Accident and Emergency Waiting Times
Kate Green Excerpts(11 years, 3 months ago)
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Andy Burnham
I will give way one last time to each of my hon. Friends, but then I must finish my speech.
Andy Burnham
I think that everyone needs to consider their position in the light of the evidence that is emerging about pressure on A and E, particularly in London. I pay tribute to the excellent and determined campaign run by my hon. Friend, and I noted what was said yesterday by the hon. Member for Enfield North. Perhaps one of the consequences of today’s debate will be agreement across the Floor of the House to delay any closures pending a personal review of the evidence by the Secretary of State.
Kate Green
As my right hon. Friend will know, my local A and E unit at Trafford general hospital is one of the 30-odd units that are scheduled for downgrading. Meanwhile, it is more than 30 weeks since the two nearest A and E units, at Central and South Manchester hospitals, failed to meet the 95% performance target last September. Does my right hon. Friend agree that the Secretary of State should also publish advice that he has received from the Independent Reconfiguration Panel which will inform his decisions, so that we can determine whether the latest pressures have been taken into account?
Andy Burnham
I think that full openness about these decisions is essential in the current context. I know that the panel’s report is with the Secretary of State, and I think he owes it to local Members of Parliament to be open about its conclusions and the evidence on which they were based. That is why I ask him to review every proposed A and E closure personally, and to give a guarantee to communities such as that represented by my hon. Friend that no changes will be made unless he is personally satisfied that it is safe to make them.
In conclusion, this is a crisis that could have been avoided. For the last three years the NHS has been struggling with the toxic medicine of budget cuts and top-down reorganisation. All the focus should have been on the front line, but instead the Government siphoned £3 billion out of it to pay for a back-office reorganisation that no one wanted and no one voted for—a reorganisation that has placed the NHS on a fast track to fragmentation and privatisation.
But it is worse than that. The Government’s own risk registers, which they refused to publish during the passage of the Health and Social Care Act 2012, warned them of the consequences of pushing ahead with a reorganisation when the NHS was facing great financial stress:
“The consequences could be compromised clinical care and patient safety, the failure of the 95% operational standard for A&E wait and a concomitant impact on other trust services”.
So they knew the risks they were taking when they reorganised the NHS at a time of financial stress; they were warned about this A and E crisis, but ploughed on regardless. It is the height of irresponsibility. No wonder they wanted to keep the risk registers secret. But with the looming cuts to jobs and social care, the problems in A and E will get worse, not better, if no action is taken on the points I have outlined today.
We have given the Secretary of State a practical plan, and he either needs to accept it or put one forward of his own. Right now, his complacency is one of the biggest dangers facing the NHS. He has failed to act on warnings about the collapse of social care. He has sat on his hands while front-line jobs are cut in their thousands. He has presided over the disastrous 111 service. He has closed NHS walk-in centres and downgraded A and Es without a convincing clinical case. It is no good his standing up today and blaming everyone else: this is a mess of his making—his first real test as Secretary of State and he has been found badly wanting. People want answers and action, and he needs to start providing them right now.
Health and Social Care
Kate Green Excerpts(11 years, 4 months ago)
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Kate Green (Stretford and Urmston) (Lab)
It is a pleasure to follow the hon. Member for Worcester (Mr Walker). I, too, want to talk about social care. First, however, let me reinforce the comments made by my right hon. and hon. Friends about the announcement on compensation for sufferers of mesothelioma. That devastating illness affects a number of families in my constituency, as well as many workers in Trafford Park over many decades. Work was begun by Labour on a system of compensation for asbestos-related illness where employers and insurers cannot be traced, and we now at last have a proposal from the Government although it is disappointingly limited in its reach.
The proposed scheme will apply only to diagnoses made after 2012, and it completely misses half the victims of asbestos-related cancers because it is limited to mesothelioma sufferers and a cap is imposed on the level of payments. The deal favours insurance companies; it is not good enough for victims or for the public purse because many sufferers will continue to rely on payments from the Department for Work and Pensions as they will not be eligible for the compensation scheme. Although the proposals in the Queen’s Speech for a system of compensation are welcome, I hope we will be able to improve the legislation as the Mesothelioma Bill passes through the House.
