Edward Argar – 2022 Speech on Ambulance Response Times in Shropshire

The speech made by Edward Argar, the Minister for Health, in the House of Commons on 31 March 2022.

Just as I had the pleasure of giving the final speech in the final debate before the House went into recess before the last half-term, I have the same privilege today. To that end, I congratulate the hon. Member for North Shropshire (Helen Morgan) on securing this important debate. In the short time in which she has been a Member of this House, she has taken an extremely close interest in the issues of ambulances and healthcare for her constituents more broadly. She has been assiduous in raising them in the House, as she has today, or through other means with Ministers and the Department. I pay tribute to her for that.

The hon. Lady will be aware, as she has genuinely and openly said, that there are complex causes behind the challenges faced by her constituents, and also by people around the country, with the ambulance service and ambulance response times. Ambulance services have faced extraordinary pressures, which have been particularly exacerbated during the pandemic. I am sure the House will join me in expressing gratitude, as she did, to all the ambulance service staff in the NHS for their outstanding work and dedication during this time. I recognise the very powerful individual cases that the hon. Lady cited, suitably anonymised, to illustrate her arguments and her case.

As I have mentioned, the pandemic has placed very significant demands on the service. In February this year, the service answered over 760,000 calls to 999—this is nationally, and I will turn to the hon. Lady’s local situation in due course—which is an increase of 13% on February 2020. That places very significant pressures on the ambulance service and the wider NHS, and I will turn to the broader causes shortly. She was absolutely right to highlight that the issue is often not with the ambulance service itself—the number of ambulances or the number of staff—but about handovers and the ability to do turnarounds having safely deposited a patient at an acute setting in a hospital, but I will turn to that in a minute.

A range of other issues, as well of course as demand, impact on performance, including the need for infection prevention and control measures, which remain in place in hospitals. They may not be as acute or as severe as they were at the height of the pandemic, but they are still there, and that does have an impact. There are the handover delays the hon. Lady spoke about, which are linked to capacity with those infection prevention and control measures, but also to the ability either to treat and discharge or to admit patients to a hospital. In recent months, we have also had high workforce sickness absence rates, often down to covid and covid self-isolation, with staff quite rightly taking the view that when they test positive for covid they should stay at home until they do not.

In spite of these pressures—and this is in no way to diminish the point the hon. Lady made about the impact on her constituents, but is by way of context—the average response time in the west midlands to category 1 calls, the most serious calls classified as life threatening, was maintained at eight minutes and 11 seconds in February 2022. That was despite of a 40% increase in that category of calls on the previous year and a 16% increase locally in 999 calls overall. At a national level, the category 1 response time has been largely maintained at about nine minutes on average over the last several months—so not quite as good as the performance in the West Midlands—despite a 23.5% increase in those incidents compared with before the pandemic. However, we are clear that there have been significant increases in response times in the other categories, which of course we must improve.

Helen Morgan

I just want to make the point that in Shropshire we are not seeing the same level of service that we see across the west midlands as a whole. I am calling for more granular data because I think some excellent service provided elsewhere in the West Midlands Ambulance Service area is overshadowing some of the specific problems we are seeing in Shropshire. In addition, the number of hospital admissions to the Shrewsbury and Telford Hospital NHS Trust is running roughly at the same level as in prior years, so although the covid pandemic has provided challenges in separating out such patients when they arrive through infection control measures, it is not actually leading to a higher level of admissions.

Edward Argar

I am grateful to the hon. Lady, and I will turn to her specific asks in a moment.

However, I will turn now to the Bill introduced by the hon. Member for St Albans (Daisy Cooper), which I am aware of. I have to be honest and say that we do not consider that the Bill would necessarily be the most appropriate way of achieving what she wants. The challenge with that legislation is that, at a time when we wish trusts to be focused on the delivery of frontline services, it is another administrative process of data collection. I would add that trusts of course operate at trust level, not at an individual station or county level, and trusts may cover a number of counties. So while I am aware of her legislation, it is not something that I believe would achieve the outcomes or be practical in the way she wishes, and she and I regularly have a to and fro across the Dispatch Box about a number of issues when she speaks for her party on health and care matters.

