Ambulance Services (Devon)

Sarah Wollaston Excerpts

Wednesday 12th July 2017 Westminster Hall

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move,

That this House has considered ambulance services in Devon.

It is a pleasure to serve under your chairmanship, Mr Davies. Let me say at the outset that we all pay tribute to our blue light services and that this debate is not in any way intended to criticise them. The intention is to set out the challenges that they confront and to celebrate their professionalism and the work that they do, but also to ask my hon. Friend the Minister to address some key issues that they face in Devon and, in particular, in my constituency.

The debate has been triggered by a number of incidents. People have contacted me either directly or indirectly to raise concerns about long waiting times faced by my constituents; an incident that typifies the situation happened last month. An elderly lady was left for two hours at the roadside, on a baking hot day, waiting for a paramedic crew to arrive. She had serious neck injuries and was in some distress. Were it not for the kindness of passing strangers, things might have been even worse, but a consultant anaesthetist happened to be passing and was able to provide critical assistance at the scene, and the lady also had assistance from the police and from staff from South Hams Community Hospital. As a result, the outcome has been good, but it could have been very different. That has caused a great deal of concern, because it is not an isolated incident. Although much of the focus of my speech will understandably be on the critical, type 1 cases, which require a response within eight minutes—everyone understands that—I would like the Minister also to think about those other cases that we are all coming across in our constituencies which are not immediately life threatening but are nevertheless very serious and where the outcome can be very different unless we see a timely response from our ambulance services.

First, I would like to address demand, which is rising at an extraordinary rate. During the five years to 2016-17, over the area of the South Western Ambulance Service NHS Foundation Trust we have seen a considerable rise in demand, but there has been a 19.2% increase in the Totnes constituency alone, a 29% increase in Plymouth and a 23.7% increase in Torbay. The challenge is far greater in a rural setting, for obvious reasons. The SWASFT area is the most rural area in England; and if we look at the activity for Devon, we see that 23.5% of SWASFT’s activity is in that county, but that is matched by only 22.2% of its funding.

[Neil Parish (Tiverton and Honiton) (Con)]

I very much appreciate the debate that my hon. Friend has introduced in the Chamber today. She is making a very good point about the rurality of Devon, which is one of the largest counties in the country. Of course, the issue is not just its size. If one starts going north-south, there are no really fast roads—we need much more done to the north Devon link road. Apart from the scale of the county, however, the issue is about getting an ambulance to an incident in time and our very scattered population. My hon. Friend makes a very good point. I am sure that Ministers are aware of the size of Devon, but there is also the question of the time it takes to get from A to B if one is not going on major roads.

[Dr Wollaston]

I thank my hon. Friend for his intervention. Of course, as we know, demand can escalate considerably during the peak summer times, but many of our roads are single-track ones with passing spaces, and it can be very difficult to get an ambulance resource to the scene in a timely manner.

My first point to the Minister is that there are no concessions for rurality; there is no funding premium to allow SWASFT to meet the extra demands that it faces. In fact, overall, its funding has fallen by 2.46% per incident in 2017-18, compared with 2014-15. It has to meet the huge increase in demand with shrinking resource, in what is one of the most challenged areas in England because of rurality. I would like the Minister to acknowledge that key point and the impact of rurality on response times.

My second point to the Minister is that although overall SWASFT is doing a good job in meeting the performance target of 75% of category 1 calls receiving a response within eight minutes, that does rather mask the picture in the most rural parts of the area. Let us take the South Devon and Torbay clinical commissioning group area as a whole, for which we have some data that show that it just meets the target, with the figure of 75.65% of calls. If we look at the breakdown for the Totnes constituency, we see that during the past three months the figure has been 61%, so my point to my hon. Friend is that, when considering a county such as Devon, he should look not just at the overall, top-line figure, but at the impact in the most rural parts of the constituencies. I hope that he will ask for that as an ongoing measure, as a response to this debate.

[Peter Heaton-Jones (North Devon) (Con)]

There is a specific example of exactly what is being described by my hon. Friend in my constituency of North Devon—the situation in Lynton and Lynmouth, the twin villages right on the north coast. At the beginning of last week, the South Western ambulance trust withdrew what was in effect a rapid-response paramedic vehicle that was traditionally stationed in Lynton and Lynmouth, specifically because of the rurality and the distance from anywhere else of those two villages. There is a lot of concern in the community because that service has been withdrawn. I pay tribute to the CCG, which is looking for an alternative arrangement, but the fear is that there is still a gap, and the response time, because of the distance of Lynton and Lynmouth from everywhere else, is key. May I ask my hon. Friend the Minister, through my hon. Friend the Member for Totnes (Dr Wollaston), to consider that particular example?

[Dr Wollaston]

I thank my hon. Friend for that intervention. Likewise, very considerable concerns have been raised in my constituency about the withdrawal this month of rapid-response vehicles from Dartmouth and Kingsbridge and in Totnes. I understand the reasoning that double-crewed ambulances can provide the conveyance that people need to hospital and that utilisation of the single vehicles is less—about 24%. I understand the rationale behind it, but equally I ask the Minister to respond to precisely the concerns that my hon. Friend the Member for North Devon (Peter Heaton-Jones) has raised, because the worry in communities such as mine is that once the double-crewed ambulances are conveying a casualty to an urban centre, they tend not to come back again, whereas the rapid-response vehicles did. There is a genuine concern about how we will ensure that the double-crewed ambulances come back.

