Jeremy Hunt, the health secretary, has told MPs that up to 30% of people using A&E departments do not need emergency care and that he would like some of them to be directed elsewhere. In a statement to MPs, he also said the four-hour A&E target was only supposed to apply to genuine emergencies - not to people using A&E unnecessary. (See 4.45pm.) He said that, to help some hospitals cope with the current demand, some non-urgent operations may be cancelled and GPs released for urgent care work. (See 4.58pm.)
Responding to him for Labour, the shadow health secretary Jonathan Ashworth said:
I know La La Land did well at the Golden Globes last night - I didn’t realise the secretary of state was living there. Perhaps that’s where he has been all weekend. Can he now confirm that the NHS is facing a winter crisis and the blame for this lies at the door of No10 Downing Street? Does the secretary of state agree it was a monumental error to ignore the pleas for extra support for social care in the autumn statement a few weeks ago? Will he now support calls to bring forward the extra £700m allocated for 2019? Will he bring that forward now to help social care?
Sir Oliver Heald, the justice minister, has told MPs that the government is “determined” to ban perpetrators of domestic abuse from cross-examining their victims in the family courts. He said:
The lord chancellor has requested urgent advice on how to put an end to this practice. This sort of cross-examination is illegal in the criminal courts, and I’m determined to see it banned in family courts too.
Andrew Tyrie, the Conservative MP who chairs the Commons Treasury committee, has urged Theresa May to clarify her Brexit plans, particularly in relation to the single market, the customs union and a transitional plan. In a speech to a City dinner tonight he will say:
The prime minister rightly talked about securing a deal with the EU that commanded the support of both leave and remain voters. That matters a lot. There is almost certainly a majority in the country – and a cross-party majority in parliament – for a continued close economic and political relationship with the EU from outside. Safeguarding the economic wellbeing of the country probably requires a relationship that is considerably deeper than that provided for under WTO rules.
Given the need to build a broad-based support for its position, at home and abroad, the sooner the government can provide clarity, the better.
The Department of Health is saying that Jeremy Hunt’s comments about the four-hour target (see 4.45pm) were not intended to mean that it is being watered down. It is not. He was making the point that the target was only supposed to apply to people in A&E in a real emergency. This is from Huffington Post’s Paul Waugh.
DH insists Hunt is NOT scrapping or even amending 4hr A&E waiting target. But clear msg: non-urgent cases shd stay away cos skewing figures
Hunt says operations may be cancelled in some areas to reduce pressure on A&E departments
And this is what Hunt said in his statement about the emergency measures that may be taken in some areas to relieve pressure on A&E departments.
As of this weekend, there are signs that pressure is easing both in the most distressed trusts and across the system. However with further cold weather on the way this weekend and a spike in respiratory infections there will be further challenges ahead.
NHS England and NHS Improvement will also consider a series of further measures which may be taken in particularly distressed systems on a temporary basis at the discretion of the local clinical leaders. These may include:
temporarily releasing time for GPs to support urgent care work by extending the QOF [quality and outcomes framework] reporting period to the end of April
clinically triaging non-urgent calls to the ambulance service for residents of nursing and residential home before they are taken to hospital;
continuing to suspend elective care, including, where appropriate, suspension of non-urgent outpatient appointments;
working with the CQC [Care Quality Commission] on rapid re-inspection where this has the potential to re-open community health and social care bed capacity;
working with community trusts and community nursing teams to speed up discharge.
Hunt says operations may be cancelled in some areas and GPs released for urgent care work to reduce pressure on A&E departments.
Hunt says up to 30% of A&E cases aren't emergencies and should be directed elsewhere
This is what Jeremy Hunt said about excluding non-urgent cases from the four-hour A&E target.
However, looking to the future, it is clear that we need to have an honest discussion with the public about the purpose of A&E departments. There is nowhere outside the UK that commits to all patients that we will sort out any health need within four hours. Only four other countries, New Zealand, Sweden, Australia and Canada, have similar national standards which are generally less stringent than ours.
This government is committed to maintaining and delivering that vital four-hour commitment to patients. But since it was announced in 2000 there are nearly 9m more visits to our A&Es, up to 30% of whom NHS England estimate do not need to be there. And the tide is continuing to rise.
So, if we are to protect our four-hour standard, we need to be clear it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor.
As Prof Keith Willett, NHS England’s medical director for acute care has said, no country in the world has a standard for all health problems, however small, and if we are to protect services for the most vulnerable, nor can we.
So NHS England and NHS Improvement will continue to explore ways to ensure that at least some of the patients who do not need to be in our A&Es can be given good alternative options, building on progress under way with the streaming policy in the NHS England A&E plan. This way we will be able to improve the patient experience for those with more minor conditions who are currently not seen within four hours, as well as protect the four-hour promise for those who actually need it.
