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House of Commons Hansard

North East Ambulance Service

04 May 2016
Volume 609

    [Mr Adrian Bailey in the Chair]

  • I beg to move,

    That this House has considered the performance of the North East Ambulance Service.

    We as a country pride ourselves on our world-class NHS services, which are the envy of the world. It is therefore always important that we highlight failures and shortcomings to ensure that our services do not fail our constituents when they need them most.

    Strains on services are part and parcel of life in the NHS, but in recent years the pressures have been exacerbated by the Government’s policies. Ever since the Conservatives were elected to office in 2010, the NHS has struggled due to their mismanagement. In particular, the Health and Social Care Act 2012 implemented a costly, top-down reorganisation, which was neither needed nor wanted. It led to a disjointed funding model and resulted in my local ambulance trust, the North East Ambulance Service, running an expected budget deficit of £3.5 million for 2015-16. It comes as no surprise that I have received a growing number of complaints and concerns about the NHS in recent years, which is why this northern group of MPs decided that we had to call for the debate.

    All the services that the NHS provides are important, but when someone suddenly falls ill in an emergency such as a stroke or a heart attack, or has a fall or an accident, it is understandable that they have high expectations of our ambulance service. The important work that paramedics do in our region day in, day out is undeniable, but, as the cases that my constituents have brought to my attention and those that have been reported in the press show, patient safety is in jeopardy. That is mainly due to waiting times, which, as the cases I will outline illustrate, have increased and are causing distress to many of my constituents.

    For red 1 and red 2 cases—potentially life-threatening incidents—the trust remains below the national standard. Although that is reflected across the country—only two ambulance trusts in England met red 1 standards—it is concerning that, in our region, that failure has continued for the past three years, despite the fact that our response time of eight minutes is higher than the national average. That is exacerbated by the fact that red demand calls have increased by 21.3% in the past 12 months. The performance targets for the fourth quarter of 2015-16 were breached, leading to the trust’s third consecutive quarter breach.

    I called this debate to give myself and my fellow north-eastern colleagues the opportunity to raise cases and concerns directly with the Government to ensure that our constituents receive the very best standard of service, which they rightly expect. It is right that we raise concerns with the Government, who are ultimately responsible for the service and can ensure that something is done about the problems we raise. I will touch on some of the many cases ranging from 2012 to 2016 that my constituents have brought to my attention, and I know that other Members will do the same.

  • I am most grateful to my hon. Friend for securing this extremely important debate. I am very concerned about the management. That was highlighted to me when I wrote a letter to the North East Ambulance Service about ambulance services in Teesdale. I got a letter back headed, “Ambulance services in Weardale”. The worst thing that happened was to Violet Alliston, whose partner rang three times in an hour. No ambulance came, and she died. That is obviously totally unacceptable.

  • I thank my hon. Friend for that very sad example, which I fear and predict will be one of many—perhaps not all with such a tragic ending—that we will hear this afternoon.

    The correspondence I have received about ambulance waiting times in my constituency makes it clear this has been a persistent problem since 2012. I was first told about the problem with waiting times by the league chairman of the Wearside football league after he raised concerns with the North East Ambulance Service directly about numerous incidents. In his correspondence, he said that waiting times for football players who had broken their leg had continually gone over 70 minutes. In one case, after a player broke his leg, the league chairman called 999 at 11.40 am, but he was called back and informed that no ambulance was available and that he should take the player by car. He rang 999 back and complained that that went against what trained first aiders were told about not moving people with broken bones. An ambulance then arrived at 1 pm—80 minutes after the initial call—and the young man was taken to hospital.

    Ever since that case, I have received a range of correspondence from other constituents highlighting failures and shortcomings in ambulances going out to emergencies. An issue particular to my local area—I do not think it is replicated in other parts of the region, although we may hear differently when other colleagues speak—is that ambulances struggle to get to certain parts of my constituency due to confusion in finding the address. That has been repeatedly brought to my attention by my constituent, Mr Walker, who for the past two years has highlighted the difficulty that ambulance crews have getting to the Usworth Hall estate in Washington. When a shocking murder took place in the area in 2014, the ambulance did not arrive for more than an hour and the man died.

    An example of that failure happened when a woman was in labour and her sister-in-law had to deliver the baby because the ambulance went to the wrong street. The children of the woman in labour had to search the streets for the ambulance. When they found it, they guided it by foot, as they were not allowed on board, for more than a mile to where it should have been.

    I could give many other examples. It has been a persistent issue for the residents of Usworth Hall, who, through Mr Walker, have highlighted their concerns and their exasperation at those problems. On each occasion, I forwarded their concerns to the North East Ambulance Service, which looked into each issue. To its credit, it has tried to address them. That was highlighted in a letter to me in July 2014, in which it explained that it had set up an electronic flag system for all residents in Usworth Hall and had a duty manager from its control room go out and survey the area for problems. However, Mr Walker contacted me again at the beginning of April and informed me that an ambulance was parked outside his house one evening. When he went out to speak to the staff, he found that they were lost and supposed to be in another street.

    Paramedics understandably do not have the local knowledge that residents have, but sat-nav equipment is provided to help ambulances get to the right destination at the right time.

  • Does my hon. Friend think that those delays could be because of the shortage of paramedics and the fact that, as the service has admitted, it uses volunteers and private contractors to provide ambulances? That exacerbates the problem of people not knowing how to get to where they need to be.

  • My hon. Friend makes a very good point. I will come on to the shortage, which is running at about 15%, and the stress on paramedics, to which she alluded.

    If the sat-nav equipment continues to fail, and if my interventions on behalf of my constituents and the ambulance trust’s action do not rectify the situation, there needs to be a serious investigation into what is going wrong. We cannot have our ambulances driving round lost on estates looking for the right street.

    My most recent piece of casework is from February and is deeply concerning. It concerns my constituent, Mrs Ellen Sherriff. I feel that using the words emailed to me by my constituent’s husband, Mr David Sherriff, can help to highlight the situation and the distress that can come from having to wait hours and hours for an ambulance to arrive. I hope that you will allow me a moment to read out Mr Sherriff’s words, Mr Bailey. He said:

    “Ellen became unwell at 10.35am yesterday morning with severe head pain on the right-hand side. She felt like she was going to pass out. I checked her blood pressure which was very high, so phoned 111 at 11am and spoke to a call handler who told me he was sending an emergency ambulance and not to be worried if it arrived with blue lights.

    Two and a half hours later no one had come. Ellen remained unwell and could not stand any light.

    I phoned 999 and was told the ambulance that was coming had been diverted to Cramlington but that we would be next unless a more urgent call came in.

    At 2.40pm, a patient transportation ambulance arrived with two ambulance men. I asked why it had taken so long. They said given the circumstances Ellen should have been seen earlier. They had no equipment, not even a blood pressure machine. They said they couldn’t risk moving Ellen in case they caused the bleed in her brain to become life threatening and they would send for a paramedic. They would also remain here till he arrived. They also complained to the control room regarding the wait.

    They sat outside until 5.30pm, 6 and a half hours after I first phoned. When the paramedic first arrived he examined Ellen and said she should have been in hospital 5 hours earlier.”

