Norman Lamb – 2018 Speech on the East of England Ambulance NHS Trust

Below is the text of the speech made by Norman Lamb, the Liberal Democrat MP for North Norfolk, in the House of Commons on 2 February 2018.

I want to start by making it clear that I recognise absolutely that there is intolerable pressure generally across the emergency care system, and there are serious issues that have to be addressed particularly around handover delays, and I include within that the sense that there is quite a variation from one hospital to another and we need to understand why it appears as though some hospitals are more successful than others in addressing this.

I also want to make it clear that it is not my intention to focus on the adequacy of funding of the NHS in this debate; that is for another occasion. The question I want to address here is whether the East of England Ambulance Service NHS Trust is doing all it can with the resources it has.

I also want to place on record my understanding that we have incredibly committed clinical staff in this trust, and I want to express my gratitude to them; they are often working under intense strain, frequently dealing with extraordinarily distressing and sensitive personal situations, and they do so admirably. I should also express my gratitude to the Minister for meeting me this morning to hear more about my concerns, and for the seriousness with which he listened to them.

My reason for calling this debate is that I met a senior employee of the trust, who is a whistleblower in effect, and who came to me with deep concerns about what is going on in his service. I found the testimony to be very credible and I took the concerns extremely seriously. I have seen a list of 40 cases of potential patient harm associated with delays in response times, including 19 cases where patients lost their lives.

Fiona Onasanya (Peterborough) (Lab)

Simon and Michelle came to see me about this very issue. Their 999 call was downgraded, and as an unintended consequence, they lost their baby girl, Darcey, in what appears to be one of a catalogue of failures in the interaction between the ambulance trust in the hospital.

Norman Lamb

I am grateful for that intervention, and the hon. Lady is doing exactly the right thing in pursuing that matter on behalf of her constituents. They deserve answers to the concerns that they have expressed over that tragic case.

Beyond the list of 40 cases, I understand that a further 120 incidents of potential patient harm and a potential 81 patient deaths have been associated with delays over this period of time. One case, which is not on the list of 40 that I have seen, concerns a constituent who does not want her family’s name to be mentioned. She has written to me as follows:

“My Mum had been ill from Boxing Day and finally on New Year’s Day she deteriorated to such a level that I had to call an ambulance. When I first logged the call they advised me that as she was still breathing we would have to wait an hour before a team could get to us. Mum’s health deteriorated further to a point that I had to place another call to the ambulance call centre as she had suffered a stroke and then a heart attack and had stopped ​breathing. My sister and I had to perform CPR whilst waiting for the crew. When they finally arrived, although they tried, they said that there was nothing they could do and she was pronounced dead.”

I should say that my constituent commends the crews that attended for the work that they did.

Clive Lewis (Norwich South) (Lab)

I have great respect for the right hon. Gentleman for bringing this debate to the House today. Does he agree that this is due to a systemic crisis, rather than to individual failings? Since publicising this issue in the Chamber some weeks ago, I have been inundated by cases of people from across the country, not just the east of England, who have experienced similar failings in the ambulance service. We must make it clear that this is not just about blaming managers at the East of England Ambulance Service NHS Trust; it is also about accepting that the Chancellor of the Exchequer and the Secretary of State for Health bear responsibility for what is happening to ambulance services across the country.

Norman Lamb

I thank the hon. Gentleman for his intervention. Ultimately, the Government are responsible for keeping the people of this country safe, with emergency services that work effectively. That is ultimately what we are debating.

This is not something that just happened over the Christmas and new year period. Just last Friday, the 91-year-old mother-in-law of some close friends of ours in south Norfolk fell on to a cold stone floor. They called 999 at 8:45 pm, but the ambulance did not arrive until 4 am. It left at 4.45 to go to the hospital, but she had to wait in the ambulance until 6 am. She then had to wait on a trolley for two more hours. That is intolerable; she is 91 years old. This could happen to a family member of any of us; we all have a stake in this. We have to recognise that it is intolerable. Another constituent has told me about his 92-year-old mother who broke her leg. She had a nine-hour wait, during which she developed hypothermia. Then a car arrived, rather than an ambulance, and she had to wait another 40 minutes for the ambulance. That is simply intolerable.

I am told that, according to the assessment of many people internally, the service over that period was unsafe, and that no assurances have been given that the trust would be able to provide a safe service in the future, if there were to be a period of very cold weather or a flu epidemic, for example. That is a matter of serious concern to the people of the east of England. On several occasions during the period, there were more than 200 999 calls that could not be responded to at the moment they came in, because no crews or ambulances were available.

The Care Quality Commission told me this morning:

“This is a service that is in crisis”.

It also said:

“Patients are at risk”.

However, the CQC appears to have confidence in the leadership of the trust. I fear that it is being complacent in its attitude, and that it is not taking seriously enough the number of patient harm incidents that I have referred to. I have deep concerns about whether any family member of mine, any constituent, or anyone else across the east of England who has to rely on the service will get a service that will protect and safeguard them in ​their hour of need. I am told response times in North Norfolk are dire—not just that the trust is not meeting the target but that the long tail beyond the target is deeply concerning. I do not have the assurance that we need.

