Ambulance Waiting Times

Jim Shannon Excerpts

Monday 17th October 2016 Commons Chamber

[Richard Drax (South Dorset) (Con)]

It is a pleasure to address the Chamber under your chairmanship, Madam Deputy Speaker. It is also a pleasure to see in his place my hon. Friend the Minister of State, Department of Health, who is a very able Minister.

My speech is not an attack on the Government per se. It is my job as the MP for South Dorset to stand up and speak for people without fear or favour. In my six years as MP, I have seen the ambulance service increasingly struggle, and I hope that any information that I impart will lead to the improvement of the service.

I pay tribute to the men and women of the ambulance service, whose professionalism, dedication and selflessness have saved countless lives. People’s ability to dial 999 in an emergency in the expectation of receiving urgent and expert medical help has long been one of the NHS’s treasures. Now, it is the ambulance service itself that is facing an emergency. In the year to May 2016, ambulance response times hit a record low. Not a single one of the 10 ambulance trusts in England met the target of reaching 75% of incidents within eight minutes. Worryingly, the current national average for a response within eight minutes is 68%. This trend has grown over the past four years, which is the period for which the Government have published response figures.

Ambulance control rooms across the country are buckling under the twin strains of increased demand and dwindling resources. The increased demand is undeniable. Last year set a new record, with 10.8 million ambulance call-outs in 12 months—a staggering number. The London control room alone now fields 5,000 calls for ambulances every single day.

The numbers show that emergency calls for ambulances have risen by 6% year on year for 10 years. This has not been helped by the fact that people are finding it harder to see their GP, meaning that they fall back on A&E. Although we can debate the causes, the fact remains that there are simply not enough vehicles, paramedics and clinicians to cope with the increase in workload. At the same time, the resources available have been cut or frozen. Six of the 10 English ambulance service trusts are currently in deficit, having overspent their budget, despite making efficiencies. East Midlands Ambulance Service NHS Trust alone had a £12 million deficit last year.

In my constituency, efficiency savings have directly affected the South Western Ambulance Service NHS Foundation Trust, which I shall refer to from now on as the trust. An ambulance call-out in the trust now costs 2.5% less than last year. The trust covers Bath and north-east Somerset, Bristol, Cornwall and the Isles of Scilly, Devon, Dorset, Gloucestershire and South Gloucestershire, Somerset, Swindon and Wiltshire—a huge predominantly rural land mass covering 20% of England. I highlight the trust’s area of responsibility because it is the most rural of all the ambulance trusts and the area is one of the most sparsely populated, which means longer distances, higher fuel costs, patients who are harder to locate and hospitals that are more spread out. This means that ambulances need to be parked at intervals across the region, as I see all the time.

Achieving response times and meeting budget targets under such circumstances is a challenge. It is not just the increased demand and reduced resources that are creating the problems; the target culture does not help. Though well intended, targets can skew both priorities and outcomes. For example, to meet target times, a fast-response paramedic on a motorbike or in a car might be sent to a critical incident that would almost certainly require ambulance transportation to hospital. Those red-category incidents include life-threatening emergencies such as cardiac arrest, where survival depends on swift and specific action. Sending the wrong resource in such a case might well tick the target box on response times, but the eventual outcome might not be so satisfactory. For example, if responders reach a patient only one second short of the eight minutes, it is considered a success, even if that patient dies.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this matter to the House. In 2014-15, the Northern Ireland Ambulance Service met its eight-minute deadline in only 60% of cases. Such problems beset all of us across the United Kingdom—here on the mainland and in Northern Ireland. Does he agree that it may be time to share those experiences and also ideas about how we can make things better across the United Kingdom? If we can do that together, to see what improvements we can make, we will all benefit.

[Richard Drax]

I entirely concur. As I said at the start of my speech, I am not here to condemn the Government, because they have the most appalling situation to deal with, given rising costs and all the things we know about the health service. Yes, more integrated systems, which the Government are working on, are definitely part of this. As I will say at the end of my speech—perhaps I will say it now—we really ought to think about the whole NHS and how it is run, not just the ambulance service. We need to do that free of politicians, with expert advice being sought from non-politicians—those who know how the health system works, not least the clinicians—so that we can re-look at this whole situation. We have enough money, but we have not spent it particularly wisely in every case.

Let me just go back to my example—you might well have lost the thread, Madam Deputy Speaker—about the target times for red-category incidents. I was saying that if responders reach a patient only one second short of the eight-minute target, it is considered a success, even if that patient dies. Conversely, it is deemed a failure if a patient lives, but help has arrived just one second over the eight-minute response time. Worse, the trust is marked down for it.

Once at the hospital, ambulance crews face yet another target: they must hand over their patient to the emergency department within 15 minutes. Anything over 30 minutes incurs a fine, although it is not applied to all areas and is capped by the trust’s commissioners. Yet, handovers can be achieved only if there are available beds and bays in the emergency department, which in turn can free up space only by transferring patients to wards or into surgery. That flow—from ambulance to emergency department to ward and, hopefully, to home and recovery—simply is not happening, because beds are not being cleared. The so-called bed blockers—the chronically ill and often elderly patients—languish in hospital beds because there simply is nowhere else for them to go. Without enough community care outside the hospital to discharge them to safely, there is no alternative, and so if the wards are full—they often are—there is gridlock. Regrettably, we have all become accustomed to the sight of ambulances lined up outside the emergency department with their crews tending to their patients until they can be handed over. In August this year, ambulances delivered patients to the Royal Bournemouth hospital’s emergency department 650 times. The 30-minute handover target time was breached 91 times, and in eight cases patients waited for more than two hours.

