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House of Commons Hansard
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A and E and Ambulance Services
18 December 2014
Volume 589

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(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the performance of accident and emergency departments and ambulance services, and what plans are in place to help them cope with winter pressures.

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I welcome this opportunity to come to the House and confirm NHS plans to support A and E and ambulance services over the challenging winter period. First, we must recognise the context. The NHS always faces significant pressures during the winter months, and with an ageing population we have 350,000 more over-75s than four years ago. As a result, more people are turning up at our A and Es, with attendances up 5% on last year, and a greater level of sickness among those who turn up has led to an increase in emergency admissions of nearly 6% on last year. That picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland, as well as England, missing key performance standards as a result.

In England, where performance has been relatively better than in other home nations, we have been preparing for this winter for more than nine months—indeed, I chaired my first meeting to discuss the issue on 17 March. On 13 June we gave the NHS an additional £400 million for winter pressures. That was topped up in autumn by £300 million, making a total of £700 million to ensure that local services had the certainty of additional money and time to plan how it should best be used. That funding was provided earlier than ever before in NHS history, and was possible because a strong economy has allowed us to make year-on-year real-term increases in NHS spending. That funding will pay for the equivalent of 1,000 more doctors, 2,000 more nurses, and 2,000 other NHS and care staff, including physiotherapists and social workers. It will fund up to 2,500 additional beds in the acute and community sectors, and provide £50 million to support ambulance services.

We are also progressing with a long-term plan to reduce pressures on A and E. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, and more than 4 million people are already benefiting from that. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. The Five Year Forward View is funded by an additional £2 billion of new money announced in the autumn statement—we have a long-term plan for our NHS, just as we do for the economy.

The winter will be tough, but a number of changes made over the last four years will put us in a much stronger position. Since 2010, the NHS has nearly 1,200 more A and E doctors, including 400 more consultants, almost 600 more registrars, 1,700 more paramedics and 17,200 more clinical staff overall. Our A and E departments are seeing and treating around 2,000 more people within four hours every day, and our ambulances are making nearly 2,000 additional emergency journeys every day. The Care Quality Commission has confirmed that compassionate care in A and Es has improved over the last two years, and according to patients the NHS is getting record scores for the safety of care, and for treating people with dignity and compassion.

I will conclude by thanking hard-working NHS staff across the country for the outstanding care that they continue to deliver under a great deal of operational pressure. On behalf of the whole House I also thank the 70 NHS front-line volunteers who will be making this country safer by spending their Christmas in Sierra Leone on the front line in the fight against Ebola. They are the bravest of the brave and make our entire country proud.

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I thank the Secretary of State for his statement. I of course echo the sentiments he expressed about NHS staff and volunteers fighting Ebola.

I have to say, however, that I heard a good deal of misplaced complacency in what he had to say. Winter has not begun in earnest, but there are already signs of A and Es and ambulance services being stretched to the limit. Last week, a record number of people waited more than four hours in A and E and on trolleys. Ambulance response times are getting worse across England, with some 999 calls taking hours. Overnight, news has emerged of an 82-year-old man who waited more than three hours for an ambulance to arrive at his nursing home. He then waited a further 19 hours on a trolley in a corridor. That is appalling, and there are fears that things will get worse when the House is in recess.

Given that, it should not be for me to drag the Secretary of State here today to explain what he is doing to prevent a full winter crisis in the NHS. The question he did not answer, but must answer today, is this: does he have a winter plan? If he does, will he publish it? People working in the NHS need to know what is in it. [Interruption.] He seems to suggest that he has one, but let me quote Dr Mark Porter, chair of the British Medical Association. He criticises what he calls the

“total failure by government to come up with a meaningful plan”.

The Secretary of State will have to reassure Dr Porter.

The Secretary of State mentions money, but is it not the case that £300 million of it was allocated only in November? Does he really think that that gave the service enough time to plan? Dr Clifford Mann, chair of the College of Emergency Medicine, does not think so. He says:

“Had these funds been used back in summer and early autumn we might have more resilience in the system now.”