On social care, everyone agrees that people would prefer to be cared for in their own home for as long as possible, but community-based provision must be in place for that to happen. As many right hon. and hon. Members have said, a lack of community provision is placing excessive strain on the NHS with regard to A and E and bed blocking, and my local authority in Trafford has received repeated reports that a lack of access to rehabilitation, physiotherapy, speech and language therapies—for example, after a stroke—and to support and care packages means that it is often impossible to discharge someone, even when they are medically fit to go home. That backdrop is of particular concern at a time when a significant reconfiguration of our national health service is being proposed in Trafford. There must be real concern about a squeeze on NHS services when community provision is not in place.
I am pleased that the Secretary of State has recognised the need for a single named professional to have oversight of an individual’s health and social care needs, but the fragmentation and contracting of NHS services does not help. Competition works against the integration of primary, secondary, tertiary and social care and, as many colleagues have said, cuts to local authority budgets are having a massive effect. Trafford is cutting nearly £3 million this year from social care budgets, which means cuts to day services, for example, or increased costs for meals. Curiously, the local authority intends to achieve a large part of those savings through the introduction of personalised budgets, which we understood were not intended as a savings measure.
Families want to help and keep loved ones at home, but they are under great pressure and rely particularly on day services and respite care. They tell me that assembling a personal package is complex. One constituent —a highly resourceful and articulate businessman—told me of his struggle to use a personalised budget to assemble a care package for his partner. He called seven potential providers, but most could not cope with assembling the package she needed to meet her complex needs. If my constituent could not put together that package, how—as he rightly asked me—will the more marginalised and excluded manage? He pointed to the importance of decent brokerage services, yet at the same time we are seeing cuts to advocacy services. There is already evidence that personalised budgets do not work so well for elderly people or those without family and friends to help.
It is not clear what the long-term effects of spreading personal budgets will be, but they could lead to further fragmentation of services or exacerbate inequalities. For example, there is evidence of a lack of cultural awareness among brokers and providers, and the complexity of putting together a personal care package may leave the most excluded even further behind. I invite Ministers to tell the House what steps they will take to monitor the impact of personal budgets on inequality and outcomes for the elderly and most vulnerable.
Norman Lamb
Does the hon. Lady accept that there has sometimes also been a lack of cultural awareness in the traditional way of delivering services when people make assumptions about someone’s care needs and the right way to deliver them? Putting the individual in charge and letting them determine their priorities gives us a better chance of getting it right and meeting the cultural choices that are so important to people.
Kate Green
I accept what the Minister is saying but evidence suggests that for certain more disadvantaged and vulnerable individuals, articulating those needs is very difficult and so culturally appropriate advocacy, representation and brokerage services will be of huge significance. Evidence from research carried out so far suggests that the effects of personal budgets are patchy. I am sure the Minister will wish to raise standards across the board, and I look forward to the further work that we—collectively and with local authority colleagues—can do to ensure that that is the case.
Work force issues relating to social care are also a concern. As others have pointed out, many of those working in social care earn the national minimum wage and contract pressures mean that they have little time to do more than rush in and out of appointments and provide the basic physical care that clients need. There is little time to stop for a chat or a cup of tea, or for some of the social interaction that is so valued by those in receipt of social care. Many providers have told me they are anxious and that they are being screwed down on pricing as a result of local authority spending pressures, which could lead to their contracts becoming unviable. Poor levels of pay— as my hon. Friend the Member for Bridgend (Mrs Moon) said, staff are often not paid as they move from one appointment to the next—mean that they will not be motivated to provide the best care in those circumstances, and some will be forced to give up their jobs.
