House of Commons
Wednesday 21 January 2009
The House met at half-past Eleven o’clock
[Mr. Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
Lord Saville informed me last November that he expects to submit his inquiry report this autumn. As I have made clear to Lord Saville, to the families involved and to the House, we are deeply disappointed by the continued delay in publication. However, I remind the House that it is in the interests of everyone that the independent inquiry works first and foremost to establish the truth of the events of that tragic day.
Because its contents remain a matter for the independent inquiry, I have no idea what will be achieved in relation to those contents. However, I can tell the hon. Gentleman that I am concerned about the costs. As a result, working with the inquiry, I have now arranged for the office in Northern Ireland to be closed, the size and costs of the accommodation in London to be significantly reduced and the IT contracts to be renegotiated. We will therefore make savings of about 20 per cent. of what would have been spent in the remaining months.
May I ask my right hon. Friend about any lessons that could be learned from the tragedy that the Saville inquiry is investigating? Is there any read-across to the inquiry by Sir Peter Gibson into the Omagh bombing, a statement on which was made this morning? That statement seems to have exonerated GCHQ from any of the allegations made by the BBC, among others. It seems that if there was any malpractice or any problems, they were more on the Royal Ulster Constabulary special branch front, and those issues were largely addressed by the 2001 reorganisation. Does my right hon. Friend agree about that?
I thank my right hon. Friend for providing me with the opportunity to make that read-across from Lord Saville’s work to the Omagh report, and I commend Sir Peter Gibson for the thorough and exhaustive way in which he has approached the task of considering lessons to be learned from the sharing of intercept material on the day, and around the time, of the Omagh bombing.
I ask the House to note that I have placed in the Library today not only my written statement but Sir Peter’s summary report and a response to it by the Chief Constable. I thank Sir Peter for his comprehensive work. It is difficult to make a direct read-across to Lord Saville, except to say that for those involved, it is important to produce material as quickly as we can.
May I echo what the Secretary of State has just said and add my thanks to Sir Peter for reporting so expeditiously? Does that not point to a lesson for the future? Does he agree that, as the Select Committee on Northern Ireland Affairs recently stated, no further major inquiries should be launched unless there is a unanimous desire for them among the parties in Northern Ireland?
May I take this opportunity to congratulate the Select Committee on its recent report, which rightly raised a number of these issues? It may be helpful if I inform right hon. and hon. Members that next week we expect Lord Eames and Denis Bradley’s Consultative Group on the Past to publish its report on the way forward. The Government look forward to that and will be studying its proposals carefully.
Does the Secretary of State agree that if members of the Conservative party are presenting themselves as being worthy of government, they should show better grace and reflection on the issue of the Saville inquiry, rather than constantly go on about the cost? They should show some consideration for the families and their quest for truth and for the vindication of the innocence of their loved ones, as well for as the wider fundamental issues that will hopefully be addressed in the report. Does he accept that many of us would have wanted an oral statement on the Gibson review, so that we could have shown our concern and consideration for the needs and rights of the Omagh families?
I thank the hon. Gentleman for his remarks and share his view of the importance of the work that is being done on the Saville inquiry. I remind the House that when the former Prime Minister established that independent inquiry, he said that it would have to be conducted
“without any preconditions as to what the outcome may be, so that the truth can be established and told.”—[Official Report, 29 January 1998; Vol. 305, c. 505.]
I should perhaps also tell the hon. Gentleman that my office is making arrangements to meet representatives concerned with those terrible events in Londonderry that day, so that we can talk through with them the arrangements for publication in the autumn.
The Secretary of State has referred twice to getting at the truth. Given the exceptional difficulty, if not impossibility, of doing that in all the inquiries, and given that the inquiry industry in Northern Ireland is blossoming to the extent of costing £60 million a year, does he accept that it is time to call a halt to investigating the past and instead to look to the future?
I am sure that many hon. Members share the hon. Gentleman’s concern about the amount of money involved. However, I caution against the use of the pejorative description of an “inquiry industry” simply because, although some may regard it as an industry, for the families affected, the victims and those whose lives have been destroyed by the troubles, it is essential to find ways to get at the truth. There may be better ways of doing that in future. If we can find ways that provide better value for the taxpayer, we have a duty to do that. However, first and foremost, we have a duty to do all that we can to provide justice for families, and for victims who needlessly lost their lives during the troubles.
The Secretary of State has referred to the families, but not to the former soldiers, some of whom are my constituents. For 11 years, they have had the threat hanging over their heads. I spoke to some of them this morning. They did their duty by their country but they feel that the Government have not done their duty by them. Will the Secretary of State please at least send a message to them that he understands their concerns and those of their families and do something to reassure them that the matter will be brought to a speedy conclusion? They are now in their 70s and some have already died. 1 Para has a reunion next month—please give its members a positive message.
The hon. Gentleman has been unstinting in his advocacy for the work of the security forces. I again put on record my admiration for the way in which our security forces have responded over many years to terrorism in Northern Ireland. Undoubtedly, there are lessons for us all to learn from mistakes that may have been made, but the support of the Government and the House for our armed forces has been and remains unshakeable.
The hon. Gentleman mentioned the concern that some of those to whom he spoke expressed. It is a matter of parity that, just as I am prepared to meet families from Derry to discuss arrangements for publication, if he would like to bring a delegation to meet me to discuss that, I would be more than happy to meet with it.
I met Lord Ashdown last week and he updated me on the ongoing work of the review. I welcome the progress made, and look forward to receiving the final report when the review group has concluded its work.
I know that the hon. Gentleman is keen for a resolution on the Drumcree parade, and I pay tribute to him for his efforts in discussions with me and others, including members of the Portadown District Orange Lodge, who have also made considerable efforts. Of course, I am happy to meet him and consider his views. In the end, determination of parades is a matter for the Parades Commission and, again, I take the opportunity to join him in encouraging all individuals and organisations to get into dialogue about the issue as soon as possible.
I readily join my hon. Friend in paying tribute to the Parades Commission, and especially to its chairman, Roger Poole, for its unstinting efforts to ensure that we have peaceful parading in Northern Ireland. It is worth reflecting on the fact that the Whiterock parade, which went so dreadfully wrong, happened only a little over three years ago. Everybody has worked hard in those three years to ensure peaceful parading in Northern Ireland, but we have made it clear that, if there is a consensus about an alternative system for regulating parading and having oversight of it, we are prepared to consider it. Lord Ashdown has been given that task, and I hope to receive his report in due course.
One of the proposals in the interim report by Lord Ashdown is to transfer responsibility for decisions on parading to the First Minister and Deputy First Minister. If that happens, would they have to be in agreement when deciding on parades and the details of parades, as they have to be on many other issues? Given the time-limited nature of the process for making decisions on parades, seeing as there are so many of them, what would happen if the First Minister and Deputy First Minister could not reach such agreement?
It is important to understand what was actually in the interim report from the parading review group. It proposed that the administration of applications for parades should be overseen by local councils and that the system for the resolution of disputes should be overseen by the Office of the First Minister and Deputy First Minister. That does not mean political interference or adjudication; rather, it is a question of administration. We know that the review group has consulted on that proposition. We await its final report to see whether its views have changed or whether its recommendations have been refined. However, I am sure that the hon. Gentleman will join me in urging everybody in Northern Ireland to try to reach a consensus, so that we can make further progress.
My hon. Friend has been very careful in what he has said about the Parades Commission and in how he has structured his answers, but some people say that the Parades Commission should be abolished, so perhaps he could tell me this: what is the Government’s position on the Parades Commission?
I normally try to take some care with the words that I use, particularly in the Chamber. As I said to my hon. Friend the Member for Belfast, South (Dr. McDonnell) earlier, the Government fully support the Parades Commission and believe that it has done an extremely good job in difficult circumstances. However, we know that there are people and organisations in Northern Ireland that do not share that view. If it is possible for all the parties and all sections of the community to arrive at a consensus on an alternative system, we will obviously be prepared to consider it, because in the longer term we need a sustainable approach to parading. We cannot lurch from parade to parade and season to season, unsure about the future. We have to have a sustainable approach to parading, so that peaceful parading can be guaranteed.
I hold regular discussions with the Chief Constable on a range of matters, including decommissioning. Having weighed all the advice that I have received, including that from the Independent International Commission on Decommissioning, I have made it clear that we will not seek renewal of the order on decommissioning beyond the next 12 months.
Since the Northern Ireland peace process began more than a decade ago, the people of Northern Ireland have been promised a deal, which is to say a compromise on political issues in return for the decommissioning of the vicious paramilitary groups whose activities have scarred Northern Ireland for far too long. The public have delivered their side of the deal, so why are the Government prevaricating on their side?
Let us be clear about what the purpose of this process is. We all want to see every gun and every weapon removed from the streets. The decommissioning order provides an additional route towards seeking that goal. The record of achieving decommissioning over the years has been successful. I have to weigh the advice of the Chief Constable, as well as that of the IICD and the other bodies that give me security advice, about whether they believe that it would be useful to continue for another year to provide that additional way of getting weapons off the streets. It does not prevent the police from doing their work and removing those weapons, which are of course illegal, but if it provides an additional route that may be successful in removing the guns, it would be foolish of me to ignore that advice.
Is the Secretary of State aware that there is no belief in the community in Northern Ireland, in the PSNI, in the Police Federation or in the loyalist communities that decommissioning will take place between now and 2010? Is he aware that 29 police officers are under threat at the moment and that five face death threats from loyalists? The police say that they know where the weapons are. What democratic Government would stand back and allow those weapons to be used, as they were in Belfast, where four blast bombs were used last month, and in the many other crimes involving weapons that have also occurred? The community in Northern Ireland is subjected to extortion and the presence of brothels and drugs by the paramilitaries. We will not tolerate the extension if we can do anything about it. The Secretary of State should revisit his intentions in that respect.
I am grateful for the hon. Gentleman’s advice and I am sorry that I am going to take this opportunity to disagree with him. In relation to the work of the PSNI, let me simply say that everyone in the House admires the bravery of the men and women of the PSNI, which continues to be quite extraordinary on the streets of Northern Ireland. In relation to the specifics, however, the PSNI’s record in combating loyalist criminality and paramilitary activity has been a very good one. In the last year alone, 15 loyalists were arrested and firearms, ammunition and explosives were seized. It acts on the evidence and material that it is given. Let me say to him that it is also very important to recognise that the Independent International Commission on Decommissioning, which has been very successful in bringing about decommissioning, continues to give me advice that we should prevail with one more year. I have made it clear that this is the last year; at the end of this 12 months, that is it—the end of this process.
The Secretary of State will be aware of the very strong opposition of the Police Federation to the extension of the decommissioning legislation, which comes after attacks on police officers and the intimidation of police and prison staff by those connected to loyalist paramilitary groups. My party is not convinced about the extension of this legislation. Can the Secretary of State give us any evidence that the loyalist paramilitaries are now in a position to decommission their weapons?
I will meet the Police Federation on Monday next week to discuss the representations that it has made on this matter. May I counsel the hon. Gentleman, his party and other hon. Members—I am slightly hesitant to say this, but I use my words very precisely and carefully—that the Independent International Commission on Decommissioning has confirmed to me that it is currently making meaningful progress, and I hope to report to the House in future on that progress?
The Secretary of State will be aware of the growing number of loyalist death threats to members of the PSNI. What message would he send out today from his office to those brave policemen? Will he ensure that members of the PSNI receive the same support and protection as the former Royal Ulster Constabulary did in the face of IRA death threats?
I am sure that all hon. Members would wish to express their gratitude to the men and women of the PSNI. It remains a matter of fact that the greatest threat to those officers, as expressed in the last year, has come from those paramilitary criminal organisations such as the Real IRA and the Continuity IRA. They are the organisations that have despicably, and in a cowardly way, attacked police officers at traffic lights when they were dropping off their children at school. They have fired shots into the chest of one police officer who is very lucky still to be alive. In another case, an explosive device was placed under an officer’s car and his partner was nearly murdered by it. PSNI members do very brave things for the people of Northern Ireland and this country every day, and we will do everything we can to protect the lives of those brave men and women.
I am sure that the Secretary of State will agree that loyalist or republican paramilitary activity is unacceptable. Will he look again at extending this decommissioning period, because not a single political party in Northern Ireland wants it, and many of the police from whom I have had communications certainly do not want it? Is it not a very delicate matter to permit a further extension when we know that decommissioning is necessary and not to decommission is unacceptable?
The hon. Gentleman rightly draws attention to the very delicate balance on whether we will achieve more by renewing the order for a final 12 months—and it is a final 12 months—or by moving in the other direction. As I say, I have decided, on balance, that we should proceed in that way, but this is based on very specific advice from the commission. If that advice should result in an act of decommissioning, I say to the hon. Gentleman that if my not renewing the order were to result in those weapons not being destroyed and put for ever beyond use, I think we would be failing the people whom we are actually trying to protect.
Is my right hon. Friend not aware of the major concerns in nationalist communities among those who want to see the peace process move on—for example, by removing the peace walls—about the thought that there are loyalist paramilitaries with weapons preventing those developments? Will he reconsider his decision?
As I have said to the House, given the very specific advice I am being given by the commission that it is currently engaged in meaningful dialogue that will result in weapons being removed from the streets, if that is our goal, it would be very foolish of me to ignore that strong advice.
May I join the Secretary of State in paying tribute—[Interruption.]
Thank you, Mr. Speaker.
May I join the Secretary of State in paying tribute to the bravery of the PSNI in the work it does? Does he not think, however, that that bravery deserves a bit more than a few nods and winks from these thugs and racketeers before he is prepared to extend for a further 12 months the 11 years that they have already had to decommission their weapons? He knows that we have rarely departed from our support for the Government in the peace process, but I put him on notice today that unless he comes up with something more substantial than he has done so far, he will put this measure through without any support from the Liberal Democrat Benches.
I hear the word of warning from the hon. Gentleman, and I take it seriously, but I would simply say this to him: we have succeeded in bringing about peace in Northern Ireland by all the political parties in this House working together. It is through that work that we have established the various bodies that have supervised and brought about the continuing peace process. If it is the view of the Independent International Commission on Decommissioning that we should prevail for 12 more months because it is currently engaged in meaningful discussions, I would urge him to think a second time as to whether now, rather than in the last 10 years, he chooses to ignore not my advice, but the advice of the commission.
Eleven years on from the agreement, it is unacceptable that there are armed gangs operating in any part of Northern Ireland. The Secretary of State has just mentioned new evidence that has convinced him that the amnesty should be extended. Will he give us some of that evidence now?
The purpose of sharing with the House the advice from the Decommissioning Commission is to encourage Members of this House to listen very carefully to that advice, as well as to me. I am not in a position to disclose the commission’s current negotiations, but I simply say to the hon. Gentleman that there are channels available to him through which I am prepared, and happy, to engage.
The Chief Constable has consistently said that anyone who has guns should give them up immediately. One officer has been shot in the back, and five have had to be rehoused. By extending the amnesty period, the Government are letting down local communities and the police who are trying to protect them. These are parasitical gangsters, drug dealers and protection racketeers. They do not deserve another extension. As we are strongly opposed to what is proposed, will the right hon. Gentleman consider withdrawing this statutory instrument?
I do not know whether the hon. Gentleman has a hearing difficulty, but as I have just explained to him, it is advice to us from the commission that has ensured that, on balance, we have made this decision. In my last answer, I made the offer to the hon. Gentleman to discuss further details with him, through the usual channels, but if he really thinks it would be helpful for me to make public now the content of discussions that might result in guns being removed from the streets, I have to question what his motives are. If his motive is to remove the guns, I suggest that he listens to the advice from the commission. On the other hand, if his intention is simply to proceed with a decision he made before that information emerged, I am afraid that even I am unable to help him.
For the purposes of clarification, I should say to the hon. Gentleman that Bombardier is not a project; it is actually a global aviation company that has been, and continues to be, very successful around the world, not least in Belfast, where its pioneering new project will create up to 1,200 new jobs, and up to almost 3,000 new jobs in the UK as a whole.
An article in The Guardian on 31 December had the headline, “DUP was rewarded by government for backing 42 days, claims first minister”. According to the article, he said that
“his party’s decision to support counter-terrorism bill helped deliver major economic investment for Northern Ireland”.
He also said that the Government
“came up with the goods in terms of the Bombardier deal ... they bent over backwards to help us.”
Whatever the merits of this investment, does not the Secretary of State agree that this smells of pork barrel politics at its worst and without principle?
It is perhaps encouraging to see that the hon. Gentleman now takes to reading his information about Northern Ireland in The Guardian. Clearly the one big difference between his party and the Labour party is that what we were prepared to do consistently since 2004 with Bombardier was to hold discussions to see how we could help bring jobs to Northern Ireland. Significantly, thanks to the assistance of my right hon. Friend the Prime Minister and the Government since 2004, which has allowed the company to secure the investment that has come to Northern Ireland, up to 1,000 new jobs will come to Northern Ireland. I am very sorry that where the Conservatives will do nothing, we will secure the jobs for the future.
The Prime Minister was asked—
Before I list my engagements, I am sure the whole House will wish to join me in sending our profound condolences to the brave families and friends of the servicemen killed in Afghanistan in the past week—Captain Tom Sawyer, Corporal Danny Winter and Corporal Richard Robinson. They were courageous and committed men, who were dedicated to their country, to their colleagues and to the cause of peace. We owe them and all who have lost their lives our gratitude for their service and sacrifice, and we will remember them with pride.
