Health and Care Bill

Committee (9th Day) (Continued)

My Lords, I am a bit reluctant to get up again and say something, because when I did this yesterday, we sat until 3.25 am. The Opposition Chief Whip has asked me to point out that we still have 10 groups to go. Unfortunately, I am speaking mainly to the Front Benches, which have been very co-operative, but we still have 10 groups to go, and the usual channels have agreed between us that this Bill must complete this evening. So I implore noble Lords not only to be brief, as I have said many times before, but to limit their points to those that are relevant to the amendments before the Committee. I know the Front Benches will seek to do the same, so I hope all noble Lords will try to be very brief and to the point. Then we can get through this in a reasonable time.

Amendments 293 to 294 not moved.

Amendment 295

295: After Clause 148, insert the following new Clause— “Ambulance response times: local reporting (1) The Secretary of State must, not later than 31 July 2022, make regulations which require ambulance trusts in England to publish the following information on the internet within two weeks of the end of each month—(a) category 1, 2, 3 and 4 ambulance response times for the trust area for the previous month broken down by—(i) integrated care system area, and(ii) postcode, and(b) for all incidents where the relevant response time was missed by a margin set out in the regulations, a detailed explanation of why that target was missed.(2) In this section—“ambulance trusts” means ambulance trusts whether they are NHS trusts or NHS foundation trusts;“category 1, 2, 3, and 4 ambulance response times” has the meaning given in the NHS England Ambulance Response Programme.(3) Regulations under this section may make such incidental or transitional provision as the Secretary of State considers appropriate.(4) Regulations under this section must be made by statutory instrument and are subject to annulment in pursuance of a resolution of either House of Parliament.”Member’s explanatory statement This amendment would require ambulance services to provide more accessible and localised reports of ambulance response times.

My Lords, I hope the Government Chief Whip will send the memo round.

Last Tuesday, my noble friend Lady Barker introduced a Question for Short Debate about ambulance response times. In introducing the debate, she looked behind the distressing headlines about people with life-threatening illnesses waiting too long, sometimes fatally, for an ambulance. She outlined the underlying factors important in identifying the problems and solutions for our ambulance services.

The NHS has set out national targets for a seven-minute average response time for life-threatening incidents. However, the average has been rising and was over nine minutes in December 2021. Targets for less serious incidents have also been rising. This amendment would put in place just one of the potential solutions to the ambulance crisis, which my noble friends Lady Barker, Lady Brinton and Lord Scriven referred to in that debate. It would set up a system for ambulance trusts to collect data about ambulance response times by integrated care system and by postcode. They would also have to publish information about where response targets were missed. In any situation that requires corrective action, it is vital that we know where we are starting from, and transparent and detailed data collection and publication does exactly that.

During the debate, my noble friend Lord Scriven suggested that in order to understand why ambulance services are so hard-pressed, we need to look up the line to primary care services. He was, of course, correct: many urgent cases occur because patients have been unable to get a GP appointment, despite the fact that GPs tell us they are now carrying out more consultations than ever through triage telephone consultations.

The problem is caused by the shortage of GPs, particularly in some areas. We have been promised 5,000 more GPs but that has not been achieved. My noble friend also mentioned the lack of community mental health services, and in some cases the almost complete absence of child and adolescent mental health services that often lead to a mental health crisis resulting in the patient calling an ambulance.

My Lords, I thank the noble Baroness, Lady Walmsley, for presenting this amendment. I too take the view that ambulance services play a significant role in our National Health Service, particularly in the redesign of care pathways to reduce pressure on hospitals and provide better care to patients. If that can be at the right time, in the right place, that produces the greatest benefits.

The amendment in the name of the noble Baroness, Lady Walmsley, sets out the case for a more rigorous and accessible reporting system for ambulance services on response times. As your Lordships’ House debated just last week, and as the Minister acknowledged, at present performance is below what is acceptable. I am pleased that under the amendment, the method for introducing regulations would be subject to proper review by Parliament. On the specifics, it is welcome that there is a requirement of the use of data already captured by ambulance control and dispatch systems, specifically requiring analysis by integrated care system area and by postcode. This would provide a valuable source of further evidence about inequalities in care provisions which would mean that it was possible to identify and address them.

On the proposed requirement for the recording of explanations for all incidents where the relevant response time target was missed, it would of course be important to ensure that any extra recording of data in an emergency care environment did not add to existing pressures. I look forward to the Minister’s response.

I thank the noble Baroness, Lady Walmsley, for bringing this short but important debate before the Committee.

The Government fully recognise the importance of ambulance response times and of patients receiving the help they need when they need it. Like other emergency care services in the NHS during the pandemic, ambulance trusts have come under significant pressure, answering almost a million 999 calls in December alone —an increase of 22% on the year before. That is why we have put significant support in place to help ambulance trusts at this time. I will not go into the detail, which we covered in the debate last week. Instead, I will respond to the specifics of the amendment.

