Blackpool Teaching Hospitals NHS Foundation Trust

– in the House of Commons at 5:44 pm on 24th October 2019.

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Motion made, and Question proposed, That this House do now adjourn.—(Maggie Throup.)

Photo of Gordon Marsden Gordon Marsden Shadow Minister (Education) 6:05 pm, 24th October 2019

This is the second Adjournment debate I have been granted in 16 months on Blackpool Teaching Hospitals NHS Foundation Trust and concerns about its governance. In the first debate, last June, I expressed profound concerns about the processes and lack of transparency leading up to the appointment of the trust’s current chair, Pearse Butler. As I said then, it was the first time in my 20-year relationship with the trust and its predecessors, as a Blackpool MP, that I felt it necessary to express such concern in an Adjournment debate. I felt I had no choice, given the catalogue of errors, evasion and lack of transparency that had accompanied the process, including failings within NHS Improvement.

Last year I said:

“I am forced to conclude that the nominations committee thought that it could get away with evading proper scrutiny and transparency—that a thin veneer of irritated politeness attempting to conceal a determined effort to override public governors unless they were rubber-stamped…would do the trick. Well, it does not do the trick”.

The Minister’s predecessor, Stephen Barclay, said in his reply that the issues I raised

“are clearly a cause for concern…it is clear that the recruitment process for the new chair had a number of irregularities.”

He criticised the trust’s failure to give decent or timely advice to MPs and stakeholders or to give suggestions for people who might apply. He assured the House that he would be

“working with NHSI to ensure that the irregularities regarding this appointment do not occur in the future. The hon. Gentleman has done the House a service in highlighting the clear irregularities in respect of this appointment.”—[Official Report, 27 June 2018;
Vol. 643, c. 1005-9.]

Indeed, when I met the new chair, Pearse Butler, in August 2018 for a review and a discussion of all the hugely important issues affecting our trust, which not only serves 330,000 acute patients on the Fylde coast but provides community health for nearly half a million patients into Wyre and north Lancashire, he hastened to assure me that he had taken on board the critique and would ensure new openness and transparency on these issues. I accepted the assurance at face value. I little dreamed that, just over 12 months later, I would have to return to the subject, but this time with him not as the passive beneficiary of a flawed process, but as an active agent—probably the leading agent—in another area.

I make it clear that my concerns in no way reflect on the vast majority of hard-working staff in the trust or on the challenging financial and other circumstances, especially in my Blackpool South constituency, which is the most deprived in England—overall health in Blackpool is the worst on 23 of the 32 health indicators. Their work, and many examples of good care under extreme pressure, were noted in the recent Care Quality Commission report, and I associate myself with those comments.

Photo of Cat Smith Cat Smith Shadow Minister for Voter Engagement and Youth Affairs

I congratulate my hon. Friend on securing yet another Adjournment debate on the Blackpool Teaching Hospitals NHS Foundation Trust. It is, indeed, a sorry state of affairs when we find ourselves debating the trust once again. He makes important points about the staff, who work incredibly hard. Does he share my concern that the CQC report said that the staff did not always feel respected, supported or valued, and were concerned about the culture within Blackpool Victoria Hospital?

Photo of Gordon Marsden Gordon Marsden Shadow Minister (Education)

I share those concerns, and I will show how they are inextricably linked to some of the shenanigans in the confirmation of the chief executive. It is all the more reason why staff might share the concerns and sense of grievance to which I will refer.

In the autumn and winter of last year and into this spring, as the trust’s chair settled into his new position, the problems of cuts, waiting times and cancelled operations, which still leave the trust with some of the worst mortality rates and waiting times in England, continued. A snap visit by the CQC in January found patients waiting on the floor of Blackpool Victoria Hospital, because of a lack of space, and triage delays of more than three hours. As Blackpool’s The Gazette said when the report finally came out, the CQC was demanding that

“bosses must improve the standards of care and staffing…in the emergency department”.

Unfortunately, by this time, the trust had a further shadow hanging over it, with a police probe into issues of alleged poisoning in the stroke unit. That situation remains unresolved and I do not intend to talk about it further. The then chief executive, Wendy Swift, had left fairly unexpectedly in April, and the chair was at pains to tell The Gazette that her departure was

“in no way related to the trust’s performance.”

