Accident and Emergency Provision (North-East)

Dan Poulter Excerpts

Wednesday 13th February 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship, Mr Crausby. I congratulate the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) on securing the debate and I thank all hon. Members who have come to advocate their constituents’ needs. The hon. Gentleman and I met earlier this year to talk through some of the problems and challenges in his local area. We discussed some of the individual cases that he has highlighted today, which we all agree to be unacceptable, in particular the case of one of his constituents who experienced a completely unacceptable 11-hour delay as a result of problems with getting the high-quality care they deserved.

There are several interacting issues: the ambulance service, the local A and E response, and the services provided at local A and Es. One key theme, as the hon. Gentleman and I discussed when we met, and as his speech made apparent, is the need to fundamentally change and improve how the NHS looks after older people. That point was brought home vividly last week by the report on the Mid Staffordshire NHS Foundation Trust. In addition, at the end of last year the Dr Foster hospital guide found that 30% of older people in hospital should not be treated there, and that more community-based support was needed. When we met, the hon. Gentleman rightly stressed the important role that local, smaller health care providers, in Guisborough and East Cleveland and elsewhere, can play in providing better community-based care. When people do not need to be in A and E in the first place, it is better for them to be looked after in their homes and communities, and it also brings financial benefits to the NHS. For older people, being admitted to hospital when they do not need to be there is distressing, and their length of stay tends to be much longer.

The hon. Gentleman threw down this challenge: will the changes being made to the health care system nationally put us in a better place to deal with the long-term challenge? The answer to that is yes, and I will briefly deal with that point before I come on to the local challenges that he has outlined.

Why do we need to change what we are doing in the NHS? I have set out clearly that we must do better, by keeping people well in the community. Before I came to the debate, I was talking, over the river at St Thomas’ hospital, about how we must improve children’s health, better look after children with long-term conditions, ensure that children with asthma and diabetes who do not need to be in hospital are not there in the first place, and provide better community-based care. Such improvements are particularly important for the care of the elderly. From April, we will put 80% of the NHS budget into the community, with clinical leadership through doctors and nurses. That is a strong step in the right direction of focusing on community-based and preventive care. I believe that we should all regard that as a good way forward.

[Pat Glass]

My recent experience reflects what the Minister has said. Older people who stay in hospital for long periods of time come out able to do less for themselves because things are done for them in hospital. When my father came out of hospital after five weeks, he was able to do far less. Will the transfer of funding into the community prevent that from happening? Will it allow people like him to be supported at home so that they do not have to spend long periods of time in hospital and come home with less mobility?

[Dr Poulter]

The hon. Lady makes a good point. A prolonged period of bed rest can have a huge impact on an older person’s mobility and their ability to look after themselves. The challenge, as she rightly outlines, is to get more support in the community. Putting the budget in the community is a step towards the provision of more preventive care, more community-based care and more care that keeps people, particularly older people, better supported and looked after in their homes.

The other challenge is to achieve a more joined-up approach between secondary care in an acute hospital—such as James Cook hospital—and care in the community. There is sometimes too much silo working, and we need to break that down and develop a more joined-up approach to care. That might be done, for example, through intermediate care teams that operate out of a hospital, who will help through physiotherapy and occupational therapy. When an older person arrives in A and E, we need immediately to gear up the right support in the short and longer term to enable them to go home more quickly. That is an important part of a more integrated and joined-up approach to ensure that an older person can be effectively supported and looked after at home if that is right for them. It is important that we get that more integrated approach across the whole country.

On local issues, the hon. Gentleman highlighted two-hour handover delays, which are clearly completely unacceptable. In my experience, the fault for handover delays might lie in two areas. First, the triaging system in a hospital might need to be reviewed to ensure that ambulance handovers are dealt with more promptly and quickly. Secondly, a delay in ambulance handover results in ambulance crews and ambulances being pinned down in A and E when they need to be back out on the road elsewhere. I know that the hospital will want to look at that closely.

In relation to having more community-based care, sufficient community-based resources must be available to better support people with day-to-day health care needs in the community, so that they are not forced to pitch up at a hospital’s main A and E department. At our meeting, the hon. Gentleman and I discussed the fact that the opening hours of the urgent care centres at Guisborough and East Cleveland hospitals are now 9 am to 5 pm during the week and 8 am to 8 pm at weekends, which has made it difficult for local people to access local health care service and created pressure on A and E departments. Having spoken to the trust, I am pleased to report that job interviews will be held on, I believe, 25 February for specialist nurse and other posts at those hospitals, with a view to extending the opening hours again in the future.

[Pat Glass]

I make a special plea on that issue. Weardale, in my constituency, is in one of the remotest parts of the country, but 5,000 people live there. Their out-of-hours GP service is at Bishop Auckland hospital, which for some of them is 20 miles away across roads that are among the most remote in the country, and particularly difficult to use in winter. Will the Minister look at that?

[Dr Poulter]

Absolutely. Sir Bruce Keogh will be conducting a review of emergency and other urgent care services, in which A and E services will not be lumped into one category but will be considered in a more nuanced way, reflecting the fact that rural communities face particular challenges. The review will consider how out-of-hours care, urgent care and emergency care should be delivered in such areas to take into account the rural nature and the distances that people have to travel. In some cities, there is a lot of A and E provision, but in other, more rural parts of the country where people have to travel further that is not the case. I am pleased that Sir Bruce will take that into account in his review.

[Pat Glass]

Will that review also cover services such as ambulance services? There are real concerns in Weardale, where I am involved in a campaign, that lives will be put at risk if ambulance services are not improved.

