Hospital of St Cross: Accident and Emergency
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The Minister for Health (Edward Argar)
I congratulate my hon. Friend the Member for Rugby (Mark Pawsey) on securing this important debate. He is right to highlight that it is the responsibility of Members of Parliament to highlight and champion their constituents’ concerns, and he is doing exactly that today, just as his illustrious predecessor and father did over a combined total of about 18 years in this House, representing that area with distinction just as he does. My hon. Friend has been a regular campaigner for the NHS in his constituency. Indeed, as I recall from oral questions some time ago, I think I am right in saying that he volunteered at the Locke House vaccination centre during the pandemic to assist his local NHS. Not only does he talk the talk; he walks the walk in supporting his local NHS, and his constituents in Rugby are incredibly lucky to have such a passionate local champion for their cause in this House.
My hon. Friend’s engagement with his constituents, and his being in tune with their concerns, is reflected by the survey he mentioned. He said he had received around 3,000 responses, which is a phenomenal response rate for such a survey. I think I read that it was reported on the excellent CoventryLive site, which highlighted exactly what he had done. He asked me to acknowledge, and of course I do, the virtual uniformity of the concerns raised in his constituents’ responses. That is a powerful message that his constituents are sending to us.
I understand that the Hospital of St Cross has operated an urgent care centre since the closure of the full A&E in 2011, transitioning to become an urgent treatment centre in line with national changes in 2019. That service is available 24 hours a day, seven days a week, allowing patients to access the urgent care services that it is able to provide at any time. Trained nursing staff are on hand and patients can have X-rays and blood tests and access a pharmacy. As my hon. Friend said, patients with more complex medical conditions requiring advanced tests or investigations will be referred or taken by ambulance to be cared for by specialists at the University Hospital in Coventry. This, to a degree, reflects the staffing availability and specialist staff required for different services, and which services are available in a particular setting.
My hon. Friend highlighted an important point, which applies not only to his local hospital but more broadly across the country. There is more we can do to help our constituents, and those who may need services, to understand what services each different NHS destination —be it an A&E or a UTC—can provide, and hopefully reduce the number of people who see the H sign on the motorway and think, “I’ll go there because I need assistance,” only to end up being transferred to another hospital to receive the services they need for their condition. There is more we can do to make that clear.
I appreciate my hon. Friend’s call for a restored full A&E service in Rugby, on the basis of demographic change since the decision was taken in 2010 and implemented in 2011. He is right to highlight the pace of change, including in population. I know his patch a little; it is a relatively short hop down the M69 and back across the M6 from my patch to his. He is right to highlight all that Rugby and the area is doing to help support the objectives of providing affordable housing for people who need it; but that of course comes with additional pressures on local public services and local infrastructure, as he rightly emphasised.
As my hon. Friend knows, the original decision to alter local service provision was made following a full public consultation to address concerns raised at the time that the unit was not able to sustain full A&E services, with serious cases, even then, being sent to Coventry for treatment. I can assure my hon. Friend that this decision will rightly be taken by the local clinical commissioning group, as it was in 2010—although it was possibly a primary care trust at the time. Shortly, it will be a decision for the local integrated care boards, which are due to come into force very soon, following the passage of the Health and Social Care Act 2022. It would not be right for the inception of such decisions to come from Ministers in Whitehall. I would note, however, that for any future changes we will see slightly altered powers for Ministers, with the power of direction and intervention introduced in that legislation.
I can assure my hon. Friend that the funding available to his local health system has risen in line with demographic change since 2010—as determined by the formula set by the Advisory Committee on Resource Allocation—and that ensuring that resources are allocated to deliver the best care for patients is a key duty of both the CCG and, subsequently, the ICB. The local health system is best placed to consider sustainability, location, and demand for services across its area. Any such assessment of whether to reduce services, move services or open new services should include consideration of the mix of accident and emergency services, UTCs and other treatment services, such as GP access.
Without wishing to pre-empt any particular course of action that my hon. Friend’s local system might be persuaded by his forceful advocacy to consider, I would also comment that it is for the ICBs and trusts to plan for reconfigurations of NHS services. Judging by what my hon. Friend said, he is already lobbying them pretty firmly. Where services are reconfigured, we are clear that these are subject to four stringent Government tests, which are strong public and patient engagement, consistency with current and prospective need for patient choice; a clear clinical evidence base, and support for proposals from clinical commissioners.
