Simon Burns

Conservative Party | Chelmsford West

Debate on emergency care in house of commons

21st January 2009

House of Commons

Mr. Simon Burns (West Chelmsford) (Con): I am delighted that we have the opportunity today to debate emergency and urgent care in the NHS. I fully support the motion put down by my right hon. Friend the Leader of the Opposition and our Front-Bench team, but—perhaps unusually—I can also support the beginning of the Government's amendment.

Like my hon. Friend the Member for South Cambridgeshire (Mr. Lansley)—to be fair, I must add that the Secretary of State expressed the same sentiments in his opening remarks—I fully support and admire the people who work in the NHS. Without all the doctors, nurses, consultants and ancillary workers—who too often are not mentioned—we would not have a national health service. They are there, day in and day out, often without much praise or notice, delivering health care to our constituents and to ourselves.

In my brief comments I shall discuss accident and emergency services, which all too often work under tremendous stress and strain. For many members of the population, that is the first point of contact with the local hospital. The problems that A and E services face have been exacerbated—certainly in my area, mid-Essex—by the dramatic increase in the number of people turning up or being admitted to A and E as a result of drug or alcohol-related abuse. That is a growing problem.

The Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), who is on the Front Bench now, answered a written question from me yesterday. His reply showed that in 2002-03 there were just over 2,500 admissions to Broomfield hospital in Chelmsford as a result of drug or alcohol-related problems. By 2005-06 that had increased to just over 4,000 episodes. Fortunately, the next year, 2006-07—the last year for which figures are available—the level had marginally dropped to just under 4,000, but the figures show the dramatic increase in that problem, arising from the increased incidence of binge drinking and irresponsible drinking and behaviour in our town centres. The problem is spreading to our rural areas as a result of abuse, a misunderstanding of the dangers of alcohol consumption, and the failure to adopt a responsible and mature attitude towards it.

The knock-on effect is the strain that that puts on A and E staff, not only because of the medical problems emanating from the abuse that brings people to A and E, but sadly, because of the behaviour of some of the patients resulting from the state of mind that they are in. If someone has been brought into A and E by friends who have been out with them, the friends, too, may be suffering the effects of alcohol abuse, which exacerbates the problem and the way in which they interrelate with staff. The patience and the behaviour of such people are not as they would be if they were sober. That is unacceptable and needs to be addressed more strenuously than it is at present, although I accept that most hospitals are adopting zero tolerance of bad and antisocial behaviour.

A similar problem, although it does not arise directly from alcohol abuse, is violent and aggressive behaviour towards staff. It is incredible that people whose entire raison d'être and work is to relieve pain, remedy sickness and reduce the suffering that results from illness should be verbally or physically abused for their pains. It is a sad reflection of the society in which we live.

Mr. Lansley: My hon. Friend raises an important point. He will know, as I do from spending Friday and Saturday evenings with accident and emergency department staff, how difficult that can be for them. Things should not be that way. Will he join me in commending the action taken by, for example, the Queen's medical centre in Nottingham? Instead of sitting in the accident and emergency department waiting for cases to be brought to them, often causing considerable trouble in the department for other people attending and needing care, A and E staff go out and set up field hospitals in the centre of Nottingham, to take care to the place where trouble is predicted. That does not mean that they want trouble, but it shows that they are thinking proactively about how to manage care more effectively. There is the additional benefit that large numbers of ambulances are not tied up in the course of an evening.

Mr. Burns: I am extremely grateful to my hon. Friend for an important and interesting example of a proactive service. The NHS in other parts of the country should look at the experience in Nottingham to see whether they could learn and benefit from setting up a proactive service themselves. I strongly believe that there is a positive future role for A and E departments throughout the country to learn from that experience and seek to replicate it. As with preventive medicine, it is important for the health service to be proactive. In the longer term that pays handsome dividends.

Mr. Nicholas Soames (Mid-Sussex) (Con): Will my hon. Friend confirm that the increased workload comes on top of substantial increases in the workload caused by respiratory infections in elderly people, flu and the norovirus, which have placed an immense added responsibility on accident and emergency departments? By and large they have coped magnificently.

Mr. Burns: My hon. Friend is right. He highlights another problem that has developed in the health service. It was always assumed that the pressure points of increased activity occurred in the winter months when it was coldest or iciest. In the past few years we have seen that those pressure points in the NHS are no longer restricted to the traditional winter months when the weather is particularly bad. In my local hospital, Broomfield, the pressure was worse in June last year than it had been in the worst winter month. The health service has had to adapt to changing circumstances, and the old accepted problems of winter pressures are being extended, for other reasons, to other months, putting extra pressure on resources and staff.

