Urgent and Emergency Care

Baroness Merron Excerpts

Tuesday 6th September 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, as the new Prime Minister is appointing her first Government, I am very glad to see the Minister in his place this evening. I have a sense of despair over the dire situation in the ambulance service that led to yet another Statement. However, I welcome the inclusion of the importance of vaccination and the funding for motor neurone disease. I also pay tribute to St John Ambulance and am pleased that it has now been formally commissioned. Could the Minister confirm that this extra capacity is being used by the system today?

The outgoing president of the Royal College of Emergency Medicine has said that ambulance delays have got so bad that the NHS is now “breaking its promise” that life-saving emergency care will be there when it is needed. The facts are that 29,000 patients waited more than 12 hours in A&E in June—more than ever before—and 10,000 urgent cases waited more than eight hours for an ambulance last month. But this is not just about life and death; it is about the distress and severe discomfort of those who are kept waiting. Analysis by the Financial Times estimates that the deteriorating state of emergency services could be costing 500 lives a week, so can the Minister give an estimate of the number of people the department believes have died unnecessarily because they have been stuck in an ambulance waiting to get into A&E, or because an ambulance has turned up late or not at all?

We have gone from no crisis in the system in 2010 to annual winter crises, and now to there being a crisis all year round. We hear that the NHS will tell patients to avoid A&E as the winter crisis bites early. Can the Minister tell your Lordships’ House when the winter crisis will now start? What is the forecast of how much worse excess deaths will be over this winter? What is the Minister’s response to the QualityWatch report’s assessment that the roots of record waiting lists and delays to ambulance services predate the pandemic?

Ambulance delays are directly related to one in seven hospital beds being occupied by patients medically fit to leave but who cannot be discharged because there is no social or community care to support them. To give but one example, there are reports today of an elderly man who, sadly, died last month in the back of an ambulance after waiting six hours to be admitted to Norfolk and Norwich University Hospital. The chief nurse at the hospital said that the man

“remained in the ambulance due to significant pressure on our emergency department and inpatient wards.”

However, at the same time, more than 200 patients in the hospital were medically fit to be discharged. Will this matter be considered in the investigation? How will situations such as this up and down the country be resolved?

How do the Government intend to ensure that we have the supporting social and community care workforce we so desperately need? Why is there continued resistance to workplace planning and reporting to this House?

Care workers, who are desperate for a decent wage, are being lost to the likes of Amazon. The Government’s answer has been to pull the “immigration lever” and to recruit people from overseas on lower wages. How will this be sustainable? What difference will it make in the long term?

The Statement mentioned the new mandate for Health Education England to train 3,000 paramedic graduates. What is the Government’s reasoning behind conversely capping the equally important number of medical graduate training places, which the Medical Schools Council has criticised?

We all know that the cost of living crisis is likely to be devastating. If people cannot afford to keep themselves warm, they are more susceptible to illness and infections. We know that 10,000 people a year already die as a result of cold homes, and that this could be far worse this year without action. Could the Minister say what the Government will do to address this? Have they assessed the impact of the cost of living, which continues to rise alarmingly, on health outcomes and well-being? Do they have a strategy to help people proactively?

What consideration has been taken of the fact that rising energy costs will push care providers to breaking point, with some homes facing closure, unable to absorb increases of 500% or more? What plans do the Government have to protect care home residents from finding that they have no home?

The reality of the ambulance services’ situation is that things are getting worse, not better. Can the Minister advise your Lordships’ House on what exactly the Government will do to reverse this trend?