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NHS: Accident and Emergency

Volume 705: debated on Wednesday 5 November 2008

asked Her Majesty’s Government:

What progress they have made in the past year in meeting their target on waiting times at hospital accident and emergency departments; and how many hospitals have not met that target.

My Lords, most patients’ experience of accident and emergency has improved dramatically in recent years. In 2007-08, nationally 97.9 per cent of patients were admitted, transferred or discharged within four hours of their arrival at accident and emergency, against a four-hour standard of 98 per cent. Of the 157 acute trusts that provide accident and emergency services, 45 did not achieve the standard for the whole year, but that is improving this year.

My Lords, I thank the Minister for that reply. Is she aware that on 13 October at 9.15 in the evening I went to St Thomas’ A&E department with cellulitis and that the waiting time was five and a half hours? Is she aware that no one checked the patients, who included two small babies who were breastfeeding, during that time? It was a very uncaring situation. Does she agree that, with drug-resistant TB, this is a very unsatisfactory situation?

My Lords, the accident and emergency department at St Thomas’ is the one most frequented by noble Lords during their working week. I include myself in that, having taken a tumble in the Chamber and sprained my ankle some years ago. The fact is that during 2008-09 98.2 per cent of patients at St Thomas’ were seen, diagnosed and treated within four hours, although that does not mitigate the noble Baroness’s unsatisfactory experience. Nevertheless, the hospital seems to have given her clear information, however unsatisfactory, on which to base her decision and course of action. That would have been based on the particular situation at the time, although I do not know what that was. The aim is for a range of emergency care services to be available. We expect all patients to be seen according to their clinical needs, and they should receive high-quality and timely care.

My Lords, the figures for 1997 were not collated, but in 2003 almost a quarter of patients spent over four hours in accident and emergency departments. Patients have told us over and over again that waiting times are a priority for them. It is worth noting that in the 1990s it was not uncommon for patients to wait on trolleys for up to 12 hours. Today, however, due to the hard work of NHS ambulance drivers, paramedics, nurses, doctors and other staff, and a large investment in services, that occurrence is quite rightly a matter for public comment and action by the trust in question.

My Lords, does the Minister share with me a feeling of enormous admiration, gained through personal experience, for those who work in the emergency departments? They often have to work in extremely unpleasant and dangerous situations, and they do so with terrific grace and efficiency. Perhaps I may also ask whether it is true that one is no longer allowed to send flowers to people in hospital. If she does not have the answer now, perhaps she could write to me.

My Lords, I need to declare an interest: my brother is an ambulance driver. So, I completely concur with the noble Baroness’s comments. I will write to her about sending flowers. I do not think that that is the case. I have just dispatched some to someone in hospital, so I hope that it is not.

My Lords, I share the noble Baroness’s gratitude to all doctors and nurses working in casualty departments. But can the Minister tell us whether there is any evidence that NHS managers are indulging in a little creative reporting, such as discharging casualty patients after four hours and then readmitting them, or counting intermediate, casualty beds, A&E beds and assessment beds as in-patient beds? I should declare an interest. At one time I was a health service manager, but not in A&E.

My Lords, there have certainly been accusations along the lines that the noble Baroness has outlined and we take them extremely seriously indeed. Any substantiated case of misreporting would obviously be considered a very serious issue. All the data received by the Department of Health should have been certified as accurate by the NHS trust and the chief executive. Anyone who thinks that any manipulation has taken place should certainly raise it with their medical director or chief executive.

My Lords, I declare an interest as my daughter is an A&E trainee. Can the Minister tell us what investment is being made in minor injuries units and in units able to cope with patients who present at A&E because they have not, for whatever reason, been able to see their general practitioner? This group inflates numbers and detracts staff from cases involving major trauma and illnesses that may require a lot of time for complex decision-making, with a risk that patients are speeded through under pressure from the clock.

My Lords, the noble Baroness raises a series of very interesting points, as usual. There is no reason why accident and emergency departments and the trusts that run them should not know the demands which will be placed on them from either a transient population or a very young population. They should be prepared to have the resources available. We now have 94 per cent more A&E consultants, 600 per cent more A&E registrars and many, many more nurses. The fact that we have to provide emergency care in a variety of different forms should not mean that any less care is taken.

My Lords, I understand that many incidents in A&E are alcohol-related. Can my noble friend tell the House how closely the part of her department that oversees A&E is working with the part of her department that deals with education about alcohol?

My Lords, my noble friend points out something that is very important and that we are very well aware of. I do not have the details of how they are working together but will write to her about it. I suspect that they are working closely together because the issue has such a major effect on service delivery in A&E departments.