East of England Ambulance Service

Priti Patel Excerpts

Tuesday 25th June 2013 Westminster Hall

[Priti Patel (Witham) (Con)]

Mr. Howarth, it is a pleasure to serve under your chairmanship this morning. I thank Mr Speaker for granting me this debate and I thank all colleagues from across the region who are present today for their support in securing this debate and for pursuing this issue so assiduously.

We in the east of England are fortunate that two of our Members of Parliament are Ministers—the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), and the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb)—and both are well aware of this issue and have taken a great deal of interest in it. I put on the record my thanks in particular to my noble Friend Lord Howe, who has not only taken a strong interest in this subject, but helped facilitate many meetings with various bodies and the ambulance trust, and others, to explore this issue further. I know that this Minister will be well briefed on this matter and will be aware of the many and considerable concerns of colleagues in the region about the performance of the East of England Ambulance Service NHS Trust. She has shown strong interest in the health problems of my constituents and they will welcome her active involvement in helping to get this trust turned around.

This is a timely debate, following on from the scandalous revelations about the cover-up at the Care Quality Commission and the lack of responsibility and accountability from NHS directors. This trust has also experienced serious issues with accountability and mismanagement. It is suffering from the rotten culture that my hon. Friend the Member for Central Suffolk and North Ipswich recently mentioned.

Before I run through many of the problems with the trust encountered by my constituents and I, and the challenges, including delays, response times, damning reports from the CQC and from Dr Anthony Marsh, I should like to begin on a positive note and pay tribute to the outstanding work undertaken by the front-line staff. Despite many problems with the trust and its board, the front-line staff have earned admiration and a great deal of respect from all our constituents. They work in difficult conditions, all made worse by the failure of the trust’s board, but they continue to save lives daily and, of course, they help patients get better.

[Mr Richard Bacon (South Norfolk) (Con)]

I support what my hon. Friend says about front-line staff; I have had personal experience of that in my own family in Norfolk. The paramedics that we encountered were outstanding. Does she share my puzzlement that some of the best staff in the call centre, whom I have sat next to, were bewildered by the systems they were asked to deal with? The problem is not the front-line staff at all, who are superb, but is basically one of leadership.

[Priti Patel]

Of course, my hon. Friend hits the nail on the head. This is about management and lack of leadership and direction from the trust.

I also pay tribute to the volunteer community first responders who support the trust. I think that all hon. Members will have met first responders in their constituencies. Let us be clear that those individuals sacrifice their own time to attend to ill and injured people quickly and remain with them until paramedics arrive. I have been briefed by the co-ordinator of first responders in my constituency and am more than impressed by the actions they take to save the lives of patients in emergency situations, dealing with a wide range of conditions, including heart attacks, allergic reactions and unconsciousness. This month, the trust announced that 30 more of these volunteers had completed their two-day training course. We should celebrate that achievement and praise those volunteers for their dedication to helping the ambulance service and, of course, all our constituents. Those front-line members put the needs of patients first.

With so much devotion and commitment from the front-line staff and volunteers, of course it is more than disappointing that they have been so badly let down by the trust’s board and management. Staff and volunteers deserve more support and strategic leadership from the trust. It is because the trust’s board has failed to demonstrate in the boardroom the high level of expertise, skill and devotion required that is displayed on the front line that the trust has been brought into such a dreadful state.

The biggest danger to patients, which many hon. Members have experienced, is delays getting ambulances to them. The Minister will know that this trust has failed lamentably to meet the A8 and A19 targets. Patients with life-threatening conditions are being made to wait longer than they should for paramedics to arrive.

[Mr John Whittingdale (Maldon) (Con)]

I agree with what my hon. Friend says about ambulance delays, but does she agree that this is a particularly severe problem in more rural areas, such as the Dengie peninsula, which I represent, where one survey of a patient group of a medical practice, the William Fisher medical centre, showed that patients had to wait for more than 40 minutes, and in some cases more than a hour, before the ambulance arrived?

[Priti Patel]

My hon. Friend is right. Many hon. Members have experienced horrific delays, particularly across our rural constituencies. I know of delays in excess of two hours. That is unacceptable. Lives are put at risk.

