Mike Penning (Hemel Hempstead) (Con): It is a pleasure to respond to the debate on behalf of Her Majesty’s Opposition on such an important subject, which affects all our constituents and the whole country.
I pay tribute to all staff in the NHS, whether in the emergency or primary care sectors. They do a wonderful job and we should praise them at every opportunity. I also take the opportunity, following my recent visit with other parliamentarians to Afghanistan, to praise NHS staff serving in the Territorial Army, especially in the emergency centres and triage centres in places such as Camp Bastion, which could not survive without the NHS contribution to our armed services. Their work there is simply fantastic.
We are in a sad predicament. At one stage, when I looked at the Government Benches, I thought I was in an Adjournment debate. Only one Labour Back Bencher made a speech on the NHS. Remember 1997 and “24 hours to save the NHS”? Yet the Government Benches could not be filled for such an important debate. Only one Labour Back Bencher, who is desperate to save her seat, contributed. If she returns, I shall consider her speech shortly.
Let me consider the Secretary of State’s opening remarks. I want especially to deal with urgent care. It worried me that the right hon. Gentleman appeared to refer to another review, which may happen sometime in future, into urgent care, especially a second emergency number. In looking at my notes, it was interesting to remember that the Government promised us a framework for urgent care three years ago, in 2006. Six months later, Lord Warner promised a strategy by the end of the year. In the first half of 2007, the right hon. Member for Doncaster, Central (Ms Winterton) promised that we would have an answer about the secondary number. Again in 2007, Lord Darzi mentioned it in his reports. Now, in early 2009, the Secretary of State mentions it again. We do not need it to be mentioned; we need action.
This morning, Ofcom stated in its parliamentary briefing that it would conduct an immediate review—I hope that the Secretary of State is aware of today’s announcement—and that it will look into the numbers that are available as well as 999. I will deal later with some of the comments about whether we need a second number or whether everything can be done through using 999.
Ofcom has specifically said that it would be inappropriate to use 888. Most people understand that, especially those who live in London. Anyone in the area covered by the 7 code who had to dial 8 could end up dialling 888 inappropriately. However, Ofcom has suggested that it would be possible to use not only the 116 116 numbers, with the permission of our European friends, but triple numbers from 102 to 119, including 117. Myriad numbers are available should the Government wish to proceed. Ofcom is on board. We have been calling for the change for two and a half years. It is imperative that the public have a simple way of accessing urgent care, not myriad different services all the way through.
We have heard many contributions today, mostly from the Benches behind me, and it is important that we consider some of them. The Liberal Democrat spokesman, the hon. Member for Romsey (Sandra Gidley), talked about 116 numbers, but she was slightly confused when she said that she did not want the public to go through an operator system. That is not what is proposed. Most of the ambulance trusts operate a system similar to what is proposed already. My concern is duplication. We do not have unlimited cash in the NHS. We cannot have the public confused with different numbers; nor can we have the cost of different services by different agencies.
There was also some confusion when the hon. Lady responded to the interventions that my hon. Friend the Member for West Chelmsford (Mr. Burns) made on her. The ambulance service is a complex system and we need to try to understand how it operates. I ask the hon. Lady to go to one of the ambulance trusts and to sit there while staff are doing a triage call, because it is fascinating. The minute a call comes in, staff are dispatched, based on the location of the call. They would much rather turn back an ambulance or downgrade a call than worry that they were not getting people there.
There is a concern about the eight-minute call, which means that staff need to get someone there within eight minutes 75 per cent. of the time. We understand that. What cannot happen, but what is happening—this has followed the amalgamation of the ambulance trusts, although I do not think that it was intentional—is that, because the number of responses getting there in time is grouped, if an ambulance trust has an urban and a rural part, which most do, it can have an attendance rate of almost 100 per cent. in time in the urban part, but almost zero in the rural part. I am sure that that is the point that the hon. Lady was trying to make.
Sandra Gidley: Will the hon. Gentleman give way?
Mike Penning: No, I have to stick to my time; that is the problem with this sort of debate. The point is that the issue of the 116 number could be addressed almost immediately.
I am really disappointed that the right hon. Member for Enfield, North (Joan Ryan) is not in her place. She made a contribution of nearly 15 minutes, in which her position on the future of Chase Farm hospital flip-flopped. In the consultation on Chase Farm she opted for option 1, which is to downgrade the Chase Farm A and E facilities. That was her position then. Her position today is that she is fighting to keep all the facilities at Chase Farm. The right hon. Lady cannot have her cake and eat it. Either she is for her Government, who are willing to close the A and E department at Chase Farm, or she is not. It will be this Government who will close the A and E departments at Chase Farm hospital, at Welwyn Hatfield hospital and, yes, at Hemel Hempstead hospital. That is something that I go on and on about, and I am very proud to do so. The reason why I go on about it so hard—it is also why my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes) is in his place, unlike the right hon. Member for Enfield, North—is that the community does not want to lose the life-saving facilities that they have now.
