East of England Ambulance Service

George Howarth Excerpts

Tuesday 25th June 2013 Westminster Hall

[Mr Henry Bellingham (North West Norfolk) (Con)]

I congratulate my hon. Friend the Member for Witham (Priti Patel) on her characteristically candid and very well-crafted speech. She speaks for many of us in expressing those strong arguments.

Like my hon. Friend, I pay tribute to the paramedics, drivers and engineers—the people at the sharp end—because they have done a consistently good and professional job, despite poor leadership; they have not had the backing that they deserve. I also join her in paying tribute to the Minister’s ministerial colleague, Earl Howe, who has been very attentive to our concerns throughout.

Dr Marsh’s report is well researched and impressive. If the report has one compelling conclusion, it is that the crisis in the ambulance service trust is the consequence not of a lack of resources, but of a lack of leadership, vision and strategic direction. The comparisons that he draws with West Midlands Ambulance Service NHS Foundation Trust are pertinent, because it is a trust with a similar population base—the population is obviously more urban—that faces similar challenges, but it has met those challenges through strong direction and leadership throughout. That is why the West Midlands Ambulance Service NHS Foundation Trust is at the top of the pile. Unfortunately, our trust is down at the bottom.

I agree with my hon. Friend the Member for Broadland (Mr Simpson), who said in his important intervention that recently, over a number of years, a management culture has emerged in the East of England Ambulance Service NHS Trust that basically deems second best to be acceptable, and consequently action that should have been taken has not been taken.

If the trust was an alternative investment market-listed company that had gone into crisis mode, the non-executive directors would have resigned on principle; if the trust was a company listed on the main stock exchange, the directors would have had to resign. It is staggering that they have somehow decided that it is okay to cling on to their jobs and stay, despite the complete lack of oversight of corporate governance and the failure to adhere to the combined code. As I understand it—the Minister will correct me if I am wrong—the non-executive directors are responsible under the combined code in the same way as directors of public companies. The trust is obviously not a public company, but it has the same corporate governance rules. Notwithstanding the fact that it is a different organisation, the non-executive directors have that responsibility. If they had any integrity, they would offer their resignations.

I hope the Minister is able to tell us that she will advise the non-executive directors, with the approval of the Secretary of State, to resign before tomorrow’s board meeting. It is no good for the interim chairman, Dr Harris—there is a whole lot of management speak here—to review the board members’ benchmarking against leadership criteria, etc. What the hell does that mean? Basically, the board needs reconstituting, and it needs reconstituting very soon. Will the Minister give us some insight into what her Department is doing to try to bring new blood—people with real ability, not jobsworths who simply get recycled around one public board after another—on to such boards?

Just as the trust has fallen way down to the bottom of the league, King’s Lynn and west Norfolk is unfortunately lagging behind the rest of East Anglia. I find that very worrying. Obviously, I accept that, in remote rural areas, there are some hamlets and remote communities where it is physically impossible for an ambulance to reach a patient within the targets. We know that. There are some places in my constituency, and in the constituencies of many of my colleagues here today, where that is absolutely impossible, even with the best will in the world. There might be a coincidence in which, for example, an ambulance is going along a main road at a particular juncture, but achieving the target may well be impossible, so it is even more important that the targets are met in the towns and bigger communities, where it might be thought perfectly reasonable to expect ambulances to get to a call within the target time in 95%-plus of cases. Unfortunately, the targets are not even being met in the towns in my constituency.

I have been given permission by my constituent Mrs Delna Barrett to refer to her case. Her husband, Chris, had been suffering from Parkinson’s disease for some 20 years. He stopped breathing in a restaurant in Hunstanton, which is the second-largest town in my constituency, and it took the ambulance more than 20 minutes to arrive. Despite numerous resuscitation attempts, he died in hospital two days later. We do not know whether, if the ambulance had arrived within the target time, he would have had a better chance of surviving. The family are not criticising the paramedics or the staff, but the bottom line is that the ambulance did not arrive within a reasonable time.