But he struck a very different tone last month when he told governors that the trust had

“needed a leader with gravitas and experience who could lead a different type of engagement with our staff.”

That person was Kevin McGee, who was appointed as the interim temporary chief executive for the six months to 31 October. Naturally, when I heard of that, in May, I spoke to the chairman, who assured me that there would be a full and proper process for appointing a permanent chief executive in due course. I said in a subsequent letter to him, on 10 June, that it would be helpful to confirm when the process would begin, with details of the period between stakeholders being advised and of the closing period, and that this had been one of the issues in respect of his appointment as chair. I heard no more until 20 June, when the trust’s secretary sent me a note, which said that the post had been advertised on 9 June and the shortlisting process would take place at the remuneration committee on 27 June. I want to emphasise that that was an even more rushed deadline that the one that the Minister’s predecessor had criticised for the chairman’s own appointment. In effect, it blocked MP stakeholders from having any ability to inform other potentially suitable applicants.

I began to be concerned, but what I did not then know was that the timeline described in the note to governors on 16 September to rubber stamp Mr McGee’s appointment as the permanent chief executive without due process had been given the following rationale:

“On 27th June, the Remuneration Committee reviewed the shortlist provided by Odgers”— the recruiters—

“and determined that the candidates presented did not demonstrate either the experience or the leadership…required for the post…The Non-Executive Directors and myself did not believe that re-advertising the post would result in a stronger field of applicants and this had been discussed with, and agreed by, the Regional Director of NHS Improvement, after a range of discussions with experienced Chief Executives across the sector.”

How cosy! It was very cosy, and I think that to any impartial outside observer it would look like a complete stitch-up by the great and good of the region. The only communication I had received from the trust between June and 16 September was a staff bulletin from Pearse Butler, in which he had confirmed the cancellation of interviews and said

“we will now take a few weeks to consider our options”.

In the meantime, my attention had been drawn to an article published on 9 August in the Health Service Journal headed “Chief executive makes bid to lead second trust”. The journalist, Lawrence Dunhill, had interviewed Mr McGee about creating chain models and shared leadership. Mr McGee was admirably concise about what he thought—they were a jolly good thing. He told Mr Dunhill:

“Take personalities out of it, just the ability to work together in a different way”.

When asked whether he wanted to lead both trusts permanently, he said:

“If we can look at working in a different way across Lancashire then it would be a really good thing to do and I’d be really interested in doing that.”

The article stated:

“As reported last month, former Salford Royal chief executive Sir David Dalton…has been brought in to help trusts in Lancashire look at options for closer collaboration.”

Incidentally, this was the same Sir David Dalton who had been the independent assessor for the process of Pearse Butler’s own appointment as chair, which the previous Minister referred to last year.

I want to make it clear that I am not making any judgment—certainly not yet—as to whether Mr McGee will be a good, bad or indifferent chief executive. He comes with some reputation, but as he has not met me since his appointment in May, I cannot say more. What is very clear is that for the second part of this exercise, having got Mr McGee as an interim chief executive of Blackpool Teaching Hospitals NHS Foundation Trust, in addition to his existing position as chief executive of East Lancashire Hospitals NHS Trust, there was a clear determination on the part of the chair at least to push through his confirmation without any attempt to reopen the selection process. We know that because of the answer to a parliamentary question that I received from the Minister on 8 October. I asked in what capacity NHS Improvement had given advice on discussing the possibility of mergers, and the reply said:

“The Chair at Blackpool Teaching Hospitals NHS Foundation Trust and the Chair at East Lancashire Hospitals NHS Trust sought the views of NHS England and NHS Improvement on the possibility of merging services and provision between the two Trusts.”

