Baby Loss and Safe Staffing in Maternity Care

Helen Morgan Excerpts

Tuesday 25th October 2022 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Hartlepool (Jill Mortimer) for securing this important debate and for speaking so movingly about her experience.

I draw Members’ attention to the fact that I am the vice-chair of the APPG on baby loss and a member of the APPG on maternity. I joined those APPGs shortly after my election last December because in Shropshire the issue of avoidable baby loss is extremely raw. Although neither of the Shrewsbury and Telford NHS Trust hospitals are located in my constituency, the vast majority of families in North Shropshire welcome their new arrivals in one of those maternity wards.

I did not have my baby in Shropshire as I lived in Buckinghamshire at the time. When he arrived in 2009 by emergency caesarean, making his feelings about the indignity of the situation known to everyone in the theatre at an enormously high volume, I never once worried that either of us were likely to be unsafe. The idea that things might go tragically wrong did not even cross my mind. Although the birth of my baby did not go to plan, I felt brilliantly cared for at all times. When I moved to Shropshire four years later, I realised that, tragically, that is not always the case. Friends with experiences similar to mine told of near misses, blue babies being resuscitated and long stays in special care baby units. A close friend told me she did not realise until many years later that flashbacks to the trauma of the birth were not normal.

We now know, thanks to the bravery of many families and the detailed review of Donna Ockenden and her team, that there were serious and systemic failings at Shrewsbury and Telford over a long period of time. The tragic stories include those of constituents and personal friends. I know of many other women who did not come forward, either because their baby did not suffer any long-term consequences or they did not want to revisit painful tragedies. It sometimes seems that everyone of my age in Shropshire knows a family who lost a baby.

The causes are multiple and this is not the time to discuss them, but safe staffing was fundamental in that tragedy. In the executive summary to the report, Donna Ockenden states:

“It is absolutely clear that there is an urgent need for a robust and funded maternity-wide workforce plan, starting right now, without delay and continuing over multiple years.”

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

The APPG’s report on staffing shortages found that hospital staff feel that post-natal care has suffered the most from cuts, with most aftercare being devolved to healthcare workers who do not hold the same level of qualification as a midwife. That will impact on the health of mother and baby—for example, if they do not have access to breastfeeding support because resources are stretched too thin. Does the hon. Member agree that post-natal care needs urgent attention?

[Helen Morgan]

I agree. Many of us have experience of less than brilliant post-natal care, and the staff shortages are well documented. The Health and Social Care Committee report recommendation that £200 million to £350 million a year is required to be invested immediately in maternity services speaks to that issue. On Wednesday 30 March, the then Health Secretary, the right hon. Member for Bromsgrove (Sajid Javid), confirmed that £222 million had already been committed but was not guaranteed for the future, although he would keep it under review. That was two Health Secretaries ago.

On 1 September, the next Health Secretary argued that, given how stretched the NHS was, services such as maternity might no longer be a priority. I seek reassurance from the Minister that that is not the case. Maternity services have been treated as a Cinderella service for years and we have been left with shocking scandal after shocking scandal, with thousands of families devastated by poor care at a time when they were supposed to be at their happiest. I am at a loss to understand the deprioritising of maternity services—the one service that every one of us will need at least once in our lives.

The workforce gap of 2,000 midwives and 500 new consultants has been referred to, but it is estimated that nearly 700 midwives have left the profession in the past year, and eight out of 10 report that they do not have enough staff on their shift to provide a safe service. Will the Minister commit to increasing funding to meet the £200 million to £350 million-a-year recommendation, for a specified period of time, and to developing a fully costed, multi-year workforce plan?

The safe staffing report produced by the baby loss and maternity APPGs, on which I serve, has already been referred to. I draw particular attention to the need for more bereavement midwives. The pressure and increased likelihood of failure, and the sheer exhaustion that overworked maternity staff feel, must be a cause of some of the other issues we have seen at Shrewsbury and Telford NHS Trust, and at the other trusts that face challenges.

Shropshire is not the only area of the country to have suffered a crisis in its maternity services, with Morecambe Bay, East Kent and Nottingham all facing serious issues. Far too many families have faced tragedy. I ask the Minister to ensure that their experiences are not in vain, and that the Government will act on unsafe staffing.

Urgent and Emergency Care

Helen Morgan Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

As I said in my statement, additional funding has been put in to boost A&E capacity. There was some £450 million of funding in the spending review in 2020, which has been applied across 120 trusts. Of course, the ICSs will look at the commissioning priorities in particular areas, and the NHS England taskforce is looking at trusts where there is acute pressure.

[Helen Morgan (North Shropshire) (LD)]

I am concerned that people across England and Wales, including in Shropshire, have died as a result of the ambulance delays we have seen for a long period. I have raised the issue a number of times in this place. I welcome the improvement in the response times of the west midlands ambulance service, but I am worried that the regional data masks huge differences between rural areas such as Shropshire and densely populated urban areas. Will the Secretary of State consider the Ambulance Waiting Times (Local Reporting) Bill, which my hon. Friend the Member for St Albans (Daisy Cooper) tabled earlier this year, so that the disparity between urban and rural response times can be properly understood and tackled?

