Tonight I am seeking an opportunity to shed some light on the continuing saga of the Katie Road NHS walk-in centre in my constituency. Its future status has been in doubt ever since its fate was placed in the hands of one of the new clinical commissioning groups. My constituents have had to live with rumours, on-off consultations and continuing threats to the long-term future of an immensely popular and highly valued service that sees about 70,000 patients a year. The origins of the service lie in concerns that the large number of students in the area, as well as vulnerable individuals—often with mental health conditions and in unstable accommodation—were placing a demand on GP services that could not be met by existing provision, which was in turn placing intolerable strains on the local accident and emergency services.
My own fairly extensive consultations with constituents have established that the centre is regularly used by those who cannot easily secure quick appointments with their own GP. That is often a problem for those in work—especially those who work unsocial hours—and for families with elderly relatives or young children who cannot easily gain access to GPs at weekends or in the evenings. The Katie Road centre sees about 300 to 400 patients during an average weekend.
There is now fairly widespread recognition of the value of walk-in centres. The 2014 Monitor review reported rising demand for the service year on year. About 70% of the centres that were surveyed reported that they were seeing an average of 20,000 to 45,000 patients a year, as opposed to anticipated attendances of between 12,000 and 24,000. Yet despite the demand and support for walk-in centres, local commissioners have closed more than 50 since the start of 2010, reduced services at 23 others and reduced overall capacity by about 20%. I am not aware that, other than the Monitor report, there has been any substantial review into the impact of that loss of provision. I wonder whether the Minister is in a position to enlighten me, and whether he might take this opportunity to say what the Government’s position is on urgent care generally and walk-in centres in particular. I noticed that the Department of Health consultation “Refreshing the Mandate” says that
“we want to improve people’s access to primary care through new forms of provision including rapid walk-in access.”
In early 2013, Birmingham CrossCity clinical commissioning group announced plans to consult on the future of the Katie Road walk-in centre. That was apparently based on a report commissioned by the former South Birmingham primary care trust, a report that remains secret to this day. I first asked to see a copy of it in March 2013. In June 2013, the CCG called off its plans for walk-in centres and it was announced that they had been saved, only for the chair of the clinical commissioning group to reveal later that it planned to renew the contract temporarily and that Katie Road had been saved for 12 to 18 months. Later, the CCG announced that it planned a two-stage consultation, with a pre-consultation phase and then a main consultation with the public.
Naturally, I wanted to ensure that my constituents had their say on the matter. When I consulted them, I discovered that more than 72% had experience of using the centre and were firmly opposed to any plans to close it.
I agree that walk-in centres have the ability to take pressure off overworked A&Es, but does the hon. Gentleman agree that the best way to take pressure not just off A&Es but walk-in centres is to have GP surgeries open seven days a week, so that people can access services overall?
I might agree with that, but one of the problems in my area is that GP surgeries have been cut as well, so that is not the answer.
As I said, more than 72% of the people I consulted had experience of using the centre and were firmly opposed to any plans to close it. I also found that 56% of people had used the centre for out-of-hours emergency treatment, and 55% expressed serious concern about any plans to move the service to or near the A&E unit. My findings are consistent with that of the survey conducted on behalf of the NHS central midlands commissioning support unit in 2012, which found that more than two thirds of patients surveyed at eight walk-in centres and urgent care centres across Birmingham and Solihull indicated that they had attended because of an access-related issue—for example, they could not get an appointment with their GP or had to wait a considerable time to be seen.
There were major objections from my constituents to relocating their walk-in centre to the main hospital. They referred, for example, to the distance, waiting times, parking and accessibility. During a visit to Katie Road, I witnessed an ambulance crew bring into the walk-in centre an elderly lady in need of stitches to a leg injury. They did that rather than take her to the A&E unit because of their concerns over the likely delays. The CCG’s own figures suggest that an average visit to the walk-in centre costs around £45, as opposed to £75 to £100 for an A&E visit.