Finally, I welcome the development of extra care for those in need of residential care, and some good projects are under development in Trafford. I hope the proposed development in Old Trafford will receive approval. As colleagues have pointed out, the Dilnot recommendations, as taken forward in a more limited form by the Government, will leave many families in my constituency with substantial costs but without liquid savings with which to meet them, meaning they are still likely to be forced to consider the sale of the family home.
Overall, the Queen’s Speech needed a much bolder approach to prepare us for an ageing society, including policies for maximising saving in working age—difficult when the Government are putting family budgets under such pressure—and a bolder approach that looks at combining health and social care budgets, investment in primary and community health provision to keep people out of hospital longer, integration over competition, personalisation accompanied by a service investment programme, and serious attention to work force development. I regret the many missed opportunities in those areas in the Queen’s Speech.
A and E Waiting Times
Kate Green Excerpts(11 years, 5 months ago)
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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.
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.
Oral Answers to Questions
Kate Green Excerpts(11 years, 5 months ago)
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Anna Soubry
I am afraid that the hon. Gentleman’s question depicts a situation that I simply do not recognise. As I visit hospitals and other organisations, both in my constituency and across the country, I am told that there has been a huge improvement, especially in commissioning—[Interruption.] No, by front-line clinicians, who talk with enthusiasm about how the commissioning of services has improved because now at last the clinicians—those who know best—are in charge, and not, as has often been the case, faceless bureaucrats and managers.
Kate Green (Stretford and Urmston) (Lab)
15. When he expects to take a decision on the reconfiguration of hospital services in Trafford.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Following a referral from the joint Manchester and Trafford health overview and scrutiny committee, the Secretary of State requested initial advice from the independent reconfiguration panel. That was received on 27 March 2013. The Secretary of State will consider the advice and make a decision in due course.
Kate Green
This issue is of huge importance to my constituents, who are concerned about access to accident and emergency and acute services and about delays in discharge into the community in the absence of adequate community provision. So far, Ministers have refused to meet me so that I can make representations about my constituents’ concerns. Will the Minister give me an undertaking that no final decision will be taken until that meeting can take place so that local concerns can be properly taken into account?
Dr Poulter
I am sure that we would be happy to meet the hon. Lady; I am certainly happy to do so. A number of the concerns she has outlined in the House and at a local level will be taken into consideration by my right hon. Friend the Secretary of State when he considers the report.
Oral Answers to Questions
Kate Green Excerpts(11 years, 7 months ago)
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Mr Russell Brown (Dumfries and Galloway) (Lab)
4. What the reason is for the time taken to produce the Government’s sexual health policy document; and when he now expects it to be published.
Kate Green (Stretford and Urmston) (Lab)
11. What the reason is for the time taken to produce the Government’s sexual health policy document.
The Parliamentary Under-Secretary of State for Health (Anna Soubry)
This is an important document, which we want to get right. I anticipate that it will be published next month.
Anna Soubry
I certainly support the sentiment behind the hon. Gentleman’s question, and make it clear that I wanted to ensure that the document included the need for everybody to eradicate prejudice in all sexual health work. I was very keen to put that in the document, and I am sure he will join me in welcoming its publication, which will, we hope, be next month.
Kate Green
The under-18 pregnancy rate has fallen by 25% in the past 10 years. Will the Minister confirm that the strategy document will make it clear that it is important to protect specialist, dedicated sexual health services for young people, such as the Brook service at the Talkshop in Trafford in my constituency?
Accident and Emergency Departments
Kate Green Excerpts(11 years, 7 months ago)
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Kate Green (Stretford and Urmston) (Lab)
I want to speak about changes to the A and E department at Trafford General hospital in my constituency.
Over the years, Trafford General has experienced financial and management problems, and last year it was absorbed into Central Manchester University Hospitals NHS Foundation Trust. We all expected that there would be a reconfiguration of services following that acquisition, and that is what happened. Last month, following public consultation on the so-called new health deal for Trafford, NHS Greater Manchester announced its intention to proceed with a downgrade of the A and E at Trafford General, first to an urgent care centre open from 8 am until midnight, and in due course to a nurse-led minor injuries unit, alongside other changes to services. I expect those changes now to be referred to the Secretary of State for decision.
