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Cheshunt Urgent Care Centre

Volume 525: debated on Wednesday 23 March 2011

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

It is a great honour to speak on the Adjournment this evening—we have had the Budget today, so the eyes of the nation are upon this place.

Two years ago, I was involved in a fantastic community campaign to bring an urgent care centre to Cheshunt. I was joined by more than 3,000 constituents in a letter-writing campaign to the primary care trust. We had a number of public meetings, with the car parks overflowing and many hundreds of constituents making their views known. The campaign culminated when I, along with the chief executive and the leader of the council, visited the then Secretary of State for Health, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), at the Department of Health. It was a true community campaign. If the big society means anything, that is its basis: people coming together from across a community and joining in one voice to bring a much-needed facility to the constituency.

Since the centre arrived in October 2009, it has been fabulously well received. It is estimated that 400 people a week would use it at most, but in some weeks we have had 700 people voting with their feet by coming to that GP-led urgent care centre. It really is at the heart of the community. The reason so many people choose to use the facility is that it is open 12 hours a day, seven days a week, from 8 in the morning to 8 at night. Unlike many GP surgeries, it does not close for lunch and is open on Saturdays and Sundays, when people can use a medical facility because they are not at work in London.

Despite that enormous success, I was horrified to learn a few months ago that the PCT was not happy with the centre’s performance. I do not need to tell you, Madam Deputy Speaker, that being a Member of Parliament over the past three years has been fairly challenging, but one of the bright spots of my career has been walking around my constituency and being stopped by people saying, “Charles, we are so pleased we have the urgent care centre. It was so much needed in this part of the borough. Thank you so much for the campaign you led.” It has been enormously gratifying and satisfying to get that level of feedback.

The PCT came to the House to meet Hertfordshire Members and I had my turn to chat with them about the issues relevant to Broxbourne. After 10 minutes of pleasantries I asked, almost off the cuff, “Of course, you’re not thinking of closing the urgent care centre, are you?” The reply was, “I’m afraid, Charles, that that is one of the options on the table.” I am normally a mild-mannered Member, but I am afraid that on that occasion I blew up. I think that I swore. Indeed, I know that I swore. I am ashamed of my behaviour, but it demonstrates how passionately I feel about the centre.

I pay tribute to my hon. Friend for his passion and commitment to the urgent care centre and for the joint campaign run in Cheshunt and Enfield for the retention of a fully functioning accident and emergency department at Chase Farm hospital. Does what has happened to the urgent care centre not highlight the importance of the Secretary of State’s decision to encourage us all to think again about options other than the Barnet, Enfield and Haringey strategy, which would lead to the downgrading of not only Chase Farm hospital in Enfield, but, as predicated, an urgent care centre there?

My hon. Friend makes an excellent point. He is at the forefront, along with my hon. Friend the Member for Enfield North (Nick de Bois), of the campaign to save Chase Farm hospital’s A and E, and I am always proud to join him outside those gates, making the argument for a fully functioning A and E service there.

The PCT has told me that it believes that the GP-led urgent care centre is treating inappropriate cases—whatever those are—and that people going there should be going to their GPs. It asks why it should have to pay for that treatment twice. Of course, they should not pay for it twice, but I always believed that the money should follow the patient, not the GP who does not deliver the service. My constituents use the urgent care centre so fully, because many—not all, but many—GP practices in my constituency do not deliver on their promise, or live up to their end of the deal, to provide a full GP service to them. So my constituents vote with their feet.

GP surgeries close for lunch, early in the evening and at weekends. If people want an appointment, they have to call up on the morning that they want it, only to be told, “We haven’t got any today, but if you want to come and see us tomorrow try calling us tomorrow.” That is not acceptable, and my constituents are not going to sit at home and wait to be treated like that day after day; they are going to walk to the urgent care centre and get treated there. What really upsets me is that the beacon of success in our constituency—the one that sees up to 700 people a week—now faces closure, while the GPs are not facing the necessary censure for some of their practices in delivering services to my constituents.

I discovered in a PCT board paper that many GP practices in my constituency are in the NHS version of special measures, meaning that they are in the bottom 10% of GP practices in the country. That leads me to ask again, “Why does the urgent care centre, which delivers a high level of service, face closure?” while GPs, as I said earlier, are not delivering the service that they are paid to deliver.