I am aware that there are many examples of walk-in centres being co-located with other health or social care services, and that some have a pharmacy on site or are co-located with diagnostic services such as X-ray services, dental facilities or family planning, but I should like to ask the Minister whether there is any evidence that shows an obvious advantage in co-locating an urgent care or walk-in centre alongside an A&E unit, especially evidence that would outweigh such negatives as distance, waiting times, parking and accessibility. In fact, is it not the case that most walk-in centres have a limited ability to refer patients on to secondary care services, as patients needing a referral to secondary care are normally referred by GPs, who are the traditional gatekeepers—a role that has, if anything, been strengthened as a result of the reorganisation of the NHS?
In autumn 2013 the CCG commenced its pre-consultation. The chair of the CCG met with a number of my constituents in February 2014, when he heard clearly their desire to retain Katie Road and their objections to a plan being pushed by the CCG to relocate the walk-in centre to a site at the University Hospitals Birmingham NHS Trust site, adjacent to the hospital’s A&E unit. In July 2014 I invited the chair of the CCG and a number of his staff to take part in a second meeting attended by more than 80 constituents—we were limited by the size of the room, or it would have been many more. At that meeting they heard clearly once again that there was total opposition to the closure of the walk-in centre and the plans to relocate to the hospital. That review or consultation eventually fizzled out, with the promise of a bigger and better consultation later in 2014.
The issue of such walk-in centres closing down is difficult for all of us in our constituencies. It is no good Conservative Members saying that we will have a seven-day a week GP service, because what they have done already with regard to the junior doctors dispute shows that they are not capable of doing that. That means that our constituents will continue to suffer. In particular, those at work cannot access services and are therefore put at greater risk through further misdiagnosis or non-diagnosis.
My hon. Friend will know very well that there is a problem with GP provision in his part of Birmingham as well as my own, so it is difficult to see how it could be stretched further.
As I said, we were promised a bigger and better consultation for later in 2014, but that was abandoned in light of the impending general election, the date of which had, obviously, been known since the Fixed-term Parliaments Act 2011.
No satisfactory explanation for the proposed change has ever been provided, but now, once again, the CCG wants to consult on the future of the walk-in service. This time it apparently wants to consult on a new model of service, the details of which are known only to itself but which has apparently not been clinically tested. It appears that, once again, it involves plans to relocate the walk-in centre to a site adjacent to the A&E unit.
“Transparency is important in ensuring that commissioners are accountable for their decisions. As noted, commissioners also have a duty to involve the public in commissioning decisions.”
It is not clear to me where in that part of the Act there is support for a series of bungled and inadequate on-off reviews and a constant determination to impose one outcome irrespective of the arguments to the contrary. I would welcome the Minister’s view on that. I am deeply concerned at the continuing threats to the service, which plays such a vital part in the delivery of healthcare for my constituents. I cannot see how the loss of a provision such as Katie Road is consistent with the Government’s ambitions for a seven-day NHS—perhaps the Minister can advise me on that.
Ironically, I have recently discovered that the opening hours of the Katie Road centre are to be extended to help cope with winter pressures. Dr Lumley, who works with the neighbouring CCG, which also serves south Birmingham, is quoted in the press as saying, in response to that announcement, that
‘this is great news for patients in Birmingham and means they can access the Walk in Centre until late, seven days a week.”
Such a pity her views are not shared by her colleagues in CrossCity CCG, who assumed responsibility for Katie Road in the carve-up following the introduction of the Lansley reforms.
It seems to me that the CCG is clearly out of its depth in handling a public consultation, or certainly one that can command any public confidence. What advice and support, if any, do the Government offer to CCGs on conducting consultations with the public? I am curious to know how much public money—money that could obviously have been spent on patient care—the CCG has spent on its on-off reviews and consultations so far. Is there any limit to how much public money a CCG is entitled to spend on a review or consultation on a single issue? If so, how much is it? Who is ultimately responsible for making a decision on the future of urgent care provision in south Birmingham? Do the Government accept any responsibility for this unsatisfactory state of affairs, and is there anything the Minister can do to help me and my constituents secure the future of this popular and well used health resource in south Birmingham, which is clearly needed and highly valued?
