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Accident and Emergency Provision (North-East)

Volume 558: debated on Wednesday 13 February 2013

Motion made, and Question proposed, That the sitting be now adjourned.—(Mr Evennett.)

Government targets say that no more than 5% of patients should wait longer than four hours in accident and emergency departments, yet on Monday 14 January, The Northern Echo reported that the North East Ambulance Service

“has admitted that it is struggling to meet demand, after an elderly Parkinson’s Disease sufferer waited 11 hours before being taken to hospital. North-East Ambulance Service (NEAS) NHS Trust bosses said a surge in winter-related call-outs meant it was having to prioritise patients. NEAS has apologised to 84-year-old Eileen Anderson, of Marton, Middlesbrough, after it emerged ambulances are queuing for hours at hospitals across the region before being able to hand over patients.”

Mrs Anderson is a constituent of mine, and although that may be an extreme example of the delays that are occurring, unfortunately, it is not an isolated incident.

Late last year, the health care regulator, the Care Quality Commission, reported that 33% of people spent more than four hours in A and E—that was before this winter—while research shows that the number of people waiting for A and E treatment in England has risen by 47,000. Those waiting times are the worst in almost a decade. Nationally, almost 1 million extra visits to A and E units across England were recorded by the Department of Health in 2010-11, with a doubling of trolley waits—people waiting in A and E for longer than four hours to be admitted—in a single year. A freedom of information request revealed that eight-hour trolley waits almost trebled between 2009 and 2011.

The CQC has warned that 17 hospitals are understaffed and cannot guarantee patients’ safety. The excellent James Cook university hospital, which serves many in my constituency, including Mrs Anderson, has said that delays in admitting patients are being caused by insufficient staff and a lack of available beds. My most recent information is that the hospital is holding weekly meetings with ambulance bosses in an attempt to alleviate delays. The trust should be praised for taking action, but the fact that action is necessary is indicative of a sorry state of affairs.

I have recently had a very unfortunate experience of the NHS involving admissions to A and E. Both my parents have been admitted to A and E over the past two months. Their care has been absolutely excellent—I could not criticise it at all—but staff took the opportunity to tell me that the staffing levels, particularly at weekends, in A and E and on wards is putting life at risk, which is surely a concern to us all.

I thank my hon. Friend for that point, which I will try to extrapolate from during the debate.

Paramedics say that delays prevent them from responding to calls, and fear that such delays could lead to a tragedy. As recently as last week, it was reported that the hospital was the second worst in the north-east for hospital handover delays of longer than two hours. Any hospital handover delay of more than two hours is classified as a serious incident by the NEAS. Of equal concern is the fact that in December, the hospital failed to meet national targets of responding to 75% of the most serious incidents—classified as red incidents—within eight minutes; its result was 69%.

Accident and emergency departments are the foremost example of NHS front-line services. If they appear to be failing, it is hard to deny that something is not right. It is not justifiable to have patients queue in a corridor, as Gladys Herbert had to. She described the situation:

“It’s as plain as the nose on my face there’s not enough beds and not enough staff in the hospital”.

That occurred at James Cook hospital, where there was a queue of up to 10 ambulances at one point. Frankly, that is an appalling risk to patient safety. The Prime Minister has personally promised to protect the NHS, but he is leaving patients such as Mrs Anderson and Mrs Herbert waiting longer in pain and discomfort.

I rise to support my hon. Friend, and I congratulate him on securing this debate. I entirely support what he is saying, because some weeks ago my own mother lay on a hospital trolley for five hours at James Cook hospital, waiting for admission to a ward. Ambulance staff had to remain with her until she was admitted before they could go on to their next task, which is a complete and utter mismatch of resources. I support my hon. Friend’s comments.

My hon. Friend makes an excellent point. It is a sorry state of affairs, and personal experiences, that people from our area are reporting. The warning signs are there, and I believe front-line staff when they say, as has been reported:

“Somebody is going to die somewhere down the line and it could be the most vulnerable, children. Families of sick people arrive at hospitals and expect to find them in a bed, but they are still outside in an ambulance.”

