Brighton MP highlights concerns about local NHS in Commons debate

Brighton Pavilion MP Caroline Lucas flagged up concerns about the NHS in Brighton and Hove in an hour-long debate in the House of Commons yesterday evening (Monday 24 October).

The Green MP spoke for half an hour about a series of problems affecting patients and staff in and around her constituency, including the closure of doctors’ surgeries.

The problems included the Sussex Patient Transport Service – the non-emergency ambulance service contracted to Coperforma.

She also spoke about Brighton’s main hospital trust, which is in special measures, as is the South East Coast Ambulance Service which responds to 999 ambulance calls.

Peter Kyle, the Labour MP for Hove, and Tim Loughton, the Conservative MP for East Worthing and Shoreham, intervened in the adjournment debate, the last item of business in the Commons each day.

Health Minister Philip Dunne responded for the government. During his 30-minute reply he said that the sustainability and transformation plan (STP) for the area would help improve care and better balance the books for trusts struggling financially.

Below is an extract from Hansard, the official record of parliamentary debates.

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Caroline Lucas
This debate is intended to highlight the ongoing NHS crisis affecting my constituency and the city of Brighton and Hove and to outline solutions to what is far more than a purely local problem. The concept of a publicly funded national health service is at risk, and the situation in Brighton and Hove reveals a whole host of systemic problems that stem in large part from the Health and Social Care Act 2012. Patients and staff are being let down in my constituency and elsewhere, and it is more than likely that the additional strain of the winter months will further exacerbate the crisis.

The picture I will paint of the situation in Brighton and Hove is deeply worrying. It encompasses our hospital, our GP provision, our ambulance services and our community care. Those services are held together by incredibly dedicated staff, who often work well beyond the hours for which they are paid to keep things going. I want to thank and pay tribute to each and every one of them. Despite their tireless efforts, however, the overall picture of health and social care in Brighton and Hove is chaotic, not because of a lack of hard-working staff, but mainly as a result of two things: harsh funding cuts and an increasingly fragmented structure based on marketisation and the increasing commercialisation and privatisation of our NHS.

I will provide a quick overview. Our local hospital, the Royal Sussex, is in special measures for both quality and finance. As of July, over 9,000 people had been waiting for more than 18 weeks to start treatment – the worst recorded among 185 providers and the 208 clinical commissioning groups that submit data nationally. Over 200 people have been on a waiting list for more than a year.

While I am talking about the hospital, let me quickly put on the record the fact that I am very grateful that we are soon to have a brand new building – we certainly need it. The hard-working staff in that hospital are operating in a building that stems from before Florence Nightingale. It is the oldest estate in the whole NHS. At the same time, it is undertaking increasingly complex work for the whole of Sussex as a major trauma centre for the wider region.

Peter Kyle
My neighbour mentions that we are constructing a new wing to the hospital and a bunch of other services locally. Does she agree that the fact that this is going to create an additional administrative burden and challenges for staff, including clinical staff, means we have to get this situation in Brighton and Hove right now, otherwise the additional burden could just be too much for the system locally?

Caroline Lucas
I am grateful to the honourable gentleman, as he anticipates exactly what I am going to say. Of course we need new bricks and mortar, but we also need finances for the services inside them. We desperately need a central funding settlement that recognises the unique pressures on our hospital, so that the systems can be updated. For example, we need a computerised records system – this is not rocket science but we desperately need it. We need increased capacity, particularly for accident and emergency, because we are now serving a much wider region, as a result of being a central trauma centre. With debts currently of about £45 million, Brighton and Sussex University Hospitals NHS Trust is facing a situation that is simply unsustainable.

That is just one example, but there are plenty of other examples of what is going wrong in the health service in Brighton and Hove. Patients in the city have seen six GP practices close so far this year alone. When The Practice Group announced that it was walking away from its contract to run five surgeries in the city, the decision was largely a financial one. With almost 11,500 patients registered, the disruption and uncertainty was widely felt, and other nearby surgeries were simply expected somehow to manage increased patient numbers. NHS England was not required to step in to help because of the terms agreed with The Practice Group. The fact that this type of contract is no longer permissible was of little comfort to the patients forced to find a new GP with whom to register. I particularly recall the constituent who contacted me after a sixth surgery, Goodwood Court, was closed and who was unable to visit the emergency drop-in clinic at Brighton station for an urgent inhaler prescription because of a disability. That is just one individual, among many, who has experienced unnecessary, unhelpful anxiety and distress as a result of the Government’s NHS policies.

