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East of England Ambulance Service

Volume 565: debated on Tuesday 25 June 2013

Motion made, and Question proposed, That the sitting be now adjourned.—(Anna Soubry.)

Mr. Howarth, it is a pleasure to serve under your chairmanship this morning. I thank Mr Speaker for granting me this debate and I thank all colleagues from across the region who are present today for their support in securing this debate and for pursuing this issue so assiduously.

We in the east of England are fortunate that two of our Members of Parliament are Ministers—the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), and the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb)—and both are well aware of this issue and have taken a great deal of interest in it. I put on the record my thanks in particular to my noble Friend Lord Howe, who has not only taken a strong interest in this subject, but helped facilitate many meetings with various bodies and the ambulance trust, and others, to explore this issue further. I know that this Minister will be well briefed on this matter and will be aware of the many and considerable concerns of colleagues in the region about the performance of the East of England Ambulance Service NHS Trust. She has shown strong interest in the health problems of my constituents and they will welcome her active involvement in helping to get this trust turned around.

This is a timely debate, following on from the scandalous revelations about the cover-up at the Care Quality Commission and the lack of responsibility and accountability from NHS directors. This trust has also experienced serious issues with accountability and mismanagement. It is suffering from the rotten culture that my hon. Friend the Member for Central Suffolk and North Ipswich recently mentioned.

Before I run through many of the problems with the trust encountered by my constituents and I, and the challenges, including delays, response times, damning reports from the CQC and from Dr Anthony Marsh, I should like to begin on a positive note and pay tribute to the outstanding work undertaken by the front-line staff. Despite many problems with the trust and its board, the front-line staff have earned admiration and a great deal of respect from all our constituents. They work in difficult conditions, all made worse by the failure of the trust’s board, but they continue to save lives daily and, of course, they help patients get better.

I support what my hon. Friend says about front-line staff; I have had personal experience of that in my own family in Norfolk. The paramedics that we encountered were outstanding. Does she share my puzzlement that some of the best staff in the call centre, whom I have sat next to, were bewildered by the systems they were asked to deal with? The problem is not the front-line staff at all, who are superb, but is basically one of leadership.

Of course, my hon. Friend hits the nail on the head. This is about management and lack of leadership and direction from the trust.

I also pay tribute to the volunteer community first responders who support the trust. I think that all hon. Members will have met first responders in their constituencies. Let us be clear that those individuals sacrifice their own time to attend to ill and injured people quickly and remain with them until paramedics arrive. I have been briefed by the co-ordinator of first responders in my constituency and am more than impressed by the actions they take to save the lives of patients in emergency situations, dealing with a wide range of conditions, including heart attacks, allergic reactions and unconsciousness. This month, the trust announced that 30 more of these volunteers had completed their two-day training course. We should celebrate that achievement and praise those volunteers for their dedication to helping the ambulance service and, of course, all our constituents. Those front-line members put the needs of patients first.

With so much devotion and commitment from the front-line staff and volunteers, of course it is more than disappointing that they have been so badly let down by the trust’s board and management. Staff and volunteers deserve more support and strategic leadership from the trust. It is because the trust’s board has failed to demonstrate in the boardroom the high level of expertise, skill and devotion required that is displayed on the front line that the trust has been brought into such a dreadful state.

The biggest danger to patients, which many hon. Members have experienced, is delays getting ambulances to them. The Minister will know that this trust has failed lamentably to meet the A8 and A19 targets. Patients with life-threatening conditions are being made to wait longer than they should for paramedics to arrive.

I agree with what my hon. Friend says about ambulance delays, but does she agree that this is a particularly severe problem in more rural areas, such as the Dengie peninsula, which I represent, where one survey of a patient group of a medical practice, the William Fisher medical centre, showed that patients had to wait for more than 40 minutes, and in some cases more than a hour, before the ambulance arrived?

My hon. Friend is right. Many hon. Members have experienced horrific delays, particularly across our rural constituencies. I know of delays in excess of two hours. That is unacceptable. Lives are put at risk.

I congratulate my hon. Friend on calling this important debate on an unacceptable level of service. Further to the previous intervention on rural areas, can we also agree that this is not just about what are called emergency services, but also about non-emergencies? Many people in my constituency, particularly elderly people, are kept waiting for up to eight hours, often in significant pain, before the ambulance gets to them.

My hon. Friend makes the point clearly about the impact on elderly patients and the unacceptable waiting times that his constituents, and those of other hon. Members, have endured.

Data from the trust show that in the last quarter of 2012-13, the A8 target for paramedic arrival to treat a patient in a life-threatening condition within eight minutes was met 70% of the time, compared to the 75% target. The A19 target was also missed, as ambulances arrived to transport patients with life-threatening conditions within 19 minutes 92% of the time, compared to the 95% target. Patients with other conditions have experienced appalling delays. In each of the 10 months from April 2012 to January 2013, the trust failed to meet the target to get 62% of stroke patients to hospital within 60 minutes. In fact, in seven of those months the figures were below 50%.

The delays in an ambulance arriving to transport patients to hospital after they have been attended to by a volunteer community first responder or paramedic in a rapid response vehicle are particularly alarming. Figures provided by the trust to me covering Essex showed that in 2012 there were 39,921 of these back-up requests, but on 12,584 occasions it took more than 30 minutes for the ambulance to arrive. In Witham alone, in 206 incidents it took more than 30 minutes for an ambulance to arrive, from 639 back-up requests.

It is scandalous that almost one third of patients needing to go to hospital by ambulance were left waiting, causing them distress and preventing the initial paramedic or volunteer who attended the scene from moving on to help other patients elsewhere. Four patients a week in Witham, 242 in Essex and many hundreds more across the region have endured those waits, and the trust’s board sat idly and did nothing while the situation got ever worse. The failures have led to the trust becoming the worst performing ambulance trust in the country. The statistics are terrible and the delays can have serious consequences for the lives of patients affected.

The Minister will have seen numerous news reports from local, regional and national newspapers highlighting devastating cases across the region. Colleagues from across the region will, like me, have seen cases all over their local newspapers and will have had numerous constituents writing to them about their own experiences.

There have been some dreadful incidents affecting my constituents who have faced not only unacceptable delays, but a devastating impact of the consequence of those delays. One constituent from Tiptree suffered lengthy delays on not just one but two occasions—in August and September—before passing away. On the first occasion, she suffered a mini-stroke, and the emergency doctor who attended her home called for an ambulance that morning, but it took more than three hours for a paramedic to arrive. The paramedic then called for a back-up ambulance, which did not come. After waiting four hours, members of my constituent’s family placed her in one of their cars to take her to hospital. Although my constituent had suffered a stroke, the trust neglected her. If her family had not taken the risk of transporting her to hospital, she may never have got there.

The following month, my constituent fell in her care home and banged her head, resulting in a lump larger than a chicken egg on her temple. The ambulance was called at 9.38 pm, but it did not arrive until almost two hours later, at 11.25 pm, despite the fact that the care home was barely five minutes from Colchester ambulance station. Once my constituent was in hospital, a CT scan confirmed that she was haemorrhaging on the brain, and she died soon after. Had the ambulance arrived sooner, my constituent would have received treatment more promptly and might still be alive today. I raised the case with the trust, but it took two months to reply, coming up with a feeble excuse and a shallow apology.

Other constituents have also let me know of their frustration about delays. Mrs Houghton, from Tolleshunt Knights, has two young daughters with serious medical conditions that require frequent hospital care. One has a condition that can lead to sudden death syndrome; the other suffers from a condition that includes supraventricular tachycardia, which can cause her heartbeat to quicken, and her treatment requires a life-saving injection. Last year, my constituent reported to me that ambulances were taking longer to arrive than they used to and that rapid response vehicles were sent instead to take her daughters to hospital. As the Minister will appreciate, these incidents have caused Mrs Houghton increased anxiety, particularly given that her daughters are children. They need an ambulance to attend promptly, but that is simply not happening.

