Accident and Emergency Waiting Times

David Lammy Excerpts

Wednesday 5th June 2013 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

This is an enormously complex issue and we must not look at A and E in isolation. We also have to be very careful about the way we use data. I recommend that all Members look at the King’s Fund blog on this to see how the way in which the codings were changed and the data recorded to include walk-in centres and minor injuries units between 2003-04 gives a different perspective to the debate.

Given that complexity, we need to look at the solutions, which need to come by ensuring that people can see the right professional at the right time in the right place. That is key to this. But as my right hon. Friend the Member for Charnwood (Mr Dorrell) said, we must also recognise that the key driver for demand in this is our ageing population. If we look at the impact within general practice, we see a 75% increase in the number of consultations during a 13-year period. This is not just within general practice. The patients who are arriving are much sicker and have much greater complexity, and that is the root of the problem. It is a cause for celebration that we are all living longer, but dealing with that needs detailed planning.

[Mr David Lammy (Tottenham) (Lab)]

I am grateful to the hon. Lady for giving way, given her expertise in these areas. Does she recognise the work of Sir George Alberti a few years ago and the establishment of emergency care collaboratives that were very engaged with social care and local councils, and that the further cuts expected in local authorities will make this worse for elderly communities throughout the country?

[Dr Wollaston]

The reality that we face is that there is a limited amount of public funding. We can spend that pot of public money only once, so we must spend it in the right place, and that often means that we need to spend more of it within social care. That is why I welcome the fact that some of the health budget has been shifted to social care, and that is very important. I also commend Torbay. My constituency covers Brixham and Paignton, and Torbay has been nationally and internationally recognised for its work on integrating health and social care. It is no coincidence that it does so well on A and E waiting times, and we should be looking at what it has achieved.

But how will we keep people out of our A and E centres? In the Health Committee, we heard evidence about the effect that paramedic crews have. If the paramedic crew in an ambulance are highly skilled, the person they treat is less likely to need to go to casualty in the first place because the expertise is there to keep them at home. There needs to be better access to records. We need to consider how we can improve IT so that the patient owns their record and every part of the system can safely access their drug and medical history—with their consent, of course.

--- Later in debate ---

[Mr Ben Bradshaw (Exeter) (Lab)]

I associate myself absolutely with the remarks made by the hon. Member for Totnes (Dr Wollaston) about tariff reform, but given the time constraints, I will restrict my remarks to one particular issue that is putting pressure on the A and E crisis. I am talking about access to GPs.

I want to share testimony that I have recently received from people in Exeter. The first comes from a young teacher:

“Again and again, whenever I want to see a doctor there are no appointments available for as long as a week away, in addition to appointments not being made available at accessible times. Being a teacher, I am unable to easily pop out for a doctor’s appointment.”

Another constituent wrote to me last month about the A and E crisis:

“I believe one of the main reasons for this is that it has become very difficult to see your own GP unless you are prepared to wait three weeks for an appointment. I have personal experience of this, as do many of my friends and colleagues, and this is making people with minor ailments attend A and E in order to be seen.”

You will remember, Madam Deputy Speaker, that when Labour was in government, we introduced a requirement on GPs to grant appointments to their patients within 48 hours. We also introduced incentives in the GP contract for GPs to open at weekends and in the evenings, and we established GP walk-in centres in every primary care trust in England—in some areas, we established more than that. It worked. By the end of our Government, complaints from the public about GP access had declined significantly, as had pressure on A and Es that resulted from people not being able to see a GP.

By May 2010 more than 75% of GP practices in England were opening in the evenings and at weekends. Under this Government, however, 500 of those practices have reduced their opening times again. By May 2010, there were walk-in centres in every area offering quick, easy access to a GP, seven days a week and 12 hours a day. Since 2011, 25% of those centres have closed, and scrapping the requirement for GPs to offer an appointment within 48 hours has led to a return of the bad old days of people waiting days or weeks to see a GP, and therefore going to A and E instead.

[Mr Lammy]

Will my right hon. Friend give way?

[Mr Bradshaw]

I regret I will not do so because I have so little time.

When I wrote to the Health Secretary with the cases from Exeter that I referred to earlier, his colleague, Earl Howe, replied:

“It is our view that 48-hour access did not focus on outcomes, and specifying a particular model to deliver better services for patients misses the point about local needs, local services and local accountability.”

That, I am afraid, is gobbledegook. My hard-working constituents, who pay for the NHS, want to be able to see a GP when they need to and at a time convenient for them. Earl Howe’s letter went on to say that as this was a local issue, I should raise my concerns with the clinical commissioning group, which I promptly did. It replied stating:

“As this relates to GP services, the letter should be sent to NHS England.”

I await its response with interest.

Will the Minister help the House by making clear in her response who is responsible for ensuring that the public can see a GP quickly and conveniently? I was encouraged to hear the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) tell the “World at One” yesterday that he wanted to improved GP access, including opening times, in response to the A and E crisis. Hallelujah! May I suggest, however, that he and he colleagues start by stopping the closure of walk-in centres, and reintroduce Labour’s requirements and incentives for GPs to give appointments within 48 hours and to open their surgeries at weekends and in the evenings? Without such measures, I am afraid that current pressures on A and Es will simply get worse.

--- Later in debate ---

[Ann Clwyd (Cynon Valley) (Lab)]

As colleagues will know, over the past few months I have read from the direct experiences of the 2,500 people who have written to me about their treatment in the health service. This time, I am going to speak about my husband, who died in October last year. That is because I have had the 117-page report from the hospital, which I asked a GP friend to have a look at because a lot of it is gobbledegook to any ordinary person.

My husband died from hospital-acquired pneumonia. One of the concerns that I have talked about is upheld by University Hospital of Wales in Cardiff. The report says:

“A delay in review by medical staff did occur in AU. Mr Y”—

it is anonymised, ridiculously—

“remained in EU for 6 hours longer than the target timescale of 4 hours. Mr Y then remained in EU for approximately 21 hours, significantly longer than the target time of 8 hours for this type of area.

Mr Y should not have been nursed in the EU/AU for the length of time he remained there. The length of time Mr Y spent in EU and AU fell significantly below the standard expected, and this is unacceptable.

The distress this poor experience caused is acknowledged and the Health Board apologises that the standard experienced by Mr and Mrs Y was below that expected.

This concern is upheld.”

There are many other things I would have liked to talk about, but there is not enough time. I asked my GP friend to look at the hospital’s record, and she said:

“I don’t think that the notes you were given are supposed to be a complete record that Owen was properly investigated or treated.”

She goes on to say:

“Of course Owen spent too long in Casualty. The analogy with a ‘battery hen’ is apt: cooped up on a too small trolley for 27 hours, pressed against the bars…no record of adequate food or water and unclothed.”

She goes on to ask:

“Why ever not? In 27 hours Owen is recorded as drinking 150 ml and eating one ice-cream—and he was dehydrated when he came in.”

There was apparently a “Do not resuscitate” notice. She goes on:

“The DNR notice and records are lamentable, and reinforce my impression that because Owen’s care plan on 11 October could not be fulfilled, there was no other clear care plan in place for him…But I am not surprised you did not fully comprehend what they were not going to do. The enquiry papers state UHW does not follow the Liverpool Care Pathway; this is a pity as they wrote Owen up for the LCP recommended medication after antibiotics were stopped yet failed to attend to the spiritual needs of the patient in this critical juncture.”

[Mr Lammy]

Will my right hon. Friend give way?

[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—”