Accident and Emergency Services (Hansard, 15 February 1994)

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumlberlege)
My Lords, the aim of the Government's policies is to ensure that patients receive high quality accident and emergency services whenever they need them. We are continuing to take action to develop and improve standards and conditions in accident and emergency departments.

§ Lord Molloy
My Lords, I thank the Minister for that reply. Does she agree that accident and emergency cases which arrive at the hospital have probably been sent there by a doctor and must therefore be treated immediately? Is she aware that there is much concern, particularly in the Royal College of Nursing, the BMA and Unison, that emergency and accident cases are put on trolleys in corridors? That situation ought not to be tolerated. Will she at least be prepared to examine what appears to be— I have made some investigations— a somewhat distressing situation?

§ Baroness Cumberlege
My Lords, we shall certainly undertake to do that. However, I should like to set the situation in context. Over 13 million people attend accident and emergency departments annually. The Government find it absolutely unacceptable for people to wait on trolleys once a decision for admission has been made. But sometimes it is necessary to wait, for observation purposes or for diagnostic treatments which have to take place in the accident and emergency department. It is interesting to see how similar hospitals vary, even within the same vicinity. We believe that a great deal of that is due to poor management.

§ Lord Skelmersdale
My Lords, does my noble friend agree that there is a danger in looking at accident and emergency departments in isolation from the rest of the hospital? If beds are blocked, for example by geriatric patients, in medical or even surgical wards, will there not be a trickle-down effect, making it impossible for the patients who need to go up to the other wards to get out of the accident and emergency department?

§ Baroness Cumberlege
My Lords, my noble friend is absolutely right. It is essential that the hospital should have a good discharge policy and that there are community facilities to support people once they leave the hospital. We know that, with some of the new procedures that are being introduced, that is possible and when a patient comes in for treatment a discharge policy is worked out almost immediately so that the support services can be in place when the time comes for that person to leave.

§ Lord Ennals
My Lords, has the Minister studied the report of the Royal College of Nursing which was published only last month? It shows that in one third of accident and emergency units in hospitals patients have to stay overnight before they are admitted to a ward. Does she accept that that is not a satisfactory situation and that in fact it is worse outside London than it is in London itself, contrary to some views? The average waiting time is five and a half hours. Will she confirm that that is a situation to which she and her colleagues must address their minds?

§ Baroness Cumberlege
My Lords, a very interesting aspect of the review of the Royal College of Nursing was that resources were not the issue. The Royal College itself said that it was management that needed to be tightened up. The survey carried out was a 98 telephone survey. In two of the hospitals that were rung up, it was difficult to find the person who had replied to the survey.

§ Lord Ennals
My Lords, but does the noble Baroness agree that in that report it was said that a high proportion of the cases were as a result of bed closures, which surely must be linked with resources?

§ Baroness Cumberlege
I do not accept that, my Lords. One can look at some of the London hospitals — for example, University College Hospital — where 71 beds have been closed. We know that it has one of the best accident and emergency departments in the country.

§ Earl Russell
My Lords, the noble Baroness said that she found it "absolutely unacceptable" for patients to wait in a corridor on a trolley. Did she mean the word "absolutely" literally enough to be prepared to commit additional money to prevent that?

§ Baroness Cumberlege
My Lords, I made it perfectly clear what I meant. I qualified it by saying that of course there are times when patients do have to wait on trolleys for diagnostic, observation and other purposes. But, once admission has been agreed, then that patient should be admitted. That is our policy and that is what we are working towards.

§ Baroness Masham of Ilion
My Lords, does the Minister agree that there have been some improvements in the accident and emergency departments since consultants were appointed? And can she say how many accident and emergency departments do not have consultants in charge and leave patients to junior doctors?

§ Baroness Cumberlege
My Lords, the noble Baroness is right. We notice that, where consultants are in charge, the difference is very great indeed. I am afraid I do not have the figures but I shall certainly make them available to her. We note also that, where there are hospital discharge managers and where senior nurses are bed managers, the difference is considerable. That is what I am saying in terms of the managing process.

§ Lord Carter
My Lords, is the Minister aware that nearly half of all surgical units are cutting back on operations and one-third are giving priority to patients of GP fundholders? Is she aware also that more than half of the NHS trusts are facing a steep rise in emergency admissions as the GPs fight to obtain beds for their patients? Does the Minister agree with the view therefore that nurses should be given the authority to admit patients to hospital, provided there is a bed, without having to wait for a decision to be made by a doctor?

§ Baroness Cumberlege
My Lords, the question of GP fundholders is not an issue in this case. The patients of GP fundholders have direct access to A&E departments, as does every other patient in the country. Where patients need accident and emergency treatment, they receive it.