A and E Waiting Times: 23rd April 2013

Heidi Alexander (Lewisham East) (Lab)
I congratulate my right hon. Friend the Member for Cynon Valley (Ann Clwyd) on securing this debate.

What struck me when listening to the contributions from all parties represented in Westminster Hall this morning is the consensus that exists about the fact that we need to hear from the Government their vision for accident and emergency services. I agree entirely with the comments of the hon. Member for Cheltenham (Martin Horwood) and my hon. Friend the Member for Stretford and Urmston (Kate Green) when they say that we need clarity about how that vision is developing.

There is a fundamental tension between the centralisation of specialisms in accident and emergency services, and the desire of local people to be treated close to home. In London, there are fantastic A and E facilities in some of our central London hospitals, such as Guys and St Thomas’s hospital over the river, and yet—as hon. Members know—we equally find that hospitals in some of the outer parts of London are, frankly, either being sold off or seeing their services hugely downgraded, such as the downgrading that we are experiencing at Lewisham hospital at the moment.

Before I make some specific remarks about the situation in south-east London and some of the things that I have learned and been thinking about since we have been dealing with the issue at Lewisham hospital, I will quickly pick up on one of the other remarks made by ​my hon. Friend the Member for Stretford and Urmston. She talked about the problems she had experienced in extracting clear and concise information from the Department of Health about waiting times in Manchester hospitals. I, too, have asked several questions recently, not about waiting times but about the provision of health services at hospitals in London. I have simply been told that the Department does not hold that sort of information and it has been recommended that I make freedom of information requests. That is all well and good, but the public want to be reassured that Ministers at the heart of Government understand what is happening in hospitals out there and that they have an appreciation of the wider picture so that they can develop their vision of hospital services, whether they are A and E services or maternity services, but I am not sure that we feel reassured when we get such parliamentary answers that that is the case.

I will make two specific points about Lewisham hospital. Hon. Members will know that, in January, the Secretary of State for Health announced that Lewisham hospital would have a smaller A and E department, and that it would lose its maternity services. That was as a result of the trust special administration process that took place in the South London Healthcare NHS Trust, which was in huge financial difficulties. The hospitals in Woolwich, Bromley and Sidcup had a very significant operating deficit, and as a result of that we were told that the hospital down the road in Lewisham would have its services decimated. The full A and E department at Lewisham hospital will close; all blue-light ambulances will go past Lewisham hospital to other hospitals; all medical emergencies will not be able to be treated at Lewisham hospital; and yet the Secretary of State still calls it a “smaller” A and E department.

We might think that, on the basis of taking capacity out of the system at Lewisham hospital and—I should say—having to invest £37 million in other hospitals to deal with the displacement of people from Lewisham’s A and E department, everything is operating smoothly and well in south-east London. That is not the case. One in 10 people is waiting longer than four hours at hospitals that used to be part of the South London Healthcare NHS Trust, and now in Lewisham, one in 10 people is waiting longer than four hours to be treated. That was not the case in Lewisham a year ago; in March 2012, 97% of people were being treated at Lewisham hospital within four hours. So there is huge pressure upon A and E departments in south-east London.

Yesterday, I asked Lewisham hospital for information about the number of times that ambulances had been diverted to it from other hospitals. Lewisham hospital told me that, since December 2012—in the last four months—there have been 25 separate occasions when ambulances have been diverted to Lewisham. On 10 of those occasions, ambulances were diverted from the Queen Elizabeth hospital in Woolwich, and on 11 other occasions ambulances were diverted from the Princess Royal university hospital in Bromley. Those are the very hospitals that are meant to be picking up the people who will no longer be able to go to Lewisham hospital when our full A and E department goes. I seek a guarantee from the Minister that no changes will be made at Lewisham hospital until these diverts from other hospitals have stopped, and that no changes will ​be made until we see that, at the other hospitals I have mentioned, they are dealing with patients within a four-hour window.

