East of England Ambulance Service

Richard Bacon 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.

--- Later in debate ---

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

It is a pleasure to speak in this debate and I congratulate my hon. Friend the Member for Witham (Priti Patel) on securing it. The national health service includes many people with different callings, and thank goodness for that. Some have a calling to look down microscopes and to do scientific experiments to figure out how to solve the problem of cancer. Some have a calling to work with people with mental health problems and to help them return to stability, productivity and a flourishing life. Some have a calling to help at the roadside those who are in critical danger following dreadful accidents and those of us who are unfortunate enough to face near death. Imagine what it must be like to have that calling, to feel that one’s life purpose and work is to help such people, to have the training of a practitioner in emergency medicine, but to have to hold someone who is dying because an ambulance trust does not work properly and those higher up let down the practitioners. What would be the reaction?

There would come a point when people would say, “I can’t stand this any longer. I can’t stand coming to work and failing people because those above me are failing me.” That is exactly what has happened. It is absolutely clear, as my hon. Friend the Member for Harlow (Robert Halfon) said when quoting from the Marsh report, that it is not about money. The problem is about leadership and accountability. I will draw out some brief points from that report. It says that

“critical decision making has ceased in some areas. The trust has lost focus of the strategic objectives, which may partly be due to the board not fully understanding the purpose of the business.”

It continues:

The management structure is overly layered and appears heavy…The trust seems to demonstrate limited urgency and pace in moving forward.”

It also states:

“Leadership does not come from Board level”.

What are they doing, and why are they still there after that damning report?

As a member of the Public Accounts Committee, I have spent 12 years studying slow-motion disasters in various areas of Government and I have read many National Audit Office reports across the whole swathe of Government activity and public expenditure, but I have rarely read words as damning as those. Yet the people who are responsible, who, as my hon. Friend the Member for Harlow said, have so badly failed those whose job it is to serve us and our constituents, are still in post. That is something I cannot understand, and I very much hope that the Minister will address it. If it is not addressed, there will come a point when people will start asking the Department of Health why it has not been addressed, because the matter is so serious.

This did not use to happen. I have been the Member of Parliament for South Norfolk in the east of England for 12 years, and until the last year or two I do not recall people regularly writing to me with complaints about ambulance delays. I do not remember regularly turning up at meetings in the House where there were 15 paramedics talking to the Minister, Earl Howe, facilitated by east of England MPs, because there was no possibility of their having a sensible conversation with the management of their own organisation. This is an extraordinary state of affairs and it requires radical reform.

There is not time in this debate to talk about the wider issues of the NHS culture, but reference has been made to revolving doors and how people lose jobs in one place and gain them in another—I have seen a lot of that myself. In addition there is the issue of confidentiality clauses and the way in which the guidance against using them has been weakened. In 1999, it was stated that confidentiality clauses had no place in NHS contracts; by 2004, it was apparently okay if the guidance was studied carefully.

In the limited time available I want to make a point about size. The ambulance trust in the east of England covers Hertfordshire, which is practically outer London, and Bedfordshire, which is also practically outer London and highly urbanised, as well as places as far away as Cromer in north Norfolk, Great Yarmouth, Southwold in the constituency of my hon. Friend the Member for Suffolk Coastal (Dr Coffey) and Lowestoft in the constituency of my hon. Friend the Member for Waveney (Peter Aldous). It is simply too big, and that is obvious to everyone.

In my rural constituency, ambulances are not just dragged away from the rural areas to Norwich. I accept the point made by the hon. Member for Cambridge (Dr Huppert), who is no longer in his place, that it is not just a rural problem; it is a rural and an urban problem. When I find that ambulances are being dragged away to Bedford and Luton, which are one hour 20 minutes, one hour 25 minutes or one hour and 30 minutes from my constituency, I know that something is fundamentally wrong. We must stop thinking so much about economies of scale and start thinking about the economy of flow—removing the blockages that stop things working properly.

--- Later in debate ---

[Anna Soubry]

That is a good point, but it is not for me to say whether it has any merit that should be taken forward. But clearly it is an important point, which must now be considered.

May I quickly pay tribute to all the very helpful interventions from hon. Friends? My hon. Friend the Member for Broadland (Mr Simpson) talked about the buck passing in the NHS and the recycling. We also heard from my hon. Friends the Members for Maldon (Mr Whittingdale) and for Huntingdon (Mr Djanogly). My hon. Friend the Member for Waveney (Peter Aldous) made an excellent speech. My hon. Friend the Member for Suffolk Coastal also made an excellent and important speech. There were interventions from my hon. Friends the Members for Clacton (Mr Carswell) and for Cambridge (Dr Huppert) and from my right hon. Friend the Member for Saffron Walden (Sir Alan Haselhurst). There were speeches by my hon. Friends the Members for Harlow, for North West Norfolk and for South Norfolk (Mr Bacon). They all made important and good points.

We know that overall in England in 2012-13 the number of emergency calls to ambulance services was 9.08 million—a 6.9% increase. That is an important figure, I would suggest. We know that overall, in England, the performance figures are stable. That does not really assist in this debate, of course, because we also know that the East of England ambulance trust and, I have to say, my own, the East Midlands ambulance trust, have serious failings and the performance figures are simply not good enough.

The best that I can say of the performance of the East of England ambulance trust is that it has not been good. It is clearly recognised as the lowest-performing ambulance trust in England. As with the national picture, its overall poor performance figures hide huge discrepancies between the services and response times in the urban and rural areas that it covers. There are too many stories—we have heard many today—of patients in distress having to wait hours for ambulances, or solo paramedics being sent when an ambulance is needed. Solo paramedics cannot transport patients and might not, for instance, be able to lift or move a patient unaided. It is simply not good enough.

It is clear to me that some hon. Members and many patients might be forgiven for thinking that the trust seems to have forgotten that it is there to serve all patients and not only tick the performance boxes as far as it can. Concentrating resources in towns and effectively abandoning people in the countryside is simply unacceptable.

[Mr Bacon]

Will the Minister give way?

[Anna Soubry]

May I make some progress? Then I will take an intervention. The latest figures, as we have heard, show that the East of England ambulance trust failed to deliver two of the three response time standards. The exception was the performance against Category A Red 1—immediately life threatening—calls, where the 75% standard was achieved, with 75.8% of calls responded to within eight minutes.

[Mr Bacon]

The phenomenon of people forgetting what they are there for, which my hon. Friend alluded to, is of course what would happen in a mates culture. I have had the feeling for a long time that there has been the growth of what we might call a self-serving nomenclatura that looks after its own interests first. Then I heard my hon. Friend the Member for Bristol North West (Charlotte Leslie) on the radio the other day referring to a mafia within the top of the NHS, looking out for their own interests. What I want to know is, as this is a recognised phenomenon—I do not think we are going mad—what is the Department going to do about it?

[Anna Soubry]

In short, what I will say is that the Secretary of State has made it clear that it is a culture that he will not accept, and that no member of his ministerial team will accept. He is now becoming undoubtedly the champion of the patient. We are seeing that. We saw it last week with the CQC and then of course we saw the change: the names of people who had been put forward in the report were made public and people are now being held to account. We are beginning to see at least a tackling of this culture; we now need to see some results.