Ambulance services in Devon

12th July 2017

Philip Dunne responds to an Adjournment Debate on ambulance services in Devon.

It is a pleasure to serve under your chairmanship, Mr Davies. I wish you every success in your endeavours elsewhere today. On that note, I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing not only this debate but unopposed re-election to the Chair of the Select Committee on Health, which role I am delighted to see her continue in.

By happy coincidence, I had the pleasure of visiting the South Western Ambulance Service NHS Foundation Trust only last week. Having visited the chief executive in his office, and seen for myself some of the challenges presented by the rurality and the distances—as mentioned by hon. Members in this debate—I feel slightly better briefed than I would otherwise have been. I drove from Exeter to Barnstaple to Plymouth on the same day, in the height of summer, on a Friday, when the roads were, it is fair to say, not at their least busy. I do absolutely appreciate some of the challenges reflected in this debate that are imposed on the ambulance service’s ability to deliver the service to residents in this large, very rural and very beautiful county. It is particularly appropriate therefore that we have the chance to discuss this briefly this afternoon.

I thank my hon. Friend for the characteristically considerate and appropriate way she posed challenges to me and thanked people employed in the ambulance service, and those who support it as volunteers, for the magnificent work that they do. She began her speech by recognising that the ambulance service in the south-west, like all other ambulance services in the country, is busier than ever. Demand has been rising significantly. Across the country, there were some 7 million face-to-face responses from the ambulance service in the year ending 31 March—a 14% increase over the last five years. In the south-west of England, demand has increased even more sharply, with a 29% increase over five years; I think she mentioned a 19% increase in her area of south Devon.

The trust is challenged by the geography of the area it serves, with its greater distances and slower transport routes. Nevertheless, it is doing well, not just in meeting national targets but in comparison with other trusts. We should congratulate all those involved, but that does not mean that there are not a number of challenges. My hon. Friend the Member for Totnes mentioned a particularly difficult case in which an elderly lady was left waiting for some time, and my hon. Friend the Member for Torbay (Kevin Foster) raised a case from his constituency in which a child had to wait some time for an ambulance.

This is clearly an operational issue. I strongly encourage hon. Members who are concerned about individual cases to bring them to the attention of the chief executive of the relevant trust, and to continue to represent to their constituents that even if the overall number of such incidents is not great, the ambulance service is required to provide an appropriate response through the disposition of its resources. From experience in my own area, I know that MPs are listened to by chief executives of ambulance trusts and can make a difference in securing deployment of resource to meet the particular demands and concerns of their constituents. It is well worth pursuing that approach.

Let me touch on some of the initiatives under way to meet the challenges that we all recognise and that have been referred to in the debate. Sir Bruce Keogh undertook a review of the NHS urgent and emergency care system, which is trying to cope with the root causes of demand. Following the review’s recommendations, ambulance services will increasingly be transformed into mobile treatment centres, with greater use of “hear and treat”, in which telephone calls are closed with advice, and “see and treat”, in which paramedics are equipped to treat patients on the scene without a conveyance. There will also be greater integration with the rest of the health system. Some 2,600 more paramedics are now operating within our ambulance services across the country than in 2010, and in the past year 1,400 trainees have started on paramedic courses. There has been a big shift towards training more ambulance staff to undertake treatment on the ground.

The Care Quality Commission has recognised that SWASFT is one of the highest-performing trusts in England, particularly in its “hear and treat” service, which enables clinicians to assess and triage patients over the phone and close the call without the need to send an ambulance. In April, 49.1% of calls to SWASFT were resolved without transportation to A&E—the highest percentage of any trust in England. That allows more patients to be treated in their own home or in the community without needing to be taken to hospital, helping not only the patient, but the system.

Another way in which SWASFT is addressing the growing demand for services and the need to better manage peaks of activity is through reviewing how emergency vehicles and staff are rostered. Its review has moved ambulance resources closer to areas of high public demand. Instead of a paramedic crew logging on for a shift at a rural station and then getting pulled into an urban area—an issue highlighted by my hon. Friend the Member for Totnes as a particular challenge in her constituency—resources should now be positioned in the right places and should stay more local, more of the time. She expressed a degree of scepticism about whether that is actually happening. I can confirm that in my area in the west midlands, we have worked with the ambulance service to ensure that ambulance stations are not necessarily kept in the same physical location, but are placed in parts of the country where demand is highest. This can now be well mapped by ambulance systems to ensure that service is provided as close to areas of demand as possible.

Evidence from the trust’s rota review shows that the patients with the most serious, time-critical and life-threatening injuries have experienced improvements in response times, and that ambulance resources stay local more of the time. My hon. Friend makes a perfectly reasonable challenge for that to be proven—for the facts that demonstrate it to be provided to Members of Parliament and the public—and I will encourage the trust to provide that information.

My hon. Friend and other hon. Members referred to the trust’s fleet. It is being reviewed to enable the right resource to be sent the first time. The trust has invested £3.6 million, which has allowed an additional 61 double-crewed ambulances—an increase of 20%—across the operational area, meaning that in South Devon four more double-crewed ambulances will be available this year than last year. This approach has allowed a reduction in rapid response vehicles, which—as my hon. Friend said—are not being utilised as fully as the ambulance crews themselves and are therefore not always the best resource to send.

There are now some 57 fewer rapid response vehicles. My hon. Friend the Member for North Devon (Peter Heaton-Jones) highlighted some areas in which that has caused local concern. I would say to him that the ambulance service needs to demonstrate to local people that fully crewed paramedic-staffed ambulances are now more readily available to serve communities, so that the people in most need of conveyance to hospital are more likely to get there more quickly. The trust needs to demonstrate that as it moves its resources to this new pattern.

My hon. Friend the Member for Totnes is aware of the ongoing review of the way in which ambulance services respond to calls through the ambulance response programme. SWASFT has been involved in piloting new operating models. The new programme seeks to deliver clinically appropriate responses to all patients and is part of ensuring that the ambulance service in England remains sustainable. The evidence behind the ARP is extensive, covering data collected from more than 14 million emergency 999 calls. The review has looked at a number of key issues for the south-west, including the provision of ambulance services in rural areas and putting an end to unacceptably long waits by removing the long tail of ambulance response times.

A revised operating model is crucial to achieving sustainability in the ambulance service, given the growing demand that we have all described. Trials have been independently evaluated, and the Secretary of State has recently received recommendations from NHS England. I hope to report to the House the ARP’s findings and NHS England’s recommendations shortly.

In addition, SWASFT has adopted a number of recommendations to improve response times, particularly in rural areas. One such initiative, which my hon. Friend referred to, is the increasing use of community first responder groups across the south-west. Totnes is one of the focuses for the next phase of recruitment in South Devon, which will start later this month. There are some 458 community first responders and a further 110 fire co-responders across the county, alongside the network of public access defibrillators that she mentioned. SWASFT is in discussions with three of its local fire services about introducing a conveyance and support service by fire crews, which would help to supplement conveyance when ambulances are not available. These initiatives do not change the priority or category of a 999 call, but they help to ensure that a patient with a life-threatening emergency can begin to receive the required care as soon as possible.

My hon. Friend rightly raised staffing. I understand that the clinical vacancy rate at the trust is currently 7.7%. The trust has undertaken a very successful graduate recruitment campaign, which has resulted in 130 graduates accepting offers to join it. They are expected to start in September, including 31 who will start in the west division, which covers Devon.

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