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Ms Harriet Harman (Peckham): I thank the Secretary of State for his statement. On the casualty crisis,I welcome the fact that he has adopted three of the proposals in the five-point plan that I set out following his statement in January. Although he rubbished our proposals at the time, now--three months later--he says that he will monitor the problems carefully.
Will the Secretary of State please report to the House on the information that he receives from the chief executive in June and September? He says that someone will be appointed in each area to examine how local resources can best be used to address the problem and that specific attention will be paid to those people who are in hospital, but who could be cared for at home or in residential care.
We welcome all that, but the right hon. Gentleman has still failed to address two central problems in the casualty crisis. First, it is the cuts in hospital beds that leave patients waiting on trolleys in accident and emergency departments. Whatever his charters say, why can we not have a moratorium on bed closures? Secondly, there is still a shortage of accident and emergency staff. He said that health authorities must undertake work force planning, but does he plan to do anything about it?
It is hard to find words to express the sense of outrage and betrayal that everyone must feel on hearing how 10-year-old Nicholas Geldard died. The North West regional health authority inquiry team was shocked and dismayed by what happened to him. Although there are many organisational failures that the Secretary of State must address, does he acknowledge that the Geldard inquiry team concluded that, while Nicholas's life was hanging by a thread, no intensive care bed could be found for him, so he had to be taken by ambulance across the Pennines through a blizzard in the small hours of the morning?
Will the Secretary of State admit that the Geldard report confirms that it was not a one-off, tragic case, but that, every week in the north-west, children are turned away because there are no intensive care beds for them? Will he admit that the problem is not only in the north-west, but throughout the country?
Is it not the case that, having heard what happened to Nicholas Geldard, every parent in the country thought, "That could have been my child--it could have been me"? Every parent in the country will now fear that, if a child falls ill, the NHS might not be there.
Will the Secretary of State tell us how many children are turned away from intensive care units throughout the country each day? Should he not give the House that information today?
Why, when the Government trumpet patients charters for dozens of minor NHS procedures, will they not guarantee an intensive care bed for a child who is gravely ill? Does not the Secretary of State recognise that the shortage of intensive care beds means that patients face cancellations of heart operations--sometimes repeatedly? How many patients each year have operations cancelled because of the lack of intensive care beds? Is that not information that he, as Secretary of State, should know? Should he not tell the House today?
Does the right hon. Gentleman not recognise that patients waiting for transplants die because, when an organ becomes available, the operation cannot go ahead if there are no intensive care beds? Is not the final irony the fact that, although seriously ill patients are waiting for liver transplants, Leah Betts' liver could not save a life in Britain, but had to be flown to Spain?
The NHS must have the spare capacity to respond to emergencies. The Government do not understand that it is not slack in the system; it is a safety margin. Will the Secretary of State tell the House what he believes is the safe occupancy level for intensive care beds? Many operate at up to 100 per cent. occupancy. The Intensive Care Society believes that there should be an occupancy level of no more than 70 per cent. Does he agree with that?
Today, the Secretary of State says that he will publish another report in April, but have there not been numerous reports on intensive care? Eight years ago, the Association of Anaesthetists for Great Britain and Ireland produced a report entitled "Intensive Care Services: Provision for the Future".In December 1993, a report was published by the British Paediatric Association's working party on intensive care and, on behalf of the Department of Health itself, came the Metcalf McPherson report. The problem is not that there have not been enough reports; the problem has been the lack of action.
Will the Secretary of State admit that there are not enough intensive care beds, and tell us how many more he believes there should be? The Intensive Care Society says that we have only 1,500 such beds but that we need 2,000. Does the Secretary of State agree with the society?
The Secretary of State referred to high-dependency beds, but will he admit that the development of such beds, although welcome, does not solve the problem of too few intensive care beds? Why does he fail to acknowledge and tackle the shortage of specially trained intensive care nurses? That failure is a disgrace and an insult to doctors, as they are the ones who have to turn away very sick patients, knowing that it might cost those patients their lives. Doctors have to make those decisions every day, yet the Secretary of State implies that they have to do so because they are somehow mismanaging their beds. The plain fact is that there are not enough beds.
Does the Secretary of State remember that the NHS changes were the Government's response to the 1988 intensive care beds crisis? The Government imposed the internal market on the NHS, with the result that there were more managers than ever before, but the problems got worse.
Why does the Secretary of State think that providing more managers is the answer to every problem in the NHS? A sick child needs a hospital bed, not a manager. Why should anyone be turned away from intensive care
when an extra £1.5 billion is being spent on managers? Does the Secretary of State recognise that this is a question not of technicalities but of fundamental principle--the principle that, in an emergency, one can count on the NHS?
We cannot accept that a critically ill person whose life could be saved should be turned away. This more than anything else symbolises the Tories' failure on the NHS--if they cannot run the emergency service, how can the NHS be safe in their hands? Why does not the Secretary of State understand that it is not a matter for managerial adjustment, fiddled figures or more reports? Now is the time for him to face up squarely to the depth of the crisis and take action. If he cannot, he should not be running the NHS.
Mr. Dorrell:
The final point that the hon. Member for Peckham (Ms Harman) made in her long tirade was very close to the final point that I made. I quoted the report on the availability of paediatric intensive care beds and said:
That is precisely why I have set up a process that will demonstrate publicly by the end of April the delivery of our targets for the availability of paediatric intensive care beds. There is no doubt about the need now to deliver a proper level of paediatric intensive bed space. It will be done and accounted for to the House by the end of April.
The hon. Lady began by welcoming a number of the announcements I made about the emergency services.I am grateful to her for that. She asked what was being done about staff in accident and emergency departments. She might like to know that, since 1990--this information is not based on some politically convenient figure--there has been an increase in the number of doctors and nurses committed to accident and emergency care. That shows that we have been increasing staffing resources, and we shall continue to ensure that staffing resources available to accident and emergency departments are sufficient.
The hon. Lady was confidently expecting at the end of last year that there was going to be a shortage of junior doctors at 1 February this year, when the rotationscame through the accident and emergency departments.My hon. Friend the Minister for Health took action just before Christmas to ensure that there would be sufficient junior doctors to man accident and emergency departments.
Mr. Dorrell:
The hon. Lady says that there are not, but we have conducted a census of accident and emergency departments. Senior house officer vacancies are currently running at 4.5 per cent., which does not imply a service with a massive inability to recruit.
I am grateful to the hon. Lady for her welcome for the steps we are taking to strengthen the emergency services and to ensure that the lessons which must be learned from this winter's experience are learned. The hon. Lady was keen to argue that we need more intensive care beds.
If it were true that we had 1,500 intensive care beds in the health service, the hon. Lady would be right, but we have 2,500 intensive care beds--as I published in a parliamentary answer to her predecessor--including beds that provide coronary care. Every definition of intensive care facilities includes those that are used for planned
surgery need as well as those that meet emergency need. That is precisely why I said in my statement that it is important to distinguish the emergency services from the intensive care service, which meets both emergency and planned need. We have 2,500 intensive care beds in the health service.
"the time for talk and discussion about this issue . . . is over".
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