Dr Mann also questions where this money has gone, saying “very little” has been seen by front-line A and E staff, and instead

“a lot of it has gone to shoring up balance sheets in acute trusts”.

Is that true? Will the Secretary of State provide of full breakdown of how that money was allocated and has been spent to date? Were any conditions attached? I am sure he will claim the money has been used properly, but, if that is the case, why is the NHS already under so much pressure?

Over the break, hon. Members will want to monitor the situation in their local hospitals very closely. However, we have learnt that from tomorrow the publication of data on A and E will be suspended for three weeks over the crucial Christmas period. That is simply unacceptable. Given that we know the figures are still being collected, there is absolutely no reason why they should not be published. The Secretary of State rightly puts a premium on transparency. Will he today order an end to the news blackout and instruct NHS England to maintain weekly reports?

I have visited a number of acute trusts in recent days and they all say that the pressure on A and E is critically linked to the severe shortage of places in nursing and residential homes and cuts to social care. The sad truth is that today a record number of older people are trapped in hospital. They are well enough to go home, but do not have the support to do so. When are the Government going to wake up to the very real crisis in social care and the fact that it is dragging down the NHS?

Finally, no one can predict what this winter will hold, but the warning signs are there and the NHS needs to plan for all eventualities. What discussions has the Secretary of State held with other Departments, and do the Government have a wider contingency plan for the NHS?

This is a serious situation. If patients and staff are to have confidence, they need better answers than they have had so far. I hope the Secretary of State will start providing them now.

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First, may I thank the shadow Health Secretary for bringing this matter to the attention of the House? As a former Health Secretary, he knows that operational pressures are one of the biggest challenges facing any Health Secretary. Indeed, he had many examples of very, very poor care on his own watch and he is absolutely right to give the House a chance to hear more about our plans for winter.

The shadow Secretary of State asks whether we have a plan. It seems to me that he prepared his comments before he listened to the statement. We have put in more money than ever before. Plans were announced in June. NHS England had a press conference in which it went through the plans relating not just to the £400 million, but the extra £300 million that was agreed in September and allocated through October. That is a record amount. Let us consider what is happening in his own constituency. In Wigan borough, since 2010, because of spending that he opposed, Wrightington, Wigan and Leigh NHS Foundation Trust has taken on 78 more doctors, 149 more nurses and 209 more clinical—[Interruption.] He says, “Does this help?” These are extra doctors and nurses on the front line, helping patients in his own constituency.

The right hon. Gentleman talked about care homes. The £3.3 million going to help his own constituents with winter pressures is to monitor the mental and physical health of patients in care homes and to help reduce the number of emergency admissions. We have a winter plan that is working in his own constituency to help improve the lot of his constituents. He needs to acknowledge that.

The right hon. Gentleman talked about the publication of figures over Christmas. We have never published figures over the Christmas period because it would mean forcing NHS staff to work over Christmas, whereas, where possible, we would like them to be able to go home for Christmas, just like Members of this House. When he was Health Secretary, did he publish performance or weekly A and E figures over Christmas? He did not. He did not publish them at Christmas or Easter; he did not publish any weekly A and E figures at all, so to come to the House and call it a news blackout says to me that he is more interested in political opportunism than in care for patients.

It is disappointing that the right hon. Gentleman did not take this opportunity to disown his own leader’s instructions to weaponise the NHS. The NHS is not, and never should be, a political weapon. This is what third parties say. Dr Mann, president of the College of Emergency Medicine, whom the shadow Secretary of State mentioned, said yesterday that

“the system is under pressure but it’s working pretty well”.

The Foundation Trust Network said:

“NHS providers prepared for this Winter earlier and more fully than ever before”

and that—he should listen to this bit—the

“NHS needs support not criticism”

please. The NHS Confederation said the NHS was pulling out all the stops on urgent care and A and E, and that earlier planning and extra money were helping.