In a separate case, a constituent who is a carer for a relative, Mrs Gladys Money, reported to me the delay Gladys experienced while waiting for an ambulance. Only two weeks ago, Gladys, who is 96 years old, suffered a fall in her kitchen. She could not reach the telephone, so she used the emergency call line button she carries with her at all times to request assistance. An ambulance was called, but it did not arrive for an hour and a half. During that time, Gladys was in much distress and could not lift herself up or even call for further help. Such delays in the treatment of elderly people are unacceptable; they are simply not right, and people cannot be treated in this way.

Another constituent reported to me his outrage when, in November, an ambulance failed to arrive after his 20-month-old grandson started hyperventilating and developed a high temperature. After two hours’ waiting and three telephone calls, he was assured an ambulance would arrive shortly, but that did not happen. After being told that ambulance crews were too busy to attend, he resorted to taking his grandson to accident and emergency himself. There are so many other cases I could mention, and I have no doubt that other hon. Members have plenty of other examples they wish to raise.

Despite the fact that the trust received complaints from Members of Parliament, members of the public and its own staff, nothing was done to address the problem seriously. What made the trust’s lack of attention to the problems all the more shocking was the fact that, in May 2012, the CQC reported concerns with response times. It clearly stated that

“the Trust had not met some of its key performance standards in relation to response times”

and needed

“to seek ways of addressing the challenges it faces in responding quickly in very rural areas and on improving turn around times at the hospitals in its region so that people receive care in a timely and effective manner.”

Senior managers, directors and non-executive directors should have seen the warning signs. They should have been working with hospitals in the region to improve handover times. They should have reassessed changes to staffing rotas and brought in new front-line staff to fill the 200 empty posts. They should have re-examined how they prioritise calls. They should have altered the allocation of resources to put more ambulances on the road. Finally, they should have got a grip on the trust’s growing deficit.

Many things should have been questioned and required serious attention. However, the trust acted only this year, following another CQC inspection in February, the report of which was published in March. That inspection came about only as a result of the persistence of my hon. Friend the Member for Suffolk Coastal (Dr Coffey)and other Members of Parliament in the region, who pressed for an investigation into the trust. The report demanded action to improve the

“Care and welfare of people who use services”.

It concluded that since the

“last inspection the trust’s performance in relation to its ambulance response times had deteriorated and people could not be assured they would receive care in a timely and effective manner.”

I congratulate my hon. Friend on initiating the debate. I also congratulate my hon. Friend the Member for Suffolk Coastal (Dr Coffey)—La Pasionaria of Southwold, as she is her known in her constituency—on her role. Last October, my wife had a serious accident, and there were considerable delays in treating her. We are all aware of such things, but does my hon. Friend the Member for Witham (Priti Patel) agree that there is a systemic culture of failure and buck-passing not only on this issue, but, sadly, in wider areas of the NHS and the public sector? What worries me—my hon. Friend might come on to this—is that if a new board is appointed, it might well consist of recycled individuals from the quangocracy who may have failed in other parts of the country.

My hon. Friend’s assessment of the culture in the NHS is absolutely correct. Let us not forget that the Under-Secretary of State for Health, my hon. Friend the hon. Member for Central Suffolk and North Ipswich, alluded to the rotten culture in the NHS. I will come to the fact that cultural change is required and that we must stop this revolving door and this recycling of people in the NHS.

I congratulate the hon. Lady on bringing this matter to the House. Although the debate is specifically about the East of England Ambulance Service NHS Trust, the same rationale applies across the whole of the United Kingdom of Great Britain and Northern Ireland. The response by paramedics relies on data and modern technology, so it is important that funding restrictions do not limit what they can do. Does the hon. Lady feel that it is essential that funding is always available so that they can do the work they need to? Does she also feel that training is important?

I thank the hon. Gentleman for his intervention. Interestingly, funding was not an issue in this case; the trust is very well funded, and I will come to that. This is about professionalism and training. With the board and the trust, we have seen a complete failure of not only leadership, but skills; there is a question about the skills base of the board and the non-executive directors, and it is clear that they have failed in their duties and responsibilities.

My hon. Friend the Minister will know from the Mid Staffordshire inquiry and from events involving the CQC, Cumbria and other trusts the consequences of the rotten culture of management failures, cover-ups and inept strategic leadership in the NHS, which the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, touched on. That culture is simply not acceptable, and it is about time we took the lid off many NHS trusts and started to ask questions about the failure we have seen across the country.

The East of England Ambulance Service NHS Trust is another trust we can add to the list of those where scandal and incompetence have put lives at risk. As I said, this is not a resourcing issue, because the trust is funded above the national average. This is a problem with senior management, directors and non-executive directors. Since the publication of the CQC report, a new interim chair, Dr Geoff Harris, has been brought into the trust. A governance review and additional support are being provided by Dr Anthony Marsh, the chief executive of the country’s best-performing ambulance trust, in the west midlands. Those are welcome steps. Of course, it was Dr Marsh’s review of governance that highlighted the extent of the scandal and failure at the heart of the trust.

I congratulate the hon. Lady on the debate, and on the work that she and colleagues have done over many months. She is right to say that the issue is not money. I have heard it suggested that the problem is to do with rural ambulance services, but I assure her that constituents of mine with awful problems have had to wait an hour and a half for ambulances that were simply not available. The problem is urban as well as rural, and I know that she realises that. The solution must affect all of us.

Absolutely. My hon. Friend is right. The key is that there is a failed service, and it requires immediate turnaround, which must have one clear focus: putting patients first, rather than the interests of board and trust members. The issue is about patients.

I am encouraged by my initial contact with Dr Harris and Dr Marsh. It is incumbent on us all to support them, to ensure that they get the trust back on its feet.

I congratulate my hon. Friend on the lead she is giving and on bringing the facts to light, although I worry that in rehearsing some of the problems we create greater worry among our constituents; but we must get to the bottom of the problem. She has mentioned Dr Anthony Marsh, and some of us recall that in the days of the Essex ambulance service there were nothing like the difficulties that there are today. It is clear from the fact that other ambulance trusts are performing better—some to a very high standard—that there should be some pressure. There is a model of how things should be done, and pressure should be brought to bear so that we can get the East of England Ambulance Service NHS Trust sorted out.

My right hon. Friend is right. The issue is the turnaround of the trust and a key thing is to learn from successful ambulance trusts. That means looking at skills and capabilities as well as at times, both in urban centres and rural parts of constituencies. The east of England is a big region, and we must consider how resources can be correctly allocated to ensure that patients are not left waiting as they have been in the past.

Most of the executive directors at the trust have moved on, and the former chair, Maria Ball, resigned recently after the CQC report earlier this year. However, it is deeply alarming and thoroughly disgraceful that five non-executive directors who have presided over the mismanagement of the trust still sit on the board. They are Paul Remington, Phil Barlow, Margaret Stockham, Anne Osborn and Caroline Bailes. They all seem to refuse to take any responsibility for the failure that they have presided over, and they continue to receive funds from the taxpayer to continue in their role. By choosing to remain in post they are putting their own interests above those of the public, patients and front-line staff.

I congratulate my hon. Friend on bringing the issue up for discussion. There has been a series of appalling incidents in my part of Essex as well, in Tendring. Are not all the failures further evidence that the ambulance trust is run for the convenience of the senior management on the payroll, and not that of the taxpayer who pays taxes to be provided with an ambulance? Surely we need proper accountability, which means examining the regional structure, which is too cumbersome, and perhaps adopting a system of local accountability, putting it at county level as it once was. We should also make sure that the service is not stuffed full of quangocrats, and that the people who are there to speak for the taxpayer are accountable to the taxpayer, rather than having CVs full of parasiting off the taxpayer.

