University Hospital Coventry

Parliament as a Workplace – in the House of Commons at 4:49 pm on 13th June 2019.

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

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South 4:52 pm, 13th 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.

Photo of Matt Western Matt Western Labour, Warwick and Leamington

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?

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

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.

Photo of Marcus Jones Marcus Jones Vice-Chair, Conservative Party

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?

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

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—

Motion lapsed (Standing Order No. 9(3)).

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

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South 5:00 pm, 13th June 2019

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.

Photo of Matt Western Matt Western Labour, Warwick and Leamington

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?

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

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?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care) 5:05 pm, 13th June 2019

I thank Mr Cunningham and congratulate him on securing this important debate. I thank the other Members who have contributed. I want to start this debate as I try to start all debates in the House when talking about the NHS, by congratulating and thanking the staff who work in the NHS—in particular, given the nature of the debate, the staff who work in the hospitals of Coventry and Warwickshire and throughout the west midlands.

The hon. Gentleman made a number of important points that I will try to address. I know that he wrote the Department a letter in May. I will ensure that there is a response to it, but I can tell him now that the response will be that I would be delighted to meet him and the fellow MPs who have signed the letter to discuss its contents and what I am about to say.

The hon. Gentleman raised a number of important concerns regarding the discussions to transfer HPB services from University Hospitals Coventry and Warwickshire NHS Trust to University Hospitals Birmingham NHS Foundation Trust. HPB services treat patients who have disorders of liver, bile ducts and pancreas, including pancreatic and liver cancer. A large volume of HPB services are delivered in local hospitals, but because of their complex nature and the high cost of care, delivery in conjunction with specialist tertiary centres is often necessary.

As the hon. Gentleman indicated, in October last year, NHS England confirmed that no decision had been made to transfer or close the HPB service in Coventry, despite some concerns that national clinical service specifications were not being met. I understand that he is still concerned about that, but I can confirm that there are currently no plans to transfer HPB cancer services away from University Hospitals Coventry and Warwickshire NHS Trust. However, NHS England is actively supporting the trust to work alongside University Hospitals Birmingham NHS Foundation Trust, to ensure that patients have access to safe, high-quality treatment.

University Hospitals Coventry and Warwickshire NHS Trust has said that it is proud—rightly so—of the HPB service, which has excellent outcomes and feedback about the quality of healthcare provided, as the hon. Gentleman mentioned. In 2015, the West Midlands Clinical Senate reviewed the three HPB services across the west midlands and recommended combining them across two sites, because they did not meet national requirements.

The “Improving Outcomes” guideline document specifies that a population base of at least 2 million is required to make a compliant service. Currently, University Hospitals Coventry and Warwickshire NHS Trust treats a population of about 1 million. The guidance also specifies that for a population of around 2 million, around 215 pancreatic and liver resections a year would be expected as a proportion of the population size.

The hon. Gentleman talked about the number of operations and resections done by this unit. Between 2013 and 2018, an average of 80 resections a year were performed in University Hospitals Coventry and Warwickshire NHS Trust. He quoted a rather larger figure, but it was 80 pancreas and liver resections a year. I am happy to discuss with him at the meeting the number he quoted, but it is not one I recognise.

I understand that, over the past two years, teams in both trusts have been discussing how to work together with a view to creating a single point of access and shared multidisciplinary teams for HPB in the local area. Both trusts have agreed that the most complex services should be conducted on University Hospitals Birmingham’s Queen Elizabeth site. However, the trusts are yet to agree on an established definition of the most complex surgery. The clinicians from both hospitals who are currently delivering the service will continue to work together to develop this new combined model of care. NHS England will determine the best way to meet patients’ needs collaboratively, based on specialist surgical skills and the skills that are available at each hospital, as well as on the volume and complexity of clinical cases.

