Ambulance Response Times

Helen Morgan Excerpts

Thursday 6th March 2025 Westminster Hall

[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.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

It is a pleasure to serve under your chairship, Ms Jardine. I am grateful to the hon. Member for Glastonbury and Somerton (Sarah Dyke) for securing the debate. I thank all the hon. Members who have taken part, including my hon. Friends the Members for Redditch (Chris Bloore), for Ilford South (Jas Athwal) and for Wolverhampton West (Warinder Juss), and the hon. Members for West Suffolk (Nick Timothy) and for South Devon (Caroline Voaden), as well as the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), and the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson). I will endeavour to deal with as many issues and questions as I can. If I do miss any, will hon. Members please get in touch with me afterwards, and I will make sure they are picked up?

The hon. Member for West Suffolk mentioned the commitment made by the Secretary of State to meet him and visit his constituency, and I will ensure that that issue is raised. The parliamentary private secretary, my hon. Friend the Member for Ealing Southall (Deirdre Costigan), is here, and I am sure she will be happy to pursue a response. We will also do what we can to get a response from the Treasury for the shadow Minister.

The hon. Member for Glastonbury and Somerton and other hon. Members rightly raised constituents� experiences of long waits for an ambulance response. I put on record my deepest sympathies for the hon. Lady�s constituent Jim on the loss of his wife. As the Secretary of State has made clear, this is not the level of care that staff want for their patients, and it is not the level of care that this Government will ever accept for patients.

Lord Darzi investigated the issues facing the NHS, and his report was honest about the challenges facing the health service. Urgent and emergency care performance remains a long way from a resilient position and there is continued high demand for A&E and ambulance services, with ongoing seasonal winter pressures. For example, in December the London Ambulance Service recorded more than 121,000 incidents, the highest on record for the service. Improvement needs to happen across the urgent and emergency care pathway and through the expansion of neighbourhood health services.

Nationally, congested emergency departments reduce the productivity of ambulance services, a matter that I think almost all hon. Members raised. A huge amount of time is lost to ambulance handover delays because there is no space for patients. Having crews tied up waiting outside hospitals exacerbates poor ambulance response times. We have also seen the continued normalisation of corridor care. We will never accept patients being treated in corridors; it is unsafe and undignified. We are investing an extra �26 billion to begin turning around the NHS, and we will do all we can, as fast as we can, to consign corridor care to the history books.

Lord Darzi�s investigation into NHS performance highlighted wide variation across different parts of the country. The situation is unfair to patients and goes against the principle of a universal service. I acknowledge that there can be challenges in rural areas, where longer distances often mean that patients wait much longer for ambulances than in urban areas. I often find myself in this place with the hon. Member for Glastonbury and Somerton, and we both talk about the experience in our rural constituencies. I assure her that that is on my agenda. As she says, ambulance response times for the south-west and some other areas highlight the rurality differential.

In January, the South Western Ambulance Service�s average response for category 2 emergency incidents, which include strokes and heart attacks, was 51 minutes and 45 seconds, which is 26 minutes longer than the best-performing ambulance trust in England. The NHS constitutional standard for category 2 average response times is 18 minutes, and no ambulance trust in England has met that target since the pandemic. This cannot go on. Prioritising patient safety will always be the Government�s and the NHS�s main focus. We are committed to getting A&E waiting times and ambulance response times back to NHS constitutional standards.

The independent review of ambulance trust culture was published in February 2024. Its recommendations included addressing workforce pressures. NHS England is working closely with ambulance trusts to implement those recommendations. We have made some significant investments in the ambulance workforce, and the number of NHS ambulance staff has grown by 9% compared with last year, but we recognise that there is much more to do on retention and wellbeing for ambulance staff. That is something that we will continue to work on.

We cannot keep plugging the gaps. There is a need for more fundamental reform. We have been clear that there are no quick fixes and that to turn things around will take investment and reform. We have provided the highest real-terms capital budget for the NHS since before 2010. We announced an extra �22.6 billion in day-to-day health spending and an additional �3.1 billion further capital investment over two years. That extra investment will be accompanied by fundamental reform, of which ambulance services.

In January, the Government published �Road to recovery: the government�s 2025 mandate to NHS England�, which clearly sets out delivery instructions for the NHS through the prioritisation of the five key objectives aimed at driving reform in the NHS. Improving A&E and ambulance service performance was also one of a small number of prioritised objectives in the Government�s mandate to NHS England to specifically start to address the current challenges facing urgent and emergency care.

In turn, NHS England�s planning guidance for this year includes the target to improve average category 2 ambulance response times to no more than 30 minutes across 2025-26. The guidance also sets out a range of key actions for the NHS to deliver in the same timeframe, focused on reducing avoidable ambulance dispatches and conveyances and reducing hospital handover delays.

[Helen Morgan]

Will the Minister pick up on the point about social care? Inability to admit to hospital is a key point in the handover delay problem, and the social care talks are a key measure in solving it.

[Ashley Dalton]

The hon. Member will be delighted to know that I am coming to that point next.

We are working on reducing delays and getting hospital handovers back to within 15 minutes, ensuring that no handover between hospital and ambulance services takes longer than 45 minutes. We want to improve the range and co-ordination of services to avoid unnecessary ambulance conveyances, including through improving access to urgent community response and hospital at home services, and continuing to build on ambulance services and the great work that they do to increase the hear and treat rates so that people can be advised on what they can do and what services they can access that might mean they do not need that ambulance. We will also be driving consistency and commissioning practices across England for ambulance services. I will say a little more about the rurality element in a moment.

We are taking the first steps in the reform and improvements that we want to see in services, and we will shortly set out further plans in the urgent and emergency care services plan. We know that there is no solution for ambulances that does not include tackling the challenges facing adult social care. Health and care services need to be more joined up.

Today, there are approximately 12,000 patients in hospital beds who have no criteria to reside. They do not need to be there but cannot be discharged for reasons of capacity. Over the last month, on average, 276 of the patients with no criteria to reside were in the Somerset integrated board area. That is why the Government are making available up to �3.7 billion of additional funding for local authorities that provide social care. We are funding more home adaptations through the disabled facilities grant this year and next, so that people�s homes can be safer, reducing the risk of their needing an ambulance. We are reforming the better care fund to ensure that the pooled NHS and local authority funding spent on social care contributes to wider efforts to reduce emergency admissions and delayed discharges.