Ambulance Response Times

Baroness Barker Excerpts

Tuesday 1st February 2022 Lords Chamber

Asked by

[Baroness Barker]

To ask Her Majesty’s Government what assessment they have made of the current ambulance response times; and what actions they are taking to reduce ambulance response times.

[Baroness Barker (LD)]

My Lords, there were a few moments during the last hour when I thought that some Members of your Lordships’ House might need medical attention and that my debate might be a welcome move on that part. In starting this debate, I welcome the noble Baroness, Lady Penn, back to the Front Bench. She has been otherwise occupied for the past few months; it is very good to see her back and looking so well.

I make no apology for returning to the subject of ambulance services. Not a week goes by when ambulance services are not in the headlines. Inevitably, when there are stories of distress and patients being left unattended, they do grab the headlines, but I hope that this evening we can do the job that this House really should do: go behind the headlines and look at the underlying factors, which are of enduring importance in determining the problems of and solutions for our ambulance services.

I am aware that a number of noble Lords are here again, having taken part in many debates on the Health and Care Bill. That piece of legislation is somewhat puzzling, frankly. Your Lordships’ House is now several days into Committee on that Bill, the purpose of which, so the Government tell us, is to lead to the better integration of health and social care in order to overcome health inequalities, as well as to move the National Health Service away from being a service that is largely reactive and acute to one that is much more about prevention and the promotion of well-being in communities. Yet we are considering the legislation without having seen either the White Paper on social care or the White Paper on integration, so it is all a bit Alice in Wonderland. If that feels confusing to us trying to do our job, as we have this debate, we might well hold in our minds those people in the ambulance service who are trying to build sustainable services that meet all its objectives and yet are having, sometimes day to day, to deal with competing demands and policy directions that are unclear.

We know that, at the moment, the ambulance service has a national framework and national targets. We also know that those are not being met. We know that national standards were set in 2017. Calls to the ambulance service are triaged into four categories, depending on the level of urgency. All ambulance trusts must respond to 90% of category 3 calls in two hours and category 4 calls in three hours. Nationally, ambulance waiting times have more than doubled in the past two years.

Very recent statistics from NHS England say that, on the level of demand in December 2021, per day, 29,800 calls to 999 were answered. That is 2% more than in November 2021, 9% more than in December 2019 and 22% more than in December 2020. On response times, in December 2021, the England average response time for category C1—the most urgent incidents—was 9.13 minutes; in the C1 90th centile, it was 16.12 minutes. So neither of them met the seven-minute mean or the 15-minute 90th centile standards that they were supposed to meet. For C2 in England, the average response time in December 2021 was 53.21 minutes and the 90th centile was one hour and 59 minutes, so the 18-minute and 40-minute standards were not met. The next statistics are due in February but it is unlikely, I suggest, that things will have changed dramatically in that time. The Government say that the NHS is under sustainable pressure, but I put it to noble Lords that these figures show that the pressure is not sustainable.

My colleague in another place, Daisy Cooper, met the British Heart Foundation last week, and it made a really interesting point. Not only are ambulance times slow but it had examples of heart patients who called the hotline because paramedics had turned up to stabilise them on site and then left them for an even more important job, asking family members to take them or leaving them at home so as not to take them into hospital at all. Were we to drill down, we would find a lot more of that kind of statistical manipulation going on behind those average national statistics.

My friend Helen Morgan, who I am delighted to say is the new MP for North Shropshire, has been doing a lot of work on the problems in her constituency. It is a large rural constituency in which four ambulance hubs have been removed and there have recently been waits of over seven hours to hand over patients at Shropshire hospitals. That is not unusual, but it is unacceptable.

We know what the problems are because organisations such as NHS Providers have told us. Problems with admissions to A&E are most often because A&E beds are blocked by people who cannot be moved out into the rest of the hospital, because beds in other wards are being blocked by people who are well enough to go home but for whom there are no social care packages.

There are three things that the Government could and should do. First, they should make sure that the data on hospital waiting times is much more rigorous, timely and defined. At the moment we are being given average national data, which is not helping us to plan and, most importantly, to configure services.

Secondly, we need to increase social care funding. Everyone knows across the NHS that, although money has gone into the NHS—as indeed it should—it is absolutely clear that unless and until there is investment in social care all these blockages in the NHS will continue to happen.

Finally, rather than continuing to treat the ambulance service as an afterthought—a simple way of getting people between one acute service and another—the Government should look at a paper that was recently produced by Public Health England and the Association of Ambulance Chief Executives. It is about developing the ambulance service as a public health service by equipping and training ambulance staff to note what is happening when they go on site to find people and the causes of incidents. They could then develop that dataset, some of which they already have from call centres, and use technology that is coming online, such as AI, to begin to predict with much more detail the demands on the ambulance service. That would enable it to work not just with acute hospitals but social services departments, the police and others and to become much more refined at predicting incidents and demand. It is only by managing demand and bringing it down that we will build an ambulance service that is sustainable in the longer term.

I would love to talk about the use of the ambulance service for mental health, but I do not have the time.

One final thing: during the last two years of Covid, the ambulance service has been kept afloat by St John Ambulance. What are the Government doing to make sure that St John Ambulance remains sustainable over the coming months?