Skip to main content

Locums (Accident and Emergency)

Volume 573: debated on Tuesday 14 January 2014

4. How much has been spent on medical locums in accident and emergency departments in each year since 2009-10. (901947)

Staff employment is a matter for NHS trusts and we do not collect that data centrally. We recognise the challenge in recruiting and retaining A and E doctors, who can take up to six years to train. However, growth in the medical work force has kept pace with the increase in attendances since 2010.

I am sure the Minister will agree that it is a grotesque situation where a trainee doctor working as a locum is paid as much as a fully qualified doctor. That is the result of not listening to legitimate concerns during the passage of the Health and Social Care Act 2012, so will the Minister not blame women in the work force or overpaid doctors but do something quickly to stop this drain on public money?

I hope the hon. Lady will be pleased to hear that under the current Government we have reduced locum costs to the NHS by about £400 million. That is, of course, good medical practice: it is good for patients to receive better continuity of care from permanent doctors. In A and E, specifically, we have seen the work force grow by more than 350 since 2010.

Last week, my son had to visit A and E in Brighton and spent the week in hospital. Will the Minister join me in thanking the hard-working doctors and nurses, including locums, in Brighton for their outstanding care and dedication, and for the excellent service they provide?

Yes. My hon. Friend will be aware that I have a particular knowledge of his local trust. I pay tribute to the dedication of the many high-quality front-line staff working there, and to those who put in extra hours to work as locums, usually from within the existing trust work force, who often have to cover maternity leave and other periods of staff sickness.

17. The Minister talks complacently about improvements in A and E consultants, but in Queen’s hospital in Romford only seven of the 19 posts have permanent A and E medical doctors in post. Surely he is fiddling while Rome is burning. People are not getting the service they need, while he is spending a fortune on locums. (901961)

The important point the hon. Lady has to remember is that it takes six years to train an A and E consultant, so it would be much better to put the question about advanced work force planning to the former Secretary of State, the right hon. Member for Leigh (Andy Burnham), rather than to members of this Government. Since we have taken charge of medical education and training, the number of those entering acute common training—those who may go on to become A and E consultants—has increased. We are now seeing a complete fill rate for those entering that training—something that the previous Government were not able to achieve.

How much of this difficulty might be caused by excellent staff working part time in accident and emergency? On a recent visit to the emergency department at York hospital trust, I was struck by the excellent work done by doctors, many of whom, by choice, worked long shifts three days a week. Will my hon. Friend look into this matter?

I will certainly do that and write to my hon. Friend to reassure her, although members of staff who work part time often put tremendous effort into their work, and we often get well rewarded by the broader experience they bring as a result of being part time, so there are benefits to having part-time staff in the NHS.

Figures out today show a staggering 60% rise in spending on locum A and E doctors under this Government—in some trusts, 20 times more—because they cannot recruit staff. It has now come to light that Ministers were warned about this problem three years ago. Dr Clifford Mann, president of the College of Emergency Medicine, said that when he tried to raise this issue, he was left feeling like

“John the Baptist crying in the wilderness”.

Why did Ministers ignore an explicit warning in 2011 from the top A and E doctor in the country?

The first warnings about the challenges facing A and E were put to the previous Government in 2004. The shadow Secretary of State was a Health Minister in 2006 and Secretary of State in 2009-10, but he failed to act adequately to deal with the shortages. It takes six years to train A and E consultants, so it will take six years to deal with the problem. The good news is that under this Government enough doctors are entering acute care common stem training to fill the places available.

Order. I do not wish to be unkind to the hon. Gentleman, but his answers almost invariably suffer from the failing of being far too long. It is nothing to be smug about; he really has to improve.

Mr Speaker, sometimes it takes a long time to rewrite history, which was what the Minister was just doing. The first warnings did not come in 2004. Dr Mann said:

“The first warning signs were three years ago when we failed to recruit 50% of our posts. Those concerns were raised at the time.”

Why does he believe his concerns were ignored? He blames “decision-making paralysis” caused by a top-down reorganisation no one wanted and nobody voted for. Ministers dismantled work force planning structures, making redundant the very people who could have done something to stop the locum bill spiralling out of control. Will he now concede that breaking the coalition agreement promise of no top-down reorganisation has weakened the NHS and made the A and E crisis worse—[Interruption.]

It is the right hon. Gentleman who needs a lesson about not rewriting history. Dr Mann said that this issue had been building for the past decade. When the right hon. Gentleman was Secretary of State and before that a Minister in the Department, he failed to make those long-term work force decisions and also signed up to the European working time directive, which exacerbated the problems on medical rotas. Those were decisions that he made. He created this crisis; we are fixing it and increasing the number of doctors working in A and E.