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Opposition Day

[15th Allotted Day]

Accident and Emergency

1.32 pm

Andy Burnham (Leigh) (Lab): I beg to move,

That this House is concerned about recent Government statements on Accident and Emergency (A&E) and Government claims that it is not in crisis; notes that last week, 79 A&Es and the NHS overall missed the Government’s A&E target; further notes that attendances at hospital A&Es have increased three times faster since 2009-10 than in the period from 2004-05 to 2009-10, and that in the last 12 months more than one million people have waited more than four hours; believes there are a range of reasons for the current pressure on Accident and Emergency but that difficulty in accessing GP services is one of the primary causes; regrets the Government’s decision to cut funding for evening and weekend GP opening and scrap the guarantee of a GP appointment within 48 hours; and, to ease the pressure in Accident and Emergency, calls on the Government to reverse for winter 2013 its scrapping of the 48-hour appointment guarantee.

As we approach the end of 2013, it is becoming clear that this has been the worst year in accident and emergency for at least a decade. All year, the pressure has been relentless. It is not just a winter crisis, but a spring, summer and autumn crisis. Across the 12 months, more than 1 million people have waited more than four hours to be seen, which is a threefold increase since 2010. For the past 22 weeks, hospital accident and emergency departments have missed this Government’s target. Last week, the target was missed by the NHS as a whole, which is a warning sign that winter has now arrived and things are getting even worse.

Accident and emergency is the barometer of the whole health and care system. All year, that barometer has been warning us of severe storms ahead, and yet, three weeks ago, the Secretary of State stood at that Dispatch Box and claimed that this was

“a crisis that is not happening”.—[Official Report, 26 November 2013; Vol. 571, c. 155.]

He should try telling that to the families of people left waiting for hours on trolleys in corridors; to the people who have been ferried to hospital in police cars and taxis because ambulances are trapped in queues at accident and emergency; and to the A and E sister who attended our A and E summit here in Parliament last week and said:

“It feels like we’re fire fighting. It’s crisis management.”

David Wright (Telford) (Lab): Is this problem not compounded by the fact that in many places such as Telford and Wrekin and the wider Shropshire area, the future of full A and E services at many hospitals is in doubt? That situation is bad for morale, and it compounds the other problems such as waiting times. People want some reassurance about the future of their A and E services.

Andy Burnham: That is a question for the Secretary of State. How can it make sense to close so many A and E departments in the middle of an A and E crisis? This year, the facts on the ground have changed. As I have said, it has been the worst year for a decade. Any proposal to change A and E in areas such as that of my

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hon. Friend needs to be considered in the light of that new evidence. We need to consider whether it is safe to proceed. As the A and E sister said, it is crisis management. That is the view from the real world. In here, it is a different story. It is, “Crisis, what crisis?”

My purpose in holding this debate is to cut through the spin. I want to bring into our debate today the voices of those A and E nurses, occupational therapists, paramedics, community nurses, and NHS 111 staff and mental health professionals who came to our summit. For instance, there is the paramedic who told us of his worries about ambulance response times getting longer because ambulances are trapped at A and E; and of the time when a patient who was held a long time at the door of a busy A and E suffered a heart attack and had to be rushed back to the ambulance. Another paramedic told us about being at the scene of a serious incident in a city centre. After calling for back-up, he was joined by a private ambulance which did not appear to have adequately trained staff to take patients to hospital. A community nurse spoke of her frustration at spending an hour and a half on the phone trying to get a GP appointment for a frail patient. An A and E-based occupational therapist said that she was now regularly diagnosing dementia for the first time in older patients who had ended up in A and E. Surely we can do better than that.

Grahame M. Morris (Easington) (Lab): My right hon. Friend is giving an excellent argument as to why we are in this crisis. Is it not completely predictable given the response that we have just had on the local government grant settlement? Increased pressures on the system will be felt by old people and in deprived areas.

Andy Burnham: I agree. The Government have made grave mistakes. I warned them—they misquote me every week—that it would be irresponsible to give increases to the NHS, which is what they were promising, if they had to ransack local government, particularly social care budgets, to pay for them. That is a false economy. It means that older people have support withdrawn from the home, and they drift towards A and E in ever greater numbers. That is what is happening today on this Secretary of State’s watch.

Steve Rotheram (Liverpool, Walton) (Lab): Given that we have just heard that Liverpool will face 62% reductions in local government settlements, does my right hon. Friend agree that the obvious consequence will be to put additional pressures on A and E in Liverpool hospitals?

Andy Burnham: The Government are tearing up the social fabric of England’s most deprived city. This is a city in which people struggle to feed their kids and to make ends meet. Council services are utterly crucial in helping people to cope. The Government do not understand, or they do not care, and they just rip up the fabric of an entire city. It is disgraceful.

Caroline Lucas (Brighton, Pavilion) (Green): Does the right hon. Gentleman share my concern about the impact of the fines that are being levied as a result of delays in ambulance handovers? Many hard-working

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staff at the Brighton hospital say they are incredibly demoralising because they punish A and E for a problem that is actually hospital-wide, and it is hospital-wide because of cuts to the national tariff and because of the top-down reorganisation that nobody wants and that is hugely costly.

Andy Burnham: As the hon. Lady says, ambulance services and A and E are often now not working well together. I mentioned the paramedic held at the door, and we are hearing of queues at A and E. What we cannot have are perverse incentives in the system. The Secretary of State needs to look at the issue that she raises.

Several hon. Members rose—

Andy Burnham: I will make some progress because I am conscious that many Members want to speak in both debates.

The picture that emerged from our summit was of a health service on the edge, creaking at the seams, with corners being cut and A and E as the last resort for people failed by other services—people who, in an ideal world, ought not to have been there. We heard of people with severe mental health problems in A and E because of a lack of crisis beds, people with severe dental pain who could not afford treatment, disorientated older people with dementia and, perhaps saddest of all, palliative patients in A and E waiting areas.

It is clear that the cost of living crisis and this Government’s failure to support people through it might also be driving people to A and E. The House is soon to debate the scourge of food poverty that now blights our land. Food banks are growing at an exponential rate. Indeed, we now read that it is Government policy to ask councils to set up more, even though they have just cut the funding of the councils with the most food banks. It is unbelievable. It suggests to me that they expect food poverty to be with us for some time to come and have no real intention of tackling it. People will go on having to choose between eating properly and putting the heating on—[Interruption.] The Secretary of State chunters, but he has no idea what it is like to do that, has he?

People are making other impossible choices that might damage their health. I am told of the growing number of people now taking prescription medicines on an empty stomach because they cannot afford to eat properly. Dr Ellie Cannon, a GP who also writes for The Mail on Sunday, recently tweeted:

“I’m sad to say that at my NHS practice if we have a patient who has unexplained symptoms, we have started asking if they can afford to eat”.

How can that possibly be right in England in 2013? Has the Secretary of State considered reviewing the effect on people’s health of the growing problem of food poverty and has he discussed the effects of benefits policy on people’s health with the Secretary of State for Work and Pensions? If he has not, I suggest that he does so immediately.

Barry Gardiner (Brent North) (Lab): As my right hon. Friend is talking about general practitioners, does he agree that the Government’s failure to honour the guarantee that we gave that people could see a GP within 48 hours means that more and more people are going directly to A and E?

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Andy Burnham: That is the central point of my speech: the removal of the guarantee that patients could get an appointment within two working days. The Government removed it in June 2010 and, as a result, we all hear stories, do we not, of people saying that they are getting up and ringing the surgery at 8 or 9 o’clock in the morning and are being told that there is nothing available for days. That is a result of the Government’s decision to remove the two-day guarantee. That is why people are facing that frustration. I shall explain that in more detail—[Interruption.] Government Members say that the guarantee did not work, but in 2005 nine out of 10 people said that they could get an appointment within two days. Have those Members checked the figures recently? There is falling satisfaction with GP services and it is happening on their watch.

I asked the Secretary of State whether he had spoken to the Work and Pensions Secretary, and he needs to do so urgently. The truth is that pressure has been growing all year on A and E and he has been ignoring the warnings, sticking to his usual line of blaming everyone else. His original line was to blame the 2004 GP contract, but that was undermined by the Chair of the Select Committee on Health and the inconvenient fact that there was no winter crisis in 2005, 2006, 2007, 2008 or, indeed, 2009.

Having seen his original spin dismissed, the Secretary of State changed tack. In a message to NHS staff on 6 December he said:

“Our ageing society has meant 1.2 million more people in A&E every year compared to 3 years ago”.

Finally we have an admission that the pressure has built on his watch, but as ever, it is nothing to do with the Government. It is nothing to do with the break-up of NHS Direct and its replacement with the disastrous NHS 111, nothing to do with the closure of a quarter of NHS walk-in centres, nothing to do with the severe cuts to social care and the removal of home care from vulnerable people, nothing to do with the loss of 6,000 nursing jobs and nothing to do with the reorganisation that no one wanted and no one voted for that threw the entire NHS into chaos just when it needed stability and that has led to precious NHS money being spent on redundancy payments only for those people to be re-employed by new NHS bodies. No, it is now all the fault of the ageing society. You could not make it up, Madam Deputy Speaker.

Ms Margaret Ritchie (South Down) (SDLP): My right hon. Friend is making a compelling case about the problems in accident and emergency. Is he aware that they extend to Northern Ireland? Although devolved arrangements are responsible, we are told that the problems are down to the shortage of doctors, which emanates from Whitehall and the Department of Health. It is no longer a compulsory part of GP training for doctors to do a component in A and E and that is causing a problem.

Andy Burnham: I mentioned the reorganisation, through which we saw the complete disruption of training arrangements in the NHS. The Government’s eye was taken completely off the ball of the growing problem of recruitment, not just of GPs but of A and E doctors. That is a real problem around the country. We now have fewer GPs per 1,000 of population than we had a few years ago, so my hon. Friend is absolutely right to raise that issue.

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The new spin is that the Secretary of State admits that A and E has got worse on the Government’s watch, but it is not his fault and it is not a crisis. That is the public line, at least. In private, it is a different story. This is the Secretary of State who has taken up ringing hospital chief executives who are not meeting their A and E targets. I have heard from two senior sources that the Secretary of State has discussed within government whether Cobra should be convened to discuss the A and E crisis. Can he confirm or deny whether that is the case? I have no way of knowing, but he needs to give a straight answer.

The longer we see the Secretary of State in this job, the more familiar we become with his style: spin before substance. That is the real danger when someone holds a job as important as his. If they use spin to distract people from the real causes of the problems, they end up neglecting those problems and precious time is lost.

Dr Thérèse Coffey (Suffolk Coastal) (Con): I know that the right hon. Gentleman is passionate about the NHS, but he seems to ignore the history. In the last year of the Labour Government, the average wait in A and E was 77 minutes. It is now 33. The Labour-run Welsh NHS has missed every target since 2009. Frankly, I am proud that our Government are putting the patient at the heart of the NHS by tackling the issues in hospitals and in our ambulance services.

Andy Burnham: Last week, the NHS missed its A and E target—the hon. Lady’s A and E target—which is a lowered target. If she is going to maintain that complacency through the winter, I suggest that it might well backfire on her.

Mr Gareth Thomas (Harrow West) (Lab/Co-op): My right hon. Friend’s description of rising waiting times in A and E and ambulances queuing outside A and E will be recognisable to my constituents who use Northwick Park hospital. What is his view of the Government’s proposed new funding formula, which, I hear, might mean that £20 million will be cut from Harrow’s NHS budget?

Andy Burnham: Since the change of Government, the previous Secretary of State and this one have talked about a formula based predominantly on need, not deprivation. The worrying thing about that is that it means that we have a formula based on the use of NHS services as opposed to the need to improve health. NHS England has been debating that issue this week and I hope that it has taken heed of what has been said in this House, because to do this to the NHS alongside the local government cuts mentioned by my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) will be catastrophic for the communities in this country with the greatest need.

Mr David Lammy (Tottenham) (Lab): Does my right hon. Friend recognise the perversity of our having a debate about airport expansion, with the London population rising to 10 million, while at the same time closing A and Es in west London, experiencing problems at St Helier in south London, closing Chase Farm and making changes in the east? Does that make sense with a rising population? Will it not lead to chaos?

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Andy Burnham: The Secretary of State really needs to answer for the cuts to London’s A and E departments, particularly at a time of unprecedented pressure, and for the desire to bring forward closures supported by a financial case, rather than a clinical one, as in Lewisham.

I want to set the record straight about the 2004 contract and dismiss the myths that have been put about. The fact is that it gave the public much quicker and more convenient access to GPs and relieved the pressure on A and E. Let me explain the changes it made. First, it created the ability to add an incentive to allow patients to book an appointment several days ahead. Members might recall Tony Blair being challenged on that very point during a live TV debate before the 2005 general election. As a result, he brought forward a new measure to give people that ability to plan ahead. Secondly, it created incentives for GPs to offer evening and weekend opening. Thirdly, it allowed the previous Government to offer people a new guarantee of a GP appointment within two working days. And it worked. In 1997 only half of patients could get an appointment within 48 hours, but by 2005 nine out of 10 patients could do so. As a result, A and E was performing much better than it had been in 1997.

What has happened since? This Government have scrapped all those measures to improve patient access and convenience. They removed the right set out in the NHS constitution to an appointment within two days, stating that it was no longer a priority. It might not be a priority for them, but let me tell them that it remains a high priority for my constituents and those of my hon. Friends. This is the simple truth that they do not like to admit: it has got harder to get a GP appointment under this Prime Minister and this Government. People who call their surgery early in the morning only to be told that nothing is available now know why.

