Accident and Emergency Waiting Times Debate
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Jeremy Hunt
Main Page: Jeremy Hunt (Conservative - South West Surrey)Department Debates - View all Jeremy Hunt's debates with the Department of Health and Social Care
(10 years, 11 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
What we have heard today will rank as one of the poorest speeches ever given by an Opposition on the NHS. [Interruption.] I predict—[Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. [Interruption.] Mr Karl Turner, thank you for your advice, but we can manage without it today. I make this appeal to both sides: I want to hear what the Secretary of State has to say, just as I wanted to hear what the Opposition had to say.
Mr Hunt
Thank you, Mr Deputy Speaker.
I repeat: it was one of the poorest speeches ever given by an Opposition on the NHS, and I predict that the right hon. Member for Leigh (Andy Burnham) will bitterly regret choosing to make an issue of A and E pressures, because the root causes of the problem have Labour’s fingerprints all over them.
The right hon. Gentleman was right on one thing, however: there is complacency on this issue—not from the Government, who have been gripping it right from the start, but rather from Labour, which still does not understand why things went so badly wrong in the NHS on its watch.
Labour’s narrative has, I am afraid, a single political purpose at its heart: to undermine public confidence in one of our greatest institutions—an institution which, in challenging circumstances, is performing extremely well for the millions of vulnerable people who depend on it day in, day out.
Labour’s story today is a totally irresponsible misrepresentation of reality. One million more people are now going through A and Es every year than in 2010, which creates a lot of pressure, so how are A and E departments actually performing? The latest figures show performance, against the 95% target, of 96.7%. The week before it was 96.5%, then before that 96.3%, 96.6% and 95.6%. Yes, we had a difficult winter and a cold Easter, and I will come to the causes of the problems we had then, but, thanks to the hard work of NHS doctors and nurses, our A and E departments are performing extremely well.
Henry Smith (Crawley) (Con)
The Secretary of State is absolutely right to say that we should point to the record of the previous Government, who closed the A and E department in Crawley.
Angie Bray (Ealing Central and Acton) (Con)
My right hon. Friend should know that my constituents welcome his decision to refer to an independent review the plans to close the four A and Es closest to my constituency. Does he agree that the review will need to look carefully at whether due consideration was given to the impact of those four closures on the neighbouring hospitals and their A and E departments?
Mr Hunt
I will make some progress and then give way. I want to ask why the Opposition have chosen to call this debate. I am afraid it is nothing less than a smokescreen, because their objective is to try to dress up the pressures on A and E as a short-term crisis when, as every A and E department in the country will tell us, to deal with the pressures we need to address long-term structural problems that the previous Government either ignored or made worse.
Bill Esterson (Sefton Central) (Lab)
May we talk about one of the pressures on A and E, which is the pressure of social care? I hope that the Secretary of State will accept that significant cuts have been made in social care under this Government and that the role of social care is crucial in keeping people in their homes in the first place and in returning them to their homes after they have been in hospital. As a result of those cuts, it is very difficult for social care to perform that role. Will he examine the suggestion by my right hon. Friend the Member for Leigh (Andy Burnham) to use the underspend from the Department of Health to support social care to perform its essential role?
Mr Hunt
I will come to that suggestion, but I agree with the hon. Gentleman. If we are going to deal with bed blocking, which is one of the root causes of the problems that many A and E departments talk about, we have to have better integration between the health and social care systems—that is essential. I say to him that the problem of the underfunding of social care did not start in 2010; as my hon. Friend the Member for Stourbridge (Margot James) said, it is a problem that goes back many years, and the failure to integrate health and social care was a failure that happened over 13 long Labour years.
Mr Hunt
I am going to make some progress and then I will give way.
There is something else that the Labour party does not want the public to notice and it is another elephant in the room: the NHS is actually doing better under the coalition than it ever did under Labour. Let no one forget the NHS we had in 2010: no cancer drugs fund for the 26,000 people who now benefit from it; 400,000 fewer operations every year; double the number of MRSA infections; and 18 times more people waiting for more than a year for their operation.
