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Joan Ryan (Enfield, North) (Lab): First, let me pay tribute to the hospital in my constituency, Chase Farm hospital. It has been much mentioned in this Chamber over past years and will surely continue to be mentioned in time to come.
I was at the hospital just over two weeks ago on a Saturday afternoon with my four-year-old granddaughter, who had injured her hand. She is recovering. When one is interacting with the NHS at the point of an emergency, it really comes into its own. It is fantastic. Within five minutes of walking into the hospital, my granddaughter
was assessed and in less than two hours she was treated. She was then referred to another hospital that had a hand specialist. That is an important point, because when we talk about access to emergency departments and urgent care it is important to remember that accident and emergency departments do not deal with everything. A patient who goes into an accident and emergency department might be referred to another one or might be assessed in the ambulance by the paramedics and taken to a specialist hospital. The idea that there are not specialist hospitals or that accident and emergencies deal with everything all the time is a false assumption.
That little girl saw a hand specialist at 8.30 on a Saturday night. By the Monday morning, she had had a small operation and I am pleased to report that she is recovering well. I think that that is a model story and I do not think that it is an unusual one. I base my opinion not just on that story but on the way in which Chase Farm hospital has responded to the pressures of winter and those over the Christmas period. The staff have worked very hard. Morale is sometimes low, because of the proposals to do with the hospital, but the staff have responded magnificently in recent times to the pressures that they are under and I pay tribute to them.
I want to go back a little to the remark made by the hon. Member for South Cambridgeshire (Mr. Lansley) that we should stick in this century. I would like to point out that we are only nine years into this century, which is not a lot. The idea that history has no impact on the present or future is clearly nonsense.
In 1997, when I was elected MP for Enfield, North, through the doors of my advice surgery came many people, often elderly people, who had waited in pain, for almost two years for a hip replacement. That pain not only made the quality of their lives appalling but, even after the operation, undermined their health. Lots of people came to my surgery who had waited considerable amounts of time for cataract removal. The wait significantly affected their ability to engage in life and to be independent. I no longer have anybody coming through my surgery doors with those problems. That is not to say that nobody comes through the door with issues about the NHS, but they do not come to see me with those problems. The 18-week wait is a significant gain for the people who depend on the NHS.
All those factors affect urgent and emergency care. If people are dealt with early in the onset of any illness or disease, they are much more likely to make a good recovery and much less likely to present at an emergency department at some point in the future. The same is true if there is good, accessible, available primary care, as people are then much less likely to need to present at an accident and emergency department or to need urgent care.
In Enfield, we very much need the primary care strategy that our primary care trust is planning. I worry that the Conservative policy of deriding and undermining confidence in the notion of polyclinics will damage the ability to put in place a good primary care strategy. Let me give an example of what that strategy means to us in
Enfield. We know now that we are getting a health centre in the Enfield Lock area. Professor Sir George Alberti came to Enfield, and he said, You need an improvement in access to primary care in the north-east of your constituency. That is now happening. The plan is that we are to have a big health centre with an independent living facility attached to a community school. It will provide a first-class service to the people of Enfield Lock, Enfield Highway and north-east Enfield. That will reduce the number of people who have to leave the area and go to accident and emergency centres with problems that local GPs or walk-in centres can deal with. The health centre will mean that people have much more access to local primary care.
The primary care strategy will have another impact in Enfield, North. Although it will not be built in the next two or three years, a polyclinic is planned for the town centre. Many GPs practise in that area, so it is nonsense to say that people will have to travel vast distances to get to their doctor if a polyclinic is set up. It is a densely populated, town-centre area, so there is no need to fear that. The polyclinic will have longer opening hours, and people will have much greater access to a greater range of specialist GPs. Moreover, the centres technological diagnostic resources will mean that people will not have to wait for a hospital appointment to get the same service.
The primary care strategy for Enfield, North means that there will be a polyclinic in the town centre and a health centre in north-east Enfield. Add to that the fact that people will have access to the Forest road health centre just over the border in Edmonton and to the walk-in centre at the North Middlesex hospital, and it is clear that the strategy will be a huge improvement.
The result will be that people will have access to their local health centre and then, if they need it, they will be able to go to the much larger health centre set-up that is sometimes known as a polyclinic. Beyond that, they will have the walk-in centres, local accident and emergency facilities, and the trauma centre provided by the North Middlesex hospital. At local level, the primary care strategy will really serve the needs of people living in Enfield. I worry that some of the propaganda pumped out by the Opposition encourages people to fear any kind of change at all. It undermines their confidence in the excellent service provided by the NHS, and in what is very necessary change to primary care provision.
I want to say a few words about Chase Farm hospital. I am pleased to have the opportunity to do so as I have spoken about it many times, both in this Chamber and in Westminster Hall. Indeed, the hon. Member for Enfield, Southgate (Mr. Burrowes) had an Adjournment debate on the issue only last week. I attended and intervened, and my hon. Friend the Minister is well aware of my views.
