Mount Vernon Cancer Centre

Wednesday 4th March 2020 Westminster Hall

[Sir Christopher Chope in the Chair]

16:15

[Gareth Thomas (Harrow West) (Lab/Co-op)]

I beg to move,

That this House has considered the future of Mount Vernon Cancer Centre.

A devastating report last summer into the future of Mount Vernon Cancer Centre by a clinical advisory panel led by Professor Nick Slevin at the instigation of NHS England stated that there was

“increasing concern as to whether high quality, safe and sustainable oncology services can continue to be delivered…and there is an urgent need to address this concern.”

If media reports are to be believed, that was the first time in the NHS’s 71-year history that a major hospital specialising in such an important disease had been deemed to pose a risk to patients and declared unfit for purpose. The panel went on to note that many of the existing buildings and much of the estate used by the cancer centre was

“dilapidated and not fit for purpose. There is a need for considerable investment in buildings, equipment replacement and IT connectivity”,

as well as staff.

Mount Vernon is a nationally recognised specialist cancer service, up there alongside the likes of the Royal Marsden or the Christie in Manchester, so for it to be so dilapidated and so short-staffed when cancer diagnoses are rising is deeply worrying. The panel recommended a change in the trust managing the service and, crucially, that some parts of the service—it would appear in practice to be most—be relocated to a hospital with comprehensive acute services. The report insisted that significant capital investment should be made available to address the need for a full or even partial move of the service. It argued that the buildings and wider estate used for cancer services should then be managed by the NHS trust actually providing the services to strengthen operational control.

Professor Slevin made it clear that he and his colleagues were greatly impressed by the determination of staff to continue to provide the best quality care that they could in the difficult circumstances they were working under. He also noted the consistently positive feedback from patients about the care they receive at Mount Vernon—a point that many of my constituents who have used the service have underlined to me.

Mount Vernon is a part of the NHS that I have known for a long time, having used the minor injuries centre a number of times and having campaigned to save its then accident and emergency department in the mid-1990s. More than 1,000 residents in Harrow use the service each year, and I have yet to hear a negative view of the professionals there. My constituents and I are keen to ensure that the service is maintained to a high standard and that it stays on the Mount Vernon site, or in the next best scenario, in an area local to Mount Vernon. Critically, we need a sustained period of investment in staff, buildings and equipment. I now believe that despite University College London Hospitals coming on board, there is no plan to shift Mount Vernon’s cancer service to central London, but it would be good to hear that confirmed by the Minister.

Professor Slevin’s report set out a short-term action plan involving the transfer of the leadership, governance and management of Mount Vernon’s cancer services to an experienced tertiary or leading cancer service provider from London—that apparently is now sorted—as well as the appointment of additional staff and urgent backlog maintenance work to existing clinical facilities. I would welcome clarity from the Minister on the progress made in implementing that short-term action plan. In particular, will he publish the list of urgent backlog maintenance work that Professor Slevin and the rest of the clinical advisory panel noted was essential? Crucially, what progress has been made in tackling that work?

I tabled a written parliamentary question that the Minister answered on 11 February, suggesting that removing asbestos from Mount Vernon would alone cost £12 million, while the answer to another written parliamentary question that I tabled, published on 21 October last year, stated:

“Challenges remain around sourcing capital funding for backlog maintenance and long-term solutions for the service.”

On staffing, will the Minister set out how many additional staff needed to be appointed to the acute oncology service in July last year, when the report was published, and the progress that has been made in tackling those staffing shortages? I understand from the answer that I received on 21 October in response to another written parliamentary question that I tabled that a business case for additional staff in that area was developed and approved. Will the Minister release the business case and confirm how many of the staff positions approved for recruitment have been filled?

The short-term action plan noted that robust implementation of policies concerning admission criteria, daily consultant rounds and patient reviews was necessary, which would require additional medical staffing. Again, it would be good for the number of extra clinicians needed from July last year to be published, and to know what progress has been made in tackling those staffing shortages. The answer to my written parliamentary question suggested that a proposal for an enhanced seven-days-a-week consultant model and robust outreach medical acute oncology service provision had been developed. Was it approved? Can the business case be released, and the House informed of progress on its implementation?