Our emergency ambulance service was placed in special measures on 29 September following a Care Quality Commission report that rated it as “inadequate”. The inspectors praised frontline staff but identified unsafe levels of staffing as well as poor procedures and leadership. The city’s mental health services, especially those serving children and young people, are overstretched and underfunded. Adult social care services in Brighton and Hove face ongoing cuts despite the cost to individuals and the NHS. That means that over the next four years the city council is looking at potential cuts of £24 million and the complete privatisation of the remaining council adult social care, day centres, carers and so on.

I have lost track of the number of times that ministers assert they are investing record amounts in the NHS yet conveniently fail to mention the record amounts they are simultaneously cutting from local authority budgets that are supposed to cover essential care services for vulnerable people.

Tim Loughton
The honourable lady is my near neighbour and I refer back to some of the comments made earlier by my neighbour, the honourable member for Hove (Peter Kyle). She is painting a gloomy picture, and I acknowledge the severe problems within Brighton and Hove. Does she also acknowledge that, next door, the Western Sussex Hospitals NHS Foundation Trust is one of only five hospital trusts in the whole country rated “outstanding” yet we face the pressures of having one of the most elderly populations in the country and having increasing pressures placed on us because of people coming from Brighton and Hove to access NHS services across the county boundary? Why is Brighton and Hove in such a parlous state at the moment yet a few miles down the round we are able to run a rather good hospital service?

Caroline Lucas
I thank the honourable gentleman for his intervention and congratulate him on the performance of his local hospital trust. I recognise what he is saying about the extra pressures put on the surrounding area when there is a particular problem as there is in Brighton and Hove but I contest the implication of what he is saying, which is that there is something particular to Brighton and Hove. If we look around the country, we see that, sadly, a great many hospital trusts are in severe difficulties. Only a few months ago, the Public Accounts Committee was absolutely saying the same thing and I shall refer to that shortly. If I am asked specifically about Brighton and Hove, I would say that we face some issues – for example, the fact that we are working in the oldest building in the whole NHS. There are particular problems when that is combined with the demographics. There are particular challenges in Brighton and Hove that come from having a number of older people and people with lots of complex problems, such as mental health problems and homelessness problems. I do want to challenge the idea that, somehow, this might be a problem simply in Brighton and Hove, because it is not.

Tim Loughton
Fortunately, we have lots of time to debate this matter. The honourable lady must acknowledge that, certainly recently, the average age of a patient in Worthing hospital – taking out maternity and paediatrics – is 85. That places considerable extra pressures on our hospital system. The average age in Brighton and Hove, the city, is considerably younger. The average age of people accessing health treatment in her city is considerably younger and therefore less demanding so why is there such a contrast in the performances of our respective hospital trusts?

Caroline Lucas
That would be a very interesting issue to debate. The honourable gentleman can get his own debate on Worthing Hospital but what I know about are the particular problems that are facing Brighton and Hove and I will point again to the particular complex needs that come together when one has a city full of young people as well as very elderly people, a lot of people with mental health problems, homelessness problems, vulnerability problems and so on. If he will give me a little more time, I will set out for him what some of the problems are in Brighton and Hove and also, crucially, what some of the answers are.

I was talking about adult social care and about the fact that, unfortunately, the government are cutting yet more money from local authority budgets that is supposed to cover those essential care services for vulnerable people.

The government know that social care in places such as Brighton and Hove is on its knees and that that has very direct knock-on effect on the NHS that no amount of financial smoke and mirrors can conceal. Brighton and Hove National Pensioners Convention has begun a valiant campaign to protect adult social care services from cuts, with unions such as the GMB fighting alongside it. I really hope that the minister is listening because this is a crisis that lets down everyone and there is no hiding from it. Where should responsibility for this catalogue of troubles lie?

What has happened to the city’s non-emergency patient transport service goes some way towards answering that question, and I wish to look at this in a bit more detail. It also demonstrates what can only be described as an utter dereliction of duty on the part of the Secretary of State for Health and I want to repeat my call for his department to step in and for him personally to resolve an unacceptable and untenable situation.

I am referring to a service that takes people to essential non-emergency appointments – kidney patients going for dialysis and cancer patients going to and from chemotherapy and radiotherapy. Since April, it has been run by a private company called Coperforma and a number of subcontractors. Coperforma faced intense criticism from the outset, with patients saying that they had experienced delays reaching appointments and subcontractors reporting that they had not been paid. Two of those subcontractors, Langfords and Docklands, went bust in September, leaving some ambulance drivers with up to six weeks’ worth of wages unpaid. In early October, drivers for another Coperforma subcontractor turned up for work only to be sent home again.