When the chairman had secured the agreement of the governors at the meeting to his proposal for Mr McGee, he finally decided to tell certainly me, and I think my parliamentary neighbour, Paul Maynard, of his news. This consisted of a rushed phone call to me, I think out in the countryside, just before he was about to go on holiday to Japan. I made it clear to him that I was surprised that he seemed to have learned nothing from the failings of process and transparency in his own appointment, that he was now preparing to foist a merger between the two trusts, that this was a major step, and that there should be utmost clarity and transparency in the process. When I asked him why he had not taken that option in respect of Mr McGee, he dodged the question about putting him automatically on the shortlist and said that it would be a great move. When I said to him that it was effectively a merger, it said that it was not, saying that it was an alignment and that no decisions had been made about any merger. We know from the answer to the parliamentary question that that was incorrect. Perhaps the House will not be surprised that in the article in The Gazette entitled “More controversy at Blackpool Victoria Hospital”, I said that the process had been

“at best ambiguous and at worst evasive” in respect of the merger, and that we needed confirmation of what was proposed. I have no doubt that the chair will continue to try to muddy the waters but, to continue the analogy, if it walks like a duck and quacks like a duck, it is a duck.

We now have clarity from the answer to a second parliamentary question that I received from the Minister that Mr McGee will receive a single salary, agreed by both remuneration committees, although the trust still refuses to tell us what is going to be. I said to The Gazette that the situation “beggars belief” after last year’s debate, and I still believe it does. It appears I am not the only one. The smooth and slippery stakeholder brief that was put out by way of formal amendment for the trust talks of “strategies of collaboration” and extensive discussions with, among others, the governors at Blackpool foundation trust. I am reliably informed that that is not the case. At least one governor has said that they were called on 16 September simply to ratify McGee’s appointment, and that nothing was said about the implications of a merger. I gather that others are asking for more clarification. The Gazette, which was initially fobbed off about the truth and timing of the appointment, told us the same story. It seems that a number of other non-executive directors have also been confirmed without further press or selection.

It has to be said that this is not the first time that Mr Butler has attracted controversy with governors. When he was chair of the Morecambe Bay trust and outsourced Barrow hospital’s out-patient services, the media reported governors as saying, “I do not believe you got any influence on this structure. You drove the decision and due process was not done.” Governors were not informed of what was happening until July. In this case, it was not only MPs who were not consulted, as is confirmed by the Minister’s answer to my parliamentary question, and nor was the chair of the clinical commissioning group, or the CCG itself. Sadly, in the “not good enough” CQC report on the June inspection that came out just last week, this is amply and damningly exposed.

Photo of Mark Menzies Mark Menzies Conservative, Fylde

The hon. Gentleman refers to the CQC report, which sums up what is quite frankly a failing of management and senior administration at the hospital. We have a litany of records going missing—paper records like something from the 1950s—for months on end, and patients not being informed if their records have been found. Today, one of my constituents went to the hospital for an appointment only to be told that that appointment had been cancelled, although they had never been informed. This is not about money; it is about basic admin and basic management. Quite frankly, I say to the Minister that if these people cannot sort themselves out, the time is up. We should send in a taskforce, take these people in hand and sort it out. Our constituents demand better. We are putting the money in and we need to sort these people out if they cannot sort themselves out. My patience has worn out.

Photo of Gordon Marsden Gordon Marsden Shadow Minister (Education)

The hon. Gentleman speaks very powerfully about the whole process, and I agree with him exactly. Sadly, in the “not good enough” CQC report about the inspection in June, which came out just last week, ample and damning concerns are exposed. There was a continuing series of “requiring improvements” for safety, effectiveness and responsiveness; and one “good” for caring, which speaks volumes for the staff. The biggest black mark went against leadership. When asked to judge whether the trust was well led, the CQC said that it was not, and that it was “inadequate”. It gave chapter and verse on the issues. I cannot read all of it out, but I will give the Minister a selection:

“There was limited understanding of the importance of culture…Staff did not feel respected, valued, supported or appreciated by some members of the board…When something went wrong, people were not always told, did not consistently receive an apology…There were levels of bullying, harassment, discrimination and the organisation was not taking adequate action to reduce this…When staff raised concerns, they were not treated with respect, or the culture, policies and procedures did not provide adequate support for them to do so…We heard from several staff groups particularly those from a BME background.”

