Oral Answers to Questions

Paula Sherriff Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

I have sympathy for people who are frustrated about that issue. As I have said before, my objection is not one of principle; it is whether it is practical to do it. Perhaps that is something that GPs could decide at a local level.

[Paula Sherriff (Dewsbury) (Lab)]

T9. The Health Secretary said there was a “small” number of incidents in the NHS this winter. What is his definition of “small”? We had what I would call a large number in my constituency alone. I extend an invitation to him to visit my local hospital and see that for himself, as the shadow Health Secretary will later this week.

[Mr Hunt]

May I gently tell the hon. Lady that I do not think our debates on the NHS are helped by her taking my comments out of context? I was quoting Chris Hopson, from NHS Providers, talking about a specific week when he said there were, in that week, a small number of incidents. We recognise the pressures across the NHS, which is why this Government are backing the NHS with record funding.

Provision of Cervical Screening

Paula Sherriff Excerpts

Friday 27th January 2017 Commons Chamber

[Paula Sherriff (Dewsbury) (Lab)]

It is an honour to follow the hon. Member for Harrow East (Bob Blackman), who is no longer in the Chamber. He has worked incredibly hard to gest a very important and much-needed Bill through this House.

I declare an interest as chair of the all-party group on women’s health. I am thankful for the opportunity to hold this debate today because this week is Cervical Cancer Prevention Week. The phrasing is important, because cervical cancer is notable for being not only treatable but preventable, under the right screening conditions. The events of this week are all about trying to ensure that those conditions exist for as many women as possible throughout the UK.

I start by acknowledging the invaluable work of Jo’s Cervical Cancer Trust, which I believe is unique in the UK in being dedicated to this issue. I thank it for its work in raising awareness during this week, such as through its #SmearForSmear campaign—there is still plenty of time to take up the offer to do your selfies, gentlemen—in which women, and indeed men, are encouraged to take a selfie with smeared lipstick to raise awareness of smear testing. I look forward to seeing those pictures later.

[Vicky Foxcroft (Lewisham, Deptford) (Lab)]

That is a fantastic idea. Only this week, I went for my own smear because of the campaign and the highlighting of the issue. All of us might want to join together to do #SmearForSmear, and tweet the pictures after the debate.

[Paula Sherriff]

I absolutely agree. I definitely expect the Minister, at least, to partake in such activity.

I thank Jo’s Cervical Cancer Trust for the work that it does all year round towards the eradication of this disease. It has been my pleasure to work with it, through the auspices of the all-party group, on issues to do with access to cervical screening, and I look forward to doing so again in the future.

I am glad that the Minister is sitting down, as I would also like to break with my habit in this House by giving a word of praise for current Government policy. As almost all cervical cancers are caused by persistent human papillomavirus—HPV—I welcome the Government’s commitment to the HPV vaccination programme, even though I feel that its effect could be amplified with compulsory sex and relationships education in our schools.

Successive Governments have developed a successful cervical screening programme and, to their credit, this Government have maintained it. It is responsible for saving an estimated 5,000 lives a year. That is to be applauded, but it should not be taken for granted. Recent years have seen a drop in cervical screening coverage, and this risks an increase in the incidence of cervical cancer and the danger of further unnecessary deaths when we have been very close to making a breakthrough. We need to be vigilant if we are to maintain the progress we have already made and make up further ground in tackling the disease.

Even with the progress that we have made on screening, some 3,000 people a year are diagnosed with cervical cancer, and an astonishing 890 a year people die of it. The figures for 2015-16 show that the coverage in England sits at 72.7% of eligible women, which is the lowest for 19 years. This is in spite of the so-called Jade Goody effect, when the TV star’s death from cervical cancer in 2009 resulted in 400,000 more women getting screened. Sadly, that effect has now been completely reversed. The numbers of screenings have been falling year on year, and they now stand at 3% lower than they were in 2011. Screening coverage rates across all age groups are falling.

I cannot stress strongly enough how significant and worrying these statistics are. They mean that more than a quarter of women in this country are leaving themselves open to a cancer that can be prevented, but that can easily be fatal if left undetected. As we all know, the general rule of cancer is that early diagnosis leads to a better prognosis, and cervical cancer is no different. The later the diagnosis, the poorer the health outcomes, and the more invasive and personally costly the treatment options. It benefits everyone involved if cervical cancer can be prevented, or detected and treated early.

Let me address one of the groups with the least coverage: young women. Women are invited for smear tests from the age of 25, but new research by Jo’s Cervical Cancer Trust has shown that more than a quarter of women in the 25 to 29 age bracket are too embarrassed to attend one. Shockingly, the same research also suggested that 70% of young women did not believe that smear tests could reduce a woman’s risk of cervical cancer. Let me be clear: they absolutely can. We know that 75% of cervical cancers can be prevented from developing through regular smear testing, yet more than 220,000 of the 25 to 29-year-olds invited for a test in England in the past year did not attend.

The research found several other causes for concern, including the fact that 24% of young women were unable to recognise a single symptom of cervical cancer, and that only just over half of them recognised that bleeding outside of periods was a symptom. That is the most common symptom of cervical cancer. Additionally, fewer than half knew that smear tests look for pre-cancerous cells, and almost a quarter incorrectly thought that the test was for ovarian cancer.

This problem is not unique to the younger generation. The 25 to 29 age group remains the group with the lowest coverage, but the 45 to 49 age group has seen the fastest decrease in coverage in recent years. Women over 50 display a similar tendency to put off or ignore smear testing, with a third having delayed or not attended their test. A shocking one in 10 have delayed for more than five years. This is particularly disconcerting because women aged 50 to 64 are the most likely to receive an advanced stage diagnosis, with half of those being stage 2 or later. As I mentioned earlier, this means more invasive treatment and risks poorer outcomes.

