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Wera Hobhouse (Bath) (LD)
I beg to move,
That this House has considered waiting times for ambulances and emergency department care.
It is a pleasure to serve with you in the Chair, Mr Stringer, and I am pleased to see so many Members here to discuss the highly concerning issue of the unacceptably long waiting times patients in our constituencies endure to access emergency care.
Our urgent and emergency care system provides a vital service supporting a significant number of patients with a huge variety of medical conditions, ranging from acute emergencies and trauma to mental health crises, the care of our homeless population and care of elderly patients. Emergency care should be there for all of us when we need it. Few of us plan to attend emergency departments, but we are all potential patients.
Covid-19 has had a detrimental effect on our ambulance services. More and more people are calling ambulance services or attending A&E because they are having difficulties accessing other, more appropriate parts of our health system. National NHS performance figures illustrate that our healthcare service does not have the capacity to meet demand, and during May 2022, only 60% of patients were seen, admitted or discharged within four hours of their time of arrival. We should all be worried by those figures, which demonstrate that the health service is unable to meet the needs of patients with current levels of resource and capacity.
I want to share the example of the Royal United Hospital in my Bath constituency. It demonstrates the severity of the problem and the way in which hospitals have to step in because the Government are not willing to accept that there is a real crisis. There have been several cases in Bath in which residents waited many hours for an ambulance. Recently, an elderly man was forced to sleep on the floor of a local church as it took 12 hours for an ambulance to arrive—12 hours. A GP surgery ran out of oxygen for a patient due to the time it took for the ambulance to arrive. Ambulance handover delays are a significant patient-safety risk at the RUH, and up to 90% of the causes of delay are linked to the availability of beds in the hospital.
The RUH has consistently been running with a bed occupancy of over 90% for the past year, which is significantly impacting the hospital’s ability to move patients out of the emergency department. The hospital is one of the most challenged in the south-west for “non-criteria to reside”—in other words, medically fit for discharge—patients, and NHS England is reporting that the RUH has 24.3% of its beds occupied by patients who are medically fit, which is the third highest figure in the south-west. That is driven by gaps in the domiciliary care and social care markets.
My local authority, Bath and North East Somerset Council, has been short of 1,600 hours per week, community teams are struggling to recruit and our local care group has a vacancy rate of more than 30%. The RUH is working with the council to develop its own in-house domiciliary care to try to plug the gaps, but the recruitment crisis remains acute. NHS England is assessing the trust and is trying to help to reduce the bed gap at the RUH. The hospital recently launched a “home is best” transformation programme that aims to increase the number of patients who go home instead of into a community hospital bed. Our hospitals are trying all this, yet there is a crisis. It is important that we recognise that, and that the Government recognise it and step in on behalf of the hospitals.
Our hospital in Bath is also working out ways to reduce the number of patients who need to go into the emergency departments in the first place, and has launched a same-day emergency care offer for frail patients. However, nationally, the lack of staffed beds has resulted in staggering numbers of patients waiting beyond 12 hours after the decision is made by the A&E doctor. There have been more patients waiting 12 hours or more from the decision to admit this year than there were in the entire reporting period leading up to 2022. In May, there were more than 19,000 patients waiting 12 hours or more from the decision to admit, yet research from the Royal College of Emergency Medicine shows that that number is only the tip of the iceberg. We know that far greater numbers of patients endure waits of 12 hours or more if the clock is started as soon as they set foot in A&E. Many more patients endure extremely long waits but are not captured by the current metric. We need to understand the true scale of the problem. If we do not know about the extreme delays that our patients are enduring, we cannot take action. Transparency is key, and reporting metrics from the moment of arrival at the A&E department must be the starting point.
Such delays mean that emergency services are not able to respond to 999 calls from critically ill patients. Instead, they are being held in stacks of hundreds each day, and staff are forced to prioritise among even the most serious cases. Staff have to wait with the patients in corridors, and sometimes even outside the hospital, unable to have them treated and unable to respond to new emergency calls. We must think very carefully about what that means. Behind every statistic is a patient. Those patients are stuck and have no choice but to wait for a bed to be freed up so that they can be admitted and can receive the care they need. Unfortunately, some patients end up on trolleys in crowded corridors with many other patients. We should be treating patients with dignity. We know that crowding is dangerous and is linked to avoidable harm and, in some cases, death.
The pressure that the NHS faces, which has been building over recent decades, has real detrimental consequences on the emergency medicine workforce and patients. Staff are considering reducing hours, changing careers or retiring early. Additionally, emergency staff face constant abuse from those left waiting, which is hugely distressing. The more people leave, the more pressure is created.
The Royal College of Emergency Medicine’s “Retain, Recruit, Recover” report detailed findings from its survey of emergency medicine clinicians. It found that 59% of respondents experienced burnout during the second wave of the pandemic, and described their levels of stress and exhaustion from having worked the second wave as higher than normal. The report found that operational pressures, patient safety and staff wellbeing are intrinsically linked. In 2021, the Royal College of Emergency Medicine highlighted a UK-wide shortfall of 2,000 to 2,500 whole-time equivalent emergency medicine consultants. The needs of our population’s health and wellbeing are greater now than they have ever been. We cannot afford to lose even more of the workforce at this critical time of need.
It is clear that this very serious issue is a matter of life and death for many patients. Among those who are suffering from serious but not necessarily prioritised issues, it is elderly and frail patients who are being hit the hardest. Although it is easy for the Government to point the finger at hospitals and management, it is clear that this issue needs to be addressed centrally at Government level. It is not exclusive to Bath or north Shropshire; it is a national problem, as the range of MPs in the debate demonstrates.
What is more, the consequences of a failed social care system, which does not allow for the timely discharge of patients who are medically fit to leave hospital, has resulted in further crowding and corridor care in our hospitals. The chief executive of NHS England recently acknowledged the important role that social care plays in supporting patient flow through hospitals. The Government must outline the steps they will take to ensure the social care system is adequately equipped ahead of next winter.
Last autumn, the NHS published a 10-point plan for the recovery of the urgent and emergency care system. It has no targets or timelines, and it lacks any indication of how progress will be reported. It details only how the whole system will work together to recover urgent and emergency services, focusing on immediate and medium-term activities. The plan aimed to
“mitigate against the current pressures felt across systems and improve performance in all settings”—
great words, but where are the outcomes? All that is happening is that the situation is getting worse.
The NHS standard contract 2022-23 was recently amended to change the way in which 12-hour waits in A&E are calculated. As a result, A&E is now collecting 12-hour data from the patient’s time of arrival, not from the decision to admit. Despite that, the Government and NHS England have not indicated when the data will be publicly available. Publishing the figures nationwide will allow for transparency across the system, so perhaps the Minister will tell us when that will be publicly available. That should lead to improvements.
The Liberal Democrats have been sounding the alarm bells for months, calling for an urgent investigation into England’s ambulance services and a review of ambulance station closures, but the Government keep turning a blind eye to the crisis. We are calling for more investment in local ambulance services, an urgent campaign to recruit more paramedics, and enabling trusts to restore community ambulance stations in rural areas in Devon, where waiting times are unacceptably long.
Richard Foord (Tiverton and Honiton) (LD)
I found on the doorsteps in my part of Devon over the last month that pretty much every door I knocked on had somebody behind it with an anecdote about how ambulance waiting times had affected them personally. In south-west England we have the longest waiting times in the country. One paramedic told me that despite his very best efforts to treat patients, there were times when he came across very undignified scenes. He talked about one example of how he came across a lady who had fallen down and had to wait 14 hours for an ambulance to arrive.
Graham Stringer (in the Chair)
Order. I realise that the hon. Gentleman is new, but interventions should be short and to the point. I did not want to interrupt him, but I ask him to remember that interventions should be as brief and to the point as possible.