[Steve Barclay]

The hon. Lady makes an important point about variation not just between regions but within regions. As a rural Member of Parliament, I get the point that there is often significant variation within a region. That has been a key area of focus. The federated data platform, which is due to come on stream in April, will give her local ICS much better data on what is happening and on what community capacity there is. Over the summer, we have worked with ambulance trusts to look at operational performance data on a much more granular level. That is why I have flagged to the House the issue that a small number of trusts are driving a large proportion of the handover delays. That is exactly the sort of variation that we are looking at.

Ambulance Pressures

Helen Morgan Excerpts

Monday 18th July 2022 Commons Chamber

[Steve Barclay]

I am happy to look at that, and I thank my hon. Friend for his service locally. I am keen to follow up on his point, because it is absolutely right. From the feedback from ambulance trusts so far, it seems that category 2 average response times were broadly stable at the weekend, but how we triage, how we categorise calls, and what additional support can be given by considering the skills mix are all factors in improving performance.

[Helen Morgan (North Shropshire) (LD)]

I also attended the meeting on Friday morning about Shropshire’s health crisis, and I echo the comments of the right hon. Member for Ludlow (Philip Dunne) on that. Quite apart from this week’s heatwave, there is increased demand on Shropshire’s ambulance service, and the local team are clearly working hard to find solutions, but I did not feel reassured that they had any quick fixes for this crisis. One of their big problems is with recruiting social care workers; the team say that they have never seen a market like it. What is the Secretary of State doing to address the critical workforce problem in social care, not only in rural areas but across the country?

[Steve Barclay]

Through initiatives such as the better care fund and the £2.6 billion of investment, we are looking at how to allocate funds in an integrated way. That requires better integration of data between the care sector and the NHS, and that is an area that I am keen to explore.

Ambulance Services and National Heatwave Emergency

Helen Morgan Excerpts

Wednesday 13th July 2022 Commons Chamber

[Mr Speaker]

I granted the urgent question because the shadow Secretary of State tabled it and normally we would expect a Secretary of State to come. I recognise that they may be busy in other areas, but it is something we ought to be aware of. More and more, we are seeing fewer Secretaries of State across all Departments, not just this one.

[Helen Morgan (North Shropshire) (LD)]

Last Friday, I passed by Royal Shrewsbury Hospital. It is in a neighbouring constituency, but it serves my constituents. It was not a particularly bad day, but there were eight ambulances with their doors open in the heat, waiting to transfer patients. This is not a new situation and I have repeatedly raised the issue in this place: on my first day in Parliament with the Prime Minister; with the Secretary of State for Health in an Adjournment debate; and in a Westminster Hall debate with the hon. Member for Charnwood (Edward Argar). All those people have now resigned. Shrewsbury and Telford Hospital Trust has declared its fifth critical incident this year. When will the Government end the chaos and infighting, and start taking steps to prevent avoidable deaths in Shropshire and across the country?

[Maria Caulfield]

I can reassure the hon. Lady that the hon. Member for Telford (Lucy Allan) has been working very hard behind the scenes to get more investment into that local hospital. We will be making announcements shortly on future funding for hospital trusts.

Ambulance and Emergency Department Waiting Times

Helen Morgan Excerpts

Wednesday 6th July 2022 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I am grateful to my hon. Friend the Member for Bath (Wera Hobhouse) for securing the debate. On 25 May this year, the nursing director of the West Midlands Ambulance Service, Mark Docherty, said that the ambulance trust would face a “Titanic moment” and collapse entirely this summer. He gave the specific date of 17 August. Mark went on to say that patients were “dying every day” from avoidable causes created by ambulance delays. That was 42 days ago. He predicts that we now have another 42 days before the ambulance service in my community collapses.

I have had an Adjournment debate with the Minister on that subject, and a meeting with the former Secretary of State for Health, the right hon. Member for Bromsgrove (Sajid Javid), yet this Government still have not got a grip on the problem. As a proud resident of North Shropshire, I was aware of our ambulance crisis before I was elected in December, and before I started campaigning in November. However, on the campaign trail, and since being elected, it has become evident that the scale of the crisis is absolutely shocking.

Just last week, I was contacted by a constituent whose 85-year-old mother, who suffers from dementia, had fallen and suffered a suspected broken hip. Her son called the ambulance, but she sat in agonising pain in their living room for 18 hours before the ambulance arrived at her home. Everyone in this Chamber will agree that this should not be happening in this country, or in this century. It is one of many stories I have received. Many other people are attended by the ambulance crew in fairly reasonable time, but then wait 12 or 13 hours in the ambulance before being transferred into the hospital.