By far the biggest risk factor in developing cervical cancer is not attending cervical screenings, but Jo’s Cervical Cancer Trust has found that attendance declines with age. The charity’s long-term modelling has shown that if screening coverage continues to fall at its current rate, incidences of cervical cancer will have increased by 16% among 60 to 64-year-olds, and by a shocking 85% among 70 to 74-year-olds, by 2040. If screening coverage falls by another 5%, the mortality rate among 60 to 64-year-olds will double.

Age is not the only determining factor of one’s likelihood of being screened. One area of particular concern is that only 78% of black and minority ethnic women knew what a cervical screening test was compared with 91% of white women. This fell to 70% when looking at Asian women alone. Worryingly, only 53% of BAME women thought that screening was a necessary health test. This needs to be addressed, both nationally and within those communities.

The anxieties that all women were found to have about being screened, including embarrassment, worries about taking their clothes off in front of a stranger or discomfort with their body in general, are all heightened in particular ethnic communities with certain cultural norms. I have heard examples of mothers in certain minority ethnic households intercepting NHS screening invitation letters, leading to distress among younger women, who may experience cultural pressure that they should have maintained their virginity. If such factors put young BAME women off getting screened, that exposes them to significant risk of the disease. Particular focus should be paid to ensuring that mothers in those communities appreciate the dangers of cervical cancer, and that such cultural norms are not worth risking their daughters’ lives over.

We must ensure that coverage does not continue to fall. Indeed, it must be raised to an acceptable level, but the current outlook is mixed. A new report by Jo’s Cervical Cancer Trust for this year’s Cervical Cancer Prevention Week found that local provision is confused. While there is some evidence of best practice among local authorities and clinical commissioning groups, almost half of local authorities and almost two thirds of CCGs in England have not taken steps to increase cervical screening attendance in the past two years. The report also found regional disparities. In Yorkshire and Humber, 65% of CCGs had taken steps to increase screening, compared with just 18% of CCGs in the west midlands and the north-east. Similarly, 78% of local authorities in the north-west have taken action compared with just 33% in the east midlands. Perhaps most shockingly of all, in London, where coverage lags behind the rest of the country at just two thirds of women, 20 out of 32 local authorities reported no activity at all towards increasing screening coverage. That has all the appearance of a postcode lottery. We risk coverage continuing to fall in some areas of England while other areas make progress. Nobody wants a situation in which someone’s likelihood of developing cervical cancer is determined in no small part by the area in which they live. The Government should play their part to ensure that improvement happens across the board.

What can be done? We must seek to make access to cervical cancer screening as easy as possible. Screening takes five minutes and can save a life. Great strides have been made in recent years in making another simple test—blood pressure—available at every opportunity, which has been remarkably successful. There is every reason to expect that we could do the same for cervical cancer screening. However, I fear that the Government have taken a step in the wrong direction in recent years. Cuts to sexual health funding have led to a significant reduction in the provision of cervical screening through sexual health services. Jo’s Cervical Cancer Trust found that screening is available to all women through sexual health services in less than a third of areas, which again points to a postcode lottery. That seems like a grave misstep when over a third of women in the 25 to 29 age group expressed a wish to access screening through such services, while one in five women over the age of 50 wanted more flexibly timed access to screening. My GP practice offers cervical screening only every Tuesday morning, making access difficult and deterring many women from going for an appointment. I hope that the Government will look again at how much their cuts to local government funding have affected sexual health services, particularly the accessibility of cervical screening.

We must also move with the times. In addition to the cultural issues about invitation letters that I mentioned earlier, the use of letters is now old fashioned. While I appreciate that many NHS services across the country now use text message reminders, we should ensure that reminders to come in for screening are, to the greatest possible extent, accessible in the format of the patient’s choice, be that text message or email. Digital accessibility is necessary in the modern world. We must also be cautious about the wording of the reminders. It has been brought to my attention that the current NHS literature sent out with reminders reads:

“It is your choice whether to have a cervical screening test or not. This leaflet aims to help you decide.”

I fail to see how that in any way contributes to the aim of urging as many women as possible to attend cervical cancer screening. We already know that far too many women across all age groups and ethnicities are already content to put it off for a potentially dangerous length of time. I implore the NHS to reconsider the wording of the leaflets and to include a greater degree of urgency, because the phrasing will undoubtedly have an effect.

You will note, Madam Deputy Speaker, that I might not have been my usual challenging self this afternoon. Because of the gravity of the issue at hand, I happily recognise where the Government are on the right path. The inclusion of a commitment to increase cervical cancer screening in the 2015 cancer strategy is particularly welcome, as is the Government’s commitment to HPV primary screening, the implementation of which could prevent at least 400 cases of cervical cancer a year.

I will finish by asking several questions of the Government. Will the Minister commit to a national campaign to prioritise an increase in cervical screening attendance? How will the Government encourage co-operation between the different levels of the health service to ensure that we see cervical screening rates rising once again? Will the IT systems for HPV primary screening be up and running as planned, or will we experience unnecessary delays that could result in avoidable diagnoses? Will the Minister look at the quality and outcomes framework incentives for general practitioners to make sure that GP practices are really incentivised to improve cervical screening coverage? Finally, how do the Government intend to address problems with the accessibility of cervical cancer screening among particularly hard-to-reach groups, such as BAME women?

