Accident and Emergency

Norman Lamb Excerpts

Wednesday 18th December 2013 Commons Chamber

[Lisa Nandy (Wigan) (Lab)]

My A and E in Wigan is, like so many others across the country, under significant pressure at present. Earlier this year we saw an unprecedented rise in A and E attendances. That is a result of a series of problems, including the difficulty in getting GP appointments, as outlined eloquently by my right hon. Friend the Member for Leigh (Andy Burnham), but I think the single most significant cause is the cuts that have been made over the past three and a half years to social care. Does the Minister have any idea what those cuts and the unfair distribution of them—my constituency of Wigan has been cut three times more than Windsor— have meant to people in their lives?

I want to say something about the situation of older people. I have been shocked over the past couple of years by what is happening to older people because of the deep and front-loaded cuts to social care, which have left councils with no option but to cut services. Over the last two years we have seen an unprecedented rise in the number of over-90-year-olds coming into my local A and E and others across the country by ambulance.

[The Minister of State, Department of Health (Norman Lamb)]

The hon. Lady talks about the situation in social care and of course I understand that there is real pressure, but will she welcome the fact that in 2012-13 there were 37,473 fewer days lost in delayed discharge due to social care, so in other words social services are doing better now than they were in previous years?

[Lisa Nandy]

In the very short amount of time that I have got I will simply echo the words of my hon. Friend the Member for Stretford and Urmston (Kate Green) who said to the Secretary of State that she thought people would be staggered by the complacency of Members on the Government Benches and would not recognise the picture they paint, which stands in stark contrast to the lived experiences of my constituents, some of whom are old and vulnerable and deserve so much better than this. Behind the increase in the number of admittances to hospital lies a picture of older people who are living alone at home, worried, lonely and ill.

The Minister’s Government have not caused all of this, but, like my right hon. Friend the Member for Leigh, I have talked about my concern about what has happened in social care and the rise of zero-hours contracts and choosing the lowest bidder over recent years, so, by God, I must also say this: his Government have made the situation so much worse. By the end of next year the budget of my council in Wigan will have been cut by £66 million, and we were told this summer that another 10% is still to come. We have done everything. We have pared that organisation to the bone. The truth is there are no more efficiencies to be had; there are only cuts.

I say this to the Minister as well: this is not just about councils, because what this Government have done, and the Darwinian approach they have taken to the voluntary sector, has severely undermined the capacity of charities to respond to this crisis at the very time when they are needed most. This is the true meaning of the big society.

We are seriously disrupted in Wigan—

[Norman Lamb]

rose—

--- Later in debate ---

[Clive Efford]

There is example after example of broken promises. The Conservatives accused people of planning to close hospitals when there was no plan to do so, and then came in and did it themselves.

We have a curious situation. The Secretary of State has been saying, “Crisis? What crisis?” Today, he read out a quote saying that the crisis is behind us. That is a little confusing. Of course, the crisis that he was talking about was a summer crisis. He did not mention that. He presided over a summer crisis. That is pretty unique. I do not think that even Virginia Bottomley achieved a summer crisis, but I could be wrong.

The crisis is of the Government’s own making. The Secretary of State talked about the need for services away from the hospital to protect A and E from being overwhelmed. However, one of the first things that they did was to do away with the 24-hour promise of a visit to the GP. They then introduced 111, which had algorithms and questions that all ended with the advice, “Go to your A and E.” There are now 850 fewer surgeries opening at evenings and weekends, and a quarter of walk-in centres have closed. Talk about reinventing the wheel—the Government are now saying that those are the sorts of things that we need to do. The crisis in A and E is of the Government’s making. It is their decisions that have created the situation.

To return to south-east London, the Secretary of State appointed the trust special administrator to oversee the merger of Lewisham and Queen Elizabeth hospitals. The local authority took on that decision because the powers that the Government took were not within their remit. The Government were challenged in the court and defeated. The Government are now moving the goalposts. Having said before the last general election that there would be no top-down reconfiguration and that they would not enforce closures if the local community did not agree with them, they are taking powers to impose closures on local communities.

In the minute that I have left, I want to say to the Minister that there has been a series of broken promises. It is fitting that a Liberal Democrat is summing up a debate on broken promises on the NHS.

[Norman Lamb]

indicated dissent.

[Clive Efford]

It is true. Where were any of the things that are happening to our NHS in the Liberal Democrats’ manifesto? None of them was in their manifesto. They never put them before the electorate.

