Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 6th June 2023 Commons Chamber

[Mr Philip Hollobone (Kettering) (Con)]

Kettering General Hospital is aiming to submit its final business case for its £34 million net zero energy centre in December, but has been told that when it does so, it can expect at least a 13-week wait for approval. The Secretary of State has been good enough to see for himself the urgent need for this new power plant. Is there anything he can do to speed up this process?

[Steve Barclay]

I share my hon. Friend’s desire for us to move at pace on the scheme. As he says, I have seen at first hand the importance of the scheme at Kettering, and I stand ready to work constructively with him to expedite that case, because I do not think anyone is in any doubt of the importance of the work at Kettering. It is a huge tribute to him and the way he has championed the case for Kettering that it was such a central part of the new hospital programme announcement.

New Hospitals

Philip Hollobone Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

As I touched on a moment ago, there are a range of initiatives across the NHS estate. The leadership team from the Getting It Right First Time programme, including Professor Tim Briggs, recently visited Wycombe to discuss proposals with the senior clinical team, and we look forward to working constructively with the local integrated care system as it designs the right fit for Wycombe and the wider system.

[Mr Philip Hollobone (Kettering) (Con)]

I thank the Secretary of State for his personal interest in and commitment to Kettering General Hospital and his visit to the hospital last July. Will he confirm that Kettering General Hospital’s place in the new hospital programme continues to be secured with a fully funded, redeveloped, improved and expanded hospital due on the existing site by 2030, in line with the original timeline?

[Steve Barclay]

As I set out in my statement, the place of Kettering in the new hospital programme is secure. That is in large part a result of my hon. Friend’s campaigning. He has raised this issue with me on a very regular basis and shown me at first hand the issues at Kettering. He has championed investment in Kettering General Hospital, and today’s announcement is a very positive day for the staff and patients of Kettering.

NHS Strikes

Philip Hollobone Excerpts

Monday 6th February 2023 Commons Chamber

[Will Quince]

I thank the hon. Lady for her question, but she could not be more wrong. I was in Darent Valley hospital today and I was in Watford hospital last week, and I have the utmost respect for all those who work in our NHS. Everybody in this Chamber wants those who work in our NHS—in fact, all public sector workers—to be paid more, but the independent pay review process is a tried and tested process that has been used for more than 40 years, and it is important that the unions engage with it so that we get this right from April.

[Mr Philip Hollobone (Kettering) (Con)]

Due to the covid pandemic, the NHS has a large care backlog, which my constituents in Kettering are keen to see addressed. Will the Health Minister confirm that spending on the NHS is at record levels and that the Government have a plan to reduce NHS backlogs, which the strikes are disrupting? For every day of NHS strike action, how many NHS operations and procedures are lost?

[Will Quince]

I will gladly write to my hon. Friend on the specifics, but he is right to point out that NHS spending in England this year is about 11.4% higher in real terms than it was in 2019-20. He is right to point to his constituents on the waiting lists, and I want to get the numbers down as quickly as possible, particularly for those who have been waiting the longest. On top of a £2 billion recovery fund, we have invested £8 billion over three years; we have already opened 92 community diagnostic centres, and we will open 160 by March 2025; and we have opened 89 surgical hubs, with an aim to open 140. Our aim is 9 million more treatments and diagnostic appointments by 2024, so that constituents of my hon. Friend who have been waiting too long get that service.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 24th January 2023 Commons Chamber

[Maria Caulfield]

I thank my right hon. Friend for her kind words. I absolutely agree on that, which is why helping women back into work and dealing with their health issues in the workplace is one of the first eight priorities of the women’s health strategy. We are working with colleagues in the Department for Work and Pensions on that. Last night, I had a roundtable with tech and STEM— science, technology, engineering and maths—employers, and they were desperate to keep their women in the workforce and to recruit more. Whether we are talking about young women who need support as they go through endometriosis or IVF treatment, or older women who are dealing with the menopause, we are absolutely committed to supporting women’s health needs in the workplace.

[Mr Philip Hollobone (Kettering) (Con)]

I welcome the recent announcement of enhanced breast cancer facilities at Kettering General Hospital. Is that not just the sort of extra investment we need to improve the delivery of women’s health services?

--- Later in debate ---

[Steve Barclay]

I am not sure how many times one needs to say the same point. The Government’s position on this is clear: we are committed to treatment free at the point of use. That is the Government’s position, and it has been throughout the NHS’s history, the majority of which has been under Conservative Governments.

[Mr Philip Hollobone (Kettering) (Con)]

How many operations have been lost to strike action in the NHS so far?

[Will Quince]

On an average strike day, I believe it is about 2,500.

NHS Winter Pressures

Philip Hollobone Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

I agree that a combination of pay and wider conditions have an impact on recruitment and retention. That is why we have been keen to engage constructively with the trade unions; we had a good discussion earlier today. We recognise that there is a range of factors. To take the example of paramedics, the feedback from my discussions with a number of paramedics was that their frustration about handover times and the delays that they were experiencing was more important to them than pay. It is important to have discussions through the independent pay review bodies about pay, what is affordable and what is the right balance, but a range of non-pay factors are also extremely important to staff.