I know that the whole House and the British people will wish to join the Government in sending their best wishes to President Obama at the start of his presidency. I can assure the whole House that we will maintain and strengthen the special relationship between our two countries. The importance that President Obama places on urgent action on the economic recovery, on environmental stewardship and on the fact that citizenship carries with it responsibilities as well as rights will have a resonance in every part of the world.
This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall have further such meetings later today.
I should tell the hon. Gentleman the real facts: our proposals are for more transparency than the Conservative party’s proposals were and for more transparency than is the case in most Parliaments in the world. That is why we will publish a revised Green Book with clear rules, and there will be enhanced audit by the National Audit Office. We will put the proposals to the House on a free vote. We thought we had agreement on the implications of the Freedom of Information Act as part of this wider package. Recently, the support that we believed we had from the main Opposition party was withdrawn. I believe that all-party support is important on this particular matter, on which we will continue to consult.
Tuesday 27 January is Holocaust memorial day, and events will be taking place across the country. What will my right hon. Friend be doing to mark and to commemorate the occasion? Will he join me in commending the work of the Holocaust Educational Trust, which does so much to educate and inform our young people about the horrors of the holocaust?
To commemorate Holocaust memorial day, there will be a debate in this House next Thursday. I was very privileged to be involved with the original funding of the Holocaust Memorial Day Trust’s work in education, which enables us to send, from schools in every part of the country, young men and women to see for themselves at first hand what happened at Auschwitz and then to report back to their fellow students in their schools and colleges. This is an important contribution in ensuring that people will never forget the millions of lives lost as a result of anti-Semitism, prejudice and discrimination.
May I join the Prime Minister in paying tribute to the three servicemen who have been killed in Afghanistan in the past week—Captain Tom Sawyer, Corporal Danny Winter and acting Corporal Richard Robinson? Our thoughts should be with their families at this time.
I agree with the Prime Minister that the whole House will be united in sending our best wishes to President Obama, who starts work with the good will of people throughout the world.
Today’s rise in unemployment of 78,000 in a single month reminds us of the recession’s real effect on families throughout the country. With the pound falling, debt rising, and new forecasts showing that our recession will be deeper than elsewhere, it is clear that the British economy faces dark days indeed. Does the Prime Minister accept that the market and public reaction to the latest set of Government initiatives suggests that there is no real confidence that Government policies are working?
Every job lost and every redundancy is a matter of regret and sadness for us all. That is why we will do everything in our power to help people who have been made unemployed back into work. We may not be able to help them to keep their existing jobs, but we will help them to get new jobs. That is why the latest measures that we have taken include help for people in work, help for people to move into work, and help for people to get new skills for work. That is what we should do to help people as we take them through this difficult time.
I believe that the indication that President Obama has given in the past few days that he will take the fiscal stimulus action that we have taken, and action in relation to banks in the way that we have done, shows that the world can work together to deal with the problem. The one thing that President Obama did not say in his speech yesterday was, “Fellow Americans, let’s do nothing.”
I can tell the right hon. Gentleman one thing that President Obama will not be doing. He will not be putting up national insurance contributions on people earning £19,000 or £20,000 because the country is so bust.
Let me ask the Prime Minister again about the market reaction to his announcements. On Monday, he announced a package to help banking, but since then the Royal Bank of Scotland has lost two thirds of its value, Lloyds TSB has lost half its value, and the pound lost nearly 4 per cent. in one day. Is not one of the problems with the Prime Minister’s announcements that there is so little clarity? Let me take one element of what he announced on Monday to support the banking system—only the Prime Minister could laugh at those plummeting prices. Can he confirm that he announced an insurance scheme for toxic assets without saying what he is insuring, what the premiums are, what the exposure is, or how long it will last? Is that not a staggering lack of detail?
I should explain to the right hon. Gentleman—he has the benefit now of a new shadow shadow Chancellor to help him on his way—[Laughter.] I should explain that when markets fail and banks are unable to do the job for which they are intended, the only agency that can step in is the Government. If the Government do not take action, no one else will. That is the lesson that has been learned in every single country of the world, and that is the lesson that President Obama said yesterday is the work that will be pursued in America.
On the action that we have taken on banks themselves, every guarantee that we have made is set against the banks’ assets. In the insurance policies that we have signed there is a fee, and every loan is to be paid for as a result of the credit that we have extended. The right hon. Gentleman referred to the asset purchase scheme, and what we actually announced on Monday was a process by which we will talk to the banks in individual detail, and we will look at their assets and liabilities with them. We will therefore conduct the audit of the banks’ finances that he says is necessary. We will report back to the House on the nature of the insurance scheme that we agree, and the risks will be shared with the banks in the scheme. It is similar to schemes that are being adopted in other countries, and that may continue to be adopted in America and elsewhere. I believe that it is the right thing to do, but the right hon. Gentleman must decide which central proposition he agrees with—that the recession must take its course, or that, when markets fail, Governments must step in.
The fact is that this recession is getting worse. The Prime Minister talks about action, but the fact is that when we suggested a national loan guarantee scheme, he attacked it—and he has now introduced it. We suggested changing the terms of the bank recapitalisation; he attacked that idea, but he has now introduced it. We said that he needed to extend the special liquidities scheme; he attacked it, but he has now introduced it. The fact is that he is behind the curve on every single issue.
I am delighted that the Prime Minister has mentioned my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke). The difference between this former Chancellor and that former Chancellor is that this one left a golden legacy and that one wrecked it.
The Prime Minister said that the insurance scheme was a temporary measure. His City Minister, Lord Myners, said that it could last for up to nine years. How can the Prime Minister describe something as temporary that might last for nine years?
First, the shadow Business Secretary called the Conservative European policy “crackpot”, “dotty” and “absurd”. I know that they are trying to find a way of sitting together but they do not agree with each other’s views on Europe and many other things.
As for the action that we have taken, let me quote a member of the Conservative party who has to make decisions. The Mayor of London said:
“It’s absolutely right that there’s a huge problem in trying to get credit flowing and the Government is doing what it can.”
That was the Mayor of London. He went on to say:
“if we get it right and we invest in the right things…and…make sure…that we drive forward the projects of infrastructure that we want to see developed over the next ten years, London could emerge…more competitive and better placed”.
The Mayor of London is far from saying that we should not invest in public infrastructure, while the Conservative party says that we should not invest in infrastructure. The Mayor of London and the Conservative party hold totally different views.
Let me tell the right hon. Gentleman something that the Mayor of London, the former Chancellor and I all agree about: the Prime Minister is making a complete mess of the economy. When it comes to these great infrastructure projects, who just put back the carrier programme? Who cancelled the widening of the motorways? It was this Government, because they have run out of money.
The Prime Minister gave me absolutely no answer to my question about the insurance scheme. People want detail because they want to know that their money is being put to good use. This is not the first time that the Prime Minister has announced measures to bail out the banks. In the first bank bail out, he put £37 billion of taxpayers’ money into the banks. He said that the shares that the Government bought would
“grow in value over the next period of time”.
Will he confirm that, as matters stand, the taxpayer has actually lost more than £20 billion?
I was very grateful for the support that the Opposition party gave to the recapitalisation of the banks three months ago. I suppose that I should not be surprised that the minute there is a difficulty, they withdraw their support from the right proposal. The recapitalisation of the banks was the right thing to do. The right hon. Gentleman has no other policy that would replace that policy. We are right to continue to support the banks so that they can lend to people in this economy, and the measures that we have announced this week are the right measures to take us forward.
The right hon. Gentleman is completely isolated from every major party in every country in the world. Every country understands that when the private sector and the markets fail, and particularly when banks fail, the Government have a duty to act. He wants to cut public investment while others want to increase it. He wants to withdraw help from the unemployed while we want to give it. As far as the banks are concerned, he does not know what his policy is because it changes from one day to the next.
The Prime Minister talks about being isolated, but does he not realise that he is the only person in the country who thinks he is doing a good job? [Interruption.] There was not exactly a roar of approval from behind him. The whole point about the first recapitalisation was that it was meant to get the banks lending. It has failed to do that, as even the Prime Minister has admitted. Let me put the question again. The shares were worth £37 billion. They are now worth less than £17 billion. Will he confirm—it is simple maths—that, as things stand, the taxpayer has lost more than £20 billion?
The point of the recapitalisation of the banks—[Interruption.] I am sorry that the Conservatives do not want to understand economics. The purpose of the recapitalisation of the banks—[Hon. Members: “Answer!”] They should really grow up and face up to the big issues. The point of the recapitalisation of the banks was to stop them collapsing. If we had taken the right hon. Gentleman’s advice and not put our stake into the banks, they would have collapsed. Thousands more people would have been worse off and thousands more businesses would have suffered. As a result of what we have done no saver has lost any money. What is his alternative to the capitalisation of the banks?
The fact is that the Prime Minister is completely unwilling to answer the most basic questions about what the recapitalisation has cost so far, and what it might cost in the future. This comes at a time when the whole country is asking whether the Government know what they are doing. Is that surprising when we have the Employment Minister saying—today of all days!—that he can already see light at the end of the tunnel? Is it surprising when we have the Business Minister talking about the “green shoots of recovery”, or the Housing Minister—she is not in her place—saying that there is a new boom in the housing market? Meanwhile, we have a Prime Minister who thinks that he has saved the world.
Is it not the case that the British people are losing confidence in the Prime Minister and the Government? Is it not right to say that, without confidence, we will not get a recovery?
The right hon. Gentleman has not one idea about how to begin to sort the problem out. I asked him what he would do in place of the recapitalisation of the banks, and he had no idea what he would do. Only this week, the secretary general of the CBI said:
“The Government needed to be bold and it has been. These measures are the essential pre-cursors for economic stability which will expand the availability of credit”.
We are doing what other countries are doing. The only thing that the right hon. Gentleman says is that we should do nothing. He spends all his energies going around the country telling people that nothing can be done about this recession. We will act, but the Opposition will not. He is out of step with the rest of the world, and he is out of his depth.
Were the Serious Organised Crime Agency, the Financial Services Authority or our security and intelligence services fast asleep, or were they part of a cover-up in relation to Lloyds TSB’s illegal handling of money from Iran to get round sanctions? Surely we need a statement about why this bank—no individual has been prosecuted in the UK—laundered in America $300 million of Iranian money and money from London that related to the Sudan. I think we should be told.
My hon. Friend is making very detailed allegations. Our sanctions policy against Iran has been one of the toughest in the world. It is tough on banks, tough on oil companies and tough on other institutions. I will of course look at the allegations that he has made, but I can tell him that we and other countries are leading the world in the sanctions against Iran.
I should like to add my own expressions of sympathy and condolence to the family and friends of Captain Tom Sawyer, Marine Danny Winter and Corporal Richard Robinson, all of whom tragically lost their lives in Helmand province this last week. I should also like to join in welcoming the inauguration of President Obama, and I especially welcome his early announcement of the suspension of all military tribunals at Guantanamo Bay.
The British economy is now standing at the edge of a cliff. It is clear that international markets believe that many of our banks are effectively broke, and that is pushing confidence in the pound and in the Government’s finances to an all-time low. Will the Prime Minister accept that his announcements and half-measures have created confusion and uncertainty, when the country desperately needs clarity and certainty at this very dangerous time?
I shall just repeat what Richard Lambert, the head of the CBI, said. He said that these measures
“if fully implemented…should stem a further downward recessionary spiral and provide a stable economic platform on which the UK can trade through this difficult period.”
The right hon. Gentleman has to understand that we have done three things. The first is that we have recapitalised the banks to stop them collapsing. We have done that not to help bankers but to ensure that people who rely on the banks, and who have their savings in them, can be secure.
The second thing that we have done is give real help to families and businesses through this difficult period, when it is right that the Government should intervene; only the Conservative party seems to oppose that. The third thing that we have done is take measures to extend lending to businesses and families. Lending to businesses now takes the form of the Bank of England being in a position to lend to non-bank institutions and to lend directly to companies through the corporate bond market. We have created the asset insurance scheme so that we can give more certainty for the future about how we will deal with the problem of assets. All those things are done so that the banks can be stronger to extend lending. I believe that that the right hon. Gentleman will find that other countries around the world are doing the same.
I am grateful to the Prime Minister for his reply, but does he not see the extreme danger in any remaining ambiguity in the Government’s response? Does he agree with me, and the Chair of the Treasury Committee, that that must now mean the full, if temporary, nationalisation of our weakest banks without any further delay?
The issue is the extension of lending; that is the issue before us. The agreements that we have signed with the banks already are, I believe, agreements that are being honoured at the moment. I have to say to the right hon. Member that the problems is that when the banking crisis started, foreign banks that were operating in Britain reduced their capacity in Britain. Non-banking institutions that were lending in Britain for mortgages and companies reduced their capacity, so even if the Royal Bank of Scotland, Lloyds TSB, Barclays or those other banks increased the capacity substantially, we would have suffered a loss, just as every other country has suffered a loss of foreign capacity. That is the problem that we are trying to deal with. The problem is the resumption of lending; that is still the problem that has to be dealt with, whatever the status of the banks.
Will the Prime Minister agree with me that people all around the world will have been moved by the inauguration of President Obama? There are many reasons to welcome his inauguration, but one is that when a man whose father, 60 years ago, could not have been served in restaurants in Washington becomes President of the United States, we can all of us, in our communities, turn to our children and say, “Yes, you can.”
I am very grateful to my hon. Friend for showing the historic nature of the moment that we are seeing in America. This is the first black President of the United States of America. Let us not forget the history books: the White House was built by slaves, and it is now occupied by the first black American President.
The hon. and learned Gentleman misunderstands what we are doing and the transparency that we are providing in the expenses. I said earlier that the main Opposition party and the Government had discussions about the statutory instrument. The Opposition party gave the impression that it was supporting that statutory instrument but it has now withdrawn its support for it. It is right, then, to seek all-party agreement on that, and that is exactly what we are doing. Far from spending a great deal of time this week on the issues that he is talking about, I am spending my time dealing with the problems of the British economy, and that is what I will continue to do.
This problem has not been caused by inflation in our economy or in other economies. It is a global banking crisis that must be dealt with by global co-operation, and I am pleased that President Obama and others want to see that co-operation happen.
I am grateful for the hon. Gentleman’s question. The Sun said only a few days ago that there was only one MP who was more independent of the Conservative party Front-Bench positions than him, and that was the right hon. and learned Member for Rushcliffe (Mr. Clarke), now the shadow Business Secretary. With reference to pensioners, we have increased the winter allowance this year—£60 extra is going to pensioners now. We have also increased the pension from April. We will do everything we can to help pensioners with their savings. That is why we have the individual savings accounts for pensioners, and we have raised the pensioners’ tax allowances so that 60 per cent. of pensioners pay no tax at all. We will do everything that we can in the next few months to help them. The hon. Gentleman is an Independent Member, so he, like those on the Labour Benches, can criticise the Conservatives for not supporting the £60 extra that we are giving to pensioners.
The people of Gaza want to see aid and trade flowing across their borders again. The people of Israel rightly demand an end to rocket attacks on Israeli towns. Does my right hon. Friend agree that neither side will get those assurances in the long term unless we do more to neutralise the toxic influence of Iran in the region? Can he tell us what more he intends to do, besides the sanctions that he has already imposed, to neutralise that influence?
I believe the international community has to show great unity in isolating Iran, not only for the position that it takes on nuclear weapons but for its attitude to Israel. The best way to isolate Iran in the middle east is by finding a settlement between the Palestinians and the Israelis, whereby the middle east countries and the Arab countries can become united in supporting the two-state solution that other people have proposed.
Since the ceasefire, it is important that Israeli troops leave Gaza as quickly as possible. It is important that the crossings are opened. That is being discussed at meetings in Egypt tomorrow. It is also important that the peace process is moved forward. Although this may seem one of the most distant prospects at the moment, I believe we have a duty to use this opportunity to get countries to talk together about the process of peace. But the most important, urgent thing is the humanitarian aid that must be brought into Gaza. We have trebled our support for humanitarian aid, we are helping to transfer children from Gaza into hospitals, we are trying to get rid of the unexploded bombs in the area by working with people in the region, and at the same time we will give all the food aid and all the support aid we can. There has been a terrible catastrophe over recent weeks. We must do everything that we can now to help the people of Gaza, while at the same time stopping rocket attacks from Gaza into Israel. We must see that the ceasefire holds and then brings forward the process of peace.
We have successfully lobbied for the European Investment Bank to double the support for cars that have green technology and manufacturing processes. That will help car companies in the north-east. I am not aware that a north-east company has had any application for European Investment Bank support rejected. I hope they will make such applications, and I am happy to talk to the right hon. Gentleman about the economy of the north-east and what we can do to help it.
President Obama and many countries around the world will be putting forward programmes for public investment in the future: public works programmes, investment in environmental technologies, investment in roads, transport, schools and hospitals. That is what we will do to keep jobs moving in the economy. It is unfortunate, as my hon. Friend says, that there is one party that opposes public investment in the future, and indeed would cut public investment at the time we need it most, and it is unfortunate that the Conservative party is isolated across the world.
That is exactly the matter that is being discussed now internationally to agree common standards of disclosure, common standards of transparency, common standards of risk management by the banks and common standards of responsibility to be taken by board members. We will do better by getting an international agreement on these standards and I believe that that will feature in our discussions at the G20 summit on 2 April.
Point of Order
On a point of order, Mr. Speaker. May I raise with you a matter of the gravest importance that arises from your duties to protect the rights of Back Benchers? This is an instance in which the right of Back Benchers to scrutinise Government decisions has been obstructed in a most serious and deliberate way.