The focus of this debate should be on solutions to the problem, but it is also crucial to understand how we got here. Ambulance service delays are a symptom of wider issues plaguing the NHS and health services across the country, and the issue of staff shortages is critical to that, as colleagues have alluded to today. So far, the Government have failed to address that. They have thrown our hard-working doctors and nurses pretty much under the bus. We are short of nurses, carers, GPs and decision-making doctors in A&E. In February, the all-party parliamentary group for rural health and care published a report concluding that the 10 million people who live in rural and coastal areas in the UK deserve better healthcare outcomes. Colleagues here representing rural constituencies know from first-hand accounts that it is not just access to healthcare that is compromised but, in the words of the APPG report,

“the very determinants of health itself.”

That is why our ambulance crisis is even worse than in some of Britain’s more urban areas. Worse still, it is hidden by the published data. West Midlands Ambulance Service reports some of the better response times in the country, but a decent outcome in Birmingham and the black country conurbation is masking a deep crisis in the countryside.

How are the hard-working professionals in our NHS to deal with another significant rise in covid admissions? They are struggling to deal with the broken social care service, a hospital bed crisis and people who cannot access a GP and so are turning up at A&E. I know those professionals have the best will in the world, but they simply cannot deal with that. That is why Shrewsbury and Telford Hospital NHS Trust has declared yet another critical incident this week. I have lost count of the number of times that has happened this year—I think it is the fourth or fifth—but a summer incident is unprecedented. The winter is coming at us fast, and now we need to understand what we can do to fix the problem.

We know there is no quick fix, but one thing the Government could do now to understand the problems and come up with effective recommendations is commission the Care Quality Commission to investigate delays in the ambulance service and their underlying causes. In my Adjournment debate before easter, the Minister said it was open for me, or others, to raise that with the CQC. However, they have subsequently written to my hon. Friend the Member for St Albans (Daisy Cooper)—the Liberal Democrat health spokesperson—to confirm that that is not the case. It is clear that while the Health Secretary has the power to commission the CQC, unfortunately I do not. Crucially, Mark Docherty, the nursing director of West Midlands Ambulance Service, has also called for the CQC to investigate the issue. I would like to take this opportunity to urge the newly appointed Health Secretary to commission the CQC to conduct an investigation to identify the measurable actions we need to take to resolve the issues that we face across the country.

The Government could also adopt the recommendations of my hon. Friend the Member for St Albans by commissioning ambulance waiting times by postcode, so that we can direct the resource where it is needed and not just over large regions. They could also act on the recommendations of the APPG’s February report to deal with the health inequalities faced by the one fifth of our population who live living in rural or coastal communities. There are positive steps that can be taken to fix this crisis. I would like the Minister to say exactly what is going to happen now.

North East Ambulance Service

Helen Morgan Excerpts

Monday 23rd May 2022 Commons Chamber

[Maria Caulfield]

First responders do have an important role but they are not a substitute for paramedics. We have 3,000 paramedic graduates trained nationally per annum and we have increased our ambulance and support staff by 38%, so we are making that investment in the ambulance service.

[Helen Morgan (North Shropshire) (LD)]

I have been struck by the similarities between this case and the failings in maternity care at the Shrewsbury and Telford Hospital NHS Trust that were in part due to a toxic management culture—as outlined by Donna Ockenden earlier this year—in which staff were afraid to raise concerns. Given the similarities, will the Minister commit to ensuring that we have a system where staff can whistleblow to an independent organisation and where they feel safe to admit that they have made a mistake?

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 19th April 2022 Commons Chamber

[Sajid Javid]

I know that my hon. Friend knows Helen Harrison extremely well, but he is right to talk about the importance of the NHS and the adult social care sector and local authorities working together. We must make sure that it is a true partnership, where one does not overwhelm the other and they work together towards their shared interests.

[Helen Morgan (North Shropshire) (LD)]

One key cause of the urgent care crisis in Shropshire, in the Shrewsbury and Telford Hospital NHS Trust, is the inability to discharge patients who are medically fit to go home into social care in the community. Shropshire Council’s resource challenges in that area are well known. Will the Secretary of State commit to putting extra resource into social care in Shropshire so that the medically fit can be discharged into the community when they are ready?

[Sajid Javid]

The hon. Lady is absolutely right to raise this issue, and the whole House heard just before the recess the results of the independent work done by Donna Ockenden. The hon. Lady is right to talk about that and the pressure that has been faced locally. I understand that she has already reached out to my hon. Friend the Minister for Health and that he will be meeting her to discuss just that.

Ambulance Response Times: Shropshire

Helen Morgan Excerpts

Thursday 31st March 2022 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I thank Mr Speaker for granting today’s Adjournment debate on a topic that is so important to my constituents in North Shropshire and to people across Shropshire and across the country. I start by making it clear that I am not here to criticise the hard-working NHS staff in our ambulance services and emergency departments. Indeed, I thank them for their incredibly hard and dedicated work in difficult and demotivating circumstances, but there is clearly a problem with the provision of emergency care in Shropshire, with complex causes, and I bring it before this House to urge the Government to take some action.