There are now 854 fewer GP practices in England offering evening and weekend openings than there were in July 2009. The Patients Association has found that six out of 10 people said they could not see a GP for at least two days and four out of 10 said they could not book an appointment for at least two days in advance. All that is leading to some people turning straight to A and E and others getting sicker while they wait and then arriving in A and E as a more serious case.

The Government have tried to blame GPs for the problem, but that is unfair, because this Government have cut the funding for general practice, cut the funding for delivering better patient access and convenience and, I have already said, cut the number of GPs per thousand of the population. The analysis could not be clearer. The question is where do we go from here.

The House has got used to the Secretary of State’s stock speech, which takes no responsibility for what is happening now in the NHS and seeks to blame the previous Government for everything that is going wrong. Well I have news for him: that will not work today. A and E is getting worse on his watch. He has presided over the worst year in A and E for a decade. People need an honest assessment of the situation, and of the urgency and the NHS’s ability to cope this winter. Does he accept that there is a crisis in A and E? He has gone quiet, but we will hear from him in a moment. Or does he still maintain that it is not happening? We need to know.

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With January just around the corner, people want practical answers to straight questions and some proposals to make things better. First, will he consider making urgent changes to NHS 111 and putting nurses and clinicians back on the other end of the phone line? Evidence from across the NHS tells us that the cut-price model of call handlers with computer algorithms simply does not work. Too often the computer says, “Call an ambulance or go to A and E.” The sensible change back to an NHS Direct-style system was recommended by Sir Bruce Keogh in his report and should be made right now ahead of the winter.

Secondly—this is the centrepiece of what I want to say today—given the evidence to show that the 48-hour guarantee worked to divert people from A and E, there is a clear case for reintroducing it this winter. It is true that GPs might not be so keen on it, but it was valued by patients, and that is the most important thing. The Secretary of State needs to listen to what people are saying about their difficulties in getting an appointment in office hours, not in out-of-office hours. He must do something to address that. Will he divert some of the funding that he has made available to meet A and E pressures to that purpose, or indeed will he reclaim some of the funding he has handed back to the Treasury? It is so important that people can get appointments when they need them.

Those are two practical suggestions that I hope the Government will consider and accept. If the Secretary of State will not accept them, he needs to put forward other suggestions of his own to help people get access to good advice via a GP or over the phone and to avoid A and E this winter. If he refuses to do that, is he really saying that everything possible has been done to ensure that things do not get worse in the months ahead?

In conclusion, the NHS today stands on the brink of its most dangerous winter in years. It is a serious situation and people are looking for straight answers from the Secretary of State. It has got harder to get a GP appointment on his watch and people want to know what he is going to do about it. A and E is getting worse and worse on his watch and people want to know how he plans to turn things around and ensure that all A and E departments and ambulance services can get safely through the winter. He now needs to put away his stock speech, cut the spin and get a grip, and fast.

1.55 pm

The Secretary of State for Health (Mr Jeremy Hunt): What we have heard today is a deeply unconvincing attempt by the Opposition to turn A and E into a political football. As a former Health Secretary who missed his own target for 14 of the 26 weeks that covered winter, the shadow Secretary of State should know better than to run down the phenomenal achievements of hard-working NHS staff at this busy time of year.

The right hon. Gentleman threw out numerous statistics—[Interruption.] He asked me to give him some answers, so he should just listen. He threw out numerous statistics, but let us look at the facts he chose not to mention. First, given that A and E departments across the United Kingdom face similar demographic challenges and have similar structures and targets, a comparison with Wales is instructive, not least because,

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with a Labour-run Government, it is following policies that are closer to those that he favours. The most recent full-month data available for both countries show that England hit the target, with 95.7%, but Wales missed it, with 90.4 %. Last year, England hit the target, with 95.9%, but Wales missed it, with 87.7%. In fact, Wales has missed it every single year since 2009. He also talked about ambulance times. In October, the figure for England was 74.6%, and for Wales 65.2%.

The right hon. Gentleman used some strong language. He talked about complacency and crisis. Will he now demonstrate that those comments were not shallow point scoring by making the same criticisms of Labour in Wales? If not, the House will see those comments for what they are: a hollow attempt to turn an operational challenge—one that he faced, that I face, and indeed that all Health Secretaries face—into a political argument regardless of the impact on patients or staff. Vulnerable people are relying on our emergency services this winter, so to whip up fear and run down performance, as he has done, is frankly shameful. It is putting politics before patients, and not for the first time from the Opposition Benches.

If the right hon. Gentleman does not want to talk about Wales—[Interruption.] I will move on to that later. If he does not want to talk about Wales, let us look more closely at England. Again, the statistics he did not want to share with the House show that NHS A and E departments are actually performing much better than when he was Health Secretary.

Guy Opperman (Hexham) (Con): Does the Secretary of State welcome the example being shown by the award-winning Northumbria NHS Trust, which is building a brand-new specialist emergency care hospital in these difficult times, offering 24-hour cover seven days a week with consultants? That idea preceded the Keogh review and shows the way forward that A and E should be taking.

Mr Hunt: My hon. Friend is absolutely right. Huge progress is being made on the ground to deal with the challenges, and under a lot of pressure, and that is why we need to use language responsibly, rather than using the kind of hyperbole we have heard this afternoon.

Grahame M. Morris: If the Government are doing so well in relation to targets, why have they downgraded the four-hour waiting target from 98% to 95%?

Mr Hunt: I will tell the hon. Gentleman why. It was done on clinical advice, for the good reason that there are some patients whom it is better to see, even if it takes longer than four hours, so that they can be discharged and sent home, rather than admitting them to the hospital, which is what was happening under the 98% target. Labour agrees with that, because it is following the same procedure in Wales.

David Wright: Will the Secretary of State give way?

Mr Hunt: I am going to make some progress.

I want to talk about what is happening in England, because the right hon. Gentleman wanted to know the truth. These are the statistics he did not want to tell the House about the comparison with his time in power,

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which he said was so good: 1.2 million more people are going through A and E every year, and more than 2,000 are being seen within four hours every single day, compared with when he was Health Secretary. The average wait to be seen is now 33 minutes compared with 77 minutes when he was Health Secretary—that is 44 more minutes longer, on average, to be seen under Labour than under this Government. For treatment, the average wait is now 75 minutes compared with 102 minutes when he was in office.

Andy Burnham: Will the Secretary of State give a straight answer to this simple question: is there or is there not a crisis in A and E?

Mr Hunt: I refer the right hon. Gentleman to the people who know about this at the College of Emergency Medicine, which says today on its website:

“There is now cause for optimism that the crisis is behind us.”

He should listen to that before whipping up fears of a crisis that the College of Emergency Medicine says is not happening.

Several hon. Members rose

Mr Hunt: I am going to make some progress and then I will give way.

There are 216 more consultants and 111 more registrars than during Labour’s time. On ambulance performance, frankly the right hon. Gentleman should be ashamed, because his whipping up of the problem so appalled the ambulance service that he received a letter from the chief executive of the south-western ambulance service, who said about his comments in the House of Commons:

“It is both disappointing and concerning that the information provided to your office has been misinterpreted and misreported in order to present a grossly inaccurate picture for the purposes of apparent political gain...I am astonished that anyone would present such misleading information to the House of Commons.”

Something else that the right hon. Gentleman did not want to tell the House regarding delays is that there has been a 28% fall in the number of 30-minute handover delays compared with the same period last year—that magically did not make it into his speech. Yes, ambulance services are under pressure; yes, there are issues with the performance of some trusts; and yes, this is a busy winter, but the one thing they and the patients they serve can do without is Opposition politicians demotivating crews by misrepresenting the reality on the ground.

Kate Green (Stretford and Urmston) (Lab): Patients in Trafford will not recognise the Secretary of State’s characterisation of this as a crisis that is in the past. They are reporting long delays at Wythenshawe hospital’s and Manchester Royal infirmary’s A and E departments, particularly, as he will know, because Trafford general hospital’s A and E was downgraded to an urgent care centre and now closes overnight, as of three weeks ago. Does he agree that during transition periods for such reconfigurations it would make sense to ensure that there were adequate resources for neighbouring A and Es to take on the new patients? Those resources have not been provided to these hospitals; will he guarantee to provide them now?

Mr Hunt: I recognise the hon. Lady’s concern for her constituents. I have looked into the issues in the Manchester and Trafford areas very carefully, and I am assured by

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people on the ground that the problems and challenges they face do not relate to the changes that have been announced in Trafford.

David Wright rose

Mike Gapes (Ilford South) (Lab/Co-op) rose

Mr Hunt: I am going to make some progress.

Lorely Burt (Solihull) (LD) rose

Mr Hunt: First, I want to give way to my hon. Friend.

Lorely Burt: We have had a very successful campaign in Solihull to restore two-member-crew ambulances being based in the constituency. However, they still face a big problem with admittance to Heartlands hospital to discharge their patients so that they can get out on the road and back to Solihull again. Can the Secretary of State suggest how the ambulance service could work in a joined-up way with hospitals in order to improve flow-through?

Mr Hunt: My hon. Friend raises an important point. Again, we would not hear this from the Opposition spokesman, but ambulance services across the country are making great strides. For example, in the past year there has been a 10% increase in the number of patients that ambulance services do not take to A and Es, and an 8% increase in the number of patients that ambulance services and paramedics are able to treat and discharge on the spot. Those kinds of things can make a huge difference.

Mike Gapes rose

Mr Hunt: I am going to make some progress.

I want to move on to what we have been doing. As I said, every Health Secretary deals with difficult winters in the NHS. However, this year is different because we have taken unprecedented steps to relieve the pressure in the short and the long term. For this winter, we have distributed more financial help—£400 million in total—than ever before. So far, that money has paid for 2,900 additional staff, 1,100 more hospital beds, and 1,200 more community beds. It has also paid for additional support for ambulance services and 111 centres. We distributed that money earlier than ever before. [Interruption.] The hon. Member for Copeland (Mr Reed) says that we should not have cut the money in the first place. We did not—we protected and increased the NHS budget, which the shadow Health Secretary still wants to cut, as he reaffirmed today and on Monday. We distributed the money in August, earlier than ever before. We extended the winter flu campaign to two and three-year-olds. Patients who require emergency treatment this winter can be assured that they are getting high-quality and speedy care despite the pressure that we all recognise A and E departments are under.

We have gone further. This year, we have started to tackle the root causes of the long-term pressures in A and E, which are the result of the ageing population, yes, but also, sadly, the disastrous mistakes made by the previous Government, including the 2004 GP contract changes and the 48-hour GP appointment target that did not work.

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Mike Gapes rose

Barbara Keeley (Worsley and Eccles South) (Lab) rose

Mr Hunt: I want to make some progress on this because it was the central point of the shadow Health Secretary’s speech. The reason the 48-hour target was scrapped is very simple: access was getting worse, not better, under that target. On the right hon. Gentleman’s watch, the proportion of people getting an appointment within two days fell, while 25% of people who wanted an appointment more than two days ahead could not get one. They would call wanting an appointment for the following week and be told, “You can only get an appointment by calling less than 48 hours in advance.” But do not take it from me. This morning—

Mr Jamie Reed (Copeland) (Lab): Nobody takes it from you.

Mr Hunt: Well, the hon. Gentleman should listen to the Royal College of General Practitioners if he does not want to take it from me. This morning, its chair, Dr Maureen Baker, said that Labour’s

“proposal to bring back the 48-hour target for GPs is an ill-thought out, knee-jerk response to a long-term problem.”

Unlike Labour, we listen and act when doctors tell us that Government targets are harming patient care.

Siobhain McDonagh (Mitcham and Morden) (Lab): If the right hon. Gentleman feels that scrapping the 48-hour rule for GP appointments was wrong, what would he say to my constituent Mr C, who has e-mailed me today imploring me to get an appointment with his GP because his wife needs a new prescription for her blood pressure drugs and he has spent the past 48 hours on the phone attempting to gain one? How could he help my constituent?

Mr Hunt: I would urge him to urge his own MP to back this Government’s initiative to introduce seven-day GP surgery opening in pilots in every single region of the country, and to back plans like those in north-west London, where seven-day GP opening has been introduced—for which we have not had support from Labour.

Guy Opperman: Does the Secretary of State agree that prevention is the most important thing to alleviate A and E pressure, and that the simplest thing we can do is to encourage the populations in all our constituencies to take up the flu jab, which will prevent a large number of people going to A and E?

Mr Hunt: My hon. Friend is absolutely right. This year we have extended flu jabs to two and three-year-olds because we think that prevention is better than cure.

We have been looking at other causes of the long-term pressure on A and E, such as Labour’s 2004 GP contract. The right hon. Gentleman spent the past year telling this House that that contract, which scrapped named GPs, has nothing to do with the problems in A and E. This is despite what nearly every A and E department in the country is talking about—namely, the pressure being caused by poor primary care alternatives, particularly for the frail elderly. What did he tell Sarah Montague on the “Today” programme when we reversed that GP contract and brought back named GPs for the over-75s?

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He conceded to her, as he never has in this House, that our changes which reversed that contract would help A and E, so he is finally accepting on the radio what he does not accept in this House and what A and E staff have been saying for months—that having someone in the community responsible for frail elderly will help.

