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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure to serve under your chairmanship, I believe for the second time, Mr Weir, and to reply to the hon. Member for Birmingham, Erdington (Jack Dromey), whom I congratulate on securing this debate. I acknowledge his hard work on behalf of his constituents in campaigning for the retention of Erdington walk-in centre, and the strength of feeling locally, which he eloquently outlined.
Before I move to the local context, it would be remiss of me not to pick up the issues of national consequence raised by the hon. Gentleman. This Government will have invested £12.5 billion more in the NHS between the last election and the one in 2015, which is providing some, albeit small, real-terms growth in the NHS budget. Even though we are in difficult economic times, the Government have made a clear commitment that the NHS is a special case that needs further investment, which we are providing. It might be worth the hon. Gentleman taking that up with one of his Front-Bench colleagues, the right hon. Member for Leigh (Andy Burnham), who in contrast said that such investment was irresponsible. Indeed, the Labour party running the NHS in Wales intends to make an 8% real-terms cut in its budget. It is worth reflecting on the reality of the situation before getting drawn into any political rhetoric.
The hon. Member for Birmingham, Erdington is right to raise the specific pressures on A and E. We know that A and Es are being accessed by increasing numbers of patients, and we know from history that one key driver of that was the previous Government’s decision to contract out-of-hours GP care away from local GPs. One direct consequence of that has been additional pressures on accident and emergency departments. In many ways, that pulls against what he spoke about and what I believe in, which is the need to deliver more and higher quality care in the community. That cannot be nine-to-five or nine-to-six care in the community; it has to be all-day, 24/7 care, which is what integrated good health care looks like. I believe that the decision was bad. I saw its consequences when I worked as a casualty doctor in A and E. We have lived to regret it, and it has been badly to the detriment of patients.
The report on the Mid Staffordshire NHS Foundation Trust graphically outlined the fact that targets have often got in the way of front-line patient care. That is why this Government, when they came to power, relaxed the 98% target for the four-hour wait in A and E and set it at 95%, which doctors, nurses and my fellow health care professionals said was in the best interests of patients. Too often the four-hour target meant that a patient who perhaps had a broken toe was given priority ahead of a patient with potentially life-threatening chest pain. That was not good medicine or patient care, but showed targets getting in the way of looking after patients effectively, a lesson that was graphically depicted in the Francis report on the Mid Staffordshire trust. We must learn such lessons and acknowledge that although targets can have a place in health care, we have to trust and listen to front-line health care professionals if we are to deliver high-quality care for patients.
On the national context of urgent care and accident and emergency care, the Government are committed to developing a more coherent 24/7 urgent care service in every part of England. That will provide universal access to high-quality 24/7 urgent care services, so that whatever people’s needs or location, they will get the best care from the best person in the best place and at the right time.
The NHS has always had to respond to patients’ changing expectations and advances in medical technology. As lifestyles, society and medicine continue to change, the NHS will also need to change. The reconfiguration of urgent care services is therefore about modernising the delivery of care and facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives. We are clear that, as the hon. Gentleman outlined, the reconfiguration of front-line services is a matter for the local NHS. That was the previous Government’s policy and is this Government’s policy.
Services should be tailored to meet the needs of the local population. We expect proposals for service changes to meet four tests: to demonstrate a clear clinical evidence base underpinning any proposals, focusing on improved outcomes for patients—in other words, to save lives—and to show clear support from GPs as the commissioners of local health-care services, strengthened arrangements for public engagement and support for patient choice. Even when all those tests are met, if the responsible local authority is concerned about a decision, it will have the option to refer such a decision to the Secretary of State.
Our vision for urgent care is to replace the ad hoc, unco-ordinated system that has developed over the past few years—characterised by poor quality and too much variation in care throughout the country—with a more consistent system that delivers improvements in patient care. The Government are committed to putting GPs in charge of commissioning urgent care services. We believe that empowering GPs and other health professionals will achieve better and more patient-focused services.
It would be wrong not to talk about the winter pressures faced by the NHS. In response to those pressures, we have put about £330 million of additional money into the NHS to deal with them. I am aware that local hospitals in the Birmingham area recently issued a statement advising patients to attend A and E only for matters requiring urgent attention, because of the pressures of demand experienced by emergency departments. There is always more pressure on the NHS during winter months, with more demand on urgent and emergency care services, and this year is not different. During October and November 2012, NHS Midlands and East scrutinised winter plans, escalation triggers and protocols across its health economies, and it is monitoring pressure on health services during the winter across the whole of the strategic health authority area to ensure that patients continue to have access to high quality NHS care in Birmingham and elsewhere.
I turn to the local context, which is obviously of importance to the hon. Gentleman and his constituents. He is a tremendous advocate for his constituents, and has eloquently outlined some of the local concerns, which relate to an NHS review of urgent care provision in Birmingham and Solihull. The clinical commissioning groups in the area are developing an urgent care strategy to improve access to and integration of services for people with urgent health care needs, to make the system simpler to navigate and to avoid duplication.
I understand that local commissioners have engaged stakeholders in the process, and they include clinicians, patient groups, providers and health overview and scrutiny committees. The local NHS has collected evidence from local people to understand the usage of current urgent care services, such as walk-in centres.
The hon. Gentleman will be aware that the local NHS is now developing a draft strategy outlining some initial options. However, it is important to make it clear that as yet no decisions have been made. That is for local determination, and it would not be appropriate for me to comment further on the detail of the urgent care review.
I am assured by the local NHS that engagement with local people and other stakeholders will continue over the coming months to ensure their input in the final proposals ahead of the formal consultation later in the year. Of course I expect any proposals to meet, where appropriate, the four tests for service change.
I understand that the hon. Gentleman met representatives of Birmingham CrossCity CCG in December 2012 to discuss the review, and I encourage him to continue engaging with local NHS staff on the matter.
Jack Dromey
It is certainly true that we had a meeting in December and that it was clear beyond any doubt that there was a real threat to both the walk-in centres. A commitment was given that by the end of January there would be a route map of the next stages of process and engagement, but here we are in the first week of March and it has yet to be produced. The suggestion now is that it might not be with us until mid-April at the earliest. Although I understand what the Minister is saying in good faith about the importance of proper engagement with the community, I have to say that those responsible in the national health service in Birmingham have been dragging their heels.
Dr Poulter
The hon. Gentleman is right to say that when there is talk of service change, effective engagement is important and must be dealt with in an expedient manner. There must be an awareness that the prospect of any change can lead to understandable concerns among both staff and patients. A time of change is always potentially unsettling. I know that he, like me, will want to encourage the CCGs to come to the table and address this matter more effectively than they have done. I will endeavour to ensure that there are representatives from the CCGs at the meeting that we have later in the month, as that will be an effective way of helping to facilitate matters and bring them to a more speedy resolution.
In conclusion, I encourage local people in Birmingham and Solihull and their elected representatives, including the hon. Gentleman, to participate in the engagement process and subsequent consultation to ensure that their views are taken into account. I look forward to meeting the hon. Gentleman later this month to ensure that we do all we can to facilitate a speedy resolution of the matter and to ease these times of uncertainty that are faced by his constituents.