Mr Hunt
I am going to make some progress. The right hon. Member for Leigh talked about grip. There is one place where grip is badly lacking. Labour does not like to hear about this because it is Labour-run Wales, where, as the Prime Minister said this morning, the A and E target has not been met since 2009. It is where performance—[Interruption.] I know that Labour Members do not want to hear this, but I suggest they listen to it, because performance in Wales—[Interruption.] Let me finish making the point. Performance was worse in Wales than in England for every one of the weeks that we missed our A and E target this winter. If the right hon. Gentleman really cared about patients, he would be condemning what is happening in Wales.
Mr Hunt
I will make my point and then I will give way. Labour Members need to hear about what is happening in Wales, because Labour runs the NHS in Wales. One patient in Wales had a cardiac arrest—[Interruption.] I know that this is difficult for Labour Members, but they need to hear about what is happening in Labour-run Wales. One patient had a—
Mr Hunt
I will give way to the shadow Health Secretary in a minute. One patient there had a cardiac arrest in the eye-examination room as there was no room in the resuscitation bay, and 24 to 36-hour waits for beds are now common in Wales. One patient spent a full three days in a Welsh emergency department. So let me give him a chance finally to condemn what is happening in Wales.
Andy Burnham
People watching this debate will be wondering why the Secretary of State is talking about something that is not his responsibility; nor is it mine. He is not responsible for the NHS in Wales; nor am I. I have put to him today serious questions about the NHS in England right now. He is the Secretary of State for the NHS in England, so will he now address the questions I put to him?
Chris Bryant (Rhondda) (Lab)
Will the Secretary of State give way to a Welsh MP?
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. We want a little more calm. Mr David, you are getting far too excited. It is not good for you and it is not good for the Chamber—[Interruption.] Order. I do not want you to repeat your point. I have just explained to you that I need you to be a little calmer. It is up to the Secretary of State whether he wishes to give way and at the moment he is not doing so. It is his choice and shouting will not make any difference whatsoever.
Mr Hunt
I will give way to the hon. Gentleman, if he will just take his place for a moment while I make my point. I will also give way to my hon. Friend the Member for Enfield North (Nick de Bois)—[Interruption.] I will reflect on whether I want to give way to the hon. Member for Rhondda (Chris Bryant), but I will certainly give way to the hon. Member for Caerphilly (Wayne David).
What is happening in Wales is directly relevant to what is happening in England, because in England the NHS budget has increased in real terms and NHS spending has increased in real terms. If we did not increase them both, that would mean fewer doctors, fewer nurses and longer waits for operations—[Interruption.] The shadow Secretary of State shouts from a sedentary position that the NHS—
Andy Burnham
On a point of order, Mr Deputy Speaker. The Secretary of State has just said at the Dispatch Box that the budget for the NHS has increased in real terms. In December, I referred the Secretary of State’s comments to the UK Statistics Authority and I received a letter back saying that they were incorrect. Will you ask the Secretary of State to correct the parliamentary record and ensure that when the statistics commissioner makes a ruling it is adhered to by the Secretary of State?
Mr Deputy Speaker
That is not a point of order, but the right hon. Gentleman has certainly made his clarification for the record.
Mr Hunt
I thought that the shadow Health Secretary might try to do that, so let me give him the figures. I have the figures provided by the Department of Health finance department, based on the latest GDP deflators, as published at the Budget. Spending in the NHS—not the budget—in 2009-10 was £99.7 billion and for 2012-13 it is forecast to be £106.6 billion. That is a cash increase of £6.9 billion and a real-terms increase of £0.6 billion, so there is a real-terms increase in the NHS budget. The shadow Secretary of State does not agree with the real-terms increase of £600 million in the NHS today; there would be a Labour cut in NHS spending and I suggest that he might want to correct the record, as I am afraid he has got this wrong.
Nick de Bois (Enfield North) (Con)
My right hon. Friend knows, as his predecessor does and as the Prime Minister does, of my consistent opposition to the downgrading of Chase Farm hospital. Does he agree with me that it is utterly inacceptable for the hon. Member for Hammersmith (Mr Slaughter), who is no longer in his place, to suggest otherwise in this Chamber?
Wayne David
I thank the Secretary of State for eventually giving way. Does he not accept that, despite the fact that the block grant to the Welsh Government has been cut by £1.4 billion, Welsh spending on the health service has been maintained in real terms?
Mr Hunt
What Labour did in Wales was cut the NHS budget by 8% and that is why that Government have not met their A and E targets since 2009. Those on the Labour Front Bench in England want to cut the NHS budget here. That would not help pressures on A and E; it would make them a great deal worse.
