Jamie Reed’s Full Speech
**CHECK AGAINST DELIVERY**
Thank you, Mr Speaker, for granting this adjournment debate – the last Parliamentary business of 2015. The issue at hand is one that my constituents and those living across West Cumbria care a great deal about. I know too that the Minister responding is well aware of the challenges we are facing in my constituency. He has responded positively to my questions and requests in the past, I’m exceptionally grateful for that and I hope he can do so again today.
I want to start by outlining the issues facing my constituents with regard to their ability to access health services in West Cumbria. The issues facing the North Cumbria UH Trust, the pressures on ambulance services and the intense pressure on overworked and under resourced staff are well documented, but despite this, little f any progress would appear to be being made with regard to solving these problems. I then want to address the Success Regime and the opportunity that this presents for health services in West Cumbria and therefore the opportunity it represents for our communities.
The recent floods, the effects of which are being keenly felt throughout the county, have magnified the issues at the heart of the debate over health services in West Cumbria and I will talk about this also. I will conclude by outlining the needs of the West Cumbrian community. This, after all, is what it comes down to. This is the key issue for decision makers, for Government, for Ministers and for NHS Executives: What do the people of West Cumbria need from their health service and how can this be delivered? This is a very different question from ‘What is the North Cumbria UH Trust prepared to provide?’
The simple answer is that the people of West Cumbria need better access to health services than they currently have, in particular hospital services provided bythe West Cumberland Hospital inWhitehaven. In this context, ‘access’ has myriad meanings. It means the actual services provided locally, it means ensuring that these services are staffed appropriately so they can be provided at a high quality and it means empowering the community so that when decisions about their services are taken, they are listened to. It also means proper planning for the significant population expansion that is forecast for the area. In West Cumbria, each of these areas are immensely challenging and this is what we must address.
Background, Special Measures and Recruitment
Mr Speaker, in July, 2013, Sir Bruce Keogh published his review into mortality rates at a number of Hospital Trusts around the country. North Cumbria University Hospitals Trust, which serves my constituents, was one of these and along with ten other Trusts, was placed in Special Measures.
The Trust had higher than average mortality rates and action to remedy this was obviously welcomed. At the time, Ministers were unable to provide basic information about what Special Measures actually meant for the Trust. What was patently clear at that time though was that a major reason for care failings at the Trust was a chronic staff shortage. It is only right that I use this opportunity to thank, on a personal level and on behalf of my constituents, the tremendous staff, working tirelessly, in trying conditions to provide high quality care. I know that many work unpaid overtime because they care about their patients, about their work and by extension about the service they provide to their community. It’s going to be a tough winter, the pressures are going to be huge, but I want them all to know that I know and my constituents know that they are working in extraordinary circumstances.
The Trust simply needs more staff. Government must intervene to ensure this and this request has fallen on deaf ears for too long.
The most recent report by the Care Quality Commission, published in September shows the scale of the challenge:
It read: “The recruitment of nursing staff also remained an on-going challenge. At the time of our inspection nurse staffing levels, although improved, were still of concern and there was a heavy reliance on staff working extra shifts and on bank and agency staff to maintain staffing levels. There were times when the wards were not appropriately staffed to meet the needs of patients.”
This simply isn’t acceptable.
In 2013/14, the Trust spent £16 million on agency staff. This cannot be sustainable. It is clearly a false economy. Agency staff are a short term expensive solution, when the Government should be empowering Trusts to achieve long term, efficient solutions. Capping agency costs are a small, tentative step in the right direction, but it would be better if the Government provided funding to enable Trusts to train and recruit for the long term. This would surely save money in the long run and enable predictable, stable, secure service design for the long-term.
Will the Minister commit to making relief funding available to allow the Trust to be more competitive in recruitment? If my local trust has to pay over the odds to secure services taken for granted in other parts of the country, then it ought to be able to do that and it should be funded appropriately.
In my constituency, I have been working with the Trust and the University of Central Lancashire to bring a medical school to West Cumbria so we can grow our own medics. This is a long term sustainable solution to one of the key problems we are facing. I’m delighted to say that the new West Cumberland Medical Education Campus now exists at the Westlakes Science Park, immediately adjacent to the new WCH. So far, this has succeeded without the support or involvement of government, but I hope that the government will be able to support this development, not just in spirit, but in terms of practical assistance, including money. In addition to growing our own medics in West Cumbria for the benefit of the entire Cumbrian health economy, we are also providing the basis for policy solutions by becoming a ‘rural health policy lab’. The campus can and should become the crucible of innovation for providing the solutions to the problems facing rural areas when it comes to the provision of high quality, accessible, universal health services. I hope the Minister can express the government and the department’s support for this today.
