Steve Barclay
MP for North East Cambridgeshire · Conservative · United Kingdom
“I speak to my brief exchange earlier with the Minister. As the previous speaker, the hon. Member for Harpenden and Berkhamsted, said, the draft regulations are fairly benign and very welcome to help people who are struggling with their bills.”
“The issue is not the lack of will; the issue is the alignment between procurement, regulation and clinical leadership, particularly in the colleges, as well as the ability to scale innovation—it is not about having more ministerial pilots.”
“Just to localise it to my own constituency, the Cambridgeshire and Peterborough ICB alone paid out £14 million in redundancies last year. It merged with a number of other ICBs to form the Central East ICB, yet we know hear from the Government that it should align with metro mayors, which means going back to exactly what it was before: the…”
“My right hon. Friend is absolutely right: the Government are spending millions of pounds and there is no plan. The measure was announced without working that out, it came as a surprise to many within the system, and it has had a chilling effect on many decisions. That is not isolated.”
“I rise to speak to clause 1 on the abolition of NHS England and clause 6 on promoting innovation. What characterises the first of those is an announcement without any clear plan. That is what has driven the cost and confusion that a number of Members across the House have spoken about.”
“All this is around 18 months on from the actual announcement. The confusion seems to extend to the Government themselves, because they seem unable to answer pretty straightforward written parliamentary questions. Given the time limit, I will give just a few examples.”
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“Other significant actions include the deployment of hospital ambulance liaison officers in emergency departments to help reduce the incidence of handover delays, and an independent review of the trust to ensure that it has the appropriate resources and processes to deliver against its performance standards. I will expand on these measures further, but it is worth considering them in the context of wider national initiatives to improve ambulance performance more generally. As I stated in the House on 22 January, the NHS is busier than ever and the ambulance service is experiencing unprecedented demand, dealing with more than 11 million calls every year. There were almost 7 million face-to-face responses from the ambulance service in 2016-17, which is a 14% increase over the past five years.”
“The trust has worked to grow its frontline workforce, fielding 700 more staff since 2014-15, and has achieved a low rate of staff turnover. However, like the right hon. Gentleman, I want further assurance that the trust’s staff plans are sufficient to meet the demands facing the city. I will raise that in my discussions with NHS Improvement. Substantial local initiatives are under way to improve the trust’s performance. Importantly, more money is being invested in the service: its funding was increased by £90 million this year—an increase of 10%—and it will further increase by £27 million over the next two years.”
“Improvements will also be made to the trust’s adherence to the national REAP guidelines, and actions will be taken to moderate service pressures, which will allow the trust to de-escalate to REAP level 2. The trust is also working with hospitals to ensure adherence to the national guidance on handover delays, particularly where ambulances waiting to hand patients over receive a new 999 call, which was a specific point that the right hon. Gentleman raised. I also assure him that we will work closely to monitor the outcomes of the work to ensure that safe, high-quality ambulance services continue to be provided to his constituents. The right hon. Gentleman has also raised concerns that the trust has underspent on its funding while putting in place a hiring freeze.”
“I am advised that actions to deliver immediate service improvements are being taken forward under the following themes: ensuring that the trust has sufficient capacity for the rest of winter; the effective implementation of handover delay policy with hospitals; the proper execution of REAP level measures; staff access to executive leadership; sound escalation procedures; bringing in independent assurance around the serious incident investigation procedures; working with CCGs and other stakeholders to manage demand for ambulance services; and the full exploitation of emergency service collaboration with police and fire. As a result of those actions, to help to manage winter demand the trust will put eight additional vehicles on the road each day until Easter, with immediate effect.”
“I am assured that, where there were serious delays in response times, the trust has identified all potential causes. Following an initial investigation, it is examining 22 such cases through the serious incident procedure. That will ensure that individual cases are properly investigated. The hon. Member for Peterborough (Fiona Onasanya) mentioned a specific case and we are determined to ensure that that is addressed. I am happy to discuss that with her further. In terms of the report mentioned by the right hon. Member for North Norfolk, which was previously commissioned for the trust, I am happy to update the House and say that the report should be published as soon as possible. Again, that is an issue I will follow up. Let me turn to the specific actions arising from the risk summit.”
