Clive kept up the campaign to re-open the Source medical centre in Sibthorpe Road by using the very last Parliamentary debate of the year to highlight the campaign.
Clive Efford Labour, 20th December 2018: I realise that the House has just been debating a very important subject, so I will not be offended if my hon. Friends leave the Chamber, despite my debating a very important issue for my constituents. I wish them on their way out a very happy Christmas and a prosperous new year.
The Source drop-in health centre is a nurse-led centre on the Horn Park estate in my constituency. It was opened in a partnership between the local council and health service under the single regeneration budget early in the 2000s in recognition of the unique situation of the Horn Park estate and its residents and the need to improve access to health services. The council provided a shop premises at a peppercorn rent, round five of the SRB paid for the refurbishment, and the NHS provided the staff and equipment.
The Horn Park estate is among the 20% most deprived communities in England, according to the index of multiple deprivation’s latest figures, for 2015, and ranks 5,591 out of 32,844, which actually makes it one of the 18% most deprived. The estate is largely made up of council-built housing, and residents are mostly council and housing association tenants. It is located at the south-west edge of the Royal Borough of Greenwich and borders directly the London Boroughs of Lewisham and Bromley.
Being on the periphery of three boroughs always puts the community at a disadvantage when it comes to public services, as was recently highlighted by Professor Tony Travers of the London School of Economics. To the north, the boundary of the estate is marked by the A20 Sidcup dual carriageway and the A102 south circular, a similar dual carriageway. The community is therefore very isolated from its neighbouring communities in the Borough of Greenwich.
There is a small parade of shops that used to include convenience stores, a chip shop and post office. The post office moved into the convenience store, but that has now virtually completely closed, and there is now just the chip shop. An attempt was made to put in a satellite Sure Start centre in one of those shops, but that has since been closed, and the Source occupied one of those other empty shops in the middle of the estate. For everything else, the residents have to leave the estate, and there are many elderly people and families with young children on the estate, and 30% of them do not have access to a car.
The Horn Park estate lost its only GP practice in 1990, when Dr Denis retired. I remember campaigning to keep the practice open at the time. The Greenwich district health authority, which was then in charge of the health service in Greenwich, decided that the practice at Horn Park should be taken over by the Evans practice, based in Court Yard, central Eltham, over one and a half miles away. The Evans practice closed the Dr Denis’s satellite surgery on the estate and never provided any services locally. This was the beginning of a trend of gentrification in the location of surgeries, as a succession of GP practices closed surgeries based on council housing estates.
I have several communities in my constituency among the most deprived in England on the index of multiple deprivation. The Page estate, made up of four communities, is among the 20% most deprived, and the Middle Park estate, made up of three communities, has one among the 10% most deprived. The Brook estate is among the 30% most deprived. Lower Brook estate is among the 40% most deprived and the Horn Park estate has two communities among the 20% most deprived. With the exception of one community on the Page estate, they all have one thing in common: they do not have a GP practice.
When the clinical commissioning group closed the Source in 2016, it decided to invite expressions of interest from GPs in Greenwich to establish a branch surgery on the site as a replacement for the Source. No GPs stepped forward. In an attempt to justify its decision, the CCG claimed that there were six GPs within a “manageable distance”—less than 1 mile—from the Source’s location in Sibthorpe Road. In fact, there are no GPs less than 1 mile’s walking distance away. The nearest is actually 1 mile away, and the rest are more than 1 mile away—up to 1.5 miles away. There is no pharmacy on the estate, and the nearest one is 1.5 miles away, in a direct walk, at Newmarket Green on the neighbouring Middle Park estate. However, that is not a suitable walk for anyone with mobility problems or for a parent with children.
If the CCG truly wants to tackle health inequalities in Eltham, it could start by making services more accessible in the communities where they are most needed. It is unacceptable that it is possible to walk to five different practices within ten minutes in the most affluent area of my constituency, while the Greenwich CCG says that it cannot afford to keep a nurse-led service available on the Horn Park estate. Before its closure, the Source was dealing with over 5,000 patient visits per year, at an average cost of £26 per visit. This compares with £45 for the average cost to visit a GP, and over £80 for a visit to an A&E. These facts were completely disregarded by the GPs on the CCG when the decision to close the Source was made.
The Source was closed in 2016. Greenwich CCG’s then chief officer explained that Greenwich CCG was forced by NHS England to reduce its planned spending by £15.5 million by March 2017. Closing the Source, she claimed, would save £75,000 a year. The total CCG budget for Greenwich in 2016 was just under £370 million.
