A& E Departments: Staffing

Julian Lewis Excerpts

Monday 23rd March 2020 Commons Chamber

[Chris Bryant]

One of the things I have been so angry about over the past few days is the panic buying going on, with people virtually elbowing one another out of the way to get the last remaining courgette or tin of tomatoes. When I see that, I think to myself, what will happen when the poor person coming off their long shift at A&E at 8 or 10 o’clock at night finds that there is literally nothing left in the shop to buy? The person who was so greedy, hoarding and selfish will then turn up at A&E in two weeks’ time and be treated by somebody who was unable to get enough food. My fundamental premise is that we can only get through all this together, because in the end we achieve far more by our common endeavour than we do by going it alone.

[Dr Julian Lewis (New Forest East) (Con)]

In the presence of an appropriate Minister, can we urge the point that food supplies ought to be made available at the place of work for key workers? When they come off their unduly long shifts, they should not be in the position of not being able to get any food to take home.

[Chris Bryant]

That is an extremely good point. I wonder whether Tesco, Sainsbury’s, Morrisons and all the other supermarkets—once they have managed to recruit more delivery staff—should think about making deliveries specifically to hospitals and other care points, so that there is specific provision for key workers. That could make a significant difference.

What is essential to running a good accident and emergency department is, first, good, strong leadership. That means consultants who are well trained, and not just relying on locums who are on a part-time contract. It requires really strong teamwork. There is just as much value in a calm receptionist or a meticulous cleaner as a well-trained doctor, consultant or a nurse. We need resources and training to make an A&E flourish. We need people with an extraordinary set of skills, including the ability to make swift and yet very important, time-critical decisions. We need a wide range of disciplines that feed into the whole of the rest of the hospital. Those people have to be able to deal with strong emotions, from rage and anger to grief, anguish, upset, fear and love, all mingled in a very difficult situation. Unfortunately, they have to be able to deal with the particularly strange combination of adrenaline and alcohol, which sometimes makes an accident and emergency department—especially on a Friday or Saturday night—a very difficult place to be.

The truth of the matter is that we have a great number of shortages in our A&Es across the country. In terms of consultants, we are somewhere between 1,200 and 1,500 consultants short across the whole of the UK. There is a particular shortage at my local hospital, the Royal Glamorgan, which is why it has had to rely substantially on locums for the last year. That is not a sustainable model for the future, which is why I am determined to make sure that the local health board campaigns to recruit more consultants for local hospitals. Other countries have a much higher number of A&E consultants per 1,000 people than we do in the UK. We are aiming to get to one for every 7,000 people, and in most other countries it is one to every 4,000. We still have not reached one to every 7,000, so that is a problem. I would urge any doctor who is thinking of training now, or any young person who is thinking of going into medicine, to please think about being an A&E doctor. You will see over the next few months that we love our A&E doctors almost more than anybody else in the whole of the NHS.

Beds are another real issue. We have one of the lowest numbers of critical care beds in Europe, fewer than Spain and France, half of those in Italy, and only a fifth of what they have per 1,000 head of population in Germany. That puts us, as we will discover over the next few days, in a really difficult position. Some areas of the country will face even bigger challenges than others. The most rural parts of the country, where there is an older population and where there are significant health problems—in particular, in the south-west and in the semi-rural areas of the south Wales valleys—will face a particular difficulty, because they already have 83% to 90% occupancy of all their intensive care unit beds, and that is before anybody else comes in through the door.

Lots of hospitals have done an amazing job over the past fortnight, trying to turn other wards into intensive care units that can be used specifically for coronavirus patients, and recruiting additional staff who have previously retired to come back into the service. Hospitals are doing a phenomenal job in all of that, but the truth is that across the whole of Wales we have only 153 intensive care unit beds, and 90% occupancy. That will pose a phenomenal difficulty for my constituency, where we have a large number of people with chronic obstructive pulmonary disease, a large number of people with diabetes and many with the conditions that make them the most vulnerable—and an ageing population at that. The whole nation will have to think very hard about how, in the long term, that situation is sustainable, even if we do manage to struggle through the next few months. In a sense, in our NHS at the moment, intensive care needs intensive care.

On coronavirus specifically, I praise every single doctor, nurse, cleaner, decorator and builder who has been involved in the process of reshaping intensive care units and emergency departments. The turnaround has been remarkable. Sometimes they have had to devote hours to training to use PPE, and then they have discovered that the equipment is not easy to use, and they have used all the equipment that they had on training in how to put it on and take it off. They have been working at pace, and undoubtedly they have been working many, many more hours than they are contracted to do, and I think we would all want to say thank you to them for that.

I also want to praise all the staff who work in accident and emergency departments, because I know from talking to doctors over the past few days that they know they will have to make some very, very difficult and horrible decisions—decisions that none of us in this House would ever want to make. They know already—they have protocols that were put in place in 2009 when we were looking at the H1N1 strand—that they will have to make decisions about who they can provide ventilator beds for and who they cannot provide ventilators beds for. That will obviously be horrible for the families and the individuals concerned, but just think of the emotional stress and strain for each of the doctors and nurses who at some point over the next few months are going to have to say, on occasion, “I’m sorry, there is no bed for you, because you are not a priority.” That will hurt because that is not what anybody was ever trained to do when they became a doctor or a nurse. The trauma—the emotional trauma—of that for many people will be phenomenally difficult.

My heart is just full of praise for all those doctors, all those nurses, all the cleaners and all the other parts of the A&E teams. Madam Deputy Speaker, I know you know that I do not like clapping in the Chamber, and I am sure you do not like it either, but I think there are very exceptional moments when this House would like to thank people who do a phenomenal job on behalf of all of us, so if you could close your ears for a moment, I am going to applaud the A&E staff up and down the land. [Applause.]

--- Later in debate ---

[Helen Whately]

I have been absolutely assured that the equipment being supplied to the frontline is appropriate and that it has been tested to make sure that it is fit for purpose.

[Dr Julian Lewis]

Quite a major distribution and logistics firm in my constituency has offered drivers and vehicles for the cause of fighting the virus. Is there some sort of central one-stop shop to which volunteers and offers of that sort can be directed, so that they can be put to best use? I appreciate that the Minister may not be able to answer me immediately, but if she cannot, perhaps she could inform me afterward.

[Helen Whately]

One of the fantastic things we have seen over the last few days is the number of offers to help from all parts of society and the economy. There are some specific contact details for ways in which people can help, and I will be happy to share them with my right hon. Friend after the debate.