Edward Argar – 2022 Speech on Ambulance Services
The speech made by Edward Argar, the Minister for Health, in the House of Commons on 10 February 2022.
Reflecting the rest of the week, Mr Deputy Speaker.
I am grateful to the hon. Member for Ellesmere Port and Neston (Justin Madders) for securing this important debate. In the same spirit, this is rather nice; it is like déjà vu: he used to shadow me at that Dispatch Box and in Committee. It is a pleasure to respond to his debate on this occasion.
However, I must say that responding to the hon. Gentleman is a pleasure slightly tempered by caution on my part, because I know the depths of his expertise on this subject after his many years shadowing the Minister for Health—I think he shadowed my predecessors as well. He has great depth of knowledge in this space. He is and has been a notable advocate for our ambulance service and what it needs, and he looks forensically into those issues. I also know that he is a diligent reader of The BMJ, the Health Service Journal and various other excellent trade and specialist publications. It is a genuine pleasure to respond to him on this extremely important issue. It is a shame that the way in which the House allocates debates means that this is the last debate of the day, so there are few Members in the Chamber for it, because it is important. However, those we have in the Chamber are quality, and I look both at the shadow Minister—sorry, the former shadow Minister—and the hon. Member for City of Chester (Christian Matheson).
As the hon. Member for Ellesmere Port and Neston highlighted, ambulance services have faced extraordinary pressures during the pandemic. I am sure that the House will join me and the shadow Minister—the former shadow Minister; by force of habit, I keep calling him the shadow Minister. The hon. Gentleman and I have not always agreed, but we have been as one in paying tribute to all those who work in our ambulance services up and down the country. They have done an amazing job over the past two years, during the pandemic, to the very best of their ability. Of course, they do that amazing job day in, day out; irrespective of pandemics, they always do everything they can to support those who need them.
The hon. Gentleman rightly highlights that the pandemic has placed significant demands on the service. In January 2022, it answered more than 800,000 calls. That is an increase of 11% on January 2020 and is one of the factors placing significant pressures on ambulance services, the wider NHS and the A&E departments to which they will take people when they feel that there is a clinical need. Although 999 calls tend to highlight the demand related to more serious medical conditions, many ambulance services are also responsible for 111 calls, which, in December last year, saw an increase of 15.5% compared with December 2019.
I use those statistics to illustrate the demand pressures, but I understand that behind those numbers, in every case, lies a human story—someone in need of care, someone worried and anxious, with friends and family anxious for them—so before I seek to go into the reasons, statistics and our plans and support, I want to say that I am sorry for patients who have suffered the impact of those service pressures. I want to be very clear that patients should expect and receive the highest standards of service and care.
The hon. Gentleman highlighted some specific examples, including the case of Bina Patel. He is right that the right hon. Member for Ashton-under-Lyne (Angela Rayner) has raised that with me. I have asked for full information because I want to get back to her with as full an answer as I can, and I hope that he can convey that to her, if he speaks to her before I do. I am fully aware of her correspondence raising this on behalf of the family.
Let me turn to ambulance response times and the reasons sitting behind some of the pressures. The ambulance service is facing a range of challenges that are impacting on its performance. The hon. Gentleman will be familiar with many of them, including the impact, still, of infection prevention and control measures not only in the ambulance service but particularly in A&E departments and wider acute clinical settings. Higher instances of delays in the handover of ambulance patients into A&E as a result of some of those factors, which I will turn to, are therefore leading to ambulances waiting for longer in queues and not being as swiftly out and about on the road and able to respond to calls. So there are knock-on effects there.
One of the key challenges, which the hon. Gentleman will be very familiar with, remains the question of flow through an A&E and through a hospital. I am referring to the flow of patients out of ambulances into the A&E, who are then able to be treated in the A&E and discharged, hopefully, or who are then, in some cases, able to be admitted to a bed in a hospital ward. To do that, we have to see discharges continue of patients who no longer meet the criteria to reside because they have recovered sufficiently, and the national discharge taskforce has done a huge amount of work on addressing that challenge.
In recent months, we have seen the combined pressures of winter—the hon. Gentleman and I are familiar with those on an annual basis—and the impact of the omicron variant on the number of hospitalisations, which have not been as high as many feared and predicted, thankfully, but which have still had a significant impact on hospital beds. The combination of those factors, coupled with a high level of workforce sickness absence rates, including through positive covid tests—particularly over recent months with omicron—has created pressures that we would not expect to be systemic or built into the system. That partly reflects longer term pressures, and I will move on to what we are doing to address those, but a large element of it is down to the specific circumstances of the past winter.
The hon. Gentleman touched on the support in place to improve services, and asked what we are going to do about it, and what is being done to address these issues. He is true to form from when he shadowed me, as he will always set out the challenge and ask me what I am going to do or am doing about it, rightly holding the Government to account. Because of the pressures I mentioned 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 the end of March. All trusts are receiving part of that funding, which will increase call handling and operational response capacity, boosting staff numbers by around 700.
NHS England has strengthened its health and wellbeing support for ambulance trusts, recognising the pressure of the job on those working in the ambulance services, with £1.75 million being invested to support the wellbeing of frontline ambulance staff during the current pressures. NHS England and Improvement is undertaking targeted support for the most challenged hospitals, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That is focused on the most challenged hospital sites where delays are predominantly concentrated, with the 29 acute trusts operating those sites being responsible for more than 60% of the 60 million-plus handover delays nationally. That is targeted support for trusts that have particular challenges, either from the current situation or where there are underlying issues that we need to resolve.
