Ambulance Response Times: Shropshire
(2 years, 7 months ago)
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Helen Morgan (North Shropshire) (LD)
I thank Mr Speaker for granting today’s Adjournment debate on a topic that is so important to my constituents in North Shropshire and to people across Shropshire and across the country. I start by making it clear that I am not here to criticise the hard-working NHS staff in our ambulance services and emergency departments. Indeed, I thank them for their incredibly hard and dedicated work in difficult and demotivating circumstances, but there is clearly a problem with the provision of emergency care in Shropshire, with complex causes, and I bring it before this House to urge the Government to take some action.
It was clear throughout my election campaign, and has been clear from my inbox since then, that stories of excessive waits for an ambulance are not a rarity. I have since urged my constituents to contact me and share their experiences. Just since Monday, my office has been met with a tidal wave of correspondence, each story as saddening and frightening as the last. A care home reported a wait of 19 hours for an elderly resident with a broken hip. An elderly diabetic man fell and dislocated his shoulder. He was advised not to drink or eat anything in case surgery was required, and then waited 15 hours for an ambulance to arrive. A disabled man fell in his bathroom and waited for 21 hours for an ambulance. He was fortunately lifted from the floor after eight hours by a helpful neighbour. A man waited with a stranger experiencing heart attack symptoms on the side of the road for hours, only to give up and drive the gentleman to A&E himself.
A man with a suspected stroke waited nine hours for an ambulance and a further five in the ambulance waiting to be transferred into hospital. A 92-year-old lady fell at 8.30 in the morning, suffering bleeding from the head and a broken leg. She was looked after by her 75-year-old neighbour for almost eight hours until the ambulance arrived, and then waited in the ambulance for transfer into the A&E department until 2.30 the next morning. She had not eaten since 6.30 the evening before her fall. An elderly woman fell down the stairs shortly after lunch. Her emergency carers—she has a red button to press for them—made her comfortable and called an ambulance, but they could not carry on waiting forever. After an 11-hour wait, she was alone with her front door open so that the ambulance crew could access her house. That was 3 o’clock in the morning.
I could easily spend the next half hour relating heartbreaking stories, and I thank all my constituents who contacted me for taking the time to get in touch and explain the scale of the problem. One story in particular brought the issue home, and some Members may have read about it in the newspapers. It was the story of a young footballer who slipped on AstroTurf while playing football at school. He dislocated his knee and waited so long for an ambulance that by the time one finally arrived he had developed hypothermia. I do not know whether Members can imagine the distress of this young man, and the teaching staff who stayed on in the dark, long after the school day had ended, as his condition deteriorated out in the cold.
What all these stories have in common is that they could have been much worse. I am sure everyone in the House would agree that nobody should have to suffer waiting an excessive amount of time for an ambulance, yet tragically in North Shropshire it is pretty common. I know this problem is not unique to Shropshire. I am sure that many colleagues have received similar emails describing similar events. In parts of Britain, an excessive wait for an ambulance has become normal.
The problems surrounding this crisis are complex, and I am not here to propose a simple quick fix. However, there are consistent themes at the core of the issue. It is vital that we recognise them if we are to work out how to move on from here. The first is the problem of handing over patients at the emergency departments in Shrewsbury and Telford. West Midlands Ambulance Service has told me that, on the day the young footballer dislocated his knee, 868 hours were lost waiting to hand over patients, and that nearly 2,600 hours were lost in the month up to 29 March. Handover times in Shropshire are significantly worse than in the rest of the country, and there have been times when every ambulance based in Shropshire is waiting outside a hospital to discharge a patient.
The hospital trust has declared a critical incident on no less than four separate occasions so far this year, and each of those incidents coincided with an increase in the number of heartbreaking stories coming into my inbox.
Lucy Allan (Telford) (Con)
I congratulate the hon. Lady on bringing this incredibly important issue to the House. Such heartbreaking stories are common to all Shropshire MPs. Does she agree that a combination of factors—I am sure she will go on to discuss some of them—including the transfer of patients on to wards, as well as the inaccessibility of general practitioners, is putting additional pressure on A&E?
Helen Morgan
I thank the hon. Lady for her intervention, and I entirely agree with her. I will stress some of those points later in my speech.
The emergency departments of the Shrewsbury and Telford Hospital NHS Trust report that they suffer from a shortage of space and staff, along with the additional challenges of separating covid patients—on Tuesday this week, the trust had more covid patients than at any previous point in the pandemic. The trust also reports delays in discharging patients who are well enough to leave hospital because it is struggling to find care packages or care home spaces.
