That this House has considered requests for military aid to civil authorities during the covid-19 outbreak.
It is a pleasure to serve under your chairmanship today, Mr Hollobone. I am grateful to the House for allowing time for this important debate.
Coronavirus has created pressures on all public services the likes of which we have never seen before. When those services are critical for preserving life, the pressures—increased absenteeism and greater demand—are significantly more noticeable. Many constituents have had awful experiences of waiting four, eight or even 10 hours for an ambulance for either themselves or a relative. I applied for this debate because constituents—many of whom are relatives of vulnerable people—have recently been in touch to share their despair over having to wait many hours for an ambulance, even in urgent circumstances.
One constituent had to stay by the side of his late father’s body for nine hours before an ambulance was able to attend to his father and take him away. The shock of finding his father unexpectedly dead at home would have been enough—I cannot imagine having to sit beside a deceased loved one for many hours, waiting for help that just does not turn up. Another constituent in her 80s waited for an ambulance for 10 hours after she broke her hip at home. Another was identified as having a stroke by a doctor who lived nearby; because they could not wait for an ambulance, the doctor kindly drove her directly to the hospital.
There are many such stories. I am sure West Dorset is not the only area in the United Kingdom experiencing such difficulty, and I am sure I am not the only MP hearing such stories. In this debate, my intention is not to pile criticism on the South Western Ambulance Service. In West Dorset and across the wider south-west, our ambulance service has been working to absolute capacity until it simply cannot do any more. Diligent MPs cannot stand by and allow this situation to go on without proper scrutiny. It is clear that something needs to change.
I congratulate the hon. Gentleman on an absolutely superb debate, as I was saying to him beforehand. It will probably encapsulate all our thoughts, and I know the Minister will wish to respond to him. We have been grateful recipients of Army medics in our hospitals during covid-19; indeed, even this week, help is being given by 50 to 60 medics in the Ulster Hospital, just on the edge of my constituency. Does the hon. Member not agree that there is a very clear role for the Army to play, and that that role has not yet ended? Further, we owe a debt of gratitude to those who serve us in times of war and peace—our wonderful armed forces.
I cannot agree enough with the hon. Gentleman. I am delighted to be part of the armed forces parliamentary scheme and spending time with the Royal Navy at the moment. Those in the armed forces not only dedicate their lives to service of this country, but go so far in supporting and helping those in need in the most difficult situations. They are to be commended far more than I can do in this debate this afternoon.
Although we understand that armed forces capacity is not limitless, we unconsciously rely on them, safe in the knowledge, that in the direst circumstances our service personnel will step in and avert a crisis. When that does not or cannot happen, the resilience of our emergency services comes into question.
My local South Western Ambulance Service first scoped its request for military support in July last year. There were six operational and clinical areas where it sought additional support, because of increased activity and absenteeism due to coronavirus. Of those six areas, only one was fulfilled. After many weeks of negotiation, the South Western Ambulance Service received very limited military personnel on 11 August last year: 18 soldiers to fill logistics roles, who also replenished equipment on ambulances until the end of August. Those 18 soldiers were much appreciated, but that was only 18 for 5 million people in the south-west.
The South Western Ambulance Service had also asked for clinicians, blue-light drivers and mechanics, among other roles, but those requests were not granted. I know that it is not the role of Her Majesty’s armed forces indiscriminately to provide any and all support to civilian services that is requested. However, in March 2020, the Secretary of State for Defence announced:
“From me downwards the entirely of the Ministry of Defence and the armed forces are dedicated to getting the nation through this global pandemic.”
At that time 10,000 personnel were put at higher readiness, thus making 20,000 personnel available, if needed. Therefore, we might be forgiven for believing that assistance from the Government would be more forthcoming in this case.
It is a pleasure, as ever, to service under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this debate, and I pay tribute to him for the manner in which he conveyed some challenging personal experiences on the part of his constituents and others. I will turn first to the situation faced by ambulance services, before clarifying for my hon. Friend that many of the expectations in terms of specialist posts are not realistically achievable within the constraints on the military’s resources.
Ambulance services have faced extraordinary pressures over the past 18 months, and I know that all hon. Members will join me in paying tribute to all the staff for their dedication and hard work. The pandemic placed significant demands on the service. In December 2021, it answered almost 1 million calls—a 22% increase on December 2020—placing significant pressures on ambulance services and the wider NHS.
We know the background reasons for that: infection prevention and control measures, higher instances of delays in the handover of ambulance patients into A&E and, crucially, the staff absence rate. Flow through our hospitals, which is always the key determinant of the ability of ambulance services to offload patients to the safety of A&E, is about the ability of that A&E to either get those patients discharged safely or admitted to hospital. A combination of those factors has placed unprecedented stress on the service and driven increased response times to patients in the community. Despite those pressures, performance for category 1 calls—the most serious calls, classified as life-threatening—has been largely maintained at around nine minutes on average over the last several months, despite a 16% increase in these calls compared with before the pandemic, although we are clear that there has been a significant increase in response times across other categories.