My hon. Friend makes some pertinent and valid points. Transparency and accountability are key things. I have touched on the issue of the revolving door in the NHS, but cronyism is another issue. We must stop the same people being placed on and recycled around various boards in the NHS. NHS board members should put patients first, but, as the governance review by Dr Marsh concluded,

“there is a lack of focus and grip from the Board which has contributed towards the deterioration of performance across the Trust.”

The question, as we have already heard, is whose interests the board is serving. It should be putting patients first.

The Minister will know that the review is full of many other statements about the board, each of which is a damning indictment of each non-executive director and of the board. As to the quality risk profile showing that a number of outcomes relating to patient care and welfare were not being achieved, the review states at page 13:

“The Board should be taking leadership decisions and actions on these Outcomes and holding others to account,”

but of course there has been collective failure and

“this doesn’t appear to be happening.”

On page 14 the review refers to the current trust board and senior management team appearing to have developed “a sense of ‘helplessness’” and states that

“the Board have not been taking both the responsibility collectively as well as they could or should have and that Board members have not been held to account”.

On page 18 the report highlights

“a lack of confidence and trust that the Board has the expertise, experience or gravitas to respond to the substantial challenges facing the organisation.”

Page 22 contains the conclusion that

“the overall Governance arrangements cannot have been adequate for the Trust to get into this much difficulty.”

The non-executive directors’ fingerprints are, to be frank, all over the crisis. The trust is experiencing major failures, and every day that the individuals remain on the board they are being financially rewarded for blatant failure. Their poor leadership and inability to acknowledge and deal with the challenges facing the trust have led to patients’ lives being put at substantial risk. The trust’s staff survey results have demonstrated the lowest morale in the country.

My hon. Friend the Member for Suffolk Coastal and I wrote to Paul Remington while he was acting chair, to ask him and his fellow non-executive directors to explain their actions and what they had done about improving the trust. We wanted to give them a fair and proper chance to explain themselves in the aftermath of the CQC’s report earlier in the year. We received a substantive reply from Mr Remington two months later, on the eve of the publication of the Government’s review, and it was light on information and did not acknowledge the mess that the trust was in. It was thoroughly unconvincing. In view of those poor responses I hope that the Minister will appreciate that the presence of those non-executive directors on the board is undermining public and staff confidence in the trust. It is scandalous that they have not already been dismissed, and shocking that, despite the publication of the Marsh review, board members whose terms are due to expire this year are to be reappointed for the foreseeable future. The report of the chair and chief executive for tomorrow’s board meeting states that, during the recruitment process for the new non-executive directors,

“the TDA has agreed to extend Mr Remington’s period of service on an interim basis.”

That is utterly unacceptable. Why should Mr Remington and other non-executive directors be allowed to continue on their taxpayer-funded ride, when they have failed so miserably to fulfil their responsibilities? What will happen to the other non-executive directors, whose terms do not end this year? How much longer will they be permitted to remain in post? They refuse to do the right thing and step down, so I urge the Minister to recommend to the Secretary of State and the NHS Trust Development Authority that they should use their powers to remove them with immediate effect, before the board meets in Bedford tomorrow.

In addition to the board’s inability to lead the trust, its secretive and unaccountable handling of criticism by Members of Parliament is also disturbing.

I have a question for my hon. Friend based on ignorance: there have been some extensions, but by whom were they made? Is that part of the revolving door?

My hon. Friend asks a valid and pertinent question, and I give him one word: accountability. His question is very good, and we need to continue to ask who is making the decisions.

In the board papers for the trust meeting tomorrow there is no reference to the fact that Members of Parliament for the region have questioned the board’s competence and called for resignations. Our correspondence is not even mentioned. The papers merely state that the chair and the chief executive have

“met a number of MPs over the last month to discuss issues such as ambulance responses”.

That is simply not good enough and fails to reflect the serious concerns that all Members of Parliament across the region have expressed in their questioning of the trust on behalf of their constituents. Decisive action is now necessary, because the trust, its front-line staff and the 6 million people who live in the east of England need to have skilful and competent non-executive directors leading the board. I hope that when my hon. Friend the Minister concludes the debate she will commit to ensuring that resources will be made available to help the trust head-hunt and bring in the right set of people as soon as possible to support both Dr Harris and Dr Marsh.

It is also clear to me that the problems with the board have yet again demonstrated the wider failures within the NHS appointment process. Again and again, incompetent and ineffective individuals have been placed in important roles. Some of the five non-executive directors who should be dismissed from the trust sit or have sat on other NHS bodies, and it is shocking to think that they could be recycled elsewhere in the NHS. I would welcome an assurance that those non-executive directors, who have devastated the East of England Ambulance Service NHS Trust, will be prohibited from holding any further NHS job.

By the end of the debate, I am confident the Minister will be left in no doubt of the seriousness of the situation with the ambulance trust and of the desire of the public, front-line staff and all Members in the region to see our trust improve. I hope she can give an assurance that the Government will do everything possible to help patients receive the first-class service that they deserve, to hold those in responsible positions to account and to resolve the mismanagement of the trust that we have all endured for far too long.

I congratulate my hon. Friend the Member for Witham (Priti Patel) on her characteristically candid and very well-crafted speech. She speaks for many of us in expressing those strong arguments.

Like my hon. Friend, I pay tribute to the paramedics, drivers and engineers—the people at the sharp end—because they have done a consistently good and professional job, despite poor leadership; they have not had the backing that they deserve. I also join her in paying tribute to the Minister’s ministerial colleague, Earl Howe, who has been very attentive to our concerns throughout.

Dr Marsh’s report is well researched and impressive. If the report has one compelling conclusion, it is that the crisis in the ambulance service trust is the consequence not of a lack of resources, but of a lack of leadership, vision and strategic direction. The comparisons that he draws with West Midlands Ambulance Service NHS Foundation Trust are pertinent, because it is a trust with a similar population base—the population is obviously more urban—that faces similar challenges, but it has met those challenges through strong direction and leadership throughout. That is why the West Midlands Ambulance Service NHS Foundation Trust is at the top of the pile. Unfortunately, our trust is down at the bottom.

I agree with my hon. Friend the Member for Broadland (Mr Simpson), who said in his important intervention that recently, over a number of years, a management culture has emerged in the East of England Ambulance Service NHS Trust that basically deems second best to be acceptable, and consequently action that should have been taken has not been taken.

If the trust was an alternative investment market-listed company that had gone into crisis mode, the non-executive directors would have resigned on principle; if the trust was a company listed on the main stock exchange, the directors would have had to resign. It is staggering that they have somehow decided that it is okay to cling on to their jobs and stay, despite the complete lack of oversight of corporate governance and the failure to adhere to the combined code. As I understand it—the Minister will correct me if I am wrong—the non-executive directors are responsible under the combined code in the same way as directors of public companies. The trust is obviously not a public company, but it has the same corporate governance rules. Notwithstanding the fact that it is a different organisation, the non-executive directors have that responsibility. If they had any integrity, they would offer their resignations.

I hope the Minister is able to tell us that she will advise the non-executive directors, with the approval of the Secretary of State, to resign before tomorrow’s board meeting. It is no good for the interim chairman, Dr Harris—there is a whole lot of management speak here—to review the board members’ benchmarking against leadership criteria, etc. What the hell does that mean? Basically, the board needs reconstituting, and it needs reconstituting very soon. Will the Minister give us some insight into what her Department is doing to try to bring new blood—people with real ability, not jobsworths who simply get recycled around one public board after another—on to such boards?

