Accident and Emergency Waiting Times

Anna Soubry Excerpts

Wednesday 5th June 2013 Commons Chamber

[Dr Wollaston]

I commented on that on Twitter. The remark was unfortunate; I think women GPs contribute enormously, but there we are. I would say that, wouldn’t I?

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

rose—

[Dr Wollaston]

I am short of time, I am afraid.

I go back to how we get people directed to the right place. We need NHS 111 to do the job it is intended to do—direct and signpost people to the right place. Some 42% of people do not know how to access their out-of-hours service; they will go to where the lights are on. We need to make sure that there is good-quality information about how to see the right professional in the right place at the right time and about communication in all parts of the system.

We also need to consider how commissioners can be supported to keep people at home, which is the right place for frail elderly people, by using community resources. There are some wonderful organisations in my area—Brixham Does Care, Totnes Caring, Saltstone Caring and Dartmouth Caring. Having the flexibility to commission small local units is vital, rather than there being a push to commission larger units that do not have that local focus. The issue is about local focus helping to have local solutions. What works in Lewisham will not work in rural Devon, so let us get the solutions right and have flexibility.

Let us make sure that we address the delays within casualty departments and the pressures that cause that. Very often the issue is to do with diagnostics. Let us look at the groups of people who constantly re-attend. I do not want to bore the House too much with my views on minimum pricing, but anybody who wants to spend a Friday or Saturday night in an inner-city casualty department will see what the delays are due to. I hope to win my bet eventually with the right hon. Member for Exeter (Mr Bradshaw).

Let us have a sensible policy that considers mental health, for example. A huge number of readmissions in casualty departments involve people with mental illness. In the west midlands, liaison psychiatry is being used to help reduce readmissions among those with mental illness—again, it is about getting people the right support at the right time in the right place. Some 5.6% of bed days in the NHS are taken up by people who have been readmitted within a week of discharge. That is simply not acceptable.

There is also the issue of designing the tariffs. I was pleased to hear the Secretary of State refer to tariff reform. If the financial drivers are in the wrong place, we will not solve the problem. Let us try to take the party politics out of this debate and focus entirely on how we can support NHS England and our clinical commissioning groups to get the right care in the right place at the right time.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Oh dear, what a pity. Until the hon. Member for Denton and Reddish (Andrew Gwynne) rose to speak, it was going rather well. There was almost an outbreak of consensus after a number of thoughtful contributions from Members on both sides of the House. Unfortunately, as ever, the hon. Gentleman had to fall back into the old ways of cheap party political points and cheap partisan comments. I agree with him on one point. [Interruption.] Hon. Members may want to calm down and chill out a little. The hon. Gentleman rightly paid tribute to all the doctors, consultants, nurses, receptionists and everyone who works in our accident and emergency departments.

[Helen Jones]

Even the women?

[Anna Soubry]

That sort of cheap comment does the hon. Lady no justice whatsoever or credit. Let me explain to her—I was here for the debate, and she was not—that I did not in any way blame women doctors. As someone who has worked as a woman professional all my life, I really do not want to hear any lessons from Opposition Members. What I did was echo the comments of the president of the Royal College of General Practitioners, and I paid tribute to all our GPs for their hard work and dedication to our NHS, and to their patients.

There are immense pressures on the NHS as a whole, and on A and E in particular. Our A and E departments are dealing with 1 million more people than they did when the previous Government were in power. The causes of that increase in demand are complex: a long, cold winter; an ageing population; and more people with long-term conditions. The system itself, let us be honest, has not helped, from poor integration between health and social care to the lack of public confidence in out-of-hours primary care services. We can have an argument about the 2004 GP contract, but as the hon. Member for Southport (John Pugh) rightly said, it has not helped. Today, we have a situation in which, if people do not know where to go, or they are not sure that they will get a good service, they go to A and E. In a recent hearing by the Select Committee on Health, Dr Patrick Cadigan, a registrar from the Royal College of Physicians, set out the position perfectly:

“Patients will go where the lights are on. In many of these alternatives, the lights are not on after five o’clock in the evening or at weekends.”

That presents a set of challenges that the Government are determined to address. First, it is important that we deal with the current situation, and we are.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No.

Already, emergency departments have recovered from the dip in performance over the winter. [Interruption.] The hon. Member for Denton and Reddish did not give way, and I am adopting his admirable approach in this debate.

