North East Ambulance Service

Monday 23rd May 2022 Commons Chamber

15:34

[Wes Streeting (Ilford North) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the North East Ambulance Service and if he will launch an investigation.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Can I start by saying how horrified I was to read the concerns raised about the North East Ambulance Service in reports over the weekend? My thoughts are first and foremost with the families affected by the tragic events described. I cannot imagine the distress they are going through. It is hard enough to lose a loved one suddenly, but to have fears that mistakes were made that could have made a difference, and more than that, that the facts of what happened were not revealed in every case, goes further. They have my unreserved sympathy and support.

In healthcare, a willingness to learn from mistakes can be the difference between life and death, and it is because of this that, as a Government, we place such a high value on a culture of openness and a commitment to learning across the NHS. That is why the allegations raised by The Sunday Times this weekend are so concerning. As was made abundantly clear by the Secretary of State’s predecessor almost a decade ago, non-disclosure agreements have no place in the NHS and reputation management is never more important than patient safety.

The Government are wholly supportive of the right of staff working in the NHS to raise their concerns. Speaking up is vital for ensuring that patient safety, and quality of services, improve, and it should be a routine part of the business of the NHS. That is why, over the last decade, substantial measures have been introduced to the NHS to reduce patient harm and improve the response to harmed patients, including legal protections for whistleblowers, the statutory duty of candour, the establishment of the Health Services Safety Investigations Body and the introduction of medical examiners. It is also why, in response to a recommendation of the Sir Robert Francis “Freedom to speak up” review in 2015, the Government established an independent national guardian to help to drive positive cultural change across the NHS so that speaking up becomes business as usual. However, when it comes to patient safety, we cannot afford to be complacent. It remains a top priority for the Government and we continue to place enormous emphasis on making our NHS as safe as possible.

I note the concerns raised in this weekend’s reports. They have been subject to a thorough review at trust level, including through an external investigation, and the trust’s coronial reporting is subject to ongoing independent external audit and quarterly review by an executive director. I also note that the Care Quality Commission has been closely involved. However, given the seriousness of the claims reported over the weekend, we will of course be investigating more thoroughly and will not hesitate to take any action necessary and appropriate to protect patients.

The Government are also committed to supporting the ambulance service to manage the pressures it is facing. We have made significant investments in the ambulance workforce, with the number of NHS ambulance and support staff increasing by 38% since 2010. Health Education England has mandated a target to train 3,000 paramedic graduates nationally per annum from 2021, further increasing the domestic paramedic workforce to meet future demands on the service, while 999 call handlers have been boosted to over 2,400, so we are very serious about improving resources for the service.

I fully appreciate the concerns of right hon. and hon. Members across this House, and we will be pleased to meet any who have constituents affected by the reports this weekend so we can look at the issue more fully.

[Mr Speaker]

Can I just say that it is three minutes—and that means three minutes, not three minutes and 40 seconds —and I am sure whoever writes these speeches can actually time them through? I say to those on both Front Benches that we have to think about Back Benchers, who need to get their hospitals mentioned and their ambulance trusts as well.

I call the shadow Secretary of State, who I am sure will stick to the allocated time.

[Wes Streeting]

I pay tribute to the courage of the whistleblowers, as well as The Sunday Times journalists David Collins, Hannah Al-Othman and Shaun Lintern, without whom none of this would have come to light. But with respect to the Minister, it should not have taken an urgent question to bring her to the House today. On what she said about the Department further investigating, what form will this investigation take, who will be involved and what assurance can she give the families that there will be both answers and accountability, which is what they deserve?

Peter Coates died after an ambulance did not reach him in time. An ambulance two minutes away could not be dispatched because the station door was faulty, and staff did not know about the manual override. The ambulance that was dispatched decided to stop at a service station, even though it had sufficient fuel. Information about these errors was then withheld by the service, statements were changed and staff were asked to withhold the mistakes from the coroner. Peter Coates’ family learned the full truth only when contacted by reporters last week. His is just one of what is thought to be 90 cases involving gross negligence, cover-ups and tens of thousands of pounds of taxpayers’ money offered in exchange for staff silence.

The Minister mentioned the CQC. Why did it fail to spot this, rating the service “good” in 2018? Why did it fail to spot the situation even after being tipped off in 2020? Why is taxpayers’ money still being offered to buy the silence of staff when non-disclosure agreements were supposedly banned in 2014? What role did under-resourcing and understaffing play in this scandal?

