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A and E Waiting Times

Volume 561: debated on Tuesday 23 April 2013

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

It is a huge privilege to chair the debate. Had I not been in the Chair, I would have asked to speak, because there is an issue with accident and emergency waiting times at Kettering general hospital, but as it is, we go straight to our main speaker, Ann Clwyd.

Thank you, Mr Hollobone. It is a pleasure to be here under your chairmanship. I am sorry that you are unable to be on the Floor making your own points, but I am sure you will find other ways to do so.

I shall start by going through some press headlines from the past few weeks: The Mail on Sunday, “Shock 250% rise in patients waiting more than 4 hours in A and E: Six-month total soars by 146,000”; Mail Online, “Major hospitals have missed A and E targets every week for 6 months”; The Daily Telegraph, “Crisis hospital sets up tent for A and E patients…A hospital set up a makeshift tent to treat casualty patients amid a deepening crisis in emergency services across the country”; The Guardian, “NHS failed to hit A and E target for two months”; Mail Online, “Mother barely conscious with pneumonia was treated in a cupboard because hospital was ‘too full’ to give her a bed”; The Guardian, “The latest casualty of health reform: casualty itself …A and E departments are the pressure valve of the health system, yet the Government is moving rapidly to turn it off”; The Daily Telegraph, “Inquiry into failings in NHS emergency care...MPs are to launch an inquiry into NHS emergency care amid fears that patients are being put at risk by catastrophic failings in the operation of a new 111 helpline”; and Mail Online, “A and E patients ‘still waiting too long’”.

As you know Mr Hollobone, official figures this month show that many A and E departments are failing to meet their target of dealing with 95% of patients within four hours. The NHS in England has missed targets for major A and Es for 29 weeks and missed the target for all A and Es for the past 12 weeks. The failure to meet targets on so-called “trolley waits” happened despite the Government’s reducing the target figure from the previous target of 98%. In the past six months, more than 530,000 patients have waited more than four hours at A and E departments—a rise of almost 30% since last year. England’s A and Es are struggling. One in three patients now waits four hours or more for emergency treatment in the worst affected areas.

About 14 million patients a year are seen in major A and E units. A Department of Health spokesman has said that the NHS is experiencing an extra 1 million patients in A and E compared with two years ago. Research by the King’s Fund shows that A and E attendance was up by 353,457 patients in the first three quarters of 2012-13 compared with the same period in 2009-10. Unfortunately, the Government also propose to close or downgrade 34 more A and E departments across the country in the coming months. Most trusts are reducing the number of beds as part of their quality, innovation, productivity and prevention plans. Pressure on A and E is felt at both ends of the system. A lack of free beds on wards means that staff cannot admit patients and, with A and E full, paramedics cannot hand over patients.

The resulting strain in A and E departments was nowhere more obvious than outside Norfolk and Norwich university hospital. Over the Easter weekend, the east of England ambulance service was forced to erect a major incident tent outside the hospital to treat patients and relieve pressure on the A and E department. Reports say that there were queues of up to 15 ambulances waiting with patients. One patient was made to wait more than five hours under the West Midlands Ambulance Service NHS Trust. Given the pressure they are under, we must all applaud and commend the work of Britain’s ambulance men and women—they are doing an extraordinary job.

Hospitals continue to make severe cuts to front-line staff, with many operating below recommended staffing levels. The Care Quality Commission has warned that one in 10 hospitals is failing to meet the standard on adequate staffing levels. Worryingly, a recent CQC report found that patients report not only longer waiting times, but a reduction in the quality of care in A and E. Thirty-three per cent. of respondents said that they waited more than half an hour before they were first seen by a doctor or nurse—up from 24% in 2004 and 29% in 2008. One in 10 respondents said that they could not attract the attention of staff, nearly a fifth felt that staff were not doing “everything they could” to control their pain, and 59% were not told how long they would have to wait for an examination. Compared with previous years, fewer patients had conversations with staff about their condition and fewer felt appropriately informed. Senior doctors now say that lives are being put at risk, because people are unable to get through to the new 111 number, which replaced NHS Direct. Many argue that it is difficult to access and mistrusted by patients, which has led to an increase in emergency call-outs and trips to A and E. Desperately ill patients are left waiting for hours while ambulances are dispatched to less critical cases.

I have had something like 2,000 e-mails and letters over the past few months since I first raised compassion in nursing, and they are still coming in. They are obviously not all about A and E, but some are. One man told me that he took his wife, who had injured her lower left leg, to A and E at 7.20 pm on a Thursday evening. On arrival at the hospital, he registered at reception at 8.10 pm and about one hour later his wife was seen by a male nurse, who said that the injury needed to be seen by a doctor because the damage was extensive—about 1.5 square inches of skin was only partially attached. The husband sent me a diary of his time in A and E. The male nurse cleaned and dressed the wound and said that it would be less than one hour before the doctor could see her:

“Apparently there had been a longer wait but he assured us that several more doctors were now attending the minor injuries section. With about 6 other patients we were told to wait in an ante room closer to the surgery rooms. At 11.15 pm after we had waited for over 3…hours an announcement over the loudspeaker system said ‘It would be a further 6 hours before a doctor would be available to treat anyone’. This was a general message, and indicated that no one would be seen for 6 hours. The voice then said ‘anyone feeling that they were fit enough to leave without seeing a hospital doctor should visit their own doctor in the morning’. It must be stressed here that these people were previously told by the nurse that they must see a hospital doctor. If the injury was so minor that they could go to see their doctor in the morning then why not tell them then?

One young lady had already spent 6 hours the previous day waiting to see a doctor because she was vomiting blood. She was there again with her friend and had already waited another six hours to be told that she was required to wait another six hours. Intolerable! She should have been admitted straight away the previous day. Another…young man was waiting almost as long as us because he had been in a three car pile up on the M4 and had damaged both knees and his back. He left after the announcement. He could have had internal injuries as well but was untreated.

How could my wife, and most of the people who were instructed to wait for a hospital doctor have the medical knowledge to leave hospital and wait another day? I went to reception to state that my wife needed to take her medication housed at home and could not wait another 6 hours on the off-chance that she may see a doctor. That was greeted by a shrug of the shoulders. I asked if any doctors were at all present and was told that one was on duty. There were 20 to 30 people waiting there at that time and most were casualties.”

On the way home, at about midnight, the man took his wife to a local hospital—no A and E there—to see if she could be treated the following day. His letter continues to tell how the next day he

“took her to this hospital and she was registered and treated within one hour not by a doctor but by a sister and a nurse. The skin flap had shrunk by that time and attempts were made to re-stretch it back over the wound. We were informed by these nurses that injuries such as this must be treated straight away to avoid shrinkage of the skin flap. This was an extremely painful process for my wife, but very necessary. Butterfly stitches were put in place that were intended to pull the skin flap back to its original size and cover the open wound.”

That is just one of many letters I have had. I have the consent of the people concerned to quote from their letters, and I will briefly read from two others. The first says,

“my wife miscarried at 10 weeks and I had to race her down…at 4am. She was left to sit in A&E for ages and I feared she was beginning to go into shock. I was pleading with the people behind the screen to help but kept being told with increasing irritation by them to sit with her and wait. Eventually they found a bed for her but there were no sheets, no drip. I had to cover her with my coat to keep her warm while nursing our sleeping 2-year-old in my arms. It took both of us a long time to get over that. To be honest we have never got over it. The sheer lack of sympathy and comfort, and being made to feel that you were an irritant. I should have made a formal complaint at the time but just didn’t have the energy.”

