Accident and Emergency

Kate Green Excerpts

Wednesday 18th December 2013 Commons Chamber

[Mr Hunt]

I am going to make some progress and then I will give way.

There are 216 more consultants and 111 more registrars than during Labour’s time. On ambulance performance, frankly the right hon. Gentleman should be ashamed, because his whipping up of the problem so appalled the ambulance service that he received a letter from the chief executive of the south-western ambulance service, who said about his comments in the House of Commons:

“It is both disappointing and concerning that the information provided to your office has been misinterpreted and misreported in order to present a grossly inaccurate picture for the purposes of apparent political gain...I am astonished that anyone would present such misleading information to the House of Commons.”

Something else that the right hon. Gentleman did not want to tell the House regarding delays is that there has been a 28% fall in the number of 30-minute handover delays compared with the same period last year—that magically did not make it into his speech. Yes, ambulance services are under pressure; yes, there are issues with the performance of some trusts; and yes, this is a busy winter, but the one thing they and the patients they serve can do without is Opposition politicians demotivating crews by misrepresenting the reality on the ground.

[Kate Green (Stretford and Urmston) (Lab)]

Patients in Trafford will not recognise the Secretary of State’s characterisation of this as a crisis that is in the past. They are reporting long delays at Wythenshawe hospital’s and Manchester Royal infirmary’s A and E departments, particularly, as he will know, because Trafford general hospital’s A and E was downgraded to an urgent care centre and now closes overnight, as of three weeks ago. Does he agree that during transition periods for such reconfigurations it would make sense to ensure that there were adequate resources for neighbouring A and Es to take on the new patients? Those resources have not been provided to these hospitals; will he guarantee to provide them now?

[Mr Hunt]

I recognise the hon. Lady’s concern for her constituents. I have looked into the issues in the Manchester and Trafford areas very carefully, and I am assured by people on the ground that the problems and challenges they face do not relate to the changes that have been announced in Trafford.

--- Later in debate ---

[Dr Lee]

There has actually been a 37% increase in emergency admissions over the past decade, while 65% of hospital admissions are of people over 65. Dementia is doubling as we speak, and 25% of the NHS budget will be spent on diabetes by 2025. I am sorry, but to try to suggest that the genesis of the challenge we face has been during the three years of this Government is simplistic. The most polite way to put it is that the hon. Gentleman is making a simplistic argument.

[Kate Green]

I do not disagree with the hon. Gentleman about our wanting a configuration of services that ensures that patients get the best possible care and saves lives, but does he not agree that, if changes have to be made, transition planning and resources to support the transition are absolutely vital components of success? I have to tell him that, in relation to the reconfiguration we have just gone through in Trafford, I simply have not seen such resources put in place.

[Dr Lee]

I agree with the hon. Lady that the plans for many of the configurations have been somewhat made up on the hoof. They have usually been created and pushed by a series of local issues—such as 19th or 20th-century buildings that can no longer deliver 21st-century health care—but I recognise the need for a plan, and I will come back to that at the end of my speech.

I fear that a perfect storm is looming at the moment. [Interruption.] If the hon. Member for Eltham (Clive Efford) will allow me, I will come on to what I think we need to do. The perfect storm is that we have infrastructure that is not fit for purpose, too many hospitals that we cannot staff properly—one of the contributory factors in Mid Staffordshire was poor staffing levels, because it was trying to work over two hospital sites for a population that is not big enough to support one—and an ageing and increasingly obese society, as well as changes in people’s attitudes to pain and suffering and to seeking health care.

I have not yet heard a speech about the type of presentations occurring in casualty departments. Such presentations are rarely accidents and are extremely rarely emergencies. We must ask ourselves how we can address that. I am standing here with a dreadful cold and feeling pretty lousy. I have seen hundreds of patients who have presented to me as a GP or in A and E feeling like I do, but I will not go either to my GP or to A and E, because I understand that I have a viral infection that will get better by itself. The problem at the moment is that people just rock up at A and E because they think that it is the only place they will get seen, and no one questions whether they should just not bother turning up.

--- Later in debate ---

[Kate Green (Stretford and Urmston) (Lab)]

I want to speak about the current situation in Trafford and some of the lessons that Ministers might want to learn from the transition we went through when the A and E department at Trafford general hospital was downgraded to an urgent care centre and closed overnight. Despite assurances that neighbouring accident and emergency services at Manchester royal infirmary and Wythenshawe hospital would be able to cope following that change, problems are already piling up. Those problems may not have been caused wholly—or perhaps at all—by the changes at Trafford, but the impact on Trafford patients is pretty dire and we must take account of that.

Those A and E departments were already exceptionally busy, with the one at Wythenshawe working well beyond capacity. It was built to accommodate 70,000 patients a year but was already dealing with more than 100,000, as my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) pointed out from the outset. We welcome the fact that the Department now appears to have unlocked a route to additional funding for capacity at Wythenshawe, but that funding, let alone the additional capacity, is not yet in place.