Record ambulance waits exist in every part of the country, with heart attack and stroke victims waiting longer than an hour for an ambulance. As for the North East Ambulance Service, it is advising the public to phone a friend or call a cab rather than wait, while presiding over gross negligence, cover-ups and taxpayer-funded gagging orders on staff. That is the record on its watch. It is a national disgrace. What are the Government doing about it?

[Maria Caulfield]

We take the patient safety element of this extremely seriously. To answer the hon. Gentleman’s questions on who we will be meeting, I am happy to meet all the families affected to hear their concerns and the actions that they want taken. We met with the CQC this morning on this specific example, but we will be meeting with the ambulance trust. I also want to meet the coroner, and we want to hear from the whistleblowers. I am very happy to meet any member of staff who wants to raise concerns so that we can get to the bottom of exactly what has happened.

This Government introduced the duty of candour. Mistakes will always happen, no matter how much money is put into the health service or how many staff it has, but when a mistake does happen the hospital trust or ambulance trust should be open and up front about it, start a proper investigation, and learn the lessons so that it never happens again.

[Mr Speaker]

I call the Chair of the Health and Social Care Committee.

[Jeremy Hunt (South West Surrey) (Con)]

I thank the Minister, who is a practising nurse, for her profound commitment to patient safety. What happened to Peter Coates, Quinn Evie Beadle and others was a terrible tragedy for them and their families. No doubt the paramedics made mistakes, but everyone makes mistakes in the course of their work. What is unforgivable is the cover-up by the North East Ambulance Service, and the fact that we made the families go through such hell to get to the truth.

At the heart of this is that we still make it far too difficult for everyone involved in such cases to distinguish between ordinary human error and gross negligence, with the result that the organisations responsible for people’s care default to a defensive, covering-up position. Will the Minister take this up with the Ministry of Justice to ensure much clearer delineation between the ordinary human errors that we all make and gross negligence, which is never forgivable?

[Maria Caulfield]

I thank my right hon. Friend for making those points. Several safety measures were started when he was Secretary of State for Health, including the duty of candour. There is supposed to be a culture in place where, if mistakes happen, the health service is open and honest about that. The Healthcare Safety Investigation Branch was introduced. There is independent investigation. Anyone can report concerns to that body and an investigation will take place. There is the early notification system in maternity, where if mistakes or incidents happen the process is first and foremost to say that to relatives and family and to start a lessons-learned process. The patient safety commissioner is to be appointed shortly. We are doing everything we can not just to improve patient safety, but to improve openness and learning within the system to change the culture within the NHS.

[Ian Lavery (Wansbeck) (Lab)]

The North East Ambulance Service has been dysfunctional for years—before covid, during covid, since covid. Elderly women and men are still lying on the pavement with broken bones waiting to receive attention. Pregnant women and people suffering from acute problems such as heart attacks and strokes are still being asked to call a cab to get to hospital. It is not good enough. When this investigation starts, will MPs in the region be allowed to participate? We all have numerous tragic cases that we would like to discuss.

[Maria Caulfield]

As I said in my opening remarks, I am happy to meet the affected MPs. It is important that we hear from everyone, whether that is the family and friends of those affected, staff who have concerns or MPs who hear from their constituents first hand, but may I just say that the staff in the North East Ambulance Service are working hard? In the past year, they responded in less than 15 minutes to more than 28,000 serious and life-threatening incidents. Mistakes can happen, and it is important to learn from them, but we should place on record our thanks for all the hard work they do on a daily basis.

[Dehenna Davison (Bishop Auckland) (Con)]

At a surgery earlier this month, Mr Mitchell, a retired paramedic, told me about how his wife suffered a cardiac arrest. He called an ambulance and was told that there would be a wait for that ambulance. After 20 agonising minutes, and knowing the importance of timely care, he drove his wife down to a local defibrillator and administered care himself. Ninety minutes after his call, five ambulances arrived on the scene. His wife, sadly, lost her life. That is just one case brought to my attention that outlines the absolutely shocking record of the North East Ambulance Service. Will my hon. Friend give me, Mr Mitchell and all our affected constituents her assurance that the Department will investigate NEAS’s failures fully and rapidly to ensure that no more lives are needlessly lost?

[Maria Caulfield]

I have heard of the sad incident affecting Mr Mitchell. Incidents such as that are exactly what we need to learn from. It is not acceptable for five ambulances to arrive on the scene after 90 minutes. We need a learning culture and system where staff can flag such concerns and learn from them, with systems put in place so that these incidents do not happen again, but my concern is that I am not confident that that is happening at the moment. I am happy to meet my hon. Friend and other local MPs to discuss what more needs to be done.