I should like to make two general points about some issues that have already been touched on. There is a fundamental problem with people’s understanding of where they should go for the best possible treatment. The Government have asked Sir Bruce Keogh to conduct a review of emergency care, which is much needed and timely. I would rather the Government waited for the outcome of that review before they took decisions about hospitals such as Lewisham.

At the moment, when people are ill, they have no idea where they should go. They are faced with a plethora of places. Should they go to their general practitioner, a walk-in centre, a minor injuries unit or an urgent care centre, or A and E? It is confusing for people. If there was better information about where people can get the most appropriate treatment, potentially people who do not need to be in A and E would not go there. I do not criticise people for going to A and E, because they know that they will get treatment there and will be dealt with—hopefully—quickly. We cannot expect them to understand all the intricacies of what is available elsewhere. That fundamental problem needs to be addressed.

The Government are making the situation worse in Lewisham, when they say that Lewisham will retain a smaller A and E. On the day that the Secretary of State made that announcement, I said to myself, “What is a smaller A and E? What will happen there?” I am not the only one who is concerned about this. On 21 February, the president of the College of Emergency Medicine, Mike Clancy, tweeted:

“We have raised questions about the lack of clarity”—

with regard to Lewisham hospital—

“and that what’s proposed doesn’t meet our definition of an”

emergency department. Even the CEM is saying that the Government are making this more confusing for people. The way that the whole process has been dealt with has been quite deceitful and potentially dangerous. Telling people that there is a smaller A and E when it will be nothing more than an urgent care centre has potentially serious implications.
 
The Parliamentary Under-Secretary of State for Health (Anna Soubry)
I am sure that the hon. Lady is not suggesting the Secretary of State was in any way deceitful.

Heidi Alexander
I said that the whole process was deceitful and potentially dangerous. A legal challenge about Lewisham is under way. We have to await the outcome of that to see what the future holds for Lewisham. I stand by my remarks. The process was not really open from the outset.

My final point has already been mentioned. We need to work out exactly how we stop people going into A and E who do not need to be there. Yesterday, I was at my grandmother’s funeral. For a number of years, she had been very poorly and was a frequent attendee at her local hospital. Several times when she turned up there, she did not really need to be there. She was a poorly, lonely old lady. If we are to address the number of people who present at A and E when they do not need to be there, we must find proper ways of caring for people well and with dignity, especially towards the end ​of their lives, in the community. The problem at the moment is that we are trying to reduce the availability of A and Es in local areas when we do not have alternative care in place to stop people having to rely on A and E as the last resort.

I am grateful for the opportunity to speak in this debate. Again, I congratulate my right hon. Friend the Member for Cynon Valley on securing the debate. The availability of high-quality local health services matters to everyone. It will be interesting to hear what the Minister says about how she is going to address those important issues.

Grahame M. Morris (Easington) (Lab)
It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my right hon. Friend the Member for Cynon Valley (Ann Clwyd) on securing this debate and compliment hon. Members who have spoken so far, highlighting concerns about the increase in A and E waiting times that are affecting their constituents.

I shall make specific references to my area and to the increase in A and E waiting times. I shall also spend a few moments reflecting on why we are in this situation and will mention the Health questions debate, during which I was bitterly disappointed by responses from the Health Secretary and Ministers to questions from hon. Members regarding increases in A and E waiting times.

An impartial observer might think the coalition Government had inherited a health service on the brink of collapse. The truth is that the Government inherited an NHS that had been transformed from what the previous Labour Government inherited after 18 years of Conservative Government and under-investment. My area was one of many, perhaps including Kettering, that were beneficiaries of considerable investment. There were 100 new hospitals; actual spend on the NHS increased from £30 billion to more than £100 billion; and much of the aged NHS infrastructure was replaced. My area and many others saw the construction of new walk-in centres, primary care centres and a new generation of modern community hospitals. GP opening hours were also extended. We have had the benefit of more doctors and nurses than ever before. We also had NHS Direct.

