111 Telephone Service
Debate between Anna Soubry and Jamie Reed(11 years, 5 months ago)
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Anna Soubry
I will take interventions, but I want to make these points first.
The population is also living considerably longer. That is good and welcome, but there are many frail elderly people with complex illnesses and diseases, so they attend A and E in a way they did not previously. In addition, we suffered under the previous Government from a lack of integration between health and social care. That was one of the things that the Health and Social Care Act 2012 addressed, and will solve. It is about better integration. The hon. Member for Copeland sneers at that.
Anna Soubry
He laughs at it, Hansard will record. It is not a laughing matter at all. What I was describing is one of the achievements of the Act. I am confident it will deliver.
Anna Soubry
I, too, know that it does no one any favours to make out that someone forcefully and passionately giving a view based on their experience is manufacturing it. I know that that is not true of my hon. Friend, and I thank him for his valuable contribution. He is right.
Mr Jamie Reed
I think casual outside observers will struggle with the concept that politicians from different political parties should seek to have different political opinions about the services and Department for which the Minister is responsible. She makes an almost Kafkaesque defence of the Government’s NHS record, but will she accept that the awful implementation of the 111 scheme, the collapse of adult social care, the closure of walk-in centres and the huge pressures on the NHS elsewhere in the system have resulted in the crisis in A and E?
Anna Soubry
I will not accept any of what the hon. Gentleman says, because he does his cause no service when he makes cheap political points. The matter is hugely complex, but it is wrong to say that the Government caused the problems in A and E. He is wrong in that. It is difficult and complex.
Anna Soubry
Indeed. I will answer as many of my hon. Friend’s questions as I can. There are some questions I will not be able to answer, but I will certainly write to her.
One of the reasons we introduced pilot schemes was to learn from them, and I can tell my hon. Friend a few things as a result. The university of Sheffield did an evaluation report, which said that there was “no statistically significant” impact on services in most of the pilot areas. Importantly, NHS England is collecting data on 111 and its impact on other services, especially, as one would imagine, on A and E. NHS England is in a position to monitor that, and it will report in due course. I am told that the April data will be published this Friday.
I am reliably informed that the A and E performance of York Teaching Hospital NHS Foundation Trust, which serves my hon. Friend’s constituency, is that in 2013-14 so far, 96.1% of people have been seen within the four-hour target. That is above target. I think the average across England for people being seen in A and E is some 55 minutes.
Mr Jamie Reed
This question is not a trap in any way, shape or form. The Minister just said that NHS England is assessing data on the performance of 111 thus far, which will be made available in due course. This is an empirical question: will the system be rolled out across the country without the data on the effect of the 111 service on the rest of the system being fully understood?
Anna Soubry
I do not know the answer, and I will not start speculating because it invariably gets one into terrible trouble.
Anna Soubry
I am more than happy to write to the hon. Gentleman with some sort of answer from either NHS England or the Department.
I should say, of course, that we know that 111 has not been successful in the way it should have been in many parts of the country, and we know that there were particular problems over the bank holiday and Easter periods, but we also know that it has now been rolled out to 90% of England. NHS England is monitoring, overseeing and collecting the data, as we would all hope.
I will do my very best to respond to the content of today’s debate and the questions that have been raised, with apologies for those questions that I do not answer.
The ratio of call handlers to professionals, about which my hon. Friend the Member for Thirsk and Malton asked, is 4:1. That ratio is not specified, however. There is no prescription that it must be 4:1. As 111 is locally commissioned in the way that I have explained, it is for local commissioners to decide whether to change that ratio, depending on the particular needs of the people in their area. One of the great benefits of the 2012 Act is that we have enabled local commissioners, either as a CCG or as a cluster, to commission services to meet the specific needs of their patients. I hope that will mean that a cluster or CCG in a rural area, obviously knowing that its patients live in a rural area, will ensure that its service is tailor-made to suit the needs of those patients, which may be different from the needs of patients in, say, a city and its surrounding suburbs. That is one of the joys of local commissioning.
My hon. Friend asked whether the three to three-and-a-half hours—in truth, I think it was really four hours—before her father was seen is normal, and the unequivocal answer is no. Is it acceptable? In my view, it is certainly not acceptable.
My hon. Friend then asked who pays. She is concerned about whether the debt in which her primary care trust found itself will have an impact. The 111 service is paid for by CCGs, which is one reason why CCGs are involved in the local commissioning of the service.
How are the concerns of GPs being addressed? The NHS is having a review in the way that I described. My hon. Friend the Member for Brigg and Goole (Andrew Percy), who must be a member of the Select Committee on Health—that shows my profound ignorance, and I apologise to him—has helpfully reminded me that Dr Gerada, who is the chair of the Royal College of General Practitioners, said in her evidence yesterday that she has not seen such queues since the flu epidemic of two to three years ago. She said that the reasons for the high demand are mixed and complex, including the nasty flu virus that went around earlier this year and at the end of last year. I reiterate my point: if only it were so simple to cure the problems in A and E.