It is not unthinkable that we could see the effective eradication of cervical cancer if we take the necessary action. Although I applaud the Government’s existing programmes and their commitment to tackling cervical cancer, I hope that the Minister will take note of the research from Jo’s Cervical Cancer Trust—perhaps he will even work with it to identify where there are still gaps in provision—and take that action now.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Just before I call the Minister, I say to the hon. Lady that Jade Goody lived in my constituency. When she died, I wrote to her mother to say that her daughter’s death had not been in vain because it had drawn attention to the situation and had warned generations of women of the action that they must take to protect themselves and give themselves a chance.

I am shocked that the hon. Lady has drawn to the attention of the House this afternoon the fact that that has not been the case. I sincerely hope that her bringing this debate to the House this afternoon and the Minister’s attention to the points she has made—I am sure he is about to address them now—will reverse that situation.

NHS and Social Care Funding

Paula Sherriff Excerpts

Wednesday 11th January 2017 Commons Chamber

[Paula Sherriff (Dewsbury) (Lab)]

First, may I pay tribute to my hon. Friend the Member for Chesterfield (Toby Perkins) for his incredibly moving speech?

People are dying—literally. We are no longer saying people will die unnecessarily; we are now in the present tense, and we are hearing horror stories from around the country of people dying on hospital trolleys and at home waiting for ambulances to arrive. These are lives that could have been saved had it not been for this crisis.

People are dying in hospitals undetected by overworked nurses and other members of our amazing medical staff. A constituent of mine went to visit her grandad in hospital and, very sadly, found him dead in his bed on the ward. The overworked nurses had missed the fact that he was at the end of his life and had passed away. He died alone while his relatives were at home, unaware of how seriously ill he was.

I am bemused to hear Member after Member on the Government Benches standing up to defend the Government, when the facts are absolutely clear. They seem to be in severe denial. How can this be normal? How can the Government sit back and say that the solution is to discard the waiting time target? It is not the people who turn up with sore throats who are clogging up the system; it is genuinely sick people who desperately need medical attention.

Another constituent of mine arrived at A&E just last week, only to be told that she would have to wait at least 10 hours to see a doctor. That is not good enough. We are one of the richest nations in the world. It transpired that she had sepsis, a potentially fatal illness, and it is only because an overworked and stressed triage nurse recognised her symptoms and immediately instigated treatment that she is alive today and is able to tell me her horrendous story. Her treatment was started in the hospital corridor, where she sat on a chair while on an intravenous drip, because there were no beds available, not only in that hospital but in any of the neighbouring hospitals in the trust.

The theme is the same from all my constituents who come to me with their horrendous experiences. The doctors, nurses and other healthcare staff are doing absolutely everything they can. They are on their knees. No one wants to blame them, because they can see that what is being asked of them is far beyond what anyone would ever be asked to do in any other profession, but they can all see that the system is at breaking point. Instead of berating the Red Cross for suggesting that our NHS is in the midst of a humanitarian crisis, let us stop for a moment and think about why it had to use that term. Let us talk about what we can do.

We owe our incredible junior doctors so much, and they have been treated appallingly recently. A friend of mine recently attended an outpatient appointment at our local hospital and mentioned to the overworked junior doctor that I was an MP. He pleaded with her to tell me how bad things were, how overworked they were, how the NHS was crumbling around us, and how he and his colleagues could not perform to the best of their abilities due to the horrendous pressure they were under. He talked about working 12 to 14-hour shifts with a 10-minute break. He told her that he loved his job, saying that it was a vocation, never just a job. He said that he was proud of this country and its national health service, and that the only thing that kept him working here instead of fleeing abroad, as many of his friends had done, was that he cared so much for his NHS.

When is the Secretary of State going to stand up and take responsibility for what is going on? People are waiting hours for ambulances and waiting for hours in A&E. They are being treated on trolleys in seminar rooms and in corridors. Where does this end? We are already seeing the creeping privatisation of our NHS, with companies such as the dreadful Virgin Care putting profits before patients. Perhaps the end goal is for us to move to an American-style system where people are literally dying on the streets and where someone turns up at A&E and the first question is, “Have you got insurance, and can you prove it?”

My constituency is served by two hospitals: Dewsbury and district hospital and Huddersfield royal infirmary. Both are due to be downgraded, losing vital services and beds as their respective trusts struggle to meet the financial pressures that have been placed on them. One of the hospitals that is supposed to pick up the resulting demand from the downgrades, Pinderfields hospital in Wakefield, was last week warning people against attending its A&E, and this is before the downgrades have even taken place. I am in absolutely no doubt that if the downgrades go ahead, lives will be lost. I plead with the Ministers and the Secretary of State to stop those downgrades now and to bring forward the much-needed funds that could save the lives of my constituents. It was interesting to hear the Prime Minister refer to those hospitals today at Prime Minister’s questions. She said that there were two hospitals in the trust. Perhaps someone could pass on to her the fact that there are three.

I have quoted Nye Bevan, the founder of our great national health service, before, but I feel that this is more relevant today than ever. He said:

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

As those on the Conservative Benches appear to have lost faith and stopped fighting, it is our duty on the Labour Benches, now more than ever, to step up that fight. I would not like to speculate about when a Government Member last set foot in an NHS hospital outside of an official visit—[Interruption.]

[Henry Smith]

Between Christmas and new year.

[Paula Sherriff]

I thank the hon. Gentleman for his intervention. Perhaps he should show some more empathy for the patients who are waiting on trolleys for up to 10 hours just to be seen. One thing I know for sure is that many thousands of my constituents rely on such services every day and the message from them is unequivocal: the NHS needs funds, and needs them now.

