Health Services: Southend West

Anna Firth Excerpts

Wednesday 6th July 2022 Commons Chamber

[Anna Firth (Southend West) (Con)]

Let me begin by saying what a huge pleasure it is to be holding my first Adjournment debate since my election in February—and on such an uneventful day! Let me also thank Mr Speaker for granting a debate on a subject that is so important to everyone in Southend West; and I am particularly pleased to see that we still have a Minister here to respond to it.

Making Southend West healthier is my absolute priority, and I want to say a huge thank you to all our brilliant local NHS workers. Their incredibly hard work is an inspiration to us all, and it is no exaggeration to say that our country would simply not function without them. However, it was very clear during my election campaign that, sadly, our local healthcare system was simply not up to scratch. Since my election, my mailbox has been dominated by problems with our hospital, with our ambulance service, with 111 and with GPs. Literally every day I receive complaints from constituents, and I have promised to do something about it.

There are four issues that I want to focus on this evening. The first is Southend University Hospital. The hospital lies right at the heart of my constituency, and the tower—which I had the pleasure of abseiling down earlier this year for charity—dominates the local skyline. The hospital now has 670 beds, serving as the main healthcare centre and accident and emergency department for around 330,000 people. Just over 4,500 staff work around the clock to provide the best possible care to local residents. However, the hospital is hampered by its setting, on a fairly small plot of land right in the centre of the city. There is no room to expand, so the hospital really has to make the most of every spare bit of space available.

The small site of the hospital is mirrored by the limited size of the A&E department, which can safely admit around 55 people within a 24-hour period. According to hospital staff, they regularly have to deal with between 120 and 150 people daily. This is quite simply unsafe. The Minister will know that the Care Quality Commission rated the Department as “requires improvement” late last year. Understandably, my hon. Friend the Member for Castle Point (Rebecca Harris) is keen that patients from her constituency are encouraged to attend Basildon A&E instead of Southend.

Clearly, the number of people the A&E department has to deal with has consequences for treatment waiting times. Statistics last month showed that more than a third of patients needing the most serious A&E care waited more than four hours to be seen. The lack of space in the A&E wing also means that ambulances regularly have to queue up for several hours outside the hospital to discharge their patients. Indeed, it is not unusual to see what effectively amounts to a temporary field hospital of 15 ambulances in the car park.

The national guidance states that patients arriving at an accident and emergency department by ambulance must be handed over into the care of A&E staff within 15 minutes. Shockingly, the average handover time for a person arriving by ambulance at Southend Hospital is 84 minutes, which is five times the national target. The worst day at Southend this year was 11 April, when the average handover time was 178 minutes. That is nearly three hours, and 12 times the national guideline. Of course, some patients wait considerably longer. One of my constituents contacted me last month to tell me that he had spent six hours in the back of an ambulance in agony, and one 79 -year-old constituent had to wait eight hours in severe pain before being seen. If this is happening in the spring and summer, I dread to think what the situation might be in winter.

This brings me to my first ask of the Minister this evening. The hospital trust, led by Anthony McKeever and the outgoing chief executive officer, Clare Panniker, has put together a plan for a major clinical reconfiguration of the Mid and South Essex integrated care system. This reconfiguration has been fully costed at £118 million and the funding was first promised in Parliament in 2017. Southend is the major beneficiary of this funding envelope, with £51 million also promised in 2017 for the development of, among other things, a new emergency care hub at Southend Hospital. This would go a long way towards addressing the critical issues with space and flow in the emergency department. It would also see additional inpatient wards and new and refurbished theatres in the hospital, as well as myriad other essential medical services.

This scheme is ready to roll, but for one big stumbling block. Approval of £8.4 million in capital enabling funding is needed to allow the development of the full business cases necessary to unlock the whole £118 million programme, and it is still awaited. In May, the Minister reconfirmed at a meeting with Essex MPs that these crucial enabling funds will be expedited. Sadly, this has not yet happened. Will he please confirm tonight the release of the £8.4 million of enabling funding needed for these essential upgrades at Southend Hospital? In the words of Cuba Gooding Jr., when will he “Show me the money”?

Problems with people waiting absurdly long times for an ambulance to arrive are not unique to Southend. This year we have already had debates in this place on delays everywhere from Cornwall to Shropshire to Ellesmere Port. One elderly woman in my constituency waited 12 hours for an ambulance to arrive after falling at home and fracturing her hip. Another 86-year-old waited six hours while suffering from sepsis.

