Accident and Emergency Waiting Times

John Pugh Excerpts

Wednesday 5th June 2013 Commons Chamber

[John Pugh (Southport) (LD)]

The last time I was in A and E I had hit myself on the head with a 300 lb iron bar—don’t ask why. I had a lump the size of an egg, but no lasting damage, apparently. The time before I was involved in an accident on the M1. I was not driving the car, but I ended up in North Hampshire A and E. My latest visit was with my mother-in-law who had had a suspected heart attack. I use those cases to illustrate that although nobody wants to go to A and E, people end up there for a whole range of reasons. Either they have a genuine accident and emergency, or they fear that they have had an accident or emergency and need informed triage, or they have a problem and simply do not have anywhere else to go. I suspect that we are looking not at increased pressure because of a huge number of accidents and emergencies—although there are many elderly people, which will increase the number—but at a big increase in cases to triage and in the number of people with nowhere else to go.

I note that the situation is not inferior to that before 2004, but in relative terms I am prepared to admit that it is a crisis. So far the debate has been about whose fault that crisis is. We cannot say that the situation is entirely due to the GP contract and the extraction from out-of-hours service, but we could say that that will not help. We cannot say it is down to the strange decision to replace midstream NHS Direct with the 111 service, but that will not help. We cannot say it is all down to a massive reorganisation of the NHS and the siphoning off of millions into redundancy payments, but clearly that will not help. We cannot say it is due to the closure of walk-in centres. They were often paid for by the PCTs of the past and are not necessarily popular with GPs, but their closure will certainly not help. We cannot say that the situation is due to the absence of strategic health authorities, although in the past those authorities often forced ambulance trusts and hospitals to work seamlessly together, not just gaming their own targets and looking at performance indicators. They helped to stamp out trolley waits, parking up and needless diverts, but the absence of a strategic oversight is clearly not going to help. We cannot say that the failure of our system to deal with chronic alcohol abuse is the sole reason, but as the hon. Member for Totnes (Dr Wollaston) pointed out, it is not helping. The fact that we do not link treatment to successful rehab certainly does not help.

What would help, as we all agree, is rapid progress towards the integration of health and social care, proper community budgeting, stopping unnecessary admissions, increasing co-operation and resource efficiency, and making better use of hard-pressed social services budgets. This was the big-ticket item in the in-tray in 2010—the holy grail. There was also the instability of the acute sector. It is a genuine pity that well-intentioned people in this place spent the first two years of the Parliament wrangling about a largely pointless, if not positively unhelpful, reorganisation. Never mind missing A and E targets because of the stupid, adversarial, arrogant and hubristic culture of this place, where each successive Government feel obliged to do everything in a new way: it is not just A and E that missed the target; we missed the target.