I was admonished by Mr Speaker today for berating the Prime Minister during PMQs, but let me be absolutely clear: I will continue to do that while this mismanagement of our national health service is ongoing. I will never, ever stop fighting for our NHS.

Mental Health and NHS Performance

Paula Sherriff Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I am absolutely prepared to do that. We need to be open-minded about the fact that mental health, in some ways, is a relatively new field, and research on what works best is continuing to uncover many new things—much of that research is happening in this country. There has been a big move away from thinking that medication is always the best way forward. We have seen a huge expansion in talking therapies in the past few years in this country, and I am sure that trend will continue.

[Paula Sherriff (Dewsbury) (Lab)]

Despite the best efforts of dedicated NHS staff, patients attending one of my local A&Es were told that they would routinely have to wait 11 hours just to be seen. People were routinely on hospital trolleys for up to 20 hours. Mental health patients were sent to Colchester because it had the nearest available in-patient beds for 17-year-olds. Somebody I know waited six hours for a 999 ambulance, despite calling 999 three times. We can do better than that. To that end, I implore the Secretary of State—in fact, I plead with him—to intervene and suspend the needless downgrades of Dewsbury and Huddersfield hospitals, which will cost lives.

[Mr Hunt]

None of those examples of poor care is remotely acceptable. On my watch and under this Government we will see no return to the bad old days when people were routinely waiting far too long. [Interruption.] We recognise the problems that we have just had, and we are absolutely determined to make sure that we sort them out. If the hon. Lady’s local hospital reconfiguration ends up on my desk because it is referred by the local health scrutiny committee, I will look at the matter carefully and consider whether to refer it to the independent reconfiguration panel.

Social Care Funding

Paula Sherriff Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

The hon. Gentleman is quite right. I congratulated Halton and Warrington Councils on being two councils that have particularly low rates of delayed transfers of care. The fact that they are achieving that in spite of the budget constraints that he mentions demonstrates that this is not just about money; it is about quality, it is about leadership and it is about best practice.

[Paula Sherriff (Dewsbury) (Lab)]

The chief executive of Care England has said that under the current regime,

“about 40% of care services will no longer be viable,”

meaning that a number of services will be lost. When does the Minister intend to do something about this crisis?

[David Mowat]

The number of beds available in the system right now is about the same as it was six years ago. There is an issue with managing the financial performance of significant care providers. One thing we brought in two years ago was a robust process, led by the CQC, to look at the financial performance of the biggest providers and to warn us of any issues that may arise. We are very keen on pursuing that and making sure that it happens.

Community Pharmacies

Paula Sherriff Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

I can only repeat that we value the contribution that community pharmacies make, and that the savings that we shall propose shortly are needed for other parts of the NHS. We believe that provision will not be affected, and that other parts of the package, including the integration fund and the hiring of an additional 2,000 pharmacists for the GP sector, will make this sector work better than it does at present.

[Paula Sherriff (Dewsbury) (Lab)]

Does the Minister agree that should one in four community pharmacies close, the effect on the elderly, the vulnerable, the poor and those with long-term conditions could be very serious indeed, and potentially catastrophic?

[David Mowat]

We do not believe that the proposals that we will be announcing shortly will do anything to the detriment of any of those patient groups.

Oral Answers to Questions

Paula Sherriff Excerpts

Tuesday 11th October 2016 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

My hon. Friend is right to highlight the fact that the London ambulance service is in special measures and has been for some time. I visited it this summer and am pleased to confirm that some £63 million of additional funding has been provided to the ambulance service since April 2015. The service is starting to make significant inroads in increasing the number of paramedics who are available on call, with some 250 more being added over the last couple of years.

[Paula Sherriff (Dewsbury) (Lab)]

T2. Last October, the then Health Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), confirmed that my constituency fell far below the national average in terms of NHS dental provision. In fact, it is one of the worst in the country. Unfortunately, nothing has changed since then. Does the Secretary of State believe it is acceptable that my constituents, including many children, are unable to get an NHS dentist?

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is clearly unacceptable if the situation that the hon. Lady sets out is the case. I am happy to meet her and work with her to take the action that is needed to make things better.

--- Later in debate ---

[Mr Speaker]

I am sorry, but, rather as in the health service under any Government, demand has exceeded supply and we must move on.

[Paula Sherriff (Dewsbury) (Lab)]

rose—

[Mr Speaker]

I was keeping the hon. Lady waiting for only a moment, so that there was a due sense of anticipation in the House. That sense now definitely exists.

NHS Sustainability and Transformation Plans

Paula Sherriff Excerpts

Wednesday 14th September 2016 Commons Chamber

[Paula Sherriff (Dewsbury) (Lab)]

In common with many other Members, I have received hundreds of emails from concerned constituents about the sustainability and transformation plans and what they mean for the NHS nationally, regionally and locally. To provide some local context, my constituency covers an area that sits largely in the middle of two health trusts: the Mid Yorkshire Hospitals NHS Trust and the Calderdale and Huddersfield NHS Foundation Trust. There are four clinical commissioning groups: North Kirklees, Wakefield, Calderdale and Greater Huddersfield. We are in the borough of Kirklees Council, which serves a population in excess of 430,000.

The Mid Yorkshire trust is in the advanced stages of reconfiguration—or downgrade, as many people, including myself, see it. Dewsbury hospital will this week lose its consultant-led maternity unit, and there will be changes and reductions in services for acute surgery, gynaecology and paediatrics. Next spring, the A&E department will be reduced to an urgent care centre with no provision for acute services.

