Ambulance Response Times

Ashley Dalton Excerpts

Thursday 6th March 2025 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

It is a pleasure to serve under your chairship, Ms Jardine. I am grateful to the hon. Member for Glastonbury and Somerton (Sarah Dyke) for securing the debate. I thank all the hon. Members who have taken part, including my hon. Friends the Members for Redditch (Chris Bloore), for Ilford South (Jas Athwal) and for Wolverhampton West (Warinder Juss), and the hon. Members for West Suffolk (Nick Timothy) and for South Devon (Caroline Voaden), as well as the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), and the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson). I will endeavour to deal with as many issues and questions as I can. If I do miss any, will hon. Members please get in touch with me afterwards, and I will make sure they are picked up?

The hon. Member for West Suffolk mentioned the commitment made by the Secretary of State to meet him and visit his constituency, and I will ensure that that issue is raised. The parliamentary private secretary, my hon. Friend the Member for Ealing Southall (Deirdre Costigan), is here, and I am sure she will be happy to pursue a response. We will also do what we can to get a response from the Treasury for the shadow Minister.

The hon. Member for Glastonbury and Somerton and other hon. Members rightly raised constituents� experiences of long waits for an ambulance response. I put on record my deepest sympathies for the hon. Lady�s constituent Jim on the loss of his wife. As the Secretary of State has made clear, this is not the level of care that staff want for their patients, and it is not the level of care that this Government will ever accept for patients.

Lord Darzi investigated the issues facing the NHS, and his report was honest about the challenges facing the health service. Urgent and emergency care performance remains a long way from a resilient position and there is continued high demand for A&E and ambulance services, with ongoing seasonal winter pressures. For example, in December the London Ambulance Service recorded more than 121,000 incidents, the highest on record for the service. Improvement needs to happen across the urgent and emergency care pathway and through the expansion of neighbourhood health services.

Nationally, congested emergency departments reduce the productivity of ambulance services, a matter that I think almost all hon. Members raised. A huge amount of time is lost to ambulance handover delays because there is no space for patients. Having crews tied up waiting outside hospitals exacerbates poor ambulance response times. We have also seen the continued normalisation of corridor care. We will never accept patients being treated in corridors; it is unsafe and undignified. We are investing an extra �26 billion to begin turning around the NHS, and we will do all we can, as fast as we can, to consign corridor care to the history books.

Lord Darzi�s investigation into NHS performance highlighted wide variation across different parts of the country. The situation is unfair to patients and goes against the principle of a universal service. I acknowledge that there can be challenges in rural areas, where longer distances often mean that patients wait much longer for ambulances than in urban areas. I often find myself in this place with the hon. Member for Glastonbury and Somerton, and we both talk about the experience in our rural constituencies. I assure her that that is on my agenda. As she says, ambulance response times for the south-west and some other areas highlight the rurality differential.

In January, the South Western Ambulance Service�s average response for category 2 emergency incidents, which include strokes and heart attacks, was 51 minutes and 45 seconds, which is 26 minutes longer than the best-performing ambulance trust in England. The NHS constitutional standard for category 2 average response times is 18 minutes, and no ambulance trust in England has met that target since the pandemic. This cannot go on. Prioritising patient safety will always be the Government�s and the NHS�s main focus. We are committed to getting A&E waiting times and ambulance response times back to NHS constitutional standards.

The independent review of ambulance trust culture was published in February 2024. Its recommendations included addressing workforce pressures. NHS England is working closely with ambulance trusts to implement those recommendations. We have made some significant investments in the ambulance workforce, and the number of NHS ambulance staff has grown by 9% compared with last year, but we recognise that there is much more to do on retention and wellbeing for ambulance staff. That is something that we will continue to work on.

We cannot keep plugging the gaps. There is a need for more fundamental reform. We have been clear that there are no quick fixes and that to turn things around will take investment and reform. We have provided the highest real-terms capital budget for the NHS since before 2010. We announced an extra �22.6 billion in day-to-day health spending and an additional �3.1 billion further capital investment over two years. That extra investment will be accompanied by fundamental reform, of which ambulance services.

In January, the Government published �Road to recovery: the government�s 2025 mandate to NHS England�, which clearly sets out delivery instructions for the NHS through the prioritisation of the five key objectives aimed at driving reform in the NHS. Improving A&E and ambulance service performance was also one of a small number of prioritised objectives in the Government�s mandate to NHS England to specifically start to address the current challenges facing urgent and emergency care.

In turn, NHS England�s planning guidance for this year includes the target to improve average category 2 ambulance response times to no more than 30 minutes across 2025-26. The guidance also sets out a range of key actions for the NHS to deliver in the same timeframe, focused on reducing avoidable ambulance dispatches and conveyances and reducing hospital handover delays.

