15:46 - The House having divided: - Ayes: 242 / Noes: 307 - Question accordingly negatived.
The Secretary of State for Health (Mr Jeremy Hunt)
What we have heard today is a deeply unconvincing attempt by the Opposition to turn A and E into a political football. As a former Health Secretary who missed his own target for 14 of the 26 weeks that covered winter, the shadow Secretary of State should know better than to run down the phenomenal achievements of hard-working NHS staff at this busy time of year.
The right hon. Gentleman threw out numerous statistics—[Interruption.] He asked me to give him some answers, so he should just listen. He threw out numerous statistics, but let us look at the facts he chose not to mention. First, given that A and E departments across the United Kingdom face similar demographic challenges and have similar structures and targets, a comparison with Wales is instructive, not least because, with a Labour-run Government, it is following policies that are closer to those that he favours. The most recent full-month data available for both countries show that England hit the target, with 95.7%, but Wales missed it, with 90.4 %. Last year, England hit the target, with 95.9%, but Wales missed it, with 87.7%. In fact, Wales has missed it every single year since 2009. He also talked about ambulance times. In October, the figure for England was 74.6%, and for Wales 65.2%.
The right hon. Gentleman used some strong language. He talked about complacency and crisis. Will he now demonstrate that those comments were not shallow point scoring by making the same criticisms of Labour in Wales? If not, the House will see those comments for what they are: a hollow attempt to turn an operational challenge—one that he faced, that I face, and indeed that all Health Secretaries face—into a political argument regardless of the impact on patients or staff. Vulnerable people are relying on our emergency services this winter, so to whip up fear and run down performance, as he has done, is frankly shameful. It is putting politics before patients, and not for the first time from the Opposition Benches.
If the right hon. Gentleman does not want to talk about Wales—[Interruption.] I will move on to that later. If he does not want to talk about Wales, let us look more closely at England. Again, the statistics he did not want to share with the House show that NHS A and E departments are actually performing much better than when he was Health Secretary.
Guy Opperman (Hexham) (Con)
Does the Secretary of State welcome the example being shown by the award-winning Northumbria NHS Trust, which is building a brand-new specialist emergency care hospital in these difficult times, offering 24-hour cover seven days a week with consultants? That idea preceded the Keogh review and shows the way forward that A and E should be taking.
Grahame M. Morris
If the Government are doing so well in relation to targets, why have they downgraded the four-hour waiting target from 98% to 95%?
Mr Hunt
I will tell the hon. Gentleman why. It was done on clinical advice, for the good reason that there are some patients whom it is better to see, even if it takes longer than four hours, so that they can be discharged and sent home, rather than admitting them to the hospital, which is what was happening under the 98% target. Labour agrees with that, because it is following the same procedure in Wales.
Mr Hunt
I am going to make some progress.
I want to talk about what is happening in England, because the right hon. Gentleman wanted to know the truth. These are the statistics he did not want to tell the House about the comparison with his time in power, which he said was so good: 1.2 million more people are going through A and E every year, and more than 2,000 are being seen within four hours every single day, compared with when he was Health Secretary. The average wait to be seen is now 33 minutes compared with 77 minutes when he was Health Secretary—that is 44 more minutes longer, on average, to be seen under Labour than under this Government. For treatment, the average wait is now 75 minutes compared with 102 minutes when he was in office.
Andy Burnham
Will the Secretary of State give a straight answer to this simple question: is there or is there not a crisis in A and E?
Mr Hunt
I refer the right hon. Gentleman to the people who know about this at the College of Emergency Medicine, which says today on its website:
“There is now cause for optimism that the crisis is behind us.”
He should listen to that before whipping up fears of a crisis that the College of Emergency Medicine says is not happening.
Mr Hunt
I am going to make some progress and then I will give way.
There are 216 more consultants and 111 more registrars than during Labour’s time. On ambulance performance, frankly the right hon. Gentleman should be ashamed, because his whipping up of the problem so appalled the ambulance service that he received a letter from the chief executive of the south-western ambulance service, who said about his comments in the House of Commons:
“It is both disappointing and concerning that the information provided to your office has been misinterpreted and misreported in order to present a grossly inaccurate picture for the purposes of apparent political gain...I am astonished that anyone would present such misleading information to the House of Commons.”