    It was not until 6 pm, more than eight hours after the initial phone call, that my constituent, Mrs Sherriff, was admitted to hospital, where it was discovered that she did indeed have a bleed in the brain and that she should have been there much sooner.

    Until Friday, Mr Sherriff was still awaiting a response to his complaint, which was sent in February. Perhaps the prospect of this debate ensured that he eventually got it. The trust has admitted errors in the handling and categorising of Mrs Sherriff’s condition, meaning that it was continually not treated with the urgency required. The trust has apologised and said that a “reflection and learning session” has been given to the original call handler, but this case could easily have had a tragic ending.

  • I thank my hon. Friend for securing the debate, which is important to all of us. Does she agree that the issue is not only with the ambulance service? Last summer, in the middle of the night, I took a relative to the university hospital in Durham. In the morning, when I came outside, I counted 12 ambulances stood outside the hospital and unable to discharge their passengers and get patients admitted. The whole system in the north-east is now simply not working.

  • My hon. Friend makes a valid point—we often hear about the queues of ambulances at accident and emergency. Patients have waited hours and hours for the ambulance to come, but when they get to the hospital, they sit in a queue outside. I have raised that with my local hospital. There is a huge breakdown in the system. Something is going seriously wrong, and it is completely unacceptable. Mrs Sherriff, a patient who had a suspected bleed in the brain, had to wait for more than eight hours before getting to A&E. That is truly shocking, and all those cases mentioned highlight concerns that the Government and the North East Ambulance Service must address.

    I have one more issue to discuss before concluding, and that is to do with the numbers of qualified paramedics, which my hon. Friend the Member for North Tyneside (Mary Glindon) mentioned in her intervention. When waiting times are going up and demand is rising, we clearly need to look at workforce retention and recruitment. Our paramedics do an amazing job, but they cannot be in two places at the same time.

    At this point, I want to place clearly on the record that I am not apportioning any blame or criticism at all to any paramedic or ambulance crew. They do an amazing job, under very difficult and trying circumstances, day in, day out, and they should not be placed in situations whereby, once allocated, they race through traffic to a call, within the appropriate time allowed, only to be faced with stressed and sometimes angry people, who say, “Where’ve you been? I’ve been waiting four, five, six or seven hours.”

  • I congratulate my hon. Friend on securing this debate. I have an example from my constituency. A young lad, a teenager, had a road traffic accident, getting a compound fracture of the leg, but it took three hours for an ambulance to get to him.

    When I met the ambulance chief executive, she told me that the problem is that the organisations that do employment and support allowance assessments are poaching qualified paramedics from the ambulance service, creating a great hole. There is a role there for Government, perhaps, to talk to the whole organisation, to see what can be done to put a stop to that.

  • My hon. Friend makes a valid point, which I will touch on, although he made the case well. We have to look at the slippage, to where in the rest of the health service the paramedics are haemorrhaging, and why. I will say more about that in a moment.

    Paramedics are there to treat people and give them emergency—perhaps life-saving—healthcare, but before they can even start to treat them, they might first have to calm the patient and relatives down, because of something that was completely out of their hands. It is therefore no surprise that, nationally, there is a shortage of qualified paramedics, and all trusts are struggling to fill vacancies so that they can operate at full capacity. The North East Ambulance Service has a 15% shortage, and is plugging the gap with private and voluntary organisations, as my hon. Friend the Member for North Tyneside mentioned. The service has said, however, that it will be up to full establishment in a year, but how many more people will wait for hours and hours before we get to that stage?

    Something therefore needs to be done about the recruitment and retention of paramedics, especially since evidence has shown that more staff are leaving the profession than ever. Also, mental health charity Mind reported that 62% of blue-light emergency service workers have experienced a mental health problem and, worryingly, one in four has considered ending their own life. It is shocking to think about the stress that those people are working under.

    It is no surprise that research conducted jointly by Unite, Unison and the GMB revealed at the end of last year that more than 1,500 paramedics had left the service in 2014-15, compared with 845 in 2010-11—still a high number, but a little more than half the later figure. Of paramedics surveyed as part of other research by the three unions, 75% had considered leaving the profession due to stress and pay.

    Action therefore needs to be taken on recruitment, which is why I welcome the work of my local university, the University of Sunderland, which in partnership with the North East Ambulance Service has launched a diploma programme in paramedic practice. It will pair theoretical study with practical training over two years, and it will help to address the shortages faced by not only our regional trust, but other trusts around the country. That innovative work by my local university, alongside that of the outstanding paramedic practice degree at Teesside University, which is seen as a beacon of best practice in our region, if not the country, is important and will help.

    It is, however, unsustainable not to address strategically the staffing shortages and the increasing demoralisation of a workforce who are haemorrhaging away, because that is clearly having an impact on waiting and call-out times for emergencies. That is why I hope that the Minister will address those concerns, and outline what the Government are doing to deal with recruitment and retention. How will she work with my local ambulance service trust to ensure that it reaches the target of being fully operational by this time next year? How will the ambulance trust ensure that those who are recruited into the field are retained and do not slip off to work for other parts of the health service, so that we do not see further shortages down the line?

    It is important that our emergency ambulance services are up to the standard that we all expect. That means working collaboratively among ourselves, as the local Members of Parliament who represent our constituents and their concerns, and with the Department of Health, NHS England and the North East Ambulance Service Trust. Our constituents deserve the best standards in our NHS, and it is up to the Government seriously to address pressures on our NHS services, especially the case of the workforce in the ambulance service.

    I hope that the Minister has listened carefully to my concerns, and will listen to those that my colleagues from the north-east who have attended the debate today express. I look forward to hearing what she has to say at the end of the debate.

  • I will call the Front-Bench spokespersons at 3.40 pm. Simple arithmetic will demonstrate that if I am to get everyone who wants to speak to speak—I want you to speak as well—you need to confine your remarks to about six or seven minutes. I will be grateful if you follow that guidance.

  • I wish to make a brief contribution to the debate. It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing a debate on a matter that is of importance throughout the north-east of England. This is an important service, run by good people under extraordinary pressure. To give an example, on Monday 7 December last year, there were 1,837 emergency calls to the service. That is equivalent to new year’s eve and was a 46% increase on the year before. That was accompanied by 1,664 calls taken by the 111 service.

    The service is fast becoming a gateway to healthcare as others become more difficult to access and some, such as walk-in centres, are no longer there at all. Repeated requests to the public to call the service only in life-threatening situations can do only so much. I accept that a certain amount of problems are caused by hoax calls and other misuse of the service. People who do such things are completely irresponsible and stand to be condemned, but that is not at the heart of the problems faced by the service in our region.

    I would like to touch briefly on a number of issues. The first is commissioning, which is not one of the strongest features of the Government’s national health service reorganisation. How focused are the commissioners on the service they are supposed to be in charge of? Are they working alongside the chief executive in a supportive and encouraging way? When has their role ever been reviewed or carefully considered by those in charge? There is a case for looking at that and at staff morale, as my hon. Friend rightly said, and asking ourselves why it is as it is. Surveys of the service show that 90% of staff are stressed. That is consistent with the picture that came from her address—and no doubt will come from colleagues—of a service that is trying to do its best under enormous pressure.

