Article 50 Extension

Debate between Norman Lamb and Steve Barclay

Wednesday 20th March 2019 Commons Chamber

[Stephen Barclay]

My hon. Friend is right that not only the Prime Minister but the EU says that the only deal on the table after over two years of negotiation is the deal that she has negotiated.

[Norman Lamb (North Norfolk) (LD)]

The Secretary of State says that the House is not very good at deciding what it wants, but we are crying out for the opportunity to vote for what we want. He said that countries around the world are looking to us to respect democracy. Will he respect democracy in this House and give us the chance to vote on that now?

[Stephen Barclay]

The right hon. Gentleman talks about respecting votes and whether the House has had an opportunity to vote on issues. His party wants a second referendum—a people’s vote—yet we had a vote on that issue last Thursday. Indeed, the right hon. and learned Member for Holborn and St Pancras did not vote for a people’s vote. If the right hon. Member for North Norfolk (Norman Lamb) is going to practise what he preaches, I say with respect that we had a vote on the people’s vote last Thursday, and the House spoke on that.

East of England Ambulance Service NHS Trust

Debate between Norman Lamb and Steve Barclay

Friday 2nd February 2018 Commons Chamber

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

First, I wish to thank the right hon. Member for North Norfolk (Norman Lamb) for securing this debate. I recognise the concerns raised about the East of England Ambulance Service, including questions about whether delays to ambulance responses have caused additional harm to patients over the Christmas period, and his concerns about the leadership of the trust and the role of the CQC. I assure him that I am taking these allegations seriously, both as a Minister and, as he knows, as a constituency Member of Parliament in the East of England. I have put in place a number of actions to immediately ensure improvements to services are put in place by the trust.

As the right hon. Gentleman will be aware, a risk summit was held this week, on Tuesday 30 January, which examined whether the service is operating effectively now and sought to put in place any required actions to improve it going forward. I have spoken personally to the chief executives of NHS England and NHS Improvement, and to the chair of the risk summit. I will expand on the findings further, but I wish to emphasise that a wide-ranging plan of immediate actions has been put in place to address the issues that were identified. Details of the action plan have been published today and a progress meeting in two weeks will be led by NHS Improvement and NHS England. I agree with the right hon. Gentleman about the accessibility of the trust leadership in respect of the chief executive and the chair making themselves available for media bids. I have communicated that to the trust.

I recognise that the right hon. Gentleman is concerned about the overall approach of the trust’s senior management and about the level of external assurance from the CQC. In addition to the action plan identified at the risk summit, which was attended by other external parties including NHS England and NHS Improvement, I have gone further by asking NHS Improvement’s executive medical director, Kathy McLean, to provide her own assurance to Ministers in the coming week. That will assess the immediate steps taken to address the concerns expressed in the House and whether actions suggested in the earlier external reports have been implemented. Alongside that, I am happy to have further discussions with the right hon. Gentleman about his specific point about the Association of Ambulance Chief Executives.

I am assured that, where there were serious delays in response times, the trust has identified all potential causes. Following an initial investigation, it is examining 22 such cases through the serious incident procedure. That will ensure that individual cases are properly investigated. The hon. Member for Peterborough (Fiona Onasanya) mentioned a specific case and we are determined to ensure that that is addressed. I am happy to discuss that with her further.

In terms of the report mentioned by the right hon. Member for North Norfolk, which was previously commissioned for the trust, I am happy to update the House and say that the report should be published as soon as possible. Again, that is an issue I will follow up.

Let me turn to the specific actions arising from the risk summit. I am advised that actions to deliver immediate service improvements are being taken forward under the following themes: ensuring that the trust has sufficient capacity for the rest of winter; the effective implementation of handover delay policy with hospitals; the proper execution of REAP level measures; staff access to executive leadership; sound escalation procedures; bringing in independent assurance around the serious incident investigation procedures; working with CCGs and other stakeholders to manage demand for ambulance services; and the full exploitation of emergency service collaboration with police and fire. As a result of those actions, to help to manage winter demand the trust will put eight additional vehicles on the road each day until Easter, with immediate effect.

Improvements will also be made to the trust’s adherence to the national REAP guidelines, and actions will be taken to moderate service pressures, which will allow the trust to de-escalate to REAP level 2. The trust is also working with hospitals to ensure adherence to the national guidance on handover delays, particularly where ambulances waiting to hand patients over receive a new 999 call, which was a specific point that the right hon. Gentleman raised. I also assure him that we will work closely to monitor the outcomes of the work to ensure that safe, high-quality ambulance services continue to be provided to his constituents.