In fact, a tragedy has already taken place. Last year, an ambulance crew brought a patient to the hospital, but he was not officially handed over to A and E staff. Before he could be seen by a nurse or doctor, he went into a fatal cardiac arrest. The patient, who has not been identified, died at James Cook university hospital, having waited for emergency treatment for more than two hours.

The delays are obviously stretching resources all over the place; for example, ambulances from as far away as Lancashire are being brought in to cover other emergencies. I fear that, with changes in NHS provision elsewhere in the north-east and north Yorkshire, James Cook hospital’s resources might become even more stretched. Surgeries’ general reduction in their late opening times for out-of-hours appointments in some areas across the north-east is putting further pressure on regional A and Es. For example, in County Durham, 69 GP surgeries offered late opening appointments in 2011, but in 2012 that was down to 61 surgeries, which is a 7.6% drop. In Newcastle, 33 GP surgeries offered late appointments in 2011, which dropped to 24 surgeries in 2012. In Hartlepool, 15 GP surgeries offered late appointment times in 2011, but that dropped to 10 in 2012, which is a 31.3% decrease. As the Minister will admit, triage is essential, and that is enormously helped by walk-in centres in my constituency, across Middlesbrough and in Redcar, especially as regards less affluent transient populations who are often not on GP registers.

As the Minister knows following the meeting he kindly agreed to have with me and a representative of the trust, urgent care provision in east Cleveland is facing particular problems. The trust claims to be taking steps to resolve the problems, but if the issues are not resolved, I fear that in the interim—and possibly in the longer term—a reduction in urgent care provision in east Cleveland might further increase the demand faced by James Cook hospital’s accident and emergency department, as patients search for alternative treatment. To an extent, we have already seen that with the draw-down in services at Guisborough general hospital’s minor injury unit.

I congratulate the hon. Gentleman on securing what is an important debate for many of our constituents. Many of my constituents use James Cook hospital—some by choice, because it is such a good hospital. The hon. Gentleman is talking about the reorganisation of services across the north-east and its impact. We have seen A and Es closing, or being focused in smaller areas to provide specialist care. How would a new hospital at Wynyard impact on future service provision for our constituents?

I thank the hon. Gentleman for his input. A hospital at Wynyard would be an excellent provision for the region. It was planned by the previous Labour Government. That was as part of a different financial package and under a different scheme, but it was always in the Labour Government’s plans. It is good that the present Government also want that to happen. However, we are discussing current services, and the impact of the reduction in moneys on James Cook hospital and services in east Cleveland and north Yorkshire, which he will no doubt have read about in the local press.

Changes in provision for A and E departments in north Yorkshire might increase the pressures faced by James Cook hospital. In the neighbouring constituency of Scarborough, the trust has given assurances as to the future of overnight A and E services, but local people feel that there are uncertainties over the future of those services. In Northallerton, the Secretary of State for Foreign and Commonwealth Affairs, the right hon. Member for Richmond (Yorks) (Mr Hague), has been campaigning against cuts to services, particularly maternity services, at the Friarage hospital. In Malton, the minor injuries unit has been closed at weekends. I fear that if services at those hospitals are further reduced, additional demand might be placed on James Cook hospital, despite the fact that it already struggles to cope with demand.

When someone is taken to hospital in an ambulance, most reasonable people would expect them to receive care and treatment very quickly. Although I accept that demand is difficult to predict, I certainly do not expect my constituents to have to wait two and a half hours after been taken to hospital by paramedics. I do not hold nurses or doctors responsible for that; after all, more than 5,000 nurses have been cut across the NHS since May 2010. The situation is more likely to have been caused by the budgetary squeeze and the organisational changes that local NHS trusts find themselves dealing with due to the Government’s cuts and unnecessary NHS reorganisation.

