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21 Jan 2009 : Column 759

Opposition Day

[1st Allotted Day]

Emergency Care

Mr. Speaker: I inform the House that I have selected the amendment in the name of the Prime Minister.

12.39 pm

Mr. Andrew Lansley (South Cambridgeshire) (Con): I beg to move,

In this, the first Opposition day debate of this Session, we have the opportunity to reiterate our support for the national health service, which is our No. 1 priority and that of the people of this country. Even in the midst of economic crisis, we must be aware of how vital it is that all of us can continue to call on the NHS when we need it, and to know that its staff will respond with the capacity required, as well as the commitment and compassion that they have always shown in treating us as patients when we go to hospital or otherwise access the NHS. That is never more necessary than when we need emergency care for ourselves or for our families. Over recent weeks, we have seen great pressures on the service, with cold weather; widespread infections; wards closed by norovirus; an influenza outbreak; staff, both as a result of that and for other reasons, falling sick; accident and emergency departments that have been stressed 24/7; and, consequentially, elective operations being cancelled.

Throughout all that, doctors, nurses and other NHS staff have coped and cared. I therefore want to start by thanking NHS staff, as many Members will have done personally in their constituencies. Right at the turn of the new year, I had an opportunity to visit Ipswich hospital and to speak directly to the staff working in the A and E department there, to thank them and to hear from them about all the pressures that I mentioned. To give the House an illustration of what this has meant for staff, I note that Sally Ferguson, who is chief nurse at Bradford Royal infirmary, said:

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We should not forget ambulance staff, for whom this has been an incredibly difficult time. Let me read this quote from Rob Ashford, who is chief operating officer at west midlands ambulance service:

Philip Davies (Shipley) (Con): I am grateful to my hon. Friend for thanking the staff at Bradford royal infirmary for their hard work. I can confirm that they work incredibly hard under difficult circumstances. Will he join me in thanking the staff at Airedale general hospital, which my constituents also use, because the staff there do an equally good job?

Mr. Lansley: I am grateful to my hon. Friend and heartily endorse what he says.

Happily, it is agreed across this House that NHS staff working in emergency and urgent care services do a fabulous job. We depend on them, and over these recent weeks, in all parts of the country, they have not let us down; they have responded terrifically. That is appreciated by patients. A patient wrote to his local newspaper about staff at Leighton hospital just outside Crewe, saying:

Another patient, writing about Derbyshire Royal infirmary, said:

I could add more and more of just those kinds of commendations for NHS staff.

Mr. Simon Burns (West Chelmsford) (Con): My hon. Friend rightly, like many hon. Members, praises, thanks and congratulates nursing staff and doctors in our hospitals and throughout the NHS. Does he agree that it is equally important to mention that the other unsung heroes of the NHS are the ancillary workers who provide the nuts and bolts of the operation of A and E departments and wards in our hospitals?

Mr. Lansley: I am grateful to my hon. Friend. Staff at Broomfield hospital, which serves his constituency, will greatly appreciate his comments. I know from talking to staff across the NHS that we sometimes underestimate the contribution that is made by all its professions and ancillary staff. We simply cannot run hospitals without a wide range of staff being present in order to make it happen, particularly out of hours and at weekends. Services can slow down dramatically without ancillary services such as diagnostics, portering and cleaning, and pathology laboratories being available. They are critical to maintaining the level of service that we all hope to receive when we go into hospital.

Today, I want not only to express our thanks but to take the opportunity to make real our appreciation by understanding what the pressures experienced over recent weeks tell us about the capacity of the service, the impacts of Government policies and plans on emergency
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and urgent care services, and the need—which I express on behalf of NHS staff—for the implementation of long-overdue reforms to emergency care and its support structures.

Let me give the House an important example in relation to understanding the pressures. In London, primary care trusts have been commissioning services from hospitals based on the framework for action that was published by Lord Darzi in July 2007. It is interesting to make a comparison, in order to understand what is going on. I heard from an NHS trust in London that its accident and emergency attendances in the 11 weeks before Christmas were up 10 per cent. on the preceding 11 weeks, that the elective admissions to the hospital were 15 per cent. above the level predicted by the primary care trust, and that its A and E attendances, year on year, had gone up by nearly 10 per cent., even though the primary care trust had said that they would go down.