Mr Hunt
I shall make some progress, because this gets even worse for Labour.
The shadow Secretary of State wrote to me at the weekend, asking me to relieve pressure on A and E by using the health underspend to put extra money into social care. There is a way of releasing resources into social care, but it is not that, because the underspend he talks of sits largely with NHS trusts and clinical commissioning groups, which are allowed to keep their underspends and roll them over to subsequent years. If we took away that money and put it into social care, we would therefore have to take it away from hospitals, where it is needed most to help tackle pressures in A and E and other places.
Let us look at some of the hospitals that would lose money under Labour’s plans. Wigan and Leigh NHS Foundation Trust, in the right hon. Gentleman’s own constituency, had a £4 million underspend in 2012-13. It would be prevented from using that money to reduce A and E pressures, as would the Royal Cornwall, the Royal United hospital Bath, Nottingham University hospitals—
Mr Hunt
I am going to make some progress. The Royal Wolverhampton, East Lancashire, Royal Liverpool and Broadgreen, North Bristol, Coventry and many other hospitals would also be prevented from using the money. So Labour’s solution to the A and E crisis is to cut funding to hospitals—about as logical as wanting to reduce debt by increasing the deficit.
From a Labour party that wants to be a Government in waiting, this is not good enough. It is against a cut in NHS spending that did not happen, but when there is a real cut in Wales it says nothing. It is against hospital reconfigurations in England, where we are hitting the A and E target, yet says nothing about reconfigurations in Wales, where Labour is missing the A and E target. It says it is against reorganisations and it has just proposed its own huge structural reorganisation to merge the health and social care system. Why is that? It is because in the end it is more interested—we have seen this today—in party politics than the right policies. I think we can expect better from someone who used to be a Health Secretary.
Mr Hunt
I shall make some progress because I have some important points to make.
A and E pressures are not the only thing that happened to the NHS this winter; we also had the Francis report into Mid Staffs. That tragedy is also relevant to A and E pressures, because at the height of its failures in care, Mid Staffs, unbelievably, was actually hitting its A and E target. In fact, between 2004 and 2009, there were only three quarters in which Mid Staffs failed to see 95% of people within four hours—hitting the target and missing the point. But in Labour’s NHS, hitting the target was all that counted, because Ministers ignored three reports, 50 warning signs and 81 requests for a public inquiry into Mid Staffs and what was going on.
Things have changed in the NHS, and I say this plainly. It is harder now for hospitals to hit their A and E target, because we will not condone cutting corners to get there. Targets matter, but not at any cost, and we are determined to reach them by doing things properly, making sure that we always treat patients with dignity and respect.
Mr Hunt
I shall make some progress.
Labour’s complacency on that issue is revealed as even more shocking when we look at the root causes of pressures on A and E departments, because nearly all of them involve issues that Labour either failed to tackle in office or made a great deal worse—for example, the IT fiasco, so heavily criticised by the National Audit Office. It is completely unacceptable that A and E departments are not able to access, with their consent, people’s GP records. Last year, there were 30,000 wrong prescriptions in the NHS and 11 deaths—something we know would be significantly improved with e-prescribing in hospitals. The Government have addressed that, with a fund that I announced last month and an ambitious programme to make the NHS paperless by 2018, learning from that procurement debacle for which we are now paying the price.
Let us look at other causes. The working time directive, which Labour signed up to, makes the recruitment of A and E staff very much harder.
Mr Hunt
I think the hon. Gentleman should listen to this. Professor John Temple described that as having the biggest impact on the emergency and out-of-hours parts of the NHS, which is why the Government are now having to increase recruitment into A and E through the mandate that the Government have set Health Education England. Or there is the total failure—
Gloria De Piero (Ashfield) (Lab)
In one week in April 2012, 75 people in Sherwood Forest trust waited longer than four hours at A and E. In the same week in April this year, 266 people waited longer than four hours at A and E. That is a 255% increase. How does the Secretary of State account for that?
Mr Hunt
I agree that A and E departments are under huge pressure, and that is why we are taking a lot of measures to deal with them, which is what I am talking about. But I am saying that we have to deal with the root causes, which were things that the shadow Secretary of State’s Government failed to deal with. [Interruption.] Labour Members need to listen. We listened to the shadow Secretary of State’s solutions, which were not really solutions; now I am telling them what we think needs to happen.