I hope that my examples make it clear that there are serious problems on Teesside and across the region, and that they cannot be allowed to continue. I appreciate that the Minister is monitoring the situation with regard to urgent care staff in other hospitals in my constituency. I would be grateful if, alongside that process, he closely monitored A and E performance at James Cook university hospital. There is a very real danger that the situation could deteriorate. At the moment, the capacity for the hospital’s A and E department is 60,000 patients a year; that is what it was designed for. This year, it expects almost double that figure—105,000 patients. That is a time-bomb waiting to go off, which would have repercussions across the region.

It is a pleasure to serve under your chairmanship, Mr Crausby. I congratulate the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) on securing the debate and I thank all hon. Members who have come to advocate their constituents’ needs. The hon. Gentleman and I met earlier this year to talk through some of the problems and challenges in his local area. We discussed some of the individual cases that he has highlighted today, which we all agree to be unacceptable, in particular the case of one of his constituents who experienced a completely unacceptable 11-hour delay as a result of problems with getting the high-quality care they deserved.

There are several interacting issues: the ambulance service, the local A and E response, and the services provided at local A and Es. One key theme, as the hon. Gentleman and I discussed when we met, and as his speech made apparent, is the need to fundamentally change and improve how the NHS looks after older people. That point was brought home vividly last week by the report on the Mid Staffordshire NHS Foundation Trust. In addition, at the end of last year the Dr Foster hospital guide found that 30% of older people in hospital should not be treated there, and that more community-based support was needed. When we met, the hon. Gentleman rightly stressed the important role that local, smaller health care providers, in Guisborough and East Cleveland and elsewhere, can play in providing better community-based care. When people do not need to be in A and E in the first place, it is better for them to be looked after in their homes and communities, and it also brings financial benefits to the NHS. For older people, being admitted to hospital when they do not need to be there is distressing, and their length of stay tends to be much longer.

The hon. Gentleman threw down this challenge: will the changes being made to the health care system nationally put us in a better place to deal with the long-term challenge? The answer to that is yes, and I will briefly deal with that point before I come on to the local challenges that he has outlined.

Why do we need to change what we are doing in the NHS? I have set out clearly that we must do better, by keeping people well in the community. Before I came to the debate, I was talking, over the river at St Thomas’ hospital, about how we must improve children’s health, better look after children with long-term conditions, ensure that children with asthma and diabetes who do not need to be in hospital are not there in the first place, and provide better community-based care. Such improvements are particularly important for the care of the elderly. From April, we will put 80% of the NHS budget into the community, with clinical leadership through doctors and nurses. That is a strong step in the right direction of focusing on community-based and preventive care. I believe that we should all regard that as a good way forward.

My recent experience reflects what the Minister has said. Older people who stay in hospital for long periods of time come out able to do less for themselves because things are done for them in hospital. When my father came out of hospital after five weeks, he was able to do far less. Will the transfer of funding into the community prevent that from happening? Will it allow people like him to be supported at home so that they do not have to spend long periods of time in hospital and come home with less mobility?

The hon. Lady makes a good point. A prolonged period of bed rest can have a huge impact on an older person’s mobility and their ability to look after themselves. The challenge, as she rightly outlines, is to get more support in the community. Putting the budget in the community is a step towards the provision of more preventive care, more community-based care and more care that keeps people, particularly older people, better supported and looked after in their homes.

The other challenge is to achieve a more joined-up approach between secondary care in an acute hospital—such as James Cook hospital—and care in the community. There is sometimes too much silo working, and we need to break that down and develop a more joined-up approach to care. That might be done, for example, through intermediate care teams that operate out of a hospital, who will help through physiotherapy and occupational therapy. When an older person arrives in A and E, we need immediately to gear up the right support in the short and longer term to enable them to go home more quickly. That is an important part of a more integrated and joined-up approach to ensure that an older person can be effectively supported and looked after at home if that is right for them. It is important that we get that more integrated approach across the whole country.

