Proposal: Transforming Urgent Care in Wycombe
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Yesterday, I spoke in the debate on the NHS, calling for a new generation of urgent care centre in Wycombe in line with NHS England guidance, particularly:

Steve Baker (Wycombe) (Con): I begin by paying tribute to the staff and leadership of Buckinghamshire Healthcare NHS Trust. The trust went through special measures as a result of the Keogh review, when it was found to have high mortality, and they have done a sterling job of turning the trust around. On my visit recently with my right hon. Friend the Secretary of State for Health, I found a renewed enthusiasm and optimism in the trust, and I am very grateful to the staff and leadership for delivering that outcome.

When the right hon. Member for Leigh (Andy Burnham) opened the debate, he asked for shared solutions, striking a markedly different tone from the usual partisan pose. I shall suggest some shared solutions later in my speech. But normal service quickly resumed. The right hon. Gentleman spoke of stories of failure. There are, of course, some stories of success, and I shall mention a few. England’s NHS has the best measured emergency care performance of any western nation, according to NHS England. Dr Sarah Pinto-Duschinsky, director of operations and delivery for NHS England, said:

“In the week ending December 28th A&E attendances were up more than 31,000 on the same period last year, meaning we successfully treated more patients in under four hours than ever before.”

I will come to why in a moment.

The Government have allocated an additional £700 million to cope with winter pressures. The College of Emergency Medicine said:

“This represents the largest annual additional funding yet seen.”

In the course of this Parliament, the NHS budget will have increased by £12.7 billion in cash terms. This additional winter pressures funding has paid for 2,500 additional beds in acute and community treatment and the equivalent of 1,000 doctors. There are almost 1,200 additional A and E doctors, including an additional 400 A and E consultants and 1,700 additional paramedics since 2010. Some 850,000 more operations are being delivered by the NHS each year compared with 2010, and numbers waiting longer than 18, 26 and 52 weeks to start treatment are lower than they were under the previous Government. It cannot reasonably be said that that is a continuous record of failure. There are considerable successes under this Government.

In an intervention on my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), I mentioned branding. One of the things that we could do is continue to tell patients that they should go where treatment can best be provided, but we see that patients stubbornly insist on going to hospital. The brand A and E is well understood; people know that if they have an urgent problem, they can go to A and E. It will take years of persuasion before people behave differently, and I do not think we should keep on persuading people to want something other than the preference they are clearly displaying by their behaviour, which I shall return to.

Let us not forget the legacy that the Government have had to cope with, including the grievous financial position that they inherited. Let us not forget that around the world special monetary measures are still in place to ensure that Governments can keep spending. We have had problems with patient care. I alluded earlier to the turnaround in Buckinghamshire; across the country, there have been special measures and turn-arounds. The BBC reported that a probe into whistleblowing has been swamped by people getting in touch. The Government have had to deal with an enormous range of cultural problems and turnarounds.

That brings me to solutions—first, funding. In Buckinghamshire there are pockets of real poverty. In my constituency in Micklefield, Castlefield, Oakridge, Bowerdean and Disraeli there are—by anyone’s standards —pockets of poverty and deprivation, but we suffer on funding because of how it has historically been calculated. It is time for us to look seriously at where the demands on A and E are coming from, and to reorientate funding towards the human factors producing that demand—that is, ageing. Where there are older populations, they should be properly funded. It is a simple matter of treating people humanely, decently and—dare I say it—equally.

Secondly, it is time for us to take seriously the documents of NHS England. I am talking about not just the urgent care review, which I have in my hand, but the “Five Year Forward View”. What we see emerging now is a clear vision of where places such as Wycombe should go. It is becoming increasingly obvious to me that we will never manage to achieve the return of an old-style A and E to Wycombe hospital. The clear reason for that, as set out by NHS England, is that the NHS is moving in a different direction.

Click for larger image
Click for larger image

The urgent care review includes a clear model of future urgent care, with major emergency centres, emergency centres and urgent care centres.

I am not able to tell the hospital trust and the clinical commissioners what they should do, but if I could I would now have a clear understanding from NHS England’s own documents of what should be done in Wycombe. We have a very expensive public finance initiative hospital, and we need to make the most of it for the 20 years-plus that are left to run on it. We should have an urgent care centre, an enhancement of the current minor injuries unit, a pharmacy, GPs, social services, nurse practitioners, and a full set of services and diagnostics in Wycombe named in a way that the public can understand. We should be proud of the centre and encourage people in Wycombe to present there if it is the best thing for them to do. We should not turn off the 111 service, and we should provide the services that people need in the places where they present.

We cannot go on for ever pretending that we will re-educate the public to want something different; that is not going to happen. I am not suggesting that we have an enormous new surge in admissions—nobody wants that. What we should recognise is that the vast majority of people, when they are in difficulty, want quick reassurance. If the people of Wycombe were in charge, they would want our hospital to have a full range of diagnostic and treatment facilities available to them all year round, giving them peace of mind. They would not want poor quality care. I think most people would accept being stabilised and moved to the place that could give them the best care.

We have a heart attack and stroke unit. I do not suppose that many people in Aylesbury, where there is an A and E unit, would be very happy if they realised that in the event of a heart attack or stroke, they would be coming to Wycombe. But that is the point. A huge amount of confusion, waste and anxiety is being wholly unnecessarily created despite the fact that NHS England, through the forward view document and the review of urgent care, has set out a clear trajectory on how to give the public peace of mind and the right treatment in the right place—yes, close to home, but also making best use of the PFI hospitals, which are a millstone around the NHS’s neck. We should do the absolute best we can to get best value for money, which means a new generation of urgent care centres in places such as Wycombe.

You can find my two-page proposal here: Transforming Wycombe Urgent Care.

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