A and E Waiting Times

Kate Green Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Kate Green (Stretford and Urmston) (Lab)]

It is a great pleasure to serve under your chairmanship, Mr Hollobone, on an issue about which I know that you are deeply concerned. I am grateful to my right hon. Friend the Member for Cynon Valley (Ann Clwyd) for calling for this debate now, because it is of incredibly timely importance to my constituents, given what is about to happen at Trafford general hospital.

As I listened to the hon. Member for Cheltenham (Martin Horwood), I was struck by the many parallels between our situation in Trafford and that experienced by other hon. Members in relation to their local hospitals. I strongly endorse his request to the Minister that we should now start to get a clear strategic picture of the Government’s vision for the future of emergency provision. Many of the difficulties in Trafford that I will mention have arisen because of the complete lack of clarity about that vision.

I want to highlight only a few issues, because I know that other hon. Members wish to speak. I apologise, Mr Hollobone, that I will have to duck out for a quarter of an hour to make a phone call, but I will be back to hear the winding-up speeches. I am grateful to you for calling me to speak in this debate.

I want to explain that, as the Minister will know, Trafford general hospital—it has its own accident and emergency department, but since last year has been part of the larger Central Manchester University Hospitals NHS Foundation Trust—is subject to NHS Greater Manchester’s recommendation that the accident and emergency unit should initially be downgraded to an urgent care centre and, in due course, to a minor injuries unit. The Secretary of State requested advice on that and other reconfiguration changes at Trafford from the Independent Reconfiguration Panel, which I know he has received and is now considering. I am grateful that the Minister’s colleague, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), has agreed to meet me and my parliamentary neighbours to discuss that situation which, as I am sure she appreciates, is causing great local concern.

The first issue that I want to highlight is that it is important—certainly for elected Members, but also for the wider public—that there is absolute transparency of data and information about what is going on in our A and Es. A couple of weeks ago I tabled a parliamentary question asking about waiting times at all Greater Manchester accident and emergency units, because constituents have been coming to me with anecdotal evidence of delays and problems, such as those described by my right hon. Friend the Member for Cynon Valley, and I wanted to assess the evidence before taking the matter further. I asked for information at the level of not only the NHS foundation trust, but every individual unit, because I am obviously particularly concerned about my local A and E, which falls within a larger foundation trust.

I was surprised to receive a written answer last Tuesday that told me that the information was not available at individual unit level. Of course, that is nonsense. I contacted Central Manchester University Hospitals NHS Foundation Trust, which said that it could of course give me the information for Trafford, and it duly did. It absolutely does not build confidence in my mind or that of the public if we do not receive clear written answers from Ministers. I was glad that I could raise that issue in health questions last week.

My first question to the Minister is: what can she do to ensure that there is absolute transparency of data available to elected representatives and the public at large about what is going on in our areas? I am sure that she would agree that it is unhelpful for speculation and anecdote to inform what the public think is going on, when data are available and might present a different picture.

The second matter I want to raise is related to waiting times. Obviously, there is a definition around the four-hour waiting time target, but patients’ experience is about not just when they arrive at accident and emergency and when they are passed on to wherever they are going next, but an end-to-end process, which starts from the minute they pick up the phone. They feel that the whole experience can be very protracted. They have to phone, wait for an ambulance or a paramedic to come, potentially wait in the car park to get into the hospital, wait in A and E to be triaged—they are often triaged quite quickly—and then wait around to see more medical experts. Then there is further waiting around before some clinical disposal ultimately results. There is a sense that the totality of the end-to-end process is becoming very protracted, and that is certainly causing public concern. I invite the Minister to comment on the context in which people are waiting and being seen within A and E units and what thoughts the Government have on addressing the end-to-end patient experience, because that is what matters to my constituents.

Thirdly, the changes that are being proposed at Trafford, and at the hospitals in the constituencies of other hon. Members, are part of a much broader range of changes both in Greater Manchester and in the NHS as a whole. In the context of the proposed changes for Trafford, my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) has repeatedly asked what the impact will be on the neighbouring hospital at Wythenshawe, and we are equally concerned about what will be going on at A and E units at Manchester Royal infirmary and Salford Royal. It is clear to us that it is not possible to remove capacity at one unit if there is insufficient capacity at the neighbouring units to mop up the work. My right hon. Friend believes that Wythenshawe is not in a position to take on significant additional numbers of A and E admissions without substantial extra investment. The purpose of my written question to Ministers about NHS trusts around Greater Manchester was to try to get a picture of what is going on across the whole city region. Clearly, capacity on the wider geographic basis is important.

It is equally important that we have provision in the community either to ensure that people can be discharged quickly or to prevent them having to go to A and E in the first place. That is at the heart of the integrated care model to which we are all signed up in Trafford and in which we believe very powerfully. However, the fact of the matter is that services are being taken out before the community provision appears to have been put in, and that cart-before-the-horse approach does nothing to reassure local people.

The hon. Member for Cheltenham mentioned the problems that have arisen following the launch of the 111 number, which had to be withdrawn in Greater Manchester only a few hours after its launch because it simply could not cope. I have no doubt that one consequence of the changes to the out-of-hours service is that more people are likely to go to their A and E. Equally, if that local A and E in due course sees its hours curtailed or is downgraded, there will be a knock-on impact on GPs, because they will have more people presenting at their surgeries with emergency conditions. As things stand, while that might be a good place for people to go in theory, GPs do not have the capacity to see those additional patients. Again, that is a failure of planning about which people are concerned.

We are also worried about the ambulance service in the north-west, which has undergone some significant changes of late. There is also the matter of the interface with mental health. Many people who present at our A and E have both a physical and a mental health problem. It might be that the mental health problem is the underlying issue that is more crucial to resolve because it is probably part of the driver of the physical condition.

