Mr Speaker, I welcome this opportunity to come to the House and make a statement on accident and emergency services.
First, we must recognise the context. The NHS always faces significant pressures during the winter months, but, with an ageing population, we now have 350,000 more over-75s than just four years ago. As a result, we are seeing more people turning up at our A and Es, with 279,000 more attendances in quarter three of this year as compared with last, and a greater level of sickness among those who do arrive, leading to an increase in emergency admissions of nearly 6% on last year. This picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland all missing key performance standards as a result.
A number of hospitals have declared major incidents over the past few days, in what is traditionally a particularly busy time in A and E. A major incident is part of the established escalation process for the NHS, and has been since 2005. This enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.
The decision to declare a major incident is taken locally—there is no national definition—and we must trust the managers and clinicians in our local NHS to make these decisions, and support them in doing so by making sure there is sufficient financial support available to help deal with additional pressures.
I chaired my first meeting to discuss that support on
The NHS started this winter with 1,900 more doctors and 4,800 more hospital nurses than a year ago. This planning and funding has been widely welcomed by experts in the system, including NHS England, NHS Providers, the College of Emergency Medicine and the NHS Confederation. The funding the Government have put in, which is on top of the year-on-year real-terms increases in funding, is made possible by a strong economy, and will pay for the equivalent of 1,000 more doctors, 2,000 more nurses and 2,000 other NHS and care staff including physiotherapists and social workers. It will fund up to 2,500 additional beds, both in the acute and community sectors, and also provide £50 million to support ambulance services.
But the NHS also needs longer-term solutions to these pressures. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, with over 4 million already benefiting. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. And we have funded the NHS’s own plan to deal with these pressures, the five-year forward view, with an additional £1.7 billion for the NHS in 2015-16 and £1 billion of capital over the next four years to improve primary care facilities.
Mr Speaker, let me finish by thanking hard-working NHS staff across the country for the outstanding care they continue to deliver under a great deal of operational pressure.
All over England, the NHS is stretched to the limit—and in places is at breaking point. Staff are working flat-out and we thank each and every one of them for all they are doing, but the situation is now serious and getting worse. Right now, too many vulnerable people are exposed to too much risk, waiting hours for ambulances to arrive, and held in the back of them outside A and E or on trolleys in corridors. This cannot be allowed to carry on. Patients and staff deserve better answers than they have had to date about what is being done to address this issue, and that is why, faced with this complacency, we have again had to force the Secretary of State to come here today.
Fourteen hospitals have declared major incidents. Will the right hon. Gentleman explain clearly what this means for services in those areas? What is the official advice to people living in those areas? Is he providing any central support and advice to those hospitals? If a number of major incidents are declared in the same area at the same time, what contingency plans will be put into place to protect the public? More broadly, what new measures does he have under active consideration to ease pressure at all hospitals?
The Secretary of State mentioned resources. When he allocated additional resources for winter pressure, what assessment was used to determine how much was needed? Clearly, it is not working. Does he now plan to reassess the situation and perhaps allocate more? Ministers keep blaming unprecedented demand, but the question is this: why is there such unprecedented demand? Could it have anything to do with the difficulty in getting a GP appointment, the closure of walk-in centres or the cuts to social care?
Let me turn to ambulance services. There are alarming reports of people waiting hours for ambulances to arrive. This is because ambulances are trapped in queues outside A and E departments. We are hearing that at least one service has implemented a policy of leaving patients at the door of A and E without handing them over to A and E staff. Is the Secretary of State aware of this practice, and is he satisfied that it is not putting patient safety and care at risk?
The last time we had to drag the Secretary of State here, he failed to inform the House that he had approved a proposal to relax 999 response times. So will he today tell the House what the current status of those plans is and whether they are still going ahead this winter? I have real concerns, which I have relayed to ambulance leaders, about making any such change without proper consultation and evidence. There are also reports of police and fire vehicles being used to carry people to A and E. What discussions has he had with police and fire service leaders about this practice? What training or advice have been given to front-line police and fire staff? Is he fully satisfied that patient safety is not being compromised?
Finally, cuts to social care are a root cause of the pressure on hospitals. A record number of elderly people are trapped in hospital beds, and any solution to this crisis must involve councils and a solution for social care. So will the Secretary of State now act on our constructive proposal to hold an urgent summit of all the public services affected—councils, police and fire services—and to develop a co-ordinated plan to ease this crisis? NHS staff deserve it. Safe patient care demands it. When will he deliver it?
First, let me thank the right hon. Gentleman for this opportunity once again to go through the plans that we have in place to support the NHS and to reiterate the gratitude of the whole House to NHS staff for what they are doing under huge pressure at the moment. Let me start by telling him where I agree with him. I agree that what happens in the social care system is closely linked to what happens in the NHS. That is why, from June last year, meetings have been happening in 140 local authority areas between the local NHS and local authorities to work out how best to plan for winter. The result of that planning process, which is funded by £700 million of Government support, is extra doctors, extra nurses, extra beds and new plans in every area. I am absolutely satisfied that that money is making a difference. Every day in our A and E departments, 2,500 more people are being seen within four hours than was the case four years ago when the right hon. Gentleman was Health Secretary. The local structures worked last year, and they are working now. Now is the time to get behind them and to support the local NHS.
In a letter that the right hon. Gentleman wrote to me yesterday, he talked about Government failure. This is not the time to play politics—[Interruption.] Perhaps Opposition Members will listen to this. This is what the head of NHS England, Simon Stevens, a former Labour special adviser, said yesterday:
“the NHS, the Department of Health and local clinicians have done everything that could reasonably be expected” to put in place plans over the last weeks. If the right hon. Gentleman will not listen to that, perhaps he will listen to Rob Webster, who runs the NHS Confederation, a representative body of all NHS organisations. He says that we should be grateful for the huge effort NHS staff have put in over the past few weeks and that it is not the time to play political football.
