Urgent and Emergency Care Recovery Plan

Lord Hogan-Howe Excerpts

Thursday 2nd February 2023 Lords Chamber

[Lord Markham (Con)]

I will take it in reverse order. We do have the ability to stand up that capacity quickly so that the ambulances can discharge. I have already ordered a number of those, and some are ready to go, to provide exactly that capacity. Others are coming on stream in the coming weeks, so we are rapidly responding to the exact point that my noble friend raises.

Just as important—I am glad to have the opportunity to talk a bit more about this—is that a lot of the time ambulances do not need to bring the person to A&E. The mental health ambulances we are introducing, or the falls service ambulances that every ICB now has to introduce and have running every day, are critical. They can go there, right the person who has fallen and set them back up again. That needs only one person, not a big ambulance. That sort of care in the community—solving those problems and the right access—is critical in this situation.

On Lincolnshire, I will find out. The key thing here is making sure that we are expanding capacity in terms of beds.

[Lord Hogan-Howe (CB)]

My Lords, I sat with the noble Baroness, Lady Armstrong, on the Public Services Committee for that report. Two things were left with me; they follow up on the point from the noble Lord, Lord Porter, about ambulances attending the scene. We heard numerous cases, the worst I heard being that of a 95 year-old man who lay on the floor for 24 hours with a broken collarbone and hip. His family put a tent around him and no one in the health service—I do not mean just the ambulance service—went to help.

I just cannot understand that. There are over a million people in the health service; the Minister just mentioned that he is trying to get action around this, but why did the bosses not get out and drive an ambulance? Why did a GP not attend? Why did someone in society not think that that guy should not be lying there for 24 hours on the floor with a tent around?

Those examples really shame us. I do not say “the Government” or anybody else; they shame us. A piece of evidence which stuck with me was that one of the paramedics pointed out that one of the good things that has changed in strategy to improve outcomes for patients is that they spend longer on the scene, so they improve the initial treatment and improve the outcome. Of course, I asked what the overall impact of that was; he reckoned that they were able to attend about half the incidents that they did before, so were halving the effectiveness of the number of ambulances that we have. It does not look like the number of ambulances and staff will shift as a result of that change, or that there will be a different model of delivery—perhaps that one person might go or whatever. But those good outcomes for the heart-attack patient, perhaps, were not replicated for everybody: if they never got the ambulance, that did not help them. It just struck me that the change of delivery had not changed as much as the change of the model—spending longer at the scene—had improved the outcomes where ambulances attended.

[Lord Markham (Con)]

Yes, what the noble Lord talks about is critical. To my mind, this is where the data—I know data and analysis sound dry—is needed to arm the local decision-makers. This is the whole idea behind the ICSs: that they can invest in the right services in the right places. We have often got too much into thinking that the one-size-fits-all model of the ambulance with the two paramedics is the solution, whereas we know that the full service can do things far more effectively and keep the person in the home. To my mind, that is the whole sense of direction of the ICBs, which need to understand and own their areas. I saw a fantastic example in Spain: Ribera Salud, with which many people here are familiar, I think. It ran the local hospitals and local primary care. There was investment in primary care, and A&E entrances plummeted. That is what I want ICBs to look at, and what I want the workforce plan to do: to make sure that we give the right care in the right places, and have flexible delivery of different types of ambulances and types of staff, who will go and problem-solve. Sometimes that is problem-solving as per the example that we gave, but mainly it is trying to give the local ICBs the analytical tools, powers—for want of a better word—and resources, so that they can properly shape things. Some of them will do very well, and others will probably take longer. But that is the critical thing about letting people run their own areas: making sure that they adopt best practice, but that they have flexibility in that approach so that they can solve the problems on the doorstep.