The concerns appear to have been recognised because a risk summit was convened. According to the official guidance, a risk summit is normally triggered

“if there are significant and serious concerns that there are, or could be, quality failings in a provider or system.”

The guidance further states that a risk summit should be called

“only as a last resort”.

Well, we clearly have a last resort here.

My central plea to the Minister is that we need an independent governance review, and I would like a specific response to that because I genuinely believe it is needed, but I would like to raise the following specific concerns. I understand there was a £2.8 million underspend in the trust in month nine of the financial year. How can that be justified? Is the Minister satisfied with that?

I am told that more than 100 staff have been recruited but are currently on a waiting list to start. Some have been on the list for more than a year. I am told there has been no recruitment in Norfolk, which is where response times are at their worst. Staff have left without being replaced.

There was an independent assessment in August 2016, never published, by Operational Research in Health, which said that hundreds more staff are needed across the region to run a safe service. Why has that never been implemented? The only area where there has been recruitment of late, according to adverts online, is in Bedfordshire and Hertfordshire, the best-performing areas. The impression I am left with is that it is all about hitting the national target, rather than ensuring that all parts of the region are safe.

Interestingly, the online job advert has just been changed to include other counties, but the public board papers say there are no vacancies in those other counties. At the same time, lots of additional management posts have been created. There is a new deputy director of human resources, an associate director of HR, a deputy director of strategy and sustainability and other deputy director posts.

The trust has also doubled its spend on lease cars, which in November 2017 was up from just under £500,000 to nearly £1 million, with directors and deputy directors making no contribution. I am told that directors and deputy directors drive around in Jaguars, Range Rovers, Mercedes and Audi A5s. Is the Minister comfortable with that? The policy allows discretion by the director but, with a service that is under such strain, for me it is a question of judgment and culture in this organisation.

I am told there was a very late sign-off of the plan for the Christmas and new year period following the letter from Professor Keith Willett, so the trust was not better prepared than ever, which is the Government’s mantra. Did meetings take place between the trust’s chief executive and the chief executives of hospitals where the delays were at their worst in the run-up to the Christmas and new year period? We have a right to know.

The trust issued a statement that it had not been made aware of any patient safety issues internally, but that is not true. I have a copy of an email from a constituent to the chair of the trust on 9 January ​specifically referring to the fact that someone in the trust had come forward to raise patient safety concerns. Is that acceptable? It is a wholly misleading statement to the public. Does the Minister feel comfortable with that?

Is it acceptable that neither the chief executive nor the chair of the trust has been prepared to be interviewed publicly since the new year? When there have been so many patient safety incidents, surely they should be being held to account for that service on television and radio.

There has been a big issue about director presence over Christmas and new year, with claims and counter-claims having been made, and we need to get to the bottom of it. Will the Minister ensure that we are told who was actually on duty all the way through the Christmas and new year period? By that, I mean on duty and in the region—not at home in some foreign country—leading the service in this region. It was new year’s eve before REAP 4— Resource Escalation Action Plan 4—was declared. That is the highest level. Many people in the organisation felt it should have been happened before that, so that mutual assistance could have been secured from surrounding trusts. Why did that not happen?

A report was commissioned last year from SSG Health—a “phase 2 report”—on how the trust can save money. It has never been published. I have tried to get hold of it under freedom of information but my request has been refused. Will the Minister ensure that it is now put into the public domain? Given the scale of the crisis, which the Care Quality Commission has acknowledged, we have a right to know what that report says and what is being done about it. It cost more than £500,000 for this report on how to save money. That shows the scale of the culture problems that we face.

On late finishes, staff regularly work 14-hour to 15-hour shifts, but no data has been available from the trust to the staff side since February last year. In September, the trust removed the staff support desk, which was there to provide support to staff who were working very long shifts. No data has been made available by the trust to the staff side on “tail breaches”—these very long delays in getting to patients. The trust claims an exemption under FOI. That is symptomatic of a trust that fails to be open with staff representatives and with the public it is supposed to be serving. A constituent of mine who has worked for the trust has been declared “vexatious” for making FOI requests about patient safety issues, for goodness’ sake. How about that for the culture of this organisation! The matter is now with the Information Commissioner.

I believe, and I think the Government believe, that trusts should be entirely open; there should be an open culture, encouraging staff to speak out about patient safety issues. Will the Minister send a clear message to end the embargo on FOI requests, so that we can find out what is going on in this trust, rather than have it being kept from the public gaze? This is an issue of the utmost concern to the people of the east of England. People in this region need reassurance that they will be cared for and that the response will be there when they need it. It is frightening for anyone, but particularly for older people, to wait interminably for an ambulance to ​arrive when a loved one is very ill and potentially dying. This is intolerable in a civilised society and ultimately it is the Government’s responsibility to ensure that there is a service there to serve the people of this country.