Erdington Walk-in Centre

Jack Dromey Excerpts

Tuesday 5th March 2013 Westminster Hall

[Jack Dromey (Birmingham, Erdington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Weir.

Today I bring a simple message from my constituents—“Save our walk-in centre.” Over recent months I have led, together with the user group and the local community, a campaign to save Erdington walk-in centre—a centre at the heart of our local community and considered one of the best of its kind. It is being threatened with closure as a consequence of a review by the Birmingham and Solihull national health service of all walk-in centres in the city. The threat is not just to the centre on Erdington High street but to the one in Kingstanding, which is also in my constituency and in one of the poorest wards in Britain.

My constituents may not agree with one another on every issue, but if there is one thing on which there is unanimity of opinion, it is that they know a good thing when they see it, and they have rallied behind their walk-in centre. I was proud to see just a few weeks ago hundreds of local residents turning out on a freezing Saturday to protest on the High street in support of their much-loved and much-used walk-in centre.

The Erdington walk-in centre offers a general practitioner-led service to walk-in patients from 8 am to 8 pm, seven days a week, including bank holidays. In 2012, an average of 76 patients a day were seen in the centre. The centre participates in accident and emergency diversion when necessary and accepts some category C ambulance referrals. It has close links with two other units in the same building—the New Attitudes sexual health team on the floor above and the Health Exchange team on the floor below—and houses some community clinics, for example for drug workers and users.

The centre has served to support the local population in accessing quality GP-led health care through extended opening hours that are convenient for patients, including those who are registered with a GP but have difficulty accessing services during normal opening hours. The centre also provides an important service to vulnerable local people, including those who are unregistered or homeless. The service means that they have access to high-quality medical care.

I know first hand how the centre matters—I have used it myself. Indeed, I have used both the Erdington and Kingstanding walk-in centres. Much more importantly, I know, from talking to literally hundreds of local people, just how important the centre is to the local community, providing accessible and high-quality health care in the heart of our High street. The closure of the much-used and much-loved facility would be a devastating blow. In the words of one of my constituents, Nathalie Lynch:

“Anyone with children knows how essential it is to have quick access to medical help. My doctor’s surgery is so oversubscribed that I can’t get an appointment. The walk-in centre has been a lifeline. On three separate occasions, my son has received nebulisers for his breathing and then been sent on to hospital. What would he do without this service, I dread to think.”

Currently, the nearest alternative providers of urgent care services are the accident and emergency departments at Heartlands and Good Hope hospitals. If we lose the walk-in centre, not only will the health of local people suffer but, if local people are desperate, they will go to those A and E departments, in turn costing the taxpayer more.

Although the decision to close the walk-in centre—if that decision is made—lies with the health service, the true responsibility lies with the Prime Minister and the Government. As cuts to health care start to hit the front line—almost 7,000 nursing posts have already been lost since the general election—NHS bosses have been put in an impossible position by the downward pressure created by the top-down reorganisation of the NHS.

Despite the Prime Minister’s pledge to protect the NHS, health care bosses in Birmingham are struggling with a £76 million cut, forced on them by the Government. That is a direct result of the Government’s top-down reorganisation of the NHS, which is threatening the vital services we rely on most while costing the taxpayer £3.5 billion—all that from a Conservative party that pledged before the general election that there would be

“no more top-down re-organisation of the NHS”.

In the party’s manifesto for the 2010 general election, it pledged that

“every patient can access a GP in their area”

and not have to travel miles to meet their urgent care needs. It is wrong that local Tories who pledged all those things before the general election are now trying to wash their hands of responsibility for what their Government are doing and for that which they said should never happen.

It is vital that Ministers know the impact that their decisions will have on local communities and people. What happens when local walk-in centres are closed? People like my constituent Paul Flynn, whose 19-month-old twin girls had both caught viruses that became chest infections on a Sunday, when his doctor’s surgery was closed, would be forced to go to A and E. However, because Paul was able to take his daughters to the walk-in centre on Erdington High street, they were immediately put on nebulisers to alleviate their breathing difficulties. In his words:

“We do not know what we would have done without the walk-in centre.”

Or take Audrey Smith, a local teacher, who would be forced to take time off work if she wanted to see her GP, particularly at a time of discomfort or pain, because her surgery has restricted hours from Monday to Friday. Without vital facilities that provide accessible urgent care services, many people like her would be forced to choose between taking time off work and attending A and E.

Just last night, I received a heartfelt e-mail from a constituent, Peter McDonald, who had had a heart attack just a few yards from the walk-in centre on Erdington High street. Peter managed to walk in and see a doctor within minutes, who gave him a GTN spray before he was taken to hospital. In his words:

“I owe my life to the doctors at the centre. If the walk-in centre wasn’t there, it might have been a different outcome. This centre must stay open.”