You were kind enough to allow me a debate in November on the decision to grant a novel indemnity to the American-led company that has taken over Sellafield, an indemnity that could cost taxpayers many billions of pounds in the future. At the time, I raised the concern that I, along with other Members who had shown an interest in the subject, would have no opportunity to debate it in the House because the minute came from the civil servants, from the Government, 75 days after the final day on which we could raise objections.
In the Adjournment debate, the Minister said that that was simply a clerical error. Now, 140 pages have been released under freedom of information legislation, many of them heavily censored, but it is clear from them that this was a deliberate, calculated attempt to ensure that the House was not informed about the decision until after the recess when no objection could be raised.
It was also suggested in the document and the debate that informing a single Chairman of a Select Committee is a substitute for informing the entire House, but the decision of one Select Committee Chairman, however distinguished, is no substitute for the historic right of Parliament to decide these matters. This a matter of the gravest importance, involving a contract of £22 billion, and possibly a £1 billion-plus subsidy for taxpayers in the future. Will you ensure, Mr. Speaker, that there is some way of reversing this decision, certainly calling the Minister to the House to explain how the rights of Back Benchers have been so flagrantly abused?
I am grateful to the hon. Gentleman for giving me notice of his point of order. Members are responsible for the accuracy of their speeches; that is not a matter for the Chair. However, I always expect Ministers, who are accountable to Parliament, to provide accurate information to the House, as they are bound to do so under the resolution of the House in 1997 on ministerial accountability. The hon. Gentleman also raised the matter of how the contingent liability in relation to Sellafield was handled. I will ensure that he receives a response on that issue as soon as possible.
Presentation and First Reading (Standing Order No. 57)
Mrs. Cheryl Gillan, supported by Jon Cruddas, Mrs. Joan Humble, Roger Berry, Mr. Russell Brown, Mrs. Sharon Hodgson, Mr. Gordon Marsden, Mrs. Caroline Spelman, Mrs. Jacqui Lait, Angela Browning, Mr. Tim Boswell and Sandra Gidley, presented a Bill to make requirements relating to the collection and dissemination of information on people with autism; to make provision about support for people with autism; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 27 February and to be printed (Bill 10).
Fuel Poverty Bill
Presentation and First Reading (Standing Order No. 57)
Mr. David Heath, supported by Mr. Peter Ainsworth, Mr. Paul Burstow, Mr. Martin Caton, Alan Simpson, Mr. John Gummer, Peter Bottomley, Colin Challen, Mrs. Linda Riordan, Mr. David Amess, Susan Kramer and Dr. Alan Whitehead, presented a Bill to make further provision about fuel poverty; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 20 March and to be printed (Bill 11).
Statutory Redundancy Pay (Amendment) Bill
Presentation and First Reading (Standing Order No. 57)
Mr. Lindsay Hoyle, supported by Mr. David Crausby, Mr. Terry Rooney, Ian Stewart, Tony Lloyd, Jon Cruddas, John Bercow, Geraldine Smith, Mark Hunter, Mr. Bob Laxton, Mr. David Drew and Mr. Elfyn Llwyd, presented a Bill to provide for a mechanism for statutory redundancy pay which links it to average weekly earnings; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 13 March and to be printed (Bill 12).
Small Business Rate Relief (Automatic Payment) Bill
Presentation and First Reading (Standing Order No. 57)
Peter Luff, supported by Mr. Adrian Bailey, Roger Berry, Mr. Brian Binley, Mr. Michael Clapham, Mr. David Heath, Mr. Lindsay Hoyle, Miss Julie Kirkbride, Mr. Andrew Love, Robert Neill, Mr. Mark Oaten and Mr. Mark Prisk, presented a Bill to require small business rate relief payments to be made automatically; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 6 March and to be printed (Bill 13).
Royal Marriages and Succession to the Crown (Prevention of Discrimination) Bill
Presentation and First Reading (Standing Order No. 57)
Dr. Evan Harris, supported by Mr. Edward Leigh, Ms Katy Clark, John Bercow, Dr. John Pugh, Mr. Andrew Dismore, Andrew Mackinlay, Sir Gerald Kaufman, Mary Creagh, Mr. John Grogan, Sir Menzies Campbell and Mr. Elfyn Llwyd presented a Bill to make provision to remove discrimination in respect of Royal marriages and succession to the Crown.
Bill read the First time; to be read a Second time on Friday 27 March and to be printed (Bill 29).
Co-operative and Community Benefit Societies and Credit Unions Bill
Presentation and First Reading (Standing Order No. 57)
Malcolm Wicks, supported by Dr. Vincent Cable, Mr. Adrian Bailey, Sir John Butterfill, John Bercow, Mark Lazarowicz, Mr. Don Touhig, Linda Gilroy, Meg Munn, Mr. Andrew Love, Mr. Andy Reed and Alun Michael, presented a Bill to make provision for societies to be registered as co-operative or community benefit societies and to re-name the Industrial and Provident Societies Acts; to apply to registered societies the provisions relating to directors’ disqualification and to make provision for the application of certain other enactments relating to companies; to confer power to make provision for credit unions corresponding to any provision applying to building societies; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 24 April and to be printed (Bill 14).
Green Energy (Definition and Promotion) Bill
Presentation and First Reading (Standing Order No. 57)
Mr. Peter Ainsworth, supported by Mr. Martin Caton, Colin Challen, Greg Clark, Mr. Andrew Dismore, Mr. Nick Hurd, Mr. Oliver Letwin, Mr. Eliot Morley, Alan Simpson, Steve Webb, Dr. Alan Whitehead and Bill Wiggin presented a Bill to define the term “green energy”; to promote its development, installation and usage; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 8 May and to be printed (Bill 15).
Scottish Banknotes (Acceptability in United Kingdom) Bill
Presentation and First Reading (Standing Order No. 57)
David Mundell, supported by Mr. Ben Wallace, Mrs Eleanor Laing, Miss Anne McIntosh, Mrs. Jacqui Lait, Mr. Graham Stuart, Mr. Mark Lancaster, Angela Watkinson, Mr. Robert Goodwill, Mr. Crispin Blunt, Mr. Peter Atkinson and Mr. Tobias Ellwood, presented a Bill to make provision about the acceptability of Scottish banknotes throughout the United Kingdom; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 6 March and to be printed (Bill 16).
Leaseholders’ Rights Bill
Presentation and First Reading (Standing Order No. 57)
Mrs. Jacqui Lait, supported by Mrs. Cheryl Gillan, Simon Hughes, Mr. Lee Scott, Grant Shapps, Mrs. Caroline Spelman and Sir George Young presented a Bill to confer rights on leaseholders relating to the management and maintenance of their properties; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 26 June and to be printed (Bill 17).
Protection of Children (Encrypted material) Bill
Presentation and First Reading (Standing Order No. 57)
Sir Paul Beresford, supported by Mr. Dominic Grieve and Mr. John Randall presented a Bill to amend the Regulation of Investigatory Powers Act 2000 to increase the penalty where a person fails to comply with a notice requiring disclosure of protected material where it is likely that the material contains an indecent photograph of a child or where the offender has been previously convicted of a sexual offence involving images of children; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 20 March and to be printed (Bill 18).
Children in Care (Custody) Bill
Presentation and First Reading (Standing Order No. 57)
Mr. Stephen Crabb, supported by Mr. Iain Duncan Smith, Mr. Graham Allen, Mr. Gary Streeter, Mr. Edward Timpson, Mrs. Nadine Dorries, Julie Morgan, Mr. Douglas Carswell, Kate Hoey, Simon Hughes and Mr. Elfyn Llwyd, presented a Bill to make provision about the services provided by local authorities in relation to the care of children in care in custody; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 27 March and to be printed (Bill 19).
Palliative Care Bill
Presentation and First Reading (Standing Order No. 57)
Mrs. Caroline Spelman, supported by Mrs. Cheryl Gillan, Mrs. Jacqui Lait, Mr. Frank Field, Anne Main, Mr. David Amess, Mr. Gary Streeter, Mr. David Burrowes, Steve Webb, Alistair Burt, Jim Dobbin and Andrew Selous, presented a Bill to confer on patients a right to choose where to receive palliative care; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 24 April and to be printed (Bill 20).
Organ Donation (Presumed Consent) Bill
Presentation and First Reading (Standing Order No. 57)
Mr. Jeremy Browne, supported by Lorely Burt, Dr. Evan Harris, Mr. Adam Holloway, Paul Holmes, Simon Hughes, Norman Lamb, Peter Luff, Mrs. Madeleine Moon, David Taylor, Malcolm Wicks and Derek Wyatt, presented a Bill to provide for an organ donation scheme based upon presumed consent; to make provision in relation to safeguards for such a scheme; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 13 March and to be printed (Bill 21).
Schools (Health Support) Bill
Presentation and First Reading (Standing Order No. 57)
Mr. Jim Cunningham, supported by Mrs. Betty Williams, Helen Southworth, Mr. Adrian Sanders, Mr. Kevin Barron, Mr. Bob Laxton, Mr. Brian Jenkins, John Bercow, Dr. Brian Iddon, Sir George Young, Mr. Philip Hollobone and Mr. John Leech, presented a Bill to amend the Education and Inspections Act 2006 to establish standards in schools for the support of children with specified health conditions; to make provision about the inspection of such support; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 8 May and to be printed (Bill 22).
Presumption of Death Bill
Presentation and First Reading (Standing Order No. 57)
Mr. Tim Boswell, supported by Mr. Humfrey Malins, Bob Russell, Ian Stewart, Helen Southworth and Mr. Phil Willis, presented a Bill to make provision in relation to the presumed deaths of missing persons; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 6 March and to be printed (Bill 23).
Lending (Regulation) Bill
Presentation and First Reading (Standing Order No. 57)
Mr. Russell Brown, supported by Gordon Banks, Miss Anne Begg, Mr. Ian Davidson, Mrs. Sharon Hodgson, Mrs. Joan Humble and Mark Lazarowicz, presented a Bill to impose requirements on lenders relating to the calculation of interest rates; to regulate the promotion of lending; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 27 February and to be printed (Bill 24).
Industrial Carbon Emissions (Targets) Bill
Presentation and First Reading (Standing Order No. 57)
Mr. Charles Kennedy, supported by Mr. Michael Meacher, Peter Bottomley, Mr. Martin Caton, Mr. Mike Weir, Malcolm Bruce, Andrew Stunell, Simon Hughes and Mr. Roger Williams, presented a Bill to make provision for the establishment of carbon emissions performance targets for electricity generating stations; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 3 July and to be printed (Bill 28).
Equality and Diversity (Reform) Bill
Presentation and First Reading (Standing Order No. 57)
Philip Davies, supported by Mr. David Davis, Miss Ann Widdecombe, Mr. Peter Lilley, Mr. John Whittingdale, Mr. David Heathcoat-Amory, Mr. Greg Knight, Mr. Graham Brady, Ann Winterton, Mr. Christopher Chope and Sir Nicholas Winterton, presented a Bill to prohibit the use of affirmative and positive action in recruitment and appointment processes; to repeal the Sex Discrimination (Election Candidates) Act 2002; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 16 October and to be printed (Bill 25).
Special Educational Needs and Disability (Support) Bill
Presentation and First Reading (Standing Order No. 57)
John Bercow, supported by Mr. Lee Scott, Annette Brooke and Mr. Lindsay Hoyle, presented a Bill to make provision for further training of teachers and specialist staff; to make requirements relating to access to specialist services; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 15 May and to be printed (Bill 26).
Forces Widows’ Pensions (Equality of Treatment) Bill
Presentation and First Reading (Standing Order No. 57)
Mr. Michael Mates, supported by Mr. Bruce George, Sir Menzies Campbell, Patrick Mercer, Mr. Michael Clapham, Nick Harvey, Sir Peter Viggers, Simon Hughes and Sir Michael Spicer, presented a Bill to provide for the equal treatment of forces widows’ pensions in respect of retirement from military service for the periods before 1973 and between 1973 and 2005; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 19 June and to be printed (Bill 27).
[1st Allotted Day]
I beg to move,
That this House acknowledges the excellent reputation of emergency and urgent care services in the UK; commends the expertise and dedication of NHS emergency and urgent care staff who work around the clock to provide a consistent and reliable service; notes the strain placed on accident and emergency departments across the country from winter viruses, and commends NHS staff for their extra efforts to maintain services in the face of such pressures; supports the improvement of acute hospital services and development of specialist centres where appropriate; welcomes the recent report published by the College of Emergency Medicine, but notes with concern its conclusion that proposals for urgent care centres are clinically unproven and undermine the principle of patient choice; regrets the lack of evidence to support models of service configuration which are centred on financial concerns and pressures arising from the European Working Time Directive; deplores the Government’s lack of urgency in addressing concerns raised over trauma care; believes that the public should be given a more meaningful voice over the provision of local emergency services; recognises the unique contribution made by community first responders; recommends that the Government introduce a single number to access urgent and emergency care services; and urges the Government to publish its delayed urgent care strategy, the consultation for which was published over two years ago.
In this, the first Opposition day debate of this Session, we have the opportunity to reiterate our support for the national health service, which is our No. 1 priority and that of the people of this country. Even in the midst of economic crisis, we must be aware of how vital it is that all of us can continue to call on the NHS when we need it, and to know that its staff will respond with the capacity required, as well as the commitment and compassion that they have always shown in treating us as patients when we go to hospital or otherwise access the NHS. That is never more necessary than when we need emergency care for ourselves or for our families. Over recent weeks, we have seen great pressures on the service, with cold weather; widespread infections; wards closed by norovirus; an influenza outbreak; staff, both as a result of that and for other reasons, falling sick; accident and emergency departments that have been stressed 24/7; and, consequentially, elective operations being cancelled.
Throughout all that, doctors, nurses and other NHS staff have coped and cared. I therefore want to start by thanking NHS staff, as many Members will have done personally in their constituencies. Right at the turn of the new year, I had an opportunity to visit Ipswich hospital and to speak directly to the staff working in the A and E department there, to thank them and to hear from them about all the pressures that I mentioned. To give the House an illustration of what this has meant for staff, I note that Sally Ferguson, who is chief nurse at Bradford Royal infirmary, said:
“Our staff have been working very hard, are working additional hours and we have delayed some non-urgent, planned operations. Our staff have shown incredible dedication and a massive thank-you must go to them.”
We should not forget ambulance staff, for whom this has been an incredibly difficult time. Let me read this quote from Rob Ashford, who is chief operating officer at west midlands ambulance service:
“Many of our staff gave up their own time to work additional hours away from their families while others enjoyed themselves.”
I am grateful to my hon. Friend for thanking the staff at Bradford royal infirmary for their hard work. I can confirm that they work incredibly hard under difficult circumstances. Will he join me in thanking the staff at Airedale general hospital, which my constituents also use, because the staff there do an equally good job?
I am grateful to my hon. Friend and heartily endorse what he says.
Happily, it is agreed across this House that NHS staff working in emergency and urgent care services do a fabulous job. We depend on them, and over these recent weeks, in all parts of the country, they have not let us down; they have responded terrifically. That is appreciated by patients. A patient wrote to his local newspaper about staff at Leighton hospital just outside Crewe, saying:
“The doctors and nurses at the local A&E…all did everything they could to help me. Nothing at all was too much trouble for any of them. You are all a credit to yourselves and your professions.”
Another patient, writing about Derbyshire Royal infirmary, said:
“The treatment and attention I received at the Derbyshire Royal Infirmary was nothing short of first class.”
I could add more and more of just those kinds of commendations for NHS staff.
My hon. Friend rightly, like many hon. Members, praises, thanks and congratulates nursing staff and doctors in our hospitals and throughout the NHS. Does he agree that it is equally important to mention that the other unsung heroes of the NHS are the ancillary workers who provide the nuts and bolts of the operation of A and E departments and wards in our hospitals?
I am grateful to my hon. Friend. Staff at Broomfield hospital, which serves his constituency, will greatly appreciate his comments. I know from talking to staff across the NHS that we sometimes underestimate the contribution that is made by all its professions and ancillary staff. We simply cannot run hospitals without a wide range of staff being present in order to make it happen, particularly out of hours and at weekends. Services can slow down dramatically without ancillary services such as diagnostics, portering and cleaning, and pathology laboratories being available. They are critical to maintaining the level of service that we all hope to receive when we go into hospital.
Today, I want not only to express our thanks but to take the opportunity to make real our appreciation by understanding what the pressures experienced over recent weeks tell us about the capacity of the service, the impacts of Government policies and plans on emergency and urgent care services, and the need—which I express on behalf of NHS staff—for the implementation of long-overdue reforms to emergency care and its support structures.
Let me give the House an important example in relation to understanding the pressures. In London, primary care trusts have been commissioning services from hospitals based on the framework for action that was published by Lord Darzi in July 2007. It is interesting to make a comparison, in order to understand what is going on. I heard from an NHS trust in London that its accident and emergency attendances in the 11 weeks before Christmas were up 10 per cent. on the preceding 11 weeks, that the elective admissions to the hospital were 15 per cent. above the level predicted by the primary care trust, and that its A and E attendances, year on year, had gone up by nearly 10 per cent., even though the primary care trust had said that they would go down.
Lord Darzi’s report said that, over the next 10 years, the number of attendances at A and E departments in London would go down by 60 per cent. He said that 10 per cent. of patients did not need to be seen at A and E, and that 50 per cent. would be seen in the Government’s new polyclinics. Frankly, that is not happening. The number of attendances at A and E departments is going up.
