North Middlesex Hospital Accident and Emergency Services: Cancer Patients
(1 day, 10 hours ago)
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Dr Andrew Murrison (in the Chair)
I will call Kate Osamor to move the motion and then call the Minister to respond. I remind other Members that they may speak only with prior permission from the Member in charge of the debate and the Minister. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.
Kate Osamor (Edmonton and Winchmore Hill) (Lab/Co-op)
I beg to move,
That this House has considered the experience of cancer patients with accident and emergency services at North Middlesex Hospital.
It is a pleasure to serve under your chairship, Dr Murrison. I thank you and the House for granting me the opportunity to speak about the urgent care pathway for cancer patients at North Middlesex university hospital, and to discuss the potential for dedicated funding for an oncology assessment unit.
In Edmonton and Winchmore Hill, as in many constituencies across the country, too many people with cancer are being let down. In the UK, cancer mortality rates are significantly higher than in comparable countries, and the survival rate is lower. I am glad that the Government have recognised the issue and are taking steps to address it, most significantly through the national cancer plan. I welcome the plan’s ambition to diagnose more cancers early, to ensure that treatment starts more quickly and to improve survival.
Jim Shannon (Strangford) (DUP)
I commend the hon. Lady on securing the debate. She is right to illustrate this important issue at her local hospital, which is replicated wherever we might be the United Kingdom. Indeed, people back home are waiting 12 hours for admission or discharge. Those who attend A&E should be treated within four hours, but that is not happening. Does the hon. Lady agree that strengthening community-based cancer services is essential to protect patients, ease pressure on emergency departments and ensure that people with cancer get the right care in the right place at the right time?
Kate Osamor
I thank the hon. Member for his intervention; later in my speech I will discuss the work the community is doing.
Faster diagnosis and quicker treatment are vital to improving outcomes for cancer patients. However, I am concerned that the Government are placing less emphasis on other critical aspects of the care that cancer patients receive. The case of North Middlesex hospital in my Edmonton and Winchmore Hill constituency, which I am very proud to represent, is evidence of that. On the one hand, since 2023, North Middlesex hospital has received two new radiotherapy machines, which should help to ensure that cancer patients receive treatment more quickly and limit the number of hospital visits they need to make. But on the other hand, the hospital is under-resourced in other important areas, which is having a negative impact on patients’ experiences.
I have particular concerns about the experience of cancer patients in the accident and emergency department. From talking to my constituents and their families, I know that oncology patients who are admitted to the hospital are often assessed in the emergency department, but it does not have the physical space or isolation capacity required to safely manage immunocompromised individuals. Despite an acute oncology service that works extremely hard to prioritise those patients, the North Middlesex hospital emergency department often struggles to provide appropriate private triage areas or guarantee a rapid review for vulnerable cancer patients, because of high patient volumes and infection-control pressures. Over recent years, this has caused a number of my constituents to be put in an environment that is unsuitable for their condition, and caused a great deal of upset and discomfort.
I have been in correspondence with one of my constituents, Mrs Mary Thorn, regarding the experience of her late husband, Mr Jack Thorn, at North Middlesex hospital, and Mrs Thorn has given me permission to discuss the experience of her late husband at the hospital. Mr Thorn was diagnosed with cancer in July 2022, and in January 2023 he began chemotherapy treatment. Following the conclusion of the first type of chemotherapy treatment, Mr Thorn was told multiple times that he needed to be admitted back into hospital. However, upon arriving at hospital, rather than being admitted straight into the cancer ward, he was made to sit in the A&E waiting room to be triaged. On one occasion, he was made to wait for 15 hours. Because of the immunosuppressive treatment that many cancer patients undergo, they are at a heightened risk of infection, meaning that staying in A&E wards for extended periods risks worsening their condition.
