Ambulance Response Times

[Christine Jardine in the Chair]

15:00:00

I beg to move, That this House has considered ambulance service response times. It is a pleasure to serve with you in the Chair, Ms Jardine. I thank the Backbench Business Committee for scheduling this important debate. Unacceptable ambulance response times have become endemic in the UK, leaving people in pain and distress and costing lives. An estimated 50,000 people died last year after long A&E waits, according to Office for National Statistics data. One of those was Jim’s wife in Street. She was suffering from aggressive liver and bowel cancer and had to wait seven hours in agony for an ambulance in February last year. When the ambulance arrived, Jim and his wife were told that the crew were not trained to take her downstairs, so they were left to wait for another crew. When they arrived, several hours later, Jim’s wife was too ill to be moved and was told that the journey would kill her. She died shortly after. Jim told me again today how that experience still makes him angry, yet he recognises the perilous state that the NHS is in, caused largely by the last Conservative Government. Like Jim, many people have lost faith in health services after the NHS was stretched and left grossly underfunded as a result of the last Conservative Government’s neglect. We know that this is having a devastating impact on patients, but it is also impacting the incredibly hard-working medical staff. The 2023 NHS staff survey showed that 39% of ambulance staff respondents often or always felt burnt out. The number is higher for control room staff, at 44%, and higher still for ambulance technicians and paramedics, at 45%. I am sure that Members across the House will join me in thanking and paying tribute to everyone working in the ambulance service whose hard work, dedication and commitment to patient safety is second to none. Most people in Somerset will sadly know of someone who has faced a heartbreakingly long wait for an ambulance. The family of an 89-year-old Somerton resident told me how they faced a 10-hour wait, stuck in agony on the floor, as no ambulances could come to help them. Another resident told me about their ordeal of having to prop their mother up on the toilet after she had had a fall. They then had to spend 13 long hours waiting for an ambulance to arrive. I am sure other Members will have similar heartbreaking examples. It is important to understand the context of these examples, so I will briefly outline the NHS targets: seven minutes for category 1 calls, for which 90% of ambulances should arrive within 15 minutes; 18 minutes for category 2 calls, for which 90% of ambulances should arrive within 40 minutes; while 90% of ambulances for category 3 and 4 calls should arrive within two and three hours respectively. Those targets remain unmet in the south-west, where we have the worst-performing ambulance service in the country. In January 2025, South Western Ambulance Service failed to meet the targets for category 1 and 2 calls. The average time it took to respond to a category 2 call was 51 minutes and 45 seconds—nearly three times slower than the NHS target. This has serious repercussions for people’s health. In every minute that a stroke is left untreated, nearly 2 million brain cells die, and lifesaving treatments such as clot-busting drugs need to be delivered quickly, often within four and a half hours. I have heard from many constituents across Glastonbury and Somerton who are deeply concerned by the delays in stroke treatment due to ambulance waiting times. These fears are compounded by the planned closure of Yeovil district hospital’s hyper-acute services. The reconfiguration of services will mean that all patients who have suffered a serious life-threatening stroke will be taken to hyper-acute stroke units in Dorchester or Taunton to receive care. As much as these new cutting-edge services and facilities are welcome in the south-west, the fact remains that if stroke patients or any patient needing emergency treatment gets to hospital too late, the results will be catastrophic without improvements to the ambulance service, and all the best equipment, drugs and treatment by clinicians will have minimal impact on patient outcomes. I have spoken about the impact of these changes on stroke care in this place before. I do not feel it necessary to go into detail again today, suffice to say that ambulance delays only increase the pressure on stroke services. The Liberal Democrats have demanded that localised data on ambulance delays is published, so rural areas like Somerset that are underperforming can receive focused and appropriate support. I would welcome the Minister’s comments on that. Lengthy delays are made all the worse when we consider the impact of drawn-out handover times, meaning ambulance crews are unable to head back out on to the road to pick up more patients. The Darzi review laid bare just how dire the situation has become. In 2024, around 800 working days each day were lost due to handover delays. Incredibly, that is the full-time equivalent of nearly 14,000 paramedics over a year. In addition, ambulances across England collectively spent 112 years waiting outside hospitals to hand over patients in 2023-24.

I was in my local hospital, Queen’s medical centre in Nottingham, where they are currently trialling 45-minute handovers, to make sure that paramedics get back on the road as quickly as possible, while also making sure that patients are safely handed over into the target speciality care they need. Does the hon. Member welcome that sort of trial, given the challenges she describes?