What makes the situation in Southend unique is our rapidly ageing population. The results of the 2021 census, published last week, show that the average age in Southend is 20 years older than in England as a whole. The number of people aged 70 to 74 has risen by 37% in the past 10 years, and we now have nearly 2,000 people aged over 90. As my predecessor was so fond of saying, we have the highest concentration of centenarians in the country, which has implications for the ambulance service. Older people are more likely to have urgent medical conditions that can be dealt with only by having an ambulance come to them.

I am pleased to say that, since I was elected, we have seen some real changes. Working with my neighbouring colleagues, my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois) and my hon. Friend the Member for Castle Point, whom I thank for being here to support me this evening, we have held many productive meetings with the new chief executive of East of England Ambulance Service, Tom Abell, including another one only this afternoon. I am delighted that we will be receiving a net increase of 111 ambulance staff, and that the 11 new ambulances promised to us in March are already on our roads.

There will be no real benefit to the people of Southend West from these new ambulances if, when they arrive at the hospital, they cannot be discharged. The elderly lady with a broken hip I mentioned earlier, after waiting 12 hours at home for an ambulance, had to wait outside the hospital in that ambulance for another four hours. Sadly, her story is far from unique.

My second ask of the Minister this evening is exactly the same as my first. Will he release the £8.4 million of enabling funding needed to improve Southend Hospital’s emergency department?

[Mr Mark Francois (Rayleigh and Wickford) (Con)]

The heroic efforts of our paramedics—I use the word heroic deliberately—are being hampered because they cannot discharge a critically ill patient into Southend Hospital if there is no bed available. An ambulance in the hospital car park with a critically ill patient cannot go back out to help other ill patients.

My hon. Friend is entirely right so, as a neighbouring MP, I join her in pleading with the Minister for this vital £8.4 million. Like my hon. Friend the Member for Castle Point (Rebecca Harris), who is also in the Chamber, I would be grateful if the Minister could show all of us the money.

[Anna Firth]

My right hon. Friend makes an important point. While ambulances wait in the hospital car park, another person is waiting at home with a broken hip or something similar and is unable to be picked up.

The 111 service in Mid and South Essex is run by Integrated Care 24, and the service answered 30,396 calls from patients in June. One of the most baffling things about the 111 service is that if a call has not been triaged by a clinician within an hour, an ambulance is automatically dispatched as a fail-safe. In June alone, 100 ambulances were auto-dispatched in Mid and South Essex, which is an average of 3.1 a day, due to delays in patients being triaged. In May, I met an ambulance crew who had been auto-dispatched to treat a 12 year-old child with tonsillitis as the case had not been triaged by a clinician within an hour. The ambulance crew were as surprised as the mother that they had been sent to attend a child with tonsillitis. On average, each ambulance call-out costs the taxpayer about £350. On those figures, we could be spending nearly £500,000 annually in Mid and South Essex alone on unwanted and unnecessary ambulance call-outs. Were that situation to be repeated at every hospital trust throughout the country, we would spend tens of millions of pounds on unnecessary ambulances. Will the Minister commit to reviewing the system that causes ambulances to be auto-dispatched?

Finally, I come to GP waiting times. GPs are at the heart of so much of our health system, and they have traditionally been the first port of call for people who have minor or recurring illnesses, but since the covid pandemic we have had a tsunami of complaints from people who are not able to see their GP. According to a poll by Survation, 47% of people in Southend West experienced problems booking a GP appointment in the past year—that is nearly 50% of people who are trying to see their GP. Every week, I am contacted by at least three constituents who are struggling to get a GP appointment. Generally, the complaint is that patients are in an endless loop of calling their practice in the morning and being told that there are no appointments available and they should call back in the afternoon, only to be told then to call again the following day—and they go round the buoy again. In one case, it took a constituent five weeks to get an appointment with his doctor. At West Road surgery, in my constituency, there are currently three-week delays for urgent blood tests. I have also received many reports of GPs delaying the return of medical forms to the Driver and Vehicle Licensing Agency and of delayed referrals to specialists. One constituent who had suffered a minor injury to his head and needed to see a GP for a check-up and bandaging had to call an ambulance and attend A&E because no appointment was available. This simply adds to the pressures I spoke about earlier in this speech.

