Accident and Emergency

Grahame Morris Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andy Burnham]

That is a question for the Secretary of State. How can it make sense to close so many A and E departments in the middle of an A and E crisis? This year, the facts on the ground have changed. As I have said, it has been the worst year for a decade. Any proposal to change A and E in areas such as that of my hon. Friend needs to be considered in the light of that new evidence. We need to consider whether it is safe to proceed. As the A and E sister said, it is crisis management. That is the view from the real world. In here, it is a different story. It is, “Crisis, what crisis?”

My purpose in holding this debate is to cut through the spin. I want to bring into our debate today the voices of those A and E nurses, occupational therapists, paramedics, community nurses, and NHS 111 staff and mental health professionals who came to our summit. For instance, there is the paramedic who told us of his worries about ambulance response times getting longer because ambulances are trapped at A and E; and of the time when a patient who was held a long time at the door of a busy A and E suffered a heart attack and had to be rushed back to the ambulance. Another paramedic told us about being at the scene of a serious incident in a city centre. After calling for back-up, he was joined by a private ambulance which did not appear to have adequately trained staff to take patients to hospital. A community nurse spoke of her frustration at spending an hour and a half on the phone trying to get a GP appointment for a frail patient. An A and E-based occupational therapist said that she was now regularly diagnosing dementia for the first time in older patients who had ended up in A and E. Surely we can do better than that.

[Grahame M. Morris (Easington) (Lab)]

My right hon. Friend is giving an excellent argument as to why we are in this crisis. Is it not completely predictable given the response that we have just had on the local government grant settlement? Increased pressures on the system will be felt by old people and in deprived areas.

[Andy Burnham]

I agree. The Government have made grave mistakes. I warned them—they misquote me every week—that it would be irresponsible to give increases to the NHS, which is what they were promising, if they had to ransack local government, particularly social care budgets, to pay for them. That is a false economy. It means that older people have support withdrawn from the home, and they drift towards A and E in ever greater numbers. That is what is happening today on this Secretary of State’s watch.

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[Mr Hunt]

My hon. Friend is absolutely right. Huge progress is being made on the ground to deal with the challenges, and under a lot of pressure, and that is why we need to use language responsibly, rather than using the kind of hyperbole we have heard this afternoon.

[Grahame M. Morris]

If the Government are doing so well in relation to targets, why have they downgraded the four-hour waiting target from 98% to 95%?

[Mr Hunt]

I will tell the hon. Gentleman why. It was done on clinical advice, for the good reason that there are some patients whom it is better to see, even if it takes longer than four hours, so that they can be discharged and sent home, rather than admitting them to the hospital, which is what was happening under the 98% target. Labour agrees with that, because it is following the same procedure in Wales.

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[Lisa Nandy]

I will not give way to the Minister because I presume he will be winding up the debate and I hope he will spend the rest of his time listening to Members rather than trying to explain away such an appalling record.

I cannot understand why, despite all the pressures already being put on my A and E by this Government and despite its still being consistently one of the highest performing A and Es across the north-west, we are being disrupted by the Healthier Together programme, which has caused so much anxiety in Wigan.

[Grahame M. Morris]

Will my hon. Friend give way?

[Lisa Nandy]

I will give way very briefly to my hon. Friend.

[Grahame M. Morris]

I want to reinforce that point in relation to Durham county council. I have just been advised that Library figures show that it is facing cuts of £222 million between 2011 and 2017. That must have a huge impact on social care and a consequential impact of increased demand in A and E.

[Lisa Nandy]

My hon. Friend is absolutely right, as always.

