Ambulance Waiting Times: Royal Cornwall Hospital

Cherilyn Mackrory Excerpts

Wednesday 29th June 2022 Commons Chamber

[Cherilyn Mackrory (Truro and Falmouth) (Con)]

This issue of ambulance waiting times at the Royal Cornwall Hospital is vital to my constituents and the whole of Cornwall. I want to start by thanking all health and social care colleagues for their hard work. They work with such professionalism, dedication and selflessness, despite being short-staffed and under immense pressure. It is telling that the constituents who write to me on these issues include praise for the staff who have helped them with such compassion and care in their time of need. Over the past 12 months, I, alongside my five Cornish MP colleagues, have had many meetings with NHS leaders and other Cornish healthcare stakeholders to discuss these challenges. We have also written to Ministers to highlight individual cases and the wider situation on numerous occasions, and I appreciate this opportunity to again highlight the situation in Cornwall to Ministers.

Ambulance waiting times at the Royal Cornwall Hospital are an increasing concern, with the hospital recently recording the worst ambulance wait times in the country, topping the list for the proportion of arrivals that were delayed by more than an hour, at 41%; this represents 10% of the wait times in the whole of England. There is widespread consensus that ambulance response times are slow in Cornwall due to handover delays. The Royal Cornwall Hospital has the highest percentage of handovers over 60 minutes, at 25%. That is particularly concerning, given that the NHS standard contract states that all handovers of patients between ambulances and accident and emergency should take place within 15 minutes, with none taking more than 30 minutes. These handover delays of over 15 minutes have contributed to an average of 255 ambulance hours lost every day in May. I receive several emails each week from constituents who have experienced these delays first hand. One such constituent wrote recently that they were transferred by ambulance to the RCH in the early afternoon. On arrival, there were 15 other ambulances already waiting for their patients to be admitted. During the afternoon, evening and night, they were transferred to five other ambulances and crews. The various categories of ambulances offered stretcher beds of varying levels of discomfort, and there was a shortage of blankets, no access to food and no toilet facilities. They were eventually admitted to the emergency department at around 5 the following morning.

Delayed handovers result in poorer ambulance response times, as ambulances queue outside A&E unable to attend patients waiting in the community. That leaves patients at increased risk of delays in diagnosis and treatment, and compromises the ability to respond to serious incidents. These delays also increase pressure on clinical staff and on ambulance service call handlers, who look after distressed patients and their families, who call again and again, desperate to hear their wait time. That can lead to thousands of additional calls, placing even more pressure on the service. Constituents have told me that they have waited 13 hours for an ambulance and that they have called many times in the interim to chase an update on the expected arrival time.

Let me be clear: these delays are not to do with ambulance service call handlers; they are a whole-system issue and are impacted by acute challenges elsewhere in the system, particularly with hospital capacity and patient flow. The issues include delayed discharges to social care and other services, as well as bed occupancy. As such, a whole-system approach is needed to tackle this issue.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

This issue is important not only in Cornwall but in Plymouth, because Derriford Hospital serves part of Cornwall, providing some of the ambulances she mentioned. She is right that this is not the fault of the people who drive the ambulances or who dispatch them, but does she agree that it is utterly unsustainable that many ambulance crews may get only one shout per shift, because they spend the remainder of the shift queuing outside an emergency department in Cornwall or Plymouth waiting to hand over their patient? That is simply unsustainable if we are to have the NHS recovery we need in the south-west.

[Cherilyn Mackrory]

I thank the hon. Gentleman for his intervention, and he is absolutely right. He will know that, purely because of their geography, hospitals in Cornwall and Devon rely on each other, and the ambulance crews go between the two. He is also right that this is a multifaceted issue. Hopefully I will cover most of it in my speech and the Minister will respond knowing that there are many things we need to do to try to tackle it.

In Cornwall the capacity challenges stem partly from the hangover from the covid-19 restrictions. Predominantly, however, they are about staffing, which hinders our social care system’s ability to safely assess and care for patients at the rate necessary to clear the beds in the hospitals. On a single day last month, 190 beds in Cornwall were occupied by patients awaiting discharge into social care. Those patients had no medical need to be in those beds. Thankfully the number has now fallen below 130, but the issue remains that too many people are staying in hospital beds because of discharge challenges.

In March the Care Quality Commission inspected the whole of the Cornwall and the Isles of Scilly urgent and emergency care system. The report states:

“Delays in ambulance response times in Cornwall are extremely concerning and pose a high level of risk to patient safety. Ambulance handover delays at hospitals in the region were some of the highest recorded in England. This resulted in people being treated in the ambulances outside of the hospital, it also meant a significant reduction in the number of ambulances available to respond to 999 calls. These delays impacted on the safe care and treatment people received and posed a high risk to people awaiting a 999 response…Delays in discharge from acute medical care impacted on patient flow across urgent and emergency care pathways. This also resulted in delays in handovers from ambulance crews, prolonged waits and overcrowding in the Emergency Department due to the lack of bed capacity.”

The report goes on to state:

“Without significant improvement in patient flow and better collaborative working between health and social care, it is unlikely that patient safety and performance across urgent and emergency care will improve.”

That is key. Although we have seen some pilots and seen community services adapt to meet changes in demand, additional focus on health promotion and preventive healthcare is needed to support people to manage their own health needs.

The report also identified that adult social care in Cornwall has had one of the highest short staff shortage rates in the entire country. That directly affects the ability to discharge patients into the social care sector, as well as A&E and ambulance response times.