We welcome the fact that the Labour party has now seen the light and recognises the need for integration, but Labour Members need to show some humility, because it was the Labour Government who put in place many of the barriers—in particular payment by results mechanisms—that make that so hard to achieve. We are now trying to make integration a reality through the 10 pilots on removing barriers to integration announced by the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), as part of the vulnerable older people’s plan announced to the House last month. Without integration, we will not solve the problem of bed blocking, which is at the heart of the pressures on A and E.
Andrew Percy (Brigg and Goole) (Con)
The Secretary of State is right to say that many of the present failures started in the Labour years, particularly the problems with integration. Does he share the concern that I and many of my constituents feel about the 50,000 beds that were lost under Labour Government? We lost the beds, but the intermediate care services and step up, step down facilities were never created to deal with the consequences. That is what is behind a lot of the A and E referrals today.
Mr Hunt
That is part of the problem with Labour’s approach to the NHS—a top-down approach of closing or downgrading A and E units and making the NHS sort out the problems. We are not doing that.
It is time that Labour took responsibility for the disastrous changes to the GP contract, which contributed to making it so much harder to get a GP appointment and piled further pressure on A and E departments—[Interruption.] No, they need to listen; this is important. The changes in 2004 handed responsibility for providing out-of-hours services to administrators in primary care trusts, at a stroke removing the 24/7 responsibility for patients that until then had always been a core part of being a family doctor. As we heard earlier today, even a former Labour Health Minister regretted those changes, saying before the last election:
“In many ways, GPs got the best deal they ever had from that 2004 contract and since then we have, in a sense, been recovering.”
It is important that Labour Members hear the list of independent voices all saying that we need fundamental change in primary care if we are to deal with pressures on A and E: the College of Emergency Medicine, the Royal College of Physicians, the NHS Alliance, the Family Doctor Association, the head of the Royal College of General Practitioners, who—surprisingly—said something in support of the Government in The Guardian this morning, the Foundation Trust Network and so on. All those voices were ignored by Labour as it put its head in the sand about that disastrous change to the GP contract.
Ian Swales (Redcar) (LD)
Does the Secretary of State share my horror that the out-of-hours contracts awarded by the previous Government to companies such as Serco give them a financial incentive to call an ambulance rather than deal with cases through GPs or in the community?
Yasmin Qureshi (Bolton South East) (Lab)
Today’s debate is about the increase in waiting times at accident and emergency departments. In 2010, when Labour left office, 98% of people were seen within four hours; three years later, after three years of Conservative Government, the number of people who have to wait more than four hours has trebled. What is the Secretary of State going to do about that?
Mr Hunt
Let me say very directly to the hon. Lady that since 2010 two things have happened that have contributed—[Interruption.] I am answering the question. First, 1 million more people are now going through A and E; secondly, the target has been reduced from 98% to 95% on the advice of the College of Emergency Medicine and the Royal College of Nursing. Labour has decided to do the same thing in Wales. Obviously, in that situation, the result is an increase in the absolute numbers; however, year on year since 2010, this Government have hit our A and E targets and we intend to continue to do so.
Sir Bob Russell
Mention has been made of an additional 1 million people going to accident and emergency. The derision I received earlier was an attack on organisations such as St John Ambulance, which trains first aiders, because the simple fact is, as I said when speaking to my ten-minute rule Bill 10 years ago, that first aiders will
“reduce visits to overstretched accident and emergency departments by people whose injuries did not warrant hospital attention”—[Official Report, 19 November 2003; Vol. 413, c. 809.]
We should be getting more first aiders out there. If the last Labour Government had listened to that, we would have 1 million more first aiders.
Mr Hunt
No, I will make my concluding remarks. We will address these fundamental issues in our vulnerable older people’s plan, which is being published later this year. I have asked Sir Bruce Keogh, NHS England’s medical director, to lead an urgent review of demands on our emergency care and how services should respond in future. In the short term, we have changed the tariff arrangements for A and E payment to give hospitals a say in the use of funds earmarked to prevent avoidable admissions. The result is that A and E targets are now being met, not missed; long-term challenges are being confronted, not avoided; and the NHS, with its extraordinary professionals, is facing up to the great challenges of an ageing population with resilience and determination, treating more people more quickly and more safely than ever before in its history, and rather than deriding that performance for party political purposes the House should be celebrating its success.