It is the Government’s view that it is right that reporting happens at the level of ambulance trust region. Trusts are commissioned to meet response time targets at a regional level, not at a more granular part of their operating area such as postcode or integrated care board area. It is inevitable that there will be variations in response times within regional footprints from month to month. However, the existing ambulance response time standards already include a mechanism to performance-manage significant variation or long waits for ambulances. All ambulance response time categories include a 90th centile response time standard to measure the “tail” of ambulance response times. This means that trusts are measured on the response to every call they receive and cannot favour some parts of their region over others to game response time targets. Reporting response times down to a postcode level would require a massive expansion to existing reporting that would not be reasonably deliverable.

I also reassure noble Lords that the service transparently provides clinical outcomes data. These indicators were introduced in 2011 and provide detailed information on clinical outcomes for cardiac arrest, heart attack, sepsis and stroke patients. While the Government acknowledge the challenges to ambulance response times and are working hard to address them, for the reasons I set out, I hope the noble Baroness feels able to withdraw her amendment.

I thank the noble Baroness, Lady Merron, and the Minister for their responses to this proposition. I still think that somewhat more granular collection of data would be really helpful, because a region is a very big area and there are all kinds of factors that affect how quickly ambulances get to people who need them. It is particularly important in the case of category 1 incidents, where life is at stake and interventions can have the most amazing results, if only they get to the patient within 40 minutes, say, in the case of stroke.

So, it is vital that we get that granular information. I accept what the Minister said about the additional money that has been provided, but as I and my noble friends have said, the problems are both sides of the ambulance: downstream and upstream. It is a systemic problem, and it needs to be looked at as a whole. Having said all that, I beg leave to withdraw the amendment.

Amendment 295 withdrawn.

Amendments 296 to 297E not moved.

My Lords, in the next group of amendments, the noble Baroness, Lady Brinton, will be participating remotely.

Amendment 297F

297F: After Clause 148, insert the following new Clause— “References to women inpatients (1) An NHS Trust must not record or refer to women who—(a) have requested a sex-specific ward, or(b) have made a complaint to the relevant NHS Trust about being accommodated with inpatients who have undergone gender reassignment,in pejorative terms, including the term “transphobe”, on that ground alone. (2) An NHS Trust must not record women who have undertaken the action referred to in subsection (1)(a) or (1)(b) as having committed a non-crime hate incident on that ground alone.”

My Lords, the noble Lord, Lord Blencathra, and I have grave concerns about the present single-sex ward provision which our two amendments seek to obviate. I have had the opportunity already to discuss this with the Minister himself—the noble Lord, Lord Kamall—and I am grateful for the opportunity he gave me also to meet with his officials. None the less, these two amendments address the very sensitive issue of hospital bed space allocation and hospital service provision for women.

Traditionally, female patients in the NHS and in private hospitals have been allocated beds in single-sex wards accommodating only women patients. Transgenderism —I speak as a woman—has undermined that provision, with the 2019 NHS guidance authorising self-selection of patient gender on arrival in hospitals, something neither enshrined in law nor backed by public demand, and overriding the exemption for hospital services in the Equality Act 2010. Yet Parliament and our Ministers have consistently declared that women both need and should have privacy, dignity and safety in their most vulnerable of situations, such as when sick or pregnant. As consistently, Ministers on all sides of both Houses have declared that this will be or already is the case.

In 1999, for example, when serving in the other place, the then Health Minister, the noble Lord, Lord Hutton of Furness, responded to powerfully expressed concerns from the Member for New Forest East about female privacy by guaranteeing single-sex wards and enshrining that promise in the Patient’s Charter. Later, when the NHS constitution replaced the Patient’s Charter, the same firm commitments were made. Today, nurses, whose code of practice ensures that all patients have their privacy respected and dignity and safety assured, should have a simpler task in ensuring that these truly fundamental responsibilities to all patients are fulfilled, since the old Nightingale wards, in which sex segregation was much needed, really do not exist in the present NHS hospitals, where there is a mixture of single rooms and four-to-six bed bays. It is therefore easier for ward sisters to keep the sexes apart, rather than having mixed-sex bays, which give rise to discomfort for female and male patients alike.

None the less, female patients consistently find that the reality of mixed-sex wards has won through against the Aesculapian tradition of prioritising patient care on medical grounds alone. We now find that the earlier guarantees of the safety, dignity and privacy of women are blown apart up and down the country by hospital trusts, which are mandated to follow annexe B of the NHS 2019 guidance on same-sex accommodation. I have found too many errors and wrong quotations of the Equality Act to feel comfortable with this guidance and its annexe B. While the guidance demands same-sex wards for 11 pages, saying that,