[Mr Philip Hollobone (Kettering) (Con)]

The biggest flu outbreak in 10 years has seen Kettering General Hospital become the 28th busiest hospital in the country, with a bed occupancy rate of 96.5% in the week leading up to the new year. The Secretary of State was kind enough to visit it last year and stood in the busy and overcrowded A&E. He was also good enough to visit Thorndale care home, where he was briefed on the fact that the rate of increase in the number of over-80s in Northamptonshire gives it one of the fastest-growing elderly populations in the country. In thanking the Secretary of State for the measures that he has outlined today and the extra funding, I ask whether he will ensure that Northamptonshire, North Northamptonshire Council, the Northamptonshire ICB and, crucially, Kettering General Hospital get their fair share of the funding that he has announced, so that we can tackle these winter pressures quickly and successfully?

[Steve Barclay]

My hon. Friend is right to point to the real pressures at Kettering which, as he says, I have visited. Not only am I keen to see it get its fair share, but I know that he will absolutely champion it through his good offices to ensure that that is the case, as he always does. He also raises an important point that the pressure of an ageing population is not universally distributed but is more intense in certain areas than others. Again, in our scrutiny of the data, I am keen to look at how that plays out in the variation in performance between trusts because, as I said, 15 trusts account for 56% of ambulance handover delays and there is significant variation across the NHS. Understanding what is driving that, such as different ageing profiles between different areas, is a key part of our recovery plans.

NHS Staffing Levels

Philip Hollobone Excerpts

Tuesday 22nd November 2022 Westminster Hall

[Several hon. Members rose—]

[Mr Philip Hollobone (in the Chair)]

Order. The debate can last until 4 o’clock. I am obliged to call Front Benchers no later than 3.27 pm. The guideline limits are 10 minutes for the Scottish National party, 10 minutes for His Majesty’s Opposition and 10 minutes for the Minister. Margaret Greenwood will have three minutes to sum up the debate at the end. Nine speakers are seeking to take part so we have a time limit of four and a half minutes. I will be grateful if hon. Members stick to that.

Pancreatic Cancer Awareness Month

Philip Hollobone Excerpts

Tuesday 8th November 2022 Westminster Hall

[Several hon. Members rose—]

[Mr Philip Hollobone (in the Chair)]

Order. The debate can last until 11 am. I am obliged to call the first of the Front Benchers no later than 10.27 am. Guideline limits are 10 minutes for the SNP, 10 minutes for His Majesty’s Opposition and 10 minutes for the Minister. Jim Shannon will have three minutes at the end to sum up the debate. The next 30 minutes are Back-Bench time. There are three Members seeking to speak, the first of whom is Siobhan Baillie.

World Menopause Day

Philip Hollobone Excerpts

Thursday 27th October 2022 Westminster Hall

[Carolyn Harris]

I certainly agree with the hon. Lady. I myself spent eight years on antidepressants, believing that I had mental health problems, only to discover that I was actually menopausal. I can assure everyone that that was a relief.

I urge the Minister, his colleagues and any Member who does not have a copy—copies are available in my office—to read the book, and to join the campaign for change and for better access to menopause care. As I said, it has been almost a year since the first Westminster menopause rally, which followed the introduction of my private Member’s Bill, the Menopause (Support and Services) Bill.

Since then, we have seen a Government in chaos. There have been three different Health Secretaries, but now one has returned. An HRT tsar has come and gone within a few short months, leaving merely a list of recommendations. The HRT stock crisis rumbles on, months after the Department of Health and Social Care promised that it would be resolved. We still await the promised annual prepayment certificate for HRT prescriptions in England. As families up and down the country struggle with the costs of fuel, food and energy continuing to rise at an alarming rate, the prepayment certificate is more important than ever. Choices are being made on where to cut back on household expenses and on which luxuries can go. Menopause is not a choice and HRT is not a luxury but, for many women, the monthly cost of their prescriptions will be one of the casualties of family finance cutbacks. It is therefore vital that the promised prepayment certificate is implemented as soon as possible—women have already waited a year. The latest date we were advised for its introduction was April 2023. I would be grateful if we could have a guarantee from the Minister today that this will not slip any further.

Around the same time as my private Member’s Bill on menopause, the all-party parliamentary group on menopause, which I chair, launched its inquiry into the impact of the menopause. Earlier this month we published our latest report, which highlighted a number of areas where urgent change is vitally needed, including a call for better training for medical professionals. Stories from “It’s Beyond a Joke” show just how much that is needed. One woman says:

“The GP doesn’t want to ‘dabble’ in drugs with me”.

Another writes:

“The GP had no idea…Despite me telling him how much better I felt on HRT, it seemed that he was only concerned with getting me to stop taking it as soon as possible”.

A third shares:

“I spoke to my female GP. Her response when I mentioned the menopause was ‘Well you’re about the right age’. She prescribed antidepressants”.