There is a further issue facing accident and emergency services which it might not be tactful to discuss. The NHS must be tough and not only accept that there is a problem, but be brave enough to try to do something about it. Sadly, part of the population go to accident and emergency for treatment as a first resort, when their complaint is in no way related to an accident or emergency. A and E should not be their first port of call. They should use NHS Direct or contact their GP or, in some cases, their pharmacist. If people misdiagnose themselves and misdirect themselves to A and E for treatment, that puts excessive demands on the health service and on other patients waiting for A and E treatment, who may have far more serious complaints or conditions that warrant their being there in the first place. More must be done to educate people and to explain why they should not trot along to A and E simply because it is more convenient for them.

On the four-hour waiting time limit, four hours may be a relatively short time compared to the length of time that some people had to wait in the past, but it is still quite a long time to hang around waiting. For someone who goes to A and E with a medical complaint that is acutely painful, even if it is not as medically serious as the pain that the individual is suffering, four hours can seem a very long time. My A and E at Broomfield reflects the situation nationally. We have seen a significant increase in the number of people attending A and E in recent years. In the year up to December 2007 there were 5,469 attendances at A and E. The next year, ending December 2008, the figure was up to 5,783. The target that 98 per cent. of people should wait less than four hours is being met in my A and E department. The latest figures for 2007-08 show that it achieved 98.3 per cent. I accept that that is of little comfort to the 1.7 per cent. who are not included in those figures.

Mr. Lansley: I am sorry to interrupt my hon. Friend, who is making an important point, but it might be of interest to him and to the House to know that the NHS information centre this morning published an analysis of the data from hospital episode statistics, which shows that 4.1 per cent. of people who attended A and E departments had a recorded time for arrival but no recorded time for departure. That is the equivalent of more than half a million patients a year who appear simply to drop out of the statistics. That is quite separate from the point about 98 per cent.

Mr. Burns: Very much so. It would be interesting to hear what the Minister has to say about that. There is another discrepancy, in that the figure that I have given for my local hospital for the meeting of the four-hour target, except for those 1.7 per cent., looks encouraging because it is slightly above what it should be, but the Healthcare Commission recently published a survey of visitors to A and E at that hospital showing that patients' perception of the service varies radically, and, sadly, it is in the bottom 20 per cent. for patient satisfaction. The trust accepts that it is disappointed by the results and says that it is seeking to improve what it calls the patient experience as a top priority. That is important, because it means that the trust recognises that there is a perception with users that it is not as good as it should be.

Mr. Lansley: My hon. Friend is being generous in giving way. It is important for us to understand exactly what is going on. The Healthcare Commission found that only 73 per cent. of people who attended A and E departments reported that they were seen and treated within four hours. It surmises that a significant number of people are being put into admission units or medical assessment units, and because those are attached to A and E they believe that they are still in A and E, whereas from the hospital's point of view the clock has stopped ticking.

Mr. Burns: Absolutely. I wrote to the Minister only yesterday because I have been sent a series of allegations about what happens in A and E, and I would be grateful if he would look into them.

The point is that we must move forwards. We must ensure that there are improvements so that patients not only receive the best treatment possible, which I have no doubt that they do get at my hospital, but that the waiting time is short and the triage is swift, and that they are dealt with sympathetically and treated as quickly as possible. I welcome the fact that, as a result of the Healthcare Commission survey and the trust itself examining what goes on and what should and must be done to improve the situation, the trust has been prepared to recognise that improvements need to be made and is taking initiatives.

For example, by the end of next month a major refurbishment of the physical site of the A and E will have been completed—an important and positive step forward. On some days a GP now works alongside the A and E team to help with patients with minor injuries and ensure that they are referred to the relevant professionals. New shift patterns have been introduced for the nursing staff to seek improvements, and a new triage system has been introduced to identify major and minor patients and ensure that they are treated more quickly within the department. A fourth A and E consultant has been recruited, and a new general manager has been appointed to oversee the work of that department.

I welcome all those initiatives. They are a positive step forward. I have no doubt that we can work together with the sole aim of improving the quality of care and the quality of the experience that patients have at A and E. Most of them are not there for the wrong reasons, but because they are in pain and probably frightened or confused because they do not know what is wrong with them, and need assistance. That is why it is so important that we ensure that we have an A and E service in our local communities that is second to none, and meets the requirements of all of our constituents.