I hope the government will also look again at the issue of nursing bursaries as new policy, will, I fear, make it it harder for us to train and recruit the medical staff that we need. On the 14thDecember, the Chief Executive of the Royal College of Nursing said that the decision to cut to bursaries announced in the Chancellor’s Autumn Statement is having a negative impact on people who were considering a career in nursing. It is all well and good pledging to increase training places, but the impact is wasted if the mechanism we than adopt turns people away.
With regard to medical staff, the NHS Staff Survey shows the current strain upon staff in West and North Cumbria. There has been a big increase in the proportion of staff suffering from work-related stress and unforgivably, the prevalence of staff experiencing bullying from other staff is increasing too. Staff are working extra hours, unpaid. The people in West Cumbria rely on the services provided by these hardworking staff and much like the issue of expensive agency bills, over-working staff is simply not sustainable.
Will the Minister commit to look into this and see what action the Department can take to improve this?
Sooner or later, our luck will run out, the goodwill of lthe medical professionals – in so many ways exhausted and demoralised – will run out too – and patients will pay the price.
At the beginning of the year, I wrote to the NHS CX Simon Stevens. I asked him to visit Cumbria; see the geographic challenges; speak with patients and staff and work with me to develop a comprehensive recovery plan for the Cumbrian health economy. Nowhere in the country is quite like our county. The health inequalities, the demographic differences, the challenging geography and the contrast between the affluent and those less well-off all present unique challenges with regard to providing services.
What is provided should be broadly the same in every community in the country. A National Health Service should ensure the equality of standards and accessibility of health services, but how this is delivered must be flexible enough to accommodate unique local circumstances.
The Success Regime is the response to my request for a comprehensive recover plan. This new regime is intended to develop a locally tailored solution to the problems we face.
I support the Success Regime fully, but I have doubts about the support of the North Cumbria UH Trust. Over recent years, actions by the executive team of North Cumbria University Hospitals Trust have led to the public being understandably worried about the prospect of key services being removed from the West Cumberland Hospital.
In September 2013, the Trust moved some out-of-hours surgery services from West Cumberland Hospital to the Cumberland Infirmary in Carlisle, over 40 miles away. The public was not consulted on this change. Crucially, the modelling and assumptions unperpinningthe move were flawed – much greater numbers of patients have had to travel than was either anticipated by the Trust or told to the public. Either this was a lamentable failure to properly model the effects of service change or it was a lie. Either way, it raises serious questions about either the honesty or the competence of the Trust.
The Trust’s attitude on a number of other issues since has done little to reassure those concerned about their intentions with regard to the provision of services at the West Cumberland Hospital.
I was present at a meeting with Simon Stevens and the Success Regime in which the Trust were told categorically that the continued ‘asset-stripping’ of services from the WCH should not continue. It was an uncomfortable meeting. Days later it was reported that senior managers at the Trust told staff that the Accident and Emergency Department would be downgraded. This is unacceptable. The Trust must abandon any preconceived plans to strip services. These services must be provided at West Cumberland Hospital and the SR must be allowed to complete its work.
I welcome the NHS in Cumbria’s recent public letter setting out that the Accident and Emergency Department and other services must remain at West Cumberland Hospital. This is the bare minimum that my community would expect, yet the Trust had to be shamed into making such a basic commitment.
With regret, if the Trust does not abandon its preconceived ideas on service reconfiguration and if it tries to ride roughshod over the Success Regime programme before it has a chance to develop a plan, I have made clear that I will be left with no other option but to pursue the removal of the current Trust management. I would be grateful if the Government would support this effort of last resort. I take no pleasure in this, but unless the Trust management can commit fully to terms of reference of the Success Regime, they should have no part to play in the future of healthcare service design in West and North Cumbria.
The attitude on display from the Trust, whether it is deliberate or not, has meant that many in the local community simply do not believe anything it says.
Its lack of willingness to engage with the public who use and rely on these services means that many feel disconnected from a key service, the key service, in their community.
The service reconfiguration in September 2013 was done without public engagement and the development of the Trust’s Future Clinical Options did little to assuage legitimate concerns. The document published showed the stripping of key services from the West Cumberland Hospital, I repeat: this is unacceptable.
Last year, in front of a crowd of almost 5,000 people at the Recreation Ground, the home of Whitehaven RLFC, Trust representatives assured an anxious crowd that no decision on service reconfiguration had been made, but the publication of the Future Clinical Options Appraisal in October 2014 showed that the plans had been in development for a year. It’s easier to deal with Iran.
The duplicitous nature of the Trust’s public statements, the covert actions which seek to pursue in private the opposite to what it states it wishes to do in public and the public distrust it has singularly managed to establish is staggering. Truly breathtaking. Too often NCUHT acts as a rogue trust, seemingly beyond any accountability to anyone and beyond the influence of the Cumbrian public. Will the Minister commit to examine the behaviour of the Trust? Senior local medics, patients, local civic society, the trade unions, local representatives of all parties all doubt that any eventual consultation designed by the Trust will be genuine or honest. Progress will not be possible without trust.