    Like my hon. Friend, I welcome the establishment of the diploma of higher education in paramedic practice, which will start in September at the University of Sunderland. That two-year course has been created to try to meet the shortage of paramedics in the region as well as the national shortage. Evidence suggests that the grading of posts may be too low, and I would be interested to hear the Minister’s views on that. It seems odd that, in a region such as the north-east, where unemployment levels are still higher than the national average, there should be a persistent vacancy rate of between 10% and 15% in the service.

  • One of the issues raised with me on recruitment challenges is that it costs £1,200 to get a driving entitlement for C1 vehicles. For many people, that cost is extremely prohibitive and constituents have said to me that that has put them off applying for those kinds of jobs.

  • My hon. Friend is on to a good point. There is something odd if, in a region of higher than average unemployment, it is difficult to fill those vacancies not just in a single moment in time but persistently. We should look at all barriers to entry into the service. I accept what she said, but I harbour the thought that gradings may have been set too low and that there is a case for upgrading the job.

    I have two other points to mention briefly. Legal highs are again putting more pressure on the service as young people in particular misuse them. I suggest that it is not a good idea to take them at all, but taking them results in the ambulance service being called out. There were something like 20 incidents, including a cardiac arrest, in a single day—8 February—and so far this year there have been about 300 call-outs because of the use of legal highs. I harbour the view that they should not be legal, but perhaps that is a different debate.

    Finally, I want to mention the pressures that will be put on the service if the supported accommodation proposals that the Government are considering come to pass. If vulnerable people who are housed in projects and given support to lead their day-to-day lives are denied that support and left to their own devices, the consequence for the police, accident and emergency services at hospitals and ambulance services will be much greater, rather than lesser, pressure. That is not the right direction of travel for our society.

  • I represent a very rural seat in north Northumberland, where, in January 2015, we had the tragic case of the entirely avoidable death of a young man because an ambulance did not get there in time. The Secretary of State instituted a national review on the back of that to look at the issues that triggered that tragedy. I am grateful for that, and we have made progress.

    Some issues have come out of that, and the North East Ambulance Service should be commended. In my area, ambulances go to Northumbria hospital—our new emergency-only hospital. Some colleagues have already mentioned that we have been seeing the queuing of ambulances as they arrive at the various hospitals. I am not familiar with the wider north-east hospital framework, but at Northumbria it was quickly evident that that was a problem. To its credit, the North East Ambulance Service sent a paramedic to help in the triaging process, along with a specialist nurse who was diverted from other duties, to improve the process when the ambulances arrive—the hospital knows when they are going to turn up because they phone ahead—and to do a better job in ensuring that patients were removed from said ambulance and that the kit was returned to paramedics so that they could crack on with the next case.

    That has been working well. We have seen a much speedier process, so I would commend that to colleagues, who could encourage other hospitals in the region to look at doing that. That has been an investment, but without doubt the cost-benefit not directly to the hospital but to the overall health package for our constituents has been hugely improved, because ambulances are back in the system. We were also then able to ensure that Northumberland-based ambulances were coming back up into Northumberland and not being taken to 999 calls elsewhere in the region, leaving paramedics working 14 or 15-hour days to get the ambulance back to Berwick or Alnwick. I commend the ambulance service for listening on the challenging problems we had and trying to make improvements.

    At Northumbria hospital, the figures for urgent and emergency attendances read like this for the past three months: January had 12,911, which was a 12% increase on 2015; February had 13,731, which was a 30% increase on 2015; and March had 15,146, which was a 24% increase on 2015. However, only 24% of those cases needed emergency hospital admission. Something is broken. We are overloading our ambulance service with calls that demand an emergency ambulance, but, once at the hospital, only 24% needed emergency care.

    My concern is twofold, and I ask the Minister to look at how we can make progress on this. First, the algorithm that the 111 and 999 systems demand that staff in the call centres use is dramatically risk-averse. I do not want anyone who is having a cardiac arrest to be told they have heartburn and not be sent an ambulance; quite the opposite should happen. However, a few years ago, the North East Ambulance Service built the lower-level 111 system and tested it before it was rolled out around the country.

  • I hear what the hon. Lady says, but is not the real problem that 111 was rushed in and relied on technology? When it originally started, we had trained paramedics in the call centres who could categorise cases. There is clear evidence, which I will present, that, if something is not deemed life-threatening or someone is not having difficulty breathing, the case is categorised as green. The figures produced are meaningless.

  • I thank the hon. Gentleman for his comment. Quite a few of my constituents were among those experienced staff. Some were retired midwives or had worked as nurses and then moved into the call centre framework. There was a big shift a few years ago to downgrade the medical qualifications required for those staff. We are starting to see a change in that, because the new chief executive is mindful that the huge increase in demand is partly down to staff’s inability to assess cases correctly. If they took another 30 seconds, they could assess properly the situation on the end of the phone.

    Will the Minister work with the people who are writing the algorithm and building the system to get it right? The ambulance service personnel would then have a better tool to work with. That would also encourage ambulance services, and not just our own in the north-east, to go back to higher-value trained personnel who can ask the right questions and get the right answers, so that we do not end up with over 70% of emergency calls ending in someone getting to hospital and finding that urgent care was not needed.

    The other side of this issue, which I have been campaigning on with St John Ambulance, is the need to help families to be better educated so that they can assess their own medical conditions. Other than for cardiac arrests, strokes and such evidently dramatic changes, it is often not emergency care but urgent care that is required. We need to encourage people and build their confidence in assessing for themselves whether they should go to the pharmacy or the doctor or call for an emergency service. We need to do that across the board, focus on it and drive it forward.

    St John Ambulance wants to get into every single school, so that we are teaching young children the difference between what to do if they burn their finger on the kettle—put it under the tap, instead of dialling 999—and what to do in an emergency, such as if granny falls down the stairs. The next generation would then have confidence in knowing the difference between when emergency care is needed and when they can manage and find the right care over a longer period.

    Our paramedics will not be able to continue meeting the demand, much of which is inappropriately placed on the ambulance service. We should make much better use of our amazing paramedics and ensure that retention is higher, because they are valuable members of our community.

  • I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing this debate. In the past 18 months, I have heard about 12 quite serious cases. The ambulance service is in crisis, and that is not down to the men and women who work in it; it is down to the management. Urgent action is needed if we are to avoid people dying and prevent the suffering that my constituents are going through.

    I will give a flavour of that suffering. In July 2014, in Chester-le-Street, a woman’s husband has severe angina. The first responder arrives and says he needs an ambulance. Three hours later, the ambulance arrives. A gentleman falls in Chester-le-Street from a six-foot fence and bangs his head. He is told to stay and wait for an ambulance. He waits two hours for an ambulance that does not arrive, so his neighbour takes him to hospital. A lady in Sacriston, which is about 10 minutes from the local hospital, has severe abdominal pains and is passed out, unconscious, waiting two hours for an ambulance to arrive. In Tanfield Lea, an 86-year-old lady has a fall at 9.30 pm on 13 February. Her partner is told by the ambulance crew not to move her. After several calls, the ambulance arrives on Saturday morning at quarter to 1. Apparently it had been diverted to Newcastle.

