A&E Services

Karin Smyth Excerpts

Wednesday 24th June 2015 Commons Chamber

[Dr Whitford]

The problem with moving patients into hospitals is being exacerbated by the reduction in in-patient facilities. Every new hospital seems to have fewer beds than the old hospital it replaces. The Scottish Government finally accepted the view of clinical staff that that could not go on. We now treat people in a different way. People used to get a hernia done and lie there for a week. My breast cancer patients used to come in and stay for 10 days. That has changed, which is great for those patients, but there is an inexorable rise in the number of older patients who have complex needs. The problem is not that we are living longer. I get quite upset at the phrase, “the catastrophe of living longer”. I suggest that Members think about what the alternative is. At medical school, I was definitely given the impression that people living longer was the point.

People are surviving their first major illness and, actually, their second major illness. They may present with breast cancer in their mid-70s to someone like me and have four co-morbidities. Such patients do not get in and out quickly for elective surgery, and they do not get out quickly when something major goes wrong, such as pneumonia or a chest infection. We therefore need to stop the downward trajectory in the number of beds, because we will not get the flow of patients if we go on cutting beds.

For me, the key things that we need are the co-location of GPs; an out-of-hours service for out-of-hours issues that are better dealt with in primary care; and enough beds in the right places. Finally, we need to smooth the way of our patients to get back to their homes. In Scotland, we have free personal care that allows us to keep more people at home and stop them going into hospital and to get more people back out of hospital.

I commend the “Five Year Forward View”. Much of it is taken from something that was written in Scotland several years ago called “2020 Vision”, which was about integrating health and social care.

[Karin Smyth (Bristol South) (Lab)]

I am not aware of the position on co-location in Scotland, but one barrier to the successful implementation of co-location in England is that the tariff and the funding mechanism mean that is it not efficient. Will the hon. Lady say what the position is in Scotland, because perhaps we can learn from that in England?

[Dr Whitford]

As I am sure the hon. Lady is aware, we have a totally separate system, for which I am grateful. We do not have a system of tariffs. We have a single NHS, so we can sit around a table and try to work out a solution. That is one of my concerns about the situation that the NHS in England faces and it is where I would veer away from the “Five Year Forward View”.

The principle of working together and integrating health and social care is commendable. The integration boards in Scotland started work in April because “2020 Vision” is a few years older than the “Five Year Forward View”, but we face the same challenge: local authorities are struggling with their budgets, which can end up eating away at the health side.

The four-hour target is still useful as a weekly target to provide a quick response to what is going on in our hospitals. However, it should not be used as a stick to beat staff or to beat ourselves in this House and make public capital. The NHS is too precious for that.

--- Later in debate ---

[Maria Caulfield (Lewes) (Con)]

I congratulate the hon. Member for Dewsbury (Paula Sherriff) on her eloquent maiden speech. It is great to see another strong woman in the House.

I am mindful of the time constraints in the debate and, although I would love to talk about GP access and hospital finances, I shall concentrate on accident and emergency targets and, in particular, the target of 95% of patients being seen within four hours. I speak as a nurse who has worked in A&E under the last Labour Government when the four-hour target was introduced. I hope that my clinical experience will be used to inform the debate and take it forward.

I want to make four key points on A&E targets and the four-hour wait. First, like the hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for Totnes (Dr Wollaston), I am not a fan of targets. As a healthcare professional, I found them increasingly frustrating. They are great as a tool, but they are being used as a political stick with which to beat healthcare workers and the system. There was no clinical rationale for choosing the four-hour target. There is no evidence that the morbidity or mortality of someone who waits for four hours and 30 minutes is compromised. Similarly, there is no evidence that the healthcare received by someone who has waited for three hours and 30 minutes is any better than that received by someone who has waited for four hours. The four-hour target is actually not that helpful.

[Karin Smyth]

Will the hon. Lady give way?