Last week, the Patient Transport Service was plunged into a fresh controversy after an investigation by our local paper, The Argus, revealed that one subcontractor may not even have been licensed to operate a fleet of 30 ambulances. I have the headline from the local paper, which members can see very clearly. It says that ambulances are now in a total shambles –

Mr Deputy Speaker (Mr Lindsay Hoyle)
Do you want to put that paper down on the bench? Thank you.

Caroline Lucas
I am sure that The Argus will be sad to see itself relegated to the seat behind me.

The subcontractor is a company called Docklands Medical Services Ltd. This is apparently a phoenix company for the aforementioned Docklands. As I understand it, the new company seems to be suggesting that it was acceptable for it to operate under the Care Quality Commission licence that was issued to its predecessor, the bankrupt Docklands. The application process for a licence is carefully designed to ensure that standards for vehicles and other safety checks and safeguards have been met. Just allowing a new successor or phoenix company to inherit a licence is setting the bar dangerously low, exposing patients and staff to unacceptable risks.

As a result of this debacle, our struggling hospital trust – yes, the one in financial special measures – has incurred £171,000 of private ambulance costs so far this year to plug the gap left by Coperforma and its subcontractors. To recoup this cost, the trust has, quite rightly, invoiced the clinical commissioning group, which appointed Coperforma. No doubt other trusts similarly affected will have done the same, with serious consequences for the CCGs’ budgets and, therefore, for the money available for other services. Whichever part of the Department of Health ends up footing the Coperforma bill, it represents an unforgivable waste of money and resources and their diversion away from patient treatment and care.

I trust that the minister will agree that patients in Brighton Pavilion or anywhere else should not be paying the price for the failure of private companies that are profiting from NHS contracts. Will he therefore ensure that the CCG is not out of pocket in turn as a result of Coperforma’s mismanagement? I would also like his department to stop passing the buck when it was his government who passed the legislation that required services such as non-emergency patient transport to be put out to tender. It is unacceptable for no one in the Department of Health to know whether a fleet of 30 ambulances were properly licensed to transport Sussex patients for three months over the summer. When the minister responds, will he tell us whether he agrees?

Peter Kyle
Is it not extraordinary that the contract was awarded in the first place? Coperforma and the whole underlying supply chain have underperformed and failed patients from the very first day that they took over the contract and they continue to do so today. The service cannot be returned to where it was before because the ambulance trust that it was taken from is also in special measures and now no longer has the capacity to take it over. Is not the lesson from this experience that if such a contract is outsourced, the government must make sure that due diligence is done correctly so that patients do not suffer in this way?

Caroline Lucas
I am grateful to the honourable gentleman for his contribution and I entirely agree. When I have talked to staff of the CCG, they have acknowledged that they are using an off-the-peg contract that is not suitable for such a service, and that there have therefore been problems in the system as well as with the company which is not providing the service that people in our city deserve.

Dr Philippa Whitford (Central Ayrshire) (SNP)
I can see that in this case due diligence was not done in the contract but is there not an underlying principle that when a piece of NHS service is outsourced the NHS version ceases to exist? Therefore, at some future date, if the service is not good enough or other circumstances change, it is not possible simply to take it back in-house?

Caroline Lucas
I thank the honourable lady for her intervention – someone who knows a great deal about these issues. I absolutely agree. Once the service has been outsourced, the ability to do a convenient U-turn is taken away. That is failing patients in Brighton and Hove.

The department has said that allegations of ambulances operating illegally warrant investigation by the CQC. I have written to the Department of Health to demand that that happens and I have written to the CQC as well. Will the minister go further tonight than admitting the severity of the problem and let us know what he thinks he can do about it? Specifically, will he provide assurances that the Department of Health is no longer content to leave patient safety in the hands of private companies such as Coperforma and that it intends to step in, bring the service back in-house and at the very least check that the sub-contractors’ contracts meet the requirements?

Jim Shannon (Strangford) (DUP)
On the privatisation of the ambulance service, were there health and safety criteria that the contractor had to meet, in the same way as the NHS does? Were there ever occasions when the contractor’s work fell below the required level of service?

Caroline Lucas
That is a good question. When I have asked the CCG that very question, the answer has not been clear. I have been told that the performance of the company was not such that the contract was breached but one of the difficulties is that so much of the contract is not in the public domain. For example, if the CCG wants to see the sub-contracts between Coperforma and the various companies to which it is subcontracting, the CCG does not have access to those contracts so it cannot assure us what is in them. We have a very opaque system that makes it extremely difficult to say where accountability lies. That is why I say that this is a failed model.