It is perhaps not surprising that ambulance crews feel demotivated and demoralised, and A&E staff are equally under pressure. They are all attempting to do their best—everyone recognises that—but perhaps that is in a system that sets them up to fail. Unsurprisingly, the attrition rate in the ambulance service in England is running at 11% a year, leading to each ambulance service having to replace more than one in 10 of its call handlers, drivers, clinicians or paramedics. I am told that these invaluable, experienced professionals eventually buckle under the physical and emotional demands of their jobs, often leaving for the better hours, conditions and pay offered by GP surgeries and clinics. The retention of staff is notoriously difficult in A&E departments, too, for similar reasons. A recruitment crisis now faces the ambulance service and A&E departments. Yet, for these most dedicated and professional workers, without whom the NHS would grind to a halt, there is little light on the horizon. Instead, and extraordinarily, fines are imposed on the cash-strapped services employing them.

Hold-ups from ambulance to A&E represent a waste of precious resources; in the trust’s area, that amounts to a staggering 5,000 hours per month, and the south-west’s hospitals are by no means the worst performing in England. For that reason, the trust and the Yorkshire and west midlands ambulance services have been trialling a new response programme. The aim is to get the right resource to the right incident first time. Rather than sending a response vehicle to meet a target, more time is taken to identify the reason for the call-out. Something that is life-threatening, such as strokes and heart attacks, will inevitably need an ambulance transfer to hospital, whereas a less serious case can be dealt with by a paramedic. Members might have thought that that sounds like common sense, but it seems to me, and I think to many, that targets, in part, get in the way of common sense. Sheffield University will report on the results of the programme. Interestingly, Wales is already using the system, with a 75% success rate, and Scotland is starting trials now.

Inevitably, waiting times for ambulances are increasing as pressures mount. Regrettably, there are consequences for the patient and, of course, their family and friends. Less well known are the physical and verbal assaults on ambulance staff. In the trust’s area alone, those have doubled in 12 months—that situation is, I am told, untenable. Death threats have been made to control room staff, while physical injuries have included a broken jaw and a career-ending attack with a baseball bat. Often, drink and drugs are to blame; sometimes, mental health issues, pain, sheer anxiety and frustration make relatives and friends lash out. I am not, for one second, condoning that behaviour—in fact, I condemn it—but I am just trying to explain it. I have some experience of this with constituents who are devastated when they do not get the emergency response they expect—when we dial 999, we do indeed expect a speedy response.

Ambulance service staff are united in calling for a formal, ongoing public information campaign that tells the public not only when to call an ambulance but what to expect when one is called. With the number of calls continually outstripping the number of ambulances available, expectations need to be managed. I would be grateful if the Minister expanded a little on that when he answers. By way of example, in Dorset and across the whole trust area, 58%—nearly 60%—of 999 calls do not result in patients being sent to A&E at all, and 14% of callers are treated and advised over the phone.

Calls to make funding for ambulance services and A&E a special case chime with calls for increased social care provision to free up beds in hospitals so that a flow can be re-established. That is particularly important in Dorset and the south-west, where so many pensioners choose to live.

I would like to share some observations from Mrs Fiona Smith, who is the manager of Milton Court sheltered housing in Poole, which is not in my constituency. Her charges, who are all in their 80s and 90s, live independently and successfully in their own homes, with support services provided by the company. If they suffer heart attacks or strokes, the ambulance arrives within 10 minutes, she says, but if they fall down, the importance of the incident is downgraded by call handlers due to immense pressure from other incidents. Mrs Smith recently waited for more than four hours with a frail 96-year-old lady who remained lying on the floor with a broken hip because protocols would not allow staff to lift her. Mrs Smith is at pains to point out that she is not criticising the ambulance staff; she simply believes that there is insufficient funding and staff. Her advice to me and the Government, and to others, is that we need to get our priorities right.

I know there is no short-term solution to the picture I have painted, and I sympathise enormously with the Government’s plight. In the past, Governments of all colours have had this massive problem, which is growing as the population gets older and lives longer, and the cost of medical care rises. More joined-up care is one way forward, as the hon. Member for Strangford (Jim Shannon) suggested. I praise the clinical commissioning group in Dorset, which is working with all GPs and hospitals to try to ensure that a more joined-up care approach is working. I believe that that is happening across the country, and I am sure the Minister will expand on that. This is a vital way forward that will solve some of the problems.

Perhaps, as I hinted—I do not know whether the Minister can expand on this—we need to re-examine the whole NHS, rather than just picking on particular bits of it. Now and in the past, when politicians and Secretaries of State sometimes feel that that things need to be done—and they do—they unfortunately fail to look at the whole picture. This is not a criticism of our current Secretary of State, for whom I have high regard; I think he is doing an extremely good job in difficult circumstances. However, perhaps now is the time—as we see, to a certain extent, the writing on the wall and the warning signs flashing—for us to sit down and have another look at how the NHS is run. I leave that point with the Minister and his Department. I can only recommend that politicians are kept out of that debate until such time as ideas are put forward to us, because inevitably we would have to make the final decisions.

I end as I began by praising the staff of the ambulance service in the south-west, not least those who serve us in South Dorset and do a fantastic job. I have met many of them and cannot praise them enough. I now look to the Minister to expand on what I have said in the hope that there is some light at the end of the tunnel, and perhaps a little more money at the bottom of the bucket.