Urgent Care Centres: Hillingdon

Motion made, and Question proposed, That this House do now adjourn.—(Mark Ferguson.)

This Adjournment debate is on the future of the minor injuries unit at Mount Vernon hospital. I am particularly grateful to the Minister, who, despite representing a Bristol constituency, has a great deal of knowledge of my area having grown up in it, and to the Secretary of State for a number of conversations that have recognised that the loss of such a unit runs contrary to the 10-year plan set out to the House. It would have a much broader impact, beyond the Hillingdon hospitals NHS foundation trust, which is the overarching NHS body for both the Mount Vernon hospital and the Hillingdon hospital site to the south.

That is reflected in the fact that more than 20,000 people have signed my petition expressing concern about the loss of the service and calling for an opportunity to think again. I place on record my thanks to the Members of Parliament in a number of neighbouring constituencies who have supported me with that petition and supported their local residents. The right hon. Member for Hayes and Harlington (John McDonnell), who is present, has maintained the long tradition of Hillingdon MPs working together on issues that affect their constituencies. My neighbours in Harrow East, Hertsmere, South West Hertfordshire, South Buckinghamshire and Harrow West have all expressed a similar view. They understand the impact that the closure will have on their constituencies.

I commend the hon. Gentleman, to whom I spoke beforehand. The support for what he is proposing goes much further afield. We recently lost a minor injuries unit in a small town to a centralised urgent care A&E unit. Like him, I urge caution. I am informed that the merging of A&E and urgent care has affected waiting times, with ill teenagers lying in a cold waiting room for upwards of 15 hours. Does he agree that it is imperative that the centralisation of services does not leave worse waiting times and standards of care? That is the very issue that he is referring to.

I am grateful to the hon. Member. What he described is similar to the concerns outlined by my hon. Friends the Members for Beaconsfield (Joy Morrissey) and for South West Hertfordshire (Mr Mohindra) and others across the wider area, as well as by many people who have been in touch with me directly.

We know that minor injuries units in general, and the one at Mount Vernon in particular, are valued by people for whom A&E is not always the best place to seek treatment. Many local schools have been in touch to say that if there is an injury during the school day, minor injuries units are the ideal place for a child to get the treatment that they need. For older residents, particularly if they are not in the best of health and perhaps not up to the journey to an A&E department—many of which are under significant pressure—a minor injuries unit is the place to be. I know the Secretary of State and Ministers have responded very positively to the pleas of a number of Members across the House who have asked for the prospect of a minor injuries unit opening to serve their constituencies as part of the 10-year plan, so to see one lost that is already providing a good service seems to me a great shame.

The Minister will know that the Hillingdon hospitals NHS foundation trust has been financially challenged for many years; indeed, during my days as a non-executive director of the Hillingdon primary care trust, in the days of the last Labour Government, the overspend was significant. It is a challenge that has persisted to this day under Governments of all parties, despite numerous initiatives to try to resolve it. That is reflected in the poor state of the main hospital building, which is pending a rebuild. I should declare for the record that my wife is a doctor in that building. I know the Minister and the Government have accepted the programme of works set in place previously, which was granted planning permission by the local authority and announced under the last Government, to provide a new district general hospital at Hillingdon.

My constituency neighbour perfectly describes the very difficult situation in Hillingdon inherited by the trust leadership and this Government, such as the hotels opened under the Conservatives putting pressure on the local system. I am pleased that the Government have committed to close hotels across the country and deal with this issue and are reviewing the fair funding of local authorities. That is much overdue in Hillingdon.

The hon. Gentleman describes the situation in Hillingdon hospital, with the need for a rebuild after 14 years with no funding. Again, I am pleased that the Minister, who knows Hillingdon very well—I am sure that did not influence the decision—finally provided the almost £1.4 billion that the hospital needs. Does the hon. Gentleman agree that those are positive steps forward? I agree that the decision on Mount Vernon hospital is concerning, and I have raised those concerns with the trust’s executive leadership myself. Does he agree that there have been positive steps forward on those long-term issues and that we need to continue to work together to improve neighbourhood healthcare?

