I want to pick up on a couple of points that were made by the hon. Members for Mitcham and Morden (Siobhain McDonagh) and for Bracknell (Dr Lee) about reconfiguration. The hon. Gentleman said that all too often the experience of hon. Members is that reconfiguration feels as if it is being done on the hoof. I agree with the hon. Lady about the proposed reconfiguration in south-west London and about St Helier hospital. Whether that will ever happen is still up in the air—let us hope that it does not. A leap of faith was demanded of constituents across south-west London, not least because the plans did not contain any measures to improve out-of-hospital care, without which it would not be possible to achieve the changes to emergency services that were being proposed. Those points are part of this debate, which is primarily about whether there is a crisis and, if there is, what the nature and causes of it might be. Although the Labour motion acknowledges that there are many causes of the problem, it has a very simplistic solution.
The evidence shows that there is a mixed picture across the country. That is reflected in the allocation of the first wave of additional funding for the NHS to meet winter pressures. That funding went to the health economies that were the most challenged. Some are coping well with the seasonal change from the higher volume, but less complex A and E attendance pattern of the spring and summer to the winter pattern of fewer, but much more complex cases, which often involves more frail and older people, and leads to more admissions. That pattern is repeated year on year and the demographic changes continue year on year. The pattern is well documented and it is very sensitive to the weather. That is why I welcome the Government’s cold weather plans and their support for local government and other agencies to put in place the extra social support that is necessary to avoid admissions in the first place.
Where there are problems, the causes vary. Some of the pressure stems from changes in behaviour. People now see A and E as the easiest point of entry into the system for any ailment. Often, there is confusion about the access arrangements for out-of-hours care. Those behavioural changes are cumulative. They are a consequence of changes that were made some years ago, not least through the changes to the responsibility for out-of-hours care in the GP contract. The implementation of those changes undoubtedly sowed much of the confusion over how to access emergency care.