[Richard Foord (Tiverton and Honiton) (LD)]

During the by-election campaign in Tiverton and Honiton, almost everybody I spoke to on the doorstep had their own personal story about having to wait for an ambulance. This is not the fault of ambulance crews, but it is absolutely the system-wide issue that the hon. Member describes. Does she agree that what we really need is a community ambulance fund to alleviate some of the pressures we are experiencing in the south-west, given that we have the longest ambulance waiting times in the country?

[Cherilyn Mackrory]

I thank the hon. Gentleman for his intervention, and welcome him to the House for his first contribution. He will be aware that the CCG is responsible for distributing and commissioning services within his area. Therefore, this is not something that Ministers should have to implement. He should lobby his own CCG if he thinks that that is a beneficial service for his area.

The report also identified that adult social care in Cornwall has one of the highest rates of staff shortages in the entire country. It is right that the hospital has a comprehensive handover delay improvement plan that aims to maintain patient safety, to ensure the health and safety of trust staff and to promote effective joint working. These will cover key areas including: incidents management; reporting and external reviews; internal and external communication; data quality; and joint handover escalation plans.

The CCG is also taking positive action, working with the Conservative Cornwall Council, to use commission spend to try to bring more reablement workers online with more flexible care across Cornwall. In addition, it is plugging gaps in domiciliary care in central and mid-Cornwall, and in district nursing teams. Seventy five reablement workers will come online from November, and they are working with Health Education England to transfer their apprenticeship levy so that it is possible to employ even more people across Cornwall.

The CCG is also identifying young people who might want to stay in Cornwall. It has been learning from the work on recruitment fairs of the University Hospitals Plymouth NHS Trust, which is in the constituency of the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard), and which has successfully attracted young people in Plymouth wishing to remain in the area.

In addition, the CCG is ensuring that joined-up, accessible care in local communities is treated as a priority, responding to local needs with the inclusion of NHS services, organisations and charities. The new integrated care board, which meets for the first time on Friday, will utilise existing assets in the community to improve the availability of care services.

It is also right that the providers of the Integrated Urgent Care Service have been commissioned for a six-month pilot to test new methods for handling incoming calls. This involves ensuring that low priority calls are being assessed by a clinician, such as a GP, and in turn being directed to the most appropriate setting for treatment and care. The initial phases of the pilot have provided a clear demonstration of positive outcomes for patients, showing a 71% reduction in the need for ambulances, so it is right that it is upscaling this approach to continue to reduce demand on the ambulance service.

Another trial aims to remove ambulance need for non-injury falls, by ensuring that calls are pulled from the call stack and passed to the IUCS call centre in Truro, where a dispatcher can dispatch a resource from the independent ambulance service. This means that where someone has fallen but is not at risk from an injury that might mean they should not be moved, they are attended and settled into a more comfortable place within their own home. They then have a follow-up referral with a community team, which aims to identify why they fell, allowing it to put in place safeguards to prevent reoccurrence. Early data has shown that, in positive cases, where paramedics have responded and assessed, the person is placed back in bed in their own home within an hour.

I am also pleased that the CCG is working on the vital development of facilities at Bodmin Hospital, including the development of the urgent treatment centre, the community assessment and treatment unit and the diagnostic hub, which will all contribute to reducing the care pressures that Cornwall faces and the pressure on the RCHT.

The next few weeks see the standing down of the CCG and the standing up of the integrated care system, which will provide a much more collaborative approach to the healthcare system. As a new MP, I will be grateful for that, because, learning on the job means that we have to learn what board does what, and now there will be just one board that is accountable. I am also grateful to the Government for already taking a range of actions to tackle this issue. In 2020, I was delighted that the hospital had £42.5million-worth of debt written off as part of the Government’s announcement to reset NHS finances. After NHS England announced its goal for a seven-minute average for ambulance response time, the Government stepped in with a £55 million investment in the NHS, helping to provide 700 additional staff in control rooms and on the frontline to improve response times.

That is alongside £4.4 million to keep an additional 154 ambulances on the road over the winter. In addition, NHS 111 is recruiting an extra 1,100 staff. Moreover a £250 million winter GP capacity fund will help to avoid unnecessary ambulance calls and visits to A&E. The Government are also right to have taken the difficult decision, which was unpopular in some corners, to implement the 1.25% health and social care levy, raising £12 billion a year on average over the next three years to fix the social care crisis.

Despite that progress, we still have an alarming situation, which is why the Government must look at all options to tackle the problem. They must look urgently at tackling the staffing shortages preventing us from moving patients out of hospital beds and into domiciliary care. Constituents who are already being cared for at home are seeing a reduction in care packages due to staff shortages, which will clearly have a cumulative effect on trying to discharge hospital patients.

Cornwall has recently been found to have the country’s most understaffed social care system, with ongoing challenges around recruitment and retention. Employers in the space compete for staff with the hospitality and retail sectors, with cost of living increases and housing affordability and availability problems adding to the weight of issues. I should add that that was the case before the pandemic, but it has been compounded by the effect of covid and we see it acutely now.

We must advertise care as a profession and a career path, not just a job. We should look at creative new measures to make the profession more attractive, improve the workplace culture, tackle burnout and offer higher salaries. We must also ensure staff can afford to rent or buy affordably in the area by tackling the housing crisis and promoting key worker housing. The Government must also recognise the challenges of rurality, an ageing population, higher demand for services and the hangover from covid, which have all contributed to this issue. I believe we should also increase the number of first responders in rural areas and look at the model of the parish nurse; both are vital to the local village I live in.

Reducing ambulance waiting times at the Royal Cornwall Hospital is an urgent issue for the people of Cornwall. I look forward to working with the Government on a range of solutions available to improve the situation, and of course the Minister is always welcome to come and visit.