The right hon. Gentleman has also raised concerns that the trust has underspent on its funding while putting in place a hiring freeze. The trust has worked to grow its frontline workforce, fielding 700 more staff since 2014-15, and has achieved a low rate of staff turnover. However, like the right hon. Gentleman, I want further assurance that the trust’s staff plans are sufficient to meet the demands facing the city. I will raise that in my discussions with NHS Improvement.

Substantial local initiatives are under way to improve the trust’s performance. Importantly, more money is being invested in the service: its funding was increased by £90 million this year—an increase of 10%—and it will further increase by £27 million over the next two years. Other significant actions include the deployment of hospital ambulance liaison officers in emergency departments to help reduce the incidence of handover delays, and an independent review of the trust to ensure that it has the appropriate resources and processes to deliver against its performance standards. I will expand on these measures further, but it is worth considering them in the context of wider national initiatives to improve ambulance performance more generally.

As I stated in the House on 22 January, the NHS is busier than ever and the ambulance service is experiencing unprecedented demand, dealing with more than 11 million calls every year. There were almost 7 million face-to-face responses from the ambulance service in 2016-17, which is a 14% increase over the past five years. Under Sir Bruce Keogh’s review of the NHS urgent and emergency care system, ambulance services are being transferred into mobile treatment centres, making much greater use of “hear and treat”, which is treating patients over the phone, and “see and treat”, which is treating and discharging patients on the scene. In December, the East of England Ambulance Service NHS Trust resolved three out of 10 incidents on the scene without transporting a patient to A&E, freeing up resources to respond quickly to the patients with the most urgent needs.

Additionally, in July last year the Secretary of State approved a revision of operational and performance standards for ambulances following the ambulance response programme. These improvements have now been rolled out to all mainland ambulance trusts in England. The evidence behind this new framework is extensive, covering data collected from more than 14 million emergency 999 calls. The evaluation considered a number of key issues for the east of England, including prioritising responses to the sickest patients while helping to reduce long waits for ambulance responses, and ensuring that patients receive the most appropriate response for their condition. That being said, I do recognise that the trust’s performance against these standards needs to improve.

As I mentioned earlier, NHS England and NHS Improvement are working with the trust to help it to adapt to the new performance framework, and have also undertaken an independent service review of its operations. This review covers the trust’s demand and capacity modelling, staff recruitment and training, and its approach to pricing and contracting in order to enable it to meet the new ambulance response standards. The detail of this work is being finalised and will be presented to the trust board meeting in March.

With respect to the ambulance workforce, we are taking significant steps across the country to support staff. Compared to 2010, there are over 3,000 more paramedics in England. We agreed in December 2016 that NHS paramedics will be re-banded from band 5 to band 6 on the NHS pay scale. This moves paramedics significantly up the NHS salary structure, and helps to ensure that we are better able to recruit and retain staff in the future.

We are also working to support the trust in addressing issues with patient handovers to hospital trusts, which have been an issue in parts of the east of England. We are clear that handovers must take place within agreed timeframes, and we are supporting hospitals to ensure that improvements are made. As I noted earlier, the trust is working with hospitals to ensure adherence to the national guidance on handover delays. It has also deployed patient safety intervention teams to hospitals to undertake patient cohorting where significant hospital delays arise, as well as placing hospital ambulance liaison officers in emergency departments to help ambulance crews to respond more quickly to incoming calls.

[Norman Lamb]

I am conscious that the Minister is coming to the end of his contribution and that he is not able to respond, here and now, to all the issues I mentioned. Will he undertake to write to me on each and every one of the specific concerns that I raised, including the call for an independent governance review, so that we can get to the bottom of exactly what is happening?

[Stephen Barclay]

I am very happy to give the right hon. Gentleman that commitment. Like me, the right hon. Gentleman wants to get a grip of this issue to ensure that it is addressed. I very much hear the concerns that he and other Members have raised. I hope that he can take some comfort from the series of actions that have already been put in place, including the risk assurance and the commission to Ministers, that signal the seriousness with which this issue is being addressed.

I would like to restate that we are taking the right hon. Gentleman’s concerns seriously. I have outlined the measures already taken as a result of the risk summit, and I will closely monitor the situation to ensure that these actions are delivered on. We have also discussed the wider initiatives that we are undertaking to improve ambulance services nationally, as well as specific local actions to ensure that patients receive the highest quality of care.

Again, I thank the right hon. Gentleman for introducing this debate. I hope that he, and indeed other Members who have serious concerns about this issue, will continue to work with me on a cross-party basis to ensure that all our constituents get the service that they rightly expect.

Question put and agreed to.