I thank the hon. Gentleman for his intervention. I will come to that point a little later. With the stark realities facing people in an emergency and the distressing sight of ambulances backed up at hospitals now commonplace, leaving my constituents in Glastonbury and Somerton in despair, it is time to properly address these failures. The NHS standard contract states that handovers between ambulance and emergency departments should be 100% within 60 minutes, 95% within 30 minutes and 65% within 15 minutes, but these targets are left unmet. Between October 2023 and June 2024, 3.7 million handovers took an average of 35 minutes and one second, resulting in over 900,000 hours lost. It is even worse in the south-west. In January 2025, over half the handovers took over 30 minutes, which is nearly 30% higher than the England average. We in the south-west face specific issues due to our rurality. Analysis by the Liberal Democrats revealed that waits for life-threatening calls were 45% longer in rural areas than in urban areas. The South Western Ambulance Service has responsibility for the provision of ambulance services across 10,000 square miles, covering an incredible 20% of mainland England. Rural regions have a lower capacity to divert ambulances to other hospitals during periods of significant pressure, largely due to the vast distances between emergency departments. We may now see ambulance teams in Somerset adopt a “drop and go” policy, which involves leaving patients in certain areas in a hospital without an official handover to A&E staff. The nationally defined target for hospitals included in the NHS standard contract states that after 15 minutes of waiting, the patient in the ambulance becomes the responsibility of the hospital. If no formal handover to A&E happens within 45 minutes, the ambulance crews can just leave the patient within the department and get back on the road. The South West Ambulance Service is moving towards this approach with hospitals from Swindon and Bristol to Cornwall and Plymouth. Although this policy might alleviate some of the pressure on ambulance crews, it would fail to ease the struggles that underfunded and overstretched A&E departments in Somerset are facing. Somerset has an ageing population: within the next decade, one in three people in Glastonbury and Somerton will be 65 or older. That may make it harder to quickly discharge patients, as some may also require onward social care provision. It is inevitable, therefore, that delayed discharge due to internal processes such as waiting for pharmacy diagnostics and therapy assessments, and a lack of capacity in adult social care, will lead to poorer ambulance service performance. The social care crisis has a devastating effect on the healthcare system. Last year, Care England said that “over 45% of hospital discharge delays are linked to social care”. One in seven hospital beds are taken up by people who are medically fit to be discharged. For patients, delayed discharge can lead to an increased risk of hospital infections and the loss of mobility or cognitive function, and can make it harder for them to regain their independence. The problems in the healthcare system will never be fixed unless we urgently address the social care crisis. Only last week, social care providers felt the need to protest against Government inaction for the first time ever. The Liberal Democrats have been campaigning to fix social care by introducing free personal care based on the model introduced in Scotland, so that provision is based on need, not ability to pay. We also welcome the cross-party commission to forge a long-term agreement on social care, but we believe it can be completed within a year, not three. We cannot afford to kick this can any further down the road, and I urge the Government to listen to the Liberal Democrats’ calls. We also need to solve the hospital bed shortage in the UK. The lack of available beds negatively impacts hospital flow. As a comparison, the OECD EU nations have about five beds per 1,000 people, whereas the UK has only 2.4. The Royal College of Physicians revealed that four out of five doctors were forced to provide corridor care in the past month due to a lack of hospital beds. According to the Royal College of Emergency Medicine, bed occupancy is at a staggering 93%. The Liberal Democrats want to bring that down to a safe 85% by increasing the number of staffed hospital beds. We are waiting for the Government to publish the urgent and emergency care improvement plan soon, along with the 10-year health plan. It is vital that we urgently wrestle with the problems that the Conservatives left behind to ensure the safety of patients. Over the past seven years, the previous Conservative Government were forced to find an average of £376 million of emergency funding each year to tackle the NHS winter crises. Under the Liberal Democrat proposals, a new winter taskforce would instead manage a ringfenced fund of £1.5 billion over the next four years to build resilience in hospital wards, accident and emergency departments, ambulance services and patient discharging. That would allow integrated care boards and NHS trusts to plan their budgets more effectively to prevent winter crises, instead of just receiving emergency funding from the Government at the last minute. We urgently need to give our healthcare services the ability to forward plan. They must not be forced to deal with crises on the fly as situations unfold. Somerset’s ambulance services, like all services across the country, desperately need and deserve support. Localised data must be published to help pinpoint specific improvements that can be made in rural areas. The Government have outlined their desire to improve urgent and emergency care—they accept that ambulance waiting times are unacceptable—but now is the time to act to achieve those objectives; otherwise, more people will suffer and sadly some lives will be lost. That must be part of a serious rethink about the way we fund social care; otherwise, we will never move towards a solution that works.

I remind Members they should bob if they wish to be called to speak in the debate.

15:15:00

It is a pleasure to serve under your chairmanship, Ms Jardine. I thank the hon. Member for Glastonbury and Somerton (Sarah Dyke) for securing this much-needed debate. It is incumbent on us to get the waiting times down to the level that we all expect because in a medical emergency every second counts. Every minute without the right care could mean the difference between life or death, independence or disability, full recovery or a lifetime of complications. Yet, across nearly all categories, ambulances are failing to meet their target response times. They are often stuck waiting instead of saving lives, held up by staff shortages or gridlocked outside hospitals with no beds to offload patients. I know this from personal experience because my health trust suffers from it more than most in London. We all have a stake in improving our NHS. We all want to see more beds, more timely treatment and a healthcare system that keeps our friends, neighbours and families healthier for longer. Last year, Labour’s Budget unlocked £22.6 billion in funding for the NHS over the next two years to pay our doctors fairly, to provide critical hospital beds, and to end the backlog, but for emergency services there remains a critical issue that pumping money into the NHS alone will not fix: staff shortages. Paramedics have one of the highest turnover rates of any profession. Although the number of paramedics has increased since March 2018, absence caused by poor mental health has also increased and so has the number of staff leaving the field all together. Between 2022 and 2023, nearly 7,000 paramedics left their jobs—a 51% increase in leavers from 2019-2020. Without enough staff, ambulances cannot operate at full capacity and response times suffer. In the current state of the NHS, paramedics are overworked, stretched to the limit and living with the consequences of underfunding and lack of support. Burnout is not just a risk; it is their reality. Who can blame paramedics for wanting to leave? Let us be clear: we have reached this point not because paramedics are not working hard enough, because they are, but because the emergency services have become a safety net. Without preventive measures such as screening, GP appointments or adequate social care, patients get treated only when their condition has escalated to a true emergency, putting undue stress on services. When patients can be treated only once their condition has become an emergency, it is a failure of the system and it increases pressure on our emergency services. It is a bad deal for patients and for those working tirelessly in our emergency services—a deal made possible by 14 years of Tory mismanagement, underfunding and neglect. If we want better health outcomes and to meet our response time targets, we must make bold structural changes. We need to ensure that paramedics are not carrying the burden of overstretched services in every corner of the NHS. We must ensure that all parts of the NHS function well, from community screenings to adequate support for paramedics, who should be able to continue in their roles and not be driven out because the system has made it unbearable to stay. Every minute counts for overworked paramedics at breaking point and the patients who desperately need their care. I look to the Minister to do the heavy lifting and fix the broken system, which will be the difference between life and death.

I call Nicholas Timothy.

