Norman Lamb MP writes…Disastrous A & E figures emphasise need for independent commission on NHS future

Every day seems to bring new crushing evidence of the immense strain facing the NHS and social care. Missed key targets have become the norm rather than the exception; A&E is bearing the brunt of cuts to preventive and community services; and few were surprised when NHS trusts recently revealed a record deficit of £2.45 billion.

After hearing anecdotal accounts of ambulances queueing up outside A&E departments due to a lack of available beds in my own county of Norfolk, I decided to investigate the true scale of the problem across the whole country by submitting Freedom of Information requests to each Ambulance Trust in England.

What I discovered was far more shocking than I had feared. More than 10,000 patients were stuck in an ambulance for more than two hours waiting to be handed over to hospital staff last year – a staggering four-fold increase over just three years. The number of people having to endure waits of more than an hour before being admitted has almost trebled in the same period.

In total, almost 400,000 hours were wasted in the last year alone due to handover delays of more than 15 minutes, the national target for getting patients out of the ambulance and into the care of A&E staff. That’s equivalent to 16,554 days of patients waiting in limbo while ambulance crews and vehicles are unnecessarily tied up, unable to respond to new emergency calls.

These figures are disastrous and totally unacceptable. The situation has rapidly deteriorated over the last three years, and is only going to get worse. Behind every statistic is a person in need of acute hospital care, and they are being failed by a system brought to its knees by a desperate lack of resources.

It is hard to imagine just how traumatic it must be for a patient, having been rushed to A&E in urgent need of treatment, to then be left waiting for hours for the care they need. In a country as wealthy as Britain, it is unthinkable that anyone should have to wait outside an A&E department for more than 9 hours before being admitted. Yet that is the reality we find ourselves in. It’s an appalling reflection of the state of our health service.

The Conservative Government cannot continue to turn a blind eye to the existential challenge facing acute hospitals – and the health and care system more widely – and pin its hopes on herculean ‘efficiency’ targets as a substitute for proper investment. It’s time for the Treasury to decide whether its ideological austerity agenda can possibly justify the growing risk to patient safety in the NHS. Simon Stevens has started to concede that the NHS needs more funding than the Tories have committed to. That much is clear.

However, if the Health Secretary really wants to prove he is serious about championing patient safety and safeguarding our health and care services for future generations, he must bring together a Commission of independent and cross-party experts to design a new, long term financial settlement for the NHS and social care system.

The Government and the Labour frontbench have so far resisted these calls, but these figures highlight yet again how urgently such a Commission is needed. We are sleep-walking towards a severe crash in both the NHS and our social care services. Unless the Government wakes up to the scale of the challenge and grasps the nettle once and for all, it is patients who will continue to suffer. There can be no moral defence for that.

* Norman Lamb is MP for North Norfolk and was Liberal Democrat Minister of State at the Department of Health until May 2015. He now chairs the Science and Technology Select Committee

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  • Eddie Sammon 3rd Jun '16 - 1:44pm

    I don’t have confidence in Norman’s or the Lib Dem’s plans for the NHS. This is what I hear:

    1. Spend lots more because of the NHS deficit (I agree).
    2. Spend lots more because of a lack of hospital beds and inadequate care (I agree).
    3. Refuse to condemn the doctors going on strike over weekend pay (I disagree).
    4. Spend lots more on mental health, striving for “equality” (sceptical).

    On mental health it depends on the severity. I’ve suffered depression for years and NHS counselling was a waste of money for me. It will help others, but there are other ways to improve mental health than just giving the NHS lots of money.

    What’s the plan to grow the economy? It just seems to amount to a plan to spend mega billions more than we already are.


  • Jenny Barnes 3rd Jun '16 - 5:37pm

    Jeremy Hunt is known to be in favour of an insurance funded scheme to replace the NHS. The rest of the government don’t seem to care as long as they hand it over to the wealth extractors to run. Imagine that you have some nasty condition, and you pitch up to the hospital hoping to be treated, and the insurance company applies the “in the event of any claim this policy becomes immediately null and void” clause. I’ve recently had that sort of argument with travel insurance over a cancellation for a few hundred pounds for a medical condition – imagine if it was thousands needed for series of treatments for cancer or heart disease or any other potentially life threatening condition? Or waiting in the ambulance while they check your credit card to see if there are funds after a road traffic accident?
    Ofc they don’t want a review. They know what they are doing.

  • So what is the cause of this seemingly rapid increase in ambulance queues at A&E? More people going to A&E, A&E has fewer staff and resources than three years ago? The way waiting/admissions time for A&E has been changed?

    Yes we can give the NHS more money, but unless we know what the real problems are, we cannot give directions as to where it should be spent.

  • @Roland – I don’t know how much this directly relates to A&E, but there is a major problem with “bed blocking”. This is where a hospital can’t discharge patients as early as they would like because there are not suitable caring arrangements in place to look after them at home. This particularly affects older people.

    Of course social care at home is the responsibility of local councils, not the NHS, and they have had their budget squeezed over the last few years.

    Until we have a properly joined-up system with health and social care under one management roof and funding pot, we will be stuck with stupid situations like this.

