A and E Waiting Times

Grahame Morris Excerpts

Tuesday 23rd April 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my right hon. Friend the Member for Cynon Valley (Ann Clwyd) on securing this debate and compliment hon. Members who have spoken so far, highlighting concerns about the increase in A and E waiting times that are affecting their constituents.

I shall make specific references to my area and to the increase in A and E waiting times. I shall also spend a few moments reflecting on why we are in this situation and will mention the Health questions debate, during which I was bitterly disappointed by responses from the Health Secretary and Ministers to questions from hon. Members regarding increases in A and E waiting times.

An impartial observer might think the coalition Government had inherited a health service on the brink of collapse. The truth is that the Government inherited an NHS that had been transformed from what the previous Labour Government inherited after 18 years of Conservative Government and under-investment. My area was one of many, perhaps including Kettering, that were beneficiaries of considerable investment. There were 100 new hospitals; actual spend on the NHS increased from £30 billion to more than £100 billion; and much of the aged NHS infrastructure was replaced. My area and many others saw the construction of new walk-in centres, primary care centres and a new generation of modern community hospitals. GP opening hours were also extended. We have had the benefit of more doctors and nurses than ever before. We also had NHS Direct.

My contention is that Labour not only fixed the roof when the sun was shining, but laid the foundations and built the new hospitals, ensuring that patients received faster and better treatment closer to their communities. That was reflected in public satisfaction with the NHS, which went from the lowest ever recorded levels in the 1990s under the previous Conservative Administration, to the highest ever recorded levels by the time Labour left office. However, since the coalition Government took office, we have seen the biggest fall in public satisfaction with the NHS, as spending cuts have started to bite. [Interruption.] The Minister is saying no and shaking her head.

[Anna Soubry]

I am not. I am saying, “What?”

[Grahame M. Morris]

The Government have given back to the Treasury some £3 billion over two years. The Government have expended unnecessarily in excess of £2 billion or £3 billion on a top-down reorganisation. Factor in the £20 billion in cuts or efficiencies—however people choose to describe them—and this is a difficult time for the NHS.

[Anna Soubry]

Efficiencies.

[Grahame M. Morris]

Someone’s efficiency is someone else’s cut.

[Anna Soubry]

Will the hon. Gentleman not accept that the efficiencies that he speaks about were agreed between the then Opposition and the then Government—his Government—as savings within the NHS of some £20 billion? Does he also accept that his party, in its last manifesto and in comments by Ministers, stated that it would cut the amount of money going into the NHS? That is something this Government have not done.

[Grahame M. Morris]

I think that the Government are cutting the money that is spent on the NHS, not least with the costs of the reorganisation, which I have already mentioned. That money need not have been spent. We are giving back several billion pounds—some £2.5 billion to £3 billion to the Treasury—which could be spent addressing issues such as this. There are a couple of practical points that I want to raise with the Minister later, but I give way to the hon. Member for Cheltenham (Martin Horwood).

[Martin Horwood]

I agree with the hon. Gentleman about the reorganisation of the NHS. That time and effort would have been better spent trying to work out how to deliver health care more cost-effectively. But does not he rather undermine his case when pretending that there has been a cut to the NHS budget, when an objective analysis of the actual billions spent on the NHS clearly shows that it has gone up? The difference between a cut and an efficiency saving is that an efficiency saving is returned to the NHS budget.

[Grahame M. Morris]

I did not vote for the NHS reorganisation; I spent 40 sittings in Committee trying to resist what is now the Health and Social Care Act 2012 and the damaging changes it introduces. That includes those that are about to be implemented under section 75, on the introduction of competition, which will fragment the service and add to costs and complexities. I do not, therefore, accept the hon. Gentleman’s criticism, but I will press on because I want shortly to raise a couple of issues specifically about County Durham.

Part of our responsibility is to hold Ministers and, indeed, the Prime Minister to account. On waiting times—this was one of his five guarantees—he said:

“We will not lose control of waiting times—we will ensure they are kept low.”