Just as the trust has fallen way down to the bottom of the league, King’s Lynn and west Norfolk is unfortunately lagging behind the rest of East Anglia. I find that very worrying. Obviously, I accept that, in remote rural areas, there are some hamlets and remote communities where it is physically impossible for an ambulance to reach a patient within the targets. We know that. There are some places in my constituency, and in the constituencies of many of my colleagues here today, where that is absolutely impossible, even with the best will in the world. There might be a coincidence in which, for example, an ambulance is going along a main road at a particular juncture, but achieving the target may well be impossible, so it is even more important that the targets are met in the towns and bigger communities, where it might be thought perfectly reasonable to expect ambulances to get to a call within the target time in 95%-plus of cases. Unfortunately, the targets are not even being met in the towns in my constituency.

I have been given permission by my constituent Mrs Delna Barrett to refer to her case. Her husband, Chris, had been suffering from Parkinson’s disease for some 20 years. He stopped breathing in a restaurant in Hunstanton, which is the second-largest town in my constituency, and it took the ambulance more than 20 minutes to arrive. Despite numerous resuscitation attempts, he died in hospital two days later. We do not know whether, if the ambulance had arrived within the target time, he would have had a better chance of surviving. The family are not criticising the paramedics or the staff, but the bottom line is that the ambulance did not arrive within a reasonable time.

We know that many difficulties are caused by the problems at A and E, to which my hon. Friend the Member for Witham alluded in her excellent speech, and we know that those problems have been around for quite a long time. There certainly are problems at the Queen Elizabeth hospital in my constituency, and there are problems at the Norfolk and Norwich hospital, where at one stage back in March all 17 of the trust’s ambulances were tied up waiting outside. All that is well documented, and it is not entirely within the purview of this debate, but we cannot consider the problem of the ambulance trust in complete isolation; we must consider out-of-hours services and out-of-hours cover.

Very often, individual family events bring home to us the different parts of the health service that are perhaps in need of improvement or are examples of best practice. Some 20 years ago, I was staying with my mother near King’s Lynn, and at about four in the morning she banged on my door and said that she was dying. She was in the most appalling pain—absolute agony. My mother is a war veteran who was in the Women’s Royal Naval Service. She is a very tough person, and she never complains about anything. She told me that she was in complete agony and could not move. I rang the local doctor, who came out within 20 minutes. He said, “You have kidney stones, and I am going to give you an injection that will put you asleep until tomorrow afternoon. I will then come back and we will take stock of the situation.” He gave her some more injections the following afternoon. The stones were broken down, and she did not even have to go to hospital.

If my mother knocked on my door now, what would I do? Obviously, I would dial 111 or 999, but so risk-averse are all those call centres that she would undoubtedly have gone into A and E. I would not have been happy with any advice from someone who did not know her medical records. The key to her treatment by the local doctor was that he knew her medical records and understood that she might be prone to that problem.

We must sort out the out-of-hours cover. We cannot go back to what we had before, when each doctor’s surgery provided out-of-hours cover, but the idea of co-operatives and mergers between GP practices to provide cover and ensure that the people who deal with patients out of hours understand their medical records and are prepared to provide service is key to sorting out the problem. Otherwise, given that the population in some parts of the country is growing, that people are living longer and that many more people have challenging illnesses and a multiplicity of problems, more and more people will have out-of-hours difficulties. Unless we sort out the out-of-hours service, we will have more and more problems.

Order. The hon. Gentleman is straying somewhat from the theme. I realise that it is a related matter, but he should return the discussion to the ambulance service.

I shall do so immediately, Mr Howarth, as that is the topic of the debate. However, I wanted to put it into that context, because we cannot consider the ambulance service in isolation.

In conclusion, there is a great deal of concern throughout the region, but we take the view that the problem can be solved through new leadership if management get a grip, put common sense first and, above all, bring out the best in the people at the sharp end, who serve our constituents and take great pride in doing so. Those people set high professional standards. Given the right management, they will do the job to a high standard and give our constituents the ambulance service that they deserve. This is a turn-around situation. I wish the interim chairman and chief executive all the best in sorting out the problem. However, they require the Minister’s assistance and support, and her first step must be to grip the decision of the non-executive directors. She must then work closely with the management team to ensure that the trust is turned around for the benefit of our constituents, who deserve better.

Order. We have four further speakers. If Members take about six minutes each, we ought to be able to get everybody in, which is my aim.

It is a pleasure to serve under your chairmanship, Mr Howarth. I thank my hon. Friend the Member for Witham (Priti Patel) for leading this debate so well; her speech was a tour de force. I will bear in mind your time limit, Mr Howarth, although I could take the whole 90 minutes to tell the sad tale. It is a pleasure to follow my hon. Friend the Member for North West Norfolk (Mr Bellingham). The East of England Ambulance Service NHS Trust is actually responsible for out-of-hours care in Norfolk, so the left hand should be talking to the right hand.

I also thank the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who started work on the issue. It was right for my hon. Friend the Member for Central Suffolk and North Ipswich, a doctor, to take the lead on such matters in Suffolk, but pushing on, consistent performance from colleagues across the counties in the east of England has brought the issue to the fore.

As I suggest, this is a sad tale that started some time ago. My timelines of the issue start in the middle of 2011. We are driven by the experiences of our patients —those who have suffered. Let us be honest: the vast majority of people in our constituencies have a good ambulance service. Once an ambulance arrives, care is very good; nobody denies that. However, too often that excellence of service is concentrated in certain areas of the region in order to meet a false regional performance target, and almost everything else is put aside. It does not matter if only 50% of people in south Norfolk get an ambulance within 90 minutes as long as the regional target is met. That is all that matters to the leadership and the board of the East of England Ambulance Service NHS Trust.

We have had a long series of meetings, Care Quality Commission inspections and promises of change. Transparency has been lacking. The trust has been dragged kicking and screaming into showing its performance targets in a meaningful way—first by county, now at clinical commissioning group level—but that took a long time. It used to say, “You can look in the minutes of your local primary care trust to find response times.” It is unacceptable for those at the very top to say, “Well, that’s all right; we’re hitting our regional target.”

I have used the constituency of the hon. Member for Copeland (Mr Reed) to say that if it can happen in Cumbria and Cornwall, it can certainly happen in Norfolk and Suffolk. It is important that the Opposition spokesman does not try to drag party politics into this debate or talk about finances. The issue is about those at the top having wrong priorities and forgetting that every patient matters.

I have never had to call an ambulance in the east of England, or indeed at all, but I like to think that if I did, I could have some confidence that it would arrive in time. In reality, however, there are not enough ambulances and not enough staff. Mr Andrew Morgan recognised that early on when he came into office as interim chief executive. As Dr Marsh pointed out in his excellent report,

“the current leadership from the board just isn’t strong enough to take them forward…there is a lack of focus and grip from the board which has contributed towards the deterioration of performance across the trust.”

Many of the issues breaking open at the moment have been deteriorating for some time. The non-executives have not shown leadership by asking hard questions and going beneath the surface; they have relaxed and considered only the top regional performance target.

I thank our local newspapers, the East Anglian Daily Times and the Eastern Daily Press. Nigel Pickover and Terry Hunt have done good things to keep up the pressure and stand up for their readers, our constituents, who are patients of the East of England Ambulance Service NHS Trust.

And the Harlow Star, apparently.

In December 2011, we finally got a meeting with the Health Minister and a range of other people around the table who could have fixed the issue. We were promised that there would be change and more focus at county level, and that patients mattered. The postcode data released in November 2011 showed that that had not been the case. We have never been able to get data at that level since then, because the trust does not want to share it with us and, frankly, I am not sure that I should spend all my time on freedom of information requests.

