Accident and Emergency Departments

Jamie Reed Excerpts

Thursday 7th February 2013 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

First, let me commend my hon. Friend the Member for Ealing, Southall (Mr Sharma) and the hon. Members for Newark (Patrick Mercer) and for Eastbourne (Stephen Lloyd) for initiating this debate and the Backbench Business Committee for agreeing to it. As we have heard, given the geographical spread of concerns, this will clearly be the first of many such debates.

The recent events in south-east London have demonstrated just how timely this debate is. Members from all parts of the House have made compelling cases and shown the depth of feeling on this issue, which cannot be approached easily or without extremely strong emotion. I have always fought for the services provided by West Cumberland hospital in my constituency and I always will. I know just how Members feel about the issues facing their hospitals and I am sure the Minister does too. Indeed, I am sure we have all faced them.

The needs and best interests of patients were at the centre of the inspiration to create the national health service, almost 65 years ago, from the ashes of the second world war. The needs and best interests of the patient must remain at the centre of any discussion about health services today. This is the crux of the issue. With that in mind, the recent decision that the Secretary of State for Health took on the A and E department at Lewisham has set the NHS on a dangerous path whereby the core principle underpinning and shaping the design and delivery of hospital services—that which is in the best interests of patients—now looks set to be redefined. This Government have introduced a new basis on which to take decisions—namely, that financial considerations should take precedence over clinical considerations. Any A and E department in the country is vulnerable to change on that basis.

Those two fundamental points—financial considerations taking precedence over clinical considerations and the Government allowing the reorganisation of well functioning hospitals on that basis—create a toxic mix that could have consequences for patient care and well-being. As we have seen—today’s debate is testament to this—the new emerging principle has consequences for the legitimacy of the decision-making process for reconfiguration and the accountability of those behind such processes. We must return to the first principles of health care provision. The patient comes first. Their health care and well-being are paramount. The needs of the patient must always take priority over the needs of any other interest in the system. Services should reflect that, as should their design and delivery.

If a clinical case and clinical evidence suggest that services and, most importantly, patient care can be improved by reconfiguration, we have a duty to support those arguments in the interests of the patient. Where a reconfiguration is shown to improve patient care and ultimately save lives, we cannot and must not stand in the way. Where services can be better provided to those who use them, changes cannot and should not be opposed simply for the sake of opposition.

My right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary, has made clear the massive challenges facing our health-care system. It is a 20th-century system struggling to answer the questions asked of it by a 21st-century society. There is a huge sustainability challenge characterised by an era of economic austerity, for which there is no line on the horizon, and rapidly rising demand. However, any community that is experiencing reconfiguration without clinical evidence should know that the Opposition will be by its side fighting with it every step of the way. The NHS is our greatest achievement and we guard it jealously.

There are important progressive principles at stake. First, every penny of taxpayers’ money should be spent to its maximum effect, even more so in austere times. As arguably the nation’s most valued public service, the first duty of the NHS is to the patients and public of our country, not to public servants.

Last week, we published a report on the state and condition of A and E services throughout the country. The scale of demand and the pressures on the system are frightening. In the financial year to date about 100,000 more patients are being left to wait for more than four hours in A and E waiting rooms before being seen. That does not show the full scale of the pressure, as an extra 23,000 patients were left waiting on trolleys for more than four hours after being seen and before being admitted to A and E. The pressure then backs up through the ambulance services and, because of the lack of capacity in A and E, patients are being left waiting in the back of ambulances for, in some cases, many hours. This is an issue of capacity or, to be more accurate, lack of capacity. It shows that the system is creaking under the pressure, so reconfigurations based purely on financial considerations are simply unacceptable.

The distinction between the different forms of reconfiguration is important. If a change in services is supported and motivated by clinical evidence, it can offer real improvements to patient satisfaction and to overall levels of care; but if a closure is motivated purely by financial reasons—and if it is taken in the absence of clinical evidence or consultation—that is simply a cut to services hidden beneath the label of reconfiguration, and that is not acceptable.

There are always genuinely hard choices to be made in the national health service, but I would never accept a reconfiguration of hospital services in my constituency based on non-clinical considerations. I am sure that the Minister would not either, and I am convinced that no Member of this House would accept reconfiguration on that basis.

Lewisham A and E was not downgraded because it performed badly or because the level of care for local residents could be improved by focusing services elsewhere; it was downgraded because of financial problems in neighbouring trusts, and that is wrong.

The figures that I have quoted show a system that is on the brink. Further increasing pressures by reducing capacity without clinical reasons has the potential for truly dangerous consequences. Closing without clinical evidence an A and E department that is relied upon can be damaging to local patients and a community, but it also has wider implications for the health care system as a whole. Performance in A and E departments is a barometer of how the wider NHS is performing. Patients on trolleys indicate lack of capacity on wards, and the increased number of delayed discharges shows that patients are being kept in hospitals when they could be receiving care in their communities, but there are clear gaps in primary care provision. A and E departments are under immense strain. Department of Health figures show as much and there is simply no justification for the financially driven closure of services or the downgrading of facilities.

At the heart of the health care service is patient need, and ensuring the right provision of health care services can only be done by speaking with patients and clinicians. That is why it is crucial that consultation is undertaken at every level in any process relating to reconfiguration. A and E services should first of all be about people and not pound signs. Those of us who care about the national health service must guarantee that people are engaged at every possible juncture in the decision-making process. That will ensure that they have a stake in the future design of services, that, crucially, they have the services they need and that they are not subject to back-door, cherry-picked reconfigurations, such as that in Lewisham.

Pressures in A and E departments are felt across the whole health economy of a local health service. Removing an A and E department without clinical support or evidence is hugely disruptive and will have a profound effect on the provision, level, quality and type of every associated service in any and every local health economy. A reconfiguration of emergency services without sound clinical guidance is not a reconfiguration— it is a cut. It is a cut in services and in provision that will be detrimental to the people who rely on those services. In real terms, national health service spending has been cut, and £3.5 billion has been wasted on a reconfiguration that was not voted for by anyone at the last general election. It is not wanted by anyone in this country, including medical professionals, and it has caused chaos in the NHS and in the delivery of its key services.

Opposition Members will never accept purely financially driven reconfigurations. I call on the Minister to commit unequivocally to that principle, and to intervene without delay on reconfigurations that are being driven not by clinical need but by financial pressures. I can only echo the powerful invitation made to the Minister by my right hon. Friend the Member for Tottenham (Mr Lammy), and remind her that she has the power to intervene and stop this happening. I look forward to her doing so.