The right hon. Gentleman wants to draw comparisons. Nine out of 10 people are being seen within four hours in this country, which is a higher proportion than in any country anywhere in the world that measures A and E performance—faster than Australia, New Zealand, Canada, Scotland, Northern Ireland and, yes, faster than Labour-run Wales. Eight people out of every 100 wait more than four hours in A and E in England; in Wales, that figure is 15 hours. He should concentrate on saving the NHS in Wales, rather than running it down in England, where it is doing so much better.

Finally, if the right hon. Gentleman is worried about poor care, why is he still saying it was wrong to have a public inquiry into Mid Staffs? This is what Julie Bailey, the Mid Staffs campaigner, said this week about his comments:

“It is very worrying, because if he becomes Health Secretary again at the election it is clear we would go straight back to the old days of covering up.”

The NHS is performing well under great pressure. He should commend the efforts being made by front-line staff, not undermine them by trying to turn the NHS into a political football.

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Will my right hon. Friend join me in congratulating the staff of Broomfield hospital in Chelmsford and the GP surgeries in mid-Essex on the fantastic job they are doing to look after patients in difficult circumstances because of the significant increase in the number of patients needing and accessing care? Furthermore, does he agree that it is rather demoralising for staff and sad that Labour seeks to turn the NHS into a party political football simply—

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Order. The Secretary of State does not need to concern himself with Opposition policy, as I think the right hon. Member for Chelmsford (Mr Burns), on his good days, knows. The Secretary of State should focus on a brief statement of the Government’s policy, for which we will be grateful.

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I can confirm that the Government’s policy is to root out poor care wherever we find it, not to cover it up and conceal it for party political purposes.

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The College of Emergency Medicine gave the Secretary of State a 10-point plan in 2013. Will he say which of those 10 points he has enacted?

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We have enacted, or started to enact, every single one of them. Some of them take a bit longer—the contracts for A and E consultants, for example, which we want to ensure are attractive enough to encourage people to want to become A and E consultants. I am pleased to say that we have made some progress on that and are now getting the recruits coming into A and E that we want to see. Other things are starting to happen this winter—more co-location of GP services at A and E front doors and better discharging procedures from hospitals. We have been working very closely with the College of Emergency Medicine, which has been a great help to us in devising these winter plans.

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Last Friday, my hon. Friends the Members for Portsmouth North (Penny Mordaunt) and for East Hampshire (Damian Hinds) and I met leaders of the health and social care system in south-east Hampshire to discuss how it is dealing with the operational challenges it faces. May I commend to my right hon. Friend the model it is using—of working together to prevent unnecessary admissions, ensuring a safe and speedy assessment of those who turn up at A and E and also issuing a prompt discharge of those who are medically fit to return to their own homes?

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My hon. Friend is absolutely right, and I commend what is happening in his constituency. He will be pleased to know that this is beginning to happen all over the country. The heart of the long-term solution is to have people in the social care system, people in primary care and people in hospitals to see themselves as part of one system, in which people are properly flowing between different parts of the system in the way that is right for them, ignoring organisational or institutional barriers. Where that happens, we are making good progress and we are getting the right performance in A and Es.

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Last week, the chief executive of Imperial College Healthcare NHS Trust told me that it had a ward of patients that it was unable to discharge into the community. This week the Care Quality Commission ranked the A and E unit at St Mary’s as being inadequate owing to a lack of bed capacity and physical capacity in the ward. Yesterday the London ambulance service had to call in emergency help because it is under such pressure. What is the Secretary of State doing to turn around the crisis in central London’s health service? Will he remind us again why it made sense to close two west London A and E units in the middle of an A and E crisis?

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It is funny how the hon. Lady talks about the closing of A and E departments without talking about the opening of A and E departments and the improvement of facilities. The plans for north-west London involve significant improvements, including weekend opening of GP surgeries, which is one of the key things that the shadow Front-Bench team has talked about as something that will help A and E departments. As for what is happening specifically, I was disappointed with the CQC report about the A and E at St Mary’s, but I gently say to her that it was this Government who set up an independent inspection regime with a chief inspector who gives the public information in a way that they did not have before. I think that is the biggest spur to making sure that the right changes are made quickly.

