Ambulance Waiting Times: Royal Cornwall Hospital
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The Minister for Health (Edward Argar)
I congratulate my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) on securing this important debate. Since her election, she has been a notable advocate both in this House and more privately with Ministers on behalf of her constituents and those who work in her local healthcare system—as, indeed, are all six Members of Parliament representing seats in Cornwall.
May I also take the opportunity—I know we do not always use this sort of language now, but I will—to congratulate the hon. and gallant Member for Tiverton and Honiton (Richard Foord) both on his election to this House and on his contribution to the debate this evening. I look forward to his maiden speech, but it is a privilege for me to have had the opportunity, I think, to be the first Minister to respond to him and congratulate him. It is always a pleasure to see the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard), who may not be my hon. Friend but is my friend. I thank him for his contribution, highlighting the issues at Derriford Hospital.
As my hon. Friend the Member for Truro and Falmouth has made clear, there are complex causes behind the challenges faced by her constituents and those of other right hon. and hon. Members around the country with ambulance services and ambulance response times. As she will know, ambulance services faced significant pressures during the pandemic and continue to do so. I join her and Members on both sides of the House in putting on record, as she did, our gratitude to all the ambulance service staff and the NHS for their outstanding work, both at this time and particularly in recent years.
The service is still working under exceptional demand and pressures. In May 2022, the ambulance service answered more than 850,000 calls, an increase of 7% on May 2021 figures. Those are national figures; I will turn to my hon. Friend’s local situation in Cornwall in due course. She is right to highlight that the issue is not just with the ambulance service itself, although that is often the visual manifestation or symptom of broader challenges within the health ecosystem and the pressures it is under. It is about handovers and the ability do turnarounds and get the ambulances back on the road, having had a patient safely admitted to the A&E department in an acute setting. I will turn to that in a moment too. As she will be aware, other issues as well as demand impact on performance, including, still, although less so than there have been, elements of infection prevention and control measures. There are issues in particular areas with staff absence—for example, still, where there is an outbreak of covid. She also highlighted some very specific local factors that I will turn to.
Touching on that, I am aware of the local context that my hon. Friend set out, in that in Cornwall the demand for NHS services has combined with wider systemic issues, placing particular stress on the system. Some of those local factors include the demographic challenges of the age profile of the population and difficulties or challenges in securing the adult social care capacity to meet current and projected demand. I suspect that much of what I say about Cornwall will apply to Devon as well, as the context both demographically and in terms of patterns of demand are not completely dissimilar.
Other factors that play a key part include geography and, as my hon. Friend highlighted, the cost of living, affordable housing, and the ability to retain a skilled workforce. It is also worth remembering, in the context of Cornwall, that whereas many parts of the NHS system see very pressured demand over the winter period that tends to ease somewhat during the summer, allowing them time and space, Cornwall, and, I suspect, Devon as well, being such popular holiday destinations, see a different range of challenges and pressures on the system as holidaymakers come into to area and often need to use these services. I am very sensitive to that point.
I assure my hon. Friend, who touched on some of those issues, that significant work is under way across the entire local health and care system to improve patient flow through the hospital, which is the key element in making the system work smoothly to reduce the wait times for emergency care and reduce the numbers of delays in handing ambulance patients over to A&E. Importantly, the NHS Kernow clinical commissioning group, as it currently is—as she rightly highlighted, as of 1 July ICSs become statutory bodies—is continuing to work with all providers to create and commission additional capacity, including a plan to release 80 additional hospital beds now and 20 to 40 further beds in time for the winter. This will help to increase the flow of patients out of the emergency department, reducing overcrowding and the numbers of ambulance-patient handover delays. I pay tribute to my hon. Friend for the summit that she and local Cornwall Members convened with me earlier in the year not only to talk about the pressures faced by the system at the time but to begin looking forward to how we can mitigate future pressures.
The trust is expanding the use of virtual wards whereby patients are monitored remotely at home rather than being admitted to hospital. This further reduces pressure on local bed capacity and allows for patients to be safely treated at home, which can be beneficial for their recovery. Of course, that is done on the basis of clinical triage and assessment. There has also been an increase in the adult social care domiciliary care pay rate, helping to generate more social care capacity locally and ensure that patients are able to be discharged from hospital to home as soon as they are medically fit. That is supported by the Proud to Care recruitment campaign. I understand that the NHS and Cornwall Council are aiming to launch a targeted campaign in the autumn to encourage more under-25s to work in the care sector.
