Only a few days to go: We’re raising £25,000 to keep TheyWorkForYou running and make sure people across the UK can hold their elected representatives to account.

Donate to our crowdfunder

NHS: Accident and Emergency Units — Question

– in the House of Lords at 3:29 pm on 19th June 2013.

Alert me about debates like this

Photo of Lord Campbell-Savours Lord Campbell-Savours Labour 3:29 pm, 19th June 2013

To ask Her Majesty’s Government what assessment they have made of the impact of closures of Accident and Emergency units in Buckinghamshire on neighbouring hospitals; and how that compares with the impact of closures of Accident and Emergency units elsewhere in the country.

Photo of Earl Howe Earl Howe The Parliamentary Under-Secretary of State for Health

My Lords, we know that there have been increasing pressures in A&E across the country. In October 2012, a GP-led 24/7 minor injuries unit was introduced in Wycombe to deal with cuts, bruises, sprains and other minor injuries and illnesses. A modest increase in the number of patients going to neighbouring A&E units was expected as a result of local changes. Commissioners provided £4 million to these hospitals to address that increase.

Photo of Lord Campbell-Savours Lord Campbell-Savours Labour

My Lords, the minutes of the Heatherwood and Wexham Park National Health Service Trust disclose that the downgrading of A&E and medical emergency departments in neighbouring hospitals led to a fivefold increase in the number of people having to wait more than four hours—the national target—in Wexham Park A&E and a dramatic increase in the number of cancelled operations. Indeed, I am told that that number doubled. What is the point of making this national policy of closing these A&E departments when all it is doing is upsetting people all over the country and making them extremely angry?

Photo of Earl Howe Earl Howe The Parliamentary Under-Secretary of State for Health

My Lords, I have to emphasise to the noble Lord that, although I understand his concerns in relation to Wexham Park and other hospitals, there is no government policy about the closure of A&E departments. The whole thrust of government policy since we were elected to office has been that there should be no top-down direction of this type of decision. Rather, we are clear that any changes to healthcare services should be locally led, clinically driven and involve the local population in a consultation. All patients have the right to high-quality urgent care at whatever time they use the health service. The key for local commissioners and decision-makers is to ensure that that happens. I am aware that the situation at Wexham Park has improved and money is being invested to ensure that there are enough beds for the future.

Photo of Baroness Wall of New Barnet Baroness Wall of New Barnet Labour

My Lords, I declare an interest as the chair of Barnet and Chase Farm Hospitals NHS Trust. I was in my A&E department at Barnet Hospital this morning for two hours. In addition to the concerns that my noble friend has expressed, the real issue is that people are turning up at A&E who really should not be there, do not need to be there and ought to be able to get treatment elsewhere. Obviously, government policy is to ensure that we have more services outside, but can we make sure that that happens more quickly than is currently the case?

Photo of Earl Howe Earl Howe The Parliamentary Under-Secretary of State for Health

My Lords, the noble Baroness is absolutely right. There is no doubt from Sir Bruce Keogh’s urgent and emergency care review, published this month, that attendance at an A&E department often reflects the lack of availability or the lack of awareness of alternative sources of help. Some patients may default to A&E departments when they are unsure about which service is most appropriate to their needs. That has to be addressed and is being addressed in Sir Bruce’s review. It will look at the entire system of emergency care and how we can make sure that it provides the right care, in the right place and at the right time.

Photo of Baroness Finlay of Llandaff Baroness Finlay of Llandaff Crossbench

Will this review include an audit of the number of patients who are in A&E but cannot be sent back to their normal place of residence, whether that is their home or a care home, because of the lack of immediate transport and an absence of immediate referral systems to community services that could monitor and review the patient back in the community?

Photo of Earl Howe Earl Howe The Parliamentary Under-Secretary of State for Health

My Lords, yes, the whole patient journey should be looked at, including the role of social care in making sure that patients who are not seriously ill but need care can be looked after in their own homes or in a suitable residential setting.

Photo of Lord Brooke of Alverthorpe Lord Brooke of Alverthorpe Labour

My Lords, will the Minister be kind enough to enlighten us as to whether Ministers are under instructions these days to blame the NHS and its different levels for failings but to accept no responsibility for putting it right? I watch with increasing fascination the number of Ministers who are now attacking the way that A&E operates, although they are to blame. I heard a Minister the other day attacking GPs for failing to act in the way they should. At the end of the day, I wonder who is responsible for putting this right. The noble Earl said earlier that this is a not a “top-down” operation now. Who, then, is going to accept responsibility for the failings which are now starting to take place within the health service?

Photo of Earl Howe Earl Howe The Parliamentary Under-Secretary of State for Health

My Lords, Ministers are responsible to Parliament for the provision of the health service so I do not duck that responsibility for a second. Nevertheless, Ministers do not manage the health service day-to-day and have never done so. We are involved day-to-day in the plans to ensure that we have a health service that is properly configured to meet the needs of patients. My right honourable friend the Secretary of State could not be more assiduous in the work that he is doing to make sure that that happens. Responsibilities are not being ducked; nobody is being blamed. The fact is that demand is going up considerably, and has been for a number of years. We need to address that and we need to do it cleverly. It is not always a question of piling more money in; it is looking at how the services are configured and delivering care in the right place.

Photo of Baroness Masham of Ilton Baroness Masham of Ilton Crossbench

My Lords, does the Minister agree that drunken and aggressive people are putting great pressure on A&E departments across the country, especially at weekends? Can he do something about it?

Photo of Earl Howe Earl Howe The Parliamentary Under-Secretary of State for Health

The noble Baroness is right. Quite a considerable proportion of people who attend A&E do so at weekends after heavy drinking, and in some areas, that has overloaded the system. I am aware of many hospitals that are working with the local police force and others to keep such people out of hospital if they do not need to go, but to make sure that they do not disrupt the work of an A&E department if they do go.