Cheshunt Urgent Care Centre

David Burrowes Excerpts

Wednesday 23rd March 2011 Commons Chamber

[Mr Charles Walker (Broxbourne) (Con)]

It is a great honour to speak on the Adjournment this evening—we have had the Budget today, so the eyes of the nation are upon this place.

Two years ago, I was involved in a fantastic community campaign to bring an urgent care centre to Cheshunt. I was joined by more than 3,000 constituents in a letter-writing campaign to the primary care trust. We had a number of public meetings, with the car parks overflowing and many hundreds of constituents making their views known. The campaign culminated when I, along with the chief executive and the leader of the council, visited the then Secretary of State for Health, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), at the Department of Health. It was a true community campaign. If the big society means anything, that is its basis: people coming together from across a community and joining in one voice to bring a much-needed facility to the constituency.

Since the centre arrived in October 2009, it has been fabulously well received. It is estimated that 400 people a week would use it at most, but in some weeks we have had 700 people voting with their feet by coming to that GP-led urgent care centre. It really is at the heart of the community. The reason so many people choose to use the facility is that it is open 12 hours a day, seven days a week, from 8 in the morning to 8 at night. Unlike many GP surgeries, it does not close for lunch and is open on Saturdays and Sundays, when people can use a medical facility because they are not at work in London.

Despite that enormous success, I was horrified to learn a few months ago that the PCT was not happy with the centre’s performance. I do not need to tell you, Madam Deputy Speaker, that being a Member of Parliament over the past three years has been fairly challenging, but one of the bright spots of my career has been walking around my constituency and being stopped by people saying, “Charles, we are so pleased we have the urgent care centre. It was so much needed in this part of the borough. Thank you so much for the campaign you led.” It has been enormously gratifying and satisfying to get that level of feedback.

The PCT came to the House to meet Hertfordshire Members and I had my turn to chat with them about the issues relevant to Broxbourne. After 10 minutes of pleasantries I asked, almost off the cuff, “Of course, you’re not thinking of closing the urgent care centre, are you?” The reply was, “I’m afraid, Charles, that that is one of the options on the table.” I am normally a mild-mannered Member, but I am afraid that on that occasion I blew up. I think that I swore. Indeed, I know that I swore. I am ashamed of my behaviour, but it demonstrates how passionately I feel about the centre.

[Mr David Burrowes (Enfield, Southgate) (Con)]

I pay tribute to my hon. Friend for his passion and commitment to the urgent care centre and for the joint campaign run in Cheshunt and Enfield for the retention of a fully functioning accident and emergency department at Chase Farm hospital. Does what has happened to the urgent care centre not highlight the importance of the Secretary of State’s decision to encourage us all to think again about options other than the Barnet, Enfield and Haringey strategy, which would lead to the downgrading of not only Chase Farm hospital in Enfield, but, as predicated, an urgent care centre there?

[Mr Walker]

My hon. Friend makes an excellent point. He is at the forefront, along with my hon. Friend the Member for Enfield North (Nick de Bois), of the campaign to save Chase Farm hospital’s A and E, and I am always proud to join him outside those gates, making the argument for a fully functioning A and E service there.

The PCT has told me that it believes that the GP-led urgent care centre is treating inappropriate cases—whatever those are—and that people going there should be going to their GPs. It asks why it should have to pay for that treatment twice. Of course, they should not pay for it twice, but I always believed that the money should follow the patient, not the GP who does not deliver the service. My constituents use the urgent care centre so fully, because many—not all, but many—GP practices in my constituency do not deliver on their promise, or live up to their end of the deal, to provide a full GP service to them. So my constituents vote with their feet.

GP surgeries close for lunch, early in the evening and at weekends. If people want an appointment, they have to call up on the morning that they want it, only to be told, “We haven’t got any today, but if you want to come and see us tomorrow try calling us tomorrow.” That is not acceptable, and my constituents are not going to sit at home and wait to be treated like that day after day; they are going to walk to the urgent care centre and get treated there. What really upsets me is that the beacon of success in our constituency—the one that sees up to 700 people a week—now faces closure, while the GPs are not facing the necessary censure for some of their practices in delivering services to my constituents.

I discovered in a PCT board paper that many GP practices in my constituency are in the NHS version of special measures, meaning that they are in the bottom 10% of GP practices in the country. That leads me to ask again, “Why does the urgent care centre, which delivers a high level of service, face closure?” while GPs, as I said earlier, are not delivering the service that they are paid to deliver.

