Ambulance and Emergency Department Waiting Times

Margaret Greenwood Excerpts

Wednesday 6th July 2022 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this important debate and on her speech. The Royal College of Emergency Medicine put out a press release today saying that their new survey found that:

“Two-thirds of A&E clinical leads…are not at all confident that their organisation will cope this winter”.

Its president, Dr Katherine Henderson, said:

“This is the height of summer and yet we are seeing a state of affairs that we’d be dismayed by even in the depths of winter.”

In the north-west, the average ambulance response time for a category 1 call was eight minutes in May—better than the national average, but still a minute above the average response time target of seven minutes. The average response time for a category 2 call was around 34 minutes—again, better than the national average, but well over the target of 18 minutes. We all know that, in an emergency, every minute counts.

We all want to be confident that a well-resourced ambulance service is there should we need it, along with a properly staffed and resourced A&E department. We are aware, too, that the ambulance services and A&E are under immense pressure—because of covid, but also because of staff shortages in the NHS. There are shortages in hospitals, making it more challenging to transfer patients to hospital beds in a timely manner, and in general practice, meaning that people are going to A&E out of frustration at their inability to secure a GP appointment. Of course, that all impacts on patients, sometimes with devastating consequences for them and their families. I want to highlight the tragic case of Sheila, the 72-year-old mother of my constituent, Shirley. I thank Shirley for sharing this information with us. Sheila suffered a heart attack and passed away at home on 1 December 2021. When she began gasping for breath two days after she had been diagnosed with a chest infection, her son called 999. There were two points of failure within the service. First, the ambulance did not arrive within the target time for a category 2 call. Secondly, when Sheila’s son rang 999 for a second time, the call was kept in category 2, instead of being moved to category 1 by the emergency medical dispatcher who took the call, despite the fact that Sheila had asthma and could be heard in the background saying that she could not breathe. Tragically, 106 minutes after the first 999 call and 79 minutes after the second, Sheila’s son made a third call to explain that his mother had passed away approximately 40 minutes earlier.

The findings of the serious incident investigation lay bare some of the pressures on ambulance services. It found that the main contributory factors of the delay while the call remained category 2 were the ambulance trust’s capacity not meeting demand, and the effect that hospital turnaround delays had on its ability to respond to patients. The investigation also pointed out that, even with 100% funded operational staffing, the trust had not been able to meet targets.

The investigation into Sheila’s case also raised the issue of the training of those taking the calls, who are known as emergency medical dispatchers. As I mentioned, the emergency medical dispatcher taking the second call missed hearing Sheila say that she could not breathe, so did not change her case to category 1, which would have resulted in an ambulance being dispatched more quickly. The investigation reported that the emergency medical dispatcher noted that the call was taken not long after she had finished her mentoring, and she was still unsure about ineffective breathing. She also advised that at the time of the call she felt that there were mixed messages from supervisors and other staff on ineffective breathing, and that it was not very clear, hence she misjudged the call.

That raises important questions about the training that emergency medical dispatchers receive. Are they getting the right kind of training? Is it being delivered in a way that allows them to express themselves if they are not sure about something? Do they receive sufficient support in the workplace? They carry out an incredibly important role, which doubtless can be extremely difficult, and comes with enormous responsibility. My constituent Shirley said:

“We did not blame the paramedics or the centre staff, but understand how short staffed and underfunded the service was, and how much strain the service was under.”

I hope the Minister will respond to the issues raised in this debate with care and a commitment to improve the situation rapidly. The Government must do their first duty—namely, to keep their citizens safe. Right now, as they fail to tackle ambulance and A&E waiting times and NHS staff shortages, they are failing badly.

--- Later in debate ---

[Edward Argar]

I am grateful to the hon. Lady, but when hon. Members raise party political points, it is incumbent on me as Minister to respond and to put the facts on the record. I will turn to the specific points she has raised. I will also turn, in that context, to the various points that she and the hon. Member for North Shropshire (Helen Morgan) made about various tangible suggestions from the Liberals on the issue.

The hon. Member for Bath is right to have secured and introduced the debate, because this issue is one of growing concern, understandably, and not just for all our constituents but for those who work on the frontline of our NHS. I think it was the hon. Member for Weaver Vale who highlighted the challenges faced by those staff, who want to be there and want to help. When someone rings for an ambulance, it is not a case of making an appointment with their GP; they are deeply concerned for their health, or the health of someone else, in an emergency. All those staff want to do—I have met many of them—is be there for those people, and the hon. Gentleman was right to highlight that issue.

As the hon. Member for Bath will be aware, the pandemic has caused significant strain across the NHS and the social care sector, and emergency care performance, as hon. Members have been open in acknowledging, is recognised as a whole-system issue. The challenges in performance can be traced along the entire patient pathway. Indeed, as I think the hon. Lady acknowledged in her Adjournment debate in the main Chamber on 31 March, although there are elements of that that we need to look at, we also need to look at the issue as a whole. She was right to say that.

