Tabled by
To ask His Majesty’s Government what steps they are taking in
response to reports of long ambulance waits for serious
conditions, including heart attacks and strokes.
(Lab)
On behalf of my noble friend , and with his
permission, I beg leave to ask the Question standing in his name
on the Order Paper.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
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.
(Lab)
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?
(Con)
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.
(Con)
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.
(Con)
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.
(Lab)
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?
(Con)
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.
(CB)
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.
(Con)
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.
(LD)
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?
(Con)
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.
(Con)
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?
(Con)
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.
(CB)
My Lords, the Minister said that this is a systems failure. Who
in the Government is responsible and when will the system be
fixed?
(Con)
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.
