A&E Services

Andrew Murrison Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Reed]

If the hon. Gentleman wants to compare the records of this Government and the previous one, we will do that all day long and he will come out on the wrong side of that debate. On the ageing society, we would think from listening to Ministers and Government Back Benchers that this has just been sprung upon us. He is right to say that it has been coming for a long time, but we did an awful lot more to address it than this Government are doing. I will go on to explain why in just a moment.

A real worry for the NHS, and for those of us who use it or work within it every day, is the Government’s plan to suspend the work of the National Institute for Health and Care Excellence on its safe staffing programme. That move is a rejection of a key recommendation made by the Francis report, and in response to the move, Sir Robert Francis said:

“I specifically recommended the work which NICE has been undertaking for a reason…I would not be surprised if this news generates a significant level of concern, and it seems a shame that the work of NICE has been stopped.”

Dr Clifford Mann, president of the Royal College of Emergency Medicine, has said:

“There are real pressures on nursing levels in Emergency Departments.”

He has also said:

“We are concerned about patient safety and staff welfare.”

I would be grateful if the Minister could explain to me, and to Sir Robert Francis, why on earth the Government have suspended this crucial work.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I read the hon. Gentleman’s motion carefully and I was left slightly bewildered, as he seems to be suggesting that the solution to this problem is more resources for A&E and for primary care, yet I seem to recall that just a few weeks ago I was standing in an election campaign where my party pledged £8 billion more for the NHS and his party failed to back that. Can he explain where he will find the resources?

[Mr Reed]

That is the kind of magical thinking that afflicts Conservative thinking. The hon. Gentleman will be aware that at the last general election we talked about a specific £2.5 billion fund to train 20,000 more nurses, 8,000 more GPs and so on. What we always said was that the NHS would get the money it deserves, quite separately from that £2.5 billion, from a Labour Government. That remains the case and he knows that that is the truth. It is true that certain societal changes, including the ageing society, pose new challenges and offer new pressures for the NHS, but the service is also under increasing financial pressure as a direct result of Government policy.

--- Later in debate ---

[Ben Gummer]

My hon. Friend is right. Again, he highlights a local solution to a serious problem, and one that will not reflect what is needed in other parts of the country. That is why it is so important that we concentrate the additional money that we are providing on local solutions rather than on a top-down reorganisation.

The shadow Minister spoke about primary care. He does not seem to have listened to my right hon. Friend’s latest announcements on the new deal for GPs to increase the workforce, support new buildings for GPs, and improve access through local innovation. We are trying to reduce the pressures that we understand are on GPs and that go back many years, not helped by the GP contract signed by his Labour predecessors. We have a choice in government about whether we declare an ambition—the ambition on primary care declared by Labour at the last election was, the Royal College of GPs said, an

“ill-thought out, knee-jerk response”—

or we can try to do something about it, listen to concerns, and remodel care so that it helps patients. That is what the Government have done. My right hon. Friend has spoken about it, and the work is being carried on by the Minister with responsibility for primary care, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt).

[Dr Murrison]

Will my hon. Friend give way?

[Ben Gummer]

I am not going to take any more interventions, if my hon. Friend does not mind, because I want to cover the additional issues raised by the shadow Minister. Before I do so, I would like to know whether the shadow Minister agrees with our target for 5,000 additional GPs, which can be afforded only because of the £8 billion that we have committed to the NHS—a commitment that, again, he has been unable to sign up to.

--- Later in debate ---

[Dr Whitford]

Absolutely, we have seen the performance drop across the UK. The Minister quoted a report showing that England was performing better than Scotland. I would be interested in seeing that one—where it is comparing like for like with core A&E services—because those are not the figures I have seen. However, we all face the same challenge. We are dealing with older patients, who are more complex. The figures from Scotland last winter showed that we did not have a huge increase in numbers, but far more of those patients had to be admitted. Nothing else could be done, and we will face that situation more and more in future. The problem is that we are losing the staff to deal with that, and we are talking about A&E, but in the vast majority of cases, they key issue does not lie with A&E. There are two simple things: the number of patients coming in, which relates to out-of-hours GP access, and patients getting back out, which is described by the Royal College of Emergency Medicine as exit block.

