Transcript of the debate on the Hospital of St Cross: Accident and Emergency, 9th June 2022.
Mark Pawsey MP, Member of Parliament for Rugby and Bulkington:
It is a great pleasure to see the Minister in his place. It is a particular pleasure to have been granted this debate on health provision in Rugby—one of the most important issues for my constituents, because my predecessor and father, Jim Pawsey, held such a debate concerning the Hospital of St Cross in Rugby 25 years ago. Much has changed in the intervening period, but the hospital remains as dear to Rugby residents’ hearts now as it was then. In particular, I want to talk about the provision of accident and emergency care at the Hospital of St Cross. In the course of my speech, I will first set out the current facilities available to Rugby residents, and then go on to make the case for improved and increased provision.
The urgency of today’s debate arises because of the increasing number of cases of concern being brought to my attention by my constituents. They are currently directed to the University Hospitals Coventry & Warwickshire site at Walsgrave in Coventry, 12 miles away. One constituent told me that when he needed to visit A&E, it took 22 hours for his condition to be fully assessed due to the very high number of patients waiting for treatment. He suggested, as I will today, that to help to alleviate pressure in Coventry, the Hospital of St Cross should be used more widely.
Another constituent told me that they were taken to University Hospital by ambulance one evening after suffering heart palpitations. Although the ambulance arrived at their home within 45 minutes, once they arrived at the hospital it took an hour to be taken into the care of the hospital because of the queue of ambulances waiting to discharge their patients. My constituent told me that the care they went on to receive at the hospital was good. That is a recurring theme throughout all the cases that have been brought to me: the care, once it is received, is excellent, but it is taking far too long to access it.
According to the history of the hospital written by the Rugby local history group, the importance of timely emergency care was the catalyst for the foundation of the Hospital of St Cross. In 1882, an engineer on the railway running through Rugby had a serious accident and his leg had to be swiftly amputated. At that time, victims of such accidents were normally taken by rail to either Birmingham or Northampton, but on this occasion, there was not time. The engineer’s leg was amputated on a bed in a small hospital on Castle Street in Rugby because there was not an operating table. Sadly, the amputation was not enough to save the young man’s life. When Mrs Elizabeth Wood heard of the engineer’s fate, she presented the hospital with an operating table, and subsequently, the land for the new hospital. The Hospital of St Cross remains 140 years later. The hospital today offers a number of high-quality specialist services, including orthopaedic and ophthalmic procedures and the recently added haematology service.
In respect of emergency care, there is a minor injury and minor illness unit, which is a nurse-led service for patients over the age of five. Rugby residents can attend for small wounds, animal stings, some sports injuries, minor injuries or suspected broken bones. X-rays, blood tests and a pharmacy are available, but, significantly, for anything complex or for a serious injury, residents must travel to Coventry.
Rugby residents were bitterly disappointed in 1997 when the A&E service at St Cross was downgraded as part of a wider move away from the district general hospital model and towards a higher concentration of specialists at a smaller number of sites. At the time, serious concerns had surfaced about the quality of some of the clinical services, which resulted in the board of the Rugby NHS trust agreeing to merge with Walsgrave Hospitals NHS trust in February 1997.
The royal colleges were invited to make reports on the services. The Royal College of Surgeons noted that Rugby’s catchment area was not at that time—that is the significant bit: it was not then—large enough to provide sufficient opportunities for clinicians to maintain their skills and deliver a safe service. A further justification was that, as medical science advanced, the days of the general surgeon had ended while the required number of support staff and the cost of complex equipment had increased.
Since that 1997 decision, the population served by the Hospital of St Cross has changed substantially. The local authority in Rugby has always been pro-growth. I have been very keen to see the many housing developments in Rugby in recent years, simply because we need to meet the challenge of enabling the next generation to own their own home and because we welcome the additional footfall for our town centre at a time when high streets face stiff competition from online retailers.
