Ambulance and Emergency Department Waiting Times

I beg to move,

That this House has considered waiting times for ambulances and emergency department care.

It is a pleasure to serve with you in the Chair, Mr Stringer, and I am pleased to see so many Members here to discuss the highly concerning issue of the unacceptably long waiting times patients in our constituencies endure to access emergency care.

Our urgent and emergency care system provides a vital service supporting a significant number of patients with a huge variety of medical conditions, ranging from acute emergencies and trauma to mental health crises, the care of our homeless population and care of elderly patients. Emergency care should be there for all of us when we need it. Few of us plan to attend emergency departments, but we are all potential patients.

Covid-19 has had a detrimental effect on our ambulance services. More and more people are calling ambulance services or attending A&E because they are having difficulties accessing other, more appropriate parts of our health system. National NHS performance figures illustrate that our healthcare service does not have the capacity to meet demand, and during May 2022, only 60% of patients were seen, admitted or discharged within four hours of their time of arrival. We should all be worried by those figures, which demonstrate that the health service is unable to meet the needs of patients with current levels of resource and capacity.

I want to share the example of the Royal United Hospital in my Bath constituency. It demonstrates the severity of the problem and the way in which hospitals have to step in because the Government are not willing to accept that there is a real crisis. There have been several cases in Bath in which residents waited many hours for an ambulance. Recently, an elderly man was forced to sleep on the floor of a local church as it took 12 hours for an ambulance to arrive—12 hours. A GP surgery ran out of oxygen for a patient due to the time it took for the ambulance to arrive. Ambulance handover delays are a significant patient-safety risk at the RUH, and up to 90% of the causes of delay are linked to the availability of beds in the hospital.

The RUH has consistently been running with a bed occupancy of over 90% for the past year, which is significantly impacting the hospital’s ability to move patients out of the emergency department. The hospital is one of the most challenged in the south-west for “non-criteria to reside”—in other words, medically fit for discharge—patients, and NHS England is reporting that the RUH has 24.3% of its beds occupied by patients who are medically fit, which is the third highest figure in the south-west. That is driven by gaps in the domiciliary care and social care markets.

My local authority, Bath and North East Somerset Council, has been short of 1,600 hours per week, community teams are struggling to recruit and our local care group has a vacancy rate of more than 30%. The RUH is working with the council to develop its own in-house domiciliary care to try to plug the gaps, but the recruitment crisis remains acute. NHS England is assessing the trust and is trying to help to reduce the bed gap at the RUH. The hospital recently launched a “home is best” transformation programme that aims to increase the number of patients who go home instead of into a community hospital bed. Our hospitals are trying all this, yet there is a crisis. It is important that we recognise that, and that the Government recognise it and step in on behalf of the hospitals.

Our hospital in Bath is also working out ways to reduce the number of patients who need to go into the emergency departments in the first place, and has launched a same-day emergency care offer for frail patients. However, nationally, the lack of staffed beds has resulted in staggering numbers of patients waiting beyond 12 hours after the decision is made by the A&E doctor. There have been more patients waiting 12 hours or more from the decision to admit this year than there were in the entire reporting period leading up to 2022. In May, there were more than 19,000 patients waiting 12 hours or more from the decision to admit, yet research from the Royal College of Emergency Medicine shows that that number is only the tip of the iceberg. We know that far greater numbers of patients endure waits of 12 hours or more if the clock is started as soon as they set foot in A&E. Many more patients endure extremely long waits but are not captured by the current metric. We need to understand the true scale of the problem. If we do not know about the extreme delays that our patients are enduring, we cannot take action. Transparency is key, and reporting metrics from the moment of arrival at the A&E department must be the starting point.

Such delays mean that emergency services are not able to respond to 999 calls from critically ill patients. Instead, they are being held in stacks of hundreds each day, and staff are forced to prioritise among even the most serious cases. Staff have to wait with the patients in corridors, and sometimes even outside the hospital, unable to have them treated and unable to respond to new emergency calls. We must think very carefully about what that means. Behind every statistic is a patient. Those patients are stuck and have no choice but to wait for a bed to be freed up so that they can be admitted and can receive the care they need. Unfortunately, some patients end up on trolleys in crowded corridors with many other patients. We should be treating patients with dignity. We know that crowding is dangerous and is linked to avoidable harm and, in some cases, death.

The pressure that the NHS faces, which has been building over recent decades, has real detrimental consequences on the emergency medicine workforce and patients. Staff are considering reducing hours, changing careers or retiring early. Additionally, emergency staff face constant abuse from those left waiting, which is hugely distressing. The more people leave, the more pressure is created.

