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House of Lords

Tuesday, 20th November 2001.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers—Read by the Lord Bishop of Oxford.

Accident and Emergency Services

Baroness Greengross asked Her Majesty's Government:

    What is their response to the Audit Commission report on accident and emergency services.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, the Government have taken note of the recent Audit Commission report. We launched a £118 million strategy Reforming Emergency Care to reorganise emergency care in the NHS. Reducing long waits in A&E is at the heart of this ground-breaking strategy. The strategy and the significant investment attached to it reflect the priority that the Government place on improving access to emergency care.

Baroness Greengross: My Lords, I thank the Minister for that reply. I welcome the Government's investment in A&E services and in other aspects of the NHS. However, the majority of people attending A&E departments are elderly, and for such people waiting times are often a life and death situation. Given that fact, does the Minister agree that it is important that older people, who often suffer from multiple symptoms and pathologies, should be seen in A&E by professionals who understand and are qualified to manage their various needs?

Lord Hunt of Kings Heath: My Lords, I do not disagree with the noble Baroness. I certainly hope that, as part of the reform of emergency care and the implementation of our national service framework for older people, NHS trusts will ensure that services in A&E and others parts of a hospital are sensitive to the needs of older people. The patient forums which are shortly to be established in every trust will also provide a strong consumer view for the trust board to consider. I am sure that the needs of older people will figure largely in those discussions.

Baroness Gardner of Parkes: My Lords, will the Minister reassure the House that the triage system of determining those in most urgent need of treatment still operates in accident and emergency departments, irrespective of age?

Lord Hunt of Kings Heath: Yes, my Lords. In the proposals on emergency care, one of the key recommendations is that in future patients should be streamed. A&E patients are currently expected to wait in a single queue. Often, that means that those with the

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least serious problems find themselves continually put at the back of the queue when patients with more serious problems arrive—and that is understandable. The new emergency care policy suggests that at the triage stage people are separated. Those in need of urgent treatment will be fast-tracked, but those who require non-urgent treatment will be seen by a dedicated group of staff. Research undertaken by Warwick University suggests that by organising services in that way we can reduce overall waiting times for everyone.

Lord Peston: My Lords, my noble friend will perhaps not be aware of the fact that I spent eight hours in A&E last Sunday. I hasten to assure your Lordships that I was not the potential patient; I was simply the person looking after another potential patient. I hope my noble friend will agree that seven or eight hours is a very long period of time to spend in A&E. But the main problem, on which I should be interested to know the Government's view, is that no one knows what is going on. One is just sitting there, with, in this case, a young person—waiting, and waiting, and waiting. The psychological damage seems to me to be enormous—not merely to the patient, but in this case to me!

Lord Hunt of Kings Heath: My Lords, I am sorry to hear of the psychological problems affecting my noble friend as a result of his wait in A&E. I agree with him. Long waits are very difficult in stressful circumstances. They are made all the more burdensome if people are not kept informed as to the reason for them. That is why establishing a new system whereby effectively patients will be streamed will enable people to be seen more quickly. I accept that we need to do more to inform patients and their relatives and friends as to how long it is before they are likely to be seen. Our target is that by 2004 the maximum waiting time for the whole process in A&E will be four hours. Although my noble friend regrettably had to wait eight or more hours, in terms of reduced waiting times we are on course for an interim target of 75 per cent by 2002.

Baroness Northover: My Lords, does the Minister realise that it was in 1995 that the Oxford Clinical Trial Service Unit completed its definitive report on the number of lives that would be saved if the so-called clot-busting drugs were used for heart attack patients within hours of their attack? How many patients does the Minister think have died because only one-third of our A&E departments come up to the nationally agreed standards? What will he do to ensure that the money that he talks about will not be top-sliced all the way down, so that it barely reaches the A&E departments, as has happened with the money for cancer treatment?

Lord Hunt of Kings Heath: My Lords, the intention is that the money will be spent in A&E departments and that it will not be top-sliced. We shall performance-manage the situation to make sure that that happens. As regards drugs, in the national service framework for coronary heart disease we have set a

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target that, by April 2002, 75 per cent of eligible patients should be receiving thrombolysis within 30 minutes of hospital arrival, and within 20 minutes by 2003. We are making progress, and I am confident that we shall reach those targets.

Baroness Masham of Ilton: My Lords, as many patients are children, does the Minister agree that in A&E departments there should be more facilities for children and more people who understand their needs?

Lord Hunt of Kings Heath: My Lords, anyone who has taken a child to an A&E department can only agree with the noble Baroness. Some hospitals have introduced dedicated facilities for children. They have been aided in that by the modernisation fund that we have introduced, which has already brought additional moneys to 90 per cent of all A&E departments. We are also seeing an increase in the number of child-trained nurses, some of whom could work in A&E departments and ensure that children receive the kind of dedicated service that they require. We clearly need to build on that approach.

Baroness Strange: My Lords, is the Minister aware how absolutely splendid the accident and emergency people were at Perth Royal Infirmary when my daughter fell 10 feet off a ladder and the ladder fell on her leg? They dealt with her immediately.

Lord Hunt of Kings Heath: My Lords, I was very glad to hear that. I only wish that I could claim responsibility for the trust in Perth, but I fear that I cannot. There is no doubt that we have some very high calibre and dedicated staff working in extremely pressurised situations in A&E departments. By increasing our capacity and our staff numbers and, crucially, reorganising the way in which they work, we can relieve some of the pressure on those staff and cut down the waiting times, which we are determined to do.

Lord Avebury: My Lords, I have made a couple of visits to A&E departments in the recent past. What steps are the Government taking to ensure that staff in A&E departments are properly protected from violent criminals, who come in every Friday and Saturday night, disrupting the work of the departments and intimidating the staff?

Lord Hunt of Kings Heath: My Lords, the House is glad to see the noble Lord back in his place. I agree with him. NHS staff have been put under intolerable pressure by frightening and revolting behaviour by members of the public. My right honourable friend the Secretary of State has made it abundantly clear that we will support hospital management in taking decisive measures to ensure that action is taken against such people and that our staff are not required to cope with the situations that the noble Lord described. There have been a number of encouraging developments, including links with local police services. In some

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areas, the local police force has a police station in the vicinity of the hospital. We need to build on those initiatives.

Rheumatoid Arthritis: Drugs Appraisal

2.45 p.m.

Lord Roberts of Conwy asked Her Majesty's Government:

    Whether, following reports of a possible trial of beta interferon drugs for multiple sclerosis sufferers, they would support a clinical trial of anti-TNF drugs for rheumatoid arthritis sufferers.

Lord Hunt of Kings Heath: My Lords, following a recommendation from the National Institute for Clinical Excellence, we are currently holding discussions with the manufacturers of beta interferon and glatiramer acetate to establish whether those drugs might be secured for patients in the NHS in a manner that could be considered cost effective. NICE is currently appraising anti-TNF drugs for rheumatoid arthritis and we anticipate that its guidance will be published in March. We will consider carefully all its recommendations, including any for further research.

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