Between 2001 and 2011, the population of the Rugby borough grew from 85,000 to 100,000. I expect the 2021 census data to indicate similar or greater growth than that. Rugby is one of the fastest growing places in the UK and has an ambitious local plan that expects an additional 12,500 new homes by 2031. Accordingly, we can expect a population rise of about 30,000 people.
As part of the new developments, we have seen new roads and new schools. The people of Rugby also rightly expect to see a commensurate increase in the health services provided. There are plans for increased primary care provision. Whitehall medical practice has recently expanded and there will be additional provision in Houlton—a new housing area of Rugby—and the south-west development area, which should relieve the pressure on existing GP practices.
However, over recent years it has become clear from constituency cases brought to me and from discussions on the doorstep that Rugby residents are increasingly concerned about the provision of accident and emergency care and the impact of population increases on services. Most treatment is provided at Coventry, which is about 20 minutes’ drive from Rugby on a good day, and realistically at least half an hour’s drive for most Rugby residents. I understand from information provided by the Library that 83% of my constituents live more than 15 minutes’ drive from a major accident and emergency department.
That figure is higher than in 84% of constituencies across England. The travel time is compounded by residents’ uncertainty and lack of clarity about what constitutes a minor injury or illness and whether their need can be met in Rugby or requires travel to Coventry. I frequently hear accounts of residents attending St Cross only to be immediately directed to University Hospital in Coventry. On occasion, I hear about residents who have travelled to Coventry for a very simple matter that could have been dealt with at St Cross.
In response to broader concerns about health provision in Rugby, last autumn I carried out a survey on my website asking about accident and emergency care in Rugby. I very much thank the people of Rugby for their outstanding response: nearly 3,000 residents took the time to have their say. That is an outstanding number for such a survey, and it sends a very clear message to local health decision makers about what Rugby residents want. The key points are that 98.5% of respondents believe that Rugby should have its own accident and emergency department, and 93% believe that Rugby does not currently have adequate accident and emergency care provision.
My survey builds on the work that the Coventry and Warwickshire clinical commissioning group carried out over the summer of 2021, covering all of Warwickshire. That survey had 922 respondents, which is rather fewer than the 3,000 who responded to my survey, but about 600 of those 922 people were Rugby residents. My constituents’ hugely disproportionate participation shows their strength of feeling.
Given the large number of responses, I am pretty confident that the results of my survey were representative of the views of Rugby people more broadly. It is clear that my constituents believe that our town, particularly given its growth, is currently underserved with A&E provision. After conducting my survey, I met Professor Andrew Hardy, the chief executive of University Hospitals Coventry and Warwickshire NHS Trust. He agreed about the high volume and the unanimous response, which I hope the Minister will acknowledge in his remarks.
One issue for the accident and emergency department at UHCW is that it is very large. It has to be, because according to the Library, most accident and emergency departments serve a population of at least 200,000—the average is 320,000—but the accident and emergency department of University Hospital in Coventry serves a population of about 600,000, nearly double the national average.
It is my contention that if we improve the offer at the Hospital of St Cross, pressure on the University Hospital site in Coventry could be alleviated and waiting times could reduce. Of those residents who completed my survey, 52.7% said they had waited more than four hours for treatment on their most recent visit to Coventry.
Regrettably, since my survey was conducted last autumn, the pressures on accident and emergency departments have only increased; I am sure the Minister will acknowledge that. The minutes of the University Hospitals NHS Trust February board meeting noted that the hospital’s occupancy had been over 97% since August 2021, with full hospital protocol occurring in September and early November. However, I was pleased to note that there is an ongoing focus within the trust on using some of the capacity that exists in Rugby to assist the flow in Coventry. It is my contention, and that of my constituents, that the Hospital of St Cross could be used rather more to relieve the pressure.
The concerns of Rugby residents have been compounded by the closure of Rugby community ambulance station in October of last year, along with a number of other ambulance stations across the west midlands. That was a unilateral decision by West Midlands Ambulance Service University NHS Foundation Trust, which has been opposed by me and by other west midlands MPs. There was no consultation with residents. I was not notified, nor were my parliamentary colleagues: we read about the decision in the press.
