Sir Mike Penning leads an Adjournment Debate on the closure of overnight services at Hemel Hempstead Urgent Care Centre.
First, may I say what a privilege it is to have secured this Adjournment debate this evening, and how proud I am of my constituents who for so many years have been fighting the changes and particularly the cuts to healthcare in the Dacorum area where my constituency sits? In particular, I thank Edie and Ron Glatter and the Dacorum Hospital Action Group and its fantastic chair Betty Harris, who is very poorly; they have been fighting this campaign for many years. I also pay tribute to the fantastic work our local BBC radio station, BBC Three Counties, has done over the years, in particular that of the excellent journalist and reporter Justin Dealey; without his work, this debate would probably not have taken place.
For the national health service to carry on being the world-class service it is today, the public, our constituents, need to have faith not only in the fantastic doctors, nurses and porters and those who run the frontline services, but in the management of our hospitals and health provision. I am sorry to say, however, that the trust and feeling of commitment we need from our health service management in our part of the world are not just broken, but have completely failed.
I will not go into the history because tonight I want to talk about the urgent care centre, but the history of what has been happening to out-of-hours and urgent care, including A&E, in my constituency has been going on for many years. The previous Labour Administration decided to close the A&E and all acute services at the Hemel hospital after they had already been closed at the St Albans hospital, with all services moved into a Victorian hospital next to a football ground in Watford. We will not dwell on that tonight, however, but will come back to it on another evening.
As part of the sop to my community, we were given an urgent care centre—24/7, seven days a week, throughout the day and night—and next to it a walk-in GP centre. I was therefore surprised when Ms Fisher, chief executive of the West Hertfordshire Hospitals Trust, phoned me just before Christmas to say that, sadly, the urgent care centre would have to temporarily close on safety grounds at night. I was shocked by that, not least because the A&E in Watford struggles greatly, so the more people we can encourage to use other NHS facilities instead, the better. I said, “This is happening over Christmas which is one of the busy times,” and was told, “Don’t worry, Mr Penning, it’s only a temporary thing and we’ll have it open again just after Christmas.” They then put out a press release headed “Temporary overnight closure of Hemel Hempstead Urgent Care Centre”. Interestingly, that press release is still on their website today. I actually printed it off before I came into the Chamber this evening. As I go through my comments, Members will realise just how false that statement was.
One of my constituents then contacted Three Counties Radio, and Justin Dealey, its excellent reporter—
Justin Dealey acquired an interview with the said Ms Fisher, the chief executive of West Hertfordshire Hospitals NHS Trust. It was quite a long interview, in which Ms Fisher indicated:
“This is a short-term measure which is us acting in the interest of patient safety because, for the next few weeks over the festive period, we are unable to secure GP cover.”
I think most people would understand that, but not if they knew that the GPs were working in the room next door. But that is a separate issue. Justin went on to suggest that surely Ms Fisher understood that local constituents would have real concerns, and asked her whether she would be concerned if she lived in the area. She said:
“I completely understand their concerns, but what I want to reassure the residents of Hemel is that if there were to be any permanent change it would be our absolute intention to include people fully”
in that decision. She went on to say that
“legally we would be obliged to consult for a permanent change of that nature.”
That press release was issued not before Christmas this year but in December 2016. We have had no night provision at all in Hemel since then. Everybody has to go for urgent treatment to Watford A&E. Alternatively, they have to dial 111, which is an excellent service, but after they have been triaged they apparently get sent to Watford A&E. Watford has just come out of special measures, and I praise the work that has been done at the hospital but there is still a lot more to be done.
I thank the right hon. Gentleman for giving way. I sought his permission to intervene on him beforehand. He is outlining very well the issue with the Hemel Hempstead urgent care centre. Does he agree that, although there is immense staffing pressure, closing or scaling back on urgent care units and minor injury units only adds to the pressure on A&Es? There must be more investment in these mid-level centres if we are to prevent the A&Es from crumbling under the weight of the work they have to do.
I clearly agree with my hon. Friend. It was kind of him to come and tell me that he wanted to intervene on me on behalf of other parts of the country that are facing similar pressures.