The Secretary of State was trying desperately to say that we should take no notice of the experts who say that an urgent care centre—or whatever title we want to use—is not a replacement for an A and E department. The right hon. Lady went on about the myths propagated in her constituency; and interestingly enough, she came up with a myth herself. She should have looked at the report that the College of Emergency Medicine published just before Christmas. The College of Emergency Medicine issued a list of myths, and the right hon. Lady managed to hit the first one. “Myth 1,” the College of Emergency Medicine says, is that
“60 per cent. of patients attending an A&E department could be seen, to the same clinical standards, at less cost, in other settings”— [ Interruption. ]
I understand from my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) that the Secretary of State said the same thing. In fact, the College of Emergency Medicine—I am sure that the Secretary of State would agree that it is an expert—says:
“Between 5 and 10 per cent. of patients attending an Emergency Department...should be treated in primary care”.
We accept that. It continues:
“Another 20 per cent. of patients could be treated in primary care”
settings, but that is it. So the absolute maximum percentage of patients attending an A and E who could—not should—be treated is 30 per cent. The myth propagated by the Secretary of State and by the right hon. Lady is that it was 60 per cent. That, frankly, is wrong.
My hon. Friend the Member for West Chelmsford provided a wealth of experience—not only from his time as a shadow Minister, but as a member of the Health Select Committee before my time on it—and showed us just what could be done if we engage with the hospital in the local community. The information that he put forward was absolutely vital. I completely agree with him that many of the problems of emergency departments are to do with alcohol and alcohol abuse, and I agree with him about the assaults and abuse that NHS hospital staff have to take. The Government could do something about that tomorrow—and the Secretary of State could do something about it tomorrow. Why are only one in 1,000 assaults on our brave and professional emergency staff prosecuted? Perhaps the Secretary of State or his ministerial colleague would like to intervene to explain why our staff are assaulted on a daily basis, yet prosecutions do not take place. The right hon. Gentleman said at the start of his speech that he was dedicated to the staff and he praised them, so why are we not protecting them? My hon. Friend raised a very important issue.
Bob Spink: Will the hon. Gentleman give way?
Mike Penning: I said no to the Government side, so I am saying no to this side— [Interruption.] Believe me, I meant that I am not giving way to anyone on any side.
Bob Spink: Conservative Front Benchers intervened five times, so the hon. Gentleman should give way—
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. We do not want sedentary comments from any part of the House, as they do not help the debate.
Mike Penning: Thank you, Mr. Deputy Speaker.
My hon. Friend the Member for West Chelmsford and others raised the issue of getting ambulances to A and E departments and then getting the patients from the ambulance into them. That is a crucial issue. Many clinicians at hospitals have said that they sometimes end up looking at the clock rather than treating patients because they are so worried about the four-hour limit. We have proposed to abolish it and we look forward to seeing it go.
The hon. Member for Wyre Forest (Dr. Taylor) has campaigned on these issues for many years and has a vast knowledge to draw on. He spoke about duplication in respect of NHS Direct and other services, which I alluded to earlier. I am not sure whether the hon. Gentleman is aware of it, but his own ambulance trust, which I understand is the Great Western—
Dr. Richard Taylor indicated dissent.
Mike Penning: I apologise, I was informed that it was the Great Western trust.
Dr. Taylor: It is the West Midlands Ambulance Service NHS Trust.
Mike Penning: I stand corrected. This is fantastic: the Great Western trust is being looked after by the West Midlands trust, because the Great Western could not look after the situation itself; as its results were so poor, Anthony Marsh, the chief executive of the West Midlands trust, has gone across to help it. Let us hope that the situation improves.
The hon. Member for Wyre Forest also spoke about a very sad case of a young boy who died in his constituency. I am sure that all our thoughts and prayers are with the family. It is so difficult when that sort of things happens in our constituencies, as it does every now and again.
People needed the help of the NHS; sadly, they were let down. We look forward to seeing the results of the inquiry.
My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) never ceases to amaze me with her depth of knowledge. She worked in this sector and took a huge interest in health issues while she was there. Many of us may have worked in different areas of different industries over the years, but we have not absorbed to the same extent as her an understanding of where the problems lie. My thoughts were with her as she talked so powerfully about the loss in her family.