“I have communicated that to the trust. I recognise that the right hon. Gentleman is concerned about the overall approach of the trust’s senior management and about the level of external assurance from the CQC. In addition to the action plan identified at the risk summit, which was attended by other external parties including NHS England and NHS Improvement, I have gone further by asking NHS Improvement’s executive medical director, Kathy McLean, to provide her own assurance to Ministers in the coming week. That will assess the immediate steps taken to address the concerns expressed in the House and whether actions suggested in the earlier external reports have been implemented. Alongside that, I am happy to have further discussions with the right hon. Gentleman about his specific point about the Association of Ambulance Chief Executives.”
“Gentleman will be aware, a risk summit was held this week, on Tuesday 30 January, which examined whether the service is operating effectively now and sought to put in place any required actions to improve it going forward. I have spoken personally to the chief executives of NHS England and NHS Improvement, and to the chair of the risk summit. I will expand on the findings further, but I wish to emphasise that a wide-ranging plan of immediate actions has been put in place to address the issues that were identified. Details of the action plan have been published today and a progress meeting in two weeks will be led by NHS Improvement and NHS England. I agree with the right hon. Gentleman about the accessibility of the trust leadership in respect of the chief executive and the chair making themselves available for media bids.”
“First, I wish to thank the right hon. Member for North Norfolk (Norman Lamb) for securing this debate. I recognise the concerns raised about the East of England Ambulance Service, including questions about whether delays to ambulance responses have caused additional harm to patients over the Christmas period, and his concerns about the leadership of the trust and the role of the CQC. I assure him that I am taking these allegations seriously, both as a Minister and, as he knows, as a constituency Member of Parliament in the East of England. I have put in place a number of actions to immediately ensure improvements to services are put in place by the trust. As the right hon.”
“We have also discussed the wider initiatives that we are undertaking to improve ambulance services nationally, as well as specific local actions to ensure that patients receive the highest quality of care. Again, I thank the right hon. Gentleman for introducing this debate. I hope that he, and indeed other Members who have serious concerns about this issue, will continue to work with me on a cross-party basis to ensure that all our constituents get the service that they rightly expect. Question put and agreed to.”
“I am very happy to give the right hon. Gentleman that commitment. Like me, the right hon. Gentleman wants to get a grip of this issue to ensure that it is addressed. I very much hear the concerns that he and other Members have raised. I hope that he can take some comfort from the series of actions that have already been put in place, including the risk assurance and the commission to Ministers, that signal the seriousness with which this issue is being addressed. I would like to restate that we are taking the right hon. Gentleman’s concerns seriously. I have outlined the measures already taken as a result of the risk summit, and I will closely monitor the situation to ensure that these actions are delivered on.”
“For example, mental health patients, who are often among the most vulnerable of our constituents seeking the support of the NHS, do not on the whole face charges because those parking facilities are not charged for. This tends to be an issue in the acute sector.”
“I think we got a flavour of some of those unintended consequences in the constructive contributions made by Members on both sides of the House. Implicit in the motion is the suggestion that car parking charges apply in all NHS hospitals. It is not in the specific wording, but the impression from the debate has been that they apply across the NHS as a whole. However, as hon. Members will be well aware, 67% of NHS sites do not charge at all at present. We are talking about a subset of the NHS where charges apply, albeit that the subset is particularly concentrated in the acute sector, from which many of the examples we have heard come.”
“As English Members of Parliament—it is different for our Scottish National party colleagues—we all pay these charges, as the hon. Member for Great Grimsby (Melanie Onn) said in a constructive way. We all know that they are unpopular with our constituents and are a concern for staff working hard within the NHS. As my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) highlighted, the charges predate this Government. This issue has long been debated in the House, by parties on both sides. The issue is not the desirability of what is sought by my right hon. Friend the Member for Harlow. The issue is the execution and how it would be done in a way that does not have unintended consequences, and how those might be mitigated.”
“May I begin by commending my right hon. Friend the Member for Harlow (Robert Halfon) for securing the debate? Members across the House recognise that he has campaigned assiduously on this issue for some time, as he has on many campaigns, and he has already had some success, as reflected in the Government guidelines issued in 2014. However, it is right, in the light of the concerns raised across the House, that the issue is revisited. This has been a very constructive debate, granted by the Backbench Business Committee, and I commend all Members who have contributed and informed the House of what is happening in their constituencies. I do not think anyone in the House has any issue with the desirability of scrapping car parking charges.”
“They are not means-tested, so an affluent blue badge holder could be spared a charge while a less affluent visitor to a hospital is charged. Transparency about how the guidance is applied is therefore a factor, as has been recognised.”
