East of England Ambulance Service NHS Trust
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The Minister of State, Department of Health and Social Care (Stephen Barclay)
First, I wish to thank the right hon. Member for North Norfolk (Norman Lamb) for securing this debate. I recognise the concerns raised about the East of England Ambulance Service, including questions about whether delays to ambulance responses have caused additional harm to patients over the Christmas period, and his concerns about the leadership of the trust and the role of the CQC. I assure him that I am taking these allegations seriously, both as a Minister and, as he knows, as a constituency Member of Parliament in the East of England. I have put in place a number of actions to immediately ensure improvements to services are put in place by the trust.
As the right hon. Gentleman will be aware, a risk summit was held this week, on Tuesday 30 January, which examined whether the service is operating effectively now and sought to put in place any required actions to improve it going forward. I have spoken personally to the chief executives of NHS England and NHS Improvement, and to the chair of the risk summit. I will expand on the findings further, but I wish to emphasise that a wide-ranging plan of immediate actions has been put in place to address the issues that were identified. Details of the action plan have been published today and a progress meeting in two weeks will be led by NHS Improvement and NHS England. I agree with the right hon. Gentleman about the accessibility of the trust leadership in respect of the chief executive and the chair making themselves available for media bids. I have communicated that to the trust.
I recognise that the right hon. Gentleman is concerned about the overall approach of the trust’s senior management and about the level of external assurance from the CQC. In addition to the action plan identified at the risk summit, which was attended by other external parties including NHS England and NHS Improvement, I have gone further by asking NHS Improvement’s executive medical director, Kathy McLean, to provide her own assurance to Ministers in the coming week. That will assess the immediate steps taken to address the concerns expressed in the House and whether actions suggested in the earlier external reports have been implemented. Alongside that, I am happy to have further discussions with the right hon. Gentleman about his specific point about the Association of Ambulance Chief Executives.
I am assured that, where there were serious delays in response times, the trust has identified all potential causes. Following an initial investigation, it is examining 22 such cases through the serious incident procedure. That will ensure that individual cases are properly investigated. The hon. Member for Peterborough (Fiona Onasanya) mentioned a specific case and we are determined to ensure that that is addressed. I am happy to discuss that with her further.
In terms of the report mentioned by the right hon. Member for North Norfolk, which was previously commissioned for the trust, I am happy to update the House and say that the report should be published as soon as possible. Again, that is an issue I will follow up.
Let me turn to the specific actions arising from the risk summit. I am advised that actions to deliver immediate service improvements are being taken forward under the following themes: ensuring that the trust has sufficient capacity for the rest of winter; the effective implementation of handover delay policy with hospitals; the proper execution of REAP level measures; staff access to executive leadership; sound escalation procedures; bringing in independent assurance around the serious incident investigation procedures; working with CCGs and other stakeholders to manage demand for ambulance services; and the full exploitation of emergency service collaboration with police and fire. As a result of those actions, to help to manage winter demand the trust will put eight additional vehicles on the road each day until Easter, with immediate effect.
Improvements will also be made to the trust’s adherence to the national REAP guidelines, and actions will be taken to moderate service pressures, which will allow the trust to de-escalate to REAP level 2. The trust is also working with hospitals to ensure adherence to the national guidance on handover delays, particularly where ambulances waiting to hand patients over receive a new 999 call, which was a specific point that the right hon. Gentleman raised. I also assure him that we will work closely to monitor the outcomes of the work to ensure that safe, high-quality ambulance services continue to be provided to his constituents.
The right hon. Gentleman has also raised concerns that the trust has underspent on its funding while putting in place a hiring freeze. The trust has worked to grow its frontline workforce, fielding 700 more staff since 2014-15, and has achieved a low rate of staff turnover. However, like the right hon. Gentleman, I want further assurance that the trust’s staff plans are sufficient to meet the demands facing the city. I will raise that in my discussions with NHS Improvement.