I now turn to discharge. I have highlighted some of the action that is being taken locally to improve patient flow through hospitals by discharging patients more quickly. The aim is partly to increase the number of discharges a day, but it is also to bring more discharges forward to earlier in the day, when it is clinically safe to do so, thus making those discharges much better managed. It is important that all partners work well together on that. At a national level, we have set up a national discharge taskforce. As Minister, I now get weekly statistics about where we are on delayed discharges. My hon. Friend alluded to the number of people who are clinically fit for discharge but have not been discharged, for a variety of reasons. Reducing that by even a small proportion would have a significant impact on the availability of beds and thus patient flow. It is a complex picture with a variety of reasons behind delayed discharges. However, it is important that we continue to work across the system locally and with national support to get the number of delayed discharges down.
The CCG locally is also establishing community assessment and treatment units for frail and elderly patients as an alternative to hospital admission, alongside an innovative reablement ward that is now moving to a community hospital location, as my hon. Friend mentioned, as a permanent model of care. Taken together, these interventions will help to ensure the effective flow of patients through hospital, reducing those waiting times and crucially reducing the number of ambulance handover delays, allowing ambulances to get back on the road more rapidly.
To address the wider issues around staff recruitment and retention, the NHS is working with local partners on schemes to address cost of living concerns, including work with the Supportmatch charity on the homeshare scheme, where a householder helps to offer affordable accommodation to someone working in the sector. There is the new guardianship programme developed by Supportmatch, NHS England and NHS Improvement in the south-west that enables householders to offer a spare room to fully vetted and checked health and care workers. Typical agreements can run from two months to two years. We should recognise those sorts of innovations that have grown up locally for the beneficial effects they can have.
It is also encouraging to see that these measures are delivering improvements. Performance against the four-hour A&E standard improved from 76.9% meeting that in April to just shy of 80% meeting it in May. There is more to do, clearly, but that is a positive direction of travel. The South Western Ambulance Service also saw notable improvements across all response time categories in May compared with April, including a 24-minute reduction in the average category 2 response time. Again, there is still more to do to get those down to target levels, but that is a positive step and a positive direction of travel.
There was a reduction of more than one minute in the average response time to the most serious category 1 calls. That does not sound like a huge amount, but in April, when we were seeing challenges, that was a bit over 11 minutes. Shaving a minute off that is still hugely important. There is more to do to get it down to the circa six or seven minutes that it was in May 2019, before the pandemic. We have further to go, but we are focused upon it.
Then there is investment in hospitals locally. In this context, I highlight the £1.3 million in 2020-21 of the elective recovery estates funding, the £2 million for technology to help elective recovery, the £2.8 million for A&E upgrades and the £1.7 million previously given to tackle the backlog maintenance in my hon. Friend’s trust. I pay tribute to her, but I pay particular tribute to my hon. Friends the Members for North Cornwall (Scott Mann) and for St Austell and Newquay (Steve Double), who in the nature of their roles in this place are not able to intervene directly in this debate. It is important that I put on record their work on behalf of their constituents in lobbying Ministers and securing that investment from Government in their local hospital trust.
There is a wide range of national support in place to improve ambulance performance more widely.
Luke Pollard
According to the South Western Ambulance Service, three of the five hospitals in the country with the longest ambulance waiting and hand-over times are south-west hospitals—Derriford, Bristol and Royal Cornwall. Is there something south-west specific that the Minister needs to look at as to why south-west hospitals are experiencing the longest hand-overs?
Edward Argar
I gently say to the hon. Gentleman that the hon. Member for North Shropshire (Helen Morgan) made the point about delays in respect of her county in March, so we are seeing significant challenges across the country. I have highlighted some of the specific points about Cornwall, such as the geography and the distances. It is also about demand, which, as I alluded to, does not abate even slightly in the summer. There is a range of factors—my hon. Friend the Member for Truro and Falmouth highlighted a number of them—and I have set out some of the measures that we are taking to address them.
Nationally, as my hon. Friend alluded to, a wide range of support is in place. Ambulance trusts receive continuous central monitoring and support from the National Ambulance Coordination Centre, and NHSEI has allocated £150 million of additional system funding for ambulance service pressures in 2022-23, which will support improvements to response times through additional call handler recruitment, retention and other funding pressures.
National 999 call handler numbers have been boosted to more than 2,300 at the start of May 2022, which is about 400 more than in September 2021, with further potential increases. We are also investing £20 million of capital funding in ambulance trusts in each of the three financial years to 2024-25, in addition to the £50 million national investment across NHS 111.
We continue to work closely, in terms of additional resources and system pressures, with the ambulance trusts in the south-west and across the country. I am grateful to my hon. Friend for highlighting this hugely important issue. Her constituents are lucky to have her representing them in this place. I will continue to work with her and other right hon. and hon. Members, and the system, to deliver the improvements that we all wish to continue seeing.
Mr Deputy Speaker (Mr Nigel Evans)
I, too, welcome Mr Foord to the House on his maiden intervention—if such terminology exists; it does now.
Question put and agreed to.