A and E Waiting Times

Heidi Alexander Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Heidi Alexander (Lewisham East) (Lab)]

I congratulate my right hon. Friend the Member for Cynon Valley (Ann Clwyd) on securing this debate.

What struck me when listening to the contributions from all parties represented in Westminster Hall this morning is the consensus that exists about the fact that we need to hear from the Government their vision for accident and emergency services. I agree entirely with the comments of the hon. Member for Cheltenham (Martin Horwood) and my hon. Friend the Member for Stretford and Urmston (Kate Green) when they say that we need clarity about how that vision is developing.

There is a fundamental tension between the centralisation of specialisms in accident and emergency services, and the desire of local people to be treated close to home. In London, there are fantastic A and E facilities in some of our central London hospitals, such as Guys and St Thomas’s hospital over the river, and yet—as hon. Members know—we equally find that hospitals in some of the outer parts of London are, frankly, either being sold off or seeing their services hugely downgraded, such as the downgrading that we are experiencing at Lewisham hospital at the moment.

Before I make some specific remarks about the situation in south-east London and some of the things that I have learned and been thinking about since we have been dealing with the issue at Lewisham hospital, I will quickly pick up on one of the other remarks made by my hon. Friend the Member for Stretford and Urmston. She talked about the problems she had experienced in extracting clear and concise information from the Department of Health about waiting times in Manchester hospitals. I, too, have asked several questions recently, not about waiting times but about the provision of health services at hospitals in London. I have simply been told that the Department does not hold that sort of information and it has been recommended that I make freedom of information requests. That is all well and good, but the public want to be reassured that Ministers at the heart of Government understand what is happening in hospitals out there and that they have an appreciation of the wider picture so that they can develop their vision of hospital services, whether they are A and E services or maternity services, but I am not sure that we feel reassured when we get such parliamentary answers that that is the case.

I will make two specific points about Lewisham hospital. Hon. Members will know that, in January, the Secretary of State for Health announced that Lewisham hospital would have a smaller A and E department, and that it would lose its maternity services. That was as a result of the trust special administration process that took place in the South London Healthcare NHS Trust, which was in huge financial difficulties. The hospitals in Woolwich, Bromley and Sidcup had a very significant operating deficit, and as a result of that we were told that the hospital down the road in Lewisham would have its services decimated. The full A and E department at Lewisham hospital will close; all blue-light ambulances will go past Lewisham hospital to other hospitals; all medical emergencies will not be able to be treated at Lewisham hospital; and yet the Secretary of State still calls it a “smaller” A and E department.

We might think that, on the basis of taking capacity out of the system at Lewisham hospital and—I should say—having to invest £37 million in other hospitals to deal with the displacement of people from Lewisham’s A and E department, everything is operating smoothly and well in south-east London. That is not the case. One in 10 people is waiting longer than four hours at hospitals that used to be part of the South London Healthcare NHS Trust, and now in Lewisham, one in 10 people is waiting longer than four hours to be treated. That was not the case in Lewisham a year ago; in March 2012, 97% of people were being treated at Lewisham hospital within four hours. So there is huge pressure upon A and E departments in south-east London.

Yesterday, I asked Lewisham hospital for information about the number of times that ambulances had been diverted to it from other hospitals. Lewisham hospital told me that, since December 2012—in the last four months—there have been 25 separate occasions when ambulances have been diverted to Lewisham. On 10 of those occasions, ambulances were diverted from the Queen Elizabeth hospital in Woolwich, and on 11 other occasions ambulances were diverted from the Princess Royal university hospital in Bromley. Those are the very hospitals that are meant to be picking up the people who will no longer be able to go to Lewisham hospital when our full A and E department goes. I seek a guarantee from the Minister that no changes will be made at Lewisham hospital until these diverts from other hospitals have stopped, and that no changes will be made until we see that, at the other hospitals I have mentioned, they are dealing with patients within a four-hour window.

I should like to make two general points about some issues that have already been touched on. There is a fundamental problem with people’s understanding of where they should go for the best possible treatment. The Government have asked Sir Bruce Keogh to conduct a review of emergency care, which is much needed and timely. I would rather the Government waited for the outcome of that review before they took decisions about hospitals such as Lewisham.