Some surgeries in my constituency are attempting to innovate by bringing in an e-consult system, but they are doing so without writing and explaining the new system to their patients in advance—I am told there are no funds from the clinical commissioning group for such a letter. Not surprisingly, that is adding to the levels of frustration and anxiety. Besides, this online system is not suitable for many of the most elderly and vulnerable people in my constituency, who do not have access to the internet. Nationally, 54% of over-75s are not online, and the figure for the city of Southend is 8%, so we are talking about 12,000 people who have never even used the internet.

What my constituents need and deserve is to be able to visit their doctor, and that brings me to my final ask this evening. We can implement all sorts of clever systems to reduce waiting lists, but what we really need is more GPs and more appointments. Will the Minister please let me know what is being done to recruit more doctors in Southend, and what is being done to encourage them to increase the number of in-person appointments available?

I started this evening’s speech on a positive note by thanking our brilliant health workers, and I want to conclude on a similar one. We have some brilliant initiatives locally that are already making people in Southend West healthier. Southend University Hospital is piloting an innovative enhanced discharge service, a collaboration between Southend-on-Sea City Council, Southend clinical commissioning group and the hospital. This is helping people to get home when they have been in hospital, and it is a brilliant therapy-led assessment service that really puts people at the heart of ongoing care. I am delighted that the Government have praised the scheme, and I look forward to it being extended. I would like to take this opportunity to invite the Minister to come and visit the hospital; he and his ministerial colleagues—whoever they may be—are always welcome to come and visit.

My hon. Friend the Member for Rochford and Southend East (James Duddridge) would raise the case for a Shoebury health centre if this debate covered the whole of Southend, but I know the Minister is already aware of his passion and support for such a proposal. I fully support this endeavour and indeed would welcome one of these in Southend West as well.

To conclude, my main asks this evening are as follows. What is being done to recruit doctors in Southend, and what is being done to encourage them to increase the number of GP appointments available? What is being done to reform the 111 service to ensure ambulances are not auto-despatched needlessly? Most importantly, will the Minister please confirm tonight the release of the £8.4 million of enabling funding that is so vitally needed to improve the Southend emergency department?

[Mr Deputy Speaker (Mr Nigel Evans)]

As the Minister is a regular attendee at Adjournment debates, I would normally say that I am delighted to see him here today. After the events of the last 24 hours, however, I will say that I am relieved to see that he is here to respond to this debate.

[The Minister for Health (Edward Argar)]

I congratulate my hon. Friend the Member for Southend West (Anna Firth) on securing this important debate. She is a notable advocate for healthcare in her constituency, and a strong champion and voice for her constituents in this place. The NHS has faced extraordinary pressures over the course of the pandemic, and I am sure the whole House will join me in expressing our utmost gratitude to staff for their outstanding work and dedication during this time.

I will address a number of my hon. Friend’s points, but, although it is rare to do so at the Dispatch Box, I will come to her main point first and seek to address it head-on. My hon. Friend and my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois)—and, although she may not intervene in the debate, the Lord Commissioner of Her Majesty’s Treasury, my hon. Friend the Member for Castle Point (Rebecca Harris)—have asked whether the Government will provide the £8.4 million of funding requested to improve Southend emergency department to unlock the business case to allow it to proceed to do further work. While I regret that I am not able to give a clear answer to my hon. Friend the Member for Southend West this evening, I hope it will come as some encouragement to her that I can say that, following the tenacity of her campaigning on this issue in the Chamber, and indeed outside it, in pursuing me and other Ministers—that is exactly what Members of Parliament are here to do—I have instructed the Department to convene a meeting to review the submitted business case prior to the summer recess, and I anticipate being able to update her and the trust with the outcome of that before the House rises for the summer. That is, obviously, subject to my new Secretary of State’s decision on the recommendation of officials, but I undertake that I have instructed officials to come back to her with that decision before the House rises in a couple of weeks.

In the meantime, work to improve local services continues, and I am aware that Mid and South Essex NHS Foundation Trust hospitals and the East of England Ambulance Service NHS Trust—EEAST—have a range of actions in place to meet the high levels of demand they are experiencing. For example, EEAST is prioritising emergency cases, and, where clinically appropriate, a team of clinicians in its emergency clinical advice and triage service will advise people who do not need an ambulance to use other services. EEAST has also successfully recruited more call handlers and expanded the network of hospital ambulance liaison officers who help to co-ordinate handovers at hospitals, including by diverting crews to other hospitals where they can be seen more quickly.

