A& E Departments: Staffing

Chris Bryant Excerpts

Monday 23rd March 2020 Commons Chamber

[Chris Bryant (Rhondda) (Lab)]

I should be grateful if Members left quietly, if only because this debate is meant to be about the staffing of accident and emergency departments throughout the whole United Kingdom.

I guess that if general practice is the beating heart of the national health service, A&E departments are the keep-beating heart of the national health service. Everybody in the land has a particular emotional attachment to their local A&E department. Even if they hope that they will never need to go there, many of them will have, from their own family experiences, either a granny, a grampy, an uncle, an aunt or a child who has had to go to A&E and whose life will have been saved. For them, those will be such heightened moments of strong emotion that the local A&E will be vital and essential to them.

Sometimes, in valleys areas in south Wales and in other rural or semi-rural areas of the United Kingdom, A&E departments feel as if they are even more important, because people feel that they need to be close to home and the geography makes it difficult to get to the A&E in the critical hour to get the support, help and medical intervention that will save somebody’s life, so the attachment is felt deeply. There has been a big battle in my local area about the Royal Glamorgan Hospital’s A&E department. I am glad that the Cwm Taf Morgannwg health board has decided to put on hold any decision about the future of that A&E during the coronavirus crisis.

There have recently been significant advances in A&E, and we need to praise those who have made those advances. Major trauma centres, which the Government introduced in England—we are soon to have one in Cardiff—have made a dramatic difference in saving literally hundreds of additional lives every year. We should praise all those who have been involved in those decisions.

[Kevin Brennan (Cardiff West) (Lab)]

I congratulate my hon. Friend on securing this Adjournment debate on this very important subject. Does he agree that the staff in A&E departments and across our NHS really should have the protection at work that they deserve? Does he believe that when we look back at the current crisis, one issue that will really come to the fore will be the lack of protective equipment and the lack of testing that has been available up until this point, and I am afraid is still unavailable, for many of our NHS staff?

[Chris Bryant]

Two things are vital in this key moment when the NHS is fearing a tsunami coming down the road, if that is not a mixed metaphor. The first is personal protective equipment. My view is that, frankly, every single fashion brand in this country should be devoting every minute it has to trying to deliver enough PPE for all the doctors in our A&Es. Secondly, we should be straining every sinew to ensure that testing is available for every staff member in our health service, because apart from anything else, it will mean that they can get back to the frontline faster.

[Tom Tugendhat (Tonbridge and Malling) (Con)]

The hon. Member made a good point about PPE—does he welcome the fact that O’Reillys in Northern Ireland is turning its production to just that? A&E is not a static body or just a building. It is a collection of people who are giving their heart and soul to our community. Will he welcome with me the birth today of Grace Louise Elliott, born at home because her mother could not quite make it to the A&E in time, and yet the staff managed to get the A&E to her home?

[Chris Bryant]

That is a brilliant moment, and of course I celebrate it. When I was a vicar, I used to be there for quite a lot of births, giving blessings for babies in the special care baby unit. That is a vital part of the business, as it were, of accident and emergency departments.

[Jim Shannon (Strangford) (DUP)]

I am conscious that the A&E close to me at Ulster Hospital in Dundonald is one where there has been an increase in the number of violent attacks on staff. Does the hon. Gentleman agree that we must protect staff by not only providing them with protective gear but having CCTV and police available?

[Chris Bryant]

My heart wants to sink every time I hear of any assaults on emergency workers. That is why I brought forward a private Member’s Bill a few years ago, which I know the hon. Member supported, and I wish the prosecuting authorities used it more frequently. Any attack on our emergency workers is an attack on all of us, because they are there to save our lives and protect us in our most difficult moments.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

Does my hon. Friend agree that, as well as our emergency service workers, NHS staff urgently need guaranteed accommodation near their workplace and food supplies, and that the Government need to make those practical things available to them immediately, along with PPE?