It is a simple and regrettable fact that the closure of the community ambulance service in Rugby makes it less likely that there will be an ambulance in Rugby. I believe that if we had ambulances coming to Rugby with patients seeking accident and emergency care, there would be a greater likelihood of an ambulance in the vicinity, and ambulance response times would improve for Rugby residents because ambulances would have a reason to be in Rugby. West Midlands ambulance service says that its service is delivered by people, not buildings, and that the single biggest factor that it faces is handover delays at hospitals. This is a national problem, as the Minister will acknowledge, but, as I have said, if ambulances could come to the Hospital of St Cross rather than going straight to Coventry, there would be a greater likelihood of an ambulance in Rugby able to deal with calls from local residents.
In my survey, I asked Rugby residents this question: if they could change one thing about the NHS locally, what would it be? The vast majority said that they would like to see better accident and emergency provision in Rugby. Others noted difficulties arising from their circumstances. The key theme was the challenge posed by the journey to University Hospital in Coventry. Many residents noted that it was particularly difficult without a car, and that those without cars, who might have had to wait a long time at A&E—until late evening—often ended up returning home in a taxi and paying a large fare that they could ill afford.
I have heard from many constituents about the lack of accident and emergency provision for children under five. One parent wrote:
“My son who is 3 has had 3 fits in the last year and each time we have had to travel to University Hospital”.
“I have two small children and it terrifies me that I will have to travel so far if they needed emergency care”.
Among the responses from my constituents were a number of heartbreaking accounts, but none was more heartbreaking than an account of an issue that arose in January this year, when my constituent Jamie Rees died of a sudden cardiac arrest. The ambulance that attended the scene had to travel from University Hospital, and given that time lag it had no realistic chance of meeting the category 1 response time, which would have saved Jamie’s life. Jamie’s family have organised an extraordinarily powerful campaign, known as “Our Jay”, to raise more than £10,000 for externally mounted defibrillators. What was so frustrating for the family was the fact that a nearby defibrillator that could have saved Jamie’s life was locked inside a nearby school, which was very sad. There was no externally mounted defibrillator. One reason for people’s unwillingness to provide them is that from time to time they are subject to vandalism and theft.
Jamie’s family have also rightly asked questions of the emergency services, particularly about the impact of the closure of the community ambulance station in Rugby in October. Quite reasonably, they were really bothered about the length of time it took for an ambulance to attend. Jamie’s parents were full of praise for the amazing staff who cared for Jamie, but they rightly point to the importance of that care being accessible at the time it is needed. We know that people in Rugby want to see improved local accident and emergency provision, and I very much hope to have the opportunity to demonstrate this need for an extension to the A&E provision in Rugby when the Secretary of State comes to visit Rugby and St Cross in the near future, which he has kindly committed to do.
Our role as Members of Parliament is to represent the concerns of our constituents here in this place and to seek redress when it is needed. In Rugby, for my constituents, there is no greater issue right now than health provision, and I would not be doing my job as their representative if I was not doing all I could to make sure that that need is met. The Government have quite reasonably asked that towns such as Rugby do their bit to provide the housing that the people of this country need, and Rugby is proudly meeting that challenge. All we ask is that the Government and local health commissioners also do their bit to provide the healthcare that the people of Rugby need and are asking for.
The Minister for Health, Edward Argar MP:
I congratulate my hon. Friend the Member for Rugby (Mark Pawsey) on securing this important debate. He is right to highlight that it is the responsibility of Members of Parliament to highlight and champion their constituents’ concerns, and he is doing exactly that today, just as his illustrious predecessor and father did over a combined total of about 18 years in this House, representing that area with distinction just as he does. My hon. Friend has been a regular campaigner for the NHS in his constituency. Indeed, as I recall from oral questions some time ago, I think I am right in saying that he volunteered at the Locke House vaccination centre during the pandemic to assist his local NHS. Not only does he talk the talk; he walks the walk in supporting his local NHS, and his constituents in Rugby are incredibly lucky to have such a passionate local champion for their cause in this House.
