A&E Services

Helen Whately Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Reed]

I have been generous with time, so I must press on.

In 2013, the Government announced a call to action to improve general practice access and experience for patients. They set out six key indicators to rate the quality of access and experience for patients. One year later, every single indicator had shown a deterioration in performance. Fewer people described the overall experience of their surgery as good and fewer people were able to get an appointment. The Government must address that finding. Only by addressing the crisis in general practice in addition to social care can the Government begin to relieve the pressures on A&E departments.

When the Secretary of State and the Prime Minister discuss the NHS in this House, they like to use words such as “openness” and “transparency”. Sadly, their actions betray that sentiment on a routine basis. I refer again to Professor Keogh’s seminal letter to the Secretary of State two years ago in which he refers to the use and principle of transparency in the NHS as representing

“a turning point for our health service from which there is no return.”

Except that, for this Government, it seems that there is a return.

Currently, NHS England publishes the performance measures for each A&E in England every week. Those figures contain a wealth of information for each trust and it makes that data available to the public. The data show how each A&E department is performing across a range of measures, and it can be used to target specific interventions at trusts that are struggling. This reporting time period also means that issues can be identified quickly and resolved promptly. Rather than taking action to ensure that hospitals in England meet this target, the Government are seeking to hide the performance data. We will not be able to see how A&Es are performing each week; we will have to wait until the end of each month. By publishing a significant number of performance measures from across the NHS on the same day, the Government appear to have found an innovative way of burying bad news—publishing even worse news at the same time. Patients deserve better than that. Clearly, Ministers find it more palatable to be reminded of their failings just once a month, rather than at the end of each week. This move is designed to make the red box lighter and the scathing headlines kinder. Will people not conclude that the monthly publication of A&E data—unlike other monthly data sets—has nothing to do with patient care and everything to do with political and media management?

[Helen Whately (Faversham and Mid Kent) (Con)]

rose—

[Mr Reed]

I must make some progress.

The issues facing A&E departments, GP surgeries and social care services will not be solved by amending the date on which performance indicators are published. The public will be rightly sceptical about the motivations behind the reduced publication of data that illustrate both good and bad performance. It is a move designed to take the pressure off Ministers as they turn a blind eye to the pressures that they are inflicting on our health service.

The pressures that the Government have introduced into the health service have built up until the system can no longer cope. A&E is full to bursting and social care has been cut to the bone, which means that patients cannot be discharged, wards are getting fuller, there are delays for admission and more people are waiting longer for treatment. That is indisputable. In England, the target for seeing 95% of patients within four hours has been missed for 100 weeks in a row. Instead of easing the pressures in A&E, this Government have decided to make it harder for patients to see the effects of Government policy on the services that they use by restricting the performance data that are available. Under this Government, it is getting harder to see a GP, harder to be seen at A&E and harder to see how the NHS is performing.

Not only is the record of this Government shameful, but their cynicism and complacency are, too. Professional bodies and Opposition Members have long warned the Government that the path they have placed the NHS on is damaging the service, working against patients’ best interests and causing unprecedented professional concern. Having done that, the Government are now trying to evade scrutiny. Today, Ministers must explain why they are seeking to make NHS performance less transparent and to hide the damage caused by their policies from patients and the public, and how they intend to protect services and tackle hospital deficits this year.

--- Later in debate ---

[Dr Wollaston]

Indeed. I was going to comment further on the issue of the skill mix. This is about not only those higher skill professionals, but the mix within the NHS. I do not think that we should talk that down. We simply will not be able to manage unless we broaden the skill mix. Healthcare assistants, for example, make an extraordinary contribution to the NHS and social care. One of the reasons we lose so many of them is the lack of access to higher professional development; it is not just about a low-wage economy. This is about how we can create more pathways to becoming, for example, assistant practitioners and physician assistants, how we can use them and how we can bring in more pharmacists, who train for five years in their specialty, into what we do across the NHS?

[Helen Whately]

Picking up on my hon. Friend’s point about healthcare assistants, does she agree that improving the opportunities for healthcare assistants is a huge opportunity for the NHS at the moment?

[Dr Wollaston]

It is a huge opportunity and we must go further with that, because continuing professional development across the NHS workforce is part of addressing the burnout that the hon. Member for Central Ayrshire talked about. We must do more to address the rotas and see what is causing our staff to leave the NHS, because it is not just about pay or the allure of working in a sunnier climate—we cannot do much about that. It is also often about the work-life balance they face and how that compares with abroad. We have got into a vicious circle of increasingly having to rely on locums to fill those gaps, and that money could be far better spent addressing why the NHS is haemorrhaging so many skilled staff abroad and to outside professions.

When we talk in this House about the challenges facing primary care and A&E departments, we must be careful not to talk them down. We know that medical students find going into A&E attractive, so let us not cut off the supply any further by talking about it in terms of doom and gloom. There are things we can do to improve the working lives of people in A&E, so we should get on and do the job, and I think that this House should do so in a far more constructive frame of mind. It is time to put aside the difference we have had in the election. We have five years to go until the next election. Let us show an example to those following this debate outside by looking at this in entirely constructive terms.