[Chris Bryant]

One of the things I have been so angry about over the past few days is the panic buying going on, with people virtually elbowing one another out of the way to get the last remaining courgette or tin of tomatoes. When I see that, I think to myself, what will happen when the poor person coming off their long shift at A&E at 8 or 10 o’clock at night finds that there is literally nothing left in the shop to buy? The person who was so greedy, hoarding and selfish will then turn up at A&E in two weeks’ time and be treated by somebody who was unable to get enough food. My fundamental premise is that we can only get through all this together, because in the end we achieve far more by our common endeavour than we do by going it alone.

[Dr Julian Lewis (New Forest East) (Con)]

In the presence of an appropriate Minister, can we urge the point that food supplies ought to be made available at the place of work for key workers? When they come off their unduly long shifts, they should not be in the position of not being able to get any food to take home.

[Chris Bryant]

That is an extremely good point. I wonder whether Tesco, Sainsbury’s, Morrisons and all the other supermarkets—once they have managed to recruit more delivery staff—should think about making deliveries specifically to hospitals and other care points, so that there is specific provision for key workers. That could make a significant difference.

What is essential to running a good accident and emergency department is, first, good, strong leadership. That means consultants who are well trained, and not just relying on locums who are on a part-time contract. It requires really strong teamwork. There is just as much value in a calm receptionist or a meticulous cleaner as a well-trained doctor, consultant or a nurse. We need resources and training to make an A&E flourish. We need people with an extraordinary set of skills, including the ability to make swift and yet very important, time-critical decisions. We need a wide range of disciplines that feed into the whole of the rest of the hospital. Those people have to be able to deal with strong emotions, from rage and anger to grief, anguish, upset, fear and love, all mingled in a very difficult situation. Unfortunately, they have to be able to deal with the particularly strange combination of adrenaline and alcohol, which sometimes makes an accident and emergency department—especially on a Friday or Saturday night—a very difficult place to be.

The truth of the matter is that we have a great number of shortages in our A&Es across the country. In terms of consultants, we are somewhere between 1,200 and 1,500 consultants short across the whole of the UK. There is a particular shortage at my local hospital, the Royal Glamorgan, which is why it has had to rely substantially on locums for the last year. That is not a sustainable model for the future, which is why I am determined to make sure that the local health board campaigns to recruit more consultants for local hospitals. Other countries have a much higher number of A&E consultants per 1,000 people than we do in the UK. We are aiming to get to one for every 7,000 people, and in most other countries it is one to every 4,000. We still have not reached one to every 7,000, so that is a problem. I would urge any doctor who is thinking of training now, or any young person who is thinking of going into medicine, to please think about being an A&E doctor. You will see over the next few months that we love our A&E doctors almost more than anybody else in the whole of the NHS.

Beds are another real issue. We have one of the lowest numbers of critical care beds in Europe, fewer than Spain and France, half of those in Italy, and only a fifth of what they have per 1,000 head of population in Germany. That puts us, as we will discover over the next few days, in a really difficult position. Some areas of the country will face even bigger challenges than others. The most rural parts of the country, where there is an older population and where there are significant health problems—in particular, in the south-west and in the semi-rural areas of the south Wales valleys—will face a particular difficulty, because they already have 83% to 90% occupancy of all their intensive care unit beds, and that is before anybody else comes in through the door.

Lots of hospitals have done an amazing job over the past fortnight, trying to turn other wards into intensive care units that can be used specifically for coronavirus patients, and recruiting additional staff who have previously retired to come back into the service. Hospitals are doing a phenomenal job in all of that, but the truth is that across the whole of Wales we have only 153 intensive care unit beds, and 90% occupancy. That will pose a phenomenal difficulty for my constituency, where we have a large number of people with chronic obstructive pulmonary disease, a large number of people with diabetes and many with the conditions that make them the most vulnerable—and an ageing population at that. The whole nation will have to think very hard about how, in the long term, that situation is sustainable, even if we do manage to struggle through the next few months. In a sense, in our NHS at the moment, intensive care needs intensive care.

