Higher Education (Information) Bill

Presentation and First Reading (Standing Order No. 57)

Heidi Allen, supported by Sir Oliver Heald, Mr Jonathan Djanogly, Kevin Hollinrake, Oliver Colvile, Mr David Burrowes, Daniel Zeichner, Caroline Ansell and Victoria Prentis, presented a Bill to require information to be made available to prospective undergraduate students about what is provided to students for the tuition fees charged, how tuition fee resources are expended and what is expected of students; to establish transparency in how tuition fees are spent; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 23 October, and to be printed (Bill 21).

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Representation of the People (Young Persons’ Enfranchisement and Education) Bill

Presentation and First Reading (Standing Order No. 57)

Vicky Foxcroft, supported by Ms Mhairi Black, John Pugh, Justin Madders, Ruth Smeeth, Keith Vaz, Clive Lewis, Ian Mearns, Conor McGinn, Tulip Siddiq, Stephen Kinnock and Caroline Lucas, presented a Bill to reduce the voting age to 16 in general elections, elections to the Scottish Parliament, the National Assembly for Wales, the Northern Ireland Assembly and the European Parliament, local government elections and referendums; to make provision about young people’s education in citizenship and the constitution; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 11 September, and to be printed (Bill 22).

Crown Tenancies Bill

Presentation and First Reading (Standing Order No. 57)

Mark Pawsey, supported by Andrew Bingham, Graham Evans, Oliver Colvile, Jeremy Lefroy, Jack Lopresti, Karen Lumley, Jason McCartney, James Morris, Wendy Morton, David Mowat and Craig Tracey, presented a Bill to provide that Crown tenancies may be assured tenancies for the purposes of the Housing Act 1988, subject to certain exceptions; to modify the assured tenancies regime in relation to certain Crown tenancies; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 11 September, and to be printed (Bill 23).

Mental Health (Independent Advocacy) (England) Bill

Presentation and First Reading (Standing Order No. 57)

Mr Geoffrey Cox, supported by Stephen Hammond, Mr Charles Walker, Mrs Sheryll Murray, Stephen Phillips,

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Oliver Colvile, Mr Nigel Evans, Daniel Kawczynski and Geoffrey Clifton-Brown, presented a Bill to amend the Mental Health Act 1983 to make further provision for powers and responsibilities of independent mental health advocates for qualifying patients in England; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 20 November,and to be printed (Bill 24).

Health and Safety Executive (Powers) Bill

Presentation and First Reading (Standing Order No. 57)

James Cleverly presented a Bill to confer further powers on the Health and Safety Executive.

Bill read the First time; to be read a Second time on Friday 16 October, and to be printed (Bill 25).

Assessment of Government Policies (Impact on Families) Bill

Presentation and First Reading (Standing Order No. 57)

Caroline Ansell, supported by Mr David Burrowes, Mrs Anne Main, Mary Glindon, Richard Graham, Fiona Bruce, Martin Vickers, Jeremy Lefroy, Mr Peter Bone, John Howell, James Cleverly and Jim Shannon, presented a Bill to require ministers to carry out an assessment of the impact of government policies on families by giving statutory effect to the family test; to place a duty on the Secretary of State to make a report on the costs and benefits of requiring local authorities to carry out equivalent tests on their policies; to require the Secretary of State to establish, and make an annual report on, indicators of and targets for the government’s performance in promoting family stability; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 4 December,and to be printed (Bill 26).

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Opposition Day

3rd Alloted Day

A&E Services

1.29 pm

Mr Jamie Reed (Copeland) (Lab): I beg to move,

That this House notes that hospital A&E departments have now missed the four-hour A&E target for 100 weeks in a row; further notes that trusts are predicting record deficits this year; believes the pressures on hospitals are a consequence of declining access to out-of-hospital services under this Government, including fewer older people receiving social care and more people waiting a week or more for a GP appointment; further believes the increasing bill for agency staff is also adding to the pressure on hospitals; notes that the Government plans to stop the weekly reporting of A&E data; believes this decision will make the NHS less transparent and make it harder for patients to judge the performance of their local hospital; and calls on the Government to reinstate the publication of weekly A&E data and to set out how it will tackle hospital deficits in 2015 in order to protect services.

I want hon. Members from all parts of the House to cast their minds back to the week commencing 14 July 2013: the country was still basking in Andy Murray’s historic win at Wimbledon; England had just embarked on a successful Ashes series against Australia; and hospital A&E departments achieved their target to see 95% of patients within four hours. Since then a number of unlikely things have happened: the then reigning world champions, Spain, have crashed out of the World cup in the first round; a group of scientists remotely have landed a probe on a comet hundreds of millions of kilometres from earth; and Cuba and the United States have begun to repair diplomatic relations. But in the same period some sadly predictable things have occurred: England have crashed out of the World cup in Brazil; they have been whitewashed by Australia in the cricket; and under a Conservative Government hospitals in England have now missed their A&E target for 100 weeks in a row.

I start this debate by paying tribute to the hard-working staff at every level of our national health service. They work tirelessly in trying circumstances, and without them there would be no NHS. Ministers have in this place adopted the practice of attempting to pretend that any criticism of Government policy is a criticism of the health service or its staff, so let us make clear one thing right at the start of this debate: NHS staff are remarkable and we are all in their debt. The achievements of NHS staff are despite Government policy, not because of it.

John Redwood (Wokingham) (Con): What have the Opposition learned from the Mid Staffs disaster and tragedy, where they were hitting the targets but missing the point? What should they learn about how one drives quality forward in the health service?

Mr Reed: I thank the right hon. Gentleman for that question. If he paid attention to the Francis report, he would learn that it was not the targets themselves that were to blame for the Mid Staffs tragedy, but the way they were applied in that hospital. That is clearly stated in both the first and second Francis inquiries; indeed, it was a point that the Prime Minister made on the Floor of this House when he reported to Members.

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In the past 100 weeks, nearly 2.4 million patients have waited more than four hours in hospital accident and emergency units in England.

Gareth Johnson (Dartford) (Con): Why does the hon. Gentleman think that in my constituency A&E targets have been met for 97% of patients, that in his own hospital in his constituency in England they have been met for 93% of patients, but that in Wales they have been met for only 83%?

Mr Reed: I am grateful to the hon. Gentleman for that question. Had he been in this House longer and paid more attention to these issues, he would know that the datasets comparable between England and Wales are not actually the same. He would know also that the last time we had a Conservative Government people in Wales were waiting two years for operations, and that nobody campaigns more than I do on behalf of hospitals in my area on the waiting times there.

In the past 100 weeks nearly 2.4 million patients have waited more than four hours in hospital accident and emergency units in England; almost half a million people have spent more than four hours on a trolley waiting to be admitted; and more than 1,500 have waited more than 12 hours to be admitted.

Those figures offer a stark analysis of the difficulties facing accident and emergency. Even in this week of the summer solstice, this Government’s A&E winter crisis shows no signs of abating. In a debate in January the Secretary of State for Health said that the NHS had just been through a tough winter, but the evidence from NHS England shows that accident and emergency departments have had two tough winters and are well on their way to a third tough summer. Under this Government accident and emergency is experiencing a permanent winter.

Barry Gardiner (Brent North) (Lab): My hon. Friend will know that Northwick Park hospital in my constituency has had some of the worst waiting times in the country over the past year. Does he understand, and will he address in his remarks, the fact that the ageing population—those over the age of 80—in Brent has increased by 50%, yet the funding available to cope with that increase has been reduced by 25%? It means that, of the 250 people who attend A&E each day, 100 are dementia patients who become bed blockers because the integrated care package is not in place and is not working.

Mr Reed: My hon. Friend makes an excellent point. He is right to mention those issues, which I will come to later. I pay tribute to him for doing so.

The reason for those pressures on A&E, in addition to the issues that my hon. Friend raises, is the sharp increase in people attending A&E since 2010. In the past the Secretary of State has tried to claim that the increase is the fault of the previous Labour Government, but that is patently nonsense. Annual attendances at hospital accident and emergency units increased by 60,000 in the four years before 2010, whereas in the four years after they increased by nearly 600,000—10 times faster. The reality is that A&E dramatically improved between 2004 and 2010, when 98% of patients were seen within four hours. This is a crisis that only started on

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the Tories’ watch—after they made it harder to see a GP, after they started stripping back social care services and after they launched their damaging top-down reorganisation.

Henry Smith (Crawley) (Con): Does the hon. Gentleman not think that the closure of A&E at Crawley hospital in 2005, under a Labour Government, was distinctly unhelpful to A&E waiting times?

Mr Reed: The hon. Gentleman has made that point on the Floor of the House on many occasions, and he has been a constant voice with regard to the hospital services used by his constituents. That was a decision made by clinicians in the area, and he will recognise that. He will recognise also how much the framework has changed and how much more difficult the Government have made it for communities such as his to have their say on health reconfiguration.

Clive Efford (Eltham) (Lab): My hon. Friend is absolutely right. The point is not that there should never be any change in our national health service. When clinicians plan it and put it forward to improve services, we are right to support it. The difference is that the Conservative-led Government came in and attempted to close A&Es from the centre, such as Lewisham A&E, which they were going to close. They said they would not close Sidcup A&E, but they closed it within months of entering government. That is the difference: the Government dictated the closures, not local clinicians.

Mr Reed: My hon. Friend is absolutely right. The lesson that the Prime Minister and Secretary of State drew from those episodes was, “When you get beaten in the courts, change the law”—a completely different approach from that of the previous Labour Government.

Dawn Butler (Brent Central) (Lab): My hon. Friend the Member for Brent North (Barry Gardiner) mentioned the distressing figures at Northwick Park hospital, but the Government’s solution was to close Central Middlesex hospital’s A&E. Does my hon. Friend the Member for Copeland (Mr Reed) think that that added to the crisis or made it better?

Mr Reed: Everything that transpired in my hon. Friend’s constituency made the situation much worse, as many medical professionals have said.

Barbara Keeley (Worsley and Eccles South) (Lab): Is there not an extra pressure, with many trusts ending the year with deficits? Wythenshawe hospital, which is looking at a £3 million deficit, has decided to try to cut 33 district nursing posts, yet when the Health Committee looked at winter A&E pressures we found that it was important to hang on to district, community support and hospice nurses. Is it not just madness to force hospitals with deficits to cut district nurse posts?

Mr Reed: My hon. Friend puts her finger on the problem precisely. It is absolute madness, and it is happening at trusts throughout England, as their deficits edge up towards £1 billion for this financial year.

The number of patients waiting more than four hours each year has rocketed by more than 1 million, meaning that there are now almost four times as many people as

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there were five years ago waiting more than four hours. That is a damning record, and based on the performance over the previous Parliament five more years of the same will see almost 2.5 million patients each year waiting more than four hours by 2020. For the benefit of patients, medical professionals and the healthcare system as a whole, that cannot be allowed to continue.

Andrew Percy (Brigg and Goole) (Con): The hon. Gentleman may know that I spend my weekends working in the NHS, attending seriously ill patients. We are seeing more patients who are elderly, who have a higher acuity and who need admission to hospital; hospital is the only place for them. On his suggestion that the situation has arisen on the Government’s watch, how does he account for the Royal College of Nursing’s telling the Health Committee that the decisions that needed to be taken to deal with this demographic shift should have been taken a decade or more before my party entered government?

Mr Reed: If the hon. Gentleman wants to compare the records of this Government and the previous one, we will do that all day long and he will come out on the wrong side of that debate. On the ageing society, we would think from listening to Ministers and Government Back Benchers that this has just been sprung upon us. He is right to say that it has been coming for a long time, but we did an awful lot more to address it than this Government are doing. I will go on to explain why in just a moment.