The right hon. Gentleman talked about ambulances, where we are putting in £50 million of support this winter, and some changes proposed by the Association of Ambulance Chief Executives, which he was informed about three months earlier than they came to public light. This is what the AACE said:
“We have been surprised by some of the reaction today given that over the last three months the principles of what we are proposing…have been shared with Labour…and we have received no negative feedback”.
What did the right hon. Gentleman say? He said it was a panic decision to relax 999 standards. There was no panic, no decision, no relaxation of 999 standards; I did what any Health Secretary should do: I simply asked for clinical advice on what would be best for patients. He chose to frighten the public, to scaremonger for party political purpose. Is it not time the Labour party, for once, thought about the impact on patients of the kind of things it is saying in the press?
The right hon. Gentleman then talked, and the Leader of the Opposition has talked, about the causes of these challenges being the reforms this Government introduced in this Parliament. Let me say to him that the one part of the UK that introduced these reforms, England, happens to have the best A and E performance and the one part of the UK that has most set its face against these forms, Labour-run Wales, has one of the worst performances. If he wants to do something about A and E pressures, instead of trying to make political capital in England, he should be getting Labour to turn things round in the one place it does run the health service—Wales. He should be backing this Government’s support for the NHS in a difficult period that has meant more doctors, more nurses, more people being seen quickly, more operations, long-term support and a plan for our NHS; it should not be politics and scaremongering ahead of an election.
May I join the Secretary of State in warmly thanking NHS staff, who are stepping up to meet the extraordinary increase in demand for their care and expertise? Will he reassure the House that in meeting this extraordinary, complex challenge, they will not be made to chase targets, as we know that that was distorting clinical priorities in Mid Staffs, and that clinical staff should always feel absolutely confident that they have his support to place clinical priorities first and foremost?
My hon. Friend is absolutely right about that, and it is very important. Targets matter, but not targets at any cost. It is worth remembering that, over the four years we were seeing the tragedy unfold in Mid Staffs, it was meeting its A and E target the majority of the time. So it is very important that patient safety is the priority. That is why we have to support NHS trusts when they have major incidents and why we have to make it clear that, although targets matter, trusts need to be sensible and proportionate in their efforts to meet those standards.
It is always important to keep the algorithms used by call handlers—111—under review. I say to the right hon. Gentleman that 111 is part of the way we have been able to relieve pressure on A and E departments. Calls to 111 doubled this Christmas, and 27% of the people who called it said that they had been planning to go to an A and E department but did not do so following the call. That is a very important way of relieving pressure on our A and E departments.
Does the Secretary of State share my recollection that five years ago no political pundit of any kind predicted that the welcome ageing of the population and the ending of the 24 hours a day, seven days a week commitment of general practice would produce the quite extraordinary surge in demand that we now have to cope with? Does he therefore agree that instead of wild criticisms of local crises he needs to persist in the short term by providing resources and improving co-operation between social services and health care, and in the long term by implementing the changes necessary in response to demand, as set out by Simon Stevens in his report, which our reforms have enabled NHS England to produce?
My right hon. and learned Friend speaks with a great deal of wisdom as someone who has occupied this post and he is absolutely right. All Health Secretaries face pressures of the kind we are going through now and face difficult winters. Winter is always a difficult time for the NHS and, as the Prime Minister said, we need a short-term plan to help—that is what our plan of creating about 5,000 extra front-line clinicians this winter alone is doing—but we must also consider the long-term plan. That involves finding a better way of looking after vulnerable older people other than through A and E departments—that means better care in the community, better support from GPs and better community services—and that is exactly what we are doing.
Bolton Royal hospital is one of the hospitals declaring a major incident. The context is as follows. The Little Hulton walk-in centre was closed, when it saw 2,000 patients a month. Salford city council had £100 million cut out of its budget, so 1,000 people this year are losing care packages. I have an elderly constituent who was admitted to Bolton Royal following poor care. It is obvious that those things are causing the problem. When will the Secretary of State take responsibility?
We take responsibility and I take responsibility for everything that happens in the NHS. Let me tell the hon. Lady what we are actually doing, because there have been some serious bed capacity issues in Bolton. Bolton has had £3 million this winter to help deal with those pressures, which has included £340,000 to spend on additional beds in the hospital supporting the A and E department and more than £100,000 to pay for additional staff in A and E. Overall, compared with in 2010, there are 114 extra doctors and 571 extra nurses. She should welcome that, rather than trying to make a political issue of it.
May I remind the House that the private finance initiative, which expanded hospitals to 100 from zero after 1997, created at least £2 billion to £10 billion, and possibly even £20 billion, of additional costs that could now be used? In Hereford, the hospital is too small because of PFI. I have estimated that £30 million could have been spent on the hospital if contracts had been properly implemented in the first place. That is why my hospital, which declared an incident this week, has been struggling and it is quite wrong to suggest otherwise.
My hon. Friend is absolutely right. I congratulate the doctors and nurses who are working very hard in his local hospital and point out that there are a number of historical problems. The £71 billion of PFI debt is one of those and it means that more than £1 billion every year is diverted from the front line. We have done something about the top-heavy management structures and, as a result, across the NHS we have 9,000 more doctors and 3,000 more nurses. It is very important in this debate that we focus not only on short-term pressures but on dealing with the long-term issues in the NHS. That is what we want to do in his area and in every area.
We need to have much better working between the health and social care systems. If the right hon. Gentleman supports that, he should support the better care programme, which from April of this year will see co-operation between the local NHS and local authorities in 150 local authority areas for the first time. Instead, Labour is calling for that plan to be halted.
Will my right hon. Friend thank the staff of the NHS at Harlow Princess Alexandra hospital for their passion and commitment? Although the Government have invested £5 million in our accident and emergency services, issues in nearby hospitals mean that the pressure on our A and E has been immense. Princess Alexandra hospital is one of the busiest by far for attends by bed and with one in five ambulances arriving from out of the area. The PAH is now admitting four more patients a day that it was this time last year. Will my right hon. Friend meet me and the chief executive of the Princess Alexandra hospital, and will either he or the Minister responsible for hospitals visit the hospital to see what can be done to help the situation?