The PCT says that there was a unanimous decision on behalf of a steering committee to change the use of the urgent care centre—at best to make it a minor injuries unit, or perhaps even to close it. It says that the decision came about as a result of a meeting with various stakeholders and some research—independent research, I was told—by an organisation called Opinion Research Services. Of course, it was not independent research, because it was commissioned by the PCT: it paid the bills of Opinion Research Service. I do not know what went on at that meeting, but I am fairly sure of what did not, which is that those there did not get a full picture of how successfully the urgent care centre meets the needs of local constituents.

What I did learn is that the GP services in the area leave a lot to be desired. On page 8, the board report states:

“A quarterly patient access survey carried out nationally has highlighted perceived problems with access and satisfaction with primary care in the area served by Cheshunt UCC.”

On page 8, it goes on to state:

“In addition, perceived poor access to primary care in and around the area served by Cheshunt must be addressed.”

Notice the emphasis on “perceived”. It is not perceived poor access, however; it is real poor access. If it was perceived, hundreds of my constituents would not go to the urgent care centre.

On pages 11 and 12, the report states:

“The need to improve access to primary care in the Cheshunt area has been recognised and steps are being taken in conjunction with the Clinical Executive Committee (CEC) to support and performance manage those practices”—

not a practice, but those practices—

“in the bottom 10% nationally in terms of patient’s perceived access.”

Quite frankly, that is not good enough.

I became even more concerned about the situation when I went on to read that it is local GP commissioners who are putting pressure on the PCT to close our successful GP-led urgent care centre.

On page 9, the report states:

“Local GP commissioners do not support the configuration and have confirmed that they would not wish to commission UCCs as currently configured at...Cheshunt in the future."

On page 12, it states:

“The view of the GP Practice-Based Commissioning leads in the localities is that these needs are best addressed directly with the practices rather than by way of additional services.”

But why are the practices not addressing those needs now?

The PCT has said, with great fanfare, that it is providing additional services and support to GPs to help them to improve. Of course, that is very welcome. However, given that it is providing new telephone systems, automated self-check-in screens, waiting room plasma screens, web-based online appointments systems and electronic document management systems, my constituents and I want to know what on earth has been going on in these practices for the past 10 years. One thing that GPs have not been short of is money, so how have they not placed these absolutely critical tools for managing patient load in their surgeries, with the PCT now having to fund them?

If services in my constituency are to improve, we need competition. We need the urgent care centre to set new standards of treatment. If the urgent care centre, which is driving ever-higher levels of patient care, is shut, what incentive will there be for GPs to improve their service levels? It is incumbent on my local GPs, who are falling behind, either to deliver or surpass that level of care, or perhaps to make way and allow practices to come into the borough that are willing to take up the challenge of opening 12 hours a day and providing weekend services. Until we reach that stage, the PCT has absolutely no excuse for closing down this urgent care centre.

Earlier today, the PCT had a meeting where it decided to downgrade the urgent care centre to a minor injuries unit; it thinks it will get away with that. However, that is not good enough and it will not satisfy my constituents, because closing down the urgent care centre and removing the GPs from it removes the incentive for practices in and around the centre that are not delivering to their patients to improve their services.

As you can see, Madam Deputy Speaker, I am really very annoyed about this. I thought that I would come here and manage to smile my way through it and be magnanimous, but I simply cannot. For my whole life, I have believed that good practice and success should be rewarded. I thought that that was just the way things were—that an organisation that saw an urgent care centre that was delivering not 400 patient outcomes a week, as envisaged, but 600 or 700, would feel that it was a success story that deserved to be built on. By accident or design, our PCT has stumbled on a formula that works and meets the needs of the local community, but instead of building on that, it is pulling the rug from underneath it, and I believe that it is being pressured by some GP practices in my constituency and future GP commissioners to do so.

I will conclude, after my 15 minutes, by saying that there is only one set of vested interests that I represent in this place. It is not the PCT’s interests or the GPs’ interests—it is the interests of my constituents, more than 520 of whom turned up, at about nine days’ notice, at a public meeting that I held last Thursday to say to the PCT: “No, we want to keep our urgent care centre.” The PCT has got it wrong, it needs to listen, and we need that urgent care centre in Cheshunt.

I begin by congratulating my hon. Friend the Member for Broxbourne (Mr Walker) on securing what is a very important debate for him and his constituents. I commend him for the commitment that he has shown, as illustrated during his high-powered speech, in campaigning on health issues for his constituents to ensure that they get first-class, quality care. I also take this opportunity to recognise the hard work and dedication shown by NHS staff in his constituency. Their dedication, expertise and drive do so much to improve the health and well-being of his and other hon. Members’ constituents on a daily basis. This Government will support and empower them to provide his constituents with health outcomes that are consistently among the very best in the world.