Up and down the country, people in A and E departments have told me that, when it comes down to it—as it often did over Christmas and the new year—patients are not being treated in the community when they are seriously ill, or when they are just reasonably ill, if the services in the community are unable to function 24/7 to offer the necessary support. The emergency department is the provider of last resort. It cannot say no; it has to meet the demand that is placed on it.
There seems to be an obvious correlation between the out-of-hours doctors service and people going to A and E when they could perhaps have been treated elsewhere. Also, I believe that NHS Direct is a very good scheme but, when I used it myself, I found there to be quite a time lag between making the initial call and a nurse ringing me back, followed by a doctor ringing me back and telling me to go to an A and E department. That covered a time span of five hours. If I had not had a little medical training, which gave me the confidence to know what the problem was, I might have become nervous and whipped my husband off to A and E a lot earlier. Does my hon. Friend think that there is a problem of people going off to A and E of their own accord as a result of that time lag?
I am grateful to my hon. Friend for making that important point. In this debate, we need to press the Government. She will note from our motion that we want the Government to introduce proposals for a new, single telephone number for NHS services. I agree that telephone access to the NHS is necessary, and that it is beneficial to patients, but we should not delude ourselves that it leads to a reduction in A and E attendances. There is no evidence that it does that, but it is an important additional means of access. However, having a single telephone number to provide direct access to ambulance services, out-of-hours services and telephone advice would mean that patients would not have to move from one service to another, resulting in long delays while their needs are interpreted in order to decide which service should respond. Such a single number is sorely lacking. Emergency calls should still go to 999, but it should be possible for a call to the single number to be upgraded to receive an emergency response if necessary.
We know that that is necessary, and I think that the Secretary of State would agree. We recommended it some time ago and it has been reflected in subsequent next stage reviews across the country. The Government just have to get on with it, but for some absurd reason, when they have already accepted part of our motion, they seem to have taken it out, suggesting that they are not going to do it. They should do it. The next stage review by Lord Darzi said that it would happen, but there has been no consultation by Ofcom on access to the new single number, which we need; I hope that it will be provided soon. At the same time, we need a document from the Government showing how that number can provide access not only to NHS Direct nationally, but to out-of-hours services, local services and ambulance services. If the Secretary of State wants to interrupt me now to tell me that the Government are going to make progress on a new national telephone number for accessing urgent care services, I would be happy to give way to him.
My hon. Friend is making a powerful case. I would like to commend the accident and emergency staff at Queen Mary’s hospital in Sidcup, who did a tremendous job during the period that he highlighted. Is he aware that many residents in my borough, particularly the elderly, are very concerned about the future of those services because there is so much uncertainty?
My hon. Friend reminds me that I visited Queen Mary’s in Sidcup in the autumn, when I had the opportunity to see the emergency services and maternity services proposals at work. Many people in south-east London will be concerned about emergency services because, leaving aside the geographical distribution of emergency services in the area and the question of access at normal times, they will worry about the capacity of those services to respond. That is part of the argument about A and E in London more generally. Many dramatic pressures and a lot of demand have been put on emergency services. The number of beds in hospitals in London has been cut and departments have been downgraded.
The right hon. Member for Enfield, North (Joan Ryan) will know that the Government are trying to downgrade the emergency services at Chase Farm hospital in her constituency to an urgent care centre. Just before Christmas, the College of Emergency Medicine published a document on the way forward for emergency medicine and it did not regard urgent care centres as clinically proven or consistent with the principle of patient choice. Emergency consultants in hospitals are criticising urgent care centres, so why are the Government persisting with them? I fear that we will see the same problem in Sidcup.
It would be wrong to see the capacity challenges just as a winter issue. I have just done an analysis of capacity at the John Radcliffe hospital in Oxford, based on the advice that it gave to GPs on access from 1 July to 31 December last year. On average, patients in certain disciplines were being diverted away from the JR every other day because of lack of capacity. This is a year-round issue for certain disciplines, including A and E. Is not the nightmare that the full implementation of the European working time directive is coming towards us like a train down the track? It keeps people awake at night wondering how on earth our general hospitals, including hospitals as large as the JR, will manage when the directive is fully implemented.
My hon. Friend makes an important point, which also relates to emergency services in Banbury, even though he is talking about the John Radcliffe. I visited the emergency department at John Radcliffe about three years ago, and the quality of the redesign of emergency services and the service it provided struck me as remarkably good.
The issue of capacity is important. It is possible to have a magnificent system that works for normal levels of demand, but if there are abnormal levels of demand, we need to be able to respond to such surges. That is precisely the point made by the College of Emergency Medicine. It says that capacity in emergency departments is critical and that urgent care centres, walk-in centres, minor injury units and polyclinics may all have their place, but it would be foolish to think that they can substitute for emergency departments as the hub of the emergency care system. The resilience of the NHS to surges in demand such as the one that we have seen depends critically on emergency departments having the necessary resources—even more so if we were to encounter a pandemic. It is therefore vital that they are not downgraded or closed without regard to the implications or the evidence.
The high-tech end of medicine is extremely important, but would my hon. Friend agree that the wholesale closure of community hospitals has put considerable pressure on accident and emergency departments? In my area, for example, health care professionals are in no doubt that the closure of community hospitals has caused an increasing number of elderly and vulnerable people to end up in casualty departments, which is exactly where they should not be in the context of their long-term treatment.
My hon. Friend is very knowledgeable about these matters. I have discussed the issue with him and with the chairman of his primary care trust, who believes that community teams will be able to look after patients in the community and, as a consequence, avoid their admission to hospital. Let us look carefully at the experience of the past few weeks and find out whether it is possible to do that in practice. In reality, we have seen patients being admitted into hospitals all the same. I am sure that Ministers will know that many patients in hospitals have been transferred into escalation wards because of limited capacity; new capacity has to be created.
Quite often, community hospitals can provide a place to which patients can be transferred to relieve pressure on acute hospitals when demand is high, while at the same time they can provide a sort of step-up bed so that GPs can admit patients and observe them. That means community medical resources can be deployed through GPs to look after patients, instead of those patients having to be transferred to an acute hospital, which is the last place we would want many of them to be. Let us look at what is happening in Wiltshire, because a lot of beds have been lost in hospitals in my hon. Friend’s constituency, and I wonder what the consequences of that loss have been.
I am concerned about the selective and inaccurate way in which the hon. Gentleman is using the report to which his motion refers. I have read the report, not least because of the situation of my local hospital. He will know that the report does not help my argument, and I have my concerns about the Government’s plans for Chase Farm hospital. I make my views about the matter clear to Ministers regularly. However, my point is that I am often struck by the difference between what he says in the Chamber and what his party did when in power. If it had not been for his party putting Chase Farm hospital under the threat of closure for many, many years, Chase Farm would not be in its current situation and—
Let us stay in this century shall we? The College of Emergency Medicine said in its report:
“We find the term ‘Urgent Care Centre’ misleading with no clear definition of the case mix, staffing or how they relate to the emergency departments. There is no evidence of the clinical or financial benefits of this model.”
That is, however, precisely the model being pursued at Chase Farm. That model is being challenged locally by my colleagues and by the local authorities through judicial review, and it is incumbent on the Government, not least given the views presented by the College of Emergency Medicine, to call a halt. Given the pressures on London, they should reconsider whether Chase Farm should have a maintained emergency department, to meet demand.
As for what is being done by the strategic health authority in London, Ministers, in their amendment to our motion, do not seem to be responding to the pressures experienced by emergency departments in London by saying that they can help them. They are responding by calling them to a meeting, hitting them over the head and saying, “You must meet the four-hour target.” There are some excellent hospitals in London that are doing their level best to respond, and doing all that they can to treat patients as quickly as they can. It is far from helpful for them to be threatened by the strategic health authority because they are at 97.1 per cent. rather than 98 per cent. The College of Emergency Medicine has argued for a long time that in practice, a 95 per cent. target for the four-hour waiting time in accident and emergency departments is financially and clinically logical.
I understand the hon. Gentleman’s point about surge capacity in urgent care, but may I return him to the wider point about primary care services? They are critical, because primary care services in the community diminish the number of people presenting at A and E. Does he support extended GP opening hours and programmes for polyclinics? I am just trying to clarify the situation. Does he support initiatives to provide GP-led health care services and expand them in areas whose GP services are under-resourced? I am not talking about urgent care centres; I am trying to define whether Conservative Front Benchers support programmes to increase GP and walk-in services in communities.
We are all very concerned to have better access to primary care. The Commonwealth Fund, which Ministers are keen on quoting, published a report last year stating that of the countries that they examined in the survey that Ministers rely on, access to primary care was worst in the United Kingdom. It stated, for example, that out-of-hours evening and weekend access to primary care was available to 60 per cent. of people in this country, compared with 93 per cent. in Germany. Those figures were self-reported, and there is a big gap between where we are and where we ought to be. A lot of things contribute to that gap, but the central part of it is out-of-hours services.
The Government focus on the idea that what really matters is GPs sitting in their surgeries dealing with routine appointments at half-past 7 on a Thursday evening, as if that were the answer. However, they have implemented an out-of-hours GP contract that has had the effect of substantially diminishing access to primary care in the evening, at night and at weekends. It is no surprise that although about 14 per cent. of A and E attendances generally occur on each day of the week, the figure is about 16 per cent. on a Monday. We can therefore see that there is a substantial Monday morning increment in the demand on A and E departments. All the reports that emergency departments make to us suggest that that is a consequence of the poor access to primary care over weekends, which the Government are doing nothing to solve.
I am grateful to my hon. Friend, who has been extremely generous in giving time to colleagues. Before he leaves the issue of time pressures in the health service, I can confirm, from visiting Bedford hospital over the Christmas period, the pressures caused by the implications of the working time directive. Does he share my bewilderment as to why Labour MEPs did not vote to continue Britain’s opt-out from the working time directive, knowing the implications for the health service and the problems that it would cause?
My hon. Friend makes a vital point. It is astonishing that Labour MEPs would not adhere even to their own Government’s policy. That came after the Government’s presidency of the European Council, when they were unable to deliver the required changes to the directive. A compromise was agreed in the Council of Ministers, but the Government appear incapable of getting it through the European Parliament. It is outrageous that British MEPs should vote in a way that damages the prospects of delivering care in our NHS.
In the light of all the pressure on A and E departments, we have to ensure that they are not downgraded or closed unless what is done is evidence-based. I know that Ministers will say that because some patients need to be referred to specialist centres, such as those for major trauma, paediatric intensive care, severe head injuries, heart attacks and strokes, all patients with severe illnesses or injuries should therefore go to a regional specialist centre. The evidence does not support that. For example, the Sheffield study in the Journal of Emergency Medicine, published in 2007, concluded that increased journey distance to hospital appeared to be associated with an increased risk of mortality, the strongest association being for patients with respiratory emergencies. The study did not include cardiac arrests.
The argument is clear for an understanding that some patients will bypass their local emergency departments and go to a specialist centre, particularly those in blue-light ambulances. Let us contemplate major trauma. It is very important to have regional trauma centres, and we need the trauma network to be developed in that way. We saw in a report published in November 2007 that less than half the patients suffering major trauma received the best standard of care. That was according to the national confidential inquiry. The report called for regional planning for trauma networks, but what has been the Government’s response so far? A Minister in the House of Lords said that they were considering appointing another tsar to take on the task. We are more than a year on, and the Darzi review provided plenty of opportunity for something serious to be done about the problem, and for regional work to make something happen—but that simply has not happened.
We have been fighting accident and emergency reconfigurations. I give credit to my colleagues, because in Surrey and Sussex, for example, they have seen off plans that would have substantially undermined local capacity to offer emergency services. They have been fighting such plans elsewhere, for example in Hertfordshire, but I am afraid that they do not seem to have won so far in places such as Hemel Hempstead and Welwyn. I promise my colleagues, the House and the public that we, when in a government, will focus on ensuring that capacity is in place for the emergency services, and on not making accident and emergency reconfigurations unless they are backed by the decisions of local commissioners, such as the GPs who look after patients, and by clinical evidence of need. We will operate on that basis, and where necessary we will put a stop to misguided reconfiguration proposals.
The hon. Member for Shipley (Philip Davies), who is my MP, spoke in glowing terms about Bradford royal infirmary and Airedale hospital. I have frequently been a patient at the BRI, and Airedale hospital is in my constituency. The hon. Member for South Cambridgeshire (Mr. Lansley) is talking about outrageous this and outrageous that, but he is not offering solutions for one of the most outrageous occurrences in accident and emergency departments: the treatment of doctors, nurses and ancillary workers by members of the public who go in for treatment under the influence of either drink or drugs. On some occasions such patients are quite violent, which is truly outrageous. Does the hon. Gentleman have some magic solution to that? I do not think that there is one.
I understand the hon. Lady’s point, but I think that she does us a disservice. My hon. Friend the Member for Hemel Hempstead (Mike Penning), not least, has made clear our determination to pursue prosecutions. To my recollection, there are something like 55,000 assaults a year on NHS staff, less than one in 1,000 of which leads to a prosecution. What is the point of putting up notices across NHS buildings saying that there will be zero tolerance of assaults on NHS staff if people know that in practice, those who commit exactly that offence will not be prosecuted?
We make it clear in our motion that we want an urgent care strategy. The Government have promised that; they held a consultation in October 2006 and published the responses six months later. Two years on, they have not published a strategy. They said that the matter would be dealt with in the Darzi review, but the final Darzi report contains two references to urgent care, which are essentially nothing more than references to the single telephone number that I have already talked about. Where, then, is the urgent care strategy that is required? Everywhere I go across the country, people are looking for urgent care networks and for a better structure of urgent care that better knits together A and E, walk-in centres, out-of-hours services, ambulance services and NHS Direct, and presents seamless joined-up care for patients. It is vital that we achieve that.
I thank the Government because they have accepted the first part of our motion in their amendment, and I appreciate that. Indeed, they have expressed their recognition of the work of community first responders. In some parts of the country, such as Cheshire, that is not reflected in the behaviour of the ambulance service. Community first responders in rural areas make a vital contribution to response times, especially category B response times, but their achievement does not appear to be recognised. However, I appreciate the Government’s approach to that.
Despite that approach, the Government have gone on to delete a great deal that is necessary in the motion and replace it with some deeply flawed text. They persist with the idea that improvements in primary care and access to GPs is a substitute for access to emergency departments and emergency care. That is not the point, as the College of Emergency Medicine makes clear. It stated:
“It is disingenuous to compare a 24/7 service that cares for the whole spectrum of ill and injured patients with the care of routine patients in a GP surgery.”
“Disingenuous” is not a word that I would normally apply to the Secretary of State. The idea probably emanated from the Minister of State, the hon. Member for Exeter (Mr. Bradshaw).
I hope that we have shown that we appreciate NHS staff who work in emergency care. I think that we show that we appreciate them if we listen to them. They need a major trauma network, but the Government are letting action on the national confidential inquiry report drift. The urgent care strategy and the single number seems to have been delayed and delayed, and the Government’s assumption that patients will not turn up at accident and emergency has been proved false and—worse—dangerous. With beds being cut and A and E departments downgraded, the capacity to deal with surges in demand is being undermined. The evidence from the College of Emergency Medicine about A and E reconfigurations, which was published in December, is being ignored and the Government persist with their plans for urgent care centres in place of emergency departments, although the case for that is clinically unproven.
Emergency departments are central to the emergency care system. Instead of ignoring the views of emergency consultants and pushing polyclinics as a panacea for all ills, the Government should give emergency care the support and the structure that it needs to meet the demands that it faces in future. We will listen, not lecture. We will work with the evidence, not ignore it. We will act where the Government have drifted. I commend the motion to the House.
I beg to move an amendment, to leave out from “appropriate” to the end of the Question and add:
“acknowledges that health professionals provide excellent emergency care to 19 million patients a year in England; recognises the unique contribution made by community first responders; notes that the four hour target maximum wait in accident and emergency is hailed by many as one of the most significant steps forward in improving services for patients; welcomes the fact that patients can also access services through NHS Direct and 90 NHS walk-in centres and will soon see the benefits of 113 new GP practices in underdoctored areas and at least one new GP-led health centre in each primary care trust open seven days a week from 8 am to 8 pm; and further notes that the removal of target maximum waits for treatment will increase waiting times for patients.”
I welcome the hon. Member for South Cambridgeshire (Mr. Lansley) back to his former position after the reshuffle. Indeed, I was thinking how much I would have missed him if he had gone. I genuinely believe that we can have a debate about the motion and the amendment, which would make a change, and consider some of the issues that hon. Gentleman raised. I say that because the past couple of days have put me in a jovial mood. Yesterday, in America, Obama was inaugurated and one of the priorities, which he must tackle quickly, is the terrible problems in the health service there. In America, 46 million people are uninsured and 25 million people are underinsured. Insurance premiums have increased by 90 per cent. since 2000, whereas wages have gone up by a quarter of that. Harvard university estimates that half the bankruptcies in America are caused by medical bills. Compared with that, the issues that we are discussing and the political differences between us pale into insignificance. Barack Obama and many American politicians would like to have this sort of debate rather than the central debate that they must hold quickly about how to have an American health service that fulfils the needs of its people.
Let us wait and see. The problem with the Clinton proposals—it is questionable whether they were Bill’s or Hillary’s—is that they did not emerge until the September after the January inauguration, which was probably too late because the 100 days had passed. Secondly, they sought to overhaul the whole health system, whereas Obama is trying to examine the issues that present problems rather than those that do not.