I tabled a further written parliamentary question, which was answered on 10 February. That answer did not give me confidence that enough action was being taken to tackle the immediate critical vacancies. The Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill), said in her answer that there was a 25% vacancy rate for nurses at Mount Vernon Cancer Centre, an almost 10% vacancy rate for medical staff, an almost 30% vacancy rate for clinical support staff, and an 8% vacancy gap for scientific, therapeutic and technical staff. Given the seriousness of the findings in Professor Slevin’s report, I am surprised that more progress has not been made in reducing those vacancy rates.

It is the long-term future of Mount Vernon Cancer Centre that most exercises my constituents, and no doubt many others in surrounding areas who depend on its service. The impact of the lack of capital investment is obvious to any visitor or patient. The acid test of the commitment of Ministers to the future of Mount Vernon Cancer Centre is whether they will invest in the new linear accelerators that the service needs. Linear accelerators are fundamental to the delivery of radiotherapy services, but are costly to put in place. Mount Vernon has seven, six of which are due to reach the end of their normal operational lives over the next three years.

Professor Slevin’s report last summer noted the age of the linear accelerators, or LINACs, and an answer to another written parliamentary question on 11 February noted some of the costs of replacing LINACs, particularly if they were being moved to a new site. A day earlier, an answer to another written parliamentary question noted that three of the seven linear accelerators were due to be replaced this year, with three more due in 2022. Will the three linear accelerators due for replacement this year be replaced and, if not, why not?

Professor Slevin’s report noted that the brachytherapy service at Mount Vernon Cancer Centre is nationally recognised, but access to theatres for treatment is “constrained”. What is the long-term plan to sort that issue? The report also noted the desire of East and North Hertfordshire NHS Trust and the Hertfordshire sustainability and transformation partnership to see Mount Vernon Cancer Centre’s services re-provided in fit-for-purpose buildings, replacing the oldest facilities.

Indeed, so old and decrepit are the buildings that leaking roofs have forced “adjustments in service provision”. Nine months on, I ask the Minister whether there are still leaking roofs at Mount Vernon, forcing more of the cancer centre’s services to be moved. There are insufficient rooms for medical staff, specialist nurses, dieticians and speech and language therapists, inadequate electronic systems and poor IT connectivity, slowing the clinical process. There is no direct real-time connection of the X-ray systems between Mount Vernon Cancer Centre and hospitals in its catchment area, undermining the effectiveness of clinical management.

The report stresses that the impact of poor IT infrastructure should not be underestimated. Duplicate paper records, a lack of access to complete scanning images out of hours, and an inability to view a comprehensive patient record lead to clinical risk. In short, doctors cannot access the results of critical CT and MRI scans out of hours. In the short term, according to the answer to a written parliamentary question that I received on 11 February, a plan to digitise patient care records at Mount Vernon is expected to be ready for implementation in May this year. Has the funding been identified to allow that to happen or will it have to wait for a full review of the future of Mount Vernon Cancer Centre to be completed? I hope that it is the former.

Professor Slevin’s report left the exact long-term future for Mount Vernon unresolved. A strategic review of Mount Vernon Cancer Centre to resolve that question is expected to be completed sometime this year, according to the answer given on 11 February to my written parliamentary question. Who will lead that review, what clinical expertise will they have, and how can we be sure that they will see it through to completion? What is the timeline for that review?

Part of the problem for Mount Vernon Cancer Centre is that the Mount Vernon site is owned by Hillingdon Hospitals NHS Foundation Trust, while East Herts NHS Trust runs the cancer service. Add in the confusion regarding which part of NHS England is responsible for owning the future of Mount Vernon, and it is not hard to understand why, despite two concerning Care Quality Commission reports in the past five years, there might have been a lack of NHS focus until now on Mount Vernon’s future.