I have spoken to the CQC since the report came out and asked it to clarify exactly when it got these comments from staff and when it investigated them. It was confirmed that it was the period between March 2018 and June 2019, three quarters of which had been under Pearse Butler’s chairmanship. I asked whether there had been any discussion about the possibility of any future merger/collaboration, and was told that there had been discussions with NHSI and that it was likely—this was in June—that Mr McGee would be able to take that through. That is further evidence, if any more were needed, of this all being sorted out by the people in the bubble between June and August. There was very little evidence that they thought there was anything wrong, but of course there is something wrong—massively wrong. Let us add to this a small number of people in that bubble, in this case spearheaded by the chief executive. Yes, these decisions will affect all of our constituents.

The fact of the matter is that the implications of this merger—because that is what it is—are massive. Will the two organisations fit? How will Mr McGee handle both? Why were the governors not given the full facts? East Lancashire, which is a good trust, covers Blackburn, Accrington, Burnley, Clitheroe, Pendle, Colne and Darwen. They are all very different places in terms of geography, demographics and ethnicities. All are a very long way from some of the coastal concerns of this hospital trust. If the people of East Lancashire look to anywhere, proud inland communities though they are, they look— dare I say it—to the Pennines or to Greater Manchester. The idea that this is going to work very easily is for the birds.

Foundation trusts were established under a quid pro quo system. They have wide powers of initiative but, in return, the public and external stakeholders have a right to be properly informed, consulted and assured that process is properly applied. In this case, that has not happened. What was needed was proper scrutiny, not winks and nods from a cosy clique within the bubble and nothing that would make the culture inadequate, as was so devastatingly laid out by the CQC. I have no doubt that some of these appointments may in themselves be good—I have met the new nursing director—but the culture over which Pearse Butler has presided over the past year has attracted these black marks.

I will conclude by saying that we really must make sure that we see a turnover from this catalogue of half-truths and evasions, and that there is a proper consultation, involving all stakeholders, about a process that is effectively a merger. Perhaps someone needs to say to the chair and some others in the trust the good words of Robbie Burns:

“Oh what a tangled web we weave,

When first we practice to deceive.”

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care) 6:23 pm, 24th October 2019

On the final point made by Gordon Marsden, I would be cautious about that quote because the next line is:

“But when we’ve practiced but a while,

How vastly we improve our style.”

I am grateful to the hon. Gentleman for securing this debate. I note that my hon. Friend Paul Maynard, who is an extremely strong advocate on behalf of his constituents in respect of medical care and the hospital, is here today to listen to the debate.

The hon. Gentleman set out clearly the challenges faced by the trust and the hospital in terms of the geographical context, multiple indices of deprivation and health factors, and the performance and financial issues facing the trust. He is right to emphasise that leadership is a key part of an effective trust. Before turning to that and to the specific points he has raised, I join him in paying tribute to the fantastic work of the staff at the trust, all the way from the consultants to the cleaners and porters—every single person in that team, who I know do everything they can to deliver top-quality care every day. I think we would all recognise that; it is a point of consensus.

The hon. Gentleman rightly highlighted the situation that had gone on in respect of the chair—an issue to which my right hon. Friend Stephen Barclay responded during the hon. Gentleman’s Adjournment debate just a little over a year ago. I would not dispute what the hon. Gentleman said about that experience, including the need for proper governance processes to be followed and lessons to be learnt.

Let me turn to the appointment of the chief executive and the process that was followed. I will come to progress made and the broader issues shortly, but I think this was the crux of the hon. Gentleman’s concerns, as it goes to a broader concern he expressed about what this may signify in terms of attitude and approach. The focus must always be on what delivers for patient outcomes and patient care, and I will come in a moment to Mr McGee’s qualifications and track record.

The hon. Gentleman says that he—I understand that this is also true for my hon. Friends the Members for Blackpool North and Cleveleys and for Fylde (Mark Menzies)—has not yet had the offer of a meeting from the new chief exec. While that is a matter for the chief exec and the trust, I would give some gentle and friendly advice. In my experience, engagement, meetings and an open and trusting relationship with local Members of Parliament is to the benefit of the trust and those who work in it, as well as to the benefit of Members of Parliament. I therefore suggest that holding a meeting swiftly would probably be in everyone’s best interests. I hope that the offer is forthcoming to the hon. Member for Blackpool South and to other hon. Members who have either intervened today or have a constituency interest.