I am worried that the Secretary of State may be a little complacent. I do not think that President Obama will wish to emulate our outcomes for common causes of morbidity and mortality, especially stroke, which I hope the right hon. Gentleman will consider shortly. America—indeed, most of the western world—does considerably better than us on that.
I am afraid that the hon. Gentleman is wrong. America spends 16 per cent. of its wealth on the health service—[Hon. Members: “Outcomes.”] It has the poorest outcomes in the world for many health matters.
The Conservative party has crossed the Rubicon and supports a taxpayer-funded national health service, free at the point of need. The predecessors of the hon. Member for South Cambridgeshire, in the shadow Cabinet and when the Conservatives were in power, would have had a range of hon. Members sitting behind them who might have paid lip service to that but who were carefully making plans to undermine it—whether through the patient’s passport or all the other variations on that. I therefore welcome the hon. Member for South Cambridgeshire back. I am glad that he was not moved to make way for the right hon. and learned Member for Rushcliffe (Mr. Clarke)—although, if the right hon. and learned Gentleman had taken the post, the love-in with the BMA would have ended quickly, given his previous record.
The hon. Member for South Cambridgeshire recognised that we support six of the 11 points in the motion. The Opposition commend
“the excellent reputation of emergency and urgent care services in the UK”,
and rightly pay tribute to NHS staff, especially given the winter that we have had. I shall say more about that shortly. The motion also
“supports the improvement of acute services and development of specialist centres where appropriate”.
That is rather confusing, because specialist centres, especially specialist A and E and the need to ensure 24/7 cover by the very best people, form part of the debate that has gone on in the health service and I think, from his comments and propositions, that the hon. Gentleman supports that. However, the important words are “where appropriate”. Who decides whether the centres are appropriate? That is a major issue.
The motion includes three issues with which we disagree. First, it refers to the report from the College of Emergency Medicine, which is a new organisation, in its first year. We welcome its report and hope that it prospers, but we disagree with the suggestion that the clinical case for urgent care centres is unproven.
Secondly, the motion refers to the
“lack of evidence to support models which are centred on financial concerns and pressures arising from the European Working Time Directive”.
Thirdly, it refers to a lack of urgency in addressing concerns about trauma care.
There are a couple of neutral issues. We believe that the public should be given a more meaningful voice about the provision of local emergency services. We may disagree about the way in which that is done, and we do not agree that there has been delay in the urgent care strategy. I can understand, given the report that was produced two years ago—[Interruption.] I will deal with that shortly.
We want to hold a genuine debate about the motion and the amendment. As I said, like all Labour Members, I wholeheartedly join the hon. Member for South Cambridgeshire in acknowledging the excellent reputation of emergency and urgent care services in this country, and the dedication and commitment of NHS staff to providing an outstanding service to patients 24 hours a day, 365 days a year. I hope that he will join me in acknowledging the support that the Government have given the NHS: massive investment, doubling the number of emergency consultants, an increase of 135 per cent. in funding for ambulance services, and greater numbers of people in training, all of which lead to better, faster treatment, with greater patient satisfaction.
I hope that Opposition Members also recognise the steps that we have taken to improve the pay and conditions of staff in our emergency services. The hon. Member for South Cambridgeshire has suggested a day of celebration of nursing in this country. Given the plans of the shadow Chancellor and the Leader of the Opposition, that day might merge with the day when everyone looks back on when they had defined benefit pension contributions, because, as I understand it, while applauding the work of the 1.3 million people in the NHS, Opposition Members are also keen to attack their pensions.
The hon. Gentleman says, “Nonsense!” [Interruption.] Opposition Members are saying, “No, no, no!” The words of the Leader of the Opposition were that the private sector is moving from defined benefit to defined contribution schemes and that that has to be what we do in the public sector.
Absolutely—I did not say that it was, but that is what the Leader of the Opposition was saying. [Interruption.] We will get to the bottom of this before the next general election. As well as improving pay—[Interruption.] While we are on this point, the Leader of the Opposition has said quite clearly that there needs to be a move to defined contribution pension schemes. The hon. Gentleman can now intervene on me to say that a future Conservative Government will in no way interfere with the pension arrangements of NHS staff. I will take that intervention from him or any member of his Front-Bench team.
Ah! Well, that is very interesting.
As well as improving pay for staff on the lowest pay grades, “Agenda for Change”, which was introduced in October 2004, has significantly improved the pay and conditions for ambulance staff in particular. They are no longer expected to work nights, weekends and public holidays for the same rates of pay as normal hours. Their pay has increased, as has the training and the professional development that they receive.
The hon. Member for South Cambridgeshire is right to say that winter pressures place additional strain on urgent and emergency care. As hon. Members will know, last month was the coldest December for 30 years. Increases in accidents, flu cases and other health problems associated with cold weather put the NHS under great pressure. In some hospitals that I visited, it was miraculous that the staff were keeping the service going at such high level of quality. At one hospital that I visited in Yorkshire, the amount of ice on the roads meant that it had to treat 200 fractures over four days. However, better planning, more staff and improved organisation have given the NHS the capacity to cope with such pressure without a return to the dreadful scenes of the early 1990s, when many A and E departments had to close because they could not cope with patient demand.
I agree that we should support further improvements of acute hospitals and develop more specialist centres. I would also like to point out that the abolition of long waits and greater investment in specialist centres for conditions such as stroke over the past 12 years has radically transformed patient care in our hospitals. I, too, welcome the report by the College of Emergency Medicine, but I take issue with the claim that the vital reconfigurations of urgent and emergency care services are motivated by financial constraints or that they are clinically unproven. Every reconfiguration of urgent and emergency care is clinically reviewed by the national clinical director for urgent and emergency care and his team. All decisions are taken on the basis that they will improve patient safety and improve the quality of care and that they balance these concerns against improving patient access.
A few moments ago my right hon. Friend mentioned stroke, which the hon. Member for Westbury (Dr. Murrison) raised earlier. Will he describe in a little more detail what the Government intend to do to raise professional and public awareness of stroke symptoms, improve access to scanning, ensure that acute stroke units are brought up to the standard of the best and look into the development of hyper-acute stroke units?
I recently had occasion to visit the health service in my hon. Friend’s constituency. Stroke care is crucial. The stroke strategy that was adopted in December 2007, with the involvement of all the charities and experts, is being taken forward. The fast test, for a quick assessment of whether someone is suffering from a stroke, is now widely spread, in all GP surgeries. However, we are talking about a continuing programme, and my hon. Friend is right to raise the importance of stroke care in the NHS.
Does the Secretary of State agree that although stroke has emerged from the shadows as a true emergency because of the advent of imaging and thrombolysis, the United Kingdom has some of the worst outcomes in the western world? Will he also comment on the Stroke Association’s assertion that
“access to acute emergency stroke services throughout the UK is…in need of urgent improvement”?
We all accepted when we came into power in 1997 that the three major killers—cancer, heart disease and stroke—needed to be tackled. They could not all be tackled at the same time and with the same intensity. However, it is fair to say that although we saw early improvements in cardiovascular disease and cancer in particular, stroke care came a little later. The hon. Gentleman is right to say that. I do not know when the Stroke Association said the words that he quoted, but it has worked closely with us to improve services. Neither we nor the Stroke Association believe that we have a perfect stroke care service. However, in relation to the very issues that we are discussing today, we do believe that as specialist centres are introduced more widely and as we put in more resources and implement the stroke strategy, outcomes will improve accordingly.
I was talking about how we deal with reconfigurations and what the Conservative motion says about the importance of concentrating services where appropriate. As part of his review last year, albeit that it was separated from the final publication by a couple of months, my noble Friend Lord Darzi set out clearly the rules that will govern the changes. I would be very surprised if there were any differences, given the importance that we all attach to moving with the times and implementing more specialist care. Lord Darzi said that change must
“always be to the benefit of patients,”
and that it must always be “clinically driven”. Change must not come from a Richmond House edict, but must always be
“locally-led... Meeting the challenge of being a universal service,”
and recognising that
“Different places have different…needs”.
Change must always involve patients, the public and local staff. If proposals are adopted and change is to occur, the local population has to see the benefits in place first, before the changes occur. That means some quite expensive but very necessary double running to ensure that things work. That seems to be the perfect model in a world where no one is suggesting—I presume that that includes those on the Opposition Front Bench—that there must be no change and no so-called reconfigurations whatever.
Professionals estimate that between 50 and 70 per cent. of people who turn up at A and E would be better treated elsewhere. The majority would be better treated in primary care—that is why primary capacity is so important, as my hon. Friends have rightly pointed out—or in minor injuries units or urgent care centres. Our urgent and emergency care services see patients with a huge range of conditions, from a major trauma to a broken finger. It is nonsense to suggest that a patient who has twisted an ankle is always best accommodated alongside a patient who has had a heart attack or been seriously injured in a road accident. To deal with major trauma or severe injury successfully, A and E departments need the right concentration of expert staff to assess critically ill patients quickly. In many areas, there will be two A and E departments in relatively close proximity to each other, trying to do that as well as deal with many less serious complaints. That is why many SHAs are taking decisions to concentrate expert A and E staff in one hospital and equip the other to deal with more minor complaints. That is what has happened successfully in areas right across the country. The suggestion that these decisions are being taken because of the European working time directive is, frankly, laughable.
Does the Secretary of State agree or disagree with the College of Emergency Medicine when it argues that, for a proportion of patients, distance to an emergency department is a significant risk factor in overall outcomes? Its document published just a month ago says:
“Where the next nearest Emergency Department is more than 20 kilometres away, there is a strong argument for retaining an emergency service.”
Does the Secretary of State agree or disagree with that principle?
I would broadly agree with it; there is a strong argument for that, but it has to be decided locally. That college does not say that a hard and fast rule should be set in all circumstances. The major thrust of the report, representing as it does A and E consultants, is that we should double the number of such consultants—having doubled them already! When I was leader of the Communication Workers Union, not a single report it issued failed to suggest that more of my members were needed somewhere in British Telecom or the Post Office, so I am not surprised by that report. It also says, however, that there is no single solution to the reorganisation of emergency care. It makes the point that in urban areas where emergency departments are close together—the very point I just made—there may be advantages to amalgamating some services. On the whole, it is a bit sceptical and it makes the point about long distances, but I do not think there is anything between us if we are guided by the five principles set out by my noble Friend Lord Darzi, who knows more about the health service than all of us put together—more even than the hon. Member for South Cambridgeshire. Let us say rather that he has forgotten more than we ever knew and put it that way round! The key issue is how we deal with the problem.
Conservative Members say that the European working time directive is the issue, but they have always been a bit confused about it on the Opposition Benches—perhaps it is the word “European” that explains their opposition to it. When they were in government under an employment Minister called Mr. Portillo, they got confused and thought that it was part of the social contract—
The social chapter—the hon. Gentleman is right to correct me, as the social contract is something completely different, which I well remember from the early 1970s. Let us be clear: the Tories got confused about the social chapter and the British taxpayer—[Interruption.] I am asked what this has got to do with it, but the European working time directive is mentioned in the motion. They got confused and spent thousands of millions of taxpayers’ money, fighting a case in the European courts, which they lost because it is a health and safety measure and does not come under the social chapter or the social contract.
I was also asked in an earlier intervention about the opt-out, which the British Government intend to maintain. In co-decision with the European Parliament, we will maintain the opt-out as we have done for 12 years. The fact is that that argument—Opposition Members should understand this—will make not the slightest difference to the NHS. There is a separate agreement for junior doctors. We have decided—I would be surprised if anyone took a different view—that the national health service will have a 48-hour working week with no opt-out. The reason for that is that with the rotas and flexibility necessary in the NHS, the system cannot be run effectively if we are constantly depending on who opts in or out. Whereas individual doctors can, we are implementing this by having a 48-hour week, which will come about on 1 August 2009.
That is not to say that we do not recognise the argument about doctors flogging themselves to death. The hon. Member for Banbury (Tony Baldry), who is no longer in his place, raised this issue and said that he is kept awake at night worrying about the working time directive. The point of that directive was to stop clinicians staying awake all night because they were obliged to be at work for horrendously long hours, which adversely affected the quality of care provided.
The Secretary of State lectures us about the working time directive, but ignores the point that really matters. There was an agreement in the Council of Ministers to change the definition of “resident on call” so that it related to time spent actually working at night rather than all the time when one is resident but asleep. That is a critical issue, so will the Secretary of State explain why Labour Members of the European Parliament voted against the Council of Ministers’ compromise, the purpose of which was to enable us to interpret “resident on call” in a way that worked for the national health service?
I am raising this because I was asked about the opt-out in an earlier intervention, but the opt-out is not the issue. What the hon. Gentleman mentions is, of course, an issue. It is a crucial issue in order to ensure that the agreement we struck with the Commission, after a long period of virtually hand-to-hand fighting, was maintained. [Interruption.] It is a co-decision. I am not sure how Conservative MEPs voted on the issue, but it is a co-decision, as I said. The decision is taken based on decisions in Parliament, but it has to be agreed with the Commission and with Ministers.
The working time directive was first introduced in 1998, the NHS has made excellent progress in meeting its terms and the majority of NHS services—the vast majority of them—already meet the 48-hour requirement, which will come into force in August 2009. There will always be parts of the service where this is particularly challenging, and we will work with the British Medical Association and the Royal Colleges to address those areas over the next few months. [Interruption.] Incidentally, the BMA is fierce in protecting the safeguard of the 48-hour week and would not appreciate any—[Interruption.] That is a relief—[Interruption.]
I apologise for encouraging them, Madam Deputy Speaker.
The hon. Member for South Cambridgeshire is wrong to say that we are not prioritising the improvement of trauma care. We believe trauma care needs to be recognised as a specialist form of medicine. Patients who are severely and critically injured need the expertise of many specialist professionals—from critical care doctors to neuro-surgeons. Just as we have improved specialist care for conditions such as stroke, so we will also improve trauma care. That is why, as part of my noble Friend Lord Darzi’s review of the NHS, every strategic health authority set out how they would improve the provision of trauma care—most by setting up specialist centres in trauma care.
The hon. Member for South Cambridgeshire asked in his speech and his motion what happened to the report and why there was nothing in the Darzi review, save for the three-digit number, about urgent care. What he fails to recognise is that the Darzi report incorporated all nine SHAs’ visions for the future in their regions, which were worked out with their clinicians, their patient groups and the public. The final report published in July last year was an implementing document or an overview so that all of that could be put in place.
It was a useful idea to have all these workstreams at each SHA level, but I am somewhat confused by the acute care pathway reports for the South Central SHA, as the chair is a consultant in the care of the elderly. Many would have had more faith in the process if it had been chaired by somebody with expertise in trauma care. How can the public and people working in the sector who are trying to drive change have full confidence in the process if the team is not as appropriate as it should be?
I do not think that the process should be judged by the profession of the person chairing it. Someone has to chair these groups and in this case it was necessary to look at clinical services right across the patch. The point is that trauma was a priority in every SHA report. They made it a priority in the regions. People cannot accuse us of being top-down and top-heavy and tell us we should have local involvement, and then complain when the Darzi review is implemented in that very way—I am not saying the hon. Member for Romsey (Sandra Gidley) was complaining, but Conservative Members were.
The report on trauma care was published two years ago just as the Darzi review was being formulated, and the idea now is to carry forward those visions in each strategic health authority. We need someone to oversee this, however, and I can today announce that I am appointing Professor Keith Willett, chair of the British Orthopaedic Association’s trauma committee and a leading international expert on fractures and trauma, to be the first national clinical director for trauma. The hon. Member for Banbury, who is not in his place, will probably know him very well because he is a leading clinician at John Radcliffe, Oxford.
I agree that the public should be given a say in how urgent and emergency care services are configured. Indeed, the next stage review sought the views of more than 40,000 people, and asked them specifically what improvements they wanted to see in urgent and emergency care. Clinicians used the views expressed by patients to make their recommendations for what should happen in each region.
I join the hon. Member for South Cambridgeshire in his praise for the contribution made by community first responders. They play a vital role in improving responses to 999 calls in many parts of the country and in supporting ambulance services. They are not, however, a substitute for an emergency ambulance response. I am delighted that the Opposition are favourably disposed to potential plans to bring in a new, single digit number to access urgent and emergency care services. As my noble Friend Lord Darzi has pointed out, this would provide a quick, convenient way for people to find out about local urgent care services, particularly out of hours or away from home, and we will be consulting on this proposal in due course.
Yorkshire ambulance service, with which the Secretary of State will be familiar, provides data by local authority area at present; it does not do so on a ward-by-ward basis. Given that there is concern in rural communities about differences in performance between wards, will the Secretary of State encourage ambulance trusts around the country to provide data down to ward level so that we have a clearer picture?
That point is worth looking into, and I will do so. We currently have the best performance ever from our NHS ambulance service, and we should include it in our congratulations.
The hon. Member for South Cambridgeshire asked us to publish the urgent care strategy, and I dealt with that in mentioning the strategic health authorities. [Interruption.] I accept that my responses to the points that have been raised are of varying quality. It is sensible that SHAs should carry forward their vision, and we should help them and fund them to do that.
Over the past 12 years, there have been real—indeed, dramatic—improvements in patient care. Patients no longer have to wait years for treatment after referral; at most they have to wait 18 weeks, and the average wait is about eight weeks. The vast majority of patients wait for less than four hours in accident and emergency. Let me put in perspective what this means for patients. A doctor I spoke to recently told me about the accident and emergency department in which he worked in 1995, where waits of 12 hours or more were so frequent that patients were asked for two meal choices when they arrived. Sheets were taped across the corridor to create makeshift wards. He now works in a hospital in the same area where accident and emergency patients are treated on average in just over an hour.