I said earlier that the Coperforma example goes some way to illustrating some of the underlying causes of the NHS crisis that we are experiencing. Trying to get to the bottom of the contracts, sub-contracts and who is responsible for which bit of what is like grappling with a Gordian knot. The CCG admits that one of the biggest challenges is identifying responsibility when things go wrong. When, for example, people providing the service are not being paid, it is not clear where responsibility lies. Was it with Coperforma or with the sub-contracting companies?

That lack transparency is deeply concerning. It is also a serious example of the problems and risks associated with this outsourcing of so many of our key NHS services.

As we know, the driving force behind all this is commercialisation – commercialisation made worse by the Health and Social Care Act 2012, which has not only exposed patients to unacceptable risks but engendered structures and terms and conditions that appear to protect profit-led companies at all costs. I do not think that is the NHS the public want or deserve. It is not even an NHS that is effective. The model is failing. Contracts such as the one with Coperforma do not work and need to be brought back in-house. I pay tribute to the honourable member for Bexhill and Battle (Huw Merriman), who has done very good work on this issue, on which I think there is cross-party agreement. He has rightly asserted that, in this instance, private contracting has not worked and the local ambulance service would be better operated within the NHS family.

I would go further still, because it is not just our patient transport services that are in trouble. Coperforma is, as I say, just one example of the fragmentation and marketisation damaging the NHS. Fragmentation matters because the healthcare picture is made up of parts that ought to be interconnected, yet it is hard at the moment for one part to influence the other. For example, ambulance handover times at the Royal Sussex County Hospital have apparently risen 16 per cent this year but that is largely because of the ongoing flow issue caused by a lack of places to discharge people to. The whole system gets blocked when there is no overview. A&E, especially in winter, is all too often the pinch point for failures elsewhere, most notably insufficient capacity in local community social care.

However, fragmentation is an inevitable part of a system that is designed to give private providers as many opportunities as possible to compete for services through a continuous cycle of bidding and contracting out despite that being hugely inefficient and counterproductive. There are local fears that Brighton and Hove’s children and young people’s community nursing might be taken over by a private company such as Virgin Care. Sussex Community NHS Foundation Trust has preferred bidder status to continue delivering children’s services but the city council is still forced to undertake a procurement process in the name of market competition. I would argue that that process is a waste of time, effort and money and increases the risk of a private company stepping in and undercutting a highly valued effective provider such as Sussex Community NHS Foundation Trust – a risk that is exacerbated by the government’s mind-bogglingly short-sighted decision to cut public health spending by 3.9 per cent each year until 2021. That equates to £1 million less for our city over the same three years and it has resulted in some important services being decommissioned. Those include the Family Nurse Partnership, which provides regular visits for teenage mums during pregnancy and until their babies are two years old. That makes no sense but it is what happens when we do not have a coherent publicly planned and publicly provided NHS or a model that puts health needs before private profit – one that is based on co-operation, not competition.

That is the model that has been set out in the NHS Reinstatement Bill, of which I am a sponsor. I tried to bring it to the House in the last legislative term as a private member’s bill and it is currently before the House in the name of the honourable Member for Wirral West (Margaret Greenwood). That is the kind of NHS I think my constituents want and it has to go hand in hand, crucially, with adequate levels of funding. According to the King’s Fund chief economist, the annual average real increase in UK NHS spending over the last Parliament was 0.84 per cent. That is the smallest increase in spending for any political party’s period in office since the Second World War.

From local ambulance drivers caught up in the Coperforma debacle to junior doctors, NHS staff are universally respected – except, it seems, by this government. Our nurses should not have to fight for a measly 1 per cent pay rise after years of pay freezes. That does not only have consequences for the individuals involved. Healthwatch Brighton and Hove points out that staff retention is a specific problem in the city, with poor morale and high housing costs as contributory factors. I am particularly worried about the impact of the EU referendum on NHS staffing.

Brighton and Hove is set to benefit hugely from a major new county hospital redevelopment thanks to capital investment secured as a result of a longstanding cross-party campaign and I am grateful for that. However, I would like to extend the logic of public provision to the services that will be based in the new hospital. In the meantime, as ministers know well, the big issue is running costs, with the NHS funding settlement during the last Parliament the most austere in its history – that is according to the House of Commons Library.

Tim Loughton
The honourable lady is straying into the area of the ideology of NHS funding, but she might like to mention an example from her city. Brightpip – I declare an interest as the chairman of the trustees – works to promote the “1001 Critical Days” agenda to help children and their parents before the children are born and in the two years after they are born. That is an excellent example of the NHS working with the independent and charities sector to provide a much needed service, which I am sure the honourable lady wants to promote in her constituency. So it is not all bad if it just happens to be outside the NHS.