I am grateful that my constituency neighbour is here. Had he the same degree of history in Hillingdon as myself and the right hon. Member for Hayes and Harlington, I am sure he would recall that the hotels were set up and opened as part of a dispersal programme started under the Labour Government in the mid-2000s and led by Andy Burnham, who is now the Mayor of Greater Manchester. I know that has placed ongoing pressure on the local area, but the number of people put into that initial accommodation who are now stuck locally is very large.

I am sure the hon. Member for Uxbridge and South Ruislip (Danny Beales) shares my concern that, under the recent announcements about local authority funding, Hillingdon remains broadly the same as it always has been, but I welcome his commitment to carry on the work started under the previous Government for the rebuild of Hillingdon hospital. I know the right hon. Member for Hayes and Harlington will be very aware that the work undertaken on sewerage and electronics for that new build over the last few years has presented a significant challenge to residents in accessing the hospital—I am sure his constituents complain about it as much as mine have done.

Indeed, the challenges that will come during the rebuilding process of the hospital on what is currently its car park are a further argument for why a minor injuries unit is important in this period. It creates a bit of additional capacity to help with potentially challenging times at A&E and the difficult logistical challenge of accessing a hospital whose car park is already constrained and will be the building site for a new hospital. All those are additional reasons why a minor injuries unit remains important.

It is noteworthy in this context that the move away from an open access unit to appointment-only, which took place following covid, has significantly reduced the footfall at the Mount Vernon unit and has driven up the cost per visit compared with the previous position. This is part of a pattern that we have also seen in the Harrow part of my constituency at the Pinn medical centre, where the loss of a walk-in facility has led to more patients attending the local A&E, to longer waits and, ultimately, to increased cost to the NHS, because A&E attendances are more expensive than nurse-led walk-in services such as that which is available at Mount Vernon.

I congratulate my hon. Friend on securing this Adjournment debate. He has highlighted the issues in his constituency, and he is lucky enough that Hillingdon hospital is going to be refurbished. Given the delays to the Watford General refurbishment, where spades will not be in the ground until 2032 at the earliest, does he agree that Mount Vernon is even more critical for the surrounding areas with the capacity that it provides?

I am grateful to my hon. Friend, another constituency neighbour, for the support that he has lent to this campaign on behalf of his constituents. In a busy capital city, where there are all kinds of challenges arising not just from the airport but from our transport links, the pressure on some of those A&Es is higher than the NHS funding formula has traditionally recognised, and services such as minor injuries units have come into being over the years to make sure that that provision is there.

I know that my constituency neighbours’ constituents attend Mount Vernon not just to go to the minor injuries unit; it is also home to a cancer centre, a hospice, a private hospital, a general practitioners—a whole variety of NHS and private healthcare services—as well as to research and scanning, and nurses’ accommodation. All those things are incredibly important to the local community.

My asks of the Minister are straightforward. She understands as well as we all do that the NHS is always under financial pressure regardless of which party is in government, and she understands personally how much this unit at Mount Vernon hospital matters to local people across an area that is much wider than that served solely by the Hillingdon hospitals NHS foundation trust. She also understands that the vision of the 10-year plan puts great emphasis on out-of-hospital care. The commitment to the Northwood and Pinner cottage hospital started under the previous Government and now under construction at the site in my constituency is an example of the willingness of both this Government and the previous one to invest in those types of service. It therefore seems perverse to be closing down one such service that is already successfully in operation and that is both valued and has the potential to further reduce the cost and service pressures on our local NHS.

I ask the Minister simply to intervene with the trust and to ask her officials to engage with it about the wider impact that the closure will have beyond the Hillingdon hospitals trust alone. From the trust’s perspective, moving those staff and that budget on to the main hospital site will improve the look of its bottom line, but in the long term it will increase the costs to the NHS for those patients and reduce the quality of the service that they receive. Will she therefore consider encouraging the trust to move back to an open access model, as used to operate at the site, which would further reduce the number of A&E visits, which are costly to the NHS and stressful and time-consuming for patients? Will she confirm to the House that she notes the concerns that have been expressed so profoundly and across party by MPs from Hertsmere, Beaconsfield, South West Hertfordshire, East Harrow, and Hayes and Harlington, some of whom have taken the time even during a tube strike to be present for this debate to demonstrate the importance that they place on it?