15:19:00

Thank you, Ms Jardine, for calling me to speak and also for giving me my full name, Nicholas—I think the last time that was done was when I was six years old and in trouble with my mother. I applaud the hon. Member for Glastonbury and Somerton (Sarah Dyke) for securing this very important debate. I think we can all agree that this is an important issue not only for our constituents, but for every community across the country. As we have just heard, the time it takes for an ambulance to reach people in need of urgent medical care can make all the difference in saving lives. We have a responsibility to engage constructively across party lines to find solutions that work. Since the pandemic hit, we have all seen the challenges faced by our local health services, and ambulances are no exception. In January, average response times for the two highest priority incidents missed NHS targets. Official data shows average response times for category 1 incidents of eight minutes and 16 seconds, instead of the seven-minute target, and average response times for category 2 incidents of 35 minutes and 40 seconds, instead of the 18-minute target. Even those statistics obscure dramatic variation across the country. This is particularly concerning in my constituency of West Suffolk. Haverhill, our biggest town, has a population of 30,000 people, but the response times for the highest priority incidents in Haverhill are twice as long as they are in Cambridge. Figures from the NHS England weekly ambulance scorecard show that in the 12-month period to the end of September, Cambridge’s average response time for category 1 incidents was 7.3 minutes, just missing the national target, but Haverhill’s was 14.7 minutes. Ambulances starting their shifts in Haverhill are often dispatched towards Cambridge, which is 15 miles away at its nearest point. This is an inequality that needs to be addressed as soon as possible. The problem arises in part from the fact that Haverhill ambulance station is located right on the county boundary, at the edge of south Cambridgeshire. The ambulance station is used for maintenance, but it does not have its own ambulances on standby. This appears to have a negative effect on how ambulances are assigned for the local area, with resources sucked into Cambridgeshire and staying there. Addenbrooke’s hospital has become a hotspot for this problem: ambulances with patients waiting to be treated wait outside for long periods, instead of responding to more incidents in and around Haverhill. I have spoken to the East of England Ambulance Service several times over the past few months to learn more about the situation. It believes that the system status plan, which decides where to send ambulances, should be changed so that Haverhill becomes a priority and more ambulances can be sent there. Since my election, I have also been making the case for a co-located and purpose-built blue light facility in the town. This would allow the local police, fire and rescue service, and ambulance service to better serve local residents and save taxpayers’ money. The plan has the support of local councillors and several interested parties, and the Government have also made positive comments about adopting this approach nationally. I look forward to the publication of the Government’s urgent and emergency care improvement plan, as well as the 10-year health plan. I remind the Minister of the Health Secretary’s commitment, which he made on the Floor of the House, to follow up with me regarding this proposal. Since the Health Secretary made that commitment, I have not received a response to my letter. I hope that a Minister or appropriate official from the Department will come to visit us in West Suffolk. It would be an excellent opportunity for them to meet representatives of the East of England Ambulance Service NHS Trust, officers from Suffolk police, the Suffolk police and crime commissioner, and the fire and rescue service to discuss the next steps. I hope that today’s debate will provide us all with an opportunity to work together to improve ambulance services. I know that the problems that I have described in West Suffolk exist in other parts of the country, and we have much to learn from one another. There are solutions that can be implemented to deliver faster response times and improve outcomes for our constituents. I look forward to supporting any practical measures to help achieve exactly that.

15:24:00

It is a pleasure to serve under your chairmanship, Ms Jardine. I congratulate the hon. Member for Glastonbury and Somerton (Sarah Dyke) on securing today’s important debate. I welcome the news that ambulance waiting times are slowly improving in my area of the west midlands, but I would like to raise an issue that has been brought to me by several of my constituents in very distressing circumstances: how long those ambulances are having to wait outside A&E departments. An ambulance service needs hospital services that can support it, and my constituents deserve to know that if they need urgent healthcare, an ambulance will turn up quickly and be able to deliver them to the appropriate care as soon as possible. At the moment, that is simply not happening: 66.6% of ambulances at Worcestershire Royal hospital, which serves many of my constituents, were left waiting longer than 30 minutes in the first week of January 2025. Prior to that, in October, only 50% of people attending any of the trust’s A&E departments, including mine in Redditch, were treated, admitted, or discharged within four hours. That same month, 1,300 ambulance patients waited more than an hour outside. I would like to share what that means in reality for some of my constituents. My constituent Connie’s mother was sat in the back of an ambulance for hours outside the Royal, waiting for space to go in. Once she was finally admitted, she was left in a chair in a corridor for even longer. Not only is that a distressing situation for the patient, but while she was unable to be admitted, that ambulance was forced to stay outside and not be redeployed to help others. I heard from another constituent, Elaine, who had to call an ambulance for her 80-year-old mother-in-law due to a serious hypoglycaemic event, and although the ambulance crew were prompt in their arrival, she spent seven hours in the back of an ambulance as the A&E was not in a position to take her. She then spent 48 hours in A&E and a further three weeks in hospital before she was discharged, having received excellent care, but it is those seven hours that still stay with her now. At the Alexandra hospital in my constituency, there are no in-patient children’s beds, so very sick children have to be taken to Worcestershire by ambulance if they need to be admitted. The Minister knows all too well that I have raised this issue with her before. If these services were provided more locally, over more than one site, ambulances would be freed up to deal with truly urgent cases across Worcestershire. Our ambulance and hospital staff work tirelessly to help us stay safe and well, but they are being let down by a system that has been neglected for too long. I will not make a party political point, but—let’s be honest—we pay for the service we get. As the son of someone who worked in the NHS for 40 years, I would say that for too long we have not been investing in our health and social care systems in this country. We must take action now to ensure that our hospitals are given the resources they need so that handovers from ambulances can take place quickly and safely, and patients can truly receive the care that they deserve.