I am very happy to do that and I am aware of the significant pressures at the Princess Alexandra. I thank my hon. Friend for the way in which he is supporting staff in his local hospital, getting behind local plans. It is a mistake to say that there is always a new national initiative. Lots of people in the NHS have been saying over the past few days that they do not want new national initiatives. They want exactly what my hon. Friend is doing; they want people to support their local NHS and not to turn it into a political football.
On Monday evening, the trust of Salford Royal hospital, which, as the Secretary of State knows, is an excellent hospital, declared a major incident. I am pleased to say that the pressure has been dealt with and it has now been lifted, but it is clear to me that many of the thousands of elderly and frail people in hospital have dementia, which means that they stay longer and are readmitted more often. I welcome the better care fund, but it will not be enough. There needs to be a whole systems change to prevent people from being admitted in the first place, with better support and more action by GPs. We need to get on with that urgently.
I agree entirely with the right hon. Lady. The better care fund is a first step, but it is only a first step. It is happening from this April, but we have the NHS England five-year forward view, which is the long-term plan to improve community care. I agree that Salford Royal is an excellent hospital. It had £3.5 million to help it deal with winter pressures this year, but it is also a good example of how integrated care between the acute trust and local community services can make a real difference, and it is delivering some of the safest care in the country.
May I pay tribute to the accident and emergency staff at my local hospital, St Helier, whom I met on Monday? One thing they made clear to me is that although there is no single cause of the pressures on A and E at the moment and there is therefore no single solution, they want certainty about the long-term plans for NHS funding. Although the down payment of £2 billion announced in the autumn statement was very welcome, will the Secretary of State say whether the Government or any Government in whom he might participate in the future will deliver the additional £8 billion necessary to secure the closing of the funding gap that Simon Stevens identified?
When we did the autumn statement last year, we asked Simon Stevens and NHS England how much they needed for their plan next year and they told us it was about £2 billion, so we made that commitment. We also said that that was a down payment on delivering the entire plan, not a one-off payment. I agree about the importance of long-term certainty over funding, but the most important thing in that regard is to have a strong economy that can deliver the money that will support our NHS. It is only Government Members who have shown that they are capable of delivering that strong economy rather than the instability that would come from disastrous economic policies.
The Secretary of State and Prime Minister accuse the Labour party of using the NHS as a political football and as a weapon. May I advise the Secretary of State that the NHS is a weapon—a very powerful one—for the treatment of illness and the relief of disease and suffering, and that it is being blunted by this Government and his Department under his stewardship? I met the chief executive of City Hospitals Sunderland NHS Foundation Trust about the NHS crisis and the A and E crisis, and one of the problems he identified was the lack of sufficient staff and the need to recruit locums. What is the Secretary of State doing about recruiting more staff and how many vacancies are being carried?
I agree that we need more staff, but the hon. Gentleman should welcome the fact that under this Government there are 9,000 more doctors and
3,000 more nurses. Such an increase was made possible by a reorganisation that took money away from bureaucracy and management and put it on to the front line. What is wrong is for the Leader of the Opposition to say that he wants to weaponise the NHS—turn it into a political weapon. The NHS is not a political weapon; it is there for patients. Labour should be ashamed of trying to turn it into a political football.
Is my right hon. Friend aware that the declaration of a major incident by Addenbrooke’s hospital has caused concern among my constituents whose non-urgent admissions have had to be postponed? Is he also aware that the hospital is currently looking after more than 300 people aged over 85, which is in itself a remarkable tribute to the NHS? However, such a figure underlines the fact that we have to give more attention to the integration of health and care issues.
I am aware of the problems at Addenbrooke’s. Indeed, the main issue, as my hon. Friend rightly says, is delayed discharges relating to care. The chief executive is running the command and control system and working with the local authority to facilitate the discharges that are necessary and to de-escalate the situation. The hospital has £2.2 million for its winter pressures support and 185 more doctors than four years ago.
The national health service in my constituency is under immense pressure, as are the adult services. It has been known for some months now that the number of acutely ill people coming into hospital has been growing. Has the Secretary of State investigated the reasons for that significant increase, which I am hearing about from the chief executives of the hospitals? If he has, what are those reasons? Is it to do with access to primary care, or problems with adult social services? Will he tell the House now?
We have looked into that matter in huge detail. There are probably three broad factors that are behind the increase in demand. One is the ageing population. There are 350,000 more people over the age of 75 than four years ago. The point is that if someone of that age goes into A and E in the winter, there is an 80% chance they will be admitted to hospital and quite a large chance they will stay in hospital for some time. The second factor is changing consumer expectation among younger people who want faster health care—[Interruption.] That is what Professor Keith Willett, the director of emergency care at NHS England, said, and Opposition Members should listen to what our clinical leaders are saying. The third factor is a refusal by NHS trusts to do what they were pressurised to do in the past, which is to cut corners to hit targets.
My right hon. Friend will be aware that there have been significant changes to hospital services across north-west London. There is considerable concern from some of my constituents that the closure of A and E departments at Central Middlesex and Hammersmith hospitals has led to some of the increasing pressure elsewhere. Will he tell me whether there is any evidence of that?
I am aware that there have been particular pressures at Northwick Park hospital, but I am also aware that a plan is in place in north-west London to have weekend opening of GP surgeries to improve out-of-hospital provision. The pressures that are faced there are like those in the rest of the country—very severe. We are doing everything we can to support the hospitals in that area with our winter pressures plans.
The Secretary of State spoke about the algorithms used by 111 call handlers. Does he appreciate that a frightened mother with a sick child is not really interested in algorithms? What she wants to know is that her child can get the medical help that they need promptly. He has told the House that he has been having meetings on this winter crisis since March. Is he not a little bit embarrassed that we now have people queuing to see their GPs first thing in the morning, ambulances queuing outside hospitals, people being treated in tents outside hospitals, and old people staying in hospital longer than they need to because there is a lack of funding and no proper co-ordination between health and social care?
