Ambulance Response Times

Christine Jardine Excerpts

Thursday 6th March 2025 Westminster Hall

[Sarah Dyke]

I thank the hon. Gentleman for his intervention. I will come to that point a little later.

With the stark realities facing people in an emergency and the distressing sight of ambulances backed up at hospitals now commonplace, leaving my constituents in Glastonbury and Somerton in despair, it is time to properly address these failures. The NHS standard contract states that handovers between ambulance and emergency departments should be 100% within 60 minutes, 95% within 30 minutes and 65% within 15 minutes, but these targets are left unmet. Between October 2023 and June 2024, 3.7 million handovers took an average of 35 minutes and one second, resulting in over 900,000 hours lost. It is even worse in the south-west. In January 2025, over half the handovers took over 30 minutes, which is nearly 30% higher than the England average.

We in the south-west face specific issues due to our rurality. Analysis by the Liberal Democrats revealed that waits for life-threatening calls were 45% longer in rural areas than in urban areas. The South Western Ambulance Service has responsibility for the provision of ambulance services across 10,000 square miles, covering an incredible 20% of mainland England. Rural regions have a lower capacity to divert ambulances to other hospitals during periods of significant pressure, largely due to the vast distances between emergency departments.

We may now see ambulance teams in Somerset adopt a �drop and go� policy, which involves leaving patients in certain areas in a hospital without an official handover to A&E staff. The nationally defined target for hospitals included in the NHS standard contract states that after 15 minutes of waiting, the patient in the ambulance becomes the responsibility of the hospital. If no formal handover to A&E happens within 45 minutes, the ambulance crews can just leave the patient within the department and get back on the road.

The South West Ambulance Service is moving towards this approach with hospitals from Swindon and Bristol to Cornwall and Plymouth. Although this policy might alleviate some of the pressure on ambulance crews, it would fail to ease the struggles that underfunded and overstretched A&E departments in Somerset are facing. Somerset has an ageing population: within the next decade, one in three people in Glastonbury and Somerton will be 65 or older. That may make it harder to quickly discharge patients, as some may also require onward social care provision. It is inevitable, therefore, that delayed discharge due to internal processes such as waiting for pharmacy diagnostics and therapy assessments, and a lack of capacity in adult social care, will lead to poorer ambulance service performance. The social care crisis has a devastating effect on the healthcare system.

Last year, Care England said that

�over 45% of hospital discharge delays are linked to social care�.

One in seven hospital beds are taken up by people who are medically fit to be discharged. For patients, delayed discharge can lead to an increased risk of hospital infections and the loss of mobility or cognitive function, and can make it harder for them to regain their independence. The problems in the healthcare system will never be fixed unless we urgently address the social care crisis. Only last week, social care providers felt the need to protest against Government inaction for the first time ever.

The Liberal Democrats have been campaigning to fix social care by introducing free personal care based on the model introduced in Scotland, so that provision is based on need, not ability to pay. We also welcome the cross-party commission to forge a long-term agreement on social care, but we believe it can be completed within a year, not three. We cannot afford to kick this can any further down the road, and I urge the Government to listen to the Liberal Democrats� calls.

We also need to solve the hospital bed shortage in the UK. The lack of available beds negatively impacts hospital flow. As a comparison, the OECD EU nations have about five beds per 1,000 people, whereas the UK has only 2.4. The Royal College of Physicians revealed that four out of five doctors were forced to provide corridor care in the past month due to a lack of hospital beds. According to the Royal College of Emergency Medicine, bed occupancy is at a staggering 93%. The Liberal Democrats want to bring that down to a safe 85% by increasing the number of staffed hospital beds.

We are waiting for the Government to publish the urgent and emergency care improvement plan soon, along with the 10-year health plan. It is vital that we urgently wrestle with the problems that the Conservatives left behind to ensure the safety of patients. Over the past seven years, the previous Conservative Government were forced to find an average of �376 million of emergency funding each year to tackle the NHS winter crises. Under the Liberal Democrat proposals, a new winter taskforce would instead manage a ringfenced fund of �1.5 billion over the next four years to build resilience in hospital wards, accident and emergency departments, ambulance services and patient discharging. That would allow integrated care boards and NHS trusts to plan their budgets more effectively to prevent winter crises, instead of just receiving emergency funding from the Government at the last minute.

