NHS

Jeremy Browne Excerpts

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham]

I have given way to the hon. Lady once: I want to make some progress.

Some, but not all, of the needs of older people are met in an acute hospital environment, which explains why their condition often drops like a stone. It is a phenomenon that was accurately identified by Robert Francis QC in his report, published a year ago this week. He called for an overhaul of the way in which older people are cared for in acute hospitals. He was right to do so, and while I applaud some of the steps the Secretary of State has taken in that regard, such as the move towards a named consultant, I do not believe it will tackle the root cause of the problem, which is the arrival of far too many older people in hospital in the first place. Only when that is tackled will we begin to address the underlying causes of the A and E crisis.

[Mr Jeremy Browne (Taunton Deane) (LD)]

I am grateful to the former Secretary of State for giving way, because I am concerned—especially as we are talking about not distorting the facts—by his initial analysis. He attributed part of the pressure on A and E to an outbreak of scurvy and rickets cases. I do not want anybody in my constituency or elsewhere to be unduly alarmed, so can he please put on the record what proportion of people reporting to A and E, including those who are not seen within four hours, are doing so because they have scurvy? He can give the numbers in absolute figures or percentages, but it is important that the House not be misled and that we are given the unvarnished truth.

[Andy Burnham]

The hon. Gentleman should climb off his high horse for a moment. In answer to an important point made by my hon. Friend the Member for Stretford and Urmston (Kate Green), I pointed to the increase in cases of scurvy, rickets and malnutrition. If he wants—[Interruption.] If he wants to deny that that is the case, that is up to him—[Interruption.] If he speaks to A and E staff, he will hear that people who are not eating properly are turning up in ever greater numbers—[Interruption.] I have answered his point and I will now make some progress.

It is the case that too many older people are arriving at hospital in the first place. A recent Care Quality Commission report found avoidable emergency admissions for pensioners topping 500,000 for the first time—[Interruption.]

--- Later in debate ---

[Andy Burnham]

I agree, and the last time we had a debate on this issue I quoted a well-known GP who said that she has taken to asking her patients whether they are eating properly, because many are presenting with unexplained symptoms that she cannot identify. People on several prescription medicines who are not eating properly are putting themselves at risk—

[Mr Browne]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way once more, but I hope the hon. Gentleman makes a legitimate and reasonable point.

[Mr Browne]

I am grateful to the right hon. Gentleman for giving way. I do not dispute that there are people who live on a small amount of money or that some of those who go to see doctors are not eating adequately. But he attributed the pressures on A and E in part—he raised the issue, not me—to an increase in the number of people who are reporting to A and E with scurvy and rickets. He made that point with all the authority of a former Secretary of State, so he should tell the House how much of the extra pressure on A and E is attributable to people who have scurvy or rickets. If he does not know, why did he raise the issue in the first place?

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

This debate has laid bare the stark reality of the Government’s blinkered approach to the NHS. They are utterly complacent, hopelessly out of touch, and in complete denial not only about the scale of the crisis in A and E, but about how their changes to competition rules are making things even worse. They have nothing to offer patients and our hard-working doctors and nurses who tirelessly serve the NHS every single day, except smoke and mirrors to try to disguise the real causes.

The Government have come to the House today celebrating “the strong performance”—it is in their amendment—of A and E. We have previously heard the Secretary of State insisting that the NHS is getting better. Almost 1 million patients have waited longer than four hours in the last year and Ministers are asking for a pat on the back. In the last 12 months, trolley waits are up; delayed discharges are up; 18-week waits are up; median and mean waiting times are up; emergency admissions are up; cancelled elective operations are up; cancelled urgent operations are up; and we have even seen patients being ferried to A and E in the back of police cars because no ambulances are available. It is not getting better, it is getting worse.

If Ministers will not listen to us, perhaps they will listen to the experts and those on the front line. Today, the Foundation Trust Network has said that

“pressure on the emergency care system is growing”.

Ministers like to forget about the confusion and disorder that they have inflicted upon the NHS through their £3 billion top-down reorganisation, but they should acknowledge it. My hon. Friend the Member for Walsall South (Valerie Vaz) referred to it in detail, and it is the same top-down reorganisation that the Prime Minister promised would never happen on his watch.

Let me remind the House of the warnings the Government were given at the time. In December, Dr Clifford Mann, president of the College of Emergency Medicine, revealed that he advised Ministers more than two years ago of a growing crisis in A and E. But his words were unheeded, leaving him and his colleagues feeling like

“John the Baptist crying in the wilderness.”

Dr Mann warned that the Health and Social Care Act 2012 would take up

“a lot of time and resources from the medical royal colleges and other organisations.”

He added that it

“tied us all up in knots”—

and created—

“a lot of decision-making paralysis and stasis in the system”.

While Dr Mann was warning of dangerously low staffing levels, spending on expensive locum doctors in A and E has rocketed by 60% in the past three years.

The issue here is that too few doctors are picking emergency medicine in the final stages of their training, and who could blame them? It might take six years to train a doctor, but it only takes a second for the Government’s A and E crisis to deter a junior doctor from going into emergency medicine.

The disruption the College of Emergency Medicine talks about is the disruption that the care Minister and his fellow Liberal Democrats allowed to happen when they nodded through the Health and Social Care Act, but we hear reports that his party is preparing to disown the NHS reorganisation and pretend it had nothing to do with them.

The right hon. Member for Sutton and Cheam (Paul Burstow) has admitted today that he got it wrong on competition. Why does the care Minister not own up and admit that he got this wrong, and that he should have listened to his own supporters and hundreds of thousands of people across the country who pleaded with him not to go through with it?

The human cost of that mistake is clear for all to see. We can see it in the sheer number of people coming through the doors of A and E. As my right hon. Friend the shadow Health Secretary pointed out at the beginning of this debate, attendances at A and E rose by 16,000 in the last three years of the Labour Government. In the first three years of this Government, they have rocketed by 633,000. Ministers may be pleased that the NHS is still standing after being subjected to this level of pressure, but the question they should ask is, why are so many more people coming to A and E in the first place?

[Mr Jeremy Browne]

The hon. Lady mentioned the figure of 633,000 extra people presenting to A and E. In his opening speech, the shadow Health Secretary attributed a proportion of that number to people who had scurvy or rickets, as he tried to paint a Dickensian picture of national squalor. Now that she has had a few hours to check, can she tell me how many of those 633,000 people were diagnosed in A and E with either scurvy or rickets?

[Luciana Berger]

The hon. Gentleman may not have been here when we had the response from the Health Secretary. I will come on to the very points the hon. Gentleman raises in my speech, and I look forward to going through all the big issues we have with malnutrition in this country.

I echo the comments made by my right hon. Friend the shadow Secretary of State about the sneering we have heard from Government Members this afternoon regarding some very serious issues. Any case of scurvy in 21st-century Britain is shameful.

My hon. Friend the Member for Stretford and Urmston (Kate Green) talked about the catalogue of coincidences that have led to so many more people going to A and E in the first place. I refer back to the increase of 16,000 in the last three years of the Labour Government, and of 633,000 in the first three years of this Government. Why is that? A quarter of walk-in centres have closed. NHS Direct was abolished. The guarantee of a GP appointment in 48 hours was scrapped, and extended GP opening hours were cut. As my hon. Friends the Members for Easington (Grahame M. Morris) and for Worsley and Eccles South (Barbara Keeley) said, £1.8 billion has been hacked from social care budgets, with thousands of people losing their care packages.