I would like to reassure the hon. Gentleman and, indeed, other Members in the Chamber that I recognise that discussions concerning service change are controversial, and this case is no exception. However, I would also like to reassure hon. Members that all service changes are designed to drive up service quality, meeting the specific requirements of local populations and trying to achieve what is best for specialist service users overall. The hon. Gentleman has set out, with great emphasis, the significant challenges that remain, and it is right that the trusts continue to work together to determine the best method to deliver these highly complex services.

The hon. Gentleman and, I hope, all hon. Members know that cancer is a priority for this Government. Survival rates are at a record high. Since 2010, rates of survival from cancer have increased year on year. However, as we know, there is more to do. That is why, last October, the Prime Minister announced a package of measures that will be rolled out across the country with the aim of detecting three quarters of all cancers at an early stage by 2028.

As part of the NHS long-term plan that we announced in January, the Government have outlined how we will achieve the ambition to see 55,000 more people surviving cancer for five years in England each year from 2028. The Department invests £1 billion a year in health research through the National Institute for Health Research. It spent £136 million of that on cancer research in 2017-18, which is an increase of £35 million on 2010-11. The NIHR is funding and supporting a range of research relevant to liver cancer, including a £1.76 million trial of liver resection surgery versus thermal ablation for colorectal cancer that has spread to the liver and early research on specialised magnetic resonance imaging scanning to detect liver cancer that has spread from colorectal cancer. There is much still to be done, but much is being done.

Photo of Marcus Jones Marcus Jones Vice-Chair, Conservative Party

I hear clearly what my hon. Friend says about the improvements that are being made in this area and in wider cancer care, but I am still concerned about the potential loss of what is a good service from Coventry. I am also concerned that at the moment, while no decision has been made, discussions and negotiations are clearly going on in that regard. It is quite obvious from the discussions that the hon. Members for Coventry South (Mr Cunningham) and for Warwick and Leamington (Matt Western) and I have had that not everybody in those organisations is in the loop, actually knows what is going on and is satisfied with this situation. Will my hon. Friend look at what more can be done to make sure, in this situation, that information is disseminated widely between clinicians and organisations so that we ensure we do not unnecessarily lose very high-quality people from organisations such as University Hospital Coventry?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

My hon. Friend makes an important and valuable point, and as a result of this debate, I pledge to write to the hospitals to ensure that the ongoing discussions between the various parties are as inclusive as possible. As I said earlier, I will happily meet him, the hon. Member for Coventry South, and other Members.

Photo of Marcus Jones Marcus Jones Vice-Chair, Conservative Party

My hon. Friend is kind and generous in giving way, and I thank him for the commitment he has made. There has clearly been little public engagement, but that is what we need with regard to any changes that are made, so that the public can understand the rationale behind these changes. I am aware of one person who has been chasing information about this issue, but they have hit a brick wall.

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

My hon. Friend is assiduous in representing his constituents and making his points. As I have said, these discussions have not yet concluded, and it would be hugely inappropriate for me or any politician to try to prejudge the right clinical outcomes. When those clinical outcomes have been worked through and the discussions finalised, I have no doubt that University Hospitals Birmingham and the Coventry and Warwickshire Partnership NHS Trust will wish to publicise the result of those discussions as widely as possible.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

Following the intervention by Mr Jones, the Minister mentioned a wider discussion and involving the public. We met some representatives, including Mr Peter Burns, who is the former chair of the local chamber of commerce and a very influential person. Such organisations, as well as other public bodies, must be brought in and consulted. Will the Minister agree to do that?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

It would have been inappropriate for me to be involved in clinical discussions, but I hear what the hon. Gentleman says. Before we have that meeting, I will write to him on that point. I hope that we will have a meeting relatively soon, so that we can finalise what should be done.

Service change is often controversial. We should rightly scrutinise any service change, but that should be based on patient safety and the right clinical outcomes. I thank the hon. Gentleman for raising this matter and continuing to hold us to account, and I look forward to meeting him and other hon. Members to discuss the issue further in the near future.

Question put and agreed to.

House adjourned.