Evidence taken during the APPG inquiry saw the same pattern of misdiagnosis, ongoing symptoms and repeated appointments with GPs. I am not blaming GPs. At most, they will have had only a few hours’ training on the menopause during medical school, and some will have had none at all. I am pleased that the women’s health strategy commits to changing that, but it really does not go far enough. The women who are suffering now cannot wait seven years for current medical students to enter practice. We need a programme in place to upskill those who are practising and prescribing to support women today and ensure that everyone who needs it has access to accurate and comprehensive information and treatment.

We also need the Government to make resources available to the health service to allow it to provide this training and support to help it to improve its menopause service. Adding menopause to the quality and outcomes framework would also help. Incentivising doctors to improve their knowledge of menopausal symptoms and treatment options would undoubtedly increase levels of diagnosis and, ultimately, benefit patients.

The APPG report also recommends that all women be offered a specific menopause check-up with their GP. Identifying and addressing symptoms early is vital. We know that some women will go through perimenopause and reach menopause early on. For some, this is due to medical treatment or surgical procedures, while for others it is due to a natural decline in their hormones. For a high percentage of women, an appointment in their 40s to discuss symptoms and treatment could be life-changing. Early detection saves women not only months and possibly years of unnecessary pain and anguish, but careers, relationships and lives—it is no coincidence that the suicide rate among women increases by 16% between the ages of 45 and 55.

We also need to look at the postcode lottery that women face in accessing HRT. The stark divide between those who can afford to see a private menopause specialist and those who cannot, coupled with the different products offered as primary treatment options in different parts of the country, results in women from lower socioeconomic communities being far less likely to be able to access the best care. Evidence taken during the APPG inquiry made a clear case for the need for a national formulary, which would allow prescribers across the country to offer their patients a choice of all available HRT products.

Another issue that became a key topic of both the report and the book is support in the workplace. A report published earlier this year by the Fawcett Society found that, shockingly, one in 10 women is leaving the workplace due to a lack of support, with thousands of others reducing hours and avoiding promotion. This trend was echoed in the evidence sessions during the APPG’s inquiry and the stories submitted to the Menopause Mandate book. One woman said:

“I have had to recently step down from my role at work as I’m still not able to perform at the level needed…I tried to keep my chin up and work through, but this failed.”

Another wrote:

“I had to retire early, aged 59, as I simply couldn’t cope anymore. So, I lived in poverty for four years. I had so little money I bought no new underwear until I got my pension. I even stole toilet paper from cafes to make ends meet.”

Another woman said:

“I was dismissed from my job because of my debilitating symptoms…I was told by my employer that I was ‘fabricating an illness’. According to them, I had made it into work and looked fine.”

She was told that there was nothing wrong with her.

Such stories are devastating and, sadly, far too common. Thankfully, we are seeing change, and employers are gradually realising that they need to do more. Just two weeks ago, I hosted an event alongside Swansea City football club for businesses in Swansea to learn more about what their staff are experiencing and what employers can do to help. I was delighted by the turnout and was particularly encouraged by the desire among employers in my city to do so much more. I would love nothing more than for Swansea to be a city that really understands and embraces the menopause, and this week I saw signs of that beginning to happen. I went to watch the football on Sunday—the Swansea-Cardiff derby—and I was astounded by the number of men who came up to me, congratulated me on the work I am doing on the menopause, and asked for selfies to show their wives, so that their wives would be proud that they had spoken to the menopause MP. I hope that translates into votes.

By contrast, I heard of a woman who had gone to see her GP for some help for her symptoms. She was told by her GP, “That Carolyn Harris has a lot to answer for.” Well, perhaps I do, but is it really too much to ask that those who are suffering have access to the best possible care and treatment, and that menopausal women across society are given the attention and respect that they deserve in medical settings, in families and in the workplace? Currently, only a quarter of businesses have menopause support policies in place, but by making simple adjustments, employees will feel valued and, ultimately, businesses will retain loyal and experienced members of staff.

We really are just at that start, and I hope that the Government will sit up and listen and prioritise this area of women’s health. Progress is slowly being made, and the conversations taking place in the media and across communities are wonderful to see, because the more we talk, the more we learn. But it is not enough on its own. Support remains woefully inadequate, which, for 51% of the population, is really not good enough.

Twelve months ago, Government Ministers stood at the Dispatch Box and promised that change was coming. Twelve months ago, women celebrated triumphantly in Parliament Square. Twelve months ago, we all felt that our voices were finally being heard. Twelve months on, our economy is very fragile, families are struggling and menopausal women feel that they have been let down. We cannot keep waiting for the Government to fulfil the promises they have made.