“One of the key issues in this debate is the distinction between charges covering the maintenance of car parks, and how a reduction in charges may lead to a reduction in the number of spaces and the quality of the facilities—we heard, for example, about the state of the car parks in north Manchester—and those involving profiteering, with charges going beyond of the cost of maintenance. The hon. Lady is concerned about that, and the interplay with the current guidance. The hon. Member for Colne Valley (Thelma Walker) also mentioned that when she highlighted the distinction between the charges at her hospital and those of the local authority, and raised the issue of transparency. The right hon. Member for Kingston and Surbiton (Sir Edward Davey) expressed concerns about transparency in relation to blue badge holders.”
“With respect to my right hon. Friend, it is a statement of fact, as confirmed by my officials—I am very happy to correspond with him further about it—that 67% of NHS sites do not charge. If one wants to get into the definition of a hospital, it actually covers more than acute services. I do not want to get distracted by that point. The one I was seeking to make is to recognise that this issue is particularly concentrated on acute hospitals, and that is the issue before us. The hon. Member for Great Grimsby recognised that there is considerable room for flexibility within trusts.”
“Absolutely. As my right hon. Friend will be aware, the guidance speaks to that. My hon. Friend the Member for Cleethorpes (Martin Vickers) mentioned the 64 pages of guidance. I am very happy to take away and look at why there are 64 pages of it. Blue badges are part of the conversation that my right hon. Friend the Member for Harlow began in 2014.”
“Friend the Member for Solihull (Julian Knight) was concerned that simply removing charges would cause displacement at his hospital. The point is that there are local factors, just as there are with legacy PFI contracts, including in Scotland and Wales, where charges are still made under contracts going back to 2008.”
“I am very happy to look at such cases and to speak to those trusts to understand this better, but I was making a point about the complexity of the issue and how to manage reducing the charges. For example, as the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) will no doubt be aware, there were local media reports over the summer about a hospital car park in Inverness being used by those going to the airport; there was displacement there. We do not want a solution that constrains capacity for those using the hospital and makes access more difficult. Some of these issues have a very local flavour. That was recognised in the debate: the hon. Member for Heywood and Middleton (Liz McInnes) said that shoppers do not seek to use the car park at the north Manchester site, whereas my hon.”
“Of course, but equally the hon. Lady must recognise that the fact that charges are still being applied under PFI agreements put in place by a previous Government in 2008 signals that there are often complexities, in terms of what can be done when different factors apply. As my hon. Friend the Member for Solihull highlighted, there are factors relating to displacement. That is why trusts have local discretion, but as the House has discussed today, we need to understand the transparency around that and how it is applied.”
“It was helpful to hear in the debate contributions about the RCN’s understanding of the benefits, pressures and issues. Across the House, there is no question, as was reflected by my right hon. Friend the Member for Harlow, about the desirability of addressing iniquities and variance, and about the scope to ensure compliance with the guidance, but we need to be mindful of unintended consequences, and particularly about constraining the car parking available for those who need it. I am happy to continue my discussions with my right hon. Friend on this policy. I commend him and colleagues on a very constructive debate.”
“A point was raised about whether free parking could be addressed through tokens and barriers, but colleagues in the NHS raised concerns about how that would apply, in terms of any burden on staff. We heard examples of frequent users of a hospital being able to access concessionary schemes, but staff have raised concerns about the impact on them, and how they might be expected to assist in the administration of the scheme in regard to those visiting hospitals as a one-off. The pertinent point about the impact on staff was raised by Members from across the Chamber. Many Members have been visited recently by representatives from the Royal College of Nursing, regarding the wider discussions between NHS employers and the RCN on pay.”
“However, the law provides for the ombudsman to consider whether to review a decision if it was demonstrated that the ombudsman made their decision based on inaccurate facts, or that there was new and relevant information that was not previously available, or that they had overlooked or misunderstood parts of the complaint or relevant information. If a complainant believes that there has been maladministration in the handling of their complaint, they can apply to the courts for a judicial review. However, that must be done within three months of the conclusion of the complaints process.”
“Although I very much recognise that the hon. Gentleman’s constituent is of a different view, and he is perfectly entitled to be of a different view, it is worth placing on the record that his own medical expert, who reviewed this case, did not feel that the operation had been performed in the way that Mr Hawkins has claimed. I note that Mr Hawkins referred this matter to the Parliamentary and Health Service Ombudsman, which is independent of both the NHS and Government, but the ombudsman ruled that the claim was out of time. Ombudsman decisions are final and there is no automatic right for them to be reviewed.”