The Healthier Together programme has, at this time, caused huge anxiety across Wigan. In June, documents leaked to my local paper the Wigan Evening Post revealed plans to reclassify hospitals as red and green, with several hospitals downgraded, as my hon. Friend the Member for Stretford and Urmston knows only too well. That prompted real fears across Wigan that it would lose its well-regarded 24-hour A and E. The decision appeared to be based on population, not on the performance of hospitals. In September when I visited the Healthier Together offices in Manchester to explain my concerns with my hon. Friend the Member for Bolton West (Julie Hilling), I was surprised to see, at a time of funding pressures that are causing real pain, how expensive those offices were, situated in the middle of Manchester. Imagine my surprise, Madam Deputy Speaker, when Healthwatch Wigan found through a series of Freedom of Information Act requests that the total cost of the Healthier Together programme in Greater Manchester to date has been £3 million, with £1.3 million of that spent on third-party organisations. The NHS would not reveal who or what that money was spent on. To date, the programme could, in total, have paid for 90 new nurses, 20 A and E doctors or 9,000 bed days at Wigan infirmary. Instead, this hugely expensive programme has caused huge anxiety across my local area, and communication has been dire. I am not alone in thinking that that is a shocking waste of money.

Despite the chaos caused by this Government, our A and E works well: it is a consistently high performer. We are a big borough, with huge transport constraints. To ask people to travel to the nearest alternative hospital in Bolton just is not feasible. It is 15 miles away, which is at least half an hour by car. What the Minister may not know or understand is that many of my constituents do not have cars or the money to take several buses or use public transport. Our borough typically has large, tightly knit families. When someone’s granddad goes into A and E, not just them and their mum and dad but the entire family visit him, which will be impossible if this shambolic programme goes ahead.

The Secretary of State has caused real anxiety by acting unlawfully in respect of Lewisham A and E, announcing the single biggest closure programme the NHS has seen at a time of unprecedented pressure on A and E, and making changes in the Care Bill that will enable the closure of high-performing hospital services such as those in Wigan. Will the Minister give me a cast-iron guarantee that decisions will be made on clinical, not cost grounds, and will he reassure us that financial constraints do not come into this? Will he tell my constituents that the real-life situation of local people—transport, family networks, income and all the things that have a huge impact on people’s well-being—will be considered by this Government before any decision is taken that affects my constituents’ lives?

[Dr Phillip Lee (Bracknell) (Con)]

On 27 December 1999, I and two other junior doctors embarked on a ward round at Wexham Park hospital in Slough. We had 72 patients to see that day, and it took us 13 hours to get round to them all. I say that because it was 14 years ago, yet I am hearing that this is the A and E crisis to end all crises. Every year, doctors in the national health service are worried and concerned about the pressures that the winter will bring to bear, and I do not think that this year is any different from 1999.

I want to try to be a bit challenging today and, in view of the motion, perhaps a bit counter-intuitive. We have too many casualty departments in this country. We should look at the mortality statistics—the likelihood of survival. I would say to the hon. Member for Wigan (Lisa Nandy) that, if my grandfather went into hospital, I would want him to go into the one where he had the best chance of survival, not necessarily the one down the road. I do not know about her hospital, but a large number of hospitals in this country unfortunately do not deliver the best care or the best mortality statistics. We need to reflect on that without trying to score petty political points about a variety of different issues.

[Grahame M. Morris]

I want to query the hon. Gentleman’s point about this crisis not being anything unusual. The Government’s own Health and Social Care Information Centre has published figures showing that the number of visits to A and E departments in England has risen by 11% in four years to 21.5 million attendances, which is 60,000 a day. The numbers are clearly increasing, and our argument is that that is partially the consequence of the Government policy of cutting social services.

[Dr Lee]

There has actually been a 37% increase in emergency admissions over the past decade, while 65% of hospital admissions are of people over 65. Dementia is doubling as we speak, and 25% of the NHS budget will be spent on diabetes by 2025. I am sorry, but to try to suggest that the genesis of the challenge we face has been during the three years of this Government is simplistic. The most polite way to put it is that the hon. Gentleman is making a simplistic argument.

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[Kate Green (Stretford and Urmston) (Lab)]

I want to speak about the current situation in Trafford and some of the lessons that Ministers might want to learn from the transition we went through when the A and E department at Trafford general hospital was downgraded to an urgent care centre and closed overnight. Despite assurances that neighbouring accident and emergency services at Manchester royal infirmary and Wythenshawe hospital would be able to cope following that change, problems are already piling up. Those problems may not have been caused wholly—or perhaps at all—by the changes at Trafford, but the impact on Trafford patients is pretty dire and we must take account of that.

