Ambulance Services in England

Debate between Nigel Evans and Justin Madders

Thursday 10th February 2022 Commons Chamber

[Justin Madders]

In my constituency, the British Heart Foundation has told me that it is concerned about reports from the North West Ambulance Service that patient flow in and out of emergency departments is currently very slow, with ambulances being held for long periods, which has the knock-on effect, of course, of causing higher category 1 and category 2 stacks. Worryingly, we have heard reports of delays of up to four hours in these queues.

I am sure these figures, as shocking as they are, will not surprise hon. Members who, like me, have probably had many emails of concern and complaint from worried constituents. Behind these statistics are tens of thousands of seriously unwell people in dire need of help. As the chief executive of the Patients Association said:

“Going to A&E can be frightening. To then be stuck in an ambulance unable to get immediate medical help once you get there must add to the trauma of an emergency visit.”

I think we can all understand where they are coming from. The Royal College of Nursing’s director for England also points out:

“Having to wait outside in an ambulance because A&E is already dangerously overcrowded is distressing, not just for patients but also for staff, who can’t provide proper care.”

It must be so frustrating for those staff, knowing there are other urgent calls they could be going to, that they cannot leave their current patient because the hospital is already at capacity.

I agree with those comments. Not only does having an ambulance stuck outside A&E as it waits to offload a patient mean that it is unable to answer 999 calls, which leads to slower response times, but it means we lose ambulance hours. We lost 8,133 ambulance hours in the last week of January due to crews having to wait outside busy A&Es. That is an incredible statistic.

As NHS Providers points out:

“safety risk is being borne increasingly by ambulance services.”

We know that people are dying in the back of ambulances or soon after their admission to hospital because of these long waits. We heard from ambulance chiefs in November that 160,000 patients come to harm each year because ambulances are backed up outside hospitals.

The shocking report from the Association of Ambulance Chief Executives, which is based on NHS figures, did not report how many patients die each year because of ambulances stuck outside hospitals, but it did say:

“We know that some patients have sadly died whilst waiting outside ED”—

emergency departments—

“or shortly after eventual admission to ED following a wait. Others have died while waiting for an ambulance response in the community.”

The report acknowledges that, whether or not those deaths were inevitable

“this is not the level of care or experience we would wish for anyone in their last moments.”

The report also highlights that around 12,000 patients suffered serious harm because of delays, sometimes with a risk of permanent disability. In the same month, more than 40,000 people in England who called 999 with a category 2 condition such as a stroke or heart attack waited more than one hour and 40 minutes for an ambulance. Of course, the NHS target is to reach them within 18 minutes.

Just last week, NHS figures revealed that thousands of people are dying because ambulances are taking too long to answer emergency calls. The official statistics show that only three of England’s 32 ambulance services are reaching a majority of immediately life threatening call-outs within eight minutes. In fact, the latest available NHS England data for December 2021 shows that the average ambulance response time for category 2 emergencies —suspected heart attack and stroke patients—is 53 minutes and 21 seconds: three times the 18-minute target. Those are incredibly worrying figures.

The British Heart Foundation also reports that there were 5,800 excess deaths from heart and circulatory diseases in England during the first year of the pandemic alone. Although it acknowledges that these excess deaths were driven by a multitude of factors across the entire patient pathway, it also says it is very plausible that some of the deaths could have been prevented if these people had been able to access urgent and emergency care in a timely manner. If we are to avoid more preventable deaths and disability from heart conditions, it is vital that the most critically ill patients can access the care that they need when they need it.

Perhaps the Minister will be able to say what action has been taken to address the dangerous impact on emergency heart attack and stroke care and the victims whose lives are being put at risk, what conclusions the Department has reached as to why so many trusts are failing to reach the targets that have been set for them, and what steps are being taken to reduce waiting times for responses to 999 call-outs and ambulance waits. We know that these delays matter. If 90% of 999 calls were answered in time, 3,000 more heart attack victims could be saved each year.

I have reeled off a lot of statistics. Now I want to give a couple of constituency examples to show what this means for people who have experienced long waits. Thankfully neither case ended in tragedy, but these were clearly difficult and distressing times for those involved.