15:27:00

It is a pleasure to serve under your chairmanship, Ms Jardine. I congratulate my hon. Friend the Member for Glastonbury and Somerton (Sarah Dyke) on securing this important debate. From the January 2024 figures, we can see that the South Western Ambulance Service consistently ranked near the bottom across all categories of ambulance response times. The mean response times were nearly all below NHS targets, and the longest category 4 response was over nine hours against a target of three. The geography of rural Devon, and particularly of my constituency of South Devon, is not conducive to speedy ambulance response times—I would challenge anyone to drive along our hedge-lined rural lanes at speed, even with a blue light flashing—so it is no wonder that figures might be lower than national NHS targets dictate, but while ambulances spend hours waiting at clogged A&E departments, they are not out on the road responding to patients. I will focus particularly on two areas. The first is the very worrying issue of the proposed relocation of out-of-hours emergency cardiac services from Torbay Hospital to Exeter, which is being proposed by Getting It Right First Time—a programme that claims to present “a data-driven evidence base to support change.” Patients in Torbay and South Devon currently face significant delays with ambulances already struggling to meet response time targets, but with the relocation of cardiology services, ambulances will have to travel an extra 20 miles to Exeter after collecting and stabilising a patient, and for those who live in the furthest southern part of my constituency—Dartmouth, for example—this is a significant extra travel time to add to what is already quite a long and slow journey. That extra travel time will delay critical interventions for heart attack patients. For every 30-minute delay to treatment, there is a 7.5% increase in mortality. In other words, that is 15 people out of every 200 who could lose their life because of an extra half-hour delay. Last week, a dozen cardiologists at Torbay hospital met me and other local MPs. They told us that they have been calling on the local ICB for a year not to go through with the change and that, crucially, no evidence has been presented in a case that would justify the move. They said that even 10 to 15 minutes can literally save a life. We know that quicker response times also mean a better chance of full recovery for patients who get to hospital in time to survive. Most worryingly, South Western Ambulance Service did not know anything about the proposed move. It feels appropriate, while we are discussing ambulance services, to say that that strikes me as wholly unacceptable for a body that wants to “get it right”. There is growing support for treating strokes as category 1 emergencies, on a par with conditions such as cardiac arrest, due to their time-sensitive nature, which my hon. Friend the Member for Glastonbury and Somerton described. Quicker responses could significantly improve long-term outcomes, reducing the risk of permanent disability or death. The first three hours are critical for intervention as brain tissue continues to deteriorate after that. Faster treatment helps to prevent that damage. Although strokes are in category 2, evidence shows that response times often exceed the ideal timeframe. The average time it takes for an ambulance to arrive and provide care for category 2 calls is often well beyond the optimal window for effective stroke treatment. In the south-west, the mean time for an ambulance to respond to a cat 2 call was nearly 52 minutes, against an NHS target of just 18 minutes. The longest time was one hour and 53 minutes. Changing the categorisation of stroke could ensure that ambulances prioritise stroke victims as they would a cardiac arrest or a trauma case, which could improve response times and overall care. That would put yet more pressure on ambulance services but, after all the public education campaigns about recognising stroke symptoms—which are very welcome—ambulances are simply not arriving in time to provide the necessary treatment. Our paramedics and ambulance services have so much to offer, from providing lifesaving urgent medical care to delivering care in the community and driving welcome innovation for the NHS. Yet according to official NHS figures, in the winter of 2023-24 ambulances across England collectively spent a staggering total of 112 years waiting outside hospitals to hand patients over. It is an astonishing and dangerous waste of resources for ambulances to be stuck for hours waiting outside crammed A&Es. As my hon. Friend the Member for Glastonbury and Somerton said, the crisis in our social care system goes a long way to exacerbating bed blocking in hospitals, which is having a direct impact on ambulance services. The Liberal Democrats are calling on the Government to publish accessible, localised reports of ambulance response times and create an emergency fund to reverse closures of community ambulance stations—which are particularly vital in rural areas—and cancel planned closures where needed. We need a proper plan to fund this crucial part of our NHS, rather than last-minute emergency funding each year during repeated winter crises, which does not enable local trusts and ICBs to plan effectively and efficiently.

15:33:00

It is a pleasure to serve under your chairship, Ms Jardine. NHS England has set ambulance response time targets since 2018. As the hon. Member for Glastonbury and Somerton (Sarah Dyke) indicated, there are four categories of severity for ambulance calls, each with a different response-time standard. In my Wolverhampton West constituency, ambulance response times are managed by the West Midlands Ambulance Service. The Care Quality Commission’s 2023 inspection of the West Midlands Ambulance Service resulted in a regulation 12 notice for response times. I pay tribute to ambulance workers, who work very hard. When the ambulance was called for my parents, before they passed away, the ambulance workers were very diligent. They worked very hard and did their best for my parents. I wish to address an issue raised by my hon. Friend the Member for Ilford South (Jas Athwal): mental health among ambulance workers. Sadly, it has come to my attention as the MP in Wolverhampton West that there have been cases of bullying and harassment among ambulance workers, with whistleblowers then being targeted by management. Although I appreciate that this is probably a discussion for another time, I want to emphasise that we need to protect whistleblowers in our health service. The wellbeing of ambulance workers will have an impact on ambulance response times. The Black Country integrated care system covers my constituency of Wolverhampton West. On the four categories for ambulance response times, although the ICS’s response time for category 1 was found to be within target, the response times for categories 2, 3 and 4 were under target. In January this year, the Secretary of State for Health and Social Care acknowledged that patients have been let down by ambulances that do not arrive on time, and that there is variation in performance across different parts of the country. He also mentioned the urgent and emergency care improvement plan, which is currently in production and will be published before spring 2025. I look forward to seeing the results. The Government’s mandate to NHS England this year includes an objective to reform and improve urgent and emergency care. The mandate describes ambulance response times and A&E waiting times as unacceptable. NHS England’s priorities and operational planning guidance includes a national priority to improve A&E waiting and ambulance response times. As a Government we have made excellent strides in reducing hospital waiting lists and making more hospital appointments available, and we have improved accessibility to GP appointments. In the same way as we have made strides in reducing hospital waiting lists and increasing hospital appointments, we must now make similar strides in improving ambulance response times.

I call the Liberal Democrat spokesperson.

