NHS Winter Crisis

Rosena Allin-Khan Excerpts

Wednesday 10th January 2018 Commons Chamber

[Dr Whitford]

If the hon. Gentleman gives me a little longer, he will find that I intend to talk about the flu epidemic, but before he gets too celebratory he might want to wait until tomorrow when we will have comparable data, because while in Scotland the data are published every week, in England they are published only every month. I am glad, however, that we no longer wait six weeks after the end of a month, which is 10 weeks after the start of it, but get it a fortnight later. So that will be available tomorrow, and then he can compare hospital trusts in England with hospitals in Scotland to his heart’s content. I would have thought that, as someone who celebrates the United Kingdom, he might want to praise the fact that Scotland has led the entire UK since March 2015 on emergency admissions and A&E.

Having corrected that, all of us recognise that this is a particularly tough winter because there has been an outbreak of flu on top of a bad freeze. I point out to those who think the worst is past that the flu season lasts until March and at the moment this is an outbreak, not an epidemic, but it comes on top of underlying pressures, and across the four nations this has involved staff having to go above and beyond the call of duty.

Whether it was how Public Health England said it or how the media reacted to it, this business of stating in public that the flu vaccination does not work is unfortunate and irresponsible. The flu vaccination recipe is planned by the World Health Organisation at the beginning of each year. It will already be working on next year’s flu. It does not have a crystal ball and people who have what we in the medical profession call a retrospectoscope should recognise that that tool was not available at the time when the decisions were made. Producing vaccine is a biological process that takes months, so the decision is made in March for the northern hemisphere, and all the companies produce to that recipe. Headlines in Scotland implying that the Scottish Government popped down to Boots and took the wrong vaccine off the shelf are therefore facile, and that also encourages people not to bother.

We already have falling vaccination rates in childhood vaccination and in flu. We should be pointing out that multiple flu viruses are circulating. While all the talk in the media is of Australian flu, in Scotland that is about a quarter of the strains that are circulating.

One of the issues with flu is that it happens in cold weather, and in Scotland we get the coldest weather in the United Kingdom, so we have double the rate of flu that there is down here in England. We also had a worse freeze, and are continuing to have a worse freeze. So when the data come out tomorrow, I think we will see that Scotland will still lead the UK. We will not be performing to the level we want. We have not met the 95% target for emergency departments since August, but England has not met them since 2015 and, sadly, Wales has not met them since 2008. So this is a challenge across the board, but Scotland has been more resilient. I call on all MPs to encourage staff and other people to get a flu vaccination, because this will continue until March and it is still absolutely worth doing.

The Secretary of State often talks as if the problems in A&E are due to people who should not be there. If we talk to anyone who works in A&E, they will say that, by and large, that is not the case. With people getting fractured ankles and fractured wrists on the ice, A&Es will have been very busy with having people carted in and X-rayed, and what we call in Scotland getting a stookie put on before they go home. That is all going to take time, but anyone who works in A&E would say that the key issue is frail, sick people, often with multiple conditions, and whether they fractured their hip falling on the ice or have a respiratory problem secondary to flu, they need a bed and the issue in England is that there are not enough beds.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I work in A&E and spent some shifts in recess working in A&E—on new year’s eve and just a few days ago, on Sunday. I agree that many of the people attending A&E, particularly at St George’s where I work, are there because they are frail, but they are also there because this Government have ensured they cannot get an appointment with their GP, our social care is in crisis and we do not have mental health budgets.

[Dr Whitford]

I thank the hon. Lady for her intervention.

Obviously, the shape of medicine has changed. More is delivered in primary care—as a surgeon, I well know that more surgeries are delivered in a day—but if we are doing a straightforward operation on an older patient, they will still always require longer rehabilitation; they are more likely to stay overnight or several days, and if they have fractured their hip, they will require full rehabilitation before they go home. The problem is that the number of beds in England has been halved since 1987—under successive Governments—and the NHS stats released for the end of the second quarter of 2017-18 show that almost 1,000 beds have been lost even since the winter of last year, when the situation was described as a humanitarian crisis. That was a mild winter that did not have a flu outbreak on top.

England has only 2.4 beds per 1,000 population, whereas the EU15 that the Secretary of State refers to has 3.7, and we in Scotland have more than four. If we are running constantly with bed occupancy rates of over 85% or 90%, that is where the issue lies.

--- Later in debate ---

[Dr Rosena Allin-Khan (Tooting) (Lab)]

It is interesting to follow the hon. Member for Sleaford and North Hykeham (Dr Johnson). I have to say respectfully that I wholeheartedly disagree with her. She speaks of some kind of NHS utopia, but that is not the reality that I have seen on our A&E frontline. I am an A&E specialist and I have worked in our NHS for the past 12 years.

When we look around an A&E department, everything is on display in high definition: people’s pain, fears, courage and hopes; the unfailing dedication, expertise and strength of the staff who work there; and yes, the state of the NHS, which is in turmoil. It is in crisis, which is turning into disaster. From hospitals across the country, we have heard that the problem is not a surface or temporary issue.

The symptoms of the NHS crisis are all connected and multiply into new problems. That is not seen in statistics alone, but it is seen in A&E departments, which are completely overcrowded. People feel forced to come to A&E who should not be there: people who could not get a GP appointment or who had to wait too long for a hip replacement and are now in severe pain. Taken together with the emergency cases—from heart attacks and strokes to road traffic accidents—it is simply too much for the resources that we have.

The reality is stark. Cubicles are full because there is no space to move patients on to wards. The wards are full because our social care system is woefully inadequate and broken. When all beds are full, we see ambulances queuing up outside hospitals. They are full of patients who cannot get hospital care. What do we say to a mother or a father who is in an ambulance with their child, scared and anxious, and has to wait outside the hospital for another hour?

Doctors are too stretched to do the job we are trained to do. We are the recipients of first-class education and training in the UK and we cannot deliver the very thing that we know to be right: to treat the cause, not just the symptoms. There is little time for prevention.

On new year’s eve, when I worked in A&E, we had a teenage girl who fainted. We treated her and spent time talking to her, but we pride ourselves on being able to find root causes: is there an underlying eating disorder or is she being bullied at home or at school? To have those conversations, we need to build trust, which takes time. If we do not do that, the patient is more likely to return, sometimes in pain because their operation has been cancelled. A teenager who faints at school might need to be part of child and adolescent mental health services. That all places a burden on our already stretched NHS. It will not change until this Government decide to live up to their most sacred duty: the protection of the health and security of us all. The NHS is underfunded and overwhelmed.

[Rosie Duffield (Canterbury) (Lab)]

Does my hon. Friend agree that desperate patients should never have to resort to smuggling out secretly filmed footage of trolley-lined corridors with people sitting on the floors, such as the footage I have received from my constituents visiting and working at William Harvey Hospital in Ashford?

[Dr Allin-Khan]

I agree that it is deplorable that patients should feel that they have to do that. The historic underfunding of the NHS is not an economic necessity; it is a political choice made by this Government, which is why they will not change their direction to protect us.

So, what must we do? We must change the Government. Until we do, the NHS will continue to crumble around its heroic staff, who will carry on giving their all; I am honoured to stand alongside them. We see their work not in the headlines, but in the most harrowing, important and joyful moments of people’s lives. As NHS practitioners, we cannot always change the outcome; but with time and resources, we can change the journey. It is time that we saw a change in our A&Es, our hospitals and our Department of Health.