Ambulance and Emergency Department Waiting Times

Jerome Mayhew Excerpts

Wednesday 6th July 2022 Westminster Hall

[Jerome Mayhew (Broadland) (Con)]

I congratulate the hon. Member for Bath (Wera Hobhouse) on securing a debate that, as a number of speakers have said, affects politicians of whatever party right across the country. I am lucky enough to represent a Norfolk seat, so my Broadland constituency is served by the Norfolk and Norwich University Hospital and, to a slightly lesser extent, by the James Paget Hospital and the Queen Elizabeth Hospital. All three have been mentioned in the debate.

The problems for ambulance waiting times are multifaceted and have been well rehearsed by other speakers, so I will not go through them all. I will focus on one area: hospital handover delays. The national standard is that handover should take no longer than 15 minutes, but 60% of all handovers nationally fail to meet that standard. I will focus on the Norfolk and Norwich, the most recent statistics for which show that in June the average handover time was not 15 minutes or less, but 57 minutes—almost an hour.

When we look at ambulance times, we think it is surely the front door of the hospital that is the problem—getting people into A&E—but when I spoke to the leadership of the Norfolk and Norwich, they told me that it is overwhelmingly the back door that is the problem, by which I mean people leaving the hospital. People are medically fit to be discharged but there are not appropriate intermediate care spaces for them to be discharged into, or their care packages have not been agreed or put in place. We should focus on that more than any of the other important aspects.

If we look at the data, we see that in April this year, across the nation, 20,155 people who were medically fit for discharge were still retained in hospital beds. During the covid pandemic I learned that we have around 100,000 beds in the NHS. More than 20,000 of them are bed-blocked—a deeply unfair term because it implies that the people in the beds are refusing to leave when, of course, nothing could be further from the truth—which means that fully a fifth of hospital beds are out of use for no medical reason. That is crucial to solving this problem. How many extra hospitals that we are building is equivalent to those 20,000 beds? It is an enormous change.

We need to look at why medically fit patients are not being discharged. In my submission, a key reason is the disparity of funding and where funding comes from in respect of the move from NHS beds to care. Everyone in this room knows that one provision is funded by the NHS and the other by county councils. There is often an unedifying dispute about who should pick up the bill and how to transfer responsibility for a patient, so there is no such thing as continuity of care in the discharge process.

If we can do one thing radically to improve not only ambulance times but the service that is provided in our hospitals more generally, as well as act on the burnout that hon. Members have described—the pressures on staff and the number of staff required—it is to solve the problem of continuity of care between the back door of the hospital and the front door of intermediate care and care in the community.

My question to the Minister is: am I wrong in that basic analysis? If I am, perhaps he will tell me where I have gone wrong. If I am right, or even substantially right, I would be grateful if he set out his views on how we could take the bold step from siloed funding and responsibility between the NHS and secondary care to the transition to what we desperately need, which is continuity of care for the patient, thereby solving all the other problems we are discussing today.