Accident and Emergency Waiting Times

Andrew Gwynne Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a full and thorough debate, with some 18—or perhaps 17 and a half—Back-Bench speeches. I pay tribute to my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson), my hon. Friend the Member for Lewisham East (Heidi Alexander), my right hon. Friend the Member for Exeter (Mr Bradshaw) and my right hon. Friend the Member for Cynon Valley (Ann Clwyd), who made a very personal contribution to the debate, as well as my hon. Friends the Members for Ealing North (Stephen Pound), for Harrow West (Mr Thomas) and for Mitcham and Morden (Siobhain McDonagh), my right hon. Friend the Member for Rother Valley (Mr Barron), and my hon. Friends the Members for Worsley and Eccles South (Barbara Keeley) and for Hammersmith (Mr Slaughter). I also pay tribute to the right hon. Member for Charnwood (Mr Dorrell) and the hon. Members for Totnes (Dr Wollaston) and for Southport (John Pugh), and other Members, too many to mention individually, who contributed to the debate.

I start by paying tribute to the thousands of doctors, nurses and health care assistants who provide extraordinary and professional care in our A and E departments. They are there for us when we need them most and we owe them a huge debt of gratitude. It was apparent from the Secretary of State’s speech that he has absolutely no plans to deal with the disastrous situation in A and E that is entirely of this Government’s own creation. We know that, since this Government came to power, there are 4,000 fewer nurses, the disastrous NHS 111 service is in meltdown, walk-in centres are being closed and social care is in crisis. All those factors contribute to the current crisis in our A and E. We have all seen the news reports of ambulances queuing outside hospitals, with unacceptably long waits and some people even having to be treated in tents in car parks. It is time for Ministers to stop blaming others and to get a grip on the crisis in A and E.

Bluntly, what we are seeing today in A and E is the culmination of three full years of mismanagement of the NHS, with a needless top-down reorganisation and the waste of billions of pounds that could and should have been spent on front-line care. The truth is that there is no grip on the NHS in England. No wonder things are going so wrong so quickly.

When Labour left office, A and E was performing well, with 98% of patients seen within the four-hour target time. Since the election, the number of patients waiting more than four hours has nearly trebled and ambulance queues have doubled. Only yesterday, in a report by the King’s Fund, we saw that A and E waits are at their worst for nine years, with more than 313,000 patients waiting more than four hours between January and April this year. Simply put, under this Government more people are waiting longer. The proportion of patients attending A and E who have to wait longer than four hours is at its highest for 10 years. What more proof do Ministers need to understand that A and E departments are under real pressure and that action is needed, and needed now?

Many patients cannot even get through the doors of our hospitals. We have a shameful situation in which growing numbers of patients are waiting in ambulances to get into A and E because those departments are full. Equally shameful is the number of patients experiencing the indignity of waiting for hours on trolleys in A and E before they can be found a bed on the main hospital wards. It is almost as though we are back to the future—back to the bad old Tory days of the 1980s and ’90s.

There are many other factors that have pushed A and E into the danger zone. Indeed, A and E is a bellwether for the overall state of the NHS and social care. The Government’s cuts to local authority budgets have seen £2.6 billion taken out of adult social care since the election alone. As a result, many older and vulnerable people are having services withdrawn that could have helped them to stay healthy and independent in their own homes, and many others face rising charges for the care that they need. That is a major cause of the A and E crisis, as fewer older people get the care that they need at home, and ever more have to be admitted to hospital. It also means that there are delays in ensuring that appropriate support is available at home, or in the community, which delays a patient’s discharge. That has a knock-on effect right through the hospital: with no free beds on the wards, A and E staff cannot admit patients to the hospital wards, and with A and E full, ambulance staff cannot hand over patients.

As we have heard, under-staffing is also causing huge problems in the health service. Since the election, more than 4,000 nursing posts have been lost from the NHS, and the Care Quality Commission has warned that one in 10 hospitals is failing to meet the standard for adequate staffing levels. Hospitals are continuing to make severe cuts to front-line staffing, with many operating below recommended levels. Under this Government, right across England, we are seeing the closure of well-used NHS walk-in centres, meaning that more people are having to go to major A and E departments when they could be helped elsewhere.

Lastly, there is the meltdown of the 111 helpline; NHS England identified the poor roll-out of 111 services as one of the main reasons for the deterioration in A and E department performance. As the 111 service uses staff who do not always have clinical training, they are more likely to play it safe, meaning that more people are being directed towards A and E departments. Over Easter, callers in 30 areas waited for more than an hour for a call back, and in some regions more than 40% of calls were abandoned by patients. One patient waited 11 hours and 29 minutes.

It is no good Ministers arguing that there has been a large increase in the number of people attending A and E, driven by changes to out-of-hours care that were caused by Labour’s renegotiation of the GP contract in 2004; that was nine years ago. The Secretary of State’s spin was blown out of the water by the Chair of the Select Committee on Health, the right hon. Member for Charnwood—and by the chief clinical officer at Stockport clinical commissioning group, who said:

“The focus on the 2004 GP Contract as a main cause is not only a incorrect assumption but also serves to distract the public from the urgent debate that’s needed about the choices the NHS, the public, media and politicians now need to make”—

his words, not mine.

The Government parties should and must do more to protect the NHS from the immediate crisis, so will they now implement our A and E rescue plan? The Secretary of State derided our initiative to use underspends in the NHS budget to put an extra £1.2 billion into social care over the next two years, but that investment would not only relieve pressure on A and E, but help tackle the scandal of care services being withdrawn from older people who need them.

Will the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), review all 111 contracts? Early indications are that the number of cases referred to nurses has fallen from 60% through NHS Direct to just 17% with 111. What will she do about that? Will she also ensure that all hospitals have safe staffing levels, and intervene to prevent further job losses? Will she halt the closure of NHS walk-in centres and await the review that is being conducted by Monitor to see what the impact is on the local community and the NHS? Will she immediately and personally review all planned A and E closures and downgrades, and use the very latest evidence of local pressures to ensure that plans are based on robust clinical evidence?

Instead of accepting responsibility for the mess that they have created, the Government have spent recent weeks casting around for scapegoats. We have seen them blame the winter weather; influenza; bank holidays; immigrants; GPs; and today’s latest from the public health Minister, female doctors, because they get married, have children and work part time. [Interruption.] She protests, and I notice she had to put out a statement this afternoon to

“clarify discussion on female GPs” .

She said:

“I fully support women GPs, my comments were not intended to be derogatory.”

The truth is that this Government do not even know who to blame any more. It is just not good enough. While the components of the A and E crisis might be complex, the real cause is simple: you just cannot trust the Tories with the NHS.