Sadly, walk-in centres are closing. We are seeing the results, as A and E waiting times are going up, with 47,000 more people waiting more than four hours since September compared with last year. More than 100,000 extra patients have now waited longer than four hours for treatment in A and E since the start of 2012-13.

What is more, A and E departments are themselves being closed. Before the 2010 general election, the Prime Minister toured marginal seats, promising to save accident and emergency facilities in a cynical attempt to win votes. He promised a “bare-knuckle fight”—those were his words at the time—to save accident and emergency services at 29 hospitals, but 12 of them have now been closed or downgraded.

Two and a half years into this Parliament, we have seen broken promise after broken promise from the Prime Minister on the national health service. Not only has he cut NHS spending in real terms but his Government’s reckless approach to top-down reorganisation is creating increasing pressures and consequently casualties, which might include the walk-in centres on Erdington High street and in Kingstanding in my constituency. The message before the election was one that valued those walk-in centres; the message after the election has been very different, with more and more services being closed.

What has been the response of the Government thus far to the closure of 54 walk-in centres nationally since 2010? They have made the local NHS responsible for NHS walk-in centres. It is true that the last Labour Government realised that local people best know what is in their interest, so allowing health and well-being decisions to be taken locally, including through primary care trusts. Given what is now happening, however, I have to say to the Minister that if he dams the river at its source, he should not be surprised if the water runs dry downstream.

In conclusion, the Erdington and Kingstanding walk-in centres both provide accessible high-quality medical care to thousands of local people. I again stress that the Kingstanding one is located in one of the poorest wards in the whole of Britain. There is no alternative service within the immediate locality. If the vital centres on Erdington High street and in Kingstanding close, the hard work of the dedicated staff that has gone into the development of the walk-in centres will be wasted, as will the considerable investment that has gone into them, and local people will again have to travel miles for their urgent care needs.

The closure of the much-loved and much-used facility would be a devastating blow. That is why, with the user group and the local community, I have led a campaign against closure for the past five months, and that is why I bring this unmistakable message from the community I represent to Parliament today. I am grateful to the Minister for agreeing to meet representatives of the patient and user group. It is right that the case for the walk-in centre be heard on the Floor of the House, and that the voice of those in the community who love, use and value their walk-in centre should also be heard.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship, I believe for the second time, Mr Weir, and to reply to the hon. Member for Birmingham, Erdington (Jack Dromey), whom I congratulate on securing this debate. I acknowledge his hard work on behalf of his constituents in campaigning for the retention of Erdington walk-in centre, and the strength of feeling locally, which he eloquently outlined.

Before I move to the local context, it would be remiss of me not to pick up the issues of national consequence raised by the hon. Gentleman. This Government will have invested £12.5 billion more in the NHS between the last election and the one in 2015, which is providing some, albeit small, real-terms growth in the NHS budget. Even though we are in difficult economic times, the Government have made a clear commitment that the NHS is a special case that needs further investment, which we are providing. It might be worth the hon. Gentleman taking that up with one of his Front-Bench colleagues, the right hon. Member for Leigh (Andy Burnham), who in contrast said that such investment was irresponsible. Indeed, the Labour party running the NHS in Wales intends to make an 8% real-terms cut in its budget. It is worth reflecting on the reality of the situation before getting drawn into any political rhetoric.

The hon. Member for Birmingham, Erdington is right to raise the specific pressures on A and E. We know that A and Es are being accessed by increasing numbers of patients, and we know from history that one key driver of that was the previous Government’s decision to contract out-of-hours GP care away from local GPs. One direct consequence of that has been additional pressures on accident and emergency departments. In many ways, that pulls against what he spoke about and what I believe in, which is the need to deliver more and higher quality care in the community. That cannot be nine-to-five or nine-to-six care in the community; it has to be all-day, 24/7 care, which is what integrated good health care looks like. I believe that the decision was bad. I saw its consequences when I worked as a casualty doctor in A and E. We have lived to regret it, and it has been badly to the detriment of patients.

The report on the Mid Staffordshire NHS Foundation Trust graphically outlined the fact that targets have often got in the way of front-line patient care. That is why this Government, when they came to power, relaxed the 98% target for the four-hour wait in A and E and set it at 95%, which doctors, nurses and my fellow health care professionals said was in the best interests of patients. Too often the four-hour target meant that a patient who perhaps had a broken toe was given priority ahead of a patient with potentially life-threatening chest pain. That was not good medicine or patient care, but showed targets getting in the way of looking after patients effectively, a lesson that was graphically depicted in the Francis report on the Mid Staffordshire trust. We must learn such lessons and acknowledge that although targets can have a place in health care, we have to trust and listen to front-line health care professionals if we are to deliver high-quality care for patients.

