Debate on A&E Services

Watch my speech in the House of Commons debate on A&E services here.

It can also be viewed by clicking here

For those unable to access the video above, here is a transcript of my speech:

Mr Jamie Reed (Copeland) (Lab): I beg to move,
That this House notes that hospital A&E departments have now missed the four-hour A&E target for 100 weeks in a row; further notes that trusts are predicting record deficits this year; believes the pressures on hospitals are a consequence of declining access to out-of-hospital services under this Government, including fewer older people receiving social care and more people waiting a week or more for a GP appointment; further believes the increasing bill for agency staff is also adding to the pressure on hospitals; notes that the Government plans to stop the weekly reporting of A&E data; believes this decision will make the NHS less transparent and make it harder for patients to judge the performance of their local hospital; and calls on the Government to reinstate the publication of weekly A&E data and to set out how it will tackle hospital deficits in 2015 in order to protect services.
I want hon. Members from all parts of the House to cast their minds back to the week commencing 14 July 2013: the country was still basking in Andy Murray’s historic win at Wimbledon; England had just embarked on a successful Ashes series against Australia; and hospital A&E departments achieved their target to see 95% of patients within four hours. Since then a number of unlikely things have happened: the then reigning world champions, Spain, have crashed out of the World cup in the first round; a group of scientists remotely have landed a probe on a comet hundreds of millions of kilometres from earth; and Cuba and the United States have begun to repair diplomatic relations. But in the same period some sadly predictable things have occurred: England have crashed out of the World cup in Brazil; they have been whitewashed by Australia in the cricket; and under a Conservative Government hospitals in England have now missed their A&E target for 100 weeks in a row.
I start this debate by paying tribute to the hard-working staff at every level of our national health service. They work tirelessly in trying circumstances, and without them there would be no NHS. Ministers have in this place adopted the practice of attempting to pretend that any criticism of Government policy is a criticism of the health service or its staff, so let us make clear one thing right at the start of this debate: NHS staff are remarkable and we are all in their debt. The achievements of NHS staff are despite Government policy, not because of it.
John Redwood (Wokingham) (Con): What have the Opposition learned from the Mid Staffs disaster and tragedy, where they were hitting the targets but missing the point? What should they learn about how one drives quality forward in the health service?
Mr Reed: I thank the right hon. Gentleman for that question. If he paid attention to the Francis report, he would learn that it was not the targets themselves that were to blame for the Mid Staffs tragedy, but the way they were applied in that hospital. That is clearly stated in both the first and second Francis inquiries; indeed, it was a point that the Prime Minister made on the Floor of this House when he reported to Members.
In the past 100 weeks, nearly 2.4 million patients have waited more than four hours in hospital accident and emergency units in England.
Gareth Johnson (Dartford) (Con): Why does the hon. Gentleman think that in my constituency A&E targets have been met for 97% of patients, that in his own hospital in his constituency in England they have been met for 93% of patients, but that in Wales they have been met for only 83%?
Mr Reed: I am grateful to the hon. Gentleman for that question. Had he been in this House longer and paid more attention to these issues, he would know that the datasets comparable between England and Wales are not actually the same. He would know also that the last time we had a Conservative Government people in Wales were waiting two years for operations, and that nobody campaigns more than I do on behalf of hospitals in my area on the waiting times there.
In the past 100 weeks nearly 2.4 million patients have waited more than four hours in hospital accident and emergency units in England; almost half a million people have spent more than four hours on a trolley waiting to be admitted; and more than 1,500 have waited more than 12 hours to be admitted.
Those figures offer a stark analysis of the difficulties facing accident and emergency. Even in this week of the summer solstice, this Government’s A&E winter crisis shows no signs of abating. In a debate in January the Secretary of State for Health said that the NHS had just been through a tough winter, but the evidence from NHS England shows that accident and emergency departments have had two tough winters and are well on their way to a third tough summer. Under this Government accident and emergency is experiencing a permanent winter.