The second letter is from someone whose elderly mother needed an urgent blood transfusion:

“an ambulance collected mum and myself around 7pm and we arrived shortly after. Mum was placed on a trolley in A and E where we waited and waited. After an hour or so I could tell mum was deteriorating, she was in pain and distressed, I asked for help from various different nurses, I wanted a doctor to look at her. I can’t tell you how upset and frightened I was, I knew something was seriously wrong, I broke down and cried in front of everyone I was so desperate, at this point it was about 2 o’clock in the morning”—

that was after five hours—

“I begged a nurse for some pain relief for her and she gave mum a paracetamol that had zero effect. Mum was transferred to an observation ward at the side of the A and E, she was put in a bed with a tiny blanket over her, I tried to keep her warm and calm myself, no nurse came to see how she was, a lady in another bed was crying that she needed the toilet, I tried to find a nurse with no luck. We waited there until around 6am coping as best we could, it was a nightmare. Finally around 6am a consultant and 2 doctors came, they examined her and she called out in pain, the consultant advised me that mum would be put on a ward and a blood transfusion would be carried out, and she would be returned home later that day.”

The upshot was that the lady died at 11 o’clock that night.

I could go on and on with the letters. They illustrate that behind the stark figures and the problems in A and E, there are many human stories of people in distress, and left in distress, and sometimes the outcome of their very long waits is a tragedy for them and their families. The King’s Fund has recently published a report on the increasing demands on accident and emergency departments. The fund says that there are no easy answers—something we all know.

Few health policy issues have received greater attention than that of how best to meet the demands on A and E departments and manage the associated unscheduled admissions to hospital. I think that hon. Members of all parties know that there is a problem and want it to be resolved. The sooner it is resolved, the fewer the people who will suffer the long anxieties of waiting in A and E and the unfortunate outcomes that there are for too many people.

Order. There is a wealth of talent before me. I shall call Martin Horwood next, and then Kate Green, who sent a particularly nice handwritten letter to the Speaker, then Jim Shannon, Heidi Alexander and Grahame Morris. I propose to call the Front-Bench spokespeople at no later than 10.40 am —earlier if we can. We have about an hour, so everyone should be able to get in.

I pay tribute to the right hon. Member for Cynon Valley (Ann Clwyd) for securing this debate on such a topical matter. I had not intended to speak, but since the opportunity has arisen I would like to make some points, because the matter is very relevant to my constituency.

Cheltenham is in an unusual situation. We have two district general hospitals within eight miles of each other, one in each of the almost twin cities of Gloucester and Cheltenham. Some years ago, the hospitals came under the management of a single NHS foundation trust, and there is an almost inescapable business rationale for the trust management always to try to centralise services in one hospital or the other. Some services, including oncology and cardiology, have been centralised in Cheltenham, but with emergency services there has been a slight drift towards Gloucester, starting with neonatal intensive care and then trauma. That might make business sense to the trust, but it poses a problem because they are services that people clearly want to get to in a hurry. They are a bit like maternity services, in that people value having them within their town and do not want to have to try to find them in a hurry in an unfamiliar setting.

The current situation in Cheltenham reflects exactly the national picture that the right hon. Lady described, and we have heard from the King’s Fund that in the final three months of 2012, 232,000 people nationwide waited more than four hours in A and E, a 38% increase on the previous quarter. Some of that is clearly a seasonal increase, reflecting winter issues, but it has certainly been the case in Gloucestershire, where the situation has been rather unequal, with waiting times significantly and regularly higher in Gloucester than in Cheltenham. People are, therefore, concerned about the further centralisation of services in Gloucester, because they fear that the capacity of the emergency department there to cope with the increase will be even worse.

The situation has been explained in a number of ways. There can be a seasonal explanation—there is always a winter upturn, and we have had a series of bugs and infections, including the winter vomiting virus. Those are known factors, which vary from year to year. There is, however, a new factor in the mix, which is the 111 out-of-hours service. I have anecdotal evidence from local GPs that far more referrals into hospitals and A and E departments are occurring as a result of the introduction of the 111 service. The GPs think that they ran a rather good out-of-hours service before, under a different NHS trust, and the new service is clearly causing problems if their accounts are to be believed.

We must gather reliable data, but the evidence that I have from doctors is that they are getting fewer requests to call patients back, through the 111 service, and that a number of individuals have been referred unnecessarily to A and E, partly because the initial triage is done by people who are not really medically qualified. They have a stock set of questions and the approach is not very sensitive, so it seems that the safest thing for the operators to say is, “The best thing is to go to A and E.” If that is responsible for part of the upsurge in cases, it is adding to our existing problems.

The other problem in Cheltenham and Gloucester is the shortage of, and the difficulty of recruiting, emergency consultants and registrars. The guidelines are that there are supposed to be 10 doctors in each emergency department, which would mean 20 for Cheltenham and Gloucester. Gloucestershire Hospitals NHS Foundation Trust has told me that it has managed to fill only 11 of those posts. That is true: I have had independent corroboration from people working in the human resources department of the hospital, who have occasionally advertised for emergency posts and had no applicants. There is clearly a significant problem that they say is part of the national picture of a shortage of trained emergency doctors available to be recruited to emergency departments, which is adding to management pressures and the difficulty of managing the flow of patients into A and E departments.

That raises some other questions. Gloucestershire Hospitals NHS Foundation Trust is, as the name suggests, a foundation trust. It has the freedom to advertise higher salaries, to apply a “hard to recruit” bonus and to try harder to attract more consultants and registrars to its emergency department. As far as I can see, it does not appear to be doing so at the moment. It may be that that does not make such good sense in business terms. Emergency is a relatively expensive function for a trust compared with others, such as orthopaedics, which appears to generate income for the trust. It would be worrying if such business considerations were interfering with a trust’s ability to take management decisions that might attract more consultants and registrars into an emergency department.

I want the Minister to address, first, the national issue of the shortage of emergency doctors, which is forcing difficult decisions on trust managements and, secondly, what she thinks trust managements’ best response might be. For instance, would it be better for them to wait for the outcome of the Keogh review into emergency services, rather than to take pre-emptive decisions now to take such actions as downgrading emergency services at Cheltenham general hospital?

The suggestion is not that that hospital will be closed outright, but simply that it will be downgraded so that bluelight referrals at night are diverted from Cheltenham to Gloucester. That seems like a small and not drastic change, but there have been a whole series of changes—to trauma, neonatal intensive care, children’s services and maternity—and each small change by the trust seems to justify another change. In itself, that is worrying, because who knows what will follow this decision. Will all bluelight referrals be diverted to Gloucester? In a few years’ time, will Cheltenham end up with simply a minor injuries unit for a town of 120,000 people, given that we instinctively know that had the management arrangements been different and two different hospital trusts were in existence, they would be fighting to keep the services open?

