National Health Service Funding
Debate between Philippa Whitford and Natascha Engel(8 years ago)
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Madam Deputy Speaker (Natascha Engel)
Order. Before I call the SNP spokesperson, I must inform hon. Members that, including her speech, we have calculated, generously, that every speaker will have five minutes, but we will probably have to go down to four minutes at some point.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Does that include five minutes for me also?
Madam Deputy Speaker
Obviously the hon. Lady has no speech limit, but the speech limit has been calculated with her mind. I am just saying that the longer someone speaks for, the less time everyone else will have.
Foreign National Offenders (Exclusion from the UK) Bill
Debate between Philippa Whitford and Natascha Engel(8 years, 8 months ago)
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Madam Deputy Speaker
As the hon. Gentleman knows, it would be in order, but it is entirely up to the hon. Lady.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Further to that point of order, Madam Deputy Speaker. As a new Member in the House, I find what is happening to be shocking—not just because of the waste of time of so many Members who want to speak on an issue that is so important, but because our constituents are writing to us all, including to Conservative Members, to ask us to discuss and vote on the National Health Service Bill. [Interruption.]
Madam Deputy Speaker
Order. Before this degenerates into a slanging match, let me make it clear that the hon. Lady is doing exactly the same thing as the hon. Member for Brighton, Pavilion (Caroline Lucas)—voicing the frustration that many Members have had over the years about our proceedings for private Members’ Bills. There are other ways in which hon. Members can raise issues. There are vehicles other than private Members’ Bills. Today, however, is devoted to private Members’ Bills, and the current Bill that is being discussed is on the Order Paper.
A&E Services
Debate between Philippa Whitford and Natascha Engel(9 years, 5 months ago)
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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.