It was clear throughout my election campaign, and has been clear from my inbox since then, that stories of excessive waits for an ambulance are not a rarity. I have since urged my constituents to contact me and share their experiences. Just since Monday, my office has been met with a tidal wave of correspondence, each story as saddening and frightening as the last. A care home reported a wait of 19 hours for an elderly resident with a broken hip. An elderly diabetic man fell and dislocated his shoulder. He was advised not to drink or eat anything in case surgery was required, and then waited 15 hours for an ambulance to arrive. A disabled man fell in his bathroom and waited for 21 hours for an ambulance. He was fortunately lifted from the floor after eight hours by a helpful neighbour. A man waited with a stranger experiencing heart attack symptoms on the side of the road for hours, only to give up and drive the gentleman to A&E himself.

A man with a suspected stroke waited nine hours for an ambulance and a further five in the ambulance waiting to be transferred into hospital. A 92-year-old lady fell at 8.30 in the morning, suffering bleeding from the head and a broken leg. She was looked after by her 75-year-old neighbour for almost eight hours until the ambulance arrived, and then waited in the ambulance for transfer into the A&E department until 2.30 the next morning. She had not eaten since 6.30 the evening before her fall. An elderly woman fell down the stairs shortly after lunch. Her emergency carers—she has a red button to press for them—made her comfortable and called an ambulance, but they could not carry on waiting forever. After an 11-hour wait, she was alone with her front door open so that the ambulance crew could access her house. That was 3 o’clock in the morning.

I could easily spend the next half hour relating heartbreaking stories, and I thank all my constituents who contacted me for taking the time to get in touch and explain the scale of the problem. One story in particular brought the issue home, and some Members may have read about it in the newspapers. It was the story of a young footballer who slipped on AstroTurf while playing football at school. He dislocated his knee and waited so long for an ambulance that by the time one finally arrived he had developed hypothermia. I do not know whether Members can imagine the distress of this young man, and the teaching staff who stayed on in the dark, long after the school day had ended, as his condition deteriorated out in the cold.

What all these stories have in common is that they could have been much worse. I am sure everyone in the House would agree that nobody should have to suffer waiting an excessive amount of time for an ambulance, yet tragically in North Shropshire it is pretty common. I know this problem is not unique to Shropshire. I am sure that many colleagues have received similar emails describing similar events. In parts of Britain, an excessive wait for an ambulance has become normal.

The problems surrounding this crisis are complex, and I am not here to propose a simple quick fix. However, there are consistent themes at the core of the issue. It is vital that we recognise them if we are to work out how to move on from here. The first is the problem of handing over patients at the emergency departments in Shrewsbury and Telford. West Midlands Ambulance Service has told me that, on the day the young footballer dislocated his knee, 868 hours were lost waiting to hand over patients, and that nearly 2,600 hours were lost in the month up to 29 March. Handover times in Shropshire are significantly worse than in the rest of the country, and there have been times when every ambulance based in Shropshire is waiting outside a hospital to discharge a patient.

The hospital trust has declared a critical incident on no less than four separate occasions so far this year, and each of those incidents coincided with an increase in the number of heartbreaking stories coming into my inbox.

[Lucy Allan (Telford) (Con)]

I congratulate the hon. Lady on bringing this incredibly important issue to the House. Such heartbreaking stories are common to all Shropshire MPs. Does she agree that a combination of factors—I am sure she will go on to discuss some of them—including the transfer of patients on to wards, as well as the inaccessibility of general practitioners, is putting additional pressure on A&E?

[Helen Morgan]

I thank the hon. Lady for her intervention, and I entirely agree with her. I will stress some of those points later in my speech.

The emergency departments of the Shrewsbury and Telford Hospital NHS Trust report that they suffer from a shortage of space and staff, along with the additional challenges of separating covid patients—on Tuesday this week, the trust had more covid patients than at any previous point in the pandemic. The trust also reports delays in discharging patients who are well enough to leave hospital because it is struggling to find care packages or care home spaces.

A number of care homes in Shropshire are currently closed because of the pandemic. Shropshire shares the national problem of a shortage of care workers and care homes, which is probably exacerbated by our high proportion of elderly patients. The inability to discharge patients who would doubtless be better off at home or in a care home setting reduces the flow of patients through the hospital.

The impact of all this is that, because ambulances wait so long at hospitals, the vast majority of ambulance journeys across Shropshire begin in Shrewsbury or Telford. It is not possible to reach the most seriously ill patients towards the edge of the county within the target time if the ambulance sets out from one of those two towns. This, combined with the closure of community ambulance stations, means that very few ambulances are free in places such as Oswestry and Market Drayton when people become ill and require one.