Something else that the right hon. Gentleman did not want to tell the House regarding delays is that there has been a 28% fall in the number of 30-minute handover delays compared with the same period last year—that magically did not make it into his speech. Yes, ambulance services are under pressure; yes, there are issues with the performance of some trusts; and yes, this is a busy winter, but the one thing they and the patients they serve can do without is Opposition politicians demotivating crews by misrepresenting the reality on the ground.
Kate Green (Stretford and Urmston) (Lab)
Patients in Trafford will not recognise the Secretary of State’s characterisation of this as a crisis that is in the past. They are reporting long delays at Wythenshawe hospital’s and Manchester Royal infirmary’s A and E departments, particularly, as he will know, because Trafford general hospital’s A and E was downgraded to an urgent care centre and now closes overnight, as of three weeks ago. Does he agree that during transition periods for such reconfigurations it would make sense to ensure that there were adequate resources for neighbouring A and Es to take on the new patients? Those resources have not been provided to these hospitals; will he guarantee to provide them now?
Mr Hunt
I recognise the hon. Lady’s concern for her constituents. I have looked into the issues in the Manchester and Trafford areas very carefully, and I am assured by people on the ground that the problems and challenges they face do not relate to the changes that have been announced in Trafford.
Lorely Burt
We have had a very successful campaign in Solihull to restore two-member-crew ambulances being based in the constituency. However, they still face a big problem with admittance to Heartlands hospital to discharge their patients so that they can get out on the road and back to Solihull again. Can the Secretary of State suggest how the ambulance service could work in a joined-up way with hospitals in order to improve flow-through?
Mr Hunt
My hon. Friend raises an important point. Again, we would not hear this from the Opposition spokesman, but ambulance services across the country are making great strides. For example, in the past year there has been a 10% increase in the number of patients that ambulance services do not take to A and Es, and an 8% increase in the number of patients that ambulance services and paramedics are able to treat and discharge on the spot. Those kinds of things can make a huge difference.
Mr Hunt
I am going to make some progress.
I want to move on to what we have been doing. As I said, every Health Secretary deals with difficult winters in the NHS. However, this year is different because we have taken unprecedented steps to relieve the pressure in the short and the long term. For this winter, we have distributed more financial help—£400 million in total—than ever before. So far, that money has paid for 2,900 additional staff, 1,100 more hospital beds, and 1,200 more community beds. It has also paid for additional support for ambulance services and 111 centres. We distributed that money earlier than ever before. [Interruption.] The hon. Member for Copeland (Mr Reed) says that we should not have cut the money in the first place. We did not—we protected and increased the NHS budget, which the shadow Health Secretary still wants to cut, as he reaffirmed today and on Monday. We distributed the money in August, earlier than ever before. We extended the winter flu campaign to two and three-year-olds. Patients who require emergency treatment this winter can be assured that they are getting high-quality and speedy care despite the pressure that we all recognise A and E departments are under.
We have gone further. This year, we have started to tackle the root causes of the long-term pressures in A and E, which are the result of the ageing population, yes, but also, sadly, the disastrous mistakes made by the previous Government, including the 2004 GP contract changes and the 48-hour GP appointment target that did not work.
Mr Hunt
I want to make some progress on this because it was the central point of the shadow Health Secretary’s speech. The reason the 48-hour target was scrapped is very simple: access was getting worse, not better, under that target. On the right hon. Gentleman’s watch, the proportion of people getting an appointment within two days fell, while 25% of people who wanted an appointment more than two days ahead could not get one. They would call wanting an appointment for the following week and be told, “You can only get an appointment by calling less than 48 hours in advance.” But do not take it from me. This morning—
Mr Hunt
Well, the hon. Gentleman should listen to the Royal College of General Practitioners if he does not want to take it from me. This morning, its chair, Dr Maureen Baker, said that Labour’s
“proposal to bring back the 48-hour target for GPs is an ill-thought out, knee-jerk response to a long-term problem.”
Unlike Labour, we listen and act when doctors tell us that Government targets are harming patient care.
Siobhain McDonagh (Mitcham and Morden) (Lab)
If the right hon. Gentleman feels that scrapping the 48-hour rule for GP appointments was wrong, what would he say to my constituent Mr C, who has e-mailed me today imploring me to get an appointment with his GP because his wife needs a new prescription for her blood pressure drugs and he has spent the past 48 hours on the phone attempting to gain one? How could he help my constituent?