Mike Gapes rose

Clive Efford (Eltham) (Lab) rose

Mr Hunt: I am going to make some progress.

Our plans go much further than simply reversing the 2004 contract. GPs will offer the most vulnerable guaranteed same-day telephone consultations, which never happened under Labour. There will be a dedicated telephone line so that A and E doctors, ambulance paramedics and others can get advice from GPs about treatment in urgent situations. GPs will co-ordinate care for elderly patients discharged from A and E to try to ensure they get proper wrap-around care to minimise the chance of needing to go back.

We have done something else that the right hon. Member for Leigh never did to tackle long-term pressure on A and E. One of the biggest problems has been not being able to discharge people from hospital because of poor links between the health and social care systems. Through our £3.8 billion better care fund, this Government are doing something that Labour talked about a lot but never actually delivered: we are merging the health and social care systems. Gone will be people being pushed from pillar to post, because in order to access this fund, clinical commissioning groups and local authorities will have to commit to joint commissioning and joint provision.

Finally, we have looked at the long-term structure of A and E. The previous Government were battered by a succession of failed reconfigurations. We, too, have had challenges over decisions, such as those with regard to Lewisham. Sir Bruce Keogh’s recent review of urgent and emergency care has changed the terms of this debate by setting out a 21st-centruy vision of emergency care. Sir Bruce rightly said there should be more extensive services outside hospital, and this, too, will help to reduce A and E queues. He rightly said that while the number of A and Es is not expected to change, the services offered by all of them should not be identical if we are to maximise the number of lives saved. Our duty to patients is to make that a reality and we will not hesitate to drive that vision forward.

A and E and the ambulance services are performing well under unprecedented pressure. I cannot speak highly enough of the hard-working staff who are working around the clock to deliver vital services. They share our overriding commitment to putting patients first this winter. Unlike Labour Members, we do not seek to turn a tough winter into a political football. If they want to make the comparison between our record and theirs, we are happy to do so: more people being seen within four hours, shorter waiting times, and long-term problems being tackled—not posturing from the Opposition, but action from the Government, and a commitment to do what it takes to support hard-working front-line staff over Christmas. We should get behind them and not undermine their efforts.

Mike Gapes: On a point of order, Madam Deputy Speaker. This information was embargoed until two o’clock today, but following an investigation the Care

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Quality Commission has put King George hospital Ilford and Queen’s hospital Romford into special measures. I tried several times to intervene on the Secretary of State in order to raise the matter, but he refused to take an intervention from me. I therefore seek your advice: how can I draw attention to the matter and the fact that the previous Secretary of State said that King George’s A and E department would close within two years? That is clearly not happening. There is chaos in my local A and Es, yet the Secretary of State did not let me intervene.

Madam Deputy Speaker (Dawn Primarolo): Mr Gapes, in terms of getting your argument on the record, you have just done so, although it was not a point of order, as I think you know. As you are fully aware, it is up to the Secretary of State, or any Member of this House, whether they give way to another Member or not. I am sure you will find ways to pursue this matter over the minutes, hours, days and months ahead.

I inform Members that there is a five-minute time limit on all Back-Bench contributions in order to ensure that as many Members as possible can participate in the debate.

2.13 pm

Siobhain McDonagh (Mitcham and Morden) (Lab): The public look with incredulity at many issues relating to the Government and public services, but highest on the list is the proposal to close A and Es in our NHS when demand for them is becoming greater and stronger.

St Helier hospital in my constituency has asked for evidence and proof of why its A and E department—which sees 90,000 people a year, meets its four-hour target and has a great safety record—should be closed. We are told by the medical establishment that it will be much better for everyone and that primary care will take up the slack. At no point are the public told—I am sure this is also true of other reconfigurations—where their care will be provided, which GP practices will stay open for longer and which extra services will be available. The public, therefore, are being asked to make a leap of faith and lose their A and E, which they know is there for them in times of desperation and need, in favour of wishful thinking that things will be different in the future. The gap between the Government’s credibility and the public is growing.

What evidence do the Secretary of State and the Government have that closing A and E departments that nobody believes to be small will provide better medical services? No research shows that to be the case. All the work done by the university of Sheffield and—I never thought I would say this—The Mail on Sunday in its campaign indicates that wholesale A and E closures, not only in rural areas, but in built-up urban areas such as mine, are not in the best interests of patients, and not just in terms of waiting times, but in terms of outcomes.

We all accept that some specialist services, such as the stroke service, should be concentrated, but there is no evidence to suggest that that needs to happen for what most people go to and A and E for. For those attempting to get a GP appointment in my part of south London, the situation is desperate. I have already referred to an e-mail I received from a constituent only today. It has come to something when constituents are contacting me to ask whether I can get them a GP appointment.

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I challenge the Secretary of State to explain why his holy grail of closing A and Es is a good or wise decision. For as long as those GP services are not available, and for as long as the public do not know which surgery to attend or which services will be provided, they will never accept changes. There must be a presentation of the facts, not just a hope that somehow GPs will do more.

St Helier hospital is supported by everyone in my area—not just those who use it, but those who understand that demand on St George’s and Croydon university hospitals will increase should it close. For everybody, A and E is a safety valve to the NHS—it is there when other services are not—and for as long as that is the case, we need to keep our local A and Es.

2.17 pm

Mr Philip Hollobone (Kettering) (Con): Kettering general hospital will be well known to the Secretary of State, because he was good enough to visit it a year ago to see the excellent service provided by its doctors, nurses and ancillary staff. The hospital has been in existence for 116 years and it is badly needed and much loved. At one time or other, every resident of Kettering has had a member of their family go through the hospital.

The hon. Member for Corby (Andy Sawford), my hon. Friend the Member for Wellingborough (Mr Bone) and I have put our party political differences aside and joined forces to campaign for extra investment for the accident and emergency facility at Kettering general hospital, because it is needed by all of our constituents. We are working as one on the issue. The other good news is that both the hospital trust and the local clinical commissioning groups are working as one on the issue.

I thank the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is not in his place, for meeting all three of us, together with representatives from the hospital and the CCGs, over the summer. He has been good enough to agree to meet us again on 15 January.

All the professionals have come together and agreed that, despite their best efforts and despite following the advice of the Department of Health’s intensive support team to the letter, whichever Government are in power would have to face the fact that the A and E at Kettering is, sadly, not fit for purpose and needs extra capital investment. Their bid to the Department of Health will be for £20 million for Kettering A and E and an extra £3 million to create community hubs—in other words, urgent care centres-plus—in Corby, Kettering and Wellingborough. The three hon. Members, the CCGs and the hospital trust will make a joint bid for that money when we meet the Minister in January.

The challenge the A and E at Kettering general hospital faces is serving one of the fastest growing populations in the country. In the last decade, Kettering’s population growth ranked 31st out of 348 districts around the country and it had the sixth highest increase in the number of households. Few other parts of the country are growing as fast as the Kettering area, which also has an increasingly ageing population.

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The A and E department at Kettering general hospital was constructed in the 1970s for about 25,000 to 30,000 attendances a year. In 2001 attendances had hit 56,000 and that figure is now 85,000. The A and E centre is effectively bursting at the seams, and attendances show absolutely no sign of falling off. Typically, there could be between 170 and 230 attendances a day—the highest has been 260 in a 24-hour period this year.

The professional staff—the clinicians—in the A and E have made multiple operational changes. They have adopted all the best practice ideas provided by the Department’s intensive support team, but the key issue remains the estate, and the only way to solve that problem is an injection of capital investment. With that investment and with the development of community facilities in Corby, Kettering and Wellingborough, the professional clinicians are confident that the A and E department could at long last start hitting its A and E targets. At the moment, it is treating only 89% —well below the 98% target specified by the Government—of patients within a four-hour period.

Mr Peter Bone (Wellingborough) (Con): I apologise for being out of breath, Madam Deputy Speaker, but I just wanted to ask my hon. Friend whether the proposal he is talking about has all-party support in the north of the county?

Madam Deputy Speaker (Dawn Primarolo): Order. Mr Peter Bone has just arrived in the Chamber, but one is normally expected to be in the Chamber for more than just a few seconds so as to hear the debate before intervening. I am sure the hon. Gentleman apologises to the House.

Mr Hollobone: I am very grateful for the intervention from my hon. Friend the Member for Wellingborough because he has many duties to attend to in this House on behalf of his constituents and he has been at the forefront of the campaign to get extra investment into Kettering’s A and E, and also to develop the community hub patient facilities in Corby, Kettering and Wellingborough.

With the £3 million capital expenditure bid going to the Department, one of the options would be for a community hub at the Isebrook hospital, which would help to serve my hon. Friend’s constituents in Wellingborough and, by doing so, would take the pressure off the A and E at Kettering. If we are successful in this cross-party bid, the A and E at Kettering would be transformed into an A and E plus an urgent care centre on the site of Kettering general hospital. It would be a one-stop shop for local patients. The A and E at Kettering has the confidence of local people, but the local population growth means that capital investment is needed more than ever, and we look to the Government to provide that in early January.

Mr Bone: On a point of order, Madam Deputy Speaker. I apologise to the House for the discourtesy shown, but I was very surprised that my hon. Friend the Member for Kettering (Mr Hollobone) was called so early in the debate.

Madam Deputy Speaker (Dawn Primarolo): I do not think that is a point of order, but the House has noted it and we will move on now so we do not waste any more time.

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2.23 pm

Lisa Nandy (Wigan) (Lab): My A and E in Wigan is, like so many others across the country, under significant pressure at present. Earlier this year we saw an unprecedented rise in A and E attendances. That is a result of a series of problems, including the difficulty in getting GP appointments, as outlined eloquently by my right hon. Friend the Member for Leigh (Andy Burnham), but I think the single most significant cause is the cuts that have been made over the past three and a half years to social care. Does the Minister have any idea what those cuts and the unfair distribution of them—my constituency of Wigan has been cut three times more than Windsor— have meant to people in their lives?

I want to say something about the situation of older people. I have been shocked over the past couple of years by what is happening to older people because of the deep and front-loaded cuts to social care, which have left councils with no option but to cut services. Over the last two years we have seen an unprecedented rise in the number of over-90-year-olds coming into my local A and E and others across the country by ambulance.

The Minister of State, Department of Health (Norman Lamb): The hon. Lady talks about the situation in social care and of course I understand that there is real pressure, but will she welcome the fact that in 2012-13 there were 37,473 fewer days lost in delayed discharge due to social care, so in other words social services are doing better now than they were in previous years?

Lisa Nandy: In the very short amount of time that I have got I will simply echo the words of my hon. Friend the Member for Stretford and Urmston (Kate Green) who said to the Secretary of State that she thought people would be staggered by the complacency of Members on the Government Benches and would not recognise the picture they paint, which stands in stark contrast to the lived experiences of my constituents, some of whom are old and vulnerable and deserve so much better than this. Behind the increase in the number of admittances to hospital lies a picture of older people who are living alone at home, worried, lonely and ill.

The Minister’s Government have not caused all of this, but, like my right hon. Friend the Member for Leigh, I have talked about my concern about what has happened in social care and the rise of zero-hours contracts and choosing the lowest bidder over recent years, so, by God, I must also say this: his Government have made the situation so much worse. By the end of next year the budget of my council in Wigan will have been cut by £66 million, and we were told this summer that another 10% is still to come. We have done everything. We have pared that organisation to the bone. The truth is there are no more efficiencies to be had; there are only cuts.

I say this to the Minister as well: this is not just about councils, because what this Government have done, and the Darwinian approach they have taken to the voluntary sector, has severely undermined the capacity of charities to respond to this crisis at the very time when they are needed most. This is the true meaning of the big society.

We are seriously disrupted in Wigan—

Norman Lamb rose

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Lisa Nandy: I will not give way to the Minister because I presume he will be winding up the debate and I hope he will spend the rest of his time listening to Members rather than trying to explain away such an appalling record.

I cannot understand why, despite all the pressures already being put on my A and E by this Government and despite its still being consistently one of the highest performing A and Es across the north-west, we are being disrupted by the Healthier Together programme, which has caused so much anxiety in Wigan.

Grahame M. Morris: Will my hon. Friend give way?

Lisa Nandy: I will give way very briefly to my hon. Friend.

Grahame M. Morris: I want to reinforce that point in relation to Durham county council. I have just been advised that Library figures show that it is facing cuts of £222 million between 2011 and 2017. That must have a huge impact on social care and a consequential impact of increased demand in A and E.

Lisa Nandy: My hon. Friend is absolutely right, as always.

The Healthier Together programme has, at this time, caused huge anxiety across Wigan. In June, documents leaked to my local paper the Wigan Evening Post revealed plans to reclassify hospitals as red and green, with several hospitals downgraded, as my hon. Friend the Member for Stretford and Urmston knows only too well. That prompted real fears across Wigan that it would lose its well-regarded 24-hour A and E. The decision appeared to be based on population, not on the performance of hospitals. In September when I visited the Healthier Together offices in Manchester to explain my concerns with my hon. Friend the Member for Bolton West (Julie Hilling), I was surprised to see, at a time of funding pressures that are causing real pain, how expensive those offices were, situated in the middle of Manchester. Imagine my surprise, Madam Deputy Speaker, when Healthwatch Wigan found through a series of Freedom of Information Act requests that the total cost of the Healthier Together programme in Greater Manchester to date has been £3 million, with £1.3 million of that spent on third-party organisations. The NHS would not reveal who or what that money was spent on. To date, the programme could, in total, have paid for 90 new nurses, 20 A and E doctors or 9,000 bed days at Wigan infirmary. Instead, this hugely expensive programme has caused huge anxiety across my local area, and communication has been dire. I am not alone in thinking that that is a shocking waste of money.