For each of the past five weeks, the four-hour waiting time target has been either reached or exceeded. The average wait in A and E is currently 50 minutes. More importantly, we are making the NHS fit for the future: a future where care is designed and delivered around the specific needs of an individual patient; where care is integrated across primary and secondary care and across health and social care; and where local clinicians, not national politicians, decide what is best for their communities. The Government have taken tough decisions that will create a strong and sustainable NHS, now and for generations to come. The Health and Social Care Act 2012 has finally brought local health and social care communities together to design integrated services around the needs of their patients, building in strength for the future. So if more services are needed outside hospitals, local clinicians working with community partners can make those decisions, without having to wait for a Minister to tell them what to do.

We have not stopped there. We have provided £7.2 billion to local authorities for social care. We have given hospitals the ability to carry over underspends—free to pool their budgets locally to improve care for patients. We have new urgent care boards which will use the savings from the marginal rate emergency tariff to reduce pressure on A and E. The NHS Medical Director, Sir Bruce Keogh, is currently reviewing the provision of urgent and emergency care. This autumn the vulnerable older people’s plan will set out how we will improve primary and out-of-hours services for the frail and the elderly and how we can remove barriers to integrated care. At every step of the way we are putting local doctors and nurses in charge and designing care around the patient.

I shall deal briefly with some of the very good speeches that were made on both sides of the House. We heard first from two former Secretaries of State for Health, the right hon. Member for Holborn and St Pancras (Frank Dobson) and my right hon. Friend the Member for Charnwood (Mr Dorrell). Both were eloquent and informed. I have to say that the speech and the comments of my right hon. Friend found more favour with me. The hon. Member for Lewisham East (Heidi Alexander) asked for a grown-up debate, and we had a good contribution from my hon. Friend the Member for Totnes (Dr Wollaston). I have addressed the unfortunate remarks that she made, perhaps not having read Hansard, if I may say so.

I turn to other valuable contributions. The right hon. Member for Cynon Valley (Ann Clwyd) made a contribution, as we would expect. Then we heard from my hon. Friend the Member for Brigg and Goole (Andrew Percy), who spoke briefly about his local experience in his constituency and brought those experiences, rightly, into the debate. He touched on walk-in centres, an issue that was raised by—I nearly said my hon. Friend; I beg his pardon if that is in any way disparaging to him—the right hon. Member for Rother Valley (Mr Barron), who beautifully forgot that any decision about the future of any walk-in centre is a local decision. It is for local people—[Interruption.] I am not knocking anybody; I am explaining the facts. I appreciate that the right hon. Member for Leigh (Andy Burnham) has a problem with the facts, but the facts are that these are local decisions made by local communities and local clinicians.

My hon. Friend the Member for Bracknell (Dr Lee) gave a thoughtful and challenging speech, and I hope that many will take that away and listen to what he said. I shall deal briefly with the comments of my hon. Friends the Members for Lancaster and Fleetwood (Eric Ollerenshaw) and for Stevenage (Stephen McPartland) and the hon. Member for Cheltenham (Martin Horwood), who spoke about some of the difficulties that we have with the recruitment of doctors. Departmental officials have met. We know that it is a problem. We have worked with the College of Emergency Medicine and we know that we need to tackle the problem. We did that in 2011 and those issues will in due course be considered. I hope we will see some changes.

The hon. Member for Mitcham and Morden (Siobhain McDonagh), as ever, championed her local hospital, as I expect her always to do, but she spoke about a lack of public consultation and many of us will take away her wise observations on that. It is important to remind the House of the comments of my hon. Friend the Member for Lancaster and Fleetwood. He, like others in the debate, reported that his constituents get a good service from good staff. All of us should remember that.

To conclude, in challenging circumstances, and with this Government’s support, the people of our NHS are performing admirably. There are over 400,000 more operations now than under Labour. The proportion of cancellations remains unchanged. Fewer than 300 people—276—are waiting more than a year for an operation, compared with 18,000 under the Labour Government. Some 8,500 more clinical staff are working in our NHS, including 5,700 more doctors. MSRA rates have halved. Mixed-sex wards have been practically abolished. We are finally moving towards a paperless NHS by 2018. In addition, in stark contrast to the Labour party’s plans, we now have a protected NHS budget, with real terms—

[Ms Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put.