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Urgent and Emergency Services House of Commons Health Committee Urgent and emergency services Second Report of Session 2013–14 Volume II Additional written evidence Ordered by the House of Commons to be published 16 July 2013 Published on 26 July 2013 by authority of the House of Commons London: The Stationery Office Limited The Health Committee The Health Committee is appointed by the House of Commons to examine the expenditure, administration, and policy of the Department of Health and its associated bodies. Membership Rt Hon Stephen Dorrell MP (Conservative, Charnwood) (Chair)1 Rosie Cooper MP (Labour, West Lancashire) Andrew George MP (Liberal Democrat, St Ives) Barbara Keeley MP (Labour, Worsley and Eccles South) Charlotte Leslie MP (Conservative, Bristol North West) Grahame M. Morris MP (Labour, Easington) Andrew Percy MP (Conservative, Brigg and Goole) Mr Virendra Sharma MP (Labour, Ealing Southall) David Tredinnick MP (Conservative, Bosworth) Valerie Vaz MP (Labour, Walsall South) Dr Sarah Wollaston MP (Conservative, Totnes) Powers The Committee is one of the departmental select committees, the powers of which are set out in House of Commons Standing Orders, principally in SO No 152. These are available on the Internet via www.parliament.uk. Publications The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the Internet at www.parliament.uk/healthcom. The Reports of the Committee, the formal minutes relating to that report, oral evidence taken and some or all written evidence are available in printed volume(s). Additional written evidence may be published on the internet only. Committee staff The staff of the Committee are David Lloyd (Clerk), Martyn Atkins (Second Clerk), Stephen Aldhouse (Committee Specialist), Frances Allingham (Senior Committee Assistant), and Ronnie Jefferson (Committee Assistant). Contacts All correspondence should be addressed to the Clerk of the Health Committee, House of Commons, 7 Millbank, London SW1P 3JA. The telephone number for general enquiries is 020 7219 5466. The Committee’s email address is [email protected]. 1 Mr Stephen Dorrell was elected as the Chair of the Committee on 9 June 2010, in accordance with Standing Order No. 122B (see House of Commons Votes and Proceedings, 10 June 2010). List of additional written evidence Page 1 Dr John Wright Ev w1 2 Healthcare Audit Consultants Ltd Ev w2 3 South Western Ambulance Service NHS Foundation Trust Ev w7 4 NHS Benchmarking Network Ev w10 5 Miss Beverley Griffiths Ev w13 6 Pharmacy Voice Ev w14 7 North East Ambulance Service NHS Foundation Trust Ev w16 8 Royal College of Surgeons Ev w19 9 Priority Dispatch Ev w22 10 Royal College of Nursing Ev w23 11 The Royal College of Radiologists Ev w27 12 College of Paramedics Ev w28 13 Board of Directors of University Hospitals Coventry and Warwickshire NHS Trust Ev w31 14 Emergency Medicine Trainee Association Ev w33 15 Janet Egan Ev w36 16 UNISON Ev w38 17 Carers UK Ev w41 18 The Medical Care Research Unit, School of Health & Related Research, Ev w44 University of Sheffield 19 British Medical Association Ev w45 20 London Ambulance Service NHS Trust Ev w50 21 The King’s Fund Ev w52 22 Nuffield Trust Ev w55 23 Dr Timothy Whelan Ev w57 24 NHS Direct NHS Trust Ev w59 25 Myasthenia Gravis Association Ev w73 26 Centre for Public Scrutiny Ev w74 27 Unite Ev w78 28 NHS Clinical Commissioners Ev w82 29 Royal College of Paediatrics and Child Health Ev w83 30 Foundation Trust Network Ev w85 31 Dr Daniel Albert Ev w92 32 Parliamentary and Health Service Ombudsman Ev w94 33 The Shelford Group Ev w97 34 Circle Healthcare Ev w102 cobber Pack: U PL: CWE1 [SO] Processed: [26-07-2013 14:20] Job: 031945 Unit: PG01 Health Committee: Evidence Ev w1 Written evidence Written evidence from Dr John Wright (ES 02) Summary — The number of patients attending the Newcastle ED (RVI) has increased by 100% in eleven years. — The situation changed with the change in general practitioner responsibilities for on call in 2004. — The 4-hour target for EDs compounded the situation by making the ED the number one choice for out of hours care for many patients. — Staffing changes and efficiency improvements meant our staff could keep pace with the increased numbers until 2010–11. — For the past twelve to eighteen months there has been unprecedented demand for ED services and any reserve in the system has now been depleted at the busy times. — Trainees are shunning our specialty because of excessive work pressures and unsocial hours, there are subsequently gaps in trainee rotas. — The solution is to have one single point of access to unscheduled care: the ED. — The ED needs to be better resourced, but if it is, unscheduled care could be better than the model in operation up to 2004. Emergency Care in Newcastle ED (RVI) 1. My name is Dr John Wright. I am an Emergency Medicine consultant in the Royal Victoria Infirmary in Newcastle-upon-Tyne. I have been a consultant for twelve years, and a doctor for twenty five years. I am submitting this evidence as an individual. Any comments I make do not necessarily reflect any opinion from within my trust (Newcastle Upon Tyne Hospitals NHS Trust), other than my own. 2. For anyone interested in the background of individuals submitting evidence, I trained in Dundee University and did most of my postgraduate training in Glasgow before returning to my home city of Newcastle. I have worked in twelve UK hospitals and have practised medicine in seven countries. 