The opposition from the local community forced the CCG to hold a consultation. I attended it with my constituents as, one after another, they stated how they valued the support, advice and treatment they got from the nurses at the Source. Each and every one of them told the CCG that it took at least three weeks to get an appointment with a GP. Rather than be concerned about this fact, the CCG just told the residents of the estate that they were completely wrong about the waiting times for GP appointments.
Further misinformation was circulated by the CCG to justify its decision. It suggested that the nurses at the Source lacked the necessary qualifications to prescribe or sign prescriptions. Oxleas NHS Foundation Trust, which employed the nurses at the Source, has confirmed that this was not correct, and that the nurses were in fact qualified as independent prescribers.
The CCG’s determination to close the Source generated such overwhelming opposition that it was forced to commission a report from the Picker Institute about the use of primary care services and the Source. This report concluded that
“the Source is a highly valued service” by the local community. People were very positive about the wide range of services offered, the convenience and ease of getting an appointment, and the friendliness and approachability of the staff. The report found that local people were very concerned that local needs would not be met if the threatened closure was carried out, and that existing GP surgeries would be even more pressurised as a result. The report also found that GPs themselves recognised the value of the Source in relieving the pressure on their practices.
The report quotes a local resident saying:
“When you need to see a practice nurse quickly at my GP surgery, they just say—go to The Source”.
Another resident said:
“Receptionists are the ones sending people to the Source”.
Another said that
“within Sherard Road surgery there are posters up signposting people to attend the Source”.
In fact, most GP surgeries in the area had posters advising people to use the Source. The report also found that ease of access and the ability to be seen on the day were very popular with local people, especially those with young children and the elderly. The Horn Park estate has many elderly and vulnerable residents. It is among the 30% most deprived areas in England for income deprivation affecting older people, according to the 2015 indices of deprivation. One resident explained:
“As a carer I find it easier to get my mother to the Source in her wheelchair than taking her all the way to Eltham on and off buses as I do not drive.”
Many residents complained of having to wait three weeks for a GP appointment.
The Picker Institute took a month to compile its report, which was published in September 2016. It clearly showed that the Source was a highly valuable local facility, providing a vital service for local people, but that was not what the CCG wanted to hear. The day before the Picker report was published, it confirmed its decision to close the Source without even bothering to wait for the results of the consultation. The CCG announced the immediate closure of the Source and stripped all of the equipment out of the building.
In its 2016-17 annual report, the CCG acknowledged that
“as commissioners we have ambitious aspirations to put patients, carers and local people of Greenwich at the heart of our commissioning. We recognise that we have fallen short of our aspirations this year, especially on some of our work to reduce our expenditure as part of the Quality, Innovation, Prevention and Productivity programme, e.g. on decommissioning the Stroke Association and the Source as well as our plans to commission a musculoskeletal service where our consultation was very limited. We know that we still have a long way to go to improve our patient participation activity.”
The issue here is what the words mean. If that is what the CCG believes, how is it that it is not listening to patients about the Source? The CCG claimed that 80% of the work carried out by the Source fell outside the CCG’s delegated authority—for example, sexual health. It said that the three nearest GPs in Greenwich offer nurse-led services and encourage patient participation in the same way as the Source. It said:
“There are also pharmacists close by.”
None of that was accurate.
In 2016, NHS England and the CCG finally acknowledged the healthcare needs of the estate and the harm that the closure of the Source would cause. Moreover, the CCG recognised that Horn Park should be
“considered as an exceptional case”, because of the
“inaccessibility of general medical services for this deprived community, isolated as it is by its unique geographical location”.
While opening a new branch surgery was
“not in alignment with the GP Five Year Forward View or the Greenwich CCG Estates Strategy, with their direction of travel towards larger and more sustainable general practices”, this was not, according to the report,
“sufficient reason to set aside” the accessibility issues. That is the conclusion of the South East London Commissioning Partnership Group.
I also want to draw the attention of the Minister to a couple of reports that bear out the case for the Source. The Primary Care Workforce Commission found that nurse-led surgeries could mitigate the effects of GP shortages, helping
“address workload issues, improve the patient experience and sometimes deliver savings.”
