Ambulances

Baroness Merron Excerpts

Thursday 3rd November 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I am glad to follow the noble Baroness, Lady Brinton, and I thank the right reverend Prelate for bringing not just this debate but great clarity to the issues it deals with.

In my view, the NHS faces what can only be described as a perfect storm in the making—except perfect it is not. The situation is absolutely dire and has been for many years; this is not a new problem. We have heard many times in your Lordships’ House about the well-documented challenges of getting an ambulance in an emergency. These challenges have served only to undermine the profound trust that the public ought to have in the National Health Service. In August alone, the Association of Ambulance Chief Executives estimated that around 35,000 patients were potentially at risk of harm as a result of long handover delays, with just under 4,000 of these experiencing potentially severe harm. There is no doubt that delay is the enemy of good care and safety.

As we have heard, delayed handovers are not just damaging in themselves. They result in poorer ambulance response times, as ambulances sit queueing outside A&E departments and cannot therefore get to patients waiting in the community. This increases pressure on not only clinical staff but ambulance call handlers, as the right reverend Prelate said, as distressed patients and their families call to get updates on their wait time, leading to thousands of duplicate calls and placing ever more pressure on ambulance services.

This situation now has all the potential to get even worse, with ambulance workers in 11 trusts balloting for strike action. If it does go ahead, it will be the biggest strike in that sector for some 30 years, which is surely nothing short of a disgrace. Union leaders have said that this is as much about patient safety as pay—and of course, when we talk about pay, we are doing so in the midst of a cost of living crisis. The right reverend Prelate asked the question: what has brought us to this point? I hope the Minister will reflect on that and perhaps give a view on it today to your Lordships’ House.

The general secretary of Unison, Christina McAnea, has said:

“Striking is the last thing dedicated health workers want to do. But with services in such a dire state, and staff struggling to deliver for patients with fewer colleagues than ever, many feel like the end of the road has been reached.”


Recently, the Minister advised nurses considering strike action to regard their work as a vocation. Can he give his view today on ambulance workers who are considering whether to go on strike? Indeed, can he give his views on the widespread balloting for strikes across the National Health Service, the factors he considers have led to this unrest, and whether they could have been avoided?

The Royal College of Emergency Medicine is clear that crowded hospitals is the operational issue stopping A&E doctors treating patients effectively and efficiently. As we know, high volumes of A&E attendances lead to overcrowding, rising pressure on services and a poorer experience for patients. Between April 2021 and March 2022, there were 24.4 million attendances at A&E across England, compared with 21.5 million in 2011-12. What assessment has been made of the reason for that increase, and could it have been avoided by taking action in other parts of the NHS, including on GP access?

It is fair to say that people desperately want to see an increase in the number of social care staff and beds, but perhaps it will be helpful if I emphasise that we are talking not just about beds but staffed beds, an increase in which would relieve the pressure. I add my voice to those of the right reverend Prelate and the noble Baroness, Lady Brinton, in asking a question that has been asked on so many occasions in your Lordships’ House: where is the workforce plan to deliver this increase in staff in the short, medium and long term? All of this is desperately needed.

Perhaps I may offer a helpful suggestion to the Minister: that the Government publish monthly the data, which is already being collected, showing the number of patients waiting two hours or more from the moment they step into the hospital, rather than simply when the doctor decides to admit them. It would be hugely helpful and give a much more accurate picture of patients’ actual experience in the accident and emergency department. Can the Minister take this up with his officials?

From Secretary of State Stephen Barclay saying that ambulance delays were a priority to Thérèse Coffey’s short-lived “ABCD” plan for patients, and now back to Stephen Barclay, it is fair to say that the sector is crying out for stability. Will the Minister indicate whether the plan for patients is still valid? Perhaps he might feel able to tell your Lordships’ House whether the new ministerial team have reviewed it and, if so, whether the Minister and his colleagues feel that the plan is sufficiently ambitious. It would be helpful for your Lordships’ House to have an update on this plan.

In my recent meeting with the Minister, for which I am grateful, he indicated that there are some 15 problem trusts that are especially struggling with ambulance delays. It would be helpful to receive an update on where the department’s work is on this and how lessons might be learned across the system, and for your Lordships’ House to know what action will be taken.

As we approach winter, what forecasting has been done on how the delays in these 15 trusts are likely to develop or change, and what will be done to avert the potential pressure of Covid and flu on these delays? I again emphasise the points about the £500 million adult social care discharge fund. Reports are that it is yet to be released to the health and social care system. Can the Minister say whether this is the case? If it is, why, and what is to be done?

Finally, what assessment have the UK Government made of the impact of current nursing vacancy rates on patient safety and emergency care? If an assessment has been made, can we have a publication of the modelling that has been done? Has there been a cost-benefit analysis of current spend on agency and international staff versus investing in recruitment and retention within our domestic workforce? As the right reverend Prelate said, this is not just about ambulances. This is a whole-system problem. I hope that the debate today will encourage the Minister to see it as such.