Ambulance Resources and Response Times

Grahame Morris Excerpts

Wednesday 14th May 2014 Westminster Hall

[Mr Iain Wright (Hartlepool) (Lab)]

May I begin by saying what a pleasure it is to serve again under your chairmanship, Mr Crausby? I hope that you will pass on my most grateful thanks to Mr Speaker for assisting me in securing this important debate so quickly after I made my request to him.

I also want to thank the front-line ambulance staff and paramedics whose professionalism and expertise, combined with care and compassion, can often mean the difference between life and death. Time and time again, we hear of the dedication beyond the call of duty of front-line staff in the NHS, and it is entirely right that we hold them in high regard and give them the recognition, remuneration and resources to do their job.

This debate was prompted by the tragic circumstances surrounding the death of one of my constituents, Mr William Gouldburn. Mr Gouldburn was 73 and had served his community as a special needs teacher. He had heart problems, and in the previous couple of days he had come out of hospital after surgery to his shoulder. After leaving hospital, he had felt unwell, to the extent that a doctor was called to his home at 9 am. Less than 90 minutes later, Mr Gouldburn collapsed in his bedroom and an ambulance was called by 10.32 am. The call was not considered to be urgent by the contact centre that took it, and a response time of 60 minutes was given. However, even that response time was not met. It was after 12 noon that a St John Ambulance arrived.

My understanding is that Mr Gouldburn’s family, who were naturally frantic about his condition, placed a total of seven calls about his case to the emergency services during this period. At this point he was lying on the floor of his bathroom, and he was to do so for more than 90 minutes. A regular ambulance was eventually dispatched, but Mr Gouldburn was pronounced dead shortly afterwards. I hope that the whole House will join me in sending condolences to Mr Gouldburn’s family.

At the inquest into Mr Gouldburn’s death last month, a manager for the North East Ambulance Service said that the service had been experiencing a high level of calls and that ambulances were delayed in admitting patients to North Durham hospital due to a lack of available beds. The manager was asked by the coroner:

“Is what I’m hearing you don’t have resources to meet demand?”

The ambulance service manager stated:

“Yes, that’s correct. It is a national problem”.

Mr Gouldburn’s case raises some significant questions about ambulance services, which is why I wanted to secure this debate.

[Grahame M. Morris (Easington) (Lab)]

Will my hon. Friend give way?

[Mr Wright]

I will certainly give way to my parliamentary neighbour.

[Grahame M. Morris]

I am grateful to my hon. Friend for giving way and I congratulate him on securing this important and timely debate. There are serious concerns about the performance of the ambulance service in the north-east region. What is his opinion of the assessment by its chief executive, Simon Featherstone, that the service’s unsatisfactory performance is not as a result of the cuts, given that the trust is having to make £23 million of cuts during the lifetime of this Parliament?

[Mr Wright]

I must praise my hon. Friend, because he does fantastic work on health issues through his passionate commitment to the NHS and in his work on the Select Committee on Health. He is absolutely right, and I will come on to the finances and resources for ambulance services in a moment.

Mr Gouldburn’s case was tragic, and from what the coroner said, it was avoidable. However, a further tragedy is that his case is not unique or isolated. I have been told about similar cases, as my hon. Friends have been.

--- Later in debate ---

[Mr Wright]

I know that my hon. Friend has spoken in the House about this issue before, and I praise him for that. The use of private ambulances is taking resources away from our having a sustainable public service, which all our constituents want. As a result of that, the ambulance services are not able to invest in their work force, and something needs to be done about it. I hope that the Minister will respond directly to my hon. Friend about that issue, because the use of private ambulances is simply unacceptable.

[Grahame M. Morris]

I am grateful to my hon. Friend for giving way again. As this is a 30-minute debate, I will keep my interventions short, although I have a whole list of constituents who have waited an inordinate length of time; there is not the opportunity in a short debate, such as this one, to give all those examples.

In relation to the specific point about private ambulances, is it possible that the Government’s health reforms have led to fragmentation? I ask that because I have met representatives of front-line ambulance staff who have told me that the one-year contracts from the clinical commissioning group are not helping with the North East Ambulance Service NHS Trust’s forward planning of the services and resources that are needed to meet local demand.