3. A colleague sent the link to this Select Committee to me and suggested I might want to comment. Having witnessed a recent deterioration in the quality of service we are trying to provide due primarily to increased volume of demand I decided it was important to make members of the Committee aware of the local situation here in Newcastle. 4. When I started working as a consultant in 2001 our ED saw 59,000 patients that year. In 2012 our ED saw 120,000. That is a 100% increase in attendances in eleven years. Newcastle in general has a static population, but our case mix has changed, with increasing numbers of sick elderly patients with multiple pathologies, increasing numbers of children with minor illness and increasing numbers of patients in their twenties and thirties who bypass general practice completely. 5. The situation changed significantly from 2004 onwards when general practitioners were allowed to opt out of on-call duties. In addition, around the same time the GP contract changed, the way they were remunerated for visiting elderly patients in care homes changed (meaning after this point such patients didn’t always get the high quality service they were receiving beforehand). The Out of Hours general practice services that were set up to replace the previous system of GPs covering their own patients was inadequately funded nationally. Instead of having approximately 20–30 GPs on call for a city the size of Newcastle, the number of on-call GPs seemed to decrease to approximately four–five, with individual doctors having a much larger geographical area to cover. This of course meant patients found it increasingly difficult to get a timely response by a quality on- call doctor. It didn’t take patients (especially young adults) long to realise that they would get a quicker response by going to the local ED. To compound matters, the government of the time introduced the four-hour target for EDs, meaning in hospitals like RVI that hit this target, excessively long waits became a thing of the past for the vast majority of patients attending. 6. For about seven years after 2004 we experienced steady and sizeable annual increases in attendances, but we managed to cope by becoming more efficient and also developing rapidly and by becoming a quality specialty. Our ED doctors now equal or better the quality of emergency medicine practitioners in any other advanced country. Between 2004 and 2010 in Newcastle we increased consultant numbers from six to ten, middle grade numbers remained static and the numbers of the most junior doctors (F2s, also still called “SHOs”) were increased from twelve to seventeen. Nurse numbers increased by about 10%. 7. Unfortunately for the past twelve to eighteen months conditions in our ED have deteriorated due to unprecedented demand with limited access from the ED to inpatient beds. It is my opinion that any reserve in the system had gradually been eroded up to 2010–11 when unexpectedly we started receiving even more patients and many more unwell patients. The capacity in our hospital is limited like all others in the NHS and this means we now frequently have to hold patients in a crowded ED while waiting for a bed. Our hospital never closes to ambulances but recently we have started accepting ambulance patient diverts (on occasion) cobber Pack: U PL: CWE1 [E] Processed: [26-07-2013 14:20] Job: 031945 Unit: PG01 Ev w2 Health Committee: Evidence from three or four of the other local hospitals because they have filled all their beds. The reasons are multi- factorial, but include poor social and medical care in nursing homes, an increasing elderly population with multiple morbidities, younger patient choosing to bypass general practice for themselves or their children because they perceive a better service in the ED, and NHS Direct inappropriately triaging patients to our ED (colloquially known as “NHS re-Direct”- we must hope that “111” proves to be a better system.). 8. A massive knock-on effect of the increasing pressures on ED doctors is that there has been a sharp decline in the number of trainee doctors wishing to work in our specialty.
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