The timing of the consultation is very unfortunate, coming at just the moment of the changes to the NHS organisational structure. Perhaps I am a little cynical, but I cannot help thinking that the trust’s timing may not be entirely accidental. The primary care trust, which fought strongly to keep services at both Cheltenham and Gloucester reasonably level—it tried to serve both populations and keep a degree of equity between them—has been wound up and handed over to a clinical commissioning group that has failed to attract a single doctor from Cheltenham to serve on its board, so that a town of 120,000 people has no local voice on the main commissioning body. At the precise moment that it started—new and relatively experienced compared with the old PCT—the trust has chosen to launch changes to one of the services that is most controversial and most valued by local people, which is a very unfortunate coincidence of timing.

I want us to hear, if we can, the Minister’s real plan for the future of emergency services, and to see whether there is any long-term vision about how local MPs and people can put a case to their trusts for the preservation of local emergency departments wherever possible. We need to deliver care to people as close as possible to their homes, and not drift into a situation of its being more and more centralised in particular locations, which may enable trust managements to have a rational case for attracting more sub-specialisms and doctors to their department, but leave a town the size of Cheltenham, with 120,000 people, with a much worse service.

That is causing great alarm, particularly in the context of the waiting times that we see, even as this debate goes on, right now. In Cheltenham, the wait is 38 minutes, according to the trust’s website. At Gloucester Royal hospital, it is 68 minutes—already more than an hour—at a time when demand should actually be very low. Those emergency departments are struggling to cope, and it seems to me that the waiting times are symptoms of a rather deeper and more difficult problem that we have to tackle.

It is a great pleasure to serve under your chairmanship, Mr Hollobone, on an issue about which I know that you are deeply concerned. I am grateful to my right hon. Friend the Member for Cynon Valley (Ann Clwyd) for calling for this debate now, because it is of incredibly timely importance to my constituents, given what is about to happen at Trafford general hospital.

As I listened to the hon. Member for Cheltenham (Martin Horwood), I was struck by the many parallels between our situation in Trafford and that experienced by other hon. Members in relation to their local hospitals. I strongly endorse his request to the Minister that we should now start to get a clear strategic picture of the Government’s vision for the future of emergency provision. Many of the difficulties in Trafford that I will mention have arisen because of the complete lack of clarity about that vision.

I want to highlight only a few issues, because I know that other hon. Members wish to speak. I apologise, Mr Hollobone, that I will have to duck out for a quarter of an hour to make a phone call, but I will be back to hear the winding-up speeches. I am grateful to you for calling me to speak in this debate.

I want to explain that, as the Minister will know, Trafford general hospital—it has its own accident and emergency department, but since last year has been part of the larger Central Manchester University Hospitals NHS Foundation Trust—is subject to NHS Greater Manchester’s recommendation that the accident and emergency unit should initially be downgraded to an urgent care centre and, in due course, to a minor injuries unit. The Secretary of State requested advice on that and other reconfiguration changes at Trafford from the Independent Reconfiguration Panel, which I know he has received and is now considering. I am grateful that the Minister’s colleague, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), has agreed to meet me and my parliamentary neighbours to discuss that situation which, as I am sure she appreciates, is causing great local concern.

The first issue that I want to highlight is that it is important—certainly for elected Members, but also for the wider public—that there is absolute transparency of data and information about what is going on in our A and Es. A couple of weeks ago I tabled a parliamentary question asking about waiting times at all Greater Manchester accident and emergency units, because constituents have been coming to me with anecdotal evidence of delays and problems, such as those described by my right hon. Friend the Member for Cynon Valley, and I wanted to assess the evidence before taking the matter further. I asked for information at the level of not only the NHS foundation trust, but every individual unit, because I am obviously particularly concerned about my local A and E, which falls within a larger foundation trust.

I was surprised to receive a written answer last Tuesday that told me that the information was not available at individual unit level. Of course, that is nonsense. I contacted Central Manchester University Hospitals NHS Foundation Trust, which said that it could of course give me the information for Trafford, and it duly did. It absolutely does not build confidence in my mind or that of the public if we do not receive clear written answers from Ministers. I was glad that I could raise that issue in health questions last week.

My first question to the Minister is: what can she do to ensure that there is absolute transparency of data available to elected representatives and the public at large about what is going on in our areas? I am sure that she would agree that it is unhelpful for speculation and anecdote to inform what the public think is going on, when data are available and might present a different picture.

The second matter I want to raise is related to waiting times. Obviously, there is a definition around the four-hour waiting time target, but patients’ experience is about not just when they arrive at accident and emergency and when they are passed on to wherever they are going next, but an end-to-end process, which starts from the minute they pick up the phone. They feel that the whole experience can be very protracted. They have to phone, wait for an ambulance or a paramedic to come, potentially wait in the car park to get into the hospital, wait in A and E to be triaged—they are often triaged quite quickly—and then wait around to see more medical experts. Then there is further waiting around before some clinical disposal ultimately results. There is a sense that the totality of the end-to-end process is becoming very protracted, and that is certainly causing public concern. I invite the Minister to comment on the context in which people are waiting and being seen within A and E units and what thoughts the Government have on addressing the end-to-end patient experience, because that is what matters to my constituents.

Thirdly, the changes that are being proposed at Trafford, and at the hospitals in the constituencies of other hon. Members, are part of a much broader range of changes both in Greater Manchester and in the NHS as a whole. In the context of the proposed changes for Trafford, my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) has repeatedly asked what the impact will be on the neighbouring hospital at Wythenshawe, and we are equally concerned about what will be going on at A and E units at Manchester Royal infirmary and Salford Royal. It is clear to us that it is not possible to remove capacity at one unit if there is insufficient capacity at the neighbouring units to mop up the work. My right hon. Friend believes that Wythenshawe is not in a position to take on significant additional numbers of A and E admissions without substantial extra investment. The purpose of my written question to Ministers about NHS trusts around Greater Manchester was to try to get a picture of what is going on across the whole city region. Clearly, capacity on the wider geographic basis is important.

It is equally important that we have provision in the community either to ensure that people can be discharged quickly or to prevent them having to go to A and E in the first place. That is at the heart of the integrated care model to which we are all signed up in Trafford and in which we believe very powerfully. However, the fact of the matter is that services are being taken out before the community provision appears to have been put in, and that cart-before-the-horse approach does nothing to reassure local people.

The hon. Member for Cheltenham mentioned the problems that have arisen following the launch of the 111 number, which had to be withdrawn in Greater Manchester only a few hours after its launch because it simply could not cope. I have no doubt that one consequence of the changes to the out-of-hours service is that more people are likely to go to their A and E. Equally, if that local A and E in due course sees its hours curtailed or is downgraded, there will be a knock-on impact on GPs, because they will have more people presenting at their surgeries with emergency conditions. As things stand, while that might be a good place for people to go in theory, GPs do not have the capacity to see those additional patients. Again, that is a failure of planning about which people are concerned.

We are also worried about the ambulance service in the north-west, which has undergone some significant changes of late. There is also the matter of the interface with mental health. Many people who present at our A and E have both a physical and a mental health problem. It might be that the mental health problem is the underlying issue that is more crucial to resolve because it is probably part of the driver of the physical condition.