Since my correspondence with Mrs Thorn, I have heard from several other constituents who have suffered similar ordeals. One of my constituents, who has now sadly passed away, went to the North Middlesex emergency department following a concerning reaction to the immunotherapy treatment she was receiving for her cancer. She arrived at the hospital on a Saturday and was not moved into a side room until the Monday, meaning that she was forced to sleep in a chair for two days while very unwell. During this time she could not shower, had no privacy and was unable to return home to collect any belongings or change clothing.
Since hearing of Mr Thorn’s experience, I have engaged closely with the North Middlesex hospital and the Royal Free London NHS foundation trust, which now manages the hospital. The trust has been taking steps to improve the experience of oncology patients at North Middlesex hospital through efforts to reduce waiting times and speed up the pathway for them. Those steps include the creation of the same-day emergency care hub and the emergency ambulatory care unit, which provide a safer and more appropriate environment for patients, away from the emergency department.
Despite those measures, North Middlesex hospital has not been provided with the necessary resources for the triage of patients who require isolation. The trust proposes an initiative to establish an oncology assessment unit for patients who require minimal intervention, to bypass the emergency department, but this has been prevented from progressing further, after some promising initial steps. This was due to there being no available funds in existing budgets and the lack of external funding to hire the additional specialist staff required to establish the oncology assessment unit.
The situation highlights the urgent need for targeted investment. Without dedicated support, the trust will not be able to guarantee the safer, specialist-led pathway for cancer patients that clinicians have repeatedly recommended. The experiences of Mr Thorn and my other constituents demonstrate the human impact of the gap in provision, and the response of the trust makes it clear that local efforts alone cannot solve the issue. If the Government are serious about putting cancer patients “front and centre”, as the Secretary of State for Health and Social Care has previously stated, they must do more to support stretched and under-resourced hospitals such as the North Middlesex, as well as its dedicated and hard-working staff—not only to protect the dignity and wellbeing of cancer patients, but to improve outcomes and survival rates.
I have three requests that I would like the Minister to consider. First, will the Department consider taking steps to ensure that North Middlesex hospital is granted the funding it needs to establish an oncology assessment unit, so that patients who experience treatment-related complications can be assessed properly in an appropriate environment, avoiding the risks associated with overcrowded emergency departments? Secondly, will the Minister consider carrying out a wider assessment of the safety and suitability of the settings in which immunocompromised oncology patients are placed when they are admitted to hospitals across the country, and how that may affect outcomes for cancer patients? Lastly, how will the proposals in the 10-year health plan for England on shifting from hospital to community care affect the experience of those suffering from cancer, to prevent them from having to attend A&E in the first place?
I pay tribute to Mrs Thorn for her tireless advocacy on this matter, with me and my office, with the North Middlesex hospital and with the wider Royal Free London foundation trust, to push for improvements in oncology care following the death of her husband Mr Jack Thorn. Her constant advocacy in the face of such devastating loss is truly commendable.
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairmanship, Dr Murrison.
I thank my hon. Friend the Member for Edmonton and Winchmore Hill (Kate Osamor) for securing the debate. I echo her comments about Mrs Thorn in the light of her husband Jack’s experience. My hon. Friend has worked diligently on behalf of her constituent. We know that constituents should not have to take on such advocacy when they are suffering such trauma, but their experience is always valuable. Constituency MPs are always grateful to people who share their experiences, and my hon. Friend has done an excellent job on behalf of her constituent this morning.
We are clear that every patient should be treated with dignity and respect. For far too long, NHS performance and practices have not met the high standards that patients should expect, which is why we are taking action to improve cancer pathways and urgent emergency care, to build an NHS that is fit for the future. On the treatment of cancer patients in A&E in particular, far too many cancer patients and their families have been failed by the NHS, with care lacking empathy and dignity. It is not right that patients, and particularly those with a cancer diagnosis, face distressing situations waiting for care in A&E.