My contention is that Labour not only fixed the roof when the sun was shining, but laid the foundations and built the new hospitals, ensuring that patients received faster and better treatment closer to their communities. That was reflected in public satisfaction with the NHS, which went from the lowest ever recorded levels in the 1990s under the previous Conservative Administration, to the highest ever recorded levels by the time Labour left office. However, since the coalition Government took office, we have seen the biggest fall in public satisfaction with the NHS, as spending cuts have started to bite. [Interruption.] The Minister is saying no and shaking her head.

Anna Soubry
I am not. I am saying, “What?”
 
Grahame M. Morris
The Government have given back to the Treasury some £3 billion over two years. The Government have expended unnecessarily in excess of £2 billion or £3 billion on a top-down reorganisation. ​Factor in the £20 billion in cuts or efficiencies—however people choose to describe them—and this is a difficult time for the NHS.

Anna Soubry
Efficiencies.

Grahame M. Morris
Someone’s efficiency is someone else’s cut.

Anna Soubry
Will the hon. Gentleman not accept that the efficiencies that he speaks about were agreed between the then Opposition and the then Government—his Government—as savings within the NHS of some £20 billion? Does he also accept that his party, in its last manifesto and in comments by Ministers, stated that it would cut the amount of money going into the NHS? That is something this Government have not done.

Grahame M. Morris
I think that the Government are cutting the money that is spent on the NHS, not least with the costs of the reorganisation, which I have already mentioned. That money need not have been spent. We are giving back several billion pounds—some £2.5 billion to £3 billion to the Treasury—which could be spent addressing issues such as this. There are a couple of practical points that I want to raise with the Minister later, but I give way to the hon. Member for Cheltenham (Martin Horwood).

Martin Horwood
I agree with the hon. Gentleman about the reorganisation of the NHS. That time and effort would have been better spent trying to work out how to deliver health care more cost-effectively. But does not he rather undermine his case when pretending that there has been a cut to the NHS budget, when an objective analysis of the actual billions spent on the NHS clearly shows that it has gone up? The difference between a cut and an efficiency saving is that an efficiency saving is returned to the NHS budget.

Grahame M. Morris
I did not vote for the NHS reorganisation; I spent 40 sittings in Committee trying to resist what is now the Health and Social Care Act 2012 and the damaging changes it introduces. That includes those that are about to be implemented under section 75, on the introduction of competition, which will fragment the service and add to costs and complexities. I do not, therefore, accept the hon. Gentleman’s criticism, but I will press on because I want shortly to raise a couple of issues specifically about County Durham.

Part of our responsibility is to hold Ministers and, indeed, the Prime Minister to account. On waiting times—this was one of his five guarantees—he said:

“We will not lose control of waiting times—we will ensure they are kept low.”

Other Members have quoted the King’s Fund and patient surveys, and the figures clearly show that 32 foundation trust hospitals, out of 88 acute trusts in England with an A and E unit, missed the target in the last three months of 2012. I am not sure whether Kettering was one of them, but those figures should be cause for concern for everybody, including Ministers and the Prime Minister. That is double the number of trusts that missed the target in the same period last year, and four times the number that missed it in the previous quarter.​

It is therefore clear that A and E waiting times are spiralling out of control. There have been various surveys, including one conducted by the Care Quality Commission, which found that one in three people spent more than four hours waiting for treatment. It also noted a large rise in the number of patients waiting for 30 minutes or more before seeing a doctor or a nurse.

In my area, The Northern Echo is campaigning on this issue, highlighting the alarming rise in the number of patients in the north-east waiting more than four hours for treatment. That number has almost trebled in the past 12 months. The paper has disaggregated figures from the Department of Health and found that more than 1,000 patients have waited longer than the target time, including 536 in County Durham and Darlington. Compared with 12 months ago, the number of patients waiting more than four hours has increased by 200% in County Durham and Darlington. South Tees and York have also seen increases in excess of 200%, compared with the previous year. However, at the Newcastle foundation trusts, the percentage increase is a staggering 630%. Alarm bells should be ringing for Ministers, because those figures are quite dreadful.

