Mid Yorkshire Hospitals NHS Trust

Jo Cox Excerpts

Monday 21st March 2016 Commons Chamber

[Paula Sherriff (Dewsbury) (Lab)]

Let me start by paying tribute to the doctors, nurses and all the staff working in the Mid Yorkshire Hospitals Trust. As a Member whose constituency is covered by the trust, a local resident and indeed a patient, I have nothing but praise for their hard work, dedication and professionalism. Lord knows, the NHS may be up against it—and this trust perhaps more than most—but I am continually humbled by the quiet and determined way that all the staff at Dewsbury and District hospital, Pontefract hospital and Pinderfields hospital go about providing care and support in the face of what must seem at times like overwhelming odds.

[Jo Cox (Batley and Spen) (Lab)]

I congratulate my hon. Friend and neighbour on securing this critical debate on our local hospital. I back her in what she says and recognise that doctors and nurses and other staff at the hospital have been working in crisis mode for 15 months now. It is difficult to overstate how hard it must be for staff to go to work every day, knowing that they will miss key targets and not be able to give the care and attention that they so want to give.

[Paula Sherriff]

I thank my hon. Friend for her intervention. I absolutely agree with her. We must also pay tribute to our incredible junior doctors.

Whatever difficulties the trust is facing, there can be no doubt that those working there on the frontline are blameless, and deserve our full backing. As Members of Parliament, we owe it to them to make sure that they are given all the support they need.

The trust and its staff have to work in a challenging environment. In the area covered by the trust, the overall health of the population is below the average for England. Deprivation is higher than average, and nearly 20% of children are living in poverty. Life expectancy is lower than the national average for both men and women.

The Care Quality Commission inspected the trust in July 2014, with a follow-up inspection in June 2015. An unannounced inspection of Pontefract hospital emergency department took place in July 2015. A second unannounced inspection took place in August 2015 at Pinderfields hospital, focusing on staffing levels, with a follow-up visit to Pinderfields in September.

Although there were some improvements between the two main inspections of 2014 and June 2015, there were also areas in which the trust’s performance had worryingly deteriorated, and there were still serious concerns about staffing levels. The CQC noted that there was still a significant shortage of nurses, which was having a knock-on effect on patient care, particularly on the medical care wards, in community inpatient services, in the specialist palliative care team and in end of life services.

Two weeks ago, my hon. Friend and I met the trust’s new interim chief executive. We were both very grateful to him for his candour. He told us that the leadership team has effectively been in crisis mode for the past 14 months. He said that the trust had recently put in an additional 120 beds across the trust to cope with increasing demand, but the 100 extra staff who should have accompanied that expansion are nowhere to be seen. The posts simply have not been filled.

[Paula Sherriff]

I thank my hon. Friend for that intervention. I will come to that point later.

To make things more complex on the administrative side, the monthly staffing reports are found to be overly detailed, generally running to over 100 pages, making it difficult to identify the most urgent risks. Likewise, there are concerns that policies and procedures for the escalation of staffing risks were not always followed when they were identified. The trust aims for a ratio of one nurse to every eight patients on adult in-patient wards. The Royal College of Nursing recommends 6.7 patients per nurse on adult wards as a maximum, so one to eight is not too far wide of the mark, though not ideal. However, the CQC found that even the 1:8 ratio was very inconsistently met. During its unannounced visit to Pinderfields hospital in August, of the 17 wards only one was staffed to safe staffing levels. Ten were at minimum level and six were actually below the minimum. Indeed, records show that in August 2015 only 71% of nursing hours were achieved. Staff on the trust’s spinal injuries unit at Pinderfields are constantly reallocated to other wards, in essence robbing Peter to pay Paul. A nurse even told a patient that because they were so short-staffed, if two patients got into respiratory difficulties, which is not uncommon on a spinal injuries ward, the nurses would have to choose which patient they were to save.

The problem is particularly acute at the community in-patient sites at Monument house and Queen Elizabeth house, where between May and June last year 96% of shifts used at least one non-permanent member of staff, either agency staff or staff redeployed from other areas of the trust. Indeed, two shifts had only a single registered nurse on duty. The trust as a whole breached the Department’s cap on charges for agency staff, on average, 132 times a week during December. While it is absolutely right to prioritise patient safety over the Government’s financial targets, that is a clear indication that there has been a failure in long-term workforce planning and that it is struggling to attract and retain appropriately qualified staff.

To give credit where it is due, the trust has been making efforts to address the staffing issue. After the unannounced inspection, a risk summit was held under the leadership of NHS England to look at the actions the trust needs to undertake and the support needed from the wider healthcare community. The high number of registered nurse and care staff vacancies is now noted on the corporate risk register. The trust is looking at a range of different structures for nursing teams to get the best out of the available staff. It has invested in safety guardians to provide support and safeguarding for patients with mental health issues, freeing up time for registered nurses. It is putting extra effort and resources into filling gaps by looking to recruit nurses both locally and from Europe, proactively recruiting rather than waiting for staff to leave.

