Accident and Emergency Waiting Times

Helen Jones Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House is concerned about the growing pressure on Accident and Emergency (A&E) departments across the country over recent months; notes this week’s report from the King’s Fund which concludes that waiting times in A&E recently hit a nine-year high; further notes that in the Labour Government’s last year in office 98 per cent of patients were seen within four hours; believes that a combination of factors lies behind the extra pressure on hospitals but that severe cuts to social care budgets are one of the most significant causes; is further concerned that one in three hospitals in England say they do not have sufficient staffing levels to deal safely with demand on services; further notes that over 4,000 nursing posts have been lost from the NHS since May 2010 and that a recent survey by the Health Service Journal revealed that a further round of front-line clinical job losses are planned for the coming year; further believes that the Government has failed to show sufficient urgency in dealing with these problems; and calls on the Government to bring forward an urgent plan to ease pressure on hospitals by, amongst other things, re-allocating £1.2 billion of the 2012-13 Department of Health underspend to support social care in 2013-14 and 2014-15, and ensuring adequate staffing levels at every hospital in England.

Since the turn of the year, the Opposition have been warning the Government about building pressure in A and E departments, and yesterday there was confirmation of just how bad things have got. This year, waiting times in A and E hit a nine-year high, according to the King’s Fund. The pressure is not confined to A and E, however, and wherever we look we can see warning signs: hospitals operating with close to 100% bed occupancy, way beyond safe recommended levels; a treatment tent in a car park; long queues of ambulances outside A and E, double the number waiting longer than 30 minutes; a huge spike in the number of A and E diverts, where ambulances are turned away from units that cannot accept any more patients; reports of some hospitals issuing more black alerts in the past year than in the previous 10 years combined; more cancelled operations than for a decade; and a 30% increase in bed days lost to delayed discharges because care plans cannot be put in place, leaving older patients stranded on the ward and A and E unable to admit them.

The evidence is clear: this health and care system is showing serious signs of distress. In truth, A and E is the barometer of the system, and problems or blockages anywhere will soon show up in A and E as the pressure backs up. The situation requires decisive action and a comprehensive plan, both of which have been distinctly lacking in the Government’s response so far.

Today the Prime Minister complacently implied that the problems had been fixed, but for 34 of the 38 weeks this Secretary of State has been in post, major A and Es have missed the Government’s lowered A and E target. Today, six in 10 trusts are warning that next winter will be even worse. The Government’s response to date has been totally inadequate for the scale and urgency of the problems. First, they came to the House and denied there was a problem. On 15 January, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) stated that

“patients are being treated in a much more timely manner than under the previous Government.”—[Official Report, 15 January 2013; Vol. 556, c. 720.]

An inaccurate statement without any basis in fact.

As the pressure built, it was clear that that line would not hold, so the Secretary of State’s spin operation began. He said that the root cause of the pressure was the 2004 GP contract and changes to out-of-hours care. One must ask how the Secretary of State pushed that line with such confidence, given that a freedom of information request from his Department revealed that the first time he went to an A and E as Secretary of State was on 3 April—a full six months after he was appointed. Even then, it was the A and E within walking distance of this building. Did he just repeat back on camera what the first person he met said to him?

Throughout the early months of 2013 the NHS was going through the worst winter for a decade, yet the Secretary of State did not bother to visit any A and E department to see for himself the ambulance queues, the patients held on trolleys, or the staff stretched to breaking point. Just weeks before his first visit to A and E, he told us that hospitals were “coasting”. What an unbelievable statement. Would he have dared to say that if he had actually visited an A and E beforehand?

[Helen Jones (Warrington North) (Lab)]

Does my right hon. Friend agree that one of the pressures on A and E comes from this Government’s cuts to adult social care? We all know that if old people are not given care in their own homes they are more likely to end up in hospital, yet the Government have cut more than £2.6 billion from adult social care, and more than 230,000 people are now not getting help, compared with four years ago.

[Andy Burnham]

My hon. Friend is absolutely right. Two-thirds of NHS finance directors have identified social care and its collapse as the single biggest driver of the pressure on A and E. The Government do not like to talk about that because of the record my hon. Friend just outlined, and I will come to that later in my remarks.

The Secretary of State visited his first A and E in April, and NHS England requested action plans only on 9 May, when hospitals had already been battling with the problem for months. It is simply not good enough. The NHS needs leadership and he has not provided it; instead, he has stuck to the spin. He continued to blame the GP contract, even when experts queued up to tell him it was not the cause of the problem. The NHS Confederation, the Royal College of General Practitioners, the King’s Fund and the Foundation Trust Network all told him that the causes lay elsewhere, but he was not listening because it did not suit his argument. When the NHS needed a Secretary of State, it was left with a spin doctor-in-chief.

That brings us to the crux of this debate and the charge that I lay directly at the Secretary of State’s door. By persisting with spin and by diverting attention elsewhere, the real causes of this crisis have been left neglected.

--- Later in debate ---

[Helen Jones]

Even the women?

[Anna Soubry]

That sort of cheap comment does the hon. Lady no justice whatsoever or credit. Let me explain to her—I was here for the debate, and she was not—that I did not in any way blame women doctors. As someone who has worked as a woman professional all my life, I really do not want to hear any lessons from Opposition Members. What I did was echo the comments of the president of the Royal College of General Practitioners, and I paid tribute to all our GPs for their hard work and dedication to our NHS, and to their patients.

There are immense pressures on the NHS as a whole, and on A and E in particular. Our A and E departments are dealing with 1 million more people than they did when the previous Government were in power. The causes of that increase in demand are complex: a long, cold winter; an ageing population; and more people with long-term conditions. The system itself, let us be honest, has not helped, from poor integration between health and social care to the lack of public confidence in out-of-hours primary care services. We can have an argument about the 2004 GP contract, but as the hon. Member for Southport (John Pugh) rightly said, it has not helped. Today, we have a situation in which, if people do not know where to go, or they are not sure that they will get a good service, they go to A and E. In a recent hearing by the Select Committee on Health, Dr Patrick Cadigan, a registrar from the Royal College of Physicians, set out the position perfectly:

“Patients will go where the lights are on. In many of these alternatives, the lights are not on after five o’clock in the evening or at weekends.”

That presents a set of challenges that the Government are determined to address. First, it is important that we deal with the current situation, and we are.