A and E Waiting Times
Debate between Anna Soubry and Jamie Reed(11 years, 7 months ago)
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Mr Jamie Reed (Copeland) (Lab)
It is a pleasure to speak under your chairmanship, for what is, I think, the first time, Mr Hollobone. I thank my right hon. Friend the Member for Cynon Valley (Ann Clwyd) for securing the debate. She has an exceptionally powerful voice in these matters, and all of us, on both sides of the House, have a common interest in ensuring it is heard not only today, but throughout this Parliament. I pay tribute to the work she is doing not only in her own right, but in tandem with the Government.
I also pay tribute to the work other Members who have spoken undertake on behalf of their constituents in fighting for A and E services in their constituencies. It would be remiss of me not to thank my local A and E unit at the West Cumberland hospital for saving my life probably twice in the past two years, although I appreciate that that makes me sound careless.
Before I begin, I wonder whether the Minister can answer this fairly simple question. What have Barking, Havering and Redbridge University Hospitals NHS Trust, Burton Hospitals NHS Foundation Trust, Milton Keynes Hospital NHS Foundation Trust, North West London Hospitals NHS Trust, Portsmouth Hospitals NHS Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Shrewsbury and Telford Hospital NHS Trust, University Hospital of South Manchester NHS Foundation Trust, University Hospitals Coventry and Warwickshire NHS Trust, University Hospitals of Leicester NHS Trust and York Teaching Hospital NHS Foundation Trust all got in common? I am more than happy to give way to the Minister if she would like to hazard a guess.
Anna Soubry
These are serious matters and should be above such cheap party politics. The hon. Gentleman clearly knows the answer to his question, and is asking me to speculate. Given that the debate is about accident and emergency, no doubt the answer is that their waiting times are longer. The Government accept that, and also agree that it is not acceptable; and we are doing something about it. If the hon. Gentleman wants to play party politics, that is against him, not against anything else.
Mr Reed
That was a regrettable answer, and did not become the Minister. She clearly does not know the answer. I wonder, as do, I think, many hon. Members, whether the Government know the answer to the question. It is that those trusts have missed the A and E target for major type 1 units—
Anna Soubry
The point that I am making is that the hon. Gentleman is playing silly games with serious matters. Other right hon. and hon. Members have addressed the issue positively, with compassion, but he is just playing silly party political games.
Mr Reed
I do not think it is sexist at all.
Does the Minister know how many times her local trust has missed its A and E target, since the end of September? [Interruption.] I will tell her. Nottingham University Hospitals NHS Trust has missed its target for 17 weeks since September.
Anna Soubry
Would the hon. Gentleman care to refresh his memory? If we refer to the most recent statistics produced by Nottingham University Hospitals NHS Trust for the A and E department at the Queen’s medical centre, we can compare those for the week commencing 14 April this year with those for the week commencing 15 April last year. Last year 440 patients failed to be treated or seen within the four-hour target, whereas this year the figure had fallen to 259.
Mr Reed
I note that the Minister prepared an answer, and I am grateful for that.
Major accident and emergency units—type 1 facilities, nationally—have missed the target for at least the last six months, and all A and E units, including minor incident units, have not hit the target for 12 weeks in a row. If anyone needs help analysing the figures, I would be happy to oblige. They are easy to find and they reveal some interesting points. For example, I wonder whether hon. Members know that only one trust with a major accident and emergency unit in England has hit its target every week since the Secretary of State took his position. That is relegation form, and if this were a football match the cry from the crowd would be “You don’t know what you’re doing.”
Before the Minister attempts yet again to dismiss those statistics, I hope she will take a moment to attend to what has been said by the chief executive of the Royal College of Nursing, by Dr Clifford Mann of the College of Emergency Medicine, and by David Behan of the Care Quality Commission. Earlier this month, Dr Peter Carter, of the Royal College of Nursing said:
“These figures are yet more proof of a system running at capacity, and patients are suffering as a result. Our members are regularly telling us that pressure on the system is rising while staffing levels fall, and as a result any increase in demand results in unacceptable waits for patients who are already going through a difficult time.”
Dr Clifford Mann, of the College of Emergency Medicine said:
“We are seeing...ambulances queuing outside departments, and patients waiting too long on trolleys before they can be admitted to hospital.”
The Care Quality Commission said:
“It is disappointing that people have said they have to wait longer to be treated than four years ago. People should be seen, diagnosed, treated and admitted or discharged as quickly as possible”.
