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23 Oct 2007 : Column 56WH—continued
1.19 pm
The Minister for Borders and Immigration (Mr. Liam Byrne): Let me start by congratulating my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) on securing the debate. As she has said, I used to be the Minister with responsibility for social care, and in my time at the Department of Health, the issue of the work force in social care detained me more than most.
This afternoon, I shall sketch out the chronology of events that has brought us to this stage and the transitional arrangements that I put into place, which are benefiting nearly 80 per cent. of people in this category. Before I expand on those points, I apologise to my hon. Friends—we are all hon. Friends this afternoon—if there have been delays to the replies that they have received. Such tardiness
has sometimes been due to my concern to ensure that the policy was right before we got back in touch with people, because it has been changed substantially. I take personal responsibility for the policy, because I have spent a considerable amount of time on it in the past few months, not only with officials, but with hon. Friends and other hon. Members.
That brings me to my second introductory point: if colleagues have particular cases that they want to bring to my attention, I am always happy to meet them to discuss in detail how I can help. My hon. Friend the Member for Weaver Vale (Mr. Hall) is not present, but he has been particularly vocal in arguing this case to me, so I wanted to put his name on the record.
To give a brief chronology, the changes in this area began in October 2006, when new age discrimination legislation was introduced. Against that backdrop, care home operators continued to advertise senior care worker jobs in local job centres, as they are required to do to pass the resident labour market test. In those adverts, they specified that the post of senior care worker required a national vocational qualification level 3 and three years’ experience in a job at that level. That is important, because the work permit system has operated on two important principles since 2000—this is not a recent innovation; it has been around for seven years. The first principle is that people coming in under the work permit scheme have to be skilled. Only two parts of the immigration system operate low-skilled schemes: the seasonal agricultural workers scheme, which will soon be given over to residents of Bulgaria and Romania, and the food processing scheme. Between them, those schemes have about 20,000 places.
The second principle, with which I am sure all Labour Members will agree, is that people must be paid the going rate to do the job. My hon. Friend is right that the Home Office does not conjure its guidance out of the air. It simply reflects what Skills for Care and other sector skills councils tell us is the going rate for a particular post. Another problem then arose: Jobcentre Plus pointed out to us that employers could not justify advertising those posts as requiring an NVQ level 3 and three years’ experience because the role being performed did not require such skills. Age discrimination legislation says that a job requirement cannot stipulate skills that cannot be justified and cannot be potentially discriminatory. Research was then undertaken within the sector to see whether the senior care worker post did, in fact, meet the skills criteria. Let us not forget that the reason why the post existed was that the care industry said that the job required that level of skill. However, evidence then emerged that there was no such requirement, and our research confirmed that, which placed us in a difficult position.
Obviously, the Home Office cannot operate a policy under which we give work permits against our own guidance—the relevant guidance being that people need to have a certain level of skill to do the job. The result was that 100 per cent. of the people who applied for extensions were being refused. I was not prepared to countenance that, so I asked my Department to work with the Department of Health to see how we could introduce new guidance that would allow the post of senior care worker to be retained and waive the skill requirement that we insisted on before, on the condition that employers stepped up to pay the going rate for that
job. My hon. Friend is right that it is not for me or a Health Minister to determine that pay rate; we have been advised by Skills for Care that it is the going rate for that job. Some hon. Members have said to me that that is a national raise. Of course, social care is a different business, and there are different rates of pay in different parts of the country.
Mrs. Dunwoody: The Minister has four minutes left in which to tell us what he is going to do now. I accept that his Department got itself into a mess. The legal advice that it received was unhelpful, and it is my experience that one can get different legal advice if one wishes. The reality is that the women whom we are discussing, who have enormous abilities, are being thrown out of the country and are not being replaced, and that the ones who are left are being overworked. What is he going to do about it?
