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Emergency Care

Absolutely. The hon. Gentleman has pointed to the inherent contradiction in the Conservatives' policy: they say that they recognise the need for reorganisation, including the creation of trauma centres—the need for which he has described—yet they oppose every single reorganisation on the ground when one is actually proposed. I need to correct the figures, or the impression, given by the hon. Member for South Cambridgeshire (Mr. Lansley) about the increase in accident and emergency attendances. A small increase in the number of such attendances took place between 1997 and 2003, but between 2002-03 and 2007 the figures for the average annual increase in accident and emergency attendances were as follows: the figure for major accident and emergency departments was 2.2 per cent.; that for single specialty accident and emergency was 4.9 per cent.; that for other types of accident and emergency department, including minor injury units, was 4.6 per cent., and that for walk-in centres was 15.7 per cent. Hon. Members can see that the biggest single proportion of the increase in accident and emergency attendances arose because of walk-in centres, which did not even exist under the previous Government, and that the smallest increase was for major accident and emergency departments. [Interruption.] The figure is not going up; the hon. Gentleman is wrong about that, too. The 2007-08 figures for major accident and emergency departments—the latest ones—show that there was a reduction of 1.5 per cent. compared with the previous year. On the general issue of accident and emergency provision, a number of hon. Members have, fairly, recognised that the latest independent health watchdog report by the Healthcare Commission not only reports an improving picture—88 per cent. of the public rate their experience of accident and emergency as excellent, very good or good, which is an increase from 85 per cent. in 2003-04—but makes a number of criticisms, including some associated with pain relief and discharge, which the Government take very seriously and expect the NHS to address. The hon. Member for South Cambridgeshire gave the reply that I was going to give in response to the hon. Member for West Chelmsford (Mr. Burns) on the gap between the findings of the Healthcare Commission's survey and the official figures. That occurs because some people may, for clinical reasons, need to be to moved into an assessment unit or a side ward if the consultant who has seen them is not in a position at that stage to make a decision on their care. Such people may still feel as if they are in accident and emergency, whereas in fact they are not. That four-hour target, which the Conservative party would scrap, has been incredibly important in driving up performance. I do not know any serious manager in the health service who thinks that it would be a good idea to abandon it. That would be a recipe for returning to the terrible days of patients having to wait hours, and even days, on trolleys, and the closure of accident and emergency departments. It is important to put on the record what the College of Emergency Medicine report said about emergency medicine. It has been widely, but selectively, quoted by the Opposition, including in an early-day motion, but they omitted to mention that the report states on page 8:"““There is no single solution to the reorganisation of emergency care. In urban areas where””" emergency departments"““are close together (less than ten km apart) there may be advantages to amalgamating some services.””" It goes on to argue that that could result in a ““more coherent”” service for local residents. The college's report states that throughout the country, many patients who currently attend A and E but do not need the full services of an acute hospital could be dealt with in an urgent care centre on a hospital site or in a community setting. The recent independent Healthcare Commission report on urgent and emergency care found that, in a typical urgent care centre, care starts within an hour for 93 per cent. of patients. There is evidence of highly effective urgent care centres that are properly integrated, and have good collaborative working relationships with A and E colleagues. The key issue is that services should be integrated and staffed by people with the right skills and competencies to deal with the population using the service. Whether an urgent care centre is appropriate in a particular area, and how services are best structured, will depend on local circumstances. The Opposition motion suggests that to achieve that may mean concentrating expertise in a smaller number of centres of excellence that bring together specialists in different subjects to work together as a single team. Many people who walk through the doors of accident and emergency departments do not need such a high level of care, and for them the most effective treatment will come from a nurse or GP. We can trade figures, and other reports have been quoted, but I am advised that the most conservative estimate is that 50 per cent. of those who present in accident and emergency departments in fact require primary care. That is a huge proportion. Of course, when any reorganisation takes place it can be, and often is, controversial. But as my right hon. Friend the Secretary of State made clear in his opening remarks, the changes must be locally led, clinically driven and, in contrast with what the hon. Member for Mid-Bedfordshire (Mrs. Dorries) suggested, they require full public consultation. If democratically elected local councillors disagree with recommendations made by their local primary care trusts, they can object through the overview and scrutiny committee and refer those proposals to the independent reconfiguration panel. Some hon. Members have said that the panel is just a front, but in the past six months it has comprehensively rejected two major reorganisations, one in Oxfordshire and one