George Freeman backs new culture of NHS care

George Freeman responds to a back bench MP’s debate on Stafford hospital and the new configuration of hospital services in Staffordshire.

The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman): It is an absolute pleasure to be back at the Dispatch Box this afternoon. It is a tribute to the tireless commitment of my hon. Friend the Member for Stafford (Jeremy Lefroy) that, not content with successfully piloting the Health and Social Care (Safety and Quality) Bill through its Second Reading this morning, he has called me back this afternoon for a debate on services at Stafford hospital. I think I speak for the whole House, including Members not present today, when I pay tribute to his tireless commitment, both to his constituency and to the local NHS in his area. The way in which he has gone about it has commanded respect across the House.

My hon. Friend raised many important points, as did my hon. Friend the Member for Cannock Chase (Mr Burley), in support of new investment, importantly paying tribute to the work of the staff as well as the directors and governors. On behalf of the Department, I would echo his comments. He also raised important points about the transition period, the specific needs of children, the ambulance service and the review of maternity services, and the significant point that Stafford appears to be demonstrating that it is perfectly possible to be a thriving local acute hospital. I shall try to deal with all my hon. Friend’s points, but If I do not, perhaps he will be good enough to allow me to write to him and deal with them properly that way.

The configuration of health services is an important issue for many hon. Members across the House and their constituents, particularly those who have previously experienced poor care from local health services. We all agree that all patients should receive high-quality, compassionate care. That is why the Secretary of State has made care a crusade in his leadership at the Department.

We are all aware of the appalling lapses of care that were all too often received by patients at Stafford hospital in that terrible period.

The first of November marked a new beginning for local health services, with the dissolving of the Mid Staffordshire NHS Foundation Trust and the launch of the new University Hospitals of North Midlands NHS Trust. Over £250 million of investment is being put into health services in Staffordshire, including significant investment into County hospital.

Past events at Mid Staffordshire will not be allowed to cast a shadow over the future of health services in Stafford. Thanks to the hard work of many, not least my hon. Friend the Member for Stafford, County hospital has a bright future and will offer modern, safe, sustainable services for local people now and in the future. As my hon. Friend has said, much progress has already been made and significant investment is being made in health services in Staffordshire to ensure that that progress continues. The current service specification at University Hospitals of North Midlands NHS Trust is that recommended by the trust special administrator and has been subject to consultation and endorsed by the Secretary of State for Health. Changes to the service specification will only occur on the grounds of patient safety.

Let me reply to the specific points made by my hon. Friend the Member for Stafford. Accident and emergency departments are often the most visible hospital service, and local people therefore often focus on A and E services when looking at changes to their local hospital. Local protests have been held on the grounds of County hospital against the transfer of services. There has been some speculation that A and E at County hospital will be downgraded. Let me take this opportunity to say that that is not the case.

The A and E service will continue to operate 14 hours a day, seven days a week. In fact, thanks to significant investment, the A and E department at County hospital will double in size and have a dedicated space for treating children. That expansion will address overcrowding. The number of staff working in A and E will increase and all consultants working in the department will be trained in paediatrics.

I understand that my hon. Friend and some of his constituents would like County hospital to operate a 24-hour A and E service. It is important to note that the A and E in Stafford has operated 14 hours a day since overnight services were removed in 2011. Of course the decision to close A and E overnight was taken in the interests of patient safety.

Work by the trust special administrators has confirmed that a 24-hour consultant-led A and E remains unsustainable at this time. However, a GP-led service is planned to operate overnight in County hospital from April 2015. Therefore, those patients with conditions that are not life-threatening but that require medical treatment or advice will not need to travel outside of Stafford, no matter the time of day or night. I understand that work by local commissioners is under way to look at the possibility of an interim solution until 2015.

Investment is being made to improve A and E performance across the University Hospitals of North Midlands NHS Trust. Indeed, £80,000 of winter money has been allocated to an improvement plan that aims to have the trust consistently meeting the A and E target by March 2015. In total, £4.5 million will be invested in supporting A and E performance at the trust and a further £4 million across Staffordshire.

My hon. Friend mentioned the West Midlands ambulance service. The continued good performance of that service will be important to ensure success in both service transitions and to improve A and E performance. WMAS has been thoroughly involved in planning, and my hon. Friend has had regular and productive meetings with Dr Anthony Marsh, the trust’s chief executive.

Of course, as with all other ambulance services, WMAS is dealing with increasing demand, but I can assure my hon. Friend and his constituents that WMAS is fully engaged in the changes across Staffordshire. As he knows, A and E hours were reduced in 2011 in the knowledge that the ambulance service could and would ensure that patients were taken to neighbouring hospitals.

Jeremy Lefroy: I am grateful to the Minister for that reassurance. I pay great tribute to the staff, paramedics and everyone at WMAS—they do a fantastic job—but sometimes what is said at the top of the service and what is actually going on at the bottom are slightly different. I am not trying to point the finger at anyone. Everyone is trying to do their best. People do not want to admit sometimes that there are real capacity problems, because they want to be seen to be getting on with the job. I ask the Minister to look at this case quite closely, particularly as the indicators have been red for so long.

George Freeman: My hon. Friend makes a really important point, and I shall be happy to look at it, as he suggests.

Ambulance diversion from Stafford to larger hospitals for life-threatening conditions—stroke, cardiac arrest or serious trauma—had been in place for some time before the overnight suspension, as my hon. Friend will know. In other words, the ambulance service already has a number of years’ experience of these arrangements. The local clinical commissioning group commissioned additional ambulance service provision to cover both overnight and daily divert activity. That extra provision will remain in place.

