Mount Vernon Cancer Centre

Gareth Thomas Excerpts

Wednesday 4th March 2020 Westminster Hall

[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.