One of the things agreed at that meeting was that contracts would change. That did not happen, which is one issue relating to trust. In October 2012, Hayden Newton resigned. Coincidentally, that was a week after a series of complaints, including about the case of Nora Dennington, whose family finally went to the press to get an answer after three months. To be fair to Maria Ball, the former chairman of the trust, she got answers to those complaints then and there, and within a week, Hayden Newton resigned.

However, Newton was still on the payroll until the end of March 2013, and the chair at the time gave him a glowing tribute, saying that he would be greatly missed and

“a hard act to follow”

and that under his leadership, front-line staff were still being recruited and quality of care had improved. The chair also said:

“Thanks to Hayden’s stewardship, EEAST is now a stable, sustainable and financially sound organisation”.

I am afraid that the Marsh report blows that out of the water.

I could go on about all the different meetings, but I will not, as I am conscious of the time. What I will say is that patients’ complaints were not being answered, and patients were not being treated as individuals. The board should have seen it in the survey and the climb in sickness rates, and the CQC should have done more than tick the box saying that the trust had passed staff compliance on the basis that appraisals had been done. There was an element of external scrutiny by the CQC, the strategic health authority and, to some extent, Monitor, which did not approve the foundation trust status application, but passed the trust on the governance rating. All those different regulators, as well as the leadership of the board, need to look at themselves to understand why they, in effect, let people down. The board was fixated on getting foundation trust status; it was only focused on the regional target, and it did not matter that residents in Suffolk were being failed, as long as the regional target was okay.

Moving forward, my hon. Friends who have spoken are absolutely right: it is imperative that the remaining non-executive directors resign their posts immediately and that the NHS Trust Development Authority acts on that. The ideal solution for me would be to ask Dr Marsh to come in, whether permanently or on an interim basis, to turn around our ambulance trust, because he has the skills to make that happen. I want Dr Harris to succeed; however, it is important that we do not rely on the management speak to which my hon. Friend the Member for North West Norfolk referred, but recognise that we need to clean the slate.

There are of course external factors—we need to work with GPs and A and E—but much of the problem is internal, because there were not enough training places or staff. Incidentally, it is right that Whitehall should not seek to control everything, but it is vital that MPs have confidence that the NHS Trust Development Authority will take the matter seriously. Furthermore, CQC needs to be quicker—not to be rash, but not to be tick-box driven. It failed the ambulance trust and, more recently, it decided to withdraw from a meeting with MPs to talk about its reaction to the trust plan issued in April.

I could have spoken for longer, Mr Howarth, and I have spoken for longer than you requested, but I genuinely want to ensure that our patients, constituents and residents can rest assured that we will not stop continuing pursuit of excellence on their behalf, wherever they live in our great part of the country—they deserve nothing but the best. Again, if Cumbria and Cornwall can do it, we can certainly do it in Suffolk, Norfolk, Essex and Cambridgeshire. Frankly, until those non-executive directors go, we will not have confidence in the leadership of the trust to make the difference.

It is a pleasure to serve under your chairmanship, Mr Howarth. I give my sincerest congratulations to my near neighbour and hon. Friend the Member for Witham (Priti Patel), who has led the campaign against the shocking performance of the East of England Ambulance Service NHS Trust.

The East of England ambulance service continues to give my constituents and me huge concern. As my hon. Friend said, however, I want to make it clear that those worries are not aimed at front-line staff, for whom I have nothing but admiration, especially the senior staff and the paramedics in Harlow. They do a tough job and give 100% to their work; I am proud that we have such extraordinary people living in Harlow and throughout the east of England. The staff, however, are lions being led by donkeys—that is the truth of the matter, as so brilliantly highlighted by my hon. Friend.

At the end of 2012-13, the East of England ambulance service had failed to reach its targets, whether for category A response times for calls to do with life-threatening situations, the less serious green calls or even the ability to pick up the phone on time. Not only is the trust failing to hit demanding targets, but my post bag is regularly filled with letters from local residents complaining about the service that they have received. I have also had staff contact me to complain that they feel they are offering an inadequate service because of the shocking performance of senior managers.

It is outrageous that when I have raised constituents’ problems with the ambulance service, it has taken an unacceptably long time to respond. For example, I wrote to the trust about a serious case in which one person had, tragically, died. The trust did get back to me and acknowledged that its response was unacceptable, contributing to the man’s death, but it had taken nearly five months to respond to my letter on behalf of the family—that is a disgrace.

We have to see change in three areas: we need better resources, targeted at delivering better patient outcomes; the management system urgently needs restructuring; and we need to show staff that they are valued, increasing their skills, so that they continue to make progress. Only by doing those things can people in Harlow and throughout Essex and the east of England get the treatment that they deserve.

For far too long, I have had residents contacting me about the poor level of service. Nearly all the concerns are focused on delays that their family or friends have suffered when waiting for an ambulance or during the handover time in hospital. A tragic case is that of cyclist Robert Tyler, who died by the roadside in my constituency after waiting 45 minutes for an ambulance, despite being only three minutes away from A and E. Sadly, such anecdotes are borne out by the statistics and, as I said, the trust failed to meet its operational targets last year.

I was glad to receive a letter from Dr Geoffrey Harris that claimed he is starting to see signs of improvement. I hope that is so, but on speaking to a worker from the ambulance service yesterday, it was troubling to hear that they felt that little had improved. The worker made the important point that we need more ambulances on the road, telling me that the rapid response vehicles were only being used to ensure that targets were hit. To deliver the best patient care, according to the worker, rapid response vehicles should be in addition to ambulances, not a replacement for them. That view is held across the trust, with more than 300 staff supporting a move calling on the management to claim the A19 target only when an ambulance arrives.

I was disturbed when a constituent told me about her 97-year-old mother who had fallen, hurt her leg and was unable to stand. The first responder arrived quickly and provided good care, but because no ambulances were available, my constituent was left waiting in pain for eight hours. That is absolutely unacceptable, and the new chairman must look at providing more ambulances, so that we can minimise patient suffering and provide a more efficient service.

When I speak to local staff, time and time again they bring up problems with the management structure and their dissatisfaction with it. Some have pointed to directors whom they hold accountable for the problems in the trust; those directors have not resigned, despite the strong pressure to do so. Dr Marsh’s report, as has been highlighted, is no different: he has made it clear that some trust non-executive directors need to resign. He points to an inability of the board to claim responsibility, a lack of clear vision, too much management and no tangible recruitment plan.

It is good news that the new chairman of the trust has stated that he will be making changes to the board, but I join my hon. Friends in calling for five board members to resign and, if possible, for them to be taken to court to be sued for legal negligence—I wish that could be the case. It is shocking that they have been allowed to continue when their failings have been made so apparent. They have put their people’s lives at risk and they have treated my local residents of Harlow shoddily. The board must be refreshed, replacing those members with people who have a proven track record of driving up standards.

I have heard of other problems from workers and residents. Staff are always praised, but staff morale is the worst of all the ambulance trusts in England—it is chronically low. Staff are embarrassed by how long an ambulance can take to reach patients. Sickness levels are high, with an 8.8% sickness rate—almost double the national average for ambulance trusts in England. Also, there is lack of training, with staff telling me that they feel unsupported; records show that the level of completed training days is abysmally low and last year only 45% of appraisals actually took place.

I am pleased that Dr Harris is making some changes, but action needs to be far quicker. At previous meetings with the trust, it seemed to be suggesting that Government funding was partly to blame, but Dr Marsh’s review blows that excuse out of the water. As my hon. Friend the Member for Witham says, the review found that the trust is funded above the average for ambulance trusts, possibly by several million pounds.