My hon. Friend’s engagement with his constituents, and his being in tune with their concerns, is reflected by the survey he mentioned. He said he had received around 3,000 responses, which is a phenomenal response rate for such a survey. I think I read that it was reported on the excellent CoventryLive site, which highlighted exactly what he had done. He asked me to acknowledge, and of course I do, the virtual uniformity of the concerns raised in his constituents’ responses. That is a powerful message that his constituents are sending to us.
I understand that the Hospital of St Cross has operated an urgent care centre since the closure of the full A&E in 2011, transitioning to become an urgent treatment centre in line with national changes in 2019. That service is available 24 hours a day, seven days a week, allowing patients to access the urgent care services that it is able to provide at any time. Trained nursing staff are on hand and patients can have X-rays and blood tests and access a pharmacy. As my hon. Friend said, patients with more complex medical conditions requiring advanced tests or investigations will be referred or taken by ambulance to be cared for by specialists at the University Hospital in Coventry. This, to a degree, reflects the staffing availability and specialist staff required for different services, and which services are available in a particular setting.
My hon. Friend highlighted an important point, which applies not only to his local hospital but more broadly across the country. There is more we can do to help our constituents, and those who may need services, to understand what services each different NHS destination —be it an A&E or a UTC—can provide, and hopefully reduce the number of people who see the H sign on the motorway and think, “I’ll go there because I need assistance,” only to end up being transferred to another hospital to receive the services they need for their condition. There is more we can do to make that clear.
I appreciate my hon. Friend’s call for a restored full A&E service in Rugby, on the basis of demographic change since the decision was taken in 2010 and implemented in 2011. He is right to highlight the pace of change, including in population. I know his patch a little; it is a relatively short hop down the M69 and back across the M6 from my patch to his. He is right to highlight all that Rugby and the area is doing to help support the objectives of providing affordable housing for people who need it; but that of course comes with additional pressures on local public services and local infrastructure, as he rightly emphasised.
As my hon. Friend knows, the original decision to alter local service provision was made following a full public consultation to address concerns raised at the time that the unit was not able to sustain full A&E services, with serious cases, even then, being sent to Coventry for treatment. I can assure my hon. Friend that this decision will rightly be taken by the local clinical commissioning group, as it was in 2010—although it was possibly a primary care trust at the time. Shortly, it will be a decision for the local integrated care boards, which are due to come into force very soon, following the passage of the Health and Social Care Act 2022. It would not be right for the inception of such decisions to come from Ministers in Whitehall. I would note, however, that for any future changes we will see slightly altered powers for Ministers, with the power of direction and intervention introduced in that legislation.
I can assure my hon. Friend that the funding available to his local health system has risen in line with demographic change since 2010—as determined by the formula set by the Advisory Committee on Resource Allocation—and that ensuring that resources are allocated to deliver the best care for patients is a key duty of both the CCG and, subsequently, the ICB. The local health system is best placed to consider sustainability, location, and demand for services across its area. Any such assessment of whether to reduce services, move services or open new services should include consideration of the mix of accident and emergency services, UTCs and other treatment services, such as GP access.
Without wishing to pre-empt any particular course of action that my hon. Friend’s local system might be persuaded by his forceful advocacy to consider, I would also comment that it is for the ICBs and trusts to plan for reconfigurations of NHS services. Judging by what my hon. Friend said, he is already lobbying them pretty firmly. Where services are reconfigured, we are clear that these are subject to four stringent Government tests, which are strong public and patient engagement, consistency with current and prospective need for patient choice; a clear clinical evidence base, and support for proposals from clinical commissioners.
Decisions on any reconfiguration are rarely easy or straightforward; they are effectively about balancing different needs and benefits, including patient transport and inequalities, and it is important to hear from as many local people as possible about the practical impacts and concerns. As I alluded to, I encourage my hon. Friend to continue his conversations with his local NHS system.
