East Midlands Ambulance Service

Karen Lee Excerpts

Wednesday 21st February 2018 Westminster Hall

[Ruth George]

We can always seek to manage resources better, but East Midlands ambulance service has been seeking to manage resources for a very long time, working with Unison and the unions there.

[Karen Lee (Lincoln) (Lab)]

Does my hon. Friend agree that the closure of Lincoln’s walk-in centre, despite the fact that 94% of the people who responded to the consultation said that they did not want it to close, cannot fail to have a further impact on EMAS and local services? We are told by the clinical commissioning group that it will not have an impact and that there will be other provision, but the local ambulance teams—I will come to this point when I give my speech—told me that it will absolutely have an impact. I wonder what her thoughts are on that.

[Ruth George]

Walk-in centres were established by the last Labour Government to reduce the demand on the ambulance services and to give people the services that they actually needed on their doorstep. Every cut of every walk-in centre is hugely worrying, both for patients and the ambulance service.

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[Ruth George]

The fact is that walk-in centres are open late in the evenings and at weekends, and in most GP practices it is not possible to get an urgent appointment without phoning at 8 am exactly. In my constituency, people have to wait at least two weeks to get an appointment.

[Karen Lee]

When I went out with the ambulance team, one of the people who called and got an ambulance was an elderly gentleman of 91 who had breathing problems. He called an ambulance because he could not get a GP appointment or get to the walk-in centre at that point. It is not always people who are desperately ill who call ambulances; lots of people call ambulances in sheer desperation because they cannot get anything else.

[Ruth George]

That illustrates the point completely. We have seen a lack of primary care services, and doctors’ appointments are far harder to get than the 48 hours it took under a Labour Government. In consequence, we have a hugely overburdened ambulance service.

Now we come to funding. East Midlands ambulance service is already one of the most efficient in all the regions. In spite of the relatively sparse population and demanding geography, EMAS’s costs per face-to-face response are the third-lowest of all the regions—9% lower than the average across England. The costs per call are, again, the third lowest and more than 10% below the average.

By any measure, East Midlands ambulance service is very efficient, with 99% of its staff working on the frontline. Almost all managers take shifts so that they know exactly what is going on. It has cut all that it can, and it has had to make cuts, because EMAS has the second-lowest funding of all the regions—8% lower than the average across England. Only the North East ambulance service, which serves a more densely populated area, has lower funding than the East Midlands ambulance service.

The funding has not kept pace either with inflation or with the increased demand—in fact, it has barely increased at all in the last six years. In 2010-11, EMAS received £160 million for patient care activities. By 2016-17, we had seen over 16% inflation and a 50% increase in activity. Funding should be at least two thirds higher—£105 million extra would be the proportionate cost. Instead, East Midlands ambulance service received less than £5 million extra compared with 2011. That is less than 3% extra funding when it needed 66%.

East Midlands ambulance service has never been well funded—our region has always been the poor relation, as colleagues on both sides of the House often concur—but the cuts over the last seven years have made it impossible for it to meet its targets, and to deliver the right standard of service and care to some of the most sick and injured people, and the most at risk. That is what the Nottinghamshire coroner concluded in May 2016. In an urgent case review, she said:

“Demand is clearly greater than the resources they have most of the time”.

That is not the fault of any of the staff at EMAS. Last summer, the Care Quality Commission found that although the service was in need of improvement, it was caring and responsive—but it could not be safe or effective. The report states that there were

“caring, professional staff delivering compassionate, patient focussed care in circumstances that were challenging due to the continued demand placed on the service.”

The increased demand for primary care, emergency care and ambulance services is not being resourced. Our ambulance service is on the frontline. Our crews do their very best, but it is tough. Yes, staff sickness is slightly higher than average at EMAS, but I am not surprised. It is not just what the crews deal with; it is the constant stress and pressure, and the distress and anger that they sometimes face when they can finally arrive.

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[Matt Warman (Boston and Skegness) (Con)]

It is a pleasure to serve under your chairmanship, Mr Davies. I pay tribute to the workers on the frontline of the East Midlands Ambulance Service NHS Trust. At a constituency event, I met one who had had two teeth knocked out by a patient he was trying to help. He said, literally, “It is all in a day’s work.” Those dedicated people are doing great work. I want everything I say after this to be taken in that context.

EMAS receives a call every 34 seconds. It has been keen to embrace innovations—for example, it has done work in Lincolnshire on sepsis—which complements some of the challenges we face at United Lincolnshire Hospitals NHS Trust. It is telling that six of the seven Lincolnshire Members of Parliament are here in this Chamber. Lincolnshire faces the greatest challenges, although I do not want to diminish the challenges that EMAS faces elsewhere.

Originally, we had a Lincolnshire ambulance service. As my hon. Friend the Member for Gainsborough (Sir Edward Leigh) has said, EMAS was created to fix some of the problems we had in Lincolnshire, but I suggest to the Minister that it has palpably not done that. Some of the problems relate to handover. Only yesterday, a constituent informed me that there were 10 ambulances queuing outside Pilgrim Hospital, and he has informed me that at one point today there were 11. I make that point not to criticise a single member of the ambulance service but to endorse the point made by my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson). It is clear that we face problems, and we should look at how to solve them.

