North East Ambulance Service

Lord Beamish Excerpts

Wednesday 4th May 2016 Westminster Hall

[Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)]

I represent a very rural seat in north Northumberland, where, in January 2015, we had the tragic case of the entirely avoidable death of a young man because an ambulance did not get there in time. The Secretary of State instituted a national review on the back of that to look at the issues that triggered that tragedy. I am grateful for that, and we have made progress.

Some issues have come out of that, and the North East Ambulance Service should be commended. In my area, ambulances go to Northumbria hospital—our new emergency-only hospital. Some colleagues have already mentioned that we have been seeing the queuing of ambulances as they arrive at the various hospitals. I am not familiar with the wider north-east hospital framework, but at Northumbria it was quickly evident that that was a problem. To its credit, the North East Ambulance Service sent a paramedic to help in the triaging process, along with a specialist nurse who was diverted from other duties, to improve the process when the ambulances arrive—the hospital knows when they are going to turn up because they phone ahead—and to do a better job in ensuring that patients were removed from said ambulance and that the kit was returned to paramedics so that they could crack on with the next case.

That has been working well. We have seen a much speedier process, so I would commend that to colleagues, who could encourage other hospitals in the region to look at doing that. That has been an investment, but without doubt the cost-benefit not directly to the hospital but to the overall health package for our constituents has been hugely improved, because ambulances are back in the system. We were also then able to ensure that Northumberland-based ambulances were coming back up into Northumberland and not being taken to 999 calls elsewhere in the region, leaving paramedics working 14 or 15-hour days to get the ambulance back to Berwick or Alnwick. I commend the ambulance service for listening on the challenging problems we had and trying to make improvements.

At Northumbria hospital, the figures for urgent and emergency attendances read like this for the past three months: January had 12,911, which was a 12% increase on 2015; February had 13,731, which was a 30% increase on 2015; and March had 15,146, which was a 24% increase on 2015. However, only 24% of those cases needed emergency hospital admission. Something is broken. We are overloading our ambulance service with calls that demand an emergency ambulance, but, once at the hospital, only 24% needed emergency care.

My concern is twofold, and I ask the Minister to look at how we can make progress on this. First, the algorithm that the 111 and 999 systems demand that staff in the call centres use is dramatically risk-averse. I do not want anyone who is having a cardiac arrest to be told they have heartburn and not be sent an ambulance; quite the opposite should happen. However, a few years ago, the North East Ambulance Service built the lower-level 111 system and tested it before it was rolled out around the country.

[Mr Kevan Jones (North Durham) (Lab)]

I hear what the hon. Lady says, but is not the real problem that 111 was rushed in and relied on technology? When it originally started, we had trained paramedics in the call centres who could categorise cases. There is clear evidence, which I will present, that, if something is not deemed life-threatening or someone is not having difficulty breathing, the case is categorised as green. The figures produced are meaningless.

[Mrs Trevelyan]

I thank the hon. Gentleman for his comment. Quite a few of my constituents were among those experienced staff. Some were retired midwives or had worked as nurses and then moved into the call centre framework. There was a big shift a few years ago to downgrade the medical qualifications required for those staff. We are starting to see a change in that, because the new chief executive is mindful that the huge increase in demand is partly down to staff’s inability to assess cases correctly. If they took another 30 seconds, they could assess properly the situation on the end of the phone.

Will the Minister work with the people who are writing the algorithm and building the system to get it right? The ambulance service personnel would then have a better tool to work with. That would also encourage ambulance services, and not just our own in the north-east, to go back to higher-value trained personnel who can ask the right questions and get the right answers, so that we do not end up with over 70% of emergency calls ending in someone getting to hospital and finding that urgent care was not needed.

The other side of this issue, which I have been campaigning on with St John Ambulance, is the need to help families to be better educated so that they can assess their own medical conditions. Other than for cardiac arrests, strokes and such evidently dramatic changes, it is often not emergency care but urgent care that is required. We need to encourage people and build their confidence in assessing for themselves whether they should go to the pharmacy or the doctor or call for an emergency service. We need to do that across the board, focus on it and drive it forward.

St John Ambulance wants to get into every single school, so that we are teaching young children the difference between what to do if they burn their finger on the kettle—put it under the tap, instead of dialling 999—and what to do in an emergency, such as if granny falls down the stairs. The next generation would then have confidence in knowing the difference between when emergency care is needed and when they can manage and find the right care over a longer period.