On local issues, the hon. Gentleman highlighted two-hour handover delays, which are clearly completely unacceptable. In my experience, the fault for handover delays might lie in two areas. First, the triaging system in a hospital might need to be reviewed to ensure that ambulance handovers are dealt with more promptly and quickly. Secondly, a delay in ambulance handover results in ambulance crews and ambulances being pinned down in A and E when they need to be back out on the road elsewhere. I know that the hospital will want to look at that closely.

In relation to having more community-based care, sufficient community-based resources must be available to better support people with day-to-day health care needs in the community, so that they are not forced to pitch up at a hospital’s main A and E department. At our meeting, the hon. Gentleman and I discussed the fact that the opening hours of the urgent care centres at Guisborough and East Cleveland hospitals are now 9 am to 5 pm during the week and 8 am to 8 pm at weekends, which has made it difficult for local people to access local health care service and created pressure on A and E departments. Having spoken to the trust, I am pleased to report that job interviews will be held on, I believe, 25 February for specialist nurse and other posts at those hospitals, with a view to extending the opening hours again in the future.

I make a special plea on that issue. Weardale, in my constituency, is in one of the remotest parts of the country, but 5,000 people live there. Their out-of-hours GP service is at Bishop Auckland hospital, which for some of them is 20 miles away across roads that are among the most remote in the country, and particularly difficult to use in winter. Will the Minister look at that?

Absolutely. Sir Bruce Keogh will be conducting a review of emergency and other urgent care services, in which A and E services will not be lumped into one category but will be considered in a more nuanced way, reflecting the fact that rural communities face particular challenges. The review will consider how out-of-hours care, urgent care and emergency care should be delivered in such areas to take into account the rural nature and the distances that people have to travel. In some cities, there is a lot of A and E provision, but in other, more rural parts of the country where people have to travel further that is not the case. I am pleased that Sir Bruce will take that into account in his review.

Will that review also cover services such as ambulance services? There are real concerns in Weardale, where I am involved in a campaign, that lives will be put at risk if ambulance services are not improved.

It is absolutely right to say that any review of A and E provision, and urgent care provision, must take into account travelling distances and transfer times to hospitals and between hospitals. Those issues will be part of the discussion and the review, although they are not the major thrust of what Sir Bruce is doing. However, a number of hon. Members have arranged to meet my ministerial colleague Earl Howe, who is currently examining several issues related to ambulances, and I am sure that he would also be pleased to see the hon. Lady to talk through some of the local issues in more detail.

Increased pressure on hospital services is not necessarily unusual for this time of year, notwithstanding the fact that it is completely unacceptable for there to be long handover delays or for people not to receive prompt and high-quality treatment. There are winter pressures that occur every year, and the Government will always do all we can—the previous Government did what they could as well—to ensure that the NHS is robustly funded and supported to meet such fluctuations in demand.

The Department of Health conducts daily monitoring of the winter pressures for all acute hospital providers. I am aware that South Tees Hospitals NHS Foundation Trust has James Cook University hospital as its main acute site—of course, it is also the local hospital that most of the hon. Gentleman’s constituents will attend—and the trust, like other organisations, has experienced some additional pressures in recent months. However, under the trust’s own internal criteria, the pressures that it experienced during late December and early January were identified as level three on a scale of one to six, which demonstrates that the trust has been busy. It is important to highlight, however, that it has been coping with those additional pressures, notwithstanding the issues raised in the debate, including the need to upscale the community-based response to prevent patients who would be better looked after in the community from being in an acute hospital setting in the first place.

It is also important to say that we expect all NHS commissioners and providers to ensure that appropriate measures are in place to manage any increases in demand, particularly during the winter. The delays in patient care that have been outlined eloquently by hon. Members are simply unacceptable, be they in A and E departments or in ambulance journeys to hospital. Delays are of concern, and the local NHS trusts and their partners must ensure that they step up their local strategies to cope with unexpected increases in demand.