“Although the Department of Health does not comment on individual cases, and it is not for me to adjudicate whether all of those claims by Mr Hawkins are valid, it is worth noting that a very wide range of both individuals and organisations are alleged by Mr Hawkins either to have conspired against him or, indeed, to have failed him in this matter. It is also worth placing on the record that NHS Resolution, which was formerly the NHS Litigation Authority, informs me that in January 2016 it first became aware of an independent medical report commissioned by Thompsons, Mr Hawkins’s own solicitors, which had not been previously disclosed to NHS Resolution in the course of Mr Hawkins making his claim. That medical report concluded that there was nothing to suggest that the operation in question had been performed anything but competently.”
“Gentleman’s remarks, in respect of his contention that Mr Hawkins was let down by a number of individuals and organisations within the NHS. Specifically, it is alleged by Mr Hawkins that the hospital failed him by prioritising then Government targets, which delayed his operation; that the clinician failed him through clinical error; that the duty surgeon failed him by falsely reporting that his wound had healed; that the hospital failed him by not correcting the alleged mistake and by instructing lawyers; that Hempsons solicitors failed to disclose full records; that his own solicitors failed him by not obtaining his records; that his own clinical medical expert failed him; that the hospital failed him, regarding his report; that the ombudsman failed him; and that the NHS Litigation Authority failed him.”
“As always, it is a pleasure to serve under your chairmanship, Mr Rosindell. I begin by commending the hon. Member for Denton and Reddish (Andrew Gwynne) for securing this debate. Although he opened it by saying that it is perhaps unusual for a member of the shadow Cabinet to secure a debate such as this one, it is absolutely right that he is doing so on behalf of his constituent and bringing these matters before the House. I am very sorry to hear about Mr Hawkins’s experiences, which have clearly caused him distress. As you are well aware, Mr Rosindell, the NHS complaints process operates independently of Government, to prevent political bias in the handling of individual complaints. However, a number of points arise from the hon.”
“In addition, NHS Resolution has recently launched a service to increase the use of mediation in the NHS, to resolve issues at an earlier stage without the need for protracted litigation. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) has previously championed reducing the impact of lawyers when disputes arise. It is important that patients receive the safest care possible from the NHS and that when things go wrong clinicians are open and honest, and able to learn from their mistakes. It is equally important that patients and their families are listened to and their concerns taken seriously and addressed.”
“That includes expanding the role of the “freedom to speak up” guardians, to give them powers to initiate whistleblower complaints processes where possible. My predecessor, the hon. Member for Ludlow (Mr Dunne), particularly championed that when he was a Minister, and he did a huge amount to progress it. The complaints improvement partnership also engages with non-executive directors to explore options for them to have responsibility for monitoring the progress of complaints and serious incidents within trusts, and with Healthwatch England, to empower local healthwatch organisations. As constituency Members, I think we all work with and see the value of that body. Working with the ombudsman, the partnership also promotes best practice in the handling of complaints by providing information, advice and training.”
“The Department of Health has established the complaints improvement board to take forward a series of projects to improve the complaints process. So I hope that—irrespective of the specifics that we are discussing today—as part of the “closure” that the hon. Gentleman referred to, the improvements in the complaints process in the future will be a source of some comfort to Mr Hawkins. As part of that process, the complaints improvement partnership was established by the Department and system partners, including NHS England, NHS Improvement, the Care Quality Commission, the Parliamentary and Health Service Ombudsman, and NHS Resolution. That partnership is currently examining options for delivering a more effective complaints management system, and better use of all forms of feedback to improve NHS services.”
“I very much recognise the point that the hon. Gentleman is making. Obviously, I do not want to get drawn into the specifics of this individual case, for the reasons that I have already set out, but within this case and within the claim made by Mr Hawkins a number of factors have been outlined, and I recognise that the hon. Gentleman’s point is one limb of the claim that Mr Hawkins has made. What brings the various issues together is a question that I think applies to all of us, from all parties in the House: in the future, how do we collectively avoid cases such as Mr Hawkins’s case, and how do we improve the complaints process? That is an area where the Government have been particularly active, not least following “Hard Truths”, the report into Mid Staffordshire and the issues that arose there.”
“There is also the development of a culture of learning, through patient safety collaboratives and the national Sign up to Safety campaign, and last April the healthcare safety investigation branch became a fully operational and independent branch of NHS Improvement, to investigate serious incidents in the NHS with a strong focus on system-wide learning.”