One constituent told me that she had waited more than 10 hours for an ambulance, having first called 111 at about 10.15 am, when she was advised to call 999. When she called 999, it took a few minutes for the call to be answered. The call handler confirmed that an ambulance would be coming, before asking if it was OK for her to hang up and go on to the next call. About an hour later, having seen no sign of the ambulance, my constituent called 111 again and was told to call 999, but was then told that the ambulance waiting time was about eight hours. At 2.30 pm she was forced to call 999 again, as her husband’s condition was becoming noticeably worse. By that stage he could not move or talk because he was in so much pain. The call handler took the details again, but advised my constituent only to call if the condition worsened further.

Another three hours passed, with my constituent’s husband in absolute agony. When she decided to call again at 5.30 pm, she waited more than five minutes for the call to be answered. The call handler asked if the patient was breathing, and said that an ambulance could only be sent if a patient was not breathing, as it was a busy day, although he did also confirm that the request for an ambulance had been prioritised after her call at 2.30 pm—which, by that stage, was three hours earlier.

The ambulance eventually arrived at 8.45 pm, 10 and a half hours after the initial call. Unsurprisingly, my constituent told me that the paramedics were lovely and could see immediately that her husband needed to go to hospital. When he arrived there, he was scanned and treated, and operated on within 24 hours. It was clear that he needed urgent medical treatment; in fact, he probably needed more treatment than he would have needed had he been seen at the right time. However, in the long run, no serious harm has come to him.

That is just one example of a person who waited longer than they should have. It was not an isolated incident; we know that this is happening week in, week out throughout the country. Another constituent told me that he called an ambulance after his wife collapsed at home. They are both pensioners. My constituent called 999 at 11.45 am, and was told that an ambulance would not be able to attend for at least nine hours. He cancelled the call.

The Minister will no doubt be aware of the tragic case of Bina Patel, which has received considerable media coverage, and has been raised by my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner). Anyone who has heard the calls that were made requesting an ambulance, and the clearly urgent nature of those calls, cannot fail to be concerned about what is happening in our ambulance services. As I have tried to emphasise, these are not one-off incidents; they are part of a wider pattern, and symptomatic of a system unable to cope with the demands placed on it.

Targets are not being met and people are being put at risk or worse, but NHS England’s response is a proposed new standard contract which contains a “watering down” of several waiting-time targets, with standards lower than those that were in place before the pandemic. The proposals include scrapping the “zero tolerance” 30-minute standard for delays in handover from ambulance to A&E and setting it at 60 minutes, and introducing the additional targets that 95% of handovers must take place within 30 minutes and 65% within 15 minutes. I do wonder how performance can be improved if targets are loosened. The pandemic should not be used as a cover for this, as performance across the system was getting worse before the pandemic. Indeed, it is nearly seven years since the normal targets were met. By scrapping standards for delays in handover, the Government are trying to normalise those longer waiting times. My hon. Friend the Member for Ilford North (Wes Streeting) asked the Secretary of State earlier this month whether he really thought it should take an hour just to be transferred from an ambulance into a hospital. It should not take that long. Does anyone really think it is acceptable for people ringing 999 to be told they must make their own way to hospital?

I am sure the Minister is aware of reports in the Health Service Journal last month that several trusts, most notably the North East Ambulance Service NHS Foundation Trust, advised people calling 999 with symptoms of a heart attack or stroke to take a taxi or a lift with family or friends rather than waiting for an ambulance. I am sure the Minister will want to comment that that is not what we want to be hearing from our ambulance services.

The British Heart Foundation told me that it recently reviewed two calls to its heart helpline that highlighted instances where patients with suspected heart attacks called 999 and paramedics did attend, but then asked both to have their family drive them to hospital for further tests because the ambulance services in their area were under so much pressure. Neither person actually went to A&E, which is most unfortunate: one did not want to bother their family and the other thought that, if the ambulance was not taking them, their situation must not be urgent enough, which of course was not the case.

In short, those two patients did not access the care they needed because of the message being sent out about the burden they were placing on the system. That is completely wrong and certainly not the message we should be giving people who are clearly in urgent need of treatment.

A recovery plan has been announced this week, which, if we are honest, does not really address the issues of the wider NHS and social care pressures. It does not have any real plan for this particular area. The recovery plan, such as it is, is one part of the much wider system overhaul that is needed.