Of course I regret any individual incidents where people do not get the care they need promptly. The hon. Lady will know that the solutions to such problems are not always things that can be done overnight. If she looks at the record of joined-up care over the past few years, she will see that this is the first Government to encourage 150 local authority areas to sit down with their local NHS and jointly plan care for the most vulnerable people in the social care system. That is a very big step forward. We are also doing nearly 1 million more operations every year across the NHS. In accident and emergency, the number of people being seen within four hours has gone up by nearly three quarters of a million since the start of this Parliament. That is real progress, but of course there are long-term issues, and we will focus on those as well.
I congratulate Goole hospital on hitting its target 99.7% of time, and the trust as a whole on hitting its target 93% of the time. I spent my Christmas volunteering in the NHS at A and E and with the ambulance service. Staff repeatedly told me that as first responders what they see are more old and frail people needing to be admitted to hospital. That situation was not helped by 50,000 hospital beds being cut by the previous Government. One way of dealing with the problems would be to move to a community paramedicine model and to use the skills of our ambulance services more. I encourage the Secretary of State to ensure that NHS England is seriously looking at that option.
May I congratulate my hon. Friend on the shining example he gives to everyone in this House by being a first responder? I do agree that one thing that we could do in the next year is to integrate better what happens in the ambulance services, out-of-hours GP services and 111. Individually, they are all doing a good job, but they could do a much better job if what they did was integrated.
Facts are important in this debate. There is now good evidence to show that overcrowding in emergency departments increases mortality and length of stay. Will the Secretary of State ensure that the figures for hospitals are available in the House of Commons on a monthly basis, so that we can correlate spikes following emergencies with what happens to mortality rates? If mortalities increase, the problem is even more serious than we think it is.
I agree with the hon. Lady. It is critical that we look at the data carefully. I will see whether the data on mortality rates are available on a monthly basis. I will be as interested as she is to see it.
I have just been visiting a much-loved elderly relative in hospital and I have seen what a wonderful job our nurses are doing and the pressure that they are under, but may I tell the Secretary of State that Huddersfield and Calderdale used to have an amazingly good partnership of people in the health service working together. The antagonism now between trusts and commissioning services has destroyed that partnership. All we have now is tension and stress. We no longer have a partnership delivering health care in our country.
I agree with the hon. Gentleman about the hard work of the doctors and nurses at his local trust, but the feedback I get from the front line is of closer partnership working than has ever happened before, with the local authorities and the local NHS sitting down together planning what they will do for the most vulnerable older people through the better care fund. I want to encourage that everywhere I can.
I join the Secretary of State in praising Croydon University hospital staff who have been working their socks off in recent days, but is he aware that CUH has a recently modernised subsidiary in Purley with a minor injuries unit, which is open only in the afternoons, and an under-used X-ray department? Will he explore with Croydon commissioning group whether those facilities can be used full time, because that would take the load off the A and E department at Croydon University hospital?
I am happy to explore that. All these suggestions need to be considered very carefully. That trust has had 40 extra doctors and nearly 300 extra nurses and £4.5 million to help with its winter pressures this year. Perhaps some of that money could be used for that purpose. I am happy to look into it.
As the Minister who introduced the precursor A and E target, may I say that the Secretary of State was right to continue with the target? Making the target work was dependent on NHS Direct, delayed discharges, the integration of social care, and targets in the rest of the hospital, particularly on cancer. He has demolished that whole system. Will he now apologise for the absence of those targets, the problems in delayed discharge and the scrapping of NHS Direct?
I am afraid that what the right hon. Gentleman says is simply not correct. We have continued with key operational targets. A number of them are under pressure, but when we look at each of them we see that the reason is that the NHS is treating more people than ever before but demand is outstripping supply. For example, nearly half a million more people visited A and E in the most recent quarter than in the last quarter of the previous Labour Government, and we have 1,000 more doctors in our A and E departments. That tells us that, along with short-term help with these pressures we need a long-term solution, which is what this Government are committed to.
This is a serious and complex issue, and one of the factors causing it is that many seriously ill patients cannot be admitted to acute hospital wards because there are insufficient beds. In the light of that, I draw the Secretary of State’s attention to an NHS Confederation report from May 2006, “Why we need fewer hospital beds”. I cautioned at the time that it would be unwise to pursue such a policy without first front-loading primary and social care. Will he look at enhancing acute hospital beds until primary and social care have the capacity to help out the acute sector?
The hon. Gentleman makes an important point. In fact, I was talking with someone senior at the Royal Cornwall hospital on Monday about the particular pressures there. Indeed, some of the funding that we allocated to the NHS in the autumn statement for next year is designed to do precisely that; to allow hospitals to maintain bed capacity while we ramp up facilities in community and primary care. It is very important to get the timing absolutely right.
Yesterday the emergency department at Nottingham’s Queen’s Medical Centre faced such intense pressure that the trust was forced to enact its internal incident plan and cancel planned operations and out-patient clinics. Higher than expected admissions and delays in discharging patients who are well enough to leave hospital have been creating problems for many months. How can we resolve what is now a crisis if the Secretary of State will not even acknowledge that his Government’s deep cuts to social care are undermining the efforts of our dedicated NHS and social care staff?
We are doing an enormous amount to support social care. Some £3.9 billion of NHS funds has been given to the social care system over this Parliament, and we have strongly encouraged local authorities to ensure that any savings they have to make are done through efficiency savings, not cuts to front-line services. The hon. Lady’s local hospital has received £11 million in funding to help it through the winter. We are doing a huge amount to support the NHS through a difficult period, and she should support those efforts.
It is obviously important that those who need to be treated in A and E are treated there and that those who do not go to those parts of the NHS where they can be treated best. Does my right hon. Friend agree, therefore, that the initiatives taken by clinical commissioners in Oxfordshire where, for example, they are trying to triage patients essentially at the door of A and E so that those who need to go in can do so and those who need primary care get it, will help reduce pressures on A and E and ensure that people are treated in the right part of the NHS?
Those are exactly the kinds of initiatives that can make a big difference—indeed, they are recommended by the College of Emergency Medicine. Of course, the long-term solution is to ensure that people are better looked after at home so that they do not need to end up at the door of a hospital. That is why more proactive care by GPs—we plan to recruit 5,000 more GPs over the next five years—should mean that that becomes less of a pressure point.