“The hon. Gentleman will appreciate that the events took place more than 11 years ago and that it is, therefore, not for me to comment on what the trust knew at that time or their actions accordingly. I think we all, across the House, recognise that resolving issues without recourse to litigation is preferable, where possible, to lawyers being involved at an early stage—and I say that as a former lawyer. That is why the Government seek to improve how complaints are handled, including improving the regulation. The Care Quality Commission now rigorously inspects all trusts and primary and adult care providers, and a duty of candour—a new protection for whistleblowers—encourages staff to speak up for safety and hence fosters greater transparency.”
“I hope that the improvements that are in place will help Mr Hawkins to get some closure on the matters we have debated today.”
“Member for Denton and Reddish has rightly brought before us today is how we learn from things going wrong and how, when a patient thinks something has gone wrong, the issues are aired and resolved. I commend the hon. Gentleman for securing the debate, notwithstanding his elevated position in the shadow Cabinet, and for ensuring that his constituent’s issues have been aired before the House. The Government are committed to building a learning culture within the NHS that listens to patients and relatives and learns from mistakes, so that patients do not suffer avoidable harm. The Secretary of State deserves great credit for his championing of patient safety as a specific issue within his portfolio. We are also working to improve the complaints handling system so that it is more responsive and joined-up between organisations.”
“As a former Minister, my hon. Friend knows that there are conventions regarding Ministers of the Crown commenting on court judgments. The Secretary of State has already made clear his position on that matter, and this debate on a specific constituency issue is not the forum for moving beyond that scope. It is important for us all that we improve the handling of complaints. In a system as large as the NHS, we all recognise that, with the best will in the world, things will go wrong and mistakes will be made. The latest Care Quality Commission annual “State of Care” report, published in October 2017, recognises that the vast majority of patients get good care and that many parts of the NHS have improved thanks to the hard work of the staff. The key issue that the hon.”
“I congratulate the hon. Member for Rochdale (Tony Lloyd) on securing this debate. I know that he visited the North West Ambulance Service Trust in 2017 and has a long-standing interest in this area. He comes to the House as one of its most senior and experienced Members and a former chair of the parliamentary Labour party. I am happy to meet him to discuss his remarks in more detail in order to work collaboratively to take this forward, given the concerns he has set out, particularly concerning the delays that Ron and Pat experienced, and how we can address them. I absolutely agree with the sentiment expressed by the hon. Member for West Lancashire (Rosie Cooper) about the need for an open culture, and I am happy to work with her, as I have done in the past, in fostering such a culture.”
“As I said earlier, 3,000 more paramedics have been recruited nationally compared with 2010—an increase of more than 30%—so there are more paramedics than there were.”
“The framework brings all patients under a national response standard for the first time and improves the efficiency and resilience of the ambulance service in the face of rising demand. We recognise that the performance of the North West Ambulance Service against those standards is not good enough, and that is why NHS Improvement, NHS England and commissioners are closely engaged with the trust to ensure that it adapts successfully to the new performance framework. If the hon. Gentleman has specific concerns about the openness of the trust, I will be very happy to discuss those points and take them forward with him in a collaborative spirit. I understand that the hon. Gentleman has raised concerns about workforce directly with the trust.”
“In 2016-17, the North West Ambulance Service treated and discharged over one quarter more patients at the scene and 92% more patients over the telephone compared with 2011-12, so although I recognise that there are challenges and areas that require improvement, it is important, in the interests of balance, also to recognise the progress the trust has made in recruiting more paramedics—as part of the 3,000 more paramedics nationally—its low vacancy rate and the steps it has taken to treat more patients at the scene. Additionally, in July last year, the Secretary of State approved a revision of the operational performance standards for ambulances. Those improvements have been rolled out to all mainland ambulance trusts, which will mean better prioritisation of calls.”
“Under Sir Bruce Keogh’s review of the NHS urgent and emergency care system, ambulance services are being transformed to increase the use of “hear and treat” and “see and treat” and ensure the better prioritisation of patients so that those with the highest need are seen most urgently. The aim is to avoid what we all recognise was an issue in the past—where, in order to meet targets, often two, three or four ambulances were being sent in response to the same call. People had concerns about that across the House, but that is one of the improvements that has been brought in.”