Our paramedics will not be able to continue meeting the demand, much of which is inappropriately placed on the ambulance service. We should make much better use of our amazing paramedics and ensure that retention is higher, because they are valuable members of our community.

[Mr Kevan Jones (North Durham) (Lab)]

I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing this debate. In the past 18 months, I have heard about 12 quite serious cases. The ambulance service is in crisis, and that is not down to the men and women who work in it; it is down to the management. Urgent action is needed if we are to avoid people dying and prevent the suffering that my constituents are going through.

I will give a flavour of that suffering. In July 2014, in Chester-le-Street, a woman’s husband has severe angina. The first responder arrives and says he needs an ambulance. Three hours later, the ambulance arrives. A gentleman falls in Chester-le-Street from a six-foot fence and bangs his head. He is told to stay and wait for an ambulance. He waits two hours for an ambulance that does not arrive, so his neighbour takes him to hospital. A lady in Sacriston, which is about 10 minutes from the local hospital, has severe abdominal pains and is passed out, unconscious, waiting two hours for an ambulance to arrive. In Tanfield Lea, an 86-year-old lady has a fall at 9.30 pm on 13 February. Her partner is told by the ambulance crew not to move her. After several calls, the ambulance arrives on Saturday morning at quarter to 1. Apparently it had been diverted to Newcastle.

Patient transport is also an issue. One constituent, who had had a stroke and severe mobility problems, was waiting for patient transport to a medical appointment but was told that the ambulance would not attend. Another constituent from Stanley was transferred from his home to the Freeman hospital for regular dialysis. He had to wait two hours for transport back home, leaving him in severe discomfort. Another constituent who lives in Chester-le-Street found a young lady passed out outside her front door. She called an ambulance, and an hour and a half later, the ambulance arrived.

In New Kyo, a constituent complained that a young woman was having a fit in the local bus station. One hour and 10 minutes later, there was no response. She called the police, and they got the ambulance to arrive. Another constituent from Chester-le-Street needed to be transferred from Bishop Auckland hospital to the university hospital of North Durham. The request was made at 5 pm. She arrived in hospital at 1 am the following morning.

In Beamish, a lady fell down a flight of stairs and called an ambulance immediately. The first responder said she should not be moved. Two and a half hours later, an ambulance arrived. In March this year, an elderly lady in Sacriston—literally a 10-minute ride from the local hospital—waited an hour and 47 minutes in the cold north-east winter, being comforted by her neighbours with blankets, having broken her shoulder.

The last case I will touch on, which I have permission to mention, was raised with me by Mrs Irwin in east Stanley. Her 69-year-old mother-in-law, Joyce Irwin, had a fall on 14 March at 7.20 pm. Her son, who lives with her, came home and rang for an ambulance at 7.25 pm. He was advised by the controller that an ambulance would be there within the hour. Nothing happened. Her eldest son arrived and rang both 999 and 111. The first responder arrived at midnight, without any pain relief, and Joyce Irwin therefore had to wait until 1.10 am—four and a half hours later, having been on the floor in excruciating pain—for an ambulance to arrive. When she was finally delivered to the university hospital of North Durham, she found she had a broken hip. It is worth reading what Mrs Irwin says. She states clearly that her mother-in-law was in excruciating pain and was promised an ambulance that she did not receive. She says that Joyce has

“worked and paid her duties all of her life”.

Is that the way to treat our constituents in the 21st century? I suggest not.

There is something severely wrong with the North East Ambulance Service. I have a particular problem with the way in which it treats elderly people. My hon. Friend the Member for Washington and Sunderland West said that the service is missing its targets for red 1s and 2s, but fall cases such as those I mentioned are not even put down as red 1s and 2s; they are put down as greens. In many cases, these are elderly people who have broken bones and are in severe pain, but they are put down at the bottom of the queue. Will the Minister interrogate the hospital trust about the way it is prioritising cases?

I have been told anecdotally by a firefighter and a policeman that if someone wants an ambulance to arrive quickly, they should ring them up and say that a person either has chest pains or is unconscious. They will then get an ambulance straight away. In this day and age, it is not acceptable that our constituents—elderly, vulnerable people like Joyce Irwin, who have done the right thing all their lives—are treated like that. They have worked hard and paid into the system, and they expect in their old age that if they need the NHS in an emergency, it will deliver. It is not only the individual who is affected. The trauma also affects their families and loved ones, who, in Joyce Irwin’s case, saw her on the floor for four and a half hours in excruciating pain. That is simply not acceptable.

