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Ambulance Services and National Heatwave Emergency

Volume 823: debated on Wednesday 13 July 2022

Commons Urgent Question

My Lords, with the leave of the House, I shall now repeat in the form of a Statement the Answer given to an Urgent Question asked in the House of Commons today.

“Our ambulance service performs heroics every single day, and I put on the record my thanks to every single one of them for all their dedication and hard work. We have a duty to support this vital service and give it the resources and support it needs.

The latest figures from the NHS in England show that ambulance service response time performance has improved month on month, and that ambulance hours lost are also improving month on month. However, we fully acknowledge the rising pressures facing the service, and there are three significant factors influencing these. First, bed occupancy is currently around 93%, which we would normally see around wintertime. We know there are high rates of Covid admissions in hospital—that is either people ‘with Covid’ or ‘because of Covid’—and that puts pressure on A&Es’ ability to admit patients. We are roughly running on void beds of around 1,200 and part of this is because of the 16% increase in the length of stays. We also have pressures of delayed discharges: they remain flat, but a significant influence. We also have record numbers of calls to the ambulance service—100,000 more today compared with last year—so there is significant pressure on the system.

We also have to be mindful of the weather in the coming days. We have the Heatwave Plan for England, which was published earlier this year, and the hot weather plans that NHS trusts are able to put in place. We have also been providing sector-specific guidance setting out the best ways to protect people who might be at risk. As well as this specific support for hot weather, we are doing everything in our power to support the ambulance system more widely to make sure that it has the resilience it needs. We have allocated £150 million of extra funding to respond to ambulance service pressures in 2022-23, and we are boosting the workforce too. The number of national 999 call handlers had risen to nearly 2,300 at the start of June, which is a considerable increase on the previous September, and Health Education England has been mandated to train 3,000 paramedic graduates nationally per year during 2021 to 2024. On top of this, we have invested £50 million in NHS 111 in England for 2022-23 to give this vital service extra capacity, helping us to reduce demand on the ambulance service.

I will be meeting ambulance trusts over the coming days to make sure that we have the capacity and the resilience not just for these important few days but for the winter months too. This is an important issue that we are taking extremely seriously, and we will keep the House updated as the situation develops.”

My Lords, every ambulance service is on the highest level of alert. Just yesterday, the Association of Ambulance Chief Executives spoke of the intense pressure on the system. This is not new. As the Minister acknowledges, a maelstrom of long-standing factors is causing massive delays, leaving ambulances stuck outside hospitals unable to transfer patients, staff shortages exacerbated by the spike in Covid and, on top of this, a heatwave generating more 999 calls. Can the Minister confirm whether further COBRA meetings are planned? How are the Government prepared for the impact of this heatwave on health and care services? What communications are planned to ensure public safety?

My Lords, there are well-established and well-practised co-ordination and escalation procedures in place to manage cross-system and cross-government impacts at all levels. These are activated when appropriate and on the basis of subsidiarity. UKHSA public health advice is being regularly updated and communicated for everyone to stay safe in the heat. As noble Lords will know, today the UKHSA and the Met Office have announced that all nine English regions will be under a level 3 heat alert from Saturday 16 to Tuesday 19 July. The heat alert system runs during the summer. Depending on the level of alert, a response will be triggered to communicate the risk to the NHS, government and public health systems. Advice and information for the public and health and social care professionals, particularly those working with at-risk groups, are provided, including both general preparation for hot weather and more specific advice when a severe heatwave has been forecast.

My Lords, delayed discharges account for more than 2.5 million lost bed days in NHS hospitals. With the greatest respect, organisational reorganisation will not deal with the gross underfunding of social care that means ambulances spend hours outside A&E. What are the Government going to do now to deal with the crisis in social care funding, which causes ambulances to wait outside hospitals?