The Royal Bolton hospital in my constituency yesterday declared a major incident. As of 1 pm yesterday, there were 53 people in the A and E department, 15 waiting for a bed, some for more than 12 hours, and a number of non-urgent operations were cancelled. I first want to thank the hospital for all its hard work, because there have been problems for the past few weeks. I would like the Secretary of State to deal with the crisis by immediately reopening walk-in centres, because their closure is the reason so many people are going to A and E, and have proper funding given to local authorities so that they can put in place a proper health and social care budget for the elderly and vulnerable.
There have indeed been pressures at the Royal Bolton hospital, particularly in relation to bed capacity and intensive care unit capacity. All patients on the wards have been reviewed and discharges have been created—the plan was to discharge between 30 and 50 patients before the end of yesterday. We are doing a lot to support the hospital. It has been given £3 million in winter money, £350,000 to create extra bed capacity and £100,000 for extra A and E staff.
Order. A very large number of hon. and right hon. Members are still seeking to catch my eye. As always, I am keen to accommodate as many as possible, but I simply point out to the House that there is a statement to follow by the Secretary of State for Northern Ireland and other business. I therefore appeal to the House to help me to help individual Members. That is to say, prolonged statements prior to questions are undesirable. Pithy and succinct questions are the order of the day, in which important exercise I think we can be led by an illustrious parliamentarian, Mr Philip Hollobone.
Kettering general hospital is experiencing its busiest winter on record. The three hon. Members for north Northamptonshire, Andy Sawford, my hon. Friend Mr Bone and myself for Kettering, are working together to attract extra investment into our A and E. When we go to see the Secretary of State’s colleague, the hospitals Minister, next week, will he encourage the Minister to receive us warmly and favourably?
I think that my hon. Friend should always be able to count on being received warmly and favourably. There are particular pressures in Northamptonshire. I am planning to have a conversation with the chief executive of Northamptonshire county council in the next week to see whether there is anything more than can be done to facilitate discharges and relieve the pressure at Kettering.
I greatly welcome the £13.4 million of investment recently signed off for Medway hospital’s A and E department. Does the Secretary of State also understand the hospital’s need for a further £20 million of capital for medical wards around the A and E department to support integrated care and improve the throughput of patients to assist in turning around Medway hospital?
I am aware of those proposals, which we will obviously look at carefully. I am also aware that there are big pressures in the A and E department at Medway, but there are also other, more profound issues to do with the leadership at the hospital. The hon. Gentleman should rest assured that we are taking every step possible to try to turn things around.
I recently spent a shift at the Royal Cornwall hospital’s A and E department and saw at first hand the fantastic work it is doing. Does my right hon. Friend agree with the clinical team and with Mr Virr, who leads the department so well, that people need to remember that A and Es are for life and limb emergency treatment on the day and that they should consider the excellent alternatives, such as minor injuries departments and out-of-hours GP services, before automatically going to A and E?
I commend my hon. Friend for her tremendous interest in the Royal Cornwall hospital and for her campaigning to support its efforts. I spoke with the chief executive earlier this week about the particular challenges with discharging patients. I also spoke with the deputy chief executive of the South Western Ambulance Service NHS Foundation Trust about the dramatic increase in 999 calls this winter. My hon. Friend is absolutely right that the public can help us by ensuring that they use alternatives to A and E wherever possible.
When I led an integrated health and social care team 20 years ago, we found that carers no longer being able to care was a key reason why people went into hospital and into care. Will the Secretary of State now look again at the eligibility criteria introduced under the Care Act 2014 and ensure that a much greater number of carers can get support, because at the moment the number is being reduced?
Under that Act we introduced national eligibility criteria to try to remove the postcode lottery that had existed previously. We have also introduced new rights for carers that require local authorities to take account of the pressures on them. I think that we are going in the right direction, but I accept that there is always more that can be done.
Some 92.6% of patients in England are seen within four hours, as opposed to just 83.8% of patients in Wales. If Labour wants to make this a political football, why does it not play an away game down in Cardiff, where it is in charge and responsible for the disgracefully lower standards that we receive there?
My hon. Friend makes his point powerfully, as ever. The rhetoric that we have heard from the Labour Benches today is interesting for its absence when we have debates on Wales. It seems to the public watching this that there is one rule for England and one rule for Wales, and that Labour is satisfied with lower standards in the parts of the country that it runs.
The NHS is in financial crisis, with more money needed for A and E, yet we are spending £10 billion a year on diabetes because people are consuming twice the daily amount of sugar that they should be consuming—nine teaspoonfuls for men, which is equivalent to a can of Coke, or six for women, which is equivalent to a light yoghurt. Does the Secretary of State agree and will he support my Bill, which is published today, which requires manufacturers to express sugar content in teaspoonfuls on products to empower consumers to make rational choices in order to manage down overall obesity—
Order. [Interruption.] Order. These are extremely important matters, but their relevance to the question of A and E was not immediately obvious to me, added to which, unfortunately, the hon. Gentleman—
No. I am not debating with the hon. Gentleman; I am telling him. His inquiry suffered from one little disadvantage: it was too long.
My right hon. Friend will be aware that the Minister for Policing, Criminal Justice and Victims, my right hon. Friend Mike Penning, and I were very unhappy that the A and E was closed and moved to Watford. Since then Watford hospital has had a turbulent time. This morning the chief executive resigned, having got part-way through a process of consultation. May I ask for the consultation to be put on hold until the new chief executive is in place and has their feet under the table? We do not need more turbulence in our hospitals in west Hertfordshire.
I am sorry to hear the news about the chief executive at Watford. I am aware of the pressures there and I agree with my hon. Friend about the need for stability in management as much as possible over the next few months.
One of my constituents wrote to me about her elderly mother who faced a wait of many hours for an ambulance to A and E. My constituent told me that at A and E she saw patients on trolleys backed up through the corridor to ambulances waiting in the car park. Meanwhile, patients were waiting at home, unable to get those same ambulances. She described the scene as “a war zone”. Is it not the case that A and E is unable to cope, the ambulance service is unable to cope, and patients who need to go to A and E are suffering?