Another factor, as the hon. Member for Telford (Lucy Allan) alluded to, is the volume of patients accessing emergency departments, or being taken to one in an ambulance, because there is no other option locally, particularly in the evening or at the weekend. Shropshire has a worsening shortage of GPs, which is leading to patients attending emergency departments for relatively minor issues because they simply have no alternative. A key reason behind the problem of staff recruitment is the chronic lack of other services in Shropshire, but that is a debate for another day.

The Government must deliver on their promise to recruit more GPs, and they must ensure that people with non-urgent healthcare needs are provided with adequate resources in the community. I am incredibly proud that my constituents Sian Tasker and Lawrence Chappel in Oswestry and, beyond my constituency, Darren Childs in Ludlow, and other campaigners, are working tirelessly to keep this issue in the public light and are campaigning to keep their community ambulance stations open. It is partly because of their hard work that we are finally discussing this issue in Parliament.

I am afraid to say that, so far, the Government have refused to listen to the countless warnings by campaigners and those working on the frontline. The Care Quality Commission’s “State of health care and adult social care in England” report last year, gave a stark warning that overstretched ambulance services and emergency departments are putting patients at risk. The numbers speak for themselves. The Association of Ambulance Chief Executives has found that, nationally, 160,000 people a year are coming to harm because of delayed handovers to A&E. Of those, a shocking 12,000 experience severe harm.

I have repeatedly asked the Secretary of State for Health and Social Care to meet me and the West Midlands Ambulance Service to discuss how we can tackle local issues together. I am deeply disappointed that, so far, he has refused my request. It seems to many people in Shropshire that the Department of Health and Social Care is burying its head in the sand and refusing to acknowledge the seriousness of the issue we face. I take this opportunity to urge the Minister to meet me and my colleagues across the county to discuss the crisis and to hear some first-hand accounts of those left waiting in distress so that we can come to some sort of solution together.

I have no doubt that all hon. Members present, including those on the Government Benches, want to ensure that people at their most vulnerable are kept safe. I welcome the recently announced additional £55 million of support for ambulance services. I fear, however, that that money may not go far enough or may not be targeted in the areas of greatest need. The hopes of the Shrewsbury and Telford Hospital NHS Trust are pinned on the Future Fit hospital transformation programme, which kicked off in 2013. It is reliant on £312 million of funding, the source of which may be an interest-bearing loan—I will happily correct the record if I am incorrect, but that is my understanding. Unfortunately, more than eight years later, a strategic outline case has still not been signed off. The estimated costs have spiralled by almost 70% and it is likely that they will not be covered by the Government.

The initial promises of urgent care centres in more rural areas—for example, one was guaranteed for Oswestry—investment in community hospitals and local planned care centres were all quietly dropped in the summer of 2015. Promises of investment in public health and prevention, which is a good idea and would have been welcome in Shropshire, are also apparently no further forward. We are consistently told that there is no more money in the pot for faster, better-resourced ambulance services or urgent care staff, yet the Government wasted more than £10 billion on personal protective equipment that is not up to scratch. It is time that they listened to the warning signs that they have been ignoring and finally step up to provide proper support for ambulance services and accident and emergency departments.

There are several steps that the Government could take right away to get to the bottom of the causes of the issue. The Secretary of State could commission the Care Quality Commission under powers laid out in section 48 of the Health and Social Care Act 2008 to conduct an investigation into the causes and impacts of ambulance service delays. That is a fairly simple step and the law already allows for him to commission the CQC. Once the Government have a professional assessment of the complexity of the causes of the delays to ambulance service response, they can take the correct steps, targeted at the correct causes of the problems, to make some rapid improvements to the service. As I have outlined, the causes will most likely lie in a number of areas across emergency and social care, but until they are fully understood by the right people, they cannot be resolved.

The Government could also pass the Ambulance Waiting Times (Local Reporting) Bill of my hon. Friend the Member for St Albans (Daisy Cooper), which would require accessible, localised reports of ambulance response times to be published. Once the data was available, it would enable central and devolved Governments to accurately understand where the delays are and how best to tackle them, because we should be following the data and the facts to provide the right solutions and the right resourcing in the areas that need them most. That Bill is already written, it has had its First Reading and it is ready to go.

I brought this debate to Parliament to ensure that the Minister and the Secretary of State understand the scale of the problem in Shropshire and, crucially, the urgency in resolving it. How many more elderly citizens will have to wait for 10 hours, with their front door open, for an ambulance? How many more people will have to wait at the roadside with a stranger who they believe might be close to death? How many more young adults will develop hypothermia when they initially have a trivial injury, such as a dislocated knee? How many more cases of serious harm, or even avoidable death, will it take?

I thank the Minister for being here this evening and responding to my speech. I also thank Mr Speaker for granting this Adjournment debate. I take the opportunity to thank everybody in the Chamber for coming along and to wish them a happy Easter and a restful break.