Those A and E departments were already exceptionally busy, with the one at Wythenshawe working well beyond capacity. It was built to accommodate 70,000 patients a year but was already dealing with more than 100,000, as my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) pointed out from the outset. We welcome the fact that the Department now appears to have unlocked a route to additional funding for capacity at Wythenshawe, but that funding, let alone the additional capacity, is not yet in place.

As the Minister will know, in the past couple of weeks Wythenshawe A and E has reached “black” status for waiting times, and privately there are indications that the quarter 3 target for waiting times at the hospital will not be met. There are also reports that waiting queues for ambulances are doubling outside Wythenshawe hospital, and pressures are mounting at Manchester royal infirmary. The other day a constituent told me that she had visited on the evening of Sunday 8 December with her diabetic daughter and there were not even enough seats for waiting patients. Some people were forced to wait outside.

Those pressures were predicted. Last year, Manchester royal infirmary and Wythenshawe hospital struggled to meet waiting time targets, and indeed failed to meet them on at least one occasion in 30 out of 35 weeks. The Secretary of State was clearly concerned about the pressures on those hospitals because one criterion he set down for the reconfiguration of services at Trafford was that neighbouring hospitals should consistently meet waiting times before the changes were made.

On the basis of performance in the two summer quarters, the NHS asserted that the criterion on waiting times at those hospitals had been met, despite warnings from many people—including me—that not measuring performance during the winter months would give a distorted picture of the capacity of those hospitals to cope. The Minister must recognise that that caused a great collapse of public confidence—they were not very confident about the proposals for the reconfiguration anyway—because it seemed that fudging was going on to present an impression that hospital services could cope, when it then turned out they could not. To use data that are clearly applied in a way that suits the outcome NHS managers want, rather than being in the best interests of patients, is a matter of great concern. Will the Minister say how we can have genuine and robust criteria for reconfigurations in which the public can have confidence? The total absence of clarity and the fudging over the decision at Trafford over the past few weeks has had an unfortunate effect.

When the Secretary of State announced the funding in September, neither Manchester royal infirmary nor Wythenshawe received extra money to deal with winter pressures. I was surprised because we knew by then that reconfiguration would create extra demand on those two A and E departments. I am anxious to hear from the Minister about the Department’s approach to ensuring adequate additional resource to support transition for such reconfigurations.

[Grahame M. Morris]

My hon. Friend makes an important point about demand in deprived areas. The Government’s health and social care information centre has identified that in each of the past five years at least twice the number of attendances have been from those living in the 10% most deprived areas, compared with those from the 10% least deprived areas. That should be reflected in the allocation of funding, but unfortunately such areas receive no additional money at all.

[Kate Green]

Two pressures could be highlighted. The first is the way that funding fails to take adequate account of deprivation. Secondly, there will inevitably be a hump at the time of transition, as new arrangements settle down and people adapt to the changing service configuration. When providing resources to Manchester royal infirmary or Wythenshawe, no account seems to have been taken of the effect of that transition and the likely need for additional resource to take those hospitals through that period. Indeed, in a private meeting with the Secretary of State, after the reconfiguration was announced, he confirmed that there would be no additional transitional funding. I could, however, look forward to additional funding to enable greater integration of services, although not until 2015-16. Furthermore, it would not be new funding, but funding that had been moved from the NHS to social care.

I am as strongly in support as anyone of seeing funding directed as much as possible to preventive care and care that can be provided at home in the community, but we cannot take services from hospitals before we put that care in place in the community. Such care is simply not adequate in Trafford today.

The other matter I want to raise was alluded to by the right hon. Member for Sutton and Cheam (Paul Burstow). There is utter confusion among patients about what services they should access and when. As soon as Trafford was downgraded to an urgent care centre, Trafford patients believed they could not go there. That was not the intention of NHS managers, but the impact was undoubtedly to drive more traffic to neighbouring A and E departments.