[Mr Jonathan Djanogly (Huntingdon) (Con)]

I congratulate my hon. Friend on calling this important debate on an unacceptable level of service. Further to the previous intervention on rural areas, can we also agree that this is not just about what are called emergency services, but also about non-emergencies? Many people in my constituency, particularly elderly people, are kept waiting for up to eight hours, often in significant pain, before the ambulance gets to them.

[Priti Patel]

My hon. Friend makes the point clearly about the impact on elderly patients and the unacceptable waiting times that his constituents, and those of other hon. Members, have endured.

Data from the trust show that in the last quarter of 2012-13, the A8 target for paramedic arrival to treat a patient in a life-threatening condition within eight minutes was met 70% of the time, compared to the 75% target. The A19 target was also missed, as ambulances arrived to transport patients with life-threatening conditions within 19 minutes 92% of the time, compared to the 95% target. Patients with other conditions have experienced appalling delays. In each of the 10 months from April 2012 to January 2013, the trust failed to meet the target to get 62% of stroke patients to hospital within 60 minutes. In fact, in seven of those months the figures were below 50%.

The delays in an ambulance arriving to transport patients to hospital after they have been attended to by a volunteer community first responder or paramedic in a rapid response vehicle are particularly alarming. Figures provided by the trust to me covering Essex showed that in 2012 there were 39,921 of these back-up requests, but on 12,584 occasions it took more than 30 minutes for the ambulance to arrive. In Witham alone, in 206 incidents it took more than 30 minutes for an ambulance to arrive, from 639 back-up requests.

It is scandalous that almost one third of patients needing to go to hospital by ambulance were left waiting, causing them distress and preventing the initial paramedic or volunteer who attended the scene from moving on to help other patients elsewhere. Four patients a week in Witham, 242 in Essex and many hundreds more across the region have endured those waits, and the trust’s board sat idly and did nothing while the situation got ever worse. The failures have led to the trust becoming the worst performing ambulance trust in the country. The statistics are terrible and the delays can have serious consequences for the lives of patients affected.

The Minister will have seen numerous news reports from local, regional and national newspapers highlighting devastating cases across the region. Colleagues from across the region will, like me, have seen cases all over their local newspapers and will have had numerous constituents writing to them about their own experiences.

There have been some dreadful incidents affecting my constituents who have faced not only unacceptable delays, but a devastating impact of the consequence of those delays. One constituent from Tiptree suffered lengthy delays on not just one but two occasions—in August and September—before passing away. On the first occasion, she suffered a mini-stroke, and the emergency doctor who attended her home called for an ambulance that morning, but it took more than three hours for a paramedic to arrive. The paramedic then called for a back-up ambulance, which did not come. After waiting four hours, members of my constituent’s family placed her in one of their cars to take her to hospital. Although my constituent had suffered a stroke, the trust neglected her. If her family had not taken the risk of transporting her to hospital, she may never have got there.

The following month, my constituent fell in her care home and banged her head, resulting in a lump larger than a chicken egg on her temple. The ambulance was called at 9.38 pm, but it did not arrive until almost two hours later, at 11.25 pm, despite the fact that the care home was barely five minutes from Colchester ambulance station. Once my constituent was in hospital, a CT scan confirmed that she was haemorrhaging on the brain, and she died soon after. Had the ambulance arrived sooner, my constituent would have received treatment more promptly and might still be alive today. I raised the case with the trust, but it took two months to reply, coming up with a feeble excuse and a shallow apology.

Other constituents have also let me know of their frustration about delays. Mrs Houghton, from Tolleshunt Knights, has two young daughters with serious medical conditions that require frequent hospital care. One has a condition that can lead to sudden death syndrome; the other suffers from a condition that includes supraventricular tachycardia, which can cause her heartbeat to quicken, and her treatment requires a life-saving injection. Last year, my constituent reported to me that ambulances were taking longer to arrive than they used to and that rapid response vehicles were sent instead to take her daughters to hospital. As the Minister will appreciate, these incidents have caused Mrs Houghton increased anxiety, particularly given that her daughters are children. They need an ambulance to attend promptly, but that is simply not happening.