At the very least, I urge the Minister to write to the chair of the CCG following this Adjournment debate, urging him to communicate properly with my constituents and their elected representatives, to stop repeatedly trying to impose plans that have already been rejected and to bring this whole sorry state of affairs to a satisfactory conclusion.
I thank Steve McCabe for his clear outlining of the case for his constituents and for Katie Road walk-in centre, and I congratulate him on securing this debate. He touches on an interesting issue for the NHS as a whole, one with which clinicians have been grappling in the past few years: what is the nature of urgent and emergency care in a world where demography is changing rapidly, where demands on the service are changing and where there are incredibly different and disparate populations? He rightly points out that he represents a constituency that has a high student population, that has areas with high levels of deprivation and that has a wide mix of ethnic diversity. Other parts of the country have a significantly ageing profile and do not have the ethnic mix that he is able to enjoy in his part of Birmingham; they have a different socio-economic profile.
What is clear for commissioners and for clinicians is that the answer for urgent and emergency care in one area is different from that in another. I know that might be stating the bleedingly obvious, but it was something that was not observed by the NHS before Professor Sir Bruce Keogh initiated his review of urgent and emergency care in 2013. The result of that was a holistic, sensible and coherent plan for how urgent and emergency care should be delivered across the country. The variation in care, from Northumbria down to Cornwall, is extensive at the moment; there are considerable differences. The hon. Gentleman has highlighted the fact that there are differences even within the city of Birmingham. At the very least, we have made progress in the past few years in having a vision of what urgent and emergency care should look like. The challenge is to try to implement that across the service, which is why, over the past two years, considerable work has been done by clinicians and commissioners to try to understand how the principles of the Keogh review can inform the reshaping of emergency and urgent care in their patches.
As the hon. Gentleman has identified with the issue of one walk-in centre—he can imagine how such local controversies become all the greater when they involve accident and emergency centres and trauma centres—these are matters that are very close to the hearts of constituents, who rely on those services. Those services are there in their moment of need, and they are, in a very real sense, the single greatest embodiment of the NHS and its values. We must treat urgent and emergency care with the utmost care.
The plans that are being worked up across the country are being done carefully with commissioners in co-ordination with NHS England and, ultimately, with Professor Sir Bruce Keogh. Let me give the hon. Gentleman an idea of why that has been so carefully done and the extent of care that has been taken: it was only in the autumn that the route map for the whole country was published. I hope he will therefore understand why his local CCGs have had to revise the timetables by which they have been looking at urgent and emergency care. As he pointed out, they began their own study of this in Birmingham before Professor Sir Bruce Keogh undertook his review. They have had to revise their thinking in the light of that, and I know that they are taking forward their current consultation on the basis of the route maps that have been designed by NHS England with commissioners around the country.
The hon. Gentleman makes a fair point about process. I know why he is frustrated, and I completely understand his frustration. I also understand his irritation at the bureaucratese that can fly in his face as a representative of local people. I cannot specifically talk about the consultation of which he speaks because I do not have a detailed knowledge of it. All I can say is that in the NHS there are good and bad consultations. What we have tried to do over the past five years—and I am trying to do this in my current position—is to ensure that we bring the worst consultations up to the best, that we learn from where they have gone wrong and that they go better. I can of course commit to write to the chairman of his CCG, perhaps highlighting the work that has been done around producing very good consultations, reiterating the points that he has made in his speech, and asking for a clarification around each and every point that he has raised, so that he feels satisfied that he has raised his issues in the Chamber and that he can provide answers to his constituents. Clearly, he feels that, at the moment, there is much confusion and not too much clarity.