As part of the Government’s commitment to the NHS, we are consistently increasing the amount of money we provide to local organisations. Total revenue investment in the NHS in 2011-12 will grow to more than £102 billion. The allocations announced on 15 December will provide primary care trusts with £89 billion to spend on the local front-line services that matter most. That is an overall increase of £2.6 billion, or 3%. Of that, Hertfordshire PCT will receive £1.7 billion—a cash increase of £47.7 million, or 2.9%.

Before turning to the specific issue of the Cheshunt urgent care centre, I will set out the context of our plans to modernise the NHS and bring considerable improvements to the health care experienced by my hon. Friend’s constituents. We believe that local NHS services should be centred around the patient, led by local clinicians and free from political interference, either from this House or from the various levels of NHS bureaucracy. To this purpose, we have set out our proposals to liberate the NHS from central control. We will set front-line professionals free to innovate and to make decisions based on their clinical judgment and the needs of their patients, with the sole aim of improving the quality of care given and the outcomes achieved.

Responsibility for budgets and commissioning care will transfer from managers within the PCTs to clinicians in general practice-led consortia. Patients will receive health care that is tailored to their community and their personal circumstances. Our plans will radically simplify the NHS. Two layers of management—strategic health authorities and PCTs—will no longer be necessary. We anticipate a one-third reduction in administration costs, saving the NHS £5 billion by the next election and £1.7 billion in every year after that. Every single penny of those billions of pounds will be reinvested in front-line services.

There are now 177 pathfinder consortia across England, covering 35 million people—more than two thirds of the population. Those consortia are taking a lead in rejuvenating local services, cutting out waste and putting the needs of patients before the needs of the system. There are now three pathfinder consortia in Hertfordshire. The East and North Hertfordshire GP commissioning consortium covers part of my hon. Friend’s constituency.

Clinical leadership will go hand in hand with greater local democratic accountability. Under “any willing provider”, an increasing number of independent sector and social enterprise organisations will deliver NHS services. Unlike now, local authorities will have the power to scrutinise all providers of NHS-funded services. Local authorities will be able to require the provider to present information and to appear at scrutiny meetings to hold them to account.

Already, 143 local authorities—almost 90% of those in England—have signed up to be health and wellbeing board early implementers, including Hertfordshire county council. The make-up of health and wellbeing boards will be left to their own discretion, but will include representatives of GP consortia, directors of public health, adult and children’s services, representatives of HealthWatch, representatives of the NHS commissioning board and locally elected councillors. As well as preparing a joint strategic needs assessment, they will have to draw up a strategy to deliver the requirements set out in that assessment. In short, health and wellbeing boards will promote integrated working across the NHS, public health and social care, and will hold NHS services to account. That will lead to better, more accountable services for local people.

The Government are clear that in a patient-led NHS, any changes to services must begin and end with what patients and local communities want and need. Until the new system is in place, we expect PCTs to follow best practice in ensuring that local communities are fully engaged in such decisions. When it comes to urgent care, it is vital that local services are coherent and easily accessible around the clock. However, we have again been clear that decisions on the form that they should take are best made locally, in the light of local needs.

In the Broxbourne area, there are 12 GP surgeries, four of which are in Cheshunt. The area also has an out-of-hours GP service provided by Herts Urgent Care, based at the Cheshunt community hospital. The community hospital also provides out-patient clinics and a range of community services. There are 22 pharmacies in the borough, nine of which are in Cheshunt and one of which opens for extended hours.

On the specific matters that my hon. Friend raised regarding the Cheshunt urgent care centre, I understand that in 2007, the former two Hertfordshire PCTs, in partnership with the two Hertfordshire acute trusts, held public consultations on a health strategy, “Delivering quality healthcare for Hertfordshire”. The strategy was intended to improve access to urgent care services in Hertfordshire, so that people with urgent but not life-threatening conditions could be redirected from hospital accident and emergency departments to receive more appropriate treatment more quickly and closer to home.

In response to the public consultation, the PCTs agreed to piloting urgent care centres at both Cheshunt and Hertford, on the basis that they would be evaluated before longer-term decisions were made about their future. It is crucial to remember that they were pilot schemes, and it was always understood that after a period of time had passed, so that experience could be gained, they would be evaluated before those longer-term decisions were taken.