A real worry for the NHS, and for those of us who use it or work within it every day, is the Government’s plan to suspend the work of the National Institute for Health and Care Excellence on its safe staffing programme. That move is a rejection of a key recommendation made by the Francis report, and in response to the move, Sir Robert Francis said:

“I specifically recommended the work which NICE has been undertaking for a reason…I would not be surprised if this news generates a significant level of concern, and it seems a shame that the work of NICE has been stopped.”

Dr Clifford Mann, president of the Royal College of Emergency Medicine, has said:

“There are real pressures on nursing levels in Emergency Departments.”

He has also said:

“We are concerned about patient safety and staff welfare.”

I would be grateful if the Minister could explain to me, and to Sir Robert Francis, why on earth the Government have suspended this crucial work.

Dr Andrew Murrison (South West Wiltshire) (Con): I read the hon. Gentleman’s motion carefully and I was left slightly bewildered, as he seems to be suggesting that the solution to this problem is more resources for A&E and for primary care, yet I seem to recall that just a few weeks ago I was standing in an election campaign where my party pledged £8 billion more for the NHS and his party failed to back that. Can he explain where he will find the resources?

Mr Reed: That is the kind of magical thinking that afflicts Conservative thinking. The hon. Gentleman will be aware that at the last general election we talked about a specific £2.5 billion fund to train 20,000 more

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nurses, 8,000 more GPs and so on. What we always said was that the NHS would get the money it deserves, quite separately from that £2.5 billion, from a Labour Government. That remains the case and he knows that that is the truth. It is true that certain societal changes, including the ageing society, pose new challenges and offer new pressures for the NHS, but the service is also under increasing financial pressure as a direct result of Government policy.

Joan Ryan (Enfield North) (Lab): May I tell my hon. Friend that we should not recommend to anybody that they rely upon the promises of the Conservative party, because it promised to keep Chase Farm’s A&E unit open—the Prime Minister himself promised that at the 2010 election—but then he closed it? Every A&E department in the surrounding area that now serves the people of Enfield—those of the Royal Free, Barnet and North Middlesex hospitals—continually miss their A&E waiting time targets.

Mr Reed: I thank my right hon. Friend for that intervention, and may I say what a pleasure it is to see her again in the House of Commons? She is entirely right in what she says. We all remember the pictures, and we remember the Prime Minister’s promises and those from the previous Secretary of State. My right hon. Friend is right to say that nobody should ever take any lessons from Conservative Members or believe what they are being told by them—not one bit.

Mr Steve Baker (Wycombe) (Con): Why is it that when an A&E department is lost from a Labour constituency it is the Government’s fault, but when one was lost in a Conservative constituency under the previous Government that was “clinically led”? Can the hon. Gentleman explain the contradiction?

Mr Reed: I am afraid the hon. Gentleman is not listening; the rules have changed. The system whereby these processes are undertaken has comprehensively changed. If he were to draw a golden thread through Conservative health policy over the past five years, it would be that the public do not matter and are not listened to, and that change is driven from the centre, irrespective of what local clinicians say.

Tom Pursglove (Corby) (Con): This is all a little ironic, given that in my constituency the Labour party went around petrifying local people by saying that the A&E unit at Kettering general hospital was going to close, but it is still open and it is performing better. Would the hon. Gentleman like to apologise?

Mr Reed: If the hon. Gentleman is seeking an apology, would he like to apologise for the fact that A&Es in England have missed their waiting time targets for the past 100 weeks? I do not see any trace of an apology or any scintilla of embarrassment on his face.

It is true that certain societal changes, including the ageing society, pose new challenges and offer new pressures for the NHS, but the service is also under increasing financial pressure as a direct result of Government

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policy. First, the declining access to social care and the squeeze on primary care have forced people to turn to A&E in increasing numbers and have also meant an increasing number of admissions that could have been avoided if people had received better care outside hospital. Secondly, the Government wasted £3 billion, at least, on a damaging top-down reorganisation that nobody wanted and nobody voted for, and which was hidden from the electorate. That reorganisation sucked resources from front-line patient care. We know that senior members of the Cabinet believe that the reorganisation was a catastrophic mistake. We know that, in the words of British Medical Association chair Mark Porter,

“the damage done to the NHS has been profound and intense”,

and we know that the reorganisation has not made the NHS more productive or more efficient.

Thirdly, the effect of that wastage has been compounded by the short-sighted cuts to nurse training places at the beginning of the previous Parliament. That means that there are not enough staff working in hospitals—that was a key criticism by the Keogh review. In addition to compromising patient safety and clinical outcomes, this Government’s decision has left trusts over-reliant on expensive agency staff.

Mrs Madeleine Moon (Bridgend) (Lab): When I worked in hospitals and was responsible for arranging community-based discharge, two major problems created a delay in discharge—I hate the expression “bed-blocking” as it is such an insult to elderly people. One was access to community care facilities—home care support—and the other was ensuring that we had community equipment, such as hospital beds, hoists or bathing equipment. If we do not have all the pieces in place, which often come not from NHS funding but from local authority funding, it will not happen. That is exacerbating the problem in A&E.

Mr Reed: My hon. Friend makes a prescient point. The Government talk the talk but do not want the walk, and she has detailed precisely why that is the case.

Sir Simon Burns (Chelmsford) (Con): I am grateful to the hon. Gentleman for giving way, particularly as he has just responded to the intervention by the hon. Member for Bridgend (Mrs Moon), who is from Wales. Does he accept that in every financial year since 2010 the NHS in England has had a real-terms increase in funding, albeit a modest one, but that there has been a cut of 8% by the Labour Government in Wales and the A&E target in Wales has not been met since 2008?

Mr Reed: I congratulate the right hon. Gentleman on his knighthood—it is remiss of me not to have done that. He will know that real-terms increases and cash increases are not the same. He will also know, because he voted for it, that the budget in Wales has been cut by this Government by more than £2 billion. Let us compare like with like.

The Royal College of Nursing has calculated that almost £1 billion—£980 million—was spent on agency staff in the last year alone. Those and other choices made by this Government have meant that, collectively, trusts in England reported a total deficit of £822 million in 2014-15. That is simply unsustainable. A recent survey by the King’s Fund found that 90% of trust financial

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directors and 85% of commissioners are concerned about the financial state of their local health economies, and that view will be shared by many Members on both sides of the House. An investigation by Pulse revealed that clinical commissioning groups were being forced to use their 2015-16 winter pressures allocations just to maintain regular services.

Questions must also be asked about this week’s revelations that thousands of foreign nurses working in our NHS could be forced to leave the country as a result of the Government’s immigration rules. The RCN points out that this would cause chaos for the NHS and waste tens of millions of pounds—the Secretary of State laughs as I mention that. It would make matters much worse for patients and for front-line clinicians. Will the Minister tell us how many nurses will be lost from A&E and how many will be lost in total as a result of this move? Where in the country will they be lost? How will the vacancies be filled? What will this cost? Has he or any Minister in his Department made representations to the Prime Minister about the effects of this policy? If so, will he share those with the House? When did Health Ministers know that this policy might cause so much damage?

Robert Flello (Stoke-on-Trent South) (Lab): When the Minister replies it will also be interesting to hear him say exactly how that cut and restriction on nurses will impact on the Royal Stoke university hospital, which had the great misfortune, for patients and the public more generally, of topping the list for the longest waits last winter of more than 12 hours on trolleys.

Mr Reed: My hon. Friend is absolutely right. Stoke deserves better, and no one has worked harder than him to ensure that it gets something better. Let us ensure that the Minister answers those points.

The understaffing crisis represents a dire situation that will only get worse unless the Government demonstrate an understanding of these issues and give them the attention that they deserve. We know that, as well as deficits this year, the“Five Year Forward View” is based on assumptions that the NHS can save £22 million by 2020. Will the Minister assure us that this will not result in any fewer medical staff or cuts to hospital or community services? Will he also commit to placing the analysis and the assumptions behind the efficiency plans in the public domain so that we can have an informed and honest debate about NHS funding? We do not want a programme of services being set up to fail and then being cut by stealth.

Maria Caulfield (Lewes) (Con): I worked as a nurse under the previous Labour Government. That Government may have kept numbers the same, but they reduced the skill mix, which greatly affected the safety of patients both on wards and in out-patient facilities. Can the hon. Gentleman explain that?

Mr Reed: It is a matter of fact that we increased nursing numbers. The hon. Lady will be well aware that when we came into office in 1997, we were training 15,000 nurses a year, and when we left office in 2010, we were training 20,000 nurses a year.

On social care, under this Government, 300,000 fewer older people are getting the care they need, with more and more people being forced to stay in hospital. But

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that is only part of the story. When someone who needs care cannot get the help they need, it increases the risk that they will struggle or fall ill and have to go to accident and emergency. That is clearly demonstrated in the increasing number of older people arriving at A&E by ambulance. Almost 100,000 extra patients over the age of 90 were brought to accident and emergency by ambulance last year. That is an indictment of Government policy towards older people, and the problem is further exacerbated when the true scale of the damage to social care is revealed.

Before the election, the National Audit Office published its report on the impact of Government cuts on local council budgets. The report found that 40% of the total savings between 2013-14 and 2014-15 were made through reducing adult social care services.

The Association of Directors of Adult Social Services has calculated that a further £1.1 billion will be cut from adult social care over this financial year, and the president of the association said:

“Short-changing social care is short-sighted and short-term.”

The number of patients ending up in A&E because they cannot get the care they need to help them stay healthy outside hospital is clear evidence of this short-termism.

Cutting the social care budget is clearly a false economy, as thousands turn to A&E as a result. That is bad not only for the patient, but for the taxpayer. If a patient is not getting the care they need, their condition will deteriorate, which means that more complex interventions will be needed. A recent poll commissioned by the Care and Support Alliance found that nine out of 10 GPs believe that deep social care cuts are responsible for the overcrowding in our accident and emergency departments. The Government need to get a grip and address the crisis in social care in order to relieve the pressure on A&E departments and GP surgeries. Instead, they have chosen to risk putting more pressure on the heath system at all levels by announcing further cuts of £200 million to the public health budgets of local authorities without any idea of whether they can be made without harming vital services—services that potentially save money.

Mr Peter Bone (Wellingborough) (Con): Will the shadow Minister recognise the initiative that is happening in north Northamptonshire? Kettering general hospital will have not only an A&E, but urgent care, social care and mental health facilities and GPs all on the same site. People can go to the hospital and be dealt with there and then, correctly. I will also have an urgent care centre in my constituency. Is that not the way forward?

Mr Reed: I am grateful to the hon. Gentleman for his intervention. I absolutely agree that models such as that and local best practice can exist in pockets all over the country. It is just a shame that so many health economies are getting cut to the bone, because that stops them developing such care models. He is right that it is precisely that kind of integration that points the way to the future. Have the effects of these public health budget cuts on primary care and accident and emergency been modelled by the Department, and will the Minister share that work with the House? If that work has not been done, will he explain why? Has the Department consulted on these latest cuts, and what was the response?

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I now wish to turn to the situation in general practice. In the previous Parliament, we saw a marked increase in the number of people waiting longer for a GP appointment. By 2013-14, almost 6 million people could not get a GP appointment. If the trend continues, that figure could be around 10 million by the end of this Parliament. Those people are often left with little option but to turn to accident and emergency. The GP patient survey suggests that almost 1 million patients went to A&E last year because they could not get a convenient GP appointment. It is clear that the GP workforce crisis is a major driver of the issues under discussion today.