Wera Hobhouse
Thank you, Mr Stringer. I think every one of us has such stories from the doorstep. Almost everybody knows of a loved one or a friend who has waited an unacceptably long time. That is why it is so important that we get the urgent review that Liberal Democrats have been calling for.
We are calling for a formal inquiry. The Government need to fund thousands of extra beds to stop handover delays in A&E so that ambulances can get back on the road as soon as possible. Will the Minister comment on a formal inquiry into the crisis?
Ian Paisley (North Antrim) (DUP)
Fifty per cent. of the entire Northern Ireland budget is spent on the health service, which is a higher proportion than in the rest of the UK. But this is not just about the money. Does the hon. Member agree that it is about how the money is spent and managed, and that that is critical to any review?
Wera Hobhouse
Indeed. Not everything is always about money; it is also about proper management. At the heart of it all is transparency. We need to have the figures and to understand what the problems are. I echo the Royal College of Emergency Medicine: unless we have transparency, we cannot get to the bottom of the problem.
The Royal College of Emergency Medicine has already stated that A&E departments are not confident they will cope this winter. The Government simply cannot ignore this looming crisis on top of the existing challenges we face. They are running the NHS into the ground. With A&E wait times measured in hours instead of minutes, people are no longer confident that they can get urgent medical help when they need it. The Government need to start working with NHS staff to draw up a robust plan now to tackle the crisis in ambulance waiting times and emergency care, and start delivering. Thousands of lives depend on it.
Several hon. Members rose—
Graham Stringer (in the Chair)
I think there are 10 hon. Members wishing to speak. I intend to start calling the Front-Bench spokespeople at 10.40 am. Therefore, Members have approximately five minutes each. I will not impose a time limit unless people abuse this privilege.
Duncan Baker (North Norfolk) (Con)
I thank the hon. Member for Bath (Wera Hobhouse) very much for obtaining this very important debate. The very first subject that I raised when I was a newly elected MP was the state of ambulance response times in North Norfolk. That is a particular worry for me, because up on the North Norfolk coast I have the oldest constituency demographic in the entire country, and Wells, a beautiful seaside village, has had the very dubious honour of consecutively having the worst response times. Over the last few years, whereas the category 1 responses have flatlined, the C2 and C3 response times have got worse. Constituents are coming to me almost every other day to tell me about the appalling situation that they have encountered in calling an ambulance. The worst cases are of people having strokes in the back of their car while family members are driving them to the hospital. When we hear those accounts, we get some sense of just how bad the picture is.
I agree with many of the comments made by the hon. Member, but we have to recognise that this is not a simple issue that can be solved with a single magic bullet, and it is certainly not all the fault of the ambulance service, which is working under extreme pressure. All our health systems at the moment are really buckling under the issues that have been caused by the pandemic. That is the case in social care systems, mental health care and dentistry. There are serious problems in all places at the moment.
Let us take the Norfolk and Norwich Hospital, which is my emergency department. It has the honour—I call it an honour; it is dreadful—of being the worst in the east of England. In the first 13 weeks of the year, 723 equivalent ambulance shifts were lost. The third worst performing facility for ambulance response times is the Queen Elizabeth Hospital, with 442 equivalent shifts lost. Both ED units that serve my constituency are in the top three worst facilities in the entire east of England. It is a huge problem, with hundreds upon hundreds of hours lost every single week when ambulances are queueing up outside a hospital because they cannot get patients out of the trucks and into the A&E department. Equally, the social care system is so poor that they cannot get people back into the community, with the respite that they need.
We know that there are serious issues about sickness; there are rising levels of covid. But there are other issues also. I am told that 50% of the calls that are made to the ambulance service in Norfolk are calls that simply should not have been made; they could have been for something that was not life-critical. That is coupled with ambulances pulled off the patch to go and service other areas; actually, there would be enough ambulances in North Norfolk if they were used within North Norfolk. That just adds to the problem.
However, the most pressing issue is the sheer numbers—the hundreds of hours lost every week from ambulances queueing up. The question is why, and it is a very easy answer: 95%-plus occupancy all the time is the problem. We simply cannot have the capacity in place. It is no good saying, “Well, if we just build a bigger hospital or build a bigger ED, that will solve the problem.” I do not think it will, because the problem is so multifaceted.
The hon. Member for Bath was right: transparency of data is incredibly important. But when we drill down into the information, we realise that all the issues that I have set out are working in tandem; they are all conspiring to cause the problem. In the last minute or so available to me, I want to ask what we do about it, and there are some practical suggestions that I want the Government to take really seriously.
First, the role of our community first responders should not be underestimated. We are not treating this problem seriously enough. Why on earth are we not paying community first responders, as is the case with the retained fire service? We are asking volunteers in our community, who have to be fit men and women and who, frankly, are probably not going to be people approaching their retirement age of nearly 70. Not enough people are going to be volunteering in our communities, and that is why we suffer with the numbers. If we really got some energy behind this in order to recruit these people, help them and make it economical for them to do it, we would see, I think, uptake of that. They are the first line of defence in helping to support people.
The second issue we should be looking at is rapid response vehicles. A rapid response vehicle was nearly taken away from North Norfolk, which was absolutely appalling. These vehicles offer far better economic value than ambulances. The clue is in the name—they are able to rapidly respond. They can be stationed virtually anywhere and help suffering patients while an ambulance gets to them. They are incredibly important in rural areas, so I ask the Minister to take those issues seriously.
Finally, I will be spending the first week of the forthcoming recess volunteering with the East of England Ambulance Service so that I can see at first hand the problems it faces. Those who work there are heroic people, but, my word, they need some help.
Naz Shah (Bradford West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer.
“24 Hours in A&E” is not just a television show, but a reality that patients across the UK now face. It is no longer a short trip to the accident and emergency department, but a short stay in an accident and emergency ward, which means staff are effectively running two wards: the A&E ward and the ward where patients should have been moved to be treated. In Bradford, the demand for urgent and emergency care outstrips the capacity of hospitals to support patients, and that reflects the reality across the country. Unsurprisingly, the waiting time for emergency services and emergency department care will vary across the country, with waiting lists in the most deprived areas having increased by more than 55% compared with 36% for the least deprived areas.
As I have previously highlighted, children in Bradford wait 800 days longer for mental health intervention. The Government keep telling us that covid-19 is to blame for the waiting time, the backlog and the lack of resources and funding, but that could not be further from the truth. In fact, the Secretary of State for Digital, Culture, Media and Sport admitted that in her attack on the former Health Secretary, the right hon. Member for South West Surrey (Jeremy Hunt), for failing to prepare for covid.
When a stroke patient does not get the urgent support they need, that can mean further damage to their health and life-long injuries, which in turn costs the NHS more. On the subject of ambulances, a dear friend of mine who is chief executive of My Foster Family, based in my constituency and with whom I have worked a lot, suffered a stroke last week. Shadim Hussain, who is 43 years old, is in the intensive care unit as we speak and I hope he will recover, although it will no doubt take a long time. When there is a 45-minute wait for an ambulance, there are two victims: the person in the ambulance who is waiting to be offloaded into the hospital and the person in the community who is waiting for the ambulance to get them to hospital. Shadim Hussain was taken to hospital in a car while he was being sick and suffering from a very serious bleed to his brain.
The UK has the second lowest number of beds per 1,000 inhabitants in the EU and the third highest decline in beds per 1,000 inhabitants in the EU. When Labour left Government in 2010, there were 144,000 hospital beds available, but at present there are around 128,000 hospital beds available.
When an 18-year-old woman suffering from a mental health crisis is forced to wait eight and a half days in A&E before getting a bed in a psychiatric hospital, that also costs the NHS more, but it is not just about the cost. The NHS was set up on a moral basis to provide care for our people; it was its birthday yesterday. Instead, people wait and pray, and some go home with more injuries or trauma. According to the Royal College of Emergency Medicine, whose representatives I met yesterday, the situation is 14% worse than the current statistics tell us.
