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6 Apr 2005 : Column 501WH—continued
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East Sussex Hospitals Trust
4 pm
Mr. Nigel Waterson (Eastbourne) (Con): It is a great pleasure to have secured what I understand is the last Westminster Hall debate of this Parliament and possibly of this Government. I am delighted to see the Under-Secretary of State for Health, the hon. Member for South Thanet (Dr. Ladyman). I am sure that he is aware of the problems faced by my local hospitals trust, so I will not have to go through them in great detail. I have raised them in questions in the House, as well as in a recent meeting with the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton).
In a nutshell, we have faced some difficult problems over recent weeks and months, particularly in my local hospital, Eastbourne District General hospital. More than 140 operations have been cancelled on the day of the operation. Bed blocking is still double the national average and has been significantly higher than that. People have been turned away from the accident and emergency department, and I am continuing my campaign to ensure that the A and E department stays open 24 hours a day, seven days a week.
Things began to get difficult back in early March. On 3 March, the local trust issued a press release following its board meeting, in which it talked about the extreme pressure that the hospital is under. It said that the trust had been working at a 97 per cent. average bed occupancy rate for the past six weeks, way above the recommended bed occupancy rates. Emergency admissions were up more than 6 per cent. on the same time last year; 158 operations had been cancelled on the day of surgery, and many more a day or two in advance.
That obviously raised some difficult issues, including one of three possible options decided by the board at one stage: the closure of an A and E department during times of severe pressure. That clearly attracted a lot of local interest, and was followed up some days later by a letter from the chief executive, Annette Sergeant, setting out the background. As she put it:
"When levels of bed occupancy reach into the upper 90s risks of clinical errors become unacceptably high."
Again, she talked about closing an A and E department to give some respite. She stressed that that was to be a last resort, and, as she said:
"I would only take this decision if it was my view, and that of my clinical colleagues, that not to do so would compromise patient safety."
She referred to the ongoing problem, which seems to have been perennial rather than to have existed only since March, of so-called bed blocking in our local hospitals. That has obviously caused a lot of human problems. A number of constituents have come to me who have had their operations cancelled once or several times. One can only imagine the stress that that produces. People have to get psyched up for an operation, and in some cases they have even gone into hospital at the allotted time and then had to go home again.
There have also been problems with people being turned away from the A and E department. The local paper referred to the case of a Seaford man who had a stroke. The ambulance taking him to the Eastbourne
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District General hospital had to be diverted because there were no beds, and he was taken to the Conquest hospital in Hastings. That meant that he had to travel almost 30 miles to hospital after suffering a stroke. Matters had become extremely serious.
As I said, I had a constructive meeting with the Minister of State to discuss the various options. One of the decisions that she had taken at that stage was to put a recovery and support unit into the local NHS to try to find some solutions. It is also interesting that there is a short-term solution: on the day that I visited A and E, I found that some 19 patients had been removed that very morning and placed in nursing and care homes. It seems that, somehow, despite the background of deficits right across the local health economy and the pressures, which I will come on to in more detail, on local social services, funds were found that day to spirit 19 patients out of the hospital. It clearly made a significant difference, in A and E as well as in the medical assessment unit and other wards. We will see in a moment how long term that improvement is likely to be.
Only a few days ago, the issue came up in Health questions. I am sorry to say that the suggestion was made by some Labour and Liberal Democrat Members—even more sadly, it was endorsed by the Minister—that it was somehow the fault of the Tory-run county council. That was unfortunate, because it is not true. Since the present administration took over in East Sussex, its top priority has been helping older people. It has modernised by investing an extra 35 per cent. in services for older people during its four years, despite receiving only 1 per cent. extra in grant from the Government if one excludes the extra funds passported to education.
The county council has tried very hard to persuade the local health bodies to work jointly and also to find alternatives to hospital admission, which in some cases seems inappropriate. In particular—I would be grateful if the Minister were to comment on this specific point—it has been pressing hard for health bodies to be able to invest the fines money paid by the county council in new services as a better alternative to hospital admission. I understand that that is what many other health organisations are doing.
It is particularly unfortunate that the Minister of State forgot herself at Health questions—forgot, perhaps, that she is a Minister of the Crown whose job is to look after health care rather than make cheap political points. Had she thought for a moment, far from putting the blame at the door of East Sussex county council, she would have remembered that, according to the Commission for Social Care Inspection, East Sussex is the most improved social services authority in the country. She, or those advising her, might also have glanced at the recent Audit Commission review, "Elderly Care in East Sussex", which in broad terms finds that East Sussex social services has been doing its bit for care of the elderly but that health has much more to do. I am told that East Sussex county council has accepted the Audit Commission's conclusions in full and is encouraging health organisations to do the same.