Despite the chaos caused by this Government, our A and E works well: it is a consistently high performer. We are a big borough, with huge transport constraints. To ask people to travel to the nearest alternative hospital in Bolton just is not feasible. It is 15 miles away, which is at least half an hour by car. What the Minister may not know or understand is that many of my constituents do not have cars or the money to take several buses or use public transport. Our borough typically has large, tightly knit families. When someone’s granddad goes into A and E, not just them and their mum and dad but the entire family visit him, which will be impossible if this shambolic programme goes ahead.

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The Secretary of State has caused real anxiety by acting unlawfully in respect of Lewisham A and E, announcing the single biggest closure programme the NHS has seen at a time of unprecedented pressure on A and E, and making changes in the Care Bill that will enable the closure of high-performing hospital services such as those in Wigan. Will the Minister give me a cast-iron guarantee that decisions will be made on clinical, not cost grounds, and will he reassure us that financial constraints do not come into this? Will he tell my constituents that the real-life situation of local people—transport, family networks, income and all the things that have a huge impact on people’s well-being—will be considered by this Government before any decision is taken that affects my constituents’ lives?

2.31 pm

Dr Phillip Lee (Bracknell) (Con): On 27 December 1999, I and two other junior doctors embarked on a ward round at Wexham Park hospital in Slough. We had 72 patients to see that day, and it took us 13 hours to get round to them all. I say that because it was 14 years ago, yet I am hearing that this is the A and E crisis to end all crises. Every year, doctors in the national health service are worried and concerned about the pressures that the winter will bring to bear, and I do not think that this year is any different from 1999.

I want to try to be a bit challenging today and, in view of the motion, perhaps a bit counter-intuitive. We have too many casualty departments in this country. We should look at the mortality statistics—the likelihood of survival. I would say to the hon. Member for Wigan (Lisa Nandy) that, if my grandfather went into hospital, I would want him to go into the one where he had the best chance of survival, not necessarily the one down the road. I do not know about her hospital, but a large number of hospitals in this country unfortunately do not deliver the best care or the best mortality statistics. We need to reflect on that without trying to score petty political points about a variety of different issues.

Grahame M. Morris: I want to query the hon. Gentleman’s point about this crisis not being anything unusual. The Government’s own Health and Social Care Information Centre has published figures showing that the number of visits to A and E departments in England has risen by 11% in four years to 21.5 million attendances, which is 60,000 a day. The numbers are clearly increasing, and our argument is that that is partially the consequence of the Government policy of cutting social services.

Dr Lee: There has actually been a 37% increase in emergency admissions over the past decade, while 65% of hospital admissions are of people over 65. Dementia is doubling as we speak, and 25% of the NHS budget will be spent on diabetes by 2025. I am sorry, but to try to suggest that the genesis of the challenge we face has been during the three years of this Government is simplistic. The most polite way to put it is that the hon. Gentleman is making a simplistic argument.

Kate Green: I do not disagree with the hon. Gentleman about our wanting a configuration of services that ensures that patients get the best possible care and saves

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lives, but does he not agree that, if changes have to be made, transition planning and resources to support the transition are absolutely vital components of success? I have to tell him that, in relation to the reconfiguration we have just gone through in Trafford, I simply have not seen such resources put in place.

Dr Lee: I agree with the hon. Lady that the plans for many of the configurations have been somewhat made up on the hoof. They have usually been created and pushed by a series of local issues—such as 19th or 20th-century buildings that can no longer deliver 21st-century health care—but I recognise the need for a plan, and I will come back to that at the end of my speech.

I fear that a perfect storm is looming at the moment. [Interruption.] If the hon. Member for Eltham (Clive Efford) will allow me, I will come on to what I think we need to do. The perfect storm is that we have infrastructure that is not fit for purpose, too many hospitals that we cannot staff properly—one of the contributory factors in Mid Staffordshire was poor staffing levels, because it was trying to work over two hospital sites for a population that is not big enough to support one—and an ageing and increasingly obese society, as well as changes in people’s attitudes to pain and suffering and to seeking health care.

I have not yet heard a speech about the type of presentations occurring in casualty departments. Such presentations are rarely accidents and are extremely rarely emergencies. We must ask ourselves how we can address that. I am standing here with a dreadful cold and feeling pretty lousy. I have seen hundreds of patients who have presented to me as a GP or in A and E feeling like I do, but I will not go either to my GP or to A and E, because I understand that I have a viral infection that will get better by itself. The problem at the moment is that people just rock up at A and E because they think that it is the only place they will get seen, and no one questions whether they should just not bother turning up.

Nicholas Soames (Mid Sussex) (Con): I am following what my hon. Friend is saying very carefully. Does he agree that part of the problem with A and E is the tremendous back-up of people who are admitted, and the inability to discharge people who ought not to be in hospital?

Dr Lee: Yes, we need to integrate. The shadow Front-Bench team is right to call for more integration, which is part of the issue.

That perfect storm is coming and I suspect it will hit this or the other side of 2020, when we will have such an ageing society with such expectations, and a creaking infrastructure that is not able to deliver the best care that can be delivered.

Given the time available, I shall be brief, but we need to have a cross-party plan. I suspect that we have twice as many acute hospitals as we need, and that we probably need only about 100 in England and Wales. The population served by each acute hospital should be about 500,000, 600,000 or 700,000, which is nine or 10 constituencies, so we would not all be able to come to the Chamber to defend our local district general hospital. I am sorry, but those days have passed. If you think that I am a maverick, I am backed up by every single royal college, the King’s Fund, the NHS Confederation—I could go on. Therefore, we need to deal with the issue.

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I recognise that the politics is very difficult. I think that we should convene a cross-party committee and have a cross-party understanding. We will have to do that at some point in the next five to 10 years, and it would be remiss and wrong of us as an institution to ignore that reality. I am tired of sitting here and listening to hon. Members trying to score political points on this issue. Of course we can argue about the funding of health care and there is scope to debate philosophical differences about health care provision, but when it comes down to it, we need a hospital infrastructure that can deliver the best acute emergency and surgical care to everybody at their time of need. I fear that we do not have that.

We need to integrate social care with health care. There are some models—Cambridgeshire has embarked on a very good plan—but it needs to happen up and down the country. We need seven-day-a-week care, but to staff that appropriately, we need fewer hospitals. We will not be able to have seven-day-a-week consultant care on every district general hospital site in this country. I wish I had a bit longer, but I will conclude. I think that we really need to raise the bar, because everyone in this country wants the best care for all.

2.39 pm

Clive Efford (Eltham) (Lab): The hon. Member for Bracknell (Dr Lee) has just said that there is a perfect storm coming and has appealed for a cross-party approach to deal with the issues in the national health service. I absolutely agree with him about that.

Before the last general election, that is exactly what we had in south-east London. We had a consultation over a couple of years on the “A picture of health” programme, which involved the closure of an A and E. The point is that that was a clinically led consultation. Doctors came to us politicians and said that, if we reconfigured services in a certain way, they could treat patients better and save more lives. I took the view before the general election that the sensible approach was to support those clinicians. It would have been easy for me to man the barricades, defend my local services, say that the reconfiguration was horrible and be a populist local MP. However, I took the view that we needed leadership and cross-party agreement to make the changes that were needed to improve services.

Sadly, when this Government came in, they threw out the whole APOH reconfiguration. After saying in their manifesto that there would be no “forced closure” of A and E and maternity services, the Conservatives came in and said to Lewisham hospital, “Close your A and E and maternity services.”

The Conservatives had said that they would stop the closure of Queen Mary’s hospital, Sidcup. People could have been knocked over in the rush of Tories who wanted to join the campaign to save Queen Mary’s. What happened when they got into power? They closed Queen Mary’s. On that site, there is now a health industrial estate. It will be an incubator for private health care. There will be elective surgery there under Gravesham health care for a short period, but it will go out to tender. We all know where it will go. It will go out to the private sector. There is a site for hire at Queen Mary’s, Sidcup. All sorts of services will come in and compete with NHS services.

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Mr Andy Slaughter (Hammersmith) (Lab): That is a familiar story to all of us. There are four A and Es closing in west London and two major hospitals are changing. Charing Cross hospital will no longer be a major teaching hospital and half the site is being sold off. In its place, there will be a local hospital that provides primary care services. The Tories said that those hospitals were closing under Labour when they were not. They are now going back on their promises. In many cases, direct promises were given on site before the last election.

Clive Efford: There is example after example of broken promises. The Conservatives accused people of planning to close hospitals when there was no plan to do so, and then came in and did it themselves.

We have a curious situation. The Secretary of State has been saying, “Crisis? What crisis?” Today, he read out a quote saying that the crisis is behind us. That is a little confusing. Of course, the crisis that he was talking about was a summer crisis. He did not mention that. He presided over a summer crisis. That is pretty unique. I do not think that even Virginia Bottomley achieved a summer crisis, but I could be wrong.

The crisis is of the Government’s own making. The Secretary of State talked about the need for services away from the hospital to protect A and E from being overwhelmed. However, one of the first things that they did was to do away with the 24-hour promise of a visit to the GP. They then introduced 111, which had algorithms and questions that all ended with the advice, “Go to your A and E.” There are now 850 fewer surgeries opening at evenings and weekends, and a quarter of walk-in centres have closed. Talk about reinventing the wheel—the Government are now saying that those are the sorts of things that we need to do. The crisis in A and E is of the Government’s making. It is their decisions that have created the situation.

To return to south-east London, the Secretary of State appointed the trust special administrator to oversee the merger of Lewisham and Queen Elizabeth hospitals. The local authority took on that decision because the powers that the Government took were not within their remit. The Government were challenged in the court and defeated. The Government are now moving the goalposts. Having said before the last general election that there would be no top-down reconfiguration and that they would not enforce closures if the local community did not agree with them, they are taking powers to impose closures on local communities.

In the minute that I have left, I want to say to the Minister that there has been a series of broken promises. It is fitting that a Liberal Democrat is summing up a debate on broken promises on the NHS.

Norman Lamb indicated dissent.

Clive Efford: It is true. Where were any of the things that are happening to our NHS in the Liberal Democrats’ manifesto? None of them was in their manifesto. They never put them before the electorate.

We want no return to the closure of Lewisham A and E. The closure of Queen Mary’s, Sidcup has had the knock-on effect of overwhelming the other A and Es in south-east London. That is clear for all to see. Those A and Es are under serious pressure. It is clear that there is

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no slack in the system to pick up the additional burden from that closure. We must have a guarantee from the Government that they will not impose the closure of another A and E on the people of south-east London. I would like to hear that from the Minister when he sums up.

2.46 pm

Paul Burstow (Sutton and Cheam) (LD): I want to pick up on a couple of points that were made by the hon. Members for Mitcham and Morden (Siobhain McDonagh) and for Bracknell (Dr Lee) about reconfiguration. The hon. Gentleman said that all too often the experience of hon. Members is that reconfiguration feels as if it is being done on the hoof. I agree with the hon. Lady about the proposed reconfiguration in south-west London and about St Helier hospital. Whether that will ever happen is still up in the air—let us hope that it does not. A leap of faith was demanded of constituents across south-west London, not least because the plans did not contain any measures to improve out-of-hospital care, without which it would not be possible to achieve the changes to emergency services that were being proposed. Those points are part of this debate, which is primarily about whether there is a crisis and, if there is, what the nature and causes of it might be. Although the Labour motion acknowledges that there are many causes of the problem, it has a very simplistic solution.

The evidence shows that there is a mixed picture across the country. That is reflected in the allocation of the first wave of additional funding for the NHS to meet winter pressures. That funding went to the health economies that were the most challenged. Some are coping well with the seasonal change from the higher volume, but less complex A and E attendance pattern of the spring and summer to the winter pattern of fewer, but much more complex cases, which often involves more frail and older people, and leads to more admissions. That pattern is repeated year on year and the demographic changes continue year on year. The pattern is well documented and it is very sensitive to the weather. That is why I welcome the Government’s cold weather plans and their support for local government and other agencies to put in place the extra social support that is necessary to avoid admissions in the first place.

Where there are problems, the causes vary. Some of the pressure stems from changes in behaviour. People now see A and E as the easiest point of entry into the system for any ailment. Often, there is confusion about the access arrangements for out-of-hours care. Those behavioural changes are cumulative. They are a consequence of changes that were made some years ago, not least through the changes to the responsibility for out-of-hours care in the GP contract. The implementation of those changes undoubtedly sowed much of the confusion over how to access emergency care.

Andrew George (St Ives) (LD): Does my right hon. Friend agree that a lot of potential patients are confused about what out-of-hours unscheduled care is available? There are A and Es, minor injuries units, out-of-hours GP services, GP walk-in centres, NHS 111 and so on. Many people cannot discriminate between those services and do not know what they are supposed to provide. They therefore need to be further integrated.

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Paul Burstow: My hon. Friend is absolutely right. One of the good things that came out of the work by Keith Willett and Sir Bruce Keogh is the more coherent, communicable and understandable way in which emergency care can and should be organised. Indeed, in some cases there are also staffing pressures. Those are not helped by some of the unintended consequences of changing medical careers, as that has had an impact on the supply of medical doctors.