Nobody in Trafford is opposed to change that can improve clinical care. Already, major trauma cases are diverted away from Trafford General, while serious stroke and cardiac cases go not to Trafford but to centres of excellence at Salford Royal, University Hospital of South Manchester and Manchester Royal Infirmary. That approach is widely understood and accepted by the public. Equally, plans to develop a model of integrated care locally are popular, and it is recognised that they could help to keep people out of hospital for longer.
However, there are consequences to the reconfigurations that have already taken place and to what is now proposed. More than half of Trafford residents now attend an A and E other than Trafford General, partly because more specialist and complex cases are rightly diverted to other centres, partly because local people are choosing to attend other nearby hospitals that offer them greater convenience or the kind of care they want, partly because it is widely believed that ambulances will not take people to Trafford General unless they specifically instruct them to do so, and partly because the whole downward spiral in activity is reinforcing public behaviour so that they are increasingly even less likely to decide to go to Trafford General. In other words, reducing activity levels are, to a degree, a self-fulfilling prophecy.
There are concerns about the capacity at neighbouring hospitals. My right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) has been raising concerns about capacity at the University hospital of South Manchester in Wythenshawe since we first knew about the proposals last summer. Its A and E is already coping with tens of thousands more admissions than the 70,000 for which it was designed. It simply cannot absorb more patients from Trafford without additional investment.
Commissioners assure me that there is progress in the development of integrated care, but that is pretty well invisible to local people. Recovering patients report long waits and great difficulty in getting rehabilitative care and support at home. In the meantime, many of the admissions to our A and E are elderly and frail patients, which is undoubtedly in part the result of the gulf between the ambition for integrated preventive services in the community and the reality.
There are concerns about the capacity of the North West ambulance service. If there is a reduction in hours and capacity at Trafford general, there will clearly be more patient journeys to other hospitals. There are also worries about what will happen if mental health patients present at Trafford general’s urgent care centre and it does not have the capacity to care for them.
All of that is taking place against the backdrop of a wider planned reconfiguration across Greater Manchester. Last year, in the middle of the consultation on the changes at Trafford, we learned about Healthier Together, a major redrawing of health care provision across Greater Manchester, including A and E provision. If, as is likely, that leads to further closures and reductions in A and E services across Manchester, there will be further capacity questions that will have a significant effect on Trafford. We are in an invidious position. It has been said that the new health deal for Trafford offers the best hope of a secure future for Trafford general, but we are planning in a vacuum. We know for sure that change is coming, but we have no idea what it will look like.
Late last year, my right hon. Friend the Member for Leigh (Andy Burnham) wrote to the Secretary of State asking him to halt the reconfiguration at Trafford and to consider it within the wider Healthier Together review. The Secretary of State refused to do that, but he has offered no guarantees or reassurances regarding the impact of Healthier Together on Trafford general.
There is now a broader context still with Sir Bruce Keogh’s review of emergency services. I hope that the Minister will reassure me that decisions about the future of services at Trafford will not pre-empt Sir Bruce’s review. Sir Bruce has made it clear that it is vital that new services are in place before existing services are closed. In The Guardian on 24 January, he was quoted as saying:
“I don’t think we can change the system until we know we have a solution that is OK.”
He specifically highlighted concerns about
“the idea of some poor mum having to travel to A&E on two buses because we closed an A&E down and she doesn’t have confidence that what is left is good enough”.
That is precisely our fear in Trafford.
I have no doubt about the good intentions and efforts of local NHS managers and commissioners, but they are being constrained by financial pressures and limited, as has become clear this afternoon, by a lack of overall vision and strategy from the Government. Local people cannot be expected to sign up to changes that they do not know have been future-proofed against changes that we know are imminent.
