Accident and Emergency Waiting Times

Sarah Wollaston Excerpts

Wednesday 5th June 2013 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

This is an enormously complex issue and we must not look at A and E in isolation. We also have to be very careful about the way we use data. I recommend that all Members look at the King’s Fund blog on this to see how the way in which the codings were changed and the data recorded to include walk-in centres and minor injuries units between 2003-04 gives a different perspective to the debate.

Given that complexity, we need to look at the solutions, which need to come by ensuring that people can see the right professional at the right time in the right place. That is key to this. But as my right hon. Friend the Member for Charnwood (Mr Dorrell) said, we must also recognise that the key driver for demand in this is our ageing population. If we look at the impact within general practice, we see a 75% increase in the number of consultations during a 13-year period. This is not just within general practice. The patients who are arriving are much sicker and have much greater complexity, and that is the root of the problem. It is a cause for celebration that we are all living longer, but dealing with that needs detailed planning.

[Mr David Lammy (Tottenham) (Lab)]

I am grateful to the hon. Lady for giving way, given her expertise in these areas. Does she recognise the work of Sir George Alberti a few years ago and the establishment of emergency care collaboratives that were very engaged with social care and local councils, and that the further cuts expected in local authorities will make this worse for elderly communities throughout the country?

[Dr Wollaston]

The reality that we face is that there is a limited amount of public funding. We can spend that pot of public money only once, so we must spend it in the right place, and that often means that we need to spend more of it within social care. That is why I welcome the fact that some of the health budget has been shifted to social care, and that is very important. I also commend Torbay. My constituency covers Brixham and Paignton, and Torbay has been nationally and internationally recognised for its work on integrating health and social care. It is no coincidence that it does so well on A and E waiting times, and we should be looking at what it has achieved.

But how will we keep people out of our A and E centres? In the Health Committee, we heard evidence about the effect that paramedic crews have. If the paramedic crew in an ambulance are highly skilled, the person they treat is less likely to need to go to casualty in the first place because the expertise is there to keep them at home. There needs to be better access to records. We need to consider how we can improve IT so that the patient owns their record and every part of the system can safely access their drug and medical history—with their consent, of course.

[Mr Bradshaw]

Given the hon. Lady’s previous distinguished career as a Devon GP, does she, like me, deplore the comments made today by a Government Minister, who sought to blame the current crisis in the NHS on the growth in the number of women doctors?

--- Later in debate ---

[Dr Wollaston]

I commented on that on Twitter. The remark was unfortunate; I think women GPs contribute enormously, but there we are. I would say that, wouldn’t I?

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

rose—

[Dr Wollaston]

I am short of time, I am afraid.

I go back to how we get people directed to the right place. We need NHS 111 to do the job it is intended to do—direct and signpost people to the right place. Some 42% of people do not know how to access their out-of-hours service; they will go to where the lights are on. We need to make sure that there is good-quality information about how to see the right professional in the right place at the right time and about communication in all parts of the system.

We also need to consider how commissioners can be supported to keep people at home, which is the right place for frail elderly people, by using community resources. There are some wonderful organisations in my area—Brixham Does Care, Totnes Caring, Saltstone Caring and Dartmouth Caring. Having the flexibility to commission small local units is vital, rather than there being a push to commission larger units that do not have that local focus. The issue is about local focus helping to have local solutions. What works in Lewisham will not work in rural Devon, so let us get the solutions right and have flexibility.

Let us make sure that we address the delays within casualty departments and the pressures that cause that. Very often the issue is to do with diagnostics. Let us look at the groups of people who constantly re-attend. I do not want to bore the House too much with my views on minimum pricing, but anybody who wants to spend a Friday or Saturday night in an inner-city casualty department will see what the delays are due to. I hope to win my bet eventually with the right hon. Member for Exeter (Mr Bradshaw).

Let us have a sensible policy that considers mental health, for example. A huge number of readmissions in casualty departments involve people with mental illness. In the west midlands, liaison psychiatry is being used to help reduce readmissions among those with mental illness—again, it is about getting people the right support at the right time in the right place. Some 5.6% of bed days in the NHS are taken up by people who have been readmitted within a week of discharge. That is simply not acceptable.

There is also the issue of designing the tariffs. I was pleased to hear the Secretary of State refer to tariff reform. If the financial drivers are in the wrong place, we will not solve the problem. Let us try to take the party politics out of this debate and focus entirely on how we can support NHS England and our clinical commissioning groups to get the right care in the right place at the right time.