A number of care homes in Shropshire are currently closed because of the pandemic. Shropshire shares the national problem of a shortage of care workers and care homes, which is probably exacerbated by our high proportion of elderly patients. The inability to discharge patients who would doubtless be better off at home or in a care home setting reduces the flow of patients through the hospital.
The impact of all this is that, because ambulances wait so long at hospitals, the vast majority of ambulance journeys across Shropshire begin in Shrewsbury or Telford. It is not possible to reach the most seriously ill patients towards the edge of the county within the target time if the ambulance sets out from one of those two towns. This, combined with the closure of community ambulance stations, means that very few ambulances are free in places such as Oswestry and Market Drayton when people become ill and require one.
Another factor, as the hon. Member for Telford (Lucy Allan) alluded to, is the volume of patients accessing emergency departments, or being taken to one in an ambulance, because there is no other option locally, particularly in the evening or at the weekend. Shropshire has a worsening shortage of GPs, which is leading to patients attending emergency departments for relatively minor issues because they simply have no alternative. A key reason behind the problem of staff recruitment is the chronic lack of other services in Shropshire, but that is a debate for another day.
The Government must deliver on their promise to recruit more GPs, and they must ensure that people with non-urgent healthcare needs are provided with adequate resources in the community. I am incredibly proud that my constituents Sian Tasker and Lawrence Chappel in Oswestry and, beyond my constituency, Darren Childs in Ludlow, and other campaigners, are working tirelessly to keep this issue in the public light and are campaigning to keep their community ambulance stations open. It is partly because of their hard work that we are finally discussing this issue in Parliament.
I am afraid to say that, so far, the Government have refused to listen to the countless warnings by campaigners and those working on the frontline. The Care Quality Commission’s “State of health care and adult social care in England” report last year, gave a stark warning that overstretched ambulance services and emergency departments are putting patients at risk. The numbers speak for themselves. The Association of Ambulance Chief Executives has found that, nationally, 160,000 people a year are coming to harm because of delayed handovers to A&E. Of those, a shocking 12,000 experience severe harm.
I have repeatedly asked the Secretary of State for Health and Social Care to meet me and the West Midlands Ambulance Service to discuss how we can tackle local issues together. I am deeply disappointed that, so far, he has refused my request. It seems to many people in Shropshire that the Department of Health and Social Care is burying its head in the sand and refusing to acknowledge the seriousness of the issue we face. I take this opportunity to urge the Minister to meet me and my colleagues across the county to discuss the crisis and to hear some first-hand accounts of those left waiting in distress so that we can come to some sort of solution together.
I have no doubt that all hon. Members present, including those on the Government Benches, want to ensure that people at their most vulnerable are kept safe. I welcome the recently announced additional £55 million of support for ambulance services. I fear, however, that that money may not go far enough or may not be targeted in the areas of greatest need. The hopes of the Shrewsbury and Telford Hospital NHS Trust are pinned on the Future Fit hospital transformation programme, which kicked off in 2013. It is reliant on £312 million of funding, the source of which may be an interest-bearing loan—I will happily correct the record if I am incorrect, but that is my understanding. Unfortunately, more than eight years later, a strategic outline case has still not been signed off. The estimated costs have spiralled by almost 70% and it is likely that they will not be covered by the Government.
The initial promises of urgent care centres in more rural areas—for example, one was guaranteed for Oswestry—investment in community hospitals and local planned care centres were all quietly dropped in the summer of 2015. Promises of investment in public health and prevention, which is a good idea and would have been welcome in Shropshire, are also apparently no further forward. We are consistently told that there is no more money in the pot for faster, better-resourced ambulance services or urgent care staff, yet the Government wasted more than £10 billion on personal protective equipment that is not up to scratch. It is time that they listened to the warning signs that they have been ignoring and finally step up to provide proper support for ambulance services and accident and emergency departments.
There are several steps that the Government could take right away to get to the bottom of the causes of the issue. The Secretary of State could commission the Care Quality Commission under powers laid out in section 48 of the Health and Social Care Act 2008 to conduct an investigation into the causes and impacts of ambulance service delays. That is a fairly simple step and the law already allows for him to commission the CQC. Once the Government have a professional assessment of the complexity of the causes of the delays to ambulance service response, they can take the correct steps, targeted at the correct causes of the problems, to make some rapid improvements to the service. As I have outlined, the causes will most likely lie in a number of areas across emergency and social care, but until they are fully understood by the right people, they cannot be resolved.