This was not about money. Normally, when our constituents come to talk to us, especially about the health service, it is about money. They tell us that they are really concerned that there is not enough money to provide the services, but on this occasion we were told that this was nothing to do with money. It was to do with the contractual problem with the GPs. We kept on asking what was going to happen, and then—completely out of the blue and still without consultation—we were told that the Government had said that there should be no more urgent care centres and that they should become urgent treatment centres instead. I was repeatedly told that it was the Government saying that this should be done. I asked whether the Government had said that the centre should not be open 24/7. I was told no, but that we had to move to being an urgent treatment centre. In the past couple of weeks, the unit has changed from being an urgent care centre to being an urgent treatment centre. Interestingly enough, that means that paramedics and nurse practitioners are running the facility, and in many cases—without being rude to our GPs—they have more skills than a basic GP. I have to declare an interest, in that I was a military paramedic, so I am slightly biased about these things.
But was there a consultation before that decision was made, not just to close the UCC but to change to a UTC? No, there was not, even though it is a legal requirement to have one. We are now in a consultation, however. I could not believe it when I first heard this, but I have now heard from several constituents that in the actual meetings that took place—not when people were writing in—when different plans and options were being put to my constituents, a member of the clinical commissioning group staff was at the table trying to convince the public what sort of option they should go for. If we are going to consult the public, surely we should trust them and then have the confidence to listen to them.
What I find really fascinating about what is happening in my part of the world is that people from nowhere near my constituency—from the other side of Watford—are being consulted. They would never come to my facility in a million years—unless they just happen to be in the area—but they apparently have the same rights in this consultation as my constituents, who are again losing facilities hand over fist. Those other views are being taken into consideration because they happen to be part of the trust area. My constituents just scratch their heads and say, “This is illogical.” This facility, even though it is part of the NHS and anybody could come to it, is obviously being used by the largest town in Hertfordshire and the other towns and villages within Dacorum. However, I have no problem with the people of St Albans being consulted over this, because they are clearly part of the process.
Trust has been severely damaged. A highly paid chief executive of an NHS trust went on the radio—telling an MP is one thing, but going public is another—and tells listeners, “This is temporary. Please do not worry; it will all be okay. By the way, if I did actually change the service, that would be illegal because I have not consulted.” Frankly, when they then did not consult—the UCC is quite clearly never going to open again—that breaks the trust.
I have raised the accountability issue in the House before. It is absolutely right that my good friend the Minister on the Front Bench does not make decisions about what A&Es and UCCs are open and how many beds there should be. Those are quite clearly clinical decisions that should be based on knowledge and demand in the area—that is not what happened when our A&E was closed—but we seem to have moved from one extreme to another. I am told that if we want to challenge the consultation, the only way is to put the decision to judicial review based on the consultation. We tried that when the A&E was closed and we got a judicial review. The judge was generous and said, “You have a moral case, but you probably don’t have a clinical case. You don’t have a case in law, because the consultation was done.” However, if the consultation was a complete sham or did not take place at all, where do we go?
I have asked Ministers, I have tabled questions and I have been to see the Secretary of State. At the end of the day, who are these people accountable to? I know that we can go to the health committees at the local council, but they do not have the powers to say that an individual or a trust has brought the NHS into disrepute, and yet that is what has happened here. Nobody was twisting the chief executive’s arm to go on the radio and say what she said. We all listened to it—I got a transcript the following morning—and I sat with Justin and said, “Well, that’s it, Justin. We’re okay.” I was not at all happy about the facility being closed over the 2016 Christmas period, but at least we knew that GPs were going to be recruited and that we were going to get there.
However, the exact opposite has happened. We are not getting the GPs back, and now the facility being open 24 hours a day is only one of the options. I know that the Minister’s notes will say how many people used to go to it at night and so on, but half the problem was that it was never properly promoted. There are access issues at the A&E because so many people are turning up and being triaged when a huge percentage of them do not need to be at an A&E but somewhere else within the NHS. I would argue that they should be at a UCC or UTC or that a GP should come out to them, but that is a separate issue because hardly any GPs make home visits in my constituency.
