health

Gavin Williamson Excerpts

Tuesday 18th September 2012 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

May I, too, welcome the Minister to his place? Last week, two decisions were taken affecting the Mid Staffordshire NHS Foundation Trust, which covers the Stafford and Cannock hospitals. The first was the decision by Monitor to undertake a review of the trust’s finances. The second was the decision of the commissioners not to reopen the accident and emergency department at night, although the trust had said that it was in a position to do so. What is common to both decisions is that there has been no consultation so far with my constituents or those of my hon. Friends the Members for Cannock Chase (Mr Burley), for Stone (Mr Cash) and for South Staffordshire (Gavin Williamson). These are their health services, which is why I have established a working group specifically to look at Stafford hospital, so that my constituents can make their proposals and views clear, both to Monitor and to the commissioners.

As hon. Members will know, there has been a public inquiry into the failings of Stafford hospital, especially those in the period 2005 to 2009, although the failings go back much further. The Francis report in 2010 exposed shocking care, particularly of the elderly and vulnerable. The public inquiry, which looks at why the NHS and others failed to pick up these problems, is due to report later this year, so I will not comment on that. The time of publication will be the time for very careful and mature reflection on what happened and how the NHS must change in response. As a senior member of the Royal College of Physicians said to me, it is the most important inquiry into the NHS in two or three decades.

Standards at Stafford hospital have improved considerably in the past three years, although there is no room for complacency. The Care Quality Commission recently lifted all its remaining areas of concern and the accident and emergency waiting time target has been met for the first time in a long time. There remains a substantial financial deficit, however, with an operating deficit of some £16.5 million last year and one of £15 million predicted for this year. At this point, I thank the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), who is in his place as Leader of the House, and the former Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), for their steadfast support for the trust as it sought to recover, as well as the staff of the hospital and those from the Ministry of Defence who helped out at A and E for a few weeks.

The financial problems facing the Mid Staffordshire trust that Monitor wishes to tackle arise, in my analysis, from three sources. The first is underuse of the estate in Stafford and Cannock. It is essential in my view, and that of my hon. Friend the Member for Cannock Chase, that both hospitals remain open, but the estate must be used efficiently as money that is needed for services is being spent on empty property.

Secondly, the consequences of the events at Stafford mean that patients who would normally attend Stafford no longer do so. Confidence in the hospital needs to return, and that confidence must be based on real progress. There are welcome signs that that is happening, but it will take time.

Thirdly, and most importantly by far, endemic problems face medium-sized acute trusts across the country. Mid Staffordshire is far from unique and that is where the Monitor review is vital as it has the chance to establish a sustainable model for district general hospitals around the country. There seems to be a view gaining currency that all medical care in the future will either be highly specialised or general, based in community hospitals, which will squeeze out the medium-sized acute hospitals. Not only does that not accord with the evidence, it goes against the wishes of the public.

I do not dispute the need to concentrate highly specialised care in larger hospitals where consultants in each specialty are available around the clock. That has happened for some time. However, there is an increasing and substantial need for emergency and acute care, particularly for the elderly, which is much better given as locally as possible and in close co-ordination with social care services. District general hospitals such as Stafford remain the best place for that.

Monitor therefore has an excellent opportunity to work together with the people of Stafford and Cannock to show how a medium-sized acute trust can flourish in the tough financial climate we face. Indeed, Monitor has a duty to do so under section 62 of the Health and Social Care Act 2012, which states that its main duty

“in exercising its functions is to protect and promote the interests of people who use health care services by promoting provision of health care services which…is economic, efficient and effective, and…maintains or improves the quality of the services.”

It also states that:

“In carrying out its main duty, Monitor must have regard to the likely future demand for health care services.”

The last paragraph is very important as not only is the population of the area predicted to rise substantially in the coming years, but there will be a greater demand for acute care.

It may be argued that none of Monitor’s duties requires that services be provided locally. I reject that. To provide services locally is economic, efficient, effective and an intrinsic part of their quality, so Monitor has a duty to promote health care services that are as local as possible. We also need to be very careful in the definition of the word “services”. In the debate in Committee on what was then clause 69, I said that

“it is extremely important to have clarity on what constitutes a service. Services can be salami-sliced down to very small items or, as others have said, they can be an agglomeration. One could say that, in an acute hospital, a service is not only the accident and emergency, but some—not necessarily all—of the other wards associated with it. That might constitute a block of service or, under other definitions, several services. How will Monitor interpret that word?”––[Official Report, Health and Social Care Public Bill Committee, 22 March 2011; c. 943.]

[Gavin Williamson (South Staffordshire) (Con)]

Everyone in Staffordshire knows how hard my hon. Friend has fought on behalf of Stafford hospital. Does he agree that the closure of Stafford A and E at night will put an increasing burden on many other local hospitals, including New Cross hospital in Wolverhampton and the University hospital of North Staffordshire?

[Jeremy Lefroy]

I entirely agree. Of course, the hon. Member for Walsall South (Valerie Vaz) has the Manor hospital in her constituency, too, and I pay tribute to the work done by her hospital, by my hon. Friend’s hospital in New Cross and by Stoke and Burton hospitals.

So, how will Monitor interpret the word “services”? To date, as far as I am aware, we do not know the answer to that question. I want to make a very clear case that Monitor must, in the case of emergency and acute services, view the matter in the round and not engage in accountancy-based salami slicing. One cannot separate an A and E from a medical admissions unit, a surgical admissions unit, a paediatric admissions unit, an intensive care unit and the related diagnostic and therapeutic services. They must be considered as a service block. Of course, there will be a difference between the block in a district general hospital and that in a major specialist hospital, as the latter will cover emergency and acute events that a district general hospital cannot.

That brings me to the question of the accident and emergency department at Stafford, which has been closed between 10pm and 8am since 1 December last year. Today a petition is being presented in Downing street to urge the reopening of the department at night. Up until Sunday 16 September, 4,381 patients who would have been treated at Stafford at night have gone to other hospitals. To put that in perspective, the A and E department treated 51,000 people in 2011-2012. That is more than 4,000 patients who could not use their local acute hospital in an emergency when previously they could. We need to see them back at Stafford.

The reason given for closing the A and E department at night was that it was not safe for 24/7 reopening. Subsequent events have proved that to be the right decision as the department was close to breaking point. However, a set of criteria were given for reopening and the trust considers that, after much hard work, they have now been met, although there are concerns about sustainability. The commissioners have decided not to go ahead with night-time reopening but instead to pursue what they call a model of 24/7 emergency and urgent care. My constituents and I were very disappointed with that, because, nearly 10 months after night-time closure, we still do not have an A and E 24/7 but also because we do not have details of what that emergency and urgent care model might be. What are the similarities and differences between emergency and urgent care and A and E as traditionally understood? That needs to be made clear, not just in Stafford and Cannock but everywhere such a model is proposed.

The commissioners’ statement made it clear that even while A and E was closed, children, maternity and GP cases continued to be received at Stafford at night. They are also working on how to bring back to Stafford the 15 or so patients who currently have to go elsewhere each night. That is welcome and sounds similar to the service prior to closure. So what is different? Can we not return to an open-door 24/7 service with effective triaging to filter out the unnecessary attendances that place a strain on emergency departments everywhere?

Mid Staffordshire trust may be exceptional in the long hard road it has to travel to regain the confidence of local people—and it has come a long way down that road—but it is not exceptional in the pressures it faces as a district general hospital. The Government have a chance to show how district general hospitals can thrive, providing emergency, acute and elective services to their people, working closely with social care and with the specialist hospitals in their neighbourhood.