15:37:00

It is a pleasure to serve with you in the Chair, Ms Jardine. I thank my hon. Friend the Member for Glastonbury and Somerton (Sarah Dyke) for securing this important debate and for opening it with, as usual, a thoughtful and well-researched contribution. It is no surprise that Members have largely been in agreement in this debate, and they have made useful contributions, so I will quickly run through them. The hon. Member for Ilford South (Jas Athwal) importantly highlighted the issue of burnout and the impact of the current situation on hard-working staff in the ambulance service, and the hon. Member for West Suffolk (Nick Timothy) highlighted the huge regional variations and the inequality of service for people who live in very rural areas. The hon. Member for Redditch (Chris Bloore) told a story—which would be familiar to people in Shropshire—of long handover delays; my hon. Friend the Member for South Devon (Caroline Voaden) mentioned the importance of dealing with stroke patients and seeing them quickly; and the hon. Member for Wolverhampton West (Warinder Juss), with whom my constituents and I share the West Midlands Ambulance Service, highlighted some of our concerns with that service as a whole. I was first elected in the North Shropshire by-election back in December 2021. All that time ago, when my colleagues and I were out canvassing, it was extremely apparent that ambulance service delays were the No. 1 issue for my constituents. Every canvassing session we did, somebody heard an absolutely heartbreaking story of an ambulance delay that had led to a much worse outcome for a loved one, or possibly even a death. In all honesty, it was a shocking campaigning issue to have to focus on. Almost a year later, after being elected, I completed a shift with West Midlands Ambulance Service in Shropshire, and I was blown away by the professionalism, dedication and hard work of the ambulance crew. But suffice it to say, the delays were still as appalling as they had been a year before. Since then, there has been huge political turmoil, and that has not helped the situation. There have been four Prime Ministers, six Secretaries of State for Health and Social Care, and two Governments, and I am afraid to say we are still not seeing the improvement that we need. This winter, handover and waiting times reached the point where in some ambulance services people suffering heart attacks were at times advised to drive themselves to hospital. That is an unacceptable situation. The most recent available data for my local ambulance service in Shropshire—the rural element of the West Midlands Ambulance Service—goes up to December 2024, and it still paints a stark picture of the distressing reality facing my constituents and people across Shropshire. The mean waiting time for category 1 callouts was 12 minutes 19 seconds, while the target is seven minutes. For category 2 callouts, the mean waiting time was 50 minutes and 36 seconds, while the target is 18 minutes. Those categories include callouts to people suffering from heart attacks and suspected strokes. For category 3 callouts, the mean waiting time was well over 200 minutes, and the target is an hour. After a long campaign, £21 million was secured to boost emergency care, and there has been improvement, but response times are still totally unacceptable. At times, as many as 16 ambulances have been queuing outside the Shrewsbury and Telford emergency departments that serve my constituents. More than one in three ambulances have to wait for more than an hour to hand over a patient, and the longest wait was an astonishing 17 hours. Even this week, as we approach the spring, a constituent told me they had stopped to help an elderly lady laying on a cold pavement with a suspected stroke and had had to wait nearly an hour and a half for an ambulance or first responder to arrive. All the while, the lady’s breath become more and more shallow. This crisis is real, and it has not significantly improved. Let us look at the national picture. The Darzi report found that each day in 2024 around 800 working days were lost to handover delays. However we cut that—14,000 paramedics a year; 112 years—it is just not acceptable. It is no surprise that people have lost faith in emergency health services as a result of the last Government’s appalling neglect of the NHS. The paramedics, nurses and doctors in our emergency departments go above and beyond, but they are stretched to breaking point and are unfortunately starting to leave the service because of burnout. We are campaigning to end excessive handover delays by increasing the number of staffed hospital beds and by tackling the impact of degrading corridor care. Let me focus for a moment on social care. Crucially, A&E delays are often caused by an inability to admit patients because thousands of people are stuck in hospital every day when they would be better cared for elsewhere. Bed occupancy is well above safe levels in hospitals, and one in seven hospital beds are occupied by somebody who would be better cared for either in a care home or in their own home. Meanwhile, local authorities such as Shropshire are spending as much as 80% of their budget on social care. They are at risk of issuing section 114 notices as they are unable to cope any longer. It is really important that we get on with the cross-party talks on social care and with the Casey review. We in the Liberal Democrat party absolutely welcome that, but we urge the Government to speed up the timetable and crack on with it as soon as possible, because 2028 is too late for a long-term solution for social care. The cross-party talks that fell through last week need to be reinstated. I urge the Minister to encourage the Secretary of State to do that as soon as possible. Let us focus for a moment on the rural problem. Imagine an ideal scenario in which the issue of handover delays has been resolved, the urgent and emergency care plan has been successfully implemented and the 10-year plan has sorted out other issues across the NHS. For those who live near Oswestry, Whitchurch or Market Drayton in my constituency, the nearest community ambulance station has closed and the nearest station or hospital is well over 20 minutes away—that is, if the traffic is clear. Otherwise, if the response time targets for category 1 or 2 calls is to be met, they are reliant on a spare ambulance roaming free in the community, waiting for that call to come in. That is unrealistic. We would expect and hope that, in between calls, paramedics would go and have a cup of tea and a sit down, to decompress from some of the awful things they have seen that day, if they do not have a patient to go to immediately. Hopefully, they go back to the ambulance station in between call-outs. The implementation of this centralised model across the country is detrimental to the people who live a long way from an ambulance station. It may well be efficient in urban areas, but it certainly is not working in rural ones. I hope the Minister will commit to reviewing the service that is received in rural places. There are thousands of people in large market towns. For example, Oswestry has nearly 18,000 residents, Market Drayton has more than 12,000 and Whitchurch has nearly 10,000. These people expect to receive an ambulance within the target time. I must urge the Minister to commit to looking at ambulance station provision in those areas. I also repeat my colleagues’ calls for the Government to publish accessible, localised reports on response times and to create an emergency fund to reverse the closures of community ambulance stations that have already taken place. The Midlands Air Ambulance Charity does fantastic work across the west midlands and is one of the busiest air ambulance charities in the country. It does not have an NHS contract; it is entirely reliant on the contributions of people living locally. I wonder whether the Minister might consider putting air ambulance services on a statutory footing, because we are so dependent on them, particularly when specialist hospitals might be a long way away and air ambulance crews supply specialist support to stabilise patients where they are found, at the roadside or in their home. The situation is unacceptable, and I look forward to seeing the urgent and emergency care plan, which I hope it will consider the needs of rural areas. I must urge the Minister to look at social care, because that is one of the key things we need to do to fix the crisis in the NHS.

I call the Opposition spokesperson.