Lord Darzi’s report said that, over the next 10 years, the number of attendances at A and E departments in London would go down by 60 per cent. He said that 10 per cent. of patients did not need to be seen at A and E, and that 50 per cent. would be seen in the Government’s new polyclinics. Frankly, that is not happening. The number of attendances at A and E departments is going up.

Up and down the country, people in A and E departments have told me that, when it comes down to it—as it often did over Christmas and the new year—patients are not being treated in the community when they are seriously ill, or when they are just reasonably ill, if the services in the community are unable to function 24/7 to offer the necessary support. The emergency department is the provider of last resort. It cannot say no; it has to meet the demand that is placed on it.

Angela Browning (Tiverton and Honiton) (Con): There seems to be an obvious correlation between the out-of-hours doctors service and people going to A and E when they could perhaps have been treated elsewhere. Also, I believe that NHS Direct is a very good scheme but, when I used it myself, I found there to be quite a time lag between making the initial call and a nurse ringing me back, followed by a doctor ringing me back and telling me to go to an A and E department. That covered a time span of five hours. If I had not had a little medical training, which gave me the confidence to know what the problem was, I might have become nervous and whipped my husband off to A and E a lot earlier. Does my hon. Friend think that there is a problem of people going off to A and E of their own accord as a result of that time lag?

Mr. Lansley: I am grateful to my hon. Friend for making that important point. In this debate, we need to press the Government. She will note from our motion that we want the Government to introduce proposals for a new, single telephone number for NHS services. I agree that telephone access to the NHS is necessary, and that it is beneficial to patients, but we should not delude ourselves that it leads to a reduction in A and E attendances. There is no evidence that it does that, but it is an important additional means of access. However, having a single telephone number to provide direct access to ambulance services, out-of-hours services and telephone
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advice would mean that patients would not have to move from one service to another, resulting in long delays while their needs are interpreted in order to decide which service should respond. Such a single number is sorely lacking. Emergency calls should still go to 999, but it should be possible for a call to the single number to be upgraded to receive an emergency response if necessary.

We know that that is necessary, and I think that the Secretary of State would agree. We recommended it some time ago and it has been reflected in subsequent next stage reviews across the country. The Government just have to get on with it, but for some absurd reason, when they have already accepted part of our motion, they seem to have taken it out, suggesting that they are not going to do it. They should do it. The next stage review by Lord Darzi said that it would happen, but there has been no consultation by Ofcom on access to the new single number, which we need; I hope that it will be provided soon. At the same time, we need a document from the Government showing how that number can provide access not only to NHS Direct nationally, but to out-of-hours services, local services and ambulance services. If the Secretary of State wants to interrupt me now to tell me that the Government are going to make progress on a new national telephone number for accessing urgent care services, I would be happy to give way to him.

Mr. David Evennett (Bexleyheath and Crayford) (Con): My hon. Friend is making a powerful case. I would like to commend the accident and emergency staff at Queen Mary’s hospital in Sidcup, who did a tremendous job during the period that he highlighted. Is he aware that many residents in my borough, particularly the elderly, are very concerned about the future of those services because there is so much uncertainty?

Mr. Lansley: My hon. Friend reminds me that I visited Queen Mary’s in Sidcup in the autumn, when I had the opportunity to see the emergency services and maternity services proposals at work. Many people in south-east London will be concerned about emergency services because, leaving aside the geographical distribution of emergency services in the area and the question of access at normal times, they will worry about the capacity of those services to respond. That is part of the argument about A and E in London more generally. Many dramatic pressures and a lot of demand have been put on emergency services. The number of beds in hospitals in London has been cut and departments have been downgraded.

The right hon. Member for Enfield, North (Joan Ryan) will know that the Government are trying to downgrade the emergency services at Chase Farm hospital in her constituency to an urgent care centre. Just before Christmas, the College of Emergency Medicine published a document on the way forward for emergency medicine and it did not regard urgent care centres as clinically proven or consistent with the principle of patient choice. Emergency consultants in hospitals are criticising urgent care centres, so why are the Government persisting with them? I fear that we will see the same problem in Sidcup.

