Accident and Emergency Departments

Debate between Siobhain McDonagh and Lord Barwell

Thursday 7th February 2013 Commons Chamber

[Siobhain McDonagh]

rose—

[Gavin Barwell]

I shall give way to my hon. Friend, because I promised that I would.

[Gavin Barwell]

My hon. Friend has put the case for his local hospital firmly on the record. I do not know the detail and would not want to comment. I shall try to make time to allow the hon. Member for Mitcham and Morden to intervene once I have advanced my argument a little. I referred to her, so it is only fair to give her that opportunity.

The point I am trying to make is that there is a need for balance. Constituents want to be able to access facilities at a local hospital, both from their own point of view and because if they have an extended stay they want friends and relatives to be able to come and visit them easily. There is a balance to be struck between convenience and quality of treatment. For example, my hon. Friend the Member for Banbury (Sir Tony Baldry) referred to someone with a serious aortic problem who was able to go to a hospital with specialist expertise.

Let me make a couple of points about improving the quality of care, which was also touched on in the “Better Services, Better Value” review. One concerns the European working time directive’s impact on the NHS. The review states:

“The implementation of the EWTD has resulted in shorter sessions of work with complex rotas as well as more frequent handovers. Resulting difficulties in maintaining continuity of care can have implications for patient safety.”

The review also contained some powerful findings about the four-hour target, introduced by the previous Government for laudable reasons, which included wanting to monitor the level of care people received. The data for south-west London show that A and E admissions spike between 245 and 260 minutes in all south-west London acute trusts, suggesting that internal standards are aligned solely to the four hours rather than other quality issues.

There are a range of issues relating to A and E in south-west London. I want to say a brief word about Lewisham, but first I shall give the hon. Member for Mitcham and Morden a chance to intervene.

[Siobhain McDonagh]

Last year, 90,000 people turned up at St Helier’s A and E, 26% of whom were admitted to a bed. The idea that we can condescend to 90,000 people and tell them that they turned up in the wrong place is untenable. They are making an entirely rational decision to go to A and E because there is nowhere else to go. The GP out-of-hours service is woeful, its standards are poor and as long as there are no alternatives, people will continue to go to A and E whatever the hon. Gentleman says or does.

[Gavin Barwell]

I am grateful to the hon. Lady for that point. She said earlier that “Better Services, Better Value” talked about a figure of 60%, but she was actually misleading the House—unintentionally, I am sure—as the report specifically rejects that. It states that

“there is no firm evidence”

to support the Healthcare for London figure. It conducted a local study across south-west London that found that 48% of all activity was coded as minor and that 40% of patients were discharged with no follow-up treatment required. The conclusion was that they could be dealt with in an urgent care centre, which could be attached to the A and E. That would mean we could ensure the provision was available to deal with such cases.

Let me comment briefly on Lewisham. I listened with great sympathy to the arguments made by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham West and Penge (Jim Dowd), who is no longer in the Chamber. I have constituents who work at Lewisham hospital and feel very angry, as the right hon. Lady does, about what has happened there. Let me make one point, which I tried to make to the hon. Gentleman in an intervention: we have a national health service and as a consequence when things go wrong in a neighbouring area it has a knock-on effect.