In a separate case, a constituent who is a carer for a relative, Mrs Gladys Money, reported to me the delay Gladys experienced while waiting for an ambulance. Only two weeks ago, Gladys, who is 96 years old, suffered a fall in her kitchen. She could not reach the telephone, so she used the emergency call line button she carries with her at all times to request assistance. An ambulance was called, but it did not arrive for an hour and a half. During that time, Gladys was in much distress and could not lift herself up or even call for further help. Such delays in the treatment of elderly people are unacceptable; they are simply not right, and people cannot be treated in this way.

Another constituent reported to me his outrage when, in November, an ambulance failed to arrive after his 20-month-old grandson started hyperventilating and developed a high temperature. After two hours’ waiting and three telephone calls, he was assured an ambulance would arrive shortly, but that did not happen. After being told that ambulance crews were too busy to attend, he resorted to taking his grandson to accident and emergency himself. There are so many other cases I could mention, and I have no doubt that other hon. Members have plenty of other examples they wish to raise.

Despite the fact that the trust received complaints from Members of Parliament, members of the public and its own staff, nothing was done to address the problem seriously. What made the trust’s lack of attention to the problems all the more shocking was the fact that, in May 2012, the CQC reported concerns with response times. It clearly stated that

“the Trust had not met some of its key performance standards in relation to response times”

and needed

“to seek ways of addressing the challenges it faces in responding quickly in very rural areas and on improving turn around times at the hospitals in its region so that people receive care in a timely and effective manner.”

Senior managers, directors and non-executive directors should have seen the warning signs. They should have been working with hospitals in the region to improve handover times. They should have reassessed changes to staffing rotas and brought in new front-line staff to fill the 200 empty posts. They should have re-examined how they prioritise calls. They should have altered the allocation of resources to put more ambulances on the road. Finally, they should have got a grip on the trust’s growing deficit.

Many things should have been questioned and required serious attention. However, the trust acted only this year, following another CQC inspection in February, the report of which was published in March. That inspection came about only as a result of the persistence of my hon. Friend the Member for Suffolk Coastal (Dr Coffey)and other Members of Parliament in the region, who pressed for an investigation into the trust. The report demanded action to improve the

“Care and welfare of people who use services”.

It concluded that since the

“last inspection the trust’s performance in relation to its ambulance response times had deteriorated and people could not be assured they would receive care in a timely and effective manner.”

[Mr Keith Simpson (Broadland) (Con)]

I congratulate my hon. Friend on initiating the debate. I also congratulate my hon. Friend the Member for Suffolk Coastal (Dr Coffey)—La Pasionaria of Southwold, as she is her known in her constituency—on her role. Last October, my wife had a serious accident, and there were considerable delays in treating her. We are all aware of such things, but does my hon. Friend the Member for Witham (Priti Patel) agree that there is a systemic culture of failure and buck-passing not only on this issue, but, sadly, in wider areas of the NHS and the public sector? What worries me—my hon. Friend might come on to this—is that if a new board is appointed, it might well consist of recycled individuals from the quangocracy who may have failed in other parts of the country.

[Priti Patel]

My hon. Friend’s assessment of the culture in the NHS is absolutely correct. Let us not forget that the Under-Secretary of State for Health, my hon. Friend the hon. Member for Central Suffolk and North Ipswich, alluded to the rotten culture in the NHS. I will come to the fact that cultural change is required and that we must stop this revolving door and this recycling of people in the NHS.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to the House. Although the debate is specifically about the East of England Ambulance Service NHS Trust, the same rationale applies across the whole of the United Kingdom of Great Britain and Northern Ireland. The response by paramedics relies on data and modern technology, so it is important that funding restrictions do not limit what they can do. Does the hon. Lady feel that it is essential that funding is always available so that they can do the work they need to? Does she also feel that training is important?

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[Priti Patel]

I thank the hon. Gentleman for his intervention. Interestingly, funding was not an issue in this case; the trust is very well funded, and I will come to that. This is about professionalism and training. With the board and the trust, we have seen a complete failure of not only leadership, but skills; there is a question about the skills base of the board and the non-executive directors, and it is clear that they have failed in their duties and responsibilities.