I was concerned by the Secretary of State’s responses at Question Time. One disturbing characteristic of this Government is that they are not taking responsibility or coming forward with proposals to address these issues. Specifically, in response to a question from my hon. Friend the Member for Manchester Central (Lucy Powell), the Health Secretary said:

“We are looking at the root causes of the fact that admissions to A and E are going up so fast”

—I think he quoted a figure of an additional million. The factors he blamed were that

“there is such poor primary care provision…changes to the GP contract led to a big decline in the availability of out-of-hour services…and…health and social care services are so badly joined up.”

He added:

“That is how we are going to tackle this issue”.—[Official Report, 16 April 2013; Vol. 561, c. 168.]

That really is not good enough. Indeed, Dr Laurence Buckman, who is chair of the British Medical Association’s General Practitioners Committee, has been quite dismissive and scathing about the Health Secretary’s decision to blame the increase in A and E numbers on the changes to GP contracts. He said it was “impressively superficial”—[Interruption.] Well, that is what the man said, Minister. He said that the decision was not based on any evidence. He went on to say:

“Most GPs were not providing personal access out of hours anyway; it was provided through a variety of out-of-hours routes and that has been the case for the past 30 years, so it would be nonsense to suggest that because GPs haven’t been personally responsible since 2004, therefore casualty is full of people. That is just such fatuous nonsense. I question the wisdom of the people briefing the Secretary of State.”

I tend to agree with him.

There is no magic bullet. With a complex organisation such as the NHS, we need a broad-spectrum antibiotic; we need to apply a number of measures. The fragmentation of the service is certainly contributing to the problem. There is also the issue of people not having access to their GP within 48 hours. Like many Members, I have, unfortunately, had experience of close family members and constituents being left with little alternative but to ​go to A and E, when the GP could have addressed the issue, had they been available in a reasonable period. This issue therefore requires a team effort.

I am also concerned about what the RCN is saying about the reduction in the number of community and district-based nurses, and I hope the Minister will refer to that. Information provided through freedom of information requests shows that the number of nurses in communities who are part of the rapid emergency assessment and co-ordination teams and the rapid response teams that help to keep elderly people, in particular, out of hospital, has been dramatically reduced.

Heidi Alexander
Does my hon. Friend agree not only that there are fewer community nurses, but that those who still remain have much enhanced work loads, which means the time spent with each individual patient is reduced? That, too, causes problems with the quality of care provided in the community.

Grahame M. Morris
That is certainly a factor, and I thank my hon. Friend for raising that issue. Part of the solution is a more visionary approach and a care model that integrates NHS services with social care in a seamless service. We need to end the fragmentation and to have full co-operation. We do not want people—particularly elderly patients—to be discharged from hospital, only for their cases not to be followed up by social care or primary health care services. That is a key challenge facing the Government. I will leave it at that.

Mr Jamie Reed (Copeland) (Lab)
It is a pleasure to speak under your chairmanship, for what is, I think, the first time, Mr Hollobone. I thank my right hon. Friend the Member for Cynon Valley (Ann Clwyd) for securing the debate. She has an exceptionally powerful voice in these matters, and all of us, on both sides of the House, have a common interest in ensuring it is heard not only today, but throughout this Parliament. I pay tribute to the work she is doing not only in her own right, but in tandem with the Government.

I also pay tribute to the work other Members who have spoken undertake on behalf of their constituents in fighting for A and E services in their constituencies. It would be remiss of me not to thank my local A and E unit at the West Cumberland hospital for saving my life probably twice in the past two years, although I appreciate that that makes me sound careless.

