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THIRTEENTH VOLUME OF SESSION 2002–2003House of Commons

Tuesday 3 June 2003

The House met at half-past Two o'clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Accident and Emergency Services

1. Andrew George (St. Ives): What advice he has given to hospital trusts in respect of measuring the 2004 accident and emergency four-hour wait targets. [116524]

The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): We have issued detailed guidance on how to measure the number of patients attending accident and emergency departments, and the number of those patients seen, treated and admitted or discharged in four hours or less from arrival. All trusts with an A and E department are required to measure and report these numbers.

Andrew George : But patients are no better off for being treated in other parts of the hospital while being taken off the four-hour wait times, and they are still being treated on trolleys. The recent BMA survey

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showed that both before and after the monitoring period in March, A and E departments met much lower thresholds. Doctors are worried that the process is distorting clinical priorities. Does not the Minister share my concern that hospital trust administrators are finding ever more inventive ways of treating targets rather than patients?

Mr. Lammy: No, I do not. The hon. Gentleman knows that the Royal Cornwall hospital, part of his local trust, is taking positive steps towards the A and E target and exceeding it, because of the new medical assessment unit that is in place and because of the £2 million that the trust has put in to establish a new ward. People should not wait longer than four hours in our emergency departments. His trust and trusts around the country are making tremendous progress on the target that we set for the end of 2004.

Judy Mallaber (Amber Valley): In an emergency, a four-hour wait for a liver to turn up for a transplant can be too long. Will my hon. Friend ask the Crown Prosecution Service to stop the prosecution against a senior ambulance driver for ferrying a liver, and will he consider the possibility of amending the law to exempt transplant vehicles?

Mr. Lammy: I have sympathy for my hon. Friend's constituent. Clearly, the case is before the court and it would be wrong of me to comment on it at the Dispatch Box. We wait to see what determinations are made.

Dr. Evan Harris (Oxford, West and Abingdon): Is not the Minister embarrassed about the number of trusts that are forced to cheat to meet the target? Is he not concerned that the British Medical Association survey showed that a majority of respondents in A and E felt that the measures taken

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Does not that make the target a sham, undermine confidence in statistics, undermine the Government's credibility, and involve the distortion of clinical priorities and resource allocation? Should he not stop it now?

Mr. Lammy: The hon. Gentleman knows that the BMA surveyed only 30 per cent. of its members. Only the Liberal Democrats could think that that was a majority. It is not a majority, and indeed the BMA did not survey all trusts. There has been tremendous performance towards the A and E target that we set for the end of next year, because of the hard work, dedication, innovation and commitment of nurses and doctors in our A and E departments across the country. There has been investment and the target has focused and concentrated minds. The hon. Gentleman should make a distinction between the extra resources and capacity that go into trusts to achieve that milestone and those targets, and the fiddling, which is a disgraceful accusation to make of nurses and doctors across the country.

Mr. David Hinchliffe (Wakefield): My hon. Friend will be aware that A and E services have been monitored over many years by community health councils, which are due to abolished at the end of August. Could he explain to the House why CHC staff received a letter this weekend indicating that they will not be made redundant within the three-month period as they expected, and what the statement that the Department is to make later this week will tell us about the future of CHCs and their replacement bodies?

Mr. Lammy: My hon. Friend is right that by independent monitoring, CHC staff made a great contribution to our A and E departments through casualty watch. There are on-going discussions with the Association of Community Health Councils for England and Wales and CHC members about that. I shall make a statement in due course about the issues that my hon. Friend raises.

Dr. Liam Fox (Woodspring): The Minister must accept that the entire monitoring exercise on A and E was a charade. The hospitals knew when they were to be measured, and they knew that they had to meet the Government's targets or they would be punished, because this is the "Targets R Us" Government. More importantly, the majority of doctors—not just those in the BMA—have said that the waiting time for those with more serious conditions went up during the monitoring period, and that operations were not scheduled at all or were cancelled. In effect, patients suffered so that Ministers could take credit. What does that say about the moral foundations of the Government's policy?

Mr. Lammy: The milestone focuses minds. It means that hospitals across the country put in investment, resources and innovation to ensure that people are waiting no longer than four hours in our A and E departments. Does the hon. Gentleman want to return to the situation under the Tories, in which people were

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waiting six, seven, eight or nine hours in our A and E departments? Does he want to return to trolley waits in our A and E departments lasting 24 or 36 hours? Of course not. When he quotes the BMA, he is being selective. The chairman of the BMA's A and E committee said:

and said that that is clearly dependent on continuing staffing levels. That is because of the investment that the Government are putting in. The hon. Gentleman knows that and he should support our A and E doctors and nurses, not seek to undermine them.

Dr. Fox: What fantasy is this—the idea that no patients are waiting more than four hours? Simply because the Government fiddle a survey, it does not mean that that is what is happening in the real world. In the real world, extra staff were taken on, staff were asked to work longer shifts and patients were shifted from one part of the system to another. It is not us who are undermining the staff, but the Government, with their constant interference and imposition of targets on them. The targets are now the only thing that matters, irrespective of their effects on doctors, nurses or patients in the system, and no matter what the distortions of clinical priorities. As long as Ministers are kept happy, that is the main thing. We have seen the waiting list figures fiddled and the star ratings distorted, and while the Prime Minister struggles with his 45 minutes to Armageddon and the Chancellor plays fantasy economic growth, the Secretary of State is doctoring the casualty figures. Is it any wonder that in this country it is not only Cabinet Ministers who feel that they are being duped?

Mr. Lammy: It was a milestone set for the end of March. That is very straightforward. The target is for the end of the year, next year. There has been improvement month on month in our A and E departments since September. As to the hon. Gentleman's suggestion that that figure for the end of March was not sustainable, we saw average improvement in April as well.

Andrew Mackinlay (Thurrock): Will the Minister reflect on the fact that, if we are trying to ensure sensible use of A and E services and maximise throughput, the corollary is that minor injuries units must be effective? Like many hon. Members, I am concerned that minor injuries units that are seen, rightly or wrongly, as a substitute for some withdrawn A and E services, should have the maximum availability in terms of hours. Will he please address that issue and, in particular, consider the Orsett hospital in Thurrock, where the minor injuries unit is not open to a sufficient extent in terms of compensation for my constituents?

Mr. Lammy: I shall undertake to do that. My hon. Friend will know that minor injuries units and walk-in centres make a tremendous contribution to emergency services and should sit alongside mainstream A and E services, medical assessment units, clinical decision units and a lot of other initiatives to ensure a quick throughput in our A and E departments and across the board.

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