Urgent and Emergency Care

Debate between Steve Barclay and Tony Lloyd

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

I have set out a range of things that we are doing to tackle what we recognise are significant pressures facing the NHS, whether that is through the taskforce that we have set up, which is targeted on delayed discharge; the intensive work that has been undertaken with, in particular, the 10 trusts that account for 45% of ambulance delays; the improved capacity within our call handling; or looking at our data, as was raised earlier, on the variation in performance between ambulance trusts on areas such as conveyancing or within the integration between the NHS and social care. I pay tribute to the huge amount of work that is being done within the NHS and social care in recognising that there are significant challenges within the system, which is why so much work has gone into addressing that over the summer.

[Tony Lloyd (Rochdale) (Lab)]

The Secretary of State might recall that in his previous Health incarnation, he responded to a debate about the crisis in the ambulance service in my constituency. It is worse today—much worse. I take the point about delayed discharge, but, even so, is it not better to have people moving into a hospital setting, rather than people not being picked up by ambulances? That is where the real risk is. Will he also guarantee that I get an answer to my letter asking that Rochdale, which lost its A&E service some years back, gets it back? That would make a material difference.

[Steve Barclay]

On the hon. Gentleman’s second point, I will ensure that that particular letter to the Department is highlighted following this statement. On his first point, as I said in my statement, I agree that the greater risk is the unmet need if an ambulance does not arrive, rather than a patient who is in hospital. That is why Professor Stephen Powis and chief nurse Ruth May wrote to the system when there was pressure during the heatwave, flagging that as a specific issue. We have been working with trust leaders, including leading figures such as Anthony Marsh, on pre-cohorting and post-cohorting, capacity in emergency departments, and where risk sits in the system. I recognise the hon. Gentleman’s point.

Checks on Goods: Northern Ireland and Great Britain

Debate between Steve Barclay and Tony Lloyd

Thursday 24th October 2019 Commons Chamber

[Tony Lloyd (Rochdale) (Lab)]

(Urgent Question): To ask the Secretary of State for Exiting the European Union if he will make a statement regarding checks on goods moving from Northern Ireland to Great Britain and Great Britain to Northern Ireland under the current withdrawal agreement.

[The Secretary of State for Exiting the European Union (Stephen Barclay)]

On 17 October, the United Kingdom and the European Union reached political agreement on a new withdrawal agreement and political declaration for the future relationship. That includes a revised protocol for Northern Ireland, which has been extensively debated in this House. The agreement is clear that Great Britain and Northern Ireland are one customs territory. Goods that are not at risk of moving to the European Union will attract no tariffs. These arrangements mean that Northern Ireland would remain in the UK’s customs territory and could benefit from the UK’s new trade deals with third countries. Goods moving from Great Britain to Northern Ireland that are destined for the European Union will have to comply with European Union rules. To ensure that the correct tariffs are applied and that goods comply with the rules of the single regulatory zone, some information will be needed on goods moving from Great Britain to Northern Ireland.

The deal also explicitly allows the United Kingdom to ensure unfettered market access for goods moving from Northern Ireland to Great Britain. There will be minimal targeted interventions designed to prevent, for example, trade in endangered species, which I would have thought the House agreed on. We will work with the European Union to eliminate those limited processes as soon as possible after Brexit. The most important point is that the arrangements automatically dissolve after four years unless a majority of the Northern Ireland Assembly in Stormont votes to keep them.

[Tony Lloyd]

Thank you, Mr Speaker, for granting this urgent question, which really does matter.

There is confusion at the very heart of government. Yesterday, the Prime Minister told the House there would be “no checks” and “no tariffs” between Northern Ireland and Great Britain; that is in direct contradiction to what the Secretary of State just told the House. It is in contradiction with the steadily progressing views expressed in different statements from the Secretary of State for Northern Ireland and the Justice Secretary, who said last night on “Newsnight” that there will be checks in both directions—from GB to Northern Ireland, and Northern Ireland to GB. The manifest confusion at the heart of government is compounded by the confusion for businesses in Northern Ireland—particularly small businesses—and the Northern Ireland civil service in planning for the long term. That is simply unacceptable. The Government were trying to ram the European Union (Withdrawal Agreement) Bill through the House in three days, but they themselves do not properly understand what they are doing. That is problematic, and we need absolute clarity.

While this is outside the Secretary of State’s immediate brief, there are other consequences. The House spent a long time arguing that there should be no hard border across the island of Ireland to prevent an impact on the nationalist community; we did not think we would now be talking about the impact on the Unionist community and political Unionism. The new Chief Constable of the Police Service of Northern Ireland said:

“whatever ends up as a Brexit deal, if there is one that could be perceived in a way that sort of threatens the security of the loyalist community...our concern is also the loyalist community has at times shown it can mobilise quickly, bring large numbers of people on to the streets and engage in public disorder in support of their cause.”

I hope that every Member takes that warning very seriously, because it is a profound warning from a senior and experienced police officer.

