Healthcare: North Staffordshire

Jack Brereton Excerpts

Monday 23rd October 2017 Commons Chamber

[Gareth Snell]

My hon. Friend is absolutely right. I could not agree more. As a former trade union official with Unison, I think the way the staff have been treated is simply unacceptable. It is also an additional cost burden. Staff have been made redundant at a cost to the clinical commissioning groups, which may find that the work they were doing is brought back into use if the consultation suggests the beds should exist. Again, I ask the Minister to provide some rationale as to why that is an effective use of public money in a healthcare system that we all agree is overspending and needs to find a way of closing its budget gap.

It is all too easy to point at Royal Stoke Hospital and say, “The hospital is the problem; fix the hospital and everything else will sort itself out”. That is partly true, but there are also issues around our capped expenditure programme. Over the next two years, Staffordshire is being asked to take £160 million out of its broader healthcare economy spending. A sustainability and transformation plan identified a deficit of almost half a billion pounds by 2022, yet the way to deal with that appears to be a disjointed approach to solving little problems in little areas without any reasonable thought about the way forward and how this can be redressed.

I go back to the community care beds. They provided a platform whereby people who were in an acute expensive setting could be discharged, at a point of being considered medically fit for discharge, to a provision that was designed to give them the care they needed before they transitioned to their home, a private care provider or a council-run care facility. That allowed them to make the change without the prospect of them re-presenting, at the expense of the acute system, because they had been discharged too quickly. Again, this is money circulating around a system that is identifiable as waste in many people’s considerations of what waste is, while at the same time it is being manufactured by the decisions of the CCG.

The CCG’s decision on community care beds was referred to the Minister under paragraph 29(6) of the 2013 regulation almost a year ago. Letters from myself and my hon. Friend the Member for Stoke-on-Trent North (Ruth Smeeth), which were countersigned by my hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly), Baroness Golding and the former Member for Stoke-on-Trent South, Mr Flello, have gone unanswered. I have raised the issue here as a point of order and at business questions, and I have asked the Secretary of State directly when we will get that response, but to date we still have had none. That is almost a year of referrals from the two tier 1 authorities and of unanswered parliamentary requests. It is creating an unacceptable level of uncertainty in the economics of the health service in Staffordshire.

[Jack Brereton (Stoke-on-Trent South) (Con)]

I recognise that there are significant financial challenges, particularly around the hospital, but North Staffordshire Combined Healthcare NHS Trust, for example, has made significant improvements in the wider health economy. Does the hon. Gentleman agree that the main financial challenges are with the hospital and that, if we can address those, we can help the wider health economy?

[Gareth Snell]

The hon. Gentleman, like me, wants the best for the constituents of Stoke-on-Trent, but it is far too easy simply to blame the hospital for our wider concerns about the health economy in Stoke-on-Trent and north Staffordshire. He is right about the combined trust making great headway—for example, in dealing with mental health—but he, like me, will still have people coming to his surgery to complain that they have to wait four, five or six months for a referral to the child and mental health adolescent support team; that they ring the access and crisis number and it rings out; or that they have been unable to find a bed with a mental healthcare provider. In Staffordshire, the latter is virtually impossible; in the west midlands, possibly slightly easier. Either way, this is a national issue that is not being addressed and which is not of the making of the hospital in Stoke-on-Trent.

To take the hon. Gentleman’s point slightly further, the CCG in north Staffordshire currently has a programme of slashing and burning all those support services and peripheral services that keep people from having to go to hospital in the first place. There is now no support for drug and alcohol services as a result of decisions by county councils, city councils and the CCG. Previously, these people were not presenting with acute problems in hospitals, but they now have no recourse to support and will end up presenting in A&E, in expensive treatment centres, getting the wrong sort of help for their conditions.

Independent support services in north Staffordshire for people presenting in hospital due to domestic violence are also being looked at and could be lost. The north Staffordshire users group, which recently changed its name to Voice, has had all its funding withdrawn by the CCG, meaning that people with mental health conditions can no longer advocate or receive support to advocate for the help and support they need. Again, that will compound the situation in our acute setting, but small, lower cost interventions from the community or the third sector could have prevented such people presenting.