Before I begin, I wonder whether the Minister can answer this fairly simple question. What have Barking, Havering and Redbridge University Hospitals NHS Trust, Burton Hospitals NHS Foundation Trust, Milton Keynes Hospital NHS Foundation Trust, North West London Hospitals NHS Trust, Portsmouth Hospitals NHS Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Shrewsbury and Telford Hospital NHS Trust, University Hospital of South Manchester NHS Foundation Trust, University Hospitals Coventry and Warwickshire NHS Trust, University Hospitals of Leicester NHS Trust and York Teaching Hospital NHS Foundation Trust all got in common? I am more than happy to give way to the Minister if she would like to hazard a guess.

Anna Soubry
These are serious matters and should be above such cheap party politics. The hon. Gentleman clearly knows the answer to his question, and is asking ​me to speculate. Given that the debate is about accident and emergency, no doubt the answer is that their waiting times are longer. The Government accept that, and also agree that it is not acceptable; and we are doing something about it. If the hon. Gentleman wants to play party politics, that is against him, not against anything else.

Mr Reed
That was a regrettable answer, and did not become the Minister. She clearly does not know the answer. I wonder, as do, I think, many hon. Members, whether the Government know the answer to the question. It is that those trusts have missed the A and E target for major type 1 units—

Anna Soubry
I just said that.

Mr Reed
Can she tell me for how long?

Anna Soubry
I am not playing silly games with our NHS.

Mr Reed
They have missed it for each of the last 29 weeks. These points are not silly; they are matters of fact.

Anna Soubry
Will the hon. Gentleman give way?

Mr Reed
Of course; I look forward to an answer.

Anna Soubry
The point that I am making is that the hon. Gentleman is playing silly games with serious matters. Other right hon. and hon. Members have addressed the issue positively, with compassion, but he is just playing silly party political games.

Mr Reed
I now know what it feels like to be handbagged.

Anna Soubry
That is sexist.

Mr Reed
I do not think it is sexist at all.

Does the Minister know how many times her local trust has missed its A and E target, since the end of September? [Interruption.] I will tell her. Nottingham University Hospitals NHS Trust has missed its target for 17 weeks since September.

Anna Soubry
Would the hon. Gentleman care to refresh his memory? If we refer to the most recent statistics produced by Nottingham University Hospitals NHS Trust for the A and E department at the Queen’s medical centre, we can compare those for the week commencing 14 April this year with those for the week commencing 15 April last year. Last year 440 patients failed to be treated or seen within the four-hour target, whereas this year the figure had fallen to 259.

Mr Reed
I note that the Minister prepared an answer, and I am grateful for that.

Major accident and emergency units—type 1 facilities, nationally—have missed the target for at least the last six months, and all A and E units, including minor incident units, have not hit the target for 12 weeks in a row. If anyone needs help analysing the figures, I would be happy to oblige. They are easy to find and they reveal ​some interesting points. For example, I wonder whether hon. Members know that only one trust with a major accident and emergency unit in England has hit its target every week since the Secretary of State took his position. That is relegation form, and if this were a football match the cry from the crowd would be “You don’t know what you’re doing.”

Before the Minister attempts yet again to dismiss those statistics, I hope she will take a moment to attend to what has been said by the chief executive of the Royal College of Nursing, by Dr Clifford Mann of the College of Emergency Medicine, and by David Behan of the Care Quality Commission. Earlier this month, Dr Peter Carter, of the Royal College of Nursing said:

“These figures are yet more proof of a system running at capacity, and patients are suffering as a result. Our members are regularly telling us that pressure on the system is rising while staffing levels fall, and as a result any increase in demand results in unacceptable waits for patients who are already going through a difficult time.”

Dr Clifford Mann, of the College of Emergency Medicine said:

“We are seeing…ambulances queuing outside departments, and patients waiting too long on trolleys before they can be admitted to hospital.”

The Care Quality Commission said:

“It is disappointing that people have said they have to wait longer to be treated than four years ago. People should be seen, diagnosed, treated and admitted or discharged as quickly as possible”.

