Sarah Gibson

The hon. Member is quite right. We are seeing promises not being delivered; whether that is because HCRG is a private service or because of the management of the system is not for me to say. I hope that the Minister will be able to look into the matter. I personally spend a lot of time in the NHS—not out of choice, but as a patient and a carer for my husband. The frontline staff are fabulous. They go above and beyond to support the patient, regardless of whether that patient happens to be their MP. But as their MP, I do find that the staff tend to approach me in confidence to say that they fear using the formal channels for feedback. Patients and staff working across the community-based healthcare system are raising the same issues with me: delays, difficulty navigating the referral pathway and concerns about whether requests always reach the right clinical team. I think Ministers have a responsibility to take those concerns as seriously as the Members sitting next to me. Patient safety is my chief concern since HCRG took over. One community nurse described families contacting nursing teams because a loved one approaching the end of life was experiencing severe pain despite being told that help would be available. The nurse reported instances of when no referral appeared to have reached the community nursing team at all. Visits were eventually arranged, but the patient spent several hours without adequate pain relief. A former community nurse separately described trying to obtain additional medication for palliative patients and not being able to get it. Nobody approaching the end of their life should spend hours in avoidable pain because the system is inadequate. I have also heard concerns about delayed wound care, time-critical medication and urgent catheter issues. One district nurse described attending a patient whose leg wounds had leaked through his dressing. His daughter had contacted the service twice over the weekend without receiving assistance. By the time the nurse arrived, the patient had resorted to wrapping plastic bags around his legs—and I understand that the same problem occurred the following weekend. The concerns I have received are not limited to community nursing. A physiotherapist working in Chippenham hospital described concerns about the introduction of the new referral system. According to the information, staff noticed that referrals were dropping dramatically under the new system. But when those delayed referrals were eventually identified and processed, clinicians faced a sudden influx of cases, including urgent post-operative patients. We are talking about knee replacements not being seen in a timely manner, in which case they will end up being re-done. That is a cost for no reason. Clinicians describe patients waiting around eight weeks after knee replacement surgeries, despite the treatment being expected much sooner. The concerns raised are not simply about waiting times, but about the possibility of avoidable deterioration and long-term impacts on recovery. They are not simply administrative inconveniences; they are potentially about patient safety. I want to touch briefly on wheelchair services. I understand that Wiltshire currently has one wheelchair technician, although it had originally been intended to have four. One constituent from Calne told me that she was supplied with an unsuitable wheelchair without being properly measured. She raised concerns about the difficulty, her safety and the fact that she could not get on to the bus. Despite repeated attempts over months to resolve the matter, she is getting nowhere. Another constituent reported from Chippenham that their replacement battery and updated seating did not arrive, which meant that they were unable to get to college. When repair and maintenance services are not functioning as they should, the consequences for the patient are immediate and profound. Something that particularly troubled me was a comment made to me by some patients who were no longer bothering to complain because they had become accustomed to the delays and difficulties. Sometimes, the absence of formal complaints reflects a loss of confidence rather than anything else. That is particularly concerning when we think about older patients, disabled patients and those already struggling to navigate a complex health system. The people who find it the hardest to access services are often the people least likely to make their voices heard. That is why scrutiny and transparency matter. When constituents raise concerns about HCRG services, they expect clear, simple answers. Who is responsible? We have an ICBC contract oversight group that reports to the ICBC collaborative oversight forum. We have the BSW community delivery group, which oversees transformation across the system. We have joint contract oversight groups, quality boards and safeguarding groups that all scrutinise performance, but many of the same organisations sit across multiple levels of that oversight. The integrated care board, the local authority commissions and the HCRG itself are involved throughout that governance structure. The organisations commissioning the contract and managing the contract are also scrutinising the contract—all of them seem to be on the same table. Frankly, even we elected representatives struggle to work out who is accountable. When everyone is involved in the oversight, it can be remarkably difficult to identify who is responsible for acting when problems emerge. There is a risk that organisations end up marking their own homework, with concerns passing between governance groups rather than being subject to genuinely independent challenge. Patients deserve a system in which responsibility is visible, understandable and transparent from the outset. Where persistent concerns are being raised about access to care, referral pathways and patient safety, it is entirely reasonable to ask whether the Care Quality Commission should take a closer look. We should not worry about independent scrutiny; we should welcome it, because it will lead to improvements. I would be grateful if the Minister addressed two specific points. First, will she ask BSW’s ICB and the HCRG to publish some comparable pre-transformation and post-transformation performance data that includes call waiting times, callback performance, referral processing times, complaints and patient outcome, broken down where possible to a local level? In that way, patients and parliamentarians will be able to see whether the promised improvements have actually been delivered a year and a half into the contract, despite the fact that the group had six months before the contract started to provide for the transition. Secondly, will the Minister engage with the Care Quality Commission about a case for further independent scrutiny of HCRG’s Wiltshire services and clarify what further regulatory action may be available if the persistent concerns about access, referrals and patient safety continue, as was referenced by my hon. Friend the Member for Melksham and Devizes? Patients do not really care how many committees or meetings are called; they want answers. Their concern is whether they are getting the care they need, when they need it.