However, the most recent British social attitudes survey recorded an unprecedented fall in public satisfaction with the NHS. When we left Government, we had the highest rates of satisfaction in the NHS as we had eliminated waiting times. We now have the lowest levels of satisfaction since 1997, with long waiting times at the top of the list of reasons given for dissatisfaction. That dissatisfaction is not due to the doctors, nurses, ambulance staff, receptionists or cleaners. As the hon. Member for Bath (Wera Hobhouse) said, the staff are often abused. The dissatisfaction is because of the lack of resource provided by the Government.
In Bradford, we have an increase in emergency department attendances, with some very busy days when we exceed 400 attendances in any given 24 hour period. Bradford Royal Infirmary is around the corner from where I live. There are currently 46 covid-positive patients in the hospital, or 1.5 wards-worth. The segregation of covid patients, elective and acute patients is impacting on the ability to place patients in the correct bed in a timely fashion, and all that exacerbates the strain on an exhausted workforce. The continued focus on the clearance of elective backlogs means that we are trying to undertake more elective procedures at the same time as dealing with all that, and there are workforce challenges associated with staff with covid infections and colleagues who have worked relentlessly through the pandemic. Despite all that, the trust continues to perform in the top quartile across a number of key metrics, including urgent, cancer and elective care.
I put on the record my thanks to all the staff, from the chief executive’s team to the porters who run the hospital, not just through covid—they continue to do so—in spite of the underfunding for years and years, before we even got to the pandemic, and despite not having the right resources now. The Government clapped for the NHS workers during the pandemic, but the claps were never enough. It is now time for action, not political slogans and gestures.
Peter Aldous (Waveney) (Con)
It is a pleasure to serve with you in the Chair, Mr Stringer. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this debate. I will focus my comments on the work of the East of England Ambulance Service NHS Trust and the James Paget University Hospitals NHS Foundation Trust, which together serve north Suffolk and east Norfolk, including the Waveney constituency.
The staff and management of both NHS trusts are under enormous pressure at the current time and are working incredibly hard to meet a challenge that is largely not of their own making. The East of England Ambulance Service has faced a number of institutional and cultural challenges over the past decade, which the current management are addressing. During that time, for the most part, it has provided the local community with a good service, although there have been three occasions when it has not done so: in 2012, when the system broke down very badly, at around Christmas time in 2017-18, when the then management failed to properly plan for seasonal pressures, and today, as it works against a very difficult backdrop.
For the week ending 26 June, the average arrival-to-handover delay at the James Paget was one hour 30 minutes. For the previous week, it was one hour four minutes. For the week before that, it was 49 minutes. The trajectory is very much upwards. The worst individual case that has been brought to my attention is a wait of 16 hours, and I am also aware of the situation with poor triaging.
Working collaboratively and in a co-ordinated way, the ambulance service and the James Paget hospital are putting in place a range of measures to relieve the pressures. The hospital has expanded its emergency department, launched a new surgical assessment unit and invested £900,000 in a new GP streaming service aimed at providing care for patients who attend A&E and who need a doctor rather than hospital treatment. For its part, the ambulance service is putting more ambulances on the road, developing co-responses with the fire services and local communities, and staffing cohorting areas at the Paget with its own HALOs—hospital ambulance liaison officers.
Those initiatives are welcome, and the two trusts should be commended for putting them in place, but they are, in many respects, a sticking plaster. They do not address the root cause of the current crisis, which is the logjam caused by the difficulty that the James Paget and other hospitals are facing in discharging patients to free up beds.
The Paget regularly has an average of 100 patients—the equivalent of four wards—who are ready for discharge, but have nowhere to go. They have opened 22 beds at the Carlton Court Hospital, a facility that the Paget now shares with the mental health trust, but there is an urgent need for more beds to be made available in the community, whether at home, or in care and nursing homes.
The problem with care at home, which in many respects is to be preferred, is that councils such as Suffolk County Council and its social services department are struggling to recruit carers and agencies to go into people’s homes to look after them after they have left hospital. In the long term, there is a need for strategic workforce planning in both the health and care sectors.
In the short term, Government need to work with councils such as Suffolk, with the East of England Ambulance Service and with hospitals such as the James Paget hospital—as well as with the wider care sector—to remove the blockage that is impacting all the way along the ambulatory care pathway. I look forward to hearing from the Minister the Government’s plans for doing that.
Helen Morgan (North Shropshire) (LD)
It is a pleasure to serve under your chairmanship, Mr Stringer. I am grateful to my hon. Friend the Member for Bath (Wera Hobhouse) for securing the debate. On 25 May this year, the nursing director of the West Midlands Ambulance Service, Mark Docherty, said that the ambulance trust would face a “Titanic moment” and collapse entirely this summer. He gave the specific date of 17 August. Mark went on to say that patients were “dying every day” from avoidable causes created by ambulance delays. That was 42 days ago. He predicts that we now have another 42 days before the ambulance service in my community collapses.
I have had an Adjournment debate with the Minister on that subject, and a meeting with the former Secretary of State for Health, the right hon. Member for Bromsgrove (Sajid Javid), yet this Government still have not got a grip on the problem. As a proud resident of North Shropshire, I was aware of our ambulance crisis before I was elected in December, and before I started campaigning in November. However, on the campaign trail, and since being elected, it has become evident that the scale of the crisis is absolutely shocking.
Just last week, I was contacted by a constituent whose 85-year-old mother, who suffers from dementia, had fallen and suffered a suspected broken hip. Her son called the ambulance, but she sat in agonising pain in their living room for 18 hours before the ambulance arrived at her home. Everyone in this Chamber will agree that this should not be happening in this country, or in this century. It is one of many stories I have received. Many other people are attended by the ambulance crew in fairly reasonable time, but then wait 12 or 13 hours in the ambulance before being transferred into the hospital.
The focus of this debate should be on solutions to the problem, but it is also crucial to understand how we got here. Ambulance service delays are a symptom of wider issues plaguing the NHS and health services across the country, and the issue of staff shortages is critical to that, as colleagues have alluded to today. So far, the Government have failed to address that. They have thrown our hard-working doctors and nurses pretty much under the bus. We are short of nurses, carers, GPs and decision-making doctors in A&E. In February, the all-party parliamentary group for rural health and care published a report concluding that the 10 million people who live in rural and coastal areas in the UK deserve better healthcare outcomes. Colleagues here representing rural constituencies know from first-hand accounts that it is not just access to healthcare that is compromised but, in the words of the APPG report,
“the very determinants of health itself.”
That is why our ambulance crisis is even worse than in some of Britain’s more urban areas. Worse still, it is hidden by the published data. West Midlands Ambulance Service reports some of the better response times in the country, but a decent outcome in Birmingham and the black country conurbation is masking a deep crisis in the countryside.
How are the hard-working professionals in our NHS to deal with another significant rise in covid admissions? They are struggling to deal with the broken social care service, a hospital bed crisis and people who cannot access a GP and so are turning up at A&E. I know those professionals have the best will in the world, but they simply cannot deal with that. That is why Shrewsbury and Telford Hospital NHS Trust has declared yet another critical incident this week. I have lost count of the number of times that has happened this year—I think it is the fourth or fifth—but a summer incident is unprecedented. The winter is coming at us fast, and now we need to understand what we can do to fix the problem.