May I also ask the Minister to tackle the North East ambulance trust about its response to Members of Parliament, because it is absolutely diabolical at responding to Members’ complaints? I have had many complaints from people who have called an ambulance when they have seen an incident and they ask why the ambulance took so long. When I inquire, the ambulance trust responds, “We cannot discuss that case because of patient confidentiality,” because the complainant was not affected. That is complete rubbish. Those people do not want to know what happened to the individual; they just want to know why an ambulance did not turn up. It is interesting that we have got this debate today, because I recently had a flurry of answers to my questions, but I say to the Minister that there is a serious issue about how Members of Parliament can represent their constituents who complain to them.

I have a similar problem—if the Minister wants to intervene, that would be helpful—with the North Durham clinical commissioning group, which has failed to answer any complaints at all, so I have raised the matter with NHS England. There is something seriously wrong with the North East ambulance trust, although it is not down to the hard work of the individuals who work for it. They do a tremendous job in very difficult circumstances. There is also a question about the priority system that uses algorithms, as the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) suggested.

There is a question about rurality as ambulances are diverted to more urban areas rather than rural areas. I did not think I would say this, but it might be time to break up the North East Ambulance Service and put it into special measures. It covers a large area and is completely failing. Will the Minister look into whether it is fit for purpose in the long term? I do not think it is. Urgent action is needed. People are not only suffering, but they have lost faith in the service, which is a terrible thing. What should be a flagship service—North East Ambulance Service—that people call upon only in a time of need is clearly failing.

--- Later in debate ---

[Ian Lavery]

What I am saying is not meant to be any criticism of the people in the call centre, either—because if they veer from the crib sheet they have got, they are in trouble; but it shows how bad the whole situation is.

I want to mention Mr Taylor. I must say that he is a relative of my wife, who waited 11 and a half hours for an ambulance to arrive. He was really poorly. Plenty of people came from the NHS and said, “He needs an ambulance”—and then someone says “He doesn’t” and someone says “He does,” and someone else says “He doesn’t”. When he actually got the ambulance, at 1.45 in the morning, he was in a coma. That was seven months ago, and he is still lying in a coma as we speak. If that ambulance had turned up before, he might not be.

I will not dwell on that point other than to say that that brings me on to the complaints procedure, because MPs have complained, as well, about what happens to our constituents. We get a chronological list of what happened, and why the ambulances could not come, because they were diverted to other more serious incidents. That is not good enough. It is not good enough for me to say to one of my constituents, “Your mam couldn’t get an ambulance because somebody else was more important”—when she was lying suffering. Or if someone has a terminal disease and is desperate, or someone has a chest disease—it is not good enough; and the complaints procedure is not good enough. They are not treating people like human beings.

I have got lots to say and not a lot of time to say it, but I am going to reiterate the fact that these delays are utterly unacceptable and we cannot continue on this basis with the North East Ambulance Service operating as badly as it is. Someone mentioned that the service will be fully operational in 12 months. I have heard that before. It is not good enough for the people who will trip, fall and stumble. It is not good enough for elderly people, or young people playing football.

[Mr Kevan Jones]

My hon. Friend has obviously had the same letter from the North East trust that I have had; but does he agree, also, that it is not good enough because it is a question of our constituents’ confidence in the service? It should be a first world service, but it is more reminiscent of the third world.

[Ian Lavery]

I fully concur with my hon. Friend’s sentiments, and I am pleased about that intervention, because I think I might otherwise have needed an ambulance myself. I feel as if my blood pressure it is getting exceedingly high.

More seriously, we have to look at the North East Ambulance Service now. We cannot announce a review in weeks to come. We have got to get to the bottom of why the service is operating so badly. It is not meeting its major targets in almost every single category. It has been mentioned that it may perhaps be put in special measures, or that it should be broken up. To be honest, I do not have the answers, but one thing I will say is that the Government have to look at the North East Ambulance Service and improve it in the same way as in other areas of the country. There is no reason why people in my area, in the north-east, should be tret any differently from anywhere else in the country. We need to get hold of the situation immediately.

--- Later in debate ---

[Mr Kevan Jones]

I hear this from the Minister and I hear it from the trust, but could I ask her officials or NHS England to actually delve into the figures? The hon. Member for Berwick-upon-Tweed (Mrs Anne-Marie Trevelyan) raised an interesting issue. This is actually about the ways in which ambulance calls are classified. There are clearly reds that are not reds, but the other point that I would like the Minister to address, even if she cannot answer it today, is the way older people are being treated, because they are being put down as greens, whereby they get no priority at all, and they are some of the most vulnerable people in our community.