15:46:00

It is a pleasure to serve under your chairmanship, Ms Jardine. I thank the hon. Member for Glastonbury and Somerton (Sarah Dyke) for securing a debate on this important subject. I pay tribute to the ambulance services and to paramedics and their colleagues, who are on the frontline of our healthcare service, today and every day. Regardless of the weather, or whether it is a bank holiday, they are always there for all of us. In my medical career, I have been required to deliver full intensive care to children, and particularly babies, who were being transferred across the county in East Midlands ambulances throughout the night and day. I have hurtled along in the back of an ambulance as it travelled down country roads, around corners and down the hard shoulder of motorways, so I understand some of what ambulance crews do. That has given me a deep appreciation of their work, and highlighted to me some of the unique challenges and pressures they face, particularly in our rural areas. Before I was elected, I had two experiences of delayed ambulance services. On one occasion, I was driving up the A1 when the gentleman in the car in front of me skidded on some water and went into a tree. I am sorry to say that the ambulance took a very long time to arrive, and he died shortly afterwards. There was a fire truck, police officers and an incident manager, but there was no ambulance service. I do not think it would have made a difference to the outcome, but in other cases it might have. On another occasion, I was sat in traffic when a police officer knocked on the window, which is always slightly worrying. They were looking for a doctor because they had been waiting so long for an ambulance for the people in the accident that was causing the traffic. It took a further 40 minutes from me arriving at the scene for the ambulance to arrive—I am not clear how long the people at the scene had been waiting before. So this issue was a great priority for me before I became a Member of Parliament. In my first question at Prime Minister’s Question Time, in January 2017, I thanked the East Midlands Ambulance Service for its brave and stellar work serving the people of Sleaford and North Hykeham, and asked for ambulance service response times to be a priority. I also raised the issue in my first meetings with the then Prime Minister and Health Secretary. I understand that response times have improved somewhat, at different periods with different initiatives but overall, as we have heard, they are not where we need them to be. In January, a constituent wrote to my office detailing the difficult experience of waiting too long for an ambulance to arrive. This 85-year-old gentleman came downstairs at 10 am to find his 82-year-old wife, who suffers from advanced dementia, lying on the hardwood floor, covered in blood, crying and confused. He managed to get her into a chair, calm her down and call 999. The operator could not hear him properly because the phone service was bad, his wife was crying and trying to get out of the chair, and he was struggling. Eventually, he was told the ambulance would be there in 12 hours. The ambulance did eventually arrive, and his wife is now in a stable condition, but that was a traumatising experience for her and the 85-year-old man. I was sorry to read that harrowing tale, and tales like it are too common across the country. I am interested in what the Minister will do to improve the situation; it is easy to say that things are not where they need to be, but it is important to consider how one can improve them, and that is what I hope to hear from her. Of course, the pandemic threw everything off kilter, and demand for ambulance services rose significantly, with almost 3 million calls in March 2020. In 2022-23, an extra £150 million was allocated to improve ambulance response times through extra call handler recruitment and retention. In January 2023, to improve performance further, the last Government published an urgent and emergency care plan, which set out ambitions to improve average ambulance response times for category 2 incidents to 30 minutes over 2023-24, with further improvement in 2024-25 to get back towards pre-pandemic levels. The plan aimed to increase ambulance capacity by making over 800 new ambulances available during 2023-24, including 100 new specialist mental health vehicles for those who require different types of service. However, in December 2024, under this Government, ambulance response times rose to an average of three hours and two minutes for category 3 calls—category 3 covers elderly people who suffer falls but not a head injury. What steps will the Government take with NHS England to reduce those response times so that people are not waiting hours in pain and discomfort? I have said to the Minister that it is important that we talk about how we can improve things, as well as about what the problems are. It is crucial that we all do that, and one suggestion from my hon. Friend the Member for West Suffolk (Nick Timothy) was co-located blue-light services—I am sure he is aware that the first such services were opened not long ago in Lincolnshire. The blue light hub tri-service centre, in the Lincoln constituency, is a co-located site, and co-location is leading to improvements in services. Although that is not my constituency, I am sure the hon. Member for Lincoln (Mr Falconer) would be open to an approach if my hon. Friend wished to see the site. It is important to look at risk all along the pathway. We have talked about handover delays, but there is a whole pathway from the moment someone calls 999 to the transfer journey, the wait to get into A&E and then the wait in A&E. The risk is clearly highest at the point where someone has called 999 but does not yet have access to on-site or in-person medical care. To improve that, we need more ambulances on the road and fewer sat outside A&E. I have some questions for the Minister. Ambulances are double-crewed—there are two people in the ambulance —but do two staff need to stay with the patient? If two ambulances have arrived, each with two staff and one patient, could two of the four crew go off in one of the ambulances to see more patients? That would avoid a situation where there are two staff per patient in the ambulance, when many patients are not that unwell medically. Nursing in intensive care is only one to one, but we are providing higher levels of care than that with these staffing ratios. Is that necessary? We also have a delay in handover—in getting people out of the ambulances—because the A&E is said to be full. The front door is open, but the back door, for people coming in an ambulance, is in effect closed. If patients got out of the ambulance and walked round the building to the front door, they could go in and be triaged as normal. It does not make sense. Some of my medical colleagues have gone to see people in the ambulance and discharged them from there, without their needing to come into the hospital at all. So there are clearly people with a level of medical acuity that would potentially allow the crew, with guidance and training, to discharge them into the front door of the hospital instead. On another question, if some people are well enough to be discharged from ambulances, are the public sufficiently aware of what constitutes a necessity when it comes to calling an ambulance? How many ambulances that are called are necessary? One would not wish to deter anyone who is frightened and concerned for their wellbeing from calling an ambulance if they feel they need one, but education on when one is needed might be useful. As has been alluded to, staff retention is also important. One o constituent—a single mum with children—left her role as a paramedic because she was struggling with working hours that overlapped with getting her children ready for school in the morning. She was able to cover most other aspects of childcare—such as picking them up from school—with after-school clubs and the like, but she struggled in a morning, and her flexible working request was refused. I recognise that there must be balance, and that all hours of the day must be covered by ambulances, but has the Minister thought about how working practices and hours could be changed? The Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), mentioned resources in rural areas. That is important because response times will necessarily be increased by the geography, so greater levels of resource perhaps need to be provided to rural areas, in recognition of the fact that if we want response times in them to fall, we need a higher level of ambulance availability. Another significant factor causing delayed ambulance response times is staff sickness, which is not necessarily an issue of NHS funding. Ambulance services in England report the highest level of sickness absence rates of any other profession across the NHS. Against a national average absence rate of 4.3% over an eight-year period, ambulance staff showed an average absence rate of 6.2%, with year-on-year increases. There are stark regional differences in sickness rates, with the West Midlands Ambulance Service consistently maintaining a lower absence rate—around 50% lower than its counterparts in London or the east midlands. The NHS would benefit from sharing best practices between trusts, which would make a real difference, ensuring a healthier workforce and, ultimately, better patient care. The issue is also costly financially, and an independent review published by Lord Carter in 2016 estimated even then that a mere 1% reduction in staff absences could save ambulance trusts up to £15 million a year. That figure would clearly be even higher now. I also want to raise the issue of air ambulance services. Air ambulance charities deliver lifesaving treatment every single day and complete more than 25,000 lifesaving missions across the country every year—an average of more than one every 10 minutes. I commend the work of all those involved, and particularly Lincs & Notts Air Ambulance, which operates in and around my constituency, the crew who airlifted my husband from Silverstone to Coventry last year and looked after him so well. In the last Parliament, the previous Government gave significant support to air ambulances. The Department of Health and Social Care’s three-year capital grant programme in 2019 allocated £10 million to nine charities across England. That funding supported air ambulance charities to move towards 24/7 operations and improved seven airbase facilities across England. However, services are now under threat from the Chancellor’s rise in national insurance and taxes. Lincs & Notts Air Ambulance will need to find another £70,000 just to pay the national insurance rise—this is an entirely charitably funded organisation. Can the Minister justify that policy, given the vital work that air ambulance charities do across the country? On 19 November, my right hon. Friends the Members for Newark (Robert Jenrick), for Gainsborough (Sir Edward Leigh), for South Holland and The Deepings (Sir John Hayes) and for Louth and Horncastle (Victoria Atkins), my hon. Friends the Members for Rutland and Stamford (Alicia Kearns) and for Grantham and Bourne (Gareth Davies), the hon. Member for Boston and Skegness (Richard Tice) and I wrote to the Chancellor to ask about exemptions from the national insurance hike for air ambulances. Despite raising the issue at Treasury questions and in a point of order, and despite repeated chasing from my office, we have not had the courtesy of a proper response to our letter from the Government, although they have suggested that they are now asking the Department of Health and Social Care to respond to the letter. That is a huge discourtesy to the House, and I would be grateful for the Minister’s assurance, because the letter is apparently with the Department of Health, that we will receive a response by the end of the week. That is quite a reasonable request. Finally, it is fair to say that ambulance crews are doing a sterling job, but that response times are not where we need them to be. I look forward to hearing the Minister tell us how she will improve those services for our constituents.

