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Queen Mary’s Hospital: Urgent Care Services

Volume 682: debated on Monday 12 October 2020

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

I am grateful that Mr Speaker has granted this debate, and to the Minister for Health, the hon. Member for Charnwood (Edward Argar), for taking time out of his schedule to respond to it. This issue is of huge concern to my constituents, as I am sure he can understand. More than 300 of them have signed my petition just this past week, and many have been in touch with me to explain how important the issue of urgent care services at Queen Mary’s Hospital is to them.

I have called for this debate and am standing here today because I really value our local hospitals and all the work that the fantastic staff have done during this pandemic to care for us, to endlessly adapt systems and services and to save lives. I take this opportunity to thank the NHS managers, doctors, nurses, cleaners and support staff for all that they do. It is because I, and local residents, value our local hospital so much that I ask the Minister to support the reopening of the urgent treatment centre and the pharmacy for out-patients before the winter and the increasing demand begins. It is really important that it is a walk-in treatment centre that does not require bookings.

Allow me to provide some context for the Minister. In August 1997, Queen Mary’s Hospital, which is in Roehampton, ended its A&E service, and has since had a minor injuries unit, which the trust gave a gold-standard accreditation in November last year. So there is no A&E service in my constituency. The minor injuries unit was upgraded to an urgent treatment centre, with a GP added to the excellent nurse practitioner staff, earlier this year. In a normal year, the centre serves 16,000 to 18,000 people, so it is a vital service in our community.

During the peak of the pandemic, the decision was taken to temporarily close the service because of a lack of space for social distancing and to be able to adhere to Government guidelines, and also to move the staff to other areas that needed them more. The pharmacy for out-patients has only recently been closed, and at very short notice. Of course I understand, as do local residents, that changes had to be made and that health services had to adapt. I fully appreciate that our NHS managers had to make some extremely difficult decisions on service provision as they faced the prospect of being overwhelmed, which they are now facing again, with the second wave. The continued closure makes us in Roehampton feel overlooked, and it is putting additional pressures on NHS services at Teddington, the walk-in centre at Kingston, St George’s Hospital A&E and local GP surgeries. I am concerned that this will cause untold long-term damage to the health and wellbeing of our community. 

I have been asked, “What about the person with the dislocated shoulder, the chest pain, the allergic reaction?” They all need to be assessed and stabilised urgently, but at the moment they are being turned away. I have met the chief executive of the hospital trust and raised these issues. I asked her to assure me that the centre would be reopened as soon as it was safe to do so, but she has not confirmed when it will reopen, if at all. That is very worrying. I hope to hear from the Minister this evening that he will support the trust in making plans to reopen the walk-in urgent treatment centre. 

I would like briefly to explain the impacts that the closure is having on local people. Anyone who goes to where the minor injuries unit used to be is asked to travel far away to the Teddington walk-in centre, to Kingston A&E or to St George’s A&E in Tooting. Those bus journeys can take an hour, which can result in painful journeys or in many people not making the journey, not being seen and not being treated. I am sure the Minister will agree that an hour on public transport is an unacceptably long journey time when there is a really good hospital right there in Roehampton, but it is just not open for walk-in urgent care. One of my constituents wrote to me this week to say:

“I took my elderly father, who is nearly 90 years old, to Queen Mary’s just over a month ago, because he had cut his fingers quite badly and they were bleeding. The kind staff there had helped us when my father had a similar problem last year and they knew how to bandage his fingers because he has very thin skin…Because the Centre was closed, we had to go all the way to Kingston Hospital which was quite stressful. While his treatment there was good, it would have been far easier if we could have gone somewhere more local to him as my father isn’t used to travelling that far.”

Also, some patients are unable to travel or should not travel. An example is patients with diabetic foot ulcers, who should keep their activity to a minimum to allow ulcers to heal. At the same time, if they have an infection, it needs treating immediately as it could deteriorate rapidly leading to the need for amputation. That is one group of patients who are not getting the care they need because the urgent treatment centre and the pharmacy are not open. There is an obvious health risk to people needing to travel further if they are seriously ill.