The board must take full responsibility for the problems that have plagued the service over the past few years. Action should be taken, including provision of a proper training programme for existing staff, a coherent recruitment plan to rebalance the staff ratio and direction of resources so that more ambulances are on the roads. I favour the ambulance service being broken up, so that there is an Essex ambulance service, because the East of England service is far too big. Genuinely, with the right management and the right resources, we can deliver some of the best care to my constituents in Harlow, to Essex and throughout the east of England.

I will call Peter Aldous in a moment and the Opposition spokesman at 10.40 am. If the two remaining speakers before the Front-Bencher take five minutes each, that should just about cover the time.

I will try to keep to your timetable, Mr Howarth, but if I do not, please intervene.

I am grateful to my hon. Friend the Member for Witham (Priti Patel) for this debate. In the middle of last year, it hit home to me that there are serious problems with the ambulance service and that they are placing people’s lives at risk. The trickle of complaints became a torrent. When an elderly lady suffered a stroke, the paramedics and rapid response vehicle arrived within 10 or 15 minutes, but the ambulance to take her to hospital did not arrive for another 105 minutes. A gentleman in Lowestoft fell off his bike and it took 90 minutes for the ambulance to arrive from Ipswich, some 45 miles away. A 90-year-old disabled gentleman fell at home when going to bed and his 84-year-old wife was unable to help him. It took four and a half hours for an ambulance to arrive.

Only in December did the ambulance trust agree to carry out a full review of operations, and that was when I spent two evenings with crews working out of the Waveney depot in Gorleston in the constituency of my hon. Friend the Member for Great Yarmouth (Brandon Lewis). Those evenings left me with three lasting impressions.

First, all the staff I met were dedicated professionals, but they were worn down by the pressures of the job. Their pleas for understanding to the trust’s senior management fell on deaf ears. On those two evenings, we were on the go from the moment we left the depot. There was no time for meals or comfort breaks, and I was told that 12-hour night shifts almost invariably became 13 or 14-hour shifts.

Secondly, it became clear to me that the trust did not have the right balance of vehicles on the road. There were too many cars and not enough ambulances. There is concern that the cars are used to reach patients quickly and to meet targets—effectively acting as clock-stoppers. If an ambulance is then required to take a patient to hospital, there can be a long delay before it arrives, and for a stroke victim that could be very serious.

Thirdly, based on what staff told me, it was clear that the handover delays at district general hospitals are a major reason why the service is not functioning properly. On the two nights when I was out, there were no problems at the James Paget hospital in Gorleston, and I pay tribute to David Hill, its interim chief executive, who will step down shortly. Whenever I am with him at the hospital to discuss the problem, he takes me straight down to A and E to see what the situation is like at that time and to get feedback from staff. His is the hands-on, at-the-coal-face, sleeves-rolled-up management that the trust should replicate.

Although there were not problems at JPH, there were problems at the Norfolk and Norwich hospital, which is a Bermuda triangle that swallows up ambulances. I do not want to place too much blame at the hospital’s door, but the development of a large hospital, albeit one that provides high-quality services and serves a large rural catchment area, means that a possible weak link is inadvertently created in the health system in Norfolk and Suffolk. It is important that the new management of the ambulance trust work with the Norfolk and Norwich hospital to strengthen that weak link.

Is it any wonder that the management have become so out of touch with their staff and the service they run when they set up their headquarters in a stand-alone, business park location in the middle of the fens? In effect, they are working in a vacuum. Surely they should be close to their operational centres where they can be in day-to-day contact with those who are working on the front line. That isolation may have contributed to their pursuit of foundation trust status when the service they ran was so clearly inadequate for the needs of their patients. They were fiddling while Rome burned.

There has been a failure to work properly with voluntary first-responder groups, which play a key role in working with professional paramedics in more isolated rural areas. Rumburgh in my constituency has a dedicated team of responders with the necessary equipment provided by successful fundraising activities, but it has been unable to work properly because it has been provided with no training, no accreditation and no up-to-date maps.

As to the future, I believe that a corner has been turned, but a lot of work is necessary. The trust’s turnaround plan includes 89 recommendations and there is concern that if they are addressed in a random, scattergun way the new board might achieve nothing. It must focus on the most important issues: patients and staff. Staff are the most important asset in any organisation, and that must be remembered as we go forward.

It is a pleasure to speak in this debate and I congratulate my hon. Friend the Member for Witham (Priti Patel) on securing it. The national health service includes many people with different callings, and thank goodness for that. Some have a calling to look down microscopes and to do scientific experiments to figure out how to solve the problem of cancer. Some have a calling to work with people with mental health problems and to help them return to stability, productivity and a flourishing life. Some have a calling to help at the roadside those who are in critical danger following dreadful accidents and those of us who are unfortunate enough to face near death. Imagine what it must be like to have that calling, to feel that one’s life purpose and work is to help such people, to have the training of a practitioner in emergency medicine, but to have to hold someone who is dying because an ambulance trust does not work properly and those higher up let down the practitioners. What would be the reaction?

There would come a point when people would say, “I can’t stand this any longer. I can’t stand coming to work and failing people because those above me are failing me.” That is exactly what has happened. It is absolutely clear, as my hon. Friend the Member for Harlow (Robert Halfon) said when quoting from the Marsh report, that it is not about money. The problem is about leadership and accountability. I will draw out some brief points from that report. It says that

“critical decision making has ceased in some areas. The trust has lost focus of the strategic objectives, which may partly be due to the board not fully understanding the purpose of the business.”

It continues:

The management structure is overly layered and appears heavy…The trust seems to demonstrate limited urgency and pace in moving forward.”

It also states:

“Leadership does not come from Board level”.

What are they doing, and why are they still there after that damning report?

As a member of the Public Accounts Committee, I have spent 12 years studying slow-motion disasters in various areas of Government and I have read many National Audit Office reports across the whole swathe of Government activity and public expenditure, but I have rarely read words as damning as those. Yet the people who are responsible, who, as my hon. Friend the Member for Harlow said, have so badly failed those whose job it is to serve us and our constituents, are still in post. That is something I cannot understand, and I very much hope that the Minister will address it. If it is not addressed, there will come a point when people will start asking the Department of Health why it has not been addressed, because the matter is so serious.

This did not use to happen. I have been the Member of Parliament for South Norfolk in the east of England for 12 years, and until the last year or two I do not recall people regularly writing to me with complaints about ambulance delays. I do not remember regularly turning up at meetings in the House where there were 15 paramedics talking to the Minister, Earl Howe, facilitated by east of England MPs, because there was no possibility of their having a sensible conversation with the management of their own organisation. This is an extraordinary state of affairs and it requires radical reform.

There is not time in this debate to talk about the wider issues of the NHS culture, but reference has been made to revolving doors and how people lose jobs in one place and gain them in another—I have seen a lot of that myself. In addition there is the issue of confidentiality clauses and the way in which the guidance against using them has been weakened. In 1999, it was stated that confidentiality clauses had no place in NHS contracts; by 2004, it was apparently okay if the guidance was studied carefully.

In the limited time available I want to make a point about size. The ambulance trust in the east of England covers Hertfordshire, which is practically outer London, and Bedfordshire, which is also practically outer London and highly urbanised, as well as places as far away as Cromer in north Norfolk, Great Yarmouth, Southwold in the constituency of my hon. Friend the Member for Suffolk Coastal (Dr Coffey) and Lowestoft in the constituency of my hon. Friend the Member for Waveney (Peter Aldous). It is simply too big, and that is obvious to everyone.

In my rural constituency, ambulances are not just dragged away from the rural areas to Norwich. I accept the point made by the hon. Member for Cambridge (Dr Huppert), who is no longer in his place, that it is not just a rural problem; it is a rural and an urban problem. When I find that ambulances are being dragged away to Bedford and Luton, which are one hour 20 minutes, one hour 25 minutes or one hour and 30 minutes from my constituency, I know that something is fundamentally wrong. We must stop thinking so much about economies of scale and start thinking about the economy of flow—removing the blockages that stop things working properly.

