Accident and Emergency

Debate between Valerie Vaz and Andrew George

Wednesday 18th December 2013 Commons Chamber

[Andrew George (St Ives) (LD)]

My expectations for this debate were low, having previously endured shouting matches between the former Labour Secretary of State, the right hon. Member for Leigh (Andy Burnham), and the current Secretary of State, with the usual antics of carefully selected and spun statistics thrown at each other. Those expectations were not disappointed. This issue is not helped by being dragged into the gutter of partisan politics. The fact is that the A and E crisis—if there is indeed an A and E crisis—has existed and has been endemic in the NHS before and after 2010. This is largely the result of A and E being seen as an issue that somehow needs to be treated separately and not part of an integrated NHS. Before 2010, there were ambulances queuing outside the A and E in my constituency and in the Royal Cornwall Hospitals Trust in Truro. The problem exists. From time to time, there will be those kinds of pressures, which are created by a whole set of things that are not entirely the fault of a failing A and E service.

One aspect of unscheduled care in Cornwall that I raised with the former Secretary of State is the out-of-hours GP service. The previous Labour Government were perfectly happy to see that service put out to tender and privatised, and we saw a fragmented unscheduled care service. I reported the Serco out-of-hours GP service to the CQC, because it was simply putting profit before patients by manipulating statistics to make the outcomes appear better than they were. It was announced last week that Serco will be handing that contract back early. I hope that that will result in an integration of unscheduled out-of-hours care, as that is the kind of thing we need to do. This is not an issue that should be subject to party political point scoring, because that completely misses the target.

[Valerie Vaz (Walsall South) (Lab)]

The hon. Gentleman sat on the Select Committee with me. He must surely accept that there was a top-down reorganisation that nobody wanted and that cost the NHS £3 billion.

[Andrew George]

Yes, and the previous Labour Government were involved in multiple top-down reorganisations of the NHS. The hon. Lady knows that I opposed that top-down reorganisation; I voted against the Health and Social Care Bill.

We could just bemoan the things that are going wrong, but I want, in two minutes, at least to lay on the table my prescription for what needs to be put right. The two themes have to be integration and prevention. My intervention on my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) spelled out the theme of integration. Unscheduled care includes not only A and E, but minor injuries units, urgent care services, the 111 service, the ambulance service, the out-of-hours GP service, GP surgeries themselves, and, indeed, GP walk-in centres, which the previous Government created. Significant confusion is created about where the general public are supposed to take themselves if they have an urgent need for medical attention. We really need to find ways to integrate those unscheduled services in a way that does not result in the fragmentation that bedevils the service at present.

On prevention, often in acute hospitals planned work cannot go ahead because patients cannot be discharged from hospital and other patients cannot be admitted because there are insufficient beds. The health service is not integrated, because there are insufficient community beds and the primary care service is struggling and stretched to the limit, unable to provide the kind of care for people in their homes and community hospitals that would avoid them ending up in hospital as emergency cases. Those are the two themes: further integration of the service, which is not helped by the Health and Social Care Act 2012, and significant investment in preventive care and primary care.