Covid-19: Military aid to Civil Authorities

(Limited Text - Ministerial Extracts only)

Tuesday 8th February 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure, as ever, to service under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this debate, and I pay tribute to him for the manner in which he conveyed some challenging personal experiences on the part of his constituents and others. I will turn first to the situation faced by ambulance services, before clarifying for my hon. Friend that many of the expectations in terms of specialist posts are not realistically achievable within the constraints on the military’s resources.

Ambulance services have faced extraordinary pressures over the past 18 months, and I know that all hon. Members will join me in paying tribute to all the staff for their dedication and hard work. The pandemic placed significant demands on the service. In December 2021, it answered almost 1 million calls—a 22% increase on December 2020—placing significant pressures on ambulances services and the wider NHS.

We know the background reasons for that: infection prevention and control measures, higher instances of delays in the handover of ambulance patients into A&E and, crucially, the staff absence rate. Flow through our hospitals, which is always the key determinant of the ability of ambulance services to offload patients to the safety of A&E, is about the ability of that A&E to either get those patients discharged safely or admitted to hospital. A combination of those factors has placed unprecedented stress on the service and driven increased response times to patients in the community. Despite those pressures, performance for category 1 calls—the most serious calls, classified as life-threatening—has been largely maintained at around nine minutes on average over the last several months, despite a 16% increase in these calls compared with before the pandemic, although we are clear that there has been a significant increase in response times across other categories.

It is exactly because of those pressures that we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to March. All trusts will receive part of this funding, which will increase call handling and operational response capacity, boosting staff numbers by 700. NHS England will also strengthen health and wellbeing support for ambulance trusts, investing £1.75 million to support the wellbeing of frontline ambulance staff during these pressured times. More broadly, NHS England is undertaking targeted support for the most challenged hospitals, where delays are predominantly concentrated, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That includes a £4.4 million capital investment to keep an additional 154 ambulances on the road this winter.

The crux of my hon. Friend’s speech was to acknowledge those pressures and to look to the military, through the MACA system, for further assistance. The scale of the challenge we faced, and continue to face, cannot be overestimated. The UK, like every other country in the world, saw its health systems and capabilities stretched to the limit. As many of our civilian agencies and institutions struggled to cope, we should take great pride in the role our armed forces played in assisting them in responding to the pandemic, reacting with skill and agility. However, we must be cautious about the limitations on the numbers of those who are qualified to drive blue-light ambulances, and indeed clinicians. I have to say that, of the 20,000 personnel my hon. Friend spoke of, only a small proportion would be clinically qualified to assist as paramedics or qualified to drive a blue-light service.

[Chris Loder]

I completely understand some of the difficult points the Minister makes, but does he agree that St John Ambulance has a wonderful suite of resources and could play a much more substantial role in supporting our emergency services?

[Edward Argar]

I will address that point and then return to the military point. I had a very productive meeting with St John Ambulance in the past couple of weeks to discuss exactly that. We should not underestimate the huge role it has already played throughout the pandemic in supporting our ambulance and other emergency services.

[Jim Shannon]

This does not cover the constituency of the hon. Member for West Dorset (Chris Loder), but Northern Ireland has a Territorial Army medical regiment based in Belfast. The majority of people in it are probably NHS staff—they are doctors, nurses or whatever —and that is where their interest in being in the TA comes from. Will there be circumstances on the mainland in which the TA medical corps could be used to our advantage and to address staffing shortcomings?

[Edward Argar]

It is important that we take advantage of all opportunities in terms of those qualified professionals and their ability to support our more regular frontline services.

To pick up on the point raised by my hon. Friend the Member for West Dorset about MACAs and military capacity, a large number of those 20,000 were used for testing and helping to build Nightingale hospitals, and they have recently been helping in vaccine testing centres. However, capacity in terms of, for example, clinically qualified Army medics is limited, and they often already serve in the NHS and in hospitals, so there is not a huge pool to draw on. It is important that we are clear about that. Secondly, I mentioned to my hon. Friend the point about those qualified as blue-light drivers. Again, that is not all the 20,000 or anywhere near. We have to be—realistic is the wrong word—careful in our expectations of the capacity to support specific requests, such as the specific types of support that his ambulance service put in for.