I do not oppose change, but it is important that local people are listened to and, without exception, the people and elected representatives in my constituency do not support the proposed changes at Chase Farm hospital. However, that needs to be put in context, and to that end the past is important once again. For the first time in 20 years, the people in my area can be confident that a hospital will be maintained on the Chase Farm site. We have managed to achieve some real gains, including
ensuring a secure future for the hospital, and I advise anyone who doubts thatincluding Opposition Membersto compare local Conservative literature with the hospital trusts original proposals. One of those proposals was to close the hospital altogether, so it is clear that our success in saving it is a real achievement.
The second gain is that there will be an expansion in planned surgery at Chase Farm hospital. That protects the heart of the hospitalits wards and operating theatresand so is very important to people in Enfield, especially those elderly people who are much more likely to need orthopaedic and other operations. It is very important that they be able to go into hospital locally.
We have also gained some local accident and emergency services. The original proposals put forward what might be called a hot-cold model, under which Chase Farm would provide only electivethat is, plannedsurgery and nothing else. We have managed to get rid of that proposal, which is a gain in itself. In addition, and with the support of the Minister, we have also managed to achieve agreement about having a midwife-led birthing unit, so that Enfield babies can continue to be born at Chase Farm.
I am not in favour of any reduction of service at Chase Farm hospital, but it is important to understand the context. I shall continue to campaign and do everything that I can to maintain the present level of service.
The motion refers to a report from the College of Emergency Medicine, but the interpretation offered by the hon. Member for South Cambridgeshire was inaccurate. In an intervention, he spoke about distances, but in that respect the report does not help the argument about Chase Farm hospital. I have asked the Minister to look at the matter again, given the significant increases in birth rate and the elderly population. The report notes:
There is no single solution to the reorganisation of emergency care. In urban areas where
are close together (less than 10 km apart) there may be advantages to amalgamating services.
That would not help our argument, as Chase Farm hospital is 9.43 km from North Middlesex hospital, and 10.48 km from Barnet hospital. Therefore, the report does not make the across-the-board point that the hon. Gentleman imagines. It might be more applicable in rural areas, but I do not know, as I do not represent a rural area. It certainly has very little application in my area.
The report says that each case must be taken on its merits. I agree: I have presented the case for Chase Farm hospital and will continue to do so, but I will not accept that the NHS is almost no better than it was in 1997, as it has improved significantly. There has been a huge step change, and it is time that people gave that more credit, rather than always talking the service down and looking for the negative.
Mr. Simon Burns (West Chelmsford) (Con): I am delighted that we have the opportunity today to debate emergency and urgent care in the NHS. I fully support the motion tabled by my right hon. Friend the Leader of the Opposition and our Front-Bench team, butperhaps unusuallyI can also support the beginning of the Governments amendment.
Like my hon. Friend the Member for South Cambridgeshire (Mr. Lansley)to be fair, I must add that the Secretary of State expressed the same sentiments in his opening remarksI fully support and admire the people who work in the NHS. Without all the doctors, nurses, consultants and ancillary workerswho too often are not mentionedwe would not have a national health service. They are there, day in and day out, often without much praise or notice, delivering health care to our constituents and to ourselves.
In my brief comments I shall discuss accident and emergency services, which all too often work under tremendous stress and strain. For many members of the population, that is the first point of contact with the local hospital. The problems that A and E services face have been exacerbatedcertainly in my area, mid-Essexby the dramatic increase in the number of people turning up or being admitted to A and E as a result of drug or alcohol-related abuse. That is a growing problem.
The Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), who is on the Front Bench now, answered a written question from me yesterday. His reply showed that in 2002-03 there were just over 2,500 admissions to Broomfield hospital in Chelmsford as a result of drug or alcohol-related problems. By 2005-06 that had increased to just over 4,000 episodes. Fortunately, the next year, 2006-07the last year for which figures are availablethe level had marginally dropped to just under 4,000, but the figures show the dramatic increase in that problem, arising from the increased incidence of binge drinking and irresponsible drinking and behaviour in our town centres. The problem is spreading to our rural areas as a result of abuse, a misunderstanding of the dangers of alcohol consumption, and the failure to adopt a responsible and mature attitude towards it.
The knock-on effect is the strain that that puts on A and E staff, not only because of the medical problems emanating from the abuse that brings people to A and E, but sadly, because of the behaviour of some of the patients resulting from the state of mind that they are in. If someone has been brought into A and E by friends who have been out with them, the friends, too, may be suffering the effects of alcohol abuse, which exacerbates the problem and the way in which they interrelate with staff. The patience and the behaviour of such people are not as they would be if they were sober. That is unacceptable and needs to be addressed more strenuously than it is at present, although I accept that most hospitals are adopting zero tolerance of bad and antisocial behaviour.