As I have said, I welcome the increase in the double-crewed ambulance resource as the rapid-response vehicles come away, and I am aware of the data whereby efforts are being made to provide a reassuring response that actually the number of hours in total will increase. However, that change is just coming in this month, and I would like the Minister to assure the House today that he will look very closely at the data as they emerge over the next few months, to ensure that those vehicles are returning to the rural areas, because I fear that otherwise we will again see that SWASFT is meeting the overall, top-line target for the entire patch, but that will be at the expense of rural constituencies such as my own, where there will simply be a worsening of the response. We need to look at that very closely, and I would like the Minister to assure me that, following this debate, he will specifically ask SWASFT to ensure that there is a response available and it does not worsen in the rural parts of Devon.

I would also like to address the matter of the workforce, which is an issue across the NHS as the Minister knows. Within our paramedic resource there is actually an 11% turnover of paramedic staff, in part because they are such a skilled and valued workforce, which means in many cases they are being attracted into other parts of the NHS, for example to work in casualty departments and minor injuries units. Everyone can understand that, but we need to make sure that we are recruiting and retaining within our blue light response services as well. For example, there are currently about 100 vacancies over the whole of the SWASFT area, and 16 whole time equivalent vacancies in Devon alone. What is the Minister doing to work alongside Health Education England to address the workforce issues? I will again make the point I have done in previous debates about the impact of the pay cap on the recruitment, retention and morale of the workforce. Again, I call on Ministers to consider giving the pay review bodies greater flexibility to be able to increase the rates of pay.

We know that there are pressures on our ambulance services, but we cannot view them in isolation. I would like the Minister to consider the impact that this is having on our other blue light services, particularly the police. They have raised some worrying concerns with me about not only the amount of time that they are having to spend on scene—as they did the other day in the incident that I described—while they wait for an ambulance resource to arrive, but the fact that on occasion they themselves have to take people to hospital who should really be conveyed by an ambulance resource. To clarify, in May this year there were 226 incidents where an ambulance was requested but no ambulances were available to be assigned in the Devon and Cornwall police area, and in June there were 158. These long waits are having a knock-on on the police’s ability to carry out their other duties, and that should concern us all.

[Kevin Foster (Torbay) (Con)]

I thank my hon. Friend and neighbour for giving way and congratulate her on securing this much needed debate. As she will be aware, it is not only the police who are experiencing long waits. One of my constituents, Susannah Tandy, has got in touch about an incident a week ago when her 12-year-old son fell 11 foot from a tree. An ambulance was called at 1 pm but did not arrive until about quarter to 4. These sorts of waits not only build up anxiety but could see situations get much worse. Thankfully Murphy appears to be making a recovery, but it could have been a lot worse.

[Dr Wollaston]

I think we are all glad to hear that Murphy is making a good recovery. As my hon. Friend says, we must focus not just on the immediately life-threatening incidents but on the kinds of incidents that he described, where an ambulance is very important and somebody’s condition could deteriorate because of a long wait. For SWASFT we must keep an eye on not just the category 1 incidents, but the others as well, and I hope the Minister will do so.

In this debate we should also celebrate the successes, because there are undoubtedly those as well. We have seen examples of very good co-working between our blue light services. For example, in the “collapsed behind closed doors” scheme fire services co-operate with the ambulance service where there are concerns that somebody might be collapsed in a residence. In the past the police may have responded, but now the fire service can also provide that assistance, and I pay tribute to those co-responders in the fire service. From my time as a rural GP in Chagford, I remember the number of occasions when people phoned me in surprise because the fire service had arrived instead of the ambulance service, but it is actually providing a fantastic resource. On occasions when it is absolutely critical that somebody has a defibrillator on site as soon as possible, the fire service can and does perform an amazing job. We have got further to go, particularly in remote rural communities where a fire resource might be closer to hand. I hope the Minister will look at how we can go further to make sure that we develop a multi-skilled workforce who are properly rewarded for the expertise and skills that they develop across the fire service.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

The ambulance crews across Devon do a fantastic job. I represent an urban seat in Plymouth, but the demand that is placed on both urban and rural ambulance services has a knock-on effect, because there is no wall that divides Plymouth from the rest of Devon. Demand needs to be understood between both urban and rural areas. Will the hon. Lady comment on what happens in the summer months when the south-west becomes an even more popular tourist destination and additional demand is placed on not only the ambulance services but our wider emergency services? That moves the ambulance resources out of their normal patterns. Ambulances are increasingly moved to further away places with longer response times than their normal patterns might take them.

[Dr Wollaston]

The hon. Gentleman makes an extremely important point. He will know that for both our ambulance services and our police services those kinds of influxes from outside are not adequately reflected in the funding formula. That is in addition to the rurality that he referred to. In fact, the key point remains that the greater danger is to people living in rural areas where, for example, a resource might take somebody to Derriford Hospital but not return, and then when the ambulance service dispatches the nearest ambulance it will be in Derriford. That is why ambulance services tend to get tied up.

I would briefly like to mention the impact of the 111 service. SWASFT is doing extremely well—it is, in fact, the best-performing in the country—at treating patients at home rather than conveying them to hospital. That is the so-called “see and treat” model, and they are also doing well with “hear and treat”. However, there is a concern about the increase in calls, because there has been an overall increase in calls of 24% for the whole of the SWASFT area over five years, with 470 more calls per day, although only an additional 81 people per day are having to go to hospital. While that may reflect the great success of paramedics’ expertise in seeing and treating at home, will the Minister consider whether it also reflects unnecessary calls and the impact of 111, which has been raised many times in this House? Are too many people still having an ambulance called on their behalf when it could have been avoided?

Finally, I would like to end on a positive note in thanking all our volunteers who do so much to save lives across Devon, working alongside our blue light services. I would like to praise all those who support our Devon air ambulance service, all the volunteer community first responders and those who support, fund and supply defibrillators in our communities. On behalf of all in this House, we thank them and our wonderful paramedics and ambulance service crews.