[Julie Elliott (Sunderland Central) (Lab)]

I am not reassured by the Minister’s response. She talks about substantial measures, but substantial measures have not worked. She talks about the CQC, but it has been involved, it did not find the errors and it has not apologised for the mistakes. I would like the Minister to add the trade unions—the GMB and Unison in particular, who represent the majority of NEAS staff—to the list of people she will talk to. NEAS has been making mistakes for decades and nothing seems to be done about it. She needs to get a grip of it for the people of the north-east.

[Maria Caulfield]

I am absolutely happy to meet anyone who wants to discuss concerns, but there are routes. We introduced the whistleblowing policy so that, at any stage, those staff and their unions can raise concerns and instigate investigations with the Healthcare Safety Investigation Branch, with those investigations looking at a service as a whole. I am happy to take any concerns forward and meet any group who wants to discuss them with me.

[Mr Richard Holden (North West Durham) (Con)]

My constituents have been horrified to see and read about what has been going on in their local ambulance services. They have a right to know what has been happening, and bereaved families in my constituency and those of my neighbours really have a right to know. It is also crucial to know that so that we can get to the bottom of it and prevent it from ever happening again. Will the Minister ensure that her Department acts rapidly on this? Will she also reiterate that NDAs have no place in our NHS, because they go to the heart of preventing the positive change and learning from mistakes that we need to see?

[Maria Caulfield]

I can reassure my hon. Friend that I have already had an initial meeting with the CQC and the trust this morning and that I will instigate further meetings after today. On NDAs, a previous Health Secretary made a move to outlaw them, and I will speak to the Secretary of State about whether we need to go further, because I am concerned that we cannot have a culture of learning and disclosure while NDAs may be in place.

[Andy McDonald (Middlesbrough) (Lab)]

This cover-up totally stinks. It will stink to the family of a gentleman who tragically died while waiting for an ambulance which, unbeknown to the family, had been dispatched to Middlesbrough from Bishop Auckland, around 25 miles and 40 minutes away. If the family had been allowed to know how long the ambulance would take to get there, they would indeed have tried to save his life by driving him to the hospital less than 3 miles away. The people of Middlesbrough and the north-east are entitled to the security of knowing that an ambulance will get to them promptly in the event of an emergency. Will the Minister guarantee that?

[Maria Caulfield]

I would like to hear more from the hon. Gentleman about his constituent’s case. I have concerns about what was reported in The Sunday Times. I am concerned that the process followed in investigating those concerns has not got to the bottom of some of the fundamental problems, so if he would like to meet me afterwards I would be very happy to take it further.

[Dr Julian Lewis (New Forest East) (Con)]

When senior managers and administrators are found to be directly involved in gross negligence and deliberate cover-ups, will they lose their jobs or will they be allowed to continue?

[Maria Caulfield]

A statutory duty of candour is in place. As I said, if a mistake happens—mistakes can always happen, even with the best prevention methods in the world—there is a statutory duty to reveal it to the family and the patient involved, and to have a full investigation and learn lessons from it. I am concerned that that may not have happened in this case.

[Liz Twist (Blaydon) (Lab)]

The reports in The Sunday Times yesterday on what has happened with the North East Ambulance Service and the cover-ups were truly shocking. My thoughts, and I am sure those of everyone, are with the families who have found out information that had previously been covered up. The Minister talks about the steps the Government have taken to ensure that whistleblowers can come forward, but clearly something has not worked. Equally, the CQC also missed it. What more steps will the Government take to pursue the investigation to ensure that this simply cannot happen again?

[Maria Caulfield]

The hon. Lady is quite right that the reports in the newspaper this weekend were absolutely shocking. The cases highlighted were not about ambulances not attending, but about mistakes that happened at the scene. What is more concerning is that those facts were not necessarily shared with the coroner and that families were not told either. That is more concerning to me than the actual events, because when there is a suspicion that the facts are not known, it prompts fears about what else is not known. I therefore take that extremely seriously and will be following up later today, and with the Secretary of State, to see what steps we need to take to reassure families further.