    Patient transport is also an issue. One constituent, who had had a stroke and severe mobility problems, was waiting for patient transport to a medical appointment but was told that the ambulance would not attend. Another constituent from Stanley was transferred from his home to the Freeman hospital for regular dialysis. He had to wait two hours for transport back home, leaving him in severe discomfort. Another constituent who lives in Chester-le-Street found a young lady passed out outside her front door. She called an ambulance, and an hour and a half later, the ambulance arrived.

    In New Kyo, a constituent complained that a young woman was having a fit in the local bus station. One hour and 10 minutes later, there was no response. She called the police, and they got the ambulance to arrive. Another constituent from Chester-le-Street needed to be transferred from Bishop Auckland hospital to the university hospital of North Durham. The request was made at 5 pm. She arrived in hospital at 1 am the following morning.

    In Beamish, a lady fell down a flight of stairs and called an ambulance immediately. The first responder said she should not be moved. Two and a half hours later, an ambulance arrived. In March this year, an elderly lady in Sacriston—literally a 10-minute ride from the local hospital—waited an hour and 47 minutes in the cold north-east winter, being comforted by her neighbours with blankets, having broken her shoulder.

    The last case I will touch on, which I have permission to mention, was raised with me by Mrs Irwin in east Stanley. Her 69-year-old mother-in-law, Joyce Irwin, had a fall on 14 March at 7.20 pm. Her son, who lives with her, came home and rang for an ambulance at 7.25 pm. He was advised by the controller that an ambulance would be there within the hour. Nothing happened. Her eldest son arrived and rang both 999 and 111. The first responder arrived at midnight, without any pain relief, and Joyce Irwin therefore had to wait until 1.10 am—four and a half hours later, having been on the floor in excruciating pain—for an ambulance to arrive. When she was finally delivered to the university hospital of North Durham, she found she had a broken hip. It is worth reading what Mrs Irwin says. She states clearly that her mother-in-law was in excruciating pain and was promised an ambulance that she did not receive. She says that Joyce has

    “worked and paid her duties all of her life”.

    Is that the way to treat our constituents in the 21st century? I suggest not.

    There is something severely wrong with the North East Ambulance Service. I have a particular problem with the way in which it treats elderly people. My hon. Friend the Member for Washington and Sunderland West said that the service is missing its targets for red 1s and 2s, but fall cases such as those I mentioned are not even put down as red 1s and 2s; they are put down as greens. In many cases, these are elderly people who have broken bones and are in severe pain, but they are put down at the bottom of the queue. Will the Minister interrogate the hospital trust about the way it is prioritising cases?

    I have been told anecdotally by a firefighter and a policeman that if someone wants an ambulance to arrive quickly, they should ring them up and say that a person either has chest pains or is unconscious. They will then get an ambulance straight away. In this day and age, it is not acceptable that our constituents—elderly, vulnerable people like Joyce Irwin, who have done the right thing all their lives—are treated like that. They have worked hard and paid into the system, and they expect in their old age that if they need the NHS in an emergency, it will deliver. It is not only the individual who is affected. The trauma also affects their families and loved ones, who, in Joyce Irwin’s case, saw her on the floor for four and a half hours in excruciating pain. That is simply not acceptable.

    May I also ask the Minister to tackle the North East ambulance trust about its response to Members of Parliament, because it is absolutely diabolical at responding to Members’ complaints? I have had many complaints from people who have called an ambulance when they have seen an incident and they ask why the ambulance took so long. When I inquire, the ambulance trust responds, “We cannot discuss that case because of patient confidentiality,” because the complainant was not affected. That is complete rubbish. Those people do not want to know what happened to the individual; they just want to know why an ambulance did not turn up. It is interesting that we have got this debate today, because I recently had a flurry of answers to my questions, but I say to the Minister that there is a serious issue about how Members of Parliament can represent their constituents who complain to them.

    I have a similar problem—if the Minister wants to intervene, that would be helpful—with the North Durham clinical commissioning group, which has failed to answer any complaints at all, so I have raised the matter with NHS England. There is something seriously wrong with the North East ambulance trust, although it is not down to the hard work of the individuals who work for it. They do a tremendous job in very difficult circumstances. There is also a question about the priority system that uses algorithms, as the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) suggested.

    There is a question about rurality as ambulances are diverted to more urban areas rather than rural areas. I did not think I would say this, but it might be time to break up the North East Ambulance Service and put it into special measures. It covers a large area and is completely failing. Will the Minister look into whether it is fit for purpose in the long term? I do not think it is. Urgent action is needed. People are not only suffering, but they have lost faith in the service, which is a terrible thing. What should be a flagship service—North East Ambulance Service—that people call upon only in a time of need is clearly failing.

  • It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing this debate.

    I declare an interest as a former chairman of the northern region of the National Union of Public Employees and as a former president of Unison. For 15 years I had the privilege of representing ambulance staff. I first became their representative a year after they were described by the right hon. and learned Member for Rushcliffe (Mr Clarke) as little more than glorified taxi drivers. We were in the middle of an ambulance dispute at the time, so he probably did not really mean what he said, but there is one thing for sure: the staff are true professionals trying their hardest against insurmountable odds to try to deliver the quality public service that we all rely on, and it was to them I turned for this debate.

    A constituent of mine retired from the ambulance service last year due to stress-related illness. I asked him, “What is the picture today? Can you give us some idea?” and he sent me an email this morning in which he said a number of issues have been going on for quite some time. He said that there is huge pressure on the services, especially over the winter period, and they ask the public to call only in genuine emergencies. Increased waiting times outside A&E hold up crews continually. The shortage of funding and paramedics results in long waiting times for patients. He goes on to say that they rely on charities to supplement the shortfall. They recently had to call on a charity to supply volunteer doctors over Easter to help with the response to the most urgent calls. There is a shortage of at least 15% of qualified paramedics and a large increase in the use of private companies, but the capabilities of such staff are not known. According to Unison, staff stress levels have increased and 90% of staff say they have suffered work-related stress owing to long hours and staff shortages. One member is quoted as saying that the levels are dangerous. There is also the ongoing issue of the Government continuing to put pressure on people whose morale is low by keeping in place an eight-year public sector pay freeze. People doing very important work are being penalised for doing it.

    Like my hon. Friend the Member for North Durham (Mr Jones), I asked my office to give me a snapshot of the information that people have been feeding to us. I will quote from some emails. Pam, who lives in my constituency, wrote:

    “Hi Dave, developed a problem with my left leg which according to 111 merits an emergency ambulance to take me to A&E. I have had a phone call from a paramedic apologising for the delay but please can you tell the Tory toffs that I have waited 2 hours for this ambulance and still no signs.”

    Someone from Swalwell, near the very busy A1 in my constituency, wrote:

    “An old man, aged 74, had to wait (lying bleeding on the cold ground in the rain) for 80 minutes for an ambulance. He fell just outside of my house...He was bleeding profusely throughout the entire 80 minute wait. Another neighbour repeatedly called for the ambulance and kept being told they were busy and that ambulances were being diverted to more urgent cases. We were unable to move the gentleman because of the amount of blood he was losing and also we weren’t sure if he had broken anything. He was cold and uncomfortable lying on the wet pavement. I brought out pillows and blankets. Other neighbours brought out bandages and towels and held umbrellas over him. I ended up calling a friend of mine who is a nurse, specialised in head injuries. She arrived very quickly and was able to work out that he was bleeding so heavily due to medication he was taking which was stopping his blood from clotting.”