Despite the pooling of some funds to help with the immediate problem, which may have coincided with my arrival at A and E, the county council is dubious about
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whether putting more money into the system will solve the problem. It feels that beds will fill up again as soon as they are empty, and that council tax would spiral as a result, hitting older and more vulnerable people. Not unreasonably, it points to the whole systems review by the Audit Commission, to which I referred. It also points to the fact that in the financial year just ended the county council funded an additional 100 residential and nursing home placements at a cost of £3 million from its own resources. In March, it agreed to a further 40 placements, to be funded jointly with primary care trust partners. However, it says:
The primary care trust, which has a crucial role in all this, has told me of its position; apart from anything else, it has "severe financial difficulties". It was looking to end the year with a deficit of £980,000. It is not the only trust in that situation. The last projection I saw for the East Sussex hospitals trust, which includes my hospital, was a forecast for a £4.7 million overspend at the year end.
There is a difficulty. I wager that the Minister will say, "Yes, it is important that all those bodies work together to try to solve the problem." If, as I believe, the underlying cause of the problem is underfunding, of both health and social care, it is no wonder that those bodies are often at each other's throats, blaming each other for the present situation. Anyone who knew anything about it—I served on the Committee that dealt with the Community Care (Delayed Discharges etc.) Bill—would have known that the system of fines would only exacerbate relationships between organisations that should be working closely together to solve the problem.
I have three main points to put to the Minister. The first is about the deficits. I have already explained that, for some time, all the health organisations in my area have been struggling with substantial deficits. There is a rumour going around that Ministers are themselves telephoning chief executives in some parts of the country demanding that they eliminate their deficits by the year's end. I have no evidence for that, but I have no evidence to the contrary either. At Health questions I asked the Minister of State whether she could
"assure me and my constituents that no one is putting any pressure on the trust to reduce the deficit at this very difficult time?"—[Official Report, 22 March 2005; Vol. 432, c. 728.]
I believe that it is significant, although I am open to persuasion, that she made no attempt to answer that direct question and merely talked about the importance of local agencies working together.
My first specific question for the Under-Secretary is this: can he answer that question? Is any pressure being put by Ministers, the strategic health authority or anyone else on my local health authority to eliminate deficits, particularly if, at this delicate time, it could be at the expense of patient care? Although I do not complain, I remain somewhat mystified how, all of a sudden, these organisations, all of which seem to have historic deficits, were able to find money for those 40 extra placements.
Secondly, I ask the Minister of State, through the Under-Secretary, to reconsider her attitude to this issue and try to remove the party political stuff, which
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intruded at Health questions. I have already made the point that her own inspectorate gave an extra star to East Sussex social services and that the Audit Commission in its report came out in favour of the social services department and said that the health organisations could and should do more. I have already indicated how the Conservative-controlled county council has set as a priority increasing spending on older people's services. If the Under-Secretary really believes that the problem lies with social services, why on earth did the Minister of State decide to put in the recovery and support unit, which I assume is there to deal with health issues and not social services?
Thirdly, will the Under-Secretary or other Ministers seriously consider in the medium term the question of underfunding? East Sussex has the highest concentration of people aged over 85 in the country, yet this year it received the smallest increase in grant of any county. There simply is not enough money to go around. The Government seem content to allow the various health bodies and the county council to squabble over the limited resources available. My constituents and I think that it is time for this blame game to stop. It is played out week after week in my local paper. I am heartily sick of it.
I mentioned the funding that was discovered for 40 extra placements only a couple of weeks or so ago. It is perfectly true that there was a short-term improvement after some funding was found recently. I described that at the time as a sticking-plaster solution. I note from the latest figures from the trust that the figures for bed blocking are creeping up again. Bed blocking in Eastbourne is twice the national average. The percentage this week in Eastbourne is 6.1 per cent—30 beds—which is an increase of six from only last week. I fear that we are slowly getting back to the position we were in when this crisis blew up at the beginning of March.
I ask the Under-Secretary to think again about the funding issue. The problem will not go away. He may go away and I may go away, but the problem will remain. Whichever Minister of whatever party is in his place after 5 May they will still have to tackle it. For the moment I am not going to give up and neither will my constituents.
4.14 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman) : I congratulate the hon. Member for Eastbourne (Mr. Waterson) on his interest in the NHS and on securing this debate. I am always bemused in these debates when Conservative Members start off by making an overtly political comment about the result of the next general election and bury numerous other political comments in their speeches, yet say constantly that they want to avoid party political fighting and want some form of consensual politics.