Some colleagues in this Chamber will have been lobbied by their constituents to attend today’s debate. Many will have posted menopause-related content, which I know will have been well received by their constituents, because the menopause revolution is marching on. We are not going away. We are not going to stop asking for what is needed, and we will not be silent. We are not asking for special treatment, and we are not asking to be treated differently. We just want the resource, the respect and the support for women to experience the normality that the menopause can all too often rob them of.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 4.30 pm. I am obliged to call the Front Benchers at no later than 3.57 pm, and the guideline limits are 10 minutes for the Scottish National party, 10 minutes for His Majesty’s Opposition, and 10 minutes for the Minister. Then, Carolyn Harris will have three minutes to sum up the debate at the end. It is Back-Bench time until 3.57 pm and eight Members wish to contribute. There is a strict four-minute limit and I strongly discourage speakers from accepting interventions, because if you do, it means that somebody will drop off the list. If you keep it to four minutes, everybody will get in.

Kettering General Hospital Redevelopment

Philip Hollobone Excerpts

Wednesday 26th October 2022 Westminster Hall

[Peter Dowd (in the Chair)]

Order. Can people kindly leave the Chamber, please? I will call Philip Hollobone to move the motion, and then the Minister to respond.

[Mr Philip Hollobone (Kettering) (Con)]

I beg to move,

That this House has considered redevelopment of Kettering General Hospital.

It is a genuine pleasure to see you in the Chair, Mr Dowd. I thank Mr Speaker for granting me this debate, and I welcome the Minister to his place. The redevelopment of Kettering General Hospital is the No. 1 local priority for all residents in Kettering and across north Northamptonshire because our hospital is a much-loved local institution. It has been in the town of Kettering since the year of Queen Victoria’s diamond jubilee, in 1897. That was a great year for Kettering because of the establishment of not only the hospital but the much-loved local newspaper, the Northamptonshire Evening Telegraph. Here we are, 125 years on, with an extremely exciting programme of investment going into the hospital. It is such an important issue that this is now my ninth debate on Kettering General Hospital and my sixth since September 2019. We really want this redevelopment programme to succeed.

I want to start by acknowledging the Government’s commitment to the hospital, because they have pledged a massive amount of money, totalling £563 million. That includes the write-off in 2020 of £167 million of trust debt; an award of £46 million, initially to develop an on-site urgent care hub; and the main investment of £350 million—which was always going to be for 2025 to 2030—under health infrastructure plan 2 funding, for the major redevelopment of the hospital. I welcome that very much indeed. However, pledges of investment are one thing; actually delivering the cash is another. That is why this is now the sixth debate since September 2019. I see it as my role to constantly prod the Government to ensure that the investment is forthcoming.

We need that investment because Kettering and north Northamptonshire are among the fastest-growing places in the country. The hospital serves the population of Northamptonshire and south Leicestershire, which has already grown by double the national average over recent years. The latest Office for National Statistics data estimates above-average percentage population growth of up to 40% over the next 30 years in all three components of population change—net within-UK migration, net international migration and net births and deaths. Corby also has the country’s highest birth rate. The hospital expects a 21% increase in the number—

--- Later in debate ---

On resuming—

[Mr Hollobone]

As I was explaining before our debate was interrupted by votes in the House, the redevelopment of Kettering General Hospital is badly needed. Corby has the country’s highest birth rate, and the hospital expects a 21% increase in the number of over-80s in the local area in the next five years. The area has committed to at least 35,000 new houses over the next 10 years, and the local population is set to rise by some 84,000 to 400,000 people. The accident and emergency unit already sees up to 300 patients every single day in a department that is sized to safely see only 110. Over the next 10 years, the hospital expects the number of A&E attendances to increase by 30,000, up from 100,000. That is the equivalent of almost 80 extra patients a day.

Basically, the A&E is full. It was constructed in 1994 to cope with just 45,000 attendances each year, but 170,000 attendances are expected by 2045. Seventy per cent. of the buildings on the main site are more than 30 years old, and there is a maintenance backlog of £42 million. Sixty per cent. of the hospital estate is rated either poor or bad. Local people all know that investment is badly needed, and the Government have rightly accepted that.

I was delighted when the then Health Secretary, my right hon. Friend the Member for Suffolk Coastal (Dr Coffey), and the newly reappointed Health Secretary, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), came to visit the hospital on 22 July. The Minister has a photograph, which I have shared with him, of the Health Secretary standing in front of the temporary power plant, which is now 10 years old. It was hissing, spluttering and sneezing in front of us. That is why the newly redeveloped hospital needs a new energy centre.

One month after the visit, I was delighted to get a nice letter from the Secretary of State, which stated:

“Further to my visit on 22 July to Kettering General Hospital. I write to confirm approval of the funding you requested for enabling works for the next phase of the new hospital.

We discussed how the hospital presently relies on a temporary steam boiler plant and your concerns with the main high voltage electricity supply. You made a compelling case. I can therefore confirm that up to £34m is approved for investment in the new Energy Centre and enabling works, together with a further £4.1m for the high voltage cable. This will now enable this work to commence, and is a positive step forward in providing the facilities staff and patients need.

At our meeting we also discussed the scope to apply the new Hospital 1:0 design, through which the NHS will now procure and build new hospitals, enabling a quicker Treasury approval process, economies of scale delivering better value for money, and faster construction timescales unlocking earlier operational delivery. I look forward to working with you on this as we progress the wider programme of work at Kettering General Hospital.”