    She concludes:

    “I understand there are limited resources but an old man lying in the rain bleeding heavily should not be left for so long. By the time the ambulance arrived, his wife was feeling dizzy and struggling with...shock.”

    A 76-year-old went to a councillor’s surgery in my part of the world. She told the councillor that she had had to wait an hour and a half for an ambulance and that when she was contacted she asked why she could not go to the hospital in Hexham, which is closer and where she would normally go. She was told that she was not allowed to go there. She had to go to the Queen Elizabeth hospital, which is at the other end of the A1 and in rush hour is a nightmare to reach. However, they insisted, so she had an hour and a half of waiting and then went to a hospital that made the wait even worse.

    Another constituent, Mrs Waller, wrote:

    “I recently contacted your secretary...regarding my husband...who is a palliative patient, he had a fall in the bathroom 14th March at 10.05 am and it was 15.20pm before an ambulance arrived. I rang 999 which was the advice given if this ever happened, I had to make a further two calls and my husband’s palliative nurse also made a call as well”,

    as did my secretary from my office.

    “I do not wish to have a go at the ambulance service but this is the problem that Mr David Cameron has caused due to the cutbacks in the NHS. No one should have to spend almost five and a half hours on a cold wet room floor. There was no way I could get my husband up due to his reduced mobility because of his cancer.”

    The North East Ambulance Service is in the Minister’s remit. Basically, she is presiding over unmanaged decline. A hands-off attitude is unacceptable and not worthy of such a cherished institution. My hon. Friend the Member for North Durham spoke about the people who created the health service: the people who can remember what it was like before 1948 and how desperate it was. They have paid into the service all their lives and it is a cherished institution in this country, yet it is being rubbished because of the failures of the service that is in place. We must give the people who run and work in the service the chance to get it back where it was. The Minister needs to talk and listen to the people on the frontline.

    Also, we need to listen to the people who pay for the service and for all of us to stand here and talk about it. They are the people who are important in this debate and they are the people who are being let down. The Minister needs to take action and put the ambulance service right.

  • It is a pleasure to serve under your chairmanship, Mr Bailey. Great credit must be given to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) for securing this timely debate.

    The North East Ambulance Service is not creaking at the seams; it is totally and utterly broken. It is in meltdown, and that causes great concern. As has already been said, there is a total lack of any confidence at all in the North East Ambulance Service among the residents. It is failing people of all ages in their time of most need. As my hon. Friends have said, we must place on the record our thanks for the commitment and passion of the workforce in the North East Ambulance Service.

    Unfortunately, there is a staff shortfall of between 10% and perhaps 15%, which has been mentioned. That puts huge stress on the remaining individuals, who must make up for the shortfall. My hon. Friend the Member for Washington and Sunderland West suggested that 64% of people have complained about stress. There is a high rate of people employed in the service who cannot go to work any more because of stress; and is it not really alarming that one in four people has considered taking their own life: paramedics—people working in the ambulance service, who we are terribly proud of? We urgently need to look at the situation.

    There is a complete lack of staff. The service is undermanned and underfunded, and we have not got the resources we need for the situation we have in the north-east. We have to ask why there is a shortage in the first place. I believe that the wages in the North East Ambulance Service are the lowest in the country. That is one factor. We do not have the resources to pay even on a par with the counties next to us. The wages, terms and conditions are much lower than those of other ambulance services.

    Like all the other hon. Members who have spoken I want to mention a few instances. My hon. Friend the Member for Washington and Sunderland West mentioned a young fellow playing football, who broke his leg on the pitch. Now, you would expect an ambulance to come and pick you up, wouldn’t you? Is that too much to ask if someone is lying in agony with a broken bone from playing football on a cold Saturday afternoon? Of course they would want an ambulance. We cannot just push people to the side and wait, and explain to them, “There’ll be somebody coming shortly.”

    That is not even the most important example. Everyone who has spoken has given examples of what has been happening—mainly to elderly people. There are lots of elderly people in my constituency—Mrs Robson, for one. She is 78 years old. She slipped on a pavement in the middle of winter. She had to wait one hour and 40 minutes for an ambulance; but the message that comes is: “I’m sorry; you’re going to have to wait, because it is not at crisis point. You are not an emergency.” Of course she is an emergency. If a 78-year-old lady is lying on the floor crumpled in absolute agony, that is an emergency; but on paper—“Sorry, you’re not an emergency.”

    I will tell hon. Members what happens. Someone rings up, and they have got a crib sheet in the central office. My hon. Friend the Member for North Durham (Mr Jones) mentioned that if someone is unconscious or has got pains in the chest, the service will come to them. The first question is “Are they conscious? Are they breathing?” “Yes.” “Right. Are they bleeding?” “No.” Then, if they are conscious and not bleeding, they are put right down the pecking order. Quite frankly, it is simply not acceptable.

  • Does my hon. Friend agree that the morale of the call centre staff has been lowered? They can no longer care when they talk to people, but are like call centre handlers, with things being very automated; and they do the minimum to reassure patients because everything is down to time and hitting targets. They are no longer people dealing with callers who are in distress. They are not able or allowed to show any emotion or any support, because they simply have to deal with the call as quickly as they can, to get on to the next one.

  • What I am saying is not meant to be any criticism of the people in the call centre, either—because if they veer from the crib sheet they have got, they are in trouble; but it shows how bad the whole situation is.

    I want to mention Mr Taylor. I must say that he is a relative of my wife, who waited 11 and a half hours for an ambulance to arrive. He was really poorly. Plenty of people came from the NHS and said, “He needs an ambulance”—and then someone says “He doesn’t” and someone says “He does,” and someone else says “He doesn’t”. When he actually got the ambulance, at 1.45 in the morning, he was in a coma. That was seven months ago, and he is still lying in a coma as we speak. If that ambulance had turned up before, he might not be.

    I will not dwell on that point other than to say that that brings me on to the complaints procedure, because MPs have complained, as well, about what happens to our constituents. We get a chronological list of what happened, and why the ambulances could not come, because they were diverted to other more serious incidents. That is not good enough. It is not good enough for me to say to one of my constituents, “Your mam couldn’t get an ambulance because somebody else was more important”—when she was lying suffering. Or if someone has a terminal disease and is desperate, or someone has a chest disease—it is not good enough; and the complaints procedure is not good enough. They are not treating people like human beings.

    I have got lots to say and not a lot of time to say it, but I am going to reiterate the fact that these delays are utterly unacceptable and we cannot continue on this basis with the North East Ambulance Service operating as badly as it is. Someone mentioned that the service will be fully operational in 12 months. I have heard that before. It is not good enough for the people who will trip, fall and stumble. It is not good enough for elderly people, or young people playing football.

  • My hon. Friend has obviously had the same letter from the North East trust that I have had; but does he agree, also, that it is not good enough because it is a question of our constituents’ confidence in the service? It should be a first world service, but it is more reminiscent of the third world.

  • I fully concur with my hon. Friend’s sentiments, and I am pleased about that intervention, because I think I might otherwise have needed an ambulance myself. I feel as if my blood pressure it is getting exceedingly high.

