A&E Services

Debate between Karin Smyth and Maria Caulfield

Wednesday 24th June 2015 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

I congratulate the hon. Member for Dewsbury (Paula Sherriff) on her eloquent maiden speech. It is great to see another strong woman in the House.

I am mindful of the time constraints in the debate and, although I would love to talk about GP access and hospital finances, I shall concentrate on accident and emergency targets and, in particular, the target of 95% of patients being seen within four hours. I speak as a nurse who has worked in A&E under the last Labour Government when the four-hour target was introduced. I hope that my clinical experience will be used to inform the debate and take it forward.

I want to make four key points on A&E targets and the four-hour wait. First, like the hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for Totnes (Dr Wollaston), I am not a fan of targets. As a healthcare professional, I found them increasingly frustrating. They are great as a tool, but they are being used as a political stick with which to beat healthcare workers and the system. There was no clinical rationale for choosing the four-hour target. There is no evidence that the morbidity or mortality of someone who waits for four hours and 30 minutes is compromised. Similarly, there is no evidence that the healthcare received by someone who has waited for three hours and 30 minutes is any better than that received by someone who has waited for four hours. The four-hour target is actually not that helpful.

[Karin Smyth]

Will the hon. Lady give way?

[Maria Caulfield]

I will not take any interventions owing to the restriction on time.

I shall give the House an example. When I worked as a nurse in A&E—under the Labour Government—an elderly gentleman was brought in during a busy night shift. He had fallen at home and broken his hip, and he was put in a corridor to wait. After three hours and 30 minutes, he called me over, saying, “Nurse, I desperately need to go to the toilet.” I had nowhere to put him. The best thing I could do was to wheel a curtain around his trolley, and there, in the middle of a busy hospital corridor, that elderly gentleman with war medals on his chest went to the toilet. He was seen within four hours. That box was ticked and he was deemed to have had good healthcare, but I was not particularly impressed with that care. Let us not kid ourselves that meeting that target always means that the patient experience is good or that the outcome is any better.

My second point, which relates to my worry that this debate is being used as a political football, is that the four-hour target is not being seen in the context of the bigger picture. Other targets show that, even with the increased numbers attending A&E, more and more patients are getting their treatment within four hours. Similarly, the clinical outcomes—surely the most important factor—relating to diseases such as heart attacks show that morbidity and mortality rates have improved. There have also been better outcomes for people who have had strokes and for trauma victims. So outcomes for patients are improving despite the four-hour target not having been met during the past 100 weeks. We should welcome that and congratulate our NHS staff on achieving it.

Thirdly, if this is a serious debate about A&E services throughout the whole of the United Kingdom, which we are surely all here to represent, why are we not looking at the rate in Scotland of only 87%, in Labour-run Wales of 83% and in Northern Ireland of 79%? This debate is a political one, and as a healthcare worker, I find that distressing. It is interesting that those Members who have worked in the NHS believe that the four-hour target is a useful tool but that it should not be used as a political stick.