The measures we have taken over the past 12 years have dramatically improved the quality of urgent and emergency care, as the Opposition motion recognises. The abolition of long waits for treatment is one of the NHS’s finest achievements. Greater investment, more staff, better planning and strong leadership have transformed urgent and emergency care services for patients, and I commend the amendment to the House.
I welcome this debate. When I first read the Conservative motion, I thought it was a bit of a hotch-potch: half of it nobody could disagree with—it praises everyone under the sun, and there is nothing wrong in that—but the rest of it seemed like the product of a brainstorm, with references to almost anything that might be remotely related to emergency and urgent care. However, although some of those topics have not been pursued in the debate so far, the Conservatives have highlighted a very important subject.
The hon. Member for South Cambridgeshire (Mr. Lansley) took the Secretary of State to task because the Government’s amendment mentions out-of-hours care, but I think the changes in the provision of that care have had an impact on emergency and urgent care, so it is probably worth mentioning some of them. The Government have done many things to improve care for patients, but they would probably acknowledge quietly that one of their biggest mistakes was to take responsibility for out-of-hours care away from GPs and put it in the hands of the primary care trusts. As a result, the GPs were only responsible for the core hours from Monday to Friday. In some areas, GPs wanted to provide weekend care, particularly if they had a high commuter base, but that was actively discouraged by PCTs. The costs shot through the roof, and in some places the out-of-hours services were introduced hurriedly—to describe what was on offer in many areas of the country as an “unmitigated disaster” is putting it quite mildly. Many people waited more than four hours for a GP to arrive. In my area, we are flying in doctors from various parts of the European Union. A lot of them are German. I have no problem with German doctors; they are all very nice, and people generally had a positive experience. However, those doctors did not understand local services and a number of significant problems arose; if they wanted to section somebody, for example, they did not understand the UK law and procedures governing that decision.
The number of people resorting to calling an ambulance also markedly increased. It is perfectly understandable that a concerned patient might do that if the out-of-hours service is not responding and they are not getting the reassurance they need. We should not criticise patients for doing that.
The Government amendment applauds the increase in GP opening hours. I concede that that may have enhanced choice, but I do not think it has improved access to urgent care because many people are making routine appointments for those extra hours. It is important to consider what urgent care actually is, and it is worth posing a couple of fundamental questions. How does the patient know whether their symptoms are the sign of something serious—whether they can wait to have them checked out, or if they should be making a fuss about being seen? It is clear that different patients respond in different ways. Most GPs will have their regular complainers, but in the days when GPs knew their patients—I hate to say “the good old days”, because I am not sure they were good in all respects—the GP was often able to make a value judgment. They could say, “I saw Mrs. X only last week. I know her quite well, and I think reassurance will go a long way in this case.” In the hands of a doctor who does not understand Mrs. X, however, more resources might be used because they do not know the background and personality of the patient and they will therefore treat them on a more precautionary basis.
I suspect that most Members present will have been out with an on-duty ambulance crew. From witnessing them calling on people, it is obvious that there is a wide range of differing attitudes as to the circumstances in which it is appropriate to call the ambulance service out. One of my first pieces of casework when elected as an MP related to an ambulance that did not arrive to a call from a rural setting, and I was horrified to find out that ambulance crews were often having to deal with very trivial cases. Although the ambulance service does a wonderful job, it does not need to do much of what it does. Every time somebody with a trivial complaint calls out an ambulance, they are potentially endangering the life of somebody else. That risk is not communicated often enough.
The first point of call for people who are ill is usually the surgery. Even if it is closed, they often think of calling their GP, and, in many cases, the call is diverted to the appropriate out-of-hours service. That is what one would expect, but the recent Healthcare Commission report showed that in a significant number of cases—I cannot recall the statistic off the top of my head—the relevant information was not communicated. That resulted in the patient either having to dial somewhere else or thinking that they did not want to speak to a doctor who they did not know and wondering whether they had any other options. Some people will look at various websites for advice, whereas others will go to their nearest pharmacy. Accessing NHS Direct, either on the web or by phone, is a popular choice. Other people will choose to use a walk-in centre or out-of-hours care, or they may call an ambulance because they do not know what to do and are worried.
I welcome the move towards having a single contact number, but I make a plea that during the consultation we examine what has happened when the police and other bodies have introduced such a number. Often, what has happened is that all the other numbers have gradually been withdrawn and people have not then been able to choose to ring the department that they want directly; they have always then had to go through a central switchboard, and often they have not been able to ring their local provider and speak to the person whom they know. To be fair to the police, locally they have got much more sophisticated about this and have found other ways of getting around the system. People who know whom they wish to ring find it frustrating to have to go through a bureaucratic telephone triage service—to go somewhere else. By all means, let us have a single point of contact, but if someone knows whom they want to contact, it should be easy for them to do so—there should be no barrier. So, there are pluses and minuses to the proposal.
I wish to discuss the strain on ambulance services. As a result of inappropriate calls, the London ambulance service, among others, introduced a clinical telephone advice team to advise callers who had less serious conditions—the team made a point of ringing such people back. During 2007-08, the London team handled more than 58,000 calls, and analysis showed that, over the year, that freed-up the equivalent of 35,383 ambulances for patients who needed them more. Not every ambulance trust has that sort of system in place, despite facing similar pressures, so it may be worth considering whether that is best practice. Although different areas rightly provide different solutions, it is also worth examining things that work well elsewhere.
This might be an appropriate time briefly to mention ambulance response times. The most commonly known target is to reach 75 per cent. of category A life-threatening situations within eight minutes of the call. I have never been able to establish why eight minutes was decided as the crucial figure or why 75 per cent. is acceptable—perhaps the Secretary of State could enlighten me—but there are added pressures this year. In previous years, some ambulance trusts have been accused, rightly or wrongly, of manipulating the time when the clock started in order to improve their results. Now, so that there is no dispute, the clock starts ticking as soon as the call connects and there is thus a level playing field.
If the hon. Lady is correct in saying that the clock starts when the call commences—presumably we are talking about the call from the member of the public to the ambulance service—how can there be a level playing field, given that some people may take three minutes to explain the problem about which they are ringing whereas others may take just half a minute?
I do not think that the people who take three minutes are predominantly to be found in Chelmsford and the people who take half a minute are predominantly to be found in another area of the country; the variation will be found across the country. I do not really understand the point that the hon. Gentleman is making; I think it is a rather trivial one.
No, I will continue with the point that I was intending to raise. Just before Christmas, the pressures to which allusion has been made—I will not repeat them—meant that the London ambulance service had its busiest week in history; ambulance staff responded to 20,939 emergency incidents across the capital in the seven days up to 14 December. That was an increase of 8 per cent. on the average for the previous four weeks. The pressure was intensified by the high percentage of calls that were initially treated as category A situations. There is a growing sense of disquiet in some quarters about that fact that canny members of the public know that if they mention chest pain, an ambulance will be sent very quickly. There is a need for a retrospective review as to whether calls are being categorised correctly. No trust wants to gamble with people’s lives, so perhaps this is the way we have to do things, but the system has been in place for some years and it is probably time to change it.
Just after Christmas, particular problems were encountered in Hampshire. The Southern Daily Echo cited a story of a pensioner who was left waiting 70 minutes for an ambulance when she suffered a suspected broken leg, having slipped on an icy pavement. The temperature was below zero, the lady was 85 years old and, apparently, it did not require a paramedic to see that her leg was broken because it was at a fairly unnatural angle. The South Central ambulance service was unable to provide a comment at the time of the report.
Only two days later, another serious incident took place. A seriously injured policeman had to be rushed to hospital in a fire engine because no ambulance was available. A special equipment unit was transformed into the makeshift ambulance because the patient needed urgent medical treatment following a crash in Southampton. A paramedic had arrived on the scene, as had a BASICS—British Association for Immediate Care—doctor, but the ambulance response was not forthcoming. There are always times when unusual demand is difficult to cover, but in an emergency a situation such as I have described is of concern.
I wish to discuss BASICS doctors, because they have not been mentioned in this debate and they are an often-forgotten part of the response to major trauma. Dr. Phil Hyde, a constituent of mine, approached me—
This could be a debate that we have had in Westminster Hall, but as some hon. Members were not present for that, it is worth repeating things. In addition, some of the points from the Westminster Hall debate were not addressed. If the hon. Gentleman is saying that because we had a debate on Equitable Life, we do not need to discuss it again, that is fine, but I contend that if a subject is important, it is worth discussing on repeated occasions.
Prior to the meeting with my constituent, I had no inkling of the fact that if I were seriously injured in a road accident, my prognosis would be severely affected by whether or not a voluntary doctor was available. Many such doctors work full-time in the NHS, often in disciplines such as anaesthetics and sometimes in emergency care. I had always thought it was like “Casualty”—once a year, usually on the Christmas special, there is a major incident and all the casualty doctors go to the scene of the accident—but, in real life, that is not what happens in most parts of the country. This matter is important because of what is said in the often-overlooked 2007 report by the National Confidential Enquiry into Patient Outcome and Death, entitled “Trauma, Who Cares?”. It concluded that the current structure of pre-hospital management is insufficient to meet the needs of severely injured patients. There is a high incidence of failed intubation and of people arriving at hospital with a partially or completely obstructed airway. The report continued:
“Change is urgently required to provide a system that reliably provides a clear airway with good oxygenation and control of ventilation. This may be through the provision of personnel with the ability to provide anaesthesia and intubation in the prehospital phase, or the use of alternative airway devices.”
The report said that ambulance trusts must address that.
The stark reality is that patients who die from severe injuries often do so within the first hour after an accident, and in the UK that time has usually passed before the patient reaches hospital, and that is on the assumption that the ambulance and paramedic response to the scene is normal. If a BASICS doctor arrives, they can stabilise the patient at the scene of the accident and decide the most appropriate destination for that person. It must be borne in mind that, because of centralisation of services and major trauma centres, the destination is not always the nearest hospital. BASICS doctors therefore provide a benefit in terms of the appropriate care.
During the Westminster Hall debate, the Minister said that he would shortly have a meeting with the people responsible for producing the report from National Confidential Enquiry into Patient Outcome and Death, and that he would raise some of the issues that were mentioned during the debate. It would be useful if he could update us on that. The BASICS service is voluntary and often funds its own equipment because doctors do not have enough time, after doing their full 48 hours in the NHS, to provide the emergency service and carry out fundraising.
Some parts of the country, such as Sunderland, have focused on trauma injuries and significantly reduced the death rate from major trauma from the national average of 5.8 per cent. to 2.9 per cent., and have introduced new response teams, which seem to be having an effect.
Many parts of the country rely on air ambulances, and it is frustrating that the running costs are often funded by local donations and voluntary contributions. I am a little worried about that. Although in my neck of the woods in Hampshire the air ambulance service is relatively new and is given the current financial pressures well supported at the moment, there is concern that funding for all charities may decline. The South Central Ambulance Service NHS Trust told me that it pays for the clinical response, but not for the helicopter, which is funded by a well organised group. That was a strange response, because it does not say that it will provide paramedics but not fund the costs of ordinary ambulances. I am not sure of the significance of different modes of transport. What consideration has the Minister given to charitable funding of air ambulances, and does he believe that that is sustainable in the long term?
Last year, the Healthcare Commission’s report, “Not just a matter of time”, reviewed urgent and emergency care. It concluded that most sectors performed well against national standards for access to services, but it found that performance was more varied in services that receive less national attention. That is no great surprise, and Members of Parliament are always highlighting those services. The overall stats show that the response to category A calls was generally good. That is where the main focus falls, and there is not a lot of room for argument, but one should note that those results are given by trust. I made a freedom of information request to find out the response times on a ward-by- ward basis in my constituency. Lo and behold, those parts of my constituency in Southampton received an 80 or 85 per cent. response, which is excellent for people who live in the big city, but in some of my more rural wards an ambulance had never reached an emergency within eight minutes. That is not something to shout about, because it is inequitable—indeed, it is the reverse of the inequality usually seen in the health service, because those who are suffering are not those who live in urban areas, but who perhaps live in more affluent areas. Does the Minister have any plans to refine the targets so that it is realistic to expect an ambulance to reach people within eight minutes, wherever they live, not just in the large urban conurbations?
Perhaps my choice of words was unfortunate, but at the moment the response times are based on large geographical areas, so if a 75 per cent. rating is achieved throughout a trust area, the target is reached, but there is no subdivision that provides that targets must be reached in all areas. It is clear that some areas do not receive the service that they should, and I suggest that the hon. Lady makes a freedom of information request to her ambulance trust. I had always suspected that my rural areas received a less than good service, but the results are much worse than I had anticipated, and almost a whole borough council area was missing the target. Surely there is something wrong with such a response time.
May I try again on the targets? Despite the look on the hon. Lady’s face, I think that she misunderstood my point. She suggested that the eight minutes starts at the moment the call is taken, but if someone is agitated, they may take three minutes to explain why they need an ambulance, and someone who is less agitated or more articulate may take 30 seconds. Surely a target of eight minutes is unfair if the starting time for monitoring purposes is the moment that the call starts. That is all I was trying to say.
The level playing field to which I referred was between trusts. There has been significant variation in the way in which response times were monitored. For example, some started the clock when a call first came into the centre, others started it when the call was answered, and so on. I understand the hon. Gentleman’s point, but if trusts are given flexibility to make a value decision on how to obtain the correct information, that is open to manipulation. All the evidence that I have seen shows that trusts consider every step of the pathway to try to make their figures look better and to hit the target. I do not blame them, because if they achieve their target, they are not subject to greater scrutiny, but there is not a quick, easy and simple way of taking that measurement out of the system and retaining equity in the way in which response times are compared with other trusts. I sympathise with the hon. Gentleman’s point, but there is no quick and easy answer.
If the hon. Gentleman does have a quick and easy answer, it is probably not appropriate for an intervention. He might want to stand up and make some comments later, but I feel that I should finish my speech so that other hon. Members can speak.
The response to category A calls is good, but there is much more variation between the targets and the responses in the case of other urgent calls. The Healthcare Commission found that in some areas fewer than 80 per cent. of ambulances arrive within the target time. On arrival in hospital, there are significant variations in the proportion of patients seen by a doctor or nurse within the first hour after arrival. That figure varied from 40 to 100 per cent. Clearly, there is work to be done.
There is also evidence of poor compliance with guidance on access to medication from out-of-hours GP services. Although that might not be seen as urgent care, if a patient is in pain or something like that, the care is certainly urgent to them. Concerns were also raised that suggested that many people were either unaware of the full range of urgent and emergency care services or were unsure about how and when to use them, which brings us back to the issue of the single contact number. Most importantly, the need to improve the way in which the services work together was highlighted.
Data-sharing is poor and PCT commissioning was highlighted as a concern. A survey produced last week showed that patients rate their care highly but raise concerns about pain control and information given on discharge. That takes us back to the mention of data sharing in the earlier reports. The people who are providing emergency care often do not have sufficient information about the patient. If somebody has been in accident and emergency, or has even been treated in out-of-hours care services, the relevant information is not always relayed back to the GP in as timely a fashion as it could be. Perhaps the Minister could tell us when decisions will be made about information-sharing with regard to the NHS IT project. There is a lot of healthy debate about what level of information can be accessed by whom, but it could be crucial to outcomes in those particular cases.
I want to end by making a comment that many hon. Members start their speeches with: I thank those who do their best to provide an emergency service, whether they are paid workers or volunteers such as community first responders or BASICS doctors. We owe it to all those people to ensure that attention is given to ensuring that people have the best possible outcome in the case of emergencies and that the PCTs ensure that funding streams are adequate. The problem with this area of medicine is that most people are grateful to have received urgent care, and they are often so pleased to be better and to have their problems sorted that they do not take the time to step back and ask whether their outcome could have been improved or whether their quality of life could have been different had a doctor been on the scene. Staff want to do better, but in many cases they are hampered by a lack of attention to best practice and, in some cases, sadly, by a lack of funding.
First, let me pay tribute to the hospital in my constituency, Chase Farm hospital. It has been much mentioned in this Chamber over past years and will surely continue to be mentioned in time to come.
I was at the hospital just over two weeks ago on a Saturday afternoon with my four-year-old granddaughter, who had injured her hand. She is recovering. When one is interacting with the NHS at the point of an emergency, it really comes into its own. It is fantastic. Within five minutes of walking into the hospital, my granddaughter was assessed and in less than two hours she was treated. She was then referred to another hospital that had a hand specialist. That is an important point, because when we talk about access to emergency departments and urgent care it is important to remember that accident and emergency departments do not deal with everything. A patient who goes into an accident and emergency department might be referred to another one or might be assessed in the ambulance by the paramedics and taken to a specialist hospital. The idea that there are not specialist hospitals or that accident and emergencies deal with everything all the time is a false assumption.
That little girl saw a hand specialist at 8.30 on a Saturday night. By the Monday morning, she had had a small operation and I am pleased to report that she is recovering well. I think that that is a model story and I do not think that it is an unusual one. I base my opinion not just on that story but on the way in which Chase Farm hospital has responded to the pressures of winter and those over the Christmas period. The staff have worked very hard. Morale is sometimes low, because of the proposals to do with the hospital, but the staff have responded magnificently in recent times to the pressures that they are under and I pay tribute to them.
I will not, because I have only 15 minutes. I am sorry that I cannot give way, but time is pressing.
I want to go back a little to the remark made by the hon. Member for South Cambridgeshire (Mr. Lansley) that we should stick in this century. I would like to point out that we are only nine years into this century, which is not a lot. The idea that history has no impact on the present or future is clearly nonsense.