I want to return to an issue the hon. Member for Central Ayrshire touched on: seven-day working. Just as we should not be trapped by targets, let us not be trapped by political dogma. Let us look at what the unintended consequences sometimes can be if we are driven by the mantra that it must be 8 till 8 and seven days a week in every situation. I used to practise in a rural community. If we create a system in which we make it deeply unattractive to work in small, rural practices and in which we divert resources from the key priorities of seven-day working—which should be to reduce avoidable mortality and unnecessary hospital admissions—and if we take our eyes off that as the key priority and drive towards having to achieve 8 till 8 in every location, we could find that we have a further recruitment shortfall, as has happened in my constituency. That can translate into real unintended harms, such as the closure of many beds at Brixham hospital because the GPs could no longer safely man the in-patient beds. We could find ourselves in a spiral of unintended consequences. Let us listen to those on the front line and to our patients and keep them first and foremost in our minds when we consider what we are doing in the NHS.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a good debate. I pay tribute to hon. Members who made their maiden speeches. I particularly congratulate my hon. Friends the Members for Dewsbury (Paula Sherriff) and for Salford and Eccles (Rebecca Long Bailey). Having been a student at the University of Salford, I had not realised until now that I followed in the footsteps of Marx and Engels by supping in The Crescent; you learn something new every day. The hon. Member for Dumfries and Galloway (Richard Arkless) also made his maiden speech. I congratulate them on their contributions. It is clear that all three will make their presence felt in the House of Commons in the coming years.

I thank the other Members who have contributed, particularly my hon. Friends the Members for Birmingham, Edgbaston (Ms Stuart), for Hartlepool (Mr Wright), for Hammersmith (Andy Slaughter) and for Ealing Central and Acton (Dr Huq), and the hon. Member for Central Ayrshire (Dr Whitford), who leads on health issues for the SNP. On the Government Benches, we heard from the hon. Members for Totnes (Dr Wollaston), for Sittingbourne and Sheppey (Gordon Henderson), for Lewes (Maria Caulfield), for Crawley (Henry Smith), for Braintree (James Cleverly), for Bath (Ben Howlett), and for Morley and Outwood (Andrea Jenkyns). Many Conservative Members stuck very closely to their party’s policy research unit paper, a copy of which I was conveniently sent earlier today. I congratulate them on being so loyal to their Whips Office.

It would be very remiss of me not to place on record my own tribute to the doctors, nurses, healthcare assistants and other dedicated NHS staff who provide such extraordinary and professional care. Many Members of this House who have been here for a number of years will know that I had a run of bad health about five years ago. As a result, I became far more familiar with my own local hospitals, Tameside general and Stepping Hill, than I had hoped to, even given my position as a constituency Member of Parliament and a shadow Health Minister. I have experienced the very best of NHS care. If I am honest, I also experienced some care that did not meet the standards that we perhaps expect of our NHS. I know, however, that we have a workforce who are completely dedicated and caring.

The House should be in absolutely no doubt, though, that those staff are under a great deal of pressure—sustained pressure that has been building over the past five years. The facts need to be laid out in the open, and Ministers need to be challenged on their fictions. They made all sorts of desperate promises to get them through an election campaign, and now they need to show where the money is going to come from to pay for those promises and to set out exactly how they are going to deliver them. Yet what have Ministers been doing since the general election? I do not disagree with Professor Sir Bruce Keogh’s decision to improve the publication of data for mental health and for cancer—that is welcome—but I do disagree with what this Government intend to do in relation to A&E data. Instead of dealing with the pressure facing the NHS in England, they have decided to stop publishing weekly data about those pressures.

[Helen Whately]

Will the hon. Gentleman acknowledge that the NHS leads the world in transparency, and that an excessive focus on one data point—the four-hour target for A&E—is detrimental overall to patients?

[Andrew Gwynne]

We should remember, of course, that the last Labour Government started that transparency with heart and stroke data.

I think we all know what is going on here. There can be no clearer sign of the Tories’ failure on the NHS than the fact that hospital accident and emergency departments have now missed their own four-hour target for 100 weeks in a row. This is a landmark failure, to which the Prime Minister promised he would not return. The reality is that this Government caused the crisis by making it harder to see a GP and by stripping back social care services.

Let us be under no illusions—[Interruption.] The Secretary of State can chunter, but social care cuts are NHS cuts. The Government made damaging mistakes that have seen the number of people going into hospital soar. The best thing that they could do is to admit it and explain what they are going to do to fix the problem. It is stunning that their only solution is to spin their mistakes and to make the NHS less transparent.

Let me briefly come on to nurse staffing problems. Only this week, we have seen yet another example of poor policy coming out of the Department of Health. If it insists, along with the Home Office, that migrants not earning £35,000 after six years must go home, that will cut a hole right through the middle of our NHS. The Royal College of Nursing estimates that 6,620 nurses will have to leave the country by 2020. Because of the Government’s failure to train adequate numbers of nurses in the UK, those nurses will have cost almost £40 million to recruit from overseas. People coming from other countries to work in the NHS make a huge contribution and our health service would not be able to cope without them, but this is now a mess entirely of Ministers’ own making.

The short-sighted cuts to nurse training in the early years of the last Parliament left NHS hospitals with no option but to recruit from overseas or hire expensive agency nurses. That is also one of the main reasons why many hospital trusts are now in deficit. It was an absolutely profound error and I hope that the Minister will acknowledge that. As ever with this Government, patients and taxpayers will pay the price for the Prime Minister’s mismanagement of the health services.

There have been further mistakes. On GP access, it stands to reason that if it is made harder to see a GP, people will be more likely to end up in hospital. As we have heard, the reasons for the crisis are many, but the lack of access to GP services appears to account for much of the problem. No amount of obfuscation and massaging of figures can hide the fact that this Government have made it harder to get a GP appointment. All Members will know of constituents who have had to phone their doctors only to be told that no appointments are available and that they should ring back the next day—which they do, only to experience the same problem again. That they end up in frustration in A&E should not come as any shock.

The Prime Minister has now repeated his 2010 promise to provide access to GPs seven days a week, but he cannot even provide access to them five days a week. When patients want up-to-date information on how their local hospital is performing, this Government plan to publish the data less frequently. I hope that the Government will now see sense, and I commend our motion to the House.