As I know the hon. Gentleman knows, the appointment of a chief executive in an NHS foundation trust is the responsibility of the trust’s non-executive directors, including the chair, with approval from the trust’s council of governors. He touched on the circumstances in which this situation came about—that, following the retirement of former chief executive Wendy Swift in 2018, Blackpool Teaching Hospitals NHS Foundation Trust undertook an extensive recruitment exercise to look for a chief executive.

It is my understanding that that exercise failed to find the right person from the point of view of the trust and those responsible for appointments. The chair of the trust and the chair of East Lancashire Hospitals NHS Trust then sought the views of NHS England and NHS Improvement, as they are entitled to do, regarding their proposal for a joint chief executive working across both organisations. Both trusts provided assurances that these proposals would bring benefits to both organisations and, crucially, would improve the care of patients in Blackpool and East Lancashire. On that basis, NHS England and NHS Improvement had no objections to the proposal that was put to them.

The hon. Gentleman mentioned his concerns about the interview process, including the cancellation of interviews. I do not have details about that, but if he writes to me, I would be very happy to look into that specific point, if that is helpful to him.

In the light of the advice from NHS England and NHS Improvement, Blackpool Teaching Hospitals NHS Foundation Trust announced in April that Kevin McGee had been appointed as interim chief executive of the trust from 1 May 2019 while retaining his previous post as chief exec and accountable officer of East Lancashire Hospitals NHS Trust. On 4 October, both trusts announced they had agreed to work in closer collaboration and to support the appointment of Mr McGee as the chief executive and accountable officer of both trusts and on a permanent basis, which understandably prompted some written parliamentary questions from the hon. Gentleman.

The arrangement that has been put in place for Blackpool is genuinely designed to deliver several benefits, including enhanced quality of care, financial sustainability and improved performance. Mr McGee has a strong track record of significant care quality improvement in the NHS. Under his leadership, he has improved East Lancashire Hospitals NHS Trust’s CQC quality rating from “requires improvement” to “good”. Furthermore, in a previous chief executive role, he led George Eliot Hospital NHS Trust out of special measures for quality reasons in 2014.

My hon. Friend—indeed, my friend—the Member for Fylde made a typically passionate intervention on behalf of his constituents. I understand that entirely; he is absolutely right to be concerned for their care and always to be promoting the best possible care for them. Clearly, the hospital has need of strong leadership and a chief executive who has experience in turning around and improving hospitals, and since his appointment the new chief executive has commissioned an external review of governance processes.

On the basis of the information that I have from the trust, and NHS England and NHS Improvement, I understand that proper and due process was followed in the chief executive’s appointment, but I take on board the point made by the hon. Member for Blackpool South about the cancellation of interviews and similar. As I say, if he wants to add to the letter any other facts that he feels are relevant, I will of course look at them and respond to him as swiftly as I can. As he will know, in addition to appointing a new chief exec, the trust appointed a new director of nursing and medical director in October this year.

The Care Quality Commission published the report of its June 2019 inspection of the trust, which the hon. Gentleman mentioned, on 17 October. While it rated that the trust “requires improvement” for quality overall, it did recognise that there had been recent significant leadership changes and that Mr McGee had been in post for only a short time prior to the inspection. I am pleased to note that the CQC rated Blackpool “good” for caring, as he said. That is a testament to the staff, but also, I believe, a positive indicator of the direction of travel.

In the few minutes remaining to me, I will touch on a couple of other factors. The hon. Gentleman talked about mergers. I suspect that part of his concern is that this is a precursor to something that he would not support. It is important—I have spoken to my hon. Friend the Member for Fylde about this—that any decisions or discussions reflect the views of local stakeholders, including local Members of Parliament. I would say to the trust that my hon. Friend has been very clear with me that he believes that any merger would be the wrong way forward, and the hon. Member for Blackpool South has also been pretty clear on that. I would hope that the trust will listen to what informed local stakeholders such as Members of Parliament say.

I believe that the trust is learning from its mistakes and that the current chief executive is determined to tackle the quality issues and bring improvements to patient care. It must be given the space to do that. I have put on record what I believe it should reflect on, and I know that the hon. Member for Blackpool South will continue to make his points. I am very happy to meet him, my hon. Friend the Member for Fylde and, indeed, other hon. Members on this matter if they feel that is helpful.

Question put and agreed to.

House adjourned.