That is fantastic news, and we need the project to start as soon as possible. The present timescales that the hospital has provided me with suggest that the electrical work for the new high-voltage cable, for which the hospital has the money, can start in April or May 2023 and be complete by the end of the year. As for the energy centre itself, between now and January 2023, the hospital intends to appoint a construction partner. It aims to complete its final business case by early summer next year, with subsequent approval by the Department of Health and Social Care. Construction will potentially start in December 2023 and be complete by December 2024. The good news is that local residents can expect to see works starting on site in the spring of next year.

The trust has received written approval, not only from the Secretary of State but from the joint investment committee of the Department of Health and Social Care, to progress with the next stage of its plans to build the new energy centre. The next stage is to appoint a construction partner to take the scheme to the final stage of design and to submit a full business case. The total cost is £38.2 million, which includes £4 million for upgrading the electrical intake to the site. To manage the risk of further inflation—which is running at 10% nationally—the trust is looking for commitment from the Department’s new hospital programme team to work on the final business case together, in order to prevent delays in later approvals. I would welcome the Minister’s support for that.

There is also a number of other small enabling works that are “final scheme option agnostic”—in other words, whatever the final design of the newly redeveloped hospital after 2025, those enabling works will be required. They are on a critical path for the hospital to start now in order to keep things on track. Those costs, including the £38 million that has been allocated, are all covered by the initial allocation of £46 million already awarded to the trust. They sit outside the national new hospital programme budget. However, the trust has been told by the new hospital programme team that it cannot proceed with those additional small enabling works. I seek the Minister’s intervention to try to unblock that refusal.

The national new hospital programme team has stated that it is not reviewing overall outline business cases for the main build after 2025 until the end of this year at the earliest. That is a shame; I think it should be sped up. The 2025 timeline for the main new building works to start therefore remains at risk. Will the Minister support Kettering hospital trust with £400,000 of capital in this financial year to progress a small number of other works that are on the critical path? That is not a huge sum of money, and it would enable the scheme to be completed earlier.

Will the Minister encourage the new hospital programme team to co-produce, with the hospital trust, the full business case for the energy centre to minimise further inflation risk related to delays? Will he recognise the advanced position of the overall Kettering scheme, its minimal risk and its ability to make visible, significant progress faster than bigger, more complex schemes, by prioritising it among the current wave three and four schemes?

Since the Secretary of State’s visit, the trust has received official approval from the joint investment committee of the Department of Health and Social Care for the energy centre business case. That approval understandably came with a number of conditions, which the trust and the national team are proactively working through together. That is based on the estimated cost of £38 million. Importantly, it has been agreed that the trust can start the procurement process for a ProCure23 construction partner to develop the energy centre scheme to the next level of detail, and to build the centre.

Following a question from the joint investment committee chair, the trust itself has made a proposal for how it could work with the national team to co-produce the full business case for the energy centre, so that the approval process can be as speedy as possible and inflation and procurement matters can be best managed. That was warmly received by the joint investment committee chair. Timescales for completion remain late 2024, but they could be advanced through such an approach. I encourage the Minister to actively support us in that bid.

In terms of moving other smaller enabling works forward, the trust has set out which elements are on the critical path for a main build start date after 2025. All elements are agnostic about which final option is approved for the main build, but if they do not start soon, they will affect the trust’s ability to make visible progress on the main scheme once approved. Those elements include the creation of a new car park for patients and staff to replace those lost once construction starts, and moving staff and clinical services into Kettering town centre to free up space on the site for any new build to begin. That also supports the levelling-up agenda and the regeneration of Kettering town itself. I remind the Minister that Kettering is a priority 1 area for levelling-up funding.

The trust is requesting £400,000 in the current year to help to progress those elements, but it will require a total eventual early drawdown of around £8 million for the essential enabling works across the calendar years 2023 and 2024. It is worth noting that adding that £8 million to the £38 million for the energy centre brings the total to the original £46 million sustainability and transformation plan wave 4b funding, which is already part of the trust’s allocation. It is not subject to the larger new hospital programme budget; however, up to this point the trust has so far been told that it cannot progress the additional enabling works.

The hospital’s business case for the main £350 million clinical scheme was submitted on 6 July, and the current national position is that none of the waves 3 and 4 schemes is being considered or reviewed. The trust scheme is a wave 4 scheme, and therefore the hospital is unable to progress any further until the timescales are improved. I emphasise to the Minister that the Kettering General Hospital NHS Foundation Trust scheme continues to be ready to progress to the next level of detail, and remains a relatively low-risk scheme to deliver visible progress for the national programme quickly. The hospital already has pre-application planning approval. It does not require public consultation or new land negotiations. It is fully supported by the relevant clinicians and the local integrated care board, and it meets all the key national requirements in terms of net zero carbon and digitalisation.

