North West Ambulance Service

Tony Lloyd Excerpts

Monday 22nd January 2018 Commons Chamber

[Tony Lloyd (Rochdale) (Lab)]

As you will be aware, Madam Deputy Speaker, I applied for this Adjournment debate on North West Ambulance Service some time ago. By coincidence, I had a phone call today from my constituent, Ron Gerner. Ron and his elderly wife, Pat, had to ring for an ambulance on Boxing day at 9 o’clock in the evening. It was 5 o’clock the following morning before the ambulance arrived to take a very sick lady to Fairfield General Hospital. She arrived at Fairfield not very long after 5 o’clock in the morning. It was about 2 o’clock in the afternoon before she was finally admitted to a ward. Since that time, sad to relate, Pat’s health has deteriorated and she is now due to move to Springhill hospice. She was due to be picked up by an ambulance at 11 o’clock this morning. The ambulance did not arrive. We are now told that it will arrive at 8 o’clock tomorrow morning.

I say to the Minister and to the House that an elderly couple like Ron and Pat who are going through a very difficult time in their lives should be treated massively better. They should be cosseted, not face the kind of outrage that has now affected their lives. They are happy for me to talk about this because, not unnaturally, Ron is livid on his wife’s behalf. I am livid on Ron and Pat’s behalf, and indeed on behalf of the whole of their family.

It is something of an irony that when I wanted to illustrate the failings of North West Ambulance Service, that phone call, totally unsolicited, came into my office this evening. The sad reality is that North West Ambulance Service is a shambles. That, of itself, underlies something much more serious—as a shambles, it is of course putting people’s lives at risk. This is simply unacceptable in modern Britain.

It is worth recording that for the highest category of calls, of which 75% should be answered within eight minutes, the mean time in the north-west is 11 minutes. For the second category, for which central Government and the NHS nationally decided to lower the limit so that there is now an 18-minute tolerance for 75% of calls, the mean time in the north-west is 44 minutes. Those are calls that are serious and certainly cannot be dismissed as trivial. If the mean time is 11 minutes for the most serious cases and 44 minutes for the still very serious cases, what happens with the cases that are massively worse than that? Something is going very wrong.

It would be tempting to say that this is something to do with the winter crisis, but it is not. North West Ambulance Service, apart from a brief flurry of activity, has not hit its targets since 2014. Just very briefly in the summer of 2015, things seemed to have got back up to the norm, but at the moment, in about three out of four of the most serious cases, it is missing the target that has been established at national level. That is putting people at risk.

What is going wrong? We can say some fairly straightforward things. I am bound to point out that the national health service has made decisions that themselves make it more likely that the ambulance service will come under pressure. The decision to close the Rochdale accident and emergency facility some years back inevitably means that instead of being taken to the local hospital, people in my constituency have to travel that little bit further afield. That of course puts pressure on an ambulance service that is already under pressure elsewhere.

It is a matter of practical fact—the Minister may want to confirm this, or he may have different figures, but everything I have seen indicates it—that the North West Ambulance Service is the worst performing ambulance service in England in terms of its ability to hit its targets.

[Norman Lamb (North Norfolk) (LD)]

A lot of things the hon. Gentleman is talking about in the north-west appear to be reflected also in the east of England. Does he share my view that it is really important for Ministers to send out the clear message to staff in these organisations, first, that they are valued and, secondly, that they must feel able to speak out—in other words, to whistleblow—if they are worried about patient safety? The last thing we want is for pressure to be put on staff to make them feel that they are unable to speak out about such concerns.

[Tony Lloyd]

The right hon. Gentleman is of course absolutely right on both counts. First and foremost, we must value the paramedics and the technicians who make our ambulance service work, and nothing whatever of what I am saying is critical of them. They joined the service to help save lives and to get people into our national health service, but this is of course the reality, and I am grateful to people who have spoken privately about what is going on. Whistleblowers are really important.

To make another point briefly, I wrote to the North West Ambulance Service about its failings—I will come on to the particular failing later—in the middle of August, but I had to raise the issue on the Floor of the House to get an answer two and a half months later. Quite frankly, the answer is almost not worth the paper on which it is written because the climate of secrecy—the climate of “Mind your own business,” which is said even to Members of Parliament—is very unhealthy. I hope that the Minister will take that on board.