On the other side of my constituency sits the Huddersfield Royal Infirmary. The Greater Huddersfield and Calderdale CCGs have just completed a so-called consultation on their “reconfiguration of services”—or, once again, downgrades. If the proposals are accepted, the infirmary will have its A&E department downgraded and the whole of Kirklees, which includes all of my constituents, will be left without full A&E provision. That is over 430,000 people who will have to travel outside the borough to access vital emergency healthcare for themselves and their loved ones.

Kirklees is a vast geographical area that spans many towns and rural and semi-rural areas. Many people there rely solely on public transport as a means of travel, and parts of the borough are in the top 10% of the country’s most deprived areas, which brings about huge health issues and inequalities. The cuts to services are not improving life chances or enhancing healthcare provision; they are purely part of a cost-cutting exercise that could result in lives being put at risk. It has been reported just this afternoon that a senior representative from a local CCG has commented that it is almost as if NHS England is putting money before quality.

We now learn that the Government have set up STPs to look at health services on a larger footprint. Some might say that is akin to shutting the stable door after the horse has bolted. How can these STPs work, given that we are so far down the line already? The reconfigurations and downgrades that have been developed are being implemented completely in isolation from each other, with no regard for the wider population or the geographical boundaries that they cover. How can the STPs work—unless, that is, they have been put in place simply to implement further cuts to our already overstretched NHS services?

Sadly, we on the Opposition Benches have to acknowledge that our NHS is in crisis. We are genuinely fearful for the future of health provision in our country, and that fear is shared by many health experts. The British Medical Association has said that

“one of the key aims of STPs is to achieve financial balance by 2020”,

and that it has concerns

“that this will be the priority for STPs rather than developing the best models for patients.”

The King’s Fund has said:

“Our assessment of draft plans shows that, in the absence of eye-watering efficiency improvements, there will be a financial gap running into hundreds of millions of pounds by 2020/21 in most of the footprints”,

and that even with cost efficiency measures that are already being implemented,

“it will still not be possible to achieve the financial balance expected by national regulators.”

Its assessment of seeing one STP struggle to achieve its goals was that it was like

“attempting to undertake synchronised swimming against a rip tide”.

How many more years will we have to endure this, and how many lives will be lost before the Government admit that their “efficiency plans” are simply not working and that the only way fully to address people’s needs is to stop the cuts and to pledge more money to fund our NHS adequately?

A constituent contacted me this week desperately worried about a loved one who was suffering many health problems in hospital. I said to her the words that many of us have used many times over the years, “At least he’s in the right place; he’s in hospital, getting the best care”. Although I know at first hand how hard those on the front line of our health service are working and how much our incredible staff do in our hospitals, how much confidence can we have in those words nowadays? At a time of diminishing budgets and major cuts to services, can we really have confidence that our health services are adequate to provide the best care for our loved ones?

As Nye Bevan, whom I have quoted a number of times and will continue to quote, said:

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

Let it be known that I, along with my hon. Friends, will continue to fight tooth and nail to ensure that this Government do not succeed in destroying the health service that we hold so dear.

Mid Yorkshire Hospitals NHS Trust

Paula Sherriff Excerpts

Thursday 21st July 2016 Commons Chamber

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

I wish those Members departing the Chamber a good summer and thank you, Mr Speaker, for granting me the final debate before the summer recess. I also welcome the new Minister to the Dispatch Box.

I called this debate, following the one brought a few months ago by my hon. Friend the Member for Dewsbury (Paula Sherriff), because she, I and many Yorkshire Members are deeply concerned about the staffing levels not just at the Mid Yorkshire trust but at other hospitals across Yorkshire and the serious effect they are having on our health service. We have warned Ministers before about this, but we are deeply concerned that nothing is yet being done. Things will get worse if action is not taken.

Last year, I was contacted by a constituent, Mr Fanshawe, whose mother-in-law, Edith Cunningham, had recently died at the end of a short illness in Pinderfields hospital. As well as dealing with the grief and bereavement, Mr and Mrs Fanshawe were having to cope with the deep distress and anger caused by the way in which Mrs Fanshawe’s mother was treated and the care she received, in her final days and hours, because of serious staff shortages at the hospital.

Nursing staff were so overstretched that, at one point, Edith Cunningham had to wait two hours for a bed pan—two hours for an elderly lady in distress—and one weekend she had to wait 25 hours to see a doctor. It became clear to the Fanshawes that the staffing shortages on the ward were such that they could not leave her, so they stayed; they did her bed pans, they fed her, and when the pressure mattress they had requested was brought up, they changed it themselves, because there was no one else to do it.

I have met the Mid Yorkshire trust and the Fanshawes, and the chief nursing officer has given them a full apology and made it clear that it was an unacceptable level of care and that it was the result of staffing shortages on ward 43 at the time. Since then, the trust has continued to work on a wide range of recruitment and staffing initiatives to improve the situation.

[Paula Sherriff (Dewsbury) (Lab)]

I thank my right hon. Friend for calling this important debate. As she alluded to, I had a debate on this issue in March, but sadly it appears that little progress, if any, has been made. Last week, I attended a patient safety walkabout on ward 2 of Dewsbury hospital, and once again patients raised issues of short staffing. Several patients had been told not to ring their alarm bell at night because there was only one member of staff on duty. The number of beds on the ward had been increased from 24 to 30, but sadly no extra staff had been brought in to accommodate the extra patients. I plead with the Minister: we need tangible progress to ensure patient safety.