We always needs to be aware of such seasonal variations in the NHS. That is why the Department of Health has given more than £300 million to the NHS specifically to deal with winter pressures. However, it is for local NHS providers to recognise that that extra investment has been made and to co-ordinate their response with the community, particularly through highly skilled community intermediate care teams, which help to get older people back home from hospital as quickly as possible so that they can be better looked after in their own homes.

The other main concern expressed by the hon. Gentleman was about ambulance performance. Delaying ambulances outside A and E departments, as a result of a temporary mismatch between A and E and hospital capacity and the numbers of elective emergency patients arriving, is simply not acceptable. There is a need for the local ambulance trust and the local hospital to work more constructively together, to ensure that such delays do not happen. That might be about having better triage, or the local ambulance trust might need to put more resources into the front line in the local area.

I also take this opportunity to say that the Government have provided £330 million of additional funding specifically to help the NHS cope with the winter pressures this year, so that patients receive the treatment they deserve. I understand that South Tees Hospitals NHS Foundation Trust received more than £1 million from that additional funding, and Middlesbrough primary care trust has received a further £264,000. Investment in social care services will also benefit the broader health system, but that requires the local trust to ensure that it uses the money wisely to address the concerns raised in the debate.

In January, the hon. Gentleman and I had what I thought was a constructive meeting with the trust, and I hope that will be the foundation for him and other local MPs to engage constructively with the trust to encourage a quick solution to the problems that have been outlined. One good thing that came out of the meeting, as the hon. Gentleman already knows, is that there is now an active process going on for the recruitment of specialist nurses to the smaller hospitals—the community hospitals —in the local area. When those nurses are in place, that will be a big step forward; I hope those hospitals will be open for additional hours, which will help to take pressure off acute settings.

In response to growing demand, an overall increase in ambulance activity and longer stays in hospital owing to more complicated medical conditions, I understand that the trust has already taken some specific measures, with £650,000 of investment being put into extra nurses and consultants. To deal with times of acute winter pressure, a bed winter ward will also open. The trust is also now working actively with its partners to redesign patient services, along the lines of the rapid response teams and intermediate care teams that I described earlier, to prevent inappropriate hospital admissions in the first place. In addition, it is exploring the development of a separate paediatric A and E department to create extra space for patients.

I am sure that the hon. Gentleman would have hoped that some of those measures would have been in train earlier, but following our meeting, and after the trust has listened to this debate, I am sure it will be all the more determined to do what it can to put things right in the future. As he knows, through our engagement I am taking an active interest in these issues and I will welcome further discussions if there are more problems in the future, because the delays that have been described today are unacceptable.

The Minister has been very constructive in previous meetings and the response that he has given today has been very constructive as well. On specialist care staff for Guisborough hospital and East Cleveland hospital, he knows from our meeting that the trust has advertised those positions four times already. Would he be willing to meet me again if the fifth attempt also proves unsuccessful?

I have already made the offer, and I do so again now, that I am very happy to meet again. The trust is now taking the issue very seriously and is putting in place robust measures to deal with the concerns raised during this debate and when the hon. Gentleman and I met the trust. I understand that there are 16 applicants for the posts, so a good number of people have applied. I am hopeful that after the interviews on 25 February there will be additional nursing capacity in those local health care settings, to ensure that the scope of the community health care response is improved. Also, I hope that the number of hours that the services are available will be increased, because as the hon. Gentleman knows community health care is about taking pressure off acute A and E services wherever possible, and ensuring that people who can be treated locally are treated locally. That is why those two hospitals—Guisborough hospital and East Cleveland hospital—are such important care settings.

I hope that we are now in a better position, after this debate and through the actions that the trust is already taking—following our meeting earlier in the year—to deal with some of the challenges. I again congratulate the hon. Gentleman on securing the debate, which has been constructive, and I know that he and I will be meeting again if the situation in his area does not improve.

Thank you, Mr Crausby, for chairing the debate.

Sitting suspended.