Like me, the Royal College of Nursing, the College of Emergency Medicine and the Care Quality Commission will be appalled that the key performance indicators for the NHS, such as A and E waiting times, are getting steadily worse. In the past six months, 582,811 people waited more than four hours in major A and E units, compared with 420,921 for the same period in the previous year. That is an increase of 161,890 people. That is not silly: it is a question of people’s lives. Those figures relate to people in need who did not get treatment in the time when they needed it. They represent more than 500,000 extra waiting hours in one year. People will find it hard to stomach the fact that there are now about 5,000 fewer nurses than there were in 2010, at a time when, as hon. Members on both sides of the House have mentioned, demand in our A and E units is increasing.

One way to get the figure down—it has been touched on already in the debate—would be to offer services for people with non-emergency ailments, so that they do not feel the need to travel to an A and E department. However, instead of NHS Direct being used as a tool for easing pressure on A and E departments, the roll-out of NHS 111 has turned into a trade marked Government shambles. Patients calling the new 111 service wait hours for advice. One patient waited 11 hours and 29 minutes for a call back. No wonder they feel that they have to go to A and E, when they cannot trust a telephone service with such an inadequate response rate.

Accident and emergency departments are a litmus test, or a barometer, for the performance of the NHS as a whole. If people are waiting in A and E, it means that there are too few beds or too few staff to cope with demand. That is just a fact of health service planning. If there are too few beds, it is because community services ​are being cut and patients who should be at home are kept in hospital. That reverberates back through the entire system. If patients who could be at home are in hospital, beds are occupied. If beds are occupied, A and E staff cannot admit patients. If A and Es are full, paramedics cannot hand over patients. If patients are queuing in the back of ambulances, those ambulances cannot respond to a potentially serious call-out. One failure leads to another. Each compounds the other. That is what is so serious about the debate. It is not just about the patient sitting in A and E for hours on end; the statistics I have highlighted show much more than that—the experiences of patients throughout the entire system.

Martin Horwood
In my remarks I suggested another possible factor in the current problems of emergency departments: the difficulty in recruiting emergency doctors. That may have something to do with the attractiveness of emergency medicine as a specialty—the long hours, and so on. However, it also obviously dates back to the training numbers that I am afraid prevailed under the Labour Government. Does the hon. Gentleman accept that there may be some such responsibility, dating back several years, in relation to attracting sufficient numbers into training for emergency medicine?

Mr Reed
I expect the Minister to talk about new doctors in the NHS when she replies to the debate; and, of course, we trained those doctors. We commissioned, paid for and put in place the training of those doctors, so I take what the hon. Gentleman says seriously. I also commend him for being the only Member of Parliament from either of the coalition parties to attend the debate to defend the Government’s record.

The statistics highlight more than the simple numbers: they show the experience of patients throughout the system. One person waiting in A and E can reflect one person in a bed on a ward and another waiting at home for an ambulance. I hope the Minister will acknowledge and accept that, and explain what the Government plan to do. It is essential that they explicitly acknowledge the problems faced by accident and emergency in England. Constant denials do them no credit. They must acknowledge the scale of the problem before any solutions can be introduced.

The NHS in England is completely different from the NHS in Wales. I expect the Government will be tempted to compare the two, but I want to address the issue head on. The reality is that Welsh Ministers are dealing with a £2.1 billion real-terms cut to their budgets. Yet, despite that, they have still managed to protect NHS services. There are now more GPs working in Wales than in 2010, and the number of nurses, midwives and health visitors has remained consistent. That is in stark contrast to England, where nurse numbers are falling. I am sure that hon. Members who have heard such tired comparisons over and over would be interested to know that there are differences in the way A and E waiting times are measured in the two countries, and in how frequently performance is measured.