We urgently need to give our healthcare services the ability to forward plan. They must not be forced to deal with crises on the fly as situations unfold. Somerset�s ambulance services, like all services across the country, desperately need and deserve support. Localised data must be published to help pinpoint specific improvements that can be made in rural areas. The Government have outlined their desire to improve urgent and emergency care�they accept that ambulance waiting times are unacceptable�but now is the time to act to achieve those objectives; otherwise, more people will suffer and sadly some lives will be lost. That must be part of a serious rethink about the way we fund social care; otherwise, we will never move towards a solution that works.

[Christine Jardine (in the Chair)]

I remind Members they should bob if they wish to be called to speak in the debate.

[Jas Athwal (Ilford South) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Jardine. I thank the hon. Member for Glastonbury and Somerton (Sarah Dyke) for securing this much-needed debate.

It is incumbent on us to get the waiting times down to the level that we all expect because in a medical emergency every second counts. Every minute without the right care could mean the difference between life or death, independence or disability, full recovery or a lifetime of complications. Yet, across nearly all categories, ambulances are failing to meet their target response times. They are often stuck waiting instead of saving lives, held up by staff shortages or gridlocked outside hospitals with no beds to offload patients. I know this from personal experience because my health trust suffers from it more than most in London. We all have a stake in improving our NHS. We all want to see more beds, more timely treatment and a healthcare system that keeps our friends, neighbours and families healthier for longer.

Last year, Labour�s Budget unlocked �22.6 billion in funding for the NHS over the next two years to pay our doctors fairly, to provide critical hospital beds, and to end the backlog, but for emergency services there remains a critical issue that pumping money into the NHS alone will not fix: staff shortages. Paramedics have one of the highest turnover rates of any profession. Although the number of paramedics has increased since March 2018, absence caused by poor mental health has also increased and so has the number of staff leaving the field all together. Between 2022 and 2023, nearly 7,000 paramedics left their jobs�a 51% increase in leavers from 2019-2020. Without enough staff, ambulances cannot operate at full capacity and response times suffer.

In the current state of the NHS, paramedics are overworked, stretched to the limit and living with the consequences of underfunding and lack of support. Burnout is not just a risk; it is their reality. Who can blame paramedics for wanting to leave? Let us be clear: we have reached this point not because paramedics are not working hard enough, because they are, but because the emergency services have become a safety net. Without preventive measures such as screening, GP appointments or adequate social care, patients get treated only when their condition has escalated to a true emergency, putting undue stress on services. When patients can be treated only once their condition has become an emergency, it is a failure of the system and it increases pressure on our emergency services. It is a bad deal for patients and for those working tirelessly in our emergency services�a deal made possible by 14 years of Tory mismanagement, underfunding and neglect.

If we want better health outcomes and to meet our response time targets, we must make bold structural changes. We need to ensure that paramedics are not carrying the burden of overstretched services in every corner of the NHS. We must ensure that all parts of the NHS function well, from community screenings to adequate support for paramedics, who should be able to continue in their roles and not be driven out because the system has made it unbearable to stay. Every minute counts for overworked paramedics at breaking point and the patients who desperately need their care. I look to the Minister to do the heavy lifting and fix the broken system, which will be the difference between life and death.

[Christine Jardine (in the Chair)]

I call Nicholas Timothy.

--- Later in debate ---

[Warinder Juss (Wolverhampton West) (Lab)]

It is a pleasure to serve under your chairship, Ms Jardine.

NHS England has set ambulance response time targets since 2018. As the hon. Member for Glastonbury and Somerton (Sarah Dyke) indicated, there are four categories of severity for ambulance calls, each with a different response-time standard. In my Wolverhampton West constituency, ambulance response times are managed by the West Midlands Ambulance Service. The Care Quality Commission�s 2023 inspection of the West Midlands Ambulance Service resulted in a regulation 12 notice for response times.

I pay tribute to ambulance workers, who work very hard. When the ambulance was called for my parents, before they passed away, the ambulance workers were very diligent. They worked very hard and did their best for my parents.