Furthermore—I know this is not unique to north Staffordshire—the social care system in Staffordshire is a problem, not least because getting people out of hospital into social care is a problem. The Royal Stoke, Stoke-on-Trent City Council and Staffordshire County Council routinely have unacceptable wait times in hospital, and more and more people are having temporary arrangements put in place and having their care packages changed while they are being delivered, which we all accept is not good for patients, for providers or for our overall health economy, because every change will cost money.

I know that the Minister has received numerous substantive briefings from healthcare providers across north Staffordshire—I know that mainly because they have told me and partly because I would not tell them what I was going to say today so they had to cover a multitude of areas. To save the Minister having to regurgitate facts already shared with MPs, I have prepared what I hope are simple questions which, if he can answer them, will provide us with an opportunity to move the debate forward. Everybody, irrespective of party politics, wants to move forward. We want a hospital that has the funding it needs; community care provision that meets the needs of people in our communities; a mental health system that not only responds to people when they hit crisis point, but actively works with them to ensure they do not get to crisis point in the first place; and a social care system that allows people who need care at home to receive it.

Will the Minister commit himself to providing a full response to the community care bed referrals from Staffordshire County Council and Stoke-on-Trent City Council, and respond to the letters from the Members whom I mentioned earlier? Will he do that as a matter of courtesy, if nothing else, even if his response is “We are rejecting the referrals”? At present those beds are mothballed, and the consultation is being rerun. The Minister has an opportunity to ensure that 168 community care beds are returned to our health economy this winter, which would significantly reduce pressures on A&E departments.

I ask the Minister to use whatever powers he has to intervene between the University Hospital of North Midlands Trust and the clinical commissioning groups to ensure that the £10 million of fines are waived, because they constitute the difference between our hospital’s getting through the next 12 months and its crawling through the next 12 months on its knees. It does not make financial sense to penalise a hospital further for not meeting targets that it has struggled to meet because of its funding crisis. That is perverse economics by anyone’s standards.

I should be grateful if the Minister would guarantee that the £9.9 million from the Department of Health and the £14.9 million from NHS England which were promised to Royal Stoke University Hospital so that it could cope with taking on the responsibilities and, dare I say, the burdens of the county hospital for a short time as part of the trust special administrator model will be handed over to Staffordshire as a matter of urgency. That money is already budgeted for in Royal Stoke’s plans, and is part of the amount that would enable it to reduce its deficit from £119 million to £69 million. Without it, we shall face a winter of absolute crisis.

Would the Minister consider convening a meeting to reassess the 2018-19 and 2019-20 cost improvement programme figures of £35 million each? Asking the hospital to take a further £70 million out of its operating budgets over the next two years is akin to asking someone with no money to pay a huge fine. It will just rack up more debt, and will end up being fined for not meeting its financial targets and fined further for not meeting its medical targets. This is a vicious and horrible circle, and I hope that, if the Minister cannot do so himself, the Secretary of State will use his powers to halt it so that we can have a little breathing space in which to try to solve the problems in our hospital.

Will the Minister intervene to ensure that the £19.5 million that is owed to Staffordshire County Council for the better care fund to help relieve the pressure on local authorities that are trying to deliver social care can be handed over? NHS England should have handed over that money, but it has not done so, and the delay has caused the better care fund to have a deficit. If the money is released, the assessment programme that was meant to alleviate some of the hospital’s problems with discharging may be able to continue, but without it we shall be storing up problems for the future.

My next request involves a personal interest. As I am sure the Minister will know from his briefings, Staffordshire was a pilot area for a cancer care contract undertaken by Marcus Warnes of the CCG. The CCG hoped to procure a provider to deliver cancer care services, and £890,000 of public money was spent to that end—including staff time, the total came to nearly £3 million—only for the contract never to be let, and the process to be aborted. I appreciate that we cannot go back in time and rewrite the process, but what we can do is learn the lessons from Staffordshire to ensure that no other CCGs go through such an appalling and bungled procedure that wastes taxpayers’ money. I should be grateful if the Minister would consider convening a meeting that would enable us to learn the lessons and share them with other CCGs so that we, and they, do not make the same mistakes in the future.