Caroline Lucas
If the honourable gentleman had been listening carefully, he would have noticed that I am talking about private companies that are taking over and cherry-picking key NHS services. He and I worked together on Brightpip, and I am incredibly proud of what it has achieved, but he will know that it does not work for profit. It ploughs money back into the services it provides. It is a wonderful example and there are many others, including the wonderful Martlets hospice in the constituency of the honourable member for Hove (Peter Kyle). There are plenty of examples of the charitable sector doing amazing work and the NHS reinstatement Bill absolutely made provision for them as well. What I am criticising is when the private sector comes in and cherry-picks services, which are then lost from the NHS and work for profit.

Last week the Prime Minister claimed that NHS funding was being increased by £10 billion. In doing so, she ignored a plea from the respected chair of the Health Committee, the honourable member for Totnes (Dr Sarah Wollaston), for ministers to stop using such a misleading figure, when the correct figure is less than half the amount claimed.

The chief economist of the Nuffield Trust argues that even that is overstating the case, highlighting King’s Fund research that found that NHS-specific inflation means that the real increase is about £1 billion – about a 10th of the figure that the Secretary of State and others repeatedly use. It is certainly not £350 million a week. I would be very surprised if any ministers repeated that blatant lie again but anyone who claims that the investment is £10 billion is playing hard and fast with the truth. Indeed, the NHS chief executive admitted to the Health Committee that the spending review settlement would actually deliver

“negative per person NHS funding growth”

in 2018-19, with “very modest” increases in the other years.

On top of that, ministers expect the NHS to find £22 billion in efficiency savings by 2020-21. No one with expertise thinks that that is possible. In a scathing report in March, the Public Accounts Committee found that a significant number of acute hospital trusts are in

“serious and persistent financial distress”.

It said that there is a “spiralling” trend of increased deficits and that the current payment system is “not fit for purpose”. That is perhaps most starkly demonstrated by our beleaguered social care provision, the funding of which all three Care Quality Commission inspectorates agree is seriously affecting the NHS. The committee goes on to warn that it must be funded sustainably as a priority.

Yes, we have the Better Care Fund, intended to advance the integration of health and social care services but the majority of that comes directly from the NHS budget, resulting in what the King’s Fund describes as

“a sharp and sudden reduction in hospital revenues.”

In other words, the government are robbing Peter to pay Paul while local authority social care budgets are slashed and people are having to sell their homes to pay for care or are not getting it.
Nor is the government’s secretive sustainability and transformation programme the solution. Many constituents are worried that plans are being conducted behind closed doors and that vital NHS services could be cut as a result. We urgently need clarity on what STPs will mean in practice for both patients and staff. The Sussex and East Surrey STP area, which includes Brighton and Hove, faces a financial funding gap of literally hundreds of millions of pounds by 2021 and it is not at all clear how our STP will bridge that financial gap or whether acute services will be cut.

Dr Philippa Whitford
Does the honourable lady agree that the principle of STPs going back to place-based planning could actually help reintegrate the NHS but that, if it is done on the basis of budget-centred care instead of quality and patient-centred care, we will get the wrong answer?

Caroline Lucas
I am grateful to the honourable lady for her intervention. I agree that place-based planning is potentially a very useful tool but I fear that it is being used as a back-door way of making yet more cuts. I am also worried that that is happening in an untransparent way which is giving rise to concerns among my constituents about exactly what is being set out. Winter is coming and the crisis already playing out in Brighton and Hove is likely only to get worse if the NHS continues down the path on which the government have put it.

Specifically, we spend 2.5 per cent less of our GDP on health than countries such as France and Germany. I am prepared to say what few others will say, which is that, if we want an NHS that meets our complex health and social care needs, we do not need privatisation and competition; we need those who can afford it to pay more in tax. This is something we can put a price on whereas the cost of the worry, misery, pain and sheer uncertainty for many of my constituents is incalculable. Whole families have to live with the agonising wait for a loved one’s treatment. It often falls to them to act as carers during that time. The knock-on effect of NHS delays cannot and should not be dismissed. Concerns about delays and cancellations at our digestive diseases unit, for example, come up repeatedly. Operations are repeatedly cancelled, with patients in distress. There is the amazing mum fighting tooth and nail for adequate care and support for her severely disabled son. For her, the system is a battleground. She has to co-ordinate equipment in four different places and put up with repeated delays. She told me:

“It’s this that pushes people beyond despair and to breaking point.”