Other Members have quoted the King’s Fund and patient surveys, and the figures clearly show that 32 foundation trust hospitals, out of 88 acute trusts in England with an A and E unit, missed the target in the last three months of 2012. I am not sure whether Kettering was one of them, but those figures should be cause for concern for everybody, including Ministers and the Prime Minister. That is double the number of trusts that missed the target in the same period last year, and four times the number that missed it in the previous quarter.

It is therefore clear that A and E waiting times are spiralling out of control. There have been various surveys, including one conducted by the Care Quality Commission, which found that one in three people spent more than four hours waiting for treatment. It also noted a large rise in the number of patients waiting for 30 minutes or more before seeing a doctor or a nurse.

In my area, The Northern Echo is campaigning on this issue, highlighting the alarming rise in the number of patients in the north-east waiting more than four hours for treatment. That number has almost trebled in the past 12 months. The paper has disaggregated figures from the Department of Health and found that more than 1,000 patients have waited longer than the target time, including 536 in County Durham and Darlington. Compared with 12 months ago, the number of patients waiting more than four hours has increased by 200% in County Durham and Darlington. South Tees and York have also seen increases in excess of 200%, compared with the previous year. However, at the Newcastle foundation trusts, the percentage increase is a staggering 630%. Alarm bells should be ringing for Ministers, because those figures are quite dreadful.

I was concerned by the Secretary of State’s responses at Question Time. One disturbing characteristic of this Government is that they are not taking responsibility or coming forward with proposals to address these issues. Specifically, in response to a question from my hon. Friend the Member for Manchester Central (Lucy Powell), the Health Secretary said:

“We are looking at the root causes of the fact that admissions to A and E are going up so fast”

—I think he quoted a figure of an additional million. The factors he blamed were that

“there is such poor primary care provision…changes to the GP contract led to a big decline in the availability of out-of-hour services…and…health and social care services are so badly joined up.”

He added:

“That is how we are going to tackle this issue”.—[Official Report, 16 April 2013; Vol. 561, c. 168.]

That really is not good enough. Indeed, Dr Laurence Buckman, who is chair of the British Medical Association’s General Practitioners Committee, has been quite dismissive and scathing about the Health Secretary’s decision to blame the increase in A and E numbers on the changes to GP contracts. He said it was “impressively superficial”—[Interruption.] Well, that is what the man said, Minister. He said that the decision was not based on any evidence. He went on to say:

“Most GPs were not providing personal access out of hours anyway; it was provided through a variety of out-of-hours routes and that has been the case for the past 30 years, so it would be nonsense to suggest that because GPs haven’t been personally responsible since 2004, therefore casualty is full of people. That is just such fatuous nonsense. I question the wisdom of the people briefing the Secretary of State.”

I tend to agree with him.

There is no magic bullet. With a complex organisation such as the NHS, we need a broad-spectrum antibiotic; we need to apply a number of measures. The fragmentation of the service is certainly contributing to the problem. There is also the issue of people not having access to their GP within 48 hours. Like many Members, I have, unfortunately, had experience of close family members and constituents being left with little alternative but to go to A and E, when the GP could have addressed the issue, had they been available in a reasonable period. This issue therefore requires a team effort.

I am also concerned about what the RCN is saying about the reduction in the number of community and district-based nurses, and I hope the Minister will refer to that. Information provided through freedom of information requests shows that the number of nurses in communities who are part of the rapid emergency assessment and co-ordination teams and the rapid response teams that help to keep elderly people, in particular, out of hospital, has been dramatically reduced.

[Heidi Alexander]

Does my hon. Friend agree not only that there are fewer community nurses, but that those who still remain have much enhanced work loads, which means the time spent with each individual patient is reduced? That, too, causes problems with the quality of care provided in the community.

[Grahame M. Morris]

That is certainly a factor, and I thank my hon. Friend for raising that issue. Part of the solution is a more visionary approach and a care model that integrates NHS services with social care in a seamless service. We need to end the fragmentation and to have full co-operation. We do not want people—particularly elderly patients—to be discharged from hospital, only for their cases not to be followed up by social care or primary health care services. That is a key challenge facing the Government. I will leave it at that.