[The Minister for Health (Edward Argar)]

Just as I had the pleasure of giving the final speech in the final debate before the House went into recess before the last half-term, I have the same privilege today. To that end, I congratulate the hon. Member for North Shropshire (Helen Morgan) on securing this important debate. In the short time in which she has been a Member of this House, she has taken an extremely close interest in the issues of ambulances and healthcare for her constituents more broadly. She has been assiduous in raising them in the House, as she has today, or through other means with Ministers and the Department. I pay tribute to her for that.

The hon. Lady will be aware, as she has genuinely and openly said, that there are complex causes behind the challenges faced by her constituents, and also by people around the country, with the ambulance service and ambulance response times. Ambulance services have faced extraordinary pressures, which have been particularly exacerbated during the pandemic. I am sure the House will join me in expressing gratitude, as she did, to all the ambulance service staff in the NHS for their outstanding work and dedication during this time. I recognise the very powerful individual cases that the hon. Lady cited, suitably anonymised, to illustrate her arguments and her case.

As I have mentioned, the pandemic has placed very significant demands on the service. In February this year, the service answered over 760,000 calls to 999—this is nationally, and I will turn to the hon. Lady’s local situation in due course—which is an increase of 13% on February 2020. That places very significant pressures on the ambulance service and the wider NHS, and I will turn to the broader causes shortly. She was absolutely right to highlight that the issue is often not with the ambulance service itself—the number of ambulances or the number of staff—but about handovers and the ability to do turnarounds having safely deposited a patient at an acute setting in a hospital, but I will turn to that in a minute.

A range of other issues, as well of course as demand, impact on performance, including the need for infection prevention and control measures, which remain in place in hospitals. They may not be as acute or as severe as they were at the height of the pandemic, but they are still there, and that does have an impact. There are the handover delays the hon. Lady spoke about, which are linked to capacity with those infection prevention and control measures, but also to the ability either to treat and discharge or to admit patients to a hospital. In recent months, we have also had high workforce sickness absence rates, often down to covid and covid self-isolation, with staff quite rightly taking the view that when they test positive for covid they should stay at home until they do not.

In spite of these pressures—and this is in no way to diminish the point the hon. Lady made about the impact on her constituents, but is by way of context—the average response time in the west midlands to category 1 calls, the most serious calls classified as life threatening, was maintained at eight minutes and 11 seconds in February 2022. That was despite of a 40% increase in that category of calls on the previous year and a 16% increase locally in 999 calls overall. At a national level, the category 1 response time has been largely maintained at about nine minutes on average over the last several months—so not quite as good as the performance in the West Midlands—despite a 23.5% increase in those incidents compared with before the pandemic. However, we are clear that there have been significant increases in response times in the other categories, which of course we must improve.

[Helen Morgan]

I just want to make the point that in Shropshire we are not seeing the same level of service that we see across the west midlands as a whole. I am calling for more granular data because I think some excellent service provided elsewhere in the West Midlands Ambulance Service area is overshadowing some of the specific problems we are seeing in Shropshire. In addition, the number of hospital admissions to the Shrewsbury and Telford Hospital NHS Trust is running roughly at the same level as in prior years, so although the covid pandemic has provided challenges in separating out such patients when they arrive through infection control measures, it is not actually leading to a higher level of admissions.

[Edward Argar]

I am grateful to the hon. Lady, and I will turn to her specific asks in a moment.

However, I will turn now to the Bill introduced by the hon. Member for St Albans (Daisy Cooper), which I am aware of. I have to be honest and say that we do not consider that the Bill would necessarily be the most appropriate way of achieving what she wants. The challenge with that legislation is that, at a time when we wish trusts to be focused on the delivery of frontline services, it is another administrative process of data collection. I would add that trusts of course operate at trust level, not at an individual station or county level, and trusts may cover a number of counties. So while I am aware of her legislation, it is not something that I believe would achieve the outcomes or be practical in the way she wishes, and she and I regularly have a to and fro across the Dispatch Box about a number of issues when she speaks for her party on health and care matters.

There is strong support in place to improve performance. At the national level, as the hon. Member for North Shropshire generously recognised, there was £55 million of investment last summer, in advance of the winter, to help increase ambulance staffing capacity to manage pressures. All trusts received a portion of that funding to expand capacity through additional crews on the road and additional clinical support in control rooms as well as extending hospital ambulance liaison officer cover at the most challenged acute trusts.

On overall staffing, which includes frontline clinical staff and the clinical support staff who work with them, our ambulance service has seen about a 38% increase since 2010—the Liberal Democrats can quite rightly take some credit for that from their five years in government—and, indeed, in the last year we have seen an increase of about 500 frontline staff. So we have increased staff and continue to increase available staff.

The £55 million was supported by an additional £4.4 million in capital investment—these are still national figures, but I will turn to her specific local circumstances—which helped to keep an additional 154 ambulances on the road during winter over and above normal levels. Call handler numbers, which are equally important, are being boosted with more than 2,400 on target to be in place by the end of March—the end of today. That is about 500 more FTE—full-time equivalent—staff compared with September 2021, with potential for services to increase in capacity further during the coming financial year.

