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DERMOT MURNAGHAN: Joining me now to discuss some of the pressures on A&E are the Shadow Health Minister, Diane Abbott, the co-leader of the National Health Action Party and member of the Board at the British Medical Association, Dr Clive Peedell and from Bristol by the Conservative MP and member of the Health Select Committee, Charlotte Leslie. Well a very good morning to you all and leaving the politicians out of it I want to start with the professional first of all, Dr Peedell. I mean there are so many issues as we are reporting and have reported over the months and years that are building up the pressures on A&E. Are there any simpler solutions though that would help ease that crisis?

CLIVE PEEDELL: I think the first thing to say actually to understand what’s going on is there is an underlying scandal here, the government knew about this crisis three years ago, Department of Health officials produced a Risk Register when they brought these new reforms, this massive top-down reorganisation, at a time of massive austerity for the NHS and they said there was going to be an emergency care crisis. So now they are throwing £500 million, which is a drop in the ocean compared to the £3 billion that the Treasury has clawed back in the last couple of years, so they have given with one hand and taken away with the other, that’s why we’re in a mess. We haven’t got enough staff, we have seen that from the survey today up and down the country, we are on average 10% down. We haven’t got enough GPs, that’s one of the solutions and social care in terms of bed blockers being put out into the community, we haven’t got the funding for it. Where’s the planning?

DM: So joined up. Let me put this to Diane Abbott then, this is coming from your boss Andy Burnham on joined up social care, this is one of the big pressures on A&E units is older people coming in with problems who really shouldn’t be there, they should be treated in the community or elsewhere.

DIANE ABBOTT: First I think it’s great that Sky’s doing this but one of the reasons, one of the underlying reasons for the pressures on A&E is older people presenting to A&E because government cuts have meant they can’t get the kind of social care and the care they need at home. The one place that is open all hours is hospital A&E. When there is a growing crisis in the health service the first place to show the pressure is A&E and that’s what we’re seeing.

DM: But is that government cuts or is it just an ageing population? There are so many more people living over 80 and 90.

DIANE ABBOTT: It’s the cuts in relation to local authorities which are affecting what they are doing for social care. If you are sending somebody for 15 minutes to an old lady, she doesn’t have time to say she’s not feeling very well so what does she do, she calls an ambulance and she goes to A&E.

DM: Okay, I have to put some of these points to Charlotte Leslie of course. Charlotte Leslie, I don't know if you had any problems hearing that but deal with first of all the point made by Dr Peedell there about you saw this one coming, you had that risk register at the time of the NHS reorganisation and you yourselves as a party identified this as one of the big problems.

CHARLOTTE LESLIE: I think since the NHS’s creation we’ve seen this coming. We’ve got a myriad of factors here, the first one to say is growth in population, we’ve got a growing population and we’ve also got an ageing population and we’ve got, as many doctors will tell you, a population that’s changing in its expectations of what healthcare can deliver. So GPs will say that the elderly will come in to them and say I’m all right doctor, the younger generation will come in and be full of higher expectations. That’s the first thing to say and that’s been happening, I think it’s party political to the point of being really unhelpful to say this has suddenly happened in the last three years. Is hasn’t, this has been a problem that has been growing since the NHS was built after the World War for a very different world. I think the second thing to say is that GPs as well have been seeing this increased demand as well as at A&E and I don't think the GP contract with the out of hours situation has helped. Some GP surgeries are still offering out of hours and it is certainly not the major part of the problem but it is a factor. I think thirdly you have now got so many different places for people to go if they are not well, people get very confused and A&E is a sure stop place you can go. I think we all appreciate that 111 hasn’t worked out at all ideally, I think it’s a shame that it wasn’t piloted longer but finally there is a big issue about getting the right people into A&E. You need good triage at the beginning so that specialists get in as quickly as possible to make sure that the people who need to be seen are seen. That’s happening across the piece but we need to do more. Also I’m afraid as politicians we all need to get less squeamish about waiting times, we need to make sure that those who most urgently need to be seen are seen as quickly as possible and those who aren’t so urgent, maybe we shouldn’t get so squeamish if it is four hours and one minute or three hours and fifty nine minutes. I think that will help doctors and those in A&E sort out who needs to go in and deal with emergencies better. A final thing to say, a junior doctor said to me there is no incentive for doctors to go into emergency medicine, it is very hard, the hours are difficult …

DM: I’m sorry to butt in Charlotte Leslie but you can’t have all the time. Diane Abbott, respond to some of that then, an awful lot in there.