Barry Gardiner (Brent North) (Lab): My hon. Friend will know that Northwick Park hospital in my constituency has had some of the worst waiting times in the country over the past year. Does he understand, and will he address in his remarks, the fact that the ageing population—those over the age of 80—in Brent has increased by 50%, yet the funding available to cope with that increase has been reduced by 25%? It means that, of the 250 people who attend A&E each day, 100 are dementia patients who become bed blockers because the integrated care package is not in place and is not working.
Mr Reed: My hon. Friend makes an excellent point. He is right to mention those issues, which I will come to later. I pay tribute to him for doing so.
The reason for those pressures on A&E, in addition to the issues that my hon. Friend raises, is the sharp increase in people attending A&E since 2010. In the past the Secretary of State has tried to claim that the increase is the fault of the previous Labour Government, but that is patently nonsense. Annual attendances at hospital accident and emergency units increased by 60,000 in the four years before 2010, whereas in the four years after they increased by nearly 600,000—10 times faster. The reality is that A&E dramatically improved between 2004 and 2010, when 98% of patients were seen within four hours. This is a crisis that only started on the Tories’ watch—after they made it harder to see a GP, after they started stripping back social care services and after they launched their damaging top-down reorganisation.
Henry Smith (Crawley) (Con): Does the hon. Gentleman not think that the closure of A&E at Crawley hospital in 2005, under a Labour Government, was distinctly unhelpful to A&E waiting times?
Mr Reed: The hon. Gentleman has made that point on the Floor of the House on many occasions, and he has been a constant voice with regard to the hospital services used by his constituents. That was a decision made by clinicians in the area, and he will recognise that. He will recognise also how much the framework has changed and how much more difficult the Government have made it for communities such as his to have their say on health reconfiguration.
Clive Efford (Eltham) (Lab): My hon. Friend is absolutely right. The point is not that there should never be any change in our national health service. When clinicians plan it and put it forward to improve services, we are right to support it. The difference is that the Conservative-led Government came in and attempted to close A&Es from the centre, such as Lewisham A&E, which they were going to close. They said they would not close Sidcup A&E, but they closed it within months of entering government. That is the difference: the Government dictated the closures, not local clinicians.
Mr Reed: My hon. Friend is absolutely right. The lesson that the Prime Minister and Secretary of State drew from those episodes was, “When you get beaten in the courts, change the law”—a completely different approach from that of the previous Labour Government.
Dawn Butler (Brent Central) (Lab): My hon. Friend the Member for Brent North (Barry Gardiner) mentioned the distressing figures at Northwick Park hospital, but the Government’s solution was to close Central Middlesex hospital’s A&E. Does my hon. Friend the Member for Copeland (Mr Reed) think that that added to the crisis or made it better?
Mr Reed: Everything that transpired in my hon. Friend’s constituency made the situation much worse, as many medical professionals have said.
Barbara Keeley (Worsley and Eccles South) (Lab): Is there not an extra pressure, with many trusts ending the year with deficits? Wythenshawe hospital, which is looking at a £3 million deficit, has decided to try to cut 33 district nursing posts, yet when the Health Committee looked at winter A&E pressures we found that it was important to hang on to district, community support and hospice nurses. Is it not just madness to force hospitals with deficits to cut district nurse posts?
Mr Reed: My hon. Friend puts her finger on the problem precisely. It is absolute madness, and it is happening at trusts throughout England, as their deficits edge up towards £1 billion for this financial year.
The number of patients waiting more than four hours each year has rocketed by more than 1 million, meaning that there are now almost four times as many people as there were five years ago waiting more than four hours. That is a damning record, and based on the performance over the previous Parliament five more years of the same will see almost 2.5 million patients each year waiting more than four hours by 2020. For the benefit of patients, medical professionals and the healthcare system as a whole, that cannot be allowed to continue.
Andrew Percy (Brigg and Goole) (Con): The hon. Gentleman may know that I spend my weekends working in the NHS, attending seriously ill patients. We are seeing more patients who are elderly, who have a higher acuity and who need admission to hospital; hospital is the only place for them. On his suggestion that the situation has arisen on the Government’s watch, how does he account for the Royal College of Nursing’s telling the Health Committee that the decisions that needed to be taken to deal with this demographic shift should have been taken a decade or more before my party entered government?