I bring my own experience to the subject of what used to be called road traffic accidents—we have changed the language over the years, but I will continue to call them RTAs. When I first joined the fire service, I came in with a paramedic qualification from the armed forces. I was asked to take a first aid course. That is where we were. I sat so often at road traffic accidents and saw how the medics—there were no paramedics in those days—did their very best to keep going the vital signs of people who we were trying to extricate from vehicles. Very often, people died. I had the most appalling experience with a young lady who had a stoved-in chest and was drowning internally; no one had the ability to drain her or keep her airways open. That, thank goodness, has changed.
Although I understand my hon. Friend’s concerns about single responders, I have been present at RTAs that it has been physically impossible for an ambulance to reach—let alone an air ambulance, if one was available. Bikes do get through, however. She is right that they are not a replacement for a two-crewed ambulance, and it is vital that ambulances are dispatched at exactly the same time. I also understand her point about all the different techniques such crews need to have, and that it is better to have six hands than four or even two. Two is better than none, however; I have been at RTAs where there have been none, and it is better to have someone there. I agree that we must make sure that we do not only have single responders, but I do not think that is the situation; I have not met an ambulance trust chief executive who has told me that they have only single responders to RTAs, and I have asked every time. If that were ever brought in, it would be fundamentally wrong, and I am sure the Secretary of State would object to that, too.
However, there is a crisis in the ambulance service involving the difference between paramedics and technicians and what has been described as the wonderful new skilled roadside role of the emergency care assistant. I had in the past understood that in no situation would an ambulance go out without a paramedic or technician on board, but it is now my understanding that at present ambulances are responding to emergencies with under-qualified staff on board and they are invariably called emergency care assistants. That is very worrying. Over the years, we have built up the skills of paramedics. They have increased, not least because of the extra skills they pick up on operations with the military and then take back into the domestic sector. We cannot go the other way, and allow decreased skills. At present, we have paramedics on the one hand and emergency care assistants on the other hand, and something is falling through the middle: the skill base that we would all want.
Let me say a few words about queues outside hospitals. Ambulances queue up and hospitals will not take patients in because they are worried about the four-hour limit. This is no criticism of the West Midlands trust, but let me explain a situation I learned of while visiting Birmingham recently. There were 17 of the trust’s ambulances queued up outside a hospital, and the only way they could be freed up was by putting one of the senior ambulance officers into the porch area of the accident and emergency department so that the ambulance crews handed over patients to her but not to the hospital. If that is what happens in a modern hospital service in the 21st century, something is seriously going wrong. I understand that happens around the country. It is one of the ways that ambulance trusts manage to free up their vehicles and get them back out on the road again; they have to avoid getting their patients into the hospital accident and emergency department because there is concern about the four-hour target.
My new colleague, my hon. Friend the Member for Crewe and Nantwich (Mr. Timpson), raised an important point about how communities feel about responders. Although they are unpaid, I have to emphasise to him that they all need to learn their skills. They need to come out of their basic training; 18 weeks is a short period but it is long enough to get their basic skills together. The key is that skill base as we take them forward. If we just left them with 18 weeks of training, and they went back in the community and never had any further training, that would not be useful. In terms of my hon. Friend’s comments, what particularly worried me is that the critical care they give is key, so excluding them from category A—in other words, saving lives at critical points—is the opposite of what we should be doing. In many respects, their job is to save lives, not just to patch up a fracture or tend to a sprained ankle. It is crucial that we use them with such necessary skills, rather than pushing them off to less important roles. I will take that issue up in my shadow role.
When making notes for winding up this debate, I particularly wanted to talk about the ambulance issue because I knew that my hon. Friend the Member for South Cambridgeshire was going to talk in his opening remarks about the accident and emergency issue. I did not want to talk only about emergency care assistants or the emergency response times. I do not think that the Government intended to happen what is happening when they moved to regional ambulance trusts, but it is happening; if the ambulance trusts were smaller, it would be more difficult for the figures to become skewed between rural and urban.
I covered the way in which the performance targets work—that is a major issue and I hope that the Minister will examine it. The crucial thing when examining the performance of a trust is that we examine the outcomes. He is disagreeing with most things that I am saying, but if he thinks that the accident and emergency facility at Chase Farm should be closed, as is proposed, and that the accident and emergency closures that affect the Welwyn Hatfield area should proceed, or if he wants to continue with the mad closure programmes for the Hemel Hempstead general hospital, he should call an election—he should go to his boss and say, “Let the people decide.” The Secretary of State says that he wants local democracy, so let us have an election and let the people decide.
3.45 pm
| Hansard
