Ambulance Pressures

Baroness Henig Excerpts

Tuesday 19th July 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Statement suggests that everything is in hand. This was not the case before the heatwave, and it is not the case now. Just last week, in response to an Urgent Question, the Minister said,

“we fully acknowledge the rising pressures facing the service”. —[Official Report, 13/7/22; col. 1489.]

She spoke of some of the contributing factors: near maximum bed occupancy, high rates of Covid admissions in hospital, pressure on the ability of A&Es to admit patients, an increase in the length of stays, delayed discharges and record numbers of calls to the ambulance service. I am glad that the Secretary of State also referred to these pressures. However, does the Minister acknowledge that the Government have allowed these unsustainable pressures to develop? If not, can she indicate where the responsibility lies?

To that list I would add the failure to provide a wraparound, long-term plan for social care, and insufficient planning and attention to the recruitment, retention and training of health and care staff. Can the Minister say what action will be taken to address these shortfalls, as well as the other pressures on the system, which Ministers themselves have acknowledged? All these pressures, along with a record 6.6 million people waiting for NHS treatment, often in pain and discomfort, were in place long before the pressure of an unprecedented heatwave.

The Statement talks of creating additional space for new patients in hospitals. Will this be in existing hospitals? How and when will that happen? What money, resources and staff will be allocated? What does additional space actually mean? Can the Minister give an assurance that this will not mean more patients being left in corridors on trolleys or in car parks?

The people about whom we speak today are those waiting in queues of ambulances outside hospitals, in soaring temperatures, unable to enter the very place that they need to be, while people with conditions triggered by excessive heat are struggling to get an ambulance in a timely fashion because ambulances are log-jammed outside A&E. What can the Minister offer to them and their families?

The situation is impacting mental health too. People attending A&E experiencing a mental health crisis may not be able to get a bed in a psychiatric hospital, and their wait in A&E can be more than three days. What assessment has been made of the impact of cutting a quarter of all mental health beds?

Last week, the Minister of State in the other place said that the Government had procured a £30 million contract for an auxiliary ambulance service, but in fact it was yet to be awarded. Can the Minister confirm whether a correction has been issued to this statement?

I wonder if it is possible to comment on why the Prime Minister did not chair COBRA yesterday, despite the country being in the midst of a national emergency and ambulances finding themselves on the highest level of alert.

On practicalities, has there been any discussion involving the military to seek its assistance at any time? What is being done to reduce injuries and discomfort for ambulance crews who need to have the right vehicles in place for them to use but find that they do not?

It has been 10 months since the Government closed their national resilience strategy consultation. Can the Minister tell your Lordships’ House when we can expect the Government to publish their response?

I am sure we are all agreed that credit and thanks are due to all of the staff team, but if they are overworked in health and social care and do not have the time and resources to take care of themselves in this heat, the care that they give patients will be affected. Heatwave working poses new challenges for paramedics and all health and care staff, who may be wearing thicker PPE. Can the Minister outline any discussions the department has had about ensuring safe and comfortable working conditions?

In the midst of this unprecedented heatwave, can your Lordships’ House be reassured that, when it comes to the pressure that winter presents, steps will have been taken to ensure no further crisis in the ambulance service and across the health and care sector?

I hope the Minister will acknowledge the need to build resilience and for us all to see urgent action.

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to speak.

[Baroness Brinton (LD) [V]]

My Lords, I start by paying tribute to our ambulance and paramedic staff, as well as the ambulance call handlers. They are doing the absolute best they can despite the circumstances, and we owe them an enormous debt of gratitude.

There is no doubt that our ambulance services are at breaking point. Record-long ambulance waits are leaving vulnerable patients stuck in the heat outside hospitals, waiting for the treatment they need. There was a new first over the weekend, as temperatures rose, when patients inside ambulances were in a hospital car park for over 24 hours because A&E was full and there were no beds in the hospital.

This is not a recent crisis. Among many incidents reported in the press, a couple of months ago a senior NHS trust doctor in Gloucestershire rang 999 having had a suspected stroke, and was told to get a family member to drive her to hospital because no ambulance could get to her for at least an hour and there would then be a considerable delay after that. There are daily reports of people dying waiting for ambulances or in the back of an ambulance outside A&E.

Frankly, this Government have run ambulance services into the ground, with every single target being missed for the most severe cases. For months, they have failed to act on warnings that ambulance services are struggling to maintain a safe and timely service. The Government need to get a grip of this emergency. Even Liz Truss, one of the contenders to be the next Prime Minister and a very senior member of Cabinet, said in the ITV leaders’ debate on Sunday that ambulance waiting times in her rural constituency were “appalling”. Surely now is the time for Ministers to finally commit to commissioning the CQC to conduct an investigation into the causes and impacts of ambulance service delays, which would not just look at the very front line but take a whole, systemic approach.

One of the solutions proposed by the Secretary of State in the Statement is more use of 111 to ease pressure on call handlers receiving 999 calls, but there is already a major problem with 111: it takes much longer to get through and sometimes calls are not even answered. Not getting through to 111 will exacerbate waiting times and not help get them under control, because it risks piling even more pressure on our ambulance services, as desperate people whose conditions have worsened struggle and then turn to 999 instead. Can the Minister say what extra staffing and training there will be for the 111 service? Specialist training will be needed, because staff do not receive the highly specialised training that the 999 service call handlers do.

We need to remember that this is not just about ambulances, but they are the very visible evidence of a broken health and social care system. We on these Benches, and others around your Lordships’ House, have regularly been asking questions about our ambulance and A&E services, under pressure for well over the last six months. For years, we have also highlighted the shortage of hospital beds compared with other OECD countries. In 2021, the UK had 2.3 beds per 1,000 people, compared with France at 5.7 and Germany at 12.6. It was a mistake to cut so many beds. So will the Government undertake to fund thousands of extra beds to stop handover delays at A&Es, so that ambulances can get back on the road as soon as possible?

All of this is compounded by the lack of training and education places for doctors, nurses and other vital healthcare professionals, such as physios, occupational therapists, and speech and language therapists. Will any of the long-term plans to provide finance and support to enable hospitals to recruit and train more specialist healthcare staff be brought forward? Otherwise, we will just continue to lurch from crisis to crisis.

Finally, as the Statement notes, the Met Office has issued the first ever red warning for extreme heat, at a time when all 10 of our ambulance services in mainland England are already at the highest level of alert. The news this afternoon is of a number of serious fires in London and elsewhere; Hertfordshire, my local area, has had 240 calls to its fire service, which is many more than usual. Temperatures peaking at over 40 degrees centigrade just demonstrates that the pressure on ambulances, A&E and our wider NHS is likely to increase from injuries sustained by firefighters and those caught up in the fires.

The Statement talks as if the only effect is on people currently in hospital. The effects of climate change will make heat waves more frequent and intense in the future, so I ask the Minister what the Government are building in to help the NHS tackle the problems arising from these heat incidents, which sadly we must now plan for on a regular basis.