Healthcare in West Cumbria Debate

4th May 2016

** CHECK AGAINST DELIVERY **

Health Services in West Cumbria

Thank you for chairing this debate on the subject of Health Services in West Cumbria: but more particularly the ongoing work of the Success Regime process.

I am pleased to see the Minister in his place, he responded to my debate concerning these issues in December last year and I know that he is well aware of the numerous and difficult issues that I will raise with him today.

He will know that any criticisms that I will make are not personal or even necessarily politically partisan: in this debate and in this cause for all the years that I have now fought, I represent thousands of constituents who do not vote for me or my party: I always have and always will place my constituents’ interests above any superficial party political interests. But most of all, in this debate, I seek solutions for the ongoing problems facing the north, east and west Cumbrian health economy. These problems have persisted for too long, they have worsened and they can no longer be allowed to defy resolution.

The Minister 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 University Hospitals Trust are well known. There is intense pressure on overworked and under resourced staff and I’m grateful for the work undertaken by the Cumberland News and the News & Star, in particular the journalists Emily Parsons and Pam McGowan in helping to illustrate the scale of the problem –again – within the Trust and I will return to these later. The pressures on ambulance services are enormous too, in such a rural county with such dispersed areas of urban population. And the pressure upon Primary Care and GP services as a result of doctor shortages and truly catastrophic cuts to adult social services as a result of the government’s choice to cut the budget of Cumbria County Council is unprecedented. Now, a new threat in the guise of the potential closure of beds in the area’s community hospitals has emerged – to widespread anger and condemnation from every community that relies upon them.

Added to these problems now are the problems – caused exclusively by government – facing the Success Regime. In particular, I want to address the Success Regime and despite the initial optimism that this represented, the manifest problems and difficulties that this process has now found itself presented with. Critically, I will talk about the consequences of the failure of the SR, and how we can avoid this and solve the problems facing this health economy: the most challenged in Britain.

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 the area and I will talk about this also.  Finally, I will pose as many of the questions sent to me as I can, before outlining the health needs of my community and those of neighbouring communities.  This, after all, is what it comes down to.  This is the key issue for decision makers, for Government, and for its Ministers: What do the people of West Cumbria need from their health services and how can this be delivered? This is a very different question from ‘What is the government prepared to provide?’

And make no mistake, at the heart of this issue is the question: Is the National Health Service worthy of the name?

And when we answer these questions, we should have the humility and wisdom to recognise that the consequences of the decisions we take now will outlast the lifespan of this government and will certainly outlast the political careers of the Minister and I : this is the gravity and the reality – and the privilege-  of this situation we find ourselves in.

The simple answer is that the people of West Cumbria need better access to health services than they currently have, in particular the hospital services provided by the West Cumberland Hospital in Whitehaven: but which serves a vast rural area with many tightly compacted urban communities with all of the attendant challenges that this provides.  In this context, ‘access’ can be defined in a number of ways.  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 and what the SR was meant to address.

At this point, I have to thank the hundreds of patients, medical professionals past and present and members of  the public who responded to my request for questions or evidence relating to the SR process and the condition of the local health service in general. Time limits mean that I will not be able to put every question to the minister today but I will either table these as parliamentary questions or write to the Secretary of State for Health with these concerns. I am particularly grateful to the RCN, the Joint League of Friends of Community Hospitals, West Cumbrians’ Voice for Health Care and healthcare campaigners in Millom, Keswick and right across Allerdale,Carlisle and Penrith & the Border. I hope the Minister will ensure that the Secretary of State repies honestly and at length.

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, 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 welcome and necessary.  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 again use this opportunity to thank, on a personal level and on behalf of my constituents, the amazing 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. I know and my constituents know that they are working in extraordinary circumstances beyond their control and we are so grateful for the work that they do – I doubt that any community in the country prizes its medical professionals so highly.

The truth is that every part of the health economy in West, East and North Cumbria simply needs more staff. In primary care, secondary care, acute care and across our preventative services. Government must intervene to ensure this problem is resolved – assisting with local initiatives wherever possible – and this request has fallen on deaf ears for too long.