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The general public will not have been impressed with the political posturing from the shadow Secretary of State. Does my right hon. Friend agree that a significant number of people who go to A and E should not be there, and as part of his long-term NHS planning, does he agree that if first aid were taught as part of the national curriculum, fewer people would go to A and E?

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I commend my hon. Friend for championing this cause. He is absolutely right that we need first aid. I think that my hon. Friend the Member for Brigg and Goole (Andrew Percy)—I am not sure he is here—is a first responder, and I want to commend him for the work he does in that respect, because it makes a big difference in emergency situations if we can people to patients more quickly.

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The CQC report into Imperial, to which my hon. Friend the Member for Westminster North (Ms Buck) referred, found poor standards of cleanliness, too few nurses and thousands of patients awaiting surgery. It is the third CQC report in west London in four months, and it has found five major hospitals as requiring improvement and three A and E departments inadequate. The only one that is not inadequate—Charing Cross, which is good—is the one the Secretary of State wants to close. Waiting times are down to some of the worst in the country, yet they used to be among the best. We in west London do not recognise what he is saying. After two years of refusing, will he now meet me and other west London MPs to talk about the crisis in west London health care?

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On the contrary, it is the hon. Gentleman’s constituents who do not recognise what he says or all the scaremongering leaflets about what is happening to NHS services in north-west London. We have plans to open two brand-new hospitals; we have weekend opening of GP surgeries; and we have big improvements happening in A and E departments. Let me gently say to him that, along with his Front-Bench team, he voted not to have a chief inspector of hospitals who could provide independent information about the quality of services. Now that he is quoting that information, I hope he realises that that was a mistake.

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Clinical commissioning groups and hospital trusts throughout the country, including those in Oxfordshire, are working very hard to ensure that they can triage people at the entrance to accident and emergency departments, so that those who need primary care get primary care and those who need A and E services get A and E services. Was the urgent question not simply a new form of political ambulance-chasing?

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What my right hon. Friend has said about what is happening in Oxfordshire is very important. I commend the efforts that are being made there, as well as those that are being made in so many other parts of the country. It is interesting to note that all the questions that are being asked by those on the Government Benches are about the details of how we can help the NHS to get through the winter, while on the Opposition Benches it is all about politics. I think we know which side cares about patients the most.

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There have been serious problems with ambulance response times in Clacton. I recognise that the ambulance trust is addressing some of them, and I recognise that the Secretary of State is taking genuine steps, not least in establishing proper inspection systems, which is fantastic. However, many of the problems have been connected with turnaround times at Colchester hospital’s A and E department. Would it not be helpful if patients could access primary care via GPs in the first place rather than being forced to go to A and E departments? Emergency care would be then accessible in emergencies.

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The long-term solution is to provide more GPs and GP capacity, which is why we plan to train 5,000 more GPs over the course of the next Parliament, but that will take time, so we need to find shorter-term solutions. We are working with the Royal College of General Practitioners to establish what can be done in the short and medium term.

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Does my right hon. Friend agree that hoax calls are one of the causes of the pressures on the ambulance service, and that those responsible should always be prosecuted and dealt with in the most severe manner possible?

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It is totally unacceptable for people to create extra pressure on ambulance services when they should not be doing so. One of the encouraging aspects of the better care programme is the fact that we are starting to analyse the ambulance service, the local NHS and the social care system in order to establish where the highest volumes of ambulance calls are coming from and sort out the problem.

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Two weeks ago, along with other Members of Parliament, I met executives of the Sheffield Teaching Hospitals NHS Foundation Trust, which, as I am sure the Secretary of State agrees, is an outstanding trust that invariably meets its care and financial targets. However, we were told that even that trust was not meeting its A and E targets. Would the Secretary of State care to reflect on the fact that if a trust as good as the Sheffield Teaching Hospitals trust is experiencing those problems now, there is a real prospect of crisis in the NHS this winter?

