Natascha Engel
Main Page: Natascha Engel (Labour - North East Derbyshire)Department Debates - View all Natascha Engel's debates with the Department of Health and Social Care
(8 years, 10 months ago)
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Madam Deputy Speaker (Natascha Engel)
Order. Before I call the Minister, I am putting a six-minute time limit on Back Benchers—that does not apply to Front Benchers. Six minutes is already a little over-generous, so may I make a plea for few interventions, so that we can get in as many Back-Bench speakers as possible? With that in mind, I call Ben Gummer.
Barbara Keeley
On a point of order, Madam Deputy Speaker. I really wonder whether this is within scope. Is it at all orderly to be debating which Minister is answering or proposing a debate? This happens quite a bit in this House—for example, the Chancellor did not come last week. It is just not orderly to be starting off the debate in this way.
Madam Deputy Speaker (Natascha Engel)
I thank the hon. Lady for that point of order. I think the point has been made. Perhaps we can move on with the debate.
Ben Gummer
It is a matter of importance, Madam Deputy Speaker, because in this episode of “Health Handbags”, we have been given an insight into the crisis within the Labour party and Labour Members’ inability to understand what the priorities are for the NHS and for the country.
If the NHS and A&E services are of such importance to the Labour party, one would expect the shadow Secretary of State—
Madam Deputy Speaker (Natascha Engel)
Order. If the Minister could sit down for a moment, I will take the point of order, which I imagine is very similar to the previous one. It would be nice if we could move the debate on, as there are several maiden speeches waiting to be taken. It is an important subject and I would like to move on, rather than get bogged down in this. I will take the point of order, and then I hope we will move on.
Robert Flello
I am grateful, Madam Deputy Speaker. For the benefit of new Members on both sides of the House, I think it would be helpful if you spent a moment clarifying when it is in order to challenge the Chair’s ruling on something and when it is not.
Madam Deputy Speaker (Natascha Engel)
Thank you very much. It is the person in the Chair’s decision whether something is within scope or not. I did not take the Minister’s response to my decision as a challenge to the Chair; I merely wanted to point out that it would be nice to get on with the debate and to allow other hon. Members to speak, especially new Members who wish to make their maiden speech. If the Minister could move on, we would all be very grateful.
Ben Gummer
With pleasure, Madam Deputy Speaker.
In the absence of the shadow Secretary of State, I shall channel him, which is something I enjoy doing. I like the right hon. Member for Leigh (Andy Burnham); he is a man who often—sometimes; a few times—speaks some sense. Just before the last election, he said that after the election,
“we need to come together, and then allow the NHS to get on with the job of building 21st-century services”.
What I do not understand about the motion that he and other Opposition Members have put before the House is that, far from coming together and trying to build consensus on the future of the NHS, what they are seeking to do—once again—is reproduce the golden oldies of criticism that they put before the country before the last election, and that were so roundly rejected.
That comment was about after the election. What I do not understand is what the shadow Secretary of State felt was the purpose of leading a campaign so politicising the NHS before the election. I, like so many others, had a leaflet through my letterbox saying that there were 24 hours to save the NHS—
Madam Deputy Speaker (Natascha Engel)
Order. We are straying into the general election, which has passed, and away from what is on the Order Paper, which is a debate on A&E services. If the Minister could stay on that subject, I would be enormously grateful.
Ben Gummer
With pleasure, Madam Deputy Speaker. The point is that we were warned that there were 24 hours to save the NHS, yet it is still there, and the A&E crisis, which is named at the top—
Madam Deputy Speaker (Natascha Engel)
Order. If the Minister could resume his seat, we are beginning to stray into the realms of challenging the Chair’s decision. We do not have much time and I do not want to take any more points of order on this one subject, so if he could stick to the subject on the Order Paper and let us move on, I would be very grateful to him.
Ben Gummer
I apologise, Madam Deputy Speaker.
The motion is about A&E services, and I would like to talk about the progress that the NHS has made in the past five years. Far from the picture painted today by the hon. Member for Copeland (Mr Reed) and Members who intervened during his speech, the NHS is treating more people than ever before, it is treating more people in A&E than ever before and it is treating more people at a higher rate of satisfaction than ever before, and the result of that is that patient outcomes—something we did not hear much about from the shadow Minister—have improved. We are treating more people to a higher standard.
Helen Hayes (Dulwich and West Norwood) (Lab)
I want to raise a point of substance that affects my constituents. There are young people in my constituency who would love to train as nurses and work in the NHS, but by cutting the number of training places in London by 25%, the Government have made that much harder. At the same time, when I last spoke to the recently retired chief executive of King’s College Hospital NHS Foundation Trust, he told me that he was recruiting nurses in the Philippines, because there are not enough nurses—
Madam Deputy Speaker (Natascha Engel)
Order. When the Chair is on her feet, Members sit. I have said before that interventions need to be very short and kept to a minimum. That was too long.