The most recent report by the Care Quality Commission, published in September 2015 illustrated 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 is clearly a false economy.  Agency staff are a short term expensive solution, to a long term problem. Stable, long term recruitment is key to turning around the finances of the local health economy and the hospital trust in particular.

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. This must be accepted by the SR and it must be accepted by government. This is not presently the case. Sadly, nor is I ta conflation of the issues to point out that the  antagonistic and insulting behaviour of the Secretary of State towards Junior Doctors is severely worsening the recruitment problem in challenged health economies such as Cumbria’s.

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. The Minister has expressed support for this in the past but government should now support this financially and in terms of policy: will he request Health Education England to work with UCLan and the Trust as a matter of urgency so that innovative models of healthcare training such as ‘earn while you learn’ models cab be rolled out not just in Cumbria but in other challenged areas?

I hope the government will also look again at the issue of nursing bursaries the Chancellor’s decision to scrap these will only make it it harder for us to train and recruit the medical staff that we need.  The market will not deliver the workforce that the NHS needs, t will only deliver inefficiency and inequality: we need proper workforce planning in the NHS.

On the subject of the local health workforce, Will the Minister commit to look into the morale issues affecting health professionals in the area covered by the SR and to undertake  action to improve this?

In December, I told the Minister that sooner or later, our luck wiould run out, and that patients would pay the price. Tragically, as documented in the News & Star and Cumberland News recently, the signs are that this is already happening.

It was reported yesterday that in March, a patient was transferred from the WCH to the CIC but died  – according to those medics that have come forward – because specialist staff were not alerted to the patients arrival in Carlisle who subsequently had a cardiac arrest and died. If this is true then not only is this a direct result and a damning indictment of policy, but the inevitable consequence of an over burdened, under funded under staffed system.

I cannot imagine the despair that the family of the deceased most feel and I cannot describe how angry I am that in all likelihood, a constituent of mine has died as a result of being transferred from the West Cumberland Hospital to the Cumberland Infirmary in Carlisle. The community has repeatedly warned of such an event. The community has not been listened to and so I ask the Minister to commit to make a statement to the House about this, and other so-called never events occurring across the NCUHT as a matter of urgency. We need to solve these problems, and we need to determine accountability for them, too. I know that the medics want to get this right and I know that the new Chief Executive Stephen Eames is determined to get this right.

At the beginning of 2015, 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.

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 recovery plan.  This new regime was intended to develop a locally tailored solution to the problems we face. I was a shadow health minister at the time I made the request and it is sadly unusual for an Opposition spokesperson to ask Ministers in the government department that they cover to work together on an issue of joint concern for the greater good.

In December, I expressed my concerns about the then management team of the NCUHT. I pointed out how it had attempted to defy the NHS Chief Exec and sabotage the work of the SR.  the appointment of Stephen Eames has changed all of this to date but the public is still understandably worried about the prospect of key services being removed from 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, but a welcome one in which the primacy of the SR in determining what services would be provided where, was asserted.

In December I told the Minister that unless the previous Trust management committed fully to the SR process they should have no part to play in the future of healthcare service design in West, North & East Cumbria. Now, the information coming from many people from within the SR process is that the SR process is not working and that the reason for this is government intransigence, a refusal to listen to the experts on the ground and a refusal to grant the additional resources that the process needs to succeed.

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 communities when it comes to health services than the communities of West, North & East Cumbria.  We want the SR to work, the people within the SR want it to work but right now, government is stopping it from working. I am told, from within the process, that we know what we need to do as a health economy but that as soon as ideas are put forward, they are being knocked down. I have been asked to ask the Minister this question: does the government recognise that a premium is required to continue to enable the people of West Cumbria to access certain acute services at the West Cumberland Hospital? Does the government recognise that centralising services in Carlisle is about service cost, not service quality and that this will lead to worse outcomes for patients? Again, I’m told from within the SR that the exercise is becoming one that is not as has been advertised. Rather than a process of investigation and improvement, it has become a cost-management tool and that the people within the process do not want it to be this way – yet the government insists that cuts, not quality are king. I’ve been asked, again from within the SR, what happened to the PM’s promise of a bare-knuckled fight for district general hospitals and maternity services? Because it either hasn’t materialised or it was a knowing deception.

