Ambulance and Emergency Department Waiting Times

Karin Smyth Excerpts

Wednesday 6th July 2022 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer, and to listen to this very well-informed debate. I commend the hon. Member for Bath (Wera Hobhouse) on securing it and on highlighting this important issue. We share boundaries across the south-west. I also thank the Minister for staying in the Chamber for the entire debate. He is now free to use his time. We will all be with him.

We know that under this Government record numbers of people are waiting for care, and they are waiting longer than ever before. Waiting times for ambulance and emergency department care are a symptom, as we have heard this morning, of the problems across the entire health and social care system. A record six million people are waiting for NHS treatment. There is a shortage of 100,000 staff and 17,000 fewer beds. That is not due to the pandemic, but deliberate underfunding of the NHS by a government who themselves admit—as the Culture Secretary recently did—that a decade of Conservative mismanagement had left our NHS “wanting and inadequate” even before covid hit.

I welcome the hon. Member for Tiverton and Honiton (Richard Foord) to his place and commend him on the points that he made. As we all know, on the doorstep, waiting times matter to constituents—a point that he made eloquently.

Waiting times for emergency care are nothing short of shocking. Like many Members of Parliament, I hear that every day from constituents. It is very distressing—and dangerous. There are cases of people waiting in agony outside the emergency department in an ambulance for over four hours, and waiting in the road for an ambulance for more than five hours. The average response time for an ambulance call-out for a stroke or suspected heart attack is 51 minutes and 22 seconds. The target, introduced by the last Labour Government, is 18 minutes. In May 2022, more than 19,000 patients were reported by NHS England as having spent more than 12 hours from the decision to admit to their admission to hospital. That really is a damning indictment. This winter, 89.8% more ambulances than the previous year were subject to delays of more than 30 minutes or more. My hon. Friend the Member for Jarrow (Kate Osborne) told us of the shocking incidents in the North East Ambulance Service and the investigation.

I could go on. What I am really interested in is the solution to this appalling state of affairs, as many hon. Members have said this morning. In fact, many hon. Members, particularly those on the Government side, have written my speech for me. Our highly skilled emergency department staff and paramedics show incredible courage and quick thinking on a daily basis. They need our support and they need a proper workforce plan that addresses shortages not only in emergency care but across the whole NHS.

Alarmingly, the Government’s manifesto commitment to improve waiting times for emergency departments was downgraded in the mandate from the Department of Health and Social Care to the NHS. The aim is now to improve performance “as conditions allow”. Under this Government, that will be never.

The hon. Member for North Shropshire (Helen Morgan) raised the case of the West Midlands Ambulance Service predicting a date on which it felt it would not be able to cope. This is not just about funding; it is also about the incoherent policies that leave patients and the public perplexed—a point that was touched on by the hon. Member for North Norfolk (Duncan Baker). Most urgent care takes place outside hospitals, but the complex mix of 111, GP out-of-hours, minor injuries units, walk-in centres, urgent care centres, as well as the plethora of online advice, is part of the chaos of fragmentation caused mostly by the now-discredited fetish for outsourcing and competition.

Currently, as we heard from the hon. Member for Waveney (Peter Aldous), schemes such as HALOs—hospital ambulance liaison officers—are just a sticking plaster. If we look at this as an A&E problem or just an acute hospital problem and do not incentivise all the ambulance services and primary care bits of the system to work together, we will not address the demand, which is a point made by the hon. Member for Broadland (Jerome Mayhew). The incentives, particularly after the Health and Social Care Act 2012, really do not help.

We need to make it simple for patients and their families to access the right care in the right place. That means supporting primary and community care, as well as ambulance services. As my hon. Friend the Member for York Central (Rachael Maskell) said, it is about bringing medical care to where people are and not expecting them to keep moving into the system.

Our highly skilled emergency teams must be free to manage all but the really serious acute cases referred to them, and then some of the problems would lessen, but the crux of the matter is that unless we improve discharges from hospital—as all hon. Members have said this morning—and ensure that our social care system is fit for purpose, we will not resolve the issue at the front of the hospital and we will not be helping patients. The pressures in leaving hospital has a direct impact on waiting times in emergency departments, and they put staff under pressure and patients in danger.

