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Accident and Emergency Health Specialists

Volume 571: debated on Tuesday 26 November 2013

I have asked Health Education England to consider how we can improve the structure and skill mix of the emergency medicine work force to deal with long-standing shortages in staff at both consultant and trainee levels. Along with the Emergency Medicine Taskforce, we are considering a number of options, such as increasing the non-doctor work force and the number of emergency nurse practitioners.

Just what is going on in medical education in this country? We train doctors, but some never work as doctors, and others move abroad. Calderdale and Huddersfield NHS Foundation Trust has advertised and advertised again, but it cannot recruit accident and emergency staff. It certainly cannot recruit any who have been trained in this country, or who have been trained in paediatrics. What is going wrong with medical education here?

The hon. Gentleman has raised some important issues. We do face big challenges. We have increased the number of doctors in the NHS by 6,600 over the last three years, but it is still very difficult to attract as many people as we need to disciplines such as A and E.

I know that Calderdale and Huddersfield NHS Foundation Trust is especially concerned about A and E staffing. I had a very good meeting with representatives of the College of Emergency Medicine last week to discuss A and E consultants’ terms and conditions and, in particular, their antisocial working hours. We are giving the matter close consideration, but I agree with the hon. Gentleman that we need to do better in this regard.

While it is important to recruit and retain more A and E specialists, part of the problem is that a third of the patients who are dealt with in A and E departments could receive better treatment closer to their homes. What can the Secretary of State do to encourage that?

My hon. Friend is absolutely right. One of the biggest mistakes made in health care over the past decade was the introduction of the disastrous changes in the GP contract in 2004, which broke the personal link between GPs and their patients. Hard-pressed A and E departments, including the one at Kettering hospital, say that one of the things that will make the biggest difference to them is the provision of a named GP for the over-75s, so that they know that someone is responsible for those people when they are not in hospital.

Is it not the chaotic and overstretched nature of many A and E departments that makes A and E an unattractive discipline for people to work in? Ever since the closure of the A and E department at Wycombe general hospital in my constituency, Wexham Park hospital has been unable to cope. What will the Secretary of State do about that?

We have gained more than 600 additional A and E doctors over the last three years, so the numbers are rising. However, the best thing that we can do for A and E staff is to give them a sense that we are addressing the long-term challenges that they face. The issues of integration with social care and delayed discharges are being addressed through the health and social care integration transformation fund, but we must also ensure that there are better primary care alternatives. The named GP for the over-75s will make a big difference in that regard.

My local hospital, Russells Hall, is experiencing considerable difficulty in recruiting A and E consultants. Would not a good alternative approach be to train more paramedics to serve on ambulances and provide more effective and robust triage at emergency centres, so that patients can be redirected when necessary?

As ever, my hon. Friend speaks very wisely about this subject. In his review of A and E services, which was published a couple of weeks ago, Professor Keogh said that paramedics could deal with 50% of 999 calls on the spot, without taking people to hospital. I think that there is a big role for ambulance services that are prepared to upskill. It is also important for us to ensure that they have the necessary information. One of the main changes that we intend to make next year will ensure that they have access to the GP records of the people whom they pick up, so that they can give those people the care that they need in their own homes.

The president of the College of Emergency Medicine has said that the Government’s reorganisation has made A and E recruitment worse; the chief executive of the NHS Confederation has said that A and E pressures have been compounded by three years of structural reforms; yesterday, we learnt that the number of nurses choosing to leave their profession had jumped by more than one quarter under this Government; and the Health Secretary himself admits he is worried by the fall in nurse numbers on this Prime Minister’s watch. I hope he listens carefully so that he can answer precisely: will he today give the House a guarantee that every A and E in the country will have enough nurses this winter?

Will the hon. Gentleman think about what he has said? He said he was against a reorganisation that got rid of 8,000 managers and put 6,600 doctors on to the front line. That is why we are doing nearly a million more operations every year and why waiting times for longer waits are shorter than they were under Labour. We are recruiting more doctors because we are putting money into the front line.

It takes seven years to train a doctor, but, for whatever reason, the new GP contract is looking to end seniority pay in six years. Is my right hon. Friend not concerned that that will lead to a mass retirement of doctors at the end of that six-year period in 2020?

We have to make the GP profession attractive to younger GPs as well. The money we save from getting rid of seniority pay will go back into practices, but it should not be given to people just for length of service; it should be related to quality of service too, which will make the GP profession much more attractive.