Patient Deaths: Ambulance Waiting Times

Question

Asked by

To ask His Majesty’s Government what assessment they have made of reports that over 500 seriously ill patients died in England last year after long waits for an ambulance; and what steps they are taking in response.

We recognise the pressures facing the NHS and the need to recover performance following the impact of the pandemic. We are working hard to make sure that no one waits longer than necessary, given how important response times are for patient care and outcomes. We are backing the NHS to meet these challenges and our emergency care plan will deliver one of the fastest and longest-sustained improvements in waiting times in history, backed by £1 billion in funding and up to 800 new ambulances.

My Lords, it is alarming that last year, the number of deaths of patients waiting for an ambulance for up to 15 hours more than doubled from the previous year. What action will the Government urgently take, co-ordinated across the whole of health and social care services, to reverse this tragic tide? Can the Minister also explain the lack of a government plan over the years for getting to hospital in time those who have had a stroke or a heart attack, whose breathing has stopped, or who have been in an accident?

I thank the noble Baroness for that question. As I said, we are providing 800 new ambulances, but there is a flow issue, as she rightly points out. To resolve the issue at the back end, so to speak, £500 million will be provided for new adult social care places, which is a vital part of unblocking 13% of the beds that are blocked and creating space throughout the system. At the same time, providing ambulance hubs will create offloading space so that ambulances can quickly get back on the road again. These are all key aspects. Fortunately, we are starting to see an improvement but there is a lot more that needs to be done.

My Lords, talking of patient care, is it not a matter of shame that the strike by junior doctors is leading to patients with heart problems and cancer problems and those needing hip operations having their operations postponed for more than six months, because the doctors have walked out of hospitals and operating theatres? How does that help patient care?

Clearly, we regret any circumstances where capacity is taken out of the system, and this is a clear example. Patient care is primary, and we hope to sit down and resolve the differences. I am glad to say that we are now having good conversations with the nurses’ unions and other unions, and I hope we can have similar productive conversations with the doctors.

My Lords, NHS data shows that there are significant variations in ambulance response times in different areas of England, and we see especially long response times in areas like the east of England, where some category 4 patients were waiting for over eight hours in February. Can the Minister explain how we got into this situation with what are supposed to be national targets? What are the Government doing specifically to help areas that are currently missing the targets by a country mile?

Local ICBs—integrated care boards—are integral to this, understanding the need for ambulances in each of their areas. As noble Lords have heard me say before, often, having a fall does not require an ambulance response at all, but it is much better to have a full service. Now, it is the responsibility of every ICB to set up a full service so it can respond more appropriately. Additionally, we are tasking each ICB with getting on top of ambulance wait times.

My Lords, the Royal College of Emergency Medicine’s February report says:

“The crisis in emergency care is relentless and staff are burned out and exhausted. The significant shortfall of beds and staff is driving this crisis.”

In February there were 1.2 million A&E attendances. More than 126,000 patients waited more than four hours from the decision to admit them—these are trolley waits —and nearly 35,000 of those were delayed by more than 12 hours. What are the Government doing in their workforce plan to look at projected workload and figures and ensure that the plan has minimum staffing levels and staff numbers overall?

The noble Baroness is correct that capacity is key to this, as are the workforce and the workforce plan. I am pleased to say that a more advanced version of that will be published shortly, hopefully showing that we are getting on top of it. At the same time, we have put 7,000 extra beds into the system, which is starting to have an impact. Category 2 wait times are down by an hour compared with last month, but clearly there is more that we need to do.

My Lords, I declare that I am a councillor in Telford and Wrekin. Shrewsbury and Telford hospitals are under one health trust. The Government plan to close 24/7 A&E services at Telford hospital, which means that people will have to travel 15 miles to Shrewsbury in ambulances. This will put further pressure on our already overstretched ambulance services. Does the Minister agree that this will have a negative impact on the people of Telford and Wrekin?

I am convinced that the ICS will make the best decisions for that area. I am very familiar with Sir Jim Mackey’s plans, which advocate setting up so-called hot and cold sites. It is often better to specialise in A&E in one area and “cold” elective treatments in another, in order to have more efficient treatment in both. I imagine that is very much part of the plan, which will see improvements in both A&E and elective services.

My Lords, may I ask about dissemination of good practice? Some trusts are improving ambulance response times but others are not. I accept that they are working in different geographies with different demographics, and have different A&E capacity in each area, but how are the Government making sure that proven best practice is being disseminated across the country?

The noble Baroness is absolutely correct. Some 50% of all wait times—I have used this statistic before and I will correct it if I have not got it exactly right—come from I think 20 trusts. Clearly, there is a focus on working on those areas. That is starting to bear fruit, with each of those trusts having specific plans to ensure that they use best practice. We have tried to pick the best practitioners in an area— I have done this on two occasions recently—and bring them into the centre to help us advise across the board. That really is making a difference.

My Lords, as well as disseminating good practice, there is the issue of accountability. The Government have put significant sums of money into the NHS, so what are the regulators —NHS England and others—doing to ensure that good practice is disseminated and, more importantly, that the chief executives and the boards are delivering on the commitments they have made?

My noble friend is absolutely correct: with responsibility for these things comes accountability, and it is the job of us all to hold people to account where performance is not where it should be. I know each Minister has their own set of ICBs— I have a particularly close relationship with seven; other Ministers have the same—so that we can bear down on exactly these sorts of differences and hold people to account.

My Lords, does the Minister agree that the junior doctors’ representative at the BMA and the Department of Health should get round the table and negotiate the end of the doctors strike before more harm is done to the patients? To express a personal view, as a doctor, I would never withdraw my services from patients.

I thank the noble Lord for his contribution, as ever. Yes, absolutely; these things always have to be resolved around the table. As I say, I am pleased that we are making good progress with nurses and ambulance workers, and I hope we can get around the table and make more good progress with GPs as well.

My Lords, there is a shortage of nurses, a shortage of doctors and a shortage of ambulances. What have the Government been doing for 13 years to let this crisis happen?

Noble Lords will be aware that this is a situation facing people all around the world. Just today I was being grilled by a Select Committee talking about the problems in Stanford in California, where people were having to wait 48 hours to go from A&E to get to a bed. It is a worldwide issue.

Oh!

It absolutely is; just look at Wales, at Scotland and at the whole country: it is a systemwide issue and we are implementing a systemwide solution. We have recruited 29,000 additional nurses, with still more to come and more in training than before. There are more doctors. We are targeting 50 million additional GP appointments and we have increased them by 30 million to date. That is solid action. Is there more to do? Yes. Are there plans to address that? Yes. Will I report on them very regularly? Absolutely.