Before any comparison is made—and I hope that none will be—I want to point out that it is misleading to try to make a direct comparison. However, it is fair to say that all parts of the UK are experiencing increased pressures on A and E. The key difference is that in Wales, Labour are doing something about it, whereas in ​England the coalition is sitting on its hands. In Wales, 270 additional beds were opened this winter to cope with demand, easing pressure throughout the system. The Welsh Government have also agreed an all-Wales action plan for unscheduled care, which means that health boards must ensure that they have sufficient capacity to meet demand.

Will the Minister inform us today what the Government plan to do to help A and E services in England? When and where will they start to provide such help, and how much will it cost?

That aside, will the Minister also answer a few important questions on A and E waiting times? First, will she explain why, when demand is clearly so high and the current services are at breaking point, the Government have handed P45s to almost 5,000 nurses? Will she also explain why the Secretary of State chose a period of intense demand and structural reorganisation to roll out the 111 service when it was clearly not ready to be rolled out?

May I tempt the Minister to speculate on the causes of that rise in A and E waiting times? Does she agree that a combination of inadequate staffing levels, a distracting reorganisation of the NHS and deep cuts to council care budgets is the principal reason for the sharp increase in A and E waiting times? If she does not agree that they are having a major impact on the NHS, can she explain why the Government think that fewer nurses and a distracting reorganisation have improved services?

The problems that others and I have outlined today are well known to many, but they are still sadly neglected by the Government. Despite its imperfections and its many real challenges, the NHS remains one of the best models of national health care in the world. It is filled with dedicated professionals who believe passionately in the aims and values of the service, but it is clear that an expensive, unwanted and unloved reorganisation, combined with Government-induced staff shortages, are causing and have caused deterioration in performance. That is unfair on health care professionals, and, far more importantly, it is unfair on patients. I look forward to the Minister explaining in detail how her Government intend to get a grip and bring all A and E services in England back up to national standards.

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
It is a pleasure to serve under your chairmanship, Mr Hollobone.

I have just about eight minutes to respond to all the valuable contributions made in this debate. I will not be able to answer all the questions, but I will write to anyone who has asked a question that I cannot answer.

Obviously, I begin by paying tribute to the right hon. Member for Cynon Valley (Ann Clwyd) for securing this debate and for the way she is championing the cause of the patient. She will not hesitate to leave no stone unturned. As many others know, she is doing great work in leading our independent review of NHS complaints. She mentioned just some of the many cases that have come her way. She did not give dates, but I suspect the cases were not all fresh by any means, because, as she, I and many others recognise, this is by no means a new phenomenon; it is a serious problem ​that requires serious action, which the Government are taking. Would it not be refreshing and brilliant if we could have a debate on a serious issue without falling into the trap of cheap party politics, which, unfortunately, has been a little evident in some, but mercifully not all, the speeches? As the right hon. Lady said in her speech, there are no easy answers.

Some important points have been raised. We know that there is a problem, and we recognise that. It is not uncommon for the four-hour waiting time standards not to be met, especially during the winter period. That happened under the previous Government as well as under this Government. Indeed, in 2008-09 there were 23 weeks in which the waiting time target was breached, and it was breached during a further 14 weeks in 2009-10 up to May 2010. We know that those problems continue. We want to know and understand why, and we want to take quick action.

Mr Jamie Reed
Will the Minister give way?

Anna Soubry
I have only six minutes to address all the contributions, so the hon. Gentleman had better be quick.

Mr Reed
I am grateful to the Minister for giving way. This is a very important point. Does she accept that Labour’s A and E target for hospitals was tougher than the one set by her Government?

Anna Soubry
No. I am not going to go into all that in the short time that is available to me. We accept that waiting times are a problem—we are not trying to hide from that, and we are up for transparency—and I will address the data in a minute.