As the Minister will know, in the past couple of weeks Wythenshawe A and E has reached “black” status for waiting times, and privately there are indications that the quarter 3 target for waiting times at the hospital will not be met. There are also reports that waiting queues for ambulances are doubling outside Wythenshawe hospital, and pressures are mounting at Manchester royal infirmary. The other day a constituent told me that she had visited on the evening of Sunday 8 December with her diabetic daughter and there were not even enough seats for waiting patients. Some people were forced to wait outside.

Those pressures were predicted. Last year, Manchester royal infirmary and Wythenshawe hospital struggled to meet waiting time targets, and indeed failed to meet them on at least one occasion in 30 out of 35 weeks. The Secretary of State was clearly concerned about the pressures on those hospitals because one criterion he set down for the reconfiguration of services at Trafford was that neighbouring hospitals should consistently meet waiting times before the changes were made.

On the basis of performance in the two summer quarters, the NHS asserted that the criterion on waiting times at those hospitals had been met, despite warnings from many people—including me—that not measuring performance during the winter months would give a distorted picture of the capacity of those hospitals to cope. The Minister must recognise that that caused a great collapse of public confidence—they were not very confident about the proposals for the reconfiguration anyway—because it seemed that fudging was going on to present an impression that hospital services could cope, when it then turned out they could not. To use data that are clearly applied in a way that suits the outcome NHS managers want, rather than being in the best interests of patients, is a matter of great concern. Will the Minister say how we can have genuine and robust criteria for reconfigurations in which the public can have confidence? The total absence of clarity and the fudging over the decision at Trafford over the past few weeks has had an unfortunate effect.

When the Secretary of State announced the funding in September, neither Manchester royal infirmary nor Wythenshawe received extra money to deal with winter pressures. I was surprised because we knew by then that reconfiguration would create extra demand on those two A and E departments. I am anxious to hear from the Minister about the Department’s approach to ensuring adequate additional resource to support transition for such reconfigurations.

[Grahame M. Morris]

My hon. Friend makes an important point about demand in deprived areas. The Government’s health and social care information centre has identified that in each of the past five years at least twice the number of attendances have been from those living in the 10% most deprived areas, compared with those from the 10% least deprived areas. That should be reflected in the allocation of funding, but unfortunately such areas receive no additional money at all.

[Kate Green]

Two pressures could be highlighted. The first is the way that funding fails to take adequate account of deprivation. Secondly, there will inevitably be a hump at the time of transition, as new arrangements settle down and people adapt to the changing service configuration. When providing resources to Manchester royal infirmary or Wythenshawe, no account seems to have been taken of the effect of that transition and the likely need for additional resource to take those hospitals through that period. Indeed, in a private meeting with the Secretary of State, after the reconfiguration was announced, he confirmed that there would be no additional transitional funding. I could, however, look forward to additional funding to enable greater integration of services, although not until 2015-16. Furthermore, it would not be new funding, but funding that had been moved from the NHS to social care.

I am as strongly in support as anyone of seeing funding directed as much as possible to preventive care and care that can be provided at home in the community, but we cannot take services from hospitals before we put that care in place in the community. Such care is simply not adequate in Trafford today.

The other matter I want to raise was alluded to by the right hon. Member for Sutton and Cheam (Paul Burstow). There is utter confusion among patients about what services they should access and when. As soon as Trafford was downgraded to an urgent care centre, Trafford patients believed they could not go there. That was not the intention of NHS managers, but the impact was undoubtedly to drive more traffic to neighbouring A and E departments.

[Mr Slaughter]

My hon. Friend makes an important point. A and Es and anything we would recognise as such are being closed. They are turned into urgent care centres, which deal with minor injuries with GP cover at best. They are called second-tier A and E units, which is incredibly damaging, dangerous and confusing for people. It is done simply as a political fix, so that Tory councils and others can distribute leaflets saying, “There’s still an A and E on this site.”

[Kate Green]

Whatever the motivation—NHS managers in my area have tried to communicate the changes and how patients should respond to them—there is huge patient confusion about where they should go, what time they should go and what treatment they will receive. The right hon. Member for Sutton and Cheam referred to Sir Bruce Keogh’s report, which highlighted patient confusion. During periods of transition, confusion is heightened as people become used to new configurations. What lessons are being learned on how to communicate effectively with patients so they have proper understanding of what services are available and where they ought to go?

Massive problems are piling up over this winter period, when we might expect additional pressures—we see them every winter. There is a failure of local planning and ministerial engagement in ensuring that those transition processes work smoothly for patients in Trafford. I hope the Minister comments on how transitions will be handled in future. I venture to suggest that Trafford is, I fear, an early example of how not to do it. I look forward to his response.

[Several hon. Members]

rose—