In 1997, when I was elected MP for Enfield, North, through the doors of my advice surgery came many people, often elderly people, who had waited in pain, for almost two years for a hip replacement. That pain not only made the quality of their lives appalling but, even after the operation, undermined their health. Lots of people came to my surgery who had waited considerable amounts of time for cataract removal. The wait significantly affected their ability to engage in life and to be independent. I no longer have anybody coming through my surgery doors with those problems. That is not to say that nobody comes through the door with issues about the NHS, but they do not come to see me with those problems. The 18-week wait is a significant gain for the people who depend on the NHS.
All those factors affect urgent and emergency care. If people are dealt with early in the onset of any illness or disease, they are much more likely to make a good recovery and much less likely to present at an emergency department at some point in the future. The same is true if there is good, accessible, available primary care, as people are then much less likely to need to present at an accident and emergency department or to need urgent care.
In Enfield, we very much need the primary care strategy that our primary care trust is planning. I worry that the Conservative policy of deriding and undermining confidence in the notion of polyclinics will damage the ability to put in place a good primary care strategy. Let me give an example of what that strategy means to us in Enfield. We know now that we are getting a health centre in the Enfield Lock area. Professor Sir George Alberti came to Enfield, and he said, “You need an improvement in access to primary care in the north-east of your constituency.” That is now happening. The plan is that we are to have a big health centre with an independent living facility attached to a community school. It will provide a first-class service to the people of Enfield Lock, Enfield Highway and north-east Enfield. That will reduce the number of people who have to leave the area and go to accident and emergency centres with problems that local GPs or walk-in centres can deal with. The health centre will mean that people have much more access to local primary care.
The primary care strategy will have another impact in Enfield, North. Although it will not be built in the next two or three years, a polyclinic is planned for the town centre. Many GPs practise in that area, so it is nonsense to say that people will have to travel vast distances to get to their doctor if a polyclinic is set up. It is a densely populated, town-centre area, so there is no need to fear that. The polyclinic will have longer opening hours, and people will have much greater access to a greater range of specialist GPs. Moreover, the centre’s technological diagnostic resources will mean that people will not have to wait for a hospital appointment to get the same service.
The primary care strategy for Enfield, North means that there will be a polyclinic in the town centre and a health centre in north-east Enfield. Add to that the fact that people will have access to the Forest road health centre just over the border in Edmonton and to the walk-in centre at the North Middlesex hospital, and it is clear that the strategy will be a huge improvement.
The result will be that people will have access to their local health centre and then, if they need it, they will be able to go to the much larger health centre set-up that is sometimes known as a polyclinic. Beyond that, they will have the walk-in centres, local accident and emergency facilities, and the trauma centre provided by the North Middlesex hospital. At local level, the primary care strategy will really serve the needs of people living in Enfield. I worry that some of the propaganda pumped out by the Opposition encourages people to fear any kind of change at all. It undermines their confidence in the excellent service provided by the NHS, and in what is very necessary change to primary care provision.
I want to say a few words about Chase Farm hospital. I am pleased to have the opportunity to do so as I have spoken about it many times, both in this Chamber and in Westminster Hall. Indeed, the hon. Member for Enfield, Southgate (Mr. Burrowes) had an Adjournment debate on the issue only last week. I attended and intervened, and my hon. Friend the Minister is well aware of my views.
I do not oppose change, but it is important that local people are listened to and, without exception, the people and elected representatives in my constituency do not support the proposed changes at Chase Farm hospital. However, that needs to be put in context, and to that end the past is important once again. For the first time in 20 years, the people in my area can be confident that a hospital will be maintained on the Chase Farm site. We have managed to achieve some real gains, including ensuring a secure future for the hospital, and I advise anyone who doubts that—including Opposition Members—to compare local Conservative literature with the hospital trust’s original proposals. One of those proposals was to close the hospital altogether, so it is clear that our success in saving it is a real achievement.
The second gain is that there will be an expansion in planned surgery at Chase Farm hospital. That protects the heart of the hospital—its wards and operating theatres—and so is very important to people in Enfield, especially those elderly people who are much more likely to need orthopaedic and other operations. It is very important that they be able to go into hospital locally.
We have also gained some local accident and emergency services. The original proposals put forward what might be called a “hot-cold” model, under which Chase Farm would provide only elective—that is, planned—surgery and nothing else. We have managed to get rid of that proposal, which is a gain in itself. In addition, and with the support of the Minister, we have also managed to achieve agreement about having a midwife-led birthing unit, so that Enfield babies can continue to be born at Chase Farm.
I am not in favour of any reduction of service at Chase Farm hospital, but it is important to understand the context. I shall continue to campaign and do everything that I can to maintain the present level of service.
The motion refers to a report from the College of Emergency Medicine, but the interpretation offered by the hon. Member for South Cambridgeshire was inaccurate. In an intervention, he spoke about distances, but in that respect the report does not help the argument about Chase Farm hospital. I have asked the Minister to look at the matter again, given the significant increases in birth rate and the elderly population. The report notes:
“There is no single solution to the reorganisation of emergency care. In urban areas where”
“are close together (less than 10 km apart) there may be advantages to amalgamating services”.
That would not help our argument, as Chase Farm hospital is 9.43 km from North Middlesex hospital, and 10.48 km from Barnet hospital. Therefore, the report does not make the across-the-board point that the hon. Gentleman imagines. It might be more applicable in rural areas, but I do not know, as I do not represent a rural area. It certainly has very little application in my area.
The report says that each case must be taken on its merits. I agree: I have presented the case for Chase Farm hospital and will continue to do so, but I will not accept that the NHS is almost no better than it was in 1997, as it has improved significantly. There has been a huge step change, and it is time that people gave that more credit, rather than always talking the service down and looking for the negative.
I am delighted that we have the opportunity today to debate emergency and urgent care in the NHS. I fully support the motion tabled by my right hon. Friend the Leader of the Opposition and our Front-Bench team, but—perhaps unusually—I can also support the beginning of the Government’s amendment.
Like my hon. Friend the Member for South Cambridgeshire (Mr. Lansley)—to be fair, I must add that the Secretary of State expressed the same sentiments in his opening remarks—I fully support and admire the people who work in the NHS. Without all the doctors, nurses, consultants and ancillary workers—who too often are not mentioned—we would not have a national health service. They are there, day in and day out, often without much praise or notice, delivering health care to our constituents and to ourselves.
In my brief comments I shall discuss accident and emergency services, which all too often work under tremendous stress and strain. For many members of the population, that is the first point of contact with the local hospital. The problems that A and E services face have been exacerbated—certainly in my area, mid-Essex—by the dramatic increase in the number of people turning up or being admitted to A and E as a result of drug or alcohol-related abuse. That is a growing problem.
The Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), who is on the Front Bench now, answered a written question from me yesterday. His reply showed that in 2002-03 there were just over 2,500 admissions to Broomfield hospital in Chelmsford as a result of drug or alcohol-related problems. By 2005-06 that had increased to just over 4,000 episodes. Fortunately, the next year, 2006-07—the last year for which figures are available—the level had marginally dropped to just under 4,000, but the figures show the dramatic increase in that problem, arising from the increased incidence of binge drinking and irresponsible drinking and behaviour in our town centres. The problem is spreading to our rural areas as a result of abuse, a misunderstanding of the dangers of alcohol consumption, and the failure to adopt a responsible and mature attitude towards it.
The knock-on effect is the strain that that puts on A and E staff, not only because of the medical problems emanating from the abuse that brings people to A and E, but sadly, because of the behaviour of some of the patients resulting from the state of mind that they are in. If someone has been brought into A and E by friends who have been out with them, the friends, too, may be suffering the effects of alcohol abuse, which exacerbates the problem and the way in which they interrelate with staff. The patience and the behaviour of such people are not as they would be if they were sober. That is unacceptable and needs to be addressed more strenuously than it is at present, although I accept that most hospitals are adopting zero tolerance of bad and antisocial behaviour.
A similar problem, although it does not arise directly from alcohol abuse, is violent and aggressive behaviour towards staff. It is incredible that people whose entire raison d’être and work is to relieve pain, remedy sickness and reduce the suffering that results from illness should be verbally or physically abused for their pains. It is a sad reflection of the society in which we live.
My hon. Friend raises an important point. He will know, as I do from spending Friday and Saturday evenings with accident and emergency department staff, how difficult that can be for them. Things should not be that way. Will he join me in commending the action taken by, for example, the Queen’s medical centre in Nottingham? Instead of sitting in the accident and emergency department waiting for cases to be brought to them, often causing considerable trouble in the department for other people attending and needing care, A and E staff go out and set up field hospitals in the centre of Nottingham, to take care to the place where trouble is predicted. That does not mean that they want trouble, but it shows that they are thinking proactively about how to manage care more effectively. There is the additional benefit that large numbers of ambulances are not tied up in the course of an evening.
I am extremely grateful to my hon. Friend for an important and interesting example of a proactive service. The NHS in other parts of the country should look at the experience in Nottingham to see whether they could learn and benefit from setting up a proactive service themselves. I strongly believe that there is a positive future role for A and E departments throughout the country to learn from that experience and seek to replicate it. As with preventive medicine, it is important for the health service to be proactive. In the longer term that pays handsome dividends.
Will my hon. Friend confirm that the increased work load comes on top of substantial increases in the work load caused by respiratory infections in elderly people, flu and the norovirus, which have placed an immense added responsibility on accident and emergency departments? By and large they have coped magnificently.
My hon. Friend is right. He highlights another problem that has developed in the health service. It was always assumed that the pressure points of increased activity occurred in the winter months when it was coldest or iciest. In the past few years we have seen that those pressure points in the NHS are no longer restricted to the traditional winter months when the weather is particularly bad. In my local hospital, Broomfield, the pressure was worse in June last year than it had been in the worst winter month. The health service has had to adapt to changing circumstances, and the old accepted problems of winter pressures are being extended, for other reasons, to other months, putting extra pressure on resources and staff.
There is a further issue facing accident and emergency services which it might not be tactful to discuss. The NHS must be tough and not only accept that there is a problem, but be brave enough to try to do something about it. Sadly, part of the population go to accident and emergency for treatment as a first resort, when their complaint is in no way related to an accident or emergency. A and E should not be their first port of call. They should use NHS Direct or contact their GP or, in some cases, their pharmacist. If people misdiagnose themselves and misdirect themselves to A and E for treatment, that puts excessive demands on the health service and on other patients waiting for A and E treatment, who may have far more serious complaints or conditions that warrant their being there in the first place. More must be done to educate people and to explain why they should not trot along to A and E simply because it is more convenient for them.
On the four-hour waiting time limit, four hours may be a relatively short time compared to the length of time that some people had to wait in the past, but it is still quite a long time to hang around. For someone who goes to A and E with a medical complaint that is acutely painful, even if it is not as medically serious as the pain that the individual is suffering, four hours can seem a very long time. My A and E at Broomfield reflects the situation nationally. We have seen a significant increase in the number of people attending A and E in recent years. In the year up to December 2007 there were 5,469 attendances at A and E. The next year, ending December 2008, the figure was up to 5,783. The target that 98 per cent. of people should wait less than four hours is being met in my A and E department. The latest figures for 2007-08 show that it achieved 98.3 per cent. I accept that that is of little comfort to the 1.7 per cent. who are not included in those figures.
I am sorry to interrupt my hon. Friend, who is making an important point, but it might be of interest to him and to the House to know that the NHS information centre this morning published an analysis of the data from hospital episode statistics, which shows that 4.1 per cent. of people who attended A and E departments had a recorded time for arrival but no recorded time for departure. That is the equivalent of more than half a million patients a year who appear simply to drop out of the statistics. That is quite separate from the point about 98 per cent.
Very much so. It would be interesting to hear what the Minister has to say about that. There is another discrepancy, in that the figure that I have given for my local hospital for the meeting of the four-hour target, except for those 1.7 per cent., looks encouraging because it is slightly above what it should be, but the Healthcare Commission recently published a survey of visitors to A and E at that hospital showing that patients’ perception of the service varies radically, and, sadly, it is in the bottom 20 per cent. for patient satisfaction. The trust accepts that it is disappointed by the results and says that it is seeking to improve what it calls the patient experience as a top priority. That is important, because it means that the trust recognises that there is a perception with users that it is not as good as it should be.
My hon. Friend is being generous in giving way. It is important for us to understand exactly what is going on. The Healthcare Commission found that only 73 per cent. of people who attended A and E departments reported that they were seen and treated within four hours. It surmises that a significant number of people are being put into admission units or medical assessment units, and because those are attached to A and E they believe that they are still in A and E, whereas from the hospital’s point of view the clock has stopped ticking.
Absolutely. I wrote to the Minister only yesterday because I have been sent a series of allegations about what happens in A and E, and I would be grateful if he would look into them.
The point is that we must move forwards. We must ensure that there are improvements so that patients not only receive the best treatment possible, which I have no doubt that they do get at my hospital, but that the waiting time is short and the triage is swift, and that they are dealt with sympathetically and treated as quickly as possible. I welcome the fact that, as a result of the Healthcare Commission survey and the trust itself examining what goes on and what should and must be done to improve the situation, the trust has been prepared to recognise that improvements need to be made and is taking initiatives.
For example, by the end of next month, a major refurbishment of the physical site of the A and E will have been completed—an important and positive step forward. On some days, a GP now works alongside the A and E team to help with patients with minor injuries and ensure that they are referred to the relevant professionals. New shift patterns have been introduced for the nursing staff to seek improvements, and a new triage system has been introduced to identify major and minor patients and ensure that they are treated more quickly within the department. A fourth A and E consultant has been recruited, and a new general manager has been appointed to oversee the work of that department.
I welcome all those initiatives. They are a positive step forward. I have no doubt that we can work together with the sole aim of improving the quality of care and the quality of the experience that patients have at A and E. Most of them are not there for the wrong reasons, but because they are in pain and probably frightened or confused because they do not know what is wrong with them, and need assistance. That is why it is so important that we ensure that we have an A and E service in our local communities that is second to none, and meets the requirements of all of our constituents.
By amazingly happy coincidence, the NHS constitution was published this morning, and I want to read to the House two pledges. First:
“The NHS also commits to inform you about healthcare services available to you, locally and nationally”,
“to offer you easily accessible information to enable you to participate fully in your own healthcare decisions and to support you in making choices.”
In an emergency, that pledge will be fulfilled only if there is a three-digit telephone number that everybody can contact. People know when to ring 999, but, as I have been stating since I secured an Adjournment debate on the subject in 2007, they do not know what to do in an intermediate emergency, when they have so many alternatives to consider.
The Minister, whom I am pleased to see in his place, will remember that in that July 2007 debate I drew attention to an absolute tragedy at home—the death of a little boy aged seven and a half, whose perfectly intelligent, competent parents could not work their way through the system to obtain the right care for their little boy in an area that had lost its A and E department.
In Health questions on 16 December I asked about progress in achieving a single phone number, and the Minister replied that very good progress had been made. He encouraged me to be a little more patient and await the formal announcement, so I am putting him on the spot. When will the formal announcement be made? I was horrified to hear the Secretary of State say that the Government were considering going out to consultation shortly. This is so urgent. I agree that we must get it right and that we must consider the triage system to which it is connected and what happens to the ambulance triage systems and the out-of-hours services that have their own phone numbers. I agree that the matter is complex, but consultation with those bodies should be a matter of absolute urgency and priority and should take only a short time.
Ensuring that the correct telephone numbers are available will help stressed A and E departments because people will be prevented from attending unnecessarily. The phone number must connect people to the relevant information about services available in their health community—A and E, urgent care centres, minor injuries units or out-of-hour services—which is likely to be served by a PCT and the emergency services under that PCT. Services must be networked, and everyone must know what each bit of the service can do.
I entirely agree with the hon. Gentleman and he will no doubt have noticed from what we have said over two and a half years that we very much support exactly this notion, but he has not mentioned NHS Direct. We are clearly in favour of a single national telephone number, which would replace 0845 46 47, but NHS Direct must be franchised into the same system, so that it is not separate from the system that he describes but is an integral part of it.
I am grateful for that intervention; I should have mentioned NHS Direct, which I will get out of the way now. There have been many criticisms of NHS Direct; perhaps I inadvertently forgot to mention it because I have not been very impressed by it. According to reports, it refers on many more cases than it solves.
The next thing that I want to plug, and I have done so before, is an effective, excellent trialled triage system that is ready and waiting to be taken up. The Department of Health initiative, NHS pathways, offers a high-class computer software system for triaging. Work on the initiative has been going on a long time, but announcements on its progress seem to have disappeared. Nearly two years ago, the North East Ambulance Trust conducted a successful trial of the system.
Like most hon. Members, I browse on Google a good bit of the time; googling “NHS pathways” tells me that it has won awards—a FileMaker Cube award in 2008 and the British Telecom e-health insider award as the health care IM & T team of the year for 2008. The chair of the independent panel judging for that latter award said that NHS pathways was “an impressive piece of software” that was already delivering “gains” where it was in use. He added:
“Getting patients to the right place in these circumstances saves lives and stops precious resources being misdirected.”
Given those accolades, NHS pathways must surely be made available across the NHS.
I feel that NHS Direct should be just for information about illnesses and diseases, and should not involve the triage system and access. NHS pathways not only gives a person advice on where to go with their problem but makes the arrangements, but it must be integrated with ambulance services, out-of-hours providers, NHS Direct and other organisations.
