NHS

Yasmin Qureshi Excerpts

Wednesday 5th February 2014 Commons Chamber

[Margot James (Stourbridge) (Con)]

rose—

[Yasmin Qureshi (Bolton South East) (Lab)]

rose—

[Andy Burnham]

I will make a little progress and then I will give way.

There have been record levels of hypothermia this year and thousands of over-75s have been treated in hospital for respiratory or circulatory diseases. That brings me to the second underlying cause of the increase in attendances at A and E. The ageing society is not a distant prospect on the horizon. Demographic change is happening now and it is applying increasing pressure on the front line of the NHS.

We all need to face up to the uncomfortable fact that our hospitals are increasingly full of extremely frail elderly people. Too many older people are in hospital who ought not to have ended up there or who are trapped there because they cannot get the right support to go home. That situation is unacceptable and it has to be addressed.

[Andy Burnham]

The hon. Lady wants me to answer that question, but I direct her to her right hon. Friend, the Chairman of the Health Committee, who has dismissed the self-serving spin from the Government that says that these problem are all to do with a contract that was signed 10 years ago. I began my speech by citing figures that show an exponential rise in the number of people attending A and E since 2010. Many of those people are very frail older people. That is the issue before the House, so it does not help the debate for the hon. Lady to stand up and make a spurious political point.

[Yasmin Qureshi]

Is not one of the reasons why more elderly and frail people are going to hospital that there has been a £1.8 billion cut in adult social services and support? Those people are ending up in hospital because they are not receiving the care that they need at home.

[Andy Burnham]

My hon. Friend is absolutely right. I will come on to say that the single most important underlying cause of the A and E crisis is the severe cuts that we have seen to adult social care. That has created a situation in which older people are trapped on the ward and cannot go home because there is not adequate support at home. That means that A and E cannot admit to the ward because the beds are full. Hospitals are operating way beyond safe occupancy levels. Because of that, the whole hospital begins to jam up and the pressure backs up through A and E. When A and E cannot admit to the ward it becomes full, so ambulances queue up outside because they cannot hand people over to A and E.

That is exactly what is happening in our NHS at the moment. A and E is the barometer of the whole health and care system. If there is a problem anywhere in the system, it will be seen eventually as pressure in A and E. That is what is happening. The simplistic spin from the Conservative party, which says that it is all to do with a GP contract from 10 years ago, is discounted by expert after expert.

--- Later in debate ---

[Andy Burnham]

I agree with the hon. Gentleman. There are examples of good practice out there, but I suggest that he speaks to chief executives of clinical commissioning groups and trusts. They are telling me that the competition regime introduced by his Government is a barrier to that kind of sensible collaboration. The chief executive of a large NHS trust near here says that he tried to create a partnership with GP practices and social care, but was told by his lawyers that he could not because it was anti-competitive. Does the hon. Gentleman support that? Is that what he thought he was legislating for when he voted for the Health and Social Care Act? People are being held back from doing the right thing for fear of breaking this Government’s competition rules.

Recently, we heard of two CCGs in Blackpool that have been referred to Monitor for failing to send enough patients to a private hospital. The CCG says that there is a good reason for that: patients can be treated better in the community, avoiding costly unnecessary hospital visits. That is not good enough for the new NHS, however, so the CCG has had to hire an administrator to collect thousands of documents, tracking every referral from GPs and spending valuable resources that could have been spent on the front line.

[Yasmin Qureshi]

My right hon. Friend might be aware that recently the trust in Bournemouth wanted to merge with neighbouring Poole trust, but the competition rules stopped the merger taking place.

[Andy Burnham]

My hon. Friend is right. For the very first time in the history of the NHS, competition intervenes to block sensible collaboration between two hospitals seeking to improve care and make savings. Since when have we allowed competition lawyers to call the shots instead of clinicians? The Government said that they were going to put GPs in charge. Instead, they have put the market in charge of these decisions and that is completely unjustifiable. The chief executive of Poole hospital said that it cost it more than £6 million in lawyers and paperwork and that without the merger the trust will now have an £8 million deficit. That is what has happened. That is not just what I say; listen to what the chief executive of NHS England told the Health Committee about the market madness that we now have in the NHS:

“I think we’ve got a problem, we may need legislative change…What is happening at the moment…we are getting bogged down in a morass of competition law…causing significant cost and frustration for people in the service in making change happen. If that is the case, to make integration happen we will need to change it”—

that is, the law. That is from the chief executive of NHS England.

--- Later in debate ---

[Jeremy Lefroy (Stafford) (Con)]

First, I want to praise all those who work in accident and emergency departments up and down the country to provide a vital full-time 24/7 service locally and nationally. Many Members have already pointed out that it is almost a year since the Francis report was published. Its reception in the House demonstrated one of the best examples of cross-party respect from the Prime Minister and the Leader of the Opposition and, subsequently, from my right hon. Friend the Secretary of State and the shadow Secretary of State. I would like to see that cross-party support being built on.

I should also like to praise the Secretary of State for the work that he has done to take the recommendations forward. He has mentioned some of them today, including those relating to the chief inspector of hospitals, to social care and to general practice. Many more aspects of the report have already been mentioned, and there will no doubt be more to come. I must stress, however, that we need to have a proper debate on the Francis report now, one year on, in Government time in the House, to see where we have got to.

I also pay tribute to all those people who did the work that enabled the Francis report to come about. They include Julie Bailey, Helene Donnelly and the many others who worked with Cure the NHS, and all those in Stafford hospital who have subsequently responded to the report to make the hospital a place that I am proud to say now provides some of the best care in our region, including those in the A and E department. We have, however, lost our 24/7 A and E department; we now have a 14/7 A and E department. That is something that we are going to have to look at again; we need to look at how we are to cover the out-of-hours emergency care in our area. Nevertheless, we now have some of the best A and E care in the region, because it is consultant led. We now have sufficient consultants to cover that service.

I want to make four points that I believe need to be taken fully into account in this debate on A and E services. The first is about doctors. The Secretary of State has already mentioned the problem with recruiting people into emergency medicine. It is not seen as the most attractive career, perhaps because of the shift work involved. We need to look at the whole training structure. Perhaps it would be better for trainee doctors to spend more time in accident and emergency departments in their foundation years. Perhaps we should add a third foundation year in order to enable them to spend more time in A and E, because that is surely where they will learn most about this kind of medicine.

We also need to look carefully at the role of specialisms in the NHS. Although that would be the subject for a whole other debate, it is very important, because we have more than 60 specialisms in this country, compared with about 20 in Norway. Their increasing role means there is a need to maintain a full-time specialist rota of up to 10 consultants, which is placing increasing stress on the finances of the NHS. That is true in A and E, as elsewhere. That is a subject for another day, but it is a very important point.

Another area to mention is demographics, although I will not go on at length about it because the facts are known to us all. In Staffordshire, we are expecting the number of over-85s to double and the number of over-60s to go up by 50% in the next 25 years. There is no doubt that we have reached a tipping point, particularly as the baby boomers enter their retirement years, and that is not recognised. It is not just a straight line graph; there is a bit of exponential growth in the number of older people now coming in to our hospitals. That is to be expected.

[Yasmin Qureshi]

I agree with everything the hon. Gentleman has said so far. Will he also consider the fact that A and E waiting time rises have also been caused by: the effect of walk-in centres closing; the closure of NHS Direct and its replacement by the botched 111 system, which has not helped anyone; and a real cut in adult care, which has meant that a lot of elderly people have been taken to hospitals, instead of being cared for at home, and they cannot be released unless they have somewhere safe to go to?