We know there is no quick fix, but one thing the Government could do now to understand the problems and come up with effective recommendations is commission the Care Quality Commission to investigate delays in the ambulance service and their underlying causes. In my Adjournment debate before easter, the Minister said it was open for me, or others, to raise that with the CQC. However, they have subsequently written to my hon. Friend the Member for St Albans (Daisy Cooper)—the Liberal Democrat health spokesperson—to confirm that that is not the case. It is clear that while the Health Secretary has the power to commission the CQC, unfortunately I do not. Crucially, Mark Docherty, the nursing director of West Midlands Ambulance Service, has also called for the CQC to investigate the issue. I would like to take this opportunity to urge the newly appointed Health Secretary to commission the CQC to conduct an investigation to identify the measurable actions we need to take to resolve the issues that we face across the country.
The Government could also adopt the recommendations of my hon. Friend the Member for St Albans by commissioning ambulance waiting times by postcode, so that we can direct the resource where it is needed and not just over large regions. They could also act on the recommendations of the APPG’s February report to deal with the health inequalities faced by the one fifth of our population who live living in rural or coastal communities. There are positive steps that can be taken to fix this crisis. I would like the Minister to say exactly what is going to happen now.
Jack Brereton (Stoke-on-Trent South) (Con)
I start by thanking all our NHS and care workers, who do an incredible job every day in dealing with the huge pressures on our local health services.
As I have said on a number of occasions, we are seeing significant challenges in north Staffordshire with ambulance delays and demand at the Royal Stoke A&E. Many of my constituents have contacted me after waiting for many hours for an ambulance. I have had to intervene on more than one occasion to get West Midlands Ambulance Service to respond to patients who have waited for 12 hours or more.
It is totally unacceptable for elderly and vulnerable people to be left to suffer without the emergency response that they need. Ambulances are now frequently queuing up outside the Royal Stoke A&E due to the lack of space to admit people. Our experience is similar to that of many other Members, with occupancy levels in the Royal Stoke hospital at over 90% much of the time. Despite the efforts to increase flow through the hospital, we still see too many patients fit for discharge not being able to be discharged, due to the lack of social care beds or not having care packages in place.
The availability of social care places across Staffordshire has continued to be significantly affected by covid, with homes locked down to new admissions, and a number of places have been lost due to quality and staffing issues. Our health and care services are still being impacted by the effects of the pandemic, and work to recover them from the pandemic is ongoing. What is clear is that these pressures cannot be sustained and that the situation must improve, but there are multiple causes that cannot simply be fixed overnight. Many of the pressures in the local health care system predate the pandemic. These relate to the period when the new private finance initiative hospital was built by the last Labour Government. That hospital has fewer beds and faces more demand following the Stafford Hospital scandal—also under Labour’s watch—as well as the amalgamation of Staffordshire Ambulance Service into West Midlands Ambulance Service.
We must address some of these deep-seated challenges. I commend the Government’s work to invest £36 billion in our NHS and care services, which are record levels of Government investment. However, this is not just about more money. We will not put our health and care services on a sustainable path by just pumping in more money. We must also use the opportunity that this investment provides to fix some of the wider systemic problems.
One of my constituents who is a student paramedic contacted me this week. He described the huge overcrowding at the Royal Stoke A&E and on occasions having to spend his whole 12-hour shift with frail, elderly and vulnerable patients just waiting outside A&E to be admitted. He hits the nail on the head when he said that many are turning to A&E and calling ambulances due to failures to properly manage their conditions in the community, with the challenges of accessing primary care. Accessing primary care and GP services are all too common problems, with people needing to resort to far more costly acute and secondary care.
I do not doubt that many working in primary care are equally overloaded and are doing their best to support patients, but primary care services need to be prioritised more. Access to primary care in our communities needs to be improved, as this is the route to greater prevention and earlier intervention to reduce some of the demands on the wider healthcare system. I very much support the improvements that the Government are making through the Health and Care Act 2022, which will help to better integrate healthcare services with integrated healthcare systems, which went live from the start of this month. I hope that the key focus of our ICS in Stoke-on-Trent and Staffordshire will be on better integrating primary, secondary and social care, so that we develop a more patient-focused service. That requires all healthcare partners, and partners more broadly, to work together. We must see greater collaboration to help to address some of these challenges.
Key to reducing demand will be greater prevention and early intervention, whether in physical or mental health. This will also very much rely on communities and the charitable third sector, which have much to give when it comes to prevention of illness and improving quality of life. Pharmacies can also do more, and I was pleased to attend the event in Parliament just down the corridor from here yesterday to support pharmacies. As the Minister knows, I have also raised before the keenness of Staffordshire Fire and Rescue Service to do more to help West Midlands Ambulance Service out. It has first-aid trained professionals; indeed, those professionals are already responding to more minor emergencies in some parts of the country when demand on the ambulance service is high.
For north Staffordshire, it is also particularly vital that we see the delivery of the four proposed integrated care hubs, especially the one in Longton in my constituency, completing the second phase of the new Longton primary care centre. These will bring together healthcare services and significantly improve access to NHS and care services right at the centre of the community. We have been talking about those improvements and going through consultation after consultation for far too long. We need to get on and deliver them. I very much hope the new community diagnostic hub will also be located on the site in Longton in a new, purpose-built facility.
Overall, what is most important is that we continue to support the NHS and care workforce and ensure the necessary investment that the Government have committed so that we see more of those doctors and nurses directed straight on to the frontline. I will continue to support our local NHS system in Stoke-on-Trent and Staffordshire.
Rachael Maskell (York Central) (Lab/Co-op)
It is a pleasure to see you in the Chair, Mr Stringer. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this debate, which we all, across the House, recognise is needed, as are the solutions.
The issues in York are no different from those that I have heard about today from Members of all parties. We know the diagnosis of what is wrong: we do not have the staffing or the capacity and our hospitals are running hot the whole time. In York, we have been in OPEL 4—that is the operational pressures escalation level—for a considerable amount of time. We are all wrestling with sufficiency in the ambulance service.
The statistics I have heard this morning map on to many of the statistics in York. In May, handover took more than an hour in 752 cases—24.6% of arrivals—and then there are the trolley waits for hours on end. The mean waiting time for non-admitted patients was four hours and 18 minutes in A&E, while for admissions it was nine hours and 22 minutes. There are then the challenges on the wards as patients progress through their journey. We know that there are challenges across the system, but receiving timely emergency care is the most important thing and what we are focusing on today.
Before proposing a couple of solutions to the Minister, I want to reflect on the impact that this situation is having on staffing. We have heard about the need for a workforce plan, which is crucial, but retaining staff is important too. Many people are leaving because the pressures are bearing too heavily on them. Working long hours is one thing—it is almost a social contract that people have to acknowledge, wrongly, I say, as part of working in the service, in either an emergency department or an ambulance service—but on top of that there is the trauma that people face. We cannot describe the impact that has on individuals.
What hurts the most is hearing the radio and knowing that there is another call, another person, another life that could be saved, but being tied down and unable to reach that call, or turning up incredibly late to see a patient, knowing that the life chances of that person in your hands have been changed because of the minutes or even hours of delay. Those are the pressures that bear down on our incredible NHS staff, making the job intolerable and eventually breaking them.
We have to look specifically at what we are doing for staff so that they can carry on with their jobs. Some 69% of emergency responders said that their mental health deteriorated during the pandemic, while just 26% described their mental health as good or very good. We know about the impact this situation is having on people day in, day out, while working those long hours. It is unsustainable. We are seeing that in the retention rates. My plea to the Minister is to introduce a good mental health support programme for staff to maintain that sufficiency. That means fixing the system as well; we cannot have one without the other.
I want to pick up on something I am very mindful of, having spent time talking to paramedics. A constituent contacted me about the poor mental health of their patients, its increased acuity and the impact of that on the service. I have met a group of campaigners who are calling for a specific mental health service with a specific phone number—instead of people having to call 999 or 111—through which people can be triaged by mental health experts and put in the right place in the service. It is about building a proper acute mental health service around people, because A&E may not be the right place for them, yet where else can we take them? It is important not only to look at the whole clinical pathway for people in crisis but to ensure that paramedics can focus on and spend their time on people with acute physical illness. I would like the Minister to reflect on the opportunity that that could bring.