I spoke to senior commissioners in the South Birmingham CCG today in advance of this debate to ensure that I was availed of the facts of the situation. They assured me that there is a full intention to continue services at Katie Road. The centre’s value is understood and well known, which is precisely why there was a temporary extension of the hours till 10 pm to deal with the winter pressures that are felt across the service. The commissioners also made it clear that there has not been a predetermination about the location of a further urgent care centre. It will be in Selly Oak, and it will be considerably larger than Katie Road so it will be able to accommodate more services and will be of greater use to the hon. Gentleman’s constituents. The commissioners have not come to a decision yet about where it should be located. I know that they will want to engage fully with him and with the community in order to ensure that it goes to the right place.
When the Minister was given an assurance that Katie Road would continue, he was presumably told that the contract was due to come to an end. Was there any indication that there was an intention to have yet another roll-over contract, or whether there is a timescale attached to the consultation—yet another one?
No, I was not assured in that level of detail—I can ask for that information in my letter to the chairman of the CCG—but I think that the intentions were clear, and they seemed entirely honourable. They understood the purpose of the centre, and they clearly saw the disadvantage of those services discontinuing before a new urgent care centre opens. I think that they understand the hon. Gentleman’s perfectly reasonable point that there needs to be some sort of continuity of service so that local people know where to go and can feel confident about local service provision.
On the important point about location and co-location, it will be different for different areas. The hon. Gentleman might have local pressures at University Hospitals Birmingham that do not pertain elsewhere in the country. It might be right—we are having exactly the same discussion in my constituency at the moment—to make use of an A&E brand and say, “Right, you have one simple place to go,” or it might be right to locate services on a different site. That will be different for different places. That is why it was decided in 2009, under the previous Labour Government, to give commissioners a greater role in local decisions on urgent and emergency care, because they are the ones who know their patches best, and what I write in Whitehall might not be right for local conditions in Selly Oak, or anywhere else for that matter.
I cannot therefore give the hon. Gentleman an answer on co-location because it will be different in different parts of the country, but what I can tell him is that my letter to the chairman of the CCG will include a particular reference to the fact that he and his constituents wish to be consulted and that there needs to be a clear rationale behind the location so that people feel that it is done not for the ease of NHS-land, but for the betterment of patient service.
The hon. Gentleman asked about consistency with seven-day services. I would like to reassure him that we are building seven-day services on the basis of the urgent and emergency care networks that were outlined by Professor Sir Bruce Keogh in his 2013 review and the consequent work. Contrary to the suggestion of his hon. Friend Mr Mahmood, the seven-day services programme is entirely clinically led. It draws on the work that the Academy of Medical Royal Colleges undertook in 2013 to develop 10 clinical standards. That is the basis of the work we are taking forward. The contract reform that we have undertaken, both for junior doctors and for consultants, is based in part on the recommendations of those 10 clinical standards, so it is routed entirely in the need to respond to the top clinicians’ advice on how we achieve consistency of service across seven days of the week.
I would therefore expect the results of any consultation into urgent and emergency care in Birmingham to match precisely the overall work that we are doing to ensure consistency of standards across seven days of the week, good access for patients and a clear and transparent approach to urgent and emergency care, which in parts of the country, as the hon. Gentleman has identified, can at times be both patchy and confusing.
Finally, the hon. Gentleman asked whether there is a threat to walk-in centres. Under this Government he will see continued investment in urgent and emergency care. We will seek to find greater clarity around urgent and emergency care so that there is a clearer brand and more easily recognisable services for local people, so that we eliminate inconsistencies across the service and so that we fulfil the best clinical advice on how to achieve better services in urgent and emergency care by following the recommendations of Professor Sir Bruce Keogh and the work that has been done by local clinicians since. I do not believe therefore that there is a threat to urgent and emergency care services, and I believe they will improve over the next four years.
That is why I am happy to promise the hon. Gentleman that I will continue to answer questions on Katie Road. Should he have any further concerns, I would be delighted if he came to me so that we could talk about them. I will do what I can to allay those concerns and to make representations on his behalf to his clinical commissioning group so that he can get the answers he seeks.
Question put and agreed to.