    More seriously, we have to look at the North East Ambulance Service now. We cannot announce a review in weeks to come. We have got to get to the bottom of why the service is operating so badly. It is not meeting its major targets in almost every single category. It has been mentioned that it may perhaps be put in special measures, or that it should be broken up. To be honest, I do not have the answers, but one thing I will say is that the Government have to look at the North East Ambulance Service and improve it in the same way as in other areas of the country. There is no reason why people in my area, in the north-east, should be tret any differently from anywhere else in the country. We need to get hold of the situation immediately.

  • It is a pleasure to serve under your chairmanship, Mr Bailey. I, too, thank my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), not just for securing the debate, but for the passionate and thoughtful speech she gave, which got right to the heart of the issue. She articulated something that has been brewing among my constituents since I was elected last May. It gives me great concern and I want to share some experiences I have had.

    Like my colleagues, I have become deeply concerned about the pressures on the North East Ambulance Service and their impact on my constituents. If someone is waiting for an ambulance, they are probably at one of the most distressed and vulnerable times of their life. Every minute waiting for an ambulance feels like an hour. Every moment is precious—vital; and there is a critical impact on people’s distress levels, and, as we have heard, their chances of survival. The Government must look at the situation to make sure that the service improves. I have heard far too many stories from constituents about people waiting several hours for an ambulance to arrive. As others have mentioned, that has affected elderly people particularly, and not just in minor cases—people who are elderly and vulnerable.

    I want to mention a recent case, which happened just last month. A 72-year-old woman in Marske in my constituency fell and fractured her hip in the street in the centre of the village. She was left lying in immense pain on the pavement in the freezing cold. It is a seaside town and she was left virtually on the sea front for three hours. Thanks to members of the public and many local business owners who came out of their shops, she was cared for by the community; but we can imagine not just her distress but the distress and horror of the community at seeing such a thing happening in their village—someone at a vulnerable time in her life, waiting in agony for the ambulance that they had paid for with their taxes, and which they expected to come to support a community member. It was completely unacceptable that she had to wait in pain for so long.

    Another constituent, an elderly lady of 99 years who was born during the first world war, fell in her home at the end of last year, breaking her arm in three places. She was in so much pain that her family did not want to transport her themselves so they called an ambulance. Again, it arrived three hours later. She was 99 years old. What sort of society are we? If a 99 year-old woman who has had a fall and broken her arm is not an emergency and top of the priority list, I cannot imagine who is. Thankfully, she was at home in the warmth of her house and not outside on a pavement, but who is to say that she would have been any more of a priority if she had been outside on a stone-cold pavement.

    As many of my colleagues have said, something is wrong with the prioritisation of people, particularly of elderly people, who have paid, worked and strived for their whole lives. How can we as a society look ourselves in the eye when that is how we treat someone who was born before the NHS started and has contributed to the system?

    A local district nurse told me recently of another incident, involving a bed-bound patient with a suspected ruptured bladder. Although a blue light was not needed, the patient required an urgent ambulance. They were given an initial response time of one hour, but the ambulance eventually arrived after five hours. That waiting time was completely unacceptable; and again, there was an issue of the ambulance being diverted.

    That is important. If ambulances keep being diverted to more important calls, the original call becomes increasingly more urgent. The knock-on cost of the crisis in the service and the level of support that people need falls on the NHS, but more crucially on those affected, in the increasing danger they are in while waiting longer and in the agony and the tragedy they experience. That is where cuts have a serious impact, because they cost more down the line, as the service becomes increasingly crisis-led and ambulances are diverted to more urgent calls. What was a lesser priority becomes more urgent and more costly to the NHS and the individual’s life.

    In highlighting these cases, I am not criticising the work of paramedics and switchboard staff, because they do a fantastic job on the frontline that I do not think I could do. We owe them a massive debt of gratitude. They work under extreme pressure, dealing with people in life-or-death situations, and often in dangerous situations. Many are underpaid or struggling with their terms and conditions. They sometimes have to deal with distressed or angry families, and who can blame those families when they have waited hours and seen their loved ones in agony while failing to get the most basic service they need?

    I want to comment on the failure of the North East Ambulance Service NHS Trust. According to the ambulance clinical quality indicators, the North East Ambulance Service takes longer than any other region in the country to answer calls. It also has the highest number of abandoned calls in the country. Colleagues have given plenty of examples showing that the service is in crisis and cannot continue as at present. Our elderly and vulnerable constituents are suffering.

    Constituents have told me that a crew said that the Teesside service has a lower headcount than it should have and that ambulances have had to come from Durham, which is why we get delays. Parts of the north-east are geographically spread out and rural, and it is just not acceptable that ambulances are having to come from Durham. The morale of our ambulance workers is low. They are overstretched and, despite their heroic efforts, pressure is leading to targets being missed and patients and our constituents suffering.

    I look forward to hearing from the Minister what the Government plan to do to tackle the problem and ensure that the investment they have promised for the NHS will go to this vital, front-line service in the north-east to save the lives of our most vulnerable constituents.

  • It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing this very important debate and on the eloquent way she made the case for her constituents, as have other right hon. and hon. Members for their constituents. People deserve a better service from the North East Ambulance Service.

    I join other Members in praising the dedication and commitment shown by the thousands of paramedics who work in the NHS today. They are the best the NHS has to offer and they work under incredibly difficult circumstances delivering life-saving treatment. I add my thanks for the service they provide to us and to all our constituents every day of the week. Although ambulance services continue to deliver a good service for most, as we have heard today, they do not do so for everyone and the service is patchy across the country.

    Members have spoken in detail this afternoon about the difficulties facing the North East Ambulance Service and the poor care that many patients have received from it. Over the past few years, the North East Ambulance Service has seen a dramatic deterioration in its performance against national response time standards. Between June 2012 and March 2013, the trust responded to 77% of the most serious emergency calls within eight minutes but, three years later, only 70% of ambulances were arriving within eight minutes. That is compared with the national target of 75%. The decline in standards is even worse for other emergency calls: that figure has fallen from 77% to 62%.

    Behind each of these statistics are seriously ill patients and tragic stories of failed care. I hope that my hon. Friend will allow me to say that, when researching this matter, I was deeply shocked to read about an elderly man in her constituency who was told in December that he faced a five-hour wait for an ambulance after collapsing from a suspected stroke—a five-hour wait for an ambulance on the street in the middle of December. That is not what we should expect for our loved ones from our NHS.

    When the Minister responds, I hope she will set out what actions the Department of Health is taking to prevent such incidents from ever happening again. The sad truth is that that decline in performance is not restricted to the north-east. The House of Commons Library has forecast that this year only three trusts in the whole of England will meet the national performance target for responding to emergency calls. The service in England has met the target only twice during the past 12 months, and more than 45,000 seriously ill patients have had to wait longer than eight minutes for an ambulance to arrive.

    That is a worrying decline in performance. Too many people are being failed by the system and services are starting to fray at the edges. What does the Minister intend to do to improve the quality of care provided by ambulance trusts in England? What conversations has she or her colleagues in the Department had with NHS England about the performance of this ambulance service? What assessment is the Department making of the impact the decline in standards is having on the rest of the NHS in this region?