EEAST is working with acute hospitals to develop cohorting areas, where patients can be assessed before going into the emergency department, helping to get ambulances back on the road more quickly. In the context of ambulances, I am reminded of an incident that was recounted to me—I could not possibly reveal the source from which I acquired this information. When she was abseiling to raise money for charity while dressed as Wonder Woman, my hon. Friend spotted ambulances queued up. As soon as she got to the ground and across the car park, she pursued the issue to find out what was going on. Such is her commitment to her constituents and her passion for this issue, and I commend her for that.

After a successful trial at Lister Hospital, EEAST is now using a rapid release process with some acute hospital partners, where the handover of patients is fast tracked if an urgent response is required in the community. At busy times, EEAST may also offer enhanced pay rates to encourage staff to complete additional shifts.

These local initiatives are also supported by national actions to reduce waiting times, including continuous central monitoring, support from the National Ambulance Coordination Centre and the allocation of £150 million of additional system funding for ambulance service pressures in 2022-23, supporting improvements to response times through additional call handler recruitment, retention and other funding pressures. My hon. Friend has quite rightly highlighted the additional ambulance service staff and the additional ambulances themselves. She is absolutely right to highlight the fact that while the ambulance service may often be the visual manifestation of the challenges faced, it is a system challenge with a number of complex, interrelated parts.

My hon. Friend has raised an important issue concerning the NHS 111 service and the automatic dispatch of ambulances. I am advised that when a patient calls 111 and the automated call handler assessment concludes that a low-urgency ambulance should be dispatched, a clinician will call the patient back to validate that that is actually required. I understand that that happens about 95% of the time. Where the patient is not able to be contacted within a fixed timeframe, as my hon. Friend has said, the call will be passed to the ambulance service for dispatch. However, it is important to understand that the call may still be scrutinised by the ambulance service as to whether an ambulance is really needed.

Although no remote triage process can be perfect, there is consistent clinical review of these calls to ensure the wise use of resource, and NHSEI does not believe that significant numbers of ambulances are being dispatched unnecessarily. I have already asked officials in the Department to look into the specific issue that my hon. Friend has raised to understand the extent to which that is happening, whether it is happening unnecessarily and what the consequences are in terms of cost and time resource.

We are also building the capacity of NHS 111 to act as the front door to the emergency care system, so that patients receive an ambulance or go to A&E only when needed. This is being supported with £50 million in 2022-23, helping to ensure that people can access urgent care when they need it, increasing the ability to book callers into alternative services or into a timed slot at their local A&E where appropriate.

On general practice, we know that general practitioners are still under huge pressure. I am incredibly grateful for the contribution of GPs and their teams over the past two years. They have stepped up to deliver our world-leading vaccination programme while still providing exemplary care for their patients during a pandemic. We made £520 million available to improve access and expand general practice capacity during the pandemic. That was in addition to at least £1.5 billion announced in 2020 to create an additional 50 million general practice appointments by 2024 by increasing and diversifying the workforce.

GPs and their teams will always be there for patients, alongside NHS 111 and community pharmacy teams, and it is important that people do not delay in coming forward with health concerns. In 2021-22, we saw the highest ever number of doctors accepting a place on GP training—a record 4,000 trainees, up from 2,671 in 2014. GP trainees support fully qualified GPs, helping to ease workloads and increase capacity, and allowing more patients to get the care they need. Just as in hospitals, doctors in training are delivering direct patient care while being safely supervised and supported.

I hope that our exchange today provides a degree of reassurance that there is significant support in place at local and national level to address performance issues, as well as a determination to improve the provision of health services in Southend West and more broadly in the local area. As you alluded to, Mr. Deputy Speaker, I have been a regular at the Dispatch Box in these Adjournment debates, certainly over the past two to three years. I am grateful to my hon. Friend for bringing forward this debate, and it has been a great pleasure and privilege to answer it.

[Anna Firth]

May I thank the Minister very much for the careful way in which he has responded to all my points and for his assurance that there will be some news on the £8.4 million before the recess?

[Edward Argar]

I am grateful to my hon. Friend for her kind words. I will just conclude by saying that it has been a huge privilege to respond to debates such as this, and I am very grateful to her for affording me that privilege this evening.

Question put and agreed to.