My right hon. Friend the Member for South Holland and The Deepings (Mr Hayes) made a fair point when he said that there are problems with the management at EMAS. To give but one example, I have raised problems with EMAS every time I have attended health debates in this place, and EMAS has not made a single proactive attempt to reach out to explain even what it is trying to do. I suggest that the waiting times and the service we get from management indicate that the ambulance service is not serving us, as the elected representatives of patients, or patients themselves. This is a serious situation.

I have a number of suggestions to put to the Minister. First, he should support the Lincolnshire County Council manifesto commitment to create, or at least to explore, a Lincolnshire ambulance service. In various parts of Lincolnshire—particularly in my coastal, sparsely populated constituency—there is a huge drain on resources as ambulances inevitably go westwards and do not come back. A Lincolnshire ambulance service, using sensible modern technology, could achieve a great deal more than what was possible under the previous regime, and would address some of the challenges we face simply due to the rather random creation of EMAS—as the hon. Member for Bassetlaw (John Mann) has said, the east midlands is an area that does not really exist in the mind of the public.

To go slightly further, it would be good to see the Minister continuing the work that was done prior to the reshuffle, looking at what we can do sensibly to combine blue-light services. We already do some creative work in Lincolnshire with the fire brigade. We do some really important, sensible things that allow the fire brigade to save lives. Indeed, in some cases, they are saving lives that, under previous, unreformed systems, would not have been saved. There is good work to build on.

[Karen Lee]

Does the hon. Gentleman agree that if we ask firefighters to extend their role, that should be properly resourced and funded and not just given as an extra job on top of what they do already?

[Matt Warman]

I agree, of course, that we need the resources and reform package that will put us where we need to be. As my right hon. Friend the Member for South Holland and The Deepings has said, the issue is not solely about money—though to be fair to everyone present, I do not think that anyone is pretending otherwise —but of course proper resources are a big part of the equation.

Sensible moves on a blue-light combination would be a logical thing to do. I also think that one of the problems we face—this relates both to the issue of handover and to the number of ambulances waiting outside hospitals—is in large part due to the recruitment and retention challenges we have in Lincolnshire. A medical school in Lincolnshire would play a part in solving some of those problems. I say that in part because we need to recognise that this is a system problem, not solely an EMAS problem.

In conclusion, I was all set before the debate to stand up and say that successive Governments have not managed to get a grip on this problem—

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[Karen Lee (Lincoln) (Lab)]

I personally have witnessed how hard EMAS staff work. I pay tribute to their professionalism and dedication.

On 18 January my right hon. Friend the Member for Islington North (Jeremy Corbyn) came to Lincoln and we visited the call centre up at Bracebridge Heath. We saw at first hand what was happening. We were told that the single biggest problem in the increase in response times is when the ambulances get to hospital and cannot hand patients over. The day before I went out with an ambulance crew, there had been a seven-hour wait to hand over and at 7 am the next morning 22 patients were still waiting in A&E for a bed. As I have said, during my right hon. Friend’s visit we talked to ambulance crews and the handover time at hospital is causing the problem and increasing response times.

On 3 January I went out on my own with a crew—I, too, am a healthcare professional: a nurse. Ordinary people were phoning for ambulances. An elderly gentleman called one because he could not breathe and was terrified —he actually had a chest infection, so he was given a nebuliser and did not have to go to hospital, but he had not been able to get a GP appointment. We went to an old lady who had fallen and was on the floor. The paramedics dealt with her and within an hour we left her—she stayed at home and did not need to go to hospital. Our ambulance services deal with all sorts of cases.

A more personal example is my mum, who has mental health problems—she had a breakdown a few years ago. The Friday before Christmas, at half-past 4 in the afternoon, I was called from my office to go to her. I went, called 111 and got her assessed by about 6.30 pm or 7 o’clock. I did not get an ambulance until quarter to 1 in the morning. She just had to wait. There was a bed at Witham Court, but we could not get an ambulance. My mum was getting increasingly distressed—she was in a right state and I had to sit with her. If I had not been there, my stepfather would have had to deal with her, and he has dementia. I was wandering around Tesco at 2 am on the Saturday before Christmas because I had had to stay in to look after my mum—another ambulance wait.

Other examples are personal to me because I am a cardiac nurse. When my right hon. Friend the Member for Islington North came to Lincoln, we went to the heart centre. I am also aware of stuff that has come through my post bag about people with chest pains waiting two and a half hours for an ambulance. The figures for issues such as door-to-balloon time are all going up at Lincoln County Hospital because people who are actually having heart attacks cannot get an ambulance. They are at risk of going into an arrhythmia, whether it be VT or VF—ventricular tachycardia or ventricular fibrillation—because they are having a heart attack. They are not getting the treatment they need, because they are waiting for an ambulance.

Our NHS is in crisis. It is time that the Government acknowledged that. If A&E is so packed that ambulances cannot hand over, the NHS is in crisis—please admit that and let us do something about it. What is happening with EMAS is symptomatic of the situation. NHS workers are underpaid right across the board, with a pay cap, and they are understaffed. All those things work together. I feel sorry for EMAS—at the moment it is set up to fail and there is nothing it can do about that. I am sorry, but this is utterly political: why do we starve public services of resources? It is all right to say that we are giving them money, but we are not giving them enough money. When we do not give them enough money but cut taxes, frankly that is immoral.

[Geraint Davies (in the Chair)]

I call Ben Bradley. Is he here? He has just walked out, has he? He was here. I am sorry about that. I will call the first Front Bencher instead.