The Government could also pass the Ambulance Waiting Times (Local Reporting) Bill of my hon. Friend the Member for St Albans (Daisy Cooper), which would require accessible, localised reports of ambulance response times to be published. Once the data was available, it would enable central and devolved Governments to accurately understand where the delays are and how best to tackle them, because we should be following the data and the facts to provide the right solutions and the right resourcing in the areas that need them most. That Bill is already written, it has had its First Reading and it is ready to go.
I brought this debate to Parliament to ensure that the Minister and the Secretary of State understand the scale of the problem in Shropshire and, crucially, the urgency in resolving it. How many more elderly citizens will have to wait for 10 hours, with their front door open, for an ambulance? How many more people will have to wait at the roadside with a stranger who they believe might be close to death? How many more young adults will develop hypothermia when they initially have a trivial injury, such as a dislocated knee? How many more cases of serious harm, or even avoidable death, will it take?
I thank the Minister for being here this evening and responding to my speech. I also thank Mr Speaker for granting this Adjournment debate. I take the opportunity to thank everybody in the Chamber for coming along and to wish them a happy Easter and a restful break.
The Minister for Health (Edward Argar)
Just as I had the pleasure of giving the final speech in the final debate before the House went into recess before the last half-term, I have the same privilege today. To that end, I congratulate the hon. Member for North Shropshire (Helen Morgan) on securing this important debate. In the short time in which she has been a Member of this House, she has taken an extremely close interest in the issues of ambulances and healthcare for her constituents more broadly. She has been assiduous in raising them in the House, as she has today, or through other means with Ministers and the Department. I pay tribute to her for that.
The hon. Lady will be aware, as she has genuinely and openly said, that there are complex causes behind the challenges faced by her constituents, and also by people around the country, with the ambulance service and ambulance response times. Ambulance services have faced extraordinary pressures, which have been particularly exacerbated during the pandemic. I am sure the House will join me in expressing gratitude, as she did, to all the ambulance service staff in the NHS for their outstanding work and dedication during this time. I recognise the very powerful individual cases that the hon. Lady cited, suitably anonymised, to illustrate her arguments and her case.
As I have mentioned, the pandemic has placed very significant demands on the service. In February this year, the service answered over 760,000 calls to 999—this is nationally, and I will turn to the hon. Lady’s local situation in due course—which is an increase of 13% on February 2020. That places very significant pressures on the ambulance service and the wider NHS, and I will turn to the broader causes shortly. She was absolutely right to highlight that the issue is often not with the ambulance service itself—the number of ambulances or the number of staff—but about handovers and the ability to do turnarounds having safely deposited a patient at an acute setting in a hospital, but I will turn to that in a minute.
A range of other issues, as well of course as demand, impact on performance, including the need for infection prevention and control measures, which remain in place in hospitals. They may not be as acute or as severe as they were at the height of the pandemic, but they are still there, and that does have an impact. There are the handover delays the hon. Lady spoke about, which are linked to capacity with those infection prevention and control measures, but also to the ability either to treat and discharge or to admit patients to a hospital. In recent months, we have also had high workforce sickness absence rates, often down to covid and covid self-isolation, with staff quite rightly taking the view that when they test positive for covid they should stay at home until they do not.
In spite of these pressures—and this is in no way to diminish the point the hon. Lady made about the impact on her constituents, but is by way of context—the average response time in the west midlands to category 1 calls, the most serious calls classified as life threatening, was maintained at eight minutes and 11 seconds in February 2022. That was despite of a 40% increase in that category of calls on the previous year and a 16% increase locally in 999 calls overall. At a national level, the category 1 response time has been largely maintained at about nine minutes on average over the last several months—so not quite as good as the performance in the West Midlands—despite a 23.5% increase in those incidents compared with before the pandemic. However, we are clear that there have been significant increases in response times in the other categories, which of course we must improve.
Helen Morgan
I just want to make the point that in Shropshire we are not seeing the same level of service that we see across the west midlands as a whole. I am calling for more granular data because I think some excellent service provided elsewhere in the West Midlands Ambulance Service area is overshadowing some of the specific problems we are seeing in Shropshire. In addition, the number of hospital admissions to the Shrewsbury and Telford Hospital NHS Trust is running roughly at the same level as in prior years, so although the covid pandemic has provided challenges in separating out such patients when they arrive through infection control measures, it is not actually leading to a higher level of admissions.
