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The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I congratulate the hon. Member for Hartlepool (Mr Wright) on securing the debate. Given the wide range of topics that he and his colleagues raised, I am not sure whether I will be able to cover them all in the time available, so if I do not, I will attempt to respond to any substantive points after the debate. I will also certainly alert my noble Friend Earl Howe to the points made.
As the hon. Gentleman said, ambulance services are vital to the health care system and provide rapid assistance to people in urgent need of help. Many lives are saved by the hard work of ambulance service personnel. He is right to place his congratulations on the record and I want to place on the record my appreciation of the work done by staff in ambulance trusts. I gently suggest that I do not recognise some of the words and phrases used in the debate to characterise the service provided, but I am sure that they were used to stress a point.
Jane Ellison
No, because I have only just begun and the hon. Gentleman took many interventions.
Emergency services are the first port of call for many of us when serious illness or accident strikes. The total number of emergency calls to ambulance services in England in 2013-14 was 8.4 million, which is a 0.9% drop over the previous year. Unfortunately, a small proportion are unnecessary or frivolous, but the overwhelming majority are from people who feel in need of urgent help.
The growing number of people living with chronic conditions and the ageing population to which the hon. Gentleman referred are placing increasing pressure on urgent care services, something that we all acknowledge. It is important for my Department to work with Public Health England, local commissioners and health care providers to educate and engage the public on measures to prevent chronic health problems from developing. There are a number of people who end up in A and E because they have not taken medication properly or who suffer acute problems as a result of a chronic condition. Hon. Members will be aware of some of the longer-term problems in their region, which result from difficult public health challenges. Tackling those is my own particular portfolio, and is one way in which we can make the emergency services more sustainable in the longer term.
I hope hon. Members recognise that. At times, it seemed that they were merely committing themselves to significant additional future spending rather than also turning their minds to the longer-term challenges.
Jane Ellison
I am going to continue and try to make a few substantive points. If I have time, I will give way.
All 999 calls are triaged into two basic categories, red and green, depending on the seriousness of the call. Those placed in the red category are calls where the patient is in a life-threatening condition; an example would be someone suffering a cardiac arrest. Such calls require assistance on the scene as quickly as possible and the Government have set targets for all ambulance services in England of a response within eight minutes in 75% of cases. The latest figures, for March 2014, show that in north-east England—the area of the hon. Member for Hartlepool—the median average response time for red category calls was 6.4 minutes. Nationally, those figures show that 76.2% of red 1 calls, which are the most critical, received a response within eight minutes. In the north-east the target was also met, with 75.2% of patients receiving a response within eight minutes. That is not to say that there are not significant problems in some cases, but it is important to place on the record the service’s effective work in meeting that target.
Less critical 999 calls placed are in the green category. Those calls are not subject to national targets. Some ambulance services set their own targets for response times, and NEAS uses a one hour standard. It is important that such calls receive a timely and appropriate response, but red calls must be prioritised, as a person’s life may be in immediate danger.
There has been recent media coverage of long waits for ambulances, and hon. Members have alluded to constituents’ experience of such waits during this short debate. Every patient should expect to receive first-class care from the ambulance service, but the nature of emergency response work means there will always be incidents where unfortunate timing leads to a situation in which someone who is assessed as being in a non-life-threatening situation calls 999 at the same time as several other people who are in life-threatening situations. I am sure that hon. Members recognise that that would be the case under any Administration.
Grahame M. Morris
I am grateful to the Minister for giving way, but I cannot let that pass, because the situation is different now. I have had the honour of representing Easington for four years and it is evident from the cases that are coming to me and to colleagues from the region that the situation is worsening. One case was that of a young man who broke his hip playing football and waited for two and a half hours in the rain. He was in the centre of the constituency, in an area that is readily accessible. Another was of an old lady who waited two and a half hours for an ambulance. She died the following day. Something is sadly wrong with the North East Ambulance Service and the situation is deteriorating. We have all had cases that are really quite shocking, and something needs to be done.
Jane Ellison
I am not familiar with the cases that the hon. Gentleman mentioned, but I will draw them to the attention of my ministerial colleagues and of the trust. I spoke to the head of the trust yesterday, and will make sure that the debate is brought to the trust’s attention. However, I gently say to hon. Members that they surely cannot be suggesting that at no previous time, under any previous Government, have there been any cases in which a service did not get this right. It is important to—
Jane Ellison
I do not recognise that description, and I do not think the service would recognise it.