The PCT says that there was a unanimous decision on behalf of a steering committee to change the use of the urgent care centre—at best to make it a minor injuries unit, or perhaps even to close it. It says that the decision came about as a result of a meeting with various stakeholders and some research—independent research, I was told—by an organisation called Opinion Research Services. Of course, it was not independent research, because it was commissioned by the PCT: it paid the bills of Opinion Research Service. I do not know what went on at that meeting, but I am fairly sure of what did not, which is that those there did not get a full picture of how successfully the urgent care centre meets the needs of local constituents.

What I did learn is that the GP services in the area leave a lot to be desired. On page 8, the board report states:

“A quarterly patient access survey carried out nationally has highlighted perceived problems with access and satisfaction with primary care in the area served by Cheshunt UCC.”

On page 8, it goes on to state:

“In addition, perceived poor access to primary care in and around the area served by Cheshunt must be addressed.”

Notice the emphasis on “perceived”. It is not perceived poor access, however; it is real poor access. If it was perceived, hundreds of my constituents would not go to the urgent care centre.

On pages 11 and 12, the report states:

“The need to improve access to primary care in the Cheshunt area has been recognised and steps are being taken in conjunction with the Clinical Executive Committee (CEC) to support and performance manage those practices”—

not a practice, but those practices—

“in the bottom 10% nationally in terms of patient’s perceived access.”

Quite frankly, that is not good enough.

I became even more concerned about the situation when I went on to read that it is local GP commissioners who are putting pressure on the PCT to close our successful GP-led urgent care centre.

On page 9, the report states:

“Local GP commissioners do not support the configuration and have confirmed that they would not wish to commission UCCs as currently configured at...Cheshunt in the future."

On page 12, it states:

“The view of the GP Practice-Based Commissioning leads in the localities is that these needs are best addressed directly with the practices rather than by way of additional services.”

But why are the practices not addressing those needs now?

The PCT has said, with great fanfare, that it is providing additional services and support to GPs to help them to improve. Of course, that is very welcome. However, given that it is providing new telephone systems, automated self-check-in screens, waiting room plasma screens, web-based online appointments systems and electronic document management systems, my constituents and I want to know what on earth has been going on in these practices for the past 10 years. One thing that GPs have not been short of is money, so how have they not placed these absolutely critical tools for managing patient load in their surgeries, with the PCT now having to fund them?

If services in my constituency are to improve, we need competition. We need the urgent care centre to set new standards of treatment. If the urgent care centre, which is driving ever-higher levels of patient care, is shut, what incentive will there be for GPs to improve their service levels? It is incumbent on my local GPs, who are falling behind, either to deliver or surpass that level of care, or perhaps to make way and allow practices to come into the borough that are willing to take up the challenge of opening 12 hours a day and providing weekend services. Until we reach that stage, the PCT has absolutely no excuse for closing down this urgent care centre.

Earlier today, the PCT had a meeting where it decided to downgrade the urgent care centre to a minor injuries unit; it thinks it will get away with that. However, that is not good enough and it will not satisfy my constituents, because closing down the urgent care centre and removing the GPs from it removes the incentive for practices in and around the centre that are not delivering to their patients to improve their services.

As you can see, Madam Deputy Speaker, I am really very annoyed about this. I thought that I would come here and manage to smile my way through it and be magnanimous, but I simply cannot. For my whole life, I have believed that good practice and success should be rewarded. I thought that that was just the way things were—that an organisation that saw an urgent care centre that was delivering not 400 patient outcomes a week, as envisaged, but 600 or 700, would feel that it was a success story that deserved to be built on. By accident or design, our PCT has stumbled on a formula that works and meets the needs of the local community, but instead of building on that, it is pulling the rug from underneath it, and I believe that it is being pressured by some GP practices in my constituency and future GP commissioners to do so.

I will conclude, after my 15 minutes, by saying that there is only one set of vested interests that I represent in this place. It is not the PCT’s interests or the GPs’ interests—it is the interests of my constituents, more than 520 of whom turned up, at about nine days’ notice, at a public meeting that I held last Thursday to say to the PCT: “No, we want to keep our urgent care centre.” The PCT has got it wrong, it needs to listen, and we need that urgent care centre in Cheshunt.