I understand too that a further transfer of responsibility for Mount Vernon’s future from NHS East of England to NHS London is inevitable when University College London Hospitals NHS Foundation Trust takes over direct responsibility for the cancer centre. Given that, and given the number of Ministers in the Department of Health and Social Care who have answered my questions about Mount Vernon so far—answers for which I am very grateful—it would be good to know who among the Secretary of State’s ministerial team will continue to have immediate and ongoing responsibility for the project. If it is the Minister present today, given his seniority within the Department, I am sure that my constituents and I would welcome that news.

This 117-year-old hospital is not one of the six named for rebuilding or one of the 40 for which a rebuild or upgrade appears to be on the cards over the next five years. Unsurprisingly, I have been asked whether Mount Vernon Cancer Centre is set to close. The omens certainly do not look good, but assuming that that is not Ministers’ intentions, and that central London is not their intention for a move either, that would suggest a local move—to Hillingdon Hospital or Watford General Hospital, where I understand that upgrades have been announced or are planned. Failing those two options, either Northwick Park Hospital or Stevenage, Cambridge or Luton is likely.

My constituents and others deserve to know that the problems of Mount Vernon Cancer Centre are being sorted out. To give confidence to that end, transparency for the local community is essential. Given the seriousness of Mount Vernon’s situation, regular quarterly updates that are easy to understand and that offer a route to track progress are surely not much to ask for all those who use the cancer centre. To make such updates helpful, they should include consistent answers to three fundamental continuing questions. First, what extra staff does Mount Vernon need and what is being done to fill the vacancies? Secondly, will the three linear accelerators due to be replaced this year be replaced? Thirdly, when will a decision be made on Mount Vernon’s future, who will have a say in it, and how can they be influenced? I hope that the Minister will agree to give those updates.

Lastly, it would be remiss of me not to mention the fact that, earlier this week, a clinician at Mount Vernon Cancer Centre was suspected of having coronavirus. I understand that, after testing by Public Health England, the member of staff has fortunately proven to be negative for the virus. Inevitably, that initial concern will have been profoundly worrying for staff and patients. It is a further tribute to the professionalism of the staff at Mount Vernon Cancer Centre that they have maintained care and the high standards for which they have a deserved reputation. I look forward to the Minister’s response.

16:29

[The Minister for Health (Edward Argar)]

I thank the hon. Member for Harrow West (Gareth Thomas) for securing this debate on the future of Mount Vernon cancer centre. I know that the provision and location of radiotherapy services is of great interest to many hon. Members, and I was delighted to meet my hon. Friend the Member for Stevenage (Stephen McPartland) and my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) earlier this month to discuss aspects of this matter as it relates to their constituencies and their campaigns for a satellite radiotherapy centre, working with Mount Vernon to help serve their constituents.

The hon. Gentleman rightly paid tribute to the work of the staff at Mount Vernon—not just the work that they are and will be doing to help deal with coronavirus, but the work that they do day in, day out, for his constituents and many others. I join him in paying tribute to their work and dedication. He has made a typically courteous but powerful case for investment in that hospital and in the services that serve his constituents. If I may, I will say a little bit about cancer care more broadly before I turn to the specifics of what he has said regarding Mount Vernon.

Improving cancer treatment remains a priority for this Government, and survival rates are at a high. Since 2010, rates of survival from cancer have increased year on year, but we know there is more to do nationally. That is why the NHS long-term plan states how the Government will achieve their ambition of seeing three quarters of all cancers—

[Sir Oliver Heald (North East Hertfordshire) (Con)]

Will the Minister give way?

[Edward Argar]

I will.

[Sir Oliver Heald]

I am grateful to the Minister for giving way, and apologise to the sponsor of the debate, the hon. Member for Harrow West (Gareth Thomas). Does the Minister agree that both of the preferred options put forward for Mount Vernon include a satellite radiotherapy centre in our area of Hertfordshire? I hope that will form part of the Minister’s thinking, as it seemed to during our recent discussion.