The hospital is confident that, compared with other larger, more complicated and less advanced schemes, the Kettering scheme offers the national programme an excellent opportunity to push forward a scheme to construction stage by early 2025. Kettering General Hospital and its redevelopment is the No. 1 local priority for local residents. The Minister’s own constituents use Kettering General Hospital on a regular basis. This is a nimble scheme that will deliver early clinical benefits to local patients. I urge him to get fully behind it, so that Kettering can have the redeveloped hospital that all local residents want and need.

Unavoidably Small Hospitals

Philip Hollobone Excerpts

Tuesday 6th September 2022 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

Welcome to Westminster Hall, and to the debate on unavoidably small hospitals. I call Bob Seely to move the motion.

[Bob Seely (Isle of Wight) (Con)]

I beg to move,

That this House has considered unavoidably small hospitals.

Thank you very much, Mr Hollobone; as ever, it is a pleasure to serve under your chairmanship. I thank the Minister for being here, and I wish her luck in any coming reshuffle. I also thank colleagues from Yorkshire, Devon, Cornwall and other parts of the United Kingdom for being here. Indeed, we have two Members from Yorkshire—my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) and my right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak). It is a delight to see them both. I saw one quite recently on the Isle of Wight, but sadly not both.

The debate was originally granted prior to the covid pandemic. Clearly, much has changed since then, but I also wonder whether the fundamentals of unavoidably small hospitals have changed. The reason why I called the debate back then, and why I want it now, is that I fear they are still the poorer cousins of larger district general hospitals.

I will make two points. Clearly, I am going to talk specifically about St Mary’s Hospital on the Island, because it is in my constituency, but there are broader points to be made about unavoidably small hospitals throughout the United Kingdom. I want specifically to ask the Minister to put as much information as possible about the funding processes for unavoidably small hospitals in the public domain. We were talking prior to the debate, and she said that some of that information rests with the new integrated care boards. That may well be the case, and that is fair enough, but they are not elected bodies. We know that the NHS can be rather top down and bureaucratic in some of its behaviours, and the more information she can put in the public domain to help Members with unavoidably small hospitals understand the situation, the better.

Before I address that further, let me put on record my thanks not only to staff at St Mary’s but to GPs on the Isle of Wight and their staff, and to the pharmacists, the dentists and all the staff in care homes, who do a no less valuable job. Some of the problems we are facing are because of a lack of integration with our adult social care system; the inability to find a home for the elderly and vulnerable that that system looks after puts additional pressure on hospitals.

Let me also put on record my thanks to the Government for the £48 million additional capital spending on the Island. Indeed, I suspect that the former Chancellor, my right hon. Friend the Member for Richmond (Yorks), deserves thanks for that, as well as for the fair funding formula reference for the Isle of Wight. I am delighted and very grateful that he did both those things. That £48 million was part of getting a better deal for the Island, which is clearly an ongoing project.

In England and Wales, there are 12 unavoidably small hospitals, which are defined as hospitals that, due to their location and the population they serve, and their distance from alternative hospitals, are unavoidably smaller than the “normal” size of a district general hospital. In the Isle of Wight’s case, we are about half the size—about 55% to 60%—of the population needed for a district general hospital.

I would argue that the pressures on these small hospitals are greater than elsewhere. They are smaller, so they are more easily overwhelmed due to their size, and they are under greater economic pressure, because the NHS funding model—we recognise that there has to be a funding model—is designed for an average-sized, “normal” district general hospital, rather than an undersized one. You cannot give birth on a helicopter or a ferry; on the Island, we need to run our maternity services and our A&E 24 hours a day, seven days a week. However, our income is based on national tariffs that do not equate to the size of our population. As the Island’s trust says,

“the Island’s population is around half of that normally needed to sustain a traditional district general hospital.”

The third pressure on unavoidably small hospitals is because they exist outside of major population centres. Without a shadow of a doubt, they are in some of the loveliest parts of England and Wales, but because they are outside of those major population centres, recruitment and retention of staff becomes more difficult, which adds pressure on the staff who are there and adds costs in terms of locums and agency staff, which can have a highly significant effect on budgets. Ferries aside—with the partial exception of the Scilly Isles—the pressures at St Mary’s on the Isle of Wight are shared by other unavoidably small hospitals. I think that helps to explain why, in the last decade, a number of unavoidably small hospitals have been put in special measures or have sadly failed, despite the best efforts of those people who work there.

Our hospital, St Mary’s, is classed as 100% remote, which is unique even by unavoidably small hospital standards, because it is accessible only by ferry—although, as far as I can see, accessibility by sea is not a factor in the definition of an unavoidably small hospital. On the Island, our need for healthcare is arguably higher than elsewhere in the United Kingdom. We struggle to get the national standard, but our need for that national standard is greater because over a quarter of our resident population is aged over 65 and, by 2028, over-65s will be one third of the population. Indeed, we have a particularly large cohort of 80 to 84-year-olds.

All the evidence and common sense suggests that that has a disproportionate effect on healthcare: older people, and especially the very old and frail, need healthcare more than young people. We on the Island are struggling—as, potentially, are other USH areas—to provide quality for that ageing population. In addition, the Island’s population doubles over the summer, because we have lots of lovely visitors. That impacts demand, which means that our A&E can be close to overflowing at times, even as efficiently run as it is.

