Accident and Emergency Waiting Times

Stephen Dorrell Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

Oh dear, Mr Deputy Speaker. It is hard for this Government, who have decimated social care, to lecture us about it. Between 2005 and 2010, A and E waits fell. That was after the GP contract was signed. Let us have some facts. We did much to support social care and to deliver an NHS with the lowest ever waiting lists and the highest ever patient satisfaction.

The second point in our A and E rescue plan concerns safe staffing levels—another aspect that we have raised repeatedly with the Secretary of State.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way to the right hon. Gentleman in a moment.

All over the country, NHS staff are saying that there are not enough people on the ward to deal safely with the pressure that they are under. The College of Emergency Medicine has warned of a “workforce crisis” in A and E and of

“a lack of sufficient numbers of middle grade doctors and Consultants in Emergency Medicine to deliver consistent quality care.”

More than 4,000 nursing posts have been lost since May 2010 and the Care Quality Commission says that one in 10 hospitals in England is understaffed. It emerged last week that the problem is set to get worse. A survey of NHS HR directors by the Health Service Journal found that 27% of trusts were planning to cut nursing jobs in the coming year, that 20% were planning to cut doctors and that one in three was not confident that they had enough staff to meet demand.

As I have said before, all parties in this House, including my own, need to learn the lessons of the failures in care at Mid Staffs and of the Francis report. The primary cause of those failures was dangerous cuts to front-line staffing. There is a clear risk that the NHS is repeating that mistake. I therefore call on the Secretary of State to intervene in the further round of job cuts and to ensure that all hospitals in England have safe staffing levels.

[Mr Dorrell]

May I bring the right hon. Gentleman back to the interface between social care and health care? He knows that I have a lot of sympathy for the points that he made about the importance of making that interface work more smoothly than it has done for a long time. Is the House to interpret his remark that an additional £1.2 billion ought to be made available for social care as a spending commitment that has the consent of the shadow Chancellor, on the day when the Labour party has said that it will not make good the child benefit changes that it opposed earlier in the Parliament?

[Andy Burnham]

It is important for me to answer the Chairman of the Health Committee. Those of us who are in the club of former Secretaries of State understand that the health and social care systems are interconnected and must be seen as one system, because the failure of social care lands on the doorstep of the NHS.

To answer the right hon. Gentleman’s point directly, the money that I was talking about would come from the underspend. It is part of the allocated budget that his Government gave to the Department of Health for 2012-13. The Department did not spend the whole budget so there was a £2.2 billion underspend. As he knows, the practice has been that Departments can take forward that resource to meet new pressures in later years. I am asking the Secretary of State please to ask for access to that money to relieve the pressure on social care. Simply handing it back to the Treasury when there is an A and E crisis and social care is collapsing is not good enough.

The third point I want to address is out-of-hours advice and the introduction of the 111 service. Last week’s summit heard worrying evidence that the problems of 111 are not just teething problems, as the Secretary of State has claimed. We were told that the problems were more structural and were a result of how 111 has been set up—a feature of the cost-driven contracts that have replaced the successful and trusted NHS Direct. Contracts have gone to the lowest bidder, and they are saving money by having inexperienced call handlers working to a computer algorithm that too often results in the advice “Go to A and E”. There has also been a huge reduction in nurse-led call back, which was the norm with NHS Direct.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the fact that we are debating increased evidence of service pressures in the national health service. Having attended health debates in the House of Commons for quite a few years, I can say that there is a depressingly familiar tone to this debate. May I tell the right hon. Member for Leigh (Andy Burnham) that if we want to develop party points in the House and convince the electorate that there is something in it, it is not a bad idea to begin by establishing where the real differences exist between the Government and the Opposition? If we look at the evidence for why we have experienced increased service difficulty in the health service, we see that it is not the differences between the Government and the Opposition that are striking but the fact that there is a shared analysis. However, there is an apparent unwillingness to apply that analysis and work it through in the necessary large-scale service change that we require.

As for the roots of increased service pressures in the health service, I agree with quite of lot of what my right hon. Friend the Secretary of State said about the GP contract, but that is not why those pressures exist. Their true roots go back to the time in which the right hon. Member for Leigh was Secretary of State. In 2009, David Nicholson said that demand would go on rising in the health service, and that given the state of public finances we had to find ways of meeting that demand without continuing to make calls on the taxpayer on the scale that we had grown used to over the first 60 years in the history of the health service.

[Steve Baker (Wycombe) (Con)]

In Wycombe, ever since our A and E was closed under the previous Government, people have wanted nothing more than to get it back. It is clear that medicine has changed and that they will not do so, but does my right hon. Friend agree that there has been a long-standing failure to explain those pressures to the public?

[Mr Dorrell]

I absolutely agree with my hon. Friend. We cannot blame people in the country for not understanding the need for change in the health service if politicians never explain why that need has arisen. I quite often quote Enoch Powell—not someone who wins a consensus across the House—who as Health Minister went to the equivalent of the NHS Confederation conference, which is now under way in Liverpool, to explain the need for the change in the service model in mental health. He said in his speech that

“Hospitals are not like pyramids, built to impress some remote posterity”.

That is the case that we need to begin to explain.

[Chris Bryant]

rose—

[Mr Dorrell]

I shall give way once more.

[Chris Bryant]

I am grateful for the right hon. Gentleman’s generosity. One of the ironies is that Enoch Powell recruited a lot of doctors overseas. He would have had absolutely nothing to do with the argument advanced yesterday by one of the right hon. Gentleman’s colleagues that all the problems in A and E are to do with the arrival of migrants. If anything, we need to change immigration policy in this country, so that more doctors can come here.

[Mr Dorrell]

I have four minutes, or with two interventions, six minutes, so if the hon. Gentleman will forgive me, I shall not go off into a discussion about immigration policy.

I want to focus on the changing needs that the health service has to meet. I sometimes wonder whether people talking about rising demand on the health service and rising demand for emergency care have ever sat in a GP’s surgery. Have they noticed around them in a GP’s surgery the kind of people who present in a surgery and the conditions that bring them there—dementia, diabetes and drug and alcohol abuse? How can we expect a service that was designed to meet the needs of patients, inasmuch as it was designed at all, in the 1950s, 1960s and 1970s to meet the needs of today’s increasingly elderly and dependent patients, without rethinking the way care is delivered?

This is—I come back to my core point—a shared analysis. It is not a subject of party political debate. It is a shared analysis between the two Front Benches, and what is even more surprising is that not only is the analysis shared, but the conclusions about the right policy response are shared.

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Dorrell]

Forgive me. I have a minute and a half and I want to develop what I think is an important point.

When I make the case for greater urgency about integration between the different parts of the health and care system, I am often told that I am supporting Andy Burnham’s plan. I am quite happy to support Andy Burnham’s plan. Actually, I gently claim credit for the fact that the Health Committee on a cross-party basis has been advancing this analysis from the beginning of this Parliament, and with due deference to the right hon. Gentleman and to my colleagues on the Select Committee I will also point out that part of the answer that the right hon. Gentleman is—rightly, I think—advancing builds on health and wellbeing boards, which are the creation not of me or of him, but of my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), the former Secretary of State for Health and now the Leader of the House of Commons.

The right hon. Member for Holborn and St Pancras (Frank Dobson) talked about a duty of candour. Could we not have a duty of candour about agreement in the House of Commons—agreement that what needs to happen is not to find artificial divisions, but to build on the need for urgent change to meet the needs of today’s patients?