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David Wright (Telford) (Lab): I understand the hon. Gentleman’s point about surge capacity in urgent care, but may I return him to the wider point about primary care services? They are critical, because primary care services in the community diminish the number of people presenting at A and E. Does he support extended
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GP opening hours and programmes for polyclinics? I am just trying to clarify the situation. Does he support initiatives to provide GP-led health care services and expand them in areas whose GP services are under-resourced? I am not talking about urgent care centres; I am trying to define whether Conservative Front Benchers support programmes to increase GP and walk-in services in communities.

Mr. Lansley: We are all very concerned to have better access to primary care. The Commonwealth Fund, which Ministers are keen on quoting, published a report last year stating that of the countries that they examined in the survey that Ministers rely on, access to primary care was worst in the United Kingdom. It stated, for example, that out-of-hours evening and weekend access to primary care was available to 60 per cent. of people in this country, compared with 93 per cent. in Germany. Those figures were self-reported, and there is a big gap between where we are and where we ought to be. A lot of things contribute to that gap, but the central part of it is out-of-hours services.

The Government focus on the idea that what really matters is GPs sitting in their surgeries dealing with routine appointments at half-past 7 on a Thursday evening, as if that were the answer. However, they have implemented an out-of-hours GP contract that has had the effect of substantially diminishing access to primary care in the evening, at night and at weekends. It is no surprise that although about 14 per cent. of A and E attendances generally occur on each day of the week, the figure is about 16 per cent. on a Monday. We can therefore see that there is a substantial Monday morning increment in the demand on A and E departments. All the reports that emergency departments make to us suggest that that is a consequence of the poor access to primary care over weekends, which the Government are doing nothing to solve.

Alistair Burt (North-East Bedfordshire) (Con): Will my hon. Friend give way?

Mr. Lansley: I shall give way one more time and then I must make some progress, because I do not want to take up too much time.

Alistair Burt: I am grateful to my hon. Friend, who has been extremely generous in giving time to colleagues. Before he leaves the issue of time pressures in the health service, I can confirm, from visiting Bedford hospital over the Christmas period, the pressures caused by the implications of the working time directive. Does he share my bewilderment as to why Labour MEPs did not vote to continue Britain’s opt-out from the working time directive, knowing the implications for the health service and the problems that it would cause?

Mr. Lansley: My hon. Friend makes a vital point. It is astonishing that Labour MEPs would not adhere even to their own Government’s policy. That came after the Government’s presidency of the European Council, when they were unable to deliver the required changes to the directive. A compromise was agreed in the Council of Ministers, but the Government appear incapable of getting it through the European Parliament. It is outrageous that British MEPs should vote in a way that damages the prospects of delivering care in our NHS.

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In the light of all the pressure on A and E departments, we have to ensure that they are not downgraded or closed unless what is done is evidence-based. I know that Ministers will say that because some patients need to be referred to specialist centres, such as those for major trauma, paediatric intensive care, severe head injuries, heart attacks and strokes, all patients with severe illnesses or injuries should therefore go to a regional specialist centre. The evidence does not support that. For example, the Sheffield study in the Journal of Emergency Medicine, published in 2007, concluded that increased journey distance to hospital appeared to be associated with an increased risk of mortality, the strongest association being for patients with respiratory emergencies. The study did not include cardiac arrests.

The argument is clear for an understanding that some patients will bypass their local emergency departments and go to a specialist centre, particularly those in blue-light ambulances. Let us contemplate major trauma. It is very important to have regional trauma centres, and we need the trauma network to be developed in that way. We saw in a report published in November 2007 that less than half the patients suffering major trauma received the best standard of care. That was according to the national confidential inquiry. The report called for regional planning for trauma networks, but what has been the Government’s response so far? A Minister in the House of Lords said that they were considering appointing another tsar to take on the task. We are more than a year on, and the Darzi review provided plenty of opportunity for something serious to be done about the problem, and for regional work to make something happen—but that simply has not happened.

We have been fighting accident and emergency reconfigurations. I give credit to my colleagues, because in Surrey and Sussex, for example, they have seen off plans that would have substantially undermined local capacity to offer emergency services. They have been fighting such plans elsewhere, for example in Hertfordshire, but I am afraid that they do not seem to have won so far in places such as Hemel Hempstead and Welwyn. I promise my colleagues, the House and the public that we, when in a government, will focus on ensuring that capacity is in place for the emergency services, and on not making accident and emergency reconfigurations unless they are backed by the decisions of local commissioners, such as the GPs who look after patients, and by clinical evidence of need. We will operate on that basis, and where necessary we will put a stop to misguided reconfiguration proposals.