Breaking point is exactly where we are. A perfect storm caused by decades of chronic underfunding and privatisation has met the consequences of fragmentation and ramped-up marketisation. Terms and policies manifest themselves in grave and very real problems of the kind that I described when I opened this debate. Those problems are not unique to my constituency or city but Brighton and Hove has an unusual demographic profile, with many younger people, as I have said, with complex needs, mental health problems, drugs and alcohol addiction, homelessness and long-term conditions. It also has some very elderly people.

That means that the array of services to support people using the NHS may need to become more complex, more tailored and more multi-agency, including police, voluntary agencies and so on. We need an ecosystem of healthcare, in which each part complements other parts as well as the whole, and which is achievable locally and nationally if we strip back the unnecessary, ineffective and damaging complexity that currently infects the NHS, if we reinstate the basic principle of a publicly funded and provided national health service that is free at the point of access and if we give patients, staff and the public a voice from the outset and not just as part of a box-ticking exercise. I believe that is the way to bring us back from the brink.

I have raised a number of questions, and I will repeat them for the Minister before I give the floor to him for his response. Will the Department of Health step in to bring back accountability and stability to the non-emergency transport system in Brighton and Hove? Will it bring that service back into the public sector as a matter of urgency and pick up the Coperforma bill? Can the minister promise that the STP plans will not mean cuts to services and closures? Will our hospital trust and mental health trust get the money that they need to address the staffing and other crises that they face without having to impose cuts dressed up as efficiency savings?

Will the minister and other ministers stop using inaccurate figures when they talk about investment in the NHS and use the autumn statement to announce a genuine step change when it comes to funding social care via local authorities and NHS services in the round, taking full account of NHS-specific inflation? Will he petition the Home Secretary to immediately guarantee EU workers the right to remain and protect the NHS from yet further instability and uncertainty? Finally, will he take a really honest look at the knock-on effects and inefficiencies of a healthcare model that is jeopardising accountability, transparency, standards and patient care?

The Minister of State, Department of Health (Mr Philip Dunne)
I congratulate the honourable member for Brighton Pavilion (Caroline Lucas) not just on securing this debate but on doing so on a day that enabled her to get through her entire speech and take interventions from the honourable member for Hove (Peter Kyle) and my honourable friend the member for East Worthing and Shoreham (Tim Loughton) – a considerable achievement.

The honourable lady has a long-standing interest in health outcomes for her constituents, as we all do in the House. I would like to join her at the outset by highlighting the excellent work carried out every day by all those who work in the NHS, not just in her constituency but equally in my own and across the country. Before addressing the specific points that she made, I should like to give the House an overview of the NHS in her constituency.

Brighton and Hove Clinical Commissioning Group covers a geographical area of approximately 34 square miles, with a patient population of some 300,000. It commissions a wide range of healthcare services including from the main local acute trust, Brighton and Sussex University Hospitals NHS Trust, with a regional teaching hospital working across two sites in Brighton and Haywards Heath. I understand that the trust treats over 750,000 patients every year and it recognises its growing role as a developing academic centre.

The honourable lady has asked, not for the first time, for more funding to improve services and facilities in Brighton. I am pleased that she recognised the capital investment of more than half a billion pounds that is under way at the Royal Sussex County Hospital, replacing some very old buildings, as she said, and supporting the service quality improvements planned by the trust. I was a bit disappointed that, in his intervention, which came around the time that she referred to that capital investment, the honourable member for Hove (Peter Kyle) did not acknowledge that that is a significant investment in the facilities at the heart of health provision in Brighton.

The government created the Care Quality Commission to shine a light on good and bad healthcare up and down the country. Its independent inspection teams provide a vital function on behalf of patients and everyone in England in challenging how hospitals, GP surgeries, care homes and all other healthcare providers are delivering to the standards we should all expect.

The CQC has identified that the local NHS in the honourable lady’s constituency faces some challenges. I acknowledge that the confluence of inspection reports – they have come at around the same time to several of the different providers and commissioners in her area – is an unusual challenge to correct for the benefit of local residents. In stark contrast, as my honourable friend the member for East Worthing and Shoreham said, next door, there is the outstanding-rated Western Sussex Hospitals NHS Foundation Trust, which serves residents of West Sussex. As she pointed out, Brighton and Sussex University Hospitals NHS Trust was rated inadequate earlier this year by the CQC. To support its recovery, NHS Improvement placed the trust into special measures.

Peter Kyle
I am grateful to the minister for giving way so early in his speech. He mentions that there has been an unusual confluence of reports. I would suggest that the unusual thing is that each of the reports indicates extreme failure in many different parts of our health system in Brighton and Hove, from the ambulance trust and six GP surgeries, as was brilliantly outlined by the honourable member for Brighton Pavilion (Caroline Lucas), right through to the hospital trust – all in special measures, and the hospital in financial special measures. That is the unusual thing. I suggest that the health economy in Brighton and Hove is now bankrupt.