I suggest that there is an additional factor: the impact of high levels of social isolation. People retire to the Island as a couple and one sadly dies, leaving the other isolated from family and social networks because they lived most of their life in other parts of the United Kingdom. That leads to increased reliance on statutory services.

All this has been noted. The former Health Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock), confirmed his concerns to me in July 2019, telling the House:

“As for Island healthcare costs, my hon. Friend is right to say that the Isle of Wight is unique in its health geography, and that there are places in this country—almost certainly including the Isle of Wight—where healthcare costs are”—[Official Report, 1 July 2019; Vol. 662, c. 943.]

increased.

I am not saying that we are the only place like that. There is isolation in other parts of the country, including Yorkshire, Cornwall, Devon and Cumbria, but in the Island’s case the situation is cut and dried because of our separation by sea from the mainland. In its January 2019 sustainability plan, the Isle of Wight NHS Trust estimated that the annual cost of providing a similar—I stress to the Minister that this is the critical element—standard of healthcare and provision of 24/7 acute services, including maternity and A&E, on the Island to that enjoyed by mainland residents would be an additional £9 million. These are 2019 figures.

The estimated cost of providing additional ambulance services, including coastguard helicopter ambulance services, was about £1.5 million. In the Scilly Isles, patient travel is funded out of the clinical commissioning group—now the ICB—budget. Ours is not. Our patient travel budget comes from ferry discounts and council contributions, and it was estimated to be £560,000. In total, one is looking at between £10 million and £12 million at 2019 figures.

Either because they were going to do so anyway or, hopefully, because of representations from myself and others, the Government have recognised since then that unavoidably small hospitals need a funding model that serves them, because there is no alternative but to keep those hospitals open to serve those populations in a way that is ethical and, frankly, legal nowadays.

I am proud of our efforts to highlight the plight of unavoidably small hospitals to the Government, and I thank them for listening and for trying to put in place a package of support for them. I say to the Minister that this is where I would welcome more facts being put in the public domain. I have trawled through NHS documents for the last couple of days, and the last figure I can see for the unavoidably small hospital uplift for St Mary’s on the Isle of Wight is that from 2019, when we received £5.3 million. That is roughly half of what we think we need to run a national level service, so we are grateful that the Government have recognised the need for an uplift for unavoidably small hospitals. Will the Minister please update me on how much money St Mary’s has had as an unavoidably small hospital since 2019, given that we have clearly had issues with covid?

According to page 13 of the NHS “Technical Guide to Allocation Formulae and Pace of Change” for 2019-20 to 2023-24, that money was given in 2019 due to

“higher costs over and above those covered by the”

market forces factor. I cannot see other figures in the public domain. I do not quite understand how the Government could calculate that figure in 2019 when the advisory committee said in January 2019 that it was

“unable to find evidence of unavoidable costs faced in remote areas that are quantifiable and nationally consistent such that they could be factored into allocations”.

That is from the NHS England document “Note on CCG allocations 2019/20-2023/24”.

The Government say that they cannot work out how much extra to give unavoidably small hospitals, while at the same time a different NHS document says, “We are going to do some calculations, and here is the rough calculation.” Can the Government work out the additional costs or can they not? They are basically saying the same thing in two separate documents.

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[Several hon. Members rose—]

[Mr Philip Hollobone (in the Chair)]

Order. The debate can last until 11 o’clock. I am obliged to call the Front-Bench spokespersons no later than 10.37 am, and the guideline limits are 10 minutes for Her Majesty’s Opposition and 10 minutes for the Minister. Bob Seely will then have two or three minutes at the end to sum up the debate. There are six highly distinguished colleagues seeking to contribute. I do not wish to impose a time limit, but if everybody limits their remarks to eight minutes, everybody will get in.

--- Later in debate ---

[Rishi Sunak (Richmond (Yorks) (Con)]

It is a pleasure to speak under your chairmanship, Mr Hollobone, and thank you for accommodating me at a late stage in the debate. I had not planned on speaking, but this morning I saw the Order Paper and it turned out that I had more time on my hands than I had anticipated! It is a pleasure to be here with my hon. Friend the Member for Isle of Wight (Bob Seely) to discuss this very important topic.

I am here to speak about the Friarage Hospital in Northallerton, in North Yorkshire, which is in my constituency. It is one of the smallest district general hospitals in the country, serving a rural population of over 100,000 people and covering an area of a thousand square miles, stretching from the North York Moors at one end to the central Pennines at the other, bordered by York in the south and Darlington in the north. When I was first elected in 2015 and when I was campaigning before that, I told my constituents that the hospital would be my No.1 priority.

The reason for that is simple. Of course the NHS is the country’s most prized public service but, as we have heard in all the contributions from hon. Members today, the accessibility of healthcare in rural areas specifically is an issue of acute anxiety and the pattern over several years had been in a negative direction. Indeed, as I was being elected, my local hospital had lost its consultant-led maternity unit. Shortly to follow was the loss of paediatrics. That had an enormous impact on the local community. They feared for the very future of our beloved local hospital and I committed to do everything I could to reverse the flow of services away from it to ensure a bright future for the Friarage.