[Yvette Cooper]

My hon. Friend is exactly right. We hear continually from constituents often saying the same thing: the nursing staff are wonderful, look after them and work immensely hard, but are overstretched; there are simply not enough of them to do the job they want to do.

The trust has recruited not just locally but from across Europe and India, which has sometimes raised language issues. It is looking at new ways to recruit from the local area, and in some areas, the number of vacancies has fallen. It has also put in place processes to switch staff around to make sure that gaps are filled every day. I welcome the commitment by the chief nursing officer and the chief executive to do everything they can to fill the staffing gaps, but it is still not enough.

We agreed with the trust that the Fanshawes and the local health watch should be able to do an unannounced visit to ward 43, talk to parents and report on what they found. I quote from their report:

“Patients... reported kindness and very good care. Patients generally agreed that staff are lovely but are ‘run off their feet’”.

They found that staffing levels were better than last year,

“but it is still often a struggle and only rarely does the ward have the right quota of staff”.

Just this week, I received another email from another family with a relative in ward 43 raising serious alarms about the level of staffing on the ward and the level of care that their relative was being given. There were not enough healthcare assistants or nurses to provide the basic care and support needed. That fits with the findings last year of the Care Quality Commission, which also raised concerns about safe staffing levels. Once again, we cannot pay sufficient tribute to the kindness and hard work of the staff at the trust. However, when they are stretched in all different directions, it is in the end the patients who lose out and the staff who are deeply concerned because they are not able to provide the level of care that they want.

I am concerned, too, about the financial pressures on the Mid Yorkshire trust. It is not the only trust where the money received is simply not enough to meet rising demand. I suspect that the Minister will have been briefed on some of the financial pressures and the squeeze facing the Mid Yorkshire trust. There is a risk of services being cut not for sensible medical reasons, but simply because it does not have the funding or the staffing to provide them safely.

It is even worse than that. Even where the Mid Yorkshire trust has budgeted for the staff, it cannot recruit or retain enough to deliver the services in the way it wants and the way our communities need. The latest figures from the trust list 150 nursing vacancies: that includes healthcare assistants and safety support workers, and amounts to about 12% of budgeted posts. The vacancy rate for nursing staff in the theatre department is 17%, and it is 20% in intermediate care. If we take account of holidays, maternity leave, sick leave, stress, and temporary secondments to other departments, the gaps are bigger. Monitoring by department in May, which looked at the actual staffing relative to the planned levels wanted, showed cardiology at only 76%, stroke rehab at 65% and short stay at 70%.

The trust also measured unavailability, which encompasses the percentage of contracted hours lost owing to staff absence, including for sickness and stress. When some staff are working so hard, and some are also being moved around from one department to another in order to cope with gaps elsewhere, facing further stress and uncertainty, it leads to higher levels of absence.

[Paula Sherriff]

I shall try to be briefer in this intervention. I was recently contacted by Dewsbury hospital, and was told that, on any given day, the minimum staffing level in the A&E department is eight qualified nurses and four healthcare assistants or unqualified nurses. On this occasion, there were three nurses and one healthcare assistant. I think that speaks for itself; clearly, it will have an impact on patient safety.

[Yvette Cooper]

My hon. Friend is right, and these are the sort of individual examples that we increasingly hear about from our constituents—from both staff and patients. I have heard from staff in intensive care and in paediatrics who are deeply worried about the pressures and responsibility on them lest something should go wrong on their watch as a result of understaffing. They are deeply concerned that they will be unable to provide the care that is needed and are worried about the implications.

The trust’s planning guidance suggests that it can cope with up to 22% of the contracted hours not being provided and still provide a safe service. Beyond that, it shows that significant problems are likely to be encountered in delivering the right level of care. Overall, however, the gap is not 22%, but 26% for registered nurses and 30% for registered midwives. In A&E, the average shortfall in contracted hours is 30% and there is a similar 30% shortfall in children’s services. On some wards, the proportion of temporary staff from agencies and the NHS banks is particularly high. On acute assessment wards, 20% of the nursing staff are agency staff. On the short-stay wards, 11% of the nursing staff and 33% of the healthcare assistants are from agencies and the bank.

It is not just about the pressures on nursing staff. Senior staff at the Mid Yorkshire trust say that they are doing a huge amount of work to address the nursing shortages, but they are even more worried about the shortage of doctors—not just at Mid Yorks, but across Yorkshire. According to the Royal College of Physicians, 14% of the consultant posts at the Mid Yorkshire trust are vacant. In A&E and neurology, there is a particular problem, and there are regular and significant gaps in the contract rota for junior doctors. Some 15% of the acute medicine rota is not filled by contracted staff, and it is 18% for the emergency medicine rota, 20% for the anaesthetics rota and 20% for the surgery rota.

In practice, the trust is having to fill the rotas either with consultant staff acting down in more junior posts, or with locum staff. It is a choice between doing that and cancelling operations, or turning ambulances away. The trust is, of course, is committed to providing the best service that it can provide and not letting patients down, but locum care means that medical staff do not have the relationships or the knowledge of the system that would enable them to do the best possible job, and it costs far more as well. Because the trust cannot recruit enough contracted staff, its average spend on agency doctors in the first three months of the current financial year was £1.5 million a month—and, as we know, it is a trust that faces significant financial pressures. So what is it supposed to do?

However, this does not apply only to Mid Yorkshire Hospitals NHS Trust. In the country as a whole, two in five vacant consultant posts went unfilled last year, according to the Royal College of Physicians. In the north of England, there are serious staff shortages in our hospitals. That is what we hear from our constituents. My hon. Friend the Member for Dewsbury spoke of appointments being cancelled and waiting times being affected. What troubles me particularly is the fact that there is now a 20-week wait for the pain clinic. Because of staffing problems, patients who are suffering pain and could be supported and helped are having to wait 20 weeks to be seen.

