Ambulances

Lord Bishop of London Excerpts

Thursday 3rd November 2022 Lords Chamber

Asked by

[The Lord Bishop of London]

To ask His Majesty’s Government what progress they are making on ensuring swift ambulance handovers, as set out in Our Plan for Patients, published on 22 September, given the decision of ambulance workers across 11 trusts to ballot for strike action.

[The Lord Bishop of London]

My Lords, I start by saying how grateful I am to your Lordships’ House for setting time aside for what I think is an important and timely debate. I am also grateful for the briefing from the House of Lords Library.

Last week, the GMB union announced that it was balloting ambulance workers over strike action across 11 trusts in what would be the biggest ambulance workers’ strike for 30 years. I think it would be wise to ask ourselves what has happened across the whole system to bring us to this point. Ambulance handover delays are an increasing issue across the trusts in England. The NHS contract for this year sets out that 90% of handovers should take place within 30 minutes and 65% within 15. However, the Association of Ambulance Chief Executives notes 40,000 cases of patients waiting longer than an hour for handover—this was recorded this year and is the third-highest volume on record.

Long handover delays increase the risk of harm to patients while they are in ambulances. The NHS Confederation says that eight out of 10 patients who were delayed beyond 60 minutes were assessed as having had an experience that had potentially harmed them, and nearly one in 10 experienced severe harm as a result. The number of ambulances waiting to transfer their patients also impacts on the availability of ambulances, and the response times therefore increase. This in turn risks increasing further harm to those who are waiting for an ambulance in the community. Florence Nightingale famously once said that hospitals should do no harm. It is a sentiment that I believe is appropriate to the wider healthcare system. The healthcare system should do no harm.

Delays in handover also cause extreme anxiety for patients and families at a time when they are often very distressed. To be honest, waiting in an ambulance in this way is not how we should be treating people who have an inherent dignity. Long handovers are also putting pressure on staff and services right across the board. The Care Quality Commission’s annual report State of Care highlights the impact of waiting for handover on ambulance workers themselves. They cannot respond to incidents in the community. There may be a higher pressure on all staff involved, including call handlers who are trying to manage people who are repeatedly re-calling to check the status of their ambulance.

In addition to this, some ambulance workers are missing breaks and finishing their shifts late because they are required to stay with their patients as they wait to hand them over. These services function because people are working hard, even if they are not getting the resources that are required and the support they should be getting. The truth is that we cannot expect them to keep doing this.

The plan for patients set out by the former Secretary of State for Health and Social Care promised a “laser-like focus” on ambulance handover times. However, the plan that was set out lacked detail and made no headway in addressing the issue of workforce sustainability or retention. Will the Minister tell us when we can expect a workforce strategy to be published? A workforce strategy is key to any attempt to address this issue, which of course is one of the major issues facing the NHS and social care at this time.

The issue of ambulance handovers is one that gets to the heart of so many difficult issues which are within the health and social care sector. The NHS Confederation analysis of ambulance handovers states:

“Ambulance handover delays are not an ambulance issue, they are a whole-system issue and require a whole-system response.”


Some of the other issues that sit within the whole system are those we have discussed very recently in this House. They include, for example, the difficulty that people face in making a GP appointment. If you are unable to make a GP appointment, it may delay the time that you present, and therefore you become sicker. If you fail to be able to make a GP appointment, it may exacerbate the numbers of people who come to A&E.

There is also the significant issue of discharge into social care. The £500 million adult social care funding, announced by the then Secretary of State for Health and Social Care, was intended to assist with this. However, Matthew Taylor of the NHS Confederation has written to the Secretary of State, Steve Barclay, to say:

“Leaders across the NHS and local authorities are yet to see a single penny of this investment and any official detail on how it will be allocated”.


Change does not come quickly. Therefore, having the detail of this money and how it is to be allocated is important if we are going to avert a crisis this winter.

Furthermore, we have yet to understand whether this is not just an absorption of the health and social care levy repeal. As we discovered during the short passage of the Health and Social Care Levy (Repeal) Bill, the general budget is absorbing the loss of the tax increase so that the overall funding level for the health and social care sector does not change. Is it possible that this new £500 million for adult social care discharge fund is not new money, but is contributing to the absorption of the cut in the levy? I wonder whether the Minister could write to confirm the position.

I am sure noble Lords are aware that I have a particular concern for health inequalities. These inequalities are showing themselves in this area as well. The Care and Quality Commission annual report states that those living in the most deprived areas are likely to be more severely impacted by ambulance delays. It goes on to discuss the role of the ambulance service in meeting the needs of people caused by other failings across the sector:

“Anecdotal evidence … suggests that, traditionally, the ambulance service has fulfilled an informal role in helping people from deprived communities to navigate the health system”.


I have been fortunate recently to chair the Health Inequalities Action Group, which published its report last month. The report notes some of the barriers that both faith groups and healthcare workers face in engaging with each other, and the impact that would be possible with more constructive engagement, and the effect on reducing health inequalities. There is much work to be done to ensure that the more hidden groups, such as those known and represented by faith groups, can access the full benefit of healthcare available. If undertaken, this type of work will reduce pressure on the NHS, which, as a former Chief Nursing Officer for the Government, I feel is in crisis. This type of work, reducing health inequalities between healthcare and faith care workers, could also be part of a whole-system approach.

Ambulance handovers must be improved. However, without a workforce that is valued, supported and listened to, it is difficult to see how this is possible. In some ways, it is unsurprising that this balloting on action is being undertaken. According to the GMB acting national secretary, a third of ambulance workers think that a delay they have been involved with has led to a death. Can you imagine the impact that has on the well-being of healthcare and ambulance workers? Healthcare workers are also experiencing the cost of living crisis.

To draw to a close, what assessment have the Government made of the impact of ambulance waiting times on the loss of staff, and the loss of staff on ambulance waiting times? This will be the biggest ambulance workers’ strike for 30 years if it goes ahead, and this workforce is not in isolation. Last week, there was a further announcement of strikes across the NHS from UNISON. Yesterday, the Royal College of Nursing closed its UK-wide ballot for the first time for strike action in 106 years. The Royal College of Midwives and the Chartered Society of Physiotherapy are also balloting on strike action. It cannot be overstated how serious this is, not just for patients or our health but for the economic recovery of this country. This is a whole-systems problem which requires a whole-systems solution. I look forward to the contributions of other noble Lords and to the Minister’s response.