There is also an increased risk of covid infection through asking people to travel greater distances by public transport during the pandemic, especially when they are unwell or chronically ill. They could have an underlying condition, which might be the reason they are going to the urgent care centre in the first place. That would make them more susceptible to the effects of covid-19. Closing the pharmacy is having the effect of delaying patients receiving treatment, as they are now being referred to their GP by the clinics. If they cannot immediately get an appointment with their GP, this can lead to delays of up to 48 hours before starting their treatment. That is another impact.

There is also a knock-on effect on services in other places. The fact that 16,000 to 18,000 people a year used to be treated at Queen Mary’s is putting pressure on St George’s and Kingston, along with the increasing demand at the moment. GP surgery appointments are already at a premium, and this demand will only worsen as the difficult winter months approach. Even before the pandemic, it was reported that over 11 million patients had to wait more than 21 days for a GP appointment. In my constituency, there are 14 main surgeries and three branch practices. My team has called round all the local GP services. Several are still only doing appointments over Zoom, and in one local medical centre, a member of staff begged for the urgent care centre to reopen due to the pressure its closure is causing for GP surgeries.

Increased demand for overstretched GP surgeries with finite resources ultimately means fewer local people’s conditions or illnesses receiving treatment, and even more concerningly, serious and urgent illnesses such as cancer being missed and going undiagnosed. It is cancer diagnosis that I am particularly concerned about. As the Minister knows, lots of cancers are diagnosed when people present at hospital with a symptom. With the doors of the urgent treatment centre still closed, many cancers that might otherwise have been spotted will have been missed.

Motion lapsed (Standing Order No. 9(3)).

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

Many cancers will be missed if people cannot go to the urgent care centre and are redirected to other facilities, because there is a real concern that they are not making that journey.

According to Breast Cancer Now, the importance of GP referrals and of the NHS breast screening programme to breast cancer survival cannot be overestimated. However, the number of people referred to see a specialist with suspected cancer declined dramatically during the peak of the coronavirus outbreak. In England, between March and July this year, there were 95,000 fewer referrals by a GP for tests.

Prostate cancer is also of real concern. This cancer claims the life of one man every 45 minutes in the UK. Early diagnosis, as I know from my own family, really does save lives. The impact of covid-19 has meant that around 3,500 men in the UK risk being diagnosed with last-stage, incurable prostate cancer. With GP appointments often hard to get, urgent care centres such as the one at Queen Mary’s Hospital are very important in spotting signs of cancer early on. The prolonged closures of urgent care centres are accelerating the crisis in cancer care. Cancer and other serious diseases will not wait for the covid-19 crisis to abate—they will not wait until the winter is over—before taking lives again. We cannot lose sight of this. We cannot risk the lives of local people.

In summary, the urgent treatment centre and pharmacy at Queen Mary’s Hospital is a very valued and valuable local health service with fantastic staff. I understand that it had to close and that difficult decisions had to be made, but for too long, people in Roehampton, Putney and Southfields needing urgent care have been sent away. That is leading to some people going untreated and others suffering on long journeys, and it is adding to the pressure on A&E services at Kingston Hospital and St George’s Hospital in Tooting. It is time to stop sending people with dislocated shoulders, deep cuts, chest pains or severe allergic reactions to places an hour away when we have a great hospital with great urgent care nurses in our own community. We need the out-patient pharmacy to provide medications for treatment as soon as they are needed. There is more demand than ever for a walk-in service at the urgent treatment centre, which used to treat 16,000 to 18,000 people a year. My ask of the Minister is simple: will he do everything in his power to reopen the urgent treatment centre with walk-in capacity and the out-patient pharmacy at Queen Mary’s Hospital before the winter begins?