I have a number of specific questions for the Secretary of State. First, what overall impact assessment have the Government made for the Northern Ireland economy? What assessment have they made for trading ports and airports in Scotland, Wales and England? Her Majesty’s Revenue and Customs estimates that each declaration for shipments from Great Britain to Northern Ireland will cost between £15 and £56, and Border Force says that a “minimum amount” of electronic information will be required for movements from west to east. When will the Secretary of State be able to give certainty to businesses about what the checks will be and how they will be undertaken? If the Justice Secretary was right when he told “Newsnight” that there would be checks from Northern Ireland to Great Britain, when will we know the detail of what those checks will be, rather than their being superficially dismissed as of no importance?

In the end, the Government have to put an end to this confusion. Will the Secretary of State guarantee that he will make an early statement to the House about the full impact of the checks in both directions? Does he accept the warning of the Chief Constable about the potential impact and do the Government take that seriously? If so, what is their assessment? Finally, I have to ask about a political point, although it is an important one: does the Secretary of State believe that the Prime Minister himself at last understands the impact of his deal on Northern Ireland and on the relationship between Northern Ireland and the rest of our country?

[Stephen Barclay]

I know that the House and the hon. Gentleman take these issues very seriously. He raises some very legitimate points, which I will seek to address.

First and foremost was the hon. Gentleman’s concern about any hard border between Northern Ireland and Ireland. I am happy to give him assurances on that; it is a key part of what the Government have agreed. If he looks at the preamble to the Northern Ireland protocol, he will see clear commitments from the EU and the UK to the Belfast/Good Friday agreement. It states that

“nothing in this Protocol prevents the United Kingdom from ensuring unfettered market access for goods moving from Northern Ireland to the rest of the United Kingdom”.

The hon. Gentleman also raised a legitimate concern about the statement from the Chief Constable of the Police Service of Northern Ireland. The Government take it incredibly seriously, and the Secretary of State for Northern Ireland liaises closely with the Chief Constable and other senior officers. This is one reason why it is important to get the Executive back up and running, as I am sure the hon. Gentleman agrees. Part of the reason why the Government extended article 50, for which they were criticised at the time, was precisely that the previous Prime Minister took those concerns very seriously, and we have continued to work with the PSNI to address them. However, I remind the hon. Gentleman that one of the central concerns is the potential impact of no deal on the border, which is another reason it is important that the House comes together and agrees a deal, because that is the best way of safeguarding the Belfast/Good Friday agreement and addressing those concerns.

The hon. Gentleman asked about the comments of my right hon. Friend the Prime Minister. The Prime Minister was distinguishing between the paperwork required, which will be done digitally and is a single form, and the introduction of physical checks. In the coming months, we will work within the United Kingdom and with the European Union to discuss how to eliminate the limited administrative processes that there are. The hon. Gentleman will know that article 6 of the protocol requires further work through the Joint Committee to minimise any impact. That is an ongoing commitment.

The hon. Gentleman made a valid point about certainty for business. It is something we hear about in our engagement with businesses in Northern Ireland. It is important to reassure businesses that this is an administrative process—an electronic form—and something as part of bookings that will be done with the haulier as an aspect of the shipment of goods. It will involve fairly straightforward data about who is exporting, who is importing and the nature of the goods. That said, I am happy to have further discussions with him, because he does reflect concerns among businesses, particularly the small and medium-sized enterprises sector in Northern Ireland, about these arrangements.

The hon. Gentleman also asked when we would come back to the House with further updates. My right hon. Friend the Secretary of State for Northern Ireland is keen to continue to update the House, following his discussions on this issue and, more widely, about the restoration of the Executive. I will speak to my right hon. Friend about how we keep the House updated.

The issue is that these are administrative processes pertaining in particular to international obligations on things such as Kimberley diamonds and endangered species and to things that hauliers will be able to prepopulate in their IT systems. However, it is the case—the hon. Gentleman is right—that concerns have been expressed in Northern Ireland. Indeed, concerns have been expressed, which I very much respect, by our confidence and supply partners. Again, I very much offer to work with colleagues across the House on how we address the real concerns—the very real concerns—that I know they have to minimise any disruption that they are concerned about.

North West Ambulance Service

Debate between Steve Barclay and Tony Lloyd

Monday 22nd January 2018 Commons Chamber

[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.

Oral Answers to Questions

Debate between Steve Barclay and Tony Lloyd

Tuesday 18th July 2017 Commons Chamber

[Stephen Barclay]

My hon. Friend rightly champions that key sector which provides £71 billion of tax to fund public services. It is in the interests of the UK and the EU to avoid fragmentation because that will increase costs, and the Prime Minister has made it clear that we are ambitious, in terms of the trade deal that we reach with the EU, to come to an arrangement that delivers regulatory equivalence.

[Tony Lloyd (Rochdale) (Lab)]

Does the Chancellor accept that the confusion and conflicting ambitions of the Government’s policy on Brexit are already having an impact on investment? In the long run, that will be massively damaging to the economic prospects of this country.