There is capital investment of £4.4 million to keep an additional 154 ambulances on the road this winter, and a £75 million investment in NHS 111 to boost staff numbers by just over 1,000, boosting call taking and clinical advice capacity that will better help patients at home, and better help triage those who genuinely need an ambulance and those who can be treated safely in a different context. There is continuous central monitoring and support for ambulance trusts from NHS England’s national ambulance co-ordination centre, and we have also made significant long-term investments in the ambulance workforce. The number of NHS ambulance staff and support staff has increased by 38% since July 2010.
More broadly, alongside the ambitious plan set out by the Government earlier this week, showing how we will invest the significant additional resources in outcomes for patients, just over a year ago we invested £450 million in A and E departments, to help mitigate the impact through increased capacity of infection prevention and control measures. I have regular direct meetings about discharge rates, and what we can do further to improve the flow of patients through hospital trusts within NHS England, with members of the taskforce on that.
I am pleased to reassure the hon. Gentleman that those measures have had an impact, and we are seeing improvements in response times from the peak of the pressures in December. Performance data for January, published today, shows significant improvement against all response time categories. Performance for category 1 calls—the most serious calls, classified as life-threatening—has largely been maintained at around nine minutes on average over the past several months, and improved to eight minutes and 31 seconds in the latest figures. That is despite a 19% increase in the number of incidents in that category compared with December 2019. Average responses to category 2 calls improved by more than 15 minutes compared with December, and the 90th centile responses to category 3 calls by more than two hours.
We recognise that that is welcome progress, as I am sure the hon. Gentleman would agree, but there is much further to go to recover fully from the pandemic’s impact on response times and to sustain that improvement. We welcome the service’s hard work and dedication and pay tribute to it for making those changes and delivering the significant improvements on which I am updating the hon. Gentleman.
Justin Madders
As always, the Minister is being courteous and comprehensive in his response. Will he comment on the concern expressed earlier about patients being told, when visited by the service, that they needed to go to hospital but should find their own way there? That is extremely worrying, and we should be clear that it is not what we expect to happen.
Edward Argar
I am grateful to the hon. Gentleman—I keep feeling tempted to say shadow Minister; he is a shadow Minister but he is no longer my shadow—for that point. He is right that when people ring 999 they should be given the appropriate clinical advice on whether they need to go to hospital, and if they do, an ambulance should be sent. I suspect that in individual cases a call handler may have made a tough clinical decision about the fastest way to get someone to hospital given the availability of ambulances, but the hon. Gentleman is right that if someone rings 999 and their condition is clinically deemed to require an ambulance and swift transfer to hospital, they should be able to expect an ambulance to come, assist them and take them to hospital.
At a time when the NHS is facing unprecedented demand, ambulance services are absorbing some of the increase in pressure. They are treating more people over the phone and finding other ways to reduce pressure in a clinically safe way. With clinical support in control rooms, the ambulance service is closing around 11% of 999 calls with clinical advice over the phone. That is far more than the 6.5% achieved in January 2020 and saves valuable ambulance resources for response to genuinely more urgent clinical needs.
Let me say a little about North West Ambulance Service, if that is helpful to the hon. Gentleman—I know that he and the hon. Member for City of Chester take a close interest in their local ambulance service. Our support and investment has benefited the North West Ambulance Service. The hon. Member for Ellesmere Port and Neston’s local trust received £6.2 million of funding, which it has used to increase its workforce for operational and contact centre teams. The trust is also engaged with regional NHS England and Improvement and commissioning teams to develop a six-point winter plan that seeks to address six key areas throughout the winter period. As it starts to get a little warmer and the daffodils start to come out, it is tempting for people to think that winter has passed, but winter pressures in the NHS can continue into late February and occasionally a bit beyond. I wanted to add that caveat.
Three systems-led initiatives focus on the reduction of hospital handover times, the improvement of pathways for patients with mental health presentations and ensuring that alternatives to emergency departments—including access to primary care and other non-emergency-department pathways—are available to North West Ambulance Service in a timely and responsive manner.
Hospital handover delays continue to challenge the North West Ambulance Service footprint. Through its Every Minute Matters collaboration, which began three years ago, the trust has been working with other hospital trusts on improvements by working with senior leadership teams in hospital trusts to ensure there is a shared understanding of the risks of handover delays and a lack of ambulance resources to respond to patients in the community, to revisit action cards for operational commanders and, crucially, to recognise and thank staff for their continued reporting of delays and willingness to highlight problems to their managers or to the trust.
The trust’s strategic winter plan has been activated and includes details of the measures in place to handle winter pressures and mitigate the effects of increased demand and a loss of capacity. The plan is comprehensive and covers a wide range of topics and details on the preparation for various scenarios. It includes several continuous improvement initiatives for support during the winter period.
In summary, North West Ambulance Service is increasing its double-crewed ambulance capacity in line with winter funding arrangements, reducing conveyance to emergency departments and reducing the number of lost operational hours caused by day-to-day operational challenges. The trust has already seen significant improvements in the number of patients managed effectively through telephone advice, which helps free up ambulances to be deployed to where they are most needed. The trust has recruited additional paramedics and emergency medical technicians and upskilled its ambulance care assistants to blue light driving standard, thereby enabling the trust to deploy 269 additional frontline staff by the end of December.
I close by reiterating the Government’s commitment to support the ambulance service. We retain regular contact with ambulance services, trusts and those delivering on the frontline to help to ensure that patients and the ambulance service receive the care and support that they need. I am grateful to the hon. Member for Ellesmere Port and Neston for bringing this matter to the House.