Last month, my right hon. Friend the Member for Leigh set out a vision for the future of district general hospitals such as Trafford general, which offered a different kind of future and a secure one. I agree with the hon. Member for Croydon Central (Gavin Barwell) that it is important to strike the right balance between quality and convenience, but process and trust are also important. Today, I have to inform the Minister that people do not feel that trust in relation to the plans for Trafford.
Oral Answers to Questions
Kate Green Excerpts(11 years, 8 months ago)
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Mr Hunt
I am interested to hear that suggestion from the Labour Benches, which is not necessarily where I would have expected it to come from. The hon. Gentleman might be surprised at my response, which is that I would be very concerned about such a system. I understand the issue and I think we need to modernise the process of GP and hospital appointments. Technology can play a good role in that, for example by giving people text reminders of appointments that they have booked. My concern is that the system suggested by the hon. Gentleman would put people off going to see their doctor if they needed to. I would not want to do anything that deterred people from using the NHS who most need to do so.
Kate Green (Stretford and Urmston) (Lab)
10. What estimate he has made of the number of patients who waited longer than four hours for treatment in accident and emergency departments in 2012; and if he will make a statement.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
In 2012, the NHS saw nearly 22 million people in A and E across the country, with 96% seen within four hours, which I am sure the hon. Lady will agree is a great achievement. That means that the A and E clinical quality indicators for high-quality patient care are being met in the NHS.
Kate Green
Last week, the Manchester Evening News reported that more than 1,000 patients had waited more than four hours at A and Es across Greater Manchester in December. I am sure the Minister is well aware of the planned downgrading of services at Trafford general hospital, and I understand that last night the joint health scrutiny committees of Trafford and Manchester agreed that the proposals should be referred to the Secretary of State for decision. Given last month’s alarming figures, will Ministers assure me that in reaching a decision about the future of Trafford general hospital, full account will be taken of capacity across Greater Manchester?
Dr Poulter
I thank the hon. Lady for her question. I recognise her concerns for her constituents. As has been outlined, there are seasonal variations, and I am sure that local commissioners will want to take such issues into account when they make decisions, and they must meet the reconfiguration tests set out by the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley).
Oral Answers to Questions
Kate Green Excerpts(11 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
7. What steps he is taking to ensure that primary care trusts do not ration access to NHS treatments and operations.
Kate Green (Stretford and Urmston) (Lab)
12. What steps he is taking to ensure that primary care trusts do not ration access to NHS treatments and operations.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Rationing on the basis of cost alone is completely unacceptable. That is why the Government are increasing the NHS budget by £12.5 billion over the life of this Parliament and giving front-line health care professionals the power to decide what is in the best interests of patients.
Dr Poulter
It is worth pointing out to the hon. Lady, who raises a legitimate point about that gentleman’s case—[Interruption.] The right hon. Member for Leigh (Andy Burnham) says “Do something”, but this type of rationing of varicose vein surgery occurred when the previous Labour Government were in power—[Interruption.] It did, and rationing of many other types of services was much worse. It is this Government who have introduced the cancer drugs fund to stop the rationing of cancer treatments to patients, which has benefited 23,000 extra patients, and many more elective procedures are taking place across the NHS every single day. On the specific case the hon. Lady raises, obviously if her constituent has a specific concern, there are safeguards in place locally for him to raise it if he thinks the decision is not based on clinical criteria.
Kate Green
Trafford primary care trust offers one cycle of in vitro fertilisation treatment to women up to age 29. The Minister will be aware that the National Institute for Health and Clinical Excellence guidance is for up to three cycles and up to age 39. Last year the all-party group on infertility pointed out that a very large majority of PCTs were not meeting the NICE guidance. Why does he think that is, and what is he going to do about it?
Dr Poulter
Of all Ministers in the House, the hon. Lady has probably asked the right one about this issue. This is a long-standing problem that goes back many years. There has been great variability in the availability of IVF in different parts of the country, and, at a national level, NICE finds that unacceptable. I will be taking the matter forward, and I assure her that we will make sure that we do all we can to iron out that variability and follow NICE guidelines so that everyone can receive the best IVF treatment.
