Jim Cunningham – 2019 Speech on University Hospital Coventry

Below is the text of the speech made by Jim Cunningham, the Labour MP for Coventry South, in the House of Commons on 13 June 2019.

I am grateful to Mr Speaker for granting me the opportunity to raise this issue, which is very important to my constituents in Coventry South. I am sure it is also important to the constituents of colleagues from Warwickshire.

I thank my colleagues—my hon. Friends the Members for Coventry North East (Colleen Fletcher), for Coventry North West (Mr Robinson) and for Warwick and Leamington (Matt Western), and the hon. Members for Nuneaton (Mr Jones), for Rugby (Mark Pawsey) and for North Warwickshire (Craig Tracey)—for their support. Together, we sent a letter to the Secretary of State for Health and Social Care to request a meeting to discuss these issues, and I am keenly awaiting a response. Many of those colleagues also attended an informative meeting with two surgeons from the hepato-pancreato-biliary unit at University Hospital Coventry, Mr Khan and Mr Lam. The point of the letter was that we wished to discuss the transfer of the HPB unit, which provides pancreatic services at University Hospitals Coventry and Warwickshire, to hospitals in Birmingham and Worcester.

UHCW has been developing pancreatic cancer services since 1990. It has an excellent team of doctors, specialists, nurses, surgeons and other healthcare professionals, and has completed more than 1,000 major operations and thousands of other therapies. It deploys cutting-edge robotic, endoscopic and radiologic technology to treat patients in Coventry. It takes a patient-centred approach to its service, resulting in excellent feedback from those who have undergone treatment in its care. The success of the department cannot be denied. The outcomes of therapies are on a par with international standards in all spheres. Proposals to shut down this extremely successful department will be a great loss to the NHS.

Matt Western (Warwick and Leamington) (Lab)

I thank my hon. Friend for giving way. He is making a very important point. Does he agree that one of the key issues, as he was just alluding to, is that with any potential loss of service comes not just the potential loss of reputation but the issue of what sort of haemorrhaging effect it may have on the rest of this great hospital?

Mr Cunningham

Yes, I fully agree with my hon. Friend. That was one of the points made by the surgeons whom I and the hon. Member for Nuneaton met a few weeks ago.

These proposals stem from the 2014 regional review of services. They are based on the fact that the UHCW was not providing care for enough people, according to the requirements of the Department of Health and Social Care and commissioning guidelines. There were serious capacity constraints at University Hospital Birmingham, leading to multiple cancellations of operations on the day and prolonged waiting times. The process of the review was in fact challenged by a legal notice. The initial proposal stated that UHB and UHCW services should be amalgamated, with the teams working together to develop a model that would provide more efficient services in the west midlands and maintain operating at both sites, with the joint service to be led by UHB.​

Mr Marcus Jones (Nuneaton) (Con)

I congratulate the hon. Gentleman on securing this debate. These are important services that my constituents also access. Clearly, amalgamating these services is of concern to me as it will take away the choice of residents as to whether they want treatment at Coventry or Birmingham. As the population is growing significantly in our area, amalgamating those services may also lead to longer waiting times. Does he agree with me?

Mr Cunningham

The hon. Gentleman makes a valid point, and I will be touching on that a little later on in my comments.

As a bigger hospital in one of the UK’s biggest cities, UHB had a great deal of influence over these discussions. It soon became apparent to the UHCW team that the sacrifices would be one-sided. UHCW felt that it must pull out of the talks, as it was clear that its services would be downgraded and its specialised work would be removed completely—services that it had worked hard to develop. That would be detrimental to the people of Coventry, Warwickshire and beyond.

In November 2018, NHS England served a formal notice on UHCW to transfer specialised liver and pancreas services to UHB in Birmingham or risk decommissioning. UHCW was denied the opportunity to establish the population base required to be an independent centre. There is now a concerted effort from UHB trust management and NHS England to enforce the takeover of the HPB centre at Coventry.

