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Accident and Emergency

Volume 485: debated on Tuesday 16 December 2008

6. Whether any of those accident and emergency departments redesignated as urgent care centres have subsequently been reinstated as blue light accident and emergency departments. (243636)

Not as far as we are aware. It is up to the local national health service to ensure that urgent and emergency care meets national performance requirements as well as reflecting local needs.

That is a disappointing reply. The transfer of blue light accident and emergency from Burnley to Blackburn has been a running sore for more than a year. Given the present capacity problems at the Royal Blackburn hospital, ambulances are again taking patients back to Burnley. Why cannot we reinstate our accident and emergency at Burnley general hospital, if necessary with a published protocol indicating where patients should be taken with their various injuries and conditions, whether it be to Burnley, Blackburn, Preston or even Manchester?

I am nervous about intruding on what I understand to be the historic but friendly rivalry between Blackburn and Burnley. Seriously, however, I understand the organisation of services there to be a result of what clinicians felt would be the best way to concentrate specialist accident and emergency care in Blackburn and elective planned surgery in Burnley, which would avoid some of the cancellation problems that his local hospital was experiencing because of the need to deal also with accident and emergency cases. My hon. friend will also be aware that the democratic check on those organisations—in his case, the Lancashire overview and scrutiny committee—strongly supported the proposals. The recent problems that he mentions happen in many accident and emergency services when there are particular, localised and sudden pressures, and they are not peculiar to the reorganisation to which he refers.

Could the Minister confirm that the urgent care centres are in addition to accident and emergency provision, and not in place of it? The care centres are a better use of the expensive professional staff—doctors and consultants—instead of a way to close accident and emergency services. People who would have automatically gone to accident and emergency are being transferred to a more appropriate form of treatment.

Yes, the hon. Gentleman is absolutely right. The decision at local level is made on a case-by-case basis, but he is right to draw attention to the benefits of urgent care centres in reducing the pressure on, and unnecessary referrals to, accident and emergency departments.

I hear what my hon. Friend says. One of the most difficult aspects of the way we now treat accident and emergency departments is how they must lock in carefully with the ambulance service. One of the continuing problems in Gloucestershire is the number of times that ambulances back up in the car parks of our two main acute centres. Is it not time to look at how the ambulance service operates in relation to accident and emergency, and consider ways we can improve that operation?

Let me say loud and clear to the trusts, through my hon. Friend and any other hon. Members who experience that problem, that it is totally unacceptable for ambulances to back up either because they are being forced to do so by the accident and emergency department or because the ambulance service has decided to do so. I am sure he is aware that the clock starts ticking on the four-hour maximum wait 15 minutes after the ambulance arrives. Any accident and emergency department that thinks it can fiddle its achievement of the four-hour figure by keeping ambulances stacked up outside the hospital is wrong. That message has gone out loud and clear many times from this Department and I am happy to repeat it in the House today.

Will the Minister confirm that when making decisions about the structure of emergency care in the years ahead, it will be increasingly important to take account of not only the evidence on how to achieve the best clinical outcomes but the resource implications of the different structures of emergency care? The Government have been signalling for some time that the rate of growth of cash available to the health services is going to slow down. In the pre-Budget report, the Chancellor made it clear that spending cuts were intrinsic to the Government’s plans. Against that background, is it not important to begin to manage expectations about the structure of emergency care that is likely to be delivered by the health service in the years ahead?

“Lower increases” would, I think, be a more accurate description of future spending projections. Of course, last week we announced annual increases of 5.5 per cent. and 5.5 per cent. for PCTs in each of the next two years. There will be lower increases from the Government, but there would be cuts from the Opposition, were they to get into government.

The right hon. Gentleman is absolutely right, and I commend the thoughtful remarks that he made at the King’s Fund discussion either today or yesterday, which I read. He is right to say that high-quality care is often the most cost-effective care. There is no doubt—this is the pattern not just in this country but in other countries around the world—that when it comes to accident and emergency services it is safer, better and more effective to concentrate care in a smaller number of specialist units. It is often better for in terms of survival rates and health outcomes people to travel a little bit further to those specialist units.

In view of the confusion that still exists among patients about whether they should go to accident and emergency, urgent care centres, minor injuries units or the out-of-hours GP centre, will the Minister tell us what progress he is making in establishing a single telephone number, less than 999, that would be relevant to each area and would direct every patient down the appropriate pathway for their area?

Very good progress, I am pleased to tell the hon. Gentleman. However, he will have to be a little more patient before we make a formal announcement.

Will the Minister find time before Christmas to go to Enfield and tell the people there why they do not need an accident and emergency department at Chase Farm hospital and why it will be replaced by a non-blue light service at the urgent care centre? The most recently published report by the experts, the College of Emergency Medicine, concluded:

“There is no evidence of the clinical or financial benefits”

of the urgent care centre model, and that the Government’s proposals are

“clinically unproven and against the principle of patient choice of access to proper emergency care.”

In the light of those statements, will the Minister and the Secretary of State reverse their decision to replace accident and emergency services at Chase Farm with an urgent care centre?

The hon. Gentleman is aware—or at least he should be—that there is a potential legal challenge, if not an active legal challenge, to that case. I shall therefore not comment on his specific point. He will be aware that the proposals in north-east London have been through the democratic check of both the overview and scrutiny panel and the independent reconfiguration panel. Everybody—including the four primary care trusts, most of which cover boroughs with Conservative majorities—is agreed that the proposals are the best solution for the north-east London health economy.