Ambulance Response Times

Baroness Penn Excerpts

Tuesday 1st February 2022 Lords Chamber

[Baroness Penn (Con)]

My Lords, I thank noble Lords for their warm welcome; it is great to be back. I also thank the noble Baroness, Lady Barker, for securing a debate on such an important topic, as my first debate back in this House. I join all noble Lords in expressing my gratitude for the outstanding work done by ambulance service staff and the wider NHS in what are often difficult circumstances.

Before we get into the details of statistics, funding and plans, it is important to address the question, asked by the noble Lord, Lord Scriven, of what I would say on a human level to those who have been affected by delays, often in tragic circumstances. All I can say is that I am sorry and that, while I will explain in more detail the circumstances in which these delays occurred and what we are doing to address them, the Government are clear that, while the delays are explicable, they are certainly not acceptable and we are doing all we can to improve the situation we face.

As noble Lords have acknowledged, ambulance services have faced extraordinary pressure over the last 18 months. The pandemic has placed significant demands on the service. In December 2021, the service answered almost 1 million calls, an increase of 22% on December 2020. While 999 calls tend to highlight demand related to more serious medical conditions, many ambulance services are also responsible for 111 calls, which, in November 2021, increased by just over 20% compared to November 2019.

Infection prevention and control measures, higher instances of delays in the handover of ambulance patients to A&E, as many noble Lords have noted, tying up ambulances in queues and delaying the response to new calls, and high workforce sickness absence rates, are all affecting the service. This combination of factors has placed unprecedented stress on the service and driven increased response times to patients in the community. Despite these pressures, performance for category 1 calls—the most serious calls, which are classified as life-threatening—has now been largely maintained at around nine minutes on average over several months, despite a 16% increase in these calls compared to before the pandemic. However, there have been significant increases in response times against the other categories, and even in category 1 we are not meeting the targets that we have set ourselves.

We must improve performance, and therefore we have put in place a number of measures. We have invested £55 million in staffing capacity to manage winter pressures up to March. All trusts are receiving part of this funding, which will increase call handling and operational response capacity, boosting staff numbers by 700. The noble Baroness, Lady Merron, asked about a breakdown of some of those figures on a trust-by-trust basis. I do not have them to hand, but I will see whether they exist and I can get them for her. The noble Baroness, Lady Brinton, referred to the pressure on ambulance staff in these circumstances. We recognise that and have put in place improved health and well-being support from NHSE and NHSI for ambulance trusts, with £1.75 million being invested to support the well-being of front-line ambulance staff during these pressures.

Almost all noble Lords noted that delays in handover are a big part of this picture. Targeted support to the most challenged hospitals to improve their patient handover processes has been put in place, helping ambulances swiftly to get back out on the road. This is focused on the most challenged hospital sites, where delays are predominantly concentrated. The 29 acute trusts operating the most challenged sites are responsible for 60% of the 60 minute-plus handover delays. As several noble Lords have said, it is not a uniform picture across the country and more data on a trust-by-trust level will help us to draw that picture out further.

We have also made a £4.4 million capital investment to keep an additional 154 ambulances on the road this winter, and a £75 million investment in NHS 111 to boost staff numbers by 1,100, boosting call-taking and clinical advice capacity to better help patients at home and avoid unnecessary ambulance calls and trips to A&E. There is continuous central monitoring and support to ambulance trusts from NHSEI’s national ambulance co-ordination centre, and we have also made significant long-term investments in the ambulance workforce. The number of NHS ambulance staff and support staff has increased by 38% since July 2010.

It is also right to recognise the contribution of the ambulance service in managing the demands of the pandemic on the wider health service. Ambulance services link the whole of the NHS, providing an interface between primary, community and secondary care. At a time when the NHS is facing unprecedented demand, ambulance services are absorbing some of that increase, treating more people over the phone and finding ways to reduce the pressure on other services. With clinical support in control rooms, for example, the ambulance service is closing 12% of 999 calls with clinical advice over the phone, which is up from 7.4% in December 2019, saving valuable ambulance resources to respond to more urgent calls.

The noble Baroness, Lady Barker, raised a number of points in her opening speech, reflected in the comments by other noble Lords, about how the challenges that the ambulance service is facing are symptomatic of wider challenges, not just within the NHS, but in social care, and looking at what we are doing to address that integration.

The Government published their plan on social care in December last year, and the integration White Paper is expected early this year, so those pieces of work will be updated. However, progress on those issues is not waiting for further White Papers to published.

In September last year, we committed to investing an additional £5.4 billion over three years to begin a comprehensive reform programme on social care. That is on top of funding in previous years, particularly to address—for example, through the better care fund—delayed discharges, which are having a knock-on effect across the NHS.

We have talked a bit about the statistics, and noble Lords said that there was not much sign of hope. I would not overstate the signs of hope we can take from some of the statistics, but one noble Lord mentioned the REAP status of ambulance trusts, and I have some updated figures on that since the Parliamentary Answer that was provided in the Commons. Since 22 January, the West Midlands Ambulance Service has moved to REAP level 3 and has remained there. The North East Ambulance Service moved to REAP level 3 on 25 January and remains there. Also, in the week to 19 January, category 2 responses have improved to an average of 31 minutes.

That performance is still significantly longer than the current target but might be a sign that some of the investment we have been putting since we announced further support last summer is having an effect on the ground. We are continuing to recruit and improve the numbers of call handlers and 111 handlers, for example.

I have addressed handover delays. There were three things on the wish list of the noble Baroness, Lady Barker, speaking for those who work in the service and, more widely, those who are close to the pressures they are facing. On more rigorous and timely hospital data, I have committed to write to the noble Baroness, Lady Merron, if I have any more trust-by-trust data on the resources being put in. I undertake to look if there is anything further I can say on that.

Increasing social care funding and social care reform is getting under way. I am sure the Government will look closely at the great point about developing the ambulance service as a public health service, which sees the causes of incidents on site. Ambulance service trusts have sophisticated demand modelling processes to look at some of those issues.

The noble Baroness also mentioned the excellent work done by St John Ambulance during the pandemic, to which I pay tribute. NHS England and NHS Improvement have contracted St John Ambulance to provide support to ambulance trusts throughout the pandemic, and they continue to work with St John on its continuing role in the future.

The noble Lord, Lord Scriven, raised the question of whether individual ambulance trusts might be reformed as part of the wider reform picture. I am not aware of any plans to do that, but it is an interesting point that I will take back to the department. He also mentioned mental health; the Government have put increased investment into that in recent years. There is more to do, but one example is community crisis cafes, an alternative place where people who may be in a mental health crisis can go that is not A&E and does not involve calling out an ambulance. They are safe spaces where people can get the help they need. The Government have put more funding into those kinds of services, and I am sure that they will continue to do so.

I am short on time, so I will close by reiterating the Government’s support for the ambulance service. Ministers are in regular contact with NHSEI on the performance of the emergency care system, including the ambulance service, and will continue to provide the support the NHS needs to ensure that patients receive the help they need, when they need it.

Once again, I thank the noble Baroness, who has rightly raised this important issue and secured such a thoughtful and interesting debate, if a shorter one than that on the Bill to which we will return.