There is a great deal of contextual challenge that is contributing to people’s concern about the ability of accident and emergency units, including the one at Trafford, to cope. It is clear to me that without that context being properly resolved and without the guarantees that all that other provision is properly in place, it is simply not possible to start to withdraw services that people rely on because they have nowhere else to go. There are also further broader contextual changes that are causing us concern right now. The hon. Member for Cheltenham mentioned the Keogh review. In Greater Manchester we have the Healthier Together review, which, I am afraid to say, is still opaque both to elected Members and to local people in terms of what it might propose. Undoubtedly, it will have a significant impact on the map of hospital, A and E and wider provision across Greater Manchester. Again, people feel that they are being asked to sign up to a decision about Trafford’s accident and emergency unit without understanding what the context and provision across the whole of Greater Manchester might look like in two or three years’ time.

The public are concerned, sceptical and worried. If Trafford general hospital’s A and E is downgraded, they are unsure where they will go with a particular condition in the future. They do not know whether to travel to Trafford or to go to another location, because Trafford might not be open or capable of dealing with their problem. It is not that people are unwilling to travel to other units when they understand that that is the right unit for them to go to. In Greater Manchester, we have done a good job in persuading people of the importance of going to Salford Royal if they have had a stroke, and of the importance of the major trauma centres around the city, but there needs to be clarity about what is on offer, where it is on offer, when it is on offer and why they can feel confident, if the service is not being provided locally, that that is in their best interests. They feel that a local A and E is important to them. There is a long conversation to be had with the public, which, I venture to suggest to Ministers, nobody has tried to embark on as yet.

The Secretary of State is considering the recommendations in relation to Trafford, and I expect that a decision will be taken shortly. I am grateful to the Minister’s colleague, the Under Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, for agreeing to meet me and my parliamentary neighbours. We are canvassing diary dates as we speak. Will the Minister ask her colleague to read very carefully my remarks from the debate this morning because they are a foretaste of some of the issues that I will raise when we have that meeting? May I also invite her to bring home to both the Under Secretary of State and the Secretary of State that we will be deeply concerned if a decision is taken about Trafford before elected Members have had an opportunity to put their concerns directly to them? We have not yet had that opportunity. It is vital that local people’s voices are heard before decisions are taken about services that are available to them. I hope that the Minister will convey those concerns to her colleagues following this morning’s debate.

I congratulate the right hon. Member for Cynon Valley (Ann Clwyd) on securing this important debate and on giving us all an opportunity to speak on accident and emergency provision. The last time we had such a debate in Westminster Hall, the Minister gave a positive response to our concerns, so we look forward to her doing the same again today.

Health is a devolved matter in Northern Ireland, and the Northern Ireland Assembly has full responsibility for it. None the less, I want to contribute to the debate and outline some of the important issues that we face. I preface my remarks by commending the ambulance staff and the accident and emergency staff on the long, tedious and hard work they do under intense pressure. For many of them, their job is a vocation. That is true of many of the accident and emergency staff in my constituency, especially those in Ulster hospital in Dundonald and in Ards community hospital. They should all be commended on their excellent work and commitment.

Across the UK, waiting times in A and E departments are on the increase, and Northern Ireland is no different. A report in The Daily Telegraph said:

“Data obtained from 60 NHS finance directors as part of the study revealed that 40 per cent of trusts did not meet their productivity targets in 2011-12.”

It went on to say:

“This will be a significant concern as last year was the first in a four-year spending squeeze, during which the NHS needs to find £20 billion in productivity improvements.”

Just four of the finance chiefs questioned said that their organisation was forecasting a deficit this year, backing up national figures that estimate a surplus of £1.5 billion across the NHS. That is worrying, not just for the patients coming in to A and E, but for the doctors and nurses on the front line who are bearing the brunt of the pressure along with the brunt of people’s frustration at being held waiting.

In her speech, the right hon. Member for Cynon Valley gave some examples of where A and E units have found it difficult to respond to people’s needs, and we can all reiterate such examples over and over again. However, an important point is that whenever someone is ill and in need of help, sometimes their frustration spills over towards those people who are trying to help them. We must have a system whereby those who are in need can be helped at the time they are in need.

Due to the cuts in the block grant and the need for massive savings, our Health Minister in Northern Ireland has been forced into making very hard decisions such as closing the A and E unit at Belfast city hospital, which then impacted on my constituency. Yet there was no option, because those were hard decisions that had to be made. We had to take the impact upon the surrounding A and E units into full consideration and the extra staff and resources needed to deal with that. By and large, that consideration seems to have taken place, but I want to give a few examples of issues.

The savings had to be made to meet Government cuts in the block grant. That is the position that many of our trusts are in, and the Government must decide which is more important at this time—achieving productivity targets or achieving their efficiency savings. It is abundantly clear that it is becoming harder and harder to do both, and it is grossly unfair for the trusts to have to balance what cannot be balanced. Our Health Minister in Northern Ireland is doing a good job in difficult circumstances. However, my fear is that more and more will be asked, and that it will be impossible to deliver on those extra demands as time goes on and as the savings required become more and more difficult to achieve.

I have had occasion to visit the A and E unit in my constituency, because of complaints that my constituents have made about an inability to be seen, waiting times, unavailability of staff and the cramped conditions. I have passed on those complaints to the trust and I have met the chief executive, Hugh McCaughey. I have explained to him the complaints that were made, and, in fairness, he and his staff responded by putting in place a number of measures: better allocation of staff when it comes to A and E units; access to services centrally, which is sometimes required rather than people having to go across town to another hospital to get the service they need; and a more accountable and fluent monitoring response at A and E units. The hon. Member for Stretford and Urmston (Kate Green) mentioned triage; it is so important to get that right at A and E units. As I say, those significant changes have been made at the A and E unit at the Ulster hospital in Dundonald, as a result of complaints by my constituents and the meetings that we have had with staff.

Such improvements are good news. However, as the restriction on moneys continues, we have extra pressures on the A and E units, which are now under pressure because of the changes that have taken place. I am particularly concerned about that issue. It is closely monitored in the devolved Northern Ireland Assembly, with the Health Minister receiving monthly reports and the Committee for Health, Social Services and Public Safety receiving quarterly reports. The Minister and I came into political life at the same time. We live in different parts of the country, but we are good friends and we communicate regularly on these issues. However, there is too much pressure on the A and E departments for them to be able to handle their case load, and I know that the Royal College of Nursing, among other professional bodies, has expressed concern that there is not enough cover, but once again this comes back to the age-old issue of money and how the resources can be better spent.

It is my opinion—and I believe that of many people—that the trusts are doing as well as possible, but it is clear that the efficiencies that have been required of them are too much to balance with the targets that have been set, and above all to ensure that patients receive a good standard of care, which is the standard they should expect from one of the best health care systems in the world—indeed, the NHS is the envy of many in the world. Our doctors and nurses do a fine job, indeed a great job. I know that they do the best that they can, and we must assume some responsibility in this place for the care that people receive; that care is down to decisions that are made here. For that reason, I again implore the Government to reconsider the efficiency targets that have been set. Instead, they should allow trusts to have the ability to have a good staff, on duty and on call, to handle what is required and to protect the most important thing that we possess, which is our health.

I apologise in advance, Mr Hollobone, for leaving early because there is a Public Bill Committee that I should attend.

I congratulate my right hon. Friend the Member for Cynon Valley (Ann Clwyd) on securing this debate.

