Ambulance Services in England

Nigel Evans Excerpts

Thursday 10th February 2022 Commons Chamber

[Justin Madders]

In my constituency, the British Heart Foundation has told me that it is concerned about reports from the North West Ambulance Service that patient flow in and out of emergency departments is currently very slow, with ambulances being held for long periods, which has the knock-on effect, of course, of causing higher category 1 and category 2 stacks. Worryingly, we have heard reports of delays of up to four hours in these queues.

I am sure these figures, as shocking as they are, will not surprise hon. Members who, like me, have probably had many emails of concern and complaint from worried constituents. Behind these statistics are tens of thousands of seriously unwell people in dire need of help. As the chief executive of the Patients Association said:

“Going to A&E can be frightening. To then be stuck in an ambulance unable to get immediate medical help once you get there must add to the trauma of an emergency visit.”

I think we can all understand where they are coming from. The Royal College of Nursing’s director for England also points out:

“Having to wait outside in an ambulance because A&E is already dangerously overcrowded is distressing, not just for patients but also for staff, who can’t provide proper care.”

It must be so frustrating for those staff, knowing there are other urgent calls they could be going to, that they cannot leave their current patient because the hospital is already at capacity.

I agree with those comments. Not only does having an ambulance stuck outside A&E as it waits to offload a patient mean that it is unable to answer 999 calls, which leads to slower response times, but it means we lose ambulance hours. We lost 8,133 ambulance hours in the last week of January due to crews having to wait outside busy A&Es. That is an incredible statistic.

As NHS Providers points out:

“safety risk is being borne increasingly by ambulance services.”

We know that people are dying in the back of ambulances or soon after their admission to hospital because of these long waits. We heard from ambulance chiefs in November that 160,000 patients come to harm each year because ambulances are backed up outside hospitals.

The shocking report from the Association of Ambulance Chief Executives, which is based on NHS figures, did not report how many patients die each year because of ambulances stuck outside hospitals, but it did say:

“We know that some patients have sadly died whilst waiting outside ED”—

emergency departments—

“or shortly after eventual admission to ED following a wait. Others have died while waiting for an ambulance response in the community.”

The report acknowledges that, whether or not those deaths were inevitable

“this is not the level of care or experience we would wish for anyone in their last moments.”

The report also highlights that around 12,000 patients suffered serious harm because of delays, sometimes with a risk of permanent disability. In the same month, more than 40,000 people in England who called 999 with a category 2 condition such as a stroke or heart attack waited more than one hour and 40 minutes for an ambulance. Of course, the NHS target is to reach them within 18 minutes.

Just last week, NHS figures revealed that thousands of people are dying because ambulances are taking too long to answer emergency calls. The official statistics show that only three of England’s 32 ambulance services are reaching a majority of immediately life threatening call-outs within eight minutes. In fact, the latest available NHS England data for December 2021 shows that the average ambulance response time for category 2 emergencies —suspected heart attack and stroke patients—is 53 minutes and 21 seconds: three times the 18-minute target. Those are incredibly worrying figures.

The British Heart Foundation also reports that there were 5,800 excess deaths from heart and circulatory diseases in England during the first year of the pandemic alone. Although it acknowledges that these excess deaths were driven by a multitude of factors across the entire patient pathway, it also says it is very plausible that some of the deaths could have been prevented if these people had been able to access urgent and emergency care in a timely manner. If we are to avoid more preventable deaths and disability from heart conditions, it is vital that the most critically ill patients can access the care that they need when they need it.

Perhaps the Minister will be able to say what action has been taken to address the dangerous impact on emergency heart attack and stroke care and the victims whose lives are being put at risk, what conclusions the Department has reached as to why so many trusts are failing to reach the targets that have been set for them, and what steps are being taken to reduce waiting times for responses to 999 call-outs and ambulance waits. We know that these delays matter. If 90% of 999 calls were answered in time, 3,000 more heart attack victims could be saved each year.

I have reeled off a lot of statistics. Now I want to give a couple of constituency examples to show what this means for people who have experienced long waits. Thankfully neither case ended in tragedy, but these were clearly difficult and distressing times for those involved.

One constituent told me that she had waited more than 10 hours for an ambulance, having first called 111 at about 10.15 am, when she was advised to call 999. When she called 999, it took a few minutes for the call to be answered. The call handler confirmed that an ambulance would be coming, before asking if it was OK for her to hang up and go on to the next call. About an hour later, having seen no sign of the ambulance, my constituent called 111 again and was told to call 999, but was then told that the ambulance waiting time was about eight hours. At 2.30 pm she was forced to call 999 again, as her husband’s condition was becoming noticeably worse. By that stage he could not move or talk because he was in so much pain. The call handler took the details again, but advised my constituent only to call if the condition worsened further.

