Accident and Emergency

Phillip Lee Excerpts

Wednesday 18th December 2013 Commons Chamber

[Dr Phillip Lee (Bracknell) (Con)]

On 27 December 1999, I and two other junior doctors embarked on a ward round at Wexham Park hospital in Slough. We had 72 patients to see that day, and it took us 13 hours to get round to them all. I say that because it was 14 years ago, yet I am hearing that this is the A and E crisis to end all crises. Every year, doctors in the national health service are worried and concerned about the pressures that the winter will bring to bear, and I do not think that this year is any different from 1999.

I want to try to be a bit challenging today and, in view of the motion, perhaps a bit counter-intuitive. We have too many casualty departments in this country. We should look at the mortality statistics—the likelihood of survival. I would say to the hon. Member for Wigan (Lisa Nandy) that, if my grandfather went into hospital, I would want him to go into the one where he had the best chance of survival, not necessarily the one down the road. I do not know about her hospital, but a large number of hospitals in this country unfortunately do not deliver the best care or the best mortality statistics. We need to reflect on that without trying to score petty political points about a variety of different issues.

[Grahame M. Morris]

I want to query the hon. Gentleman’s point about this crisis not being anything unusual. The Government’s own Health and Social Care Information Centre has published figures showing that the number of visits to A and E departments in England has risen by 11% in four years to 21.5 million attendances, which is 60,000 a day. The numbers are clearly increasing, and our argument is that that is partially the consequence of the Government policy of cutting social services.

[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.

[Nicholas Soames (Mid Sussex) (Con)]

I am following what my hon. Friend is saying very carefully. Does he agree that part of the problem with A and E is the tremendous back-up of people who are admitted, and the inability to discharge people who ought not to be in hospital?

[Dr Lee]

Yes, we need to integrate. The shadow Front-Bench team is right to call for more integration, which is part of the issue.

That perfect storm is coming and I suspect it will hit this or the other side of 2020, when we will have such an ageing society with such expectations, and a creaking infrastructure that is not able to deliver the best care that can be delivered.

Given the time available, I shall be brief, but we need to have a cross-party plan. I suspect that we have twice as many acute hospitals as we need, and that we probably need only about 100 in England and Wales. The population served by each acute hospital should be about 500,000, 600,000 or 700,000, which is nine or 10 constituencies, so we would not all be able to come to the Chamber to defend our local district general hospital. I am sorry, but those days have passed. If you think that I am a maverick, I am backed up by every single royal college, the King’s Fund, the NHS Confederation—I could go on. Therefore, we need to deal with the issue.

I recognise that the politics is very difficult. I think that we should convene a cross-party committee and have a cross-party understanding. We will have to do that at some point in the next five to 10 years, and it would be remiss and wrong of us as an institution to ignore that reality. I am tired of sitting here and listening to hon. Members trying to score political points on this issue. Of course we can argue about the funding of health care and there is scope to debate philosophical differences about health care provision, but when it comes down to it, we need a hospital infrastructure that can deliver the best acute emergency and surgical care to everybody at their time of need. I fear that we do not have that.

We need to integrate social care with health care. There are some models—Cambridgeshire has embarked on a very good plan—but it needs to happen up and down the country. We need seven-day-a-week care, but to staff that appropriately, we need fewer hospitals. We will not be able to have seven-day-a-week consultant care on every district general hospital site in this country. I wish I had a bit longer, but I will conclude. I think that we really need to raise the bar, because everyone in this country wants the best care for all.