[Dr Poulter]

It is absolutely right to say that any review of A and E provision, and urgent care provision, must take into account travelling distances and transfer times to hospitals and between hospitals. Those issues will be part of the discussion and the review, although they are not the major thrust of what Sir Bruce is doing. However, a number of hon. Members have arranged to meet my ministerial colleague Earl Howe, who is currently examining several issues related to ambulances, and I am sure that he would also be pleased to see the hon. Lady to talk through some of the local issues in more detail.

Increased pressure on hospital services is not necessarily unusual for this time of year, notwithstanding the fact that it is completely unacceptable for there to be long handover delays or for people not to receive prompt and high-quality treatment. There are winter pressures that occur every year, and the Government will always do all we can—the previous Government did what they could as well—to ensure that the NHS is robustly funded and supported to meet such fluctuations in demand.

The Department of Health conducts daily monitoring of the winter pressures for all acute hospital providers. I am aware that South Tees Hospitals NHS Foundation Trust has James Cook University hospital as its main acute site—of course, it is also the local hospital that most of the hon. Gentleman’s constituents will attend—and the trust, like other organisations, has experienced some additional pressures in recent months. However, under the trust’s own internal criteria, the pressures that it experienced during late December and early January were identified as level three on a scale of one to six, which demonstrates that the trust has been busy. It is important to highlight, however, that it has been coping with those additional pressures, notwithstanding the issues raised in the debate, including the need to upscale the community-based response to prevent patients who would be better looked after in the community from being in an acute hospital setting in the first place.

It is also important to say that we expect all NHS commissioners and providers to ensure that appropriate measures are in place to manage any increases in demand, particularly during the winter. The delays in patient care that have been outlined eloquently by hon. Members are simply unacceptable, be they in A and E departments or in ambulance journeys to hospital. Delays are of concern, and the local NHS trusts and their partners must ensure that they step up their local strategies to cope with unexpected increases in demand.

We always needs to be aware of such seasonal variations in the NHS. That is why the Department of Health has given more than £300 million to the NHS specifically to deal with winter pressures. However, it is for local NHS providers to recognise that that extra investment has been made and to co-ordinate their response with the community, particularly through highly skilled community intermediate care teams, which help to get older people back home from hospital as quickly as possible so that they can be better looked after in their own homes.

The other main concern expressed by the hon. Gentleman was about ambulance performance. Delaying ambulances outside A and E departments, as a result of a temporary mismatch between A and E and hospital capacity and the numbers of elective emergency patients arriving, is simply not acceptable. There is a need for the local ambulance trust and the local hospital to work more constructively together, to ensure that such delays do not happen. That might be about having better triage, or the local ambulance trust might need to put more resources into the front line in the local area.

I also take this opportunity to say that the Government have provided £330 million of additional funding specifically to help the NHS cope with the winter pressures this year, so that patients receive the treatment they deserve. I understand that South Tees Hospitals NHS Foundation Trust received more than £1 million from that additional funding, and Middlesbrough primary care trust has received a further £264,000. Investment in social care services will also benefit the broader health system, but that requires the local trust to ensure that it uses the money wisely to address the concerns raised in the debate.

In January, the hon. Gentleman and I had what I thought was a constructive meeting with the trust, and I hope that will be the foundation for him and other local MPs to engage constructively with the trust to encourage a quick solution to the problems that have been outlined. One good thing that came out of the meeting, as the hon. Gentleman already knows, is that there is now an active process going on for the recruitment of specialist nurses to the smaller hospitals—the community hospitals —in the local area. When those nurses are in place, that will be a big step forward; I hope those hospitals will be open for additional hours, which will help to take pressure off acute settings.

In response to growing demand, an overall increase in ambulance activity and longer stays in hospital owing to more complicated medical conditions, I understand that the trust has already taken some specific measures, with £650,000 of investment being put into extra nurses and consultants. To deal with times of acute winter pressure, a bed winter ward will also open. The trust is also now working actively with its partners to redesign patient services, along the lines of the rapid response teams and intermediate care teams that I described earlier, to prevent inappropriate hospital admissions in the first place. In addition, it is exploring the development of a separate paediatric A and E department to create extra space for patients.

I am sure that the hon. Gentleman would have hoped that some of those measures would have been in train earlier, but following our meeting, and after the trust has listened to this debate, I am sure it will be all the more determined to do what it can to put things right in the future. As he knows, through our engagement I am taking an active interest in these issues and I will welcome further discussions if there are more problems in the future, because the delays that have been described today are unacceptable.

[Tom Blenkinsop]

The Minister has been very constructive in previous meetings and the response that he has given today has been very constructive as well. On specialist care staff for Guisborough hospital and East Cleveland hospital, he knows from our meeting that the trust has advertised those positions four times already. Would he be willing to meet me again if the fifth attempt also proves unsuccessful?

[Dr Poulter]

I have already made the offer, and I do so again now, that I am very happy to meet again. The trust is now taking the issue very seriously and is putting in place robust measures to deal with the concerns raised during this debate and when the hon. Gentleman and I met the trust. I understand that there are 16 applicants for the posts, so a good number of people have applied. I am hopeful that after the interviews on 25 February there will be additional nursing capacity in those local health care settings, to ensure that the scope of the community health care response is improved. Also, I hope that the number of hours that the services are available will be increased, because as the hon. Gentleman knows community health care is about taking pressure off acute A and E services wherever possible, and ensuring that people who can be treated locally are treated locally. That is why those two hospitals—Guisborough hospital and East Cleveland hospital—are such important care settings.

I hope that we are now in a better position, after this debate and through the actions that the trust is already taking—following our meeting earlier in the year—to deal with some of the challenges. I again congratulate the hon. Gentleman on securing the debate, which has been constructive, and I know that he and I will be meeting again if the situation in his area does not improve.

Thank you, Mr Crausby, for chairing the debate.