Accident and Emergency Departments

Debate between Stephen Lloyd and Sarah Teather

Thursday 7th February 2013 Commons Chamber

[Stephen Lloyd (Eastbourne) (LD)]

I thank the Backbench Business Committee for granting the debate and endorse my colleagues’ expressions of appreciation to the hon. Member for Ealing, Southall (Mr Sharma) for obtaining it. It was a pleasure to be one of his co-sponsors.

The debate is badly needed. Not a month seems to pass without another NHS trust announcing that it will close one or more hospital departments, and at least 15 NHS bodies in England are pursuing major reconfiguration plans. There is, however, increasing concern in the medical field that NHS care for emergency patients might be going wrong in too many instances. Essentially, this is a debate about specialism and generalism. Rare complex surgery, for example for brain tumours or severe multiple injuries, is clearly best done in large volumes in specialist centres. I do not dispute that—nor do the overwhelming majority of clinicians—but it is not true for the common types of emergency surgery that are best done within good time in a quality district general hospital.

Hip fractures, for instance, are very common and the results are better if surgery is done as soon as possible, preferably on the next day’s operating list, by a surgeon who has at least three years’ experience of fixing hip fractures, yet around the country hospitals are being reconfigured to provide a specialist service in a major centre, leaving, as many experienced clinicians assert, thousands of patients with delayed and worse care.

[Sarah Teather (Brent Central) (LD)]

As I listen to my hon. Friend, I am struck by an example from my constituency, where the likely closure of the A and E will mean that people living in Harlesden will find it almost impossible to get to Northwick Park hospital. It is important for patient experience that their relatives can visit them.

[Stephen Lloyd]

I thank my hon. Friend for her intervention. That is a very important point and I shall be covering it in more detail later in my speech.

Last October, a group of 140 senior doctors wrote to the Prime Minister expressing alarm over proposals to close and reconfigure A and E units around the country. In their open letter, they said that they had yet to see evidence that plans to centralise and downgrade A and E services were beneficial to patients. A 2010 report by the National Confidential Enquiry into Patient Outcome and Death showed that the reason people often die after surgery is not that the surgery was difficult but that there was a delay in getting them to an emergency operation. I fear that that will be worse if more A and Es are closed as there will be no surgeon on site, or the patient will face an over-long travel time to a fully functioning and adequately staffed emergency department. The report was clear, suggesting that applying one-size-fits-all medicine to a heterogeneous population with varying needs fell short in ways that were both predictable and preventable. Crucially, it stated:

“Delays in surgery for the elderly are associated with poor outcomes”.

The letter to the Prime Minister also backed this view:

“Not only do many people in some of the country’s most deprived areas face longer journeys to hospital, but those in rural areas face longer waiting times for ambulances and crowded A and E departments when they arrive.”

Let me point out the obvious: that will mean more delay for what should be routine emergency surgery.

That is in contrast to how I foresaw developments in May 2010 when the coalition Government came to power. Unlike Labour, the coalition ring-fenced NHS funding.