There is strong support in place to improve performance. At the national level, as the hon. Member for North Shropshire generously recognised, there was £55 million of investment last summer, in advance of the winter, to help increase ambulance staffing capacity to manage pressures. All trusts received a portion of that funding to expand capacity through additional crews on the road and additional clinical support in control rooms as well as extending hospital ambulance liaison officer cover at the most challenged acute trusts.

On overall staffing, which includes frontline clinical staff and the clinical support staff who work with them, our ambulance service has seen about a 38% increase since 2010—the Liberal Democrats can quite rightly take some credit for that from their five years in government—and, indeed, in the last year we have seen an increase of about 500 frontline staff. So we have increased staff and continue to increase available staff.

The £55 million was supported by an additional £4.4 million in capital investment—these are still national figures, but I will turn to her specific local circumstances—which helped to keep an additional 154 ambulances on the road during winter over and above normal levels. Call handler numbers, which are equally important, are being boosted with more than 2,400 on target to be in place by the end of March—the end of today. That is about 500 more FTE—full-time equivalent—staff compared with September 2021, with potential for services to increase in capacity further during the coming financial year.

NHS England and Improvement is also providing targeted support to the hospitals facing the greatest issues with delays in the handover of ambulance patients, helping them to identify short and longer-term interventions to reduce delays and get ambulances swiftly back out on the road. She is right that that is hugely important, and even more so in areas with large rural populations because of the distances involved. Trusts also receive supportive continuous central monitoring and support by NHSEI’s national ambulance co-ordination centre.

With clinical support in control rooms, the ambulance service is closing just over 11% of 999 calls with clinical advice over the phone, which is an increase of three quarters since before the pandemic. That helps to save valuable ambulance resources to respond to more urgent calls, with that clinical input ensuring that the advice and decisions are right.

The hon. Lady will be pleased to hear that significant local support is in place to improve response times in her county. The West Midlands Ambulance Service is working with community partners to help avoid conveying patients to hospital where there is no clinical necessity, providing alternate treatment and care at home or in the community and helping to avoid unnecessary trips to hospital, thereby freeing up resources and hopefully providing a more pleasant experience for those patients.

In raw numbers, the West Midlands Ambulance Service conveyed over 600 fewer patients to hospital in February based on the clinical advice this year compared with two years ago. It has also introduced a clinical validation team of advanced paramedics who work in control rooms and clinically triage lower urgency cases and, where appropriate, signpost patients to other services, as I alluded to. In February, that team reviewed 967 cases in Shropshire, of which 61% of were not sent an ambulance, 14% were treated on the scene and just 25% were conveyed to hospital. That was based on the clinical triage, which I am sure the hon. Lady agrees should be central to any decisions made. That has played a significant part in helping the service to tackle the pressures.

Other practical solutions include hospital ambulance liaison officers—HALOs—who are paramedics who work with bed managers to smooth out the flow of patients coming to an A&E department. They can provide a constant flow of information about capacity to the strategic command cell at the ambulance service headquarters, escalating any issues and avoiding queueing where possible. There is also joint work to cohort ambulance patients at A&E sites, where a single ambulance crew takes responsibility for three or four patients. That releases crews to respond to outstanding calls in the community more quickly.

A new same-day emergency centre—SDEC—has been opened at the Royal Shrewsbury to divert patients, as clinically appropriate, away from A&E, improving handover times. In the two and a half years that I have been a health Minister, I have discovered that there are probably almost as many acronyms in health as in the Ministry of Defence. Surgical SDEC capacity at the Royal Shrewsbury has also been expanded and all SDEC units receive ambulances directly for suitable patients.