Induced Abortion
Kate Green Excerpts(11 years, 11 months ago)
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Nadine Dorries
Later in my speech, I will address the evidence for that.
After the forthcoming debate allocated by the Backbench Business Committee, if there is a positive vote, if the debate is strongly attended and if Parliament expresses a strong feeling, that will send a strong message to the Government to bring the 1967 Act back to the House.
In 1990, the 1967 Act was amended to reduce the upper limit from 28 weeks to 24 weeks. I hope there will be a fuller debate in May, but in the meantime, following today’s debate, I will write to the Royal College of Obstetricians and Gynaecologists guideline committee, enclosing a copy of the Hansard of our speeches today, and ask it to look again. 1990 was a long time ago. As my hon. Friend the Member for Tiverton and Honiton (Neil Parish) said, things have progressed and science has moved on.
If the RCOG guidelines committee advised, based on the evidence available at the time, that the upper limit should be 24 weeks—
Nadine Dorries
I will give way only once more, as lots of people want to speak.
Kate Green
The hon. Lady implies—perhaps I misinterpret her—that the RCOG has not considered the guidelines since 1990. In fact, its most recent report was published in 2010, and it still says that foetal viability is very low up to 24 weeks. In fact, at 20 weeks it is 0%.
Nadine Dorries
I will address that point in a moment. I will not give way any more, as I know that lots of people want to speak.
I want to make it clear that my proposal to reduce the upper limit does not include babies with foetal abnormalities or, sadly, disabilities. That is a discussion to be held, as I have said, between parents and doctors. Abortion is available up until birth for foetal abnormalities. My proposal applies to abortions for social reasons.
A study by the Centre for Sexual Health Research at the university of Southampton and the School of Social Policy, Sociology and Social Research at the university of Kent found that 41% of women who have second-trimester abortions do so because they were not sure about having an abortion and took a while to make up their mind to ask for one. I believe that one positive effect of reducing the limit to 20 weeks might be to focus the mind slightly sooner than 23 weeks. Because abortion is available until 24 weeks, there is a laxity, as people have a prolonged period to make up their mind. The research says that women took a long time to make up their mind. Maybe reducing the upper limit will help.
It is clear to me that we cannot allow the present situation in our hospitals to continue. In one room in a hospital, there might be a premature poorly baby born at 22 or 23 weeks at whom the NHS will throw everything it has to help it survive. In another room in the same hospital, a healthy baby will be aborted at 24 weeks. Dr Max Pemberton recently wrote in The Daily Telegraph that
“many doctors are uncomfortable with the current cut-off point. It is not something we openly discuss, because we know it is a highly emotive area. But privately, many doctors will express discomfort that the current legislation is inherently illogical and inconsistent. Any doctor who has found themselves in the neonatal intensive care unit of a hospital will be acutely aware of it. In the same hospital where doctors are trying to save a premature baby born at, say, 23 weeks, a woman down the corridor is legally allowed to undergo a late-stage abortion on a foetus of the same gestation. So on the one hand we throw considerable money and resources to try to save a baby’s life, while on the other we sanction its destruction.”
I have consistently made that argument for the past seven years. The medical profession cannot make two arguments. Doctors cannot say that a poorly baby’s life is worth trying to save from 20 or 21 weeks onwards while stating at the same time that there is no chance of life up to 24 weeks, so it is okay to abort up until that point. There is an inconsistency in retaining 24 weeks. Should there be a case to say that doctors should not try to save the life of a poorly baby born before 24 weeks’ gestation? Can hon. Members imagine the uproar if we said, “Okay, the RCOG has said that viability is 24 weeks, so we really shouldn’t be saving premature babies before 24 weeks”? We should say, “No, the point of viability is 24 weeks, so we should stop. Wipe out the neonatal units, wipe out the premature units. Viability is not consistent before 24 weeks.”
