Accident and Emergency Waiting Times

Baroness Primarolo Excerpts

Wednesday 5th June 2013 Commons Chamber

[Madam Deputy Speaker (Dawn Primarolo)]

Briefly. Interventions are supposed to be brief, not a speech in their own right. The right hon. Lady will have to resume her seat.

[Dame Joan Ruddock]

rose—

[Madam Deputy Speaker]

Now.

[Heidi Alexander]

I agree that the evidence on which that assertion was based is deeply spurious and a meeting with Sir Bruce Keogh, which I requested, would be very helpful to the three Lewisham Members.

The situation, as I said, is repeated all over the country. There are more people stuck on ambulances waiting to get into A and E, more people waiting longer for treatment when they get there, and this Government’s answer is to close the A and E, ask people to travel further, and tell them to go to a bigger hospital, where the queue will probably be longer. If this is not the politics of the lunatic asylum, I do not know what is.

My constituents in Lewisham have been told that their full A and E service has to close in order to bail out the hospitals down the road. The whole decision-making process has been opaque and, in my view, deceitful. It is now rightly being challenged in the courts by Lewisham council and the save Lewisham hospital campaign. But for now, my constituents still face the prospect of seriously downgraded services at their local hospital. Not only are my constituents being told that they will have to travel further in future to get to an A and E, but to add injury to insult, they are being told to go to departments where performance is generally below that at Lewisham. In 29 of the 35 weeks between the end of September last year and the end of May this year, people were seen more quickly at the A and E in Lewisham than they were at the hospitals within the South London Healthcare NHS Trust where they are now being told to go.

In the first four months of this year, ambulances were placed on divert 25 times to Lewisham hospital. They were diverted away from the very hospitals where my constituents are now being told to go. It does not take a brain surgeon to work out why 25,000 people chose to march against these proposals in January. Under no circumstances should any changes at Lewisham hospital be made unless ambulance diverts have stopped and waiting time targets in neighbouring hospitals have been met. I do not want the changes to happen at all, but surely this is the least that the Government should commit to.

The Government seem intent on blaming everyone but themselves for the crisis in A and E. They seem oblivious to the fact that the things they are doing now, such as destabilising reorganisations and the devastating cuts to adult social care, are making the situation worse. They are shutting their eyes to the problem and ploughing on regardless with a programme of A and E closures. I accept that in some places reconfiguration of hospital services will be necessary, but this process must be driven by what is in the best interests of patients. That is not what is happening in Lewisham.

The Government want to blame everyone but themselves for the crisis in the NHS. The sooner we ditch the blame game and have a grown-up debate with thought-out solutions, the better our NHS will be for it.

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[Ann Clwyd]

No, I am sorry, I cannot.

Finally, my GP friend said:

“These matters and the ways you expressed your concerns are so similar to the events described in the many many letters you have received from others who have described similar misgivings. It must be very difficult to have to ‘use’ your own very personal experience as a prompt to drive the response and search for answers that so many want from you. But that is your job as Member of Parliament, to identify what, if anything—”

[Madam Deputy Speaker (Dawn Primarolo)]

Order.

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[Mr Thomas]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I remind the House that there are nine speakers still to be called, and that the winding-up speeches will begin at 6.40 pm. That means that some Members who have been sitting in the Chamber will not be able to contribute. I therefore ask Members to be sparing with interventions, and to make them only when they are absolutely crucial. I also remind them that interventions must be short, and must relate to the point that the speaker was making at the time rather than be an extra debating point.

[Mr Thomas]

I share the view of my neighbour and hon. Friend the Member for Brent North (Barry Gardiner). We need that expansion to go ahead, and to go ahead soon.

In an intervention during the speech of my right hon. Friend the Member for Leigh (Andy Burnham), I raised the plight of many of my constituents who formerly used Alexandra Avenue polyclinic, an extremely popular walk-in centre which used to be open from 8 am until 8 pm, 365 days a year, to people who were genuinely concerned about their health and did not feel that they could wait to see their GPs. It was opened by Ara Darzi some five years ago. Amazingly, its opening was opposed by my political opponents in Harrow, but it quickly came to be greatly appreciated by, in particular, people living in the south Harrow and Rayners Lane area. Those people have noted with considerable regret that, after the last general election, the primary care trust decided to restrict the opening hours of their walk-in centre, but not those of the walk-in centre in Pinner, in the constituency of my other neighbour, the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd).