I suggest to the minister that he does not do his thinking on his feet now. Would he consider arranging for his department to appoint someone to our city who can take an overview of what is right and what is wrong in our city, of the funding and of the relationship between the different health bodies and the local authority? Let us bring together all the health systems, figure out what is wrong and how we can bring them together to solve all the problems. The fractures have got too much.

Mr Dunne
I will not take up the honourable gentleman’s invitation to think on my feet but I will refer later to the sustainability and transformation plan, to which the honourable lady referred, which is providing a forum for much closer collaboration across the NHS within an area. Clearly, it is a much larger area than Brighton itself, but it is going some way towards meeting the kind of analysis that he is looking for. I will also touch on the individual trust support that is being offered by wider NHS groups to provide additional qualified medical and managerial support to help to solve the problems.

Caroline Lucas
I want to put this on record. The minister referred to the fact that up the road there is a more successful trust. Not only are we operating in a very old building but we are trying to do that when the hospital is becoming a major trauma centre. That is a massive change in Brighton and Hove. I re-emphasise the points that my honourable colleague, the honourable member for Hove (Peter Kyle), made. We need real finance and I do not think that the STP is going to do it. It needs some money.

Mr Dunne
I thank the honourable lady for her intervention. I am going to move on, but I acknowledge her point. I hope that, in part, the STP will focus the attention of the wider area to support the new trauma centre that is being established. That is part of the purpose of the STP, although, like her, I have yet to see the full details.

I think we all recognise that patients deserve the highest quality care and we expect the trust to take action to ensure the root causes of the CQC concerns are addressed. NHS Improvement has confirmed that the trust has developed a recovery plan and as part of a package of support for the trust for being in special measures, NHS Improvement has appointed an improvement director and a board adviser.

We should also acknowledge along with the trust’s challenges the fact that there are good things going on in Brighton. We should praise the team that delivers services for children at the Royal Alexandra Children’s Hospital in Brighton as the CQC rated them as outstanding for being innovative and well led.

Emergency care services at the trust are not as we would expect, as the honourable member for Brighton Pavilion identified. With support from the national emergency care improvement programme, a clinically led initiative that offers intensive practical help to trusts looking to improve their emergency services, NHS Improvement is working closely with local clinicians to make a difference for the people of Brighton and Hove seeking emergency care. The trust is also developing plans to create capacity to support delivery of the planned care standards.

As the honourable lady said, on Monday of last week NHS Improvement announced that the trust has entered financial special measures, a programme launched by the regulator that provides a rapid turnaround package for trusts and foundation trusts that have either not agreed savings targets with local commissioners or planned to make savings but deviated significantly from this plan in their quarterly returns. As part of financial special measures, the trust will agree a recovery plan with NHS Improvement. The trust will also get support from and is held accountable by a financial improvement director.

The honourable lady also referred to the challenges faced by the ambulance services in her constituency and the area. In addition, South East Coast Ambulance Service was recommended for special measures by the CQC in its inspection report published last month. NHS Improvement acknowledges that there are wide-ranging problems across the trust, including in governance structures and processes, culture, performance and emerging financial issues. NHS Improvement has agreed a support package for the trust, which was formalised on 9 August this year, and includes a formal peer support relationship with a neighbouring ambulance trust that is rated good by the CQC.
As part of the support package, NHS Improvement has also appointed an interim chair and will appoint an improvement director in due course.

Peter Kyle
For the second time, I am extremely grateful to the minister for giving way. We focus the onus for improvement on the delivery bodies in the Brighton and Hove area. NHS Improvement and the CQC have been outlining plans and their responsibility is to instigate this improvement but does he accept that NHS Improvement is also under scrutiny in how it unfolds this improvement programme and that if improvements do not happen fast enough they will also be culpable? Some of the dates for improvement have already passed without the improvements being made.

Mr Dunne
The honourable gentleman will recognise that NHS Improvement only came together in April of this year when the two previous regulators, Monitor and the NHS Trust Development Authority, were combined. It is to a degree finding its feet in working out how best to assist trusts that get into difficulty. It has introduced a number of different schemes for different types of challenge, and we have touched on the care challenge and the financial special measures challenge. It is also undertaking a five-point A&E improvement plan to focus particularly on challenges in emergency care. It is fair to say that it is early days in seeing how NHS Improvement undertakes its functions but we have every confidence that it will be able to assist trusts in dealing with these challenges.