The CQC rated the safety of services provided by the trust as “inadequate”, largely due to the shortage of staff. For instance, between May 2014 and April 2015, 258 serious incidents were reported, of which 206 were cavity-like grade 3 pressure ulcers. That sort of thing is indicative of nursing staff being rushed off their feet, unable to provide the level of patient care that they would like. Concerns were also raised about patients who required one-to-one care not receiving it, and fluid balance monitoring and nutritional assessments not being properly completed, with charts often not kept fully up to date. In January, 81.4% of accident and emergency admissions were seen within four hours; the target is 95%. More than 2,000 patients waited on A&E trolleys for more than four hours, including six who waited more than 12 hours at Pinderfields.

When looking at such statistics on patient care, we have to be very careful to remember that each number—each percentage point—represents real people. They are people who may be in pain, or vulnerable, worried or nervous. They may be upset or distressed. By any reckoning, the NHS is our nation’s most prized institution, and when people have to make use of it, they rightly expect a certain level of service. NHS staff want to give that level of service, and when they cannot the result is more than just a delay in treatment—the dignity of patients is also compromised.

A few weeks ago I received an email from one of my constituents. Her 84-year-old father had been admitted to Dewsbury hospital with stroke-like symptoms. He was on a trolley in A&E for 14 hours. After he had been admitted to a ward, his daughter came back to visit him. She found that his bed was a complete mess and covered in food, and her father was naked from the waist down. When she asked why he had on only a pyjama top and was sitting on an incontinence pad, she was told that it made it easier when he needed to urinate. When she came back later that afternoon, his bedding had still not been changed, which in the end she did herself. That is a basic outline of one case, but it is by no means the only such correspondence that I have received from concerned constituents. At the moment I receive similar emails more than once a week, which is alarming.

All that, of course, has an inevitable knock-on effect on staff motivation. The results of the 2015 NHS staff survey show just how low morale has sunk. For every key indicator the results are depressing and fall well short of national averages. Only 54% of staff felt that the care of patients was the trust’s top priority, compared with a national average score of 73%, and 55% felt that the trust acts on concerns raised by patients, whereas the national average is 72%. Just 41% of people would recommend the trust as a place to work. Perhaps most damningly of all, only 46% of people would be happy for a friend or relative to receive care at the trust.

The amount of disciplinary action being taken against staff has risen in recent months, which is generally due to staff making minor mistakes or not being able to follow procedures through fully for want of time. That is a symptom of the shorthandedness that has been experienced on the wards, and it contributes to the general air of despondency as staff are effectively penalised for not being able to be in two places at once. I have spoken to a number of past and present members of staff in the trust, who informed me that they have failed to whistleblow for fear of retribution.

The feeling of being worn down is affecting staff at all levels. I was told by the interim chief executive last week that the board has effectively been operating in crisis mode for the past 14 months, which, of course, is now taking its toll. There is a general feeling of chaos, tempers are fraying, and there is severe instability in the personnel in management teams—a sure sign that the trust is struggling to get its problems under control, which is a challenge in itself.

To be fair, there have been some slight improvements recently. The CQC’s follow-up visits noted that staff were more confident than they had been previously, and that senior management were taking some concerns on board and trying to get to grips with the issues. However, that feeling was by no means universal, and that slight improvement from such a low base is hardly a cause for celebration.

On the underlying causes of these problems, the Government must take the lion’s share of the blame. Going right back to slashing nursing training places in 2010, they have failed to ensure that the NHS has the levels of staff it needs to provide a safe and caring service. Thousands of nurses who should have begun training between 2010 and 2012 and would now be qualified—thereby helping to alleviate the difficulties in Mid Yorkshire—are just not there. Applicants for nursing courses outnumber the available places by more than two to one.

The whole ethos of the NHS has been warped from one of service and care to one of financial management. Of course the health service must keep on an even keel, but when a cash-strapped trust feels that it is appropriate to hire city consultants such as Ernst & Young, alarm bells should start ringing. Thankfully, that contract finally came to an end last September, but not before the trust had stumped up more than £15 million. Given that staff are still struggling to keep their heads above water, they could be forgiven for questioning whether that was money well spent.

[Jo Cox]

My hon. Friend makes a powerful and personal case. Does she agree that the Government have responsibility for this issue? They have cut public health funding, and there is a social care crisis locally and problems with the junior doctors contract. The Government must take responsibility for this crisis and not pass the buck to an embattled NHS trust.

[Paula Sherriff]

I absolutely agree that the buck must stop with the Government, and we must see action, not platitudes.

I have now been told several times that the solution to the problems lies in the plans to downgrade Dewsbury’s A&E and maternity services, which will be centralised at Pinderfields. I say that that is putting the cart before the horse. Nearly 70% of in-patient beds will be lost in Dewsbury, and the simple fact is that this will put lives at risk. Leaving aside the arguments about whether the proposed reforms are necessary, it is just not safe to attempt this sort of major restructuring right in the middle of a major staffing crisis.

Once again, financial considerations are overriding clinical concerns. The trust is currently consulting on proposals to bring forward the reconfiguration. I say absolutely unequivocally that, while the trust is in a state of flux, discussions must focus solely on improving safety and quality. I urge the board to abandon these plans.

