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Accident and Emergency Services

No, that is not what I said. I am sure that you were listening carefully, Mr Walker, but for the benefit of the shadow Minister, I will repeat what I said, so that there can be no misunderstanding whatever. From next April, we will introduce a range of more meaningful performance indicators balancing timeliness of treatment with other measures of quality, including clinical outcomes and patient experience. Those performance indicators are currently being drawn up by the profession and will enable doctors and nurses on the ground to deploy their greatest asset: their own professional judgment. Based on clinical advice, the Secretary of State has already reduced the threshold for meeting the four-hour target from 98% to 95%, as the shadow Minister said. The move has been widely welcomed within the medical profession. The shadow Minister will understand that the issue is about locally led, clinically led services. The same goes for the configuration of those services. It is vital that the NHS continues to modernise and improve for patients' benefit, but it is also vital that when that means reconfiguring local services, reconfiguration is based on sound clinical evidence, has the support of GPs, clinicians and the local community and considers patient choice. The days are over when a select group of people could meet behind closed doors to decide the future of local health services. In future, change will be led from the ground up, not from the top down. Where local NHS organisations have already started to consider changing services, we have asked them to go back and ensure that the proposals meet the new criteria and, if they do not, to take steps to ensure that they do so before they proceed. We have asked commissioners to complete any such reviews by 31 October. However, we do not intend to ask the NHS to reopen previously concluded processes or to halt work that has passed the point of no return—that is, projects where contracts have been signed or building work has started. The hon. Member for Southport discussed the lack of clear definitions for various services. When somebody walks through the doors of an A and E department, a walk-in centre or an emergency care centre, what exactly should they expect? What ailments or injuries are most appropriate for each setting? It is not only an issue of general confusion; it is also a matter of safety. If someone presents at a place describing itself as an accident and emergency department, but it does not have the same facilities as most A and Es, that patient could face delay and unnecessary risk. As part of the quality, innovation, productivity and prevention programme, work on standardising urgent and emergency care is under way. Its aim is to clarify what services can be expected in various facilities. By using criteria based on clinical evidence, it should be possible to standardise those terms across the country. That is currently being done in three pilot areas: East Lancashire, Manchester and Salisbury. The conclusions should be published by the end of the year, alongside the operating framework. However, it will not state which types of service should be provided in particular areas. That decision will be made locally. The hon. Member for Southport specifically raised the issue of children's services in his constituency. I understand that services were reconfigured across Southport and Ormskirk hospitals in 2005. As a result of that reorganisation, emergency surgeries, including adult accident and emergency, were centralised in Southport. All children's services, including A and E, were concentrated in Ormskirk, as the hon. Gentleman said. I know that the hon. Gentleman has been vigorously campaigning for the development of a children's walk-in centre for Southport for some time. Sefton primary care trust commissioned two national experts in paediatric emergency medicine to conduct an independent clinical review of that proposal. On 8 September this year, I understand that the hon. Gentleman met Mike Farrar, the chief executive of the North West strategic health authority, to raise some serious issues about the content of the report that he was shown in advance—issues such as his belief that the report mixes up issues of clinical safety with those of affordability. The SHA has suggested that the PCT receives that report as a preliminary report, and that further work should be conducted to address the hon. Gentleman's concerns. The final report should be completed by December. I understand that my right hon. Friend the Secretary of State fully endorsed such an approach when he met the hon. Gentleman yesterday. Although that will add a further three months to an already drawn-out process, I hope that it will provide a far stronger platform for moving forward. Such an approach will also underline the Government's determination that decisions about local services should be taken locally and include the views of GPs and the wider community. On the question of children's A and E services, one important aspect of high-quality care is ensuring that a particular institution receives a sufficient volume of cases to be safe. Patients are best seen by professionals who have access to the right equipment and support services, the right specialist skills and frequent opportunities to exercise those skills. Mercifully, serious illnesses and injuries are relatively rare but, when they occur, it may be better for a patient to travel slightly further to a specialist centre where the appropriate skills are concentrated. That is why regional trauma and stroke centres have been set up and are proving such a success. Similarly, children are best seen by specialist paediatricians in a child-friendly