Robert Flello: My hon. Friend is making an extremely good speech and is being very generous in giving way. On that point, Stoke-on-Trent has traditionally had far more patients per GP than the national average, and the age of that population is rapidly approaching, and often way past, retirement age. What we are seeing is not that people cannot get an appointment when it is convenient, but that they cannot get an appointment for days on end.

Mr Reed: My hon. Friend makes the case. What is happening in Stoke, I regret to say, appears to be something of a canary in a coal mine for the NHS around the country, and its issues will increasingly be seen in areas all over the country.

It is clear that the GP workforce crisis is a major driver of the problems. The number of full-time equivalent GPs per head has fallen over the past five years, even as demand has increased.

Henry Smith rose—

Mr Reed: I have been generous with time, so I must press on.

In 2013, the Government announced a call to action to improve general practice access and experience for patients. They set out six key indicators to rate the quality of access and experience for patients. One year later, every single indicator had shown a deterioration in performance. Fewer people described the overall experience of their surgery as good and fewer people were able to get an appointment. The Government must address that finding. Only by addressing the crisis in general practice in addition to social care can the Government begin to relieve the pressures on A&E departments.

When the Secretary of State and the Prime Minister discuss the NHS in this House, they like to use words such as “openness” and “transparency”. Sadly, their actions betray that sentiment on a routine basis. I refer again to Professor Keogh’s seminal letter to the Secretary of State two years ago in which he refers to the use and principle of transparency in the NHS as representing

“a turning point for our health service from which there is no return.”

Except that, for this Government, it seems that there is a return.

Currently, NHS England publishes the performance measures for each A&E in England every week. Those figures contain a wealth of information for each trust and it makes that data available to the public. The data show how each A&E department is performing across a

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range of measures, and it can be used to target specific interventions at trusts that are struggling. This reporting time period also means that issues can be identified quickly and resolved promptly. Rather than taking action to ensure that hospitals in England meet this target, the Government are seeking to hide the performance data. We will not be able to see how A&Es are performing each week; we will have to wait until the end of each month. By publishing a significant number of performance measures from across the NHS on the same day, the Government appear to have found an innovative way of burying bad news—publishing even worse news at the same time. Patients deserve better than that. Clearly, Ministers find it more palatable to be reminded of their failings just once a month, rather than at the end of each week. This move is designed to make the red box lighter and the scathing headlines kinder. Will people not conclude that the monthly publication of A&E data—unlike other monthly data sets—has nothing to do with patient care and everything to do with political and media management?

Helen Whately (Faversham and Mid Kent) (Con) rose

Mr Reed: I must make some progress.

The issues facing A&E departments, GP surgeries and social care services will not be solved by amending the date on which performance indicators are published. The public will be rightly sceptical about the motivations behind the reduced publication of data that illustrate both good and bad performance. It is a move designed to take the pressure off Ministers as they turn a blind eye to the pressures that they are inflicting on our health service.

The pressures that the Government have introduced into the health service have built up until the system can no longer cope. A&E is full to bursting and social care has been cut to the bone, which means that patients cannot be discharged, wards are getting fuller, there are delays for admission and more people are waiting longer for treatment. That is indisputable. In England, the target for seeing 95% of patients within four hours has been missed for 100 weeks in a row. Instead of easing the pressures in A&E, this Government have decided to make it harder for patients to see the effects of Government policy on the services that they use by restricting the performance data that are available. Under this Government, it is getting harder to see a GP, harder to be seen at A&E and harder to see how the NHS is performing.

Not only is the record of this Government shameful, but their cynicism and complacency are, too. Professional bodies and Opposition Members have long warned the Government that the path they have placed the NHS on is damaging the service, working against patients’ best interests and causing unprecedented professional concern. Having done that, the Government are now trying to evade scrutiny. Today, Ministers must explain why they are seeking to make NHS performance less transparent and to hide the damage caused by their policies from patients and the public, and how they intend to protect services and tackle hospital deficits this year.

Several hon. Members rose

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Madam Deputy Speaker (Natascha Engel): Order. Before I call the Minister, I am putting a six-minute time limit on Back Benchers—that does not apply to Front Benchers. Six minutes is already a little over-generous, so may I make a plea for few interventions, so that we can get in as many Back-Bench speakers as possible? With that in mind, I call Ben Gummer.

2 pm

The Parliamentary Under-Secretary of State for Health (Ben Gummer): May I take this opportunity to congratulate you on your election, Madam Deputy Speaker? It is a great pleasure to speak for the first time with you in the Chair. You will have noted that the subject for debate on the Order Paper is A&E services—an important matter that everyone in this House cares much about. You will also have noted that there are several proposers of the motion, including the Leader of the Opposition, the shadow Secretary of State and the shadow Minister for care and older people. My first question is why, on this important issue, which the Opposition seem to think is critical to their programme for the NHS, the shadow Secretary of State for Health cannot be here to make the argument himself. Further, we understand that the shadow Minister for care will not be wrapping up the debate.

Mr Jamie Reed: I can tell the Minister where they are not: they are not hiding behind trees, and they are not meeting Rupert Murdoch in an underground car park.

Ben Gummer: I am not sure I get the gist of the hon. Gentleman’s point, but I do think that the shadow Secretary of State for Health should propose the motion in an Opposition day debate on health matters. I hazard a guess that there has been a disagreement between the two shadow Ministers—perhaps a suggestion that one of them is using health debates as opportunities to grandstand. I hope that that is not the case.

I am slightly concerned that we are about to see another episode of the ongoing psychodrama which is the Labour party. We had the TB-GBs and then, when that very happily came to an end, we had the Miliband “Band of Brothers”—a disaster for that family but happily not for the country.

Barbara Keeley: On a point of order, Madam Deputy Speaker. I really wonder whether this is within scope. Is it at all orderly to be debating which Minister is answering or proposing a debate? This happens quite a bit in this House—for example, the Chancellor did not come last week. It is just not orderly to be starting off the debate in this way.

Madam Deputy Speaker (Natascha Engel): I thank the hon. Lady for that point of order. I think the point has been made. Perhaps we can move on with the debate.

Ben Gummer: It is a matter of importance, Madam Deputy Speaker, because in this episode of “Health Handbags”, we have been given an insight into the crisis within the Labour party and Labour Members’ inability to understand what the priorities are for the NHS and for the country.

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If the NHS and A&E services are of such importance to the Labour party, one would expect the shadow Secretary of State—

Robert Flello: On a point of order, Madam Deputy Speaker.

Ben Gummer rose—

Madam Deputy Speaker (Natascha Engel): Order. If the Minister could sit down for a moment, I will take the point of order, which I imagine is very similar to the previous one. It would be nice if we could move the debate on, as there are several maiden speeches waiting to be taken. It is an important subject and I would like to move on, rather than get bogged down in this. I will take the point of order, and then I hope we will move on.

Robert Flello: I am grateful, Madam Deputy Speaker. For the benefit of new Members on both sides of the House, I think it would be helpful if you spent a moment clarifying when it is in order to challenge the Chair’s ruling on something and when it is not.

Madam Deputy Speaker (Natascha Engel): Thank you very much. It is the person in the Chair’s decision whether something is within scope or not. I did not take the Minister’s response to my decision as a challenge to the Chair; I merely wanted to point out that it would be nice to get on with the debate and to allow other hon. Members to speak, especially new Members who wish to make their maiden speech. If the Minister could move on, we would all be very grateful.

Ben Gummer: With pleasure, Madam Deputy Speaker.

In the absence of the shadow Secretary of State, I shall channel him, which is something I enjoy doing. I like the right hon. Member for Leigh (Andy Burnham); he is a man who often—sometimes; a few times—speaks some sense. Just before the last election, he said that after the election,

“we need to come together, and then allow the NHS to get on with the job of building 21st-century services”.

What I do not understand about the motion that he and other Opposition Members have put before the House is that, far from coming together and trying to build consensus on the future of the NHS, what they are seeking to do—once again—is reproduce the golden oldies of criticism that they put before the country before the last election, and that were so roundly rejected.

That comment was about after the election. What I do not understand is what the shadow Secretary of State felt was the purpose of leading a campaign so politicising the NHS before the election. I, like so many others, had a leaflet through my letterbox saying that there were 24 hours to save the NHS—

Madam Deputy Speaker (Natascha Engel): Order. We are straying into the general election, which has passed, and away from what is on the Order Paper, which is a debate on A&E services. If the Minister could stay on that subject, I would be enormously grateful.

Ben Gummer: With pleasure, Madam Deputy Speaker. The point is that we were warned that there were 24 hours to save the NHS, yet it is still there, and the A&E crisis, which is named at the top—

Several hon. Members rose

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Madam Deputy Speaker (Natascha Engel): Order. If the Minister could resume his seat, we are beginning to stray into the realms of challenging the Chair’s decision. We do not have much time and I do not want to take any more points of order on this one subject, so if he could stick to the subject on the Order Paper and let us move on, I would be very grateful to him.

Ben Gummer: I apologise, Madam Deputy Speaker.

The motion is about A&E services, and I would like to talk about the progress that the NHS has made in the past five years. Far from the picture painted today by the hon. Member for Copeland (Mr Reed) and Members who intervened during his speech, the NHS is treating more people than ever before, it is treating more people in A&E than ever before and it is treating more people at a higher rate of satisfaction than ever before, and the result of that is that patient outcomes—something we did not hear much about from the shadow Minister—have improved. We are treating more people to a higher standard.

John Redwood: Is it not the case that the excellent policy of seven-days-a-week GP services means an expansion in the amount of GP services, which will provide welcome relief from the pressures on A&E, which will add to the good work being done in hospitals?

Ben Gummer: That is precisely the sort of policy on which we will seek consensus in the months and years ahead. There is a choice for Opposition Members. I know there are many new Members who wish to make their maiden speech in this debate, and I would just say to them that the choice is this: to come together to try to model better care within the NHS and better outcomes for patients, or to seek division.

Helen Hayes (Dulwich and West Norwood) (Lab): I want to raise a point of substance that affects my constituents. There are young people in my constituency who would love to train as nurses and work in the NHS, but by cutting the number of training places in London by 25%, the Government have made that much harder. At the same time, when I last spoke to the recently retired chief executive of King’s College Hospital NHS Foundation Trust, he told me that he was recruiting nurses in the Philippines, because there are not enough nurses—

Madam Deputy Speaker (Natascha Engel): Order. When the Chair is on her feet, Members sit. I have said before that interventions need to be very short and kept to a minimum. That was too long.

Ben Gummer: The shadow Secretary of State cut the number of training places for nurses; it was increased under the last Government and is now at a record level.

We were on the subject of performance, which is at the heart of the motion. The shadow Minister can speak warm words about the workforce, but he failed to congratulate them on their exceptional performance under unprecedented pressures. At no point in his speech did he acknowledge the real increase in pressure on A&E services in the NHS. Some 3,000 additional patients a day are being seen, treated and discharged in accordance

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with the 95% target; that is being delivered by NHS staff across the service. He fails to point out the places where we have seen remarkable successes. He fails to give the example of Barking, Havering and Redbridge University Hospitals NHS Trust, which saw a 16% improvement in A&E performance times in the last year. That is front-line staff delivering better outcomes as a result of changes made by the Secretary of State over the past five years.

Mr Jamie Reed: I am grateful to the Minister for giving way, but he gives an absolutely fictional account of my remarks to the House. If he is so confident in his description of what is happening in the health service, can he explain why a comedy document produced by the Conservative research department says:

“New polling by Conservative peer Lord Ashcroft found that 47 per cent of voters believe Labour has the best approach to the health service while just 29 per cent picked the Tories”?