For example, as hon. Members have said, the problems and delays in discharging patients home or to community services once they have recovered have a genuine impact on hospital bed occupancy—taking up beds that could otherwise be used by patients who need them. I want to give my hon. Friend the Member for Broadland a slightly more optimistic picture, which is in no way to diminish the challenge that remains. The number of beds taken up by people who are clinically fit to be discharged is not 20,000; it hovers at around 10,000. We have set up a national discharge taskforce, which is working actively with trusts and across local systems, particularly those that are most challenged, to support that discharge work. The situation is not as acute as he suggested, but it remains challenging because every one of those beds could be used to admit patients from an urgent and emergency care setting, or indeed to tackle elective backlogs and waiting lists.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I would like to make a little progress before giving way again. I am conscious that I need to leave enough time for the hon. Member for Bath to respond.

That affects how quickly patients can be admitted from A&E, and such delays increase waiting times, as has been said, and lead to that crowding in departments, which has an impact on how quickly new patients arriving in A&E can be seen and treated, including those arriving by ambulance. When this causes ambulance queues to form, the local ambulance resource available to be dispatched to incoming 999 calls is reduced. It is fair to say that although the ambulance queues and delays are often the most visible manifestation of challenge, they are in many ways a symptom of that broader patient flow and the systemic challenge we face.

The root cause of these issues is hospital bed occupancy. That has consistently remained nationally at around 93%—a level usually seen only during winter pressures, as hon. Members have said. The pandemic has played a significant part in driving those pressures, and there are nearly 9,500 in-patients either with covid or for covid in clinical settings, as of 1 July. That is about 10% of all general and acute beds in the NHS.

[Margaret Greenwood]

rose—

[Edward Argar]

I will give way to the hon. Lady, but I want to make a little progress. There are points I want to make before I run out of time, but then I will give way.

That number, as we know, has frequently been higher during the pandemic, and there is the challenge of staff absences during waves.

[Margaret Greenwood]

rose—

[Edward Argar]

If the hon. Lady is brief, I will of course give way.

[Margaret Greenwood]

The Minister will be aware that I have expressed extreme concern and tabled written questions about what happens to those people who are discharged under what was known as discharge to assess and their clinical outcomes. Will he commit to carrying out a review of the patient outcomes of all the patients discharged in that way, to see how many were readmitted to hospital within 30 days of discharge?

[Edward Argar]

I will not commit myself to what the hon. Lady specifically asks for because of the challenge of data collection, but I will say that I see where she is coming from and appreciate the underlying point, which is about understanding the impact of the policy. It has been in use since 2020 as a pandemic measure and is now in statute. The NHS will be monitoring it carefully. We do not agree on everything, but I am always happy to talk to her about these matters because she takes a close interest in them.

With regard to local actions in the patch covered by the hon. Member for Bath, as an illustration of the sorts of measures being put in place across the country, the local integrated care system is working to improve patient flow and reduce handover delays at acute trusts, including the Royal United Hospital in Bath. I join her in paying tribute to the work that her local team there are doing. That hospital is working well with community partners to help patients to return home as soon as they are well. That includes work with the hon. Lady’s local council to develop its domiciliary care provider, which will provide an additional 1,000 hours of domiciliary care a week. A £2 million investment will also be made in the Home First programme, whereby experts from across health and care help patients to get safely back home as soon as possible. The system is also working on opening an additional 20 beds at St Martin’s Community Hospital, while also developing same-day emergency care for frailty to avoid unnecessary admissions to hospital and to care for patients safely in the community.

There is of course nationally a wide range of support in place to improve urgent and emergency care more widely. That includes growing the number of call handlers for 999 and 111, and the investment that we have seen going into our ambulance services and A&Es. It is the case that £450 million of capital investment has already gone into increasing capacity in urgent and emergency care departments. In addition, we have kept, I think, over 155 more ambulances on the road over winter with our investment of £55 million more going into ambulance services. We are investing those resources in the frontline. If I recall my statistics correctly, there has been a 38% increase in the paramedic and ambulance workforce since 2010. The hon. Lady and her party can rightly claim a degree of credit for that, because a degree of that took place between 2010 and 2015. We do continue to grow the workforce.

Turning to workforce issues more broadly, it is absolutely right that, as well as providing the support to which the hon. Member for York Central (Rachael Maskell) alluded—mental health and physical support for the workforce—we continue to grow the workforce in order to ease the workload pressures. We have already witnessed over 30,000 more nurses in the NHS since that pledge was made in 2019. We continue to grow all workforces. In section 41 of the Health and Care Act 2022 we set out a very clear duty on the Secretary of State in relation to workforce planning, and that work is already under way.

I will turn to a couple of further points very briefly, because I want to give the hon. Member for Bath her two minutes at the end. She raised a number of specific points. She called for greater resources to be put in. That has been done. She called for an increase to be made in paramedics and ambulance staff. That has been and continues to be done. None of these are completed works, but they continue to be done. She called for action to stop ambulance station closures or community ambulance station closures. I have to say that those decisions are made clinically by local trusts; the power was not there for the Secretary of State to intervene. In fact, it was the Labour party that argued against giving the Secretary of State and Ministers the power to take action on those things when it voted against and spoke against that measure during the passage of the Health and Care Bill. It is right that clinicians determine what is the best set-up for clinical services in their area. I just gently make that point.

In summary, I think that both sides of the House recognise fully the challenges faced in these unprecedented times by our urgent and emergency care sector, and particularly by patients and those who work in the sector. We have a plan to fix it. We continue to invest in that plan and to support our workforce, and we will continue to do that for the benefit of patients.