What struck me when listening to the contributions from all parties represented in Westminster Hall this morning is the consensus that exists about the fact that we need to hear from the Government their vision for accident and emergency services. I agree entirely with the comments of the hon. Member for Cheltenham (Martin Horwood) and my hon. Friend the Member for Stretford and Urmston (Kate Green) when they say that we need clarity about how that vision is developing.

There is a fundamental tension between the centralisation of specialisms in accident and emergency services, and the desire of local people to be treated close to home. In London, there are fantastic A and E facilities in some of our central London hospitals, such as Guys and St Thomas’s hospital over the river, and yet—as hon. Members know—we equally find that hospitals in some of the outer parts of London are, frankly, either being sold off or seeing their services hugely downgraded, such as the downgrading that we are experiencing at Lewisham hospital at the moment.

Before I make some specific remarks about the situation in south-east London and some of the things that I have learned and been thinking about since we have been dealing with the issue at Lewisham hospital, I will quickly pick up on one of the other remarks made by my hon. Friend the Member for Stretford and Urmston. She talked about the problems she had experienced in extracting clear and concise information from the Department of Health about waiting times in Manchester hospitals. I, too, have asked several questions recently, not about waiting times but about the provision of health services at hospitals in London. I have simply been told that the Department does not hold that sort of information and it has been recommended that I make freedom of information requests. That is all well and good, but the public want to be reassured that Ministers at the heart of Government understand what is happening in hospitals out there and that they have an appreciation of the wider picture so that they can develop their vision of hospital services, whether they are A and E services or maternity services, but I am not sure that we feel reassured when we get such parliamentary answers that that is the case.

I will make two specific points about Lewisham hospital. Hon. Members will know that, in January, the Secretary of State for Health announced that Lewisham hospital would have a smaller A and E department, and that it would lose its maternity services. That was as a result of the trust special administration process that took place in the South London Healthcare NHS Trust, which was in huge financial difficulties. The hospitals in Woolwich, Bromley and Sidcup had a very significant operating deficit, and as a result of that we were told that the hospital down the road in Lewisham would have its services decimated. The full A and E department at Lewisham hospital will close; all blue-light ambulances will go past Lewisham hospital to other hospitals; all medical emergencies will not be able to be treated at Lewisham hospital; and yet the Secretary of State still calls it a “smaller” A and E department.

We might think that, on the basis of taking capacity out of the system at Lewisham hospital and—I should say—having to invest £37 million in other hospitals to deal with the displacement of people from Lewisham’s A and E department, everything is operating smoothly and well in south-east London. That is not the case. One in 10 people is waiting longer than four hours at hospitals that used to be part of the South London Healthcare NHS Trust, and now in Lewisham, one in 10 people is waiting longer than four hours to be treated. That was not the case in Lewisham a year ago; in March 2012, 97% of people were being treated at Lewisham hospital within four hours. So there is huge pressure upon A and E departments in south-east London.

Yesterday, I asked Lewisham hospital for information about the number of times that ambulances had been diverted to it from other hospitals. Lewisham hospital told me that, since December 2012—in the last four months—there have been 25 separate occasions when ambulances have been diverted to Lewisham. On 10 of those occasions, ambulances were diverted from the Queen Elizabeth hospital in Woolwich, and on 11 other occasions ambulances were diverted from the Princess Royal university hospital in Bromley. Those are the very hospitals that are meant to be picking up the people who will no longer be able to go to Lewisham hospital when our full A and E department goes. I seek a guarantee from the Minister that no changes will be made at Lewisham hospital until these diverts from other hospitals have stopped, and that no changes will be made until we see that, at the other hospitals I have mentioned, they are dealing with patients within a four-hour window.

I should like to make two general points about some issues that have already been touched on. There is a fundamental problem with people’s understanding of where they should go for the best possible treatment. The Government have asked Sir Bruce Keogh to conduct a review of emergency care, which is much needed and timely. I would rather the Government waited for the outcome of that review before they took decisions about hospitals such as Lewisham.

At the moment, when people are ill, they have no idea where they should go. They are faced with a plethora of places. Should they go to their general practitioner, a walk-in centre, a minor injuries unit or an urgent care centre, or A and E? It is confusing for people. If there was better information about where people can get the most appropriate treatment, potentially people who do not need to be in A and E would not go there. I do not criticise people for going to A and E, because they know that they will get treatment there and will be dealt with—hopefully—quickly. We cannot expect them to understand all the intricacies of what is available elsewhere. That fundamental problem needs to be addressed.

The Government are making the situation worse in Lewisham, when they say that Lewisham will retain a smaller A and E. On the day that the Secretary of State made that announcement, I said to myself, “What is a smaller A and E? What will happen there?” I am not the only one who is concerned about this. On 21 February, the president of the College of Emergency Medicine, Mike Clancy, tweeted:

“We have raised questions about the lack of clarity”—

with regard to Lewisham hospital—

“and that what’s proposed doesn’t meet our definition of an”

emergency department. Even the CEM is saying that the Government are making this more confusing for people. The way that the whole process has been dealt with has been quite deceitful and potentially dangerous. Telling people that there is a smaller A and E when it will be nothing more than an urgent care centre has potentially serious implications.

I said that the whole process was deceitful and potentially dangerous. A legal challenge about Lewisham is under way. We have to await the outcome of that to see what the future holds for Lewisham. I stand by my remarks. The process was not really open from the outset.

My final point has already been mentioned. We need to work out exactly how we stop people going into A and E who do not need to be there. Yesterday, I was at my grandmother’s funeral. For a number of years, she had been very poorly and was a frequent attendee at her local hospital. Several times when she turned up there, she did not really need to be there. She was a poorly, lonely old lady. If we are to address the number of people who present at A and E when they do not need to be there, we must find proper ways of caring for people well and with dignity, especially towards the end of their lives, in the community. The problem at the moment is that we are trying to reduce the availability of A and Es in local areas when we do not have alternative care in place to stop people having to rely on A and E as the last resort.

I am grateful for the opportunity to speak in this debate. Again, I congratulate my right hon. Friend the Member for Cynon Valley on securing the debate. The availability of high-quality local health services matters to everyone. It will be interesting to hear what the Minister says about how she is going to address those important issues.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my right hon. Friend the Member for Cynon Valley (Ann Clwyd) on securing this debate and compliment hon. Members who have spoken so far, highlighting concerns about the increase in A and E waiting times that are affecting their constituents.

I shall make specific references to my area and to the increase in A and E waiting times. I shall also spend a few moments reflecting on why we are in this situation and will mention the Health questions debate, during which I was bitterly disappointed by responses from the Health Secretary and Ministers to questions from hon. Members regarding increases in A and E waiting times.

An impartial observer might think the coalition Government had inherited a health service on the brink of collapse. The truth is that the Government inherited an NHS that had been transformed from what the previous Labour Government inherited after 18 years of Conservative Government and under-investment. My area was one of many, perhaps including Kettering, that were beneficiaries of considerable investment. There were 100 new hospitals; actual spend on the NHS increased from £30 billion to more than £100 billion; and much of the aged NHS infrastructure was replaced. My area and many others saw the construction of new walk-in centres, primary care centres and a new generation of modern community hospitals. GP opening hours were also extended. We have had the benefit of more doctors and nurses than ever before. We also had NHS Direct.