The hon. Member for Romsey (Sandra Gidley), who speaks for the Liberal Democrats, mentioned ambulance response times. Most people are aware of category A, which refers to top-priority cases—75 per cent. of which are supposed to be reached within eight minutes. I do not think that the other categories are sufficiently well known. Another tragedy in my area is under investigation at the moment. It appears that an out-of-hours GP did not assign sufficient urgency to a request, so the ambulance was delayed, with desperate results. Ambulance prioritisation categories need to be widely known.
Staff at accident and emergency departments have been praised a lot today, and I fully echo that because I know how hard they work. However, my main concerns are to get those who do not have an A and E department to the right place at the right time, to prevent them from being taken unnecessarily to such departments and to plug the three-digit number and NHS pathways. If those things could be achieved, tragedies such as the one that happened to the little boy in my area would be much less likely. That little boy’s parents would really appreciate such a memorial; they might almost feel that some good had come out of their tragedy.
I come to this debate with a range of experience of accident and emergency units. I was working in the A and E unit of Royal Liverpool university hospital on the night of the Toxteth riots; we admitted just over 350 people that night. I therefore have experience of acute care at its most acute. I have also worked in a minor injuries unit in the same region. The unit was a new development in the area and it came about as a reconfiguration. However, it was not led by government or driven from Whitehall—it was designed locally by the local hospital trust and local people.
The minor injuries unit worked well. Everybody in the area knew what they should go to the unit for and what they should go to the accident and emergency department for. The unit dealt only with minor injuries; we sutured, X-rayed and set basic fractures. The local community knew that, because the unit had been established following local consultation, including GP-patient groups. What was designed and established was what the local community needed, so the community blended well into that provision and used it well.
The Secretary of State said that one of the prerequisites that Darzi had mentioned was that services should be “locally led”, but he endorsed what the Government are doing by using the words of the national clinical director of emergency care, who did not mention consultation or interaction with local communities, patient groups or GP-patient groups. It feels as though the reconfiguration is being driven by Whitehall rather than by patients, users, doctors or nurses.
Would the same overall blanket approach work with polyclinics? That approach is being taken with them and although I do not disapprove of polyclinics in principle, I believe that local communities have local needs and that polyclinics would work in some areas but would not work at all in others.
Some of our patients in the Royal Liverpool university hospital on the night of the Toxteth riots came through our doors in shopping trolleys. I will not forget the scene of almost carnage outside the A and E doors as I left after a 12-and-a-half-hour night shift; I do not think that the working time directive would have worked very well in that instance. I do not even know from where we drafted some of the people who worked on the unit that night; we dragged members of staff from all the wards.
The one thing that I know about working on A and E is how the relationships, expertise, knowledge, and trust and respect for colleagues build up over time. Such departments are unlike any other in a hospital, perhaps because they get the blue-light jobs and the cases that they deal with are frequently matters of life and death, or perhaps the explanation is the high level of expertise deployed and the high level of training needed by both the nurses and doctors. The departments that interact with A and E—physiotherapy, radiography—all link in as well. There is a high level of skill in A and E departments, and it builds up not only through training but through the other staff.
I am concerned that we are losing those skills because of some of the targets, because of the reconfiguration that is taking place and because of the loss of morale and disenchantment among some staff. Last week, I spoke to two nurses who are now working in GP practice having worked at Bedford hospital and at Luton and Dunstable hospital. Both had left A and E as a result of centrally imposed targets. One of them said that she decided that the time to leave was when she put the phone down after she had been told that she absolutely must admit a patient from an ambulance that had been parked outside with a patient inside for some time in order not to contravene the target once the patient came in through the doors. If she had acceded to that call and admitted the patient, she would have seriously comprised the quality of care that was being provided in the unit, given the short number of staff she had on duty on that day. She was left with the option of transferring staff quickly out of the A and E department into inappropriate wards that also did not have the correct number of staff with the correct training, skills or ability to look after the patients who were in A and E at that moment.
The nurse was dealing with a road traffic accident, or RTA. In my day, almost everyone involved in an RTA ended up in hospital, but because of the safety requirements for most cars today only the very serious cases end up there. If somebody does require serious treatment they are usually very ill, and if there is not a trauma unit nearby they will end up in A and E. The nurse had some very seriously injured patients in her A and E department as the result of an RTA, and while she was trying to care for her patients she was being harassed to take in other patients to meet a target. That was the day when she decided to walk, and we lost an absolutely superb, well trained nurse manager from an A and E department who had worked there for 12 years and built up an incredible level of expertise. The nurse from Luton and Dunstable hospital had done exactly the same thing. The figures show that we are losing nurses from A and E departments all over the country because of the targets that are being imposed.
No mention has been made of the patients who have to loiter outside A and E departments in ambulances or how that impacts on ambulance crews. The hon. Member for Romsey (Sandra Gidley) talked about the waiting times from when the call is received to the ambulance getting to the patient, which are longer in rural areas. It is increasingly difficult to get ambulances to respond in the time that we need when they are still parked outside A and E doors because their patients cannot get through the doors because they might contravene a target that has been imposed on A and E staff. If the Government were going to start configuring A and E services, they should have looked at some of the existing fundamental problems before they started to look at how they farm out the entire service.
Minor injuries units, like polyclinics, can work well where there is a community need, but that need will not always be there. In fact, polyclinics can absorb much of what minor injuries units do. A minor injuries unit would probably be needed in an urban area with a high population density that is located a fair way away from a major hospital. Those are probably also the areas that would be better suited to a polyclinic, so it could be possible to deal with minor injuries at a polyclinic and combine the two things.
The Royal College of Nursing agrees that the four-hour target is compromising the patient care being delivered in hospitals. That does not only apply to situations such as the major RTA that I mentioned. For example, instead of a patient who is in need of surgery, there may be a stroke patient who needs monitoring. Let me cite an example from my constituency. A patient who was 14 days post-delivery presented at her GP surgery with a hot calf, pains in the leg and breathlessness. She obviously had a pulmonary embolism and was sent to the A and E department. She was farmed out from that A and E department to the paediatric ward, but the right dosage of Heparin, which she needed to be given fairly quickly, was not available. The nurse therefore had to go back to the A and E department to get the correct dosage of Heparin and take it back to the patient. As a PE is a fairly serious condition, it would have been far better if she had stayed in the A and E department, been treated and monitored, and then taken to an appropriate ward when a bed was available so that she could be nursed properly, but unfortunately that did not happen.
Like the right hon. Member for Enfield, North (Joan Ryan), who mentioned her granddaughter, I have experience of using A and E units not as a patient. Sadly, my own brother died in a unit where I was working at the age of 26, following a road traffic accident. He stood a chance when he arrived though our doors because he had been treated by a paramedic at the scene of the accident. Two dual-man ambulance teams arrived at the scene of his accident, and he was still alive when he arrived with us. One of the Government’s proposals is to split the dual-man teams and revert to solo response teams. I am concerned about that. When a solo response team attends a serious accident, several things need to be done. Following a road traffic accident or a serious trauma, a patient will go into peripheral shutdown and will need to have a line put up pretty quickly. That is very difficult to do if there is not the correct level of assistance. It is hard to introduce a line in order to put in the intravenous drugs—the adrenaline and other things that will be needed to keep that patient stable until they get to an A and E department. One person cannot maintain a clear airway, administer drugs, deal with peripheral shutdown and insert a line if they are on their own or do not have the right level of expertise with them. It is not just about the clinical needs at the scene of the accident—they may have chaos around them, agitated and upset people, or more than one person requiring their help. If this move towards solo response teams becomes popular, patient care at the site of an accident will be compromised. I do not think for a moment that my brother would have got through the doors of the A and E if he had been treated by a solo response team.
The Minister has claimed that the solo response team does not present a risk to patients and frees up resources for other calls. He said:
“Fast-response vehicles can often get to the scene faster than traditional ambulances.”—[Official Report, 17 December 2007; Vol. 469, c. 1195W.]
I am sure that they can, but I do not see why there cannot still be a dual-man team in the solo response vehicles. Why cannot there be two paramedics? Is the Minister referring to the fact that ambulances are larger or that they go more slowly? I am not sure why he is saying that solo response vehicles will get to the scene more quickly. [Interruption.] The Minister is indicating to me that a motorbike would be used. That is fine, but how would one man and a motorbike deal with peripheral shutdown? How would he maintain a clear airway at the same time? How would he administer drugs? How would he deal with the agitated and upset people at the scene? How would he deal with other people who may be injured at the scene? How could one person do all that? It is difficult enough for a dual-man team who are very pressurised and under a great deal of stress when they attend these scenes. How does one man on a motorbike deal with that scenario? I hope that the Minister will elaborate on that, because it causes me more concern than any of the other proposals. I understand the need to free up resources, and perhaps he wants to have more ambulances so that we can speed up response times, but I ask him to look at the four-hour target first.
There is a related issue. In a road traffic accident, the ambulance service will obviously aim to dispatch an ambulance that is capable of transporting a patient, and there would therefore be two staff present. However, the question that often arises is whether that team includes a paramedic who is capable of intubating a patient at the scene of the accident. It was interesting to note that the national confidential inquiry found that 41 per cent. of patients who were treated by a helicopter-based system were intubated at the scene before being taken to hospital, while the figure for patients treated by road ambulance teams was only 7 per cent.
That is a really interesting statistic. Intubation has a huge impact on a patient’s ability to get to an A and E or trauma unit to receive the second level of care that they need. My hon. Friend makes a fascinating point. I would say that it would be almost impossible for that figure not to be even lower than 7 per cent. under the solo response proposal. I am sorry to do this to the Minister, but I must quote his words again, because it is quite frightening that he believes that a solo response system
“does not present a risk to patients”.
I believe that those teams would present a considerable risk to patients, not because of anything to do with the commitment or ability of the one paramedic on the motorbike, but simply because that one paramedic does not have four arms. He does not have the ability to deal with whatever he might find at the scene of an accident on his own. It is a frightening scenario—
May I add my praise and admiration for the dedication, professionalism and sheer hard graft of all those in the emergency services, who do so much to help so many of us? In particular, I should like to praise my local hospital, Leighton hospital, and to thank my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) for mentioning the great work that it does. Its staff often work in difficult, traumatic and treacherous circumstances, and they deserve the highest praise that we can give them.
The Secretary of State mentioned the capacity of our A and E units to cope with the demand, particularly over the Christmas and new year period. He talked about shutdowns, during the 1980s and 1990s, in A and E departments that could not cope with the demand, and said that that was a thing of the past. Sadly, however, Leighton hospital had to close for six hours over Christmas because it could not cope with the demand coming through its doors, despite the long hours and hard work put in by the staff. We have to recognise the fact that that problem is still out there, and work even harder to ensure that we have the capacity to cope with such demand at any time of the year, including the Christmas period.
In this important debate, I particularly want to highlight the often unrecognised, unsung work of our community first responders. We must remember that they are volunteers who give up their own time and money to care for people in our local communities, who rely on them not only to respond to tragic accidents but to save lives. They perform a vital, life-saving service in Crewe and Nantwich, and that is recognised by, and embedded in, the local community. I have had the privilege of meeting a number of community first responders, not only in my own constituency but across Cheshire. It is clear that they are extremely highly regarded, not only by local residents but by the local councils, by the control centre staff with whom they deal directly, and by the paramedics on the ground, who appreciate the great work that they do. Unless we have full paramedic coverage and a blanket of defibrillators across an entire area, community first responders will have a role to play in ensuring that they are available to support their local community wherever their care and professional ability are needed.
Community first responders are a key component in relation to the response times to emergency calls. Unfortunately, the response times in Cheshire have historically been unsatisfactory. Indeed, last year, the North West Ambulance Service fell almost 20 per cent. below its target for reaching calls to life-threatening cases within eight minutes. As many Members will know, the sooner a response can be made, the better chance there is of survival for that patient. Every second is critical when a life is under threat.
Other Members have highlighted the fact that local ambulance trusts are able to hide behind their regional statistics on response times. Those statistics often mask great deficiencies in the local response times throughout the area. We have already heard about one area of the country in which the local ambulance trust has failed to respond to all category A calls with the target eight-minute period. Indeed, that also applies in the Audlem area in my own constituency, where 100 per cent. of the category A calls were not reached within eight minutes.
That serves only to re-emphasise the importance of the role that the community first responders play in our local communities. I am delighted that, after the three meetings that I have had with the chief executive of the North West Ambulance Service, he and the local primary care trust—and my hon. Friend the Member for Eddisbury (Mr. O'Brien), who sits on our Front-Bench shadow team—have managed to put together a working group to look at local response times and to encourage the ambulance service and the community first responders to work together, to ensure that whenever there are professional, qualified community first responders available, they are called on, so that everyone in the local community has the best chance of getting a response as soon as possible.
My hon. Friend is to be congratulated on the tremendous vigour with which he has fought the campaign to get some sense into the restoration of a good community first responders service, not only in his own constituency, since fighting the by-election there, but in the neighbouring area, which includes my constituency, and the more rural areas of Audlem and Buerton. I hope that he agrees that there would be no need for community first responders if the performance of the North West Ambulance Service were at least up to target, either in the more urban environments in his own constituency, or in the remoter rural parts of mine. The service’s targets have been missed by a large margin, and, with the restraint put on the community first responders, we now face a major challenge in getting our constituents to Leighton hospital so that their needs can be met. I am grateful to my hon. Friend for his efforts, but I wonder whether he agrees that the community first responders are effectively filling a major gap that has arisen due to the inadequacy of the North West Ambulance Service? The service has repeatedly been challenged on this matter, and we have reached the point at which we demand answers.
I am grateful to my hon. Friend, who has got to the nub of the issue. One of the community first responders in Nantwich has told me directly, “I wish I didn’t even have to be here.” He said that he had to fill in the gaps, as my hon. Friend says, to ensure that there was a proper service that met the needs of the local people of Nantwich. Although he enjoys his job and gets great satisfaction out of it, he would prefer not to have to do it. If there were a 24-hour paramedic service on the doorstep of everyone who lives locally, he would certainly not have to.
A process is taking place that the North West Ambulance Service calls a “standardising” of the service. It is essentially downgrading the role that community first responders play in the local community. It is taking away the life-saving drugs that they administer at the scene of an accident or in a case of trauma, and reducing their responses to certain calls such as those involving children. Perhaps most concerning of all, it is taking away their ability to use a blue light as part of their response. The original intention behind community first responders was, to quote a report by the Healthcare Commission on the Staffordshire ambulance service,
“to provide a prompt emergency services for communities that ambulances could not reach so quickly, and to improve the outcomes for patients where the speed of the first intervention can be critical, especially those with chest pain or having a cardiac arrest.”
The removal of the blue light has disabled community first responders from ensuring that they can get to the scenes of category A and other calls as soon as possible. As a result, the number of calls to community first responders in the Nantwich area has been reduced from about 80 a month to just one or two a week.
Sadly, the removal of those responsibilities of community first responders last May came at a time when a young father in my constituency needed their help. In a tragic incident, the ambulance was unable to reach him within the specified eight-minute period. The community first responder was not called, because of the downgrading of the service, and the young father died. The justification for the standardising of the North West Ambulance Service was the Healthcare Commission report that I have just cited, but of course the role of community first responders is different for each trust. In Nantwich, the responder is someone who not only has many years’ experience in the role but is qualified at the highest standard to drive with a blue light. It seems bizarre in many respects to take away the opportunity for him to respond as quickly as possible, given that he has both the training and professionalism to do so. He has done so for four years with no incident. Restricting the capabilities of the community first responders potentially puts lives at risk.
The Secretary of State said earlier that he wanted change for the benefit of patients. We certainly want such change, but we have not seen evidence that the changes to the responsibilities of the community first responders are an example of that. The depth of feeling about their role is palpable in my constituency, as I am sure it is in constituencies across the country. The situation has led not only to a petition of more than 10,000 local names being signed and delivered to Downing street but to the first march through the streets of Nantwich for a considerable time. Having spoken to some more expert local historians than I am, I understand that it is the first since the civil war. That is how strong the local feeling is. The community first responders are held in very high regard and provide a valuable service. The sooner a highly qualified community first responder can be on the scene, the greater the chance of a successful outcome.
We have been told that the North West Ambulance Service wants to expand the community first responder service, and indeed it has started to make moves in that direction. However, new CFRs are becoming qualified on the basis of just 18 hours of training, without responding to the category A, B and C calls that, as the hon. Member for Wyre Forest (Dr. Taylor) pointed out, need to be recognised as part of their service. That seems an unfortunate way in which to treat people who volunteer their services and have the capacity to ensure that the response times are met. They also offer two other benefits.
First, community first responders are great value for money—they do not ask for anything for their actions; indeed, they plough in their own money to perform the task. Local financing—often given by town councils and other charities—covers their role. They therefore provide a direct benefit to the NHS and the local community. Secondly, they are not only locally accountable but they have immense local knowledge. An ambulance that comes from many miles away may have directions about how to reach the patient, but the driver may not know the patient, and may not know the road intimately or be able to get there as fast as a community first responder. Local knowledge is therefore vital in providing the service.
It is time for ambulance trusts throughout the country, especially in my area, as well as the Government, to listen to the voice of the public about a service that is vital but currently undervalued. The community first responders have shown that they are willing not only to serve but to give to the best of their ability. It is only right that they are allowed to do that.
I now have to announce the result of a Division deferred from a previous day. On the motion relating to Northern Ireland, the Ayes were 276 and the Noes were 184, so the question was agreed to.
[The Division list is published at the end of today’s debates.]