NHS: Accident and Emergency Services

Lord Jones of Cheltenham Excerpts

Thursday 15th January 2015 Lords Chamber

[Lord Jones of Cheltenham (LD)]

My Lords, I, too, congratulate the right reverend Prelate on securing this timely and important debate. I should like to focus my remarks on the situation at the Gloucestershire Hospitals NHS Foundation Trust and the critical incidents at A&E at Gloucestershire Royal and Cheltenham General Hospitals. The latest critical incident lasted for more than a week and was lifted only yesterday. Presumably in that time, hundreds of routine operations and admissions were cancelled and have stacked up. This was the second such critical incident at GHT in a month and went on longer than those at other trusts in the country. We need to understand why.

It is complicated and not simply to do with money. We know that the coalition Government have increased NHS spending overall from £95 billion in 2010 to £115 billion this year, giving GHT £3.6 million for winter pressure this year; so what are the problems? Are too many 111 calls going into A&E? Anecdotal evidence from local doctors says that they are, and certainly the non-medical call-handlers have a naturally risk-averse system that will direct people to a doctor when in doubt. The Prime Minister, in response to a Question from my honourable friend Martin Horwood, said that only 7% of 111 calls ended in A&E. I believe that that was a statistic from October; it would be helpful if the Minister could tell us whether that is increasing and what it has been in the last month or two.

GHT has implemented what is called the UTOPIA system of routing all unplanned admissions through A&E. Has this made things worse? The theory is that people see a doctor sooner than in direct admission, when they have to wait for the next ward round, but in practice you need enough capacity in the emergency department to handle cases, which GHT pretty obviously does not have. I wonder whether the June 2013 decision to remove doctor cover from Cheltenham A&E at night and route blue-light admissions to Gloucestershire made matters worse. I understand that these decisions were made not due to a lack of money, but simply to the failure to recruit sufficient staff. Is there something wrong with the salary structure within the NHS that particularly affects Gloucestershire? At night, Cheltenham General Hospital is now really a minor injuries unit, although I understand that it still gets help from GPs in the out-of-hours service based at CGH .

I have spent more time than I care to remember as a patient in Cheltenham A&E. In January 2000, I was there following a sword attack in my constituency office which left my assistant dead and my hands in need of repair with 57 stitches. Then, in 2002, 2003 and 2006 I had three events of flash pulmonary oedema, all at night. This is a deeply unpleasant experience in which the heart goes into a ridiculous non-rhythm and stops pumping and one’s lungs quickly fill up with fluid. Fortunately, I was at home when these events occurred; I am grateful for the prompt response of the ambulance paramedics who rushed me to Cheltenham A&E. On two of these occasions my wife was called out of the family room and told to prepare herself for the worst; but thanks to the skill of the truly wonderful doctors and nurses—and, no doubt, a lot of praying in the family room—I survived. I do not know what the doctors did: I was out at the time, but I understand that a super-dose of frusemide was involved. If the recent downgrade of Cheltenham A&E had been in operation then, it would have taken an extra 15 minutes to get me to Gloucestershire Royal. I would probably not have survived and would not be here now addressing your Lordships’ House. Therefore, will the Minister ask the regulators and the Care Quality Commission to look into the difficulties in Gloucestershire to give answers as to why we have experienced these critical incident periods? Will he please ask the Gloucestershire Hospitals Trust to reinstate round-the-clock A&E services at Cheltenham General Hospital and ensure that it has the capability to recruit sufficient doctors, nurses and technicians?