I am grateful to the hon. Member for Ruislip, Northwood and Pinner (David Simmonds) for securing this debate. He mentioned that his wife works in the system, so I pay tribute to her for her service in the local trust.

As the hon. Gentleman alluded to, I am a Hillingdon girl; it is where I was brought up. My brother was born in Hillingdon hospital, some 59 years ago. It was a great pleasure to be there recently with my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales). Some years ago, I predicted that we might have a Labour MP there, so after being around the area for a long time, I am personally very pleased to see that.

The hon. Member for Ruislip, Northwood and Pinner tempted me to move into the wider areas of what are rightly a to-ing and fro-ing on some of the bigger pressures in that part of north-west London and into Hertfordshire. I will not go into that, but it is absolutely right that hon. Members use this platform to share their campaigning on behalf of their constituents.

Service changes such as these are always hard and they are rarely popular. I have been the Member of Parliament for Bristol South for more than a decade, and before that I was an NHS manager, so I have seen many service changes and reconfigurations over the years. Like the hon. Gentleman, I was also a non-executive director in a past life. All the changes that I have seen were done through good consultation, with strong clinical leadership and a good clinical case, and involved patients and the public.

I strongly believe that patients, public and staff are often ahead of the wider system and sometimes of politicians in knowing the balance of the money, the funding, the good value for taxpayers’ money, clinical outcomes and safety. If they are managed well, those conversations and the sorts of debates we are having tonight can often yield better results than maintaining the status quo or decisions made behind closed doors. I am familiar with such debates, as like many of us I often found myself standing where the hon. Member for Ruislip, Northwood and Pinner is, advocating for my constituents against changes that I thought were not in their best interest or not clearly communicated. He was right to secure this debate.

I agree with every word that the Minister has said about how we get good decisions in the interests of local people, but does she share my concern that there has been no public consultation about this decision at all? There has been very limited engagement even with local residents’ associations about the process and, for the staff involved, there has been some—shall we say—degree of ambiguity about what decisions have been made at each stage of the process. Does she agree that it would be wise at this stage, as a very minimum, to pause, to think again and to undertake that public consultation, so that the NHS managers tasked with making the decisions fully understand the impact on the local community?

I will comment on that later. I understand that there is a meeting on Friday, to which I will allude.

In preparing for the debate, I met representatives of the trust, and I am grateful to those in the local NHS for their time in giving some further background. The trust is clear that it would be more efficient for urgent care services to be consolidated at the site in Hillingdon, bringing forward the urgent care nurse practitioner service at Mount Vernon into the urgent treatment centre at Hillingdon hospital. The rationale for having urgent treatment centres alongside A&E is well established clinically.

The hon. Gentleman referenced the 10-year plan—I am pleased he is such a fan—and the direction of travel. I am pleased to say that the trust also believes that people are better served by primary care hubs, so that more responsive care can be delivered closer to where people live. Three such hubs are being developed in Hillingdon, one of which will be in Ruislip. I am sure that he welcomed the announcement this week of the roll-out of the first of the 43 hubs, including the one in Hillingdon, which will deliver the neighbourhood health services model.

Despite some of the heat in the debate, the misquoting of things that have been said and the unfortunate politicisation of this important local issue, about which there is general agreement among Members of all parties and in the community, the consensus that I hear is that people want more accessible services, more locally. There is a need for three hubs—the system wants that—and I am pleased that the Government have announced funding and prioritised Hillingdon. I have also heard that there is a potentially greater role for community pharmacies in providing urgent services and care. Does the Minister agree that more can be done by primary care providers across the board in Hillingdon and elsewhere?

I agree with my hon. Friend that that is the direction of travel that we want to see in all of our constituencies across the country.