There are more questions – all of which I will forward to the Secretary of State – but the most incredible intervention in the work of the SR was recently made by the Cumbria Partnership NHS Foundation Trust. In an open letter to the SR, governors of the Trust have given notice of their intention not to approve the work of the SR accusing its emerging options proposals as lacking logic, transparency, financial evidence and meaningful detail. The letter states: “Our problem is that on every significant issue, the Success Regime appears to us to be shrouded in impenetrable fog.” And that the SR vision is “woefully lacking in sensitivity to the health-related implications of geography and demography in Cumbria.”

Nowhere can this be seen more than in the unjustifiable proposals to remove beds from community hospitals: they deserve better in Millom, in Keswick, Maryport, Workington, Brampton and Alston.

This demonstrates precisely what we risk destroying here: a process which the people, public and medical professionals of Cumbria supported with optimism at the outset, but which now risks collapse and failure because the government has changed the remit of the SR as it’s work has progressed.

The point underpinning all of this is relatively simple: access to a full and comprehensive range of acute hospital services for the people of West Cumbria is non-negotiable and the Success Regime requires freedom from government interference to complete its work. This work requires additional funding if the SR is to succeed – let’s not pretend this is not the case.

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 and which should now become a model for how we provide care in non-metropolitan communities in the 21st century. I make a specific request of the Minister in this regard. Will he move to unblock the funding for phase 2 of the West Cumberland hospital new build? The money, I am told 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. Will the Minister tell my constituents that this will be done and done soon – as a central part of the SR process – and will he confirm that this project is not included amongst those deferred capital spending programmes identified in the HSJ this week? There can be no agreement of any kind without this money being unlocked.

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. This is due to the plan I developed in 2005 and this is the plan thaht my community has worked towards ever since. 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, that anyone should believe it’s sensible to move services 40 miles along a road in need of serious upgrading and subject to frequent closure.

The local NHS must take into account strategic infrastructure and the local population of host communities when planning services.  The Minister has been unequivocal about this in the past and I thank him again for that. Will the minister ensure that local population growth and the national obligation owed to my community as a result of its strategic importance is addressed prominently as part of the work of the SR? 

The fundamental principles in this debate are 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 said in December 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. Fully functioning community hospitals with the beds that they have provide an invaluable service in the communities of West, North & East Cumbria. These services should be built upon, expanded and improved in the face of growing demand – not cut. Government must allow the SR the freedom and the finances to make this happen.

I must mention the recent attempt by the government and local authority partners within Cumbria to reach an agreement on a devolution deal. This was an appalling deal, but local partners tried hard to make it work. Negotiations continued right up until the eve of the budget, so keen was the Chancellor to include the deal as part of his budget statement but the deal collapsed because the government refused to accommodate the wishes of local partners with regard to the Cumbria NHS. Will the Minister tell me if the department was consulted, or if this was purely Treasury driven?

I have today written to the SoS for Health, inviting him to my constituency to listen to local people, hear their concerns and answer their questions. He will be accountable for this process, come hell or high water.

To summarise, will the Minister:

  • Commit to give the Success Regime the freedom it needs and the W, E and North Cumbrian health economy the additional resources it needs?
  • Commit to making a statement to the House with regard to the recent never-events in the NCUHT, how these happened and who is responsible?
  • Commit to retaining existing acute services at the West Cumberland Hospital?
  • Support the West Cumbria medical campus with both funding and assistance from Health Education England?
  • Commit to releasing the funds for phase 2 of the West Cumberland Hospital new build?

I want the SR process to work, the Minister wants it to work and it will only work if the government works with my community, not against it. There is no doubt in my mind that we can solve these problems, but government has to want to solve the problems and the government has to let this process work.

The choice is clear. Together, we can produce something truly special, groundbreaking and innovative or else we can watch a hollowed-out, under funded, fraudulent process break the notion of a truly National Health Service. The NHS is our country’s religion, what happens in Cumbria will determine whether this government believes in it or not.

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