My hon. Friend the Minister will know from the Mid Staffordshire inquiry and from events involving the CQC, Cumbria and other trusts the consequences of the rotten culture of management failures, cover-ups and inept strategic leadership in the NHS, which the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, touched on. That culture is simply not acceptable, and it is about time we took the lid off many NHS trusts and started to ask questions about the failure we have seen across the country.

The East of England Ambulance Service NHS Trust is another trust we can add to the list of those where scandal and incompetence have put lives at risk. As I said, this is not a resourcing issue, because the trust is funded above the national average. This is a problem with senior management, directors and non-executive directors. Since the publication of the CQC report, a new interim chair, Dr Geoff Harris, has been brought into the trust. A governance review and additional support are being provided by Dr Anthony Marsh, the chief executive of the country’s best-performing ambulance trust, in the west midlands. Those are welcome steps. Of course, it was Dr Marsh’s review of governance that highlighted the extent of the scandal and failure at the heart of the trust.

[Dr Julian Huppert (Cambridge) (LD)]

I congratulate the hon. Lady on the debate, and on the work that she and colleagues have done over many months. She is right to say that the issue is not money. I have heard it suggested that the problem is to do with rural ambulance services, but I assure her that constituents of mine with awful problems have had to wait an hour and a half for ambulances that were simply not available. The problem is urban as well as rural, and I know that she realises that. The solution must affect all of us.

[Priti Patel]

Absolutely. My hon. Friend is right. The key is that there is a failed service, and it requires immediate turnaround, which must have one clear focus: putting patients first, rather than the interests of board and trust members. The issue is about patients.

I am encouraged by my initial contact with Dr Harris and Dr Marsh. It is incumbent on us all to support them, to ensure that they get the trust back on its feet.

[Sir Alan Haselhurst (Saffron Walden) (Con)]

I congratulate my hon. Friend on the lead she is giving and on bringing the facts to light, although I worry that in rehearsing some of the problems we create greater worry among our constituents; but we must get to the bottom of the problem. She has mentioned Dr Anthony Marsh, and some of us recall that in the days of the Essex ambulance service there were nothing like the difficulties that there are today. It is clear from the fact that other ambulance trusts are performing better—some to a very high standard—that there should be some pressure. There is a model of how things should be done, and pressure should be brought to bear so that we can get the East of England Ambulance Service NHS Trust sorted out.

[Priti Patel]

My right hon. Friend is right. The issue is the turnaround of the trust and a key thing is to learn from successful ambulance trusts. That means looking at skills and capabilities as well as at times, both in urban centres and rural parts of constituencies. The east of England is a big region, and we must consider how resources can be correctly allocated to ensure that patients are not left waiting as they have been in the past.

Most of the executive directors at the trust have moved on, and the former chair, Maria Ball, resigned recently after the CQC report earlier this year. However, it is deeply alarming and thoroughly disgraceful that five non-executive directors who have presided over the mismanagement of the trust still sit on the board. They are Paul Remington, Phil Barlow, Margaret Stockham, Anne Osborn and Caroline Bailes. They all seem to refuse to take any responsibility for the failure that they have presided over, and they continue to receive funds from the taxpayer to continue in their role. By choosing to remain in post they are putting their own interests above those of the public, patients and front-line staff.

[Mr Douglas Carswell (Clacton) (Con)]

I congratulate my hon. Friend on bringing the issue up for discussion. There has been a series of appalling incidents in my part of Essex as well, in Tendring. Are not all the failures further evidence that the ambulance trust is run for the convenience of the senior management on the payroll, and not that of the taxpayer who pays taxes to be provided with an ambulance? Surely we need proper accountability, which means examining the regional structure, which is too cumbersome, and perhaps adopting a system of local accountability, putting it at county level as it once was. We should also make sure that the service is not stuffed full of quangocrats, and that the people who are there to speak for the taxpayer are accountable to the taxpayer, rather than having CVs full of parasiting off the taxpayer.

[Priti Patel]

My hon. Friend makes some pertinent and valid points. Transparency and accountability are key things. I have touched on the issue of the revolving door in the NHS, but cronyism is another issue. We must stop the same people being placed on and recycled around various boards in the NHS. NHS board members should put patients first, but, as the governance review by Dr Marsh concluded,

“there is a lack of focus and grip from the Board which has contributed towards the deterioration of performance across the Trust.”