I congratulate the hon. Member for Putney (Fleur Anderson) on securing this debate on an issue that is important to her constituents and more widely across south London and on her typically reasonable and measured tone in putting her constituents’ case so clearly and firmly. As she did, I pay tribute to the staff at Queen Mary’s, St George’s University Hospitals NHS Foundation Trust and across our entire NHS for the amazing work they do day in, day out, but particularly during this pandemic. Thanks to their dedication and their response to the public health measures and restrictions, which have been difficult for many people, the NHS was not overwhelmed during the first covid wave, and we have put in place measures to prevent that from happening in a second wave.

As the hon. Lady said, coronavirus has brought challenges and forced us all to do things differently to manage the pandemic, protect the NHS and save lives. There is no doubt that it has led to rapid changes in the way that health and care services are delivered, as providers have refocused their efforts on tackling the pandemic, but also on providing services in a safe way for other service users. But it is important that these changes are temporary and that the NHS is working to reopen services as soon as it is safe to do so. She said that she hopes her constituents in Roehampton will not be overlooked in this place and I suspect that, as long as she is a Member of this House, they certainly will not be.

The hon. Lady was right to highlight the importance of local services so local people can access services easily, without transport or other challenges. It is regrettable that the urgent treatment centre at Queen Mary’s Hospital remains closed. I know that that decision was not taken lightly by the trust. It was taken on clinical advice by the trust to protect the safety of patients, staff and the public. I believe it has been closed since 30 March this year. As she succinctly put it, the issue is due to the requirements of social distancing and the critical importance of infection prevention and control. Therefore, given the configuration of the centre, and its walk-in aspect, it could not operate as it did before the pandemic. It is not able easily to segregate patients with respiratory problems, treat them with dedicated staff, or maintain the necessary distancing.

I am conscious that the trust has yet to set out a firm commitment to a reopening date, but I join the hon. Lady in saying that I hope it will set out its future plans as soon as possible. I am conscious that she has met the trust’s chief executive, Jacqueline Totterdell, to discuss these issues and plans for the reopening of the urgent treatment centre. Although that reopening date is still to be confirmed, I understand that the trust and local commissioners are undertaking work to agree a new covid-secure model of care before reopening, which is the right approach.

My offer to the hon. Lady is twofold and I hope it will be helpful. First, I am happy to raise the issue directly with the chief executive of the trust to consider both timescales and a date for the reopening. Secondly, if she feels it would be useful, I am happy to ask my office to get in touch with her and arrange to meet her in a slightly less formal environment than this Chamber, to discuss in more detail the urgent treatment centre and the pharmacy, which I will come to in a moment.

The hon. Lady highlighted not only the urgent treatment centre but its role in helping early diagnosis and treatment of cancers. I completely understand and recognise her concerns about the impact of the pandemic on cancer services and the importance of ensuring that cancers do not go undiagnosed. The NHS is working to restore the full operation of all cancer services, with local delivery plans being delivered by cancer alliances. Systems will be working with GPs and the public locally to increase the number of people coming forward and being referred with suspected cancer to at least pre-pandemic levels—I will come on to the performance of her local trust in a moment.

To support that, systems will help to ensure sufficient diagnostic capacity in covid-19-secure environments, through the use of independent sector facilities and the development of community diagnostic hubs and a rapid diagnostic centre. The hon. Lady is right to highlight that diagnostic capability is a considerable challenge, not least because, to put it perhaps a little bluntly, many diagnostic tests are very close and personal, and the equipment used is intimate in terms of looking inside the human body. The cleaning and infection control measures that are necessary between each patient make it challenging to see as many patients as would have been the case before the pandemic.