Very rarely, as we have heard, waits may be unacceptably long, but it is important to remember that the vast majority of people receive a timely response when they dial 999. I am aware of the case of William Gouldburn, who was the constituent of the hon. Member for Hartlepool and who sadly died in April last year as the result of an existing heart condition. He waited two hours for an ambulance after his collapse at home. His case is distressing, and his MP is right to champion it and make us aware of it. The trust acknowledges that it failed by not getting an ambulance to Mr Gouldburn within the one-hour target it had set itself. It has been accepted that that was not good enough.
Difficult as his story is to hear, it is important to note that Mr Gouldburn’s 999 call was categorised as a green call—that is, a non-life-threatening situation—and at the inquest the coroner accepted that the call had been correctly triaged and categorised. That is not to say that there were not things that clearly should have been done differently, but it is right to put on the record what the coroner said. There is no denying that Mr Gouldburn waited an unacceptably long time for an ambulance, but the decision on his call’s priority was made when other calls were at the same time being prioritised as red.
It is a matter for local commissioners to agree with ambulance trusts the appropriate protocols for dealing with green calls, based on available clinical guidelines and local circumstances. I know that in the case of the hon. Member for North West Durham (Pat Glass) those local circumstances have been recognised with the introduction of a specific response vehicle in her constituency. There has been increasing demand on ambulance services—the North East Ambulance Service says that it saw a 5% increase in the volume of emergency incidents in the year up to March 2014—but thanks to the hard work of service staff, fast response times have been delivered in the vast majority of cases.
NEAS advises that over 40% of the calls it receives are categorised as red, so its consistent ability to exceed the national target for response times should be commended. NEAS has also told me that in 2013-14, 74.8% of calls categorised as green 2, or serious but not life-threatening, received a response within 30 minutes.
Mr David Crausby (in the Chair)
I will adjourn the sitting at 5.15 pm. I call the Minister.
Jane Ellison
Thank you, Mr Crausby. Welcome back to the hon. Member for Hartlepool—I think some colleagues may not have been able to rejoin us.
As I was saying, NEAS tells me that in 2013-14, 74.8% of calls categorised as green 2, meaning serious but not life-threatening, received a response within 30 minutes, and 71.2% of calls categorised as green 3, meaning non-emergency, received a response within 60 minutes. Although that does not in any way diminish the tragedy of cases such as Mr Gouldburn’s, which are never acceptable, it is important that we recognise the generally excellent service provided by the trust and its staff.
Jane Ellison
I think we can all agree that those are circumstances that we want to minimise.
I want to turn briefly to one or two specific local points, and then to one or two wider points. Most recently, the Government recognised the importance of investment in front-line services with £14 million provided to ambulance services last December. Obviously, it is for local commissioners and trusts to decide how that money is used. I recognise that in the hon. Gentleman’s region, local commissioners see that more investment is needed for ambulance services, and we recognise that the trusts are working with local commissioners on that, making sure that they get that commissioning piece right.
More generally, there is also an issue about staffing in the ambulance service. Since 2010, the NHS has recruited 16% more paramedics, but we know that in some areas of the country, there is insufficient academic capacity, for example, to produce paramedics in the numbers required. Again, the Association of Ambulance Chief Executives is working with Health Education England to address that issue in the medium term.
The hon. Gentleman also alluded to ambulance handover delays. We absolutely recognise the role that they can play in making the job of the ambulance service more difficult. I believe there has been an ongoing issue, to which he alluded, for NEAS at County Durham and Darlington NHS Foundation Trust hospitals. Local commissioners have advised that there has been recent improvement, helped by winter initiatives supported by the urgent care working group. That has included support from the fire and police service, but I know there is more to be done.
Indeed, my colleague from the east of England, my hon. Friend the Member for Suffolk Coastal (Dr Coffey), who has not been able to rejoin us, was talking as we went to the vote about work that had been done specifically in her area to look at some particular issues that affect handover delay. As she said in her intervention on the hon. Gentleman, it is well worth local Members exploring some of that detail with their board as well to see whether lessons can be learnt from other parts of the country.
The urgent and emergency care review is being led by Sir Bruce Keogh, the national medical director of NHS England. He was asked to undertake a review of urgent and emergency care, looking at all aspects of the sustainability of the urgent and emergency care system. That does not exclude ambulance services. The review proposes the development of 999 ambulances; they would become more like mobile treatment services, not just urgent transport vehicles. There is a lot of fresh thinking in all sorts of areas of delivering excellence in emergency health care, and it is right that we look at new ways of delivering that health care with regard to ambulances as well, rather than just looking at the old model.
I want briefly to put a point on the record in the 30 seconds left to me. Let us not minimise the importance of people being asked about a rash as a symptom on the phone. It is one of the signs of meningitis and the royal colleges have advised that that should be asked as a question, so it is not an insignificant point.
With regard to private ambulances, that provision was brought in by the right hon. Member for Leigh (Andy Burnham), when he was in office—