Finally on the South East Coast Ambulance Service, NHS Improvement is also undertaking a capability and capacity review and will provide the trust with support with its finances. The honourable lady mentioned the problems with the non-urgent patient transport service provider. This has clearly been a very difficult time for its staff and for some patients as she has highlighted. My understanding is that the High Weald Lewes Havens CCG has overseen the implementation of plans to ensure continuity of service and has recently appointed a specialist transport adviser to look into the resilience of the contract and to explore options to strengthen this further.

The provision of the services is, quite rightly, a matter for the local NHS. The honourable lady asked who is responsible for monitoring contracts. The reality is that the CCG is the statutory NHS body with responsibility for the integrity of the procurement as well as for managing the contract. It has powers within the standard NHS contract to intervene where a contractor’s performance falls below what is expected.

Caroline Lucas
The minister says that the CCG has such a power but the CCG told me that it could not see the contract between Coperforma and its subcontractors because that was not for the CCG to see. It therefore cannot have such a degree of oversight.

If this is the last time the minister gives way, will he say if he will step in on the issue about whether the Docklands phoenix company is properly licensed to provide the service it is providing? Right now, we do not know whether it is and our patients may be at risk.

Mr Dunne
On the first point, it is down to the CCG to undertake a contract that gives it visibility on subcontracts. If that failing has emerged, the CCG needs to be able to get to see them in subsequent contracts and I am sure it will learn from that message. On the regulation of the provider, that is a matter for the CQC to look at. I undertake to inquire of the CQC what the status is of the current provider to ensure that it is properly regulated.

For much of her speech, the honourable lady talked in rather familiar terms about her understanding of the impact of the so-called privatisation of the NHS. I gently remind her that the Health and Social Care Act 2012 did not introduce competition into the NHS. Previous governments have used patient choice and competition as part of their reform programme. Independent sector providers have provided care and services to NHS patients under successive governments ever since the NHS was founded. In particular, in the area of non-emergency patient transport, that has happened across many areas of the country. In the last year for which financial data are available, NHS commissioners purchased 7.6 per cent of total healthcare from the independent sector. In 2010, that was about 5 per cent. The rate of growth in the use of private providers under this government is lower than it was under the previous Labour government.

Tim Loughton
I have no problem with the principle of outsourcing. The minister is absolutely right that the level of outsourcing may go up and may go down because it should be based on the quality of an alternative provider that is able to provide a quality service at an affordable price and is best placed to do so at the time. Will he acknowledge the whole issue with Coperforma? It has been a major issue for all of our constituents. Vulnerable people relying on regular treatment have just been left at home or dumped elsewhere and have not been able to access services. This has been going on for so long that, when we put a contract to such organisations, much better due diligence needs to be done. There also needs to be a fall-back plan because given that the ambulance service, which declined to take on the contract in the first place, is now clearly not in a position to take it on anyway, there is little option for somebody else to take on the service urgently and provide the level of care that our constituents desperately need and that has just not happened in this case.

Mr Dunne
My honourable friend makes a very powerful case. As I have already undertaken to do for the honourable member for Brighton Pavilion, I will take up the issue with the CQC and ask it to give me some reassurance about both the regulation of the entity and, to the extent that it is relevant to the CQC, the procurement. I accept that we should look at the due diligence for such activities.

I will close, without taking any further interventions, by saying a brief word more, as I promised to earlier, on the sustainability and transformation plans. These were submitted to NHS England by 44 regions across the country during the course and by the end of last week – by last Friday. As I said earlier, the intention is that the plans build on the work already undertaken to strengthen care. They will help deliver the NHS’s own plans for its future, set out in the five-year forward view, by encouraging providers and commissioners within an area to work more collaboratively – without the barriers of stovepiping that in the past have led to conflict between them – and co-operate to try to come up with the best plan for patients. That must take into account the increasing integration with social care providers in the area, which the honourable member for Brighton Pavilion has mentioned, so local authorities are also integral to the plans.

We expect most areas to undertake public engagement from now until the end of the year, building on the engagement they have already done to shape thinking. But we are clear that we do not expect changes to the services that people currently receive without proper, full local engagement and, where appropriate, public consultation. There are longstanding processes in place to make sure that happens.

In closing, I emphasise that it is the responsibility of local NHS organisations to determine how local services are delivered. They are best placed to understand the needs of the people they serve and we must ensure that changes are led locally, in some cases with improved local management where there have been management shortcomings. Changes need to be focused on the needs of the local population and not driven by central government. This government recognise the importance of ensuring that the NHS is held to the highest standards of care, in the honourable lady’s constituency and across the UK, and we will continue to work to ensure that services are high-quality, safe, appropriate and affordable.