[Mr Mark Francois (Rayleigh and Wickford) (Con)]

Some of us who have been here for a while can recall that we desperately tried to warn the last Labour Government that big was not always beautiful and that regionalising the ambulance services would not work well because they were too large and too remote. Nevertheless, they pressed on. But we are where we are. The East of England Ambulance Service has some very deep-seated problems, despite the best efforts of the paramedics, although thankfully not quite as horrendous as this case. Will the Minister, when she has a moment, announce a review into the operation of all regional ambulance trusts to improve their performance across the whole country? If that cannot be done, can they be broken up into smaller, more effective units? The current system is not working.

[Maria Caulfield]

I hear my right hon. Friend’s concerns. I am happy to look at his concerns for his own particular ambulance service and discuss them further.

[Alex Cunningham (Stockton North) (Lab)]

The Government have again failed the north-east. The failures of the North East Ambulance Service could fill a book and there is no doubt that there cannot be a north-east MP who has not had complaints about poor response times and lack of care. It is also evident that NEAS is now highly reliant on crews from other organisations, something I was told years ago would be phased out of the service as it grew its own paramedics. The latest revelations show the service is far from fit for purpose and we can no longer sit back. Will the Minister order not just an inquiry but a root and branch review of NEAS and get it sorted?

[Maria Caulfield]

In my role as patient safety Minister, I am happy to look at any patient safety concerns. The Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), who is responsible for ambulances, has heard the hon. Member’s request.

[Robert Halfon (Harlow) (Con)]

Further to the question from my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois), the Minister will be aware that there have been significant problems in the East of England Ambulance Service over a number of years. He is absolutely right that the ambulance service regions are too big, so will the Minister consider making the ambulance service in the eastern region much smaller and creating an Essex ambulance service, so that it is better able to provide the services that people in Essex and my constituency need?

[Maria Caulfield]

As I said to the hon. Member for Stockton North (Alex Cunningham), I am happy, as the Minister for patient safety, to meet to discuss any safety concerns and issues following the review of the cases that we have heard about today. As for wider ambulance reforms, the Minister for Health is here and he has heard that request.

[Grahame Morris (Easington) (Lab)]

Notwithstanding the appalling and heartbreaking cases that were highlighted in The Sunday Times and, indeed, The Northern Echo, including that of my constituent, Quinn Beadle, the Minister implied in her response that processes had been put in place to ensure that these things do not happen again. Does she want to take this opportunity to apologise to my constituents, Mr and Mrs Brocklehurst, for an incident that happened this year? Mrs Brocklehurst fell in her driveway, sustaining severe injuries, including five broken ribs, a collapsed lung, two crushed discs in her spine and other damage. It took the North East Ambulance Service three hours and 15 minutes to arrive. She experienced systemic failures throughout her experience, from a call handler advising her to place a bag of frozen peas on her broken back, to a trainee and two other paramedics wanting to lift her, before administering six syringes of morphine and placing her on a board without a neck brace. At the hospital, Mrs Brocklehurst was queued by the trust, in agony, for six hours before being treated. It is a disgrace, Minister.

[Maria Caulfield]

I am very sorry to hear that and I apologise to Mrs Brocklehurst. That is not an acceptable event to have happened, and I can only imagine the pain that she was going through. I am very happy to meet him and his constituent to discuss that further because, obviously, that wait should not have happened.

[Duncan Baker (North Norfolk) (Con)]

I have tirelessly raised the issue of North Norfolk ambulance response times over and over again in this place, and there is absolutely no sign of them improving. Wells-next-the-Sea has the record of the worst response times in the entire country, which, given the elderly demographic and high number of tourists there, is not good enough. I am trying to be practical: why can the Government not fund a national programme and recruitment drive of community first responders to really help and assist our paramedics, who are completely beleaguered? Will the Minister please take that away as a serious consideration, because we cannot keep going on as we are?

[Maria Caulfield]

First responders do have an important role but they are not a substitute for paramedics. We have 3,000 paramedic graduates trained nationally per annum and we have increased our ambulance and support staff by 38%, so we are making that investment in the ambulance service.

[Helen Morgan (North Shropshire) (LD)]

I have been struck by the similarities between this case and the failings in maternity care at the Shrewsbury and Telford Hospital NHS Trust that were in part due to a toxic management culture—as outlined by Donna Ockenden earlier this year—in which staff were afraid to raise concerns. Given the similarities, will the Minister commit to ensuring that we have a system where staff can whistleblow to an independent organisation and where they feel safe to admit that they have made a mistake?