    As we have heard, the truth is that that decline in performance is a symptom of a system that is at breaking point. All aspects of emergency care, from ambulance services to A&E departments, are struggling. In February, A&E departments in England reported their worse performance on record, with just 88% of patients being treated within four hours, compared with a target of 95%. During that period, every hospital in the north-east missed its A&E target and one in 10 patients had to wait more than four hours in A&E before receiving treatment.

    Dr Cliff Mann, president of the Royal College of Emergency Medicine, told a national newspaper the month before last:

    “The pressures have become unrelenting. In recent days I’ve been contacted by a number of senior doctors, medical directors, high-level people, who are saying the situation now is like nothing they’ve seen before…My own hospital had the busiest day I had ever experienced two weeks ago—these are situations where every time you turn round, there are another four ambulances queueing.”

    Those are worrying reports. I ask the Minister to address some of the concerns raised by Dr Mann and to say whether she believes that they are isolated incidents or whether those pressures have become the norm in our NHS.

    The North East Ambulance Service’s board has acknowledged that the decline in A&E services has had an impact on its performance. The trust’s most recent board paper said that there were 59% more handover delays of more than one hour in the first quarter of 2015-16 compared with the previous year and 60% more delays of more than two hours. The reality is that too often ambulance crews with vulnerable patients have to wait outside A&E departments because hospitals just do not have the space to admit them. I hope that, when the Minister responds, she will offer an explanation for that decline in A&E performance and explain how she will help trusts to turn the situation around, because A&E is struggling and in need of help.

    Staff shortages are also a key factor contributing to the challenges facing the North East Ambulance Service. The region currently reports 15% vacancy rates for paramedics, which puts added pressure on existing staff. Local unions have warned that nine in 10 north-east ambulance staff are suffering from work-related stress due to excessive hours and staff shortages. Across England, the recent NHS staff survey found that almost half of ambulance staff felt unwell as a result of work-related stress and one quarter say that their employer does not take positive action on health and wellbeing.

    It is clear that not enough is being done to support ambulance staff, and that is bad for patient care. Unhealthy staff mean unhealthy patients, and we cannot allow that situation to continue in the north-east or elsewhere in England. I therefore ask the Minister what steps her Department is taking to address staff shortages in the ambulance services in the north-east and across the country. Does she agree that more needs to be done to support the health and wellbeing of front-line paramedics?

    It is clear from the speeches that we have heard today that this trust is struggling against a number of key performance indicators that are widely available. I hope that, when the Minister responds, she will agree that patients in the north-east deserve better than that. I hope that she will also agree that we cannot allow that dramatic decline in performance to continue and that something has to be done to stem the tide.

  • It is a pleasure to serve under your chairmanship, Mr Bailey. I thank all who have contributed to this important debate. Some extremely serious issues of principle and general practice and some very serious constituency cases have been raised. I doubt that I will be able to deal with some of the specific issues, particularly in relation to individual constituents, during the debate, but I have made a careful note, as have my officials, of some of the specific points and we will go through Hansard after the debate and ensure that we pick up individual points. I am extremely disappointed to hear that colleagues have not always found the trust as responsive as they would wish. I spoke to the chief executive yesterday in preparation for the debate and will certainly go back to that specific point, but I will come to some of the other general points as I move through my speech.

  • Will the Minister give way?

  • It is quite early, but I will.

  • I just want to say that we are all aware that the chief executive, Yvonne Ormston, is new and has obviously inherited many of the cases. I would like to say that things have massively improved. I know that she is trying to turn the situation around, but what has happened will not all have been on her watch.

  • The hon. Lady makes that point very well and with her characteristic generosity of spirit. I am sure that that will be noted. I will take the issue forward with that very much in mind and I thank her for her comments.

    Ambulance services are obviously vital to the healthcare system. We have heard this afternoon some of the reasons why. They provide rapid assistance to people in urgent need of help. Hon. Members on both sides of the Chamber have rightly put on the record their appreciation of the work done by staff in trusts across the country and by the front-line staff in the NEAS. I add my thanks to theirs. Inevitably, we bring problems before the House—that is right, because we want to talk about how we can move things on for our constituents—but it is possible for a member of staff reading the record of a debate afterwards to think that we had only blame and criticism. Today, however, all hon. Members have been careful to praise the very hard-working staff. As has been said, they are working under quite considerable pressure.

    It will probably be helpful to provide some context about the national picture. We recognise that the NHS is busier than ever, which is why we are backing the NHS’s own plan for its future, the Five Year Forward View, with an extra £10 billion by 2020-21. The challenges faced by the North East Ambulance Service are reflected in many services across the country. Ambulance services are facing unprecedented demand, delivering over 2,800 more emergency journeys every day compared with 2010. That demand has an impact on performance indicators, such as response times, with ambulance services continuing to struggle with their targets. The Department is working closely with NHS England and with NHS Improvement to monitor and support performance in 2016-17.

    In relation to the North East Ambulance Service, I spoke briefly to the service yesterday, in addition to having received quite a detailed briefing from it ahead of the debate. I am advised by the NEAS that the average number of the most serious incidents—red incidents—that it has responded to within eight minutes has changed very little over the past three financial years, but the volume of red incidents to which the NEAS has to respond to reach the 75% performance target has increased by more than 20%, from 370 a day in August 2015 to more than 440 a day now. That change in demand in particular has placed our front-line emergency care services under real pressure, rather than the responsiveness and capacity of service provision.

  • I hear this from the Minister and I hear it from the trust, but could I ask her officials or NHS England to actually delve into the figures? The hon. Member for Berwick-upon-Tweed (Mrs Anne-Marie Trevelyan) raised an interesting issue. This is actually about the ways in which ambulance calls are classified. There are clearly reds that are not reds, but the other point that I would like the Minister to address, even if she cannot answer it today, is the way older people are being treated, because they are being put down as greens, whereby they get no priority at all, and they are some of the most vulnerable people in our community.

  • Indeed. I have very much taken that point on board and I will try to respond, but if I do not do so today, I will certainly write to the hon. Gentleman, because it is a fair point. The more general point is where the ambulance service sits in terms of our response and general position on urgent and emergency care. I will respond to some of the points made by my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan), because I think that this sits within a wider, systemic challenge and I want to touch on that.

    Every patient should expect to receive first-class care from the ambulance service, but the nature of emergency response work means that there will always be incidents in which unfortunate timing leads to a person assessed as being in a non-life threatening situation calling 999 at the same time as several other people who are in life-threatening situations. I am sure that hon. Members are realistic about that, but clearly we do not want to hear about such problems occurring on a very regular basis. Where that does occur, obviously the life-threatening situations must be prioritised and resources focused on those calls. Very rarely—unfortunately, we have heard about such cases this afternoon—waits may be unacceptably long. I do not shy away from that, but it is important to remember that the vast majority of people receive a timely response when they dial 999.

    I have already said, echoing the words of the hon. Member for Washington and Sunderland West (Mrs Hodgson), who led the debate, that although the NEAS has not met the performance targets, that does not reflect on the hard work, dedication and skills of the local staff. A number of speeches brought that out. I am advised that although ambulance delays are the main reason for patient complaints, the number of complaints received in 2015-16 fell, but we do not want any complaints; that would be the situation in an ideal world. However, the fall is indicative of the fact that the efforts of the local ambulance staff are paying dividends. Although the performance target is effective in driving improvements and maintaining response times to the most critically ill and injured patients, it does not, inevitably, paint the complete picture of how a trust is doing.