DIANE ABBOTT: Poor Charlotte. Look, first of all she says we can’t be squeamish about waiting times. I’m a mum, if my son is sick and I go to A&E, of course I’m frightened. Ordinary people do get frightened if they wait for very long periods of time and we know that under this government, not since 1945 but under this government, the numbers of people waiting for more than four hours in A&E have doubled. It is all very well for Charlotte to talk about how you manage A&E …

DM: But it is chicken and egg, that’s because the pressures have increased. Is that really a party political fault or it is about society?

DIANE ABBOTT: I’m not making a party political point, I don’t do party politics so much as you know but there is an underlying issue with the cuts in social care and there is an underlying issue with the cuts involving the NHS.

DM: Dr Peedell, is there an issue about social care …

CLIVE PEEDELL: It is an issue about funding clearly because the government has said we need an extra £500 million. You can’t train these people overnight, that’s why this risk register was so important three years ago, we needed to be training people then. If you look at the College of Emergency Medicine, they’ve been saying that they can’t fill all their training posts. There are 200 trainee unfilled posts, this should have been addressed a long time ago.

DM: Didn’t the GPs in effect pull the wool over the Labour party’s eyes when they got that contract though in the middle of the last government there, they got a terribly good deal there and people are ending up in A&E because they can’t see their GPs.

CLIVE PEEDELL: No, that’s a non-issue. If you actually look at the number of extra GPs that we need, the NHS Confederation is calling for another 10,000 so that is just a drop in the ocean. That whole contract thing has been blown out of the water by the Tories who are treading water, trying to make excuses for the complete cock up they are making of the NHS through their disastrous reforms. They are trying to privatise the health service without telling the public and they are doing all that they can with their sticking plasters to try and show they are not cutting things.

DM: I’ll have to put that to Charlotte, we’ve got two minutes left, that’s 40 seconds for you Charlotte Leslie. You are, dare I say the word again, yes I can, a cock up according to Dr Peedell.

CHARLOTTE LESLIE: … because the government is putting GPs and clinicians at the heart of commissioning and driving services after a decade where politically driven management has not seen us going in the right direction despite an awful lot of investment. Of course more investment is always needed, the government has protected that, but this is a big issue that all parties are going to have to come together and solve if we want the health service we all think we deserve.

DM: Thanks for that. That’s a fair point, isn’t it Diane Abbott, when it comes to treating people, once Labour brought in the target culture, I mean we can’t stick with that, we need to be flexible.

DIANE ABBOTT: No, we slashed waiting times. Our record when we left office was …

DM: But we know how, by moving people out of A&E and putting them on trolleys in the wards sometimes.

DIANE ABBOTT: No, when we left office satisfaction with the NHS was at record levels but I agree with Charlotte that people have to come together and one thing that Andy Burnham is saying is about bringing social care, NHS care, mental health care together because one of the problems you have is old people who are …

DM: Another reorganisation then, I thought you were against reorganisations.

DIANE ABBOTT: No, not another reorganisation but first of all getting the funding in and secondly people working more closely together.

DM: How much more funding? Charlotte Leslie said the budget is protected and in times of extreme financial hardship for the country …

DIANE ABBOTT: Oh come on!

DM: Well it’s not unlimited is it? It can’t be.

CLIVE PEEDELL: One of the big problems we’ve got with the NHS is this huge market structure. To Diane’s, to her party’s shame actually, they introduced a lot of the market to healthcare under Blair and the marketization is taking up about 10% of total NHS budget per year. If we got rid of the market in healthcare we could spend that on frontline services, that’s billions of pounds per year being wasted on the transaction costs of GPs referring patients into hospitals, all that money wasted. Foundation Trusts advertising their services, trying to attract patients, a complete waste of money and one thing Labour had done, because I’m very critical of the Labour party, they have said they are going to draw back from the market and the public and political parties like our own will hold Andy Burnham to account for that.

DM: You’ve opened up a whole new issue but guess what, we don’t have time for that now. Dr Peedell, Diane Abbott, thank you very much indeed and our thanks to Charlotte Leslie as well for listening patiently there and your contributions as well, thank you.