Before turning to pressures on A&Es more broadly and the ambulance service locally, I should say that there is already significant investment to improve services in Rugby. The University Hospitals Coventry and Warwickshire Trust remains committed to expanding services at the Hospital of St Cross, and in recent times that has included the opening of a £1 million purpose-built haematology and oncology unit, and new modular theatres to help treat more patients on elective waiting lists. It is probably fair to say that a degree of credit goes to my hon. Friend for fighting the corner for his local hospital, as he always does.
I shall now mention pressures on emergency departments. The emergency department at the University Hospital in Coventry has also been granted £15 million by the Government to increase its capacity and further enhance patient care. This investment will expand the department, including with a new minor illness and injuries unit. The funding will also be used to install additional treatment cubicles, to expand the waiting room in the children’s ED, to increase the level of same-day emergency care and to support diagnostic capacity with an additional CT scanner.
It is right that we take a whole-system approach to these challenges, and all this work is designed to complement existing services provided at both the Rugby and Coventry urgent treatment centres. My hon. Friend is right to highlight the pressures we are seeing in EDs across the country, which is often manifested in ambulance delays and ambulance queues. That is a symptom of the patient flow challenge in hospitals. Space is needed to offload patients safely into EDs, for which EDs have to be able to discharge patients safely or admit them into the hospital. To do that, hospitals have to be able to discharge patients to free up the bed space to enable that patient flow. In recent months we have seen sustained pressure in hospitals across the country in that respect, and he rightly highlights his local hospital.
My hon. Friend talked about the ambulance service and highlighted the tragic case of Jamie Rees, which has been reported on extensively by CoventryLive. Jamie sadly passed away on new year’s day following a cardiac arrest. Through my hon. Friend, I extend my sympathies and condolences to Jamie’s family and friends.
I understand the West Midlands ambulance service believes that, sadly, an ambulance station, had there been one in Rugby, would not have altered the outcome in Jamie’s case. In the 90 minutes before it received the first 999 call, I understand there had been five other emergency calls in the Rugby area. That means any ambulances based in the town would have already been dispatched to deal with those emergency cases, so the ambulances would not have been available wherever the station were based. I fear that reflects the pressures at the time. None of that will be any consolation to Jamie’s family, but I wanted to highlight the context.
My hon. Friend also rightly highlighted the “Our Jay” campaign and the number of externally mounted defibrillators, which is a hugely important topic. It is sad that there is sometimes an unwillingness to fund externally mounted defibrillators due to the despicable behaviour of utterly heartless individuals who, for some reason, think they have the right to vandalise or steal this life-saving kit. It is a sad reflection on them, and I sincerely hope they never find themselves in a situation where they need such kit to be available. I pay tribute to the “Our Jay” campaign.
More broadly, we have put a number of measures in place to try to ease the pressure on A&E and ambulance services. The discharge taskforce is helping to free up patient beds by ensuring that patients who are fit to be discharged are discharged more rapidly. In recent years, £450 million has been spent on expanding A&E departments, and there has been a £55 million investment in strengthening ambulance trusts and keeping an extra 156 ambulances in service and on the road to bolster capacity and resilience during the winter period.
I hear the passionate case my hon. Friend makes. There is significant support in place, both locally and nationally, to help ensure constituents in Rugby can access the care they need when they need it, but I also wish to make a number of points. First, I am happy to meet him to discuss this matter. I was going to offer to make the short hop down the M69 and the M6, but from what he has says I have been pipped to the post by my boss arranging to do that visit; he has perhaps upgraded the offer, with the Secretary of State rather than a mere Minister of State. I hope my hon. Friend will feel free to share the detail of his survey and the responses with me. I am also conscious that I have some outstanding correspondence from him—I checked that this morning—and I will ensure that I respond to it in the next few days. I will pull it out of the system and ensure that he gets answers to the specific points he raised.
I thank my hon. Friend, once again, for rightly raising this important issue, securing an important debate on the Floor of the House today and doing what he does so well: championing his constituents’ best interests, and making sure that Ministers have no opportunity to forget them and to forget the people of Rugby. Indeed, he ensures that they are impressed upon our minds. I look forward to meeting him to discuss this further, and I hope that will happen shortly.