I know exactly how things work, because I was a Minister for a while and know about the advice that comes down from the trust and the clinical commissioning group, which will say things that are different from what I have said. However, I can honestly say that if there is one issue in my constituency that absolutely unites every political persuasion on my patch, it is the acute health provision in my constituency. We pushed a coffin on a hospital trolley all the way from Hemel Hempstead Hospital to Watford, to indicate that lives would be lost. We had debate after debate with the ambulance service, which said, “Don’t worry, we can get the ambulances there on time.” It probably could, if it rushed them through on a blue light in the middle of the night—if an ambulance was available. Because of the previous Administration’s botching of the regionalisation of the ambulance service, there are often not that many ambulances available, even though the ambulance depot is on my patch.
People do not want to clog up A&E; they want to have the confidence that there is somewhere safe that they and their kids can go for treatment. We have no idea what the conclusion of this retrospective consultation will be. We have no faith that even if the conclusions are in agreement with what we want, we will actually get it. Not all my constituents agree with me, but in a treatment centre I would rather have a highly qualified paramedic nurse practitioner than—I have to choose my words carefully here—an ordinary GP, simply because the paramedic nurse practitioner has so much experience in that area. That is where the modernisation of the health service has been so brilliant. But after telling me that the decision was not about money, it is, frankly, disgusting to sit people down at consultation meetings and try to convince them that it would be better if the centre was not open 24 hours a day.
I hope that the Minister understands how passionate we are about the matter. My constituency is 17 minutes from London and it shares a boundary with yours, Mr Speaker. People in the top part of my constituency all go to Luton and Dunstable—quite rightly so; it is an excellent facility—and those in the bottom part of my constituency, or anyone who comes off the M1 and the M25, end up going to Watford for their acute care.
I want Watford General Hospital to succeed. I think the location of the site is completely ludicrous, and we need a new general hospital for the growing population in our part of the world. I know that you have pressures on housing, Mr Speaker, as we have. But I want the houses, because I want people to have somewhere to live—so many families are struggling at the moment—and if we are to build those houses, we need facilities, such as schools and everything else. When my constituents go to bed at night, they need to know that the urgent care centre is open in case something happens; and that if they cannot cope, we can blue-light them to Watford or to Luton and Dunstable.
I have tried for weeks and weeks to get this Adjournment debate. My hon. Friend the Minister is lucky, because I had been asking for a 60-minute debate in Westminster Hall. We may yet end up there, but that will depend a lot on what he says from the Dispatch Box.
I will do my best to address the issues raised by my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) in order to pre-empt the further debate to which he alludes. I congratulate him on securing this debate. I commend him for his continuing and passionate campaign on behalf of his constituents, and for his expertise on health issues, which he has brought once again to the House.
I reiterate the fundamental principle for all service change in the NHS: it should be based on clear evidence that it will deliver better outcomes for patients. That is the framework that is applied. I understand that my right hon. Friend is concerned about the changes proposed in his constituency. He will appreciate, not least as a former Minister, that I cannot say anything that would prejudice the outcome of the ongoing consultation, but he has spoken powerfully about his concerns in the House tonight.
I am sure that my right hon. Friend agrees that any decision should be driven by what is best for the constituency clinically, by what is best for the health service in the area, and by what is of most benefit to the greatest number of people in the area. I shall briefly set out some of the background, as I understand it, to the issues that inform the consultation. As he mentioned, in December 2016, the urgent care centre was temporarily closed overnight because of concerns about patient safety as a result of problems with staffing the GP overnight shifts. The CCG’s advice was that the urgent need to address patient safety issues did not allow time for consultation about that temporary change. I appreciate the concern that he raised about the manner in which that decision was taken.
