NHS England: Major Incidents

Baroness Jolly Excerpts

Wednesday 28th January 2015 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I shall now repeat in the form of a Statement the Answer given by my right honourable friend the Secretary of State for Health to an Urgent Question in another place. The Statement is as follows.

“Mr Speaker, as you know, I am always happy to come to the House to discuss the NHS. However, today I feel that we have been brought here to discuss a local operational issue which, regrettably, the Opposition have tried to spin as part of their policy to ‘weaponise the NHS’.

As I said to the House earlier this month, a major incident is part of the established escalation process for the NHS, and has been since 2005. It enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.

The decision to declare a major incident is taken locally, and there is no national definition. We must trust the managers and clinicians in our local NHS to make these decisions and support them in doing so by ensuring that there is sufficient financial support available to help deal with additional pressures. The document that has been questioned this morning by the Opposition health spokesman was issued by the local NHS in the West Midlands. That was done to help their CCGs work with local NHS organisations to deal with the unprecedented pressures they have been facing this winter. As the chief operating officer of NHS England, Dame Barbara Hakin, said this morning, this was a local decision and neither the responsibility of Ministers nor the result of pressure by Ministers.

Let me finish by praising the NHS for coping well with the unprecedented pressures. Performance against the A&E standard improved to 92.4% last week, which is testament to hard-working staff, and this Government will support them, not try to turn their efforts into a political football”.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Baroness for repeating that Statement, and I echo her thanks to the staff of the NHS and other agencies who are coping with such pressure at the moment. The noble Baroness said that there is no definition of a major incident. Can she tell me why there is no national definition of a major incident, given that the NHS is a national service and that we need comparators between different areas of the country? Can she also tell me why a head of operations at a major trust who received the NHS England guidance said it was designed,

“to effectively stop trusts from calling a major incident”,

and that consultants’,

“hands will be tied in most cases if they wish to call a major incident for capacity reasons”?

That sounds rather like news management by NHS England. Finally, can she confirm that, when the previous Government left office, the 98% target was being met?

[Baroness Jolly]

I shall take the noble Lord’s questions in reverse order. The 98% target was being met—up until probably the middle of November, we were hitting our target—but, from the middle of November through the cold Christmas and New Year season, demand was really very high. In 2013, NHS England produced guidance on such issues that would, clearly, have gone to all CCGs, trusts and interested organisations. It is up to local trusts, following the guidance, to make their own decisions about how appropriate it is to call an emergency. The noble Lord has an advantage over me; I have not seen the West Midlands document, so I am not sure exactly how that trust interpreted the guidance. I have not seen the document, so I cannot follow the trust’s interpretation, but from the Secretary of State’s Statement, he probably finds it difficult to follow.

[Baroness Barker (LD)]

My Lords, does the 2013 guidance that was issued to all trusts still stand? Is the purpose of that guidance not only to enable individual hospitals to signal to their CCGs that they are having a problem coping but to alert other hospitals in the surrounding area that there is a capacity issue which has to be dealt with on an emergency basis?

[Baroness Jolly]

I think that is right. The document produced in the West Midlands is the only one of its kind. Other areas have not done the same, so they would be relying on that document. Decisions like this affect the whole health economy, so not only would CCGs be involved but directors of public health, any other acute trusts within the area, community trusts, partnerships trusts, ambulance trusts and primary care organisations. It is an effort on behalf of them all to support a hospital or an A&E department that is in trouble.

[Baroness Masham of Ilton (CB)]

My Lords, is the pending ambulance strike a major incident? What information is being given to the public?

[Baroness Jolly]

I think that the last ambulance strike was dealt with quite effectively with the support of the military, who were driving and operating ambulances. My understanding is that the strike has been called off.

[Lord Christopher (Lab)]

The noble Baroness said she has not seen the document, but are the Government happy that such guidance should be given? I would have thought that declaring a major incident was a matter of judgment and common sense in the locality. To be issuing guidance seems a very risky thing to do. My second question bears upon the other side of the coin. Can the noble Baroness explain the logic of minor injuries clinics being open only in the afternoon? It is difficult to arrange to be injured only in the afternoon.

[Baroness Jolly]

No, I am afraid that I cannot explain the logic of that, but it does sound really rather bizarre, so I guess that you need to talk to the trust concerned. As to the guidance, that is of a very high level—it is just to give pointers to trusts about how to proceed.

[Lord Harris of Haringey (Lab)]

My Lords, can the Minister give us an assurance that Ministers did not express the view that it was too easy to call a state of emergency for NHS trusts. Can she give us an absolute assurance that special advisers did not convey such a message to those who might make those decisions?

[Baroness Jolly]

I was not party to any of the conversations in the department at that time. However, the safety of patients is absolutely paramount. Although emergencies like this one were called, they lasted only for hours rather than for days and days and effectively they allowed the local trust, which was in difficulties, to call in staff and talk to surrounding trusts to ask for their support to deal with what was a fairly time-limited situation.

[Lord MacKenzie of Culkein (Lab)]

My Lords, will the Minister help the House: is it right that one of the matters to be considered is the possibility of reputational damage to the trust if it declares an emergency? That is nothing to do with clinical decision-making locally. Consulting the duty officer of NHS England before declaring an emergency is nothing to do with local clinical decision-making either. Perhaps the Minister can help the House.

[Baroness Jolly]

As I have said, patient safety and quality of care have to be absolutely paramount. Certainly, under the old system, if an NHS trust decided that it needed in effect to blow the whistle, I imagine that one would have informed somebody in the old strategic health authority that that was happening. I imagine that a trust would out of courtesy inform the person with whom they normally work in their local branch of NHS England.