As a result of the cuts that the primary care trust decided to make, the walk-in service now operates only between 9 am and 3pm on Saturdays and Sundays. The fact that it remains open at all is entirely due to the scale and strength of feeling about the loss of what was an excellent service, and the campaign that we were able to run in order to save it. Perhaps some of the £3 billion that the Prime Minister spent on what was—as others have already pointed out—a completely unnecessary reorganisation of the NHS could have been invested in keeping Alexandra Avenue polyclinic open, and some of the pressure that my constituents are imposing on Northwick Park hospital’s accident and emergency unit could have been alleviated.

Staff at the excellent Pinner ambulance station in Rayners Lane do an extremely good job, generally spending all their shifts out on the road. It is clear that they, like the rest of the staff of the London Ambulance Service, are under extremely heavy pressure. On occasion, ambulances have been used as temporary reception or holding areas at Northwick Park when patients cannot be admitted to A and E as they arrive because of the pressure on that department.

There is also concern about the district nursing service in Harrow. My personal experience of that service has been mixed. An elderly relative and, more important, that person’s carer have found it difficult to gain access to it by telephone when problems have developed. It has been slow to respond, and has demonstrated poor co-ordination with other parts of the local health care system. Again, funding was cut by the primary care trust.

The new clinical commissioning group has given notice to the local trust which runs the service that it may outsource the contract, but I am not convinced that that is the answer. Investment in staff—trained staff—and, crucially, investment in management time by the local trust seems to be the immediate requirement if the problems in the service are to be sorted out. Meanwhile, to those who are aware—as many of my constituents are—that the district nursing service is far from brilliant, it is hardly surprising that family members should want to delay the discharge of elderly patients from Northwick Park.

It is telling that the number of cancelled operations is rising fast at Northwick Park. So far, it has risen by some 13%. That is a further symptom of the crisis in the national health service, as evidenced by others—

[Madam Deputy Speaker]

Order. The hon. Gentleman’s time is up.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

We have a crisis in A and E; that is clear from this afternoon’s debate. The King’s Fund report this week detailed the worst performance in nine years, with 5.9% of patients waiting more than four hours. It has been suggested that patients are just going where the lights are on. Is that the case?

I got information on A and E from the chief executive of Salford Royal NHS Trust, comparing the third and fourth quarters of 2011-12 with those in 2012-13. He found that there are 10% more ambulance arrivals every day. We actually have sicker patients, with more arriving by ambulance. There has been a 13% increase in admissions of people staying longer than 72 hours, and fewer are staying for shorter periods. There are 25% more triages into the hospital’s resuscitation area, and there has been a significant increase in risk and co-morbidity among patients and increased admissions into critical care. There is something going on there.

We know that the rising demand for A and E is particularly concentrated in those aged over 85, and cuts in social care budgets are now widely acknowledged as contributing factors. My local authority of Salford must make £24 million of cuts this year. It is the third year of cuts, and now the authority, having held on to services meeting a moderate level of eligibility, is moving to meeting only substantial levels of eligibility, taking £3.5 million out of adult social care this year and £3.5 million next year. Our former Salford primary care trust had already cut the two walk-in centres that we had, and axed the pilot of active case management for people with long-term conditions.

How is that affecting people? What do carers say? Carers UK has carried out a survey of 3,500 carers, 55% of whom are caring for a person who has been admitted to emergency hospital services in the past three years. A significant percentage of those carers referred to areas where additional support could have prevented those emergency admissions. What types of care were needed? Six per cent. said that they, the carer, needed replacement care because they were ill themselves; 21% per cent. needed a higher quality of care and support for the cared-for person; 10% needed adaptations in the home, and 7% would have been helped by telecare and telehealth. Those findings tie in with some of my casework in recent weeks, when I have heard some very similar cases.

The King’s Fund report tells us that the prospects for adult social care are bleak. Councils are planning to reduce their budgets by another £800 million a year. That is a cumulative cut since 2010 of 20% in adult social care. My local hospital tells me that patients are coming in sicker, they are admitted for longer stays, they require more time and attention and they are now heavy resource-users. It is time that Ministers stopped making excuses and started dealing with this crisis.

[Madam Deputy Speaker (Dawn Primarolo)]

I call Andy Slaughter. You have one minute.