Ben Gummer: As Madam Deputy Speaker pointed out, we have just had an election, and the voters’ voice on the NHS was loud and clear. There is a simple point to make about the performance of this nation’s NHS: an independent think-tank—one of the most respected in the field—has rated it the best performing national health service in the world. It is better than that of Scotland, Northern Ireland or Labour-run Wales. A&E, as measured by countries across the world, performs no better in any country than in this. If we wish to go to international comparisons, the shadow Minister would do well to accept the extraordinary work that NHS staff are already delivering to make this the best health service in the world.

Mr Reed: I wish the Minister was right. I genuinely wish ours was the best A&E provision in the world. However, I have to draw his attention to an article in the International Business Times in January this year. When a journalist contacted the Department of Health to learn the basis for that claim by the Secretary of State, they were told that there was

“no concrete research on which Hunt had made the statement”.

This is a complete fabrication. Will the Minister set the record straight?

Ben Gummer: The shadow Minister should know that we in this country perform best of all countries that measure A&E, and that is the only way that we can judge this. The trouble is that by talking down that remarkable fact, all we do is denigrate the work of the people who deliver that every day.

I move on to the financial performance of the NHS, the second point that the shadow Minister raised, which lies at the heart of his motion. Let me set the financial context. [Interruption.] While Opposition Members are giggling, they might like to remember that they went into the last election not willing to commit to the NHS’s own plan for the next five years. Only one major party pledged to give the NHS the funding that it requested for the next five years: the Conservative party. The history on delivery is clear: we are talking about an additional £12.9 billion of cash in the last five years; a contribution of £2 billion this financial year, and a further £8 billion to fulfil the five-year plan. That is the financial background to this debate—a background

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that the Opposition refused to match at the last election. Money on its own does not get to the root of the problem, which I am afraid is not recognised in the motion, namely the relationship between quality, standards and money.

Byron Davies (Gower) (Con): Does the Minister agree that it would probably do the shadow Minister and other Opposition Front Benchers a great deal of good to move down to Wales, where there has been an 8% cut in the budget? Wales has not met A&E targets since 2008.

Ben Gummer: It is a real delight to respond to my hon. Friend. It is a good thing for the shadow Minister and those living in England that they do not have to endure the experiences of people in Wales, which have, I am afraid, been inflicted on them by the appalling management of the Labour Government there, who chose not to invest in the NHS in the way that we did, in a time of constrained budgets across the public sector. I have to say to the shadow Minister that by concentrating on money—he cannot match the Conservative party’s commitments on that anyway—he misses the points around quality and safety, which are conjoined with money. If we go back to the Mid Staffordshire NHS Foundation Trust—[Interruption.] Opposition Members may groan, but they may wish to reflect on why Stafford hospital went wrong. It was within budget and was hitting its targets, yet at the same time it was killing people. Until that simple fact is remembered, and until we put quality and patient care first, we will not get the efficiency, as regards either care or money, that I am sure Members on both sides of the House wish to see.

Barbara Keeley rose

Ben Gummer: I am sure that the shadow Minister has come to the House without reading the speech in which my right hon. Friend the Secretary of State directly addressed the issues caused, in some trusts, largely by agency spending, which took place because of the chronic understaffing created by the previous Government, and put right by us. That led in part to the catastrophe at Mid Staffs. The shadow Minister has not read my right hon. Friend’s comments about limiting the salaries of highly paid managers in the NHS, or his comments about cutting consultancy pay. It is precisely that kind of action—including enabling chief executives of NHS trusts to control their budgets—that this Government are taking to ensure that, nationally and locally, we are living within our means.

Clive Efford: The Minister says that the Government responded to Mid Staffs. Will he give us a guarantee that there will be no removal of the minimum staffing requirement that came in on the back of the Mid Staffs report?

Ben Gummer: I can guarantee that to the hon. Gentleman. On minimum staffing, it was in response to the Francis inquiry that this Government, in their previous incarnation, set the Care Quality Commission a specific target of doing something about minimum staffing. That did not happen before then. He understands that relationship between safe care and money. I just wish that he was able to explain it to his colleagues on the Front Bench, because if they went to the Salford Royal

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hospital, they would see how, through instigating safer care, it is saving £5 billion a year. It is by combining quality and efficiency that we get the double benefit of better care for patients and better returns for the taxpayer.

Barbara Keeley rose

Tom Pursglove rose—

Ben Gummer: I give way to my hon. Friend.

Tom Pursglove: Under the coalition Government, a new urgent care centre opened in Corby, which is providing an excellent service for my constituents. That is in addition to the service in Kettering. Does the Minister agree that it is important that care is not only accessible, but as local as possible?

Ben Gummer: My hon. Friend, and our hon. Friends in Northamptonshire, have worked hard together—as Northamptonshire MPs did previously on a cross-party basis—to find the best configuration of services for their county. It is a great shame that that model of cross-party working cannot be echoed or reflected across the House. In that vein, I would prefer it if the Opposition had come here to talk about plans for social care. They have two competing visions for social care. We sometimes hear thoughtful remarks from the shadow Minister for care and older people, but then there is the shadow Secretary of State’s repetition of the phrase about wanting a top-down reorganisation of the NHS around a social care model. None of that will deliver what we all want: an integrated NHS and social care model, which is what we are beginning the journey of creating. We are doing that by reflecting locally what local places need in terms of integration rather than creating a national model to which they have to adhere. Again, it is important to fix all this—

Barbara Keeley: Will the Minister give way?

Ben Gummer: I will after I have finished this comment.

It is important to put all this in the financial context. I have been through the Lobby with the shadow Minister and with many Labour Members who were in the previous Parliament. We went through the Lobby just before the election when we agreed to cuts in public expenditure in the first two years of this Parliament and the former shadow Chancellor committed the Labour party to cuts in local government spending. Difficult choices are forced on us by the catastrophe and chaos that we were left in 2010. Labour Members need to confront those difficult choices. They cannot have it both ways. They cannot, on the one hand, say that we need massive increases in payments for social care and, on the other, say that they are going to constrain public spending. The answer to that dilemma is surely to try to find a better way of integrating social care that I hope would see cross-party consensus rather than the politicking we have just seen at the Dispatch Box.

Heidi Alexander (Lewisham East) (Lab): The Minister is talking about the financial context. My worry is that a lot of NHS managers in London talk about a Lewisham-sized hole in the NHS budget in south-east London. We stopped the Secretary of State closing Lewisham’s A&E last time. Can the Minister promise me today that he will not be coming back to Lewisham for another go?

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Ben Gummer: My right hon. Friend never planned to close Lewisham hospital. I give the hon. Lady this promise: I will certainly come and speak to her about her constituency before anything happens—in fact, if nothing happens—because I care very much about the provision of secondary and tertiary care there. That also goes for my colleagues on the Front Bench.

Let me give the facts of what we are doing in funding better social care and integrated social care in the NHS. We are already transferring £1.1 billion of NHS spending into social care funding as part of the additional £8 billion over the next five years. That money will be for social care as well as the NHS. It is part of an integrated system that NHS England envisages. Through the better care fund, funded to the tune of £5.3 billion, we are funding the local integration of social care and health care. That will produce a different solution in Manchester than in Ipswich, and that is a good thing because those two places are different.

Barbara Keeley: Will the Minister give way?

Ben Gummer: I will.

Barbara Keeley: I thank the Minister for giving way eventually, because he has made a number of points about my local area. In Salford, we are moving heavily into integration—we are one of the better places in the country for that—but the work there is not assisted by a number of things. The better care programme funding is not extra funding. A large hole has been created, as in Lewisham, by cutting back on social care funding. Even at a smaller level, the closure of walk-in centres in Salford and the ending of active case management as efficiency cuts are made have not helped. All these things are part of the jigsaw. All we have seen is cuts.

Ben Gummer: Walk-in centre closures were supported by the hon. Lady’s hospital because that gave a safer service. I walked through the Lobby with her also. Because her party is unable to make a decision about money being spent on benefits and on the general budget for government, she would not be able to pledge any more than my party; in fact, she could only promise less funding for social care. She has to be straight with voters. Labour Members cannot have it both ways. They cannot spend money on the NHS, benefits and all the other things that they are pledged to increase funding on, and also claim to be the party of fiscal responsibility. It just does not hang together.

Mr David Burrowes (Enfield, Southgate) (Con): I welcome the focus on integration, particularly in relation to social care. Enfield suffers from historical underfunding, with a lack of fairness in relation to the growing deprivation and age profile. We have made great progress, but we need to make more to ensure that there are winners, such as Enfield. That may lead to other parts of London, and inner London, being losers, but let us take these decisions now and make funding fairer, particularly in relation to social care.

Ben Gummer: My hon. Friend is right. Again, he highlights a local solution to a serious problem, and one that will not reflect what is needed in other parts of the country. That is why it is so important that we concentrate the additional money that we are providing on local solutions rather than on a top-down reorganisation.

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The shadow Minister spoke about primary care. He does not seem to have listened to my right hon. Friend’s latest announcements on the new deal for GPs to increase the workforce, support new buildings for GPs, and improve access through local innovation. We are trying to reduce the pressures that we understand are on GPs and that go back many years, not helped by the GP contract signed by his Labour predecessors. We have a choice in government about whether we declare an ambition—the ambition on primary care declared by Labour at the last election was, the Royal College of GPs said, an

“ill-thought out, knee-jerk response”—

or we can try to do something about it, listen to concerns, and remodel care so that it helps patients. That is what the Government have done. My right hon. Friend has spoken about it, and the work is being carried on by the Minister with responsibility for primary care, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt).

Dr Murrison: Will my hon. Friend give way?

Ben Gummer: I am not going to take any more interventions, if my hon. Friend does not mind, because I want to cover the additional issues raised by the shadow Minister. Before I do so, I would like to know whether the shadow Minister agrees with our target for 5,000 additional GPs, which can be afforded only because of the £8 billion that we have committed to the NHS—a commitment that, again, he has been unable to sign up to.

Mr Jamie Reed: The Minister has touched repeatedly on issues of finance. He has not given an accurate reflection of the Labour party’s position going into the general election with regard to NHS funding. Let me ask him again: will he explain how the £22 billion of efficiency savings is going to be made, and will he give a guarantee that it will not affect hospital services, A&E services, staff numbers, or any front-line services in any community in this country?

Ben Gummer: I find it difficult to have to repeat to the hon. Gentleman, as I have to the shadow Secretary of State on a previous occasion, that this is a plan by NHS England. It is a plan that we supported before the election and afterwards, and a plan that the Opposition failed to support. The details of the plan have been worked out by NHS England and will be revealed in due course. Our part of the deal is that we provide the money that it has requested, which is £8 billion. We will see the plan as it is revealed by NHS England. It is an ambitious plan but one that we will fund from our side of the bargain.

The shadow Minister reveals in his comments and in the motion to which he has put his name that his motives are not pure. He speaks about the reporting targets for A&E departments around the country, but does not mention that the decision to change the reporting standard was made not by the Government but on the basis of a recommendation made by Professor Sir Bruce Keogh, who did so as part of a general review of reporting standards. When the shadow Minister talks about reporting standards, he does not mention that we are bringing those for cancer waiting times forward from a quarterly to a monthly basis, which I would hope he would have welcomed.

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The shadow Minister does not mention that, for the first time, we are introducing mental health waiting times, as well as putting into the NHS constitution parity of esteem, which was not in the original constitution written and instituted by the shadow Secretary of State. Those are two matters of vital concern to our constituents which we are correcting on the recommendation of Professor Sir Bruce Keogh. Nor does the shadow Minister mention that Sir Bruce recommends that the A&E targets are brought on to a monthly reporting basis so that they can have clinical parity with all other standards and produce a better quality of statistical reporting.