Substantial local initiatives are under way to improve the trust’s performance. Importantly, more money is being invested in the service: its funding was increased by £90 million this year—an increase of 10%—and it will further increase by £27 million over the next two years. Other significant actions include the deployment of hospital ambulance liaison officers in emergency departments to help reduce the incidence of handover delays, and an independent review of the trust to ensure that it has the appropriate resources and processes to deliver against its performance standards. I will expand on these measures further, but it is worth considering them in the context of wider national initiatives to improve ambulance performance more generally.
As I stated in the House on 22 January, the NHS is busier than ever and the ambulance service is experiencing unprecedented demand, dealing with more than 11 million calls every year. There were almost 7 million face-to-face responses from the ambulance service in 2016-17, which is a 14% increase over the past five years. Under Sir Bruce Keogh’s review of the NHS urgent and emergency care system, ambulance services are being transferred into mobile treatment centres, making much greater use of “hear and treat”, which is treating patients over the phone, and “see and treat”, which is treating and discharging patients on the scene. In December, the East of England Ambulance Service NHS Trust resolved three out of 10 incidents on the scene without transporting a patient to A&E, freeing up resources to respond quickly to the patients with the most urgent needs.
Additionally, in July last year the Secretary of State approved a revision of operational and performance standards for ambulances following the ambulance response programme. These improvements have now been rolled out to all mainland ambulance trusts in England. The evidence behind this new framework is extensive, covering data collected from more than 14 million emergency 999 calls. The evaluation considered a number of key issues for the east of England, including prioritising responses to the sickest patients while helping to reduce long waits for ambulance responses, and ensuring that patients receive the most appropriate response for their condition. That being said, I do recognise that the trust’s performance against these standards needs to improve.
As I mentioned earlier, NHS England and NHS Improvement are working with the trust to help it to adapt to the new performance framework, and have also undertaken an independent service review of its operations. This review covers the trust’s demand and capacity modelling, staff recruitment and training, and its approach to pricing and contracting in order to enable it to meet the new ambulance response standards. The detail of this work is being finalised and will be presented to the trust board meeting in March.
With respect to the ambulance workforce, we are taking significant steps across the country to support staff. Compared to 2010, there are over 3,000 more paramedics in England. We agreed in December 2016 that NHS paramedics will be re-banded from band 5 to band 6 on the NHS pay scale. This moves paramedics significantly up the NHS salary structure, and helps to ensure that we are better able to recruit and retain staff in the future.
We are also working to support the trust in addressing issues with patient handovers to hospital trusts, which have been an issue in parts of the east of England. We are clear that handovers must take place within agreed timeframes, and we are supporting hospitals to ensure that improvements are made. As I noted earlier, the trust is working with hospitals to ensure adherence to the national guidance on handover delays. It has also deployed patient safety intervention teams to hospitals to undertake patient cohorting where significant hospital delays arise, as well as placing hospital ambulance liaison officers in emergency departments to help ambulance crews to respond more quickly to incoming calls.
Norman Lamb
I am conscious that the Minister is coming to the end of his contribution and that he is not able to respond, here and now, to all the issues I mentioned. Will he undertake to write to me on each and every one of the specific concerns that I raised, including the call for an independent governance review, so that we can get to the bottom of exactly what is happening?
Stephen Barclay
I am very happy to give the right hon. Gentleman that commitment. Like me, the right hon. Gentleman wants to get a grip of this issue to ensure that it is addressed. I very much hear the concerns that he and other Members have raised. I hope that he can take some comfort from the series of actions that have already been put in place, including the risk assurance and the commission to Ministers, that signal the seriousness with which this issue is being addressed.
I would like to restate that we are taking the right hon. Gentleman’s concerns seriously. I have outlined the measures already taken as a result of the risk summit, and I will closely monitor the situation to ensure that these actions are delivered on. We have also discussed the wider initiatives that we are undertaking to improve ambulance services nationally, as well as specific local actions to ensure that patients receive the highest quality of care.
Again, I thank the right hon. Gentleman for introducing this debate. I hope that he, and indeed other Members who have serious concerns about this issue, will continue to work with me on a cross-party basis to ensure that all our constituents get the service that they rightly expect.
Question put and agreed to.