That was published in 2015. In 2010, the King’s Fund talked about those surgeries supporting the value of continuity of care and patient experience showing improved patient outcomes and job satisfaction and professional development of the staff involved. It pointed to the fact that the quality of the service that the Source provided not only improved the health outcomes for the patients who use it, but gave greater job satisfaction, which, in turn, fed back as a valued service that the patients enjoyed. I can vouch for the committed staff who ran the Source and pay tribute to the excellent relationship that it had with the local community. This is how local health services should be delivered.
Since the closure, I have continued to receive complaints from residents on the estate about poor access to health services. In response, I recently consulted with local residents. We delivered a survey and introductory letter to every door on the estate that was on the electoral register—991 in total. We asked people either to complete the paper copy and return it to our freepost address or to complete it online, and we received over 200 responses, which is a response rate of over 20%. I am sure that the Minister will acknowledge that that is a very high response rate for a campaign of this sort. I also organised a petition calling for the Source to be reopened in Horn Park that has so far garnered nearly 700 signatures. Somewhere in the region of 900 local people have called for the centre to be reopened. Given that 1,964 people in Horn Park are on the electoral register, this means that something in the region of 45% of all adults on the estate have put their names forward to support this campaign.
The survey received 201 completed responses and 690 individuals have signed a petition calling for the Source to be reopened. Some 98% of respondents agreed that the Source must be reopened, 85% of respondents that had used the Source now find it more difficult to access health services, and 80% of respondents who had previously used the Source now rely on their GP to access the services previously provided by the Source. Over half—53%—of those who indicated how they used the Source accessed four or more different services at the centre. Some of the comments from the survey speak loudly in favour of reopening the service. Those remarks included:
“Advice close to home. If unwell no need to travel into Eltham for GPs getting an appointment can take a few weeks”,
“Reopened Source should provide all of the previous services (it can now take up to three weeks for a GP appointment)”,
“I would be happy with any walk-in service” and
“Reopen the Source. Older people really need it”.
We need more facilities like the Source, not fewer.
On Second Reading of the Health and Social Care Bill, Andrew Lansley said, in response to Andrew George, the former MP for St Ives:
“He will see that, in the Bill, a specific duty is placed on the commissioning board and each commissioning consortium to reduce inequalities in access to health care. He will see also that, through the Bill, we will strengthen accountability where major service change takes place, because it will require not only the agreement of the commissioning consortium, representing as it were the professional view, but the endorsement of the health and wellbeing board, which includes direct, local, democratic accountability.”—[Official Report, 31 January 2011;
Vol. 522, c. 610.]
The health and wellbeing board of the Borough of Greenwich is in no doubt that the Source should reopen. I pay tribute to the leader of the council, Danny Thorpe, who has committed to keeping the premises available so that we can do just that.
Reinstating the Source would address many of the objectives raised in the NHS plan such as staying healthy, ageing well, tackling clinical priorities and enabling improvement. It would also align with priorities in the Greenwich joint strategic needs assessment and would put tackling health inequalities back at the heart of this very isolated community. The CCG has acknowledged that Horn Park has “unique geographical characteristics”, and should be considered “as an exceptional case” because of the
“inaccessibility of general medical services”.
It accepts that there is a “substantial case” to treat it
“as an exception to the current direction of travel towards larger practices.”
The distances to local GPs were described by the CCG in 2016 as
“a manageable distance (around a mile or less)”, but this is not the reality, and 85% of respondents who had used the Source said that they found it more difficult to access the health service after the centre’s closure. How is that improving healthcare? Forty-five per cent. of people on the estate have expressed support for it reopening. How is this local accountability? How is it possible to continue to ignore local residents and the health and wellbeing board about reopening the Source?
The Government claim to be putting £20 billion into the national health service. Surely some money can be found for this community that can go directly to delivering the health outcomes that the Government say they want to achieve.
In wishing the Minister a happy Christmas and a safe journey home, I ask her to join me in making a new year’s resolution to press upon Greenwich CCG that it should reopen the Source and restore the health services that the community on Horn Park estate in my constituency so desperately needs.
Caroline Dinenage Minister of State (Department of Health and Social Care): I thank Clive Efford for securing this important debate and for the characteristically strong and comprehensive way in which he has brought this matter to the House’s attention. He always stands up for his constituents, and this evening is no exception.
This Government are committed to providing high-quality services, commissioned by clinical commissioning groups and NHS England on a local, regional and national basis. Ultimately, we want to continually improve health outcomes for individuals, communities and society as a whole. We believe that GPs, working with other healthcare professionals, are best placed to co-ordinate the commissioning of high-quality care for their local patients.