In this debate, the shadow Minister finds himself on the wrong side of the clinical evidence given by Sir Bruce; the Patients Association, which welcomed the change; and the Royal College of Emergency Medicine, which said:

“The move from weekly to monthly reporting better reflects meaningful trends and will in fact increase the validity of this key metric, by reducing the effect of short term and unforeseeable events”.

The Nuffield Trust said that

“the replacement of weekly A&E figures with a monthly publication of indicators for many targets should help us understand changes in performance in a more meaningful way”.

The hon. Gentleman is on the wrong side of clinicians, academics, the Patients Association and the Royal College of Emergency Medicine—and on the wrong side of the argument.

The reason why is that the hon. Gentleman has made a choice. I appeal to the new Opposition Members who are sitting behind him: they can go through the next five years, motion by motion, vote by vote, opposing everything that is done on the basis of clinical evidence, just for the purpose of making political gain. If they do that, I, in turn, will remind the Opposition of the scandal of mixed-sex wards; the scandal of the highest hospital infection rate in the developed world; the scandal of a doubled pay bill for managers; the scandal of Morecambe Bay; the scandal of Mid Staffs; and the scandal of some of the worst cancer outcomes in the world. I will remind them of those every time they seek to oppose us for political reasons. The choice is theirs—or they can take the other tack and try to listen to clinicians, to be constructive and to de-weaponise the NHS.

I will seek to do what the shadow Secretary of State claimed to want to do, which is to come together and allow the NHS to get on with the job of building 21st-century services. However, if the Opposition make the wrong choice, all they will do is confirm in the minds of the British people that they put politics before the NHS, and that for the Labour party, the party comes first—always—whereas for Conservative Members, the NHS and patients always come first.

2.32 pm

Dr Philippa Whitford (Central Ayrshire) (SNP): It is obviously a lively debate on both sides of the House. As someone who is not long from being on the front line, as a surgeon in the NHS, I find it a bit sad to listen to how angry this debate is. The four-hour target should be a tool and not an end in itself. It is used to take the temperature and to understand what is happening underneath. We would not shove a patient in a bath of ice water if they had a temperature; we would look for

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the infection, try to understand it and try to treat it. Unfortunately, the four-hour target has simply become a stick, and today that stick just seemed to be being thrown backwards and forwards.

People working in A&E face great difficulty, which is why we are not recruiting trainees to A&E and why we are losing senior doctors at an incredible rate from A&E. Instead of being one of the most rewarding places to work, people see it as the most miserable.

Dawn Butler: Although the target is used as a measure, or to take the temperature, does the hon. Lady not feel that the fact that it has gone up 401% since 2009-10 is something to be worried about?

Dr Whitford: Did the hon. Lady say that the target has gone up 401%?

Dawn Butler: The time that people have had to wait for four hours has gone up—

Madam Deputy Speaker (Natascha Engel): Order. Interventions should be kept to a minimum. The hon. Member for Central Ayrshire (Dr Whitford) is not on a time limit, but please be aware that many Members are coming in to speak. Thank you.

Dr Whitford: Absolutely, we have seen the performance drop across the UK. The Minister quoted a report showing that England was performing better than Scotland. I would be interested in seeing that one—where it is comparing like for like with core A&E services—because those are not the figures I have seen. However, we all face the same challenge. We are dealing with older patients, who are more complex. The figures from Scotland last winter showed that we did not have a huge increase in numbers, but far more of those patients had to be admitted. Nothing else could be done, and we will face that situation more and more in future. The problem is that we are losing the staff to deal with that, and we are talking about A&E, but in the vast majority of cases, they key issue does not lie with A&E. There are two simple things: the number of patients coming in, which relates to out-of-hours GP access, and patients getting back out, which is described by the Royal College of Emergency Medicine as exit block.

It is important to remember that the four hours does not involve someone sitting on a chair, waiting for four hours. People are often given that impression—that they turn up in A&E and sit there, and no one will touch them for four hours. However, they will be triaged, see a clinician, have a history taken and have investigations. They may well get sewn up or be given something, and they will go home. Those patients are moving through. Our problem is the patients who have to come in, and it results in a whole cascade of issues, such as people stuck on trolleys getting the start of a bedsore, or families made miserable, or staff very depressed at trying to look after people in a corridor. It also results in people ending up boarded to any ward—any port in a storm—so that people are not in the correct ward and not getting the correct treatment from the correct team. We know that that, bizarrely, results in longer patient stays, which exacerbates the problem.

What we need to do—as we have done in Scotland, where we set up the unscheduled care action plan—is to work with all stakeholders. That involves looking at how patients flow through. It is not about people being

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obsessed with measuring the target and counting it, but about people opening the gates in front of the patient. The data on how long patients wait should be automatically available to staff from their system; it should not require an extra body to generate that data.

If we have the data weekly, which means we are getting them timeously, we can see one week from the other and ought to be able to see the patterns. The problem with monthly data for something that is identified as a currently acute issue is that, by the time they are collated, verified and out, staff may not remember quite what made that a bad week, whereas with weekly data, they can see whether they are getting a response to their actions.

I support keeping weekly measurements, but I do not support them being used as a tool—and certainly not for beating one another across the Benches here. I can tell hon. Members that staff in the NHS feel that they are beaten over the head with these targets, so it is not about having a target, but about how it is used. In the paper released by the Royal College of Emergency Medicine here yesterday, one of its myths was that the four-hour target is a distraction. It pointed out that it allowed a focus.

To try and tackle the problem in Scotland, we have ensured that the majority of our A&Es have a co-located out-of-hours service. I mentioned before that achieving 8 till 8 in every GP practice is so far in the future that it cannot be reckoned on as a solution to this problem. We are unable to fill the GP vacancies we have now. Telling them that they will be working from 8 till 8 on Saturday and Sunday is not overwhelmingly attractive.

The pilots that have been done have started to report in the last fortnight, and they have reported a very poor uptake. When people want to deal with an out-of-hours problem, they come to A&E. Rather than trying to change the whole population, we could have a system in which people are easily diverted once they get there: “If you have this, please step next door to our primary care service.” We need to look at those solutions, and some are working quite well.

The other issue is health and social care. To get patients out at the end of their journey, they need to be able to get into care. We need to remember that, although extra money may be given to health and social care through the health side, if we are cutting local authority budgets at the same time, we end up cutting the legs from under the NHS.

Dr Murrison: The hon. Lady is making thoughtful comments and I am following them carefully. I agree with her that co-location can work in some places, but clearly it is not going to work everywhere. Does she not agree that most people who attend accident and emergency departments are neither accidents nor emergencies, and they would be much better cared for by general practitioners? To do that, however, GPs need to be trained for that case mix and incentivised for it, and most importantly, the public needs to be trained, too, about accessing the proper professional.

Dr Whitford: Before the movement of out-of-hours GP services under the banner of NHS 24, most local areas had a doctors-on-call service. In my county, we

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had Ayrshire doctors on call, which was provided by local doctors at rooms in the A&E departments in our two hospitals. Patients quickly learned where they could go to be seen quickly. We also had a car service that allowed us to make home visits. That functioned very well until NHS 24 came and pulled it away.

We have to get back to local GPs working like that as part of a co-operative in a focal position. Each practice cannot generate enough GPs or work to have someone sitting there all day Saturday and all day Sunday. When the Secretary of State talks about 8 till 8, it is not clear whether he means that that will happen in each individual practice or on a regional basis. Most of the pilots that have started to publish their experiences have quickly made it into a doctors-on-call service. There is more common sense behind that approach and it is more sustainable.

We have to look at the flow within hospitals. We should not have trackers running around bean counting when patients had what done, but people going in front of patients, opening the gates, looking at bed management and ensuring that patients are in the right place.

All these matters cascade back on to staff. We are struggling to maintain and recruit staff. There was only a 50% take-up of trainees for accident and emergency, and we are haemorrhaging senior people, which exacerbates the problem. We need the co-location of GPs and we need to look at the exit block, not only out of A&E and into the hospital, but out of the hospital.

Marie Rimmer (St Helens South and Whiston) (Lab): A 25% reduction in the number of GPs and practice nurses has been forecast over the next five years. I have the statistics to prove that. People talk about the cost of agency staff and locums in hospitals, which is out of all proportion. There are also massive increases in costs—

Madam Deputy Speaker (Natascha Engel): Order. It is essential that we keep interventions to the absolute minimum.

Dr Whitford: The problem with moving patients into hospitals is being exacerbated by the reduction in in-patient facilities. Every new hospital seems to have fewer beds than the old hospital it replaces. The Scottish Government finally accepted the view of clinical staff that that could not go on. We now treat people in a different way. People used to get a hernia done and lie there for a week. My breast cancer patients used to come in and stay for 10 days. That has changed, which is great for those patients, but there is an inexorable rise in the number of older patients who have complex needs. The problem is not that we are living longer. I get quite upset at the phrase, “the catastrophe of living longer”. I suggest that Members think about what the alternative is. At medical school, I was definitely given the impression that people living longer was the point.

People are surviving their first major illness and, actually, their second major illness. They may present with breast cancer in their mid-70s to someone like me and have four co-morbidities. Such patients do not get in and out quickly for elective surgery, and they do not get out quickly when something major goes wrong, such as pneumonia or a chest infection. We therefore need to stop the downward trajectory in the number of beds, because we will not get the flow of patients if we go on cutting beds.

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For me, the key things that we need are the co-location of GPs; an out-of-hours service for out-of-hours issues that are better dealt with in primary care; and enough beds in the right places. Finally, we need to smooth the way of our patients to get back to their homes. In Scotland, we have free personal care that allows us to keep more people at home and stop them going into hospital and to get more people back out of hospital.

I commend the “Five Year Forward View”. Much of it is taken from something that was written in Scotland several years ago called “2020 Vision”, which was about integrating health and social care.

Karin Smyth (Bristol South) (Lab): I am not aware of the position on co-location in Scotland, but one barrier to the successful implementation of co-location in England is that the tariff and the funding mechanism mean that is it not efficient. Will the hon. Lady say what the position is in Scotland, because perhaps we can learn from that in England?

Dr Whitford: As I am sure the hon. Lady is aware, we have a totally separate system, for which I am grateful. We do not have a system of tariffs. We have a single NHS, so we can sit around a table and try to work out a solution. That is one of my concerns about the situation that the NHS in England faces and it is where I would veer away from the “Five Year Forward View”.

The principle of working together and integrating health and social care is commendable. The integration boards in Scotland started work in April because “2020 Vision” is a few years older than the “Five Year Forward View”, but we face the same challenge: local authorities are struggling with their budgets, which can end up eating away at the health side.

The four-hour target is still useful as a weekly target to provide a quick response to what is going on in our hospitals. However, it should not be used as a stick to beat staff or to beat ourselves in this House and make public capital. The NHS is too precious for that.

2.46 pm

Dr Sarah Wollaston (Totnes) (Con): It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford). The House should listen to what she says about the point of targets.

I thank NHS staff across the UK and, given the subject of this debate, particularly those who work in the 181 emergency departments across England. Those people face immense challenges. Last year, they cared for 14.5 million patients—an increase of 500,000 on the previous year. As the hon. Lady said, this debate is about not just numbers, but complexity. We have to face that. It is a disappointment to those NHS staff when they see the debate descend into political diatribes. They want to hear constructive diagnoses and solutions from this House; they do not want to see this issue being used as a football. Let us move forward in that vein in this debate and look at the challenges.

This issue is immensely complex. Anyone who says that there is a single answer is not looking at the scale of the problem. In the few minutes I have, it would be impossible to address all the issues, so I will focus on the workforce challenge, which is key. That challenge does not relate just to emergency departments; there is a complex interaction that includes primary care, ambulance services and the voluntary sector.

