Ambulance Response Times: Shropshire

Nigel Evans Excerpts

Thursday 31st March 2022 Commons Chamber

[Edward Argar]

I am grateful to the hon. Lady, and I will turn to her specific asks in a moment.

However, I will turn now to the Bill introduced by the hon. Member for St Albans (Daisy Cooper), which I am aware of. I have to be honest and say that we do not consider that the Bill would necessarily be the most appropriate way of achieving what she wants. The challenge with that legislation is that, at a time when we wish trusts to be focused on the delivery of frontline services, it is another administrative process of data collection. I would add that trusts of course operate at trust level, not at an individual station or county level, and trusts may cover a number of counties. So while I am aware of her legislation, it is not something that I believe would achieve the outcomes or be practical in the way she wishes, and she and I regularly have a to and fro across the Dispatch Box about a number of issues when she speaks for her party on health and care matters.

There is strong support in place to improve performance. At the national level, as the hon. Member for North Shropshire generously recognised, there was £55 million of investment last summer, in advance of the winter, to help increase ambulance staffing capacity to manage pressures. All trusts received a portion of that funding to expand capacity through additional crews on the road and additional clinical support in control rooms as well as extending hospital ambulance liaison officer cover at the most challenged acute trusts.

On overall staffing, which includes frontline clinical staff and the clinical support staff who work with them, our ambulance service has seen about a 38% increase since 2010—the Liberal Democrats can quite rightly take some credit for that from their five years in government—and, indeed, in the last year we have seen an increase of about 500 frontline staff. So we have increased staff and continue to increase available staff.

The £55 million was supported by an additional £4.4 million in capital investment—these are still national figures, but I will turn to her specific local circumstances—which helped to keep an additional 154 ambulances on the road during winter over and above normal levels. Call handler numbers, which are equally important, are being boosted with more than 2,400 on target to be in place by the end of March—the end of today. That is about 500 more FTE—full-time equivalent—staff compared with September 2021, with potential for services to increase in capacity further during the coming financial year.

NHS England and Improvement is also providing targeted support to the hospitals facing the greatest issues with delays in the handover of ambulance patients, helping them to identify short and longer-term interventions to reduce delays and get ambulances swiftly back out on the road. She is right that that is hugely important, and even more so in areas with large rural populations because of the distances involved. Trusts also receive supportive continuous central monitoring and support by NHSEI’s national ambulance co-ordination centre.

With clinical support in control rooms, the ambulance service is closing just over 11% of 999 calls with clinical advice over the phone, which is an increase of three quarters since before the pandemic. That helps to save valuable ambulance resources to respond to more urgent calls, with that clinical input ensuring that the advice and decisions are right.

The hon. Lady will be pleased to hear that significant local support is in place to improve response times in her county. The West Midlands Ambulance Service is working with community partners to help avoid conveying patients to hospital where there is no clinical necessity, providing alternate treatment and care at home or in the community and helping to avoid unnecessary trips to hospital, thereby freeing up resources and hopefully providing a more pleasant experience for those patients.

In raw numbers, the West Midlands Ambulance Service conveyed over 600 fewer patients to hospital in February based on the clinical advice this year compared with two years ago. It has also introduced a clinical validation team of advanced paramedics who work in control rooms and clinically triage lower urgency cases and, where appropriate, signpost patients to other services, as I alluded to. In February, that team reviewed 967 cases in Shropshire, of which 61% of were not sent an ambulance, 14% were treated on the scene and just 25% were conveyed to hospital. That was based on the clinical triage, which I am sure the hon. Lady agrees should be central to any decisions made. That has played a significant part in helping the service to tackle the pressures.

Other practical solutions include hospital ambulance liaison officers—HALOs—who are paramedics who work with bed managers to smooth out the flow of patients coming to an A&E department. They can provide a constant flow of information about capacity to the strategic command cell at the ambulance service headquarters, escalating any issues and avoiding queueing where possible. There is also joint work to cohort ambulance patients at A&E sites, where a single ambulance crew takes responsibility for three or four patients. That releases crews to respond to outstanding calls in the community more quickly.

A new same-day emergency centre—SDEC—has been opened at the Royal Shrewsbury to divert patients, as clinically appropriate, away from A&E, improving handover times. In the two and a half years that I have been a health Minister, I have discovered that there are probably almost as many acronyms in health as in the Ministry of Defence. Surgical SDEC capacity at the Royal Shrewsbury has also been expanded and all SDEC units receive ambulances directly for suitable patients.