Like me, the Royal College of Nursing, the College of Emergency Medicine and the Care Quality Commission will be appalled that the key performance indicators for the NHS, such as A and E waiting times, are getting steadily worse. In the past six months, 582,811 people waited more than four hours in major A and E units, compared with 420,921 for the same period in the previous year. That is an increase of 161,890 people. That is not silly: it is a question of people’s lives. Those figures relate to people in need who did not get treatment in the time when they needed it. They represent more than 500,000 extra waiting hours in one year. People will find it hard to stomach the fact that there are now about 5,000 fewer nurses than there were in 2010, at a time when, as hon. Members on both sides of the House have mentioned, demand in our A and E units is increasing.
One way to get the figure down—it has been touched on already in the debate—would be to offer services for people with non-emergency ailments, so that they do not feel the need to travel to an A and E department. However, instead of NHS Direct being used as a tool for easing pressure on A and E departments, the roll-out of NHS 111 has turned into a trade marked Government shambles. Patients calling the new 111 service wait hours for advice. One patient waited 11 hours and 29 minutes for a call back. No wonder they feel that they have to go to A and E, when they cannot trust a telephone service with such an inadequate response rate.
Accident and emergency departments are a litmus test, or a barometer, for the performance of the NHS as a whole. If people are waiting in A and E, it means that there are too few beds or too few staff to cope with demand. That is just a fact of health service planning. If there are too few beds, it is because community services are being cut and patients who should be at home are kept in hospital. That reverberates back through the entire system. If patients who could be at home are in hospital, beds are occupied. If beds are occupied, A and E staff cannot admit patients. If A and Es are full, paramedics cannot hand over patients. If patients are queuing in the back of ambulances, those ambulances cannot respond to a potentially serious call-out. One failure leads to another. Each compounds the other. That is what is so serious about the debate. It is not just about the patient sitting in A and E for hours on end; the statistics I have highlighted show much more than that—the experiences of patients throughout the entire system.
The Parliamentary Under-Secretary of State for Health (Anna Soubry)
It is a pleasure to serve under your chairmanship, Mr Hollobone.
I have just about eight minutes to respond to all the valuable contributions made in this debate. I will not be able to answer all the questions, but I will write to anyone who has asked a question that I cannot answer.
Obviously, I begin by paying tribute to the right hon. Member for Cynon Valley (Ann Clwyd) for securing this debate and for the way she is championing the cause of the patient. She will not hesitate to leave no stone unturned. As many others know, she is doing great work in leading our independent review of NHS complaints. She mentioned just some of the many cases that have come her way. She did not give dates, but I suspect the cases were not all fresh by any means, because, as she, I and many others recognise, this is by no means a new phenomenon; it is a serious problem that requires serious action, which the Government are taking. Would it not be refreshing and brilliant if we could have a debate on a serious issue without falling into the trap of cheap party politics, which, unfortunately, has been a little evident in some, but mercifully not all, the speeches? As the right hon. Lady said in her speech, there are no easy answers.
Some important points have been raised. We know that there is a problem, and we recognise that. It is not uncommon for the four-hour waiting time standards not to be met, especially during the winter period. That happened under the previous Government as well as under this Government. Indeed, in 2008-09 there were 23 weeks in which the waiting time target was breached, and it was breached during a further 14 weeks in 2009-10 up to May 2010. We know that those problems continue. We want to know and understand why, and we want to take quick action.
Anna Soubry
I have only six minutes to address all the contributions, so the hon. Gentleman had better be quick.
Anna Soubry
No. I am not going to go into all that in the short time that is available to me. We accept that waiting times are a problem—we are not trying to hide from that, and we are up for transparency—and I will address the data in a minute.
The hon. Member for Cheltenham (Martin Horwood) rightly identifies the seasonal nature of waiting times. He speaks with passion about changes in his constituency, and rightly so. It is right and proper that people who have such concerns, as other hon. Members have said, come to this place to champion the cause of the health service within their own communities, especially when it faces reconfiguration. He spoke about 111, which is an important thing to talk about when considering some of the causes that may contribute to the unacceptable failure to hit targets. I know that the data are being monitored on a daily basis by NHS England, and the deputy chief executive of NHS England is meeting twice a week to consider what is happening and to make sure that action is taken to ensure that any problems are addressed.
The hon. Gentleman makes an important point on the difficulty of filling posts, and I will write to him on that because I know it is a problem. I also know that action is being taken by some of the royal colleges, and it is probably best if I give a fuller answer, because he makes a very important point. Of course, I can say that the Keogh review is considering exactly the other problems that he mentioned. As the Secretary of State announced, the Keogh review, which has been alluded to, will report next month. All those matters will be reviewed by Sir Bruce, and it is much to be hoped that some positive forward-thinking will come out of that.