Labour’s answer seems to be that we should go back to the good old days—whatever they were—of a 48-hour target, but that target was flawed. When it was removed by the Government, the British Medical Association welcomed the change, which it said would give GPs greater flexibility to organise their appointments. Today we have heard—quite rightly—from the chair of the BMA, Dr Maureen Baker, who said the proposal was ill thought out and a knee-jerk response to long-term problems, and that it would make a bad situation worse.

Andy Burnham: Do not the views of patients matter most? The right hon. Gentleman is quoting the professionals, but perhaps it is sometimes inconvenient for them to have to do things. Surely the point is that people are ringing surgeries and cannot get appointments. If he does not like the 48-hour target, surely he and the coalition Government should put forward their alternative so that people can get to see their doctor.

Paul Burstow: With all due respect to the shadow Secretary of State, when presenting arguments in support of his motion he set out a range of professional expertise and opinions for why there should be a 48-hour target. It is therefore not unreasonable for me to quote other professional opinion on why that would not be good for patients. I will come to some of the alternatives that I think are relevant to addressing the A and E problem, because I do not think that simply addressing it through a 48-hour target makes any sense at all.

The changes the Government are making to the GP contract will help—not least having a named person co-ordinating care for the over-75s. I hope the welcome focus on frailty and multi-morbidity will be extended to more people on the basis of their need, not simply their age. Figures show that the average number of diagnosed conditions for patients admitted from A and E has increased over the past five years. In other words, the medical needs of people attending A and E are getting more complex, and that impacts on the amount of time people spend in A and E departments. Therefore, the answer is not one simple solution but must be a combination of actions. Much of that needs to be centred in primary and social care, as well as mental health services. In primary care we must recognise that it is not just about GP services and that we need best practice around the country, for example in engaging pharmacies as first care centres or getting them to play a key role in managing long-term conditions—a big driver of pressure on A and E departments, particularly in winter.

We need concrete action to drive the integration of health and social care—that may be mentioned in the motion, but the Government are delivering it, not least with the £3.8 billion first steps for a better care fund, which is bringing health and social care together in a practical and unprecedented way that has not been achieved before. That must be welcomed as a first step

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which I hope will grow as more resources are pooled across the system. It is essential to delivering the integrated, co-ordinated care that people want.

Mental health was neglected by Labour, under which there were no access standards or targets for people suffering a mental health crisis. In fact, under Labour two thirds of people suffering from a mental health crisis waited for more than four hours to be seen. I applaud what the Minister is doing to improve that situation significantly by setting standards for the first time to drive improvement in that area.

I conclude with a quote from Dr Clifford Mann, president of the College of Emergency Medicine:

“While this winter will be tough for the NHS and A and E departments in particular—”

I think we should acknowledge that—

“I believe there is now cause for optimism and that the crisis is behind us.”

Yes, there have been problems, but the Government have been addressing them in a comprehensive way. That is why this debate is mis-timed, wrong, and does our constituents no good whatsoever. It does not identify the real problem, although this Government are getting on with sorting the issue out.

2.53 pm

Kate Green (Stretford and Urmston) (Lab): I want to speak about the current situation in Trafford and some of the lessons that Ministers might want to learn from the transition we went through when the A and E department at Trafford general hospital was downgraded to an urgent care centre and closed overnight. Despite assurances that neighbouring accident and emergency services at Manchester royal infirmary and Wythenshawe hospital would be able to cope following that change, problems are already piling up. Those problems may not have been caused wholly—or perhaps at all—by the changes at Trafford, but the impact on Trafford patients is pretty dire and we must take account of that.

Those A and E departments were already exceptionally busy, with the one at Wythenshawe working well beyond capacity. It was built to accommodate 70,000 patients a year but was already dealing with more than 100,000, as my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) pointed out from the outset. We welcome the fact that the Department now appears to have unlocked a route to additional funding for capacity at Wythenshawe, but that funding, let alone the additional capacity, is not yet in place.

As the Minister will know, in the past couple of weeks Wythenshawe A and E has reached “black” status for waiting times, and privately there are indications that the quarter 3 target for waiting times at the hospital will not be met. There are also reports that waiting queues for ambulances are doubling outside Wythenshawe hospital, and pressures are mounting at Manchester royal infirmary. The other day a constituent told me that she had visited on the evening of Sunday 8 December with her diabetic daughter and there were not even enough seats for waiting patients. Some people were forced to wait outside.

Those pressures were predicted. Last year, Manchester royal infirmary and Wythenshawe hospital struggled to meet waiting time targets, and indeed failed to meet them on at least one occasion in 30 out of 35 weeks. The

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Secretary of State was clearly concerned about the pressures on those hospitals because one criterion he set down for the reconfiguration of services at Trafford was that neighbouring hospitals should consistently meet waiting times before the changes were made.

On the basis of performance in the two summer quarters, the NHS asserted that the criterion on waiting times at those hospitals had been met, despite warnings from many people—including me—that not measuring performance during the winter months would give a distorted picture of the capacity of those hospitals to cope. The Minister must recognise that that caused a great collapse of public confidence—they were not very confident about the proposals for the reconfiguration anyway—because it seemed that fudging was going on to present an impression that hospital services could cope, when it then turned out they could not. To use data that are clearly applied in a way that suits the outcome NHS managers want, rather than being in the best interests of patients, is a matter of great concern. Will the Minister say how we can have genuine and robust criteria for reconfigurations in which the public can have confidence? The total absence of clarity and the fudging over the decision at Trafford over the past few weeks has had an unfortunate effect.

When the Secretary of State announced the funding in September, neither Manchester royal infirmary nor Wythenshawe received extra money to deal with winter pressures. I was surprised because we knew by then that reconfiguration would create extra demand on those two A and E departments. I am anxious to hear from the Minister about the Department’s approach to ensuring adequate additional resource to support transition for such reconfigurations.

Grahame M. Morris: My hon. Friend makes an important point about demand in deprived areas. The Government’s health and social care information centre has identified that in each of the past five years at least twice the number of attendances have been from those living in the 10% most deprived areas, compared with those from the 10% least deprived areas. That should be reflected in the allocation of funding, but unfortunately such areas receive no additional money at all.

Kate Green: Two pressures could be highlighted. The first is the way that funding fails to take adequate account of deprivation. Secondly, there will inevitably be a hump at the time of transition, as new arrangements settle down and people adapt to the changing service configuration. When providing resources to Manchester royal infirmary or Wythenshawe, no account seems to have been taken of the effect of that transition and the likely need for additional resource to take those hospitals through that period. Indeed, in a private meeting with the Secretary of State, after the reconfiguration was announced, he confirmed that there would be no additional transitional funding. I could, however, look forward to additional funding to enable greater integration of services, although not until 2015-16. Furthermore, it would not be new funding, but funding that had been moved from the NHS to social care.

I am as strongly in support as anyone of seeing funding directed as much as possible to preventive care and care that can be provided at home in the community, but we cannot take services from hospitals before we put that care in place in the community. Such care is simply not adequate in Trafford today.

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The other matter I want to raise was alluded to by the right hon. Member for Sutton and Cheam (Paul Burstow). There is utter confusion among patients about what services they should access and when. As soon as Trafford was downgraded to an urgent care centre, Trafford patients believed they could not go there. That was not the intention of NHS managers, but the impact was undoubtedly to drive more traffic to neighbouring A and E departments.

Mr Slaughter: My hon. Friend makes an important point. A and Es and anything we would recognise as such are being closed. They are turned into urgent care centres, which deal with minor injuries with GP cover at best. They are called second-tier A and E units, which is incredibly damaging, dangerous and confusing for people. It is done simply as a political fix, so that Tory councils and others can distribute leaflets saying, “There’s still an A and E on this site.”

Kate Green: Whatever the motivation—NHS managers in my area have tried to communicate the changes and how patients should respond to them—there is huge patient confusion about where they should go, what time they should go and what treatment they will receive. The right hon. Member for Sutton and Cheam referred to Sir Bruce Keogh’s report, which highlighted patient confusion. During periods of transition, confusion is heightened as people become used to new configurations. What lessons are being learned on how to communicate effectively with patients so they have proper understanding of what services are available and where they ought to go?

Massive problems are piling up over this winter period, when we might expect additional pressures—we see them every winter. There is a failure of local planning and ministerial engagement in ensuring that those transition processes work smoothly for patients in Trafford. I hope the Minister comments on how transitions will be handled in future. I venture to suggest that Trafford is, I fear, an early example of how not to do it. I look forward to his response.

Several hon. Members rose—

Madam Deputy Speaker (Dawn Primarolo): Order. I am reducing the time limit to four minutes. It is possible for each of the remaining speakers to have four minutes only if interventions are severely curtailed or if they do not happen at all—let me put it that way. The wind-ups have to start at 3.30 pm at the absolute latest. Those who have been waiting patiently and who have not intervened have had their time cut. Perhaps they will bear that in mind when they are called.

3.2 pm

Eric Ollerenshaw (Lancaster and Fleetwood) (Con): It is a pleasure to follow the hon. Member for Stretford and Urmston (Kate Green), who attempted to make solid, practical suggestions in a debate that has too often become too politicised, as the debate on A and E did in June. I will refer to that later.

I represent a large constituency with a large rural population. Some people are 10, 15 or 20 miles away from the one A and E. To me, it sounds a little bit rich

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when hon. Members from urban areas talk about the A and Es in their part of town when no account of that distance or rurality was included in any grant formula by the previous Government. I wanted to put that on the record.

From my perspective and, I am sure, from that of all hon. Members, the majority of our constituents get a damn good service from hard-working professionals, who will work at Christmas time when the rest of us are on holiday. Having said that, hon. Members recognise that there has been a big growth in the number of people attending A and E. Those facts are clear. Opposition Members suggest that that happened last year or a few years ago. According to the Opposition motion, the increase has been

“three times faster since 2009-10”.

However, the College of Emergency Medicine report “The drive for quality” shows a sharp upward trend in new attendances at A and E, but its figures start from 2003.

That ties in with local information. I asked my A and E doctors at the Lancaster royal infirmary to give me figures for the past few years. They say that the number of new patients attending A and E decreased between 1989 and 1993 and steadied at about 35,000 admissions a year until 1999, when the number increased rapidly. The figures are clear. There were 35,000 A and E admissions in 1999; 36,000 in 2000; and 37,000 in 2001. There was an increase of 1,000 in every single year to 2007. Funnily enough, there was a 3,000 increase in A and E attendances from 2006 to 2007. The latest figures I have are for 2011, when there were 52,500 attendances. The increase did not happen yesterday but continually over that period, for all the reasons hon. Members have mentioned.

The other side of the problem is the training and retention of A and E specialists. We have all heard stories of vacancies in A and E departments. I understand that it was announced today that Wales is 15% down on A and E specialists. One reason for that is that working in A and E is hard, and there is evening and weekend work, so people move to other specialisms. To increase retention, we need to recognise the work of A and E specialists, which might include through salaries. We need to give A and E specialists the recognition they deserve to keep them in those posts.

The Labour motion mentions the 48-hour appointment guarantee. It is no use having an appointment within 48 hours if it lasts for only five minutes before the doctor moves the patient out just to meet the target, which is what happened in the past.

3.6 pm

Toby Perkins (Chesterfield) (Lab): Hon. Members will remember that when the Prime Minister wanted to detoxify the Tory brand, he said that he could spell out his priorities in three letters—NHS—but people in Chesterfield have seen through that cruel joke. Opinion polls show us that the importance of the national health service is going up as the Government’s record is so terribly exposed.

I did a survey across Chesterfield this summer and spoke to people about a range of issues, as I did back in 2009. Back then, satisfaction with the NHS was clear, but now 37% say that GP services have got worse, and

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just 12% say they have got better. Only 8% say that they think the NHS has got better since 2010; almost 50% think it is getting worse.

I want to focus on the part of the motion that deals with the difficulty of accessing GP services, which is one of the primary causes of those figures. Some 42% of people who appear in A and E have previously attempted to contact GP services. Hon. Members might remember my raising the case of Jemma Hill on 22 October with the Secretary of State. Her GP referred her to a specialist, who recommended hip arthroscopy surgery. She was then told that her clinical commissioning group would not fund the surgery. The Secretary of State promised to look into the matter if I wrote to him. I wrote to him on 23 October but still there is no response. Jemma Hill is still in agony. She sees a fragmented national health service leaving her behind.

The problems in the NHS, and in GP services in particular, are acute in the Staveley area. A recent Care Quality Commission report found that the Rectory Road and Grange health centres failed on five different criteria. I surveyed almost every house in Middlecroft and Inkersall, which are parts of Staveley, and had hundreds of responses. Eighty-six per cent. said that services were unsatisfactory or very poor.

I have here some of the comments of the people who responded. One says, “I don’t bother going to the doctors anymore. I could never get an appointment. I simply self-diagnose on Google.” Someone else said that they are entirely dependent on locums, meaning that when their scans or results come back, the GP is not there. One patient said that a GP broke down in tears in front of them. Another patient said that no one had contacted them after their blood test results. In fact, they should have been urgently sent to hospital—subsequently, they discovered they had cancer.

One person said that they waited eight weeks for a GP appointment. When they eventually got one, they were told that they had a hernia and were sent straight to hospital. Another person waited two weeks for an appointment for a repeat prescription, meaning that they did not have their prescription for more than a week. One 90-year-old said that they had to get a taxi to the surgery and had to queue outside at 8 o’clock in the morning.