The hon. Member for Cheltenham (Martin Horwood) rightly identifies the seasonal nature of waiting times. He speaks with passion about changes in his constituency, and rightly so. It is right and proper that people who have such concerns, as other hon. Members have said, come to this place to champion the cause of the health service within their own communities, especially when it faces reconfiguration. He spoke about 111, which is an important thing to talk about when considering some of the causes that may contribute to the unacceptable failure to hit targets. I know that the data are being monitored on a daily basis by NHS England, and the deputy chief executive of NHS England is meeting twice a week to consider what is happening and to make sure that action is taken to ensure that any problems are addressed.

The hon. Gentleman makes an important point on the difficulty of filling posts, and I will write to him on that because I know it is a problem. I also know that action is being taken by some of the royal colleges, and it is probably best if I give a fuller answer, because he makes a very important point. Of course, I can say that the Keogh review is considering exactly the other problems that he mentioned. As the Secretary of State announced, the Keogh review, which has been alluded to, will report next month. All those matters will be reviewed by Sir Bruce, and it is much to be hoped that some positive forward-thinking will come out of that.​

The hon. Member for Stretford and Urmston (Kate Green) raised various issues. I am particularly concerned that she says she is not getting the answers to the questions she has quite properly asked. I think there is sometimes a problem with hon. Members not going in the first instance to the actual hospital, trust or whoever it might be. Her point, and it is a good point well made, is that when she asked my Department, she did not get those figures, and I will make further inquiries.

Only today I saw a question from the hon. Member for Ashfield (Gloria De Piero) asking precisely what the figures are for her hospital in Sherwood and, as it happens, the hospital she and I effectively share, the Queen’s medical centre A and E department. I have given those figures, and I want to set the record straight because, in fact, for the same week last year in Sherwood, 75 people waited more than four hours; this year the figure is 266.

Kate Green
I have two points to make very quickly. First, I asked for data on all Manchester hospitals. I cannot be expected to go to each one, but, obviously, what is going on in every hospital in the city matters because patients will have to move from one to another if capacity is short. Secondly, I specifically asked for data on Trafford general hospital, which falls within the Central Manchester University Hospitals NHS Foundation Trust. The Minister told me in a written answer that data were not available, but when I approached the trust itself, it told me.

Anna Soubry
I know, and I do not understand why that is. I will absolutely make further inquiries, because it is nonsense that the hon. Lady did not get the data.

I will come on to address the points made by the hon. Member for Lewisham East (Heidi Alexander), but, on the data, it is important that we monitor such things. That is precisely why the Department of Health and Health Ministers are very much alert to what is happening in A and E. We share the concerns of hon. Members, which is why we have the Keogh review, why we are considering how to solve the problem and why we are looking at the underlying causes, which, in the short time available, I hope to address. I will ensure not only that the Ministers to whom the hon. Member for Stretford and Urmston has spoken read Hansard, but that a copy of this debate goes to NHS England, which I know also shares those concerns. NHS England also wants to hear about the experiences of hon. Members, and it is taking action to ensure that we are on top of this and, most importantly, that we do what we should do.

Heidi Alexander
Will the Minister give a commitment today that no changes will be made to Lewisham’s A and E until there are no ambulances being diverted to Lewisham hospital, and waiting time targets are met in the neighbouring hospitals?

Anna Soubry
I took that intervention in good faith, hoping that I might be able to assist. The hon. Lady is more than experienced and knows that I cannot give her any such assurance. She, too, talked about the provision of data in her speech. All I know is that 75% of the people who would ordinarily have gone to A and E in Lewisham will continue to go there, but she makes important points, all of which will be put in the right place.​

I conclude by addressing the cause. Well, we do not know. There are various factors, but, as has been said, there is no easy answer and no silver bullet. We know that a seasonal downturn in performance in not unusual, but the dip in performance this year is deeper and longer than in previous years. One million more people—perhaps this is not understood by some hon. Members—are using A and E departments every year, and it is important that we understand why that is. We know that there are nearly 4 million more A and E attendances compared with 2004, when the previous Government carried out what I and others believe was a disastrous renegotiation of the GP contract, which has had a clear knock-on effect on access to out-of-hours services.