environment. Of course, that is and remains a matter for local decision making, based on local demand for urgent care for children. I shall turn briefly to the points raised by the hon. Member for Hartlepool (Mr Wright), who mentioned a number of issues concerning the provision of health care in the Hartlepool area. As he rightly said, we have had a number of debates on health care, and I am starting to feel extremely familiar with his constituency's issues, although sadly I have not yet visited it. First, on the issue of NHS 111—which was, of course, inevitably picked up by the hon. Member for Kingston upon Hull North (Diana R. Johnson)—as I am sure the hon. Member for Hartlepool knows, NHS 111 is being piloted in four areas this year. We will evaluate the experiences and knowledge we gain from those pilots and roll out nationally the 111 number to replace the NHS Direct number. He will appreciate that a 111 number is more easily identifiable in everyone's mind than the far longer 0845 number that NHS Direct uses. We will wait and see what happens on that matter. The situation that the hon. Member for Kingston upon Hull North outlined was not quite accurate. There has been no confusion. Ironically, what my right hon. Friend the Secretary of State is doing in piloting a 111 number is simply reflecting and implementing a manifesto commitment made by the hon. Lady's party at the last election. There are times when political parties share views and think that an idea should be experimented with. I am running out of time for my speech, but I reassure her that there is no confusion. The hon. Member for Hartlepool also mentioned the issue of A and E and ambulance services. As he will be aware, ambulance calls are put into the category of A, B or C. Any cover from Hartlepool would be imaged under that system, and who should use what type of ambulance or transport would depend on the category that their condition, illness or injury falls into. At this stage, I believe—I shall choose my words fairly carefully, so that the hon. Gentleman does not immediately intervene and contradict me—that the A and E at Hartlepool has not yet closed. If he will allow me, I shall look into the matter a little further, because I would like to know for my own education and knowledge exactly what is going on there. If he thinks it would be helpful, I will write to him after I have looked into the matter. I hasten to add that I do so simply for my own education and knowledge, because decisions must be taken locally. My hon. Friend the Member for Newton Abbot (Anne Marie Morris) raised some extremely important issues, not least those relating to mental health. She also mentioned a crucial matter that not only causes problems in the health sector, but gives rise to antisocial behaviour and law and order considerations: that of alcohol and alcohol-related admissions to A and E or minor injury units. I reassure her that considerable work on that is being done across Government, including in the Department of Health, because we are as concerned as she is to come up with solutions to alleviate and reduce that pressing problem, which affects all our towns and villages, particularly on a Friday and Saturday night. On the question that my hon. Friend raised about opening hours and the availability of some minor injury units at Newton Abbott, Teignmouth and Dawlish, I will make sure that her comments are drawn to the attention of the South West SHA, so that it is aware of her concerns. The hon. Member for Burnley (Gordon Birtwistle) was courteous enough to give me advance warning of the issues that were of particular concern to him. I understand and appreciate the points he raised. I know that he has written to me and if a response has not yet been received, one will shortly be sent to him from the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton). I must emphasise that it is not for me to reconsider the application of the new criteria with regard to the proposed reconfigurations in the hon. Gentleman's area. That is for local people to consider. It is for GPs, the public, local authorities and local PCTs to reassess what they consider to be a viable and successful future for the services provided in Burnley and Blackburn. The Department of Health has asked the local NHS to look at how ongoing schemes meet the new criteria, as laid down by my right hon. Friend the Secretary of State, including meeting patients' needs. NHS North West has advised us that that work will be concluded in October 2010, and that it will be able to advise on the process and the progress of that review then. As the hon. Member for Burnley outlined, he has done considerable work. I encourage him to share his and his constituents' concerns again and again with NHS North West or the PCT, as is appropriate. He needs to ensure that the strong body of public feeling and opinion within his community and constituency is brought home to the relevant authorities that are considering the matter and recommending decisions on what should happen, so that they can fulfil the criteria that my right hon. Friend the Secretary of State has set out. In conclusion, this has been an extremely helpful and useful debate. A number of very important issues have been raised by hon. Members across the divide, and by the shadow Minister, the hon. Member for Kingston upon Hull North. I know that there are a number of things that she will never accept, not least in the vision unveiled in the White Paper. However, as with all other areas of health care, on A and E—urgent care—I reassure her that the overriding principle of this coalition Government is to judge patients' quality of care by raised outcomes, rather than through process targets. That will ensure that we can give the finest health care to all our patients.