In the short amount of time I have left, I want to touch on an issue in Germany, where they are doing medical thrombectomies in ambulances at the side of the road, as opposed to losing precious time taking people to A&E departments. We can do a lot more to reformulate the way our acute services work to take medicine to the patient, as opposed to taking the patient to hospital. [Interruption.] The Minister is nodding, so I will stop there but I look forward to his response.
Jerome Mayhew (Broadland) (Con)
I congratulate the hon. Member for Bath (Wera Hobhouse) on securing a debate that, as a number of speakers have said, affects politicians of whatever party right across the country. I am lucky enough to represent a Norfolk seat, so my Broadland constituency is served by the Norfolk and Norwich University Hospital and, to a slightly lesser extent, by the James Paget Hospital and the Queen Elizabeth Hospital. All three have been mentioned in the debate.
The problems for ambulance waiting times are multifaceted and have been well rehearsed by other speakers, so I will not go through them all. I will focus on one area: hospital handover delays. The national standard is that handover should take no longer than 15 minutes, but 60% of all handovers nationally fail to meet that standard. I will focus on the Norfolk and Norwich, the most recent statistics for which show that in June the average handover time was not 15 minutes or less, but 57 minutes—almost an hour.
When we look at ambulance times, we think it is surely the front door of the hospital that is the problem—getting people into A&E—but when I spoke to the leadership of the Norfolk and Norwich, they told me that it is overwhelmingly the back door that is the problem, by which I mean people leaving the hospital. People are medically fit to be discharged but there are not appropriate intermediate care spaces for them to be discharged into, or their care packages have not been agreed or put in place. We should focus on that more than any of the other important aspects.
If we look at the data, we see that in April this year, across the nation, 20,155 people who were medically fit for discharge were still retained in hospital beds. During the covid pandemic I learned that we have around 100,000 beds in the NHS. More than 20,000 of them are bed-blocked—a deeply unfair term because it implies that the people in the beds are refusing to leave when, of course, nothing could be further from the truth—which means that fully a fifth of hospital beds are out of use for no medical reason. That is crucial to solving this problem. How many extra hospitals that we are building is equivalent to those 20,000 beds? It is an enormous change.
We need to look at why medically fit patients are not being discharged. In my submission, a key reason is the disparity of funding and where funding comes from in respect of the move from NHS beds to care. Everyone in this room knows that one provision is funded by the NHS and the other by county councils. There is often an unedifying dispute about who should pick up the bill and how to transfer responsibility for a patient, so there is no such thing as continuity of care in the discharge process.
If we can do one thing radically to improve not only ambulance times but the service that is provided in our hospitals more generally, as well as act on the burnout that hon. Members have described—the pressures on staff and the number of staff required—it is to solve the problem of continuity of care between the back door of the hospital and the front door of intermediate care and care in the community.
My question to the Minister is: am I wrong in that basic analysis? If I am, perhaps he will tell me where I have gone wrong. If I am right, or even substantially right, I would be grateful if he set out his views on how we could take the bold step from siloed funding and responsibility between the NHS and secondary care to the transition to what we desperately need, which is continuity of care for the patient, thereby solving all the other problems we are discussing today.
Mike Amesbury (Weaver Vale) (Lab)
It is a pleasure to serve under your chairmanship once again, Mr Stringer. Like everybody else, I thank the hon. Member for Bath (Wera Hobhouse) for her insightful contribution to the debate, which is giving us the opportunity to speak as we celebrate this very week the 74th birthday of the NHS.
The NHS was founded by a Labour Government to provide healthcare for all, free at the point of delivery, and it has been a life saver and a life changer—a marvel to this day throughout the world. Another Labour Government in 2010, which is some time ago now, left the NHS with the lowest waiting lists on record, reduced waiting times and the highest satisfaction rating in history.
What have we got now, 12 years later, in the dying days or dying weeks of this Conservative Government? We have an NHS and a care system cut back to the bone—well before covid, which has been referred to. That has left, in particular, elderly and disabled people without the care they have needed. That has been reflected in today’s debate, from all sides of the House.
We have a workforce crisis that has left the NHS with a shortage of 94,000 staff. There is a lack of beds caused by about 400,000 patients a month being unable to leave hospital because of care shortages, which have been acknowledged and debated here today. The social care precept, which the Minister might refer to, is nowhere near sufficient. He would probably agree with that, if he decided to leave his post in the not-too-distant future. That is a decision for him to make.
Nye Bevan will be turning in his grave at this crisis, which is perhaps most apparent when we look at emergency care provision. As is the case in the rest of the country, the North West Ambulance Service NHS Trust is missing ambulance response targets by a country mile. For the most serious cases, in which there is an imminent risk to life, average response times are almost two minutes over target.
Category 2 cases are not the highest category of emergency response, but they include people who are having a stroke or a heart attack, or who are suffering from major burns or sepsis. Such cases should be responded to in 18 minutes on average, and 90% of calls should be responded to within 40 minutes, but last year, the service took, on average, 48 minutes to respond to a category 2 call, and responded to 90% of incidents within an hour and 45 minutes. That is 150% longer than it should have taken, and 10 minutes more than the national average.
It is so obvious that it should not need pointing out, but when it comes to strokes and heart attacks, every minute counts. The difference between 18 minutes and 48 minutes absolutely can mean the difference between life and death.
For cases considered less serious than the two higher categories—but still urgent—the targets state that 90% of the time ambulances should arrive within two hours. Instead, in the north-west, nine out of 10 times people can expect to see an ambulance within seven hours and 15 minutes. It is not hard to imagine how, within seven hours, an urgent case can become incredibly serious.
Non-urgent cases fair even worse. In the north-west the 90% target is missed by seven hours, meaning that some people who still need hospital treatment will be waiting 10 hours to get help. Just last year one of my constituents, Jim Rotherham, who is a veteran and 89 years of age, fell at home and broke his hip. He waited seven hours on the floor in utter agony for an ambulance. While that complaint was still live, weeks later, Jim fell again and had yet another long wait. It is simply not good enough, and I know that feeling will be shared across the House.
I am hugely grateful to everyone in my constituency, and indeed across the region, who works as a call handler, paramedic, doctor or nurse. They are working tirelessly, under pressure, but not with the resources they need, either for their own health and safety or for the health and safety of those they serve. They are being put in an impossible situation, they do not have the resources they need and the Government simply are not governing at the moment.
Some 40% of patients in my constituency covered by the Mid Cheshire Hospitals NHS Foundation Trust now face a wait greater than four hours to be seen in A&E, as do 30% covered by the Warrington and Halton Hospitals NHS Trust. A Halton resident, Josh, told me that it is impossible to see a doctor. That situation pushes people to urgent care centres, which he tried. He was told that he could not be seen by urgent care because there was not a doctor. He went along to A&E, but he could not be seen by A&E. The situation is putting pressure on beds, more pressure on ambulances, and really is risking lives.
Two days ago, the Warrington and Halton trust alerted the public to the fact that Warrington A&E was exceptionally busy and asked people to keep the service clear for the critically injured or sick. It is a story we have heard from many Members today and that we see in the media every single day.
On the 74th anniversary of the introduction of the NHS, let us hear it from the Government—let us hear it from the Minister, while he is still in his place: how are they going to relentlessly bring those waiting times down? How will they ensure that we have sufficient GPs trained, and staff training to support GP practices? After 12 years of the Conservatives in power, we need a national care service that is properly resourced.
