with trusts in due course about the next stage of the process, and will announce the selected eight schemes later in the year.

I am conscious that my hon. Friend, his local trust and his constituents will be keen to see that progress as swiftly as possible. There is a challenge there. We want to ensure that the assessment is fair and rigorous. I am also sensitive to the upcoming purdah period for local election campaigns across the country, but I do take my hon. Friend’s point about the need for speed. I suspect that his local trust will wish to know swiftly whether it is successful or unsuccessful and, if it is successful, what it needs to do for the next stage. I hope that my hon. Friend will appreciate that I cannot comment, beyond those process points, on the specific bid that his local trust has submitted, save to say that it will receive very, very careful consideration in that process.

Let me turn to, more broadly, the quality of patient care and the points that my hon. Friend made in that respect. The CQC plays an important role, as he knows, in ensuring that NHS providers meet the standards of care expected by patients, families and carers. I recognise that the Queen Elizabeth had long struggled with financial and performance challenges, as previously identified by the CQC. The trust had previously been removed from special measures, now known as the recovery support programme, after being placed in the regime between 2013 and 2015, only for the CQC to subsequently recommend that it should fall back into those measures in 2018 when the regulator identified concerns across several core services.

Recent inspections in December 2021 and January 2022, which my hon. Friend highlighted, found significant improvements in the governance, leadership and culture of the trust. Although its overall rating was “requires improvement”, this represents a significant step forward from its previous rating of “inadequate”. I join my hon. Friend in paying tribute to the hard work and commitment of the chief executive, Caroline Shaw, the rest of the leadership of the trust and, crucially, all the staff at the Queen Elizabeth Hospital, King’s Lynn, who have clearly worked incredibly hard through even more challenging circumstances than they would usually encounter in the course of their work, and still made improvements in patient care and in the CQC rating. I pay tribute to all of them for the work they have done.

I welcome the commitment given to the CQC by the leadership to ensure that those improvements are sustainable and continue to be built on. As we would expect, the CQC will monitor the trust’s performance in order that the improvements are embedded and that further improvements in care and services are made for the benefit of patients and their families.

[James Wild]

I appreciate that my hon. Friend cannot get into the specifics, but can he assure me that the fact that this is the No.1 bid for the east of England will play heavily in the consideration of whether it will be on the shortlist and then chosen as one of the eight schemes?

[Edward Argar]

As my hon. Friend knows, each region will feed in its views about which of the schemes and bids in its area are the highest priority. Without prejudging that assessment process, I hope I can reassure him that one factor that I know he considers to be of significant importance—RAAC—will be considered. Patient safety and the safety of the buildings will be a factor in the analysis of which bids should go forward to the long list, but I do not want to go further than that at this point, however much he may charmingly seek to tempt me to do so.

Elective recovery is an area of real focus for the Department and for the whole Government, and I am aware that covid-19 has placed an unprecedented strain on routine and planned care, with waiting lists in England reaching a record high, at just over 6 million in January 2022. I understand that 19,366 of those patients are waiting for treatment at the Queen Elizabeth Hospital.

In February, the NHS published the “Delivery plan for tackling the COVID-19 backlog of elective care”, which set out a clear vision for how the NHS will recover and expand elective services over the next three years. That delivery plan commits to eradicate waits of longer than a year for elective care by March 2025. Within that, by July 2022, no one will wait longer than two years, and we will aim to eliminate waits of over 18 months by April 2023 and of over 65 weeks by March 2024.

To support elective recovery specifically, the Department plans to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and £700 million targeted investment fund already made available this year to help drive up and protect elective activity. Taken together, this funding could deliver the equivalent of around 9 million more checks, scans and procedures, and will mean that the NHS in England can aim to deliver around 30% more elective activity by 2024-25 than it was delivering before the pandemic.

In highlighting the extra resources that we are putting into our NHS, it is vital to understand that this is not about the inputs; it is about the outcomes for patients and how those resources are used wisely to deliver improved patient outcomes and improved experiences for patients, with shorter waits. With regard to what is needed to achieve those outcomes, a significant part of that funding will be invested in staff, in terms of both capacity and skills.

I understand that an orthopaedic unit bid for about £18 million has been submitted by my hon. Friend’s local hospital trust. That is in the context of the £5.9 billion elective recovery funding, and the £1.5 billion from that for capacity and social hub improvements. Those bids will be carefully considered. They will need to meet the recommendations arising from the pilots that took place in London and the getting it right first time review, but I certainly look forward to considering the bid from my hon. Friend’s trust in due course.

[Duncan Baker]

Does the Minister know that the Queen Elizabeth Hospital was named after the Queen Mother? As it is Queen Elizabeth’s platinum jubilee this year, does he agree that it would be a fitting tribute to give the green light to rebuilding a hospital that is named after her mother?

[Edward Argar]

My hon. Friend is even more dextrous than our hon. Friend the Member for North West Norfolk in seeking to tempt me into an indiscretion or a prejudgment of the application process and consideration. I hear what he says and he makes his point eloquently, but I will not be drawn while that analysis and assessment of the bids is under way.

Ambulance services, like other emergency care services in the NHS, have come under significant pressure, as hon. Members will know. In February 2022, the service answered over 764,000 calls to 999—an increase of 13% on the number of calls in the same month before the pandemic. High levels of demand on the emergency care system, alongside the need for infection prevention and control measures, has resulted in higher instances of delays in the handover of ambulance patients to A&E in some areas.

I reassure hon. Members that significant support is in place for acute trusts, to help address handover delays. NHS England and Improvement and its regional teams are working with local systems—in this case, with the Queen Elizabeth Hospital in the constituency of my hon. Friend the Member for North West Norfolk—to improve their patient handover processes, helping ambulances get swiftly back on the road. Ministers are in regular contact with NHSEI on the performance of the emergency care system, including the ambulance service and accident and emergency departments.

In conclusion, I once again pay tribute to my hon. Friend the Member for North West Norfolk and all my hon. Friends who have spoken in this brief but very important debate for the work that they are doing to champion the Queen Elizabeth Hospital, King’s Lynn. As I say, his constituents are incredibly lucky to have such a champion of their cause, of healthcare in his constituency, and of investment in his local hospital, and I look forward to continuing working with him to ensure that the quality of healthcare his constituents receive is the best the NHS can provide. I note his very kind offer, which has been reiterated to me, to visit him in sunny Norfolk—as I suspect it will be in the coming months—to see his local hospital. If I am able to do so, I will be delighted to visit.

Question put and agreed to.