The local NHS has worked hard to manage the consequences of the decision. I understand from the CCG that the volume of overnight patients at the centre was relatively low, and that the impact that has been felt at Watford General Hospital, notwithstanding the other challenges it faces, has been of the order of one or two patients per night, usually those with relatively minor injuries. As my right hon. Friend will be aware, emergency cases have been sent to Watford since the closure of Hemel Hempstead’s A&E in 2009—he referred to the protest involving a coffin about that decision, which was taken under the previous Labour Government. On provision in the early hours of the morning, he will also be aware that journey times then will be shorter than they would be at the times when the urgent care centres are open.
Let me go back a fraction. If the decision has to be based on clinical advice—I understand the principle—what is the point of consulting the public, who are not clinically trained? We have to consult them, because that is what the law says, so is the law wrong for saying we should consult people who are not clinically trained? If the decision has already been made, what is the point?
The public consultation is to inform the discussion with clinicians. If such a decision was taken by Ministers—my right hon. Friend alluded to this in his remarks—it would likewise be informed by public consultation. That is part of running a transparent and open process.
The CCG is now consulting the public on future opening hours, following a broader urgent care strategy review. The consultation seeks views on three options: retaining the current temporary hours; increasing the temporary hours by two hours at the end of the day; or re-opening on a 24-hour basis. As it runs until 28 March, I know that my right hon Friend and his constituents will wish to share their views as part of the process.
I do understand the criticism made by my right hon. Friend’s constituents that the overnight closure has been dragging on for too long and that a final decision needs to be made as soon as possible. The views gathered during the current consultation will inform the CCG’s decisions about the future opening hours for Hemel Hempstead UTC, as well as about the contract for West Herts medical centre. I further understand that the CCG has commissioned an independent research company to review and analyse all the comments received, and the feedback will be compiled into a summary report. That will be presented to the Herts Valleys CCG board meeting, in public, on 26 April, when a decision on both issues will be made.
Turning to the issue of the treatment centre’s status, on 1 December 2017, Hemel Hempstead UCC changed to a UTC, as part of national measures introduced by NHS England. I understand from the CCG that this was a change of name, not of service. The CCG therefore did not carry out a further consultation on the establishment of the UTC as it did not feel that that represented a significant change in service. I understand that no services have been withdrawn from the UTC, but there have been a number of enhancements, including: the introduction of a number of bookable appointments through NHS 111; the addition of near patient testing for some conditions, reducing waiting times and reducing the need for patients to attend Watford General Hospital for some tests; and an improved IT system, meaning that medical staff will be able to access patients’ records if they give consent. The CCG also expects services to expand to include other professionals, such as pharmacists, emergency care practitioners, those providing access to mental health services and community nursing staff.
That also dovetails with some important changes in planned care locally. I understand from the CCG that improvements in the treatment of musculoskeletal disease mean that the single point of access triage at Hemel can direct people on to community physio, where that meets their needs. That is good for the individual patient and also ensures that capacity in the acute settings is able to concentrate on those with more complex needs.
The Minister has just told the House that there has been a complete change in how physiotherapy is provided—it was provided at the hospital and is now provided elsewhere. There was no consultation on that, although I understand that there was a requirement to do so, because this involved a complete change of service in respect of where people go and so on. The point I am trying to make is: when there is no consultation, what do we do? Do we just sit back and say, “Okay”? Some kind of measure has to be taken when consultation continually gets ignored or does not happen at all.
The distinction that was being drawn was in respect of services that have been removed, on which my right hon. Friend is right that there is a legal requirement for a consultation. He has expressed to the House his concerns about the process by which that temporary decision on patient safety was taken. The point I was making was that the services that have been brought to the area are bringing a benefit to the local community. I would have thought that they would be welcomed. Indeed, from April, many patients with diabetes in the area will no longer need to travel to Watford to be seen by a consultant, because the consultants will be coming to them by working in the community. Again, that is good for patients and for the system as a whole. It is part of the way in which these systems evolve: some services come closer to the community, while others, as under the decision taken by the Labour Government in 2009, are rationalised into Watford A&E.