The simple and accepted solution, which is in line with the professional recommendations, is to implement the agreement between UHCW, Worcester Acute Hospitals NHS Trust and Wye Valley NHS Trust to provide the liver and pancreas specialised service at UHCW NHS Trust. It is important to highlight the ongoing capacity constraints at UHB. The realignment from Worcester and Hereford to UHCW would effectively fulfil the required population base to be an independent centre—as per Department of Health and Social Care guidelines—and also reduce the very long waiting times for cancer operations and improve access.

The proposals demonstrate more short-sighted, efficiency-obsessed thinking from NHS England based on the National Institute for Health and Care Excellence guidelines. The findings of the 2015 review, which stated that UHCW’s HBP unit does not serve enough people, totally ignored the good standard of pancreatic care at UHCW. It is of the highest quality and helps to provide patients with the best possible outcomes. NHS England’s proposals threaten the standard of care, which I will raise shortly. The proposals will have a detrimental impact on those in need of this care in Coventry and elsewhere in Warwickshire.

Although the 2015 review stated that the HPB unit did not reach the population requirements, thousands of lives are saved because of the outstanding service that the team at UHCW have developed. The most obvious problem that my constituents in Coventry South, and people in east Warwickshire, will be faced ​with is geographical, as the hon. Member for Nuneaton said. Many of them will have to travel about 16 miles for treatment, which will be very costly. They will have to take trains, and we all know the problems associated with that. The time it will take patients who currently use the service to travel to Birmingham is unfair. Patient access will no doubt be reduced, as the journey time, as my colleagues from Coventry will be well aware, is about an hour by car and over 80 minutes by public transport. The journey time for patients who currently use the service at UHCW and live outside Coventry, in rural areas out of the reach of public transport, will be considerably longer and the journey will be considerably more expensive. NHS England will directly increase the stress and physical discomfort that patients and family members will have to endure. In addition, once patients have made the hour-long, or hours-long, journey to UHB, there will be a good chance that their treatment will be cancelled or delayed.

University Hospital Birmingham specialises in liver transplants, and it has a success rate that the whole of the west midlands is immensely proud of. Understandably, those operations take priority because of the speed with which they need to take place. Patients at the hospital who have other, slightly less urgent, conditions find that their operations are routinely cancelled in place of a liver transplant. Moving pancreatic services to Birmingham will dramatically increase the number of patients at risk of having their vital operation cancelled. Any patient who suffers from pancreatic cancer, or people who have a family member who has died from this terrible disease, will know that the speed of detection and the speed of treatment are absolutely vital to survival. It is extremely hard to detect, and, as a result, doctors need to act quickly after a patient has been diagnosed. Any delay to operations decrease the chances of survival even further.

The closure of the HPB unit at UHCW also poses a risk to the overall status of the hospital. By closing a key unit, the hospital is at risk of losing its specialist status, and, as a result, being downgraded to a district hospital. That will have a domino effect on the rest of the hospital.

Matt Western

My hon. Friend is making some very powerful points. For me, one of the most staggering facts —I am sure he will agree—is the sheer scale of the number of such operations that are undertaken at Coventry—5,000 over the past two years, I believe. That does not seem a small figure to me. Does he agree that it is surprising that this is even being considered in the first place?

Mr Cunningham

Of course, I totally agree. As I have outlined, it is not about just the volume of operations but their quality, and the skill of the surgeons, the nurses and all the auxiliary staff who do the best that they can for the patients. UHCW will inevitably lose its most skilled doctors and staff, and see the disintegration of the team, service and leadership that the unit has spent so long building.

Finally, I understand that UHCW has written to NHS England outlining its opposition to these proposals—something that I fully support, as I am sure my colleagues here do. It is concerning that UHCW may face these proposals being forced upon it by NHS England, justified by guidelines that have little thought or respect for the quality of care already being provided and the concerns of local people. Not only do these guidelines ignore the quality of care, but NHS England has shown an incapacity ​to implement them fairly and equally across the country. There was a similar case in Stoke, but rather than close the unit, NHS England allowed it to carry on operating as normal, despite not meeting the population requirements. Will the Minister guarantee that NHS England will work with UHCW and support it by allowing it to continue to provide these outstanding services to the people of Coventry and Warwickshire?