Through our recently published national cancer plan, which my hon. Friend alluded to, we commit to addressing poor experiences, driving earlier diagnosis and supporting general practitioners to spot cancer earlier through, for example, Jess’s rule and reducing inappropriate diagnosis in A&E. Jess’s rule is a patient-safety principle that requires GPs to reflect, review and rethink a patient’s diagnosis after three unresolved presentations, to reduce missed and delayed cancer diagnosis.
My hon. Friend and I entered Parliament at the same time; she had experience in primary care and I had experience as a commissioner. She will be as shocked as I am, because in 2026 cancer patients should not be going through A&E when they are known to have a condition. We have been working on that for a very long time. Our plan will reduce the need for people who are undergoing cancer treatment to attend A&E—for example, through rapid access to a booked appointment in same-day emergency care. As my hon. Friend alluded to, we already see that in other trusts, such as the Whittington in her area. That should be standard, and is in many places.
We recognise that some cancer patients will have more extensive needs. For those patients, we need to deliver an enhanced level of care during and after treatment, known as supportive oncology. This will include support for severe and sometimes sudden symptoms, when people need rapid access to the right care in their home or community. That will be key to getting those patients the support they need, and thereby reducing the need for them ever to attend A&E.
It is vital to deliver compassionate care in the best setting for each patient. Our national cancer plan will redesign cancer services around people’s lives, not just around hospitals, recognising that more people are living longer with and beyond cancer and need ongoing co-ordinated support. That support will increasingly be delivered through neighbourhood services and be accessible digitally through the NHS app. We will ensure that patients have a named neighbourhood lead to help to co-ordinate their care locally, working alongside hospital specialists to provide continuity, reduce fragmentation and make it easier for people to navigate services, in my hon. Friend’s constituency and across the country.
We will deliver greater use of virtual monitoring and growing opportunities for treatment and follow-up in community settings, where that is safe and appropriate. This will help to ensure that patients get high-quality support early, thereby reducing the crisis situations that my hon. Friend alluded to that currently drive unacceptable and unnecessary A&E visits.
Where patients do need to attend A&E, we are committed to improving standards and returning to the waiting times set out in the NHS constitution. We have expert improvement teams providing tailored support to challenge trusts like the North Middlesex, and they have shown progress, as my hon. Friend has highlighted. I pay tribute to the work of leaders locally in improving the situation—they have made progress since last year.
In addition, the NHS team in London recently agreed to a pilot for the oncology assessment unit, to proactively support cancer patients away from the emergency department, as my hon. Friend discussed. If she needs more detail on the final confirmation of that pilot, I will make sure she gets it in writing after the debate, because we do think that is an appropriate way to proceed.
Nationally, we recently published guidance on the model emergency department, setting out the core principles and pathways for high-performing emergency departments. Our urgent and emergency care plan for 2025-26 sets out a clear path to strengthen urgent care outside hospital. We are using data from shared patient care records and digital tools to support better triage, join up services and anticipate pressures before they arise. That is backed by £2 billion of investment in NHS digital infrastructure.
We are also investing £250 million to strengthen same-day emergency care and urgent treatment centre provision, helping systems to avoid unnecessary admissions for patients and supporting the same-day diagnosis, treatment and discharge of patients. The plan is working: A&E performance is improving and people are receiving their cancer diagnosis within a month. We do not underestimate how much more there is to do and how difficult it is for many patients at the North Middlesex hospital, as my hon. Friend has spoken about, and other places. We want to take the best to the rest. We know there is more to do, but the investment and modernisation along clear pathways are starting to make a difference, and the NHS is showing clear signs of recovery.
The NHS is under pressure. The Government are taking decisive action through our urgent care emergency plan, the national cancer plan and our longer-term reforms. We are putting the service back on its feet and ensuring that patients receive the high-quality, timely care they deserve. I welcome my hon. Friend raising this issue on behalf of her constituents, and many other Members discussing the issues with me. I am happy to continue working with my hon. Friend and local NHS leaders on how we can further strengthen urgent emergency care services and the delivery of the cancer plan, to reduce the disparities and support patients to receive the right care in the right place.
Question put and agreed to.