North West Ambulance Service

Debate between Norman Lamb and Steve Barclay

Monday 22nd January 2018 Commons Chamber

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

I congratulate the hon. Member for Rochdale (Tony Lloyd) on securing this debate. I know that he visited the North West Ambulance Service Trust in 2017 and has a long-standing interest in this area. He comes to the House as one of its most senior and experienced Members and a former chair of the parliamentary Labour party. I am happy to meet him to discuss his remarks in more detail in order to work collaboratively to take this forward, given the concerns he has set out, particularly concerning the delays that Ron and Pat experienced, and how we can address them.

I absolutely agree with the sentiment expressed by the hon. Member for West Lancashire (Rosie Cooper) about the need for an open culture, and I am happy to work with her, as I have done in the past, in fostering such a culture.

[Norman Lamb]

The Secretary of State has been very good, post Francis, at being very clear that there has to be an open culture and that staff must feel free to speak out when there are patient safety risks that concern them. Will the Minister use this opportunity to re-enforce the message to the management of trusts, including ambulance trusts, across the country that they must allow their staff to speak out when they have genuine and legitimate concerns of this sort?

[Stephen Barclay]

I certainly will take this opportunity to do exactly that. As the right hon. Gentleman will be aware, like him, I myself, during my time in the House, have frequently spoken out on behalf of whistleblowers, particularly in my former role as a member of the Public Accounts Committee. I know he has other concerns that, with the leave of the House, I might touch on at the end of my remarks, but, as I am sure he will appreciate, I want to address the issues of the North West Ambulance Service in particular.

As Members on both sides of the House will know, the NHS is busier than ever. The ambulance service is dealing with unprecedented demand, with 11 million calls each year and almost 7 million face-to-face responses in 2016-17, which was a 14% increase on the previous five years. Overall, it is worth noting, on the concerns about workforce that the hon. Member for Rochdale set out, that the North West Ambulance Service has a strong record on recruitment, having recruited an extra 167 paramedics in 2017. As a result, its vacancy rate, at just 2.4%, is now one of the lowest in the country.

The hon. Gentleman is right, however, that on performance there is an issue and that the service does need to improve. As I will set out in my remarks, that is why work is under way with NHS England and NHS Improvement, working with the commissioners and the trust, to address that, as part of the wider national initiatives. It also needs to be set in the context of the pressures within the health service. About 3,000 patients are currently in hospital beds with flu and about 700 with the norovirus, so there are clearly winter pressures affecting handovers, but he is absolutely right that how we address the delays in handovers is a key area, and certainly a key ministerial focus of mine, as I will come on to in due course.

The hon. Gentleman set out several concerns about the trust’s performance. It is worth drawing the House’s attention to the fact that six ambulance liaison officers are now in place at A&Es across Greater Manchester to support handovers and address delays. The Treasury is investing £100,000 in the trust in February and March to boost operational capacity, and procedural solutions are being introduced to improve the efficiency of call handling. Under Sir Bruce Keogh’s review of the NHS urgent and emergency care system, ambulance services are being transformed to increase the use of “hear and treat” and “see and treat” and ensure the better prioritisation of patients so that those with the highest need are seen most urgently. The aim is to avoid what we all recognise was an issue in the past—where, in order to meet targets, often two, three or four ambulances were being sent in response to the same call. People had concerns about that across the House, but that is one of the improvements that has been brought in.

In 2016-17, the North West Ambulance Service treated and discharged over one quarter more patients at the scene and 92% more patients over the telephone compared with 2011-12, so although I recognise that there are challenges and areas that require improvement, it is important, in the interests of balance, also to recognise the progress the trust has made in recruiting more paramedics—as part of the 3,000 more paramedics nationally—its low vacancy rate and the steps it has taken to treat more patients at the scene.

Additionally, in July last year, the Secretary of State approved a revision of the operational performance standards for ambulances. Those improvements have been rolled out to all mainland ambulance trusts, which will mean better prioritisation of calls. The framework brings all patients under a national response standard for the first time and improves the efficiency and resilience of the ambulance service in the face of rising demand.

We recognise that the performance of the North West Ambulance Service against those standards is not good enough, and that is why NHS Improvement, NHS England and commissioners are closely engaged with the trust to ensure that it adapts successfully to the new performance framework. If the hon. Gentleman has specific concerns about the openness of the trust, I will be very happy to discuss those points and take them forward with him in a collaborative spirit.

I understand that the hon. Gentleman has raised concerns about workforce directly with the trust. As I said earlier, 3,000 more paramedics have been recruited nationally compared with 2010—an increase of more than 30%—so there are more paramedics than there were.

[Stephen Barclay]

I take that concern seriously, and I discussed it with officials earlier today. Compared with 2010-11, when the local “Healthy Futures” reconfiguration took place, there has been a 33% increase in vehicle hours assigned to the Rochdale and Bury area, with an associated staff resource increase of 43 full-time equivalent. So there has been improvement.