We want no return to the closure of Lewisham A and E. The closure of Queen Mary’s, Sidcup has had the knock-on effect of overwhelming the other A and Es in south-east London. That is clear for all to see. Those A and Es are under serious pressure. It is clear that there is no slack in the system to pick up the additional burden from that closure. We must have a guarantee from the Government that they will not impose the closure of another A and E on the people of south-east London. I would like to hear that from the Minister when he sums up.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

We have heard a lot of scaremongering about the NHS today, including endless claims about a crisis. If the Opposition are thinking about new year’s resolutions, I have one for them: stop misleading and misinforming the public. Let us look at the evidence.

[Andrew Gwynne]

rose—

[Norman Lamb]

I will not give way; I do not have time.

Up until this week, A and E targets were met in the past 32 weeks in a row. Is that evidence of a crisis? The average wait for people in A and E during Labour’s last year was 77 minutes; it is now 30 minutes. Is that evidence of a crisis? Even though more people are coming through the doors, 2,000 more patients are being seen in less than four hours every day under this Government than under Labour. Evidence of a crisis? I don’t think so. The Opposition are scaremongering, plain and simple. In fact, the College of Emergency Medicine’s president, Cliff Mann, has today said that any crisis in accident and emergency is “behind us”.

[Andy Sawford (Corby) (Lab/Co-op)]

May I associate myself with the remarks made by the hon. Members for Kettering (Mr Hollobone) and for Wellingborough (Mr Bone)? We are pressing for funding to meet the additional demand in the Kettering accident and emergency department. Will the Minister encourage us in that?

[Norman Lamb]

I applaud the cross-party effort of those Members campaigning for their community, and I am very happy to engage with them further on that matter.

[Andrew Gwynne]

rose—

[Norman Lamb]

I will not give way again; I do not have time.

Last year, of the 21.7 million people who visited accident and emergency departments, almost 96% were admitted, transferred or discharged within four hours. Target achieved. So far, it is the same this year: target achieved. The right hon. Member for Leigh (Andy Burnham) missed his A and E target in two of the three quarters when he was in charge. Did he go around telling everyone that there was a crisis at that time? No, of course he did not—

[Several hon. Members]

rose—

--- Later in debate ---

[Norman Lamb]

Thank you, Madam Deputy Speaker.

The then Secretary of State, now the shadow Secretary of State, missed the target in this very week when he was in charge. We know that the winter is tough, and that performance always dips at this time of year. We also know that the staff are under a lot of pressure. The truth is that we inherited a dysfunctional system that was crying out for reform, with too many people ending up in hospital because of crises in their care, as my hon. Friend the Member for Bracknell (Dr Lee) made clear. For years, I have argued the case for a different approach.

We are supporting the NHS to enable it to manage better in the short term. For this winter, we are investing an additional £400 million in total—more than ever before. In the longer term, we need to look afresh at how we organise urgent care. That is why Bruce Keogh’s report into urgent and emergency care is so important, and I hope that the hon. Member for Mitcham and Morden (Siobhain McDonagh) will accept the case for a clinically led review in order to achieve the right approach. We will work closely alongside NHS England in putting these reforms into practice. The hon. Member for Stretford and Urmston (Kate Green) was absolutely right to say that we have to communicate better with the public and ensure that the process is a good one.

In the longer term, we need to do more to prevent people from ending up in hospital as a result of avoidable crises. As my hon. Friend the Member for St Ives (Andrew George) said, we need to make two big shifts. The first involves a move to a much greater focus on preventing ill health and the deterioration of health. The second involves a shift from a fragmented system to one that is integrated and joined up. That is the approach that we must follow.

Integrated pioneers around the country, such as those in south Devon and Torbay, Greenwich and Labour-led Barnsley, are doing great work, joining up care, collaborating with the voluntary sector, providing better care and keeping people out of hospital. That is the vision of the health service for the future. These pioneers will help the rest of the country to make the best possible use of the £3.8 billion better care fund. The fund will encourage organisations: to act earlier to prevent people from reaching crisis point; to offer seven-day services; and to deliver care that is centred on people’s needs. I am grateful to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for welcoming that important new fund. We are also introducing named, accountable GPs for the over-75s and improving access to general practice.

We are addressing both the short-term and long-term challenges, giving the NHS the support it needs. I want genuinely to thank the excellent staff throughout our health and care services who are tackling these issues head-on. The measures and changes we have outlined today will support staff to deliver the best possible care, even in the most difficult of circumstances.

Question put.

The House proceeded to a Division.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I ask the Serjeant at Arms to investigate the delay in the No Lobby.