NHS

Margot James Excerpts

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham]

That is an indictment of the Government. They have made it harder for people to afford a good basic diet. We have seen a rise in hypothermia, rickets and scurvy. Sadly, we have also seen the rise of food banks under this Government. That is why I am beginning my speech by saying that there is a range of reasons for the sustained pressure on A and E.

[Margot James (Stourbridge) (Con)]

rose—

[Yasmin Qureshi (Bolton South East) (Lab)]

rose—

[Andy Burnham]

I will make a little progress and then I will give way.

There have been record levels of hypothermia this year and thousands of over-75s have been treated in hospital for respiratory or circulatory diseases. That brings me to the second underlying cause of the increase in attendances at A and E. The ageing society is not a distant prospect on the horizon. Demographic change is happening now and it is applying increasing pressure on the front line of the NHS.

We all need to face up to the uncomfortable fact that our hospitals are increasingly full of extremely frail elderly people. Too many older people are in hospital who ought not to have ended up there or who are trapped there because they cannot get the right support to go home. That situation is unacceptable and it has to be addressed.

[Margot James]

Does the right hon. Gentleman not accept that the emergence of older people visiting A and E in far greater numbers has been coming on for a long time? I know that he does not like to be reminded of the 2004 GP contract, but surely he agrees that it is a factor, because older people have not been able to get the necessary support over a long period. The Government are putting that right by integrating health and social care far better.

[Andy Burnham]

The hon. Lady wants me to answer that question, but I direct her to her right hon. Friend, the Chairman of the Health Committee, who has dismissed the self-serving spin from the Government that says that these problem are all to do with a contract that was signed 10 years ago. I began my speech by citing figures that show an exponential rise in the number of people attending A and E since 2010. Many of those people are very frail older people. That is the issue before the House, so it does not help the debate for the hon. Lady to stand up and make a spurious political point.

--- Later in debate ---

[Andy Burnham]

First, I would be grateful if the hon. Gentleman did not continue to misrepresent what I said on the NHS. I have never said, “Cut the NHS”. I stood at the last election on a commitment to protect the NHS budget in real terms. He stood on a manifesto promising real-terms increases for the NHS. I said that if there were to be increases for the NHS, they should be given to social care instead, and that would have relieved some of the pressures on A and E. Let us have the facts straight.

Secondly, the hon. Gentleman boasts about having enough A and E doctors. Perhaps he should speak to people from the College of Emergency Medicine and hear what they have to say on that subject. They talk of warning the Government of a recruitment crisis in A and E about two or three years ago. They said that they could not get through to Ministers who were obsessed with structural reorganisation. They were left feeling like John the Baptist crying in the wilderness—their words. Perhaps before the hon. Gentleman shouts the odds in the House, he should speak to the people who know about these things and who warned his Government —who failed to act.

One of the major problems with the pressure on A and E is the number of older people trapped in hospital. This is a product of demographic pressure and the ageing society. Nursing staff talk of how, when they first qualified, it was rare to see someone in their 90s on the ward. Now they are there in great numbers and that makes the task of meeting their needs much more complex. When people reach an advanced age it is simply not possible to separate out their physical, social and mental needs. Need becomes a blur of all three. Our hospitals are not geared up to provide the additional mental and social support that very frail elderly people often need.

[Margot James]

Will the right hon. Gentleman give way?

[Andy Burnham]

I have given way to the hon. Lady once: I want to make some progress.

Some, but not all, of the needs of older people are met in an acute hospital environment, which explains why their condition often drops like a stone. It is a phenomenon that was accurately identified by Robert Francis QC in his report, published a year ago this week. He called for an overhaul of the way in which older people are cared for in acute hospitals. He was right to do so, and while I applaud some of the steps the Secretary of State has taken in that regard, such as the move towards a named consultant, I do not believe it will tackle the root cause of the problem, which is the arrival of far too many older people in hospital in the first place. Only when that is tackled will we begin to address the underlying causes of the A and E crisis.

--- Later in debate ---

[Andy Burnham]

My hon. Friend is absolutely right. She knows the pressure people are under in our area. What we have heard from the Government is denial that this is the reality in many parts of the country. [Interruption.] We can hear them shouting now, claiming that it is a myth that people are using food banks and not eating properly, and that they cannot afford to heat their homes because of the rise in fuel bills under this Government. All of that is placing extra pressure on A and E, and people are waiting longer and longer to be seen.

[Margot James]

rose—

[Andy Burnham]

I give way to the hon. Lady, but this will be the last time.