NHS England and Improvement is also providing targeted support to the hospitals facing the greatest issues with delays in the handover of ambulance patients, helping them to identify short and longer-term interventions to reduce delays and get ambulances swiftly back out on the road. She is right that that is hugely important, and even more so in areas with large rural populations because of the distances involved. Trusts also receive supportive continuous central monitoring and support by NHSEI’s national ambulance co-ordination centre.

With clinical support in control rooms, the ambulance service is closing just over 11% of 999 calls with clinical advice over the phone, which is an increase of three quarters since before the pandemic. That helps to save valuable ambulance resources to respond to more urgent calls, with that clinical input ensuring that the advice and decisions are right.

The hon. Lady will be pleased to hear that significant local support is in place to improve response times in her county. The West Midlands Ambulance Service is working with community partners to help avoid conveying patients to hospital where there is no clinical necessity, providing alternate treatment and care at home or in the community and helping to avoid unnecessary trips to hospital, thereby freeing up resources and hopefully providing a more pleasant experience for those patients.

In raw numbers, the West Midlands Ambulance Service conveyed over 600 fewer patients to hospital in February based on the clinical advice this year compared with two years ago. It has also introduced a clinical validation team of advanced paramedics who work in control rooms and clinically triage lower urgency cases and, where appropriate, signpost patients to other services, as I alluded to. In February, that team reviewed 967 cases in Shropshire, of which 61% of were not sent an ambulance, 14% were treated on the scene and just 25% were conveyed to hospital. That was based on the clinical triage, which I am sure the hon. Lady agrees should be central to any decisions made. That has played a significant part in helping the service to tackle the pressures.

Other practical solutions include hospital ambulance liaison officers—HALOs—who are paramedics who work with bed managers to smooth out the flow of patients coming to an A&E department. They can provide a constant flow of information about capacity to the strategic command cell at the ambulance service headquarters, escalating any issues and avoiding queueing where possible. There is also joint work to cohort ambulance patients at A&E sites, where a single ambulance crew takes responsibility for three or four patients. That releases crews to respond to outstanding calls in the community more quickly.

A new same-day emergency centre—SDEC—has been opened at the Royal Shrewsbury to divert patients, as clinically appropriate, away from A&E, improving handover times. In the two and a half years that I have been a health Minister, I have discovered that there are probably almost as many acronyms in health as in the Ministry of Defence. Surgical SDEC capacity at the Royal Shrewsbury has also been expanded and all SDEC units receive ambulances directly for suitable patients.

The hon. Lady rightly mentioned hospitals, and I am grateful that my hon. Friend the Member for Telford (Lucy Allan) is here and made an intervention. During her seven years in the House, she has been a regular and vocal advocate for her local hospital in Telford. I pay tribute to her, because it was due to her campaigning and tenacity that there is an A&E locally at Telford. That is still seeing patients and helping to alleviate the pressure in Shropshire. She should rightly be proud of that, having successfully campaigned for it.

Action is being taken locally to improve the patient flow through hospitals by discharging patients more quickly to create bed space. The aim is not only to increase the number of discharges a day, but to bring more discharges forward to earlier in the day, when it is clinically safe to do so, to allow the effective discharge and transition back to care at home or in a care home. Health and care system partners locally are looking to create additional community and social care capacity to support timely discharge, create bed space to take patients from A&E and reduce ambulance handover times.

At a national level, we have set up a national discharge taskforce. As a Minister, I get almost daily statistics about where we are on delayed discharges across the country. It is a complex picture, with a variety of reasons behind delayed discharges. The hon. Member for North Shropshire is correct that some are about delays in getting into care homes or getting domiciliary care packages or rehabilitation packages at home. Some are also down to delays in the hospital in sign-offs and procedures, and there is more that we continue to do to drive those delays down.

Construction is also under way on a new modular ward at the Royal Shrewsbury site, with 32 additional beds in service by spring 2022. That is alongside a £9.3 million upgrade of the emergency department at the Royal Shrewsbury, delivering additional cubicles, a new and improved majors department, a new designated emergency zone for children and young people and a new clinical decisions unit. The first phase of that work is complete and all areas will be finished by spring 2022.

The hon. Lady raised a number of other issues, including the Future Fit model. We have been clear that funding of £312 million was allocated for that project, and that remains allocated. The challenge we face is that, thus far, the trust has not proposed a solution that meets that budget. We continue to work with the trust and to encourage it to do so. I hope that it will so that we can continue to drive that important project forward.

I will very gently push back on what the hon. Lady said about there being £10 billion of PPE that is not fit for purpose. She will know that that is not correct. In the statement that was made about write-downs, not write-offs, the amount was about £8.7 billion, and it was not all PPE, by any means, that was not fit for purpose. Only a tiny proportion of that was the case. A significant element of that was essentially due to over-ordering at the height of the pandemic to make sure that the frontline had the PPE that it needed. We were buying at the height of the market, and there is currently a glut of PPE, so its value has inevitably declined. Not all of it will be used, because we got more than we needed to make sure that clinicians and others on the frontline were not exposed.

