NHS: Ambulance Response Times

Earl Howe Excerpts

Monday 21st July 2014 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the NHS is responding to the majority of emergency calls in less than eight minutes, despite the number of these calls having increased by almost 14% from 2011-12 to 2013-14. The NHS has been supported to ensure that urgent and emergency care services are sustainable all year round and are ready for the pressures that winter can bring. Some £18 million will be allocated directly to ambulance service commissioners with a further £10 million to ensure sustained high performance.

[Lord Kennedy of Southwark (Lab)]

My Lords, FOI disclosures indicate that, since 2010, seven out of 10 of England’s ambulance trusts have increased their spending on commercial and voluntary ambulances. In London, spending has grown from £829,000 in 2010 to £9.2 million in 2013. Does the noble Earl share the concern of the president of the College of Emergency Medicine, Dr Clifford Mann, who has said that this is an issue which is causing deep concern and is,

“incredibly wasteful and potentially dangerous”?

[Earl Howe]

My Lords, patients have the right to a high-quality urgent and emergency care service whenever they call upon it, and we expect ambulance trusts to provide that. We are aware that independent or voluntary ambulance services may be used to support NHS ambulance services because they can help manage peaks in demand. Individual NHS ambulance services have got to ensure that 999 calls are attended by staff who are properly trained and adequately equipped. Indeed, since 2011 the providers of independent ambulance services have had to register with the Care Quality Commission, which monitors, inspects and regulates all services.

[Baroness Gardner of Parkes (Con)]

My Lords, is it not a shame that London has only one air ambulance, which is run by a charity, when Sydney and Paris have six and four respectively? Does the Minister not think that it would be to the advantage of patients to have more air ambulances operating in London, because at least they can deal with any major traffic problems?

[Earl Howe]

My Lords, we owe a great deal to the air ambulance services across the country, all of which, I think I am right in saying, are organised as charities. However, it is the case that in every instance the NHS pays for the clinical staff on those ambulances while the charity pays for the helicopter and the pilot. That is the balance we have struck and successive Governments have taken the view that it is the most cost-effective model for the NHS. However, that is not to downplay the very important role that ambulances perform in our society.

[Baroness Hussein-Ece (LD)]

My Lords, will the Minister give an assurance that, when ambulances are called out for patients who are having prolonged epileptic seizures, there will be qualified paramedics in attendance and that we shall not go back to the situation we had of several tragic cases where paramedics were not in attendance and patients with prolonged epileptic seizures died before they got to hospital?

--- Later in debate ---

[Earl Howe]

My Lords, I am aware of a number of those tragic cases. It is, of course, up to each response team to decide on the configuration of personnel and the skill mix on each ambulance that goes out. That judgment often has to be taken quickly. Sometimes it is a difficult judgment and, tragically, it is not always the right judgment. However, I know that every ambulance service in the country is mindful of the need to reach patients in emergencies with the greatest possible speed and the right professional skills.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can the noble Earl confirm that the average waiting time for the most urgent 999 calls has lengthened in all parts of the country on average in the past three years? What are the Government doing to improve ambulance performance, and particularly could he comment on the very poor performance of the East of England Ambulance Service?

[Earl Howe]

The noble Lord is right. Ambulance trusts are experiencing high demand and we realise that a handful of services have experienced difficulty. Broadly, we are taking action in the short term and in the medium to long term. In the short term, we are supporting trusts with operational resilience plans so that they are better equipped to manage peaks in demand and we are providing clinical commissioning groups with additional funding, as I mentioned in my original Answer. Over the longer term, the NHS England review led by Sir Bruce Keogh is considering whole-system change, incorporating ambulance services.

With regard to the east of England, I met the East of England Ambulance Service NHS Trust’s chief executive, Dr Anthony Marsh, on 8 July to discuss performance since his appointment in January, and he assured me that the trust is now in recovery stage. Having seen his detailed proposals, I accept that judgment.

[Lord Mawhinney (Con)]

My Lords, in his original Answer, my noble friend said that a majority of ambulances arrived in less than eight minutes. That majority could be 99% or 51%. Will my noble friend tell your Lordships slightly more precisely what the percentage is?

[Earl Howe]

My noble friend makes an important point. The standard for arriving in the most urgent cases is that the ambulance should do so in 75% of cases or more. In recent months, performance across the country has been slightly below that standard.