I completely understand some of the difficult points the Minister makes, but does he agree that St John Ambulance has a wonderful suite of resources and could play a much more substantial role in supporting our emergency services?
I will address that point and then return to the military point. I had a very productive meeting with St John Ambulance in the past couple of weeks to discuss exactly that. We should not underestimate the huge role it has already played throughout the pandemic in supporting our ambulance and other emergency services.
This does not cover the constituency of the hon. Member for West Dorset (Chris Loder), but Northern Ireland has a Territorial Army medical regiment based in Belfast. The majority of people in it are probably NHS staff—they are doctors, nurses or whatever —and that is where their interest in being in the TA comes from. Will there be circumstances on the mainland in which the TA medical corps could be used to our advantage and to address staffing shortcomings?
It is important that we take advantage of all opportunities in terms of those qualified professionals and their ability to support our more regular frontline services.
To pick up on the point raised by my hon. Friend the Member for West Dorset about MACAs and military capacity, a large number of those 20,000 were used for testing and helping to build Nightingale hospitals, and they have recently been helping in vaccine testing centres. However, capacity in terms of, for example, clinically qualified Army medics is limited, and they often already serve in the NHS and in hospitals, so there is not a huge pool to draw on. It is important that we are clear about that. Secondly, I mentioned to my hon. Friend the point about those qualified as blue-light drivers. Again, that is not all the 20,000 or anywhere near. We have to be—realistic is the wrong word—careful in our expectations of the capacity to support specific requests, such as the specific types of support that his ambulance service put in for.
More broadly, considerable support has been offered by the military for tasks such as logistics, which my hon. Friend highlighted—for example, in supporting the ambulance service in a range of roles. Currently, the Ministry of Defence provides support to ambulance services in the following ways: 366 personnel in a range of roles, including non-driving roles; 96 personnel continuing non-blue-light ambulance driving support for the Scottish Ambulance Service; and 313 personnel in driver support to the Welsh ambulance service.
My understanding of the specific matter to which my hon. Friend referred is that it was incorporated into the broader request for ambulance drivers between 10 and 31 August last year. The element of that request to be granted was the 28 category C drivers who were provided by the Ministry of Defence. However, I come back to the point that, while he is right that the military are always there to assist us in times of need, we equally need to be realistic about their capacity in specific places.
I appreciate the Minister’s candour. I respectfully remind him that the fundamental issue is that we have constituents—patients—who are in great difficulty for a long time. I fully appreciate the many pressures that he outlined, but what I am looking to achieve through the debate, especially for those families and individuals who have gone through painful experiences —I hope the Minister can help me a little further with this—is that we do not get into this position again, with constituents on their own waiting for such a long time.
My hon. Friend will have heard me set out exactly how we have done that with the extra investment in our ambulance services. That is the key—to reinforce the strength and resilience of our existing ambulance service provision. He is absolutely right to highlight the impact—the patient and familial impact—of long waits for an ambulance, but the real answer is the measures that we are taking to invest in the ambulance service, with the £55 million more, the investment we put into hospitals to ensure that they were ready for winter, and the broader funding across the piece for our healthcare system to strengthen it further. Today, we saw another element of that package in the announcement of waiting list recovery and how we intend to approach that.
My hon. Friend is absolutely right to highlight the military. In extremes, they are there to help in very specific and pressured circumstances, but they are not the solution to the problem in the long term or to avoiding the challenges recurring. That is why we have our plan not only for the ambulance service, but for improving urgent and emergency care. We saw £450 million invested in that over the past 18 months or so to improve A&Es across the country, helping them to function more effectively, in particular in the context of IPC—infection prevention and control—measures. More broadly, we are investing in our acute hospitals to allow for the flow of patients out of A&E and into the hospital or, we hope, home. That is the key to solving this.
I am pleased that the Minister highlighted that. I highlight and thank him again for the £65 million that the Government have dedicated to Dorset County Hospital to address that very difficulty.
I am grateful to my hon. Friend. He is right to highlight that, not least because of his role in continuing to argue for it and in supporting Dorset hospitals in that context.
The military have done, and continue to do, a fantastic job in the context of this pandemic. However, as I say, the key to this issue is long-term investment, which is exactly what we are putting in place. I am very conscious of the challenges faced by all ambulance services over the winter, but I know that my hon. Friend’s local ambulance trust faces specific challenges of geography, distance and location of hospitals, which can be difficult for it on occasion. I appreciate the particular complexities of the system in the south-west, and we continue to work closely with the local system, but also with the military where appropriate, to see where they can support us and help add additional resilience into the system.
However, there is no substitute for the investment we are putting into making those systems more resilient in the long term, the need for which my hon. Friend has highlighted again today. We continue to focus on outcomes for patients—which is, I think, exactly where he is coming from—to avoid or reduce the risk of people having to wait a long time for an ambulance in very challenging circumstances. Tackling and improving the performance of our ambulance trusts remains a high priority in my ministerial inbox. That is in no way a criticism of the amazing work their staff are doing, but they face significant challenges. We continue to focus on those, and I look forward to working with my hon. Friend and his colleagues in Dorset to meet the challenges in the south-west.
Question put and agreed to.
