NHS: Urgent and Emergency Care Review
(10 years, 6 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, with the leave of the House, I shall now repeat in the form of a Statement the Answer to an Urgent Question tabled earlier today in another place on the subject of urgent and emergency care. The Statement is as follows:
“Mr Speaker, in January this year the board of NHS England launched a review of urgent and emergency care in England. Urgent and emergency care covers a range of areas, including A&E departments, NHS 111 centres and other emergency telephone services, ambulances, minor injury units and urgent care centres. The review is being led by Professor Sir Bruce Keogh, NHS England’s medical director. A report on phase 1 of the review is being published tomorrow and it is embargoed until then.
This is an NHS England report. NHS England is an independent body accountable to me through the mandate. The report being published tomorrow is a preliminary one setting out initial thinking. The final version will be published in the new year. Sir Bruce has said that he will outline initial proposals and recommendations for the future of urgent and emergency care services in England. These have been formed by an engagement exercise that took place between June and August this year. These proposals will be further consulted upon through a number of channels, including commissioning guidance and demonstrator sites. Spring 2014 will see another progress report.
Decisions on changing services are taken at a local level by commissioners and providers in consultation with all interested parties. That is exactly as it should be, as only then can the system be responsive to local needs. It is vital to ensure that both urgent and emergency care and the wider healthcare system remain sustainable and readily understandable for patients.
A&E performance levels largely have been maintained thanks to the expertise and dedication of NHS staff. A&E departments see 95% of patients within four hours and this figure has not dropped below the 95% target since the end of April. However, urgent and emergency care is falling behind the public’s needs and expectations. The number of people going to A&E departments has risen historically, not least because of an ageing population; 1 million more people are coming through the doors than in 2010. Winter inevitably further challenges the system, which is why we are supporting the A&Es that are under most pressure with £250 million. Planning has started earlier than ever before this year, and the NHS has been extremely focused on preparing for additional pressure.
We will look at Sir Bruce’s report extremely carefully. Reform of the urgent and emergency care system may take years to complete but that does not mean that it is not achievable. We are exceptionally fortunate in this country to have in the NHS one of the world’s great institutions. NHS staff are working tirelessly to ensure that the care that people need will continue to be available for them wherever and whenever they need it”.
My Lords, that concludes the Statement.
Lord Hunt of Kings Heath (Lab)
My Lords, I am grateful to the noble Lord, Earl Howe, for repeating the Answer. I declare my interests as chair of an NHS foundation trust, president of GS1 and a consultant trainer with Cumberlege Connections.
There is no question that A&E services are under pressure—in crisis, according to the College of Emergency Medicine. Earlier this year, the Health Secretary announced that Professor Sir Bruce Keogh would lead a major review of emergency care in the NHS. It is clearly a significant piece of work, which is why I would have expected the Government to come before your Lordships’ House and the other place to make a Statement. I object very strongly to this being briefed to journalists this morning, yet Ministers were not prepared to come to the House until the Speaker granted an Urgent Question in the other place.
The noble Lord has said, quite remarkably, that because this is to be published by NHS England, it is not appropriate for Ministers to come to Parliament. He says that the NHS is independent. He must be the only person who believes that the NHS is independent. It is a wholly owned subsidiary and quango of the department. Why does a Secretary of State insist on seeing the leader of NHS England on a weekly basis if it is an independent body? I hope that the noble Lord will reflect on that. The Government should have brought this to your Lordships’ House with a proper Statement.
When the Bruce Keogh report was commissioned, the Secretary of State said that it was intended that we would learn lessons for this winter. What are those lessons? What immediate actions are now being taken ahead of winter? Weekend briefings and leaks suggest that Sir Bruce emphasises alternatives to A&E, such as walk-in centres and the 111 service, yet we have had a report from Monitor saying that NHS England has overseen the closure of walk-in centres. He cannot pass that on to clinical commissioning groups as it is well known that NHS England put pressure on clinical commissioning groups to close those walk-in centres. Will that closure programme stop now? Will he put nurses back on the 111 helpline in order to make amends for the debacle of the launch of that inadequate service months ago? What will he do about the recruitment crisis in A&E?
Bearing in mind the Birmingham health system, can he assure me that the £250 million allocated to A&E hospitals under the most pressure will be spent to alleviate the pressure on those hospitals and not be filleted away for other purposes?