Margaret Greenwood (Wirral West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this important debate and on her speech. The Royal College of Emergency Medicine put out a press release today saying that their new survey found that:
“Two-thirds of A&E clinical leads…are not at all confident that their organisation will cope this winter”.
Its president, Dr Katherine Henderson, said:
“This is the height of summer and yet we are seeing a state of affairs that we’d be dismayed by even in the depths of winter.”
In the north-west, the average ambulance response time for a category 1 call was eight minutes in May—better than the national average, but still a minute above the average response time target of seven minutes. The average response time for a category 2 call was around 34 minutes—again, better than the national average, but well over the target of 18 minutes. We all know that, in an emergency, every minute counts.
We all want to be confident that a well-resourced ambulance service is there should we need it, along with a properly staffed and resourced A&E department. We are aware, too, that the ambulance services and A&E are under immense pressure—because of covid, but also because of staff shortages in the NHS. There are shortages in hospitals, making it more challenging to transfer patients to hospital beds in a timely manner, and in general practice, meaning that people are going to A&E out of frustration at their inability to secure a GP appointment. Of course, that all impacts on patients, sometimes with devastating consequences for them and their families. I want to highlight the tragic case of Sheila, the 72-year-old mother of my constituent, Shirley. I thank Shirley for sharing this information with us. Sheila suffered a heart attack and passed away at home on 1 December 2021. When she began gasping for breath two days after she had been diagnosed with a chest infection, her son called 999. There were two points of failure within the service. First, the ambulance did not arrive within the target time for a category 2 call. Secondly, when Sheila’s son rang 999 for a second time, the call was kept in category 2, instead of being moved to category 1 by the emergency medical dispatcher who took the call, despite the fact that Sheila had asthma and could be heard in the background saying that she could not breathe. Tragically, 106 minutes after the first 999 call and 79 minutes after the second, Sheila’s son made a third call to explain that his mother had passed away approximately 40 minutes earlier.
The findings of the serious incident investigation lay bare some of the pressures on ambulance services. It found that the main contributory factors of the delay while the call remained category 2 were the ambulance trust’s capacity not meeting demand, and the effect that hospital turnaround delays had on its ability to respond to patients. The investigation also pointed out that, even with 100% funded operational staffing, the trust had not been able to meet targets.
The investigation into Sheila’s case also raised the issue of the training of those taking the calls, who are known as emergency medical dispatchers. As I mentioned, the emergency medical dispatcher taking the second call missed hearing Sheila say that she could not breathe, so did not change her case to category 1, which would have resulted in an ambulance being dispatched more quickly. The investigation reported that the emergency medical dispatcher noted that the call was taken not long after she had finished her mentoring, and she was still unsure about ineffective breathing. She also advised that at the time of the call she felt that there were mixed messages from supervisors and other staff on ineffective breathing, and that it was not very clear, hence she misjudged the call.
That raises important questions about the training that emergency medical dispatchers receive. Are they getting the right kind of training? Is it being delivered in a way that allows them to express themselves if they are not sure about something? Do they receive sufficient support in the workplace? They carry out an incredibly important role, which doubtless can be extremely difficult, and comes with enormous responsibility. My constituent Shirley said:
“We did not blame the paramedics or the centre staff, but understand how short staffed and underfunded the service was, and how much strain the service was under.”
I hope the Minister will respond to the issues raised in this debate with care and a commitment to improve the situation rapidly. The Government must do their first duty—namely, to keep their citizens safe. Right now, as they fail to tackle ambulance and A&E waiting times and NHS staff shortages, they are failing badly.
Kate Osborne (Jarrow) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for Bath (Wera Hobhouse) for securing the debate.
In the north-east, as across the UK, our healthcare system is in crisis. We have an NHS staffing crisis and a lack of GPs, millions waiting for routine operations, a loss of hospital beds, and direct cuts to mental health services funding. The Health and Care Act 2022, which came into force this month, fails to address the serious challenges facing the NHS and public health and social care, and will likely make all the problems worse as local boards will make decisions based on financial constraints, rather than patient health.
The North East Ambulance Service claims to be one of the best performing in the UK on ambulance waiting times, but that ignores the unacceptable waiting times that individuals face even in the most serious cases. Ten per cent. of people who had emergencies such as strokes or serious chest pain were left waiting for 40 minutes—more than double the target wait time—and some waited for more than 90 minutes. Shockingly, 10% of individuals with urgent conditions who needed treatment and transfer to hospital waited more than three hours, and some waited as long as five hours.
Disgracefully, just a few weeks ago, reports emerged of a cover-up in the North East Ambulance Service regarding patient safety and possible deaths. There were allegations that the service withheld details from coroners in more than 90 cases between 2018 and 2019. My constituency of Jarrow is covered by the North East Ambulance Service, and such reports are obviously very concerning.
NHS England is now investigating the tragic failings of NEAS, but it is clear for everyone to see that our NHS is at crisis point. That is not the fault of individual staff members who do their best to cope with an under-resourced and understaffed NHS; nor is it just the impact of the pandemic. For too long our NHS has been pushed to the brink by the Tories. We entered the pandemic with the longest financial squeeze in NHS history, with thousands waiting longer for cancer treatment and the A&E target not met for six years. A&E waiting times are at an all-time high with 30% of people waiting more than four hours in A&E. Those waiting times have become progressively worse over the last decade.
The South Tyneside and Sunderland trust in my constituency has 39% of people waiting longer than four hours to be seen. Our emergency services are there for us in times of crisis, making life and death decisions in an instant and providing care and comfort to us at our moment of need. They need our support and they need the Government to start investing directly in our NHS. I want to put on the record my thanks for the great work that the Save South Tyneside Hospital campaign is doing in its campaign for the future of South Tyneside Hospital and its acute and emergency services.
Instead of investing in our NHS and staff, the Government insist that staff take a real-terms pay cut and attack staff sick pay, at the same time privatising as much as they can get their grubby little hands on. Our NHS cannot sustain the current level of attacks from this Government. Inevitably, both staff and patients will suffer. It is a disgrace that the Government are attacking the workers who have kept us going through covid—the workers who put themselves at risk every day and who go to work to protect us, who are called heroes one minute and vilified the next.
More and more is being outsourced to private companies using a false narrative of bringing down waiting times. The more the private sector becomes involved, the worse the situation becomes as capacity in the NHS is reduced and private companies cherry-pick easy and lucrative cases. All of that has the devastating consequence of forcing more and more people in pain and desperation to take out loans and crowdfund on the internet to pay for an operation because the wait is too much for them to bear. A two-tier health system is being privatised by the back door.
It was the NHS’s 74th birthday yesterday. Nye Bevan said:
“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.”
If we want to make sure that future generations do not have to pay when they are ill, we must urgently ensure that our NHS is funded, and that all the parts that have been privatised are brought back in-house.
Karin Smyth (Bristol South) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer, and to listen to this very well-informed debate. I commend the hon. Member for Bath (Wera Hobhouse) on securing it and on highlighting this important issue. We share boundaries across the south-west. I also thank the Minister for staying in the Chamber for the entire debate. He is now free to use his time. We will all be with him.
We know that under this Government record numbers of people are waiting for care, and they are waiting longer than ever before. Waiting times for ambulance and emergency department care are a symptom, as we have heard this morning, of the problems across the entire health and social care system. A record six million people are waiting for NHS treatment. There is a shortage of 100,000 staff and 17,000 fewer beds. That is not due to the pandemic, but deliberate underfunding of the NHS by a government who themselves admit—as the Culture Secretary recently did—that a decade of Conservative mismanagement had left our NHS “wanting and inadequate” even before covid hit.
I welcome the hon. Member for Tiverton and Honiton (Richard Foord) to his place and commend him on the points that he made. As we all know, on the doorstep, waiting times matter to constituents—a point that he made eloquently.