What are the Government doing about this? All too often Ministers shrug their shoulders and think that it is someone else’s problem, or that someone else will sort it out. I contacted the Secretary of State in 2010 and 2011 saying that the training numbers that were being set by the Yorkshire and Humber Deanery, particularly for A & E, were not enough, and were certainly not enough to meet rising demand, but nothing was done. Given the scale of rising demand for healthcare and given our ageing population, far too few doctors are being trained. There is also a significant and serious regional disparity, with bigger shortages in the north and the midlands.

It is incomprehensible, given all those pressures, that the Government should choose this moment to pick a major fight with junior doctors that ends up demoralising them, and drives many of them to consider either going abroad or leaving the profession altogether at a time when we need every doctor we can get.

The Department of Health is also taking a massive risk when it comes to nursing staff. It is ending nursing bursaries, although in areas like ours that means that many people who could have become great nurses will be put off because they are worried about the debts that they will incur, and about not being able to afford the training. It is also refusing to give a proper assurance to the thousands of European Union citizens who work in the NHS—our trust has often recruited such people because of the shortages at home—that they can stay and fill those crucial posts.

Referring to nurse training, the Minister who responded to the debate initiated by my hon. Friend the Member for Dewsbury a few months ago said:

“Within the current spending envelope…it is simply not going to be possible to achieve the numbers that we wish to see.”—[Official Report, 21 March 2016; Vol. 607, c. 1354.]

That is not good enough. We need enough nurses, and enough doctors, to provide the care that our constituents need and deserve. That cannot simply be left to Mid Yorkshire Hospitals NHS trust, or to any individual trust in the country.

So many of the issues are linked, whether we are talking about the training numbers on which the deaneries decide or decisions made by the Department of Health that have an impact on morale, pay or incentives throughout the country. We now need a regional action plan setting out what the Government are going to do, and what NHS England is going to do, to address the serious shortages of both nurses and doctors in Yorkshire, because unless something is done, something serious will happen to patient care. I do not want to warn again about this, as I did some years ago, but it still has not been sorted out, and that is not fair on patients in Yorkshire and throughout our area.

In the case raised by Mr Fanshawe, Edith Cunningham had a family who stepped in and looked after her while she was in hospital, but many more patients do not have families who can fill the gaps and step in. So for the sake of all of those patients, and for all of those who we—all of us in all parts of the House—will want to get the best possible care, I urge Health Ministers to get a grip on this and get us the regional action plan we need, before patient safety is affected.

--- Later in debate ---

[Mr Dunne]

I will come on to what we are doing nationally to try to make sure we have an adequate number of trained professional clinicians to meet the needs around the country.

It is important to recognise that while nationally some standards are set for safe staffing ratios, which were referred to by the hon. Member for Dewsbury, these are not a hard-and-fast rule and never have been. They are guidance rather than statutory requirements, and this position has not changed. Trusts have to use their judgment and focus on quality of care, patient safety and efficiency, taking into account local factors such as case mix rather than just numbers and staffing ratios. It is not a case of meeting a particular staffing ratio or getting to a particular figure and thinking that the matter is resolved. There must be enough staff—as both hon. Members are saying—to meet the needs of the patients, and it is a matter for the clinicians on the spot to make a judgment on that.

Nationally, demands on our staff across the NHS are rising, and more patients are being cared for than ever before. That is as true of Mid Yorkshire as it is of anywhere else in the NHS. Last year, across the Mid Yorkshire Hospitals NHS Trust, 232,966 patients were seen, compared with 194,119 in 2009-2010. That is an increase of more than 15% over the past six years. There were also some 4,685 more diagnostic tests carried out in May this year than in May 2010. Activity levels are therefore rising considerably.

[Paula Sherriff]

I thank the Minister for his constructive tone in responding to the debate. Does he acknowledge that the significant increase in the tendencies is partly down to a crisis in primary care in the area? That sector is struggling to attract GPs and practice nurses, and people are therefore sometimes attending A&E inappropriately, instead of being seen in primary care.

[Mr Dunne]

It is well recognised across the country that the tendencies in A&E include a significant proportion of people who should not be there and who should be being dealt with elsewhere in the system. The reasons for that are legion; it is not all down to pressures on GPs. Much of it is down to members of the public increasingly seeing their hospital as the place to go. We have a big educational job to do across the country on that, and it behoves all of us to help to relieve the pressure on A&E by encouraging patients to get their health needs seen to in the most appropriate place, whether through a pharmacy or a GP, or through other community services.

I want to touch on the question of funding. It is not all about money, but money plays a part. As a result of the funding settlement that we have secured for NHS England, the Wakefield clinical commissioning group will receive £488.8 million in 2016-17—the current fiscal year—which represents a cash increase of just over 3% compared with the previous year. In cash terms, that is a £21.7 million increase—a significant increase compared with previous years. For North Kirklees, the other CCG that commissions the work of the trust, there was also an increase in the current year to £237.1 million, representing a 2.49% increase compared with 2015-16, or just a shade under £12 million. That increase is substantially greater than the deficit reported by the Mid Yorkshire trust for last year. Of course, the commissioning funds do not all go to the trust, but the health economy in the area has received a significant cash injection.