The hon. Lady touched on local ambulance Make Ready stations and the changes to them. Decisions on reconfigurations and changes to that are made locally by the trust; it consults, but it makes those decisions. The Government do not have any power over those matters. The Health and Care Bill, which we debated yesterday, would give the Secretary of State greater power over such reconfigurations in the way that she asked, but her hon. Friend the Member for St Albans argued against that. I gently say that that is a matter for the local trust and the usual NHS processes on reconfigurations.

The hon. Lady touched on, I think—forgive me if I am wrong—asking the CQC to look into this issue. It is entirely open for her or others to raise it with the CQC, and the CQC will make a decision or a judgment on whether it believes that it is appropriate or otherwise to look into the matter.

In the few seconds that I have left, before Mr Deputy Speaker calls me to order, I say that I recognise and do not in any way diminish the significance of the issues that the hon. Lady raised. I hope that I have given her some reassurance that we are working through these issues and that we continue to put the support in place to help her constituents in Shropshire and more broadly.

Finally, the hon. Lady requested a meeting, and I am conscious that she has raised the issue of correspondence. I have asked for that; I believe that that has happened since Christmas, as the Department works through the backlog. There is still a delay in correspondence, but I have pulled that out and asked for it, and I am happy to meet her and her fellow Shropshire MPs, together with the ambulance trust, to discuss their collective concerns or reflections that they would like to put to me as a Minister.

I conclude by wishing the hon. Lady a very happy Easter and by thanking her for bringing this to my attention and the attention of the House.

Ockenden Report

Helen Morgan Excerpts

Wednesday 30th March 2022 Commons Chamber

[Sajid Javid]

I very much agree. I want to acknowledge that the report ultimately took place because of my right hon. Friend’s decision to ask Donna Ockenden to do the independent review, but he is absolutely right that he, in turn, did so because of the bravery of Rhiannon Davies and Richard Stanton, of Kayleigh and Colin Griffiths and of the many other families who came to see him.

My right hon. Friend asked about the immediate and essential actions. The interim report sets out seven such actions; the trust has implemented them all, and across the NHS they are either fully or partially implemented. The final report also recommends such actions; their implementation has already begun. Of course, we have just received the report, but I have asked for a timetable of when it will all be done. I want to see it done as quickly as possible.

My right hon. Friend’s point about workforce is very important. I hope he welcomes the fact that, for the first time, the NHS has been asked to set out a 15-year workforce plan.

[Helen Morgan (North Shropshire) (LD)]

I join colleagues across the House in thanking all the families who have bravely come forward to share their experiences, particularly Kayleigh, Colin, Rhiannon and Richard, whose persistence has led to the review. I hope that women and babies in Shropshire, Telford and the Wrekin and across the UK will be safer in future as a result of their bravery.

I thank Donna Ockenden and her team for their thoroughness in reviewing so many tragic cases. I am sure that the Secretary of State agrees that this can never be allowed to happen again and that the deaths of these 201 babies must not be in vain. This must be a turning point for maternity services in England.

Donna Ockenden has endorsed the findings of the Health and Social Care Committee and recommended that an immediate investment of £200 million to £350 million per annum is required to keep women safe. I welcome the Secretary of State’s guarantees that the immediate and essential actions will be implemented, but may I ask whether he can commit the additional resources recommended by Donna Ockenden today?

[Sajid Javid]

I thank the hon. Lady for her comments. I assure her that constituents throughout Shropshire, Telford and the Wrekin, and indeed families across England, will be safer as a result of those brave families coming forward and this report.

On resources, the hon. Lady will have heard me talk about the £95 million given at the time of the interim report, plus the £127 million given for maternity services in the past few days. We will keep that under review.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 1st March 2022 Commons Chamber

[Sajid Javid]

I absolutely agree with my right hon. Friend. Let me take this opportunity once again to thank everyone who has been working in the NHS, especially for all that they have done during the pandemic. We are continuing to invest in the workforce through our 50,000-person expansion in the nurse programme, and we already have 44,000 more full-time employees in healthcare settings than we had this time last year, including 4,600 more doctors and 11,100 more nurses.

[Helen Morgan (North Shropshire) (LD)]

The lack of capacity in accident and emergency departments and other healthcare services is a major contributor to the ongoing ambulance waiting time crisis in my constituency. Will the Secretary of State meet me and representatives of the West Midlands ambulance service—as I have repeatedly asked him to do—to help to resolve the crisis?

[Sajid Javid]

The hon. Lady is right to raise this matter. As she will know, owing to the pressures of the pandemic we have seen significant challenges for ambulance services throughout the country. Just a few days ago I met the head of the West Midlands ambulance service to discuss some of the issues, and also how the extra funding that we provided over the winter—some £55 million of support for ambulance services—is helping.