in Sussex. It bases its decisions on the clinical case, and it was absolutely right for my right hon. Friend to take the politics out of the matter and set up a process that is transparent, independent, and based on clinical need and what is best for the patient. My right hon. Friend the Member for Enfield, North (Joan Ryan) has championed Chase Farm hospital with great effect during her years in the House. I am sorry that she was not in the Chamber for the contribution by the hon. Member for Hemel Hempstead, but she may like to read the Hansard record, because he grossly misrepresented the position on Chase Farm and what she has done to ensure that the proposals affecting Enfield are much better than they were at the outset. My right hon. Friend took the trouble to highlight the fact that many of the improvements in the NHS in her constituency, including GP-led health centres and the planned new polyclinics, represent developments that the Conservative party oppose—her local Conservative party is completely silent on that subject. We have had many such debates, and the national director for emergency access referred to the proposals from the local primary care trust—not the Government—on the reduction from three to two accident and emergency departments. He said:"““Put starkly, it is evident that safe, high quality modern care cannot be provided for all specialties in all three acute hospitals in the area...Care of the standard that members of the public have a right to expect will require the centralisation of some specialties on two of the three hospital sites. Immediate care around the clock by experienced clinicians cannot be guaranteed whilst efforts are made to maintain all three sites””." My right hon. Friend will also be aware that there is an outstanding judicial review application by the local authorities concerned, but the challenge from the local authorities to the Independent Reconfiguration Panel was not successful. The hon. Member for Romsey (Sandra Gidley) raised the issue of ambulances in some depth, but she did not mention that we are achieving the best ever response times. The ambulance service is the most popular in the NHS, as it scores the highest level of patient satisfaction of any service—some 97 per cent., according to the independent Healthcare Commission. Investment in ambulance services has increased by 135 per cent. since 1997. The hon. Lady raised the specific issue of ambulance services in rural areas, and how the new larger ambulance services are expected to perform. The Department issued directions to each ambulance trust following the reorganisation of services in 2006 to set out the requirement that each trust must be able to demonstrate that it has regard to the reasonable needs of everyone in their area, and has arrangements in place to meet the national response times. The way in which each trust does that will depend on the local geography and fleet mix, and is a matter for local decision. However, since the reorganisation, ambulance services have improved their performance and displayed the highest response ever on category A calls, with 77.1 per cent. in the latest figures. The hon. Lady—and the hon. Members for Mid-Bedfordshire and for Hemel Hempstead—also raised the issue of delayed handover of patients at accident and emergency departments. Let me make it clear again—as my right hon. Friend the Secretary of State has done on many occasions—that it is totally unacceptable for A and E departments not to accept patients, or for ambulances to have to wait outside for whatever reason. Hon. Members will be aware that the accident and emergency clock starts when the handover occurs or 15 minutes after the ambulance arrives, whichever is earlier. So if hon. Members wish to make specific allegations about such problems occurring at a hospital, they should let us know and we will come down on that hospital like a ton of bricks. The hon. Member for Wyre Forest (Dr. Taylor), and others, raised the issue of the three-digit number. I am sorry to have to say that they will have to be patient for a little longer. As the hon. Gentleman acknowledged, it is a complex issue as several different models could be implemented. As he knows, we were clear about our commitment in the next stage review, and it is important to consult on the different models with all the different organisations involved, in the public interest. The hon. Member for South Cambridgeshire rightly raised the concern about the pressure on accident and emergency departments caused by alcohol and drugs. He will, I am sure, be aware of the cross-Government strategy on alcohol and drugs, which aims to address the three problem drinker groups, and therefore take the pressure off accident and emergency departments. The hon. Member for Mid-Bedfordshire also raised concerns about solo response teams, and I will write to her in more detail. What I can say is that if, according to the best knowledge and decision making of the trust, a traditional double-crewed ambulance is required, one should always be sent—but it is important to provide a fast response as quickly as possible, with back-up if necessary. We do not have to cast our minds back too far—just to the mid-1990s—to remember the horror stories of people waiting for days to see a doctor, waiting in corridors on trolleys in accident and emergency departments. They were waiting with neither privacy nor dignity at a time when they were at their most vulnerable. Over the past decade, this Government have transformed people's experience of urgent and emergency care. Ambulance services and accident and emergency departments are scoring record performances with a huge expansion in alternatives to urgent care for people for whom accident and emergency treatment is not appropriate. That is an enormous tribute to NHS staff, and I commend our amendment to the House. Question put (Standing Order No. 31(2)), That the original words stand part of the Question. The House proceeded to a Division.