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I agree that that is an excellent hospital, and I commend the leadership of Sir Andrew Cash, its chief executive. I have been to the hospital myself; it was absolutely spotless, and I was very impressed by what I saw.

The hon. Gentleman is right. What we cannot do, given the pressures faced by the NHS, is start pointing fingers at individual hospitals, because even well-run hospitals are experiencing a high level of pressure. Hospitals tell us that the solution is often not in their own hands. It is a question of the number of people who turn up at the front door and the number of people whom they are able to discharge at the back, and if neither of those problems is sorted out—which will require proper links with the rest of the local NHS—there will be further problems. The system resilience groups that are now working throughout the country are trying to deal with the issue.

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I praise the clinical and other staff at Worthing and Swandean hospitals, and at Rustington’s Zachary Merton hospital. Could hospitals and GPs in each region or locality get together with care homes and nursing homes and establish, with the help of paramedics and members of the ambulance service, which people should be taken to hospital and which people should remain at the nursing or care homes? Too often, people in old age are taken to hospital when that is inappropriate.

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My hon. Friend is absolutely right. I commend the care at Worthing hospital. As he will know, I try to go out on the NHS front line and take part in a shift most weeks, and the very first hospital I went to was Worthing hospital, where I thought the care was excellent. He is right that it is about close working; people in care homes who end up going to A and Es when they could have been better looked after at their care home is probably top of the list of admissions to hospital that we could avoid, because we know the vast majority of those people will end up being admitted to hospital if they arrive at an A and E. That is often not the best thing for people with late-stage dementia, for example, so my hon. Friend is absolutely right and I want to reassure him that that is a big focus of our efforts this winter.

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Mrs J, an elderly constituent of mine, waited two hours following a fall for an ambulance that should have reached her in 30 minutes. The Secretary of State will be aware that there have been similar cases, not least the one described to the Deputy Prime Minister by my hon. Friend the Member for Bolton West (Julie Hilling) at Prime Minister’s questions last week. Two calls were made to the North West ambulance service in respect of Mrs J, and one was received from NWAS one and a half hours after the first report, explaining there would be a delay in getting an ambulance to her because of pressures in the system. While it is welcome that the family and carers were kept informed about what was going on, is it not a symptom of terrible pressures in the system that routine operating procedures now have to include call-backs to explain delays?

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The hon. Lady is right, and there is particular pressure in the ambulance service across the country. We are putting in £50 million of winter-pressures money to help address those issues. Where there are unavoidable delays because of other emergencies at the same time, it is important to get the communication right, and I do not think we do that as well as we should. There are times when we could give more specific information about the likely arrival times of ambulances, according to the algorithms used by 999 and 111 call-handlers. That would keep the public better informed. That is something we are looking at.

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West midlands ambulance paramedics and staff do a brilliant job under great pressure at the moment, but one thing that the head of the ambulance service has mentioned to me is the difficulty in planning ahead to provide more vehicles and staff because some of the funding—not particularly the winter-pressures funding, but funding around Stafford hospital—is on a short-term recurring, rather than a long-term, basis. Might the Secretary of State look into that and see how it could be made long term, so that instead of paying lots of overtime, we could recruit and train more paramedics?

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My hon. Friend is absolutely right to draw attention to that issue. One issue that has been debated often in this House is the money we waste in the NHS on locum staff, who are much more expensive than full-time staff. One of the ways we can deal with that is through something I announced in my response to the extra money in the autumn statement on our long-term plan for the NHS, which is to give multi-year commissioning contracts and multi-year tariffs to trusts, so that they can have a longer-term horizon. Too often the planning horizon is just for the next year. Indeed, I think there is a discussion to be had about whether this winter pressures money we put in every year to help could be better integrated in NHS core budgets, as a way of making sure we get the best use of that money.

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North-East ambulance service is now the eighth out of 10 ambulance services to be moved to operational level 4 as a result of winter pressures—while temperatures are 12° C and above. In my area, the local hospital trust is £91 million in deficit and the Government have gone into a process of closing minor injuries units in Guisborough hospital and Brotton hospital and walk-in centres in Skelton and Park End. Does the Health Secretary believe any of those factors might be adding to winter pressures, or am I just scaremongering and being political?