Earl Howe
My Lords, I am grateful to the noble Lord for his questions. To start where he did, NHS England, as he knows full well, is legally and constitutionally an independent body. It is, however, accountable to the Secretary of State through the mandate, as it is accountable in a number of other ways, including regular meetings. I do not think that there is anything wrong about those meetings; indeed, noble Lords would be surprised if the Secretary of State took a detached view of what NHS England did. There is a balance to be struck. We believe that the direction of travel of NHS England is one for Ministers to set through the mandate and through the outcomes frameworks, in particular, but it is then for NHS England to adopt a clinically led approach to how it configures itself and how it oversees commissioning in the system. That is the balance that we have struck through the legislation that the House is familiar with.
It is not unusual to have an embargoed press conference the day before a major announcement. I see nothing wrong with NHS England having done that. It would not be appropriate for Ministers to come to the House the day before such an announcement when this piece of work has not been led by Ministers or the department.
The noble Lord asked what actions the Government had taken. Because this is not a normal Statement—we have 10 minutes in all—I shall be very brief. The work that is now in train is not just about A&E. We have recognised, as has NHS England, that joining up health and care services is a big factor. We have the 10 pioneer pilot schemes. We have launched the biggest ever commitment to making co-ordinated care a reality by 2018. We are looking at how we improve services for frail older people. We are developing a vulnerable older people’s plan. There is £250 million going into the system over the winter to ease the pressures on the hospitals that are struggling the most. In the longer term, we will have the solutions laid out by Sir Bruce in his report, which is published tomorrow.
Anyone who knows the history of walk-in centres will be aware that this was an initiative begun by the previous Government with the very best of intentions but as a top-down exercise, which in many cases resulted in the duplication of services and not the best use of NHS funds. Even under the previous Government we saw the closure of some of these services. We expect clinical commissioning groups to take a holistic view of the needs of patients in their area and to configure services cost-effectively. Sometimes that does mean closing walk-in centres that do not provide value for money.
NHS 111 is now available in more than 90% of England. Despite the problems that the noble Lord is familiar with in some sites that launched around Easter, performance has stabilised significantly. NHS 111 is now the principal entry route for access to the urgent care system.
On recruitment to emergency medicine, the point that the noble Lord rightly raised was the reason we set up the Emergency Medicine Taskforce in December 2011 to address workforce issues in emergency medicine. That group published an initial report last year, making a number of recommendations. Those recommendations are being pursued. The £250 million that I referred to is being distributed to 53 trusts, as the noble Lord will be aware. I have a breakdown here of how the money is to be deployed but, in the interests of other noble Lords who may wish to intervene, I shall not read it out.
Baroness Finlay of Llandaff (CB)
My Lords, given the urgency of this crisis, what are the Government doing to meet the request from the College of Emergency Medicine that the exit block be urgently addressed, so that other disciplines support emergency medicine consultants in moving patients on from A&E departments out into the community or into in-patient beds if they are not fit enough to be discharged?
Earl Howe
We have been clear with Health Education England that this is not just about A&E consultants; it is about the entire workforce in A&E, including all relevant disciplines—nursing and others. We have tasked Health Education England with putting even greater emphasis on the need to recruit A&E consultants from medical students over the coming years.
Baroness Brinton (LD)
I know that my noble friend the Minister cannot comment on Sir Bruce Keogh’s review but I wondered, separately, if there was evidence in areas that have already reorganised their urgent and emergency care—such as the West Hertfordshire Hospitals NHS Trust, which reorganised in 2009—that services are performing well or indeed better than under the old arrangements.
Earl Howe
My Lords, I do not have that evidence in front of me but, where there is a case for change, the local NHS has to agree a number of measures to be effective before any changes to services take place. That will include ensuring additional capacity at neighbouring hospitals, where that is appropriate, or in the community, where that is appropriate. If CCGs can properly satisfy themselves that a case for change can provide safe, effective and sustainable services, that is a legitimate justification for moving forward with local proposals.
Lord Warner (Lab)
My Lords, what light can the Minister throw on the recent report in the Financial Times that the Prime Minister has put the private hospital sector on standby for capacity over this winter? Is that true and is that part of the Government’s preparation for winter pressures? What impact do the Government assess has been made on the capacity of A&E departments by the 12% cut in the tariff paid by NHS England?
Earl Howe
I am aware that the tariff has been the subject of active discussion on the part of NHS England and Monitor; in particular, the 70% of the emergency care tariff that has been withheld under the arrangements put in place a number of years ago, and how that money should be used.
As regards the independent sector, the noble Lord is correct: discussions have been taking place with representatives of the independent sector to see whether and to what extent there is capacity to absorb elective care patients over the winter when needed. I see everything to be gained by that. It was something that the previous Government did and we think it is right that the independent sector, where appropriate, should play its part in relieving the burden from the NHS.