Mr Hunt
I would urge him to urge his own MP to back this Government’s initiative to introduce seven-day GP surgery opening in pilots in every single region of the country, and to back plans like those in north-west London, where seven-day GP opening has been introduced—for which we have not had support from Labour.
Guy Opperman
Does the Secretary of State agree that prevention is the most important thing to alleviate A and E pressure, and that the simplest thing we can do is to encourage the populations in all our constituencies to take up the flu jab, which will prevent a large number of people going to A and E?
Mr Hunt
My hon. Friend is absolutely right. This year we have extended flu jabs to two and three-year-olds because we think that prevention is better than cure.
We have been looking at other causes of the long-term pressure on A and E, such as Labour’s 2004 GP contract. The right hon. Gentleman spent the past year telling this House that that contract, which scrapped named GPs, has nothing to do with the problems in A and E. This is despite what nearly every A and E department in the country is talking about—namely, the pressure being caused by poor primary care alternatives, particularly for the frail elderly. What did he tell Sarah Montague on the “Today” programme when we reversed that GP contract and brought back named GPs for the over-75s? He conceded to her, as he never has in this House, that our changes which reversed that contract would help A and E, so he is finally accepting on the radio what he does not accept in this House and what A and E staff have been saying for months—that having someone in the community responsible for frail elderly will help.
Mr Hunt
I am going to make some progress.
Our plans go much further than simply reversing the 2004 contract. GPs will offer the most vulnerable guaranteed same-day telephone consultations, which never happened under Labour. There will be a dedicated telephone line so that A and E doctors, ambulance paramedics and others can get advice from GPs about treatment in urgent situations. GPs will co-ordinate care for elderly patients discharged from A and E to try to ensure they get proper wrap-around care to minimise the chance of needing to go back.
We have done something else that the right hon. Member for Leigh never did to tackle long-term pressure on A and E. One of the biggest problems has been not being able to discharge people from hospital because of poor links between the health and social care systems. Through our £3.8 billion better care fund, this Government are doing something that Labour talked about a lot but never actually delivered: we are merging the health and social care systems. Gone will be people being pushed from pillar to post, because in order to access this fund, clinical commissioning groups and local authorities will have to commit to joint commissioning and joint provision.
Finally, we have looked at the long-term structure of A and E. The previous Government were battered by a succession of failed reconfigurations. We, too, have had challenges over decisions, such as those with regard to Lewisham. Sir Bruce Keogh’s recent review of urgent and emergency care has changed the terms of this debate by setting out a 21st-centruy vision of emergency care. Sir Bruce rightly said there should be more extensive services outside hospital, and this, too, will help to reduce A and E queues. He rightly said that while the number of A and Es is not expected to change, the services offered by all of them should not be identical if we are to maximise the number of lives saved. Our duty to patients is to make that a reality and we will not hesitate to drive that vision forward.
A and E and the ambulance services are performing well under unprecedented pressure. I cannot speak highly enough of the hard-working staff who are working around the clock to deliver vital services. They share our overriding commitment to putting patients first this winter. Unlike Labour Members, we do not seek to turn a tough winter into a political football. If they want to make the comparison between our record and theirs, we are happy to do so: more people being seen within four hours, shorter waiting times, and long-term problems being tackled—not posturing from the Opposition, but action from the Government, and a commitment to do what it takes to support hard-working front-line staff over Christmas. We should get behind them and not undermine their efforts.
Mike Gapes
On a point of order, Madam Deputy Speaker. This information was embargoed until two o’clock today, but following an investigation the Care Quality Commission has put King George hospital Ilford and Queen’s hospital Romford into special measures. I tried several times to intervene on the Secretary of State in order to raise the matter, but he refused to take an intervention from me. I therefore seek your advice: how can I draw attention to the matter and the fact that the previous Secretary of State said that King George’s A and E department would close within two years? That is clearly not happening. There is chaos in my local A and Es, yet the Secretary of State did not let me intervene.
