Accident and Emergency

Baroness Keeley Excerpts

Wednesday 18th December 2013 Commons Chamber

[Mike Gapes]

rose—

[Barbara Keeley (Worsley and Eccles South) (Lab)]

rose—

[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—

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

We know that rising demand is concentrated in those aged over 85. Cuts in social care budgets are now widely acknowledged as contributory factors in rising admissions, and the Select Committee’s inquiry heard that from witnesses again and again.

Salford city council has made cuts of 20% to its adult social care budget since 2010, given the cuts it has had from the Government. This year, the city council is changing its eligibility from moderate to substantial, and social care staff estimate that the number of people receiving council-funded care will fall this year by 1,000, from 8,500 to 7,500. That is a very big change to happen in one year.

Cuts already made to the NHS locally have also had an impact. We have seen the closure of two walk-in centres, including one in Little Hulton, a deprived area in my constituency that was under-doctored. The walk-in centre was popular and successful. The Minister’s predecessor will have heard my plea about this again and again. The local primary care trust, when we had one, axed the pilot of an active case management scheme for people with long-term conditions. Those things were done under the umbrella of NHS efficiency savings, but they achieve the opposite. More older people will not be receiving council-funded care, and that will have an impact on family carers. We have no walk-in centres and no active case management for people with long-term conditions.

I want to refer briefly to the Carers UK survey of 3,500 carers conducted earlier this year. Some 55% were caring for people who had been admitted to hospital emergency services, with a significant proportion of those carers referring to support that could have prevented those emergency admissions. We have seen exactly the same message in the CQC state of care report.

I want to take this opportunity to congratulate Salford Royal hospital on its excellent inspection report from the CQC. The hospital was found to demonstrate exceptional leadership qualities at all levels across its staff, but even excellent hospitals such as Salford Royal are now feeling the strain of extra emergency admissions. The chief executive told me that in the winter quarter last year it had 10% more ambulance arrivals, patients were sicker, there was an increase in people staying longer than 72 hours, and there was a significant increase in co-morbidity among the patients. And all that happened before the cuts and loss of council funding of care to 1,000 patients this winter.

I want to touch briefly on the shortage of emergency doctors, which the College of Emergency Medicine has been warning about since 2010. That situation is not going to improve. The fill rate of higher trainee posts has been running at 40% or less since 2010. The latest recruitment round for ST4 trainees filled 37 posts out of 193 vacancies. There is some talk today of increasing the number of vacancies for emergency medicine trainees, but people are voting with their feet. The career pressures in A and E are just too great, and they are putting people off having careers in emergency medicine.

In conclusion, £2.68 billion has been cut from adult social care since 2010. We are seeing the cuts in our budgets in Salford, and 1,000 people will lose care. That will put pressure on their health and that of their families. The Secretary of State briefly mentioned the integration transformation fund, but there is no new money in that fund—none at all. Health Ministers need to think again about the impact that cuts in social care are having on the NHS. Pooling budgets with the same amount of money in the integration fund will not help. They need to deal with the crisis in A and E staffing and try to make it a career that people want to go into. As the motion states, they need to restore the 48-hour appointment guarantee. I support the motion.