Ensuring that we have the right number of nurses —I shall start with nurses—is a vital move towards achieving the Government’s objective of having a fully seven-day NHS by 2020. Nationally, we already have 11,800 more nurses, midwives and health visitors than we did in May 2010. The number of nurse training places has increased by 14% over the past three years alone, with further increases planned in the current year. More than 50,000 nurses are currently in professional training, which includes working and learning in hospitals through placements. However, the current funding system means that two out of every three people who apply to a university to do a nursing degree are not accepted for training. That is one of several reasons why trusts such as Mid Yorkshire find it difficult to recruit.

In 2014, the last full year for which I have statistics, universities were forced to turn down 37,000 nursing applicants. As a result, the NHS suffers from a limited supply of nurses and must rely on expensive agency staff and overseas workers, as referred to earlier. That is one reason why, earlier today, the Government announced their response to the public consultation on plans to place trainee nurses in the same system as all other students, including teachers and doctors. That response has been placed in the Library.

[Mr Dunne]

I will come to how we will respond when I conclude my remarks, but the right hon. Lady is quite right to point out that the problem is not unique to this particular trust and must be seen in a regional context.

[Paula Sherriff]

I also thank the Minister for his generosity. I just want him to know that the public meeting unfortunately did not go ahead owing to the tragic death of our colleague from Batley and Spen. However, given the staffing crisis and the fact that Mid Yorkshire is still undergoing a significant downgrade programme that will see Dewsbury hospital reduced to a minor injuries unit and many patients having to go to Pinderfields Hospital in Wakefield, will the Minister please reconsider the plans?

[Mr Dunne]

The short answer is yes. I intend to honour a commitment to meet the local trust—I would be happy to facilitate a meeting for the local MPs as well—to talk about the reconfiguration plans that are afoot.

I am conscious that I am in the unusual position of winding up an Adjournment debate at this stage of the parliamentary calendar and in danger of running out of time, so I will turn to the reconfiguration plans before I conclude.

We have to look at staffing issues, wherever they are, and at all the nursing specialisations in the hospital that were referred to earlier in the context of the wider reconfiguration of services currently going on within the trust and the sustainability transformation plans within the region later this year. The reconfiguration is driven by the need to address long-term systemic problems, some of which I touched on earlier. The current service changes were agreed back in 2013 and were supported by the Secretary of State in 2014 following the advice of the Independent Reconfiguration Panel.

Implementation of the agreed service changes at the trust is a matter for the local NHS, which is undertaking detailed work to assess fully the benefits and risks of bringing the changes forward. The process will look primarily at safety and quality, as well as capacity across the system, and will take local stakeholder views into account. Local commissioners will make the decisions about precisely what is to happen, and it is for the local NHS to keep all service change under review in line with its role in ensuring that the services provided are high quality, safe and sustainable. Staffing levels at the trust, particularly in nursing, remain a concern, and are regularly identified by the trust’s regulators and commissioners.

The trust has taken some action to address those concerns, including recruitment of additional nurses and non-qualified support staff as well as strengthening safe staffing policies and increasing board level scrutiny. Clearly, that has not solved the problem, as we have heard so graphically this evening, and more needs to be done.

The trust believes that benefits could be realised in bringing forward implementation of the service changes with improved clinical safety, efficiency and patient flow. I am aware that concerns are being expressed about the knock-on effects of the proposal for changes nearby in Calderdale, of which the hon. Ladies will be aware, and that is currently under consultation.

Change at each of these trusts should not be looked at in isolation, particularly in an area such as this with so many interdependencies and challenging geography and local public transport. Following the meeting of my predecessor, my right hon. Friend the Member for Ipswich (Ben Gummer), with the hon. Member for Dewsbury (Paula Sherriff) and the late hon. Member for Batley and Spen (Jo Cox) earlier this year, he agreed to facilitate a meeting in September with the regulators—NHS Improvement, the CQC and the NHS providers and commissioners. I will undertake to ensure that that meeting goes ahead.

Question put and agreed to.

Junior Doctors Contract

Paula Sherriff Excerpts

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

My hon. Friend obviously speaks from experience and very sensibly on this issue. In this House, of course, we think about the actions of politicians, Ministers and so on, but for doctors in a hospital, the most important component of their morale is the way that they are treated by their direct line manager. One of the things that worries me most in the NHS, looking at the staff survey, is that 19% of NHS staff talk about being bullied in the last year. That is ridiculously high. We need to think about why that is. The reality is that it is very tough on the frontline at the moment. There are a lot of people walking through the front doors of our NHS organisations, and we need to do everything that we can to try to support doctors and nurses, who are doing a very challenging job.

[Paula Sherriff (Dewsbury) (Lab)]

Instead of blaming the BMA, will the Secretary of State acknowledge that yesterday’s result was indicative of the fact that a significant proportion of medical staff have lost confidence in him? More than ever, running the NHS requires the good will of its staff. How does he intend to restore that confidence?

[Mr Hunt]

Actually, in my statement I took the trouble to praise BMA leaders. Admittedly, at the outset I did not agree with their tactics at all, but they did then have the courage to negotiate a deal and try really hard to get their members to accept it. I respect them for doing that. Part of the problem was that in the early stages of the dispute, there was a lot of misinformation going around. There were a lot of doctors who thought, for example, that their salary was going to be cut by about a third. That was never on the table and never the Government’s intention. A lot of doctors thought that they were going to be asked to work longer hours. That, too, was the opposite of what we wanted to do. I am afraid that that created a very bitter atmosphere. I simply say that, in the end, the best way to restore morale is to support doctors in giving better care to their patients, and that is what the NHS transformation plan is all about and what we are working on.