My contention is that Labour not only fixed the roof when the sun was shining, but laid the foundations and built the new hospitals, ensuring that patients received faster and better treatment closer to their communities. That was reflected in public satisfaction with the NHS, which went from the lowest ever recorded levels in the 1990s under the previous Conservative Administration, to the highest ever recorded levels by the time Labour left office. However, since the coalition Government took office, we have seen the biggest fall in public satisfaction with the NHS, as spending cuts have started to bite. [Interruption.] The Minister is saying no and shaking her head.

The Government have given back to the Treasury some £3 billion over two years. The Government have expended unnecessarily in excess of £2 billion or £3 billion on a top-down reorganisation. Factor in the £20 billion in cuts or efficiencies—however people choose to describe them—and this is a difficult time for the NHS.

Will the hon. Gentleman not accept that the efficiencies that he speaks about were agreed between the then Opposition and the then Government—his Government—as savings within the NHS of some £20 billion? Does he also accept that his party, in its last manifesto and in comments by Ministers, stated that it would cut the amount of money going into the NHS? That is something this Government have not done.

I think that the Government are cutting the money that is spent on the NHS, not least with the costs of the reorganisation, which I have already mentioned. That money need not have been spent. We are giving back several billion pounds—some £2.5 billion to £3 billion to the Treasury—which could be spent addressing issues such as this. There are a couple of practical points that I want to raise with the Minister later, but I give way to the hon. Member for Cheltenham (Martin Horwood).

I agree with the hon. Gentleman about the reorganisation of the NHS. That time and effort would have been better spent trying to work out how to deliver health care more cost-effectively. But does not he rather undermine his case when pretending that there has been a cut to the NHS budget, when an objective analysis of the actual billions spent on the NHS clearly shows that it has gone up? The difference between a cut and an efficiency saving is that an efficiency saving is returned to the NHS budget.

I did not vote for the NHS reorganisation; I spent 40 sittings in Committee trying to resist what is now the Health and Social Care Act 2012 and the damaging changes it introduces. That includes those that are about to be implemented under section 75, on the introduction of competition, which will fragment the service and add to costs and complexities. I do not, therefore, accept the hon. Gentleman’s criticism, but I will press on because I want shortly to raise a couple of issues specifically about County Durham.

Part of our responsibility is to hold Ministers and, indeed, the Prime Minister to account. On waiting times—this was one of his five guarantees—he said:

“We will not lose control of waiting times—we will ensure they are kept low.”

Other Members have quoted the King’s Fund and patient surveys, and the figures clearly show that 32 foundation trust hospitals, out of 88 acute trusts in England with an A and E unit, missed the target in the last three months of 2012. I am not sure whether Kettering was one of them, but those figures should be cause for concern for everybody, including Ministers and the Prime Minister. That is double the number of trusts that missed the target in the same period last year, and four times the number that missed it in the previous quarter.

It is therefore clear that A and E waiting times are spiralling out of control. There have been various surveys, including one conducted by the Care Quality Commission, which found that one in three people spent more than four hours waiting for treatment. It also noted a large rise in the number of patients waiting for 30 minutes or more before seeing a doctor or a nurse.

In my area, The Northern Echo is campaigning on this issue, highlighting the alarming rise in the number of patients in the north-east waiting more than four hours for treatment. That number has almost trebled in the past 12 months. The paper has disaggregated figures from the Department of Health and found that more than 1,000 patients have waited longer than the target time, including 536 in County Durham and Darlington. Compared with 12 months ago, the number of patients waiting more than four hours has increased by 200% in County Durham and Darlington. South Tees and York have also seen increases in excess of 200%, compared with the previous year. However, at the Newcastle foundation trusts, the percentage increase is a staggering 630%. Alarm bells should be ringing for Ministers, because those figures are quite dreadful.

I was concerned by the Secretary of State’s responses at Question Time. One disturbing characteristic of this Government is that they are not taking responsibility or coming forward with proposals to address these issues. Specifically, in response to a question from my hon. Friend the Member for Manchester Central (Lucy Powell), the Health Secretary said:

“We are looking at the root causes of the fact that admissions to A and E are going up so fast”

—I think he quoted a figure of an additional million. The factors he blamed were that

“there is such poor primary care provision…changes to the GP contract led to a big decline in the availability of out-of-hour services…and…health and social care services are so badly joined up.”

He added:

“That is how we are going to tackle this issue”.—[Official Report, 16 April 2013; Vol. 561, c. 168.]

That really is not good enough. Indeed, Dr Laurence Buckman, who is chair of the British Medical Association’s General Practitioners Committee, has been quite dismissive and scathing about the Health Secretary’s decision to blame the increase in A and E numbers on the changes to GP contracts. He said it was “impressively superficial”—[Interruption.] Well, that is what the man said, Minister. He said that the decision was not based on any evidence. He went on to say:

“Most GPs were not providing personal access out of hours anyway; it was provided through a variety of out-of-hours routes and that has been the case for the past 30 years, so it would be nonsense to suggest that because GPs haven’t been personally responsible since 2004, therefore casualty is full of people. That is just such fatuous nonsense. I question the wisdom of the people briefing the Secretary of State.”

I tend to agree with him.

There is no magic bullet. With a complex organisation such as the NHS, we need a broad-spectrum antibiotic; we need to apply a number of measures. The fragmentation of the service is certainly contributing to the problem. There is also the issue of people not having access to their GP within 48 hours. Like many Members, I have, unfortunately, had experience of close family members and constituents being left with little alternative but to go to A and E, when the GP could have addressed the issue, had they been available in a reasonable period. This issue therefore requires a team effort.

I am also concerned about what the RCN is saying about the reduction in the number of community and district-based nurses, and I hope the Minister will refer to that. Information provided through freedom of information requests shows that the number of nurses in communities who are part of the rapid emergency assessment and co-ordination teams and the rapid response teams that help to keep elderly people, in particular, out of hospital, has been dramatically reduced.

Does my hon. Friend agree not only that there are fewer community nurses, but that those who still remain have much enhanced work loads, which means the time spent with each individual patient is reduced? That, too, causes problems with the quality of care provided in the community.

That is certainly a factor, and I thank my hon. Friend for raising that issue. Part of the solution is a more visionary approach and a care model that integrates NHS services with social care in a seamless service. We need to end the fragmentation and to have full co-operation. We do not want people—particularly elderly patients—to be discharged from hospital, only for their cases not to be followed up by social care or primary health care services. That is a key challenge facing the Government. I will leave it at that.

It is a pleasure to speak under your chairmanship, for what is, I think, the first time, Mr Hollobone. I thank my right hon. Friend the Member for Cynon Valley (Ann Clwyd) for securing the debate. She has an exceptionally powerful voice in these matters, and all of us, on both sides of the House, have a common interest in ensuring it is heard not only today, but throughout this Parliament. I pay tribute to the work she is doing not only in her own right, but in tandem with the Government.

I also pay tribute to the work other Members who have spoken undertake on behalf of their constituents in fighting for A and E services in their constituencies. It would be remiss of me not to thank my local A and E unit at the West Cumberland hospital for saving my life probably twice in the past two years, although I appreciate that that makes me sound careless.