  • To be honest this NHS problem is multi layered and some of the issues have been mentioned here :
    1. Demographics. As the age profile increases, so does the need for health and social care. We have to put more resources in, just to stand still.
    2. Bed Blocking. Adaptations to homes for disabled people are a mandatory obligation on local authorities. But Local authorities strapped for cash have longer and longer waiting times for Stairlift and Walk in Shower wet room adaptations to disabled homes. Longer waiting times for disabled adaptations are one cause of the bed blocking within the NHS. You can’t release someone from care until you know that their home is suitable for them to return to for basic,.. washing,.. dressing,,..sanitary,.. and food preparation needs.
    3. Agency staffing. Many health professionals, especially at the retirement end of their careers, are taking VER ,.. taking their NHS pension and going onto Agency lists. This is anecdotal, but I dated one lady who [retired], had a home in Cornwall, but lived on a narrow boat most of the summer months. She was a state registered nurse, and she admitted that she worked agency because 1. it was bloody good money. 2. She could work the hours she chose to. 3. She needed just enough hours to keep her state registered status. Agency staffing is lucrative for the health care individual, but it is crippling the NHS.
    4. This is the bit liberals will grind their teeth to. Yes we need immigrants for our health service. But if there were 150,000 immigrants just from the EU last year, for sure, they were NOT all health workers. And even if they were, they do not work for nothing, and we then return to the NHS resources issue.
    5. Population. Population growth through both births and immigration numbers, is a heavy weight on the resources of our health care system. We have to look to policies that encourage small family sizes, and also curtail immigration to those skills we need (Australian points system ).
    6. Shifting money into mental health care is extremely important, but we must not delude ourselves. It will involve a decrease in the resources for physical health care. We need to be more hard-headed, and decide what health services we are willing to let go. NHS resources will have to be triaged,. unfortunately.

  • @Nick – re: bed blocking
    Yes I agree this is a contributory factor, however, I’m sure it isn’t the only factor that has contributed to the four-fold increase in three years that Norman notes.

    It is also uncertain just how much population growth has contributed to the problem, although with net migration in excess of 300,000 per annum, that would seem to imply we should be building the equivalent of two new hospitals each year, to go with the hundred new primary schools and twenty secondary schools…

  • @Roland

    The biggest demand on GPs and hospitals comes from the very young and the very old. Most migrants are working age and so probably put relatively little burden on hospitals (although not zero burden of course).

    Likewise, most migrants aren’t school age. Yes, some bring children with them and some have children here, but you don’t need to accommodate an extra 300,000 per year in schools.

  • @roland please be careful not to swallow the brexiters’ spiel. I recently went for my MOT at my GP surgery (old codgers check-up). The Practice Nurse told me that she is furious with the UKIP lies. She told me that the re are numerous immigrant agricultural workers registered locally and she very rarely sees them. She said that the only contact they have with medical services is when they can’t work. First hand experience trumps political posturing. The researched London Uni study and others have concluded that the Tax/NI income from immigrants exceed welfare & other benefits so the question might be “why is it not reflected by investment in those services”

  • Nonconformistradical 4th Jun '16 - 2:24pm
  • Katerina Porter 5th Jun '16 - 9:30pm

    According to Allyson Pollock, professor of public health and research one very important factor in the great increase of the cost of the NHS started with gradual privatisation under the Labour government and now greatly accelerated as a result of the bill of 2012. This bill removed the first article of Bevan’s act of 1948 where the Secretary of State had a duty to ensure that every citizen of the country had access to the best affordable care . The whole structure was completely rebuilt with commissioning boards and all that goes with them, and the administrative costs rose from what had been for decades 3 to 4% have now have gone up to 30 to 40%. There is a video by her on TEDxexeter
    covering this ground fully. 30 to 40% of the NHS budget would pay for quite a lot of medicine and nurses.

  • @Nick Baird & BrianD – That really was my point, using what seems to be a norm: a hospital for every 150,000~200,000 of population, whilst we get an increase in demand, even over four years it doesn’t add up to very much; unless it is concentrated into particular areas. Hence why I’m interested in finding out what has caused the massive leap in ambulance queuing that Norman’s research indicates.

  • Lorenzo Cherin 6th Jun '16 - 2:48am

    Very timely article.

    Norman and this party need to be radical but not in the left or right sense.

    We need to share with the centre right the fact , not surmising, that a system that depends only on government for money , and in its practice is not a social market , even if others above fear privatisation, understandably , it has not happened , and should not, but the lack of supply and demand , the constant rationing ,means errors of the presumption that a business model is being followed, should be seen , it is not !

    We do not have a social market we have a capped dependence on the say so of central government and local commissioners. The patient figures nowhere in any of it.And would not do much better if , as feared , an insurance model was the norm.

    We need to share with the centre left the need for massive investment , planning on a scale only dreamed of by the left of old.

    We need to be aware, unlike the left, that need means demand , which means supply which means money must , as with doctor numbers , and every aspect of delivery , follow the patient .

    We need individuals to be at the forefront of every aspect , choices of where to be treated in non emergencies, immediate tests , rights and get outs and no dependency on one hospital , or one council or government.

    The capping of resources by governments or bureaucrats is almost unique to our model of health.When I hear people want to cherish the NHS I say yes. When I hear them say it is the best in the world , I despair ! We have some of the best talent and worst outcomes.

    We need to be unique in our Liberal and Democrat oriented approach.

    The best of all that is private , brought in , free at the point of need .The best of every aspect of what is in the public sphere maintained and increased. It needs liberalisation on a massive social liberal scale and democratised at the level of the individual patient having direct say !

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