A and E (Major Incidents)

Andy Burnham Excerpts

Wednesday 7th January 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the major incidents that have been declared at a number of hospitals and on A and E performance in England.

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

Mr Speaker, I welcome this opportunity to come to the House and make a statement on accident and emergency services.

First, we must recognise the context. The NHS always faces significant pressures during the winter months, but, with an ageing population, we now have 350,000 more over-75s than just four years ago. As a result, we are seeing more people turning up at our A and Es, with 279,000 more attendances in quarter three of this year as compared with last, and a greater level of sickness among those who do arrive, leading to an increase in emergency admissions of nearly 6% on last year. This picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland all missing key performance standards as a result.

A number of hospitals have declared major incidents over the past few days, in what is traditionally a particularly busy time in A and E. A major incident is part of the established escalation process for the NHS, and has been since 2005. This enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.

The decision to declare a major incident is taken locally—there is no national definition—and we must trust the managers and clinicians in our local NHS to make these decisions, and support them in doing so by making sure there is sufficient financial support available to help deal with additional pressures.

I chaired my first meeting to discuss that support on 17 March last year. On 13 June, we gave the NHS an additional £400 million for winter pressures, topped up in the autumn by £300 million to a record total of £700 million, ensuring local services had the certainty of additional money and time to plan how best to use it.

The NHS started this winter with 1,900 more doctors and 4,800 more hospital nurses than a year ago. This planning and funding has been widely welcomed by experts in the system, including NHS England, NHS Providers, the College of Emergency Medicine and the NHS Confederation. The funding the Government have put in, which is on top of the year-on-year real-terms increases in funding, is made possible by a strong economy, and 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, both in the acute and community sectors, and also provide £50 million to support ambulance services.

But the NHS also needs longer-term solutions to these pressures. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, with over 4 million already benefiting. 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%. And we have funded the NHS’s own plan to deal with these pressures, the five-year forward view, with an additional £1.7 billion for the NHS in 2015-16 and £1 billion of capital over the next four years to improve primary care facilities.

Mr Speaker, let me finish by thanking hard-working NHS staff across the country for the outstanding care they continue to deliver under a great deal of operational pressure.

[Andy Burnham]

All over England, the NHS is stretched to the limit—and in places is at breaking point. Staff are working flat-out and we thank each and every one of them for all they are doing, but the situation is now serious and getting worse. Right now, too many vulnerable people are exposed to too much risk, waiting hours for ambulances to arrive, and held in the back of them outside A and E or on trolleys in corridors. This cannot be allowed to carry on. Patients and staff deserve better answers than they have had to date about what is being done to address this issue, and that is why, faced with this complacency, we have again had to force the Secretary of State to come here today.

Fourteen hospitals have declared major incidents. Will the right hon. Gentleman explain clearly what this means for services in those areas? What is the official advice to people living in those areas? Is he providing any central support and advice to those hospitals? If a number of major incidents are declared in the same area at the same time, what contingency plans will be put into place to protect the public? More broadly, what new measures does he have under active consideration to ease pressure at all hospitals?

The Secretary of State mentioned resources. When he allocated additional resources for winter pressure, what assessment was used to determine how much was needed? Clearly, it is not working. Does he now plan to reassess the situation and perhaps allocate more? Ministers keep blaming unprecedented demand, but the question is this: why is there such unprecedented demand? Could it have anything to do with the difficulty in getting a GP appointment, the closure of walk-in centres or the cuts to social care?

Let me turn to ambulance services. There are alarming reports of people waiting hours for ambulances to arrive. This is because ambulances are trapped in queues outside A and E departments. We are hearing that at least one service has implemented a policy of leaving patients at the door of A and E without handing them over to A and E staff. Is the Secretary of State aware of this practice, and is he satisfied that it is not putting patient safety and care at risk?

The last time we had to drag the Secretary of State here, he failed to inform the House that he had approved a proposal to relax 999 response times. So will he today tell the House what the current status of those plans is and whether they are still going ahead this winter? I have real concerns, which I have relayed to ambulance leaders, about making any such change without proper consultation and evidence. There are also reports of police and fire vehicles being used to carry people to A and E. What discussions has he had with police and fire service leaders about this practice? What training or advice has been given to front-line police and fire staff? Is he fully satisfied that patient safety is not being compromised?

Finally, cuts to social care are a root cause of the pressure on hospitals. A record number of elderly people are trapped in hospital beds, and any solution to this crisis must involve councils and a solution for social care. So will the Secretary of State now act on our constructive proposal to hold an urgent summit of all the public services affected—councils, police and fire services—and to develop a co-ordinated plan to ease this crisis? NHS staff deserve it. Safe patient care demands it. When will he deliver it?

[Mr Hunt]

First, let me thank the right hon. Gentleman for this opportunity once again to go through the plans that we have in place to support the NHS and to reiterate the gratitude of the whole House to NHS staff for what they are doing under huge pressure at the moment. Let me start by telling him where I agree with him. I agree that what happens in the social care system is closely linked to what happens in the NHS. That is why, from June last year, meetings have been happening in 140 local authority areas between the local NHS and local authorities to work out how best to plan for winter. The result of that planning process, which is funded by £700 million of Government support, is extra doctors, extra nurses, extra beds and new plans in every area. I am absolutely satisfied that that money is making a difference. Every day in our A and E departments, 2,500 more people are being seen within four hours than was the case four years ago when the right hon. Gentleman was Health Secretary. The local structures worked last year, and they are working now. Now is the time to get behind them and to support the local NHS.

In a letter that the right hon. Gentleman wrote to me yesterday, he talked about Government failure. This is not the time to play politics—[Interruption.] Perhaps Opposition Members will listen to this. The head of NHS England, Simon Stevens, a former Labour special adviser, said yesterday

“the NHS, the Department of Health and local clinicians have done everything that could reasonably be expected”

to put in place plans over the last weeks. If the right hon. Gentleman will not listen to that, perhaps he will listen to Rob Webster, who runs the NHS Confederation, a representative body of all NHS organisations. He says that we should be grateful for the huge effort NHS staff have put in over the past few weeks and that it is not the time to play political football.

The right hon. Gentleman talked about ambulances, where we are putting in £50 million of support this winter, and some changes proposed by the Association of Ambulance Chief Executives, which he was informed about three months earlier than they came to public light. This is what the AACE said:

“We have been surprised by some of the reaction today given that over the last three months the principles of what we are proposing…have been shared with Labour…and we have received no negative feedback”.

What did the right hon. Gentleman say? He said it was a panic decision to relax 999 standards. There was no panic, no decision, no relaxation of 999 standards; I did what any Health Secretary should do: I simply asked for clinical advice on what would be best for patients. He chose to frighten the public, to scaremonger for party political purpose. Is it not time the Labour party, for once, thought about the impact on patients of the kind of things it is saying in the press?

The right hon. Gentleman then talked, and the Leader of the Opposition has talked, about the causes of these challenges being the reforms this Government introduced in this Parliament. Let me say to him that the one part of the UK that introduced these reforms, England, happens to have the best A and E performance and the one part of the UK that has most set its face against these forms, Labour-run Wales, has one of the worst performances. If he wants to do something about A and E pressures, instead of trying to make political capital in England, he should be getting Labour to turn things round in the one place it does run the health service—Wales. He should be backing this Government’s support for the NHS in a difficult period that has meant more doctors, more nurses, more people being seen quickly, more operations, long-term support and a plan for our NHS; it should not be politics and scaremongering ahead of an election.