It is a pleasure to speak under your chairmanship again, Mr Howarth. I intend to be fairly brief, to allow the Minister to answer many of the questions that have been put to her by colleagues. I extend my thanks to the hon. Member for Witham (Priti Patel) for securing this debate, which is timely and important, as today’s attendance illustrates.

Along with other Members, the hon. Lady is right to praise the commitment and dedication of front-line staff. Their vocational example illustrates the best of everything that there is to say about the NHS. I am sure that all Members are aware of cases that have arisen through poor ambulance service performance. Members have spoken today, sometimes in shocking detail, about examples of people who deserve better care from this ambulance service, and the debate is needed because of those cases. Indeed, in opening the debate, the hon. Lady said that, right now, lives are being put at risk.

The East of England Ambulance Service NHS Trust covers more than 7,500 square miles and deals with more than half a million emergency calls a year. That undoubtedly presents challenges, but there can be no excuse for less-than-excellent service. As the hon. Member for North West Norfolk (Mr Bellingham) said, second best is not good enough, and I absolutely endorse that.

Dr Anthony Marsh’s governance review, which was published earlier this month, is deeply worrying. He commented that the trust’s board and senior management team have developed a sense of helplessness. That is exceptionally disturbing, and it needs to be rectified. He has said that internal and external communications need to improve without delay, but furthermore, performance needs to improve.

Comparing December 2011 with December 2012, the average handover time—the time between an ambulance arriving at a hospital and the hospital taking responsibility for the patient—increased by more than three minutes to more than 20 minutes a patient. The number of patients waiting more than 30 minutes increased by 75%, from around 2,000 to more than 3,500. Even more worryingly, the wait for patients does not start there; the number of ambulances responding to the most serious call-outs within eight minutes was fewer than 70%.

Those numbers are shocking enough, but the figure that helps to demonstrate the worst type of patient experience is that, in December 2012, at least one patient waited in the back of an ambulance for more than six-and-a-half hours, and the hon. Member for Harlow (Robert Halfon) raised an even worse example. It is worrying how only a few numbers can paint such a vivid picture of a service that is clearly not working as it should for the patients who rely on it, and, as has been pointed out repeatedly, who pay for it as well.

I am heartened to learn that the trust recognises that its service has not been acceptable, and I welcome the turnaround plan that was released in late April. I ask the Minister to outline any discussions that she, or the Secretary of State for Health, has had with the trust that informed the plan and its implementation. Will she explain why, when the data that I have just given, as others have freely done today, are so easily accessible, nothing has been done previously to improve performance in the trust? I also ask her to provide the details of all efforts made by the Department to help the trust improve performance, when those began and what the results have been. We are seeing all aspects of emergency care services—whether ambulance trusts or accident and emergency departments—being driven into chaos too often of late. We have just endured the worst winter performance in A and E for years, and the warnings are that next winter’s will be even worse.

It cannot be a coincidence that during December 2012—the month to which my previous figures relate—hospitals in the east of England region missed their A and E target more often than not, and almost one in 10 patients had to wait for more than four hours in A and E before receiving treatment. Pressures in one part of the service can manifest in other places—as has often been said, A and E is the bellwether of NHS performance—and there is clearly a link between poor performance in ambulance services and the pressure so clearly apparent in A and E units around the country. When a patient needs emergency care, they are being made to wait at home, then wait in an ambulance, and then wait in a waiting room. When the Minister responds, I hope that she will offer some explanation for that poor performance. I hope that she will also outline any discussions that she has had with other ambulance trusts to ensure that those failings are not repeated elsewhere in the country.

Moving on to the personnel aspect of Dr Marsh’s report, he raised concerns about the rate of sickness absence in the trust. Alarm bells should be ringing that the level is so much higher than in other trusts. Did the Department of Health become aware of that, and if so, when did it become aware and what was done about it? In April, at the time of Dr Marsh’s governance review, the acting chief, Andrew Morgan, announced plans to recruit 350 staff. He denied a staffing crisis, but admitted that the leadership was not good enough. I think that that is an understatement, given that it was widely reported in May that the trust was offering financial incentives to staff to retire early or to leave the service. The trust spent almost £100,000 on those incentives, and it is now offering staff a £500 bonus if they refer a friend to join the trust. If it needs staff, it should not be offering incentives for staff to leave. What kind of recruitment programme is that, and how does that illustrate protection of the public purse? It is an incredibly worrying demonstration of the lack of communication and oversight within the trust. The position appears to be entirely incoherent.

Dr Marsh’s report put a great deal of emphasis on the existence of a real disconnect within the organisation. As he rightly outlined,

“It is the responsibility of the Board…to ensure the Governance arrangements and the plans for the Trust are appropriate and robust enough to keep risk as low as practicably possible”,

which includes ensuring that

“all patients receive the best treatment in a timely fashion.”

It is crucial that members of the board take responsibility for that and for patient care in a wider context. Has the Minister met the board recently to find a solution to the current organisational and personnel issues that are referred to in Dr Marsh’s report?

I have outlined the poor performance of the trust from only a few key indicators from data that are widely available. The Department needs to be robust in helping to address those issues, and I hope that the Minister gives the assurances that patients need and deserve. In her response, I hope that she tells the Chamber when she expects the problems with this ambulance trust to be resolved; what the Department is doing to assist the trust with its recovery; what additional expenditure, if any, that will require; and whether hospitals that are reliant on the trust can expect any additional support, financial or otherwise, owing to the avoidable operational pressures that the ambulance trust has placed upon them. Can she guarantee that the performance of the trust has not seriously affected clinical outcomes for patients in the local area? Based on today’s evidence, I would find that hard to accept. Can she give an assurance that, once the trust is operating acceptably, the Department will not allow this to happen again? Finally, when will patients in the east of England get the ambulance service that they deserve?

It is a pleasure to serve under your chairmanship, Mr Howarth. I begin by paying tribute to my hon. Friend the Member for Witham (Priti Patel) for bringing this matter, quite properly, to Westminster Hall this morning, for giving an excellent speech, and for her outstanding campaign on behalf of her constituents. In simple terms, she seeks to hold the ambulance trust, which clearly has performance figures that are simply unacceptable—they are the lowest in the country—to account. There is a clear feeling of anger—that is no criticism at all; it is based on frustration. I know that my hon. Friend the Member for Suffolk Coastal (Dr Coffey) has joined her in this admirable work, and despite raising the issue and notwithstanding all their efforts, they are frustrated and angry because they feel that it has taken many months for the trust to even begin to make some sort of attempt to address the inherent problems that it clearly faces.

Another thing that clearly emerges from the many interventions and excellent speeches by hon. Members this morning is that there is wholesale support, and many tributes, for the staff—the front-line workers. Nobody is for one moment saying that there is any failing on their part. The failing is clear: it is failing at a leadership level and at board level. There is a failing of leadership, which must be addressed as a matter of some urgency.

I only have about 12 minutes to address the many points that have been made, so the usual rules apply: anybody who has asked a question that I am not able to answer in my short speech will, of course, get a written answer. I just want to deal quickly with the important point made by my hon. Friend the Member for North West Norfolk (Mr Bellingham), who asked whether the usual rules that apply to non-executives on public limited companies, or on companies that are listed on the stock exchange and so on, apply to non-executives who are appointed to NHS trusts. I must tell him that the rules are not the same; their responsibilities and duties are different. I will provide more detail in a letter to my hon. Friend, but it is not as simple as it is when people are non-executive directors on other bodies, where it could be said there is much more accountability and much more of a duty on them to resign when there have been the sorts of failings that we have heard about today—if that was applied to a business, for example.

