Accident and Emergency Waiting Times

Martin Horwood Excerpts

Wednesday 5th June 2013 Commons Chamber

[Martin Horwood (Cheltenham) (LD)]

I am grateful to previous speakers, particularly the hon. Members for Lancaster and Fleetwood (Eric Ollerenshaw) and for Mitcham and Morden (Siobhain McDonagh), who made some of the comments I would have made and therefore saved me a good minute.

The crisis in emergency departments is multifaceted and we are facing a downgrade of the emergency department in Cheltenham general hospital. The rationale has not been funding pressures or extra admissions but, as the hon. Member for Lancaster and Fleetwood said, the shortage of emergency doctors. The College of Emergency Medicine recommends that we should have 20 emergency medical posts over the two A and Es in Cheltenham and Gloucester. The trust has only just managed to fill the 12th, so we are at not much better than half strength. That has obvious safety implications and has driven the trust’s recommendations for downgrading A and E at Cheltenham.

The staff shortages have their root in work force planning issues that date back many years. They must date back to the Secretary of State’s predecessor’s time and, clearly, to that of the previous Government, too. The hon. Member for Ealing North (Stephen Pound) was quite right, however, and we should not be playing a party political blame game. We should simply admit that we have a really serious problem and work out what to do about it.

The College of Emergency Medicine suggests that the initial recruitment to the discipline is quite respectable and that retention is the problem. Emergency medicine involves long hours, with a 24-hour cycle of shifts, and is an intense and stressful form of medical practice. I hate to accuse anyone of mercenary motivation, but of course those who work in emergency medicine cannot moonlight in private practice, either, which makes it less attractive from that point of view. So we do need a rethink nationally. I welcome the urgency with which the Government are now addressing that. It should have been done years ago.

In the meantime, changes inevitably are being proposed by local hospital trusts. I do not think we can blame them for that, but, as the hon. Member for Mitcham and Morden said, the process must be open, accountable and transparent. That was, after all, the idea of the new structures that the right hon. Member for South Cambridgeshire (Mr Lansley), the previous Secretary of State, foisted on us in the new system.

The consultation in Gloucestershire has raised real questions. Why has not the trust even tried to pay more for emergency medical posts, as it has the freedom to do so as a foundation trust? Could it have looked more seriously at overseas recruitment? Why has it not been prepared to wait for the Keogh review, or the Secretary of State’s urgent review of recruitment, before making the changes permanent? Why was it not prepared to trial changes just for a year, as Liberal Democrat members of the health overview and scrutiny committee requested yesterday? I deeply regret the fact that Conservative councillors on that committee from all over Gloucestershire voted down that very modest compromise proposal and backed the downgrading of A and E in Cheltenham.

In my detailed evidence I raised issues of increased mortality, and of possible increases in health inequalities resulting from these changes, but I have no evidence that my submission, or the thousands of petition signatures that we gathered locally, have been properly considered at all. The primary care trust consultation website actually disappeared halfway through the consultation process because, of course, the primary care trust ceased to exist and handed over to the new clinical commissioning group. The obvious suspicion locally is that this was a foregone conclusion, and that it is only a matter of time before the trust proposes the outright closure of the A and E at Cheltenham.

That suspicion was strongly reinforced yesterday. Within hours of the health overview and scrutiny committee meeting, the trust issued a joint statement with the new clinical commissioning group, instantly announcing that the changes would now be going ahead on a permanent basis, despite the fact that the trust has not actually considered the outcome of the consultation exercise at either its board or the CCG’s board. That is not open, accountable and transparent, and it must be in future.