Mike Penning – 2018 Speech on Hemel Hempstead Urgent Care

Below is the text of the speech made by Sir Mike Penning, the Conservative MP for Hemel Hempstead, in the House of Commons on 13 March 2018.

First, may I say what a privilege it is to have secured this Adjournment debate this evening, and how proud I am of my constituents who for so many years have been fighting the changes and particularly the cuts to healthcare in the Dacorum area where my constituency sits? In particular, I thank Edie and Ron Glatter and the Dacorum Hospital Action Group and its fantastic chair Betty Harris, who is very poorly; they have been fighting this campaign for many years. I also pay tribute to the fantastic work our local BBC radio station, BBC Three Counties, has done over the years, in particular that of the excellent journalist and reporter Justin Dealey; without his work, this debate would probably not have taken place.

For the national health service to carry on being the world-class service it is today, the public, our constituents, need to have faith not only in the fantastic doctors, nurses and porters and those who run the frontline services, but in the management of our hospitals and health provision. I am sorry to say, however, that the trust and feeling of commitment we need from our health service management in our part of the world are not just broken, but have completely failed.

I will not go into the history because tonight I want to talk about the urgent care centre, but the history of what has been happening to out-of-hours and urgent care, including A&E, in my constituency has been going on for many years. The previous Labour Administration decided to close the A&E and all acute services at the Hemel hospital after they had already been closed at the St Albans hospital, with all services moved into a Victorian hospital next to a football ground in Watford. We will not dwell on that tonight, however, but will come back to it on another evening.

As part of the sop to my community, we were given an urgent care centre—24/7, seven days a week, throughout the day and night—and next to it a walk-in GP centre. I was therefore surprised when Ms Fisher, chief executive of the West Hertfordshire Hospitals Trust, phoned me just before Christmas to say that, sadly, the urgent care centre would have to temporarily close on safety grounds at night. I was shocked by that, not least because the A&E in Watford struggles greatly, so the more people we can encourage to use other NHS facilities instead, the better. I said, “This is happening over Christmas which is one of the busy times,” and was told, “Don’t worry, Mr Penning, it’s only a temporary thing and we’ll have it open again just after Christmas.” They then put out a press release headed “Temporary overnight closure of Hemel Hempstead Urgent Care Centre”. Interestingly, that press release is still on their website today. I actually printed it off before I came into the Chamber this evening. As I go through my comments, Members will realise just how false that statement was.

One of my constituents then contacted Three Counties Radio, and Justin Dealey, its excellent reporter— acquired an interview with the said Ms Fisher, the chief executive of West Hertfordshire Hospitals NHS Trust. It was quite a long interview, in which Ms Fisher indicated:

“This is a short-term measure which is us acting in the interest of patient safety because, for the next few weeks over the festive period, we are unable to secure GP cover.”

I think most people would understand that, but not if they knew that the GPs were working in the room next door. But that is a separate issue. Justin went on to suggest that surely Ms Fisher understood that local constituents would have real concerns, and asked her whether she would be concerned if she lived in the area. She said:

“I completely understand their concerns, but what I want to reassure the residents of Hemel is that if there were to be any permanent change it would be our absolute intention to include people fully”

in that decision. She went on to say that

“legally we would be obliged to consult for a permanent change of that nature.”

That press release was issued not before Christmas this year but in December 2016. We have had no night provision at all in Hemel since then. Everybody has to go for urgent treatment to Watford A&E. Alternatively, they have to dial 111, which is an excellent service, but after they have been triaged they apparently get sent to Watford A&E. Watford has just come out of special measures, and I praise the work that has been done at the hospital but there is still a lot more to be done.

Jim Shannon (Strangford) (DUP) I thank the right hon. Gentleman for giving way. I sought his permission to intervene on him beforehand. He is outlining very well the issue with the Hemel Hempstead urgent care centre. Does he agree that, although there is immense staffing pressure, closing or scaling back on urgent care units and minor injury units only adds to the pressure on A&Es? There must be more investment in these mid-level centres if we are to prevent the A&Es from crumbling under the weight of the work they have to do.

Sir Mike Penning I clearly agree with my hon. Friend. It was kind of him to come and tell me that he wanted to intervene on me on behalf of other parts of the country that are facing similar pressures.

This was not about money. Normally, when our constituents come to talk to us, especially about the health service, it is about money. They tell us that they are really concerned that there is not enough money to provide the services, but on this occasion we were told that this was nothing to do with money. It was to do with the contractual problem with the GPs. We kept on asking what was going to happen, and then—completely out of the blue and still without consultation—we were told that the Government had said that there should be no more urgent care centres and that they should become urgent treatment centres instead. I was repeatedly told that it was the Government saying that this should be done. I asked whether the Government had said that the centre should not be open 24/7. I was told no, but that we had to move to being an urgent treatment centre. In the past couple of weeks, the unit has changed from being an urgent care centre to being an urgent treatment ​centre. Interestingly enough, that means that paramedics and nurse practitioners are running the facility, and in many cases—without being rude to our GPs—they have more skills than a basic GP. I have to declare an interest, in that I was a military paramedic, so I am slightly biased about these things.

But was there a consultation before that decision was made, not just to close the UCC but to change to a UTC? No, there was not, even though it is a legal requirement to have one. We are now in a consultation, however. I could not believe it when I first heard this, but I have now heard from several constituents that in the actual meetings that took place—not when people were writing in—when different plans and options were being put to my constituents, a member of the clinical commissioning group staff was at the table trying to convince the public what sort of option they should go for. If we are going to consult the public, surely we should trust them and then have the confidence to listen to them.