A similar problem, although it does not arise directly from alcohol abuse, is violent and aggressive behaviour towards staff. It is incredible that people whose entire raison dêtre and work is to relieve pain, remedy sickness and reduce the suffering that results from illness should be verbally or physically abused for their pains. It is a sad reflection of the society in which we live.
My hon. Friend raises an important point. He will know, as I do from spending Friday and Saturday evenings with accident and emergency department staff, how difficult that can be for them. Things should not be that way. Will he join me in commending the action taken by, for example, the Queens medical centre in Nottingham? Instead of sitting in the accident and
emergency department waiting for cases to be brought to them, often causing considerable trouble in the department for other people attending and needing care, A and E staff go out and set up field hospitals in the centre of Nottingham, to take care to the place where trouble is predicted. That does not mean that they want trouble, but it shows that they are thinking proactively about how to manage care more effectively. There is the additional benefit that large numbers of ambulances are not tied up in the course of an evening.
Mr. Burns: I am extremely grateful to my hon. Friend for an important and interesting example of a proactive service. The NHS in other parts of the country should look at the experience in Nottingham to see whether they could learn and benefit from setting up a proactive service themselves. I strongly believe that there is a positive future role for A and E departments throughout the country to learn from that experience and seek to replicate it. As with preventive medicine, it is important for the health service to be proactive. In the longer term that pays handsome dividends.
Mr. Nicholas Soames (Mid-Sussex) (Con): Will my hon. Friend confirm that the increased work load comes on top of substantial increases in the work load caused by respiratory infections in elderly people, flu and the norovirus, which have placed an immense added responsibility on accident and emergency departments? By and large they have coped magnificently.
Mr. Burns: My hon. Friend is right. He highlights another problem that has developed in the health service. It was always assumed that the pressure points of increased activity occurred in the winter months when it was coldest or iciest. In the past few years we have seen that those pressure points in the NHS are no longer restricted to the traditional winter months when the weather is particularly bad. In my local hospital, Broomfield, the pressure was worse in June last year than it had been in the worst winter month. The health service has had to adapt to changing circumstances, and the old accepted problems of winter pressures are being extended, for other reasons, to other months, putting extra pressure on resources and staff.
There is a further issue facing accident and emergency services which it might not be tactful to discuss. The NHS must be tough and not only accept that there is a problem, but be brave enough to try to do something about it. Sadly, part of the population go to accident and emergency for treatment as a first resort, when their complaint is in no way related to an accident or emergency. A and E should not be their first port of call. They should use NHS Direct or contact their GP or, in some cases, their pharmacist. If people misdiagnose themselves and misdirect themselves to A and E for treatment, that puts excessive demands on the health service and on other patients waiting for A and E treatment, who may have far more serious complaints or conditions that warrant their being there in the first place. More must be done to educate people and to explain why they should not trot along to A and E simply because it is more convenient for them.
On the four-hour waiting time limit, four hours may be a relatively short time compared to the length of time that some people had to wait in the past, but it is
still quite a long time to hang around. For someone who goes to A and E with a medical complaint that is acutely painful, even if it is not as medically serious as the pain that the individual is suffering, four hours can seem a very long time. My A and E at Broomfield reflects the situation nationally. We have seen a significant increase in the number of people attending A and E in recent years. In the year up to December 2007 there were 5,469 attendances at A and E. The next year, ending December 2008, the figure was up to 5,783. The target that 98 per cent. of people should wait less than four hours is being met in my A and E department. The latest figures for 2007-08 show that it achieved 98.3 per cent. I accept that that is of little comfort to the 1.7 per cent. who are not included in those figures.
Mr. Lansley: I am sorry to interrupt my hon. Friend, who is making an important point, but it might be of interest to him and to the House to know that the NHS information centre this morning published an analysis of the data from hospital episode statistics, which shows that 4.1 per cent. of people who attended A and E departments had a recorded time for arrival but no recorded time for departure. That is the equivalent of more than half a million patients a year who appear simply to drop out of the statistics. That is quite separate from the point about 98 per cent.
Mr. Burns: Very much so. It would be interesting to hear what the Minister has to say about that. There is another discrepancy, in that the figure that I have given for my local hospital for the meeting of the four-hour target, except for those 1.7 per cent., looks encouraging because it is slightly above what it should be, but the Healthcare Commission recently published a survey of visitors to A and E at that hospital showing that patients perception of the service varies radically, and, sadly, it is in the bottom 20 per cent. for patient satisfaction. The trust accepts that it is disappointed by the results and says that it is seeking to improve what it calls the patient experience as a top priority. That is important, because it means that the trust recognises that there is a perception with users that it is not as good as it should be.
Mr. Lansley: My hon. Friend is being generous in giving way. It is important for us to understand exactly what is going on. The Healthcare Commission found that only 73 per cent. of people who attended A and E departments reported that they were seen and treated within four hours. It surmises that a significant number of people are being put into admission units or medical assessment units, and because those are attached to A and E they believe that they are still in A and E, whereas from the hospitals point of view the clock has stopped ticking.
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