The hon. Lady rightly mentioned hospitals, and I am grateful that my hon. Friend the Member for Telford (Lucy Allan) is here and made an intervention. During her seven years in the House, she has been a regular and vocal advocate for her local hospital in Telford. I pay tribute to her, because it was due to her campaigning and tenacity that there is an A&E locally at Telford. That is still seeing patients and helping to alleviate the pressure in Shropshire. She should rightly be proud of that, having successfully campaigned for it.

Action is being taken locally to improve the patient flow through hospitals by discharging patients more quickly to create bed space. The aim is not only to increase the number of discharges a day, but to bring more discharges forward to earlier in the day, when it is clinically safe to do so, to allow the effective discharge and transition back to care at home or in a care home. Health and care system partners locally are looking to create additional community and social care capacity to support timely discharge, create bed space to take patients from A&E and reduce ambulance handover times.

At a national level, we have set up a national discharge taskforce. As a Minister, I get almost daily statistics about where we are on delayed discharges across the country. It is a complex picture, with a variety of reasons behind delayed discharges. The hon. Member for North Shropshire is correct that some are about delays in getting into care homes or getting domiciliary care packages or rehabilitation packages at home. Some are also down to delays in the hospital in sign-offs and procedures, and there is more that we continue to do to drive those delays down.

Construction is also under way on a new modular ward at the Royal Shrewsbury site, with 32 additional beds in service by spring 2022. That is alongside a £9.3 million upgrade of the emergency department at the Royal Shrewsbury, delivering additional cubicles, a new and improved majors department, a new designated emergency zone for children and young people and a new clinical decisions unit. The first phase of that work is complete and all areas will be finished by spring 2022.

The hon. Lady raised a number of other issues, including the Future Fit model. We have been clear that funding of £312 million was allocated for that project, and that remains allocated. The challenge we face is that, thus far, the trust has not proposed a solution that meets that budget. We continue to work with the trust and to encourage it to do so. I hope that it will so that we can continue to drive that important project forward.

I will very gently push back on what the hon. Lady said about there being £10 billion of PPE that is not fit for purpose. She will know that that is not correct. In the statement that was made about write-downs, not write-offs, the amount was about £8.7 billion, and it was not all PPE, by any means, that was not fit for purpose. Only a tiny proportion of that was the case. A significant element of that was essentially due to over-ordering at the height of the pandemic to make sure that the frontline had the PPE that it needed. We were buying at the height of the market, and there is currently a glut of PPE, so its value has inevitably declined. Not all of it will be used, because we got more than we needed to make sure that clinicians and others on the frontline were not exposed.

The hon. Lady touched on local ambulance Make Ready stations and the changes to them. Decisions on reconfigurations and changes to that are made locally by the trust; it consults, but it makes those decisions. The Government do not have any power over those matters. The Health and Care Bill, which we debated yesterday, would give the Secretary of State greater power over such reconfigurations in the way that she asked, but her hon. Friend the Member for St Albans argued against that. I gently say that that is a matter for the local trust and the usual NHS processes on reconfigurations.

The hon. Lady touched on, I think—forgive me if I am wrong—asking the CQC to look into this issue. It is entirely open for her or others to raise it with the CQC, and the CQC will make a decision or a judgment on whether it believes that it is appropriate or otherwise to look into the matter.

In the few seconds that I have left, before Mr Deputy Speaker calls me to order, I say that I recognise and do not in any way diminish the significance of the issues that the hon. Lady raised. I hope that I have given her some reassurance that we are working through these issues and that we continue to put the support in place to help her constituents in Shropshire and more broadly.

Finally, the hon. Lady requested a meeting, and I am conscious that she has raised the issue of correspondence. I have asked for that; I believe that that has happened since Christmas, as the Department works through the backlog. There is still a delay in correspondence, but I have pulled that out and asked for it, and I am happy to meet her and her fellow Shropshire MPs, together with the ambulance trust, to discuss their collective concerns or reflections that they would like to put to me as a Minister.

I conclude by wishing the hon. Lady a very happy Easter and by thanking her for bringing this to my attention and the attention of the House.

[Mr Deputy Speaker (Mr Nigel Evans)]

On behalf of Mr Speaker and the entire Deputy Speaker team, I wish a happy Easter and a good recess to all who work here.

Question put and agreed to.