[Margot James]

I thank the right hon. Gentleman for giving way; he is being very generous. As he is widening the debate out to the wider economy, does he not accept that, although there are many reasons for increased A and E consultations and some of the issues relating to nutrition are valid, the point made by the hon. Member for Bolton West (Julie Hilling) about people not being able to afford prescriptions must be fallacious? They will receive free prescriptions if they have a very low income and are attending food banks. There are many more reasons than the right hon. Gentleman is giving credit for.

[Andy Burnham]

Not for the first time, Government Members are showing how out of touch they are with what is happening. The hon. Lady says that she is not aware that any family is unable to afford a prescription item. Let me put her straight: that is what many families are facing at the moment, particularly those who are in work, who do not get free prescriptions. They are facing difficult choices about whether they can afford to buy their prescriptions. If she is saying she does not recognise that problem, then I am afraid she really needs to get out of this place a bit more.

--- Later in debate ---

[Luciana Berger]

I just do not know what to say to that because it is so ridiculous. There was an increase of 16,000 in the last three years of the Labour Government, which has rocketed to 633,000 in the first three years of this Government. The gap in those figures is tremendous. The GP contract happened in 2004. When have we seen crises in A and E? Not under the Labour Government, but under this Government—the Tory-Liberal Democrat Government.

What else has happened under this Government? We have seen the Health Secretary handing back £2.2 billion of underspend to the Treasury, 2,300 managers receiving six-figure pay outs and £1.4 billion siphoned off to pay for redundancies. My right hon. Friend the Member for Leigh also raise the issue of the amount of money NHS trusts are now having to spend on expensive legal fees as a result of competition, introduced through the Health and Social Care Act. That goes to show that when it comes to our NHS, this Government know the cost of everything but the value of nothing.

As the hon. Member for Stafford (Jeremy Lefroy) said, our elderly population is growing, but half a million fewer older people are receiving support compared to 10 years ago. That means more older people going to A and E because they cannot receive the care they need at home, and more older people stuck in hospital beds because there is no safe place to discharge them to.

[Margot James]

Will the hon. Lady give way?

[Luciana Berger]

I am not giving way because I have only three minutes left.

As my right hon. Friend the Member for Leigh said earlier, the CQC recently reported that in the last year, more than half a million pensioners were admitted as an emergency to hospital with potentially avoidable conditions. There is another reason for that: it is now harder, not easier, to get a GP appointment under this Government. The Royal College of General Practitioners says that it will soon become the norm for people to wait a week or longer to see their GP. Just this week, I was contacted by a constituent whose partner was suffering from chest pains. They contacted the GP but could not get an appointment for eight days.

This is what patients are having to endure right across the country, and it is being made even harder by the cost of living crisis hitting families all over Britain. People are having to eat less, and less healthily, and more than half a million people are being forced to turn to food banks. As my hon. Friend the Member for Worsley and Eccles South described so poignantly, carers are having to make the choice between heating and eating. GPs are now asking patients when they last had a meal. It is no coincidence that, as food bank use has exploded, so have cases of malnutrition. There has been a 42% increase in malnutrition cases, and in 2012-13 more than 5,000 people were thus diagnosed in English hospitals. I share the view of my hon. Friend the Member for Stretford and Urmston that that is a disgrace in 21st-century Britain.

Doctors are now treating diseases we thought had all but disappeared. It is not just scurvy; rickets and vitamin deficiency are also on the rise. The Government have already given us the longest fall in living standards since the 1870s; we now have the Victorian diseases to match. They should be ashamed of every single case of these 19th-century diseases returning to 21st-century Britain.

That is not all. With energy bills up by £300 and more children living in fuel poverty, is it any wonder that episodes of hypothermia have jumped by 40% in the past three years? We have seen a 29% increase in the number of excess winter deaths—31,000 deaths that by definition were entirely preventable—while new figures this week show a dramatic increase in the number of older people being admitted to A and E for cold-related illnesses. Furthermore, there have been 145,000 more cases of over-75s being treated in hospital for respiratory or circulatory diseases, compared with 2009-10.

Ministers cannot resolve the crisis in our NHS. They know what is happening and that their policies are stoking the crisis, but they will not admit it. Only Labour can preserve, protect and progress our NHS. Our approach focuses on the patient, and it champions integration and collaboration, not competition, fragmentation and profit. We want a public, integrated NHS free at the point of use, and a whole-person approach that combines physical, mental and social care and helps to take the pressure off A and E. That is the principle behind our motion today, and I urge Members on both sides of the House to support it.

--- Later in debate ---

[Norman Lamb]

I certainly think we have to avoid any repeat of what happened in Bournemouth. It is absolutely right for politicians to make that clear.