I met a partner at that GP surgery and we discussed how it is desperately struggling to recruit people. There is a widespread GP recruitment crisis. I was told that a huge number of GPs have retired, either because they are disillusioned or simply because they want to get out of the service. Forty-three per cent. of GPs told a Pulse survey that they will retire earlier than they had intended because of how disillusioned they are.

My hon. Friend the Member for Wigan (Lisa Nandy) spoke about the massive impact the Government’s cuts to care services have had on A and E, but there is also a huge crisis in general practice. The people of Staveley, and people across the country, do not have proper access to a GP service. The problem is getting worse and it is exacerbating the problem in A and E. The people suffering are not only the brave heroes who work so hard in the national health service, but those in the most deprived communities in our constituencies. It is a disgrace.

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3.10 pm

Andrew George (St Ives) (LD): My expectations for this debate were low, having previously endured shouting matches between the former Labour Secretary of State, the right hon. Member for Leigh (Andy Burnham), and the current Secretary of State, with the usual antics of carefully selected and spun statistics thrown at each other. Those expectations were not disappointed. This issue is not helped by being dragged into the gutter of partisan politics. The fact is that the A and E crisis—if there is indeed an A and E crisis—has existed and has been endemic in the NHS before and after 2010. This is largely the result of A and E being seen as an issue that somehow needs to be treated separately and not part of an integrated NHS. Before 2010, there were ambulances queuing outside the A and E in my constituency and in the Royal Cornwall Hospitals Trust in Truro. The problem exists. From time to time, there will be those kinds of pressures, which are created by a whole set of things that are not entirely the fault of a failing A and E service.

One aspect of unscheduled care in Cornwall that I raised with the former Secretary of State is the out-of-hours GP service. The previous Labour Government were perfectly happy to see that service put out to tender and privatised, and we saw a fragmented unscheduled care service. I reported the Serco out-of-hours GP service to the CQC, because it was simply putting profit before patients by manipulating statistics to make the outcomes appear better than they were. It was announced last week that Serco will be handing that contract back early. I hope that that will result in an integration of unscheduled out-of-hours care, as that is the kind of thing we need to do. This is not an issue that should be subject to party political point scoring, because that completely misses the target.

Valerie Vaz (Walsall South) (Lab): The hon. Gentleman sat on the Select Committee with me. He must surely accept that there was a top-down reorganisation that nobody wanted and that cost the NHS £3 billion.

Andrew George: Yes, and the previous Labour Government were involved in multiple top-down reorganisations of the NHS. The hon. Lady knows that I opposed that top-down reorganisation; I voted against the Health and Social Care Bill.

We could just bemoan the things that are going wrong, but I want, in two minutes, at least to lay on the table my prescription for what needs to be put right. The two themes have to be integration and prevention. My intervention on my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) spelled out the theme of integration. Unscheduled care includes not only A and E, but minor injuries units, urgent care services, the 111 service, the ambulance service, the out-of-hours GP service, GP surgeries themselves, and, indeed, GP walk-in centres, which the previous Government created. Significant confusion is created about where the general public are supposed to take themselves if they have an urgent need for medical attention. We really need to find ways to integrate those unscheduled services in a way that does not result in the fragmentation that bedevils the service at present.

On prevention, often in acute hospitals planned work cannot go ahead because patients cannot be discharged from hospital and other patients cannot be admitted

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because there are insufficient beds. The health service is not integrated, because there are insufficient community beds and the primary care service is struggling and stretched to the limit, unable to provide the kind of care for people in their homes and community hospitals that would avoid them ending up in hospital as emergency cases. Those are the two themes: further integration of the service, which is not helped by the Health and Social Care Act 2012, and significant investment in preventive care and primary care.

3.15 pm

Barbara Keeley (Worsley and Eccles South) (Lab): We know that rising demand is concentrated in those aged over 85. Cuts in social care budgets are now widely acknowledged as contributory factors in rising admissions, and the Select Committee’s inquiry heard that from witnesses again and again.

Salford city council has made cuts of 20% to its adult social care budget since 2010, given the cuts it has had from the Government. This year, the city council is changing its eligibility from moderate to substantial, and social care staff estimate that the number of people receiving council-funded care will fall this year by 1,000, from 8,500 to 7,500. That is a very big change to happen in one year.

Cuts already made to the NHS locally have also had an impact. We have seen the closure of two walk-in centres, including one in Little Hulton, a deprived area in my constituency that was under-doctored. The walk-in centre was popular and successful. The Minister’s predecessor will have heard my plea about this again and again. The local primary care trust, when we had one, axed the pilot of an active case management scheme for people with long-term conditions. Those things were done under the umbrella of NHS efficiency savings, but they achieve the opposite. More older people will not be receiving council-funded care, and that will have an impact on family carers. We have no walk-in centres and no active case management for people with long-term conditions.

I want to refer briefly to the Carers UK survey of 3,500 carers conducted earlier this year. Some 55% were caring for people who had been admitted to hospital emergency services, with a significant proportion of those carers referring to support that could have prevented those emergency admissions. We have seen exactly the same message in the CQC state of care report.

I want to take this opportunity to congratulate Salford Royal hospital on its excellent inspection report from the CQC. The hospital was found to demonstrate exceptional leadership qualities at all levels across its staff, but even excellent hospitals such as Salford Royal are now feeling the strain of extra emergency admissions. The chief executive told me that in the winter quarter last year it had 10% more ambulance arrivals, patients were sicker, there was an increase in people staying longer than 72 hours, and there was a significant increase in co-morbidity among the patients. And all that happened before the cuts and loss of council funding of care to 1,000 patients this winter.

I want to touch briefly on the shortage of emergency doctors, which the College of Emergency Medicine has been warning about since 2010. That situation is not

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going to improve. The fill rate of higher trainee posts has been running at 40% or less since 2010. The latest recruitment round for ST4 trainees filled 37 posts out of 193 vacancies. There is some talk today of increasing the number of vacancies for emergency medicine trainees, but people are voting with their feet. The career pressures in A and E are just too great, and they are putting people off having careers in emergency medicine.

In conclusion, £2.68 billion has been cut from adult social care since 2010. We are seeing the cuts in our budgets in Salford, and 1,000 people will lose care. That will put pressure on their health and that of their families. The Secretary of State briefly mentioned the integration transformation fund, but there is no new money in that fund—none at all. Health Ministers need to think again about the impact that cuts in social care are having on the NHS. Pooling budgets with the same amount of money in the integration fund will not help. They need to deal with the crisis in A and E staffing and try to make it a career that people want to go into. As the motion states, they need to restore the 48-hour appointment guarantee. I support the motion.

3.19 pm

Guy Opperman (Hexham) (Con): As a jockey, I spent far too much time in A and E departments after coming off race horses. Once, I wandered into Leicester hospital with a broken collarbone and four bones sticking out of my shoulder. On another occasion, I spent a long time with a cut kidney and lost a spleen at Warwick hospital—I thank Dr Mike Stellakis and his team for saving my life that night. Also, two years ago, I collapsed in the House and spent a night in St Thomas’ with a young but capable bunch of A and E doctors. I thank them all and put on the record this Christmas the huge effort made by all our public sector staff, particularly in the NHS.

In Northumberland, we feel that we are leading the way in health care provision. Begun under the previous Government, that has continued under this one. Haltwhistle is a small cottage hospital that in the olden days would have been shut, but which now is being rebuilt as an integrated NHS and local authority facility. It is the first of its kind in the country, it is utterly transformative and it is exactly what the NHS and the local authority should be doing with old buildings, although I urge the trust to resolve the contracts that are not yet resolved. When I visited it last week, however, I saw that it was a truly innovative building and that it would be a great addition.

Hexham A and E is also a fantastic building. This November, I worked there as a hospital porter, and I thank Barry, the head porter, who has worked there 31 years, for keeping me in line and ensuring I did not put anything in the wrong place. Then there is Cramlington, an innovative, pre-Keogh assessment health care centre being built for the north-east. It is a perfect example of where we should be going: a 24-hour, seven-day-a-week, consultant-led facility. As an A and E specialist care facility, it is exactly what Keogh is talking about. Interestingly, it was planned under the previous Government and is being brought forward under this one. It is exactly the direction we should be heading in.

I shall deal briefly with another issue. Northumbria has outstanding health care, but sadly North Cumbria is having some difficulties, and I urge the Secretary of

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State to expedite the merger of Northumbria and North Cumbria NHS trusts as soon as possible.

I turn now to ways we can keep our constituents and patients out of A and E. I have no spleen—it was kicked out of me by a three-mile chaser at Stratford—so every year I need the flu jab. Consequently, like pensioners, some young children and vulnerable adults, I went to get my flu jab last month at Haltwhistle GP centre. I thank Sarah Speed—it was not painful and took only five minutes. Tragically, however, at least 10% to 20% of the population do not take up the flu jab and are therefore likely to end up in A and E over the winter or possibly die. As constituency MPs, we must ram home their failure to take up the opportunity to deal with their own health care.

Finally, I turn to the hospice and dementia care systems in Northumberland. In the Charlotte Straker hospice and Tynedale Hospice at Home, we have two outstanding hospices, both of which I have assisted and one of which I have fundraised for. Both do a great job keeping people out of hospital. I should also mention the Age UK programme dealing with elderly people in my constituency. It is making a huge difference and ensuring that everyone becomes a dementia friend. Only through such actions will we bring about real change in our health care system.

3.23 pm

Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab): I wish to discuss two topics. First, I want to raise the issue of funding for the North East Ambulance Service NHS trust, the rising use and cost of private ambulances and other ambulance pressures, and, secondly, I want to raise with the Minister the ongoing Monitor investigations into the two foundation trusts, that serve my constituents, the South Tees Hospitals NHS Foundation Trust and the Tees, Esk and Wear Valleys NHS Foundation Trust.

Over the past 18 months, the A and E department at the James Cook university hospital, which serves my constituency, has come under considerable pressure. In particular, in the run-up to last winter, there were problems with handover times, with ambulances and paramedics waiting up to two and a half hours to admit patients, despite the national target time being 15 minutes. I raised this matter last year with the Secretary of State for Health, who agreed that the situation was completely unacceptable, and with the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter),in a Westminster Hall debate on A and E provision in the north-east on 13 February 2013.

In addition to the issues I raised with the Secretary of State, it became evident that James Cook’s A and E department struggled to manage with the pressure that winter placed on it. In January and February, South Tees Hospitals NHS Foundation Trust failed to meet its target of seeing 95% of A and E patients within four hours. With James Cook so clearly overstretched, I was surprised to discover in September that the Secretary of State decided not to award it, or any other hospital trust in the north-east, funding to alleviate pressures on A and E. It struck me as beyond belief that of the £250 million he awarded to 53 trusts, not a penny was to reach the north-east. Thankfully, following pressure

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from the Opposition, including in my Westminster Hall debate on north-east NHS services on 5 November, the South Tees trust is to receive £2.1 million, as announced earlier this month.

For weeks and weeks, however, I have received recurrent expressions of concern about the increasing use of private and voluntary ambulances in response to 999 calls in my constituency. I wrote to the North East ambulance service about two of these incidents. From its reply, it became clear that central Government funding cuts were eroding the blue-light service. It wrote:

“Each year we have discussions with our commissioners on the forecast number of incidents in the forthcoming year. The outcomes of these discussions for 2013-14 were that commissioners felt it necessary to set our income on activity for the next 12 months at a level less than we were forecasting... So for 2013-14, we have been contracted to respond to 376,000 incidents, although we are forecasting activity at an estimated 415,000. This means that any incidents above 376,000 will be funded on a one-off basis rather than as recurrent annual income. These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries”.

Mr Dave Watts (St Helens North) (Lab): Is there not an element almost of secrecy taking over the NHS, with trusts not allowed to talk to MPs or tell them the facts and trusts’ financial details not being published? Does my hon. Friend agree that that is not healthy for the NHS?

Tom Blenkinsop: For that reason, I had to put in a freedom of information request to the trust to get the information I shall now detail.

According to that letter, our ambulance service will see more cuts, more private ambulances and possibly a less responsive service. It is not me saying this, but the chief operating officer of the North East Ambulance Service. In 2008-09, private ambulances attended 865 call-outs in our region, costing £86,118. In 2009-10, there were 1,816 call-outs, costing £151,112. In 2010-11, however, there were 6,429 such call-outs, costing £477,575. In 2011-12, there were 9,034 of these call-outs, costing £639,819, and in 2012-13, there were 13,524 call-outs of private and voluntary ambulances, costing £754,461. Since Labour left office, therefore, a fivefold cost increase in private ambulances has occurred in the north-east—these are funds going to private contract firms. It is obvious that from 2010 onwards an explosion of private ambulance usage by the trust has occurred, costing a huge amount of taxpayer funds. As the chief executive states:

“These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

The police and crime commissioner for Cleveland, Barry Coppinger, has said:

“The bottom line is that police officers are not medical professionals and should not be put in the position of having to transport patients to hospital. Police vehicles are unsuitable and unequipped; it not only puts undue stress on the patient, but also the officer who should be able to continue to fulfil policing duties on the ground… The downward trend in incidents from September to October relates to a policy change by senior officers”—

not the NHS—

“within the Force and a directive issued that officers should not transport patients to hospital unless there is an immediate risk to life. However, there have been five occasions in November of officers being forced to take patients for urgent medical treatment due to ambulance delays.”