[Rosie Cooper (West Lancashire) (Lab)]

I agree very strongly with my hon. Friend’s comments. I recently wanted to get a transcript of some calls—harrowing calls—in cases where people had died because of the inefficiency of the ambulance service. Last year, for example, my office got a call about a family waiting 90 minutes for an ambulance to arrive for somebody who had had a heart attack. The management of the organisation several times missed an opportunity to send an ambulance, and there is no excuse for this. People are depending on this service. We need whistleblowers and we need people telling the truth, but for such an organisation not to make transcripts readily available is a disgrace.

[Tony Lloyd]

Absolutely. My hon. Friend’s point speaks for itself. We need a climate of openness and one in which people who work in the service and care about it can feel emboldened to speak out. The law actually protects them, so it is outrageous that a public service should put people under such pressure, and it is outrageous that a Member of Parliament should struggle to get transcripts relating to her own constituents. There is a lot going wrong.

The reality—the Minister may want to reflect on this—is that over the past six years, the demands in the highest category in the north-west have gone up by some 50%. We can discuss what that means, but at the same time the number of paramedics has increased by only 16% and the number of those in technician grades by some 28%, so the staffing simply is not keeping pace with the change in demand.

There is something worse. I have already mentioned the fact that we have seen the closure of A&Es and the increased pressure that those closures inevitably bring, but on top of that we face the daily reality—again, this is not part of the winter crisis—that our ambulances and our skilled paramedics are having to wait outside our hospitals in some cases for hours on end. Let me give the House a few illustrations. At one of our local hospitals, Royal Oldham—an important hospital for my hon. Friend the Member for Heywood and Middleton (Liz McInnes) and me—an ambulance had to wait for three hours and 46 minutes before it could discharge one of its patients on 7 January. At North Manchester—again, one of the hospitals that Rochdale borough depends on—an ambulance took eight hours and 50 minutes to do so on 3 January: somebody waited in the back of an ambulance for eight, or nearly nine, hours. At Fairfield, which is also one of our local hospitals, a figure of over 10 hours was recorded in December.

Something is going fundamentally wrong when people are waiting in the back of an ambulance for the care that they ought to be getting inside our hospitals. However, something else is going wrong, because such cases mean that the skilled staff in those ambulances cannot be out on the road going to the next job where they are needed and to the one after that. One of the paramedics—a whistleblower, as it were—with over two decades of service in our ambulance service told me that when he started, he typically went to nine different jobs during a working shift. It is now sometimes as few as three or four jobs a night, because he and his colleagues spend their time waiting outside hospitals, for reasons that have already been identified.

I know from the different roles I have had that things have been going wrong for years with the quality of our ambulance services. When I was a police and crime commissioner, the police would complain to me that, when attending a situation, they would often be forced to wait because there was a clear need for an ambulance, and sometimes they would have to deliver people to hospital because the ambulance could not arrive in time. The police certainly do not say that critically of their colleagues in the ambulance service, but they know that they are not the right people to be charged with carrying sick people to hospital.

The Minister has probably been told that one of the palliatives in the system is the series of green cars staffed by paramedics who are first on the scene. If we had a properly funded, properly staffed system of ambulance provision across the north-west, that might be a very intelligent design, but it is a very stupid design when paramedics are in short supply, because if the job the paramedic attends turns out to be really serious, they cannot operate as a paramedic, because the green cars are not ambulances; they are simply a means of transit. The paramedic then has to ring for an emergency ambulance. A paramedic told me that he attended a cardiac arrest where the patient was in a serious condition, but he had to wait with them for 45 minutes, without being able to give more than basic attention, before the ambulance arrived. Such situations should not be routine, but paramedics tell me that they happen regularly, so we know that things are going wrong.

I want the Minister to consider one issue particularly seriously. When Rochdale A&E was closed, a commitment was made to the people of my constituency that there would be a paramedic on every ambulance coming from Rochdale. We have found out that that is simply an illusion. My constituents were lied to—I think I can use that term, Madam Deputy Speaker—because there was no circumstance under which that promise could ever have been delivered. We were told at the time, “Don’t worry. You’ll have to travel a little bit further, but you’ll be travelling with highly skilled paramedics.” One in four of the most serious category calls across the north-west do not have a paramedic in attendance, because we do not have enough paramedics in the service.

The story I am telling is a seriously unhappy one. It would be unhappy if this were some kind of intellectual game, but as the experience of Ron and Pat Gerner shows, this is about people’s lives. It is about people, sometimes at the most difficult point in their lives, who are anxious and concerned about what will happen next at a time of individual and family crisis. This does matter and it matters enormously that something is done about it.