May I just make one other point? Then I shall be more than happy to give way, although the clock is against me, as my hon. Friend will appreciate.

Here we have another issue that should concern, as I know it does, all hon. Members, on both sides of the House. It is the culture that is now becoming clear. I take the view that it is not a new culture. I suspect that it has been there for many years. It is just that it is now being exposed, often through the admirable work of Members of Parliament and because of the work of my right hon. Friend the Secretary of State for Health. That is a mates culture, where people’s priority is to protect their mates, systems and procedures, as opposed to what should be the absolute priority for somebody in the NHS, which is to protect the patient—not their friends and the structures, but the patient—and also, of course, the hard-earned money of the taxpayer.

My hon. Friend will have heard me set out the treatment of Harlow residents. Does she agree with me and with our hon. Friend the Member for South Norfolk (Mr Bacon) that the East of England ambulance trust is too big and should be broken up, and that we should restore the Essex ambulance service trust?

That is a good point, but it is not for me to say whether it has any merit that should be taken forward. But clearly it is an important point, which must now be considered.

May I quickly pay tribute to all the very helpful interventions from hon. Friends? My hon. Friend the Member for Broadland (Mr Simpson) talked about the buck passing in the NHS and the recycling. We also heard from my hon. Friends the Members for Maldon (Mr Whittingdale) and for Huntingdon (Mr Djanogly). My hon. Friend the Member for Waveney (Peter Aldous) made an excellent speech. My hon. Friend the Member for Suffolk Coastal also made an excellent and important speech. There were interventions from my hon. Friends the Members for Clacton (Mr Carswell) and for Cambridge (Dr Huppert) and from my right hon. Friend the Member for Saffron Walden (Sir Alan Haselhurst). There were speeches by my hon. Friends the Members for Harlow, for North West Norfolk and for South Norfolk (Mr Bacon). They all made important and good points.

We know that overall in England in 2012-13 the number of emergency calls to ambulance services was 9.08 million—a 6.9% increase. That is an important figure, I would suggest. We know that overall, in England, the performance figures are stable. That does not really assist in this debate, of course, because we also know that the East of England ambulance trust and, I have to say, my own, the East Midlands ambulance trust, have serious failings and the performance figures are simply not good enough.

The best that I can say of the performance of the East of England ambulance trust is that it has not been good. It is clearly recognised as the lowest-performing ambulance trust in England. As with the national picture, its overall poor performance figures hide huge discrepancies between the services and response times in the urban and rural areas that it covers. There are too many stories—we have heard many today—of patients in distress having to wait hours for ambulances, or solo paramedics being sent when an ambulance is needed. Solo paramedics cannot transport patients and might not, for instance, be able to lift or move a patient unaided. It is simply not good enough.

It is clear to me that some hon. Members and many patients might be forgiven for thinking that the trust seems to have forgotten that it is there to serve all patients and not only tick the performance boxes as far as it can. Concentrating resources in towns and effectively abandoning people in the countryside is simply unacceptable.

May I make some progress? Then I will take an intervention. The latest figures, as we have heard, show that the East of England ambulance trust failed to deliver two of the three response time standards. The exception was the performance against Category A Red 1—immediately life threatening—calls, where the 75% standard was achieved, with 75.8% of calls responded to within eight minutes.

The phenomenon of people forgetting what they are there for, which my hon. Friend alluded to, is of course what would happen in a mates culture. I have had the feeling for a long time that there has been the growth of what we might call a self-serving nomenclatura that looks after its own interests first. Then I heard my hon. Friend the Member for Bristol North West (Charlotte Leslie) on the radio the other day referring to a mafia within the top of the NHS, looking out for their own interests. What I want to know is, as this is a recognised phenomenon—I do not think we are going mad—what is the Department going to do about it?

In short, what I will say is that the Secretary of State has made it clear that it is a culture that he will not accept, and that no member of his ministerial team will accept. He is now becoming undoubtedly the champion of the patient. We are seeing that. We saw it last week with the CQC and then of course we saw the change: the names of people who had been put forward in the report were made public and people are now being held to account. We are beginning to see at least a tackling of this culture; we now need to see some results.

My hon. Friend has alluded, as have other hon. Friends, to leadership. Is the NHS thinking of positively recruiting from senior retired people from the armed forces, who display leadership and the ability to get people to work together? A brigadier had to sort out BSE over 10 years ago, because nobody in the Department for Environment, Food and Rural Affairs could.

That is an excellent point, extremely well made. I shall certainly take it away and speak to the Secretary of State, because this really is important, but to be fair to the NHS, it does have its own leadership academy, where it seeks to bring on people. That is within the NHS. But I think that we should involve far more people from other fields, who could come into the NHS—people with huge skill sets, who have proved those in other walks of life. I am thinking of, for example, retired judges, who would have an invaluable role to play—people who have shown real leadership and not been afraid to make tough decisions in the right circumstances. All these people should now be being looked at actively to play a role.

I thank my hon. Friend for giving way; she has been very generous. There is a specific issue not just about leadership but about accountability with this trust. Is the Minister able to tell us what is preventing the current non-exec directors from resigning their posts immediately?

I know of no reason why they should not. Of course, it is a matter for their own consciences. I am not one who normally shies away from giving an opinion, as my hon. Friend, I hope, would agree, but I think that in this instance it is very important that Ministers do not give an opinion and do not get involved. I think that would be quite improper. It is for those people, or anybody who has come under criticism, to examine their own role and their own conscience and act accordingly.

We might well ask why some ambulance services with comparable funding to the East of England trust—this is not about funding, cuts or money; it is about leadership and poor management—and the same mix of urban and rural areas can provide a good level of service and others cannot. I believe that the ambulance staff will generally be the same in their dedication to caring for patients, so as I said, it is all about effective—or in this case, ineffective—management.

The trust has recently had the benefit of an excellent governance review prepared by Dr Anthony Marsh. I pay public tribute to him and thank him for that. I have referred to it already, as have other hon. Members. It is a clear and professional account, and I will arrange for a copy of it to be placed in the Library. Dr Marsh is, as we know, the chief executive of the West Midlands ambulance service and he chairs the Association of Ambulance Chief Executives, so he knows what he is talking about. His report, as we have heard, reveals how poorly the trust has been managed and how the valiant efforts of front-line staff have been undermined. My hon. Friend the Member for Harlow described them as “lions led by donkeys”.

Results from the 2012 staff survey for the trust underline that. Only one key finding improved; nine key findings became worse. The East of England ambulance service trust had by far the worst staff survey results of all ambulance trusts in England, with 13 of the lowest scores. Its sickness levels—I think this is a very important statistic; it says it all—are nearly twice the average of those in other trusts. However, I am pleased to say that Dr Marsh will be working closely with the trust over the coming months to ensure that the necessary action is taken, and taken quickly.

The NHS Trust Development Authority—it is called the TDA—provides the line of accountability from local NHS trusts to the Secretary of State for the performance of the organisation. Steps have already been taken to address poor performance. As we know, a new interim chair, Dr Geoff Harris, has been appointed; he took up his post at the end of May. His first task is to review the trust board and ensure that the right people are on it. He needs, if I may say so, to be quick and decisive. To make the necessary changes, the board needs to be fully capable of radically improving its performance. I am fully aware that many hon. Members hold strong views about the role that board members play, and I have made my comments accordingly. The duty of the trust board is to add value to the organisation, enabling it to deliver health care and health improvement within the law and without causing harm. It should do that by providing a framework of good governance.

Earl Howe, as we have heard, is the Minister responsible. He has taken a close interest in the matter and visited the trust at the end of May. He has met hon. Members. He is committed to convening a second meeting towards the end of this year, when we all expect to see real evidence of changes for the better. We will of course continue to monitor the situation closely.