North East Ambulance Service

David Anderson Excerpts

Wednesday 4th May 2016 Westminster Hall

[Mr David Anderson (Blaydon) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing this debate.

I declare an interest as a former chairman of the northern region of the National Union of Public Employees and as a former president of Unison. For 15 years I had the privilege of representing ambulance staff. I first became their representative a year after they were described by the right hon. and learned Member for Rushcliffe (Mr Clarke) as little more than glorified taxi drivers. We were in the middle of an ambulance dispute at the time, so he probably did not really mean what he said, but there is one thing for sure: the staff are true professionals trying their hardest against insurmountable odds to try to deliver the quality public service that we all rely on, and it was to them I turned for this debate.

A constituent of mine retired from the ambulance service last year due to stress-related illness. I asked him, “What is the picture today? Can you give us some idea?” and he sent me an email this morning in which he said a number of issues have been going on for quite some time. He said that there is huge pressure on the services, especially over the winter period, and they ask the public to call only in genuine emergencies. Increased waiting times outside A&E hold up crews continually. The shortage of funding and paramedics results in long waiting times for patients. He goes on to say that they rely on charities to supplement the shortfall. They recently had to call on a charity to supply volunteer doctors over Easter to help with the response to the most urgent calls. There is a shortage of at least 15% of qualified paramedics and a large increase in the use of private companies, but the capabilities of such staff are not known. According to Unison, staff stress levels have increased and 90% of staff say they have suffered work-related stress owing to long hours and staff shortages. One member is quoted as saying that the levels are dangerous. There is also the ongoing issue of the Government continuing to put pressure on people whose morale is low by keeping in place an eight-year public sector pay freeze. People doing very important work are being penalised for doing it.

Like my hon. Friend the Member for North Durham (Mr Jones), I asked my office to give me a snapshot of the information that people have been feeding to us. I will quote from some emails. Pam, who lives in my constituency, wrote:

“Hi Dave, developed a problem with my left leg which according to 111 merits an emergency ambulance to take me to A&E. I have had a phone call from a paramedic apologising for the delay but please can you tell the Tory toffs that I have waited 2 hours for this ambulance and still no signs.”

Someone from Swalwell, near the very busy A1 in my constituency, wrote:

“An old man, aged 74, had to wait (lying bleeding on the cold ground in the rain) for 80 minutes for an ambulance. He fell just outside of my house...He was bleeding profusely throughout the entire 80 minute wait. Another neighbour repeatedly called for the ambulance and kept being told they were busy and that ambulances were being diverted to more urgent cases. We were unable to move the gentleman because of the amount of blood he was losing and also we weren’t sure if he had broken anything. He was cold and uncomfortable lying on the wet pavement. I brought out pillows and blankets. Other neighbours brought out bandages and towels and held umbrellas over him. I ended up calling a friend of mine who is a nurse, specialised in head injuries. She arrived very quickly and was able to work out that he was bleeding so heavily due to medication he was taking which was stopping his blood from clotting.”

She concludes:

“I understand there are limited resources but an old man lying in the rain bleeding heavily should not be left for so long. By the time the ambulance arrived, his wife was feeling dizzy and struggling with...shock.”

A 76-year-old went to a councillor’s surgery in my part of the world. She told the councillor that she had had to wait an hour and a half for an ambulance and that when she was contacted she asked why she could not go to the hospital in Hexham, which is closer and where she would normally go. She was told that she was not allowed to go there. She had to go to the Queen Elizabeth hospital, which is at the other end of the A1 and in rush hour is a nightmare to reach. However, they insisted, so she had an hour and a half of waiting and then went to a hospital that made the wait even worse.

Another constituent, Mrs Waller, wrote:

“I recently contacted your secretary...regarding my husband...who is a palliative patient, he had a fall in the bathroom 14th March at 10.05 am and it was 15.20pm before an ambulance arrived. I rang 999 which was the advice given if this ever happened, I had to make a further two calls and my husband’s palliative nurse also made a call as well”,

as did my secretary from my office.

“I do not wish to have a go at the ambulance service but this is the problem that Mr David Cameron has caused due to the cutbacks in the NHS. No one should have to spend almost five and a half hours on a cold wet room floor. There was no way I could get my husband up due to his reduced mobility because of his cancer.”

The North East Ambulance Service is in the Minister’s remit. Basically, she is presiding over unmanaged decline. A hands-off attitude is unacceptable and not worthy of such a cherished institution. My hon. Friend the Member for North Durham spoke about the people who created the health service: the people who can remember what it was like before 1948 and how desperate it was. They have paid into the service all their lives and it is a cherished institution in this country, yet it is being rubbished because of the failures of the service that is in place. We must give the people who run and work in the service the chance to get it back where it was. The Minister needs to talk and listen to the people on the frontline.

Also, we need to listen to the people who pay for the service and for all of us to stand here and talk about it. They are the people who are important in this debate and they are the people who are being let down. The Minister needs to take action and put the ambulance service right.

--- Later in debate ---

[Jane Ellison]

Indeed. I have very much taken that point on board and I will try to respond, but if I do not do so today, I will certainly write to the hon. Gentleman, because it is a fair point. The more general point is where the ambulance service sits in terms of our response and general position on urgent and emergency care. I will respond to some of the points made by my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan), because I think that this sits within a wider, systemic challenge and I want to touch on that.