On the national context of urgent care and accident and emergency care, the Government are committed to developing a more coherent 24/7 urgent care service in every part of England. That will provide universal access to high-quality 24/7 urgent care services, so that whatever people’s needs or location, they will get the best care from the best person in the best place and at the right time.

The NHS has always had to respond to patients’ changing expectations and advances in medical technology. As lifestyles, society and medicine continue to change, the NHS will also need to change. The reconfiguration of urgent care services is therefore about modernising the delivery of care and facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives. We are clear that, as the hon. Gentleman outlined, the reconfiguration of front-line services is a matter for the local NHS. That was the previous Government’s policy and is this Government’s policy.

Services should be tailored to meet the needs of the local population. We expect proposals for service changes to meet four tests: to demonstrate a clear clinical evidence base underpinning any proposals, focusing on improved outcomes for patients—in other words, to save lives—and to show clear support from GPs as the commissioners of local health-care services, strengthened arrangements for public engagement and support for patient choice. Even when all those tests are met, if the responsible local authority is concerned about a decision, it will have the option to refer such a decision to the Secretary of State.

Our vision for urgent care is to replace the ad hoc, unco-ordinated system that has developed over the past few years—characterised by poor quality and too much variation in care throughout the country—with a more consistent system that delivers improvements in patient care. The Government are committed to putting GPs in charge of commissioning urgent care services. We believe that empowering GPs and other health professionals will achieve better and more patient-focused services.

It would be wrong not to talk about the winter pressures faced by the NHS. In response to those pressures, we have put about £330 million of additional money into the NHS to deal with them. I am aware that local hospitals in the Birmingham area recently issued a statement advising patients to attend A and E only for matters requiring urgent attention, because of the pressures of demand experienced by emergency departments. There is always more pressure on the NHS during winter months, with more demand on urgent and emergency care services, and this year is not different. During October and November 2012, NHS Midlands and East scrutinised winter plans, escalation triggers and protocols across its health economies, and it is monitoring pressure on health services during the winter across the whole of the strategic health authority area to ensure that patients continue to have access to high quality NHS care in Birmingham and elsewhere.

I turn to the local context, which is obviously of importance to the hon. Gentleman and his constituents. He is a tremendous advocate for his constituents, and has eloquently outlined some of the local concerns, which relate to an NHS review of urgent care provision in Birmingham and Solihull. The clinical commissioning groups in the area are developing an urgent care strategy to improve access to and integration of services for people with urgent health care needs, to make the system simpler to navigate and to avoid duplication.

I understand that local commissioners have engaged stakeholders in the process, and they include clinicians, patient groups, providers and health overview and scrutiny committees. The local NHS has collected evidence from local people to understand the usage of current urgent care services, such as walk-in centres.

The hon. Gentleman will be aware that the local NHS is now developing a draft strategy outlining some initial options. However, it is important to make it clear that as yet no decisions have been made. That is for local determination, and it would not be appropriate for me to comment further on the detail of the urgent care review.

I am assured by the local NHS that engagement with local people and other stakeholders will continue over the coming months to ensure their input in the final proposals ahead of the formal consultation later in the year. Of course I expect any proposals to meet, where appropriate, the four tests for service change.

I understand that the hon. Gentleman met representatives of Birmingham CrossCity CCG in December 2012 to discuss the review, and I encourage him to continue engaging with local NHS staff on the matter.

[Jack Dromey]

It is certainly true that we had a meeting in December and that it was clear beyond any doubt that there was a real threat to both the walk-in centres. A commitment was given that by the end of January there would be a route map of the next stages of process and engagement, but here we are in the first week of March and it has yet to be produced. The suggestion now is that it might not be with us until mid-April at the earliest. Although I understand what the Minister is saying in good faith about the importance of proper engagement with the community, I have to say that those responsible in the national health service in Birmingham have been dragging their heels.

[Dr Poulter]

The hon. Gentleman is right to say that when there is talk of service change, effective engagement is important and must be dealt with in an expedient manner. There must be an awareness that the prospect of any change can lead to understandable concerns among both staff and patients. A time of change is always potentially unsettling. I know that he, like me, will want to encourage the CCGs to come to the table and address this matter more effectively than they have done. I will endeavour to ensure that there are representatives from the CCGs at the meeting that we have later in the month, as that will be an effective way of helping to facilitate matters and bring them to a more speedy resolution.

In conclusion, I encourage local people in Birmingham and Solihull and their elected representatives, including the hon. Gentleman, to participate in the engagement process and subsequent consultation to ensure that their views are taken into account. I look forward to meeting the hon. Gentleman later this month to ensure that we do all we can to facilitate a speedy resolution of the matter and to ease these times of uncertainty that are faced by his constituents.