The North West Ambulance Service also aims to include a paramedic on board every ambulance. Although there are seven paramedic vacancies in the Rochdale area, nine paramedics are due to be assigned over the next 10 weeks and the trust is confident that the area will have a full complement of paramedic staff by April this year. I hope that that brings some comfort to the hon. Gentleman’s constituents about the direction of travel.

It is worth bearing in mind that, alongside those paramedics, the North West Ambulance Trust has recruited 24 graduates to operate as emergency medical technicians, and they are awaiting registration as paramedics. That will further improve the position. The trust has made it easier for emergency medical technicians to embark on paramedic training courses and worked with local universities to increase the rate of paramedic qualification. Where emergency medical technicians crew ambulances and respond to calls, they are heavily supported to do so safely, with direct access to advice from advanced paramedics and the trust’s clinical hub.

Handover delays were mentioned in several interventions. We recognise the challenge of delayed patient handovers to emergency departments. Delayed handovers tie up ambulance resources and adversely affect the trust’s capability to respond quickly to new calls. We are clear that handovers must take place within the agreed timeframes, and NHS England and NHS Improvement are supporting hospitals to ensure that improvements are made. Such work includes improved monitoring and daily review by national and regional winter operations teams, targeted assistance to challenged hospital trusts to improve their performance and the issuing of revised handover guidelines that focus responsibility on the wider system to address handover delays, including a clear escalation process. Locally, there are initiatives in place such as the placement of hospital ambulance liaison officers within emergency departments.

The trust is implementing a number of procedural solutions to improve the efficiency of the call-taking staff, including the use of post-dispatch scripts, which inform callers of the expected arrival time of a resource. In other trusts, that has minimised duplicate calls and reduced ambulance attendances by 4.6%.

To conclude on the comments of the hon. Member for Rochdale—with the leave of the House, I will then address the concerns of the right hon. Member for North Norfolk (Norman Lamb)—his concerns about performance are pertinent, and there is work ongoing to address that issue as part of the wider initiative. However, it is also important to recognise the progress that has been made, which has seen the recruitment of additional paramedics and the training of staff, with the progression of which the hon. Gentleman spoke, which allows people to progress their career into the role of paramedics. There are also further measures in terms of prioritisation, which will address a number of the concerns he set out.

On whistleblowers, that is an issue on which I, as a constituency Member of Parliament, have long campaigned. I hope my record on that speaks for itself, and the issue is something the right hon. Gentleman and I have previously discussed.

The right hon. Gentleman has also raised concerns, as has the hon. Member for Norwich South (Clive Lewis), regarding the East of England Ambulance Service. On receipt of the right hon. Gentleman’s letter, I instructed officials in my Department to share copies with the Care Quality Commission—the independent regulator of all health and social care services in England—to ensure that it is fully aware of the issues being raised. I discussed these concerning allegations directly with the chief executive of NHS England and the chief executive of NHS Improvement this morning, and asked them to confirm to me the actions they will be taking. They have subsequently confirmed that they will be holding a joint risk summit regarding the trust in the next week. The CQC will be in attendance.

[Norman Lamb]

First, I am really grateful to the Minister for addressing these issues this evening, given that this is a debate about the North West Ambulance Service. Would he be willing to meet me, given the level of concerns in the east of England?

[Stephen Barclay]

I would be very happy to meet the right hon. Gentleman. As a fellow east of England Member of Parliament, but also as a former Health Minister, he brings great experience to these issues, so of course I will.

In conclusion, I pay tribute to the hon. Member for Rochdale for raising this issue this evening. I am happy to work with him in our common interest to address the areas of performance that need to improve. However, at the same time, it is important that we recognise the progress that has been made on recruitment and reducing the vacancy level by the North West Ambulance Service, which gives a positive sign of the progress that is being made as we address the challenges being faced across the NHS.

Question put and agreed to.

Oral Answers to Questions

Debate between Norman Lamb and Steve Barclay

Tuesday 21st October 2014 Commons Chamber

[Stephen Barclay (North East Cambridgeshire) (Con)]

I welcome the additional £7 million of investment. Given that 65% of children in Fenland wait more than 18 weeks for access to mental health services, will the Minister write to me to set out how the additional investment will help rural communities in particular?

[Norman Lamb]

I would be very happy to write to the hon. Gentleman. I am sure that he welcomes the fact that, for the first time, we are introducing access and waiting time standards in mental health, including in children’s mental health. Until now, there has been discrimination at the heart of the NHS. Labour introduced waiting time and access standards, but it left out mental health. That was completely unjustifiable and I am proud that the coalition is correcting it.