Mr Reed: If the hon. Gentleman wants to compare the records of this Government and the previous one, we will do that all day long and he will come out on the wrong side of that debate. On the ageing society, we would think from listening to Ministers and Government Back Benchers that this has just been sprung upon us. He is right to say that it has been coming for a long time, but we did an awful lot more to address it than this Government are doing. I will go on to explain why in just a moment.
A real worry for the NHS, and for those of us who use it or work within it every day, is the Government’s plan to suspend the work of the National Institute for Health and Care Excellence on its safe staffing programme. That move is a rejection of a key recommendation made by the Francis report, and in response to the move, Sir Robert Francis said:
“I specifically recommended the work which NICE has been undertaking for a reason…I would not be surprised if this news generates a significant level of concern, and it seems a shame that the work of NICE has been stopped.”
Dr Clifford Mann, president of the Royal College of Emergency Medicine, has said:
“There are real pressures on nursing levels in Emergency Departments.”
He has also said:
“We are concerned about patient safety and staff welfare.”
I would be grateful if the Minister could explain to me, and to Sir Robert Francis, why on earth the Government have suspended this crucial work.
Dr Andrew Murrison (South West Wiltshire) (Con): I read the hon. Gentleman’s motion carefully and I was left slightly bewildered, as he seems to be suggesting that the solution to this problem is more resources for A&E and for primary care, yet I seem to recall that just a few weeks ago I was standing in an election campaign where my party pledged £8 billion more for the NHS and his party failed to back that. Can he explain where he will find the resources?
Mr Reed: That is the kind of magical thinking that afflicts Conservative thinking. The hon. Gentleman will be aware that at the last general election we talked about a specific £2.5 billion fund to train 20,000 more nurses, 8,000 more GPs and so on. What we always said was that the NHS would get the money it deserves, quite separately from that £2.5 billion, from a Labour Government. That remains the case and he knows that that is the truth. It is true that certain societal changes, including the ageing society, pose new challenges and offer new pressures for the NHS, but the service is also under increasing financial pressure as a direct result of Government policy.
Joan Ryan (Enfield North) (Lab): May I tell my hon. Friend that we should not recommend to anybody that they rely upon the promises of the Conservative party, because it promised to keep Chase Farm’s A&E unit open—the Prime Minister himself promised that at the 2010 election—but then he closed it? Every A&E department in the surrounding area that now serves the people of Enfield—those of the Royal Free, Barnet and North Middlesex hospitals—continually miss their A&E waiting time targets.
Mr Reed: I thank my right hon. Friend for that intervention, and may I say what a pleasure it is to see her again in the House of Commons? She is entirely right in what she says. We all remember the pictures, and we remember the Prime Minister’s promises and those from the previous Secretary of State. My right hon. Friend is right to say that nobody should ever take any lessons from Conservative Members or believe what they are being told by them—not one bit.
Mr Steve Baker (Wycombe) (Con): Why is it that when an A&E department is lost from a Labour constituency it is the Government’s fault, but when one was lost in a Conservative constituency under the previous Government that was “clinically led”? Can the hon. Gentleman explain the contradiction?
Mr Reed: I am afraid the hon. Gentleman is not listening; the rules have changed. The system whereby these processes are undertaken has comprehensively changed. If he were to draw a golden thread through Conservative health policy over the past five years, it would be that the public do not matter and are not listened to, and that change is driven from the centre, irrespective of what local clinicians say.
Tom Pursglove (Corby) (Con): This is all a little ironic, given that in my constituency the Labour party went around petrifying local people by saying that the A&E unit at Kettering general hospital was going to close, but it is still open and it is performing better. Would the hon. Gentleman like to apologise?
Mr Reed: If the hon. Gentleman is seeking an apology, would he like to apologise for the fact that A&Es in England have missed their waiting time targets for the past 100 weeks? I do not see any trace of an apology or any scintilla of embarrassment on his face.