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We know that about 15% to 20% of people who are seen in emergency departments would be better seen in another context. How do we get the skill mix right? We need to consider the fact that not every place needs the same solutions. The solutions that are right in a rural constituency are very different from the solutions that are right in an urban area.

We need to look at the challenges of recruitment, retention and retirement. We have heard that 50% of training places are not being filled, but there is also the leaky bucket of those leaving the profession. We must consider the fact that it costs about £600,000 to train someone to senior registrar level in emergency care. The scale of the brain drain is enormous, particularly to Australia and New Zealand. How do we address that? Of course, there will always be junior doctors who want to spend a year working abroad and then return with the skills that they acquire. We should not discourage that, but we could do more to make it a two-way process. The main problem is the loss of those higher professionals who have not only the skills that are needed to look after the most unwell patients in our emergency departments, but the confidence and decision-making skills that are required to know when it is safe for patients to go home.

Dr Tania Mathias (Twickenham) (Con): I absolutely appreciate what my hon. Friend says about the leaky bucket. Does she agree that every school and every careers adviser should be advising people to go into the NHS, given the 300 careers that it offers?

Dr Wollaston: Indeed. I was going to comment further on the issue of the skill mix. This is about not only those higher skill professionals, but the mix within the NHS. I do not think that we should talk that down. We simply will not be able to manage unless we broaden the skill mix. Healthcare assistants, for example, make an extraordinary contribution to the NHS and social care. One of the reasons we lose so many of them is the lack of access to higher professional development; it is not just about a low-wage economy. This is about how we can create more pathways to becoming, for example, assistant practitioners and physician assistants, how we can use them and how we can bring in more pharmacists, who train for five years in their specialty, into what we do across the NHS?

Helen Whately: Picking up on my hon. Friend’s point about healthcare assistants, does she agree that improving the opportunities for healthcare assistants is a huge opportunity for the NHS at the moment?

Dr Wollaston: It is a huge opportunity and we must go further with that, because continuing professional development across the NHS workforce is part of addressing the burnout that the hon. Member for Central Ayrshire talked about. We must do more to address the rotas and see what is causing our staff to leave the NHS, because it is not just about pay or the allure of working in a sunnier climate—we cannot do much about that. It is also often about the work-life balance they face and how that compares with abroad. We have got into a vicious circle of increasingly having to rely on locums to fill those gaps, and that money could be far better spent addressing why the NHS is haemorrhaging so many skilled staff abroad and to outside professions.

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When we talk in this House about the challenges facing primary care and A&E departments, we must be careful not to talk them down. We know that medical students find going into A&E attractive, so let us not cut off the supply any further by talking about it in terms of doom and gloom. There are things we can do to improve the working lives of people in A&E, so we should get on and do the job, and I think that this House should do so in a far more constructive frame of mind. It is time to put aside the difference we have had in the election. We have five years to go until the next election. Let us show an example to those following this debate outside by looking at this in entirely constructive terms.

I want to return to an issue the hon. Member for Central Ayrshire touched on: seven-day working. Just as we should not be trapped by targets, let us not be trapped by political dogma. Let us look at what the unintended consequences sometimes can be if we are driven by the mantra that it must be 8 till 8 and seven days a week in every situation. I used to practise in a rural community. If we create a system in which we make it deeply unattractive to work in small, rural practices and in which we divert resources from the key priorities of seven-day working—which should be to reduce avoidable mortality and unnecessary hospital admissions—and if we take our eyes off that as the key priority and drive towards having to achieve 8 till 8 in every location, we could find that we have a further recruitment shortfall, as has happened in my constituency. That can translate into real unintended harms, such as the closure of many beds at Brixham hospital because the GPs could no longer safely man the in-patient beds. We could find ourselves in a spiral of unintended consequences. Let us listen to those on the front line and to our patients and keep them first and foremost in our minds when we consider what we are doing in the NHS.

2.54 pm

Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): Thank you, Madam Deputy Speaker; it is an exceptional pleasure to speak while you are in the Chair. I hope that I will be forgiven for returning to the motion, which seems to have slipped Members’ minds over the past hour or so. It specifically states:

“That this House notes that hospital A&E departments have now missed the four-hour A&E target for 100 weeks in a row; further notes that trusts are predicting record deficits this year”.

The Government were asked to respond to that. As the Minister singularly failed to do so at the start of the debate, I hope that he will return to it in closing.

I have in my patch the University Hospitals Birmingham NHS Foundation Trust, where I first met a heart surgeon call Sir Bruce Keogh—I am not entirely sure what happened to him. I therefore have either the highest or the second highest proportion of constituents who are either doctors or who work in the health service, so the NHS and everything associated with it is something that I cannot escape. I thought that it would be useful to have an NHS tracker survey, which records over a period of time how the health service is seen not just by those who use it, but by those who work in it. I want briefly to share the results of the surveys with the

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House, because they show that the people who use the NHS and who work in it are becoming increasingly concerned about the conditions in which they are treated or in which they work.

I received about 400 responses to the last survey. Some 74% of respondents said that they were very concerned about the future of the NHS. One respondent commented:

“I work in a large university hospital Emergency Department”.

We have a number of large trusts in the west midlands conurbation, so people might be living in my constituency but working in a different trust.

“The hospital bed occupancy consistently exceeds 99%, with hundreds of well patients in beds unable to be discharged due to inadequate social care. Consequently, the A&E is overwhelmed with patients lying on trolleys while I scrabble around trying to get something done.”

Another respondent said:

“My work load leaves me worrying about my own health in the future.”

Another referred to

“staff shortage on wards leading to the use of more agency staff, wasting money on unnecessary management… staff are stressed due to doing more shifts to make ends meet.”

Another said:

“All parties want better 24-hour access but there are not enough trained doctors—especially GPs—coming through the system, and too much money is spent on bank staff and locums.

That is not political scaremongering; that is what people who work in the health service have said.

We have face up to that. It is no good sitting here and pretending that we have no control over it. Decisions on the NHS are political decisions, because we decide annually how much money to spend on it. That means that there has to be some element of control. University Hospitals Birmingham has said:

“Emergency Department activity has continued to rise with the Trust passing the 102,000 ED attendances a year… equating to a 4.9% increase”.

Those are enormous numbers—102,000 emergency admissions in one hospital—and they are going up year on year.

That brings me to the targets. I know that they are difficult, but I remember that when we introduced them they were about the only way we could get good consultants to change their way of doing things. They kept saying, “This is the only way of doing it,” so we said, “Let’s try with targets.” If we look at the most recent statistics on waiting times of four hours or less in the west midlands, we see that Walsall Healthcare NHS Trust has achieved 95%; University Hospitals Birmingham has achieved 95%; but University Hospitals Coventry and Warwickshire NHS Trust achieved 79%; Worcestershire Acute Hospitals NHS Trust achieved 81%; and the University Hospital of North Staffordshire NHS Trust achieved 87%. That tells us that something is going on that is not quite right. I think that we ought to start debates such as this one by saying, “Both sides agree that something is going on that is not quite right.” These figures are not just inventions. They tell us the trend, so how do we address it?

The Government got rid of NHS Direct, and 111 did not replace it—[Interruption.] It is no good the Minister shaking his head. I set up NHS Direct, and the big thing was that there were trained nurses, not call handlers.

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They managed to deal with demand because the person on the other end of the phone could make a clinical decision, not just pass it on. We have had those knock-on effects. I hope that at least at some stage over the next two hours the motion on the Order Paper will be addressed. The trend is in the wrong direction and we need to think about what to do about it. People are waiting longer and the hospital deficits will be horrendous. This will be a problem for us all.

3 pm

Gordon Henderson (Sittingbourne and Sheppey) (Con): It is a delight to follow the hon. Member for Birmingham, Edgbaston (Ms Stuart), who made some very interesting points. When I read the motion, what struck me most was that if I had read it having just stepped off the Mars to Earth express, I would have believed that Britain’s national health service was a total disaster and that nothing was being done to improve the services that were being delivered. Yes, there are still problems in the NHS, particularly in lots of our larger general hospitals, such as Medway Maritime hospital, which provides services for my constituency, including A&E cover. Medway Maritime has faced big challenges for a number of years, including under the previous Labour Government, and among those challenges was a failing A&E department. There were a number of reasons for the challenges, including the limitations of the site on which it is located and the demography of Medway towns in general.

Last year, those challenges came to a head and Medway Maritime was put into special measures. Following the appointment of a new chief executive and new trust chairwoman and with the buddying arrangements that have seen Guy’s and St Thomas’ NHS Foundation Trust provide Medway with advice and expertise, the hospital is beginning to see some improvement. Of course, much more needs to be done before Medway Maritime can provide my constituents with the health service they deserve and to which they are entitled.

There is general agreement that one way to relieve the pressure on the hospital is to transfer more of the services it provides into the community. In my constituency, I have two excellent community hospitals, Sittingbourne memorial hospital and Sheppey community hospital. They both provide local people with a very good service, albeit for a limited range of healthcare needs. I would like the services they provide to be expanded. Okay, we will never see a fully fledged accident and emergency department in Sittingbourne and Sheppey, but there is no reason why my two community hospitals cannot provide other services. Today’s Opposition motion contains the statement that

“the pressures on hospitals are a consequence of declining access to out-of-hospital services”.

There are a number of things going on in my neck of the woods that belie that statement, with a number of initiatives and pilots taking place that in the long term will benefit not only my constituency but the wider NHS. Let me tell Members about a couple of them.

Last week, I met managers from the South East Coast Ambulance Service, SECAMB, who told me about the vanguard initiative in which they are involved in Whitstable, just outside my constituency. It is one of several initiatives nationwide that will provide specialist out-of-hospital care in the local community and involves

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a SECAMB paramedic team, led by a specialist paramedic, working with local GPs to provide people with home treatment rather than their being taken to hospital. SECAMB is keen to replicate the model in other areas, including the Isle of Sheppey in my constituency.

Dr Mathias: Does my hon. Friend agree that with home treatments, the patient becomes the patient expert, which is another way of moving forward local solutions and the community helping itself?

Gordon Henderson: I very much agree, and I shall come onto that point in a moment. I am interested in getting that model on the Isle of Sheppey and I hope that NHS England will see the merit in the initiative and provide SECAMB with the necessary funding.

I mentioned earlier the excellent Sittingbourne memorial hospital in my constituency. It, too, is running a pilot that I believe should be extended into other areas. Last December, a wound medicine centre was opened in the memorial. It is a specialist service for patients across Swale who have chronic, complex or surgical wounds and it is operated under the care of the Kent Community Health NHS Foundation Trust. The centre uses telemedicine, with community nurses visiting patients in their home. By using mobile computer tablets to photograph wounds, nurses can send pictures back to specialists based at Sittingbourne memorial to provide an instant professional opinion. The system can also track the progress of healing wounds and use the data to work out the best treatment options, including the correct type of dressing. That has the potential to save the NHS thousands of pounds in the wasted procurement of unnecessary dressings.

Last month, I was honoured to open the HEM ultrasound clinic in my constituency. It is a new unit that provides a wide range of ultrasound scans and is the first static clinical ultrasound service in Medway and west Kent. Although it is a private clinic, it is just been contracted to Medway Maritime to help bring down its waiting lists. HEM is undertaking an average of 35 scans on behalf of the hospital every day, seven days a week. The cost to the NHS of the clinic’s service is the same as if the hospital undertook the scans itself. Let me tell those who accuse the Government of wanting to privatise the NHS that using facilities such as HEM is not about privatising the NHS but about the sensible use of private facilities to supplement NHS treatment and reduce waiting times for worried men and women.