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If the hon. Gentleman looks at the facts, rather than being political, he will see that in his constituency there are more doctors and nurses and more front-line clinical staff than there were, and he will find that more people are getting operations and more people are being seen at A and E departments than when his party was in power. That is why, I am afraid, it is very political. I notice that on the day when the Labour party is saying that there is a big issue with winter pressures in the NHS, fewer than 10 Labour Back Benchers are present—fewer than 10; that is how seriously Labour is interested in this issue. Is it not really about the politics?

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Having accompanied the London ambulance service on a shift at the Mill Hill depot in my constituency, I have seen the unrealistic demands placed on the ambulance service. Fiona Moore, the medical director of the London ambulance service, has said that more than 6,000 calls were made in the capital over the Christmas period last year in connection with alcohol-related incidents. Does the Secretary of State agree that that is unacceptable and that it places an unfair burden on the service?

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I do. I thank my hon. Friend for going out with his local ambulance service. Indeed, I want to thank the many Members on both sides of the House who go out and see what is happening on the NHS front line. The problem that my hon. Friend raises is exactly the kind of problem we are trying to address. I do not want to pretend that all these problems can be addressed this winter. Part of the issue is that the quickest way to see a doctor is to go to A and E, where the average waiting time to see a doctor is only half an hour across the country. That is the fastest time anywhere in the world. We need to find better out-of-hospital alternatives, and better alternatives to calling an ambulance, if we are to reduce the pressure on the emergency services.

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It was reported recently that Bristol’s Southmead hospital was the third worst performing hospital in the country on emergency targets, with only 84% of cases seen within four hours. NHS England temporarily withheld £1.35 million to cope with extra winter demand while a believable improvement plan was produced. Clearly, 84% is nowhere near acceptable, particularly as we approach winter. What can the Department of Health do to ensure that Southmead hospital improves its performance?

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We are doing a number of things. I have spoken to people in the Bristol area about what we need to do to improve the situation there and I assure the hon. Lady that we are focusing on it. It is partly why we are putting in £700 million this year to help hospitals to cope with those pressures. We have a brand-new hospital in Bristol as well, and it has had some teething problems, but I am confident that the staff there are working incredibly hard to turn the situation around.

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In Dover, we are looking at ways of reducing the pressure on A and E through the Prime Minister’s “8 till 8” challenge fund, and at upgrading the minor injuries unit to create a local emergency centre. Is that not a more fruitful thing to do than simply revelling in the winter problems in the NHS, as the Opposition have been doing?

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My hon. Friend is right. The NHS wants to know that it has a Government who have a long-term plan for the NHS, who are prepared to fund that plan and who have thought about the long-term solutions. Better access to GPs is one of the key things, as is access to a GP who actually knows about the patient and their condition. Sadly, we lost named GPs following the changes to the GP contract in 2004, but I am proud to say that, from next April, we will be bringing them back.

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The Secretary of State has accused Opposition Members of political scaremongering. Perhaps I should refer him to the Public Accounts Committee’s report on out-of-hours services, which showed cost-shunting to the ambulance service by out-of-hours providers, and to our recent hearing on A and E, which revealed an incredible waste of public money and a lack of joined-up thinking. That is not scaremongering; those are facts from the National Audit Office being interpreted by Members from all parties.

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Yes, and those are the facts that we are acting on with our winter plans. We are trying to reduce the amount of money spent on locum staff and to increase flow going into and out of A and E departments. There is a huge amount of practical things that can be done. I have absolutely no problem with dealing with constructive suggestions from both sides of the House on how we can help A and E departments to get through a difficult winter. It is unacceptable, however, constantly to turn this issue into a political football, when everyone knows that the pressures of an ageing population are making life very difficult for NHS staff and that those staff have a Government who are doing everything they can to support them.