It is true that certain societal changes, including the ageing society, pose new challenges and offer new pressures for the NHS, but the service is also under increasing financial pressure as a direct result of Government 
24 Jun 2015 : Column 914
policy. First, the declining access to social care and the squeeze on primary care have forced people to turn to A&E in increasing numbers and have also meant an increasing number of admissions that could have been avoided if people had received better care outside hospital. Secondly, the Government wasted £3 billion, at least, on a damaging top-down reorganisation that nobody wanted and nobody voted for, and which was hidden from the electorate. That reorganisation sucked resources from front-line patient care. We know that senior members of the Cabinet believe that the reorganisation was a catastrophic mistake. We know that, in the words of British Medical Association chair Mark Porter,
“the damage done to the NHS has been profound and intense”,
and we know that the reorganisation has not made the NHS more productive or more efficient.
Thirdly, the effect of that wastage has been compounded by the short-sighted cuts to nurse training places at the beginning of the previous Parliament. That means that there are not enough staff working in hospitals—that was a key criticism by the Keogh review. In addition to compromising patient safety and clinical outcomes, this Government’s decision has left trusts over-reliant on expensive agency staff.
Mrs Madeleine Moon (Bridgend) (Lab): When I worked in hospitals and was responsible for arranging community-based discharge, two major problems created a delay in discharge—I hate the expression “bed-blocking” as it is such an insult to elderly people. One was access to community care facilities—home care support—and the other was ensuring that we had community equipment, such as hospital beds, hoists or bathing equipment. If we do not have all the pieces in place, which often come not from NHS funding but from local authority funding, it will not happen. That is exacerbating the problem in A&E.
Mr Reed: My hon. Friend makes a prescient point. The Government talk the talk but do not want the walk, and she has detailed precisely why that is the case.
Sir Simon Burns (Chelmsford) (Con): I am grateful to the hon. Gentleman for giving way, particularly as he has just responded to the intervention by the hon. Member for Bridgend (Mrs Moon), who is from Wales. Does he accept that in every financial year since 2010 the NHS in England has had a real-terms increase in funding, albeit a modest one, but that there has been a cut of 8% by the Labour Government in Wales and the A&E target in Wales has not been met since 2008?
Mr Reed: I congratulate the right hon. Gentleman on his knighthood—it is remiss of me not to have done that. He will know that real-terms increases and cash increases are not the same. He will also know, because he voted for it, that the budget in Wales has been cut by this Government by more than £2 billion. Let us compare like with like.
The Royal College of Nursing has calculated that almost £1 billion—£980 million—was spent on agency staff in the last year alone. Those and other choices made by this Government have meant that, collectively, trusts in England reported a total deficit of £822 million in 2014-15. That is simply unsustainable. A recent survey by the King’s Fund found that 90% of trust financial directors and 85% of commissioners are concerned about the financial state of their local health economies, and that view will be shared by many Members on both sides of the House. An investigation by Pulse revealed that clinical commissioning groups were being forced to use their 2015-16 winter pressures allocations just to maintain regular services.
Questions must also be asked about this week’s revelations that thousands of foreign nurses working in our NHS could be forced to leave the country as a result of the Government’s immigration rules. The RCN points out that this would cause chaos for the NHS and waste tens of millions of pounds—the Secretary of State laughs as I mention that. It would make matters much worse for patients and for front-line clinicians. Will the Minister tell us how many nurses will be lost from A&E and how many will be lost in total as a result of this move? Where in the country will they be lost? How will the vacancies be filled? What will this cost? Has he or any Minister in his Department made representations to the Prime Minister about the effects of this policy? If so, will he share those with the House? When did Health Ministers know that this policy might cause so much damage?
Robert Flello (Stoke-on-Trent South) (Lab): When the Minister replies it will also be interesting to hear him say exactly how that cut and restriction on nurses will impact on the Royal Stoke university hospital, which had the great misfortune, for patients and the public more generally, of topping the list for the longest waits last winter of more than 12 hours on trolleys.