Ben Gummer
The shadow Secretary of State cut the number of training places for nurses; it was increased under the last Government and is now at a record level.
We were on the subject of performance, which is at the heart of the motion. The shadow Minister can speak warm words about the workforce, but he failed to congratulate them on their exceptional performance under unprecedented pressures. At no point in his speech did he acknowledge the real increase in pressure on A&E services in the NHS. Some 3,000 additional patients a day are being seen, treated and discharged in accordance with the 95% target; that is being delivered by NHS staff across the service. He fails to point out the places where we have seen remarkable successes. He fails to give the example of Barking, Havering and Redbridge University Hospitals NHS Trust, which saw a 16% improvement in A&E performance times in the last year. That is front-line staff delivering better outcomes as a result of changes made by the Secretary of State over the past five years.
Dawn Butler
The time that people have had to wait for four hours has gone up—
Madam Deputy Speaker (Natascha Engel)
Order. Interventions should be kept to a minimum. The hon. Member for Central Ayrshire (Dr Whitford) is not on a time limit, but please be aware that many Members are coming in to speak. Thank you.
Dr Whitford
Absolutely, we have seen the performance drop across the UK. The Minister quoted a report showing that England was performing better than Scotland. I would be interested in seeing that one—where it is comparing like for like with core A&E services—because those are not the figures I have seen. However, we all face the same challenge. We are dealing with older patients, who are more complex. The figures from Scotland last winter showed that we did not have a huge increase in numbers, but far more of those patients had to be admitted. Nothing else could be done, and we will face that situation more and more in future. The problem is that we are losing the staff to deal with that, and we are talking about A&E, but in the vast majority of cases, they key issue does not lie with A&E. There are two simple things: the number of patients coming in, which relates to out-of-hours GP access, and patients getting back out, which is described by the Royal College of Emergency Medicine as exit block.
It is important to remember that the four hours does not involve someone sitting on a chair, waiting for four hours. People are often given that impression—that they turn up in A&E and sit there, and no one will touch them for four hours. However, they will be triaged, see a clinician, have a history taken and have investigations. They may well get sewn up or be given something, and they will go home. Those patients are moving through. Our problem is the patients who have to come in, and it results in a whole cascade of issues, such as people stuck on trolleys getting the start of a bedsore, or families made miserable, or staff very depressed at trying to look after people in a corridor. It also results in people ending up boarded to any ward—any port in a storm—so that people are not in the correct ward and not getting the correct treatment from the correct team. We know that that, bizarrely, results in longer patient stays, which exacerbates the problem.
What we need to do—as we have done in Scotland, where we set up the unscheduled care action plan—is to work with all stakeholders. That involves looking at how patients flow through. It is not about people being obsessed with measuring the target and counting it, but about people opening the gates in front of the patient. The data on how long patients wait should be automatically available to staff from their system; it should not require an extra body to generate that data.
If we have the data weekly, which means we are getting them timeously, we can see one week from the other and ought to be able to see the patterns. The problem with monthly data for something that is identified as a currently acute issue is that, by the time they are collated, verified and out, staff may not remember quite what made that a bad week, whereas with weekly data, they can see whether they are getting a response to their actions.
I support keeping weekly measurements, but I do not support them being used as a tool—and certainly not for beating one another across the Benches here. I can tell hon. Members that staff in the NHS feel that they are beaten over the head with these targets, so it is not about having a target, but about how it is used. In the paper released by the Royal College of Emergency Medicine here yesterday, one of its myths was that the four-hour target is a distraction. It pointed out that it allowed a focus.
To try and tackle the problem in Scotland, we have ensured that the majority of our A&Es have a co-located out-of-hours service. I mentioned before that achieving 8 till 8 in every GP practice is so far in the future that it cannot be reckoned on as a solution to this problem. We are unable to fill the GP vacancies we have now. Telling them that they will be working from 8 till 8 on Saturday and Sunday is not overwhelmingly attractive.
The pilots that have been done have started to report in the last fortnight, and they have reported a very poor uptake. When people want to deal with an out-of-hours problem, they come to A&E. Rather than trying to change the whole population, we could have a system in which people are easily diverted once they get there: “If you have this, please step next door to our primary care service.” We need to look at those solutions, and some are working quite well.
The other issue is health and social care. To get patients out at the end of their journey, they need to be able to get into care. We need to remember that, although extra money may be given to health and social care through the health side, if we are cutting local authority budgets at the same time, we end up cutting the legs from under the NHS.
Marie Rimmer (St Helens South and Whiston) (Lab)
A 25% reduction in the number of GPs and practice nurses has been forecast over the next five years. I have the statistics to prove that. People talk about the cost of agency staff and locums in hospitals, which is out of all proportion. There are also massive increases in costs—
Madam Deputy Speaker (Natascha Engel)
Order. It is essential that we keep interventions to the absolute minimum.
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.