On coronavirus specifically, I praise every single doctor, nurse, cleaner, decorator and builder who has been involved in the process of reshaping intensive care units and emergency departments. The turnaround has been remarkable. Sometimes they have had to devote hours to training to use PPE, and then they have discovered that the equipment is not easy to use, and they have used all the equipment that they had on training in how to put it on and take it off. They have been working at pace, and undoubtedly they have been working many, many more hours than they are contracted to do, and I think we would all want to say thank you to them for that.

I also want to praise all the staff who work in accident and emergency departments, because I know from talking to doctors over the past few days that they know they will have to make some very, very difficult and horrible decisions—decisions that none of us in this House would ever want to make. They know already—they have protocols that were put in place in 2009 when we were looking at the H1N1 strand—that they will have to make decisions about who they can provide ventilator beds for and who they cannot provide ventilators beds for. That will obviously be horrible for the families and the individuals concerned, but just think of the emotional stress and strain for each of the doctors and nurses who at some point over the next few months are going to have to say, on occasion, “I’m sorry, there is no bed for you, because you are not a priority.” That will hurt because that is not what anybody was ever trained to do when they became a doctor or a nurse. The trauma—the emotional trauma—of that for many people will be phenomenally difficult.

My heart is just full of praise for all those doctors, all those nurses, all the cleaners and all the other parts of the A&E teams. Madam Deputy Speaker, I know you know that I do not like clapping in the Chamber, and I am sure you do not like it either, but I think there are very exceptional moments when this House would like to thank people who do a phenomenal job on behalf of all of us, so if you could close your ears for a moment, I am going to applaud the A&E staff up and down the land. [Applause.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Just for clarification, clapping is not the norm in this Chamber. The reason why it is banned is that if it became the norm and was done many times every day, it would be meaningless once we were in an exceptional situation. This is an exceptional situation, and the hon. Gentleman is right—the whole Chamber and, indeed, our whole Parliament is right—to pay tribute, in a way that will be noticed, to the many people who work in our wonderful health service.

--- Later in debate ---

[Helen Whately]

One of the fantastic things we have seen over the last few days is the number of offers to help from all parts of society and the economy. There are some specific contact details for ways in which people can help, and I will be happy to share them with my right hon. Friend after the debate.

[Chris Bryant]

Many local authorities say they have no masks, no aprons and no gloves, let alone the training in how to remove them. I am reliably informed by A&E doctors that with some of the material the danger of infection comes when one is taking it off. Are the Government working with all the other Governments in the UK to make sure that there is enough PPE for all our local authorities as well?

[Helen Whately]

A huge amount of work on PPE is going on. PPE has been distributed to GPs, community pharmacists and dentists, and it is being distributed at the moment to all care providers across England. There is also work going on to make sure we know the other needs for PPE in the system—for example, in local authorities—to make sure that supplies get to where they are needed. We are also doing our best to make sure that there is clear guidance on when people need to use PPE. Sometimes people think they need it all the time, for everything, but that is not the case. We need to make sure it is used when it is needed—for example, during close-contact clinical care of people who have coronavirus symptoms. I must move on now; otherwise, I will spend all my time talking about PPE and there is more to discuss.

I know that testing is very much on people’s minds. We in the UK have tested more people than almost any other major economy outside China, South Korea and Italy. We have been increasing testing by the day. This week, we hope to reach 10,000 tests a day, and within four weeks Public Health England and the NHS expect to be conducting up to 25,000 tests a day. After that, the number will continue to increase up to 250,000 tests a day and more. With more testing capacity, we will be able to test more patients and, critically, NHS and social care staff.

[Chris Bryant]

The former Health Secretary, who is now Chair of the Health and Social Care Committee, said earlier today that the claim 10,000 tests a day are being done now is a myth and that the number is 5,500 a day, where it is stubbornly stuck. Does the Minister disagree with him?

[Helen Whately]

That is not the data I have received. I have set out the trajectory on the testing, on the basis of the information I have. As I say, our commitment is to keep on ramping up testing, because we know it is an important part of our response.