Ambulance Response Times

Caroline Johnson Excerpts

Thursday 6th March 2025 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Ms Jardine. I thank the hon. Member for Glastonbury and Somerton (Sarah Dyke) for securing a debate on this important subject. I pay tribute to the ambulance services and to paramedics and their colleagues, who are on the frontline of our healthcare service, today and every day. Regardless of the weather, or whether it is a bank holiday, they are always there for all of us.

In my medical career, I have been required to deliver full intensive care to children, and particularly babies, who were being transferred across the county in East Midlands ambulances throughout the night and day. I have hurtled along in the back of an ambulance as it travelled down country roads, around corners and down the hard shoulder of motorways, so I understand some of what ambulance crews do. That has given me a deep appreciation of their work, and highlighted to me some of the unique challenges and pressures they face, particularly in our rural areas.

Before I was elected, I had two experiences of delayed ambulance services. On one occasion, I was driving up the A1 when the gentleman in the car in front of me skidded on some water and went into a tree. I am sorry to say that the ambulance took a very long time to arrive, and he died shortly afterwards. There was a fire truck, police officers and an incident manager, but there was no ambulance service. I do not think it would have made a difference to the outcome, but in other cases it might have.

On another occasion, I was sat in traffic when a police officer knocked on the window, which is always slightly worrying. They were looking for a doctor because they had been waiting so long for an ambulance for the people in the accident that was causing the traffic. It took a further 40 minutes from me arriving at the scene for the ambulance to arrive�I am not clear how long the people at the scene had been waiting before. So this issue was a great priority for me before I became a Member of Parliament.

In my first question at Prime Minister�s Question Time, in January 2017, I thanked the East Midlands Ambulance Service for its brave and stellar work serving the people of Sleaford and North Hykeham, and asked for ambulance service response times to be a priority. I also raised the issue in my first meetings with the then Prime Minister and Health Secretary. I understand that response times have improved somewhat, at different periods with different initiatives but overall, as we have heard, they are not where we need them to be.

In January, a constituent wrote to my office detailing the difficult experience of waiting too long for an ambulance to arrive. This 85-year-old gentleman came downstairs at 10 am to find his 82-year-old wife, who suffers from advanced dementia, lying on the hardwood floor, covered in blood, crying and confused. He managed to get her into a chair, calm her down and call 999. The operator could not hear him properly because the phone service was bad, his wife was crying and trying to get out of the chair, and he was struggling. Eventually, he was told the ambulance would be there in 12 hours. The ambulance did eventually arrive, and his wife is now in a stable condition, but that was a traumatising experience for her and the 85-year-old man. I was sorry to read that harrowing tale, and tales like it are too common across the country. I am interested in what the Minister will do to improve the situation; it is easy to say that things are not where they need to be, but it is important to consider how one can improve them, and that is what I hope to hear from her.

Of course, the pandemic threw everything off kilter, and demand for ambulance services rose significantly, with almost 3 million calls in March 2020. In 2022-23, an extra �150 million was allocated to improve ambulance response times through extra call handler recruitment and retention. In January 2023, to improve performance further, the last Government published an urgent and emergency care plan, which set out ambitions to improve average ambulance response times for category 2 incidents to 30 minutes over 2023-24, with further improvement in 2024-25 to get back towards pre-pandemic levels. The plan aimed to increase ambulance capacity by making over 800 new ambulances available during 2023-24, including 100 new specialist mental health vehicles for those who require different types of service. However, in December 2024, under this Government, ambulance response times rose to an average of three hours and two minutes for category 3 calls�category 3 covers elderly people who suffer falls but not a head injury. What steps will the Government take with NHS England to reduce those response times so that people are not waiting hours in pain and discomfort?

I have said to the Minister that it is important that we talk about how we can improve things, as well as about what the problems are. It is crucial that we all do that, and one suggestion from my hon. Friend the Member for West Suffolk (Nick Timothy) was co-located blue-light services�I am sure he is aware that the first such services were opened not long ago in Lincolnshire. The blue light hub tri-service centre, in the Lincoln constituency, is a co-located site, and co-location is leading to improvements in services. Although that is not my constituency, I am sure the hon. Member for Lincoln (Mr Falconer) would be open to an approach if my hon. Friend wished to see the site.

It is important to look at risk all along the pathway. We have talked about handover delays, but there is a whole pathway from the moment someone calls 999 to the transfer journey, the wait to get into A&E and then the wait in A&E. The risk is clearly highest at the point where someone has called 999 but does not yet have access to on-site or in-person medical care. To improve that, we need more ambulances on the road and fewer sat outside A&E.