I say to the Minister that certain things that need to be done almost leap off the page. First and most obvious, we need a better handover system from ambulances to A&E units. It is not beyond the wit of health professionals to come up with something better. If we are saying that one of the skills shortages in the health services is that of paramedics, we must use them intensively. That is what the paramedics want. They do not want to be sat in stressful conditions outside a hospital. We need to better deliver the service. Ministers have to drive that through. They have to seize this important opportunity.

[Norman Lamb]

I think what the hon. Gentleman is saying is that the way in which the system works at the moment is a grossly inefficient use of highly skilled people. They are left waiting with and caring for patients outside a hospital before they can hand them over, and sometimes they have to wait with a patient for an ambulance to arrive. If we look at the total time during the day that paramedics are left waiting with patients, rather than doing what they are skilled to do, we will see that it is an extraordinarily inefficient use of that skilled resource.

[Tony Lloyd]

Absolutely. If this is one of the skill shortages at the crisis end of our health service, let us begin to use the paramedics much more intelligently than we do now. The Minister will be delighted to know that I will come on to money, but this is not about money; it is about intelligence. I am bemused by the incompetence of the management of the North West Ambulance Service, who do not seem able to give me even semi-credible answers to this crisis. Ministers now need to seize the opportunity—and possibly even seize the throats of those who manage the process—to make them begin to deliver.

Nothing I have said tonight is meant in anything other than absolute admiration for the people who are in our ambulances, trying to make the service work. They live very stressful lives. The Minister will know that across the country—the north-west is as bad as many places—the amount of down time because of paramedics and ambulance technicians being off work from stress-related sickness is high and growing. That is symptomatic of a system going terribly wrong. Let us reform it. Let us make sure that we put the quality of life back into their jobs, so that they can put the quality of life back into those they care for.

[Liz McInnes (Heywood and Middleton) (Lab)]

My hon. Friend and I share the same area, covered by the Pennine Acute Hospitals NHS Trust, and we have very similar experiences. I used to work at the North Manchester General Hospital and at the Royal Oldham Hospital, and I am well aware of the issues. Is he aware of the latest Care Quality Commission report, which was published last year, on the North West Ambulance Service? It identified safety and leadership as “requiring improvement”. From the story that he is telling, it sounds as though those two issues have not been addressed, and that report was produced a year ago.

[Tony Lloyd]

My hon. Friend makes a really interesting point. The Minister needs to look seriously at the consequences of that kind of report. I have looked at different aspects of this issue over a number of years. I find leadership mainly in its absence. Safety is more difficult for me to comment on, except that if we have such high sickness rates among the staff, it very much indicates that the working environment is not safe for the people we want to work there.

My final point to the Minister is that we have a shortage of paramedics nationwide. As I said, we have had an uplift of something like 50% in the most critical cases in the north-west and an increase of some 16% in the number of paramedics. We are simply not keeping pace. Of course this is about money, but we have to put the resources into that kind of training. However, training is between two and four years. The Minister has to look at whether there is something in the intelligent transfer of people in the health service who already have the equivalent skills. With the right kind of incentive, they may be prepared to move across from different occupations in the health service to the paramedic and ambulance service. However, they will only do that if they believe there is a quality of job that would allow them to enjoy their work, as they are entitled to.

We have a crisis that is putting people at risk, whether that is in the east of England or in the north-west, as I and my hon. Friends the Members for Heywood and Middleton (Liz McInnes) and for West Lancashire (Rosie Cooper) have said. It is dangerous and in the case of my constituent, Pat Gerner, it is unacceptable for an elderly lady, needing to be in hospice care, to be treated in the way that she has. I look to the Minister to give not simply sympathy, but some credible belief that he will seize the day and make sure that we have the quality and determination to drive through the kind of management change that will make a difference. As well as that, he has to say to his colleagues in the Treasury that we need to see some transfer of resource into our ambulance service, if we are not going to face this crisis not simply in the winter, but every day of every week of the year.

--- Later in debate ---

[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.

[Tony Lloyd]

I know that the Minister is trying to be helpful, but one thing is bound to concern constituents. At the time of the A&E closure in Rochdale, a commitment was made that there would be paramedic cover as routine, but that is being breached regularly. Even if there has been some increase in the number of paramedics, and I concede that there has been, it has not kept pace. Nor has the North West Ambulance Service even tried to honour the commitment that was made—perhaps it should not have been made—in order to deliver the closure of the A&E. The phrase “sleight of hand” comes to mind, and we have to do better.

[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.