[Maria Caulfield]

The hon. Lady shares my concerns about what underpins all these issues. From Mid Staffs to the Ockenden review, the fundamental issues in events that have happened under a number of Governments have been about covering up facts and about staff not feeling confident or safe in speaking out. There is a HSIB mechanism whereby staff can refer a matter directly for investigation, and we have introduced the national guardian to support staff in speaking out, but it is clear that more needs to be done.

[Mohammad Yasin (Bedford) (Lab)]

A whistleblower working for the East of England Ambulance Service NHS Trust said this month that the service is on the verge of collapse. Patient safety, ambulance waiting times, inadequate pay, burnout and understaffing issues were highlighted as areas of concern after the publication of the trust’s staff survey report last month. The Minister has spoken a lot today about mistakes. Does she agree that failing to back stronger provisions on workforce planning in the Health and Care Act 2022 will prove to have been a massive mistake?

[Maria Caulfield]

I can reassure the hon. Gentleman that NHS England is doing work on workforce planning, which is crucial to ensuring that we have not just the right number of staff, but the right skills mix. I can also reassure him that performance in the ambulance service nationally has improved from March to April.

The ambulance service has been working under severe stress during the pandemic and in dealing with the ensuing backlog. We need to be mindful that although these are tragic events, the vast majority of ambulance staff are working extremely hard and caring for patients.

[Graham Stringer (Blackley and Broughton) (Lab)]

This is an appalling scandal and tragedy. Unfortunately, it follows a whole series of events that everybody in this Chamber could name, from Morecambe Bay to Mid Staffs to Bristol. The Minister claims that the NHS is open and that it has a learning culture when genuine mistakes are made. That is good rhetoric, but I am afraid that it is not the reality. What will she do to make it a reality? Last week, The Economist estimated that 1% of all deaths in this country are down to mistakes in the NHS.

[Maria Caulfield]

As I have said to other hon. Members, mistakes are always going to happen; that is human nature. The difference is that we are trying to introduce a culture of openness and learning in the NHS so that staff feel confident in coming forward, and so that when a mistake does happen, lessons are learned to prevent it from happening again.

Let us look at the record of this Government. It is this Government who are introducing a commissioner to oversee patient safety across the NHS. It is this Government who have introduced a statutory duty of candour so that when mistakes happen, patients and their families are notified and the process of learning starts. It is this Government who have introduced an early notification system specific to maternity—

[Wes Streeting]

It is not working.

[Maria Caulfield]

It is working. Neonatal deaths and stillbirths have reduced by 25%, so the systems are working. When they do not, we need to investigate and find out why.

[Chris Bryant (Rhondda) (Lab)]

It feels as if there is no sense of urgency. I introduced the Assaults on Emergency Workers (Offences) Act 2018 to protect emergency workers; I hope that it is working, but assaults on ambulance staff and paramedics are still increasing. No wonder so many of them are leaving. We need a radical overhaul to ensure that we recruit more staff into the NHS, including more paramedics, and that fewer of them leave because of burnout.

What I really do not understand is why the Minister is not announcing an investigation today. Apart from anything else, surely it is an offence to provide false information to a coroner. Should that not be investigated by the police?

[Maria Caulfield]

I reassure the hon. Gentleman that the police have investigated and that they did not find evidence of that. As I have said at the Dispatch Box, I will look into specific cases to be confident that no stone has been left unturned with respect to the allegations in The Sunday Times. There are measures in the Police, Crime, Sentencing and Courts Act 2022 that increase sentences for assaults on emergency workers, which we take extremely seriously.

[Daisy Cooper (St Albans) (LD)]

As far back as December last year, I wrote to the Secretary of State urging him to commission a CQC investigation of the crisis in our ambulance service, using his powers under the Health and Social Care Act 2008, because the CQC does not have powers to conduct thematic reviews itself. Since I wrote to him, we have seen scandal after scandal. In the north-east, people were told to phone a friend; in the west midlands, a patient waited more than 22 hours; in the south-west, stroke and heart attack victims are having to wait more than an hour; and in my own constituency, a cancer patient nearing the end of life had to wait almost 12 hours in agony for an ambulance to arrive. Surely it is time for the Government to stop sitting on their hands and to commission the CQC to launch a wide-ranging investigation of the crisis facing all our ambulance services.

[Maria Caulfield]

Let me reassure the hon. Lady. The CQC has been heavily involved in this case. I met representatives this morning to hear from them, and will be following that up. Moreover, an extra £55 million has been invested in the ambulance service nationally. We are aware of the pressures that the service is facing, and will do all that we can to support it.