I agree that there are real pressures in A and E across the system, but it is important to remind the public that even under that pressure, nine out of 10 people continue to be seen, treated and sent home within four hours. That is an extremely impressive record for the people working very hard in our A and E departments.
The Norfolk and Norwich hospital declared a major incident. Its medical staff say that care is safe. Will my right hon. Friend join me in supporting Norwich NHS staff and their innovative urgent care unit, will he urge Norwich GPs to apply to the access fund, and will he condemn some of Labour’s political leaflets in Norwich which carry fake NHS stories, as told to me by NHS workers?
It is important for all parties to behave responsibly when the NHS front line is under such pressure. My hon. Friend might want to remind her Labour opponents locally that in Norwich there are 97 more doctors than four years ago and 145 more nurses, all possible because of a strong economy.
Last week 1,631 people visited Plymouth A and E. One in 10 of them waited more than four hours. Staff are showing great dedication and doing extra shifts, but that is not sustainable. Will the Secretary of State please take his head out of the sand and, if he is serious about depoliticising the issue, will he take up the shadow Secretary of State’s offer of a cross-party summit to look at all the issues behind the crisis?
I was talking to a doctor at Plymouth last night and I recognise that there are real pressures there and staff are working very hard. The long-term solution is to back the non-party political plan that the NHS itself has put together under the leadership of Simon Stevens—the “Five Year Forward View”. We made the big call in our autumn statement to find £2 billion, which is what he said the NHS needed next year, and I hope Labour will support that. Then we can have the kind of consensus that the hon. Lady asked for.
In 2003, a dozen years almost to the day, I accompanied my grandmother to A and E. We arrived at 8 o’clock in the morning. She was not allocated a bed until 9.30 that evening. May I impress upon my right hon. Friend that money alone is not the issue? It is important that we push ahead with the long-term plan and do not adopt a short-term opportunistic approach.
My hon. Friend is right. It is important to say that lots of people in the NHS have been asked in the past few days on the media what the issues are, and they have not been saying that it is about money. They have been saying that it is about reforming the structures.
That is why, as well as the money that is available for this winter, we need to look at the plans that we can put in place to improve access to GPs, to improve the co-ordination between the health and the social care systems, to deal with issues that prevent people going to hospital in the first place. That is what this Government want to do.
Many of my constituents in Feltham and Heston have raised with me their concerns about being able to access GP services, some having to wait weeks and in the mean time having to seek emergency help. Does the Secretary of State now regret the Government’s decision to axe Labour’s guarantee of a GP appointment within 48 hours?
If the hon. Lady regrets that, she might want to ask her Labour colleagues in Wales why they also axed the 48-hour target. We do need better access to GPs. That is why we are funding the training of 5,000 more GPs over the next five years. With targets, we must be careful of unintended consequences. When we had that target in place, a quarter of people who asked for an appointment in more than two days were told that that would not be possible, because we found that people played the target. That is why we do not want to go back to that system.
I agree with pretty much all the College of Emergency Medicine’s 10-point plan. That has very much informed our approach to helping the NHS over this winter. Co-location of GP surgeries on hospital sites is very helpful, but we also need more proactive care for the most vulnerable older people before they feel the need to go to hospital. That will be at the heart of the changes that we want to see.
The reason that west London now regularly has the worst waiting times for A and E, with up to 50% of patients waiting more than four hours, is a direct result of the Secretary of State’s decision to close the Hammersmith and Central Middlesex A and E four months ago. These are sick people who need A and E, not GP services. We have GP services at those hospitals. What we need is for him to cancel or at least review the downgrading of the A and E departments at Charing Cross and Ealing hospitals to GP-led emergency centres. Will he at least do that?
I say gently to the hon. Gentleman that if we are to solve the problems in his area and others, we should listen to the doctors about the structures that will work best. The structures that we put in place are the structures that doctors advised us to set up. That is why we are supporting them.
Mrs Bone would like to offer best wishes for the new year to the Secretary of State. The reason she can do this is the excellent health care provided by the NHS in both Kettering general hospital and Northampton general hospital. Locally, the commissioners and the acute hospitals are together working out a plan to deal with accident and emergency. Is not that the way forward?
Indeed. I pass on my best wishes for the new year to Mrs Bone. Like many people, she has benefited from superb NHS care. A million more people are having operations every year under this Government, and 700,000 more people are being seen within four hours at A and E under this Government.
The NHS is a system, which is why cuts to social care and other parts of the system affect A and E. With that in mind, and with 14 hospitals in a state of emergency, will the Secretary of State review the plans that are in place should a winter crisis of cold weather come along at this very vulnerable point?
It is interesting that what the hon. Gentleman did not want to talk to the House about was his own local hospital, which is performing extremely well for A and E. It would be good if more of those on the Opposition Benches talked about the good things that are happening in the NHS, including nine out of 10 people who go to A and E being seen within four hours.
I thank the Secretary of State for the £13.4 million given to Medway Maritime hospital’s A and E department. Will he assure me that everything that everything that can be done is being done to turn around hospitals in special measures such as Medway, which had the seventh highest mortality rate in 2006 yet nothing was done? Will he also join me in paying tribute to all the front-line staff who do a fantastic job at Medway?
I am happy to do that. One of the things that this Government are most proud of is what we have done to turn around hospitals with entrenched low standards of care following the terrible tragedy at Mid Staffs, with 18 hospitals put into special measures and six of them turned around. Despite all the pressure on me and on this Government to hit targets, we are sending out signals to the system, loud and clear, that targets matter, but not at any cost, and that we do not want corners cut when it comes to patient safety.
Last weekend at Royal Blackburn hospital’s A and E, which I have been concerned about for quite a while, 18 ambulances were waiting outside. That was revealed not by the NHS but by a whistleblower, who described the situation as “chaos”. Is it happening because there are too many patients putting too much pressure on the NHS or because of mismanagement of the NHS by the Conservatives?