Lisa Nandy (Wigan) (Lab)
My A and E in Wigan is, like so many others across the country, under significant pressure at present. Earlier this year we saw an unprecedented rise in A and E attendances. That is a result of a series of problems, including the difficulty in getting GP appointments, as outlined eloquently by my right hon. Friend the Member for Leigh (Andy Burnham), but I think the single most significant cause is the cuts that have been made over the past three and a half years to social care. Does the Minister have any idea what those cuts and the unfair distribution of them—my constituency of Wigan has been cut three times more than Windsor— have meant to people in their lives?
I want to say something about the situation of older people. I have been shocked over the past couple of years by what is happening to older people because of the deep and front-loaded cuts to social care, which have left councils with no option but to cut services. Over the last two years we have seen an unprecedented rise in the number of over-90-year-olds coming into my local A and E and others across the country by ambulance.
The Minister of State, Department of Health (Norman Lamb)
The hon. Lady talks about the situation in social care and of course I understand that there is real pressure, but will she welcome the fact that in 2012-13 there were 37,473 fewer days lost in delayed discharge due to social care, so in other words social services are doing better now than they were in previous years?
Lisa Nandy
In the very short amount of time that I have got I will simply echo the words of my hon. Friend the Member for Stretford and Urmston (Kate Green) who said to the Secretary of State that she thought people would be staggered by the complacency of Members on the Government Benches and would not recognise the picture they paint, which stands in stark contrast to the lived experiences of my constituents, some of whom are old and vulnerable and deserve so much better than this. Behind the increase in the number of admittances to hospital lies a picture of older people who are living alone at home, worried, lonely and ill.
The Minister’s Government have not caused all of this, but, like my right hon. Friend the Member for Leigh, I have talked about my concern about what has happened in social care and the rise of zero-hours contracts and choosing the lowest bidder over recent years, so, by God, I must also say this: his Government have made the situation so much worse. By the end of next year the budget of my council in Wigan will have been cut by £66 million, and we were told this summer that another 10% is still to come. We have done everything. We have pared that organisation to the bone. The truth is there are no more efficiencies to be had; there are only cuts.
I say this to the Minister as well: this is not just about councils, because what this Government have done, and the Darwinian approach they have taken to the voluntary sector, has severely undermined the capacity of charities to respond to this crisis at the very time when they are needed most. This is the true meaning of the big society.
We are seriously disrupted in Wigan—
Clive Efford
There is example after example of broken promises. The Conservatives accused people of planning to close hospitals when there was no plan to do so, and then came in and did it themselves.
We have a curious situation. The Secretary of State has been saying, “Crisis? What crisis?” Today, he read out a quote saying that the crisis is behind us. That is a little confusing. Of course, the crisis that he was talking about was a summer crisis. He did not mention that. He presided over a summer crisis. That is pretty unique. I do not think that even Virginia Bottomley achieved a summer crisis, but I could be wrong.
The crisis is of the Government’s own making. The Secretary of State talked about the need for services away from the hospital to protect A and E from being overwhelmed. However, one of the first things that they did was to do away with the 24-hour promise of a visit to the GP. They then introduced 111, which had algorithms and questions that all ended with the advice, “Go to your A and E.” There are now 850 fewer surgeries opening at evenings and weekends, and a quarter of walk-in centres have closed. Talk about reinventing the wheel—the Government are now saying that those are the sorts of things that we need to do. The crisis in A and E is of the Government’s making. It is their decisions that have created the situation.
To return to south-east London, the Secretary of State appointed the trust special administrator to oversee the merger of Lewisham and Queen Elizabeth hospitals. The local authority took on that decision because the powers that the Government took were not within their remit. The Government were challenged in the court and defeated. The Government are now moving the goalposts. Having said before the last general election that there would be no top-down reconfiguration and that they would not enforce closures if the local community did not agree with them, they are taking powers to impose closures on local communities.
In the minute that I have left, I want to say to the Minister that there has been a series of broken promises. It is fitting that a Liberal Democrat is summing up a debate on broken promises on the NHS.
Clive Efford
It is true. Where were any of the things that are happening to our NHS in the Liberal Democrats’ manifesto? None of them was in their manifesto. They never put them before the electorate.
We want no return to the closure of Lewisham A and E. The closure of Queen Mary’s, Sidcup has had the knock-on effect of overwhelming the other A and Es in south-east London. That is clear for all to see. Those A and Es are under serious pressure. It is clear that there is no slack in the system to pick up the additional burden from that closure. We must have a guarantee from the Government that they will not impose the closure of another A and E on the people of south-east London. I would like to hear that from the Minister when he sums up.