Mr Reed: My hon. Friend is absolutely right. Stoke deserves better, and no one has worked harder than him to ensure that it gets something better. Let us ensure that the Minister answers those points.
The understaffing crisis represents a dire situation that will only get worse unless the Government demonstrate an understanding of these issues and give them the attention that they deserve. We know that, as well as deficits this year, the five-year forward view is based on assumptions that the NHS can save £22 million by 2020. Will the Minister assure us that this will not result in any fewer medical staff or cuts to hospital or community services? Will he also commit to placing the analysis and the assumptions behind the efficiency plans in the public domain so that we can have an informed and honest debate about NHS funding? We do not want a programme of services being set up to fail and then being cut by stealth.
Maria Caulfield (Lewes) (Con): I worked as a nurse under the previous Labour Government. That Government may have kept numbers the same, but they reduced the skill mix, which greatly affected the safety of patients both on wards and in outpatient facilities. Can the hon. Gentleman explain that?
Mr Reed: It is a matter of fact that we increased nursing numbers. The hon. Lady will be well aware that when we came into office in 1997, we were training 15,000 nurses a year, and when we left office in 2010, we were training 20,000 nurses a year.
On social care, under this Government, 300,000 fewer older people are getting the care they need, with more and more people being forced to stay in hospital. But that is only part of the story. When someone who needs care cannot get the help they need, it increases the risk that they will struggle or fall ill and have to go to accident and emergency. That is clearly demonstrated in the increasing number of older people arriving at A&E by ambulance. Almost 100,000 extra patients over the age of 90 were brought to accident and emergency by ambulance last year. That is an indictment of Government policy towards older people, and the problem is further exacerbated when the true scale of the damage to social care is revealed.
Before the election, the National Audit Office published its report on the impact of Government cuts on local council budgets. The report found that 40% of the total savings between 2013-14 and 2014-15 were made through reducing adult social care services.
The Association of Directors of Adult Social Services has calculated that a further £1.1 billion will be cut from adult social care over this financial year, and the president of the association said:
“Short-changing social care is short-sighted and short-term.”
The number of patients ending up in A&E because they cannot get the care they need to help them stay healthy outside hospital is clear evidence of this short-termism.
Cutting the social care budget is clearly a false economy, as thousands turn to A&E as a result. That is bad not only for the patient, but for the taxpayer. If a patient is not getting the care they need, their condition will deteriorate, which means that more complex interventions will be needed. A recent poll commissioned by the Care and Support Alliance found that nine out of 10 GPs believe that deep social care cuts are responsible for the overcrowding in our accident and emergency departments. The Government need to get a grip and address the crisis in social care in order to relieve the pressure on A&E departments and GP surgeries. Instead, they have chosen to risk putting more pressure on the heath system at all levels by announcing further cuts of £200 million to the public health budgets of local authorities without any idea of whether they can be made without harming vital services—services that potentially save money.
Mr Peter Bone (Wellingborough) (Con): Will the shadow Minister recognise the initiative that is happening in north Northamptonshire? Kettering general hospital will have not only an A&E, but urgent care, social care and mental health facilities and GPs all on the same site. People can go to the hospital and be dealt with there and then, correctly. I will also have an urgent care centre in my constituency. Is that not the way forward?
Mr Reed: I am grateful to the hon. Gentleman for his intervention. I absolutely agree that models such as that and local best practice can exist in pockets all over the country. It is just a shame that so many health economies are getting cut to the bone, because that stops them from developing such care models. He is right that it is precisely that kind of integration that points the way to the future. Have the effects of these public health budget cuts on primary care and accident and emergency been modelled by the Department, and will the Minister share that work with the House? If that work has not been done, will he explain why? Has the Department consulted on these latest cuts, and what was the response?
I now wish to turn to the situation in general practice. In the previous Parliament, we saw a marked increase in the number of people waiting longer for a GP appointment. By 2013-14, almost 6 million people could not get a GP appointment. If the trend continues, that figure could be around 10 million by the end of this Parliament. Those people are often left with little option but to turn to accident and emergency. The GP patient survey suggests that almost 1 million patients went to A&E last year because they could not get a convenient GP appointment. It is clear that the GP workforce crisis is a major driver of the issues under discussion today.