What I find really fascinating about what is happening in my part of the world is that people from nowhere near my constituency—from the other side of Watford—are being consulted. They would never come to my facility in a million years—unless they just happen to be in the area—but they apparently have the same rights in this consultation as my constituents, who are again losing facilities hand over fist. Those other views are being taken into consideration because they happen to be part of the trust area. My constituents just scratch their heads and say, “This is illogical.” This facility, even though it is part of the NHS and anybody could come to it, is obviously being used by the largest town in Hertfordshire and the other towns and villages within Dacorum. However, I have no problem with the people of St Albans being consulted over this, because they are clearly part of the process.

Trust has been severely damaged. A highly paid chief executive of an NHS trust went on the radio—telling an MP is one thing, but going public is another—and tells listeners, “This is temporary. Please do not worry; it will all be okay. By the way, if I did actually change the service, that would be illegal because I have not consulted.” Frankly, when they then did not consult—the UCC is quite clearly never going to open again—that breaks the trust.

I have raised the accountability issue in the House before. It is absolutely right that my good friend the Minister on the Front Bench does not make decisions about what A&Es and UCCs are open and how many beds there should be. Those are quite clearly clinical decisions that should be based on knowledge and demand in the area—that is not what happened when our A&E was closed—but we seem to have moved from one extreme to another. I am told that if we want to challenge the consultation, the only way is to put the decision to judicial review based on the consultation. We tried that when the A&E was closed and we got a judicial review. The judge was generous and said, “You have a moral case, but you probably don’t have a clinical case. You don’t have a case in law, because the consultation was done.” However, if the consultation was a complete sham or did not take place at all, where do we go?

I have asked Ministers, I have tabled questions and I have been to see the Secretary of State. At the end of the day, who are these people accountable to? I know that ​we can go to the health committees at the local council, but they do not have the powers to say that an individual or a trust has brought the NHS into disrepute, and yet that is what has happened here. Nobody was twisting the chief executive’s arm to go on the radio and say what she said. We all listened to it—I got a transcript the following morning—and I sat with Justin and said, “Well, that’s it, Justin. We’re okay.” I was not at all happy about the facility being closed over the 2016 Christmas period, but at least we knew that GPs were going to be recruited and that we were going to get there.

However, the exact opposite has happened. We are not getting the GPs back, and now the facility being open 24 hours a day is only one of the options. I know that the Minister’s notes will say how many people used to go to it at night and so on, but half the problem was that it was never properly promoted. There are access issues at the A&E because so many people are turning up and being triaged when a huge percentage of them do not need to be at an A&E but somewhere else within the NHS. I would argue that they should be at a UCC or UTC or that a GP should come out to them, but that is a separate issue because hardly any GPs make home visits in my constituency.

I know exactly how things work, because I was a Minister for a while and know about the advice that comes down from the trust and the clinical commissioning group, which will say things that are different from what I have said. However, I can honestly say that if there is one issue in my constituency that absolutely unites every political persuasion on my patch, it is the acute health provision in my constituency. We pushed a coffin on a hospital trolley all the way from Hemel Hempstead Hospital to Watford, to indicate that lives would be lost. We had debate after debate with the ambulance service, which said, “Don’t worry, we can get the ambulances there on time.” It probably could, if it rushed them through on a blue light in the middle of the night—if an ambulance was available. Because of the previous Administration’s botching of the regionalisation of the ambulance service, there are often not that many ambulances available, even though the ambulance depot is on my patch.

People do not want to clog up A&E; they want to have the confidence that there is somewhere safe that they and their kids can go for treatment. We have no idea what the conclusion of this retrospective consultation will be. We have no faith that even if the conclusions are in agreement with what we want, we will actually get it. Not all my constituents agree with me, but in a treatment centre I would rather have a highly qualified paramedic nurse practitioner than—I have to choose my words carefully here—an ordinary GP, simply because the paramedic nurse practitioner has so much experience in that area. That is where the modernisation of the health service has been so brilliant. But after telling me that the decision was not about money, it is, frankly, disgusting to sit people down at consultation meetings and try to convince them that it would be better if the centre was not open 24 hours a day.

I hope that the Minister understands how passionate we are about the matter. My constituency is 17 minutes from London and it shares a boundary with yours, Mr Speaker. People in the top part of my constituency all go to Luton and Dunstable—quite rightly so; it is an ​excellent facility—and those in the bottom part of my constituency, or anyone who comes off the M1 and the M25, end up going to Watford for their acute care.

I want Watford General Hospital to succeed. I think the location of the site is completely ludicrous, and we need a new general hospital for the growing population in our part of the world. I know that you have pressures on housing, Mr Speaker, as we have. But I want the houses, because I want people to have somewhere to live—so many families are struggling at the moment—and if we are to build those houses, we need facilities, such as schools and everything else. When my constituents go to bed at night, they need to know that the urgent care centre is open in case something happens; and that if they cannot cope, we can blue-light them to Watford or to Luton and Dunstable.

I have tried for weeks and weeks to get this Adjournment debate. My hon. Friend the Minister is lucky, because I had been asking for a 60-minute debate in Westminster Hall. We may yet end up there, but that will depend a lot on what he says from the Dispatch Box.