Hospital Casualty Departments: Central London (Hansard, 9 July 1984)

§ Baroness Masham of Ilton
My Lords. I beg leave to ask the Question standing in my name on the Order Paper.

§ Lord Glenarthur
My Lords, there are 11 hospitals with general accident and emergency or casualty departments within a three-mile radius of Charing Cross. Information on waiting times is not available centrally.

§ Baroness Masham of Ilton
My Lords, I thank the Minister for that reply, even though the second part of it was rather disappointing. Is he aware that there is tremendous pressure on the accident and emergency departments due to the enormous volume of people pouring into London every day for so many different reasons: for example, tourists or people going to work? Will he try to find out how many of these patients are genuine emergency cases and how many are those who do not have GPs or who cannot get hold of their GPs and just happen to feel ill?

§ Lord Glenarthur
My Lords, there are no departmental standards on what is an acceptable time for accident and emergency patients to wait. Clearly it depends very largely on the nature of the patient's condition and that can be assessed as a matter of medical judgment only by the doctor on the spot. One of the key jobs of the accident and emergency departments is to sort out the really ill patients, who must be seen without delay, from those who can safely wait for a little longer. It is the health authority's job to gear staffing to the workload of the department, but peaks in numbers cannot always be predicted and at these times some delays may be unavoidable. Certainly, it is a feature of the planning of the accident and emergency services that account is taken of the workload arising from the type of people to whom the noble Baroness referred, such as commuter influx, holidaymakers, and other casual attenders.

§ Lord Rea
My Lords, is the Minister aware that whenever surveys of the work of casualty departments have been carried out, it has been shown that between one-third and one-half of the total number of cases seen could more appropriately have been handled in a primal-y care setting? Does he not feel that the proper 565 answer to the hard-pressed casualty departments is to improve primary care in inner cities, in particular in London, as suggested by the Acheson Report? That report contained 115 recommendations, which I think was probably more than could have been expected. One of the more important ones was the suggestion that older general practitioners should be encouraged to retire, so that younger and more enterprising doctors could take up posts in primary care in inner London.

§ Lord Glenarthur
My Lords, certainly the Acheson Report came up with a number of recommendations aimed at improving primary health care, reducing the inappropriate use of A and E departments, and improving communications between hospital and primary health care services. The report has been recommended to health authorities, and to family practitioner committees as well, as a basis for action on those recommendations which fall within their sphere of responsibility. Additionally, I ought to say that the Government have made available an additional £9 million in total over four years to improve primary health care services in inner cities.

§ Lord Ennals
My Lords, since the noble Lord has on a number of occasions indicated the attitude of the Government towards hospital waiting lists, does he not agree that it should be a responsibility of the Government to look at waiting times in accident and emergency units? Is he aware that the Association of Casualty Surgeons tells me that it is not unusual for patients to wait for up to five hours at St. Thomas' Hospital and three-and-a-half hours at King's College Hospital, and will not the situation become very much worse when the Middlesex Hospital and St Leonard's, Hackney, close very soon? Are there any other hospitals that are now at risk, and is this not likely to be a growing problem on which the Government really should take some serious action?

§ Lord Glenarthur
My Lords, the Government certainly take it seriously as a matter of policy, to ensure that there are sufficient facilities generally to cope with the problem. But it is not always right, as I think the noble Lord will appreciate, to lay down from the Elephant and Castle exactly how best a particular district health authority should meet problems in its area. The department's policy is that an accident and emergency department should normally serve a population of at least 150,000, but, as I said in answer to the noble Baroness, Lady Masham, this is not a rigid figure.

§ Lord Kilmarnock
My Lords, can the noble Lord the Minister tell the House how many small GP hospitals in the central London area have lost their casualty departments recently, and what alternative arrangements have been made?

§ Lord Glenarthur
My Lords, not without notice, I am afraid.

Lord Wallace of Coslany
My Lords, is the noble Lord the Minister aware that the accident and emergency service is facing severe problems and that 566 this is an indication of the general malaise affecting the health service? Is he further aware that there is hardly a hospital in outer London and the South-East region which has not faced temporary closure of accident and emergency departments, thus throwing a tremendous strain on other hospitals which have to cope? This is not happening only at the moment; it has been going on for far too long, and it is an aspect of the health service that needs very urgent attention.

§ Lord Glenarthur
My Lords, the question on the Order Paper specifically refers to hospitals in central London, and I reject entirely the criticisms that the noble Lord makes of the destruction of the health service, so far as this and other matters are concerned. Over half-a-million more in-patients and day cases were treated in 1982 than in 1978; so that gives some weight to the argument.

§ Lord Ennals
My Lords, since the noble Lord said quite rightly, that this Question relates to central London, will he comment on the very imminent closure of the accident and emergency centres at the Middlesex Hospital and at St Leonard's, Hackney, and say whether any others are in danger? Surely this is absolutely relevant to the question which I put to him.

§ Lord Glenarthur
My Lords, I cannot comment specifically on the closure. What I can say about St Leonard's is that I understand that some demonstrators there are protesting at the change of use of the hospital, which was recently, agreed by my right honourable friend the Minister for Health. They are preventing certain staff from entering the hospital, and the authority is seeking to have them removed. But I have to say to the noble Lord that the change of use was agreed after full consultation and referral to Ministers. So far as other hospitals are concerned, I have no facts or figures on them, but I shall find out and let the noble Lord know.

§ Lord Molloy
My Lords, will the noble Lord the Minister at least consider that if there should be any closures of great hospitals in London, he might give an instruction to the RHAs involved that they should consult the representatives of the junior surgeons, the junior doctors, and the ambulance crews to make quite certain that the best of what is left is made available for casualty purposes?

§ Lord Glenarthur
My Lords I am sure that the regional health authorities concerned will always be willing to speak to the people to whom the noble Lord referred. As he knows, my right honourable friend the Minister of State for Health is also regularly in touch with the BMA, the junior doctors, and so on. But the fact remains that we are talking here about accident and emergency services only, and not about general hospital closures.

§ Lord Kilmarnock
My Lords, will the noble Lord investigate the point raised in the supplementary question I asked and let me have an answer in writing?

§ Lord Glenarthur
Yes, of course, my Lords.