The Royal College of Emergency Medicine’s “Retain, Recruit, Recover” report detailed findings from its survey of emergency medicine clinicians. It found that 59% of respondents experienced burnout during the second wave of the pandemic, and described their levels of stress and exhaustion from having worked the second wave as higher than normal. The report found that operational pressures, patient safety and staff wellbeing are intrinsically linked. In 2021, the Royal College of Emergency Medicine highlighted a UK-wide shortfall of 2,000 to 2,500 whole-time equivalent emergency medicine consultants. The needs of our population’s health and wellbeing are greater now than they have ever been. We cannot afford to lose even more of the workforce at this critical time of need.

It is clear that this very serious issue is a matter of life and death for many patients. Among those who are suffering from serious but not necessarily prioritised issues, it is elderly and frail patients who are being hit the hardest. Although it is easy for the Government to point the finger at hospitals and management, it is clear that this issue needs to be addressed centrally at Government level. It is not exclusive to Bath or north Shropshire; it is a national problem, as the range of MPs in the debate demonstrates.

What is more, the consequences of a failed social care system, which does not allow for the timely discharge of patients who are medically fit to leave hospital, has resulted in further crowding and corridor care in our hospitals. The chief executive of NHS England recently acknowledged the important role that social care plays in supporting patient flow through hospitals. The Government must outline the steps they will take to ensure the social care system is adequately equipped ahead of next winter.

Last autumn, the NHS published a 10-point plan for the recovery of the urgent and emergency care system. It has no targets or timelines, and it lacks any indication of how progress will be reported. It details only how the whole system will work together to recover urgent and emergency services, focusing on immediate and medium-term activities. The plan aimed to

“mitigate against the current pressures felt across systems and improve performance in all settings”—

great words, but where are the outcomes? All that is happening is that the situation is getting worse.

The NHS standard contract 2022-23 was recently amended to change the way in which 12-hour waits in A&E are calculated. As a result, A&E is now collecting 12-hour data from the patient’s time of arrival, not from the decision to admit. Despite that, the Government and NHS England have not indicated when the data will be publicly available. Publishing the figures nationwide will allow for transparency across the system, so perhaps the Minister will tell us when that will be publicly available. That should lead to improvements.

The Liberal Democrats have been sounding the alarm bells for months, calling for an urgent investigation into England’s ambulance services and a review of ambulance station closures, but the Government keep turning a blind eye to the crisis. We are calling for more investment in local ambulance services, an urgent campaign to recruit more paramedics, and enabling trusts to restore community ambulance stations in rural areas in Devon, where waiting times are unacceptably long.

I found on the doorsteps in my part of Devon over the last month that pretty much every door I knocked on had somebody behind it with an anecdote about how ambulance waiting times had affected them personally. In south-west England we have the longest waiting times in the country. One paramedic told me that despite his very best efforts to treat patients, there were times when he came across very undignified scenes. He talked about one example of how he came across a lady who had fallen down and had to wait 14 hours for an ambulance to arrive.

Order. I realise that the hon. Gentleman is new, but interventions should be short and to the point. I did not want to interrupt him, but I ask him to remember that interventions should be as brief and to the point as possible.

Thank you, Mr Stringer. I think every one of us has such stories from the doorstep. Almost everybody knows of a loved one or a friend who has waited an unacceptably long time. That is why it is so important that we get the urgent review that Liberal Democrats have been calling for.

We are calling for a formal inquiry. The Government need to fund thousands of extra beds to stop handover delays in A&E so that ambulances can get back on the road as soon as possible. Will the Minister comment on a formal inquiry into the crisis?

Fifty per cent. of the entire Northern Ireland budget is spent on the health service, which is a higher proportion than in the rest of the UK. But this is not just about the money. Does the hon. Member agree that it is about how the money is spent and managed, and that that is critical to any review?

Indeed. Not everything is always about money; it is also about proper management. At the heart of it all is transparency. We need to have the figures and to understand what the problems are. I echo the Royal College of Emergency Medicine: unless we have transparency, we cannot get to the bottom of the problem.

The Royal College of Emergency Medicine has already stated that A&E departments are not confident they will cope this winter. The Government simply cannot ignore this looming crisis on top of the existing challenges we face. They are running the NHS into the ground. With A&E wait times measured in hours instead of minutes, people are no longer confident that they can get urgent medical help when they need it. The Government need to start working with NHS staff to draw up a robust plan now to tackle the crisis in ambulance waiting times and emergency care, and start delivering. Thousands of lives depend on it.