Doctors cannot have it both ways. They cannot say in the NHS, “We try to save babies from 20 weeks because they are viable,” and then say, “We abort at 24 weeks because they are not.” The two arguments cannot stand. That is an anomaly, and it must end.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Member for Mid Bedfordshire (Nadine Dorries) on securing the debate. I am pleased to speak in this debate, and my position will become very clear. I believe in human rights. I believe in the most basic of human rights, the right to life, so I am against abortion. I believe that the strong have a duty to protect the weak and the vulnerable. It is that protection that I seek to uphold, and that is why I am here to speak on this matter.
I begin by stating clearly that I am against abortion, except in the extreme case in which it is done to save the life of the mother. Statistics show that Northern Ireland, which has a restrictive abortion law, has the lowest maternal death rate in the whole of the United Kingdom. That is backed up by the fact that the Republic of Ireland has almost the lowest maternal death rate in Europe, and has no legislation that allows abortion. The UK mainland, with its more liberal abortion law, has a higher rate of maternal deaths. That speaks volumes, and it is clear that restricted abortion to save the mother’s life, which we have in Northern Ireland, works well to save both mother and child.
If there was the option of bringing in Northern Ireland’s abortion laws, I would be pleading with everyone in this House to do just that. I have been contacted by the Christian Medical Fellowship, which states things clearly. Today’s debate is calling for a small reduction in the upper time limit for legal abortions. That will affect approximately 2,000 abortions that are carried out for social reasons—I use the phrase “social reasons”, because that is why they are happening—out of a total of nearly 200,000 abortions per year. It will not prevent the abortion of babies with foetal abnormality up to term.
This issue is emotive. A large number of people have contacted me and asked me to watch the scans of a 20-week-old baby to remind me of the humanity behind our decisions. When I look at a baby at 20 weeks’ gestation sucking its thumb, having the hiccups, crying and blinking, it is beyond me how anyone in good conscience, in this House or outside, could say that it is fine to rip away life at this stage. It is not fine. It is never going to be fine. A 2008 study by University college London found that survival rates were more than 70% for babies born between 22 and 25 weeks when high-quality care was available.
Kate Green
It is really important that we are accurate about these figures. At 24 and 25 weeks, survival rates improve a lot, but at 20 to 24 weeks, survival rates are very low: zero at 20 weeks; 1% at 22 weeks; and 11% at 23 weeks. It is wrong to imply that at under 24 weeks, we have survival rates of 75%.
Jim Shannon
I thank the hon. Lady for her intervention, but life is life as far as I am concerned; that is where I am coming from.
The survival of more than 70% of babies born between 22 and 25 weeks when high-quality care is available blows away the argument that a baby can be aborted until it is viable at 24 weeks. Recently, in America, a baby of 21 weeks responded to stimulus, crying and smiling, so there is evidence that shows clearly that it can happen. All the things that we associate with life are in evidence before the time of so-called viability.
I will give the example of a young girl from my constituency. A friend of mine had a grandchild who, they were warned, would not survive as she was so premature. The family prayed hard, and asked for all possible treatment to sustain the baby’s life. Today, Zoe-Lee is 13 years of age and is the light of her parents’ life. It is scary to think that if an abortion had been allowed at that time, that young girl would not be here today.
The question that has been posed to me by members of the medical fraternity is: how much longer can we justify doctors desperately—the hon. Member for Mid Bedfordshire referred to this as well—trying to save premature babies born at 23 weeks, while down the corridor in the same hospital, another doctor is aborting a 23-week baby, which is perfectly healthy, for social reasons?
A 24-week upper limit in the UK is outdated and out of line with other EU countries. In 2008, our 24-week upper limit was double the 12-week limit for most EU countries. Some 16 out of 27 other European countries had a gestational limit of 12 weeks or less, so if we want to be in line with other countries that have high standards, then let us do that.