The Secretary of State said this week that approximately 10 million people represent missing referrals who did not come forward for treatment during the pandemic. I am afraid they may well end up becoming urgent referrals because they have not been through treatment and been spotted and helped at an earlier stage. I do not know whether the Government have given any thought to whether those 10 million missing referrals will lead to increased pressure on emergency services and A&E attendances.

What about those people whose care was not managed to target? The British Heart Foundation estimates that up to 1,865,000 people with high blood pressure were not managed to target last year, which could mean more than 11,000 additional heart attacks and more than 16,000 additional strokes across England over the next three years if those patients do not get support. Of course, that will again increase pressure on urgent and emergency care services in the longer term.

I appreciate there is quite a lot of ground to cover here, but when the Minister responds I would be interested to hear his analysis of the situation, whether he believes the examples I have given are part of a wider pattern of concern or isolated incidents, and what he believes must be done to put the ambulance service on a sustainable, safe footing for the long term. Are those images that we have seen of ambulances queuing up outside hospitals a temporary feature of a very difficult winter, problems with the ambulance service in particular, or symptoms of a wider health and social care system that is under incredible pressure?

[Mr Deputy Speaker (Mr Nigel Evans)]

Back-to-back appearances at the Dispatch Box by Ed Argar.

Health and Care Bill

Debate between Nigel Evans and Justin Madders

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Mr Deputy Speaker (Mr Nigel Evans)]

Fantastic. I am grateful to the Minister for his brevity; he can see how many people are trying to catch my eye.

[Justin Madders]

Thank you, Madam Deputy Speaker—[Interruption.] It has been a long day, Mr Deputy Speaker, but we will get there.

I will speak to the amendments tabled in my name and those of my right hon. and hon. Friends. As the Minister said, this group of amendments covers a large range of important areas, so I will be brief.

New clause 27 flags up the issues around waiting times. Passing any amendment requiring a report is, of course, not a total solution, but it might be a source of focus. As Labour has said many times since 2010, winter pressures, waiting times and the flight into private healthcare to get earlier treatment have exacerbated the issues.

Point of Order

Debate between Nigel Evans and Justin Madders

Wednesday 24th March 2021 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

On a point of order, Mr Deputy Speaker. On Monday, I received a written answer from the Minister for Health, the hon. Member for Charnwood (Edward Argar), to a question about operation waiting times beyond 52 weeks. The response stated that

“This information is not held in the format requested.”

Yesterday, however, the respected publication the Health Service Journal indicated that it had already received this information from NHS England. I have since received a copy of this from the Health Service Journal, and indeed, it is identical to the information I requested. I believe the hon. Member for Charnwood, who I shadow, is a diligent and courteous Minister, but this situation does require significant explanation. I had given him due notice today, and I had hoped he would be able to give us an explanation.

I should also point out that the Department has responded to me on 31 other occasions during the past year stating that it does not hold the information requested, sometimes in response to questions for which I genuinely struggle to understand why it does not have that information, one example being how many patients have been treated in Nightingale hospitals. Certainly, if I were in the Minister’s shoes, I would want to know the answer to those questions. I am therefore seeking guidance from you today, Mr Deputy Speaker, about what avenues are available when I receive answers of this nature where the Department does have, or should have, the information requested.

[Mr Deputy Speaker (Mr Nigel Evans)]

Thank you, Mr Madders, for having given the Speaker’s Office notice of the point of order you have just made, and you have confirmed that you have told the Minister about it.

It is not for the Chair to comment on the accuracy or completeness of ministerial answers: we all know that that is for Ministers. However, the Government’s own Ministerial Code states that

“Ministers should be as open as possible with Parliament and the public, refusing to provide information only when disclosure would not be in the public interest”.

Therefore, if the Department does hold the information requested, it should provide it. I am sure that the Minister concerned will review the answer and provide further information if appropriate and available. If the hon. Gentleman remains dissatisfied with the answer, he might wish to raise the issue with the Procedure Committee, but I also ask the Whip on duty to ensure that the Minister is well informed of the response that I have just made to this point of order.

Public Health

Debate between Nigel Evans and Justin Madders

Tuesday 6th October 2020 Commons Chamber

[Justin Madders]

If we are going into pub quiz territory, then perhaps we can have a pint later on. I am afraid that we probably do not have time to go into that, because I know that a number of other Members wish to speak.

