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Accident and Emergency Departments

Volume 590: debated on Tuesday 13 January 2015

4. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future. (906956)

13. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future. (906965)

15. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future. (906967)

16. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future. (906968)

A strong NHS needs a strong economy, and because this Government have put Britain back on the road to recovery, we are able to invest an additional £2 billion in the NHS front line next year. This is a down payment on NHS England’s “Five Year Forward View”—the NHS’s own plan to transform care in the community and reduce pressure on hospitals.

Does my right hon. Friend agree that the NHS 111 service has been unfairly criticised by the Opposition, despite their key role in establishing it, and that it has provided impressive support this winter to our A and E departments by suggesting to patients convenient and effective alternatives to the emergency department?

My hon. Friend is absolutely right. Part of the solution to the pressure in A and E is providing good alternatives, and in the last year for which we have figures, the 111 service took 12 million calls, which is three times more than the 4 million calls that NHS Direct took in its last year of operation, and 27% of people said that had they not called 111 they would have gone to A and E. That is a huge success.

The Secretary of State will be aware of the additional pressure on Sherwood Forest hospitals trust as a result of the £40 million a year disastrous private finance initiative deal signed by the last Government. Will he meet me, my hon. Friend the Member for Newark (Robert Jenrick) and representatives from the hospital to discuss how we might move forward and deal with this terrible PFI deal?

I am aware of the problems with that deal, signed back in 2005, which is now consuming 17% of the trust’s income. It would like to spend that income on more doctors and nurses, but it cannot because of the shockingly bad deal signed. I would be happy to meet my hon. Friend to discuss what is possible in the current circumstances.

There are many causes of the pressure on A and E, and in more rural areas direct access to services can be difficult and costly. As such, will the Secretary of State consider investing further money in new technologies that could drive a revolution in health care facilities, and if such opportunities present themselves, may I promote York and north Yorkshire as an ideal testing ground for these technologies, given its ageing population and rurality?

I remember my hon. Friend’s campaigning on superfast broadband in north Yorkshire from my last portfolio. He is absolutely right that technology has a big role to play. That is why a year and a half ago the Prime Minister announced plans to expand weekend and evening GP appointments through the use of technology, which is already helping 5.5 million people and by March will be helping 7.5 million people. We must absolutely consider this as a solution.

In 2005 under the previous Labour Government, Crawley hospital’s A and E department was closed, but I am pleased to say that in recent years health and other emergency services have been returning to the facility. Will my right hon. Friend consider centring more emergency centres in Crawley, as the natural sub-regional population centre?

I congratulate my hon. Friend on his campaigning for Crawley hospital and pay tribute to staff at the hospital, which was rated “good” by the Care Quality Commission last year as part of the new inspection regime. He will welcome the fact that since 2010 the number of doctors at the hospital has increased by 97 and the number of nurses by 107. Of course, we will always consider ways to improve services for his constituents.

22. The Home Secretary talked about the £2 billion he has put aside for the NHS, some £1.5 billion of which is for clinical commissioning groups and specialised commissioning. Why are more than 50 CCGs in the south of England to receive a 3.6% increase in funding to the detriment of the north, where my own CCG is to receive only 0.24%, which is below inflation and a pittance compared with the south? (906974)

These things are decided independently by NHS England, which made the decision on the basis of which CCGs were most off their target allocation and on social deprivation and the number of older people. I remind the hon. Gentleman that there are many older and vulnerable people in the south, too, and they need a fair settlement from the NHS. That is why the decision was made.

The College of Emergency Medicine says that the extra money the Secretary of State has given is not reaching A and E. What steps is he taking to ensure that the money does not stay with the CCGs, but actually goes into A and E?

I have had a number of discussions with the College of Emergency Medicine and what it actually says is that the system is working pretty well—[Interruption.] Well, that is what the College of Emergency Medicine says. The country’s A and E doctors welcome the fact that with the winter pressures money, there are now 800 more doctors and 4,700 more nurses, but we always want to make sure that the money is getting through as quickly as possible, so if the hon. Lady has any particular examples, I would be happy to look into them.