Stafford & Surrounds CCG reports that the ambulance service’s performance on the red 1 target in its local area has shown a general upward trend. The target was met in six of the eight months between January and August 2014, and the figure was 77.8%, against a 75% standard, in August 2014. The red 1 target measures performance on the most critical calls that the ambulance service receives: calls to patients in immediately life-threatening situations where a rapid response is vital.

Across the whole trust area, the service met all three performance targets in September 2014, the latest month for which centrally verified data are available. Its performance on red 1 calls was 83%, against a 75% standard. It also met the red 1 and category A19 standards in the six months between April and September.

As I know from my Norfolk constituency, rural areas, such as those served by large parts of Stafford & Surrounds CCG, present challenges to ambulance services across the country. West Midlands ambulance service and local commissioners are working together to ensure that the ambulance service continues to cope with the changes in Stafford and the wider challenges of serving a rural region at a time of increased ambulance pressures across England.

I will touch on the transfer of maternity services. Early next year, in line with best practice guidelines, some services will transfer from County hospital to the Royal Stoke University hospital. That will begin on 16 January 2015 with the temporary transfer of consultant-led maternity services. A stand-alone, midwife-led maternity service will open at County hospital.

Jeremy Lefroy: We were given assurances that no services would be transferred without the double lock, which assures that the capacity and safety of the services would be guaranteed in the case of transfer. We now have a specific date for the transfer of services. When can we see the evidence of the double lock for safety and capacity?

George Freeman: My hon. Friend makes a good point. I will undertake to look into that and get back to him.

Women who require care provided by an obstetrician or anaesthetist will be cared for in Stoke, and transport between the two hospital sites will be improved. Those changes to maternity services are temporary, as I have stressed, pending the outcome of the review, which is due to report in June 2015. Other services will transfer permanently to Stoke, including acute and emergency surgery, which will move in February 2015. In-patient paediatrics, including in-patient paediatric surgery, will move by the end of March 2015.

These decisions are made in the interests of patient safety. Let us not forget that the root of past problems was unsafe services at Stafford. The local NHS, led by local doctors, has therefore made the decision to transfer services based on clinical evidence, with patient safety rightly at the forefront of all decision making.

Consideration has also been given to patients’ wider needs and travel distances. For example, the movement of in-patient paediatric services will create access to high-dependency services and intensive care and to tertiary specialist opinions, reducing the need for patients to travel to Birmingham. Provision will also be made for parents to accompany their children to Stoke when travel is required out of hours, including supplying accommodation if needed.

It is understandable that people have concerns when change is proposed. I have no time for those who want to frighten patients in the face of change. It is important to remember that change is sometimes needed to ensure the best outcomes for patients. We know that there were serious failings at Stafford, and it is important that the University Hospitals of North Midlands NHS Trust is able to make changes to services where they will benefit patients and ensure that County hospital provides the high-quality, safe care that local people deserve.

Turning to the future of County hospital, over £250 million is being invested in health services in the years ahead. The hospital’s A and E department will double in size and see an increase in its staff numbers. Out-patient facilities will be expanded, particularly for emergency access clinics. Wards and operating theatres will be refurbished and upgraded to be fit for 21st century medical care. There will also be new services, including a £1.2 million MRI scanner that will offer advanced diagnostic services in Stafford for the first time, which means that more than 6,000 patients who currently travel to Cannock and Stoke will be treated closer to home. Eye surgery, orthopaedics, dermatology and a new assessment unit for frail elderly people are also services that County hospital will begin to offer.

Progress is already well underway. On 1 November the Mid-Staffordshire NHS Foundation Trust was dissolved and County hospital joined the Royal Stoke University hospital under the new University Hospitals of North Midlands NHS Trust. Thanks to the hard work of many people, the process of transferring County hospital to the new trust has gone smoothly. A number of assurance processes were in place leading up to the transfer, including oversight and scrutiny of the quality and safety handover documents. That process has been overseen by the local transition board, chaired by Sir Neil McKay, an independent chair who is accountable to the CEO of the NHS Trust Development Authority. The local transition board will continue to provide oversight to ensure the safe implementation of the new service model at the new trust.

Finally, turning to CCG funding, in December 2013 NHS England adopted a revised funding formula for local health commissioners that more accurately reflects population changes. The new funding formula is based on up-to-date and detailed information and takes into account the three main factors in health care needs: population growth, deprivation and the impact of an ageing population. All CCGs have received a funding increase matching inflation for 2014-15.

The people of Staffordshire were badly let down by the local NHS in the past. The appalling difficulties that were too often uncovered gave people in the area reason to fear for the future of the hospital and to be very disappointed, rightly, at the level of service that was provided. The local NHS has worked hard to address the failings in care and to bring about substantial improvements. I pay tribute to the work it is doing. The opening of the new trust on 1 November marked a new beginning for the NHS in Staffordshire. I want to put on record the debt we owe to all those who have worked so hard to get the hospital turned around.

There is still work to be done to ensure that services in Staffordshire are of high quality and sustainable. My hon. Friend has encouraged his constituents to support County hospital and to access local treatments where appropriate, and I give the same message here today. Local engagement and support are key to the development of local services. I assure him that if his constituents are anxious about the quality of services, they can be sure that County hospital in Stafford will be under a level of public scrutiny that nowhere else in the NHS has seen. In my hon. Friend, the people and patients of Stafford could have no more doughty a champion.

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