I understand my right hon. Friend’s frustration that in his view the local CCG seems out of touch with popular opinion. Given the way in which he champions the community that he represents, I know that he is not out of touch with popular opinion—he always speaks in a well-informed way about his constituents’ needs, and I would expect that to be represented in the consultation responses that the CCG receives. The CCG is accountable to NHS England for fulfilling its functions. It is also a member of the health and wellbeing board, at which local authorities and other partners can challenge how it has been fulfilling its functions. The CCG’s activities are subject to scrutiny by local authorities and to supervision by NHS England. If NHS England believes that the CCG is failing to discharge its functions, it has the power to intervene and issue directions, or to replace the accountable officer.
It is worth reiterating that all proposed service changes should meet the four tests for service change. They should have support from GP commissioners; be based on clinical evidence; demonstrate public and patient engagement; and consider patient choice. It is right that such matters are addressed locally, where local healthcare needs are best understood, rather than in Whitehall. I think my right hon. Friend recognised the point about Ministers not making clinical-led decisions. For those reasons, I am sure that he will appreciate that I am not able to offer the House an opinion on the merits of the proposals, but of course we recognise that changes to health services inspire passionate debate, as they should, from all quarters, as we have seen this evening.
There is no standard approach on what an urgent care centre should offer. The offer varies between different urgent care centres, depending on the services required locally. Urgent care centres can treat a range of injuries, including sprains, strains and broken bones.
I want to help the Minister. The urgent care centre is gone. We do not have an urgent care centre; it is now an urgent treatment centre. This is something that confuses my constituents as well. I was trying to make two points. First, it is not just about the clinical commissioning group on its own. The decision to close over Christmas in 2016 was made by West Hertfordshire Hospitals NHS Trust, and it cannot escape blame, because it was the trust’s chief executive who made that decision and went on and acted. Secondly, it is also about the lack of knowledge and understanding of the community. We have had a churn of people coming through and running the services. They seem to come and go and come and go, never understanding or empathising with the constituency.
Before my right hon. Friend’s intervention, I was just coming to the urgent treatment centre, because there is obviously a distinction. Urgent treatment centres are about standardising the range of options and simplifying the system so that patients know where to go and have clarity about which services are on offer. My right hon. Friend made the point about how we direct footfall and constituents into services at the right point to reduce the demand on the A&E at Watford by simplifying what the UTC does, what it offers and how that is understood by constituents.
Patients and the public will be able to access urgent treatment centres that are open for 12 hours a day, and that are GP-led and staffed by a range of clinicians with access to simple diagnostics. They will have a consistent route to access urgent appointments offered within four hours and booked through NHS 111, ambulance services and general practice. A walk-in access option will also be retained. They will increasingly be able to access routine and same-day appointments, and out-of-hours general practice for both urgent and routine appointments at the same facility where geographically appropriate. UTCs are also part of a locally integrated urgent and emergency care service working in conjunction with the ambulance service, NHS 111, local GPs, hospital A&E services and other local providers.
In conclusion, these are important issues, and decisions should not be taken lightly. The location of services is a difficult and often controversial issue, and my right hon. Friend is to be commended for his campaign and the points that he has made on behalf of his constituents.
It is not often that we get more time to speak in this place, so while I have the Minister at the Dispatch Box, can he answer this very simple question: what recourse is there for me, as the MP, and for my constituents when we are misled—I know that I have privilege, but I am using the word “misled”—by a senior NHS management team about what is going to happen to the urgent care service? I am talking about when what the team says turns out to be completely untrue. What recourse is there so that we can start to rebuild some trust in my constituency?
As my right hon. Friend knows, it would be inappropriate for a Minister to comment on a specific allegation such as that from the Dispatch Box. I cannot comment on this specific consultation, which is under way as we speak. The point that has come out of this debate is that the decision of December 2016 was taken on patient safety grounds, owing to a difficulty in recruiting GPs at that time. A consultation is now under way, and it is for my right hon. Friend’s constituents to make their case as part of that consultation.
The people affected by these changes need to be involved in the decision; that is what the consultation will seek to achieve. Our starting point for discussing service change is that there will be no changes to the services that people currently receive without proper public consultation. I therefore urge my right hon. Friend and his constituents to make their voices heard as part of that consultation in the usual way.