Waiting times for emergency care are nothing short of shocking. Like many Members of Parliament, I hear that every day from constituents. It is very distressing—and dangerous. There are cases of people waiting in agony outside the emergency department in an ambulance for over four hours, and waiting in the road for an ambulance for more than five hours. The average response time for an ambulance call-out for a stroke or suspected heart attack is 51 minutes and 22 seconds. The target, introduced by the last Labour Government, is 18 minutes. In May 2022, more than 19,000 patients were reported by NHS England as having spent more than 12 hours from the decision to admit to their admission to hospital. That really is a damning indictment. This winter, 89.8% more ambulances than the previous year were subject to delays of more than 30 minutes or more. My hon. Friend the Member for Jarrow (Kate Osborne) told us of the shocking incidents in the North East Ambulance Service and the investigation.
I could go on. What I am really interested in is the solution to this appalling state of affairs, as many hon. Members have said this morning. In fact, many hon. Members, particularly those on the Government side, have written my speech for me. Our highly skilled emergency department staff and paramedics show incredible courage and quick thinking on a daily basis. They need our support and they need a proper workforce plan that addresses shortages not only in emergency care but across the whole NHS.
Alarmingly, the Government’s manifesto commitment to improve waiting times for emergency departments was downgraded in the mandate from the Department of Health and Social Care to the NHS. The aim is now to improve performance “as conditions allow”. Under this Government, that will be never.
The hon. Member for North Shropshire (Helen Morgan) raised the case of the West Midlands Ambulance Service predicting a date on which it felt it would not be able to cope. This is not just about funding; it is also about the incoherent policies that leave patients and the public perplexed—a point that was touched on by the hon. Member for North Norfolk (Duncan Baker). Most urgent care takes place outside hospitals, but the complex mix of 111, GP out-of-hours, minor injuries units, walk-in centres, urgent care centres, as well as the plethora of online advice, is part of the chaos of fragmentation caused mostly by the now-discredited fetish for outsourcing and competition.
Currently, as we heard from the hon. Member for Waveney (Peter Aldous), schemes such as HALOs—hospital ambulance liaison officers—are just a sticking plaster. If we look at this as an A&E problem or just an acute hospital problem and do not incentivise all the ambulance services and primary care bits of the system to work together, we will not address the demand, which is a point made by the hon. Member for Broadland (Jerome Mayhew). The incentives, particularly after the Health and Social Care Act 2012, really do not help.
We need to make it simple for patients and their families to access the right care in the right place. That means supporting primary and community care, as well as ambulance services. As my hon. Friend the Member for York Central (Rachael Maskell) said, it is about bringing medical care to where people are and not expecting them to keep moving into the system.
Our highly skilled emergency teams must be free to manage all but the really serious acute cases referred to them, and then some of the problems would lessen, but the crux of the matter is that unless we improve discharges from hospital—as all hon. Members have said this morning—and ensure that our social care system is fit for purpose, we will not resolve the issue at the front of the hospital and we will not be helping patients. The pressures in leaving hospital has a direct impact on waiting times in emergency departments, and they put staff under pressure and patients in danger.
As my hon. Friend the Member for Weaver Vale (Mike Amesbury) said, the Government’s so-called fix for social care is not a fix at all. It is due to start in 2023. We need action now. We need to increase capacity in social care, improve pay and conditions for staff and ensure that we have a sustainable, working care system that will alleviate the pressures on the NHS, as well as support our constituents. There is no quick fix, but if the Government are serious about improving waiting times, they must look at the whole system.
We know the serious harm that waits and crowding in emergency departments have on patients and staff. Crowding is undignified and inhumane for patients who are left waiting for treatment in precarious circumstances. As well as impairing the efficiency of hospitals, it contributes to staff burnout, morale injury and the loss of emergency care professionals. It is associated with increased mortality and increased length of hospital stay.
Last year, the Royal College of Emergency Medicine estimated that crowding was potentially associated with more than 4,500 excess deaths. My hon. Friend the Member for Wirral West (Margaret Greenwood) noted the Royal College’s point that we are in the summer. This is not the critical time. We will go into another winter—winter follows summer every year, but it seems to be a shock to the Government. This is a very serious problem.
To prevent delays, I would welcome the Minister’s commitment to primary and community care and to supporting the timely discharge of patients when their hospital care is complete. Does he agree that there is an urgent need to support the social care workforce to ensure that it can offer the provision that meets the needs of our growing and ageing population? Will the Minister commit to the safe staffing of our emergency departments?
Graham Stringer (in the Chair)
Before I call the Minister, I ask that he leaves two minutes at the end for the proposer of the debate to wind up. I call Edward Argar.
The Minister for Health (Edward Argar)
I am happy to do so, Mr Stringer.
It is a pleasure to be here on the Front Bench responding to this very important debate. If I am still in this role on Sunday, I think I will be the third longest-serving Minister for Health since 1970, which says something about either longevity or churn in this role. It is a genuine pleasure to respond to the hon. Member for Bath (Wera Hobhouse), and I congratulate her on securing this debate.
As hon. Members across the House have acknowledged, the NHS has faced extraordinary pressures over the course of the pandemic and continues to face them. Although I suspect that not everything I say will meet with agreement from Members from both sides of the House, I join them in expressing our gratitude to all those who work not just in our NHS and health services but in social care.
I will start with a couple of words of caution about the use of history and statistics. Hon. Members made a number of points. I have been doing this job for almost three years, and I have often found that assertions are made with statistics or other facts from the history of the NHS, and I want to provide a counter-narrative to three or four before turning to the specifics of the hon. Lady’s debate.
First, I urge a little caution from Opposition Members when raising bed closures, not least because between 1997 and 2007, about 32,000 beds in the NHS were closed, which is more than double the number that were closed between 2010 and now. I say that simply to caution hon. Members that statistics can be used in different ways. There has been a long-term trend under Governments of both parties as the nature of care has changed.
Edward Argar
I just want to make a few more points, and then of course I will give way to the shadow Minister. She and I spent many happy hours in the Health and Care Bill Committee over many days.
On engagement with the private sector, again I would urge a little caution. It was of course the Labour Government in 2004 who first introduced the private sector into the provision of frontline clinical services with the out-of-hours contract. A Nuffield Trust blog in 2019 highlighted the fact that the increase in the use of the private sector in the NHS began before 2010 under that Government. I do not think the hon. Member for Jarrow (Kate Osborne) was asserting anything other than that, but it is important that I put that on the record.
Of course resources are hugely important. One of the first pieces of legislation that we introduced following the 2019 general election was the NHS Funding Act 2020, which will increase funding by £33.9 billion—a record amount—by 2023-24. As the hon. Member for Weaver Vale (Mike Amesbury) would expect me to say, we introduced the health and care levy to bring more funding into our NHS and social care. It was disappointing that Opposition Members voted against additional funding for the NHS when that was put to a vote.
Karin Smyth
The Minister talks about the bed reduction, but that was in the context of massively increasing primary and community care, and the private sector capacity was brought in to reverse the horrendous waiting lists following 18 years of Conservative government. We decided to govern. The point that hon. Members are making is: why does the Minister not govern?
Edward Argar
That is exactly what we are doing: we are leading and putting forward measures. Disappointingly, Labour voted against that extra funding.
Edward Argar
I just want to finish this point, but I will give way to the hon. Lady because it is her debate.
My hon. Friend the Member for Broadland (Jerome Mayhew) and others are right in their analysis that this is about patient flows. It is about a whole-system approach and the challenges across the system. My hon. Friend asked what the solution is to making the join-up work better. A key element of the solution is the new integrated care boards and integrated care systems, which genuinely seek to bridge the gap between two parts of the system, to which the hon. Member for Bath—health and social care. They both have, for want of a better way of putting it, different DNA. The NHS, since the legislation in 1946 and its implementation in 1948, has been essentially a vertical system, whereas we have retained local care by local councils on a social care level. This is an attempt to integrate them far more effectively.