The hon. Gentleman spoke about the Source in Horn Park with great knowledge. I totally recognise his concerns about the decommissioning of the drop-in centre in 2016, and I understand the importance of people having access to services near their homes. From what he says, it sounds like this service was well valued and well used, and the location of the estate poses unique challenges to people being able to access the services they need. Equally, that is always balanced against the provision of the right services of the best possible quality. My understanding from the CCG is that its decision to decommission the Source was part of a range of actions taken to ensure that it continued to make high-quality services available to the residents of Horn Park and reduce duplication. Greenwich CCG says that, since closing the Source, it has expanded the range of services available to residents of Horn Park. That includes opening a GP access hub clinic at Eltham Community Hospital, which is located within 2 miles of Horn Park. The GP access hub is open seven days a week, with appointments available from 8 am to 8 pm on weekends and on weekday evenings until 8 pm. Patients can book appointments through any Greenwich GP at a convenient time that suits them. Overall, the CCG says that it provides an improved quality of service for local residents. Unlike those seen at the Source, patients who attend that hub will be seen by a Greenwich GP who has access to patient records. The GP will have vital information on long-term conditions, allergies and vaccinations, improving the quality and safety of care.
It should be noted that Eltham Community Hospital already offers a broad range of high-quality services to the people of Greenwich, including walk-in blood tests and walk-in X-rays. It also provides public health services, including long-term contraception and help with smoking cessation. Alongside that, we are always keen to promote local pharmacies, which are on hand for a range of services, including advice on various issues and flu vaccinations free of charge, but I note that the pharmacy on Horn Park estate has also shut.
I understand the hon. Gentleman’s position. The Source was a much-valued local facility, and there are always concerns when a well-used and well-loved facility closes and clinicians decide it is time to move to a different model, although it is right that decisions about local health provision should be made at a local level. I understand his concerns about access to services. The CCG informs me that a local bus service—the B15—connects Horn Park estate with all three Greenwich GP practices and Eltham Community Hospital.
I have heard the hon. Gentleman’s concerns about how the CCG has engaged with local residents and how it did—or, in fact, did not— listen to their views. I would like to be very clear that the Department does expect commissioners to engage properly with their communities before making any decisions on this level of service change. I am pleased to hear that the CCG has now agreed to facilitate and promote a further meeting on Horn Park in January 2019 with the hon. Gentleman and with ward councillors. I hope that that will be a good opportunity for him to raise what sound like some very valid concerns and to seek alternative options to present the evidence that he has collected in his petition and his survey. I very much look forward to hearing the outcome of that meeting and I hope that they will be positive for his area.
More generally, on 21 November, the Prime Minister announced £3.5 billion of funding for primary and community health care a year, in real terms, by 2023-24 under the long-term plan for the NHS. She also committed to grow spending on primary and community healthcare as an overall share of the NHS budget. As part of the development of this plan, we will be talking to system leaders, patients and other experts to understand how we can overcome certain challenges, like the one that the hon. Gentleman has mentioned, in a sustainable and positive way. In the meantime, I do very much recognise his concerns and thank him very much for bringing them to our attention. I hope that his meeting with the local CCG proves to be fruitful and very much look forward to hearing its outcome.
As the last speaker from this Dispatch Box this year, Madam Deputy Speaker, may I take this chance to wish you, your team, the Clerks, staff and security a very merry Christmas
Eleanor Laing Deputy Speaker (First Deputy Chairman of Ways and Means): I am sorry to stop the hon. Lady when she is giving good wishes, but I think the hon. Gentleman might like to intervene. He does not have a right to speak again, but I am sure that the Minister will give way if he wishes to intervene.
Clive Efford Labour, Eltham: Yes, just briefly. I would like to stress one point. Horn Park is an extreme example of how health services have moved away from the most deprived communities. There is an issue about accessing health services. These are the communities that are most distressed and most in need of having direct access to those services. If the Minister ever has an opportunity to talk to Greenwich CCG, will she bear that in mind when she does so and draw it to its attention? I think we could improve our health outcomes a great deal if we were to address that issue.
I wish all those who serve us here in the House a very happy Christmas.
Caroline Dinenage Minister of State (Department of Health and Social Care): The hon. Gentleman makes an excellent point, and I will of course raise it in any conversation that I do have with Greenwich CCG. He is absolutely right to say that we should be doing everything we can to close the health inequalities that people experience up and down our country.
May I, Madam Deputy Speaker, wish you a very merry Christmas and a happy, healthy and peaceful new year?