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Accident and Emergency Departments

Volume 767: debated on Monday 30 November 2015


Asked by

To ask Her Majesty’s Government what steps they plan to take in the light of the investigation by the Royal Society for the Prevention of Accidents and the Royal College of Emergency Medicine into the part that accident prevention could play in relieving pressure on accident and emergency departments.

The Government welcome the investigation’s contribution to informing activity on public health and highlighting the part that accident prevention can play in relieving the pressure on accident and emergency departments. It is for local authorities with their local partners to consider the best actions to take to prevent accidents as part of their responsibilities for improving the health and well-being of their local communities.

I thank the Minister for his reply and declare an interest as vice-president of RoSPA. At a time when A&E departments are facing mounting pressure, the RoSPA and Royal College of Emergency Medicine report shows that accidents to children represent a disproportionate number of the injuries that A&Es treat. It also shows that 72% of injuries to children under five occur at home, and that head injuries are among the most common and most serious. Will the Minister urge the Government to back the report’s analysis and its credible proposal to invest in proven techniques that would help to reduce some of the unacceptable pressure on A&Es and the spiralling costs of the NHS and, most importantly, make a significant contribution to reducing the pain, suffering and deaths caused to children by the failure to address this problem?

My Lords, I thank RoSPA and the Royal College of Emergency Medicine for the important work they have done in producing this report, and the work done by Queen Mary’s College in substantiating it. The Government’s policy is to put the main responsibility for children under the age of five in the hands of local authorities in the belief that they, by knowing the local conditions better than central government, can have a greater impact.

My Lords, given that 15 to 24 year-olds are another of the three most vulnerable groups that are liable to have accidents, will the Government consider looking carefully at the national curriculum and ensure that PSHE, including personal safety and accident prevention, is taught in every single maintained school?

That is an interesting question. However, the report shows clearly that the main problem exists with the under-fives. Of course, there are issues at all ages, including falls and other aspects of accident prevention at the end of life. The interesting work that LifeForce has done in Birmingham shows that, for not very much money, we can have a big impact. Using the health visitors who are now employed by local authorities is a very important way in which we can address this important issue.

My Lords, while I strongly support the referral of accident cases, is the Minister aware of the report in today’s paper which says that all sorts of unnecessary referrals are made in response to telephone calls for advice on what are often simple things, such as the common cold? Does he not think that resolving that would be an alternative way to take some pressure off accident and emergency services?

My noble friend makes a very important point. Many people go to A&E departments who need not go there. The review of Sir Bruce Keogh, the medical director of NHS England, concerning how we structure emergency care in this country will be very important. Clearly, we can make much more of NHS 111.

My Lords, the point that Minister’s noble friend made was that the Government’s decision to phase out NHS Direct, which used qualified nurses, and replace it with call handlers who simply use algorithms on their screens means that those call handlers are risk-averse, which therefore leads to many more people being sent to A&E. Is it not time to get qualified nurses back behind those screens and talking to patients?

The noble Lord makes a good point. If qualified people take the call, the level of risk they are prepared to absorb will be greater, and that applies throughout the whole system.

My Lords, I draw attention to my interest in the register. As we have heard from the Minister, the Government seem to accept the case that accident prevention programmes can have a significant beneficial impact on A&E attendances, but the Minister says that it is all down to local authorities. Given the huge cuts in local authority spending, with more announced just last week, what is the Minister’s assessment of the opportunities of local authorities to gain this benefit?

The report done by Queen Mary’s, which was based in Oxford, indicated that the under-fives attending A&E departments accounted for 7% of all attendances, which gives an idea of the scale of what we might try to achieve. The reduction, in real terms, in local authority spending over the next five years is 3.9% per annum. Our feeling is that local authorities are well equipped to live with that kind of reduction.

How good are A&E departments nationally at collecting information on the nature of the accident, and at root cause analysis to prevent it, and how is this information fed into a national database?

I am afraid that I am not aware of how A&E departments collect and collate this information, but I will write to the noble Lord on that matter.

My Lords, would the Minister care to reflect on the fact that when this Government talk about reducing public expenditure, it is often by putting those with full training, experience and knowledge in charge, because they have won a tender, of a particular answering service, and that the health service is just one example of that? I call to mind other mistakes or misjudgments, such as police officers with skill and experience being replaced by people who just answer the phone. Will he take that issue back to the Government?

The noble Baroness makes an interesting point. In the main, contracts, particularly in the health service, are now based on outcomes: it is outcomes, rather than inputs, that are most important.