Accident and Emergency

Paul Burstow Excerpts

Wednesday 18th December 2013 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

I want to pick up on a couple of points that were made by the hon. Members for Mitcham and Morden (Siobhain McDonagh) and for Bracknell (Dr Lee) about reconfiguration. The hon. Gentleman said that all too often the experience of hon. Members is that reconfiguration feels as if it is being done on the hoof. I agree with the hon. Lady about the proposed reconfiguration in south-west London and about St Helier hospital. Whether that will ever happen is still up in the air—let us hope that it does not. A leap of faith was demanded of constituents across south-west London, not least because the plans did not contain any measures to improve out-of-hospital care, without which it would not be possible to achieve the changes to emergency services that were being proposed. Those points are part of this debate, which is primarily about whether there is a crisis and, if there is, what the nature and causes of it might be. Although the Labour motion acknowledges that there are many causes of the problem, it has a very simplistic solution.

The evidence shows that there is a mixed picture across the country. That is reflected in the allocation of the first wave of additional funding for the NHS to meet winter pressures. That funding went to the health economies that were the most challenged. Some are coping well with the seasonal change from the higher volume, but less complex A and E attendance pattern of the spring and summer to the winter pattern of fewer, but much more complex cases, which often involves more frail and older people, and leads to more admissions. That pattern is repeated year on year and the demographic changes continue year on year. The pattern is well documented and it is very sensitive to the weather. That is why I welcome the Government’s cold weather plans and their support for local government and other agencies to put in place the extra social support that is necessary to avoid admissions in the first place.

Where there are problems, the causes vary. Some of the pressure stems from changes in behaviour. People now see A and E as the easiest point of entry into the system for any ailment. Often, there is confusion about the access arrangements for out-of-hours care. Those behavioural changes are cumulative. They are a consequence of changes that were made some years ago, not least through the changes to the responsibility for out-of-hours care in the GP contract. The implementation of those changes undoubtedly sowed much of the confusion over how to access emergency care.

[Andrew George (St Ives) (LD)]

Does my right hon. Friend agree that a lot of potential patients are confused about what out-of-hours unscheduled care is available? There are A and Es, minor injuries units, out-of-hours GP services, GP walk-in centres, NHS 111 and so on. Many people cannot discriminate between those services and do not know what they are supposed to provide. They therefore need to be further integrated.

--- Later in debate ---

[Paul Burstow]

My hon. Friend is absolutely right. One of the good things that came out of the work by Keith Willett and Sir Bruce Keogh is the more coherent, communicable and understandable way in which emergency care can and should be organised. Indeed, in some cases there are also staffing pressures. Those are not helped by some of the unintended consequences of changing medical careers, as that has had an impact on the supply of medical doctors.

Labour’s answer seems to be that we should go back to the good old days—whatever they were—of a 48-hour target, but that target was flawed. When it was removed by the Government, the British Medical Association welcomed the change, which it said would give GPs greater flexibility to organise their appointments. Today we have heard—quite rightly—from the chair of the BMA, Dr Maureen Baker, who said the proposal was ill thought out and a knee-jerk response to long-term problems, and that it would make a bad situation worse.

[Andy Burnham]

Do not the views of patients matter most? The right hon. Gentleman is quoting the professionals, but perhaps it is sometimes inconvenient for them to have to do things. Surely the point is that people are ringing surgeries and cannot get appointments. If he does not like the 48-hour target, surely he and the coalition Government should put forward their alternative so that people can get to see their doctor.

[Paul Burstow]

With all due respect to the shadow Secretary of State, when presenting arguments in support of his motion he set out a range of professional expertise and opinions for why there should be a 48-hour target. It is therefore not unreasonable for me to quote other professional opinion on why that would not be good for patients. I will come to some of the alternatives that I think are relevant to addressing the A and E problem, because I do not think that simply addressing it through a 48-hour target makes any sense at all.

The changes the Government are making to the GP contract will help—not least having a named person co-ordinating care for the over-75s. I hope the welcome focus on frailty and multi-morbidity will be extended to more people on the basis of their need, not simply their age. Figures show that the average number of diagnosed conditions for patients admitted from A and E has increased over the past five years. In other words, the medical needs of people attending A and E are getting more complex, and that impacts on the amount of time people spend in A and E departments. Therefore, the answer is not one simple solution but must be a combination of actions. Much of that needs to be centred in primary and social care, as well as mental health services. In primary care we must recognise that it is not just about GP services and that we need best practice around the country, for example in engaging pharmacies as first care centres or getting them to play a key role in managing long-term conditions—a big driver of pressure on A and E departments, particularly in winter.

We need concrete action to drive the integration of health and social care—that may be mentioned in the motion, but the Government are delivering it, not least with the £3.8 billion first steps for a better care fund, which is bringing health and social care together in a practical and unprecedented way that has not been achieved before. That must be welcomed as a first step which I hope will grow as more resources are pooled across the system. It is essential to delivering the integrated, co-ordinated care that people want.

Mental health was neglected by Labour, under which there were no access standards or targets for people suffering a mental health crisis. In fact, under Labour two thirds of people suffering from a mental health crisis waited for more than four hours to be seen. I applaud what the Minister is doing to improve that situation significantly by setting standards for the first time to drive improvement in that area.

I conclude with a quote from Dr Clifford Mann, president of the College of Emergency Medicine:

“While this winter will be tough for the NHS and A and E departments in particular—”

I think we should acknowledge that—

“I believe there is now cause for optimism and that the crisis is behind us.”

Yes, there have been problems, but the Government have been addressing them in a comprehensive way. That is why this debate is mis-timed, wrong, and does our constituents no good whatsoever. It does not identify the real problem, although this Government are getting on with sorting the issue out.