There is a great deal of contextual challenge that is contributing to people’s concern about the ability of accident and emergency units, including the one at Trafford, to cope. It is clear to me that without that context being properly resolved and without the guarantees that all that other provision is properly in place, it is simply not possible to start to withdraw services that people rely on because they have nowhere else to go. There are also further broader contextual changes that are causing us concern right now. The hon. Member for Cheltenham mentioned the Keogh review. In Greater Manchester we have the Healthier Together review, which, I am afraid to say, is still opaque both to elected Members and to local people in terms of what it might propose. Undoubtedly, it will have a significant impact on the map of hospital, A and E and wider provision across Greater Manchester. Again, people feel that they are being asked to sign up to a decision about Trafford’s accident and emergency unit without understanding what the context and provision across the whole of Greater Manchester might look like in two or three years’ time.

The public are concerned, sceptical and worried. If Trafford general hospital’s A and E is downgraded, they are unsure where they will go with a particular condition in the future. They do not know whether to travel to Trafford or to go to another location, because Trafford might not be open or capable of dealing with their problem. It is not that people are unwilling to travel to other units when they understand that that is the right unit for them to go to. In Greater Manchester, we have done a good job in persuading people of the importance of going to Salford Royal if they have had a stroke, and of the importance of the major trauma centres around the city, but there needs to be clarity about what is on offer, where it is on offer, when it is on offer and why they can feel confident, if the service is not being provided locally, that that is in their best interests. They feel that a local A and E is important to them. There is a long conversation to be had with the public, which, I venture to suggest to Ministers, nobody has tried to embark on as yet.

The Secretary of State is considering the recommendations in relation to Trafford, and I expect that a decision will be taken shortly. I am grateful to the Minister’s colleague, the Under Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, for agreeing to meet me and my parliamentary neighbours. We are canvassing diary dates as we speak. Will the Minister ask her colleague to read very carefully my remarks from the debate this morning because they are a foretaste of some of the issues that I will raise when we have that meeting? May I also invite her to bring home to both the Under Secretary of State and the Secretary of State that we will be deeply concerned if a decision is taken about Trafford before elected Members have had an opportunity to put their concerns directly to them? We have not yet had that opportunity. It is vital that local people’s voices are heard before decisions are taken about services that are available to them. I hope that the Minister will convey those concerns to her colleagues following this morning’s debate.

--- Later in debate ---

[Anna Soubry]

No. I am not going to go into all that in the short time that is available to me. We accept that waiting times are a problem—we are not trying to hide from that, and we are up for transparency—and I will address the data in a minute.

The hon. Member for Cheltenham (Martin Horwood) rightly identifies the seasonal nature of waiting times. He speaks with passion about changes in his constituency, and rightly so. It is right and proper that people who have such concerns, as other hon. Members have said, come to this place to champion the cause of the health service within their own communities, especially when it faces reconfiguration. He spoke about 111, which is an important thing to talk about when considering some of the causes that may contribute to the unacceptable failure to hit targets. I know that the data are being monitored on a daily basis by NHS England, and the deputy chief executive of NHS England is meeting twice a week to consider what is happening and to make sure that action is taken to ensure that any problems are addressed.

The hon. Gentleman makes an important point on the difficulty of filling posts, and I will write to him on that because I know it is a problem. I also know that action is being taken by some of the royal colleges, and it is probably best if I give a fuller answer, because he makes a very important point. Of course, I can say that the Keogh review is considering exactly the other problems that he mentioned. As the Secretary of State announced, the Keogh review, which has been alluded to, will report next month. All those matters will be reviewed by Sir Bruce, and it is much to be hoped that some positive forward-thinking will come out of that.

The hon. Member for Stretford and Urmston (Kate Green) raised various issues. I am particularly concerned that she says she is not getting the answers to the questions she has quite properly asked. I think there is sometimes a problem with hon. Members not going in the first instance to the actual hospital, trust or whoever it might be. Her point, and it is a good point well made, is that when she asked my Department, she did not get those figures, and I will make further inquiries.

Only today I saw a question from the hon. Member for Ashfield (Gloria De Piero) asking precisely what the figures are for her hospital in Sherwood and, as it happens, the hospital she and I effectively share, the Queen’s medical centre A and E department. I have given those figures, and I want to set the record straight because, in fact, for the same week last year in Sherwood, 75 people waited more than four hours; this year the figure is 266.

[Kate Green]

I have two points to make very quickly. First, I asked for data on all Manchester hospitals. I cannot be expected to go to each one, but, obviously, what is going on in every hospital in the city matters because patients will have to move from one to another if capacity is short. Secondly, I specifically asked for data on Trafford general hospital, which falls within the Central Manchester University Hospitals NHS Foundation Trust. The Minister told me in a written answer that data were not available, but when I approached the trust itself, it told me.

[Anna Soubry]

I know, and I do not understand why that is. I will absolutely make further inquiries, because it is nonsense that the hon. Lady did not get the data.

I will come on to address the points made by the hon. Member for Lewisham East (Heidi Alexander), but, on the data, it is important that we monitor such things. That is precisely why the Department of Health and Health Ministers are very much alert to what is happening in A and E. We share the concerns of hon. Members, which is why we have the Keogh review, why we are considering how to solve the problem and why we are looking at the underlying causes, which, in the short time available, I hope to address. I will ensure not only that the Ministers to whom the hon. Member for Stretford and Urmston has spoken read Hansard, but that a copy of this debate goes to NHS England, which I know also shares those concerns. NHS England also wants to hear about the experiences of hon. Members, and it is taking action to ensure that we are on top of this and, most importantly, that we do what we should do.