Hunt signals he wants to direct non-urgent cases away from A&E.
He says up to 30% of A&E cases are not emergencies.
He says four-hour A&E waiting target only meant to apply to urgent cases.
Hunt starts by paying tribute to NHS staff. They have never worked harder, he says.
He says NHS planning for the winter has been better than ever before.
As a result on some days NHS A&E departments have treated a record number of people within four hours.
But in some trusts the situation has been “extremely fragile”.
He says diverts and trolley waits are particular problems in certain trusts.
As of this weekend there are some signs pressure is easing.
But, with further cold weather coming this weekend, there will be further challenges ahead.
So some measures may be taken in some areas, including releasing GPs for A&E work, triaging the elderly before they are taken to hospital and working to speed up discharges.
These actions will allow the NHS to take further measures when necessary.
Merkel says limits will be imposed on UK's access to single market if it does not accept free movement
Angela Merkel, the German chancellor, has reaffirmed her belief that, if Britain does not accept free movement of EU citizens, it will not be able to keep full access to the single market after Brexit. Speaking to civil servants in Cologne she said:
Access to the single market can only be possible on the condition of respecting the four basic freedoms. Otherwise one has to talk about limits.
Martin McGuinness has been speaking to the BBC about his resignation announcement.
Sinn Fein's Martin McGuinness talks about his sudden resignation, a possible election and whether he'll be well enough run in the election. pic.twitter.com/PAMiaVed2S
The Ulster Unionists have accused Sinn Féin of letting Arlene Foster off the hook. This is from the UUP leader Mike Nesbitt.
Sinn Féin should have stayed, to hold the first minister to account, to force a public inquiry and to vote on the much-needed cost controls on the scheme.
Instead, they have prioritised self-interest, as always. This is Sinn Fein letting the DUP off the hook. The public mood clearly indicates they want the facts of the RHI debacle exposed. To move straight to an election without this taking place is farcical. They had a choice between the integrity of the institutions and electoral advantage and they appear to have chosen the latter.
Q: Why has nearly 10 years of power sharing between the old foes of Sinn Féin and the Democratic Unionist party been imperilled?
The irony about of this crisis is not that it centres not on traditional issues of dispute such as the constitutional status of Northern Ireland or even how the power-sharing government deals with the legacy of the Troubles and nearly 4,000 deaths. It has come crashing down due to a ‘cash for ash’ scandal.
Q: What is ‘cash for ash’?
In 2012 the DUP devised a green energy scheme called the Renewable Heating Initiative which was mean to encourage non-domestic consumers to use green energy such as wood pellets to heat farms, businesses and other enterprises.
Q: Why was it such a disaster?
The scheme offered £1.60 for every £1 spent by farmers and other non-domestic users if they signed up for the green initiative. It soon became apparent that there had been a massive miscalculation of the cost of the scheme, which some estimates now reckon will cost the taxpayer close to £500m in lost revenue.
Q: Why did it cause such a political furore?
Opposition parties ranging from the Ulster Unionists to Sinn Féin’s nationalist rivals in the SDLP called for an independent inquiry into the fiasco and for first minister Arlene Foster to stand down temporarily while it was held. Sinn Féin, the DUP’s sole partner in coalition government, came under intense pressure to act.
Q: Will an election clear the air?
If past results are replicated the DUP and Sinn Fein will still end up as the two largest parties but the game-changer would be if the republican party was larger than its unionist rival. In that case a Sinn Féin assembly member could be elected for the first time as first minister as the DUP may ship votes and lose seats to their Ulster Unionist competitors.
Q: Will an election naturally lead to a new power-sharing/cross-community government
Not necessarily, given the bitterness that now exists between Sinn Féin and the DUP. It may take a long series of post-election negotiations to rebuild trust and recast a new coalition government, which inevitably will involve the two largest parties.
Q: Will a collapse of power-sharing and a fresh election destabilise the peace in Northern Ireland?
While dissident republicans will rejoice, hoping to inflict some damage at the ballot box to Sinn Féin and claiming the dysfunctional relationship between Sinn Féin and the DUP proves Northern Ireland is a failed state, this crisis will not fatally undermine the peace process. The overwhelming majority of people on all sides in Northern Ireland support the peace settlement and do not want a resumption of Troubles-style 24/7 violence.
ICM Unlimited interviewed an online sample of 2,000 adults aged 18+ on 6-8th January 2017. Interviews were conducted across the country and the results have been weighted to the profile of all GB adults. ICM is a member of the BPC and abides by its rules.
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