Edward Argar
I am grateful to the hon. Lady, and I will turn to her specific asks in a moment.
However, I will turn now to the Bill introduced by the hon. Member for St Albans (Daisy Cooper), which I am aware of. I have to be honest and say that we do not consider that the Bill would necessarily be the most appropriate way of achieving what she wants. The challenge with that legislation is that, at a time when we wish trusts to be focused on the delivery of frontline services, it is another administrative process of data collection. I would add that trusts of course operate at trust level, not at an individual station or county level, and trusts may cover a number of counties. So while I am aware of her legislation, it is not something that I believe would achieve the outcomes or be practical in the way she wishes, and she and I regularly have a to and fro across the Dispatch Box about a number of issues when she speaks for her party on health and care matters.
There is strong support in place to improve performance. At the national level, as the hon. Member for North Shropshire generously recognised, there was £55 million of investment last summer, in advance of the winter, to help increase ambulance staffing capacity to manage pressures. All trusts received a portion of that funding to expand capacity through additional crews on the road and additional clinical support in control rooms as well as extending hospital ambulance liaison officer cover at the most challenged acute trusts.
On overall staffing, which includes frontline clinical staff and the clinical support staff who work with them, our ambulance service has seen about a 38% increase since 2010—the Liberal Democrats can quite rightly take some credit for that from their five years in government—and, indeed, in the last year we have seen an increase of about 500 frontline staff. So we have increased staff and continue to increase available staff.
The £55 million was supported by an additional £4.4 million in capital investment—these are still national figures, but I will turn to her specific local circumstances—which helped to keep an additional 154 ambulances on the road during winter over and above normal levels. Call handler numbers, which are equally important, are being boosted with more than 2,400 on target to be in place by the end of March—the end of today. That is about 500 more FTE—full-time equivalent—staff compared with September 2021, with potential for services to increase in capacity further during the coming financial year.
NHS England and Improvement is also providing targeted support to the hospitals facing the greatest issues with delays in the handover of ambulance patients, helping them to identify short and longer-term interventions to reduce delays and get ambulances swiftly back out on the road. She is right that that is hugely important, and even more so in areas with large rural populations because of the distances involved. Trusts also receive supportive continuous central monitoring and support by NHSEI’s national ambulance co-ordination centre.
With clinical support in control rooms, the ambulance service is closing just over 11% of 999 calls with clinical advice over the phone, which is an increase of three quarters since before the pandemic. That helps to save valuable ambulance resources to respond to more urgent calls, with that clinical input ensuring that the advice and decisions are right.
The hon. Lady will be pleased to hear that significant local support is in place to improve response times in her county. The West Midlands Ambulance Service is working with community partners to help avoid conveying patients to hospital where there is no clinical necessity, providing alternate treatment and care at home or in the community and helping to avoid unnecessary trips to hospital, thereby freeing up resources and hopefully providing a more pleasant experience for those patients.
In raw numbers, the West Midlands Ambulance Service conveyed over 600 fewer patients to hospital in February based on the clinical advice this year compared with two years ago. It has also introduced a clinical validation team of advanced paramedics who work in control rooms and clinically triage lower urgency cases and, where appropriate, signpost patients to other services, as I alluded to. In February, that team reviewed 967 cases in Shropshire, of which 61% of were not sent an ambulance, 14% were treated on the scene and just 25% were conveyed to hospital. That was based on the clinical triage, which I am sure the hon. Lady agrees should be central to any decisions made. That has played a significant part in helping the service to tackle the pressures.
Other practical solutions include hospital ambulance liaison officers—HALOs—who are paramedics who work with bed managers to smooth out the flow of patients coming to an A&E department. They can provide a constant flow of information about capacity to the strategic command cell at the ambulance service headquarters, escalating any issues and avoiding queueing where possible. There is also joint work to cohort ambulance patients at A&E sites, where a single ambulance crew takes responsibility for three or four patients. That releases crews to respond to outstanding calls in the community more quickly.
A new same-day emergency centre—SDEC—has been opened at the Royal Shrewsbury to divert patients, as clinically appropriate, away from A&E, improving handover times. In the two and a half years that I have been a health Minister, I have discovered that there are probably almost as many acronyms in health as in the Ministry of Defence. Surgical SDEC capacity at the Royal Shrewsbury has also been expanded and all SDEC units receive ambulances directly for suitable patients.