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I hope for a response from the Secretary of State or a Health Minister. I would be more than willing to talk to them about this subject, because it is a massive concern, particularly in the east Cleveland part of my constituency.

3.28 pm

Andrew Percy (Brigg and Goole) (Con): There is doubtless concern on both sides of the House about A and E and the health service in general, but there is also more than an ounce of political opportunism, some of which we have heard today. Not once did we hear any reference made to the Nicholson savings, which have put local acute hospital trusts under huge pressure, with £160 million taken out of the budget for the Humber area alone.

If we talk to the chief executives of the hospitals, we find that they say that it is not top-down reconfigurations or policy changes since the general election that have placed them under such pressure, but the Nicholson savings. I know that there is cross-party support for those savings, but we should all be as honest as possible in this place and ensure that we all accept a degree of responsibility for that challenge and the funding that it has taken out of our acute trusts, resulting in pressure on A and E departments—not just this year, but last year and in future years.

As I say, there is a huge degree of political opportunism going on about the NHS. It is clear that the Labour party has decided that this is going to be an issue at the general election. In my own constituency, the very people who stood silent when our hospital was losing its beds, when we were losing our hospital wards, when all our mental health beds were being taken away from us—these were the people who represented the town for the Labour party—now suddenly find themselves standing up and pretending to be NHS campaigners. The public see through it—and I am sure they will at the next election, too.

Similarly, we have heard not a single apology from any Labour Member about the 50,000 beds cut under their Government. We have heard a lot about how people turning up at hospital often find that there are not enough beds, but not once did a Labour Member defend the 50,000 hospital beds lost when their party was in government. That tells us all we need to know about the reason for this debate and for the general comments we have heard about the NHS recently. It is all about political opportunism; it is about the next election. I am sorry that our hard-working staff in the NHS—I work with them every weekend when I volunteer as a community first responder—are being placed in the middle of a dirty political game.

In my remaining minute and a half, I would like to talk about a couple of examples from my constituency that are helping to address the problem.

Alex Cunningham (Stockton North) (Lab): Does the hon. Gentleman have the same problem in his area as we have in Stockton-on-Tees, where GPs tell me that people are being denied registration because their lists are unofficially being closed? If that is happening across the country, surely it is no wonder that there is unprecedented pressure on A and E departments.

18 Dec 2013 : Column 798

Andrew Percy: The Montague medical centre in Goole had to close its lists down, but if we ask why, we find that it was due to the large uncontrolled immigration we had from the A8 countries. [Interruption.] That is a fact. That is why the lists had to be closed—due to the previous Government’s failure to plan for the number of people coming here—so I thank the hon. Gentleman for that helpful intervention.

Let me deal with a couple of issues in my own constituency. [Interruption.] If Labour Members want to intervene, I am happy to take an intervention rather than be chuntered at. I want to refer to some positive moves locally, which I hope can be rolled out nationally.

First, I called on the NHS ambulance trust in my area to provide advanced paramedics, so that we could use our ambulance service better—a point I have made through the Health Committee—not just to convey people, but to treat them in their homes. We established an emergency care practitioner in Goole, which in the first six to eight weeks saved 56 double-crew manned hours and numerous transfers to Scunthorpe A and E. That has proved to be an effective use of our ambulance services, and I hope that we can start to see it moving through. [Interruption.] Am I running out of time? I am just looking at the clock, Madam Deputy Speaker, and following the time indicated there. I will conclude if the Front Benchers need to sum up—

Madam Deputy Speaker (Mrs Eleanor Laing): Order. The hon. Member is quite right in his watching of the clock, but I am sure that he will have a mind to other hon. Members who wish to speak this afternoon.

Andrew Percy: Because it is Christmas, I am willing to forgo my remaining minute.

3.33 pm

Andrew Gwynne (Denton and Reddish) (Lab): We have had a good debate, with many powerful contributions from my hon. Friends the Members for Mitcham and Morden (Siobhain McDonagh),for Wigan (Lisa Nandy), for Eltham (Clive Efford), for Stretford and Urmston (Kate Green), for Chesterfield (Toby Perkins), for Worsley and Eccles South (Barbara Keeley) and for Middlesbrough South and East Cleveland (Tom Blenkinsop).

I have to say, however, that people outside listening to some Government Members’ contributions will think that they simply do not get it. They simply do not understand how hard it is to get a GP appointment; they do not understand the real issues facing their own local A and E departments; and they do not understand the pressures hitting the NHS in England. I politely suggest that they do what the shadow Health team has done—go and spend an evening at their local A and E to see for themselves the real pressures that departments serving their constituents are under.

It would be remiss of me not to place on record my own tribute to the doctors, nurses, health care assistants and other dedicated NHS staff who—as I found out myself when I visited Tameside hospital’s A and E department last Friday night—provide such extraordinary and professional care. We have a work force who are completely dedicated and caring, but the House should be in absolutely no doubt that they are under increasing pressure, and that this is a crisis of the Secretary of

18 Dec 2013 : Column 799

State’s making. The Secretary of State may wish that Labour Members had short memories, but we remember the summer news reports of ambulances queuing outside hospitals with unacceptably long waits, and some people even having to be treated in tents erected in car parks, while the Secretary of State and his Ministers buried their heads in the sand and the Secretary of State’s “Crisis, what crisis?” strategy unravelled. Labour Members highlighted those problems, as would have been expected of us.

What we are seeing in A and E is also the culmination of three and a half years of mismanagement of our NHS, with a needless top-down reorganisation and the waste of billions of pounds that could and should have been spent on front-line care. It is little wonder that, as we discovered last week, 79 A and E departments missed the Government’s own targets.

As we have heard in the debate, the reasons for the crisis are many and complicated, but it is on the lack of access to GPs’ services that we have focused today. Surely no amount of spin can hide the fact that this Government have made it harder to obtain an appointment to see a GP. All Members will know of constituents who have had to phone their doctors only to be told that no appointments are available and that they should ring back the next day, which they do, only to experience the same problem again.

Is it not obvious to all—except, seemingly, the Secretary of State and his Ministers—that many patients who phone the surgery at 9 am and find it impossible to obtain an appointment will turn to A and E for help? That is not just my conclusion. According to an analysis carried out for the Department of Health, 42% of A and E attenders had attempted to contact their GPs beforehand, and researchers at Imperial College London found that patients who were able to see their GPs within 48 hours made fewer visits to A and E departments.

Here are some inconvenient truths that the Minister and other Government Members need to consider. First, by the time Labour left office, 98% of patients were being seen within four hours at A and E departments. Secondly, by May 2010 more than three quarters of the general practices in England offered extended opening hours at weekends and in the evenings. It is also clear that Labour’s achievement in widening access to primary care is being undone on this Government’s watch: data released by the Health and Social Care Information Centre have revealed that 854 fewer general practices now offer extended opening hours than was the case in 2009.

The truth is that now, during evenings and at weekends, many people are left with no alternative but to go to A and E because of this Government’s actions. It was this Government who cut funding for extended opening hours for GPs’ surgeries, it was this Government who scrapped Labour’s guarantee that patients would be able to obtain an appointment with a GP within 48 hours, and it is this Secretary of State who shows not one degree of regret for those actions: actions that have piled more unnecessary pressure on A and E departments and more misery on patients, at the very time when they need the NHS to help them.

No wonder things are going so wrong so quickly. To put it simply, under this Secretary of State and under this Prime Minister, it has become harder, not easier, to see a doctor, and as a result more people are heading

18 Dec 2013 : Column 800

towards A and E. What more evidence do Ministers need that A and E departments in England are under real pressure and that action is needed now to prevent them from struggling further over the winter months? Their confusion has been laid bare today for all to see. In three weeks, they have gone from “Crisis, what crisis?” to “The crisis is behind us.” It does not sound as though the Secretary of State is in control; people will struggle to take reassurance from his mixed messages. The problems in A and E have the fingerprints of the Secretary of State and the Prime Minister all over them. The components of the A and E crisis might be complex, but the real cause is very simple: you just cannot trust the Tories with the national health service.

3.40 pm

The Minister of State, Department of Health (Norman Lamb): We have heard a lot of scaremongering about the NHS today, including endless claims about a crisis. If the Opposition are thinking about new year’s resolutions, I have one for them: stop misleading and misinforming the public. Let us look at the evidence.

Andrew Gwynne rose

Norman Lamb: I will not give way; I do not have time.

Up until this week, A and E targets were met in the past 32 weeks in a row. Is that evidence of a crisis? The average wait for people in A and E during Labour’s last year was 77 minutes; it is now 30 minutes. Is that evidence of a crisis? Even though more people are coming through the doors, 2,000 more patients are being seen in less than four hours every day under this Government than under Labour. Evidence of a crisis? I don’t think so. The Opposition are scaremongering, plain and simple. In fact, the College of Emergency Medicine’s president, Cliff Mann, has today said that any crisis in accident and emergency is “behind us”.

Andy Sawford (Corby) (Lab/Co-op): May I associate myself with the remarks made by the hon. Members for Kettering (Mr Hollobone) and for Wellingborough (Mr Bone)? We are pressing for funding to meet the additional demand in the Kettering accident and emergency department. Will the Minister encourage us in that?

Norman Lamb: I applaud the cross-party effort of those Members campaigning for their community, and I am very happy to engage with them further on that matter.

Andrew Gwynne rose

Norman Lamb: I will not give way again; I do not have time.

Last year, of the 21.7 million people who visited accident and emergency departments, almost 96% were admitted, transferred or discharged within four hours. Target achieved. So far, it is the same this year: target achieved. The right hon. Member for Leigh (Andy Burnham) missed his A and E target in two of the three quarters when he was in charge. Did he go around telling everyone that there was a crisis at that time? No, of course he did not—

Several hon. Members rose—

Madam Deputy Speaker (Mrs Eleanor Laing): Order. The Minister is not giving way. He has limited time, and we will hear him.

18 Dec 2013 : Column 801

Norman Lamb: Thank you, Madam Deputy Speaker.

The then Secretary of State, now the shadow Secretary of State, missed the target in this very week when he was in charge. We know that the winter is tough, and that performance always dips at this time of year. We also know that the staff are under a lot of pressure. The truth is that we inherited a dysfunctional system that was crying out for reform, with too many people ending up in hospital because of crises in their care, as my hon. Friend the Member for Bracknell (Dr Lee) made clear. For years, I have argued the case for a different approach.

We are supporting the NHS to enable it to manage better in the short term. For this winter, we are investing an additional £400 million in total—more than ever before. In the longer term, we need to look afresh at how we organise urgent care. That is why Bruce Keogh’s report into urgent and emergency care is so important, and I hope that the hon. Member for Mitcham and Morden (Siobhain McDonagh) will accept the case for a clinically led review in order to achieve the right approach. We will work closely alongside NHS England in putting these reforms into practice. The hon. Member for Stretford and Urmston (Kate Green) was absolutely right to say that we have to communicate better with the public and ensure that the process is a good one.

In the longer term, we need to do more to prevent people from ending up in hospital as a result of avoidable crises. As my hon. Friend the Member for St Ives (Andrew George) said, we need to make two big shifts. The first involves a move to a much greater focus on preventing ill health and the deterioration of health. The second involves a shift from a fragmented system to one that is integrated and joined up. That is the approach that we must follow.

Integrated pioneers around the country, such as those in south Devon and Torbay, Greenwich and Labour-led Barnsley, are doing great work, joining up care, collaborating with the voluntary sector, providing better care and keeping people out of hospital. That is the vision of the health service for the future. These pioneers will help the rest of the country to make the best possible use of the £3.8 billion better care fund. The fund will encourage organisations: to act earlier to prevent people from reaching crisis point; to offer seven-day services; and to deliver care that is centred on people’s needs. I am grateful to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for welcoming that important new fund. We are also introducing named, accountable GPs for the over-75s and improving access to general practice.

We are addressing both the short-term and long-term challenges, giving the NHS the support it needs. I want genuinely to thank the excellent staff throughout our health and care services who are tackling these issues head-on. The measures and changes we have outlined today will support staff to deliver the best possible care, even in the most difficult of circumstances.

Question put.

The House proceeded to a Division.

Madam Deputy Speaker (Mrs Eleanor Laing): I ask the Serjeant at Arms to investigate the delay in the No Lobby.

The House having divided:

Ayes 242, Noes 307.

Division No. 163]


3.46 pm


Abbott, Ms Diane

Ainsworth, rh Mr Bob

Alexander, rh Mr Douglas

Alexander, Heidi

Ali, Rushanara

Allen, Mr Graham

Anderson, Mr David

Ashworth, Jonathan

Austin, Ian

Bailey, Mr Adrian

Bain, Mr William

Banks, Gordon

Barron, rh Mr Kevin

Bayley, Hugh

Beckett, rh Margaret

Begg, Dame Anne

Benn, rh Hilary

Benton, Mr Joe

Berger, Luciana

Betts, Mr Clive

Blackman-Woods, Roberta

Blears, rh Hazel

Blomfield, Paul

Bradshaw, rh Mr Ben

Brennan, Kevin

Brown, rh Mr Gordon

Brown, Lyn

Brown, rh Mr Nicholas

Brown, Mr Russell

Bryant, Chris

Buck, Ms Karen

Burden, Richard

Burnham, rh Andy

Campbell, Mr Alan

Campbell, Mr Ronnie

Caton, Martin

Champion, Sarah

Chapman, Jenny

Clark, Katy

Clarke, rh Mr Tom

Coaker, Vernon

Coffey, Ann

Connarty, Michael

Cooper, rh Yvette

Corbyn, Jeremy

Crausby, Mr David

Creagh, Mary

Creasy, Stella

Cruddas, Jon

Cryer, John

Cunningham, Alex

Cunningham, Mr Jim

Cunningham, Sir Tony

Curran, Margaret

Dakin, Nic

Danczuk, Simon

Darling, rh Mr Alistair

David, Wayne

Davidson, Mr Ian

Davies, Geraint

De Piero, Gloria

Denham, rh Mr John

Dobbin, Jim

Dobson, rh Frank

Docherty, Thomas

Donohoe, Mr Brian H.