The hon. Lady rightly mentioned hospitals, and I am grateful that my hon. Friend the Member for Telford (Lucy Allan) is here and made an intervention. During her seven years in the House, she has been a regular and vocal advocate for her local hospital in Telford. I pay tribute to her, because it was due to her campaigning and tenacity that there is an A&E locally at Telford. That is still seeing patients and helping to alleviate the pressure in Shropshire. She should rightly be proud of that, having successfully campaigned for it.

Action is being taken locally to improve the patient flow through hospitals by discharging patients more quickly to create bed space. The aim is not only to increase the number of discharges a day, but to bring more discharges forward to earlier in the day, when it is clinically safe to do so, to allow the effective discharge and transition back to care at home or in a care home. Health and care system partners locally are looking to create additional community and social care capacity to support timely discharge, create bed space to take patients from A&E and reduce ambulance handover times.

At a national level, we have set up a national discharge taskforce. As a Minister, I get almost daily statistics about where we are on delayed discharges across the country. It is a complex picture, with a variety of reasons behind delayed discharges. The hon. Member for North Shropshire is correct that some are about delays in getting into care homes or getting domiciliary care packages or rehabilitation packages at home. Some are also down to delays in the hospital in sign-offs and procedures, and there is more that we continue to do to drive those delays down.

Construction is also under way on a new modular ward at the Royal Shrewsbury site, with 32 additional beds in service by spring 2022. That is alongside a £9.3 million upgrade of the emergency department at the Royal Shrewsbury, delivering additional cubicles, a new and improved majors department, a new designated emergency zone for children and young people and a new clinical decisions unit. The first phase of that work is complete and all areas will be finished by spring 2022.

The hon. Lady raised a number of other issues, including the Future Fit model. We have been clear that funding of £312 million was allocated for that project, and that remains allocated. The challenge we face is that, thus far, the trust has not proposed a solution that meets that budget. We continue to work with the trust and to encourage it to do so. I hope that it will so that we can continue to drive that important project forward.

I will very gently push back on what the hon. Lady said about there being £10 billion of PPE that is not fit for purpose. She will know that that is not correct. In the statement that was made about write-downs, not write-offs, the amount was about £8.7 billion, and it was not all PPE, by any means, that was not fit for purpose. Only a tiny proportion of that was the case. A significant element of that was essentially due to over-ordering at the height of the pandemic to make sure that the frontline had the PPE that it needed. We were buying at the height of the market, and there is currently a glut of PPE, so its value has inevitably declined. Not all of it will be used, because we got more than we needed to make sure that clinicians and others on the frontline were not exposed.

The hon. Lady touched on local ambulance Make Ready stations and the changes to them. Decisions on reconfigurations and changes to that are made locally by the trust; it consults, but it makes those decisions. The Government do not have any power over those matters. The Health and Care Bill, which we debated yesterday, would give the Secretary of State greater power over such reconfigurations in the way that she asked, but her hon. Friend the Member for St Albans argued against that. I gently say that that is a matter for the local trust and the usual NHS processes on reconfigurations.

The hon. Lady touched on, I think—forgive me if I am wrong—asking the CQC to look into this issue. It is entirely open for her or others to raise it with the CQC, and the CQC will make a decision or a judgment on whether it believes that it is appropriate or otherwise to look into the matter.

In the few seconds that I have left, before Mr Deputy Speaker calls me to order, I say that I recognise and do not in any way diminish the significance of the issues that the hon. Lady raised. I hope that I have given her some reassurance that we are working through these issues and that we continue to put the support in place to help her constituents in Shropshire and more broadly.

Finally, the hon. Lady requested a meeting, and I am conscious that she has raised the issue of correspondence. I have asked for that; I believe that that has happened since Christmas, as the Department works through the backlog. There is still a delay in correspondence, but I have pulled that out and asked for it, and I am happy to meet her and her fellow Shropshire MPs, together with the ambulance trust, to discuss their collective concerns or reflections that they would like to put to me as a Minister.

I conclude by wishing the hon. Lady a very happy Easter and by thanking her for bringing this to my attention and the attention of the House.