[Jane Ellison]

Indeed. I have very much taken that point on board and I will try to respond, but if I do not do so today, I will certainly write to the hon. Gentleman, because it is a fair point. The more general point is where the ambulance service sits in terms of our response and general position on urgent and emergency care. I will respond to some of the points made by my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan), because I think that this sits within a wider, systemic challenge and I want to touch on that.

Every patient should expect to receive first-class care from the ambulance service, but the nature of emergency response work means that there will always be incidents in which unfortunate timing leads to a person assessed as being in a non-life threatening situation calling 999 at the same time as several other people who are in life-threatening situations. I am sure that hon. Members are realistic about that, but clearly we do not want to hear about such problems occurring on a very regular basis. Where that does occur, obviously the life-threatening situations must be prioritised and resources focused on those calls. Very rarely—unfortunately, we have heard about such cases this afternoon—waits may be unacceptably long. I do not shy away from that, but it is important to remember that the vast majority of people receive a timely response when they dial 999.

I have already said, echoing the words of the hon. Member for Washington and Sunderland West (Mrs Hodgson), who led the debate, that although the NEAS has not met the performance targets, that does not reflect on the hard work, dedication and skills of the local staff. A number of speeches brought that out. I am advised that although ambulance delays are the main reason for patient complaints, the number of complaints received in 2015-16 fell, but we do not want any complaints; that would be the situation in an ideal world. However, the fall is indicative of the fact that the efforts of the local ambulance staff are paying dividends. Although the performance target is effective in driving improvements and maintaining response times to the most critically ill and injured patients, it does not, inevitably, paint the complete picture of how a trust is doing.

I will talk about some things that the North East Ambulance Service, has put in place to bring about improvements to service, because that is the focus of the debate and people want to hear that the direction of travel is positive. The NEAS continues to expand the number of specialist clinicians working in its clinical hub who can provide telephone assessment and advice, and who can prevent the dispatch of an emergency response if it is not deemed necessary. That goes to one of the points made earlier. The trust expects that that will have a positive effect on response times.

Last winter, the NEAS piloted an end-of-life-care transport service, which provided three dedicated ambulances that were on call to respond to transport requests from healthcare professionals to take a person to their final place to die. The scheme has meant that emergency ambulances are not tied up in transporting patients when they are needed for more serious cases, and that terminally ill patients are not waiting a long time for transport to their preferred place of death. Although we do not often like to talk about end-of-life care, the preferred place of death is an important part of reducing stress at an inevitably very difficult time for an individual and their family. Results from the pilot were overwhelmingly positive and eased pressure on vital services.

Hon. Members have raised valid concerns about handover times between ambulance crews and emergency departments in the local area, and that is an issue across the country. Patient handover needs to be as efficient as possible to achieve the best possible outcome for the patients and to free up ambulance resource, but more can be done and is being done. Measures include hospital ambulance liaison officers, which are being put in place by the NEAS. HALOs are present in hospitals across the trust territory and I am advised that the trust has sought to make use of dedicated ambulance resource assistants as well.

The urgent and emergency care vanguard programme in the north-east will include the development of a standardised handover process for all acute providers, intended to minimise delays across the patch. That goes to the shadow Minister’s point about looking at the wider system. That will be to the benefit of crews and emergency departments. I understand that, as part of the vanguard, the NEAS also hopes to secure funding for a new “flight deck” information system that will enable diverts by ambulance crews to other hospitals to be proactively managed and will prevent ambulances from stacking up outside already full A&E departments. The trust believes that those initiatives will help to distribute A&E workload evenly and will be welcomed.

Several hon. Members have rightly commented on the recruitment challenge. It is very much recognised that there is currently a shortage of paramedics nationally and the NEAS trust is no different. We recognise that front-line staff are the vital component of a safe, effective and high-performing service, and work is being done by the NEAS to rise to the recruitment challenge. The hon. Member for Washington and Sunderland West mentioned some things that are being done. Efforts include developing new advanced technician roles to support front-line services, and the trust is running a substantive recruitment of paramedics nationally and internationally.

The trust expects 77 student paramedics to graduate by February 2017, in addition to recruiting an additional 36 qualified paramedics in 2016-17. The trust has also recruited a total of 56 emergency care clinical managers, and that represents a significant investment in front-line clinical leadership. It also advises me that it expects to be up to full paramedic establishment by April 2017. I know that that commitment will be keenly watched by hon. Members.