[Edward Argar]

I am grateful to my right hon. and learned Friend for his intervention. He is right about the importance of satellite radiotherapy centres for his constituents and for large parts of Hertfordshire. He and others have made a powerful case and I have considerable sympathy for it. I find it compelling and I am looking at ways in which we might be able to deliver on that for his constituents and those of other colleagues in the area.

As I was saying, the long-term plan sets out how the Government will achieve their ambition for three quarters of all cancers to be detected at an early stage, and for 55,000 more people to survive cancer for five years in England each year from 2028. That plan includes providing new investment in state-of-the-art technology to transform the process of diagnosis and boost research and innovation. NHS England has committed more than £1.3 billion in funding over the next five years to deliver the long-term plan’s commitments on cancer.

I suspect that the hon. Member for Harrow West will say, “That is great, but what does it mean for Mount Vernon, my constituents and my constituency?” He has set out the background of what has gone on at Mount Vernon cancer centre, and of the review. He will know that the strategic review of that centre’s long-term future was launched by NHS England and NHS Improvement in May 2019. The review began with an independent clinical advisory group visiting the site and speaking with staff and patients. Its report advised that the current service model was not clinically sustainable, as the hon. Gentleman has said, and recommended that leadership of services from a specialist tertiary cancer provider would be key to future service development and sustainability, staff recruitment and retention, and enabling patient access to clinical trials. I am happy to provide him with more details in writing, if that is helpful. Indeed, if I am unable to answer all of his detailed questions in the course of today’s debate, I will write to him with detailed answers as soon as possible.

The hon. Gentleman asked specifically how the review would work, who was leading it, and who would be involved in it. It is being led by a programme board chaired by the NHS regional director of specialised commissioning and health and justice for the east of England. That board includes representatives from Healthwatch Hillingdon, Healthwatch Hertfordshire, London and the East of England Cancer Alliance, as well as local sustainability and transformation partnerships, clinical commissioning groups and a number of acute hospitals. They all sit on that board and are active participants. If it is helpful to the hon. Gentleman, rather than simply giving him the job titles, I can seek to furnish him with some names—those of the senior leadership, at least.

The hon. Gentleman said that the independent clinical advisory group made recommendations for short-term actions, including addressing urgent backlog maintenance of existing clinical facilities and the strengthening of acute oncology services. The current provider, East and North Hertfordshire NHS Trust, supported those recommendations. In January of this year, following evaluation of proposals from interested trusts, University College London Hospitals NHS Foundation Trust was selected as the preferred provider, subject to a period of due diligence. Depending on the outcome of that due diligence, the contract for running the site should transfer in April next year, with UCLH providing additional leadership support for that site over the next 14 months.

The hon. Gentleman mentioned backlog maintenance, which I have touched on. He is right to have done so, because, as he knows, backlog maintenance has increased in recent years. Although the trust received £33 million of central capital in 2019 to tackle critical infrastructure issues across the estate, monitored by NHSE&I, I know that it continues to be of concern. Although I do not wish to prejudge the future capital settlement and the capital spending review, the hon. Gentleman has powerfully made the point that the capital needs of his hospital and his trust should be considered in any future allocations of capital funding.

The hon. Gentleman raised the issue of access to brachytherapy services, which will be wrapped up in the review that is currently under way. Regarding the future location of services, I can assure him and hon. Members that options for the short-term and long-term future of the centre are being actively considered by the clinical advisory group and NHSE&I, with the local area and the hon. Gentleman’s hospital at the forefront of their thinking. When I write to him, I suspect he might wish me to be a little firmer in my reassurances. As far as I am able, subject to that review, I will endeavour to do so.

The hon. Gentleman also talked about staffing issues at the hospital. Existing clinical leads at Mount Vernon have increased their leadership duties at the hospital alongside their clinical responsibilities. Recruitment of a full-time clinical director will take place in conjunction with the new provider, once it is appointed. The hon. Gentleman mentioned the business case for appointing additional staff to the acute oncology service that has been developed and submitted to NHS England. My understanding is that the business case has been approved and recruitment has begun. I will take up with NHS England his request that he have sight of it and—ideally from his perspective, I think—that it be made publicly available. I do not know what the answer will be, but I will certainly ask that question, because it does not seem an unreasonable request.