15:58:00

It is a pleasure to serve under your chairship, Ms Jardine. I am grateful to the hon. Member for Glastonbury and Somerton (Sarah Dyke) for securing the debate. I thank all the hon. Members who have taken part, including my hon. Friends the Members for Redditch (Chris Bloore), for Ilford South (Jas Athwal) and for Wolverhampton West (Warinder Juss), and the hon. Members for West Suffolk (Nick Timothy) and for South Devon (Caroline Voaden), as well as the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), and the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson). I will endeavour to deal with as many issues and questions as I can. If I do miss any, will hon. Members please get in touch with me afterwards, and I will make sure they are picked up? The hon. Member for West Suffolk mentioned the commitment made by the Secretary of State to meet him and visit his constituency, and I will ensure that that issue is raised. The parliamentary private secretary, my hon. Friend the Member for Ealing Southall (Deirdre Costigan), is here, and I am sure she will be happy to pursue a response. We will also do what we can to get a response from the Treasury for the shadow Minister. The hon. Member for Glastonbury and Somerton and other hon. Members rightly raised constituents’ experiences of long waits for an ambulance response. I put on record my deepest sympathies for the hon. Lady’s constituent Jim on the loss of his wife. As the Secretary of State has made clear, this is not the level of care that staff want for their patients, and it is not the level of care that this Government will ever accept for patients. Lord Darzi investigated the issues facing the NHS, and his report was honest about the challenges facing the health service. Urgent and emergency care performance remains a long way from a resilient position and there is continued high demand for A&E and ambulance services, with ongoing seasonal winter pressures. For example, in December the London Ambulance Service recorded more than 121,000 incidents, the highest on record for the service. Improvement needs to happen across the urgent and emergency care pathway and through the expansion of neighbourhood health services. Nationally, congested emergency departments reduce the productivity of ambulance services, a matter that I think almost all hon. Members raised. A huge amount of time is lost to ambulance handover delays because there is no space for patients. Having crews tied up waiting outside hospitals exacerbates poor ambulance response times. We have also seen the continued normalisation of corridor care. We will never accept patients being treated in corridors; it is unsafe and undignified. We are investing an extra £26 billion to begin turning around the NHS, and we will do all we can, as fast as we can, to consign corridor care to the history books. Lord Darzi’s investigation into NHS performance highlighted wide variation across different parts of the country. The situation is unfair to patients and goes against the principle of a universal service. I acknowledge that there can be challenges in rural areas, where longer distances often mean that patients wait much longer for ambulances than in urban areas. I often find myself in this place with the hon. Member for Glastonbury and Somerton, and we both talk about the experience in our rural constituencies. I assure her that that is on my agenda. As she says, ambulance response times for the south-west and some other areas highlight the rurality differential. In January, the South Western Ambulance Service’s average response for category 2 emergency incidents, which include strokes and heart attacks, was 51 minutes and 45 seconds, which is 26 minutes longer than the best-performing ambulance trust in England. The NHS constitutional standard for category 2 average response times is 18 minutes, and no ambulance trust in England has met that target since the pandemic. This cannot go on. Prioritising patient safety will always be the Government’s and the NHS’s main focus. We are committed to getting A&E waiting times and ambulance response times back to NHS constitutional standards. The independent review of ambulance trust culture was published in February 2024. Its recommendations included addressing workforce pressures. NHS England is working closely with ambulance trusts to implement those recommendations. We have made some significant investments in the ambulance workforce, and the number of NHS ambulance staff has grown by 9% compared with last year, but we recognise that there is much more to do on retention and wellbeing for ambulance staff. That is something that we will continue to work on. We cannot keep plugging the gaps. There is a need for more fundamental reform. We have been clear that there are no quick fixes and that to turn things around will take investment and reform. We have provided the highest real-terms capital budget for the NHS since before 2010. We announced an extra £22.6 billion in day-to-day health spending and an additional £3.1 billion further capital investment over two years. That extra investment will be accompanied by fundamental reform, of which ambulance services. In January, the Government published “Road to recovery: the government’s 2025 mandate to NHS England”, which clearly sets out delivery instructions for the NHS through the prioritisation of the five key objectives aimed at driving reform in the NHS. Improving A&E and ambulance service performance was also one of a small number of prioritised objectives in the Government’s mandate to NHS England to specifically start to address the current challenges facing urgent and emergency care. In turn, NHS England’s planning guidance for this year includes the target to improve average category 2 ambulance response times to no more than 30 minutes across 2025-26. The guidance also sets out a range of key actions for the NHS to deliver in the same timeframe, focused on reducing avoidable ambulance dispatches and conveyances and reducing hospital handover delays.