As my hon. Friend the Member for Weaver Vale (Mike Amesbury) said, the Government’s so-called fix for social care is not a fix at all. It is due to start in 2023. We need action now. We need to increase capacity in social care, improve pay and conditions for staff and ensure that we have a sustainable, working care system that will alleviate the pressures on the NHS, as well as support our constituents. There is no quick fix, but if the Government are serious about improving waiting times, they must look at the whole system.

We know the serious harm that waits and crowding in emergency departments have on patients and staff. Crowding is undignified and inhumane for patients who are left waiting for treatment in precarious circumstances. As well as impairing the efficiency of hospitals, it contributes to staff burnout, morale injury and the loss of emergency care professionals. It is associated with increased mortality and increased length of hospital stay.

Last year, the Royal College of Emergency Medicine estimated that crowding was potentially associated with more than 4,500 excess deaths. My hon. Friend the Member for Wirral West (Margaret Greenwood) noted the Royal College’s point that we are in the summer. This is not the critical time. We will go into another winter—winter follows summer every year, but it seems to be a shock to the Government. This is a very serious problem.

To prevent delays, I would welcome the Minister’s commitment to primary and community care and to supporting the timely discharge of patients when their hospital care is complete. Does he agree that there is an urgent need to support the social care workforce to ensure that it can offer the provision that meets the needs of our growing and ageing population? Will the Minister commit to the safe staffing of our emergency departments?

[Graham Stringer (in the Chair)]

Before I call the Minister, I ask that he leaves two minutes at the end for the proposer of the debate to wind up. I call Edward Argar.

[The Minister for Health (Edward Argar)]

I am happy to do so, Mr Stringer.

It is a pleasure to be here on the Front Bench responding to this very important debate. If I am still in this role on Sunday, I think I will be the third longest-serving Minister for Health since 1970, which says something about either longevity or churn in this role. It is a genuine pleasure to respond to the hon. Member for Bath (Wera Hobhouse), and I congratulate her on securing this debate.

As hon. Members across the House have acknowledged, the NHS has faced extraordinary pressures over the course of the pandemic and continues to face them. Although I suspect that not everything I say will meet with agreement from Members from both sides of the House, I join them in expressing our gratitude to all those who work not just in our NHS and health services but in social care.

I will start with a couple of words of caution about the use of history and statistics. Hon. Members made a number of points. I have been doing this job for almost three years, and I have often found that assertions are made with statistics or other facts from the history of the NHS, and I want to provide a counter-narrative to three or four before turning to the specifics of the hon. Lady’s debate.

First, I urge a little caution from Opposition Members when raising bed closures, not least because between 1997 and 2007, about 32,000 beds in the NHS were closed, which is more than double the number that were closed between 2010 and now. I say that simply to caution hon. Members that statistics can be used in different ways. There has been a long-term trend under Governments of both parties as the nature of care has changed.

[Karin Smyth]

Will the Minister give way?

[Edward Argar]

I just want to make a few more points, and then of course I will give way to the shadow Minister. She and I spent many happy hours in the Health and Care Bill Committee over many days.

On engagement with the private sector, again I would urge a little caution. It was of course the Labour Government in 2004 who first introduced the private sector into the provision of frontline clinical services with the out-of-hours contract. A Nuffield Trust blog in 2019 highlighted the fact that the increase in the use of the private sector in the NHS began before 2010 under that Government. I do not think the hon. Member for Jarrow (Kate Osborne) was asserting anything other than that, but it is important that I put that on the record.

Of course resources are hugely important. One of the first pieces of legislation that we introduced following the 2019 general election was the NHS Funding Act 2020, which will increase funding by £33.9 billion—a record amount—by 2023-24. As the hon. Member for Weaver Vale (Mike Amesbury) would expect me to say, we introduced the health and care levy to bring more funding into our NHS and social care. It was disappointing that Opposition Members voted against additional funding for the NHS when that was put to a vote.

[Karin Smyth]

The Minister talks about the bed reduction, but that was in the context of massively increasing primary and community care, and the private sector capacity was brought in to reverse the horrendous waiting lists following 18 years of Conservative government. We decided to govern. The point that hon. Members are making is: why does the Minister not govern?

[Edward Argar]

That is exactly what we are doing: we are leading and putting forward measures. Disappointingly, Labour voted against that extra funding.