North West Ambulance Service

Debate between Tony Lloyd and Norman Lamb

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.

[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.