The Minister of State, Department of Health (Norman Lamb)
We have heard a lot of scaremongering about the NHS today, including endless claims about a crisis. If the Opposition are thinking about new year’s resolutions, I have one for them: stop misleading and misinforming the public. Let us look at the evidence.
Norman Lamb
I will not give way; I do not have time.
Up until this week, A and E targets were met in the past 32 weeks in a row. Is that evidence of a crisis? The average wait for people in A and E during Labour’s last year was 77 minutes; it is now 30 minutes. Is that evidence of a crisis? Even though more people are coming through the doors, 2,000 more patients are being seen in less than four hours every day under this Government than under Labour. Evidence of a crisis? I don’t think so. The Opposition are scaremongering, plain and simple. In fact, the College of Emergency Medicine’s president, Cliff Mann, has today said that any crisis in accident and emergency is “behind us”.
Andy Sawford (Corby) (Lab/Co-op)
May I associate myself with the remarks made by the hon. Members for Kettering (Mr Hollobone) and for Wellingborough (Mr Bone)? We are pressing for funding to meet the additional demand in the Kettering accident and emergency department. Will the Minister encourage us in that?
Norman Lamb
I applaud the cross-party effort of those Members campaigning for their community, and I am very happy to engage with them further on that matter.
Norman Lamb
I will not give way again; I do not have time.
Last year, of the 21.7 million people who visited accident and emergency departments, almost 96% were admitted, transferred or discharged within four hours. Target achieved. So far, it is the same this year: target achieved. The right hon. Member for Leigh (Andy Burnham) missed his A and E target in two of the three quarters when he was in charge. Did he go around telling everyone that there was a crisis at that time? No, of course he did not—
Norman Lamb
Thank you, Madam Deputy Speaker.
The then Secretary of State, now the shadow Secretary of State, missed the target in this very week when he was in charge. We know that the winter is tough, and that performance always dips at this time of year. We also know that the staff are under a lot of pressure. The truth is that we inherited a dysfunctional system that was crying out for reform, with too many people ending up in hospital because of crises in their care, as my hon. Friend the Member for Bracknell (Dr Lee) made clear. For years, I have argued the case for a different approach.
We are supporting the NHS to enable it to manage better in the short term. For this winter, we are investing an additional £400 million in total—more than ever before. In the longer term, we need to look afresh at how we organise urgent care. That is why Bruce Keogh’s report into urgent and emergency care is so important, and I hope that the hon. Member for Mitcham and Morden (Siobhain McDonagh) will accept the case for a clinically led review in order to achieve the right approach. We will work closely alongside NHS England in putting these reforms into practice. The hon. Member for Stretford and Urmston (Kate Green) was absolutely right to say that we have to communicate better with the public and ensure that the process is a good one.
In the longer term, we need to do more to prevent people from ending up in hospital as a result of avoidable crises. As my hon. Friend the Member for St Ives (Andrew George) said, we need to make two big shifts. The first involves a move to a much greater focus on preventing ill health and the deterioration of health. The second involves a shift from a fragmented system to one that is integrated and joined up. That is the approach that we must follow.
Integrated pioneers around the country, such as those in south Devon and Torbay, Greenwich and Labour-led Barnsley, are doing great work, joining up care, collaborating with the voluntary sector, providing better care and keeping people out of hospital. That is the vision of the health service for the future. These pioneers will help the rest of the country to make the best possible use of the £3.8 billion better care fund. The fund will encourage organisations: to act earlier to prevent people from reaching crisis point; to offer seven-day services; and to deliver care that is centred on people’s needs. I am grateful to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for welcoming that important new fund. We are also introducing named, accountable GPs for the over-75s and improving access to general practice.
We are addressing both the short-term and long-term challenges, giving the NHS the support it needs. I want genuinely to thank the excellent staff throughout our health and care services who are tackling these issues head-on. The measures and changes we have outlined today will support staff to deliver the best possible care, even in the most difficult of circumstances.
Question put.
The House proceeded to a Division.
Madam Deputy Speaker (Mrs Eleanor Laing)
I ask the Serjeant at Arms to investigate the delay in the No Lobby.