We know that many difficulties are caused by the problems at A and E, to which my hon. Friend the Member for Witham alluded in her excellent speech, and we know that those problems have been around for quite a long time. There certainly are problems at the Queen Elizabeth hospital in my constituency, and there are problems at the Norfolk and Norwich hospital, where at one stage back in March all 17 of the trust’s ambulances were tied up waiting outside. All that is well documented, and it is not entirely within the purview of this debate, but we cannot consider the problem of the ambulance trust in complete isolation; we must consider out-of-hours services and out-of-hours cover.

Very often, individual family events bring home to us the different parts of the health service that are perhaps in need of improvement or are examples of best practice. Some 20 years ago, I was staying with my mother near King’s Lynn, and at about four in the morning she banged on my door and said that she was dying. She was in the most appalling pain—absolute agony. My mother is a war veteran who was in the Women’s Royal Naval Service. She is a very tough person, and she never complains about anything. She told me that she was in complete agony and could not move. I rang the local doctor, who came out within 20 minutes. He said, “You have kidney stones, and I am going to give you an injection that will put you asleep until tomorrow afternoon. I will then come back and we will take stock of the situation.” He gave her some more injections the following afternoon. The stones were broken down, and she did not even have to go to hospital.

If my mother knocked on my door now, what would I do? Obviously, I would dial 111 or 999, but so risk-averse are all those call centres that she would undoubtedly have gone into A and E. I would not have been happy with any advice from someone who did not know her medical records. The key to her treatment by the local doctor was that he knew her medical records and understood that she might be prone to that problem.

We must sort out the out-of-hours cover. We cannot go back to what we had before, when each doctor’s surgery provided out-of-hours cover, but the idea of co-operatives and mergers between GP practices to provide cover and ensure that the people who deal with patients out of hours understand their medical records and are prepared to provide service is key to sorting out the problem. Otherwise, given that the population in some parts of the country is growing, that people are living longer and that many more people have challenging illnesses and a multiplicity of problems, more and more people will have out-of-hours difficulties. Unless we sort out the out-of-hours service, we will have more and more problems.

[Mr George Howarth (in the Chair)]

Order. The hon. Gentleman is straying somewhat from the theme. I realise that it is a related matter, but he should return the discussion to the ambulance service.

[Mr Bellingham]

I shall do so immediately, Mr Howarth, as that is the topic of the debate. However, I wanted to put it into that context, because we cannot consider the ambulance service in isolation.

In conclusion, there is a great deal of concern throughout the region, but we take the view that the problem can be solved through new leadership if management get a grip, put common sense first and, above all, bring out the best in the people at the sharp end, who serve our constituents and take great pride in doing so. Those people set high professional standards. Given the right management, they will do the job to a high standard and give our constituents the ambulance service that they deserve. This is a turn-around situation. I wish the interim chairman and chief executive all the best in sorting out the problem. However, they require the Minister’s assistance and support, and her first step must be to grip the decision of the non-executive directors. She must then work closely with the management team to ensure that the trust is turned around for the benefit of our constituents, who deserve better.

[Several hon. Members rose—]

[Mr George Howarth (in the Chair)]

Order. We have four further speakers. If Members take about six minutes each, we ought to be able to get everybody in, which is my aim.

--- Later in debate ---

[Robert Halfon (Harlow) (Con)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I give my sincerest congratulations to my near neighbour and hon. Friend the Member for Witham (Priti Patel), who has led the campaign against the shocking performance of the East of England Ambulance Service NHS Trust.

The East of England ambulance service continues to give my constituents and me huge concern. As my hon. Friend said, however, I want to make it clear that those worries are not aimed at front-line staff, for whom I have nothing but admiration, especially the senior staff and the paramedics in Harlow. They do a tough job and give 100% to their work; I am proud that we have such extraordinary people living in Harlow and throughout the east of England. The staff, however, are lions being led by donkeys—that is the truth of the matter, as so brilliantly highlighted by my hon. Friend.

At the end of 2012-13, the East of England ambulance service had failed to reach its targets, whether for category A response times for calls to do with life-threatening situations, the less serious green calls or even the ability to pick up the phone on time. Not only is the trust failing to hit demanding targets, but my post bag is regularly filled with letters from local residents complaining about the service that they have received. I have also had staff contact me to complain that they feel they are offering an inadequate service because of the shocking performance of senior managers.