Tony Baldry (Banbury) (Con): It would be wrong to see the capacity challenges just as a winter issue. I have just done an analysis of capacity at the John Radcliffe
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hospital in Oxford, based on the advice that it gave to GPs on access from 1 July to 31 December last year. On average, patients in certain disciplines were being diverted away from the JR every other day because of lack of capacity. This is a year-round issue for certain disciplines, including A and E. Is not the nightmare that the full implementation of the European working time directive is coming towards us like a train down the track? It keeps people awake at night wondering how on earth our general hospitals, including hospitals as large as the JR, will manage when the directive is fully implemented.

Mr. Lansley: My hon. Friend makes an important point, which also relates to emergency services in Banbury, even though he is talking about the John Radcliffe. I visited the emergency department at John Radcliffe about three years ago, and the quality of the redesign of emergency services and the service it provided struck me as remarkably good.

The issue of capacity is important. It is possible to have a magnificent system that works for normal levels of demand, but if there are abnormal levels of demand, we need to be able to respond to such surges. That is precisely the point made by the College of Emergency Medicine. It says that capacity in emergency departments is critical and that urgent care centres, walk-in centres, minor injury units and polyclinics may all have their place, but it would be foolish to think that they can substitute for emergency departments as the hub of the emergency care system. The resilience of the NHS to surges in demand such as the one that we have seen depends critically on emergency departments having the necessary resources—even more so if we were to encounter a pandemic. It is therefore vital that they are not downgraded or closed without regard to the implications or the evidence.

Dr. Andrew Murrison (Westbury) (Con): The high-tech end of medicine is extremely important, but would my hon. Friend agree that the wholesale closure of community hospitals has put considerable pressure on accident and emergency departments? In my area, for example, health care professionals are in no doubt that the closure of community hospitals has caused an increasing number of elderly and vulnerable people to end up in casualty departments, which is exactly where they should not be in the context of their long-term treatment.

Mr. Lansley: My hon. Friend is very knowledgeable about these matters. I have discussed the issue with him and with the chairman of his primary care trust, who believes that community teams will be able to look after patients in the community and, as a consequence, avoid their admission to hospital. Let us look carefully at the experience of the past few weeks and find out whether it is possible to do that in practice. In reality, we have seen patients being admitted into hospitals all the same. I am sure that Ministers will know that many patients in hospitals have been transferred into escalation wards because of limited capacity; new capacity has to be created.

Quite often, community hospitals can provide a place to which patients can be transferred to relieve pressure on acute hospitals when demand is high, while at the same time they can provide a sort of step-up bed so that GPs can admit patients and observe them. That means
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community medical resources can be deployed through GPs to look after patients, instead of those patients having to be transferred to an acute hospital, which is the last place we would want many of them to be. Let us look at what is happening in Wiltshire, because a lot of beds have been lost in hospitals in my hon. Friend’s constituency, and I wonder what the consequences of that loss have been.

Joan Ryan (Enfield, North) (Lab): I am concerned about the selective and inaccurate way in which the hon. Gentleman is using the report to which his motion refers. I have read the report, not least because of the situation of my local hospital. He will know that the report does not help my argument, and I have my concerns about the Government’s plans for Chase Farm hospital. I make my views about the matter clear to Ministers regularly. However, my point is that I am often struck by the difference between what he says in the Chamber and what his party did when in power. If it had not been for his party putting Chase Farm hospital under the threat of closure for many, many years, Chase Farm would not be in its current situation and—

Mr. Speaker: Order. This is an intervention, not a speech. The right hon. Lady might get an opportunity to make a speech.

Mr. Lansley: Let us stay in this century shall we? The College of Emergency Medicine said in its report:

That is, however, precisely the model being pursued at Chase Farm. That model is being challenged locally by my colleagues and by the local authorities through judicial review, and it is incumbent on the Government, not least given the views presented by the College of Emergency Medicine, to call a halt. Given the pressures on London, they should reconsider whether Chase Farm should have a maintained emergency department, to meet demand.

As for what is being done by the strategic health authority in London, Ministers, in their amendment to our motion, do not seem to be responding to the pressures experienced by emergency departments in London by saying that they can help them. They are responding by calling them to a meeting, hitting them over the head and saying, “You must meet the four-hour target.” There are some excellent hospitals in London that are doing their level best to respond, and doing all that they can to treat patients as quickly as they can. It is far from helpful for them to be threatened by the strategic health authority because they are at 97.1 per cent. rather than 98 per cent. The College of Emergency Medicine has argued for a long time that in practice, a 95 per cent. target for the four-hour waiting time in accident and emergency departments is financially and clinically logical.

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