Mrs. Ann Cryer (Keighley) (Lab): The hon. Member for Shipley (Philip Davies), who is my MP, spoke in glowing terms about Bradford royal infirmary and Airedale hospital. I have frequently been a patient at the BRI, and Airedale hospital is in my constituency. The hon. Member for South Cambridgeshire (Mr. Lansley) is talking about outrageous this and outrageous that, but he is not offering solutions for one of the most outrageous occurrences in accident and emergency departments: the treatment of doctors, nurses and ancillary workers by members of the public who go in for treatment under the influence of either drink or drugs. On some occasions such patients are quite violent, which is truly outrageous. Does the hon. Gentleman have some magic solution to that? I do not think that there is one.

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Mr. Lansley: I understand the hon. Lady’s point, but I think that she does us a disservice. My hon. Friend the Member for Hemel Hempstead (Mike Penning), not least, has made clear our determination to pursue prosecutions. To my recollection, there are something like 55,000 assaults a year on NHS staff, less than one in 1,000 of which leads to a prosecution. What is the point of putting up notices across NHS buildings saying that there will be zero tolerance of assaults on NHS staff if people know that in practice, those who commit exactly that offence will not be prosecuted?

We make it clear in our motion that we want an urgent care strategy. The Government have promised that; they held a consultation in October 2006 and published the responses six months later. Two years on, they have not published a strategy. They said that the matter would be dealt with in the Darzi review, but the final Darzi report contains two references to urgent care, which are essentially nothing more than references to the single telephone number that I have already talked about. Where, then, is the urgent care strategy that is required? Everywhere I go across the country, people are looking for urgent care networks and for a better structure of urgent care that better knits together A and E, walk-in centres, out-of-hours services, ambulance services and NHS Direct, and presents seamless joined-up care for patients. It is vital that we achieve that.

I thank the Government because they have accepted the first part of our motion in their amendment, and I appreciate that. Indeed, they have expressed their recognition of the work of community first responders. In some parts of the country, such as Cheshire, that is not reflected in the behaviour of the ambulance service. Community first responders in rural areas make a vital contribution to response times, especially category B response times, but their achievement does not appear to be recognised. However, I appreciate the Government’s approach to that.

Despite that approach, the Government have gone on to delete a great deal that is necessary in the motion and replace it with some deeply flawed text. They persist with the idea that improvements in primary care and access to GPs is a substitute for access to emergency departments and emergency care. That is not the point, as the College of Emergency Medicine makes clear. It stated:

“Disingenuous” is not a word that I would normally apply to the Secretary of State. The idea probably emanated from the Minister of State, the hon. Member for Exeter (Mr. Bradshaw).

I hope that we have shown that we appreciate NHS staff who work in emergency care. I think that we show that we appreciate them if we listen to them. They need a major trauma network, but the Government are letting action on the national confidential inquiry report drift. The urgent care strategy and the single number seems to have been delayed and delayed, and the Government’s assumption that patients will not turn up at accident and emergency has been proved false and—worse—dangerous. With beds being cut and A and E departments downgraded, the capacity to deal with surges in demand is being undermined. The evidence from the College of Emergency Medicine about A and E reconfigurations,
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which was published in December, is being ignored and the Government persist with their plans for urgent care centres in place of emergency departments, although the case for that is clinically unproven.

Emergency departments are central to the emergency care system. Instead of ignoring the views of emergency consultants and pushing polyclinics as a panacea for all ills, the Government should give emergency care the support and the structure that it needs to meet the demands that it faces in future. We will listen, not lecture. We will work with the evidence, not ignore it. We will act where the Government have drifted. I commend the motion to the House.

1.12 pm

The Secretary of State for Health (Alan Johnson): I beg to move an amendment, to leave out from “appropriate” to the end of the Question and add:

I welcome the hon. Member for South Cambridgeshire (Mr. Lansley) back to his former position after the reshuffle. Indeed, I was thinking how much I would have missed him if he had gone. I genuinely believe that we can have a debate about the motion and the amendment, which would make a change, and consider some of the issues that hon. Gentleman raised. I say that because the past couple of days have put me in a jovial mood. Yesterday, in America, Obama was inaugurated and one of the priorities, which he must tackle quickly, is the terrible problems in the health service there. In America, 46 million people are uninsured and 25 million people are underinsured. Insurance premiums have increased by 90 per cent. since 2000, whereas wages have gone up by a quarter of that. Harvard university estimates that half the bankruptcies in America are caused by medical bills. Compared with that, the issues that we are discussing and the political differences between us pale into insignificance. Barack Obama and many American politicians would like to have this sort of debate rather than the central debate that they must hold quickly about how to have an American health service that fulfils the needs of its people.

Mr. Burns: Would not the Secretary of State be even happier if President Obama had adopted the more extensive health care provisions of Hillary Rodham Clinton?

Alan Johnson: Let us wait and see. The problem with the Clinton proposals—it is questionable whether they were Bill’s or Hillary’s—is that they did not emerge until the September after the January inauguration, which was probably too late because the 100 days had passed. Secondly, they sought to overhaul the whole health system, whereas Obama is trying to examine the issues that present problems rather than those that do not.