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I welcome the extra money for the NHS this winter, but what more can the Secretary of State do to improve awareness of and confidence in the 111 system, in order to stop people going to A and E when they do not really need to do so?

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My hon. Friend asks an important question. The 111 service is one of the elements of the long-term solution that we have not touched on much this morning. There are definitely things that we can do to make the service better. For example, if someone is put through to a GP, that GP could, with the patient’s permission, access their medical records. That would give the GP access to information about the patient’s allergies, their medication history and other key information that would help the GP to give better advice. I am pleased to hear from NHS England that, by the end of this year, a third of 111 centres will be able to access GP records with the patient’s permission.

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Will the Secretary of State join me in praising the Fosse Way first responders and the staff of the East Midlands ambulance service, whom I will be going out with over the Christmas period? The East Midlands ambulance service has its problems, with the last Care Quality Commission report finding it was failing on four of the six major measures, and any support he can give the service will be much appreciated by its new leadership. Does he agree that Nottinghamshire residents will be surprised to hear of the Opposition spokesman’s interest in ambulance services, given that we in Nottinghamshire trace the failings of our service directly back to the last Labour Government’s decision to regionalise the ambulances services, which took an excellent ambulance service down to a failing one within five years?

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Interestingly, the Opposition, who are trying to make so much of this, have actually run out of questions in an urgent question on a matter that they said was very urgent. I commend my hon. Friend’s interest in the east of England and I reassure him that we discuss it most weeks in my Department, because two of my ministerial colleagues are covered by the east of England ambulance service and we are very conscious of the problems there. The situation is getting better but there is a long way to go.

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My right hon. Friend is fully aware, because he attended the Health Committee last week, that accident and emergency services do not operate in isolation. So does he not agree that integrating not only in-hours and out-of-hours GPs, NHS 111, ambulances services and minor injuries units, but social services, mental health services and dental services is essential to ensure that we have fewer avoidable A and E admissions and that we therefore reduce the pressure we are debating today?

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I do agree. The first thing we could do as a step towards that is properly integrate out-of-hours care, linking out-of-hours GP services, A and E departments and 111 departments. Obviously, that needs to be linked into the in-hours GP care that people will give. I wish to commend the efforts being made in Cornwall to improve A and E performance, which has been getting better in recent weeks. We are all very encouraged by that, because there have been a lot of challenges in that area.

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I thank the Secretary of State for the personal support he has given to Medway Maritime hospital, particularly the extra £5.5 million given to the hospital to improve its A and E services. Will he confirm that hospitals in special measures and in challenging circumstances will receive any additional resources they need over the coming winter months?

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We absolutely will make sure that we give Medway what it needs. I wish to thank my hon. Friend for his tireless campaigning to improve the situation, as it is very challenging there at the moment and he has taken a responsible attitude towards it. It is really important to praise the staff at the hospital, who are working very hard, and to reassure his constituents that although there are many improvement to be made, there is a lot of excellent care in that hospital and we all want to get there as quickly as we can.

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When I visited the A and E department of the University Hospitals Coventry and Warwickshire NHS Trust in Coventry, I saw some hard-working, dedicated staff dealing with many patients who had chosen to be there, rather than making an appointment with their GP, because that was easier and more accessible. Does the Secretary of State agree that much of the challenge of getting to see a GP arises from the GP contract negotiated by the previous Government?

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We know that there were some serious problems in that contract. Interestingly, the hon. Member for St Ives (Andrew George) was talking about integrated care, but we used to have named GPs who were responsible for the entirety of someone’s care—the GP’s name was on that person’s medical record. That was abolished in 2004, which was a very big mistake—we absolutely want to put it right.

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When the Opposition use the NHS for political point scoring it can undermine the efforts of staff and cause unnecessary anxiety to constituents. A previous example of that was on 26 November when at Prime Minister’s questions it was suggested that Scunthorpe general hospital was turning away emergency cases, which was not the case. That necessitated the shadow Secretary of State’s office ringing the chief executive to clarify the situation. Will my right hon. Friend take this opportunity to thank the staff at Scunthorpe’s hospital and reassure my constituents that it is open for business?