At the moment, when people are ill, they have no idea where they should go. They are faced with a plethora of places. Should they go to their general practitioner, a walk-in centre, a minor injuries unit or an urgent care centre, or A and E? It is confusing for people. If there was better information about where people can get the most appropriate treatment, potentially people who do not need to be in A and E would not go there. I do not criticise people for going to A and E, because they know that they will get treatment there and will be dealt with—hopefully—quickly. We cannot expect them to understand all the intricacies of what is available elsewhere. That fundamental problem needs to be addressed.

The Government are making the situation worse in Lewisham, when they say that Lewisham will retain a smaller A and E. On the day that the Secretary of State made that announcement, I said to myself, “What is a smaller A and E? What will happen there?” I am not the only one who is concerned about this. On 21 February, the president of the College of Emergency Medicine, Mike Clancy, tweeted:

“We have raised questions about the lack of clarity”—

with regard to Lewisham hospital—

“and that what’s proposed doesn’t meet our definition of an”

emergency department. Even the CEM is saying that the Government are making this more confusing for people. The way that the whole process has been dealt with has been quite deceitful and potentially dangerous. Telling people that there is a smaller A and E when it will be nothing more than an urgent care centre has potentially serious implications.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I am sure that the hon. Lady is not suggesting the Secretary of State was in any way deceitful.

[Heidi Alexander]

I said that the whole process was deceitful and potentially dangerous. A legal challenge about Lewisham is under way. We have to await the outcome of that to see what the future holds for Lewisham. I stand by my remarks. The process was not really open from the outset.

My final point has already been mentioned. We need to work out exactly how we stop people going into A and E who do not need to be there. Yesterday, I was at my grandmother’s funeral. For a number of years, she had been very poorly and was a frequent attendee at her local hospital. Several times when she turned up there, she did not really need to be there. She was a poorly, lonely old lady. If we are to address the number of people who present at A and E when they do not need to be there, we must find proper ways of caring for people well and with dignity, especially towards the end of their lives, in the community. The problem at the moment is that we are trying to reduce the availability of A and Es in local areas when we do not have alternative care in place to stop people having to rely on A and E as the last resort.

I am grateful for the opportunity to speak in this debate. Again, I congratulate my right hon. Friend the Member for Cynon Valley on securing the debate. The availability of high-quality local health services matters to everyone. It will be interesting to hear what the Minister says about how she is going to address those important issues.

--- Later in debate ---

[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.

--- Later in debate ---

[Anna Soubry]

I know, and I do not understand why that is. I will absolutely make further inquiries, because it is nonsense that the hon. Lady did not get the data.

I will come on to address the points made by the hon. Member for Lewisham East (Heidi Alexander), but, on the data, it is important that we monitor such things. That is precisely why the Department of Health and Health Ministers are very much alert to what is happening in A and E. We share the concerns of hon. Members, which is why we have the Keogh review, why we are considering how to solve the problem and why we are looking at the underlying causes, which, in the short time available, I hope to address. I will ensure not only that the Ministers to whom the hon. Member for Stretford and Urmston has spoken read Hansard, but that a copy of this debate goes to NHS England, which I know also shares those concerns. NHS England also wants to hear about the experiences of hon. Members, and it is taking action to ensure that we are on top of this and, most importantly, that we do what we should do.

[Heidi Alexander]

Will the Minister give a commitment today that no changes will be made to Lewisham’s A and E until there are no ambulances being diverted to Lewisham hospital, and waiting time targets are met in the neighbouring hospitals?

[Anna Soubry]

I took that intervention in good faith, hoping that I might be able to assist. The hon. Lady is more than experienced and knows that I cannot give her any such assurance. She, too, talked about the provision of data in her speech. All I know is that 75% of the people who would ordinarily have gone to A and E in Lewisham will continue to go there, but she makes important points, all of which will be put in the right place.

I conclude by addressing the cause. Well, we do not know. There are various factors, but, as has been said, there is no easy answer and no silver bullet. We know that a seasonal downturn in performance in not unusual, but the dip in performance this year is deeper and longer than in previous years. One million more people—perhaps this is not understood by some hon. Members—are using A and E departments every year, and it is important that we understand why that is. We know that there are nearly 4 million more A and E attendances compared with 2004, when the previous Government carried out what I and others believe was a disastrous renegotiation of the GP contract, which has had a clear knock-on effect on access to out-of-hours services.