The cancer recovery taskforce met in September to review the status of cancer services against recovery metrics and a national recovery plan is being developed for publication shortly. In respect of the hon. Lady’s particular trust—I am afraid that I have only the figures for the overall St George’s trust, which I hope will none the less be useful—referrals in August for cancer treatment, as I understand it, were twice as high as they were in April, so a lot of work is being done to pick that up. On the basis of the latest figures that I have, which I think are for August, the trust saw 87.8% of people within the two-week target and 94.5% of those referred for treatment received that treatment within 31 days. So I put it on the record that, in very difficult circumstances, her trust is doing a very good job to bring those services back into operation.

It is important that we continue to advise people to contact their GP or to seek the help they need about a symptom that could be cancer or that could represent a risk. The hon. Lady is right that it is important that, when people do need help, they are able to access that GP service and get the advice that they need.

I turn to cancer screening, which I know is something that, although the hon. Lady did not mention it specifically, is relevant to that diagnostic capability and capacity. In some areas, providers of screening services did reschedule invitations or appointments to a later date, again to address infection control risks, but cancer screening services as well are now being restored as swiftly as it is safe to do so. I spoke to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who has responsibility for, among other things, breast cancer screening services, and I think that something like—I may not have the exact figure—80% to 85% of the backlog has now been caught up in recent months. It is important that we sustain that improvement and that the hon. Lady’s constituents see that improvement.

As the country continues to deal with covid, I want to reassure the hon. Lady that the Government are committed to providing and ensuring access to high-quality care that meets the needs of people across England, irrespective of where they live. She is absolutely right that it is vital that her constituents are able to access and get that local medical help when they need it, and that includes the pharmacy that she mentioned. The hospital pharmacy is absolutely vital for people being able to have timely access to the medicines they need and being able to get them on site. Although people using it will have been treated and advised in hospital, they can none the less get very helpful advice from the pharmacy as well, so I share her view about the importance of that. As I have said, I include that in my offer to her—to discuss that with her and with the chief executive. I will endeavour to do that later this week, but I am afraid that, given that I think I am taking through seven statutory instruments in here tomorrow, it may be towards the back end of the week that I am able to do that. However, I will endeavour to do so.

The Government remain committed more broadly to restoring urgent non-covid services in a safe way and supporting NHS capacity to protect against the risk of a further surge in cases and, of course, the increased pressures—the hon. Lady alluded to that as the context for this—on the system during the winter. I reiterate my thanks to our NHS staff, not only for what they have done, but for what I suspect they are going to have to do in the coming months.

The hon. Lady will be aware that we have announced considerable further investment in the NHS: an extra £3 billion in July to help support the NHS, and £450 million of capital funding for urgent and emergency care services and expansions. I recognise that this is not going to her own hospital, but I would just highlight that £2.5 million is going to St George’s. Quite rightly, she will champion Roehampton, but I am sure she will welcome that more broadly as well. However, I recognise her concerns about Roehampton, which is why I am happy to meet her.

I simply reiterate that I share the hon. Lady’s view that, where services for perfectly good and legitimate clinical reasons have been temporarily closed or altered, it is extremely important that they are reopened as soon as trusts are able to do so and, where in the future any changes are proposed, that they are subject to the usual full public consultation, engagement and consideration. I do not want to see temporary measures becoming permanent by default, and she can read that as perhaps an expression of my view on what is happening in Roehampton.

As the hon. Lady knows, the next step is for the local commissioners, together with the trust, to agree the new covid-secure model of care so that the centre can reopen in a way that is safe for patients, staff and the public. I will ensure that I remind them of the need to keep her fully updated, although I suspect they will not need that, because I suspect they know that she has an extremely high level of interest in this on behalf of her constituents.

I hope that I have been able to offer the hon. Lady some reassurances today. I thank her for securing the debate, and I very much look forward to meeting her. I am afraid that, at the moment, it has to be an offer of a meeting either by Zoom or in this place, but I hope that at some point, when we are able to do so safely and without hindering the work of those working in the hospital, I may even be able to visit her hospital with her in the near future.

Question put and agreed to.

House adjourned.