The question, as we have already heard, is whose interests the board is serving. It should be putting patients first.

The Minister will know that the review is full of many other statements about the board, each of which is a damning indictment of each non-executive director and of the board. As to the quality risk profile showing that a number of outcomes relating to patient care and welfare were not being achieved, the review states at page 13:

“The Board should be taking leadership decisions and actions on these Outcomes and holding others to account,”

but of course there has been collective failure and

“this doesn’t appear to be happening.”

On page 14 the review refers to the current trust board and senior management team appearing to have developed “a sense of ‘helplessness’” and states that

“the Board have not been taking both the responsibility collectively as well as they could or should have and that Board members have not been held to account”.

On page 18 the report highlights

“a lack of confidence and trust that the Board has the expertise, experience or gravitas to respond to the substantial challenges facing the organisation.”

Page 22 contains the conclusion that

“the overall Governance arrangements cannot have been adequate for the Trust to get into this much difficulty.”

The non-executive directors’ fingerprints are, to be frank, all over the crisis. The trust is experiencing major failures, and every day that the individuals remain on the board they are being financially rewarded for blatant failure. Their poor leadership and inability to acknowledge and deal with the challenges facing the trust have led to patients’ lives being put at substantial risk. The trust’s staff survey results have demonstrated the lowest morale in the country.

My hon. Friend the Member for Suffolk Coastal and I wrote to Paul Remington while he was acting chair, to ask him and his fellow non-executive directors to explain their actions and what they had done about improving the trust. We wanted to give them a fair and proper chance to explain themselves in the aftermath of the CQC’s report earlier in the year. We received a substantive reply from Mr Remington two months later, on the eve of the publication of the Government’s review, and it was light on information and did not acknowledge the mess that the trust was in. It was thoroughly unconvincing. In view of those poor responses I hope that the Minister will appreciate that the presence of those non-executive directors on the board is undermining public and staff confidence in the trust. It is scandalous that they have not already been dismissed, and shocking that, despite the publication of the Marsh review, board members whose terms are due to expire this year are to be reappointed for the foreseeable future. The report of the chair and chief executive for tomorrow’s board meeting states that, during the recruitment process for the new non-executive directors,

“the TDA has agreed to extend Mr Remington’s period of service on an interim basis.”

That is utterly unacceptable. Why should Mr Remington and other non-executive directors be allowed to continue on their taxpayer-funded ride, when they have failed so miserably to fulfil their responsibilities? What will happen to the other non-executive directors, whose terms do not end this year? How much longer will they be permitted to remain in post? They refuse to do the right thing and step down, so I urge the Minister to recommend to the Secretary of State and the NHS Trust Development Authority that they should use their powers to remove them with immediate effect, before the board meets in Bedford tomorrow.

In addition to the board’s inability to lead the trust, its secretive and unaccountable handling of criticism by Members of Parliament is also disturbing.

[Mr Keith Simpson]

I have a question for my hon. Friend based on ignorance: there have been some extensions, but by whom were they made? Is that part of the revolving door?

[Priti Patel]

My hon. Friend asks a valid and pertinent question, and I give him one word: accountability. His question is very good, and we need to continue to ask who is making the decisions.

In the board papers for the trust meeting tomorrow there is no reference to the fact that Members of Parliament for the region have questioned the board’s competence and called for resignations. Our correspondence is not even mentioned. The papers merely state that the chair and the chief executive have

“met a number of MPs over the last month to discuss issues such as ambulance responses”.

That is simply not good enough and fails to reflect the serious concerns that all Members of Parliament across the region have expressed in their questioning of the trust on behalf of their constituents. Decisive action is now necessary, because the trust, its front-line staff and the 6 million people who live in the east of England need to have skilful and competent non-executive directors leading the board. I hope that when my hon. Friend the Minister concludes the debate she will commit to ensuring that resources will be made available to help the trust head-hunt and bring in the right set of people as soon as possible to support both Dr Harris and Dr Marsh.

It is also clear to me that the problems with the board have yet again demonstrated the wider failures within the NHS appointment process. Again and again, incompetent and ineffective individuals have been placed in important roles. Some of the five non-executive directors who should be dismissed from the trust sit or have sat on other NHS bodies, and it is shocking to think that they could be recycled elsewhere in the NHS. I would welcome an assurance that those non-executive directors, who have devastated the East of England Ambulance Service NHS Trust, will be prohibited from holding any further NHS job.

