I hope I will get better at this with practice.
We are increasing NHS capacity to reduce delays and support ambulance services in getting to patients as quickly as possible. This includes action to deliver the equivalent of 7,000 extra NHS beds and £500 million in funding to help speed up patient discharge. NHS England is providing direct support to our most challenged hospitals on ambulance handover delays, as well as £150 million of additional funding for ambulance trusts and a further £20 million to upgrade the ambulance fleet.
My Lords, has the Minister been able to watch the ITV investigation broadcast in which we saw case after case of paramedics graphically describing the desperate situations they are trying to deal with? I note that, in response, his departmental spokesperson said that they recognised the problem. Will the Minister agree to report back to your Lordships’ House on what the Government are doing, when and how, to ensure that people are not left waiting for ambulances, particularly with the anticipated winter crisis on the horizon?
I thank the noble Baroness. I have been made aware of the TV series and it is on my watch list. I am looking forward to going out overnight on an ambulance control shortly to learn at first hand. Tomorrow, I am visiting ambulance response teams and leaders in the field in the Maidstone and Tunbridge Wells area. Ambulances are of key importance; they are the “A” in the ABCD plan, and that plan very much features in everything we are doing. We are active on that and will rightly report, as we are here, on a continuing basis, and, as the noble Baroness knows, regularly report the statistics to ensure that we are on top of the problem.
My Lords, the delayed response to category 1 incidents by ambulances is really due to a systems failure, whereby those who should be treated in the community are unable to be, and those who are in hospital blocking beds are unable to go back into the community, where they should be treated. I ask my noble friend the Minister what plans there are to improve social care. I also congratulate him on answering four Questions today. As a nurse, I prescribe a strong drink at the end of the afternoon.
I thank my noble friend for probably the best advice and question I have received in my marathon series. I could answer her question at great length, because I agree that this is a whole-system issue and we need a whole-system response. I would happily talk about every aspect of that but I will pick up just a couple of the specific points that she made. Social care is clearly vital to this. That is what the £500 million discharge fund is for. We are all aware—noble Lords have probably heard me say it enough times—that 13% of our beds are occupied in this way. As my noble friend states, an ambulance will visit a home and 50% of the time will not end up conveying someone into hospital. Is having an ambulance there, with three people in it, the best use of our resources when perhaps a paramedic on a bike could solve it just as well? In a similar vein, my understanding is that roughly 50% of all A&E attendances are people who do not really need emergency treatment. Again, that goes to the point about making sure that they have opportunities to receive primary care appointments, which is what the pledge to increase appointments by 50 million is all about. This is a whole-system problem and something that we are working on with a whole-system approach.
The Minister referred to the ABCD. I remember from when I read about it—it treats us rather like kindergarten children, does it not? —that “A” is for “ambulances”. But the big idea for ambulances in that document from the former Deputy Prime Minister was to create an auxiliary ambulance service. As the problem with the ambulance service at the moment is getting patients out of ambulances and into hospitals, what good will an auxiliary ambulance service do if it merely gets more people into hospital car parks, where more of them are waiting in more ambulances?
The noble Lord is referring to the whole-system issue here, which I mentioned before. There is a £450 million investment to increase capacity in A&E facilities; that has already worked to upgrade 120 trusts to enable them to offload quickly. There are also 7,000 extra beds, and the £500 million social care discharge fund is all about freeing up more beds so that ambulances can discharge quicker.
My Lords, I must declare that I am a former deputy chair of an ambulance trust that was an exceptional performer but is no longer, associated with the fact that, in some circumstances, it cannot get patients admitted to two of its largest local hospitals in under four hours. The problem is social care, not increasing the number of ambulances on the roads. Will the Government consider much more innovative approaches to respite care support for people who are ready to leave hospital and whose families cannot afford to leave work to look after them but, with incentives, probably could do so? That would be a practical way of moving the system forward at the moment.
I agree with the noble Baroness that social care is a key solution to all this. As I said, that is what is behind the 13% of beds that are currently blocked and the £500 million spend in this area. However, we can be more innovative. That is what the virtual ward initiative, which I saw working so well in Watford, is about; it has reduced reattendance rates after 90 days from 46% to around 8% for COPD patients. This is an area where we need focus and innovation, and which is very much top of my agenda.
My Lords, as the Minister has already suggested, part of the problem is unnecessary call-outs to ambulance services for people who do not need admission to hospital. Care homes regularly call on ambulance services to lift their fallen residents, even though more than 45% are uninjured and do not require transportation to hospital. If care homes had the right equipment to lift people safely, an ambulance may not be needed after a fall. Some ambulance services are providing this kind of equipment to care homes, from their own resources, to reduce the number of unnecessary call-outs. Should we not ensure that all such homes and blocks of sheltered accommodation have access to this kind of equipment, which would get people up more quickly, reduce the number of call- outs and save money?
Many noble Lords have talked today about what is a whole-system problem, which the noble Lord has mentioned in terms of care homes. It is all about treating people in the right place, with the right equipment, so I absolutely agree with this approach. It is the approach that we are taking to make sure that people are treated in the right place, so I will take the noble Lord’s suggestion back to the department.
My Lords, I remind the House of my interest in the Dispensing Doctors’ Association. My noble friend has rightly identified the problem of underfunding in primary care. What is he going to do at this time to address the chronic underfunding in the delivery of primary care in rural areas?
The government pledge of 50 million additional appointments is across the country. It is the job of the ICBs to make sure that each area is well catered for; the idea is that this is felt in every area, including rural areas. I am glad to say that we are making good progress on our target to increase appointments by 50 million and, rest assured, I am working with the integrated care boards and their systems to ensure that they touch every part of England, including rural areas.
I think I said this is a systems issue. It is something on which we—including me and the Secretary of State—are very focused, because we need to address it across the piece. That is what the ABCD plan is all about. I am very confident that, over the coming weeks and months, we will start to see improvements from the investment we are making in 7,000 more beds and £500 million more into adult social care discharge.