It is because of unprecedented demand caused by a range of factors. If the hon. Gentleman looks at the facts, he will see an NHS that is treating more people more quickly, with more doctors, more nurses and more operations than ever before. Sometimes, though, as I said yesterday, people on the front line feel that they are running just to stand still because there is so much pressure. That is why the £700 million in our winter plan and the money we are putting in to back the five-year forward view next year are so important.
Does my right hon. Friend agree that we should not be playing party politics with the NHS in the way that my opponent in Redditch is by putting out leaflets saying that I am systematically voting against the NHS, but that we should be working together with our trusts and partners in ensuring that we get through this problem, as we are trying to do in Worcestershire?
I absolutely do agree. Labour Members should talk to some of the front-line NHS workers in their own constituencies, who will tell them that the last thing they want at this time is for the NHS to be a political football.
The Secretary of State will know that major incident status was declared at Leicester hospitals this week for the seventh time in three months. In the week before Christmas, just 67% of patients at Leicester Royal Infirmary in my constituency were seen within the four-hour target, and clinicians, who are working flat out, expect pressures to increase over the next three months. What is he now going to do to support clinicians in Leicester and get a grip of this situation?
I am aware of the situation in Leicester. The hospital has had significant space pressures in its emergency department, and a couple of nights ago it had a high in-flow during one night, but it is absolutely on the case in trying to resolve this. What are we doing? Well, we have put in £9.2 million of winter pressures money to make sure that whatever people decide the right solution is, it is not through lack of resources that they cannot do it.
Last Saturday night, while I was visiting my wife’s family in Leicestershire, my baby daughter suddenly became quite ill. Rather than going to A and E, we rang the 111 service and were quickly referred to Loughborough urgent care centre, where we had fantastic treatment; I pay tribute to the staff. Does this not go to show that we need to prioritise new models of urgent care, as set out in Simon Stevens’s review?
We absolutely do that. Telephones and the internet provide different ways to get the right advice to people quickly. The 111 service is taking a considerable amount of strain at the moment, and we have put in more money to support it. We are investing a lot more in tele-health and tele-medicine, and a lot more to help GPs who want to give people out-of-hours appointments. In the long run, that is the way we will reduce the kinds of pressures that my hon. Friend talks about.
Over three years ago, I raised with Ministers problems about the North East ambulance service that had been pointed out to me by the paramedics, but unfortunately they were brushed aside. My constituent, Violet Alliston, had the terrible experience of her partner ringing for an ambulance three times in the course of an hour before the ambulance came. She then died. This is obviously completely unacceptable. Why will not the Secretary of
State look again at the resources he is taking out of the North East ambulance service, the skills base of the call handlers, and the triage system?
I am extremely sorry to hear the story that the hon. Lady talks about, and I know that the NHS will investigate it fully. We are not cutting resources to ambulances, though. We have 2,000 more paramedics than four years ago, and £50 million is being put in this winter. Of course, we need to look very carefully into the particular case that she mentions and make sure that any lessons are learned.
Order. I really am keen to accommodate remaining colleagues, because I understand the interest in this subject. May I appeal to colleagues to put single, short supplementary questions without preamble? Now, who might be a master of the genre—Mr Richard Graham?
Thank you, Mr Speaker—I will seize the moment.
Part of the long-term solution is attracting and retaining more nurses. Will my right hon. Friend encourage the National Health Executive to allow the university of Gloucestershire to run pre-registration training courses for nurses so that we can attract and retain more local nurses?
The Secretary of State will be aware that there are particular issues at Kettering General hospital’s A and E unit. It has improved its performance, but it has been described, to the shock of all the MPs in the area, as the worst seen in the country. We have done an awful lot of work. On Tuesday we are bringing the local health organisations together to the Department. Will he encourage his ministerial colleagues to give the green light to our plan for our area?
My constituent, Mr J. Hollinshead, rang Ashfields surgery, Alsager, for an appointment at 8.30 am on
I agree that we need to recognise the successes of the NHS, and there are many of those successes. The reason we need to do that—I urge Labour Members to remember this—is that it is very important for the morale of people working in the NHS that we publicly recognise where they are being successful.
Is it not true that this Government set out with a plan to close nine out of 31 A and Es in London, including the one at Lewisham, as directed specifically from the Secretary of State’s office? Does he regret that? What state does he think the A and E services in south-east London would be in if he had been successful, in the face of public opposition, in closing that A and E?
First, as the hon. Gentleman knows perfectly well, there were never any plans to close that A and E, and he should desist from scaremongering about what was happening at Lewisham hospital. He should also remember that when this Government came into office—[Interruption.] The plans—
Order. First of all, it is unseemly to squawk, and I think it would be accurate to say that what I heard was a squawk. I am not sure if there is a verb “to squawk”, but there was a squawking sound. What is worse, it was unparliamentary language, and I believe that the hon. Gentleman used a word that he will now wish to withdraw.
I am grateful to the hon. Gentleman for his withdrawal and I note what he says.
The plans were to continue to have an A and E at Lewisham but to take some of the higher-risk patients to another hospital. Those are the plans that we originally had that have now been changed. What I will say to the hon. Gentleman, though, is that there were problems with South London Healthcare Trust for years and years. This Government dealt with them and sorted them out, and that means that his constituents are getting better care than they otherwise would have done.
Will my right hon. Friend join me in congratulating the staff at Royal Lancaster Infirmary on meeting their A and E targets in November? Will he also share my revulsion at the Opposition putting out a leaflet saying that there are all kinds of things wrong with the A and E and that it is going to close?
That is exactly the kind of scaremongering, frankly, that is incredibly demoralising for those who are on the NHS front line right now. I urge Labour Members to think before they start doing things that make a difficult situation even worse.
The South Western ambulance service came close to declaring a major incident on
As I mentioned earlier, I have talked to the chief executive of South Western ambulance service about the particular pressures it has faced, such as the 25% increase in 999 calls. We are doing a lot of things, including helping to recruit more paramedics. We have 40 more paramedics starting for the London ambulance service this month, and we are doing what we can to help the South Western ambulance service as well.