I have some questions for the Minister. Ambulances are double-crewed�there are two people in the ambulance �but do two staff need to stay with the patient? If two ambulances have arrived, each with two staff and one patient, could two of the four crew go off in one of the ambulances to see more patients? That would avoid a situation where there are two staff per patient in the ambulance, when many patients are not that unwell medically. Nursing in intensive care is only one to one, but we are providing higher levels of care than that with these staffing ratios. Is that necessary?

We also have a delay in handover�in getting people out of the ambulances�because the A&E is said to be full. The front door is open, but the back door, for people coming in an ambulance, is in effect closed. If patients got out of the ambulance and walked round the building to the front door, they could go in and be triaged as normal. It does not make sense. Some of my medical colleagues have gone to see people in the ambulance and discharged them from there, without their needing to come into the hospital at all. So there are clearly people with a level of medical acuity that would potentially allow the crew, with guidance and training, to discharge them into the front door of the hospital instead.

On another question, if some people are well enough to be discharged from ambulances, are the public sufficiently aware of what constitutes a necessity when it comes to calling an ambulance? How many ambulances that are called are necessary? One would not wish to deter anyone who is frightened and concerned for their wellbeing from calling an ambulance if they feel they need one, but education on when one is needed might be useful.

As has been alluded to, staff retention is also important. One o constituent�a single mum with children�left her role as a paramedic because she was struggling with working hours that overlapped with getting her children ready for school in the morning. She was able to cover most other aspects of childcare�such as picking them up from school�with after-school clubs and the like, but she struggled in a morning, and her flexible working request was refused. I recognise that there must be balance, and that all hours of the day must be covered by ambulances, but has the Minister thought about how working practices and hours could be changed?

The Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), mentioned resources in rural areas. That is important because response times will necessarily be increased by the geography, so greater levels of resource perhaps need to be provided to rural areas, in recognition of the fact that if we want response times in them to fall, we need a higher level of ambulance availability.

Another significant factor causing delayed ambulance response times is staff sickness, which is not necessarily an issue of NHS funding. Ambulance services in England report the highest level of sickness absence rates of any other profession across the NHS. Against a national average absence rate of 4.3% over an eight-year period, ambulance staff showed an average absence rate of 6.2%, with year-on-year increases. There are stark regional differences in sickness rates, with the West Midlands Ambulance Service consistently maintaining a lower absence rate�around 50% lower than its counterparts in London or the east midlands. The NHS would benefit from sharing best practices between trusts, which would make a real difference, ensuring a healthier workforce and, ultimately, better patient care. The issue is also costly financially, and an independent review published by Lord Carter in 2016 estimated even then that a mere 1% reduction in staff absences could save ambulance trusts up to �15 million a year. That figure would clearly be even higher now.

I also want to raise the issue of air ambulance services. Air ambulance charities deliver lifesaving treatment every single day and complete more than 25,000 lifesaving missions across the country every year�an average of more than one every 10 minutes. I commend the work of all those involved, and particularly Lincs & Notts Air Ambulance, which operates in and around my constituency, the crew who airlifted my husband from Silverstone to Coventry last year and looked after him so well.

In the last Parliament, the previous Government gave significant support to air ambulances. The Department of Health and Social Care�s three-year capital grant programme in 2019 allocated �10 million to nine charities across England. That funding supported air ambulance charities to move towards 24/7 operations and improved seven airbase facilities across England. However, services are now under threat from the Chancellor�s rise in national insurance and taxes. Lincs & Notts Air Ambulance will need to find another �70,000 just to pay the national insurance rise�this is an entirely charitably funded organisation. Can the Minister justify that policy, given the vital work that air ambulance charities do across the country?

On 19 November, my right hon. Friends the Members for Newark (Robert Jenrick), for Gainsborough (Sir Edward Leigh), for South Holland and The Deepings (Sir John Hayes) and for Louth and Horncastle (Victoria Atkins), my hon. Friends the Members for Rutland and Stamford (Alicia Kearns) and for Grantham and Bourne (Gareth Davies), the hon. Member for Boston and Skegness (Richard Tice) and I wrote to the Chancellor to ask about exemptions from the national insurance hike for air ambulances. Despite raising the issue at Treasury questions and in a point of order, and despite repeated chasing from my office, we have not had the courtesy of a proper response to our letter from the Government, although they have suggested that they are now asking the Department of Health and Social Care to respond to the letter. That is a huge discourtesy to the House, and I would be grateful for the Minister�s assurance, because the letter is apparently with the Department of Health, that we will receive a response by the end of the week. That is quite a reasonable request.

Finally, it is fair to say that ambulance crews are doing a sterling job, but that response times are not where we need them to be. I look forward to hearing the Minister tell us how she will improve those services for our constituents.

--- Later in debate ---

[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.