East of England Ambulance Service

Lord Bellingham Excerpts

Tuesday 25th June 2013 Westminster Hall

[Mr Henry Bellingham (North West Norfolk) (Con)]

I congratulate my hon. Friend the Member for Witham (Priti Patel) on her characteristically candid and very well-crafted speech. She speaks for many of us in expressing those strong arguments.

Like my hon. Friend, I pay tribute to the paramedics, drivers and engineers—the people at the sharp end—because they have done a consistently good and professional job, despite poor leadership; they have not had the backing that they deserve. I also join her in paying tribute to the Minister’s ministerial colleague, Earl Howe, who has been very attentive to our concerns throughout.

Dr Marsh’s report is well researched and impressive. If the report has one compelling conclusion, it is that the crisis in the ambulance service trust is the consequence not of a lack of resources, but of a lack of leadership, vision and strategic direction. The comparisons that he draws with West Midlands Ambulance Service NHS Foundation Trust are pertinent, because it is a trust with a similar population base—the population is obviously more urban—that faces similar challenges, but it has met those challenges through strong direction and leadership throughout. That is why the West Midlands Ambulance Service NHS Foundation Trust is at the top of the pile. Unfortunately, our trust is down at the bottom.

I agree with my hon. Friend the Member for Broadland (Mr Simpson), who said in his important intervention that recently, over a number of years, a management culture has emerged in the East of England Ambulance Service NHS Trust that basically deems second best to be acceptable, and consequently action that should have been taken has not been taken.

If the trust was an alternative investment market-listed company that had gone into crisis mode, the non-executive directors would have resigned on principle; if the trust was a company listed on the main stock exchange, the directors would have had to resign. It is staggering that they have somehow decided that it is okay to cling on to their jobs and stay, despite the complete lack of oversight of corporate governance and the failure to adhere to the combined code. As I understand it—the Minister will correct me if I am wrong—the non-executive directors are responsible under the combined code in the same way as directors of public companies. The trust is obviously not a public company, but it has the same corporate governance rules. Notwithstanding the fact that it is a different organisation, the non-executive directors have that responsibility. If they had any integrity, they would offer their resignations.

I hope the Minister is able to tell us that she will advise the non-executive directors, with the approval of the Secretary of State, to resign before tomorrow’s board meeting. It is no good for the interim chairman, Dr Harris—there is a whole lot of management speak here—to review the board members’ benchmarking against leadership criteria, etc. What the hell does that mean? Basically, the board needs reconstituting, and it needs reconstituting very soon. Will the Minister give us some insight into what her Department is doing to try to bring new blood—people with real ability, not jobsworths who simply get recycled around one public board after another—on to such boards?

Just as the trust has fallen way down to the bottom of the league, King’s Lynn and west Norfolk is unfortunately lagging behind the rest of East Anglia. I find that very worrying. Obviously, I accept that, in remote rural areas, there are some hamlets and remote communities where it is physically impossible for an ambulance to reach a patient within the targets. We know that. There are some places in my constituency, and in the constituencies of many of my colleagues here today, where that is absolutely impossible, even with the best will in the world. There might be a coincidence in which, for example, an ambulance is going along a main road at a particular juncture, but achieving the target may well be impossible, so it is even more important that the targets are met in the towns and bigger communities, where it might be thought perfectly reasonable to expect ambulances to get to a call within the target time in 95%-plus of cases. Unfortunately, the targets are not even being met in the towns in my constituency.

I have been given permission by my constituent Mrs Delna Barrett to refer to her case. Her husband, Chris, had been suffering from Parkinson’s disease for some 20 years. He stopped breathing in a restaurant in Hunstanton, which is the second-largest town in my constituency, and it took the ambulance more than 20 minutes to arrive. Despite numerous resuscitation attempts, he died in hospital two days later. We do not know whether, if the ambulance had arrived within the target time, he would have had a better chance of surviving. The family are not criticising the paramedics or the staff, but the bottom line is that the ambulance did not arrive within a reasonable time.

We know that many difficulties are caused by the problems at A and E, to which my hon. Friend the Member for Witham alluded in her excellent speech, and we know that those problems have been around for quite a long time. There certainly are problems at the Queen Elizabeth hospital in my constituency, and there are problems at the Norfolk and Norwich hospital, where at one stage back in March all 17 of the trust’s ambulances were tied up waiting outside. All that is well documented, and it is not entirely within the purview of this debate, but we cannot consider the problem of the ambulance trust in complete isolation; we must consider out-of-hours services and out-of-hours cover.

Very often, individual family events bring home to us the different parts of the health service that are perhaps in need of improvement or are examples of best practice. Some 20 years ago, I was staying with my mother near King’s Lynn, and at about four in the morning she banged on my door and said that she was dying. She was in the most appalling pain—absolute agony. My mother is a war veteran who was in the Women’s Royal Naval Service. She is a very tough person, and she never complains about anything. She told me that she was in complete agony and could not move. I rang the local doctor, who came out within 20 minutes. He said, “You have kidney stones, and I am going to give you an injection that will put you asleep until tomorrow afternoon. I will then come back and we will take stock of the situation.” He gave her some more injections the following afternoon. The stones were broken down, and she did not even have to go to hospital.

If my mother knocked on my door now, what would I do? Obviously, I would dial 111 or 999, but so risk-averse are all those call centres that she would undoubtedly have gone into A and E. I would not have been happy with any advice from someone who did not know her medical records. The key to her treatment by the local doctor was that he knew her medical records and understood that she might be prone to that problem.

We must sort out the out-of-hours cover. We cannot go back to what we had before, when each doctor’s surgery provided out-of-hours cover, but the idea of co-operatives and mergers between GP practices to provide cover and ensure that the people who deal with patients out of hours understand their medical records and are prepared to provide service is key to sorting out the problem. Otherwise, given that the population in some parts of the country is growing, that people are living longer and that many more people have challenging illnesses and a multiplicity of problems, more and more people will have out-of-hours difficulties. Unless we sort out the out-of-hours service, we will have more and more problems.

[Mr George Howarth (in the Chair)]

Order. The hon. Gentleman is straying somewhat from the theme. I realise that it is a related matter, but he should return the discussion to the ambulance service.

[Mr Bellingham]

I shall do so immediately, Mr Howarth, as that is the topic of the debate. However, I wanted to put it into that context, because we cannot consider the ambulance service in isolation.

In conclusion, there is a great deal of concern throughout the region, but we take the view that the problem can be solved through new leadership if management get a grip, put common sense first and, above all, bring out the best in the people at the sharp end, who serve our constituents and take great pride in doing so. Those people set high professional standards. Given the right management, they will do the job to a high standard and give our constituents the ambulance service that they deserve. This is a turn-around situation. I wish the interim chairman and chief executive all the best in sorting out the problem. However, they require the Minister’s assistance and support, and her first step must be to grip the decision of the non-executive directors. She must then work closely with the management team to ensure that the trust is turned around for the benefit of our constituents, who deserve better.

[Several hon. Members rose—]