Before I begin, I wonder whether the Minister can answer this fairly simple question. What have Barking, Havering and Redbridge University Hospitals NHS Trust, Burton Hospitals NHS Foundation Trust, Milton Keynes Hospital NHS Foundation Trust, North West London Hospitals NHS Trust, Portsmouth Hospitals NHS Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Shrewsbury and Telford Hospital NHS Trust, University Hospital of South Manchester NHS Foundation Trust, University Hospitals Coventry and Warwickshire NHS Trust, University Hospitals of Leicester NHS Trust and York Teaching Hospital NHS Foundation Trust all got in common? I am more than happy to give way to the Minister if she would like to hazard a guess.

These are serious matters and should be above such cheap party politics. The hon. Gentleman clearly knows the answer to his question, and is asking me to speculate. Given that the debate is about accident and emergency, no doubt the answer is that their waiting times are longer. The Government accept that, and also agree that it is not acceptable; and we are doing something about it. If the hon. Gentleman wants to play party politics, that is against him, not against anything else.

That was a regrettable answer, and did not become the Minister. She clearly does not know the answer. I wonder, as do, I think, many hon. Members, whether the Government know the answer to the question. It is that those trusts have missed the A and E target for major type 1 units—

They have missed it for each of the last 29 weeks. These points are not silly; they are matters of fact.

The point that I am making is that the hon. Gentleman is playing silly games with serious matters. Other right hon. and hon. Members have addressed the issue positively, with compassion, but he is just playing silly party political games.

I do not think it is sexist at all.

Does the Minister know how many times her local trust has missed its A and E target, since the end of September? [Interruption.] I will tell her. Nottingham University Hospitals NHS Trust has missed its target for 17 weeks since September.

Would the hon. Gentleman care to refresh his memory? If we refer to the most recent statistics produced by Nottingham University Hospitals NHS Trust for the A and E department at the Queen’s medical centre, we can compare those for the week commencing 14 April this year with those for the week commencing 15 April last year. Last year 440 patients failed to be treated or seen within the four-hour target, whereas this year the figure had fallen to 259.

I note that the Minister prepared an answer, and I am grateful for that.

Major accident and emergency units—type 1 facilities, nationally—have missed the target for at least the last six months, and all A and E units, including minor incident units, have not hit the target for 12 weeks in a row. If anyone needs help analysing the figures, I would be happy to oblige. They are easy to find and they reveal some interesting points. For example, I wonder whether hon. Members know that only one trust with a major accident and emergency unit in England has hit its target every week since the Secretary of State took his position. That is relegation form, and if this were a football match the cry from the crowd would be “You don’t know what you’re doing.”

Before the Minister attempts yet again to dismiss those statistics, I hope she will take a moment to attend to what has been said by the chief executive of the Royal College of Nursing, by Dr Clifford Mann of the College of Emergency Medicine, and by David Behan of the Care Quality Commission. Earlier this month, Dr Peter Carter, of the Royal College of Nursing said:

“These figures are yet more proof of a system running at capacity, and patients are suffering as a result. Our members are regularly telling us that pressure on the system is rising while staffing levels fall, and as a result any increase in demand results in unacceptable waits for patients who are already going through a difficult time.”

Dr Clifford Mann, of the College of Emergency Medicine said:

“We are seeing...ambulances queuing outside departments, and patients waiting too long on trolleys before they can be admitted to hospital.”

The Care Quality Commission said:

“It is disappointing that people have said they have to wait longer to be treated than four years ago. People should be seen, diagnosed, treated and admitted or discharged as quickly as possible”.

Like me, the Royal College of Nursing, the College of Emergency Medicine and the Care Quality Commission will be appalled that the key performance indicators for the NHS, such as A and E waiting times, are getting steadily worse. In the past six months, 582,811 people waited more than four hours in major A and E units, compared with 420,921 for the same period in the previous year. That is an increase of 161,890 people. That is not silly: it is a question of people’s lives. Those figures relate to people in need who did not get treatment in the time when they needed it. They represent more than 500,000 extra waiting hours in one year. People will find it hard to stomach the fact that there are now about 5,000 fewer nurses than there were in 2010, at a time when, as hon. Members on both sides of the House have mentioned, demand in our A and E units is increasing.

One way to get the figure down—it has been touched on already in the debate—would be to offer services for people with non-emergency ailments, so that they do not feel the need to travel to an A and E department. However, instead of NHS Direct being used as a tool for easing pressure on A and E departments, the roll-out of NHS 111 has turned into a trade marked Government shambles. Patients calling the new 111 service wait hours for advice. One patient waited 11 hours and 29 minutes for a call back. No wonder they feel that they have to go to A and E, when they cannot trust a telephone service with such an inadequate response rate.

Accident and emergency departments are a litmus test, or a barometer, for the performance of the NHS as a whole. If people are waiting in A and E, it means that there are too few beds or too few staff to cope with demand. That is just a fact of health service planning. If there are too few beds, it is because community services are being cut and patients who should be at home are kept in hospital. That reverberates back through the entire system. If patients who could be at home are in hospital, beds are occupied. If beds are occupied, A and E staff cannot admit patients. If A and Es are full, paramedics cannot hand over patients. If patients are queuing in the back of ambulances, those ambulances cannot respond to a potentially serious call-out. One failure leads to another. Each compounds the other. That is what is so serious about the debate. It is not just about the patient sitting in A and E for hours on end; the statistics I have highlighted show much more than that—the experiences of patients throughout the entire system.

In my remarks I suggested another possible factor in the current problems of emergency departments: the difficulty in recruiting emergency doctors. That may have something to do with the attractiveness of emergency medicine as a specialty—the long hours, and so on. However, it also obviously dates back to the training numbers that I am afraid prevailed under the Labour Government. Does the hon. Gentleman accept that there may be some such responsibility, dating back several years, in relation to attracting sufficient numbers into training for emergency medicine?

I expect the Minister to talk about new doctors in the NHS when she replies to the debate; and, of course, we trained those doctors. We commissioned, paid for and put in place the training of those doctors, so I take what the hon. Gentleman says seriously. I also commend him for being the only Member of Parliament from either of the coalition parties to attend the debate to defend the Government’s record.

The statistics highlight more than the simple numbers: they show the experience of patients throughout the system. One person waiting in A and E can reflect one person in a bed on a ward and another waiting at home for an ambulance. I hope the Minister will acknowledge and accept that, and explain what the Government plan to do. It is essential that they explicitly acknowledge the problems faced by accident and emergency in England. Constant denials do them no credit. They must acknowledge the scale of the problem before any solutions can be introduced.

The NHS in England is completely different from the NHS in Wales. I expect the Government will be tempted to compare the two, but I want to address the issue head on. The reality is that Welsh Ministers are dealing with a £2.1 billion real-terms cut to their budgets. Yet, despite that, they have still managed to protect NHS services. There are now more GPs working in Wales than in 2010, and the number of nurses, midwives and health visitors has remained consistent. That is in stark contrast to England, where nurse numbers are falling. I am sure that hon. Members who have heard such tired comparisons over and over would be interested to know that there are differences in the way A and E waiting times are measured in the two countries, and in how frequently performance is measured.

Before any comparison is made—and I hope that none will be—I want to point out that it is misleading to try to make a direct comparison. However, it is fair to say that all parts of the UK are experiencing increased pressures on A and E. The key difference is that in Wales, Labour are doing something about it, whereas in England the coalition is sitting on its hands. In Wales, 270 additional beds were opened this winter to cope with demand, easing pressure throughout the system. The Welsh Government have also agreed an all-Wales action plan for unscheduled care, which means that health boards must ensure that they have sufficient capacity to meet demand.