I wish to address an issue raised by my hon. Friend the Member for Ilford South (Jas Athwal): mental health among ambulance workers. Sadly, it has come to my attention as the MP in Wolverhampton West that there have been cases of bullying and harassment among ambulance workers, with whistleblowers then being targeted by management. Although I appreciate that this is probably a discussion for another time, I want to emphasise that we need to protect whistleblowers in our health service. The wellbeing of ambulance workers will have an impact on ambulance response times.

The Black Country integrated care system covers my constituency of Wolverhampton West. On the four categories for ambulance response times, although the ICS�s response time for category 1 was found to be within target, the response times for categories 2, 3 and 4 were under target.

In January this year, the Secretary of State for Health and Social Care acknowledged that patients have been let down by ambulances that do not arrive on time, and that there is variation in performance across different parts of the country. He also mentioned the urgent and emergency care improvement plan, which is currently in production and will be published before spring 2025. I look forward to seeing the results.

The Government�s mandate to NHS England this year includes an objective to reform and improve urgent and emergency care. The mandate describes ambulance response times and A&E waiting times as unacceptable. NHS England�s priorities and operational planning guidance includes a national priority to improve A&E waiting and ambulance response times.

As a Government we have made excellent strides in reducing hospital waiting lists and making more hospital appointments available, and we have improved accessibility to GP appointments. In the same way as we have made strides in reducing hospital waiting lists and increasing hospital appointments, we must now make similar strides in improving ambulance response times.

[Christine Jardine (in the Chair)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Ms Jardine. I thank my hon. Friend the Member for Glastonbury and Somerton (Sarah Dyke) for securing this important debate and for opening it with, as usual, a thoughtful and well-researched contribution.

It is no surprise that Members have largely been in agreement in this debate, and they have made useful contributions, so I will quickly run through them. The hon. Member for Ilford South (Jas Athwal) importantly highlighted the issue of burnout and the impact of the current situation on hard-working staff in the ambulance service, and the hon. Member for West Suffolk (Nick Timothy) highlighted the huge regional variations and the inequality of service for people who live in very rural areas.

The hon. Member for Redditch (Chris Bloore) told a story�which would be familiar to people in Shropshire�of long handover delays; my hon. Friend the Member for South Devon (Caroline Voaden) mentioned the importance of dealing with stroke patients and seeing them quickly; and the hon. Member for Wolverhampton West (Warinder Juss), with whom my constituents and I share the West Midlands Ambulance Service, highlighted some of our concerns with that service as a whole.

I was first elected in the North Shropshire by-election back in December 2021. All that time ago, when my colleagues and I were out canvassing, it was extremely apparent that ambulance service delays were the No. 1 issue for my constituents. Every canvassing session we did, somebody heard an absolutely heartbreaking story of an ambulance delay that had led to a much worse outcome for a loved one, or possibly even a death. In all honesty, it was a shocking campaigning issue to have to focus on.

Almost a year later, after being elected, I completed a shift with West Midlands Ambulance Service in Shropshire, and I was blown away by the professionalism, dedication and hard work of the ambulance crew. But suffice it to say, the delays were still as appalling as they had been a year before.

Since then, there has been huge political turmoil, and that has not helped the situation. There have been four Prime Ministers, six Secretaries of State for Health and Social Care, and two Governments, and I am afraid to say we are still not seeing the improvement that we need. This winter, handover and waiting times reached the point where in some ambulance services people suffering heart attacks were at times advised to drive themselves to hospital. That is an unacceptable situation.

The most recent available data for my local ambulance service in Shropshire�the rural element of the West Midlands Ambulance Service�goes up to December 2024, and it still paints a stark picture of the distressing reality facing my constituents and people across Shropshire. The mean waiting time for category 1 callouts was 12 minutes 19 seconds, while the target is seven minutes. For category 2 callouts, the mean waiting time was 50 minutes and 36 seconds, while the target is 18 minutes. Those categories include callouts to people suffering from heart attacks and suspected strokes. For category 3 callouts, the mean waiting time was well over 200 minutes, and the target is an hour. After a long campaign, �21 million was secured to boost emergency care, and there has been improvement, but response times are still totally unacceptable.