“About 3,000 patients are currently in hospital beds with flu and about 700 with the norovirus, so there are clearly winter pressures affecting handovers, but he is absolutely right that how we address the delays in handovers is a key area, and certainly a key ministerial focus of mine, as I will come on to in due course. The hon. Gentleman set out several concerns about the trust’s performance. It is worth drawing the House’s attention to the fact that six ambulance liaison officers are now in place at A&Es across Greater Manchester to support handovers and address delays. The Treasury is investing £100,000 in the trust in February and March to boost operational capacity, and procedural solutions are being introduced to improve the efficiency of call handling.”
“Overall, it is worth noting, on the concerns about workforce that the hon. Member for Rochdale set out, that the North West Ambulance Service has a strong record on recruitment, having recruited an extra 167 paramedics in 2017. As a result, its vacancy rate, at just 2.4%, is now one of the lowest in the country. The hon. Gentleman is right, however, that on performance there is an issue and that the service does need to improve. As I will set out in my remarks, that is why work is under way with NHS England and NHS Improvement, working with the commissioners and the trust, to address that, as part of the wider national initiatives. It also needs to be set in the context of the pressures within the health service.”
“I certainly will take this opportunity to do exactly that. As the right hon. Gentleman will be aware, like him, I myself, during my time in the House, have frequently spoken out on behalf of whistleblowers, particularly in my former role as a member of the Public Accounts Committee. I know he has other concerns that, with the leave of the House, I might touch on at the end of my remarks, but, as I am sure he will appreciate, I want to address the issues of the North West Ambulance Service in particular. As Members on both sides of the House will know, the NHS is busier than ever. The ambulance service is dealing with unprecedented demand, with 11 million calls each year and almost 7 million face-to-face responses in 2016-17, which was a 14% increase on the previous five years.”
“Gentleman’s letter, I instructed officials in my Department to share copies with the Care Quality Commission—the independent regulator of all health and social care services in England—to ensure that it is fully aware of the issues being raised. I discussed these concerning allegations directly with the chief executive of NHS England and the chief executive of NHS Improvement this morning, and asked them to confirm to me the actions they will be taking. They have subsequently confirmed that they will be holding a joint risk summit regarding the trust in the next week. The CQC will be in attendance.”
“Gentleman spoke, which allows people to progress their career into the role of paramedics. There are also further measures in terms of prioritisation, which will address a number of the concerns he set out. On whistleblowers, that is an issue on which I, as a constituency Member of Parliament, have long campaigned. I hope my record on that speaks for itself, and the issue is something the right hon. Gentleman and I have previously discussed. The right hon. Gentleman has also raised concerns, as has the hon. Member for Norwich South (Clive Lewis), regarding the East of England Ambulance Service. On receipt of the right hon.”
“The trust is implementing a number of procedural solutions to improve the efficiency of the call-taking staff, including the use of post-dispatch scripts, which inform callers of the expected arrival time of a resource. In other trusts, that has minimised duplicate calls and reduced ambulance attendances by 4.6%. To conclude on the comments of the hon. Member for Rochdale—with the leave of the House, I will then address the concerns of the right hon. Member for North Norfolk (Norman Lamb)—his concerns about performance are pertinent, and there is work ongoing to address that issue as part of the wider initiative. However, it is also important to recognise the progress that has been made, which has seen the recruitment of additional paramedics and the training of staff, with the progression of which the hon.”
“Delayed handovers tie up ambulance resources and adversely affect the trust’s capability to respond quickly to new calls. We are clear that handovers must take place within the agreed timeframes, and NHS England and NHS Improvement are supporting hospitals to ensure that improvements are made. Such work includes improved monitoring and daily review by national and regional winter operations teams, targeted assistance to challenged hospital trusts to improve their performance and the issuing of revised handover guidelines that focus responsibility on the wider system to address handover delays, including a clear escalation process. Locally, there are initiatives in place such as the placement of hospital ambulance liaison officers within emergency departments.”
“It is worth bearing in mind that, alongside those paramedics, the North West Ambulance Trust has recruited 24 graduates to operate as emergency medical technicians, and they are awaiting registration as paramedics. That will further improve the position. The trust has made it easier for emergency medical technicians to embark on paramedic training courses and worked with local universities to increase the rate of paramedic qualification. Where emergency medical technicians crew ambulances and respond to calls, they are heavily supported to do so safely, with direct access to advice from advanced paramedics and the trust’s clinical hub. Handover delays were mentioned in several interventions. We recognise the challenge of delayed patient handovers to emergency departments.”