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NHS: Emergency Medical Consultants

Volume 706: debated on Tuesday 16 December 2008


Asked By

To ask Her Majesty’s Government how they plan to meet their commitment to expanding the numbers of emergency medical consultants.

My Lords, as the noble Baroness will be aware, it is for local NHS organisations to ensure they provide the emergency care services that their local community requires. Over the past few years, considerable investment has been made in the NHS workforce and A&E services, with very positive results. I am sure that the House will want to know that the plans in place for recruitment and training mean that the number of emergency medical consultants will increase in future years.

My Lords, I thank the Minister for her reply. I hope that she will be working with the College of Emergency Medicine. I must declare that my daughter is a new member of that college. Can the Minister confirm that the new healthcare resource groups, HRG4, will recognise that emergency departments are different from the as yet unproven urgent care centres and that the tariff will allow the expansion of consultant numbers? Does the Department of Health recognise that the quality of care, cost efficacy and clinical outcomes are better when an emergency medicine consultant is directing reception, resuscitation and care, as illustrated by the London bombings?

My Lords, the noble Baroness makes a very good point. As I have said, plans are in place to increase the number of emergency medical consultants in future years. There are 749 emergency medical consultants working in the NHS and acute trusts who provide accident and emergency services. That equates to five consultants per trust—an ample number to provide 24/7 cover for every accident and emergency department.

I will answer the technical question that the noble Baroness asked and trust that she will understand the answer. In 2009-10—and I thank her for giving notice of that particular bit of the question—the national tariff for accident and emergency services will retain the existing tariff, currency and structure, HRG version 3.5, in recognition of issues with the cost data that would underpin HRG4 tariff for this activity. The current national tariff for A&E services recognises the differing resource usage of the high-cost standard of minor injury unit, with a higher tariff paid for the more difficult and complex services.

My Lords, it is interesting to hear that the Government agree with the College of Emergency Medicine that there should be an increase in emergency medicine specialists. It advocates that there should be a minimum of one doctor trained in the speciality of emergency medicine present 24/7 in an emergency department. Will the Minister describe how she is consulting with the college on how that is to be achieved, and, in the mean time, what plans there are to augment the existing service until increased numbers come on stream?

My Lords, the College of Emergency Medicine, as noble Lords will be aware, is very much the new kid on the block, having been founded in the last year. It deserves commendation and recognition for having got off to a really great start. I welcome and enjoyed reading The Way Ahead 2008-2012. Although I do not necessarily agree with all of it, it is an extremely useful document and a very important contribution to policy development nationally and service development locally. I am pleased to announce that we will be writing to the college shortly to invite it to join the newly formed urgent and emergency care board, where it will be able to help shape policy.

My Lords, does the Minister agree that, after major trauma, airway problems have been shown to be associated with much higher mortality rates? Paramedics in the ambulance service have airways skills but are not allowed to intubate patients. What progress is being made to develop the specialist trauma teams in accident and emergency departments to attend the scene of major accidents, with doctors suitably trained to anaesthetise and intubate patients before transfer to hospital?

My Lords, the noble Baroness raises an important point, which was recognised in the recent national confidential inquiry into patient outcomes and death. The department is in the process of recruiting a national clinical director for trauma care precisely to take on board the recommendations of that report, including those for major trauma. Local provision will have to be considered alongside that to ensure that the commission’s recommendations are taken into account and integrated into local emergency care.

My Lords, is the Minister aware that in too many places the four-hour access standard is not being met? Until there are better staffing levels, would it not be more realistic to reduce the demand for access to 95 per cent rather than the proposed 98 per cent, which is unrealistic?

My Lords, we do not intend to reduce those standards because the proposals are clinically led, they should aim to improve quality, we need to set a high target because patients deserve it, and we need to place demands on local healthcare services to work with all stakeholders, clinicians and doctors to focus on meeting those standards and, indeed, meeting the four-hour target.

My Lords, is it not possible to bring in extra senior staff when A&E departments face immense pressure on certain days and at certain times?

My Lords, we discussed this in November. Staff need to know when their pinch points occur locally and to ensure that they have adequate staff to cover them. They will be judged against that target.