Ask any woman who has miscarried a baby in early term—at, say, at 12 weeks—and she will tell you that she saw its perfectly formed fingers and toes, its spine and head, and that wee face. For me, it is almost unimaginable to take it from the womb at this stage, never mind any later, and to ask any general practitioner to do this is grossly unfair. I am no man’s judge, and I feel for those women who have felt that they had no other option than to take this step.
Julie Elliott (Sunderland Central) (Lab)
I thank the hon. Member for Mid Bedfordshire (Nadine Dorries) for introducing the debate, although I wonder why now. I listened to hon. Members’ contributions, and I agree with some of the arguments from both sides. I agree that abortion should available on demand until 12 weeks, and that there are serious issues about termination on gender grounds that need looking at, but the crux of the matter is about reducing the termination limit from 24 to 20 weeks, and I keep asking why now. There is no new medical evidence. The majority of professional bodies support a 24-week limit, including the British Medical Association, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the British Association of Perinatal Medicine, and the general public.
Kate Green
This is the first time that public opinion has been mentioned in the debate. Is my hon. Friend aware of the recent YouGov survey report about a week ago which showed that 47% of the public support a 24-week limit, 4% believe it should be even later than 24 weeks, and 33% want it reduced?
Julie Elliott
I thank my hon. Friend for her contribution. I am aware of the report, but it was worth telling hon. Members.
Is the answer to “Why have the debate now?” that there are more late abortions? No. The contrary is true, and 91% of abortions take place at less than 12 weeks, which is when most of us want them to occur. Only 1% take place after 20 weeks, and the figure is falling every year. There has been mention of whether a foetus feels pain, and I refer to a report from the Select Committee on Science and Technology in 2010. The Royal College of Obstetricians and Gynaecologists was commissioned by the Department of Health to update the report on foetal awareness. It concluded:
“The fetus cannot experience pain before 24 weeks gestation due to lack of development of essential parts of the brain required for pain perception.”
I turn to improving survival rates. They are improving at more than 24 weeks, and during the 20 years since the limit was changed, they have improved significantly. When I had my twins in 1991, the 28-week survival rate was quite low, and that has improved, but that is not the case below 24 weeks.
Have the people presenting for late abortion changed? No, they have not. In the main, they are still the most vulnerable people in our society—the very young, older women who may not have realised that they were pregnant until a very late stage, pregnancy deniers, and people suffering domestic abuse. The list goes on. I suspect that many of those people do not realise how many weeks pregnant they are when they present to the medical profession.
The issue is so sensitive that we should consider the impact of our debate on the general population. As medical evidence has not changed since 2008, I wonder why we are discussing the matter now. Our discussions today will have an impact on vulnerable people in our society, because the subject is upsetting, distressing and worrying for them. They may just read the headlines of the debate, which I suspect will be on the scaremongering side, because that is what has happened in the past, and that can make people feel even more vulnerable.
Oral Answers to Questions
Kate Green Excerpts(11 years, 11 months ago)
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Mr Hunt
My hon. Friend is right to highlight this point. In the draft Care and Support Bill, local authorities will be required to meet the eligible needs of carers. That is a particular concern with dementia, because, all too often, someone looking after a partner with dementia gets to a tipping point where there is no alternative to residential care, but, if we can give them better support, they will have a better chance of remaining at home, which, in the vast majority of cases, is where they want to be.
Kate Green (Stretford and Urmston) (Lab)
Many elderly people with dementia remain trapped in hospital, because there is not adequate provision in the community for them to be looked after at home. How does the Secretary of State intend funds to be extracted from hospitals to be spent in the community, particularly at a time when local authority funding cuts mean that many of the voluntary agencies providing that support are actually losing posts in my borough?
Mr Hunt
The hon. Lady is right to highlight this growing issue. One million people will have dementia by 2020, so we have to take it very seriously. It is not an either/or situation, though, because about 25% of patients in hospitals have dementia, and hospitals would like them placed in the community or at home, where they can be better looked after. This is one of those examples where, under the new reforms, we need much greater integration of services to ensure that those people are treated in the way they need to be.