At times, as many as 16 ambulances have been queuing outside the Shrewsbury and Telford emergency departments that serve my constituents. More than one in three ambulances have to wait for more than an hour to hand over a patient, and the longest wait was an astonishing 17 hours. Even this week, as we approach the spring, a constituent told me they had stopped to help an elderly lady laying on a cold pavement with a suspected stroke and had had to wait nearly an hour and a half for an ambulance or first responder to arrive. All the while, the lady�s breath become more and more shallow. This crisis is real, and it has not significantly improved.

Let us look at the national picture. The Darzi report found that each day in 2024 around 800 working days were lost to handover delays. However we cut that�14,000 paramedics a year; 112 years�it is just not acceptable. It is no surprise that people have lost faith in emergency health services as a result of the last Government�s appalling neglect of the NHS. The paramedics, nurses and doctors in our emergency departments go above and beyond, but they are stretched to breaking point and are unfortunately starting to leave the service because of burnout. We are campaigning to end excessive handover delays by increasing the number of staffed hospital beds and by tackling the impact of degrading corridor care.

Let me focus for a moment on social care. Crucially, A&E delays are often caused by an inability to admit patients because thousands of people are stuck in hospital every day when they would be better cared for elsewhere. Bed occupancy is well above safe levels in hospitals, and one in seven hospital beds are occupied by somebody who would be better cared for either in a care home or in their own home. Meanwhile, local authorities such as Shropshire are spending as much as 80% of their budget on social care. They are at risk of issuing section 114 notices as they are unable to cope any longer.

It is really important that we get on with the cross-party talks on social care and with the Casey review. We in the Liberal Democrat party absolutely welcome that, but we urge the Government to speed up the timetable and crack on with it as soon as possible, because 2028 is too late for a long-term solution for social care. The cross-party talks that fell through last week need to be reinstated. I urge the Minister to encourage the Secretary of State to do that as soon as possible.

Let us focus for a moment on the rural problem. Imagine an ideal scenario in which the issue of handover delays has been resolved, the urgent and emergency care plan has been successfully implemented and the 10-year plan has sorted out other issues across the NHS. For those who live near Oswestry, Whitchurch or Market Drayton in my constituency, the nearest community ambulance station has closed and the nearest station or hospital is well over 20 minutes away�that is, if the traffic is clear. Otherwise, if the response time targets for category 1 or 2 calls is to be met, they are reliant on a spare ambulance roaming free in the community, waiting for that call to come in. That is unrealistic. We would expect and hope that, in between calls, paramedics would go and have a cup of tea and a sit down, to decompress from some of the awful things they have seen that day, if they do not have a patient to go to immediately. Hopefully, they go back to the ambulance station in between call-outs.

The implementation of this centralised model across the country is detrimental to the people who live a long way from an ambulance station. It may well be efficient in urban areas, but it certainly is not working in rural ones. I hope the Minister will commit to reviewing the service that is received in rural places. There are thousands of people in large market towns. For example, Oswestry has nearly 8,000 residents, Market Drayton has more than 12,000 and Whitchurch has nearly 10,000. These people expect to receive an ambulance within the target time. I must urge the Minister to commit to looking at ambulance station provision in those areas. I also repeat my colleagues� calls for the Government to publish accessible, localised reports on response times and to create an emergency fund to reverse the closures of community ambulance stations that have already taken place.

The Midlands Air Ambulance Charity does fantastic work across the west midlands and is one of the busiest air ambulance charities in the country. It does not have an NHS contract; it is entirely reliant on the contributions of people living locally. I wonder whether the Minister might consider putting air ambulance services on a statutory footing, because we are so dependent on them, particularly when specialist hospitals might be a long way away and air ambulance crews supply specialist support to stabilise patients where they are found, at the roadside or in their home.

The situation is unacceptable, and I look forward to seeing the urgent and emergency care plan, which I hope it will consider the needs of rural areas. I must urge the Minister to look at social care, because that is one of the key things we need to do to fix the crisis in the NHS.

[Christine Jardine (in the Chair)]

I call the Opposition spokesperson.