As my constituency neighbour, my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), rightly pointed out, when healthcare organisations look at such things they tend to think about centralisation, because it looks very efficient on a spreadsheet wherever they might be sitting, but it does not work for our constituents. One thing I will say to the Minister is that she should send a strong message to trusts, particularly those that cover large urban centres and smaller rural hospitals in the same area, to always think about accessibility when they make their plans, which I do not believe they always do as well as they could. Secondly, I echo my hon. Friend’s recommendation about booking appointments. That is a simple, practical thing and trusts can do a good job of it when members of the public have the option to travel to smaller hospitals nearby or to others further away and to get the timing of those appointments right. That has an enormous impact on people’s ability to access the healthcare that they need.

Shortly after I was elected, I had to deal with a challenge that we have already heard about today—the downgrading of our A&E. However, that marked a turning point and I say to the Minister that what followed can serve as an example of what the future of small rural hospitals can look like. Under the leadership of Dr James Dunbar and his team, at the Friarage we pioneered an innovative new model of an urgent treatment centre that is open 24 hours a day and is consultant-led, with a clinical decisions unit. That means that it can provide a far greater range of healthcare to my constituents, including far more care for children than would typically be found. The unit is staffed superbly by nurse practitioners. It is working brilliantly and all I will say to the Department of Health and indeed to trusts where there is a similar challenge is to look at the model and see how it can be replicated around the country because, as I say, it is working brilliantly and has saved the loss of all emergency services at our hospital.

My other recommendation to the Minister and the Department is on recruitment and staffing issues, which we have heard a lot about already. It was clear during the work that I did that often the guidance from the royal colleges exacerbates some of the issues that we have heard about. My hon. Friend the Member for Thirsk and Malton said that anaesthetists are a case in point. A specialisation has occurred over decades, whereby anaesthetists used to be generalists and now we have sub-specialties. It is very difficult for small hospitals to accommodate those sub-specialties, and we need to look with the royal colleges at what safe staffing models might work to ensure the sustainability of our services.

I must commend the South Tees trust, because after repeated efforts from my hon. Friend the Member for Thirsk and Malton and me, it has focused fully on ensuring the future of the Friarage. I thank Simon Stevens for visiting the hospital in his previous capacity and understanding the challenges, and the pervious Health Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock). Since then, thanks to the philanthropy of the late Sir Robert Ogden, we have a new Macmillan cancer centre, which is providing fantastic care, a new diagnostic centre, an MRI scanner, a dialysis unit and an ophthalmology unit, all of which save my constituents a round trip of up to four hours to the much larger James Cook hospital. They are all delivering fantastic care closer to home.

I will give the Minister another example of innovation from the local team. James Dunbar came up with a new ambulatory care unit, which means that we can do emergency treatment on the same day. In the first year of its operation, it saved over 4,000 overnight stays, so it is not just a model for rural hospitals but a beacon for how the NHS can work more broadly to reduce the pressure on our bed capacity.

Most recently, I am delighted that the Government and the Minister responded to my long-running campaign to get new investment in our operating theatres. They date back to the second world war and are in urgent need of refurbishment, so I am delighted that the Government have said that they will provide £30 million of investment to refurbish all the operating theatres to the latest and greatest standards. That will have several benefits. Most importantly, it will send a very strong signal to my community about the future of the Friarage. It is very clear that the Friarage is not going anywhere and people can have confidence in its future, which helps with recruitment and retention, as we have heard. People are attracted towards working at smaller hospitals when they know that their career will be something they can bank on and that there is interesting work to do. This investment will absolutely secure that and ensure that we can attract the nurses, doctors and other staff that we need.

The Friarage also serves as a model for how we will tackle the backlogs more generally, because the hospital will be a new surgical hub with all the associated auxiliary services that are required. That means that we can now double the amount of elective surgery and do it closer to people’s homes. In the scheme of what the NHS spends, that investment will provide a very high rate of return by increasing the amount of surgical throughput. The doctors and nurses I saw just the other day—chief medical officer Dr Mike Stewart, chief surgeon Matt Clarke, and theatre nurse Sarah Baker—are all incredibly invigorated by what they can now do for our community, and that will help more broadly serve us to get the backlogs down faster, which I know is a Government priority.

I say to the Minister that it is important that small hospitals are recognised, which is something that is said very clearly in the five-year plan. It is important that the NHS continues to deliver on that. My experience locally is that that is happening, and I ask her to take on board some of my suggestions. I will close by paying tribute to the incredible doctors, nurses and staff at the Friarage, and to the Friends of the Friarage charity. I said to them when I was first elected that they would be my No. 1 priority, and they will continue to have my full support.

[Mr Philip Hollobone (in the Chair)]

We now come to the Front-Bench speeches. I call Feryal Clark for Her Majesty’s Opposition.