I think there are 10 hon. Members wishing to speak. I intend to start calling the Front-Bench spokespeople at 10.40 am. Therefore, Members have approximately five minutes each. I will not impose a time limit unless people abuse this privilege.

I thank the hon. Member for Bath (Wera Hobhouse) very much for obtaining this very important debate. The very first subject that I raised when I was a newly elected MP was the state of ambulance response times in North Norfolk. That is a particular worry for me, because up on the North Norfolk coast I have the oldest constituency demographic in the entire country, and Wells, a beautiful seaside village, has had the very dubious honour of consecutively having the worst response times. Over the last few years, whereas the category 1 responses have flatlined, the C2 and C3 response times have got worse. Constituents are coming to me almost every other day to tell me about the appalling situation that they have encountered in calling an ambulance. The worst cases are of people having strokes in the back of their car while family members are driving them to the hospital. When we hear those accounts, we get some sense of just how bad the picture is.

I agree with many of the comments made by the hon. Member, but we have to recognise that this is not a simple issue that can be solved with a single magic bullet, and it is certainly not all the fault of the ambulance service, which is working under extreme pressure. All our health systems at the moment are really buckling under the issues that have been caused by the pandemic. That is the case in social care systems, mental health care and dentistry. There are serious problems in all places at the moment.

Let us take the Norfolk and Norwich Hospital, which is my emergency department. It has the honour—I call it an honour; it is dreadful—of being the worst in the east of England. In the first 13 weeks of the year, 723 equivalent ambulance shifts were lost. The third worst performing facility for ambulance response times is the Queen Elizabeth Hospital, with 442 equivalent shifts lost. Both ED units that serve my constituency are in the top three worst facilities in the entire east of England. It is a huge problem, with hundreds upon hundreds of hours lost every single week when ambulances are queueing up outside a hospital because they cannot get patients out of the trucks and into the A&E department. Equally, the social care system is so poor that they cannot get people back into the community, with the respite that they need.

It is a pleasure to serve under your chairmanship, Mr Stringer.

“24 Hours in A&E” is not just a television show, but a reality that patients across the UK now face. It is no longer a short trip to the accident and emergency department, but a short stay in an accident and emergency ward, which means staff are effectively running two wards: the A&E ward and the ward where patients should have been moved to be treated. In Bradford, the demand for urgent and emergency care outstrips the capacity of hospitals to support patients, and that reflects the reality across the country. Unsurprisingly, the waiting time for emergency services and emergency department care will vary across the country, with waiting lists in the most deprived areas having increased by more than 55% compared with 36% for the least deprived areas.

As I have previously highlighted, children in Bradford wait 800 days longer for mental health intervention. The Government keep telling us that covid-19 is to blame for the waiting time, the backlog and the lack of resources and funding, but that could not be further from the truth. In fact, the Secretary of State for Digital, Culture, Media and Sport admitted that in her attack on the former Health Secretary, the right hon. Member for South West Surrey (Jeremy Hunt), for failing to prepare for covid.

When a stroke patient does not get the urgent support they need, that can mean further damage to their health and life-long injuries, which in turn costs the NHS more. On the subject of ambulances, a dear friend of mine who is chief executive of My Foster Family, based in my constituency and with whom I have worked a lot, suffered a stroke last week. Shadim Hussain, who is 43 years old, is in the intensive care unit as we speak and I hope he will recover, although it will no doubt take a long time. When there is a 45-minute wait for an ambulance, there are two victims: the person in the ambulance who is waiting to be offloaded into the hospital and the person in the community who is waiting for the ambulance to get them to hospital. Shadim Hussain was taken to hospital in a car while he was being sick and suffering from a very serious bleed to his brain.

It is a pleasure to serve with you in the Chair, Mr Stringer. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this debate. I will focus my comments on the work of the East of England Ambulance Service NHS Trust and the James Paget University Hospitals NHS Foundation Trust, which together serve north Suffolk and east Norfolk, including the Waveney constituency.

The staff and management of both NHS trusts are under enormous pressure at the current time and are working incredibly hard to meet a challenge that is largely not of their own making. The East of England Ambulance Service has faced a number of institutional and cultural challenges over the past decade, which the current management are addressing. During that time, for the most part, it has provided the local community with a good service, although there have been three occasions when it has not done so: in 2012, when the system broke down very badly, at around Christmas time in 2017-18, when the then management failed to properly plan for seasonal pressures, and today, as it works against a very difficult backdrop.