Will the Minister pick up on the point about social care? Inability to admit to hospital is a key point in the handover delay problem, and the social care talks are a key measure in solving it.

The hon. Member will be delighted to know that I am coming to that point next. We are working on reducing delays and getting hospital handovers back to within 15 minutes, ensuring that no handover between hospital and ambulance services takes longer than 45 minutes. We want to improve the range and co-ordination of services to avoid unnecessary ambulance conveyances, including through improving access to urgent community response and hospital at home services, and continuing to build on ambulance services and the great work that they do to increase the hear and treat rates so that people can be advised on what they can do and what services they can access that might mean they do not need that ambulance. We will also be driving consistency and commissioning practices across England for ambulance services. I will say a little more about the rurality element in a moment. We are taking the first steps in the reform and improvements that we want to see in services, and we will shortly set out further plans in the urgent and emergency care services plan. We know that there is no solution for ambulances that does not include tackling the challenges facing adult social care. Health and care services need to be more joined up. Today, there are approximately 12,000 patients in hospital beds who have no criteria to reside. They do not need to be there but cannot be discharged for reasons of capacity. Over the last month, on average, 276 of the patients with no criteria to reside were in the Somerset integrated board area. That is why the Government are making available up to £3.7 billion of additional funding for local authorities that provide social care. We are funding more home adaptations through the disabled facilities grant this year and next, so that people’s homes can be safer, reducing the risk of their needing an ambulance. We are reforming the better care fund to ensure that the pooled NHS and local authority funding spent on social care contributes to wider efforts to reduce emergency admissions and delayed discharges.

Social care is clearly very important, but what assessment has the Department made of the effect of national insurance contributions on social care provision as a whole?

The hon. Member will be aware, because we have discussed the matter many times in Westminster Hall and the main Chamber, that the funding has been made available to the statutory sector bodies for employer national insurance contributions for public sector pay, and the negotiations for the delivery of commissioned services locally and within the NHS will take place locally. I am sure that we will be able to point her to some more detail on that issue, which has been discussed at length by colleagues. We have announced the largest ever increase in the carer’s allowance earnings limit since the benefit was introduced in 1976. It is worth approximately £2,000 a year for unpaid carers. We are also introducing fair pay agreements to empower worker representatives, employers and others to negotiate pay and terms and conditions in a responsible manner. That will help to address the recruitment and retention crisis in the sector. It is not all about ENICs; it is about making sure that our social care service is resourced in order to make sure that social carers are recognised for the powerful and important work that they do. We have appointed Louise Casey to help to build a national consensus on the long-term solution for social care. The social care cross-party talks, to which the Liberal Democrat spokesperson referred, have not been called off; they have been merely delayed. As I told her in the Chamber just yesterday, it is very much about making sure that we have the right people in the room and that they can attend. It is our intention for the talks to go ahead very soon. They have not been called off; they have been merely postponed. Of course, we need further reform. We are bringing it forward through the 10-year plan this spring to accompany the additional investment in the NHS. The Government will publish that plan for radical reform in the NHS, with those three big reform shifts: from hospital to community, from analogue to digital and from sickness to prevention. The reforms will support putting the NHS on a sustainable footing so that it can tackle the problems of today and of the future. The shadow Minister asked about the configuration of ambulance services. As I am sure she is aware, decisions on service configuration must be made by those who are experts in delivering it. We have also talked about the key issues of rurality. A range of adjustments are made in the core ICB allocations formula to account for the fact that the costs of providing healthcare may vary between rural and urban areas. Some of the differences, such as the tendency for rural populations to be older, are naturally captured within the formula. We continue to review the formula for the impact of the characteristics of local areas, such as rural, urban and coastal, in the development programme. I encourage all hon. Members to raise these matters with their local ICBs, which are responsible for commissioning the right configuration of local services. The NHS has increased the availability of local data on ambulance response times performance, with category 2 ambulance performance now published at ICB level, which has increased the transparency of the important data. I encourage hon. Members to use that data to direct conversations with their ICBs. We have also talked about air ambulances. I am sure that all hon. Members recognise the contribution that they make, as the Government do. The Government support the long-standing independent air ambulance charities model for the successful operation of helicopter emergency medical services in England, which gives the sector the independence to raise funds through commercial activity and sponsorship from corporate partners. The NHS continues to support air ambulance services, including through thorough training and the provision of NHS clinicians. Communities right across the country, including the constituents of the hon. Member for Glastonbury and Somerton, are struggling with poor services and crumbling NHS estates. We are putting record capital into the NHS. We will bring down ambulance response times. We will get waiting lists back down to what they were in 2010. It will take time, but we will deliver an NHS and a national care service that provide people with the care they need, when and where they need it.

16:14:00

I thank all hon. Members for their contributions to this important debate. The examples that they raised highlight the urgent need to improve ambulance response times. It is just unacceptable that people cannot trust that when they need an ambulance, one will arrive. That is not fair on patients or on the incredible ambulance staff who dedicate themselves to saving lives. I urge the Government to listen to the Liberal Democrats’ calls to publish localised ambulance data, reduce hospital bed occupancy rates to 85% by increasing the number of staffed beds, and introduce a new winter taskforce that would manage a ringfenced fund of £1.5 billion to build resilience in the system. Those changes would lead to improvements that cannot come soon enough. Question put and agreed to. Resolved, That this House has considered ambulance service response times.

16:16:00