Decisions on any reconfiguration are rarely easy or straightforward; they are effectively about balancing different needs and benefits, including patient transport and inequalities, and it is important to hear from as many local people as possible about the practical impacts and concerns. As I alluded to, I encourage my hon. Friend to continue his conversations with his local NHS system.
Before turning to pressures on A&Es more broadly and the ambulance service locally, I should say that there is already significant investment to improve services in Rugby. The University Hospitals Coventry and Warwickshire Trust remains committed to expanding services at the Hospital of St Cross, and in recent times that has included the opening of a £1 million purpose-built haematology and oncology unit, and new modular theatres to help treat more patients on elective waiting lists. It is probably fair to say that a degree of credit goes to my hon. Friend for fighting the corner for his local hospital, as he always does.
I shall now mention pressures on emergency departments. The emergency department at the University Hospital in Coventry has also been granted £15 million by the Government to increase its capacity and further enhance patient care. This investment will expand the department, including with a new minor illness and injuries unit. The funding will also be used to install additional treatment cubicles, to expand the waiting room in the children’s ED, to increase the level of same-day emergency care and to support diagnostic capacity with an additional CT scanner.
It is right that we take a whole-system approach to these challenges, and all this work is designed to complement existing services provided at both the Rugby and Coventry urgent treatment centres. My hon. Friend is right to highlight the pressures we are seeing in EDs across the country, which is often manifested in ambulance delays and ambulance queues. That is a symptom of the patient flow challenge in hospitals. Space is needed to offload patients safely into EDs, for which EDs have to be able to discharge patients safely or admit them into the hospital. To do that, hospitals have to be able to discharge patients to free up the bed space to enable that patient flow. In recent months we have seen sustained pressure in hospitals across the country in that respect, and he rightly highlights his local hospital.
My hon. Friend talked about the ambulance service and highlighted the tragic case of Jamie Rees, which has been reported on extensively by CoventryLive. Jamie sadly passed away on new year’s day following a cardiac arrest. Through my hon. Friend, I extend my sympathies and condolences to Jamie’s family and friends.
I understand the West Midlands ambulance service believes that, sadly, an ambulance station, had there been one in Rugby, would not have altered the outcome in Jamie’s case. In the 90 minutes before it received the first 999 call, I understand there had been five other emergency calls in the Rugby area. That means any ambulances based in the town would have already been dispatched to deal with those emergency cases, so the ambulances would not have been available wherever the station were based. I fear that reflects the pressures at the time. None of that will be any consolation to Jamie’s family, but I wanted to highlight the context.
My hon. Friend also rightly highlighted the “Our Jay” campaign and the number of externally mounted defibrillators, which is a hugely important topic. It is sad that there is sometimes an unwillingness to fund externally mounted defibrillators due to the despicable behaviour of utterly heartless individuals who, for some reason, think they have the right to vandalise or steal this life-saving kit. It is a sad reflection on them, and I sincerely hope they never find themselves in a situation where they need such kit to be available. I pay tribute to the “Our Jay” campaign.
More broadly, we have put a number of measures in place to try to ease the pressure on A&E and ambulance services. The discharge taskforce is helping to free up patient beds by ensuring that patients who are fit to be discharged are discharged more rapidly. In recent years, £450 million has been spent on expanding A&E departments, and there has been a £55 million investment in strengthening ambulance trusts and keeping an extra 156 ambulances in service and on the road to bolster capacity and resilience during the winter period.
I hear the passionate case my hon. Friend makes. There is significant support in place, both locally and nationally, to help ensure constituents in Rugby can access the care they need when they need it, but I also wish to make a number of points. First, I am happy to meet him to discuss this matter. I was going to offer to make the short hop down the M69 and the M6, but from what he has says I have been pipped to the post by my boss arranging to do that visit; he has perhaps upgraded the offer, with the Secretary of State rather than a mere Minister of State. I hope my hon. Friend will feel free to share the detail of his survey and the responses with me. I am also conscious that I have some outstanding correspondence from him—I checked that this morning—and I will ensure that I respond to it in the next few days. I will pull it out of the system and ensure that he gets answers to the specific points he raised.
I thank my hon. Friend, once again, for rightly raising this important issue, securing an important debate on the Floor of the House today and doing what he does so well: championing his constituents’ best interests, and making sure that Ministers have no opportunity to forget them and to forget the people of Rugby. Indeed, he ensures that they are impressed upon our minds. I look forward to meeting him to discuss this further, and I hope that will happen shortly.
Question put and agreed.