Another three hours passed, with my constituent’s husband in absolute agony. When she decided to call again at 5.30 pm, she waited more than five minutes for the call to be answered. The call handler asked if the patient was breathing, and said that an ambulance could only be sent if a patient was not breathing, as it was a busy day, although he did also confirm that the request for an ambulance had been prioritised after her call at 2.30 pm—which, by that stage, was three hours earlier.

The ambulance eventually arrived at 8.45 pm, 10 and a half hours after the initial call. Unsurprisingly, my constituent told me that the paramedics were lovely and could see immediately that her husband needed to go to hospital. When he arrived there, he was scanned and treated, and operated on within 24 hours. It was clear that he needed urgent medical treatment; in fact, he probably needed more treatment than he would have needed had he been seen at the right time. However, in the long run, no serious harm has come to him.

That is just one example of a person who waited longer than they should have. It was not an isolated incident; we know that this is happening week in, week out throughout the country. Another constituent told me that he called an ambulance after his wife collapsed at home. They are both pensioners. My constituent called 999 at 11.45 am, and was told that an ambulance would not be able to attend for at least nine hours. He cancelled the call.

The Minister will no doubt be aware of the tragic case of Bina Patel, which has received considerable media coverage, and has been raised by my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner). Anyone who has heard the calls that were made requesting an ambulance, and the clearly urgent nature of those calls, cannot fail to be concerned about what is happening in our ambulance services. As I have tried to emphasise, these are not one-off incidents; they are part of a wider pattern, and symptomatic of a system unable to cope with the demands placed on it.

Targets are not being met and people are being put at risk or worse, but NHS England’s response is a proposed new standard contract which contains a “watering down” of several waiting-time targets, with standards lower than those that were in place before the pandemic. The proposals include scrapping the “zero tolerance” 30-minute standard for delays in handover from ambulance to A&E and setting it at 60 minutes, and introducing the additional targets that 95% of handovers must take place within 30 minutes and 65% within 15 minutes. I do wonder how performance can be improved if targets are loosened. The pandemic should not be used as a cover for this, as performance across the system was getting worse before the pandemic. Indeed, it is nearly seven years since the normal targets were met. By scrapping standards for delays in handover, the Government are trying to normalise those longer waiting times. My hon. Friend the Member for Ilford North (Wes Streeting) asked the Secretary of State earlier this month whether he really thought it should take an hour just to be transferred from an ambulance into a hospital. It should not take that long. Does anyone really think it is acceptable for people ringing 999 to be told they must make their own way to hospital?

I am sure the Minister is aware of reports in the Health Service Journal last month that several trusts, most notably the North East Ambulance Service NHS Foundation Trust, advised people calling 999 with symptoms of a heart attack or stroke to take a taxi or a lift with family or friends rather than waiting for an ambulance. I am sure the Minister will want to comment that that is not what we want to be hearing from our ambulance services.

The British Heart Foundation told me that it recently reviewed two calls to its heart helpline that highlighted instances where patients with suspected heart attacks called 999 and paramedics did attend, but then asked both to have their family drive them to hospital for further tests because the ambulance services in their area were under so much pressure. Neither person actually went to A&E, which is most unfortunate: one did not want to bother their family and the other thought that, if the ambulance was not taking them, their situation must not be urgent enough, which of course was not the case.

In short, those two patients did not access the care they needed because of the message being sent out about the burden they were placing on the system. That is completely wrong and certainly not the message we should be giving people who are clearly in urgent need of treatment.

A recovery plan has been announced this week, which, if we are honest, does not really address the issues of the wider NHS and social care pressures. It does not have any real plan for this particular area. The recovery plan, such as it is, is one part of the much wider system overhaul that is needed.

The Secretary of State said this week that approximately 10 million people represent missing referrals who did not come forward for treatment during the pandemic. I am afraid they may well end up becoming urgent referrals because they have not been through treatment and been spotted and helped at an earlier stage. I do not know whether the Government have given any thought to whether those 10 million missing referrals will lead to increased pressure on emergency services and A&E attendances.

What about those people whose care was not managed to target? The British Heart Foundation estimates that up to 1,865,000 people with high blood pressure were not managed to target last year, which could mean more than 11,000 additional heart attacks and more than 16,000 additional strokes across England over the next three years if those patients do not get support. Of course, that will again increase pressure on urgent and emergency care services in the longer term.

I appreciate there is quite a lot of ground to cover here, but when the Minister responds I would be interested to hear his analysis of the situation, whether he believes the examples I have given are part of a wider pattern of concern or isolated incidents, and what he believes must be done to put the ambulance service on a sustainable, safe footing for the long term. Are those images that we have seen of ambulances queuing up outside hospitals a temporary feature of a very difficult winter, problems with the ambulance service in particular, or symptoms of a wider health and social care system that is under incredible pressure?

[Mr Deputy Speaker (Mr Nigel Evans)]

Back-to-back appearances at the Dispatch Box by Ed Argar.