    I will talk about some things that the North East Ambulance Service, has put in place to bring about improvements to service, because that is the focus of the debate and people want to hear that the direction of travel is positive. The NEAS continues to expand the number of specialist clinicians working in its clinical hub who can provide telephone assessment and advice, and who can prevent the dispatch of an emergency response if it is not deemed necessary. That goes to one of the points made earlier. The trust expects that that will have a positive effect on response times.

    Last winter, the NEAS piloted an end-of-life-care transport service, which provided three dedicated ambulances that were on call to respond to transport requests from healthcare professionals to take a person to their final place to die. The scheme has meant that emergency ambulances are not tied up in transporting patients when they are needed for more serious cases, and that terminally ill patients are not waiting a long time for transport to their preferred place of death. Although we do not often like to talk about end-of-life care, the preferred place of death is an important part of reducing stress at an inevitably very difficult time for an individual and their family. Results from the pilot were overwhelmingly positive and eased pressure on vital services.

    Hon. Members have raised valid concerns about handover times between ambulance crews and emergency departments in the local area, and that is an issue across the country. Patient handover needs to be as efficient as possible to achieve the best possible outcome for the patients and to free up ambulance resource, but more can be done and is being done. Measures include hospital ambulance liaison officers, which are being put in place by the NEAS. HALOs are present in hospitals across the trust territory and I am advised that the trust has sought to make use of dedicated ambulance resource assistants as well.

    The urgent and emergency care vanguard programme in the north-east will include the development of a standardised handover process for all acute providers, intended to minimise delays across the patch. That goes to the shadow Minister’s point about looking at the wider system. That will be to the benefit of crews and emergency departments. I understand that, as part of the vanguard, the NEAS also hopes to secure funding for a new “flight deck” information system that will enable diverts by ambulance crews to other hospitals to be proactively managed and will prevent ambulances from stacking up outside already full A&E departments. The trust believes that those initiatives will help to distribute A&E workload evenly and will be welcomed.

    Several hon. Members have rightly commented on the recruitment challenge. It is very much recognised that there is currently a shortage of paramedics nationally and the NEAS trust is no different. We recognise that front-line staff are the vital component of a safe, effective and high-performing service, and work is being done by the NEAS to rise to the recruitment challenge. The hon. Member for Washington and Sunderland West mentioned some things that are being done. Efforts include developing new advanced technician roles to support front-line services, and the trust is running a substantive recruitment of paramedics nationally and internationally.

    The trust expects 77 student paramedics to graduate by February 2017, in addition to recruiting an additional 36 qualified paramedics in 2016-17. The trust has also recruited a total of 56 emergency care clinical managers, and that represents a significant investment in front-line clinical leadership. It also advises me that it expects to be up to full paramedic establishment by April 2017. I know that that commitment will be keenly watched by hon. Members.

  • Ambulance staff, along with other public servants, have effectively had an eight-year pay freeze. Their standard of living has gone down every year for the past eight years. Comparative jobs, particularly in the private sector, have not seen that level of control. There have also been pointers that the situation will not be alleviated in the next two or three years at least. Does the Minister not see that as a real reason that people will not come into the job? Yes, it is a vocation, but people have to put bread on the table.

  • Of course I accept that issues of pay are incredibly important. Although we cannot go into the wider economic picture, I gently say that the previous Government and this Government have made reducing the tax bill for some of our lowest paid public servants a huge priority. A huge amount of money is being spent on raising the threshold and that has made a huge difference to people’s take-home pay and standard of living. However, I hear the hon. Gentleman’s point.

    I am encouraged that the trust is looking to the future by doubling the number of places on its two-year in-house graduate training programme. Hon. Members have made several thoughtful points regarding some of the wider issues around recruitment and retention. Maintaining staff morale has been mentioned. That is very important and the trust is looking at whether things could be done, other than pay, to attract and retain paramedics. We are looking at that nationally. The debate sits in the context of urgent and emergency care.

  • Will the Minister give way?

  • If there is time, because I want to get to a really important point right at the end of my remarks, and I am starting to run the clock down. Will the hon. Gentleman make his intervention very brief?

  • I thank the Minister for allowing the intervention. She mentioned the fact that we will probably be fully operational by April 2017. Will she guarantee the people of the north-east that she will take action to ensure that the NEAS will look after the people in our area in the intervening period?

  • I intend to follow up on this debate with my colleague in the Department of Health, Lord Prior of Brampton, who leads on the topic, and I will follow up with the service itself. I will make sure that all points raised by hon. Members are drawn to its attention.

    The root causes of the increase in demand often lie outside the hands of the ambulance service. NHS England’s review of urgent and emergency care is taking a system-wide approach to redesigning the way that care is delivered. It is important to look at the provision of ambulance services in that context. We need to ensure that people with life-threatening emergency needs are treated in centres of excellence to reduce risk and maximise their chance of survival and recovery. The first part of that is about relieving the pressure on emergency services.

    The response time targets are being considered as part of NHS England’s review to ensure that they incentivise the most clinically appropriate response. My hon. Friend the Member for Berwick-upon-Tweed and the hon. Member for North Durham (Mr Jones) talked about having the clinically appropriate response in all contexts. I will ensure that we pick up on those points and draw attention to them. We hope to have advice from NHS England later in the summer on potential changes to ambulance standards in the context of that wider review of urgent and emergency care.

  • Will the Minister give way?

  • No, because I have an important point to make at the conclusion. If the right hon. Gentleman will forgive me, there might be another opportunity.

    Ambulance services are vital to emergency care and the whole NHS. We all want to be sure that when loved ones suffer heart attacks or are involved in a serious accident, they will not be left waiting, although we have heard about some distressing cases. National targets in response to red, life-threatening calls exist to ensure that that happens, and we all have an interest in ensuring that the ambulance services perform well against them. I will follow up on the points made in the debate.

    I draw hon. Members’ attention to the fact that a comprehensive Care Quality Commission inspection was carried out at the NEAS during the week commencing 18 April 2016. CQC’s formal report will be important for all hon. Members and Ministers to read. In the light of the strong feelings expressed in the debate, I think it would be appropriate for hon. Members whose constituencies are served by the NEAS to meet my colleague, the noble Lord Prior of Brampton, who leads on this portfolio, when the report is available to discuss. I hope that that will be helpful for hon. Members. In the context of that report, many of the points made this afternoon can be discussed with Lord Prior. I encourage all hon. Members to engage with the local NHS and to continue to work together to address the challenges in this critical element of our healthcare system.

    If the right hon. Member for Newcastle upon Tyne East (Mr Brown) can make his intervention in less than a minute, he may do so now.

  • How does the Minister account for the rise in demand for the service?

  • I definitely do not think that that question can be answered in less than a minute. Much of the answer lies in the work that Sir Bruce Keogh is doing as part of the NHS’s wider urgent and emergency care review. It is vital that we get people the right care in the right place at the right time. It is a complex picture, of which ambulance services are just one piece. More will be said when we know more about that review later this year.

    Question put and agreed to.

    Resolved,

    That this House has considered the performance of the North East Ambulance Service.