The hon. Lady rightly mentioned hospitals, and I am grateful that my hon. Friend the Member for Telford (Lucy Allan) is here and made an intervention. During her seven years in the House, she has been a regular and vocal advocate for her local hospital in Telford. I pay tribute to her, because it was due to her campaigning and tenacity that there is an A&E locally at Telford. That is still seeing patients and helping to alleviate the pressure in Shropshire. She should rightly be proud of that, having successfully campaigned for it.
Action is being taken locally to improve the patient flow through hospitals by discharging patients more quickly to create bed space. The aim is not only to increase the number of discharges a day, but to bring more discharges forward to earlier in the day, when it is clinically safe to do so, to allow the effective discharge and transition back to care at home or in a care home. Health and care system partners locally are looking to create additional community and social care capacity to support timely discharge, create bed space to take patients from A&E and reduce ambulance handover times.
At a national level, we have set up a national discharge taskforce. As a Minister, I get almost daily statistics about where we are on delayed discharges across the country. It is a complex picture, with a variety of reasons behind delayed discharges. The hon. Member for North Shropshire is correct that some are about delays in getting into care homes or getting domiciliary care packages or rehabilitation packages at home. Some are also down to delays in the hospital in sign-offs and procedures, and there is more that we continue to do to drive those delays down.
Construction is also under way on a new modular ward at the Royal Shrewsbury site, with 32 additional beds in service by spring 2022. That is alongside a £9.3 million upgrade of the emergency department at the Royal Shrewsbury, delivering additional cubicles, a new and improved majors department, a new designated emergency zone for children and young people and a new clinical decisions unit. The first phase of that work is complete and all areas will be finished by spring 2022.
The hon. Lady raised a number of other issues, including the Future Fit model. We have been clear that funding of £312 million was allocated for that project, and that remains allocated. The challenge we face is that, thus far, the trust has not proposed a solution that meets that budget. We continue to work with the trust and to encourage it to do so. I hope that it will so that we can continue to drive that important project forward.
I will very gently push back on what the hon. Lady said about there being £10 billion of PPE that is not fit for purpose. She will know that that is not correct. In the statement that was made about write-downs, not write-offs, the amount was about £8.7 billion, and it was not all PPE, by any means, that was not fit for purpose. Only a tiny proportion of that was the case. A significant element of that was essentially due to over-ordering at the height of the pandemic to make sure that the frontline had the PPE that it needed. We were buying at the height of the market, and there is currently a glut of PPE, so its value has inevitably declined. Not all of it will be used, because we got more than we needed to make sure that clinicians and others on the frontline were not exposed.
The hon. Lady touched on local ambulance Make Ready stations and the changes to them. Decisions on reconfigurations and changes to that are made locally by the trust; it consults, but it makes those decisions. The Government do not have any power over those matters. The Health and Care Bill, which we debated yesterday, would give the Secretary of State greater power over such reconfigurations in the way that she asked, but her hon. Friend the Member for St Albans argued against that. I gently say that that is a matter for the local trust and the usual NHS processes on reconfigurations.
The hon. Lady touched on, I think—forgive me if I am wrong—asking the CQC to look into this issue. It is entirely open for her or others to raise it with the CQC, and the CQC will make a decision or a judgment on whether it believes that it is appropriate or otherwise to look into the matter.
In the few seconds that I have left, before Mr Deputy Speaker calls me to order, I say that I recognise and do not in any way diminish the significance of the issues that the hon. Lady raised. I hope that I have given her some reassurance that we are working through these issues and that we continue to put the support in place to help her constituents in Shropshire and more broadly.
Finally, the hon. Lady requested a meeting, and I am conscious that she has raised the issue of correspondence. I have asked for that; I believe that that has happened since Christmas, as the Department works through the backlog. There is still a delay in correspondence, but I have pulled that out and asked for it, and I am happy to meet her and her fellow Shropshire MPs, together with the ambulance trust, to discuss their collective concerns or reflections that they would like to put to me as a Minister.
I conclude by wishing the hon. Lady a very happy Easter and by thanking her for bringing this to my attention and the attention of the House.
Mr Deputy Speaker (Mr Nigel Evans)
On behalf of Mr Speaker and the entire Deputy Speaker team, I wish a happy Easter and a good recess to all who work here.
Question put and agreed to.