[Mr Wright]

My hon. Friend makes an important point. How can an ambulance service plan for the next five years if it faces annual commissioning rounds? That does not work and does not provide long-term sustainability.

The North East Ambulance Service, which, like other ambulance services, has received a flat cash offer from the Government over the course of this Parliament, has been required to cut £4.83 million from its budget for 2012-13, which is some 5% in real terms, and another £4.35 million for 2013-14. Unison estimates that real cuts of about 20% to 25% have been made to ambulance services so far over this Parliament. Those cuts, coupled with rising demand, are having a detrimental impact on the quality of ambulance service that people receive.

--- Later in debate ---

[Jane Ellison]

No, because I have only just begun and the hon. Gentleman took many interventions.

Emergency services are the first port of call for many of us when serious illness or accident strikes. The total number of emergency calls to ambulance services in England in 2013-14 was 8.4 million, which is a 0.9% drop over the previous year. Unfortunately, a small proportion are unnecessary or frivolous, but the overwhelming majority are from people who feel in need of urgent help.

The growing number of people living with chronic conditions and the ageing population to which the hon. Gentleman referred are placing increasing pressure on urgent care services, something that we all acknowledge. It is important for my Department to work with Public Health England, local commissioners and health care providers to educate and engage the public on measures to prevent chronic health problems from developing. There are a number of people who end up in A and E because they have not taken medication properly or who suffer acute problems as a result of a chronic condition. Hon. Members will be aware of some of the longer-term problems in their region, which result from difficult public health challenges. Tackling those is my own particular portfolio, and is one way in which we can make the emergency services more sustainable in the longer term.

I hope hon. Members recognise that. At times, it seemed that they were merely committing themselves to significant additional future spending rather than also turning their minds to the longer-term challenges.

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

I am going to continue and try to make a few substantive points. If I have time, I will give way.

All 999 calls are triaged into two basic categories, red and green, depending on the seriousness of the call. Those placed in the red category are calls where the patient is in a life-threatening condition; an example would be someone suffering a cardiac arrest. Such calls require assistance on the scene as quickly as possible and the Government have set targets for all ambulance services in England of a response within eight minutes in 75% of cases. The latest figures, for March 2014, show that in north-east England—the area of the hon. Member for Hartlepool—the median average response time for red category calls was 6.4 minutes. Nationally, those figures show that 76.2% of red 1 calls, which are the most critical, received a response within eight minutes. In the north-east the target was also met, with 75.2% of patients receiving a response within eight minutes. That is not to say that there are not significant problems in some cases, but it is important to place on the record the service’s effective work in meeting that target.

Less critical 999 calls placed are in the green category. Those calls are not subject to national targets. Some ambulance services set their own targets for response times, and NEAS uses a one hour standard. It is important that such calls receive a timely and appropriate response, but red calls must be prioritised, as a person’s life may be in immediate danger.

There has been recent media coverage of long waits for ambulances, and hon. Members have alluded to constituents’ experience of such waits during this short debate. Every patient should expect to receive first-class care from the ambulance service, but the nature of emergency response work means there will always be incidents where unfortunate timing leads to a situation in which someone who is assessed as being in a non-life-threatening situation calls 999 at the same time as several other people who are in life-threatening situations. I am sure that hon. Members recognise that that would be the case under any Administration.

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

Briefly.

[Grahame M. Morris]

I am grateful to the Minister for giving way, but I cannot let that pass, because the situation is different now. I have had the honour of representing Easington for four years and it is evident from the cases that are coming to me and to colleagues from the region that the situation is worsening. One case was that of a young man who broke his hip playing football and waited for two and a half hours in the rain. He was in the centre of the constituency, in an area that is readily accessible. Another was of an old lady who waited two and a half hours for an ambulance. She died the following day. Something is sadly wrong with the North East Ambulance Service and the situation is deteriorating. We have all had cases that are really quite shocking, and something needs to be done.

[Jane Ellison]

I am not familiar with the cases that the hon. Gentleman mentioned, but I will draw them to the attention of my ministerial colleagues and of the trust. I spoke to the head of the trust yesterday, and will make sure that the debate is brought to the trust’s attention. However, I gently say to hon. Members that they surely cannot be suggesting that at no previous time, under any previous Government, have there been any cases in which a service did not get this right. It is important to—