If the hon. Gentleman had really wanted that, he could have set an example. He could have emphasised the massive reinvestment in the national health service: overall expenditure in the NHS has roughly doubled since 1997, and it will have trebled by 2008. He could have mentioned the fact that social services departments around the country have been given a real-terms increase of a little under 30 per cent. in their budgets
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since 1997. I shall come on to some more specific figures about the massively increased resources that we have made available since 1997. What would be the state of the hon. Gentleman's local health and social services if we were still working to the spending plans envisaged by the last Conservative Government? He would certainly have had something to complain about.
I agree with the hon. Gentleman in that I believe his local trust is experiencing some significant challenges. However, I would argue that it is trying to respond to them, and I do not think that it is helped when the hon. Gentleman raises the issue of a contingency plan to close the local accident and emergency department. He knows—he has been assured by the local authority—that that was purely an in-extremis contingency plan. If the capacity of the A and E department had reached such a point that people could no longer be treated sensibly, a contingency plan was in place; that A and E department might have been closed temporarily and people diverted to one with more capacity. That has never happened, and the hon. Gentleman knows that it is never likely to happen. He should not try to misrepresent the status of that plan.
I should like to pay tribute to all the staff of the local NHS, who are working very hard to deal with the issues that the hon. Gentleman has raised. I shall come in a moment to some of the ways in which they are thinking of doing that. As the hon. Gentleman rightly emphasised, there are two partners: the NHS and the local council. In his eyes the NHS is, of course, largely to blame for the problems, while the local council struggles gamely to try to deal with them in the face of an uncaring NHS.
Has the hon. Gentleman's analysis of the situation something to do with the fact that the council is Conservative, whereas through the NHS he can try to pass the blame on to the Labour Government? In preparing for this speech, I received an e-mail from one of the hon. Gentleman's constituents. I shall not give his name, because I do not have his permission to use it. However, I have checked the information in the e-mail and can vouch for its accuracy. It says:
"The Commission for Social Care Inspection: Performance Assessment Framework Reports November 2004 on East Sussex County Council's social services department show that ESCC is not investing enough in the older peoples' services and have been among the lowest providers across the country for some time. The comparative data shows that East Sussex County Council is the 17th worst performer in the country for delayed transfers of care. The Council's funding of home care is even worse. For intensive home care as a percentage of home and residential care the Council's performance is the 9th worst in the country. The Council is the 5th worst performer in the country for the percentage of households receiving intensive home care and the llth worst performer in the country for helping older people to live at home. This is out of a total of 150 local authorities providing social services"—
what follows is the only bit of the e-mail that I disagree with—
I would argue that almost all are in areas far more deprived than East Sussex. My correspondent goes on:
"The figures also show that ESCC performance is rock bottom when the Council is compared with the 13 local authorities who are similar to it. For supported admissions of older people to residential and nursing care, East Sussex County Council is the third lowest performer. For helping older people to live at home,
- it is the second lowest performer; and for intensive home care as a percentage of home and residential care, the Council is actually the lowest performer of the 13 authorities with which it is compared."
The correspondent goes on to say that that data
"is also reproduced in the recent Audit Commission presentation on 'Whole System Review of Services for Older People in East Sussex',"
to which the hon. Gentleman referred.
So, we have a clear picture of a county council social services department that, whatever its intentions for the future, has not been punching its weight or delivering its side of the equation: to ensure that there is capacity in the local community for people to be discharged from hospital without delay when that is in their interests. If social services is not prioritising that capacity, it is no wonder that the sort of problems that the hon. Gentleman identified arise. We must accept that the performance of social services has been lamentable.
Mr. Waterson : The Minister throws around words such as "lamentable"—$10 words that are the flavour of the moment—but why did the social services get an extra star from the inspectorate, and why is he quoting an anonymous member of the public who seems to have done a lot of research, rather than what the Department thinks? Does he agree with the Minister of State that the county council has a deliberate policy to block beds? That is a serious allegation that has yet to be sustained.
Dr. Ladyman : I quote those figures because I checked them against the official statistics and found that the correspondent is well informed and that the information is accurate. The county council could have gained an extra star for a multitude of reasons. Social services also provides services for children, and it is entirely possible—I speculate only; I would have to look at the figures—that it got its extra star for improving its care of children rather than that of older people.
The hon. Gentleman assures me that social services will try to do more to increase capacity in the local community for older people, which I applaud if it is the case. I hope that it will work better with the local health services on delayed discharges.