More broadly, considerable support has been offered by the military for tasks such as logistics, which my hon. Friend highlighted—for example, in supporting the ambulance service in a range of roles. Currently, the Ministry of Defence provides support to ambulance services in the following ways: 366 personnel in a range of roles, including non-driving roles; 96 personnel continuing non-blue-light ambulance driving support for the Scottish Ambulance Service; and 313 personnel in driver support to the Welsh ambulance service.

My understanding of the specific matter to which my hon. Friend referred is that it was incorporated into the broader request for ambulance drivers between 10 and 31 August last year. The element of that request to be granted was the 28 category C drivers who were provided by the Ministry of Defence. However, I come back to the point that, while he is right that the military are always there to assist us in times of need, we equally need to be realistic about their capacity in specific places.

[Chris Loder]

I appreciate the Minister’s candour. I respectfully remind him that the fundamental issue is that we have constituents—patients—who are in great difficulty for a long time. I fully appreciate the many pressures that he outlined, but what I am looking to achieve through the debate, especially for those families and individuals who have gone through painful experiences —I hope the Minister can help me a little further with this—is that we do not get into this position again, with constituents on their own waiting for such a long time.

[Edward Argar]

My hon. Friend will have heard me set out exactly how we have done that with the extra investment in our ambulance services. That is the key—to reinforce the strength and resilience of our existing ambulance service provision. He is absolutely right to highlight the impact—the patient and familial impact—of long waits for an ambulance, but the real answer is the measures that we are taking to invest in the ambulance service, with the £55 million more, the investment we put into hospitals to ensure that they were ready for winter, and the broader funding across the piece for our healthcare system to strengthen it further. Today, we saw another element of that package in the announcement of waiting list recovery and how we intend to approach that.

My hon. Friend is absolutely right to highlight the military. In extremes, they are there to help in very specific and pressured circumstances, but they are not the solution to the problem in the long term or to avoiding the challenges recurring. That is why we have our plan not only for the ambulance service, but for improving urgent and emergency care. We saw £450 million invested in that over the past 18 months or so to improve A&Es across the country, helping them to function more effectively, in particular in the context of IPC—infection prevention and control—measures. More broadly, we are investing in our acute hospitals to allow for the flow of patients out of A&E and into the hospital or, we hope, home. That is the key to solving this.

[Chris Loder]

I am pleased that the Minister highlighted that. I highlight and thank him again for the £65 million that the Government have dedicated to Dorset County Hospital to address that very difficulty.

[Edward Argar]

I am grateful to my hon. Friend. He is right to highlight that, not least because of his role in continuing to argue for it and in supporting Dorset hospitals in that context.

The military have done, and continue to do, a fantastic job in the context of this pandemic. However, as I say, the key to this issue is long-term investment, which is exactly what we are putting in place. I am very conscious of the challenges faced by all ambulance services over the winter, but I know that my hon. Friend’s local ambulance trust faces specific challenges of geography, distance and location of hospitals, which can be difficult for it on occasion. I appreciate the particular complexities of the system in the south-west, and we continue to work closely with the local system, but also with the military where appropriate, to see where they can support us and help add additional resilience into the system.

However, there is no substitute for the investment we are putting into making those systems more resilient in the long term, the need for which my hon. Friend has highlighted again today. We continue to focus on outcomes for patients—which is, I think, exactly where he is coming from—to avoid or reduce the risk of people having to wait a long time for an ambulance in very challenging circumstances. Tackling and improving the performance of our ambulance trusts remains a high priority in my ministerial inbox. That is in no way a criticism of the amazing work their staff are doing, but they face significant challenges. We continue to focus on those, and I look forward to working with my hon. Friend and his colleagues in Dorset to meet the challenges in the south-west.

Question put and agreed to.