Philip Dunne responds to a debate on A&E services

22nd November 2016

Philip Dunne responds on behalf of the Government to a debate on accident and emergency services in Merseyside and Cheshire.

It is a great pleasure, as always, to serve under your chairmanship, Sir Roger. I congratulate the hon. Member for Southport (John Pugh) on securing the debate. He referenced the fact that we served together on the Public Accounts Committee many years ago in the early days of my parliamentary career, and I have therefore long understood his forensic approach to matters affecting his constituency. He has shown that again today with his characterisation of the health needs of Southport. It is good to see a number of neighbouring MPs joining this short debate. They share a common interest in guaranteeing high-quality health services for their local residents. We in the Department of Health obviously share that interest.

I have listened carefully to the concerns the hon. Gentleman has expressed about A&E services in particular in the local area. He and other Members have touched on wider health issues, and I will try to address some of those in the few moments I have today. I am particularly aware of the concerns he concluded with about the potential of the sustainability and transformation plan proposals for the area, which include urgent care among many other things. I will touch on that in my remarks.

We all recognise the increasing pressures in the NHS, particularly as we move into winter. I am sure all Members would acknowledge the hard work and dedication of those providing high-quality services across the NHS, including in Southport, which the hon. Gentleman referred to. The NHS cannot stand still, however, and services need to change to continue to meet patient need and patient expectation. Nationally, there were some 1.95 million attendances at A&E departments in September, compared with around 1.86 million in September 2015—an increase of 4.9% in only 12 months. Some 1.77 million patients were admitted, transferred or discharged within four hours, compared with 1.73 million a year ago—an increase of 1.85%. I give the House those statistics to point out that the NHS is seeing and treating more people within its targets than ever before. In Merseyside and Cheshire, that means that more than 2,400 more patients were transferred, admitted or discharged within four hours of arrival this September as compared with last September.

Turning specifically to the Southport and Ormskirk Hospital NHS Trust, there are clearly performance matters that need to be addressed. Although its A&E performance does not meet the national 95% target, at 91.5% it is above the national average of 90.6%. As the hon. Gentleman said, its current A&E performance is relatively better than that elsewhere. However, the CQC report that he touched on, which was published last week, rated the A&E department as “inadequate” for safety and “requires improvement” for all other fields apart from caring. Although that may be based on work done some months ago, I am sure he would agree that it is unacceptable. The trust needs to improve its performance for the people of Southport.

 

The Minister is making an important point. The argument about the CQC inspections is to some extent related to what the CQC inspects. If it is inspecting an A&E department—I hope I made this clear in my speech—the CQC often has to bear in mind the fact that it is not an isolated unit. A&E works in conjunction with adult social care, the ambulance service and so on. Getting snapshots of a poorly performing department without taking into account the background and the other arrangements in and around A&E can give a false picture of where the problem lies.

 

I am not going to get into a prolonged debate about the CQC report, but it rates the entire trust as “requires improvement”. We have confidence in the overall reporting, and looking at A&E in that context reflects an accurate impression of the current status of the trust. For example, three of the trust’s seven A&E consultant posts are filled by locums or agency staff. That mix of staffing is not sustainable for any A&E department. I am aware that the trust and its commissioners are looking to address that.

Several hon. Members referred in interventions on the hon. Member for Southport to the NHS sustainability and transformation plans. I emphasise to the House that STPs are collaborative plans designed to help local organisations deliver on the “Five Year Forward View”. They are formed by CCGs, providers and local authorities working together in an area to develop a plan. Some have also involved other stakeholders who will be affected by changes in their area and can contribute to improvements. The true test will be whether a revised healthcare system really improves matters for patients.

We are still at an early stage in the process. The local NHS describes the plan for Cheshire and Merseyside as a plan for a plan at this stage. I will not therefore pass judgement today on the STP process or the content of the Cheshire and Merseyside STP. I am not in a position to do so. I do not know the local position as well as the local clinicians who have drawn up the plan; no one in Westminster or Whitehall does. Local clinicians must ensure that they involve the public and patients—and Members, as the hon. Gentleman called for in his closing remarks—and explain what they think is best for each local area. I reject the charge that the plan will not involve the local communities; it absolutely needs to involve local communities to be taken forward. It is a central tenet of the approval of the plans that there is public engagement.

 

rose—

 

I am afraid I have very little time, and the hon. Lady will have an opportunity to pick my brains directly on anything I do not address in my remarks, because we are meeting next week. I am happy to talk to her. We have had a dialogue over some of the health issues that are of most concern to her, and I thank her for her efforts in bringing those to my attention.

The STP process is not run by or for the Department of Health. It is run by the NHS for patients of the NHS. Design of health services, including front-line health services and A&E, is a matter for the local NHS. The reforms that my noble Friend Lord Lansley made when he was in post have put clinicians in charge of the care people receive and how it is delivered to serve their populations best. Local authorities are vital in helping set the direction of health and social care development locally. Guidance on STPs from NHS England has been clear about the importance of local authorities in partnership arrangements and of the NHS working with local authorities to deliver prevention and public health improvements. It is crucial that the NHS and local authorities work closely to ensure the key aims of the STP process can be delivered: better health, better patient care and improved NHS efficiency.

The STP for Cheshire and Merseyside was published a week ago, on 15 November. As I said, the NHS described it as a plan for a plan. In the area represented by the hon. Member for Southport, it builds on the “Shaping Sefton” local delivery system, which I understand had considerable public engagement. It is disappointing that the leaking of an early and incomplete draft of the STP led to speculation and some concern. I hope that the publication of the formal document will dispel some of those fears. I assure the hon. Gentleman that no changes to the services people currently receive will be made without local engagement. When and if final plans propose service change, formal consultation will follow in due course.

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