Mr. Byrne: Let me come to that point directly. The Home Office has to translate Government policy into the immigration rules, and that is sometimes difficult, but I do it to the best of my ability. I have put transitional guidance in place, and the figures show that 79 per cent. of the people who apply for extensions to their leave are being given further leave to remain. That is partly driven by employers accepting their responsibility to pay individuals the going rate for the job. My hon. Friend is right that those workers are hard-working, well integrated and doing something with a level of tenderness, expertise and care that is, in my experience, second to none. It is not unreasonable for businesses in the social care sector—I name Southern Cross in particular—to pay £7.02 an hour for that job.
Chris Ruane: I hear what the Minister has said. We should tackle the employers that treat their employees shoddily, not the employees themselves.
Mr. Byrne: My hon. Friend is absolutely right. That will take some fundamental changes to the way in which the immigration system is run. One of the founding principles of the points system that will be introduced at the beginning of next year is that employers will need a licence to sponsor people into the country, so that we will have a means of quality control.
Mrs. Dunwoody: What about the ones who are here now?
Mr. Byrne: My hon. Friend asks, from a sedentary position, about people—her constituents, I think—who are here now. I have made it my policy not to discuss individual cases in the Chamber.
Mrs. Dunwoody: There are 20 of them. What is the Minister going to do about the 20 that I have and the 50 that my hon. Friend the Member for North-West Leicestershire (David Taylor) has? We need an undertaking now.
Mr. Byrne:
I ask my hon. Friend whether we can meet privately to discuss her constituents’ cases and see whether there is something specific that we can do. As a general principle, the transitional guidance means that
80 per cent. of people in that category are getting their leave extended. For those who are not, I challenge the employers to pay the going rate for the job.
Mrs. Dunwoody: That is not true. I have one minute, Mr. Illsley—
Mr. Eric Illsley (in the Chair): Order. We come to the next debate.
Westmorland General Hospital
1.30 pm
Tim Farron (Westmorland and Lonsdale) (LD): I am extremely grateful for the opportunity to engage the Minister on the matter of the acute service review at Westmorland general hospital. In spring 2006, the local Morecambe Bay hospitals NHS trust began a process of consultation on proposed changes to acute services provision at the hospital in Kendal. The consultation process formally began in the summer and concluded at the beginning of September last year.
The trust presented the public with four options, all of which constituted closure of or a severe cut to the coronary care unit and other acute services at the hospital. The public outcry against the proposals was enormous: more than 27,000 people signed the petition against the planned closures, a record-breaking 7,000 formal responses to the trust’s consultation were received, and 6,000 people marched through Kendal in abysmal weather last September to protest against the proposals.
The outcome was that on 13 September 2006 the hospitals trust chose option three, which entailed the closure of the heart and stroke unit and other acute services at Westmorland general. It seemed clear to thousands of us that although we had been consulted, we had not been listened to.
The acute service review has been marked not only by a staggeringly dangerous final decision that will, undoubtedly, cost lives, but by a catalogue of maladministration, procedural flaws, management failures and broken promises, which, frankly, have brought the management of the NHS in south Cumbria into disrepute. The Minister will have done her research, no doubt. My great concern, if I can be entirely honest with her, is that the principal source of that research will have been the trusts themselves. I suggest that she take information from such sources with a pinch of salt, given that at the centre of my concern and that of just about every one of my constituents is a range of faulty decisions taken chiefly by the hospitals trust after a faulty process.
As I speak, preparations are being made for a judicial review of the consultation process. In addition, the Healthcare Commission is undertaking an unprecedented independent review of the process that led to the decision to cut acute services at Westmorland general hospital. However, it should not fall to private citizens—NHS patients and their relatives—to have to undertake the risks associated with legal and other actions when we have a democratically elected Government, and, in particular, the Department of Health, which has the power to be their champion, to exact justice and to ensure that fair decisions are made.
The hospitals trust, alongside the now defunct Morecambe Bay primary care trust, presented four options, all of which constituted a reduction in service. At the time, I made a formal request for the inclusion of further options including the status quo and an option to enhance services. My request was refused by the then hospitals trust chief executive, who stated that status quo was not possible and could not therefore be an option.
