A and E and Ambulance Services

Andy Burnham Excerpts

Thursday 18th December 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the performance of accident and emergency departments and ambulance services, and what plans are in place to help them cope with winter pressures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I welcome this opportunity to come to the House and confirm NHS plans to support A and E and ambulance services over the challenging winter period. First, we must recognise the context. The NHS always faces significant pressures during the winter months, and with an ageing population we have 350,000 more over-75s than four years ago. As a result, more people are turning up at our A and Es, with attendances up 5% on last year, and a greater level of sickness among those who turn up has led to an increase in emergency admissions of nearly 6% on last year. That picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland, as well as England, missing key performance standards as a result.

In England, where performance has been relatively better than in other home nations, we have been preparing for this winter for more than nine months—indeed, I chaired my first meeting to discuss the issue on 17 March. On 13 June we gave the NHS an additional £400 million for winter pressures. That was topped up in autumn by £300 million, making a total of £700 million to ensure that local services had the certainty of additional money and time to plan how it should best be used. That funding was provided earlier than ever before in NHS history, and was possible because a strong economy has allowed us to make year-on-year real-term increases in NHS spending. That funding will pay for the equivalent of 1,000 more doctors, 2,000 more nurses, and 2,000 other NHS and care staff, including physiotherapists and social workers. It will fund up to 2,500 additional beds in the acute and community sectors, and provide £50 million to support ambulance services.

We are also progressing with a long-term plan to reduce pressures on A and E. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, and more than 4 million people are already benefiting from that. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. The Five Year Forward View is funded by an additional £2 billion of new money announced in the autumn statement—we have a long-term plan for our NHS, just as we do for the economy.

The winter will be tough, but a number of changes made over the last four years will put us in a much stronger position. Since 2010, the NHS has nearly 1,200 more A and E doctors, including 400 more consultants, almost 600 more registrars, 1,700 more paramedics and 17,200 more clinical staff overall. Our A and E departments are seeing and treating around 2,000 more people within four hours every day, and our ambulances are making nearly 2,000 additional emergency journeys every day. The Care Quality Commission has confirmed that compassionate care in A and Es has improved over the last two years, and according to patients the NHS is getting record scores for the safety of care, and for treating people with dignity and compassion.

I will conclude by thanking hard-working NHS staff across the country for the outstanding care that they continue to deliver under a great deal of operational pressure. On behalf of the whole House I also thank the 70 NHS front-line volunteers who will be making this country safer by spending their Christmas in Sierra Leone on the front line in the fight against Ebola. They are the bravest of the brave and make our entire country proud.

[Andy Burnham]

I thank the Secretary of State for his statement. I of course echo the sentiments he expressed about NHS staff and volunteers fighting Ebola.

I have to say, however, that I heard a good deal of misplaced complacency in what he had to say. Winter has not begun in earnest, but there are already signs of A and Es and ambulance services being stretched to the limit. Last week, a record number of people waited more than four hours in A and E and on trolleys. Ambulance response times are getting worse across England, with some 999 calls taking hours. Overnight, news has emerged of an 82-year-old man who waited more than three hours for an ambulance to arrive at his nursing home. He then waited a further 19 hours on a trolley in a corridor. That is appalling, and there are fears that things will get worse when the House is in recess.

Given that, it should not be for me to drag the Secretary of State here today to explain what he is doing to prevent a full winter crisis in the NHS. The question he did not answer, but must answer today, is this: does he have a winter plan? If he does, will he publish it? People working in the NHS need to know what is in it. [Interruption.] He seems to suggest that he has one, but let me quote Dr Mark Porter, chair of the British Medical Association. He criticises what he calls the

“total failure by government to come up with a meaningful plan”.

The Secretary of State will have to reassure Dr Porter.

The Secretary of State mentions money, but is it not the case that £300 million of it was allocated only in November? Does he really think that that gave the service enough time to plan? Dr Clifford Mann, chair of the College of Emergency Medicine, does not think so. He says:

“Had these funds been used back in summer and early autumn we might have more resilience in the system now.”

Dr Mann also questions where this money has gone, saying “very little” has been seen by front-line A and E staff, and instead

“a lot of it has gone to shoring up balance sheets in acute trusts”.

Is that true? Will the Secretary of State provide of full breakdown of how that money was allocated and has been spent to date? Were any conditions attached? I am sure he will claim the money has been used properly, but, if that is the case, why is the NHS already under so much pressure?