The urgent care centres were established as part of a 12-month pilot project between January and December 2010, with the specific objective of relieving pressure on local accident and emergency services. The primary purpose and objective was to reduce the number of patients seen at A and E by 20,000 a year, by providing local people with direct access to urgent care centres. The purpose of those centres is to see and treat people with urgent, but not life-threatening, illnesses such as sprains, strains, broken bones, and minor burns and scalds in a local community setting, allowing A and E departments to concentrate on life-threatening emergencies.

Hertfordshire PCT commissioned an independent research organisation, Opinion Research Services, to evaluate the success of the pilot centres at Cheshunt and Hertford, the latter in the constituency of my hon. Friend the Member for Hertford and Stortford (Mr Prisk). I understand that during the evaluation process, the views of the general public, NHS staff and local GPs were taken into account. Evidence was then submitted to an evaluation panel consisting of local GPs, local councillors, staff from local authorities and representatives of the PCT.

When the evaluation panel met on 17 January this year, it came to the unanimous view that urgent care centres were not achieving their aim of diverting significant numbers of patients from A and E. I remind the House that that, of course, was the primary purpose of the pilot scheme when it was started at the beginning of January 2010. Instead, considerable numbers of those using the urgent care service were seeking advice and treatment usually provided by GPs, for conditions such as raised temperatures, sore throats and headaches. It was never the intention that the urgent care centres would have a primary care focus. They were established to relieve pressure on local A and E services and to treat people with urgent but not life-threatening illnesses.

The evaluation panel recommended that the pilot centres should not continue in their current format. Instead, it recommended that the PCT should consider recommissioning activity through one or two minor injuries units. It also recommended that the PCT consider how it could improve access to high-quality primary care, to compensate for the loss of the urgent care centre.

As my hon. Friend the Member for Broxbourne is aware, Hertfordshire PCT published its board papers on the issue on 18 March. I understand that the PCT met earlier today to consider the recommendations and has decided to uphold them and not recommission the urgent care centres in their current form. Instead, it will consider recommissioning a minor injuries unit at Cheshunt.

I accept, as my hon. Friend made clear, that the Cheshunt urgent care centre is well regarded by local people. However, the provision of services is a matter for the local NHS. As he understands, it is not for Ministers to interfere and micromanage the day-to-day business of the NHS.

My hon. Friend mentioned access to general practitioners in the Cheshunt area. To reiterate what he said, the evaluation panel recommends that the PCT considers how it can improve access to high-quality primary care to compensate for the loss of the Cheshunt urgent care centre. The PCT has upheld that recommendation. I understand that the PCT has a programme of measures to improve access to general practice, to which he referred. I am sure he will agree that it is important to pursue and achieve that.

I would argue that the PCT ought to have been improving the performance of GPs in my constituency for the past decade. It has arrived a little late at the party.

My hon. Friend makes an extremely valid point. It is sad that only in the last few months have this Government been able to come to grips with some of the previous Government’s failings in making the local health service more accountable to the needs, wishes and requirements of local people. He and I will be totally in agreement on that. That is why I believe that the core of our health service modernisation programme— putting patients at the heart of the delivery of care—is so important. I am sure that he and I agree that that is an appealing principle from which to work.

As my hon. Friend said, the PCT has established a funding initiative for GP practices to support the Improving Access programme, which includes funding for new telephone systems, improved appointments and check-in systems, and medical equipment. The programme continues to be a key area of work for PCT staff, who will work closely with GPs to ensure that it is implemented, and that local people see improvements.

I have been advised—I hope this reassures my hon. Friend—that the latest GP patient survey results show that four GP surgeries in his constituency scored 91% or above in terms of satisfaction with care. Two of those practices—the Cromwell medical centre, which achieved a 92% rating, and the Warden Lodge medical practice, which achieved 93%—are in the Cheshunt area.

I am assured that the PCT will hold discussions with East and North Hertfordshire GP consortium and involve it fully as it conducts that further investigation. I am also assured that the PCT will have conversations with the public and other stakeholders, including my hon. Friend if he wishes, to gain further understanding of the needs of the local population, and to explain to potential users of the services what a minor injuries unit can provide. In addition, I am advised that the PCT will strengthen its performance management of GP practices to address the problems that some local people have experienced. I fully understand my hon. Friend’s concerns, but the board has decided that the PCT needs to explore further the possibilities of setting up a minor injuries unit. I understand that the PCT will test the feasibility of the new unit with providers.

Question put and agreed to.

House adjourned.