Let me end on a convivial note. Nearly 18 months ago my predecessor, Mr Tristram Hunt, invited the Secretary of State to visit the hospital. During the by-election that I fought in February, the Secretary of State came to Stoke-on-Trent, but did not go to the hospital. On my own behalf and that of my hon. Friend and neighbour the Member for Stoke-on-Trent North (Ruth Smeeth), I invite the Minister, or one of his colleagues, to come to Stoke-on-Trent, not so that we can have a stand-up row about the future of our hospital, but so that we can actually start the process of healing it. No one in Staffordshire wants to see our hospital fail, but we are currently walking down that road blindfolded.

All I ask is for the Minister to address the seven simple questions that I have put to him, and if he were to take up the offer to visit us, he would be most welcome.

--- Later in debate ---

[Mr Dunne]

I specifically will; I will come to that point very shortly.

It is important that we get the right balance between primary, community and secondary care. NHS leaders believe that they can significantly reduce the 30% of patients who are currently being treated in Staffordshire in the wrong setting. Clearly, patients sometimes have to go to our acute settings. We have recognised that the Royal Stoke, having reviewed its emergency department, is under-bedded. There is currently a plan for 46 beds to be added over the winter to help to relieve the pressure on the acute services. I will come to the question of the community beds in a second.

[Jack Brereton]

I want to raise the point about acute beds as well, because it is a significant issue. It particularly relates to the design of the hospital, which does not have enough acute beds. Does the Minister agree, however, that some of these issues predate this Government?

[Mr Dunne]

I am sure that my hon. Friend is right, but I am not going to get into a dispute about that just at the moment. I would like to deal with the question of community beds that the hon. Member for Stoke-on-Trent Central raised. He has referred to the request by two local authorities concerning the community bed closures, seeking a referral to the independent reconfiguration panel. He suggested that there had been no response to that request, unless I have misunderstood him. I think that the hon. Member for Stoke-on-Trent North, who is sitting next to him, received a letter in February. The local authority received a letter to confirm that the referral request had been received, and the referral has been transmitted to the independent reconfiguration panel. We are currently awaiting the results of that referral and the panel’s report and recommendations. The hon. Gentleman will therefore understand that it would be inappropriate for me to pre-empt the panel’s conclusions by commenting on this specific case.

I want to touch on the financial challenges that the hon. Gentleman has referred to. I recognise some of the figures that he has referenced and questioned. We believe that Staffordshire needs to get into a financially sustainable position. At the moment, some areas of Staffordshire receive significantly more funding per capita than the rest of the county and than England as a whole. The Stoke-on-Trent CCG receives an allocation that is some 9% greater than the average for England per capita, reflecting the needs and challenges of that community. The NHS recognises that parts of Staffordshire are more challenged and need more money, but equally, the hon. Gentleman needs to recognise that each area of England needs to live within the budget that it has been set.

One of the challenges that Staffordshire has at present is that, for historical reasons that have not been addressed over the years—going back to the point made by my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton)—the pattern of provision and the models of care have not developed in the way that they have in some other areas. This has meant that the cost of providing care—in some cases, in settings that are no longer as relevant as they could be—is resulting in Staffordshire running unsustainable deficits. It is unfair that other parts of the UK should provide even more funding into Staffordshire, resulting in their not having sufficient funding to look after their own populations.

The hon. Member for Stoke-on-Trent Central referred in particular to the better care fund. I understand that concerns are shared across the House about the funding that was pledged in the Budget. It was made clear to local authorities that as a condition of that funding they would need to make progress in reducing the delayed transfers of care. North Staffordshire has made huge strides in doing that and it currently has roughly zero delayed transfers of care, which is one of the best performances in the country. We need to see that improvement across the county as a whole. I know that there was a meeting last week to discuss that, and we will see how that progresses in the future.

Question put and agreed to.