The hon. Gentleman mentions the use of the delayed discharge grant and the way in which several authorities have done deals with local health services to invest that money in capacity in the local area. East Sussex seems to believe that if that money is invested in local capacity, that will put a cap on its exposure to delayed discharges, but it does not; it does not do that anywhere in the country. I have made it absolutely clear that delayed discharge fines should be audited and that if they exceed the agreed amount to be invested in the local community, the council must pay the fines to the NHS, because the NHS is paying the cost of keeping people in acute beds when their care should be in the local community.
The hon. Gentleman does not like the delayed discharge legislation, but if his party were to win the general election would it repeal it? The legislation has saved about 1 million bed nights a year since it and the Government's efforts to reduce delayed discharges were introduced. That is the equivalent of eight or nine large
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district general hospitals. It is a massive success. Experts around the world have identified England—other parts of the UK did not introduce the legislation—as the only country in the world on track to remove delayed discharges from our hospitals.
East Sussex is the one area about which I constantly hear it said that the delayed discharge legislation is not working and a fight continues between health and social care. Everywhere else, people have managed to make arrangements that work better as a result of the legislation. East Sussex council seems to have set its face against allowing it to work. I encourage the council and local health partners to get into a room together and work out how to make it better for them. If they can do that by ensuring that the more than £1 million that East Sussex has already been given from the delayed discharges grant this year works better for the benefit of local people, that is all to the good.
In addition to social services, it is important that we move ahead and try to do what we can to improve things in the health service for the benefit of the hon. Gentleman's constituents. In the spirit of "Shifting the Balance of Power" such decisions must be taken locally; Ministers no longer take them centrally. I am pleased to say that the Surrey and Sussex strategic health authority is working with the acute trust and relevant health and social care partners to address the issue of cancelled operations that was raised by the hon. Gentleman. I have received assurance from the local NHS that cancellations, when they do occur, are handled sensitively, that people receive personal calls from officials of the trust, and that every possible effort is made to reschedule patients within 28 days. Currently, the trust is able to reschedule about 50 per cent. of cancellations, but it is working to try to increase that to 100 per cent. as soon as possible.
Leaders of the local health and social care organisations met in early March to discuss the operational problems faced by the hospital, and to urgently review local arrangements to manage the discharge of care. Some measures have been designed to help to address those problems and to free up beds. Improved intermediate care is one option that the local health and social care economy is considering. For example, I am pleased to say that Eastbourne Downs primary care trust has worked with social services to develop a 21-bed intermediate care facility funded by the NHS and social services. There are also proposals for the PCT to integrate purchasing of places in the independent sector with that of social services, to ensure effective and efficient use of the independent sector capacity that is available.
Bexhill and Rother primary care trust and Hastings and St. Leonard's primary care trust are funding the post of intermediate care co-ordinator to become substantive from 1 April 2005. The co-ordinator will have an ongoing specific brief to develop a single point of access to intermediate care services. Sussex Downs and Weald primary care trust is increasing the capacity of discharge co-ordinators based in the community who work with the acute trusts to identify patients who are appropriate for support in the community.
In addition to intermediate care, other proposals include plans to ensure that rapid access diagnostics facilities are available, so that the length of stay is as brief as possible and that hospital-avoidance initiatives
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are effective, and plans to use locality-based commissioning to engage GPs in active referral management, with a view to reducing hospitalisation rates.
Furthermore, I am advised that health and social care partners will meet on Friday 8 April to agree and sign off a joint action plan, which was compiled following the Audit Commission review of older people's services in East Sussex.
Although there are challenges at present—I agreed earlier with the hon. Gentleman that that was the case—I hope that he will accept that progress is being made, but that it must be made by both partners. Health and social care must work together.
The hon. Gentleman mentioned the issue of resources. In the past two years, an extra £100 million has been added to the access and systems capacity grant to local councils to improve the quality and range of local authority community services. In East Sussex, the council received £4.8 million for that grant last year and £6.2 million this year. That money is entirely intended to build up the social care capacity of the local community
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to allow it to deal better with those types of problems. The health service in East Sussex has also benefited from significant additional resources: between 2005–06 and 2007–08, the four PCTs in East Sussex will receive an increase of more than £111 million for health care services.
The hon. Gentleman also talked about deficits. All NHS organisations, including those in East Sussex, have received a fair share of resources. However, if that is the case, they have a corresponding responsibility to manage those effectively. It is now the responsibility of strategic health authorities to deliver overall financial balance for their local health communities and to ensure that each NHS organisation achieves financial balance. Therefore, when the hon. Gentleman raises the issue of deficits he must face the fact that if I waved a magic wand and cleared the debts, that money would have to come from someone else's health care economy.
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