It is outrageous that when I have raised constituents’ problems with the ambulance service, it has taken an unacceptably long time to respond. For example, I wrote to the trust about a serious case in which one person had, tragically, died. The trust did get back to me and acknowledged that its response was unacceptable, contributing to the man’s death, but it had taken nearly five months to respond to my letter on behalf of the family—that is a disgrace.

We have to see change in three areas: we need better resources, targeted at delivering better patient outcomes; the management system urgently needs restructuring; and we need to show staff that they are valued, increasing their skills, so that they continue to make progress. Only by doing those things can people in Harlow and throughout Essex and the east of England get the treatment that they deserve.

For far too long, I have had residents contacting me about the poor level of service. Nearly all the concerns are focused on delays that their family or friends have suffered when waiting for an ambulance or during the handover time in hospital. A tragic case is that of cyclist Robert Tyler, who died by the roadside in my constituency after waiting 45 minutes for an ambulance, despite being only three minutes away from A and E. Sadly, such anecdotes are borne out by the statistics and, as I said, the trust failed to meet its operational targets last year.

I was glad to receive a letter from Dr Geoffrey Harris that claimed he is starting to see signs of improvement. I hope that is so, but on speaking to a worker from the ambulance service yesterday, it was troubling to hear that they felt that little had improved. The worker made the important point that we need more ambulances on the road, telling me that the rapid response vehicles were only being used to ensure that targets were hit. To deliver the best patient care, according to the worker, rapid response vehicles should be in addition to ambulances, not a replacement for them. That view is held across the trust, with more than 300 staff supporting a move calling on the management to claim the A19 target only when an ambulance arrives.

I was disturbed when a constituent told me about her 97-year-old mother who had fallen, hurt her leg and was unable to stand. The first responder arrived quickly and provided good care, but because no ambulances were available, my constituent was left waiting in pain for eight hours. That is absolutely unacceptable, and the new chairman must look at providing more ambulances, so that we can minimise patient suffering and provide a more efficient service.

When I speak to local staff, time and time again they bring up problems with the management structure and their dissatisfaction with it. Some have pointed to directors whom they hold accountable for the problems in the trust; those directors have not resigned, despite the strong pressure to do so. Dr Marsh’s report, as has been highlighted, is no different: he has made it clear that some trust non-executive directors need to resign. He points to an inability of the board to claim responsibility, a lack of clear vision, too much management and no tangible recruitment plan.

It is good news that the new chairman of the trust has stated that he will be making changes to the board, but I join my hon. Friends in calling for five board members to resign and, if possible, for them to be taken to court to be sued for legal negligence—I wish that could be the case. It is shocking that they have been allowed to continue when their failings have been made so apparent. They have put their people’s lives at risk and they have treated my local residents of Harlow shoddily. The board must be refreshed, replacing those members with people who have a proven track record of driving up standards.

I have heard of other problems from workers and residents. Staff are always praised, but staff morale is the worst of all the ambulance trusts in England—it is chronically low. Staff are embarrassed by how long an ambulance can take to reach patients. Sickness levels are high, with an 8.8% sickness rate—almost double the national average for ambulance trusts in England. Also, there is lack of training, with staff telling me that they feel unsupported; records show that the level of completed training days is abysmally low and last year only 45% of appraisals actually took place.

I am pleased that Dr Harris is making some changes, but action needs to be far quicker. At previous meetings with the trust, it seemed to be suggesting that Government funding was partly to blame, but Dr Marsh’s review blows that excuse out of the water. As my hon. Friend the Member for Witham says, the review found that the trust is funded above the average for ambulance trusts, possibly by several million pounds.

The board must take full responsibility for the problems that have plagued the service over the past few years. Action should be taken, including provision of a proper training programme for existing staff, a coherent recruitment plan to rebalance the staff ratio and direction of resources so that more ambulances are on the roads. I favour the ambulance service being broken up, so that there is an Essex ambulance service, because the East of England service is far too big. Genuinely, with the right management and the right resources, we can deliver some of the best care to my constituents in Harlow, to Essex and throughout the east of England.

[Mr George Howarth (in the Chair)]

I will call Peter Aldous in a moment and the Opposition spokesman at 10.40 am. If the two remaining speakers before the Front-Bencher take five minutes each, that should just about cover the time.