Surely the Secretary of State will accept that quicker appointments with the patient’s local GP will certainly alleviate some of the blockages in A and E.

I agree with that, and I hope that the hon. Gentleman will campaign to make sure that the Northern Ireland Executive put the extra money they have received as part of the Chancellor’s autumn statement into precisely that—good GP services for the people of Northern Ireland.

It is increasingly recognised that the causes of the A and E crisis include the closure of walk-in centres, such as the one in Little Hulton in my constituency and this Government’s savage cuts to council budgets, leading in Salford to 1,000 fewer people getting care packages funded this year. When will the Health Secretary start to take responsibility for his own Government’s policies and do something to ensure investment in social care to ease that pressure on A and E? The better care fund is not the answer.

I am sorry, but this says it all about the Labour party’s campaign. It talks about savage cuts to social care and then the shadow Chancellor says he is not going to do anything to reverse them. It really has to be consistent. On the walk-in centre, Labour Members were saying earlier today that they want GPs present in every A and E department and that is exactly what has happened at Salford Royal. The walk-in centre was closed so that GP services could be moved closer to the A and E at that hospital. Perhaps the hon. Lady should talk to Sir David Dalton, her local chief executive, who will tell her why this is doing a better job for her constituents.

The Secretary of State is absolutely right to highlight the success of the coalition in delivering a better economy, which is allowing us to invest £2 billion from April this year. Will he address the point put to him about the importance of social care, and seriously consider investing some of that £2 billion in social care, not just in our health care system.

May I reassure my right hon. Friend by saying that I agree with him? I want to pay tribute to him for campaigning on this issue for some time, both in office and out of office. The truth is that there is a strong link between what happens in the social care system and what happens in the NHS. This year, we are putting £1.1 billion of support from the NHS into the social care budget. Next year, that increases by another £2 billion. We need to recognise that these two systems need to be brought together as one system—and with the better care fund, that is what is happening.

To attract more senior doctors into emergency medicine—an extraordinarily demanding specialty where doctors work solely for the NHS—should we consider paying them more than they get under the standard consultant pay scale?

I think we need to look at the emergency medicine contracts. One thing said by the College of Emergency Medicine—I have a lot of sympathy with this view—is that emergency doctors want not more money, but the right to the same holidays that other doctors get. It is the time off that is important to them. They have to work 24/7 and they get extremely tired; they want some compensation for that in being able to spend extra time with their families. We are getting more people into emergency medicine, but we should look at anything we can do to make it better.

NHS staff are working extraordinarily hard to deal with not only the extra demands, but the increased complexity of patient cases in all parts of the urgent care system. Will the Secretary of State set out what more can be done to make sure that people access the right part of the system and that all parts of the system work together?

As a former GP, my hon. Friend understands this issue better than most. For me, the single most important thing for patients with the most complex needs, particularly for vulnerable older people, is having a system where the buck stops with a doctor. Someone must be accountable for ensuring that such people get the right care wrapped around them. We have brought back named GPs for all over-75s this year as a first step, but there is much more to do.

The Secretary of State did not answer the question put by my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson). Surely the unprecedented problems we are now seeing in A and E and the wider NHS can be traced back directly to the risks of the huge top-down reorganisation, which were set out for Ministers in November 2010, but ignored. One of the current Ministers and his predecessor said, as reported in the House:

“We have every intention of publishing the risk register in due course, when we think the time is right.”—[Official Report, 10 May 2012; Vol. 545, c. 156.]

Four years on, will the Secretary of State now publish this risk register and let people see for themselves what warnings he was given about current problems and how far he has been hiding the truth on the NHS?

It was published, because it was leaked. The fact is that there is one part of the United Kingdom that carried out those reforms and has the best A and E performance in the country, and another part of the United Kingdom—Wales—that set its face against those reforms and has one of the worst A and E performances in the country.