4:26 pm
Sitting suspended.
These failures are caused not by incompetence or inefficiency, but by a greater demand upon our health systems than they are capable of handling without further back-up. A lack of social care options for people fit for discharge has caused a backing up throughout the hospital system that has ultimately compounded this situation. Ambulances often need to queue outside A&E for hours, with patients having to wait so long that they are triaged in the ambulance.
Ambulance drivers are in frequent close contact with vulnerable people. They have needed to be even more vigilant than the rest of us about self-testing and isolating when required so that they do not infect their patients. While that sense of care and responsibility is their duty, it has resulted in higher levels of absenteeism than the ambulance workforce has been able to manage.
The compounding of those issues—with absenteeism and capacity pressures in hospitals resulting in ambulances queuing at A&E, unable to leave until they have safely transferred their patients into the care of hospital staff—has meant the ambulance service is unable to respond to the next call. The result at home in West Dorset is a lack of ambulances available and people waiting for hours, sometimes in great pain and distress.
When our civilian services are in this situation, during a national crisis or not, the last step of escalation is to the Government, for assistance from the Ministry of Defence.
The period of the coronavirus pandemic has been one where our armed forces were at their most ready to assist civilian services, and they should be commended for it. Of course, more services required help and so military assistance had to be spread more thinly, but it was surprising to discover that the MACA request from the South Western Ambulance Service was fulfilled only to an extremely small extent. That gives me and my constituents great cause for concern. That was mainly as a result of the original request being filtered down and weakened by some civil servants before evaluation. That is a great concern to me as a south-west MP.
I have no doubt that difficult decisions had to be taken. The armed forces are needed operationally for so many things. To ask them to support civil services is no small request in terms of resources and, of course, the military cannot simply be diverted from its primary role. However, given the extent to which we have experienced ambulance waiting times, citizens waiting in pain for so long, and the watering down of the needs of ambulance services before evaluations took place, I question whether there are things that can be learned to improve the process of MACA requests in future, by looking at examples such as those I have outlined.
Ambulance services exist to respond to acute and critical events. Those are situations that cannot, by definition, wait without potentially endangering life. Compared with another operational deployment of the armed forces in the pandemic, testing, one has to note that, although testing was vital for oversight of the overall size of the pandemic in the UK, a timely covid test does not compare, in terms of urgency, with a person waiting for hours in acute pain—a person in their 80s having broken their hip or a person with a suspected heart attack or stroke.
Perhaps in the future we ought to have a better publicised hierarchy of need when we face a crisis that requires military support to the civilian authorities. I cannot pretend to know the intimate details of every MACA request submitted to the Government, but I can think of few acute and urgent services that might need prioritised support—and none other than our ambulance service.
One of the criteria for MACA provision is that military aid should always be the last resort, and that the use of mutual aid, other agencies and the private sector must be otherwise considered as insufficient or unsuitable. I pay tribute to St John Ambulance, which has provided much support and continues to do so. It is a volunteer army in itself, with a deeply held mission to help those in need. I wonder whether there needs to be a more established role for St John Ambulance in this area, so that it is able to more readily and structurally respond to some of these needs and to have a more substantial role in our nation’s resilience arrangements to support the emergency services. That would enable ambulance services to receive support more readily than in the cases I have outlined.
The South Western Ambulance Service did not and does not ask for help lightly. Only when the situation for its patients was becoming very difficult indeed did it contact the Government for help. I should say that it is only following my own intervention and inquiry that the ambulance service kindly shared some of its insights with me. Even I was surprised, though, to hear that only one out of six of its specific requests was partly fulfilled.
I hope this debate will offer an opportunity for the Government to review and improve the systems surrounding MACA requests. Greater clarity and transparency for those services making requests is needed so that they know what levels of support they can expect, especially when there is no alternative. Then my colleagues and I —MPs of Dorset and the wider south-west—will be able to further support the ambulance service in making sure we never experience some of these difficulties again.
It is exactly because of those pressures that we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to March. All trusts will receive part of this funding, which will increase call handling and operational response capacity, boosting staff numbers by 700. NHS England will also strengthen health and wellbeing support for ambulance trusts, investing £1.75 million to support the wellbeing of frontline ambulance staff during these pressured times. More broadly, NHS England is undertaking targeted support for the most challenged hospitals, where delays are predominantly concentrated, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That includes a £4.4 million capital investment to keep an additional 154 ambulances on the road this winter.
The crux of my hon. Friend’s speech was to acknowledge those pressures and to look to the military, through the MACA system, for further assistance. The scale of the challenge we faced, and continue to face, cannot be overestimated. The UK, like every other country in the world, saw its health systems and capabilities stretched to the limit. As many of our civilian agencies and institutions struggled to cope, we should take great pride in the role our armed forces played in assisting them in responding to the pandemic, reacting with skill and agility. However, we must be cautious about the limitations on the numbers of those who are qualified to drive blue-light ambulances, and indeed clinicians. I have to say that, of the 20,000 personnel my hon. Friend spoke of, only a small proportion would be clinically qualified to assist as paramedics or qualified to drive a blue-light service.