Every patient should expect to receive first-class care from the ambulance service, but the nature of emergency response work means that there will always be incidents in which unfortunate timing leads to a person assessed as being in a non-life threatening situation calling 999 at the same time as several other people who are in life-threatening situations. I am sure that hon. Members are realistic about that, but clearly we do not want to hear about such problems occurring on a very regular basis. Where that does occur, obviously the life-threatening situations must be prioritised and resources focused on those calls. Very rarely—unfortunately, we have heard about such cases this afternoon—waits may be unacceptably long. I do not shy away from that, but it is important to remember that the vast majority of people receive a timely response when they dial 999.

I have already said, echoing the words of the hon. Member for Washington and Sunderland West (Mrs Hodgson), who led the debate, that although the NEAS has not met the performance targets, that does not reflect on the hard work, dedication and skills of the local staff. A number of speeches brought that out. I am advised that although ambulance delays are the main reason for patient complaints, the number of complaints received in 2015-16 fell, but we do not want any complaints; that would be the situation in an ideal world. However, the fall is indicative of the fact that the efforts of the local ambulance staff are paying dividends. Although the performance target is effective in driving improvements and maintaining response times to the most critically ill and injured patients, it does not, inevitably, paint the complete picture of how a trust is doing.

I will talk about some things that the North East Ambulance Service, has put in place to bring about improvements to service, because that is the focus of the debate and people want to hear that the direction of travel is positive. The NEAS continues to expand the number of specialist clinicians working in its clinical hub who can provide telephone assessment and advice, and who can prevent the dispatch of an emergency response if it is not deemed necessary. That goes to one of the points made earlier. The trust expects that that will have a positive effect on response times.

Last winter, the NEAS piloted an end-of-life-care transport service, which provided three dedicated ambulances that were on call to respond to transport requests from healthcare professionals to take a person to their final place to die. The scheme has meant that emergency ambulances are not tied up in transporting patients when they are needed for more serious cases, and that terminally ill patients are not waiting a long time for transport to their preferred place of death. Although we do not often like to talk about end-of-life care, the preferred place of death is an important part of reducing stress at an inevitably very difficult time for an individual and their family. Results from the pilot were overwhelmingly positive and eased pressure on vital services.

Hon. Members have raised valid concerns about handover times between ambulance crews and emergency departments in the local area, and that is an issue across the country. Patient handover needs to be as efficient as possible to achieve the best possible outcome for the patients and to free up ambulance resource, but more can be done and is being done. Measures include hospital ambulance liaison officers, which are being put in place by the NEAS. HALOs are present in hospitals across the trust territory and I am advised that the trust has sought to make use of dedicated ambulance resource assistants as well.

The urgent and emergency care vanguard programme in the north-east will include the development of a standardised handover process for all acute providers, intended to minimise delays across the patch. That goes to the shadow Minister’s point about looking at the wider system. That will be to the benefit of crews and emergency departments. I understand that, as part of the vanguard, the NEAS also hopes to secure funding for a new “flight deck” information system that will enable diverts by ambulance crews to other hospitals to be proactively managed and will prevent ambulances from stacking up outside already full A&E departments. The trust believes that those initiatives will help to distribute A&E workload evenly and will be welcomed.

Several hon. Members have rightly commented on the recruitment challenge. It is very much recognised that there is currently a shortage of paramedics nationally and the NEAS trust is no different. We recognise that front-line staff are the vital component of a safe, effective and high-performing service, and work is being done by the NEAS to rise to the recruitment challenge. The hon. Member for Washington and Sunderland West mentioned some things that are being done. Efforts include developing new advanced technician roles to support front-line services, and the trust is running a substantive recruitment of paramedics nationally and internationally.

The trust expects 77 student paramedics to graduate by February 2017, in addition to recruiting an additional 36 qualified paramedics in 2016-17. The trust has also recruited a total of 56 emergency care clinical managers, and that represents a significant investment in front-line clinical leadership. It also advises me that it expects to be up to full paramedic establishment by April 2017. I know that that commitment will be keenly watched by hon. Members.

[Mr Anderson]

Ambulance staff, along with other public servants, have effectively had an eight-year pay freeze. Their standard of living has gone down every year for the past eight years. Comparative jobs, particularly in the private sector, have not seen that level of control. There have also been pointers that the situation will not be alleviated in the next two or three years at least. Does the Minister not see that as a real reason that people will not come into the job? Yes, it is a vocation, but people have to put bread on the table.

[Jane Ellison]

Of course I accept that issues of pay are incredibly important. Although we cannot go into the wider economic picture, I gently say that the previous Government and this Government have made reducing the tax bill for some of our lowest paid public servants a huge priority. A huge amount of money is being spent on raising the threshold and that has made a huge difference to people’s take-home pay and standard of living. However, I hear the hon. Gentleman’s point.

I am encouraged that the trust is looking to the future by doubling the number of places on its two-year in-house graduate training programme. Hon. Members have made several thoughtful points regarding some of the wider issues around recruitment and retention. Maintaining staff morale has been mentioned. That is very important and the trust is looking at whether things could be done, other than pay, to attract and retain paramedics. We are looking at that nationally. The debate sits in the context of urgent and emergency care.