The long-promised rebuild of Hillingdon hospital will be delivered by this Government as part of wave 1 of the new hospital programme. The money is guaranteed and construction will start between 2027 and 2028. We are already helping the trust to prepare for when we get spades in the ground, and it was a pleasure to visit the trust recently with my hon. Friend the Member for Uxbridge and South Ruislip.

The hon. Member for Ruislip, Northwood and Pinner raised the issue of consultation. I understand that there is a meeting with the trust, the integrated care board and the local authority on Friday, and I am sure that he and other hon. Members will be part of that. It is entirely proper for a Member of Parliament to raise issues about changes in their area—that is part of our democracy and democratic accountability. Now that this Government have put the new hospital programme in order, it is also proper for the House to hold us to account on its progress.

I will try to attend the meeting on Friday, but the Minister must appreciate that there is an element of scepticism about the future, in particular about what is happening with this unit. It confirms in my mind that if you stand still long enough, things will come around time and again. In our constituencies in Hillingdon, we have gone from cottage hospitals that provided immediate care for minor injuries, as well as having beds, which were closed, to being promised Darzi units, which we never saw, to looking forward to the hubs themselves. On Friday, I want to be able to convince people that there is a comprehensive plan that will be held to and properly invested in, because people will be very sceptical about the closure of a unit without the confidence that the architecture will be in place to meet the needs of our constituents. The petition has garnered such a large number of signatures because of that concern.

I understand what the right hon. Gentleman says. I have seen some of those promises made and not delivered over many years. It is important that Members of Parliament are involved and that there is a wide conversation with the ICB and the trust around those changes and the development that they make towards delivering the 10-year plan.

My right hon. Friend the Prime Minister announced that we would bring together NHS England and the Department for Health and Social Care precisely because we think that democratic accountability for £200 billion of taxpayers’ money is important. However, that accountability does not mean micromanaging, or intervening in every difficult decision that the ICB makes. We expect local NHS organisations to make changes and to reconfigure their services as best needed by the people they serve. That is in line with the direction outlined in the 10-year plan.

My right hon. Friend the Secretary of State for Health and Social Care has received several requests to intervene on a number of issues. Having looked at them thoroughly and assured himself that patient safety and access were guarded, he has decided not to intervene in nine reconfigurations. Getting our NHS back on its feet is a team effort, and we have to trust local NHS leaders to deliver. Decisions that affect the people of Hillingdon should be made in Hillingdon—it is not for someone sat behind a desk in Whitehall to make those decisions for them.

Having said that, I want to assure colleagues that that does not mean we will give local leaders a blank cheque to do whatever they like. Yesterday, we published a data tool and league tables that make NHS performance open and accessible, to inspire improvement and deliver a better NHS for all. Those NHS organisations that are doing well will be rewarded with greater freedoms, such as in how to spend their capital, and those that demonstrate the best financial management will get a greater share of capital allocation. We want to move towards a system in which freedom is the norm and central grip is the exception, in order to challenge poor performance.

Will the Minister give way?

I am going to pursue this point, if I may. Debates about service changes and reconfigurations have gone on since the birth of our NHS. I understand that they are really important for local people, and I understand the level of discussion about this issue and—as the hon. Gentleman has outlined—the wider impact on areas such as Watford. It would be easy for this Government to make ourselves popular by sacking some managers and promising people that services are never going to change, or that they will never close in any part of the country, but we were not elected on a populist platform, and it would not be in patients’ long-term interests not to reform and modernise the system.

We are building an NHS that is fit for the future. That is what the 10-year long-term plan is based on—moving services from hospital into the community, from analogue to digital, and from sickness to prevention. We expect local NHS leaders to make that happen. They must do so with local clinical leadership in the best interests of the populations they serve, and they must do it with the public—we expect open and transparent communications going forward. Local politicians have an important role in that, which Members present in the Chamber have demonstrated ably, and will continue to do so. I would be very happy to maintain contact with the hon. Member for Ruislip, Northwood and Pinner. The wider implications of the issues he has raised need to be outlined to him, and I commit to writing back to him about the consideration that is being given to those wider implications. I note his concerns, and I am happy to continue working with him.