Over the break, hon. Members will want to monitor the situation in their local hospitals very closely. However, we have learnt that from tomorrow the publication of data on A and E will be suspended for three weeks over the crucial Christmas period. That is simply unacceptable. Given that we know the figures are still being collected, there is absolutely no reason why they should not be published. The Secretary of State rightly puts a premium on transparency. Will he today order an end to the news blackout and instruct NHS England to maintain weekly reports?

I have visited a number of acute trusts in recent days and they all say that the pressure on A and E is critically linked to the severe shortage of places in nursing and residential homes and cuts to social care. The sad truth is that today a record number of older people are trapped in hospital. They are well enough to go home, but do not have the support to do so. When are the Government going to wake up to the very real crisis in social care and the fact that it is dragging down the NHS?

Finally, no one can predict what this winter will hold, but the warning signs are there and the NHS needs to plan for all eventualities. What discussions has the Secretary of State held with other Departments, and do the Government have a wider contingency plan for the NHS?

This is a serious situation. If patients and staff are to have confidence, they need better answers than they have had so far. I hope the Secretary of State will start providing them now.

[Mr Hunt]

First, may I thank the shadow Health Secretary for bringing this matter to the attention of the House? As a former Health Secretary, he knows that operational pressures are one of the biggest challenges facing any Health Secretary. Indeed, he had many examples of very, very poor care on his own watch and he is absolutely right to give the House a chance to hear more about our plans for winter.

The shadow Secretary of State asks whether we have a plan. It seems to me that he prepared his comments before he listened to the statement. We have put in more money than ever before. Plans were announced in June. NHS England had a press conference in which it went through the plans relating not just to the £400 million, but the extra £300 million that was agreed in September and allocated through October. That is a record amount. Let us consider what is happening in his own constituency. In Wigan borough, since 2010, because of spending that he opposed, Wrightington, Wigan and Leigh NHS Foundation Trust has taken on 78 more doctors, 149 more nurses and 209 more clinical—[Interruption.] He says, “Does this help?” These are extra doctors and nurses on the front line, helping patients in his own constituency.

The right hon. Gentleman talked about care homes. The £3.3 million going to help his own constituents with winter pressures is to monitor the mental and physical health of patients in care homes and to help reduce the number of emergency admissions. We have a winter plan that is working in his own constituency to help improve the lot of his constituents. He needs to acknowledge that.

The right hon. Gentleman talked about the publication of figures over Christmas. We have never published figures over the Christmas period because it would mean forcing NHS staff to work over Christmas, whereas, where possible, we would like them to be able to go home for Christmas, just like Members of this House. When he was Health Secretary, did he publish performance or weekly A and E figures over Christmas? He did not. He did not publish them at Christmas or Easter; he did not publish any weekly A and E figures at all, so to come to the House and call it a news blackout says to me that he is more interested in political opportunism than in care for patients.

It is disappointing that the right hon. Gentleman did not take this opportunity to disown his own leader’s instructions to weaponise the NHS. The NHS is not, and never should be, a political weapon. This is what third parties say. Dr Mann, president of the College of Emergency Medicine, whom the shadow Secretary of State mentioned, said yesterday that

“the system is under pressure but it’s working pretty well”.

The Foundation Trust Network said:

“NHS providers prepared for this Winter earlier and more fully than ever before”

and that—he should listen to this bit—the

“NHS needs support not criticism”

please. The NHS Confederation said the NHS was pulling out all the stops on urgent care and A and E, and that earlier planning and extra money were helping.

The right hon. Gentleman wants to draw comparisons. Nine out of 10 people are being seen within four hours in this country, which is a higher proportion than in any country anywhere in the world that measures A and E performance—faster than Australia, New Zealand, Canada, Scotland, Northern Ireland and, yes, faster than Labour-run Wales. Eight people out of every 100 wait more than four hours in A and E in England; in Wales, that figure is 15 hours. He should concentrate on saving the NHS in Wales, rather than running it down in England, where it is doing so much better.

Finally, if the right hon. Gentleman is worried about poor care, why is he still saying it was wrong to have a public inquiry into Mid Staffs? This is what Julie Bailey, the Mid Staffs campaigner, said this week about his comments:

“It is very worrying, because if he becomes Health Secretary again at the election it is clear we would go straight back to the old days of covering up.”

The NHS is performing well under great pressure. He should commend the efforts being made by front-line staff, not undermine them by trying to turn the NHS into a political football.