I want to mention one particular concern. My local Swale clinical commissioning group is led by an excellent team whose members are fully committed to providing local people with more local services to reduce pressure on Medway Maritime, but Swale CCG is one of the smallest in the country and its size presented big challenges, as does the historic health deprivation in some of the wards in my constituency. Last year, Swale CCG received an above-average increase in its budget and I want to take this opportunity to urge the Government to ensure that it receives an above-average increase again this year.

3.7 pm

Paula Sherriff (Dewsbury) (Lab): It is the ultimate honour to be here today to deliver my maiden speech as the Member of Parliament for Dewsbury, Mirfield,

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Denby Dale and Kirkburton. To every man, woman and child living in my wonderful constituency, I promise to be their champion and stand up for them at every opportunity. I warmly congratulate my fellow new Members on their excellent and eloquent contributions and I continue to enjoy my whistle-stop tour of the UK through their speeches. In keeping with tradition, I would like to take this opportunity to acknowledge the input of my predecessor Simon Reevell, and I wish him well for the future.

The suffragette movement fascinated and inspired me from a young age and visiting the cupboard where Emily Wilding Davison hid in order to be included in the census as a resident of this building reminded me of the ongoing struggle that women have both in society and in politics. It is refreshing that 65% of the new Labour intake are female, but there is a lot more to do and I look forward to contributing to that cause. As James Brown famously sang, “It’s a man’s world, but it ain’t nothing without a woman or a girl.” It is therefore a particular privilege to be the first female MP elected in the constituency since Ann Taylor, who now sits in the other place. Every corner of the constituency still holds great affection for Ann for both her unstinting commitment and her no-nonsense approach. I have big shoes to fill and I thank Ann for the generosity of her advice and support. I aspire to make her proud. On the subject of inspirational women it would be remiss of me not to mention Betty Boothroyd, born in Dewsbury, the daughter of textile workers, who broke new ground by becoming the first woman to be elected as one of Mr Speaker’s predecessors.

The Dewsbury constituency is a wonderful place in which to live, work and indeed play. Dewsbury itself is often referred to as the heavy woollen district, a nod to the manufacture of heavyweight cloth that saw a significant population of South Asian origin relocate there in the late 1950s, many of Kashmiri and Gujarati heritage. Indeed, the town maintains a rich manufacturing industry and has something of a monopoly in the bed and mattress industry.

In common with many other northern market towns, Dewsbury is struggling economically, with the town centre crying out for regeneration. It is therefore most welcome that Dewsbury has been earmarked as an enterprise zone. Dewsbury is also famous for its hospitality and the warmth of its welcome. It is perhaps unique in that, when visiting a constituent’s home intending to stay a short time, I can be greeted with a three-course banquet and an invitation to the family wedding. Many people will have shed a tear watching Mushy overcome his stammer on “Educating Yorkshire”, the fly-on-the-wall documentary filmed at Dewsbury’s own Thornhill Academy.

The town of Mirfield has strong socialist roots. The Community of the Resurrection, an Anglican religious community for men, was founded there in 1898 and hosted Keir Hardie and Emmeline Pankhurst in its incredible outdoor amphitheatre. Denby Dale and Kirkburton comprise a number of small villages and arguably boast some of the finest scenery in Yorkshire—or God’s own county, as it is better known. I always know I am near home when I catch sight of the splendid Emley Moor mast, which, at 1,084 feet, is the tallest free-standing structure in the UK.

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Many will know that I am a trade unionist, having previously acted as a shop steward and equalities officer. I will continue to seek to strengthen the bond between the Labour party and the trade union movement. The trade unions were instrumental in creating the Labour party to fight for working people in Parliament, and in this time of insecure employment, zero-hours contracts and exploitative labour, the unions have never been needed more in the workplace, just as the voice of working people has never been more needed in Parliament. This Government’s shameful attempt to weaken that collective voice should be universally condemned throughout this House.

I must also acknowledge my parents, Barbara and Michael, who taught me that I did not have to go to university to achieve my dreams and that I should maintain the courage of my convictions and never give up on my principles. I am proud to bring over 20 years’ experience on the front line of our public services to this Parliament. After some time working with the victims of crime, I worked in a front-line healthcare role for 13 years prior to taking my seat in this place. The last two years of that were challenging, as the service I worked in was privatised.

On my first day working for Virgin Care, I was advised that my political beliefs did not fit in with the company objectives. As my beliefs involved free healthcare at the point of need and always putting patients before profit, that affirmed my fears that the health service was moving away from its fundamental principles. I shall have more to say about Virgin Care in future debates. I will also continue to campaign tirelessly for a fully renationalised NHS and, on the subject of today's debate, I will fight for the future of Dewsbury hospital, which remains under threat of significant downgrade and whose accident and emergency service is fighting for its life.

Dewsbury has many challenges ahead over the next five years, not least in relation to the growing inequality we now see in our country. I intend to use my time diligently as Dewsbury’s Member of Parliament to redress that, and to fight for the fairer, more equal society that my constituents deserve.

3.12 pm

Maria Caulfield (Lewes) (Con): I congratulate the hon. Member for Dewsbury (Paula Sherriff) on her eloquent maiden speech. It is great to see another strong woman in the House.

I am mindful of the time constraints in the debate and, although I would love to talk about GP access and hospital finances, I shall concentrate on accident and emergency targets and, in particular, the target of 95% of patients being seen within four hours. I speak as a nurse who has worked in A&E under the last Labour Government when the four-hour target was introduced. I hope that my clinical experience will be used to inform the debate and take it forward.

I want to make four key points on A&E targets and the four-hour wait. First, like the hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for Totnes (Dr Wollaston), I am not a fan of targets. As a healthcare professional, I found them increasingly frustrating. They are great as a tool, but they are being used as a political stick with which to beat healthcare workers and the system. There was no

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clinical rationale for choosing the four-hour target. There is no evidence that the morbidity or mortality of someone who waits for four hours and 30 minutes is compromised. Similarly, there is no evidence that the healthcare received by someone who has waited for three hours and 30 minutes is any better than that received by someone who has waited for four hours. The four-hour target is actually not that helpful.

Karin Smyth: Will the hon. Lady give way?

Maria Caulfield: I will not take any interventions owing to the restriction on time.

I shall give the House an example. When I worked as a nurse in A&E—under the Labour Government—an elderly gentleman was brought in during a busy night shift. He had fallen at home and broken his hip, and he was put in a corridor to wait. After three hours and 30 minutes, he called me over, saying, “Nurse, I desperately need to go to the toilet.” I had nowhere to put him. The best thing I could do was to wheel a curtain around his trolley, and there, in the middle of a busy hospital corridor, that elderly gentleman with war medals on his chest went to the toilet. He was seen within four hours. That box was ticked and he was deemed to have had good healthcare, but I was not particularly impressed with that care. Let us not kid ourselves that meeting that target always means that the patient experience is good or that the outcome is any better.

My second point, which relates to my worry that this debate is being used as a political football, is that the four-hour target is not being seen in the context of the bigger picture. Other targets show that, even with the increased numbers attending A&E, more and more patients are getting their treatment within four hours. Similarly, the clinical outcomes—surely the most important factor—relating to diseases such as heart attacks show that morbidity and mortality rates have improved. There have also been better outcomes for people who have had strokes and for trauma victims. So outcomes for patients are improving despite the four-hour target not having been met during the past 100 weeks. We should welcome that and congratulate our NHS staff on achieving it.

Thirdly, if this is a serious debate about A&E services throughout the whole of the United Kingdom, which we are surely all here to represent, why are we not looking at the rate in Scotland of only 87%, in Labour-run Wales of 83% and in Northern Ireland of 79%? This debate is a political one, and as a healthcare worker, I find that distressing. It is interesting that those Members who have worked in the NHS believe that the four-hour target is a useful tool but that it should not be used as a political stick.

Dr Philippa Whitford: I would like to know where the hon. Lady got her figure of 87% from. Our figure is 92.6%, and we measure it every week.

Maria Caulfield: I was given the figure by the Nuffield Trust.

Dr Whitford: Not by the NHS?

Maria Caulfield: It is an NHS figure.

I shall attempt to move the debate forward with my fourth point. If we are serious about tackling the issues resulting from the number of patients using A&E services, we need to acknowledge that 15% of patients who go to

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A&E could receive treatment elsewhere, in local community facilities. We need to look seriously at the Government’s proposals for seven-day-a-week health service, and if Opposition Members are serious about working with healthcare professionals to improve the experience of patients, they should surely welcome the introduction of out-of-hours services to take the pressure off A&E.

The thing I find most distressing about the motion is that it is full of criticism and complaints but offers no solutions. My plea to Opposition Members is that we should work together for the benefit of patients. We cannot continue to have patients whose care is being compromised even though they have ticked the four-hour box. We have only to look at the example of Mid Staffs, where the four-hour target was met time and again while terrible incidents were happening behind the scenes. Let us stop using the NHS as a political football; let us start working together. I would welcome the efforts of all Members to work together with the Government to deliver out-of-hours services and take the pressure off A&E units and the staff who work in them.

3.19 pm

Mr Iain Wright (Hartlepool) (Lab): This is the first opportunity I have had to welcome you to the Chair, Madam Deputy Speaker. I am extremely pleased to see you in what I think is your rightful place.

I pay tribute to my hon. Friend the Member for Dewsbury (Paula Sherriff) for her excellent speech. She is part of a very talented 2015 intake—far too talented for my liking, I am afraid to say. She has already demonstrated a strong reputation for standing up for her constituency—often in the face of terrible attacks—in terms of fairness, tolerance and decency in public services. She is a strong asset to this House and I welcome her.

The issue of accident and emergency services is important for Hartlepool, because we lost our A&E in August 2011. That closure has been felt very deeply by my constituents, who now have to travel to North Tees, which is some 13 miles away, for accident and emergency services. Given the appalling provision of public transport, the low level of car ownership and the relative levels of deprivation, that is too far to travel for far too many of my constituents.

Anna Turley (Redcar) (Lab/Co-op): Will my hon. Friend comment on the impact of that A&E closure on, and its implications for, areas below the River Tees, including my constituency? In South Tees, despite the best efforts of our NHS staff, waiting times have increased and the A&E target in particular continues to be missed.

Mr Wright: My hon. Friend makes a very important point. Having fewer A&E departments puts further strain on other parts of the system, such as A&E at James Cook hospital, and other parts of the NHS, such as ambulance services. They are queuing up outside James Cook hospital, but it does not have the throughput it needs.

It is important that A&E returns to the town of Hartlepool. Given the level of health inequality, as well as the high proportion of older people relative to the rest of the country, there is a greater risk of accidents and, therefore, I think it is fair to say, greater reliance on A&E than other areas.

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To be frank—this is not a party political point—the closure was based on clinical safety factors. The number of medical staff to cover two rotas at both Hartlepool and Stockton was deemed insufficient, and the supervision of junior medical staff was deemed inadequate, as it did not meet modern guidance criteria. Additional resources will need to be provided for adequate staffing to ensure that A&E can return to Hartlepool. North Tees and Hartlepool Hospitals NHS Foundation Trust has a financial deficit of £4 million, which is expected to worsen over the coming years.

Tulip Siddiq (Hampstead and Kilburn) (Lab): In the coming winter months the Royal Free hospital in my constituency will once again face pressure in A&E and other services. Does my hon. Friend agree that the extra winter NHS funding should be allocated sooner rather than later so that hospitals can start planning, and that it should be included in the forthcoming Budget?

Mr Wright: My hon. Friend makes a really important point. On the additional resources, the north-east region has not been provided with anything, despite the level of health inequalities and the additional pressure on resources.