For the week ending 26 June, the average arrival-to-handover delay at the James Paget was one hour 30 minutes. For the previous week, it was one hour four minutes. For the week before that, it was 49 minutes. The trajectory is very much upwards. The worst individual case that has been brought to my attention is a wait of 16 hours, and I am also aware of the situation with poor triaging.

Working collaboratively and in a co-ordinated way, the ambulance service and the James Paget hospital are putting in place a range of measures to relieve the pressures. The hospital has expanded its emergency department, launched a new surgical assessment unit and invested £900,000 in a new GP streaming service aimed at providing care for patients who attend A&E and who need a doctor rather than hospital treatment. For its part, the ambulance service is putting more ambulances on the road, developing co-responses with the fire services and local communities, and staffing cohorting areas at the Paget with its own HALOs—hospital ambulance liaison officers.

It is a pleasure to serve under your chairmanship, Mr Stringer. I am grateful to my hon. Friend the Member for Bath (Wera Hobhouse) for securing the debate. On 25 May this year, the nursing director of the West Midlands Ambulance Service, Mark Docherty, said that the ambulance trust would face a “Titanic moment” and collapse entirely this summer. He gave the specific date of 17 August. Mark went on to say that patients were “dying every day” from avoidable causes created by ambulance delays. That was 42 days ago. He predicts that we now have another 42 days before the ambulance service in my community collapses.

I have had an Adjournment debate with the Minister on that subject, and a meeting with the former Secretary of State for Health, the right hon. Member for Bromsgrove (Sajid Javid), yet this Government still have not got a grip on the problem. As a proud resident of North Shropshire, I was aware of our ambulance crisis before I was elected in December, and before I started campaigning in November. However, on the campaign trail, and since being elected, it has become evident that the scale of the crisis is absolutely shocking.

Just last week, I was contacted by a constituent whose 85-year-old mother, who suffers from dementia, had fallen and suffered a suspected broken hip. Her son called the ambulance, but she sat in agonising pain in their living room for 18 hours before the ambulance arrived at her home. Everyone in this Chamber will agree that this should not be happening in this country, or in this century. It is one of many stories I have received. Many other people are attended by the ambulance crew in fairly reasonable time, but then wait 12 or 13 hours in the ambulance before being transferred into the hospital.

The focus of this debate should be on solutions to the problem, but it is also crucial to understand how we got here. Ambulance service delays are a symptom of wider issues plaguing the NHS and health services across the country, and the issue of staff shortages is critical to that, as colleagues have alluded to today. So far, the Government have failed to address that. They have thrown our hard-working doctors and nurses pretty much under the bus. We are short of nurses, carers, GPs and decision-making doctors in A&E. In February, the all-party parliamentary group for rural health and care published a report concluding that the 10 million people who live in rural and coastal areas in the UK deserve better healthcare outcomes. Colleagues here representing rural constituencies know from first-hand accounts that it is not just access to healthcare that is compromised but, in the words of the APPG report,

I start by thanking all our NHS and care workers, who do an incredible job every day in dealing with the huge pressures on our local health services.

As I have said on a number of occasions, we are seeing significant challenges in north Staffordshire with ambulance delays and demand at the Royal Stoke A&E. Many of my constituents have contacted me after waiting for many hours for an ambulance. I have had to intervene on more than one occasion to get West Midlands Ambulance Service to respond to patients who have waited for 12 hours or more.

It is totally unacceptable for elderly and vulnerable people to be left to suffer without the emergency response that they need. Ambulances are now frequently queuing up outside the Royal Stoke A&E due to the lack of space to admit people. Our experience is similar to that of many other Members, with occupancy levels in the Royal Stoke hospital at over 90% much of the time. Despite the efforts to increase flow through the hospital, we still see too many patients fit for discharge not being able to be discharged, due to the lack of social care beds or not having care packages in place.

The availability of social care places across Staffordshire has continued to be significantly affected by covid, with homes locked down to new admissions, and a number of places have been lost due to quality and staffing issues. Our health and care services are still being impacted by the effects of the pandemic, and work to recover them from the pandemic is ongoing. What is clear is that these pressures cannot be sustained and that the situation must improve, but there are multiple causes that cannot simply be fixed overnight. Many of the pressures in the local health care system predate the pandemic. These relate to the period when the new private finance initiative hospital was built by the last Labour Government. That hospital has fewer beds and faces more demand following the Stafford Hospital scandal—also under Labour’s watch—as well as the amalgamation of Staffordshire Ambulance Service into West Midlands Ambulance Service.