Doran, Mr Frank

Doughty, Stephen

Dowd, Jim

Doyle, Gemma

Dromey, Jack

Dugher, Michael

Durkan, Mark

Eagle, Ms Angela

Eagle, Maria

Edwards, Jonathan

Efford, Clive

Elliott, Julie

Ellman, Mrs Louise

Engel, Natascha

Esterson, Bill

Evans, Chris

Farrelly, Paul

Field, rh Mr Frank

Fitzpatrick, Jim

Flello, Robert

Flint, rh Caroline

Flynn, Paul

Fovargue, Yvonne

Francis, Dr Hywel

Galloway, George

Gapes, Mike

Gardiner, Barry

Gilmore, Sheila

Glass, Pat

Glindon, Mrs Mary

Godsiff, Mr Roger

Goggins, rh Paul

Goodman, Helen

Greatrex, Tom

Green, Kate

Greenwood, Lilian

Griffith, Nia

Gwynne, Andrew

Hamilton, Mr David

Hamilton, Fabian

Hanson, rh Mr David

Harman, rh Ms Harriet

Harris, Mr Tom

Havard, Mr Dai

Hendrick, Mark

Hepburn, Mr Stephen

Hillier, Meg

Hilling, Julie

Hodge, rh Margaret

Hodgson, Mrs Sharon

Hoey, Kate

Hood, Mr Jim

Hopkins, Kelvin

Howarth, rh Mr George

Hunt, Tristram

Irranca-Davies, Huw

Jackson, Glenda

Jamieson, Cathy

Jarvis, Dan

Johnson, rh Alan

Johnson, Diana

Jones, Graham

Jones, Helen

Jones, Mr Kevan

Jones, Susan Elan

Jowell, rh Dame Tessa

Joyce, Eric

Kaufman, rh Sir Gerald

Keeley, Barbara

Kendall, Liz

Khan, rh Sadiq

Lavery, Ian

Lazarowicz, Mark

Leslie, Chris

Lewell-Buck, Mrs Emma

Lewis, Mr Ivan

Love, Mr Andrew

Lucas, Caroline

Lucas, Ian

Mactaggart, Fiona

Mahmood, Mr Khalid

Mahmood, Shabana

Malhotra, Seema

Mann, John

Marsden, Mr Gordon

McCabe, Steve

McCann, Mr Michael

McCarthy, Kerry

McClymont, Gregg

McDonagh, Siobhain

McDonald, Andy

McDonnell, John

McFadden, rh Mr Pat

McGovern, Alison

McGovern, Jim

McGuire, rh Mrs Anne

McKechin, Ann

McKenzie, Mr Iain

McKinnell, Catherine

Meacher, rh Mr Michael

Meale, Sir Alan

Mearns, Ian

Miller, Andrew

Moon, Mrs Madeleine

Morden, Jessica

Morrice, Graeme


Morris, Grahame M.


Mudie, Mr George

Munn, Meg

Murphy, rh Mr Jim

Murphy, rh Paul

Murray, Ian

Nandy, Lisa

Nash, Pamela

O'Donnell, Fiona

Onwurah, Chi

Osborne, Sandra

Owen, Albert

Pearce, Teresa

Perkins, Toby

Pound, Stephen

Powell, Lucy

Raynsford, rh Mr Nick

Reed, Mr Jamie

Reed, Mr Steve

Reeves, Rachel

Reynolds, Emma

Reynolds, Jonathan

Riordan, Mrs Linda

Ritchie, Ms Margaret

Robertson, John

Rotheram, Steve

Roy, Mr Frank

Roy, Lindsay

Ruane, Chris

Ruddock, rh Dame Joan

Sarwar, Anas

Sawford, Andy

Seabeck, Alison

Shannon, Jim

Sharma, Mr Virendra

Sheerman, Mr Barry

Sheridan, Jim

Shuker, Gavin

Skinner, Mr Dennis

Slaughter, Mr Andy

Smith, rh Mr Andrew

Smith, Angela

Smith, Nick

Smith, Owen

Spellar, rh Mr John

Straw, rh Mr Jack

Stringer, Graham

Stuart, Ms Gisela

Sutcliffe, Mr Gerry

Tami, Mark

Thomas, Mr Gareth

Thornberry, Emily

Timms, rh Stephen

Trickett, Jon

Turner, Karl

Twigg, Derek

Twigg, Stephen

Umunna, Mr Chuka

Vaz, Valerie

Walley, Joan

Watson, Mr Tom

Watts, Mr Dave

Whitehead, Dr Alan

Williamson, Chris

Wilson, Phil

Winnick, Mr David

Winterton, rh Ms Rosie

Wood, Mike

Wright, David

Wright, Mr Iain

Tellers for the Ayes:

Bridget Phillipson


Tom Blenkinsop


Adams, Nigel

Afriyie, Adam

Aldous, Peter

Amess, Mr David

Andrew, Stuart

Bacon, Mr Richard

Baker, Norman

Baker, Steve

Baldry, rh Sir Tony

Baldwin, Harriett

Barclay, Stephen

Barker, rh Gregory

Baron, Mr John

Barwell, Gavin

Bebb, Guto

Beith, rh Sir Alan

Bellingham, Mr Henry

Benyon, Richard

Beresford, Sir Paul

Bingham, Andrew

Blackman, Bob

Blackwood, Nicola

Blunt, Mr Crispin

Bone, Mr Peter

Bradley, Karen

Brady, Mr Graham

Brake, rh Tom

Bray, Angie

Brazier, Mr Julian

Bridgen, Andrew

Brine, Steve

Brooke, Annette

Browne, Mr Jeremy

Bruce, Fiona

Bruce, rh Sir Malcolm

Buckland, Mr Robert

Burley, Mr Aidan

Burns, Conor

Burns, rh Mr Simon

Burrowes, Mr David

Burstow, rh Paul

Burt, rh Alistair

Burt, Lorely

Byles, Dan

Cable, rh Vince

Cairns, Alun

Campbell, rh Sir Menzies

Carmichael, rh Mr Alistair

Carmichael, Neil

Carswell, Mr Douglas

Cash, Mr William

Chishti, Rehman

Chope, Mr Christopher

Clappison, Mr James

Clark, rh Greg

Clarke, rh Mr Kenneth

Clifton-Brown, Geoffrey

Coffey, Dr Thérèse

Collins, Damian

Colvile, Oliver

Cox, Mr Geoffrey

Crockart, Mike

Crouch, Tracey

Davey, rh Mr Edward

Davies, David T. C.


Davies, Glyn

Davies, Philip

Davis, rh Mr David

de Bois, Nick

Dinenage, Caroline

Djanogly, Mr Jonathan

Dorrell, rh Mr Stephen

Doyle-Price, Jackie

Drax, Richard

Duddridge, James

Duncan, rh Mr Alan

Duncan Smith, rh Mr Iain

Dunne, Mr Philip

Ellis, Michael

Ellison, Jane

Ellwood, Mr Tobias

Eustice, George

Evans, Graham

Evans, Jonathan

Evennett, Mr David

Fabricant, Michael

Fallon, rh Michael

Farron, Tim

Featherstone, Lynne

Foster, rh Mr Don

Fox, rh Dr Liam

Freer, Mike

Fuller, Richard

Gale, Sir Roger

Garnier, Sir Edward

Garnier, Mark

Gauke, Mr David

George, Andrew

Gibb, Mr Nick

Gilbert, Stephen

Glen, John

Goldsmith, Zac

Goodwill, Mr Robert

Gove, rh Michael

Graham, Richard

Grant, Mrs Helen

Gray, Mr James

Grayling, rh Chris

Green, rh Damian

Grieve, rh Mr Dominic

Griffiths, Andrew

Gummer, Ben

Gyimah, Mr Sam

Hague, rh Mr William

Halfon, Robert

Hames, Duncan

Hammond, rh Mr Philip

Hammond, Stephen

Hancock, Matthew

Hancock, Mr Mike

Hands, Greg

Harper, Mr Mark

Harrington, Richard

Harris, Rebecca

Hart, Simon

Harvey, Sir Nick

Haselhurst, rh Sir Alan

Hayes, rh Mr John

Heald, Oliver

Heath, Mr David

Heaton-Harris, Chris

Hemming, John

Henderson, Gordon

Hendry, Charles

Herbert, rh Nick

Hinds, Damian

Hoban, Mr Mark

Hollingbery, George

Hollobone, Mr Philip

Holloway, Mr Adam

Hopkins, Kris

Howarth, Sir Gerald

Howell, John

Hughes, rh Simon

Hunt, rh Mr Jeremy

Huppert, Dr Julian

Hurd, Mr Nick

Jackson, Mr Stewart

Javid, Sajid

Jenkin, Mr Bernard

Johnson, Gareth

Johnson, Joseph

Jones, Andrew

Jones, rh Mr David

Jones, Mr Marcus

Kelly, Chris

Kirby, Simon

Knight, rh Sir Greg

Kwarteng, Kwasi

Lamb, Norman

Lancaster, Mark

Lansley, rh Mr Andrew

Latham, Pauline

Laws, rh Mr David

Leadsom, Andrea

Lee, Jessica

Lee, Dr Phillip

Leech, Mr John

Leigh, Sir Edward

Leslie, Charlotte

Lewis, Dr Julian

Liddell-Grainger, Mr Ian

Lidington, rh Mr David

Lilley, rh Mr Peter

Lloyd, Stephen

Lord, Jonathan

Loughton, Tim

Luff, Peter

Lumley, Karen

Macleod, Mary

Maude, rh Mr Francis

Maynard, Paul

McCartney, Jason

McCartney, Karl

McIntosh, Miss Anne

McLoughlin, rh Mr Patrick

McVey, Esther

Menzies, Mark

Metcalfe, Stephen

Mills, Nigel

Milton, Anne

Mitchell, rh Mr Andrew

Mordaunt, Penny

Morgan, Nicky

Morris, Anne Marie

Morris, David

Morris, James

Mosley, Stephen

Mowat, David

Munt, Tessa

Murray, Sheryll

Murrison, Dr Andrew

Neill, Robert

Newmark, Mr Brooks

Newton, Sarah

Norman, Jesse

Nuttall, Mr David

O'Brien, rh Mr Stephen

Offord, Dr Matthew

Ollerenshaw, Eric

Opperman, Guy

Ottaway, rh Richard

Parish, Neil

Patel, Priti

Paterson, rh Mr Owen

Pawsey, Mark

Penning, Mike

Penrose, John

Percy, Andrew

Phillips, Stephen

Pickles, rh Mr Eric

Pincher, Christopher

Prisk, Mr Mark

Pritchard, Mark

Pugh, John

Randall, rh Sir John

Reckless, Mark

Redwood, rh Mr John

Rees-Mogg, Jacob

Reid, Mr Alan

Rifkind, rh Sir Malcolm

Robathan, rh Mr Andrew

Robertson, Mr Laurence

Rogerson, Dan

Rudd, Amber

Ruffley, Mr David

Russell, Sir Bob

Rutley, David

Sanders, Mr Adrian

Sandys, Laura

Scott, Mr Lee

Selous, Andrew

Shapps, rh Grant

Sharma, Alok

Shepherd, Sir Richard

Simmonds, Mark

Simpson, Mr Keith

Skidmore, Chris

Smith, Chloe

Smith, Henry

Smith, Julian

Smith, Sir Robert

Soames, rh Nicholas

Soubry, Anna

Spelman, rh Mrs Caroline

Spencer, Mr Mark

Stanley, rh Sir John

Stephenson, Andrew

Stevenson, John

Stewart, Bob

Stewart, Iain

Stewart, Rory

Stride, Mel

Stuart, Mr Graham

Stunell, rh Sir Andrew

Sturdy, Julian

Swales, Ian

Swayne, rh Mr Desmond

Swinson, Jo

Swire, rh Mr Hugo

Syms, Mr Robert

Teather, Sarah

Thornton, Mike

Thurso, John

Timpson, Mr Edward

Tomlinson, Justin

Tredinnick, David

Truss, Elizabeth

Turner, Mr Andrew

Tyrie, Mr Andrew

Uppal, Paul

Vaizey, Mr Edward

Vara, Mr Shailesh

Vickers, Martin

Walker, Mr Charles

Walker, Mr Robin

Wallace, Mr Ben

Walter, Mr Robert

Ward, Mr David

Watkinson, Dame Angela

Weatherley, Mike

Webb, Steve

Wharton, James

Wheeler, Heather

White, Chris

Whittingdale, Mr John

Wiggin, Bill

Willetts, rh Mr David

Williams, Mr Mark

Williams, Roger

Williams, Stephen

Williamson, Gavin

Wilson, Mr Rob

Wright, Jeremy

Wright, Simon

Young, rh Sir George

Zahawi, Nadhim

Tellers for the Noes:

Claire Perry


Mark Hunter

Question accordingly negatived.