The Labour party has tried to paint a picture of crisis in A and E. We know that there is more pressure on this vital service.

[Margot James]

My hon. Friend is making some excellent points about Labour’s record of inviting competition into the NHS when in office. The success of that record might have been the reason why Labour’s manifesto in 2010 promised:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs”.

[Norman Lamb]

If I am right, that is called “any qualified provider” or “any willing provider”, which is exactly what this Government have pursued. Labour’s rewriting of history is breathtaking.

There are 1.2 million more people visiting A and E than three years ago—the hon. Member for Stretford and Urmston (Kate Green) is right that the system is under pressure—but the increase in the number of A and E attendances peaked in 2009-10, under the previous Labour Government, when there was a year-on-year increase of 4.7%. Since then, the increase has been slower, and in the last full year for which data are available it was just 1.2%—clear evidence that the Government’s policies are starting to work.

Doctors and nurses in our A and E departments up and down the country are doing brilliant work. Last week the NHS not only met the four-hour A and E target, but improved on its score from the same time last year. By contrast, in Labour-run Wales, A and E targets have not been met since 2009. The College of Emergency Medicine has said that Welsh A and E departments are on their knees, at the “point of meltdown”, and are putting patients at risk in Labour-run Wales. The college has complained of the ruthless

“pursuit of targets and financial balance at the expense of quality of care.”

In England, we have already met the target for more weeks this winter than when the right hon. Member for Leigh was Health Secretary. He missed his A and E target for two of his three quarters—was that a crisis in those days?—whereas we are seeing 2,000 more patients every day in under four hours than when Labour was in government. Ambulance performance is better than at the same time last year, meaning more ambulances arriving on scene in under eight minutes. Across the country, delays in handing over patients at A and E have dropped by a third compared with last year as a result of new sanctions, so we are not complacent.

As my hon. Friends the Members for Suffolk Coastal (Dr Coffey) and for Witham (Priti Patel) rightly said, we are sorting the problem. Opposition Members would like people to think that the NHS is going to ruin. They are so desperate—using the examples of scurvy and rickets. Of course, when that happens it is incredibly serious, but to suggest that that is part of the problem is outrageous. We heard the figures for scurvy, but there were 66 admissions for rickets in 2010-11 and 65 in 2012-13, so the figure has gone down. The truth is that we inherited a dysfunctional system that was crying out for reform—too many people ending up in hospital because of crises in their care, and far too much money spent on bureaucracy, as my hon. Friend the Member for Witham made clear.

For years I have argued the case for a different approach. We are making the essential changes and supporting NHS staff through difficult times. For this winter we are investing an additional £400 million in total—more than ever before. Having put plans in place earlier than ever before, with urgent care boards deciding what works in local areas, we are already seeing the benefit of those additional funds, with 320 more doctors, 1,400 more nurses, 1,200 other staff—occupational therapists, physiotherapists and so on—and more than 2,000 additional beds.

Throughout this debate we have heard that urgent and emergency care needs to change, and rightly so, but may I remind the House that we are the Government who are making that change? We have asked Bruce Keogh to undertake a fundamental review of urgent and emergency care, but there are still far too many people ending up in hospital because of crises in care. There are too many people with long-term conditions who are still receiving unco-ordinated care. That is frustrating for the patient, it wastes money for the system and it can lead to worse health outcomes, as we fail to prevent such conditions from getting worse. It is our aim in government to join up services, fitting them around people’s lives and providing better care closer to home.

The right hon. Member for Leigh seems to have had a recent damascene conversion to the case for integration. It is a shame that in the 13 years his party had in power, it did nothing significant to achieve it. In fact, many of the things it did and the decisions it made took the NHS in the wrong direction—on tariffs, on incentivising more activity in hospitals, on the disastrous private finance initiative and on the equally disastrous GP contract. I am proud to say that it is this Government who are taking the practical steps to make integration more commonplace throughout the country. We have selected 14 integrated care pioneers and we now have the £3.8 billion better care fund to achieve joined-up care throughout the country.

The truth is that the right hon. Gentleman and the whole of the Opposition have systematically dismissed the real issue with empty rhetoric. They want better care in A and E, yet we have started the reforms that will revolutionise urgent and emergency care. They want the health and care services to become more integrated. We are leading the charge to make that happen, and to improve care and support for people throughout the country. They want us to change competition law. We have made it clearer and easier to understand, and have balanced that with the need for integration, and the need to help doctors to know how and when to use it.

The Opposition are fighting their own shadow. Well, they can shadow-box all they want. They can waste time complaining rather than coming up with solutions, but this Government are actually tackling the issues, and making the changes to the health and care system that patients so desperately need.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.