I have written to the Secretary of State about the serious worries in relation to what is going on at Mid Yorkshire Hospitals NHS Trust. The Minister has kindly agreed to meet me and other concerned MPs next month to discuss this in more detail. However, I want to reinforce the point that we are in danger of forgetting the lessons learned from the Mid Staffordshire situation about the absolute priority that must be given to safe staffing levels. Unless we can crack this by getting the qualified staff we need, no amount of reorganisation will make up for poor care. We must break the spiral of demoralisation and overwork so that we can help both the patients and the staff who are currently getting the short end of the stick.

On this day exactly 70 years ago, Nye Bevan announced his plans for a national health service. His vision of universal healthcare free at the point of delivery and funded collectively is just as valid today as it was then. Bevan said:

“The NHS will last as long as there are folk left with the faith to fight for it.”

We must stand together now for the NHS, and we must support the staff who go above and beyond for the NHS every day. It is our duty as parliamentarians to continue the fight for those who, yet still, have faith in those founding principles—an NHS for all, based on clinical need and free at the point of delivery.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank the hon. Member for Dewsbury (Paula Sherriff) for bringing this matter to the House and for her powerful introduction to her constituents’ concerns. I also thank the hon. Member for Batley and Spen (Jo Cox), who intervened. They make a powerful double act for Mid Yorkshire. I have felt the pressure of the concerns they have quite rightly raised with me privately, and I hope that they will be able to do so again in the next couple of weeks.

I very much like the fact that the hon. Member for Dewsbury ended by mentioning this important anniversary. We are a few weeks away from the 70th anniversary of the Second Reading of the National Health Service Bill, as it then was, on 30 April. At that time, Nye Bevan made two points about the introduction of the NHS. The first is the one we all know, and of which we are equally proud, which is that it should be a service free at the point of need.

However, Nye Bevan made another point, which for him was as important in the establishment of a national health service—it has been forgotten by politicians on both sides during the past 70 years—which is the principle of universalising the best. He made a very powerful argument at the time, which was that the reason for a universal NHS was to ensure not just that people could approach the service without having to worry about money, but that someone from a part of the country that traditionally did not have good hospital care could rely on the same quality of service that they would expect in a wealthier or better served part of the country.

In establishing the first part of Nye Bevan’s dream, we have done well, but in establishing the second part, we have not yet succeeded. The hon. Lady’s constituents have, in part, been at the rough end of that. For years, under Governments of all kinds, we have not done well enough in universalising the best across the service. As we discussed when we had our meeting, there are hospitals not far from hers that are delivering exceptionally good and consistent levels of nursing care. They have been able to do so while under similar pressures to those in her own hospital—as she has correctly identified, similar pressures apply across the service.

Clearly, there are historical problems in Mid Yorkshire, and they will be difficult to grapple with. I completely understand why the hon. Lady feels that commissioners might not yet have a full enough grasp of the problems in her area. That is why she questions the basis of the reconfiguration. I understand that the assurance exercise into the reconfiguration is nearing its end, and we will publish that at some point in the near future. I hope that that will provide assurance that the accelerated reconfiguration can take place. I take into account the completely legitimate points that the hon. Lady made about the readiness of the reconfiguration of social care services in the area, but I think we should cross that bridge when we get to it. I am mindful of the fact that I have no power to change reconfiguration decisions—and neither does the Secretary State.

[Jo Cox]

As the Minister will be aware, the Mid Yorkshire Hospitals NHS Trust has the third highest number of admittances to A&E in the country. In that context, I share the concern of my hon. Friend the Member for Dewsbury (Paula Sherriff) about the planned reorganisation and downgrade of the Dewsbury hospital. It is a serious matter for local residents and some of my constituents. It would be wonderful to have a commitment further to discuss whether now is the time to move forward with that plan.

[Ben Gummer]

Of course I understand why it is a matter of concern. I must say what I have also said privately, which is that I must respect the opinion of clinicians and commissioners. That is why I want to hear what they say. Ultimately, there is the approval process that this reconfiguration has already gone through—namely, that of the Independent Reconfiguration Panel. I will, of course, speak to the hon. Lady whenever she wishes. It is not kindness on my part, but my duty to her as a Minister responding to an elected representative.

I spoke today to the director of nursing at the Mid Yorkshire Hospitals NHS Trust and also to representatives of the local trust development authority, and I was glad to be assured on some points. I was pleased to hear that they were co-operating with Lord Carter’s review of safe staffing ratios, which should provide a promising foundation for ensuring that we have the right kind of staffing ratios at the appropriate acuity of patients. This will be good in every hospital where it eventually applies, but for those with very challenged staffing ratios at the moment, the ability to look carefully at the rostering of staff across the service with the kind of skills and international experience that Lord Carter will bring will, I think, be helpful. Unfortunately, I was not made aware of the meeting that the hon. Lady had with the chief executive. I am disappointed about that because she clearly had a robust discussion. I have seen the contents of the letter that she sent to the Secretary of State.