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I am happy to do that. Staff will have been extremely disappointed at the efforts of the Labour party to try to turn into some sort of political football the services that they offer under a lot of pressure and with much hard work. Members of the public just need to look at the Chamber right now, and they will see which party believes in the NHS and which party does not.

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Tomorrow I will be visiting the Worcestershire Royal hospital, part of the Worcestershire Acute Hospitals Trust, in which there are 144 more nurses, midwives and health visitors as a result of investment by this Government. Hospital staff tell me that winter pressures are added to by the number of long-term dementia patients who are staying on wards. Does my right hon. Friend agree that we need to keep increasing investment in that area to ensure that we get better dementia care?

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My hon. Friend is absolutely right. One of the most heartbreaking things is to see someone with advanced dementia arriving in an A and E department. People do not know anything about their medical history and the best care that they need, and it becomes very difficult for the hospital to discharge them in that situation. Having proper personalised care wrapped around those individuals will normally mean that hospital is not the best place for them to go. Indeed, to echo the comments that have already been made, the key to that is knowing where they would like to die. Very often it is not hospital, so we need to be much better in that regard.

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Will my right hon. Friend examine the discharge situation in Gloucestershire Royal hospital? We had an instance this week of which he may be aware of clinically fit patients not being able to be discharged. We have some excellent community hospitals in Gloucestershire. Will his Department examine that problem to ensure that all branches of the NHS—the acute trust, the care services trust and the commissioning group—work closely together to avoid that problem becoming a real issue in the new year?

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I thank my hon. Friend for championing care for his constituents. Let me reassure him: I had a meeting on that very issue on Monday. It is important that the NHS community care sector plays its role alongside the social care sector in making effective discharge possible.

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I thank the Secretary of State for his kind words about first responders. I will be on duty tonight, as will thousands of first responders in Yorkshire ambulance service, Lincolnshire ambulance service and throughout the country, responding to cardiac arrest, respiratory disease and so on. On the matter of community service, what are the Government doing in the light of the Royal College of Nursing saying to us at a Health Committee a few weeks ago that a failure to invest properly in community services 10 to 15 years ago is having a major impact now on our hospitals?

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My hon. Friend is right about that. Just as this Government have taken a very robust attitude towards poor care in hospitals—we now have 6,000 more nurses on our hospital wards following the Francis report—we need to take an equally robust attitude towards what is provided in people’s homes, to make sure that we have proper care. It is a false economy to cut back on out-of-hospital care to pay for hospital care, as we need both.

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rose

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rose—

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An absolutely delicious intellectual beauty parade. Mr Martin Horwood.

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Mr Speaker, your festive generosity equals only that of Father Christmas.

Gloucestershire hospitals have been under severe pressure in recent days, but is not one complicating factor that, in Gloucestershire and elsewhere, every unplanned GP admission to hospital goes via the emergency department? Although such cases may be relatively urgent, they are not necessarily what most of us would understand as an accident or an emergency.

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The hon. Gentleman is absolutely right to make that point. There has been a lot of support for the NHS today from Liberal Democrats. If they are ever considering which is the best partner to back the NHS at any hypothetical time in the future, they should know that there is only one party that can provide the strong economy to fund a strong NHS.

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My compliments of the season to you, Mr Speaker.

May I draw attention to the fact that people with mental health problems have double the attendance rates in accident and emergency departments compared with the general population? Given that fact, is it not strange that successive Governments have not invested in the evidence? If we invest in liaison psychiatry, we can reduce the numbers needing to go to A and E and give them better results as well. Is it not time that this Government did that and did it even more than they are planning to do?

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Yes, my right hon. Friend is absolutely right. I can reassure him that we are investing more in liaison psychiatry both this year and next year. The Minister of State, my right hon. Friend the Member for North Norfolk (Norman Lamb), has particularly championed that, as it is a very good way in which to reduce pressure on A and E departments.