East of England Ambulance Service

Jamie Reed Excerpts

Tuesday 25th June 2013 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to speak under your chairmanship again, Mr Howarth. I intend to be fairly brief, to allow the Minister to answer many of the questions that have been put to her by colleagues. I extend my thanks to the hon. Member for Witham (Priti Patel) for securing this debate, which is timely and important, as today’s attendance illustrates.

Along with other Members, the hon. Lady is right to praise the commitment and dedication of front-line staff. Their vocational example illustrates the best of everything that there is to say about the NHS. I am sure that all Members are aware of cases that have arisen through poor ambulance service performance. Members have spoken today, sometimes in shocking detail, about examples of people who deserve better care from this ambulance service, and the debate is needed because of those cases. Indeed, in opening the debate, the hon. Lady said that, right now, lives are being put at risk.

The East of England Ambulance Service NHS Trust covers more than 7,500 square miles and deals with more than half a million emergency calls a year. That undoubtedly presents challenges, but there can be no excuse for less-than-excellent service. As the hon. Member for North West Norfolk (Mr Bellingham) said, second best is not good enough, and I absolutely endorse that.

Dr Anthony Marsh’s governance review, which was published earlier this month, is deeply worrying. He commented that the trust’s board and senior management team have developed a sense of helplessness. That is exceptionally disturbing, and it needs to be rectified. He has said that internal and external communications need to improve without delay, but furthermore, performance needs to improve.

Comparing December 2011 with December 2012, the average handover time—the time between an ambulance arriving at a hospital and the hospital taking responsibility for the patient—increased by more than three minutes to more than 20 minutes a patient. The number of patients waiting more than 30 minutes increased by 75%, from around 2,000 to more than 3,500. Even more worryingly, the wait for patients does not start there; the number of ambulances responding to the most serious call-outs within eight minutes was fewer than 70%.

Those numbers are shocking enough, but the figure that helps to demonstrate the worst type of patient experience is that, in December 2012, at least one patient waited in the back of an ambulance for more than six-and-a-half hours, and the hon. Member for Harlow (Robert Halfon) raised an even worse example. It is worrying how only a few numbers can paint such a vivid picture of a service that is clearly not working as it should for the patients who rely on it, and, as has been pointed out repeatedly, who pay for it as well.

I am heartened to learn that the trust recognises that its service has not been acceptable, and I welcome the turnaround plan that was released in late April. I ask the Minister to outline any discussions that she, or the Secretary of State for Health, has had with the trust that informed the plan and its implementation. Will she explain why, when the data that I have just given, as others have freely done today, are so easily accessible, nothing has been done previously to improve performance in the trust? I also ask her to provide the details of all efforts made by the Department to help the trust improve performance, when those began and what the results have been. We are seeing all aspects of emergency care services—whether ambulance trusts or accident and emergency departments—being driven into chaos too often of late. We have just endured the worst winter performance in A and E for years, and the warnings are that next winter’s will be even worse.

It cannot be a coincidence that during December 2012—the month to which my previous figures relate—hospitals in the east of England region missed their A and E target more often than not, and almost one in 10 patients had to wait for more than four hours in A and E before receiving treatment. Pressures in one part of the service can manifest in other places—as has often been said, A and E is the bellwether of NHS performance—and there is clearly a link between poor performance in ambulance services and the pressure so clearly apparent in A and E units around the country. When a patient needs emergency care, they are being made to wait at home, then wait in an ambulance, and then wait in a waiting room. When the Minister responds, I hope that she will offer some explanation for that poor performance. I hope that she will also outline any discussions that she has had with other ambulance trusts to ensure that those failings are not repeated elsewhere in the country.

Moving on to the personnel aspect of Dr Marsh’s report, he raised concerns about the rate of sickness absence in the trust. Alarm bells should be ringing that the level is so much higher than in other trusts. Did the Department of Health become aware of that, and if so, when did it become aware and what was done about it? In April, at the time of Dr Marsh’s governance review, the acting chief, Andrew Morgan, announced plans to recruit 350 staff. He denied a staffing crisis, but admitted that the leadership was not good enough. I think that that is an understatement, given that it was widely reported in May that the trust was offering financial incentives to staff to retire early or to leave the service. The trust spent almost £100,000 on those incentives, and it is now offering staff a £500 bonus if they refer a friend to join the trust. If it needs staff, it should not be offering incentives for staff to leave. What kind of recruitment programme is that, and how does that illustrate protection of the public purse? It is an incredibly worrying demonstration of the lack of communication and oversight within the trust. The position appears to be entirely incoherent.

Dr Marsh’s report put a great deal of emphasis on the existence of a real disconnect within the organisation. As he rightly outlined,

“It is the responsibility of the Board…to ensure the Governance arrangements and the plans for the Trust are appropriate and robust enough to keep risk as low as practicably possible”,

which includes ensuring that

“all patients receive the best treatment in a timely fashion.”

It is crucial that members of the board take responsibility for that and for patient care in a wider context. Has the Minister met the board recently to find a solution to the current organisational and personnel issues that are referred to in Dr Marsh’s report?

I have outlined the poor performance of the trust from only a few key indicators from data that are widely available. The Department needs to be robust in helping to address those issues, and I hope that the Minister gives the assurances that patients need and deserve. In her response, I hope that she tells the Chamber when she expects the problems with this ambulance trust to be resolved; what the Department is doing to assist the trust with its recovery; what additional expenditure, if any, that will require; and whether hospitals that are reliant on the trust can expect any additional support, financial or otherwise, owing to the avoidable operational pressures that the ambulance trust has placed upon them. Can she guarantee that the performance of the trust has not seriously affected clinical outcomes for patients in the local area? Based on today’s evidence, I would find that hard to accept. Can she give an assurance that, once the trust is operating acceptably, the Department will not allow this to happen again? Finally, when will patients in the east of England get the ambulance service that they deserve?