My Lords, as the noble Lord will know very well, we have put increased funding into our social care system, but we also have in place a national discharge task force to drive further progress and support regional and local system arrangements. That has membership from local government, the NHS and national government. Local health and social care partners are already standing up the use of additional action to support discharge and improve patient flow. The task force is looking at a number of interventions—for example, identifying patients needing complex discharge support early and ensuring multidisciplinary engagement in the early discharge plan. There is more support going into social care, but there is also a specific piece of work with the national discharge task force.

My Lords, have not the Government created the perfect storm? First, they cut the number of beds available, then they cut social care, then they do not plan for the number of doctors that we need, then they have Covid and now they have heat. What are the Government doing to address the long-term problem of hospitals that are underfunded and do not have enough beds, not enough GPs, accident and emergency units stopping functioning and the ambulance services being in crisis? What are the Government doing?

My Lords, I am not sure that the Government are responsible for Covid. The pressures that we have seen on ambulances have come since the pandemic; we were seeing a much more effective ambulance service prior to that. But we need to fix that so, as well as the specific action that we are taking to improve resources in ambulances, including more staff, more call handlers and more funding into the 111 service, we also have a long-term plan for the NHS that is putting record funding into the NHS. We have also created integrated care boards to ensure integration between health and social care in local areas.

My Lords, the Minister talked about boosting the workforce and then she referred to the NHS training 3,000 new ambulance staff. How far does that go to fill the gap in retention and recruitment, what else is being done to boost the number of people we need to create a resilient ambulance service and when will we arrive at that point?

The noble Baroness is right that, as well as additional training and recruitment, retention will be a really important part of the picture. The Government have put in place additional support save-line3for ambulance staff to ensure that retention continues. My understanding is that the target to train 3,000 paramedic graduates a year nationally between 2021 and 2024 will help the domestic paramedic workforce meet the future demands on the service. I also reassure the noble Baroness that ambulance staff and support staff have increased by almost 40% since February 2010.

My Lords, I declare an interest in that I am a member of the Order of St John in Northern Ireland—and therefore St John Ambulance—and we do not have a heatwave. Can I ask the Minister: what consultations have gone on with volunteer ambulance services in England, of which there are several, what has been the result of those and how many ambulances are they prepared to put on standby in order to support the ambulance service?

My Lords, I know that both the Department for Health and Social Care and NHS England have a strong working relationship with the organisations that the noble Viscount has mentioned. On the detail of that work in terms of the heat health alert, I will have to write to him.

My Lords, handover times at hospitals of nine hours are not uncommon and 26 hours is not unheard of. What are the Government doing to ensure that the other emergency services are working in co-ordination with the ambulance service to make sure that people who need urgent care are getting it?

My Lords, I think there has been some co-ordination with other services looking at this issue. Of course, it varies from area to area and NHS England has focused its support on those areas that are struggling the most and account for the largest delays. We have talked about the taskforce to reduce delays in discharge, but the noble Baroness is also right that there is specific work going on to improve the handover process. We are looking to address the delays in every bit of the system that are causing delays up front to ambulance response times.

My Lords, I recently had occasion to contact the ambulance service—10 days ago—and I was struck by the fact that none was going to be available for a considerable period of time. Do government statistics show a difference between the availability of ambulance services in rural areas compared to urban areas?

There are 10 ambulance service trusts and they have differing levels of performance. I acknowledge that across all those 10 trusts there is pressure on the system in rural and urban areas. Our focus is to provide specific support to those trusts that are struggling the most.

There is work under way in the NHS and the Department for Health and Social Care to deliver on that pledge.

My Lords, it is recognised that the difficulty with the handover to social care is one of the reasons for the problems faced by the ambulance service. The Local Government Association, of which I am a vice-president, estimated that there would be a £2.2 billion shortfall in funding for social care within local authorities. What are the Government going to do to address that challenging problem?

My Lords, as I said, the Government have put additional funding into social care. We have also allowed local authorities flexibility in how they approach council tax and their own local precept to support that funding. Funding is an essential part of the picture, as is better co-ordination. We can learn from those areas that are more effective at smooth discharge and ensure that best practice is shared across the country. There are some pilot sites both within the NHS and in social care to try to spread that best practice.