Wera Hobhouse
It is not very helpful that we are entering into a party political ding-dong. There is a crisis, and we owe it to our constituents to face it. We are asking the Government, who are in charge, to do something about it.
Edward Argar
I am grateful to the hon. Lady, but when hon. Members raise party political points, it is incumbent on me as Minister to respond and to put the facts on the record. I will turn to the specific points she has raised. I will also turn, in that context, to the various points that she and the hon. Member for North Shropshire (Helen Morgan) made about various tangible suggestions from the Liberals on the issue.
The hon. Member for Bath is right to have secured and introduced the debate, because this issue is one of growing concern, understandably, and not just for all our constituents but for those who work on the frontline of our NHS. I think it was the hon. Member for Weaver Vale who highlighted the challenges faced by those staff, who want to be there and want to help. When someone rings for an ambulance, it is not a case of making an appointment with their GP; they are deeply concerned for their health, or the health of someone else, in an emergency. All those staff want to do—I have met many of them—is be there for those people, and the hon. Gentleman was right to highlight that issue.
As the hon. Member for Bath will be aware, the pandemic has caused significant strain across the NHS and the social care sector, and emergency care performance, as hon. Members have been open in acknowledging, is recognised as a whole-system issue. The challenges in performance can be traced along the entire patient pathway. Indeed, as I think the hon. Lady acknowledged in her Adjournment debate in the main Chamber on 31 March, although there are elements of that that we need to look at, we also need to look at the issue as a whole. She was right to say that.
For example, as hon. Members have said, the problems and delays in discharging patients home or to community services once they have recovered have a genuine impact on hospital bed occupancy—taking up beds that could otherwise be used by patients who need them. I want to give my hon. Friend the Member for Broadland a slightly more optimistic picture, which is in no way to diminish the challenge that remains. The number of beds taken up by people who are clinically fit to be discharged is not 20,000; it hovers at around 10,000. We have set up a national discharge taskforce, which is working actively with trusts and across local systems, particularly those that are most challenged, to support that discharge work. The situation is not as acute as he suggested, but it remains challenging because every one of those beds could be used to admit patients from an urgent and emergency care setting, or indeed to tackle elective backlogs and waiting lists.
Edward Argar
I would like to make a little progress before giving way again. I am conscious that I need to leave enough time for the hon. Member for Bath to respond.
That affects how quickly patients can be admitted from A&E, and such delays increase waiting times, as has been said, and lead to that crowding in departments, which has an impact on how quickly new patients arriving in A&E can be seen and treated, including those arriving by ambulance. When this causes ambulance queues to form, the local ambulance resource available to be dispatched to incoming 999 calls is reduced. It is fair to say that although the ambulance queues and delays are often the most visible manifestation of challenge, they are in many ways a symptom of that broader patient flow and the systemic challenge we face.
The root cause of these issues is hospital bed occupancy. That has consistently remained nationally at around 93%—a level usually seen only during winter pressures, as hon. Members have said. The pandemic has played a significant part in driving those pressures, and there are nearly 9,500 in-patients either with covid or for covid in clinical settings, as of 1 July. That is about 10% of all general and acute beds in the NHS.
Edward Argar
I will give way to the hon. Lady, but I want to make a little progress. There are points I want to make before I run out of time, but then I will give way.
That number, as we know, has frequently been higher during the pandemic, and there is the challenge of staff absences during waves.
Margaret Greenwood
The Minister will be aware that I have expressed extreme concern and tabled written questions about what happens to those people who are discharged under what was known as discharge to assess and their clinical outcomes. Will he commit to carrying out a review of the patient outcomes of all the patients discharged in that way, to see how many were readmitted to hospital within 30 days of discharge?
Edward Argar
I will not commit myself to what the hon. Lady specifically asks for because of the challenge of data collection, but I will say that I see where she is coming from and appreciate the underlying point, which is about understanding the impact of the policy. It has been in use since 2020 as a pandemic measure and is now in statute. The NHS will be monitoring it carefully. We do not agree on everything, but I am always happy to talk to her about these matters because she takes a close interest in them.
With regard to local actions in the patch covered by the hon. Member for Bath, as an illustration of the sorts of measures being put in place across the country, the local integrated care system is working to improve patient flow and reduce handover delays at acute trusts, including the Royal United Hospital in Bath. I join her in paying tribute to the work that her local team there are doing. That hospital is working well with community partners to help patients to return home as soon as they are well. That includes work with the hon. Lady’s local council to develop its domiciliary care provider, which will provide an additional 1,000 hours of domiciliary care a week. A £2 million investment will also be made in the Home First programme, whereby experts from across health and care help patients to get safely back home as soon as possible. The system is also working on opening an additional 20 beds at St Martin’s Community Hospital, while also developing same-day emergency care for frailty to avoid unnecessary admissions to hospital and to care for patients safely in the community.
There is of course nationally a wide range of support in place to improve urgent and emergency care more widely. That includes growing the number of call handlers for 999 and 111, and the investment that we have seen going into our ambulance services and A&Es. It is the case that £450 million of capital investment has already gone into increasing capacity in urgent and emergency care departments. In addition, we have kept, I think, over 155 more ambulances on the road over winter with our investment of £55 million more going into ambulance services. We are investing those resources in the frontline. If I recall my statistics correctly, there has been a 38% increase in the paramedic and ambulance workforce since 2010. The hon. Lady and her party can rightly claim a degree of credit for that, because a degree of that took place between 2010 and 2015. We do continue to grow the workforce.
Turning to workforce issues more broadly, it is absolutely right that, as well as providing the support to which the hon. Member for York Central (Rachael Maskell) alluded—mental health and physical support for the workforce—we continue to grow the workforce in order to ease the workload pressures. We have already witnessed over 30,000 more nurses in the NHS since that pledge was made in 2019. We continue to grow all workforces. In section 41 of the Health and Care Act 2022 we set out a very clear duty on the Secretary of State in relation to workforce planning, and that work is already under way.
I will turn to a couple of further points very briefly, because I want to give the hon. Member for Bath her two minutes at the end. She raised a number of specific points. She called for greater resources to be put in. That has been done. She called for an increase to be made in paramedics and ambulance staff. That has been and continues to be done. None of these are completed works, but they continue to be done. She called for action to stop ambulance station closures or community ambulance station closures. I have to say that those decisions are made clinically by local trusts; the power was not there for the Secretary of State to intervene. In fact, it was the Labour party that argued against giving the Secretary of State and Ministers the power to take action on those things when it voted against and spoke against that measure during the passage of the Health and Care Bill. It is right that clinicians determine what is the best set-up for clinical services in their area. I just gently make that point.
In summary, I think that both sides of the House recognise fully the challenges faced in these unprecedented times by our urgent and emergency care sector, and particularly by patients and those who work in the sector. We have a plan to fix it. We continue to invest in that plan and to support our workforce, and we will continue to do that for the benefit of patients.
Wera Hobhouse
I thank everybody who have taken part in today’s debate to highlight the deep crisis over ambulance and emergency care services. We owe it to all our constituents to ensure that the crisis is fixed, because it can be a matter of life and death. Last but not least, I want to thank the incredibly hard-working doctors, nurses, paramedics, ambulance drivers, reception staff and call handlers who work in our emergency care and ambulance services. They are doing an impossibly difficult job at a very difficult time. We cannot ignore the workforce crisis, and the stress and impact on the lives of the current workforce. We owe them our support here, and I want to assure all of them that all of us here will not go away until we see real progress and real improvement.
Question put and agreed to.
Resolved,
That this House has considered waiting times for ambulances and emergency department care.