[Maria Caulfield]

I will not take any interventions owing to the restriction on time.

I shall give the House an example. When I worked as a nurse in A&E—under the Labour Government—an elderly gentleman was brought in during a busy night shift. He had fallen at home and broken his hip, and he was put in a corridor to wait. After three hours and 30 minutes, he called me over, saying, “Nurse, I desperately need to go to the toilet.” I had nowhere to put him. The best thing I could do was to wheel a curtain around his trolley, and there, in the middle of a busy hospital corridor, that elderly gentleman with war medals on his chest went to the toilet. He was seen within four hours. That box was ticked and he was deemed to have had good healthcare, but I was not particularly impressed with that care. Let us not kid ourselves that meeting that target always means that the patient experience is good or that the outcome is any better.

My second point, which relates to my worry that this debate is being used as a political football, is that the four-hour target is not being seen in the context of the bigger picture. Other targets show that, even with the increased numbers attending A&E, more and more patients are getting their treatment within four hours. Similarly, the clinical outcomes—surely the most important factor—relating to diseases such as heart attacks show that morbidity and mortality rates have improved. There have also been better outcomes for people who have had strokes and for trauma victims. So outcomes for patients are improving despite the four-hour target not having been met during the past 100 weeks. We should welcome that and congratulate our NHS staff on achieving it.

Thirdly, if this is a serious debate about A&E services throughout the whole of the United Kingdom, which we are surely all here to represent, why are we not looking at the rate in Scotland of only 87%, in Labour-run Wales of 83% and in Northern Ireland of 79%? This debate is a political one, and as a healthcare worker, I find that distressing. It is interesting that those Members who have worked in the NHS believe that the four-hour target is a useful tool but that it should not be used as a political stick.

--- Later in debate ---

[Andrea Jenkyns (Morley and Outwood) (Con)]

I congratulate the hon. Member for Dumfries and Galloway (Richard Arkless) on his passionate maiden speech. I know how nerve-wracking it can be to speak here.

I have experienced the good and the bad of the NHS. I have lost a loved one, but also seen the excellent care that my mum received when she had a knee replacement recently, and that my sister has received for her multiple sclerosis. For my university research dissertation, I looked at healthcare systems around the world, their per capita spend and outcomes. I can honestly say that my research showed that no country and no Government get it right 100% of the time, but I for one am proud of our NHS and I urge Labour Members to stop talking it down and to drop their selective amnesia. Every Member of this House has something to learn from our party history and I would like us all to pull together for the NHS.

We all have lessons to learn, so let us look at the UK statistics on A&E services. NHS England has a 95% A&E target and achieves 93%; the figure for Labour-controlled Wales is 83%, and for SNP-controlled Scotland, 87%. [Interruption.] Those are the figures from NHS Scotland, so perhaps hon. Members should check that out.

[Karin Smyth]

Will the hon. Lady give way?

[Andrea Jenkyns]

No, as I have only three minutes.

My point is that every Member of this House has lessons to learn. I think we should be critical friends, looking honestly at what works and what does not, and sharing best practice. If we look at our record, we see that NHS England has the best emergency care of any western nation. We should celebrate that fact. In Yorkshire and Humber alone, we have 582 more doctors and nurses than in 2010, and I celebrate that. I have worked for healthcare charities for the last four years. Today I met a patients’ association and, together, we are setting up an all-party parliamentary group on patient care. We need to do things in a constructive manner, rather than using this issue for political means. It is only through collective working, including working with patients’ groups and healthcare charities, and by looking at strong local leadership on a ward-by-ward basis, that change can happen.

I welcome the Government’s decision to have a seven-day NHS. We will need to look at how that is managed, but it will take pressure off our A&E services. I will finish by saying that we need to be a critical friend. We need to be honest and make sure there are consequences when things go wrong, and that lessons are learned. We also need to celebrate our fantastic NHS, in which we are still investing. I urge every Member in the House to support that.