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10.40 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): I congratulate the hon. Member for Northavon (Mr. Webb) on his success in securing this debate on winter pressures on the NHS in Avon. I am grateful to him for choosing that subject, because it provides me, as it provided him, with an opportunity to acknowledge the extraordinary success of the Avon health community and all its staff in coping with pressures which were undeniably extreme. There were greatly increased demands on health services. I believe that the hon. Gentleman will agree that Avon has shown by its planning and dedication that when we attempt to meet unprecedented demands, it can be done. It was done in Avon.
We must pay tribute to the staff, who have shown themselves to be extremely flexible, who were recalled and sacrificed their Christmas holidays and the millennium period. Despite the exceptional demands, those who needed care received it in Avon. I hope that the hon. Gentleman will acknowledge that.
We must acknowledge the contribution of managers and clinicians, as well as that of the nursing staff and ancillary staff, who are often forgotten. They have all played their part in those efforts.
That the NHS in Avon was under intense pressure is undeniable. In December the Avon ambulance service trust dealt with 14 per cent. more emergency responses than in the previous year, and so far this month the number of ambulance activations is 28 per cent. higher than in January last year.
Overall, on average, 254 people were admitted to hospitals per day as emergencies during the period from 27 December to 9 January, compared with 222 emergency admissions per day during the previous period. United Bristol Healthcare NHS trust admitted 726 emergencies between 26 December and 12 January, with the number of medical emergencies--an important point--showing a rise of 36 per cent. over the same period last year.
At the hon. Gentleman's local North Bristol NHS trust, too, the number of emergency admissions rose. He cited the figures. On a number of occasions the extra demand led to isolated problems, with a number of long trolley waits before admittance at United Bristol Healthcare NHS trust.
I acknowledge that the individual cases raised by the hon. Gentleman show that the service was under pressure. I appreciate the distress caused for the patients and families concerned. I in no way underestimate that distress, but it does not show that the NHS in Avon was unable to meet the demands imposed on it by the extended Christmas and millennium holidays or the influenza outbreak.
There is certainly much in the media about the pressure on critical care services--that is, intensive and high-dependency care. Although there was great pressure on those services, all Avon patients who needed intensive care received it locally. That was achieved by the
carefully planned use of theatre recovery areas and by extending high-dependency care on to general wards to enable patients to leave intensive care units.
The increase in capacity to deal with peaks in demand was provided by asking regular staff to work extra hours, as well as by using bank and agency staff. Far from being in crisis locally, the intensive care arrangements in Avon were such that the health community was able to provide assistance to other areas, as the hon. Gentleman acknowledged. It was able to take a number of patients requiring intensive care, as well as dealing with patients transferred into the area for specialist and tertiary interventions requiring intensive care afterwards.
It is further to the credit of staff, as we should acknowledge, that the NHS in Avon coped with the demand without the additional help of NHS Direct, which is available to over 60 per cent. of the population in England. I am sure that the hon. Gentleman knows that NHS Direct will be available in Avon by October this year.
I want to comment on planning, because I do not want us to believe that the system coped by accident: it coped through careful planning, which began with establishing local winter planning groups. They first met in April last year to co-ordinate health and social care services over the winter and the millennium holiday. It is important to acknowledge that, for the first time, we have pulled together health authorities, social services, NHS trusts, primary care groups, out-of-hours and deputising services, police and fire services, the voluntary and private sectors, community health councils and local authority departments. The complicated organisation of Avon health authority, which comprises 10 NHS trusts, 12 primary care groups and four unitary local authorities led to four local plans, based on the four local authority boundaries.
We must acknowledge that Avon health authority represents a tremendous success story. Its plans were assessed by the south-west regional office of the NHS executive and social care regional staff who considered them comprehensive and robust. The millennium executive team visited the local winter planning group in October. It identified some points that required further work, but it generally agreed with the regional office's assessment of the plans
The planning has built on the record extra resources that the Government made available to the NHS. I shall explain that in more detail. Unlike previous years, when money was provided late in the day, in 1999 planning started early, and the resources for contingency arrangements were made available early. In the comprehensive spending review in July 1998, we made additional resources available to the NHS. We made a three-year commitment, which allows for planning. Overall, it was the biggest injection of cash in the history of the NHS.
Avon health authority received £582.5 million, which represents a cash increase of £36.5 million, or 6.69 per cent. Next year, Avon will receive £629.4 million, a cash increase of £40.7 million. At 6.9 per cent., that represents the highest growth in the south-west region.
Mr. Webb:
When I spoke to the chair of my primary health group this week, he said that while the Government talk about growth money, it is eaten up by, for example,
Ms Stuart:
Not quite. The extra money is being provided, but in a targeted manner. Some extra money was for local planning. I shall discuss the implementation of such planning shortly. However, I want to highlight the fact that we are considering not simply extra money but modernising the service, changing some of the practices and the ways in which we use beds and deal with admissions. Avon has been excellent at finding innovative ways of doing that.
Last year's total included £4.92 million from the modernisation fund, specifically targeted at waiting lists. I know that the hon. Gentleman is worried about waiting lists and that he secured an earlier Adjournment debate on the subject. Of the additional £5.58 million that the health authority received, funding was targeted at, for example, staff recruitment and retention--again, that paid off--mental health, cancer waiting times and nurse prescribing.
However, we must not neglect the fabric of the NHS. As part of the largest capital programme in the history of the NHS, it is forecast that the total capital spend in Avon will be more than £38.5 million. That includes £2.6 million from the modernisation fund to improve the accident and emergency departments in all the major acute trusts in Avon. Avon health authority and the local trusts will have allowed for the extra spending needed to cope with the expected additional pressures when planning for winter. Making financial arrangements was part of the winter planning.
The hon. Gentleman referred to the increases awarded to nurses. Again, significant account was taken of them in the extra health allocations, which were announced recently. Although all NHS organisations in the Avon area took steps to increase their capacity to deal with winter pressures, I want to highlight the particular measures taken by the South Gloucestershire planning group, as they will be of the most concern to the hon. Gentleman's constituents. North Bristol NHS trust staffed and opened an additional 44 beds and had a further 14 on standby. Those measures included opening 18 medical beds in Elgar House at Southmead. At Frenchay hospital, the trust opened an additional ward with 17 beds to serve as an overflow facility as well as a further four medical beds on existing wards and six low-dependency beds at Blackberry Hill hospital. In addition, the trust has opened a further 62 beds this month to cope with the record number of emergency admissions.
The trust has continued its expansion of the "hospital at home" scheme and placed particular emphasis on early intervention. That has increased the scheme's capacity to take referrals from general practitioners and hospitals, reducing the need for--or cutting down the length of--hospital admissions. The health authority also made a separate non-recurring allocation of £100,000 to North Bristol NHS trust to help with winter pressures. That money has been used to provide occupational therapy, physiotherapy and home-loan equipment and to meet the extra costs of ambulance transport to assist with prompt discharge from hospitals.
The local primary care group was closely involved in planning for the winter. It put in place a number of initiatives including extra surgeries without appointments, nurse-run dressing clinics, newsletter information to patients, extra contraception clinics and influenza and pneumococcal vaccination clinics. It also planned for emergency provisions in the case of widespread utilities and systems failures. Thankfully, the last measure was not needed, but although the system failures predicted for 2000 have not happened, those plans were extremely valuable and that should be recognised.
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