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Ambulance Queues: Health Outcomes

Volume 817: debated on Thursday 13 January 2022


Asked by

To ask Her Majesty’s Government what assessment they have made of the impact on health outcomes of the time spent by ambulances waiting in queues to transfer patients into hospital Accident and Emergency departments.

My Lords, I beg leave to ask the Question standing in my name and draw the House’s attention to my interests in the register.

We recognise that waiting times can impact outcomes, so patients in queues remain under constant clinical supervision and care and are prioritised according to need. Delays tend to be concentrated in a small number of hospitals, with 29 acute trusts across 35 sites responsible for 57% of the 60-minute handover delays nationally so far this winter. These trusts are receiving intensive support to improve, including through placement of hospital ambulance liaison officers and the safe cohorting of patients.

My Lords, half a million acute bed days each year are lost due to delays in discharge directly attributable to non-availability of social care, which leads to bottlenecks in emergency departments and ambulances being unable to unload patients. Does the Minister agree that the split of money raised by the health and social care levy over the next three years therefore needs to be more generous to social care, so people stop having to wait up to seven hours in the back of ambulances?

As the noble Lord will be aware, when the charge was initially announced it was intended to help with social care, which has been neglected for a number of years under successive Governments. Given the pressures of the backlog, the NHS has decided to divert some of those resources to help tackle it. We have invested money in social care in the short-term winter plan, and in the longer term we have announced extra investment to ensure that social care is an attractive career and offers real prospects.

My Lords, does the Minister recognise that his response, saying that this involves a small number of trusts, does not address the data from NHS England for the seven days to January 2, which showed that 23% of all arrivals by ambulance had delays of half an hour or more—that is over 19,000—and that some 10% of patients waited more than an hour to be handed over? This meant that those ambulances were also unable to deliver first aid and first implementation of treatment to people who were waiting. Therefore, when patients arrived at emergency departments, they were even sicker than necessary, and it may be that some lives were lost.

The noble Baroness makes an important point. In anticipation of the winter crisis, last year we published the Urgent and Emergency Care Recovery 10 Point Action Plan to look at the direct pressures on not only A&E but the call centres, and at some of the wider system issues. For example, when people cannot get access to their doctor, they tend to go to A&E. At other times, they cannot get the replacement medication they want and have to call an ambulance to go to A&E and get it. We are looking at some of the wider system problems to make sure we address the backlog.

My Lords, NHS workers on the front line have been warning for months and months that the service is under strain due to a combination of waning workforce, Covid, respiratory infections, a backlog of patients and a build-up of health problems over lockdowns. The Royal College of Emergency Medicine has been calling for months for a response from Ministers to provide short-term and long-term solutions. We called on the Health Secretary last summer for urgent additional support to be put in place. Why are we still waiting for that leadership and necessary support to materialise?

I am sure the noble Baroness will acknowledge that a number of people have been calling for ways to address this. The Government announced the Urgent and Emergency Care Recovery 10 Point Action Plan last year, which includes supporting 999 and 111 services, looking at primary care and community health services, greater use of urgent treatment centres, increased support for children and young people, better communications and call handling, improving inflow and hospital discharge, looking at mental health needs and a number of other issues. In each of those 10 points we have drilled down on working with trusts and the ambulance service to make sure we can address the issues that are currently being raised.

My Lords, could the Government look at how many lives have been lost as a result of delays? I suggest this might be more of an issue than the Government are aware of.

We regularly talk to the NHS—every day, in fact. We have, for example, daily omicron calls. Looking at some of the data, over 925,000 calls to 999 were answered by the ambulance service in December 2021, which is nearly 30,000 calls a day. That is 2% more than in November 2021, 22% more than in November 2020 and 9% more than in December 2019. We have invested in more people in the call rooms, working with BT to better handle the calls, and ensuring we have more staff where we need them to handle the whole system and ensure we can respond quicker.

My Lords, the noble Baroness, Lady Brinton, wishes to speak virtually. I think this is a convenient point for me to call her.

My Lords, yesterday NHS England data showed that trolley waits of more than 12 hours in A&E rose in December to just under 11,000, which is three times higher than in December 2020. One hospital reported that it had a dozen patients waiting on a trolley for a bed for over 24 hours. The Minister has talked about extra money, but without staff and bed capacity in both hospitals and care homes, the crisis remains. Can he say what the Government are doing right now to help alleviate the current crisis?

I thank the noble Baroness for giving me the opportunity to say what the Government are doing right now. We are working closely with ambulance services, NHS England and the Association of Ambulance Chief Executives to reduce the handover delays. The 10-point plan I referred to earlier goes into detail about how we handle this, both in handling calls at call centres—some calls are not emergencies, for example, and patients are directed elsewhere—and in making sure that the wider system is available to make sure that patients are unloaded within the 15-minute target and that ambulances are turned around as quickly as possible. Where we have spotted disproportionate pressures in the system, as in the 29 hospital trusts across 35 sites, we have focused more resources there.

My Lords, I appreciate that my noble friend has to read out what he has in his brief, but would he take time to read the report on social care published by the Economic Affairs Committee of this House, which received pretty well universal endorsement? Will he then discuss with his colleagues whether we really have fixed social care and whether the resources he is claiming are sufficient to meet the problem?

I thank my noble friend for drawing my attention to the report and the work of that committee. I will commit to reading the report and look forward to future discussions with my noble friend and many noble Lords across the House.

Would it be possible at this time to talk also about preventing the next crisis and the crisis after that? Are we not always chasing something? The NHS, which does not spend a large amount of money on prevention, is now being hoist by its own petard,

The noble Lord raises a very important point. One of the things the NHS is looking at in more detail, and something we will discuss in forthcoming debates on the Health and Social Care Bill, is how we move a system culturally to not only treat patients once they are ill or need treatment, and work in terms of prevention and encouraging healthier lifestyles. When patients are kept too long in hospital, they can lose certain facilities such as muscle function, so we need to look at prevention as opposed to just treatment. Getting the right balance is something that the NHS and the Department of Health and Social Care are looking at closely.

My Lords, as a result of Covid’s impact, many A&E departments have reconfigured their internal infrastructure and their working practices. Could the Minister tell the House how best practice is being disseminated to other NHS trusts? What support, financial and otherwise, have trusts received to do this?

Given that it was identified that there were particular pressures on 29 trusts across 35 sites, extra resources have been targeted and teams have made site visits to work out, for example, the flows in those hospitals, and to make sure that they deal not only with the immediate issues that those departments face but also with the wider system issues. For example, as I have mentioned, sometimes patients cannot get hold of doctors and go to A&E as a substitute because they want a face-to-face appointment. We are looking at a number of those wider issues. We announced £55 million of winter funding for all ambulance services and have boosted staff numbers by 700, including for the availability of the ambulance fleet, through a £4.2 million investment to improve times. We have also invested nearly £2 million to support the well-being of front-line staff during these pressures; they have experienced increased pressures, so we must make sure we look after them as well.

My Lords, is there a breakdown on the difference between physical resources in hospitals and the shortage of staff?

I am not sure whether there is a breakdown. As my noble friend said, sometimes I have to read out what is in the pack and sometimes I freelance, as I am sure many will appreciate—or maybe will not appreciate when I divert from the government line. But I will endeavour to find out whether those stats are available.