By the end of the debate, I am confident the Minister will be left in no doubt of the seriousness of the situation with the ambulance trust and of the desire of the public, front-line staff and all Members in the region to see our trust improve. I hope she can give an assurance that the Government will do everything possible to help patients receive the first-class service that they deserve, to hold those in responsible positions to account and to resolve the mismanagement of the trust that we have all endured for far too long.

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[Anna Soubry]

That is an excellent point, extremely well made. I shall certainly take it away and speak to the Secretary of State, because this really is important, but to be fair to the NHS, it does have its own leadership academy, where it seeks to bring on people. That is within the NHS. But I think that we should involve far more people from other fields, who could come into the NHS—people with huge skill sets, who have proved those in other walks of life. I am thinking of, for example, retired judges, who would have an invaluable role to play—people who have shown real leadership and not been afraid to make tough decisions in the right circumstances. All these people should now be being looked at actively to play a role.

[Priti Patel]

Will the Minister give way?

[Anna Soubry]

I will take one quick intervention with four minutes to go.

[Priti Patel]

I thank my hon. Friend for giving way; she has been very generous. There is a specific issue not just about leadership but about accountability with this trust. Is the Minister able to tell us what is preventing the current non-exec directors from resigning their posts immediately?

[Anna Soubry]

I know of no reason why they should not. Of course, it is a matter for their own consciences. I am not one who normally shies away from giving an opinion, as my hon. Friend, I hope, would agree, but I think that in this instance it is very important that Ministers do not give an opinion and do not get involved. I think that would be quite improper. It is for those people, or anybody who has come under criticism, to examine their own role and their own conscience and act accordingly.

We might well ask why some ambulance services with comparable funding to the East of England trust—this is not about funding, cuts or money; it is about leadership and poor management—and the same mix of urban and rural areas can provide a good level of service and others cannot. I believe that the ambulance staff will generally be the same in their dedication to caring for patients, so as I said, it is all about effective—or in this case, ineffective—management.

The trust has recently had the benefit of an excellent governance review prepared by Dr Anthony Marsh. I pay public tribute to him and thank him for that. I have referred to it already, as have other hon. Members. It is a clear and professional account, and I will arrange for a copy of it to be placed in the Library. Dr Marsh is, as we know, the chief executive of the West Midlands ambulance service and he chairs the Association of Ambulance Chief Executives, so he knows what he is talking about. His report, as we have heard, reveals how poorly the trust has been managed and how the valiant efforts of front-line staff have been undermined. My hon. Friend the Member for Harlow described them as “lions led by donkeys”.

Results from the 2012 staff survey for the trust underline that. Only one key finding improved; nine key findings became worse. The East of England ambulance service trust had by far the worst staff survey results of all ambulance trusts in England, with 13 of the lowest scores. Its sickness levels—I think this is a very important statistic; it says it all—are nearly twice the average of those in other trusts. However, I am pleased to say that Dr Marsh will be working closely with the trust over the coming months to ensure that the necessary action is taken, and taken quickly.

The NHS Trust Development Authority—it is called the TDA—provides the line of accountability from local NHS trusts to the Secretary of State for the performance of the organisation. Steps have already been taken to address poor performance. As we know, a new interim chair, Dr Geoff Harris, has been appointed; he took up his post at the end of May. His first task is to review the trust board and ensure that the right people are on it. He needs, if I may say so, to be quick and decisive. To make the necessary changes, the board needs to be fully capable of radically improving its performance. I am fully aware that many hon. Members hold strong views about the role that board members play, and I have made my comments accordingly. The duty of the trust board is to add value to the organisation, enabling it to deliver health care and health improvement within the law and without causing harm. It should do that by providing a framework of good governance.

Earl Howe, as we have heard, is the Minister responsible. He has taken a close interest in the matter and visited the trust at the end of May. He has met hon. Members. He is committed to convening a second meeting towards the end of this year, when we all expect to see real evidence of changes for the better. We will of course continue to monitor the situation closely.