NHS

Jeremy Lefroy Excerpts

Wednesday 5th February 2014 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

First, I want to praise all those who work in accident and emergency departments up and down the country to provide a vital full-time 24/7 service locally and nationally. Many Members have already pointed out that it is almost a year since the Francis report was published. Its reception in the House demonstrated one of the best examples of cross-party respect from the Prime Minister and the Leader of the Opposition and, subsequently, from my right hon. Friend the Secretary of State and the shadow Secretary of State. I would like to see that cross-party support being built on.

I should also like to praise the Secretary of State for the work that he has done to take the recommendations forward. He has mentioned some of them today, including those relating to the chief inspector of hospitals, to social care and to general practice. Many more aspects of the report have already been mentioned, and there will no doubt be more to come. I must stress, however, that we need to have a proper debate on the Francis report now, one year on, in Government time in the House, to see where we have got to.

I also pay tribute to all those people who did the work that enabled the Francis report to come about. They include Julie Bailey, Helene Donnelly and the many others who worked with Cure the NHS, and all those in Stafford hospital who have subsequently responded to the report to make the hospital a place that I am proud to say now provides some of the best care in our region, including those in the A and E department. We have, however, lost our 24/7 A and E department; we now have a 14/7 A and E department. That is something that we are going to have to look at again; we need to look at how we are to cover the out-of-hours emergency care in our area. Nevertheless, we now have some of the best A and E care in the region, because it is consultant led. We now have sufficient consultants to cover that service.

I want to make four points that I believe need to be taken fully into account in this debate on A and E services. The first is about doctors. The Secretary of State has already mentioned the problem with recruiting people into emergency medicine. It is not seen as the most attractive career, perhaps because of the shift work involved. We need to look at the whole training structure. Perhaps it would be better for trainee doctors to spend more time in accident and emergency departments in their foundation years. Perhaps we should add a third foundation year in order to enable them to spend more time in A and E, because that is surely where they will learn most about this kind of medicine.

We also need to look carefully at the role of specialisms in the NHS. Although that would be the subject for a whole other debate, it is very important, because we have more than 60 specialisms in this country, compared with about 20 in Norway. Their increasing role means there is a need to maintain a full-time specialist rota of up to 10 consultants, which is placing increasing stress on the finances of the NHS. That is true in A and E, as elsewhere. That is a subject for another day, but it is a very important point.

Another area to mention is demographics, although I will not go on at length about it because the facts are known to us all. In Staffordshire, we are expecting the number of over-85s to double and the number of over-60s to go up by 50% in the next 25 years. There is no doubt that we have reached a tipping point, particularly as the baby boomers enter their retirement years, and that is not recognised. It is not just a straight line graph; there is a bit of exponential growth in the number of older people now coming in to our hospitals. That is to be expected.

[Yasmin Qureshi]

I agree with everything the hon. Gentleman has said so far. Will he also consider the fact that A and E waiting time rises have also been caused by: the effect of walk-in centres closing; the closure of NHS Direct and its replacement by the botched 111 system, which has not helped anyone; and a real cut in adult care, which has meant that a lot of elderly people have been taken to hospitals, instead of being cared for at home, and they cannot be released unless they have somewhere safe to go to?

--- Later in debate ---

[Jeremy Lefroy]

I have no doubt that some of those things will have caused increased pressure. That brings me nicely to my next point.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

My hon. Friend may not be aware that a briefing was given by the College of Emergency Medicine to Members of Parliament. One of its representatives, I believe it was Dr Mann, was asked by hon. Members about the closure of walk-in centres and he replied that there was an initial blip but that levels went back to what they were before. So in his view those closures made very little difference.

[Jeremy Lefroy]

We do not have sufficient data on this. I urge the Government to examine how we can collect more data about the reasons why people come to A and E and whether their visits could have been prevented by other provision. I am sure that that can be done in some cases, but at the moment we are arguing at cross purposes because we do not have sufficient data.

Another point, on the lack of integration, relates to discharges. There is pressure on hospitals to discharge people, particularly the elderly, because of the pressure on beds. One GP in my constituency raised this issue, citing one of their patients who was improperly discharged and saying that they were very distressed at the condition in which they found him. Stafford hospital has come up with a solution, which it will implement shortly, whereby every patient with complex needs will not be discharged unless it is absolutely clear that they have proper care in the community to go to. We would expect that for all patients, and I am very glad that Stafford hospital is taking that up.

The final reason to mention is that patients are often confused about where to go, and I am therefore glad that the Government have undertaken a review of the classification of A and E departments. We have A and E departments, urgent care centres and minor injuries units, and we have various grades of A and E. We need a national classification that makes it clear what services people can get at which point. Often people turn up and find that they have come to the inappropriate place.

I also wish to make a few remarks about the competition matters that have been raised in the debate, and I do this from a local perspective. The trust special administrators for the Mid Staffordshire NHS Foundation Trust have proposed that Stafford hospital should merge with University Hospital of North Staffordshire in Stoke and that Cannock hospital should merge with Wolverhampton’s trust. That is the right solution, it is not being opposed and we are not finding any problem with competition law. There is a big difference between the acute and non-acute sectors. As the acute sector runs in a tight way around the country, it is very difficult to see how there can be much competition in provision within it, because that has been provided exclusively by NHS trusts up to now. Within the non-acute sector we have found in my constituency that, under competition rules, an NHS service that went to the private sector under the previous Government has come back into the NHS under this Government, because it was determined that the NHS would provide a better service. So this does work both ways; it does not always go the way some people think it might.

We must not lose sight of the real hard work that people are doing in A and Es up and down the country. Almost all the work that goes on there is incredibly good and is what our constituents need, but we must make sure that the points that I and others have outlined are dealt with, because with the demographics going the way they are, we will face increasing pressures year on year.