The trusts used a formula to assess the four options, but, incidentally, had no financial costings. Option 3 came out on top and triggered the movement towards
closure of the heart and stroke units and all other acute medical services at the hospital. At a meeting of the joint health service overview and scrutiny committee in October 2006, however, the then acting chief executive of the hospitals trust demonstrated that the status quo option, which the trusts had refused to offer in the consultation, would have scored more highly across all the trusts’ criteria than three of the four options that were presented in the review.
That graphic admission, if it were the only evidence, would be evidence that would render the consultation process flawed and unsafe. We were presented with incomplete options. Indeed, it appears that the selection of options was fixed and based on internal prejudices rather than fact. The evidence suggests that a decision had, in effect, already been taken.
There was no justifiable reason to exclude the status quo as an option in the consultation. Indeed, there was no justifiable reason to exclude an enhancement of acute services at Westmorland general. An enhancement such as the provision of a CT scanner would have been completely in line with the Government’s stated policy of delivering NHS services closer to home. There was no justifiable reason for those options to be excluded. However, there was a strong unjustifiable reason—the decision to downgrade had already been taken. Before a single consultation response had been received, before the options were even presented, the trusts knew what they would conclude.
Only last month, thanks to a medical consultant, whom I will not name at this point, we secured further evidence that the decision to close acute services had been taken before the consultation had even begun. I paraphrase only slightly what the consultant told witnesses at a public meeting at Kendal town hall: “The consultants had argued for 10 years with our administration that acute medical services should be transferred from Westmorland general to Lancaster. The administration had resisted, but we saw our opportunity when the financial crisis occurred. We recognise that the consultation process was defective and we argued for accurate costs to be included, but the final decision was the one we wanted. That is all that matters.”
Of course, the Minister may think that the consultants must be right, even though there is clear evidence of prejudice and maladministration. After all, they are the experts, are they not? However, the consultant in question was not a cardiologist, and a huge body of local clinicians fully object to the trust’s conclusions. The consultant did, however, confirm the suspicions of many of us, when he clarified that the matter had been a done deal all along.
Let me explain that the trust presented its case for closure chiefly on two grounds. First, the financial imperative: the hospitals trust had a projected deficit of more than £12 million and had to make savings. Although that was the case at the time of the board’s decision in September 2006, it is not the case now. Since that time, the trust has improved its financial standing, in part thanks to the Government’s correct decision to overturn the old accounting rules so that trusts were not forced, in effect, to pay back their deficits twice over. That accounting change alone improved the trust’s financial position by £6.3 million, and it completely destroyed its financial case for the closure of acute medical services at Kendal.
The second part of the trust’s case for closure was ostensibly clinical. In a nutshell, the Royal College of Physicians produced guidance notes in 2002 which included a recommendation that consultants in acute medical care should not straddle more than one hospital. To follow that guidance to the letter would mean closing acute medical services at either Lancaster or Kendal. However, the guidance is just that—guidance. It is not an edict. Indeed, in answer to my written question last year, the then Secretary of State for Health, the right hon. Member for Leicester, West (Ms Hewitt), confirmed that it was only one of a range of considerations to be weighed up when trusts were deciding how best to allocate acute medical resources.
The principal alternative consideration to the guidance is the sheer distances involved in south Cumbria, which includes massive tracts of the Yorkshire dales and the Lake district. The Minister will know all about the golden hour in which patients must get to hospital to be stabilised in the event of a heart attack, for example. As things stand, more than half of my constituency is already an hour or more from hospital, yet the trust seeks to close Kendal and make dangerously ill patients travel a further 30 or 40 minutes to Lancaster or Barrow.
All acute medical crises have better outcomes the sooner they are treated by a full medical team of a doctor and specialist nurses situated in a fully equipped resuscitation room. Kendal has an excellent record of managing the initial stages of heart attacks and other life-threatening acute cardiac emergencies. I invite the Minister to review the statistics, which show clearly that timings at Kendal for patients getting vital treatment after the patient reaches the hospital door are significantly and consistently better than those for either Lancaster or Barrow. Outcomes are also excellent.