[Helen Morgan]

Will the Minister pick up on the point about social care? Inability to admit to hospital is a key point in the handover delay problem, and the social care talks are a key measure in solving it.

[Ashley Dalton]

The hon. Member will be delighted to know that I am coming to that point next.

We are working on reducing delays and getting hospital handovers back to within 15 minutes, ensuring that no handover between hospital and ambulance services takes longer than 45 minutes. We want to improve the range and co-ordination of services to avoid unnecessary ambulance conveyances, including through improving access to urgent community response and hospital at home services, and continuing to build on ambulance services and the great work that they do to increase the hear and treat rates so that people can be advised on what they can do and what services they can access that might mean they do not need that ambulance. We will also be driving consistency and commissioning practices across England for ambulance services. I will say a little more about the rurality element in a moment.

We are taking the first steps in the reform and improvements that we want to see in services, and we will shortly set out further plans in the urgent and emergency care services plan. We know that there is no solution for ambulances that does not include tackling the challenges facing adult social care. Health and care services need to be more joined up.

Today, there are approximately 12,000 patients in hospital beds who have no criteria to reside. They do not need to be there but cannot be discharged for reasons of capacity. Over the last month, on average, 276 of the patients with no criteria to reside were in the Somerset integrated board area. That is why the Government are making available up to �3.7 billion of additional funding for local authorities that provide social care. We are funding more home adaptations through the disabled facilities grant this year and next, so that people�s homes can be safer, reducing the risk of their needing an ambulance. We are reforming the better care fund to ensure that the pooled NHS and local authority funding spent on social care contributes to wider efforts to reduce emergency admissions and delayed discharges.

[Dr Caroline Johnson]

Social care is clearly very important, but what assessment has the Department made of the effect of national insurance contributions on social care provision as a whole?

[Ashley Dalton]

The hon. Member will be aware, because we have discussed the matter many times in Westminster Hall and the main Chamber, that the funding has been made available to the statutory sector bodies for employer national insurance contributions for public sector pay, and the negotiations for the delivery of commissioned services locally and within the NHS will take place locally. I am sure that we will be able to point her to some more detail on that issue, which has been discussed at length by colleagues.

We have announced the largest ever increase in the carer�s allowance earnings limit since the benefit was introduced in 1976. It is worth approximately �2,000 a year for unpaid carers. We are also introducing fair pay agreements to empower worker representatives, employers and others to negotiate pay and terms and conditions in a responsible manner. That will help to address the recruitment and retention crisis in the sector. It is not all about ENICs; it is about making sure that our social care service is resourced in order to make sure that social carers are recognised for the powerful and important work that they do. We have appointed Louise Casey to help to build a national consensus on the long-term solution for social care.

The social care cross-party talks, to which the Liberal Democrat spokesperson referred, have not been called off; they have been merely delayed. As I told her in the Chamber just yesterday, it is very much about making sure that we have the right people in the room and that they can attend. It is our intention for the talks to go ahead very soon. They have not been called off; they have been merely postponed.

Of course, we need further reform. We are bringing it forward through the 10-year plan this spring to accompany the additional investment in the NHS. The Government will publish that plan for radical reform in the NHS, with those three big reform shifts: from hospital to community, from analogue to digital and from sickness to prevention. The reforms will support putting the NHS on a sustainable footing so that it can tackle the problems of today and of the future.

The shadow Minister asked about the configuration of ambulance services. As I am sure she is aware, decisions on service configuration must be made by those who are experts in delivering it.

We have also talked about the key issues of rurality. A range of adjustments are made in the core ICB allocations formula to account for the fact that the costs of providing healthcare may vary between rural and urban areas. Some of the differences, such as the tendency for rural populations to be older, are naturally captured within the formula. We continue to review the formula for the impact of the characteristics of local areas, such as rural, urban and coastal, in the development programme.

I encourage all hon. Members to raise these matters with their local ICBs, which are responsible for commissioning the right configuration of local services. The NHS has increased the availability of local data on ambulance response times performance, with category 2 ambulance performance now published at ICB level, which has increased the transparency of the important data. I encourage hon. Members to use that data to direct conversations with their ICBs.

We have also talked about air ambulances. I am sure that all hon. Members recognise the contribution that they make, as the Government do. The Government support the long-standing independent air ambulance charities model for the successful operation of helicopter emergency medical services in England, which gives the sector the independence to raise funds through commercial activity and sponsorship from corporate partners. The NHS continues to support air ambulance services, including through thorough training and the provision of NHS clinicians.

Communities right across the country, including the constituents of the hon. Member for Glastonbury and Somerton, are struggling with poor services and crumbling NHS estates. We are putting record capital into the NHS. We will bring down ambulance response times. We will get waiting lists back down to what they were in 2010. It will take time, but we will deliver an NHS and a national care service that provide people with the care they need, when and where they need it.