About a third of the patients attending A and E at the Countess of Chester hospital are from the Welsh side of the border. They choose to go there because they know they will get treated a lot quicker in England than they will in Wales. Why is that the case?
Before a major incident was declared yesterday morning, 76 patients were awaiting transfer to social care in the Royal Bolton hospital—nearly four wards-full—so when is the Secretary of State going to do something effective about the crisis in social care that is causing mayhem in our accident and emergency department?
I recognise the pressures that the hon. Gentleman is talking about, but last year, for the first time, the local NHS and the local authority in Bolton sat down together to plan social care for the most vulnerable people—his constituents—who need such joined-up care and have wanted but not had it for so many years. With the better care programme from this April, we will start to see some real improvements.
In 2005, the Labour Government closed the accident and emergency department at Crawley hospital, but services are now returning to the urgent treatment centre. Does my right hon. Friend believe that such centres play an important part in relieving pressure on emergency services?
They absolutely do. One thing we must do better is signpost people to the different parts of the NHS, such as walk-in centres, urgent treatment centres, GP surgeries or A and E departments. That is why the 111 service is so important in giving that advice at the earliest possible stage.
Does the Secretary of State now regret the cuts inflicted on Southampton social care provision—they were draconian, disproportionate and possibly motivated by political football—given that Southampton city council has been unable to support the Southampton general hospital by moving people into social care and away from accident and emergency? Will he have a word with Communities and Local Government Ministers to get that put right?
I was at Ipswich hospital this morning to talk to the senior clinical team. They have exceeded their targets in A and E—it is the fifth best performing hospital in the country—and they have done so because of their work. Will the Secretary of State congratulate them, and does he regret the politicking that undermines their incredible efforts in the service of my constituents?
The services that the Ipswich team have been delivering are absolutely brilliant, and I congratulate them. I thank my hon. Friend for his support for their work, which I know is so important for the people of Ipswich.
The Secretary of State said that 14 major incidents have been declared. I am told by a senior front-line worker that many hospitals are declaring internal major incidents—they have done so for some time—because that is more politically expedient and does not get into the press. How many internal major incidents have been declared in the past month?
To my knowledge, over the past few weeks there have been 15 major incidents, including internal ones. Three have now been stood down, making a total of 12 at the moment.
The Cumberland infirmary in Carlisle is coping and improving. However, to improve more quickly, it needs to conclude the acquisition by Northumbria Healthcare NHS Foundation Trust as soon as possible. Will the Secretary of State do everything he can to help to achieve that, as I believe it will lead to better health care, both in A and E and generally, in Carlisle?
I am very sympathetic to my hon. Friend’s view. Indeed, I have spoken to him about it on several occasions. I very much hope that the merger can go ahead as soon as possible.
What is being done to address staff well-being during this exceptionally pressured period? Repeated pressure on A and E—with staff being required, or volunteering, to do extra shifts—does in the end put pressure on staff, and may cause burn-out and risk to patients. What is being done to attend to that issue?
There are two things. First, as I am sure the hon. Lady does, I take every opportunity to praise the work being done by staff through a very difficult and challenging period. Secondly, the practical way in which we can most help them is to try to recruit more staff where we possibly can, and to make sure that resources are not a barrier to recruiting more staff. We have about 5,000 more nurses in hospitals compared with 12 months ago, and that has made a difference.
The Secretary of State stood up and said that he takes personal responsibility for everything that happens in the NHS. Given that his Government undertook a costly and time-consuming reorganisation, does he now regret that people took their eye off the ball in relation to the highly predictable population shifts that have led to the pressure on A and E?
I am afraid that that is an example of the politicisation of the NHS that people find so distressing. Those reforms were not enacted in Wales, which is run by the hon. Lady’s party, and A and E performance there is significantly worse. It does not make any logical sense to blame A and E performance on those reforms.
Royal Bolton hospital says that it is in crisis because it cannot discharge patients. The Secretary of State says that the hospital and local authority in Bolton are talking to each other, but Bolton council has had £100 million-worth of cuts. What will he do to reverse the cuts in social care that have created the crisis in our hospital?
If the hon. Lady is making a criticism, I would ask her what she is going to do, because the shadow Chancellor confirmed this week that he will not find extra money for social care. I will tell her what we are doing. We are merging the social care and local NHS systems to try to stop people being pushed from pillar to post, and to give them the joined-up, compassionate, safe care that we think is an absolute priority. That is happening in Bolton—I have visited facilities in Bolton that are displaying excellent care—and we should support such efforts, not criticise them.
In January 2013, I raised with the Health Secretary the incident in which an 84-year-old lady had to wait 11 hours for an ambulance. This Christmas, a 101-year-old lady had to wait six hours for an ambulance, and an 89-year-old pensioner also had to wait 11 hours for an ambulance. When do individual incidents of failure become a pattern, and is the Health Secretary himself an individual incident of failure?
I take huge interest in individual examples of where things have gone wrong, and that has informed a lot of my approach to the job. Just like A and E departments, when ambulance services get calls, they have to triage them and deal with the highest-priority calls quickest. The calls they get can sometimes be dealt with after a period of hours, but other calls are much more urgent. The important thing for ambulance services is to know that we are backing them with more paramedics, more investment and more ambulances, and that is what we are doing.
One of my constituents, an 80-year-old woman, collapsed at home over the weekend. She had to wait an hour for an ambulance to arrive, and she then waited 10 hours in A and E before being treated by medical staff. For most of that time she was on a trolley in a corridor. Will the Secretary of State apologise to my constituent? Does he not regret wasting billions of pounds on a top-down reorganisation of the health service, instead of using the money to fund the additional doctors and nurses who could have treated my constituent and thousands of others like her across the country more quickly?
Management costs in the NHS doubled under the hon. Gentleman’s Government; under this Government, they have been cut by £1 billion a year, which is paying for 9,000 more doctors and 3,000 more nurses. That is the reality of the NHS under this Government—1 million more people are getting operations every year—and if he really believed in the NHS, he would support and welcome that, rather than criticise it.