To counter the compelling clinical evidence against the preferred option of closure, the trust management presented the board at the crucial meeting on 13 September last year with new evidence secured at the last minute. It stated that no patient in the trust area would be more than 42 minutes away from the coronary care unit at Lancaster. The board accepted the figure, and the decision was taken to close acute medical services.
I can inform the Minister that she might make it from the north of my constituency to Lancaster in 42 minutes, if the Department were to provide her with her own jet pack. However, if she had access to an ambulance only, like the rest of us, the average journey time from, for example, Chapel Stile near Ambleside to Lancaster would be in the region of 75 minutes or more. On top of that, ambulance response times in south Lakeland are often in excess of 30 minutes. Having decided to close acute medical services, partly on the basis of that laughably faulty evidence, the trust sheepishly admitted a week later that it had been wrong and that the evidence presented to the board consisted of draft figures. The severely embarrassed board hurriedly agreed to change the figures, but carried on regardless with the plans to close acute medical services. I am no lawyer, but I know that any verdict based on faulty evidence is unsafe. At that point, the trust should have gone back to the drawing board, but it seems that it had already made up its mind, so why let a few faulty facts get in the way?
Sadly, the Morecambe Bay primary care trust voted to support the hospital trust and to back the closures, but providence prevailed. Owing to NHS reorganisation
a fortnight later, the Morecambe Bay PCT was wound up at the end of September 2006. At the beginning of October, the new Cumbria PCT reacted with horror to the position that it had inherited and refused to endorse its predecessor’s decision. Eventually, the PCT organised a group of GPs who used the strength of public opinion to win some concessions, including the retention of 50 GP-managed beds, but the trust continued to press on with the proposed closure of 70 per cent. of acute medical services at Westmorland general and, particularly, the loss of the coronary care and stroke units.
The Cumbria PCT caved in on the other 70 per cent., having been promised by the hospital trust that the closures would not begin until April 2008, and on the understanding that no movement towards enacting the acute service review would take place until Lancaster and Barrow hospitals had been upgraded to take on the additional capacity and until the ambulance service had been significantly enhanced.
The upgrade to the ambulance service to cope with the significant increase in journey distances would constitute a guarantee of at least one and normally two paramedics per ambulance, a 12-lead electrocardiogram on each vehicle, full telemetry and telephone contact on each vehicle—incidentally, something that just will not work in south Cumbria because of the terrain—and one additional ambulance serving the south lakeland area. At the moment, there has been no enhancement at Lancaster or Barrow hospitals and no upgrade of the ambulance service. Indeed, senior ambulance service managers stated candidly and publicly that they cannot, for example, guarantee even one paramedic on every ambulance.
The hospital trust’s promise to wait not only until April 2008, but until all those measures are in place before moving towards closure was broken earlier this month. A report was leaked to me on 2 October showing that the hospital trust was beginning implementation of the acute service review that very week, with the closure of ward 11. I protested against that, and the PCT, to its credit, refused to support the document. Ward 11 was then re-opened, but not fully. It took a further week of pressure to ensure that the trust did more than just re-open it in name and re-opened it fully in practice. That latest demonstration of bad faith rightly led to a humiliating climbdown by the trust.
While all that was going on, nurses, doctors and other staff continued to provide outstanding service. Despite being undermined and working under a cloud of job insecurity in the knowledge that trust bosses have dealt with them and their patients unjustly, local NHS workers have not let us down. They deserve our praise and enduring gratitude, and I want to take the opportunity to register my thanks to them in this place. However, hospital staff deserve more than gratitude, and I am asking the Minister to give Westmorland general hospital staff and the whole south lakeland community what they deserve. I am simply asking the Minister to undertake a full review of the facts, with a view to instructing the local NHS trusts to go back to the drawing board, and to instruct the Cumbria PCT to lead new consultation in which all options are fully considered and due process is observed.
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