The hon. Member for Stretford and Urmston (Kate Green) raised various issues. I am particularly concerned that she says she is not getting the answers to the questions she has quite properly asked. I think there is sometimes a problem with hon. Members not going in the first instance to the actual hospital, trust or whoever it might be. Her point, and it is a good point well made, is that when she asked my Department, she did not get those figures, and I will make further inquiries.
Only today I saw a question from the hon. Member for Ashfield (Gloria De Piero) asking precisely what the figures are for her hospital in Sherwood and, as it happens, the hospital she and I effectively share, the Queen’s medical centre A and E department. I have given those figures, and I want to set the record straight because, in fact, for the same week last year in Sherwood, 75 people waited more than four hours; this year the figure is 266.
Oral Answers to Questions
Debate between Anna Soubry and Jamie Reed(11 years, 7 months ago)
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Anna Soubry
I am grateful to my hon. Friend for those comments; as he knows, these are now matters for NHS England. I will make sure it is aware of what he has said and his urging it to do both those things for the obvious benefits they would have for a cancer patient’s experience.
Mr Jamie Reed (Copeland) (Lab)
The hon. Member for Basildon and Billericay (Mr Baron) is absolutely right: it is essential that the NHS is held to account for the experiences of cancer patients and patients with other conditions, too. Accountability has undoubtedly been weakened, however, as a result of the NHS reorganisation that came into effect this month. Last week, the outgoing deputy chief executive of the NHS, David Flory, said that the loss of experience in the NHS is greater than he has ever seen and that hospitals have been left struggling as a result. How can a service stripped of so much skill, knowledge and expertise provide the accountability that patients deserve?
Anna Soubry
I am afraid that the hon. Gentleman’s question depicts a situation that I simply do not recognise. As I visit hospitals and other organisations, both in my constituency and across the country, I am told that there has been a huge improvement, especially in commissioning—[Interruption.] No, by front-line clinicians, who talk with enthusiasm about how the commissioning of services has improved because now at last the clinicians—those who know best—are in charge, and not, as has often been the case, faceless bureaucrats and managers.
Terminal Illness (Access to Medicines)
Debate between Anna Soubry and Jamie Reed(11 years, 10 months ago)
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Anna Soubry
I am grateful for that intervention and I completely agree. It is great when we see business working with our universities on research. It can be highly productive and undoubtedly mutually beneficial, including to the rest of society, and that collaborative approach is much to be welcomed. It is fair to say that many universities, at first, had a bit of resistance to working with business, seeing it somehow as sullying themselves. However, over time they have recognised the absolute mutual benefit to both and, of course, that includes, should it be successful, a benefit to society.
Mr Jamie Reed
I am grateful to the Minister for her contribution. It is clear that there is an emerging cross-party consensus—dare I say it, a coalition—which is a tremendous sight to behold for everyone who cares about this issue. She talks about the difficulties posed by the research and development sector when it comes to manufacturing medicines for orphan diseases, and the costs inherent in producing them because of the market basis on which they are produced—no argument there. However, could she explain how that might affect the commissioning choices of clinical commissioning groups when it comes to purchasing those very same medicines, given the inherently inflated costs?
Anna Soubry
I cannot give a short answer in this debate, but that is important and it has been raised by a number of hon. Members. On that basis, I will ensure that a proper and full written response is given, both to the hon. Gentleman and all other hon. Members—I suspect that my hon. Friend the Member for Southport and the hon. Member for Strangford will also be interested in the answer. All present will certainly get a written answer to that, because it is an important point; clarity is clearly being sought, and it will be given.
Returning to NICE, once effective new drugs are brought to market, it is important, as we all know, that they are made available to the patients who will benefit most from them on terms that represent value to the NHS—that means, of course, value to the taxpayer. NICE has played an important role in that by providing robust, evidence-based guidance to the NHS on drugs and treatments. In the great majority of cases, NICE now publishes draft or final guidance on significant new drugs within a few months of their launch. In 2011, for drugs appraised using its single technology appraisal methodology—the methodology used for the great majority of new drugs—NICE issued draft or final guidance an average of four months after the date of market authorisation. The end-of-life flexibilities introduced into NICE’s appraisal process from 2009 have allowed a number of important drugs for terminal illnesses affecting a small number of patients to be made available on the NHS.
The NHS constitution sets out patients’ rights to medicines positively appraised by NICE, underpinned by a statutory funding direction. In December 2011, the NHS chief executive’s report, entitled “Innovation, Health and Wealth”, introduced a NICE compliance regime to help to ensure that medicines approved by NICE are made available on the NHS quickly and consistently. Furthermore, since the cancer drugs fund started operating in October 2010, more than 25,000 patients have received cancer drugs that they would previously have been denied. Our priority is to give NHS patients better access to effective and innovative medicines. That is why we will move to a system of value-based pricing for new branded medicines from January 2014, following the end of the current pharmaceutical price regulation scheme.