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Mr. Burns: I am sorry to say that I think that the Secretary of State is a little confused. He refers to the original proposals in 1992-93, whereas I meant the proposals on which Hillary Rodham Clinton fought the primary elections in 2007-08.

Alan Johnson: Indeed, I was referring to the original proposals, which I thought were hers as well. Let us move on to British politics.

Dr. Murrison: I am worried that the Secretary of State may be a little complacent. I do not think that President Obama will wish to emulate our outcomes for common causes of morbidity and mortality, especially stroke, which I hope the right hon. Gentleman will consider shortly. America—indeed, most of the western world—does considerably better than us on that.

Alan Johnson: I am afraid that the hon. Gentleman is wrong. America spends 16 per cent. of its wealth on the health service—[Hon. Members: “Outcomes.”] It has the poorest outcomes in the world for many health matters.

The Conservative party has crossed the Rubicon and supports a taxpayer-funded national health service, free at the point of need. The predecessors of the hon. Member for South Cambridgeshire, in the shadow Cabinet and when the Conservatives were in power, would have had a range of hon. Members sitting behind them who might have paid lip service to that but who were carefully making plans to undermine it—whether through the patient’s passport or all the other variations on that. I therefore welcome the hon. Member for South Cambridgeshire back. I am glad that he was not moved to make way for the right hon. and learned Member for Rushcliffe (Mr. Clarke)—although, if the right hon. and learned Gentleman had taken the post, the love-in with the BMA would have ended quickly, given his previous record.

The hon. Member for South Cambridgeshire recognised that we support six of the 11 points in the motion. The Opposition commend

and rightly pay tribute to NHS staff, especially given the winter that we have had. I shall say more about that shortly. The motion also

That is rather confusing, because specialist centres, especially specialist A and E and the need to ensure 24/7 cover by the very best people, form part of the debate that has gone on in the health service and I think, from his comments and propositions, that the hon. Gentleman supports that. However, the important words are “where appropriate”. Who decides whether the centres are appropriate? That is a major issue.

The motion includes three issues with which we disagree. First, it refers to the report from the College of Emergency Medicine, which is a new organisation, in its first year. We welcome its report and hope that it prospers, but we disagree with the suggestion that the clinical case for urgent care centres is unproven.

Secondly, the motion refers to the

Thirdly, it refers to a lack of urgency in addressing concerns about trauma care.

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There are a couple of neutral issues. We believe that the public should be given a more meaningful voice about the provision of local emergency services. We may disagree about the way in which that is done, and we do not agree that there has been delay in the urgent care strategy. I can understand, given the report that was produced two years ago— [Interruption.] I will deal with that shortly.

We want to hold a genuine debate about the motion and the amendment. As I said, like all Labour Members, I wholeheartedly join the hon. Member for South Cambridgeshire in acknowledging the excellent reputation of emergency and urgent care services in this country, and the dedication and commitment of NHS staff to providing an outstanding service to patients 24 hours a day, 365 days a year. I hope that he will join me in acknowledging the support that the Government have given the NHS: massive investment, doubling the number of emergency consultants, an increase of 135 per cent. in funding for ambulance services, and greater numbers of people in training, all of which lead to better, faster treatment, with greater patient satisfaction.

I hope that Opposition Members also recognise the steps that we have taken to improve the pay and conditions of staff in our emergency services. The hon. Member for South Cambridgeshire has suggested a day of celebration of nursing in this country. Given the plans of the shadow Chancellor and the Leader of the Opposition, that day might merge with the day when everyone looks back on when they had defined benefit pension contributions, because, as I understand it, while applauding the work of the 1.3 million people in the NHS, Opposition Members are also keen to attack their pensions.

Mr. Lansley: Nonsense!

Alan Johnson: The hon. Gentleman says, “Nonsense!” [ Interruption. ] Opposition Members are saying, “No, no, no!” The words of the Leader of the Opposition were that the private sector is moving from defined benefit to defined contribution schemes and that that has to be what we do in the public sector.

Mr. Lansley: That is not a quotation.

Alan Johnson: Absolutely—I did not say that it was, but that is what the Leader of the Opposition was saying. [ Interruption. ] We will get to the bottom of this before the next general election. As well as improving pay— [ Interruption. ] While we are on this point, the Leader of the Opposition has said quite clearly that there needs to be a move to defined contribution pension schemes. The hon. Gentleman can now intervene on me to say that a future Conservative Government will in no way interfere with the pension arrangements of NHS staff. I will take that intervention from him or any member of his Front-Bench team.

Mike Penning (Hemel Hempstead) (Con): Get on with it.

Alan Johnson: Ah! Well, that is very interesting.

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