Hopefully, much of the Trust’s preconceived ideas around service reconfiguration will be superceded by the work of the Success Regime. In the rest of the country the Government and the NHS would be hard pushed to find a more committed, willing, well informed and passionate community when it comes to health services than the community of West Cumbria.
A campaign group set up to fight for services ‘We Need West Cumberland Hospital’ has garnered much public support and I pay tribute to their work as I do to the fantastic work of Siobhan Gearing, Carol Woodman, Lee Butterworth, Rachel Holliday and so many others.
Does the Minister agree with me, that if the Trust was committed to rebuilding trust within the community, they should involve the local public in open and transparent discussions about local services instead of defying the NS Chief Executive, undermining staff, deliberately raising doubts about services about which there should be no doubt and acting like thieves in the night?
The recent local floods did not cause the underlying issues inherent in the West Cumbrian health economy. Nor did it cause lasting damage to the ability of the NHS in Cumbria to deliver services. What the recent floods did do,amongst many other things is to prove beyond doubt the sheer folly of removing services from the West Cumberland Hospital and putting them in the Cumberland Infirmary in Carlisle, over 40 miles away.
The floods meant roads were impassable, ambulances and other emergency services, already struggling more in Cumbria than anywhere else in the North West, were under intense pressure. Power was cut to the CIC which had to rely on back up generators. Doctors and nurses couldn’t get to work and the impact upon patients was severe.
Getting from West Cumbria to Carlisle at the best of times is difficult. If the weather doesn’t beat you, the tractors or the sadly routine RTAs and diversions will. I am campaigning for serious improvements to the A595, but because of the floods, over that weekend and the following days, it was simply impossible to get from West Cumbria to Carlisle.
The levels of the flooding could not be anticipated, but there are things we can do to ensure access to, and the resilience of, our key services. Rain in the Lake District should not come as a surprise to anyone – it should never lead the international news – but severe weather should not create a health emergency because access to services has been cut off. I have been inundated with numerous individual cases.
The point underpinning all of this is relatively simple: access to a full and comprehensive range of hospital services for the people of West Cumbria is non-negotiable.
The recent flooding has shown that if services were transferred from the West Cumberland Hospital, in times of emergency patients simply wouldn’t be able to access them as they wouldn’t be able to get to the Cumberland Infirmary.
This cannot be acceptable. In times of emergency, the people of West Cumbria need to be able to access their services and that can only be assured by retaining the services in their local hospital. The West Cumberland Hospital – a fantastic new facility I have campaigned for for over ten years. I make two specific requests of the Minister in this regard. Will he move to unblock the funding for phase 2 of the hospital new build? The money has been allocated but is not accessible. I ask that this is done as soon as possible so as to provide confidence and help build trust. And if, as is suggested by some, Monitor will shortly be able to allocate a fund of £1.8b to the most challenged health economies in the country, will the Minister ensure that North Cumbria is at the top of that list?
The last point I would like to address is the short-sightedness of the Trust’s desire to move services.
West Cumbria is home to one of the most nationally and strategically important sites in the shape of Sellafield. Over the coming years, with new Nuclear reactors at Moorside, thousands of jobs will be created and my constituency will become one of the fastest growing regional economies in the country. As a result, the local population will grow significantly and quickly.
The people who live in West Cumbria now need better access to the health services they rely on, but it is simply mindboggling that when a local population is growing, the Trust think it’s possible, and maybe even desirable, to move services 40 miles up the road.
The Minister has been unequivocal about this in the past and I thank him again for that. The local NHS must take into account strategic infrastructure and the local population of host communities when planning services. Will the Minister commit to write to North Cumbria University Hospitals Trust in order to ensure that the North Cumbria UH Trust publicly acknowledges this? And can he today, at the despatch box, urge them to factor this population growth and strategic need into its future plans?
The fundamental principle in this debate is straightforward. Moving services 40 miles away from the West Cumberland Hospital is the antithesis of the principles which underpin a truly National Health Service. I would go as far to say that unless the patients and taxpayers of my community can access the same level of health care routinely provided by the NHS in other communities, then the NHS exists in name only.
40 miles is not a reasonable distance to ask people in need of medical care to travel, particularly when that 40 miles is served by such inadequate infrastructure. Mothers giving birth don’t want to sit in an ambulance on the A595 hoping they don’t get stuck behind a tractor.
A fully operational Accident and Emergency Department supported by associated departments, consultant-led maternity services and paediatric services must remain at West Cumberland Hospital. If we need to adopt a flexible approach in order to achieve this, then that is what we must do.
The Trust should know that the community of West Cumbria will stand for nothing less. After all, the Trust may be the provider of services, but the NHS belongs to all of us.
I fully support the Success Regime but ask the Minister today to tell the Trust that unless it listens and responds to the West Cumbrian community, it will face a fight the likes of which it has never seen.