Compliance is a very important matter. The vast majority of people do comply with the rule of six, but where they have not, they will obviously get a fixed penalty notice, and we need to understand how realistic it is that that will be enforced. John Apter, the chair of the Police Federation, has called for the Government to start an effective information campaign. He said:

“For policing, these constant changes to legislation are becoming the norm. The pressures on policing have increased significantly over recent months, and this latest change will add to this pressure.”

Brian Booth, who I quoted earlier, said that officers

“simply can’t enforce”

the new restrictions, adding:

“We just don’t have the resources, the world has woken up again and it’s busy… Resources are outstripped with that demand, never mind adding on Mrs Miggins reporting that seven people are having a barbecue next door.”

I am not aware of any official figures for the total number of fines that have been issued for breaching the rule of six, or indeed whether Mrs Miggins has had a fine, but it is notable that three weeks down the line, it is reported that many police forces, including North Yorkshire police, who handed out the greatest number of fines in the original lockdown, had not issued any fines for breaches of these regulations.

Will the Minister update us on the number of fines that have actually been issued? The police have had an incredibly difficult job in this crisis, and we know the very real pressures on them due to the reductions in their numbers over the past decade. They simply cannot continue to be handed responsibilities if those responsibilities are not accompanied by sufficient resources to enable them to do their job. With the number of enforceable restrictions increasing, will the Minister set out what additional resources will be handed to the police to ensure compliance? On that point, we know that Halloween is coming up very soon. It is always a busy night for the police, but this year they will have the added burden of breaking up groups of children if they become too big. Given that those children have probably spent all day with the very same kids at school in groups far larger than six, I say good luck to the officer who tries to explain to them why their parents will get a fine for it. I would be grateful if the Minister could confirm that that is what is going to happen.

There will need to be a very clear public messaging campaign, or will there be an exception? After all, the Prime Minister hinted that the rule of six could be dropped for Christmas day. Of course everyone would like to see that, but how on earth is saying that on a particular day the rule of six will not apply at all consistent with the clear public health message that the rule of six is meant to be?

Will the Minister also clarify what the rule is in relation to mingling? Apparently, a person can be fined for mingling with an existing group of six, but there is no definition within the regulations of what constitutes a mingle. The debate would be absurd if the consequences were not so serious.

In respect of police powers, the right hon. Member for New Forest West (Sir Desmond Swayne) asked the Minister whether the police can go into people’s properties to enforce the law. My understanding is that they cannot. I do not know whether the Minister expects the police to stand outside people’s properties until six people come out and then take appropriate action.

On fines, will the Minister clarify whether there was an oversight in the regulations around who has committed an offence under them? I ask that because the regulations require event organisers to carry out a risk assessment in order to comply with the regulations, but there does not appear to be any penalty for them if they fail to do so. It seems that the fine in that situation would apply to the people attending the event. How can it be right that a person attending an event in good faith is liable only because the organiser has not done their job? I appreciate that subsequent regulations came into place a few days later, on 18 September, requiring hospitality venues to enforce the rule of six or face a fine of up to £4,000, but again, I do not believe that applies to outdoor events. Can the Minister clarify whether that is the case? Are there any plans to introduce a penalty for the organisers of outdoor events who fail to comply with the regulations?

I am conscious that a number of people wish to speak, so I will conclude by confirming, as we have done on many occasions, that we want the Government to succeed in fighting the virus. However, let me be clear that the rise in infections we are seeing was not inevitable and the restrictions we are debating today were not inevitable. The Government cannot continue lurching from crisis to crisis. To take people with us, we need to see more transparency, the evidence behind the restrictions that are being introduced and better communication. We need new laws introduced after the democratic process has been completed.

How can we find ourselves, eight months into this pandemic, with confidence in the Government’s response draining away, rather than growing? How can we have one of the worst death rates in the world? How can we have a test and trace system so obviously failing to deliver the basics? The regulations might not have been necessary if the Government had fixed test and trace when the sun was shining. They wasted the summer. Let us hope that the price for that is not a very bitter winter.

[Mr Deputy Speaker (Mr Nigel Evans)]

There are eight people on the call list, and I will get everyone in if it kills me. To do so, I am introducing a rule of six. It is not an arbitrary figure; I have divided the time left by how many people want to speak. The rule of six could become the rule of five or the rule of four if there are a lot of interventions.