Will the Minister inform us today what the Government plan to do to help A and E services in England? When and where will they start to provide such help, and how much will it cost?

That aside, will the Minister also answer a few important questions on A and E waiting times? First, will she explain why, when demand is clearly so high and the current services are at breaking point, the Government have handed P45s to almost 5,000 nurses? Will she also explain why the Secretary of State chose a period of intense demand and structural reorganisation to roll out the 111 service when it was clearly not ready to be rolled out?

May I tempt the Minister to speculate on the causes of that rise in A and E waiting times? Does she agree that a combination of inadequate staffing levels, a distracting reorganisation of the NHS and deep cuts to council care budgets is the principal reason for the sharp increase in A and E waiting times? If she does not agree that they are having a major impact on the NHS, can she explain why the Government think that fewer nurses and a distracting reorganisation have improved services?

The problems that others and I have outlined today are well known to many, but they are still sadly neglected by the Government. Despite its imperfections and its many real challenges, the NHS remains one of the best models of national health care in the world. It is filled with dedicated professionals who believe passionately in the aims and values of the service, but it is clear that an expensive, unwanted and unloved reorganisation, combined with Government-induced staff shortages, are causing and have caused deterioration in performance. That is unfair on health care professionals, and, far more importantly, it is unfair on patients. I look forward to the Minister explaining in detail how her Government intend to get a grip and bring all A and E services in England back up to national standards.

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I have just about eight minutes to respond to all the valuable contributions made in this debate. I will not be able to answer all the questions, but I will write to anyone who has asked a question that I cannot answer.

Obviously, I begin by paying tribute to the right hon. Member for Cynon Valley (Ann Clwyd) for securing this debate and for the way she is championing the cause of the patient. She will not hesitate to leave no stone unturned. As many others know, she is doing great work in leading our independent review of NHS complaints. She mentioned just some of the many cases that have come her way. She did not give dates, but I suspect the cases were not all fresh by any means, because, as she, I and many others recognise, this is by no means a new phenomenon; it is a serious problem that requires serious action, which the Government are taking. Would it not be refreshing and brilliant if we could have a debate on a serious issue without falling into the trap of cheap party politics, which, unfortunately, has been a little evident in some, but mercifully not all, the speeches? As the right hon. Lady said in her speech, there are no easy answers.

Some important points have been raised. We know that there is a problem, and we recognise that. It is not uncommon for the four-hour waiting time standards not to be met, especially during the winter period. That happened under the previous Government as well as under this Government. Indeed, in 2008-09 there were 23 weeks in which the waiting time target was breached, and it was breached during a further 14 weeks in 2009-10 up to May 2010. We know that those problems continue. We want to know and understand why, and we want to take quick action.

I have only six minutes to address all the contributions, so the hon. Gentleman had better be quick.

I am grateful to the Minister for giving way. This is a very important point. Does she accept that Labour’s A and E target for hospitals was tougher than the one set by her Government?

No. I am not going to go into all that in the short time that is available to me. We accept that waiting times are a problem—we are not trying to hide from that, and we are up for transparency—and I will address the data in a minute.

The hon. Member for Cheltenham (Martin Horwood) rightly identifies the seasonal nature of waiting times. He speaks with passion about changes in his constituency, and rightly so. It is right and proper that people who have such concerns, as other hon. Members have said, come to this place to champion the cause of the health service within their own communities, especially when it faces reconfiguration. He spoke about 111, which is an important thing to talk about when considering some of the causes that may contribute to the unacceptable failure to hit targets. I know that the data are being monitored on a daily basis by NHS England, and the deputy chief executive of NHS England is meeting twice a week to consider what is happening and to make sure that action is taken to ensure that any problems are addressed.

The hon. Gentleman makes an important point on the difficulty of filling posts, and I will write to him on that because I know it is a problem. I also know that action is being taken by some of the royal colleges, and it is probably best if I give a fuller answer, because he makes a very important point. Of course, I can say that the Keogh review is considering exactly the other problems that he mentioned. As the Secretary of State announced, the Keogh review, which has been alluded to, will report next month. All those matters will be reviewed by Sir Bruce, and it is much to be hoped that some positive forward-thinking will come out of that.

The hon. Member for Stretford and Urmston (Kate Green) raised various issues. I am particularly concerned that she says she is not getting the answers to the questions she has quite properly asked. I think there is sometimes a problem with hon. Members not going in the first instance to the actual hospital, trust or whoever it might be. Her point, and it is a good point well made, is that when she asked my Department, she did not get those figures, and I will make further inquiries.

Only today I saw a question from the hon. Member for Ashfield (Gloria De Piero) asking precisely what the figures are for her hospital in Sherwood and, as it happens, the hospital she and I effectively share, the Queen’s medical centre A and E department. I have given those figures, and I want to set the record straight because, in fact, for the same week last year in Sherwood, 75 people waited more than four hours; this year the figure is 266.

I have two points to make very quickly. First, I asked for data on all Manchester hospitals. I cannot be expected to go to each one, but, obviously, what is going on in every hospital in the city matters because patients will have to move from one to another if capacity is short. Secondly, I specifically asked for data on Trafford general hospital, which falls within the Central Manchester University Hospitals NHS Foundation Trust. The Minister told me in a written answer that data were not available, but when I approached the trust itself, it told me.

I know, and I do not understand why that is. I will absolutely make further inquiries, because it is nonsense that the hon. Lady did not get the data.

I will come on to address the points made by the hon. Member for Lewisham East (Heidi Alexander), but, on the data, it is important that we monitor such things. That is precisely why the Department of Health and Health Ministers are very much alert to what is happening in A and E. We share the concerns of hon. Members, which is why we have the Keogh review, why we are considering how to solve the problem and why we are looking at the underlying causes, which, in the short time available, I hope to address. I will ensure not only that the Ministers to whom the hon. Member for Stretford and Urmston has spoken read Hansard, but that a copy of this debate goes to NHS England, which I know also shares those concerns. NHS England also wants to hear about the experiences of hon. Members, and it is taking action to ensure that we are on top of this and, most importantly, that we do what we should do.

Will the Minister give a commitment today that no changes will be made to Lewisham’s A and E until there are no ambulances being diverted to Lewisham hospital, and waiting time targets are met in the neighbouring hospitals?

I took that intervention in good faith, hoping that I might be able to assist. The hon. Lady is more than experienced and knows that I cannot give her any such assurance. She, too, talked about the provision of data in her speech. All I know is that 75% of the people who would ordinarily have gone to A and E in Lewisham will continue to go there, but she makes important points, all of which will be put in the right place.

I conclude by addressing the cause. Well, we do not know. There are various factors, but, as has been said, there is no easy answer and no silver bullet. We know that a seasonal downturn in performance in not unusual, but the dip in performance this year is deeper and longer than in previous years. One million more people—perhaps this is not understood by some hon. Members—are using A and E departments every year, and it is important that we understand why that is. We know that there are nearly 4 million more A and E attendances compared with 2004, when the previous Government carried out what I and others believe was a disastrous renegotiation of the GP contract, which has had a clear knock-on effect on access to out-of-hours services.