A&E Services

Tania Mathias Excerpts

Wednesday 24th June 2015 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford). The House should listen to what she says about the point of targets.

I thank NHS staff across the UK and, given the subject of this debate, particularly those who work in the 181 emergency departments across England. Those people face immense challenges. Last year, they cared for 14.5 million patients—an increase of 500,000 on the previous year. As the hon. Lady said, this debate is about not just numbers, but complexity. We have to face that. It is a disappointment to those NHS staff when they see the debate descend into political diatribes. They want to hear constructive diagnoses and solutions from this House; they do not want to see this issue being used as a football. Let us move forward in that vein in this debate and look at the challenges.

This issue is immensely complex. Anyone who says that there is a single answer is not looking at the scale of the problem. In the few minutes I have, it would be impossible to address all the issues, so I will focus on the workforce challenge, which is key. That challenge does not relate just to emergency departments; there is a complex interaction that includes primary care, ambulance services and the voluntary sector.

We know that about 15% to 20% of people who are seen in emergency departments would be better seen in another context. How do we get the skill mix right? We need to consider the fact that not every place needs the same solutions. The solutions that are right in a rural constituency are very different from the solutions that are right in an urban area.

We need to look at the challenges of recruitment, retention and retirement. We have heard that 50% of training places are not being filled, but there is also the leaky bucket of those leaving the profession. We must consider the fact that it costs about £600,000 to train someone to senior registrar level in emergency care. The scale of the brain drain is enormous, particularly to Australia and New Zealand. How do we address that? Of course, there will always be junior doctors who want to spend a year working abroad and then return with the skills that they acquire. We should not discourage that, but we could do more to make it a two-way process. The main problem is the loss of those higher professionals who have not only the skills that are needed to look after the most unwell patients in our emergency departments, but the confidence and decision-making skills that are required to know when it is safe for patients to go home.

[Dr Tania Mathias (Twickenham) (Con)]

I absolutely appreciate what my hon. Friend says about the leaky bucket. Does she agree that every school and every careers adviser should be advising people to go into the NHS, given the 300 careers that it offers?

[Dr Wollaston]

Indeed. I was going to comment further on the issue of the skill mix. This is about not only those higher skill professionals, but the mix within the NHS. I do not think that we should talk that down. We simply will not be able to manage unless we broaden the skill mix. Healthcare assistants, for example, make an extraordinary contribution to the NHS and social care. One of the reasons we lose so many of them is the lack of access to higher professional development; it is not just about a low-wage economy. This is about how we can create more pathways to becoming, for example, assistant practitioners and physician assistants, how we can use them and how we can bring in more pharmacists, who train for five years in their specialty, into what we do across the NHS?

--- Later in debate ---

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

It is a delight to follow the hon. Member for Birmingham, Edgbaston (Ms Stuart), who made some very interesting points. When I read the motion, what struck me most was that if I had read it having just stepped off the Mars to Earth express, I would have believed that Britain’s national health service was a total disaster and that nothing was being done to improve the services that were being delivered. Yes, there are still problems in the NHS, particularly in lots of our larger general hospitals, such as Medway Maritime hospital, which provides services for my constituency, including A&E cover. Medway Maritime has faced big challenges for a number of years, including under the previous Labour Government, and among those challenges was a failing A&E department. There were a number of reasons for the challenges, including the limitations of the site on which it is located and the demography of Medway towns in general.

Last year, those challenges came to a head and Medway Maritime was put into special measures. Following the appointment of a new chief executive and new trust chairwoman and with the buddying arrangements that have seen Guy’s and St Thomas’ NHS Foundation Trust provide Medway with advice and expertise, the hospital is beginning to see some improvement. Of course, much more needs to be done before Medway Maritime can provide my constituents with the health service they deserve and to which they are entitled.

There is general agreement that one way to relieve the pressure on the hospital is to transfer more of the services it provides into the community. In my constituency, I have two excellent community hospitals, Sittingbourne memorial hospital and Sheppey community hospital. They both provide local people with a very good service, albeit for a limited range of healthcare needs. I would like the services they provide to be expanded. Okay, we will never see a fully fledged accident and emergency department in Sittingbourne and Sheppey, but there is no reason why my two community hospitals cannot provide other services. Today’s Opposition motion contains the statement that

“the pressures on hospitals are a consequence of declining access to out-of-hospital services”.

There are a number of things going on in my neck of the woods that belie that statement, with a number of initiatives and pilots taking place that in the long term will benefit not only my constituency but the wider NHS. Let me tell Members about a couple of them.

Last week, I met managers from the South East Coast Ambulance Service, SECAMB, who told me about the vanguard initiative in which they are involved in Whitstable, just outside my constituency. It is one of several initiatives nationwide that will provide specialist out-of-hospital care in the local community and involves a SECAMB paramedic team, led by a specialist paramedic, working with local GPs to provide people with home treatment rather than their being taken to hospital. SECAMB is keen to replicate the model in other areas, including the Isle of Sheppey in my constituency.

[Dr Mathias]

Does my hon. Friend agree that with home treatments, the patient becomes the patient expert, which is another way of moving forward local solutions and the community helping itself?

[Gordon Henderson]

I very much agree, and I shall come onto that point in a moment. I am interested in getting that model on the Isle of Sheppey and I hope that NHS England will see the merit in the initiative and provide SECAMB with the necessary funding.

I mentioned earlier the excellent Sittingbourne memorial hospital in my constituency. It, too, is running a pilot that I believe should be extended into other areas. Last December, a wound medicine centre was opened in the memorial. It is a specialist service for patients across Swale who have chronic, complex or surgical wounds and it is operated under the care of the Kent Community Health NHS Foundation Trust. The centre uses telemedicine, with community nurses visiting patients in their home. By using mobile computer tablets to photograph wounds, nurses can send pictures back to specialists based at Sittingbourne memorial to provide an instant professional opinion. The system can also track the progress of healing wounds and use the data to work out the best treatment options, including the correct type of dressing. That has the potential to save the NHS thousands of pounds in the wasted procurement of unnecessary dressings.

Last month, I was honoured to open the HEM ultrasound clinic in my constituency. It is a new unit that provides a wide range of ultrasound scans and is the first static clinical ultrasound service in Medway and west Kent. Although it is a private clinic, it is just been contracted to Medway Maritime to help bring down its waiting lists. HEM is undertaking an average of 35 scans on behalf of the hospital every day, seven days a week. The cost to the NHS of the clinic’s service is the same as if the hospital undertook the scans itself. Let me tell those who accuse the Government of wanting to privatise the NHS that using facilities such as HEM is not about privatising the NHS but about the sensible use of private facilities to supplement NHS treatment and reduce waiting times for worried men and women.

I want to mention one particular concern. My local Swale clinical commissioning group is led by an excellent team whose members are fully committed to providing local people with more local services to reduce pressure on Medway Maritime, but Swale CCG is one of the smallest in the country and its size presented big challenges, as does the historic health deprivation in some of the wards in my constituency. Last year, Swale CCG received an above-average increase in its budget and I want to take this opportunity to urge the Government to ensure that it receives an above-average increase again this year.