Regarding whether the three linear accelerators due for replacement this year are going to be replaced, my latest understanding is that although East and North Hertfordshire NHS Trust has not yet agreed its full capital programme for the 2020-21 financial year, it has identified a requirement for capital funding, which the board will consider in that context. As soon as I hear the outcome of those decisions, I will write to the hon. Gentleman, who, as ever, makes his case politely but forcefully. More broadly, as he will be aware, NHS England has invested £130 million in the modernisation of radiotherapy across England, ensuring that older linear accelerators—that is, radiotherapy machines—used by hospitals are upgraded. We have made significant progress. I think the hon. Gentleman’s request acknowledges that, but he is essentially saying, “Yes, I have been given a promise, but please make sure that the delivery follows.” The decision on the trust’s investment priorities rightly sits with the board, and we will wait for that decision, but I will make sure that what the hon. Gentleman has said is communicated to the board. I suspect he will make sure of that as well, but I will ensure that the board is aware of his views.

The hon. Gentleman suggested quarterly updates to track progress against a basket of key indicators or asks in the context of the action plan. I hesitate to give a clear commitment until I have had the opportunity to talk to the trust and NHS England, but what I will say—I hope gives him an indication of my thinking—is that it sounds like an eminently practical and reasonable request to ensure that he, other interested parties and his constituents are kept informed about and engaged with a process that will, of course, be of concern to them but also of interest as well. It sounds reasonable—I am not aware of a factor that makes it unreasonable—and I will certainly press that point, because I think it is a sensible way forward.

In response to my right hon. and learned Friend the Member for North East Hertfordshire, I have touched on satellite radiotherapy centres. Alongside working with the Mount Vernon Cancer Centre, we are proactively looking at providing satellite radiotherapy centres for his constituents in the northern part of Hertfordshire and around Stevenage. It is too early to say exactly how we might do that, but I am determined to work proactively with colleagues to see if we can achieve it.

We are committed to the digitisation of paper records, which the hon. Member for Harrow West mentioned, to enable effective patient care and enhanced patient safety. The digital transformation plan, which will include the digitisation of patient care records, is under way for Mount Vernon’s main acute services and is expected to conclude in May 2020. I understand that the commitment to do that—to support and fund it—remains unchanged. If anything has changed, I will make sure that he is updated as appropriate.

There are a number of hon. Members present. I suspect they are not here to hear my or the hon. Gentleman’s eloquence, but possibly that of other hon. Members and, indeed, my right hon. Friend the Financial Secretary to the Treasury, who will take part in the debate that will start in a few minutes. Given the interest, however, I will see if it is appropriate to put in the Library a copy of my letter to the hon. Gentleman so that it is on the record.

If the hon. Gentleman thinks it would be useful, I am happy to meet him and to visit Mount Vernon with him to meet the staff, to hear the executive team’s thinking on what is going on, and to see it for myself. He raised a number of detailed and precise questions and important points. In the short time I have had, I have sought to reassure him and address a number of them, but I look forward to the opportunity to give him a more detailed answer in writing following the debate, and to visit him.

I reassure hon. Members that cancer, and improving cancer treatment and care, remains a key priority for the Government and the Department. We, along with NHSE&I and other arm’s length bodies, are working hard to ensure that the hon. Gentleman’s constituents and those of all hon. Members are provided with the best care.

Although cancer care and cancer services are the responsibility of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), given that a large amount of what the hon. Gentleman has talked about relates to performance and to capital and funding, which are in my portfolio, I will endeavour to maintain a personal direct interest in the issue, in partnership with my hon. Friend, to make sure that we both give it the attention it deserves and that he and his constituents have a right to expect.

Question put and agreed to.