It is important to remember that the four hours does not involve someone sitting on a chair, waiting for four hours. People are often given that impression—that they turn up in A&E and sit there, and no one will touch them for four hours. However, they will be triaged, see a clinician, have a history taken and have investigations. They may well get sewn up or be given something, and they will go home. Those patients are moving through. Our problem is the patients who have to come in, and it results in a whole cascade of issues, such as people stuck on trolleys getting the start of a bedsore, or families made miserable, or staff very depressed at trying to look after people in a corridor. It also results in people ending up boarded to any ward—any port in a storm—so that people are not in the correct ward and not getting the correct treatment from the correct team. We know that that, bizarrely, results in longer patient stays, which exacerbates the problem.

What we need to do—as we have done in Scotland, where we set up the unscheduled care action plan—is to work with all stakeholders. That involves looking at how patients flow through. It is not about people being obsessed with measuring the target and counting it, but about people opening the gates in front of the patient. The data on how long patients wait should be automatically available to staff from their system; it should not require an extra body to generate that data.

If we have the data weekly, which means we are getting them timeously, we can see one week from the other and ought to be able to see the patterns. The problem with monthly data for something that is identified as a currently acute issue is that, by the time they are collated, verified and out, staff may not remember quite what made that a bad week, whereas with weekly data, they can see whether they are getting a response to their actions.

I support keeping weekly measurements, but I do not support them being used as a tool—and certainly not for beating one another across the Benches here. I can tell hon. Members that staff in the NHS feel that they are beaten over the head with these targets, so it is not about having a target, but about how it is used. In the paper released by the Royal College of Emergency Medicine here yesterday, one of its myths was that the four-hour target is a distraction. It pointed out that it allowed a focus.

To try and tackle the problem in Scotland, we have ensured that the majority of our A&Es have a co-located out-of-hours service. I mentioned before that achieving 8 till 8 in every GP practice is so far in the future that it cannot be reckoned on as a solution to this problem. We are unable to fill the GP vacancies we have now. Telling them that they will be working from 8 till 8 on Saturday and Sunday is not overwhelmingly attractive.

The pilots that have been done have started to report in the last fortnight, and they have reported a very poor uptake. When people want to deal with an out-of-hours problem, they come to A&E. Rather than trying to change the whole population, we could have a system in which people are easily diverted once they get there: “If you have this, please step next door to our primary care service.” We need to look at those solutions, and some are working quite well.

The other issue is health and social care. To get patients out at the end of their journey, they need to be able to get into care. We need to remember that, although extra money may be given to health and social care through the health side, if we are cutting local authority budgets at the same time, we end up cutting the legs from under the NHS.

[Dr Murrison]

The hon. Lady is making thoughtful comments and I am following them carefully. I agree with her that co-location can work in some places, but clearly it is not going to work everywhere. Does she not agree that most people who attend accident and emergency departments are neither accidents nor emergencies, and they would be much better cared for by general practitioners? To do that, however, GPs need to be trained for that case mix and incentivised for it, and most importantly, the public needs to be trained, too, about accessing the proper professional.

[Dr Whitford]

Before the movement of out-of-hours GP services under the banner of NHS 24, most local areas had a doctors-on-call service. In my county, we had Ayrshire doctors on call, which was provided by local doctors at rooms in the A&E departments in our two hospitals. Patients quickly learned where they could go to be seen quickly. We also had a car service that allowed us to make home visits. That functioned very well until NHS 24 came and pulled it away.

We have to get back to local GPs working like that as part of a co-operative in a focal position. Each practice cannot generate enough GPs or work to have someone sitting there all day Saturday and all day Sunday. When the Secretary of State talks about 8 till 8, it is not clear whether he means that that will happen in each individual practice or on a regional basis. Most of the pilots that have started to publish their experiences have quickly made it into a doctors-on-call service. There is more common sense behind that approach and it is more sustainable.

We have to look at the flow within hospitals. We should not have trackers running around bean counting when patients had what done, but people going in front of patients, opening the gates, looking at bed management and ensuring that patients are in the right place.

All these matters cascade back on to staff. We are struggling to maintain and recruit staff. There was only a 50% take-up of trainees for accident and emergency, and we are haemorrhaging senior people, which exacerbates the problem. We need the co-location of GPs and we need to look at the exit block, not only out of A&E and into the hospital, but out of the hospital.