Robert Flello: My hon. Friend is making an extremely good speech and is being very generous in giving way. On that point, Stoke-on-Trent has traditionally had far more patients per GP than the national average, and the age of that population is rapidly approaching and often way past retirement age. What we are seeing is not that people cannot get an appointment when it is convenient, but that they cannot get an appointment for days on end.
Mr Reed: My hon. Friend makes the case. What is happening in Stoke, I regret to say, appears to be something of a canary in a coal mine for the NHS around the country, and its issues will increasingly be seen in areas all over the country.
It is clear that the GP workforce crisis is a major driver of the problems. The number of full-time equivalent GPs per head has fallen over the past five years, even as demand has increased.
Henry Smith rose—
Mr Reed: I have been generous with time, so I must press on.
In 2013, the Government announced a call to action to improve general practice access and experience for patients. They set out six key indicators to rate the quality of access and experience for patients. One year later, every single indicator had shown a deterioration in performance. Fewer people described the overall experience of their surgery as good and fewer people were able to get an appointment. The Government must address that finding. Only by addressing the crisis in general practice in addition to social care can the Government begin to relieve the pressures on A&E departments.
When the Secretary of State and the Prime Minister discuss the NHS in this House, they like to use words such as “openness” and “transparency”. Sadly, their actions betray that sentiment on a routine basis. I refer again to Professor Keogh’s seminal letter to the Secretary of State two years ago in which he refers to the use and principle of transparency in the NHS as representing
“a turning point for our health service from which there is no return.”
Except that, for this Government, it seems that there is a return.
Currently, NHS England publishes the performance measures for each A&E in England every week. Those figures contain a wealth of information for each trust and it makes that data available to the public. The data show how each A&E department is performing across a range of measures, and it can be used to target specific interventions at trusts that are struggling. This reporting time period also means that issues can be identified quickly and resolved promptly. Rather than taking action to ensure that hospitals in England meet this target, the Government are seeking to hide the performance data. We will not be able to see how A&Es are performing each week; we will have to wait until the end of each month. By publishing a significant number of performance measures from across the NHS on the same day, the Government appear to have found an innovative way of burying bad news—publishing even worse news at the same time. Patients deserve better than that. Clearly, Ministers find it more palatable to be reminded of their failings just once a month, rather than at the end of each week. This move is designed to make the red box lighter and the scathing headlines kinder. Will people not conclude that the monthly publication of A&E data—unlike other monthly data sets—has nothing to do with patient care and everything to do with political and media management?
Helen Whately (Faversham and Mid Kent) (Con) rose
Mr Reed: I must make some progress.
The issues facing A&E departments, GP surgeries and social care services will not be solved by amending the date on which performance indicators are published. The public will be rightly sceptical about the motivations behind the reduced publication of data that illustrate both good and bad performance. It is a move designed to take the pressure off Ministers as they turn a blind eye to the pressures that they are inflicting on our health service.
The pressures that the Government have introduced into the health service have built up until the system can no longer cope. A&E is full to bursting and social care has been cut to the bone, which means that patients cannot be discharged, wards are getting fuller, there are delays for admission and more people are waiting longer for treatment. That is indisputable. In England, the target for seeing 95% of patients within four hours has been missed for 100 weeks in a row. Instead of easing the pressures in A&E, this Government have decided to make it harder for patients to see the effects of Government policy on the services that they use by restricting the performance data that are available. Under this Government, it is getting harder to see a GP, harder to be seen at A&E and harder to see how the NHS is performing.

Not only is the record of this Government shameful, but their cynicism and complacency are, too. Professional bodies and Opposition Members have long warned the Government that the path they have placed the NHS on is damaging the service, working against patients’ best interests and causing unprecedented professional concern. Having done that, the Government are now trying to evade scrutiny. Today, Ministers must explain why they are seeking to make NHS performance less transparent and to hide the damage caused by their policies from patients and the public, and how they intend to protect services and tackle hospital deficits this year.

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