Lynne Hodgson, the director of finance at the trust, has said:

“The whole system is stretched financially.”

The situation is so bad that the trust has recently taken out a £2 million loan. That is not for investment in health services—it is not helping to pump prime the return of A&E to Hartlepool—but for paying the wage bills of current staff. When an organisation has to borrow to meet obligations for something as fundamental as its staff’s monthly pay packets, something is fundamentally wrong with the system.

I am arguing for the services to be returned to the town, but given the precarious finances of the trust I am fearful that most services will move further away or simply cease to operate, putting further pressures on the local health economy, such as James Cook hospital, and other parts of health and social care. What will the Government do to ensure that the finances of the North Tees and Hartlepool trust are put on a more secure footing while at the same time allowing such essential services to return to the town?

I fully accept that clinical safety for A&E services is paramount—I will never argue against that—but I have to question the model of acute accident and emergency services in my area. Over the past two decades or so, there has been a tendency to centralise services at North Tees, to the detriment of patients from Hartlepool and those slightly further away in south-east Durham. The momentum programme was going to centralise services on to a single site, culminating in a new hospital at Wynyard that would serve the populations of Hartlepool, Stockton, Easington and Sedgefield. The Government have made it perfectly obvious through their actions that Wynyard will not go ahead, which, together with NHS England’s “Five Year Forward View”, shows that smaller hospitals can thrive. Indeed, we have seen that across the region and the country. Darlington, whose population is only slightly larger than mine and which comes under the County Durham and Darlington NHS

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Foundation Trust, is able to maintain an A&E. Hexham has a population not of 92,000 like Hartlepool, but of 13,000, and it is able to maintain an A&E at Hexham general hospital. Clearly, centralisation is not the answer everywhere. Different clinical models and reconfigurations are available to allow smaller towns to retain their A&Es.

Rachael Maskell (York Central) (Lab/Co-op): Does my hon. Friend agree that there needs to be more transitional care, with step up, step down facilities, and that we need to address the skill mix of different clinicians in those facilities?

Mr Wright: That is an incredibly important point. I started with staffing and I will end on it.

I want to make a vital point. The Minister spoke of local solutions, and the people of Hartlepool, Hartlepool Borough Council and I, as the MP for Hartlepool, want that to be the approach, but we are not being heard. I understand that there are always tensions between the wishes of the public with regard to where health services are located and the essential requirements of clinical safety, but, as shown by the examples I have given, there are other ways. The local trust is simply not listening. Given that I, the people of Hartlepool and the local authority—regardless of its political complexion—want this, what will the Government do to ensure that, in the shaping of local accident and emergency services, the voices of local people and their democratically elected representatives are genuinely heard?

As I said, I started by addressing staffing and I want to finish on that, too. I hope I have made it clear that I want A&E to return to Hartlepool, but it is clear that the pressure on acute services would be reduced if there was more access to primary care. The GP per head of population ratio is low in Hartlepool, with 63 GPs per 100,000. That is significantly lower than the north-east regional average—only Stockton has a lower ratio—and it is lower than the average in England. Greater access to GPs and better integration of all health and social care services has to be the way forward, but that also includes giving the people of Hartlepool what they want, which, put simply, is a fully functioning hospital in the town and an accident and emergency department at its very heart.

3.27 pm

Henry Smith (Crawley) (Con): Thank you for giving me the opportunity to speak in this important debate, Madam Deputy Speaker. May I join other hon. Members in welcoming you to the Chair? This is the first time I have spoken with you in your place, and it is very good to see you there. May I also extend my congratulations to the hon. Member for Dewsbury (Paula Sherriff) on her maiden speech? Like other hon. Members, I thank sincerely the people who work in our NHS and perform such an important task on behalf of the nation’s health.

When the shadow Minister, the hon. Member for Copeland (Mr Reed), introduced the debate, I intervened and mentioned the fact that, in 2005, under a Labour Government—the decision was made in the then Labour Department of Health—Crawley hospital lost its accident and emergency unit. In the six decades of Crawley new town’s history, that will prove to be the worst possible mistake. The people of Crawley, which is the natural

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population centre of the Surrey and Sussex Healthcare NHS Trust area, had to travel up to 10 miles up the road, on single carriageway highways, to access East Surrey hospital. The result has been at best inconvenience and at worst dangerous situations for many patients trying to reach the hospital. The South East Coast Ambulance Service does sterling work, but it has been a great challenge.

I am pleased that, in the past five years, hospital services have returned to Crawley hospital. We have an urgent treatment centre that is open seven days a week, 24 hours a day. We are about to have new GP primary access at the Crawley hospital site in West Green, and I was delighted a few years ago to open the new digital mammography unit. We have increased beds and staff at Crawley hospital, and I was pleased to open a new MRI scanner earlier this year.

None of that would have been possible without the previous Government’s commitment to increase funding on the NHS. Through the Health and Social Care Act 2012, they ensured that many more decisions are made locally by the Crawley clinical commissioning group, which means that local doctors and clinicians have far greater influence to meet the needs of my population and my constituents in Crawley. It was a very welcome development.

I support the Government’s commitment to invest further in the NHS and to increase its funding, and their commitment to ensure that GP services are extended, not only for patients’ convenience, but to ensure that, as far as possible, we divert those unnecessary attendances at the urgent treatment centre at Crawley hospital and A&E at East Surrey hospital. That initiative will have a significant impact on reducing the pressure on A&E.

In addition, I support and welcome the Government’s commitment to ensure that social care plays an important part, so that people who should not be detained in hospital any longer, not only for their own health needs but for the health of the healthcare system, are moved into appropriate care settings. That will mean more capacity for A&E.

Finally, on the future of healthcare in the Crawley area, my constituency contains Gatwick airport. Next week, we will hear the results of the Airports Commission into runway expansion. If Gatwick is the commission’s choice, an awful lot of infrastructure investment will need to be placed into the area, not only for transport such as rail and roads but for healthcare. Should Gatwick airport be the Government’s final decision—for the reasons of infrastructure pressure, I do not believe Gatwick is the appropriate location—an absolute necessity would be a new acute hospital with full A&E.

I welcome what the Government have done to support our national health service and their commitment in this Parliament, and I look forward to playing my part in ensuring that the needs of our patients and the needs of our NHS remain a central priority.

3.33 pm

Rebecca Long Bailey (Salford and Eccles) (Lab): Thank you, Madam Deputy Speaker, for giving me the opportunity to make my maiden speech during this debate.

Earlier this year, our A&E department at Salford Royal hospital—a flagship of NHS excellence—endured a period of crisis that was a symptom not just of the

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national shortfall in funding but of the far wider challenges we face in my constituency of Salford and Eccles. None the less, Salford, Eccles, Swinton and Pendlebury collectively make an amazing place to live, in terms of both the spirit of their people and their ambition to achieve the unthinkable.

We have a rich political history. I am a proud socialist, and if any city personifies the struggles of the working class and the Labour movement, it is Salford. Salford was pivotal in the creation of the trade union movement, with Salford and Manchester trades councils founding the TUC in 1868. On 1 October 1931, thousands swarmed to Salford town hall, where a violent demonstration took place. It came to be known as the battle of Bexley Square. They were protesting at the 10% cut in unemployment benefit introduced by the new national Government. Sadly, we face similar struggles in Salford and Eccles today.

Freidrich Engels’s pioneering work, “The Condition of the Working Class”, was inspired by the struggles he witnessed in Salford, where he owned a factory and could often be found drinking in The Crescent pub with Karl Marx. Members will be delighted to know that Engels’s magnificent beard has inspired a climbing wall sculpture in Salford. The 16-foot beard statue—a “symbol of wisdom and learning”—will stand on the University of Salford’s campus. Members will be able to scale the impressive beard to a viewing platform at the top, where they might find time to rest and contemplate.

We are a city facing the legacy of post-industrial decline. Members may recall the song “Dirty Old Town”, penned by Ewan MacColl and later sung by, among others, The Pogues, about finding love in 20th century industrial Salford by the gasworks wall. The gasworks wall still exists today, but Salford’s gas industry has largely disappeared, along with our mining community, destroyed in the 1980s, as was our large shipping, engineering and manufacturing base. Thousands of lives, hopes and dreams were shattered, with generations locked in a cycle of low-paid unskilled work. We were told that free market globalisation of industry would eventually see wealth trickle down from the top. We are still waiting.

We were a city on its knees and we can be thankful for the foresight of Salford’s Labour councillors who encouraged investment and growth. They championed the transformation of the derelict docks into Salford Quays, now a residential and cultural quarter housing the Lowry gallery, theatre and shopping centre. Again, it was the Salford Labour Council and our local MPs who ensured the building of Media City, the new headquarters for the BBC and ITV, against resistance from a southern-based media that saw anything north of the Watford gap as a social and cultural backwater.

I would like to pay tribute to my predecessor, Hazel Blears. Elected alongside a record number of women MPs in 1997, Hazel is admired by many, including me, for breaking the glass ceiling not just for women in Salford but for all women from working-class back grounds like myself. Indeed, much of Hazel’s time in the House was dedicated to promoting schemes that would give young people from disadvantaged areas the chance to forge a career in politics and other vocations.

I would also like to honour Ian Stewart, who served as MP from 1997 to 2010, for the now abolished constituency of Eccles. Ian was a proud trade unionist,

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like myself, who never forgot the poverty and struggles of his childhood. Recently, in his current role as Mayor of Salford, Ian urged the Government to rethink the savage cuts to the Salford City Council budget, austerity measures that are neither justified nor necessary. These cuts are now sawing through the bones of our already fragile public services and they severely impact on the most vulnerable.

It might startle hon. Members to hear that life expectancy in the more deprived parts of my constituency is lower than the life expectancy of people living in the Gaza strip. Some 30% of children in parts of my constituency live in poverty. Our unemployment rates are above the national average and our wages for those in work far below it. Many families are trapped in a cycle of poverty and low-paid and insecure work. The gap between rich and poor is now growing at a faster rate than in the Victorian era. Evidence from the world over indicates that health outcomes are linked not just to material poverty but economic inequality. It reduces social cohesion, leading to more stress, fear, and insecurity, which places even greater strain on our NHS and public services. Our NHS will only truly succeed when we invest in people and their quality of life. That means adequate funding for our public services, decent and affordable housing, well-paid secure jobs and a clear and apparent reduction in income inequality between those at the top and those at the bottom.

My constituency and its people have a proud socialist history. I intend to use my time in the House to fight for them to have a proud socialist future as well.

3.39 pm

James Cleverly (Braintree) (Con): Before I move on to the comments I intend to make, may I pay tribute to an excellent maiden speech by the hon. Member for Salford and Eccles (Rebecca Long Bailey)? Her pride in her home town is obvious. It shone through in a very punchy and effective maiden speech, and I thank her for giving it.

My mother spent most of her professional life as a midwife in Lewisham hospital, the hospital of my birth. I used to go to her office and do my homework there after I left school, so I was literally born and brought up in Lewisham hospital. Both my sons were born in Lewisham hospital—a hospital I love and am proud of. I do not doubt for a second the passion of Opposition Members for the NHS. I remind them, however, that they do not have a monopoly on passion and respect for the national health service.

We are talking today about waiting times in A&E. There are many complicated and compounding pressures that drive those waiting times. This debate could and should have been an opportunity to discuss them and look for solutions and mitigations. I was taken by the calm and professional speech of the hon. Member for Central Ayrshire (Dr Whitford). While she was speaking, it was impossible to be in the Chamber and not to be heavily influenced by the remarks she made. We would all be in a significantly better place if, during the rest of this speech and the rest of our time in this Parliament, NHS debates could be conducted in the manner in which the hon. Lady delivered her speech.