Justin Madders
MP for Ellesmere Port and Bromborough · Labour · United Kingdom
“Friend the Member for Dunstable and Leighton Buzzard asked about, will consider the points raised in this debate and whether any of them can be put into future updates to guidance. As was mentioned, good passenger information is central to standards.”
“As the roads Minister, I of course recognise the importance of bus stops and the important effect they have on the streetscape. My hon. Friend the Member for Dunstable and Leighton Buzzard made clear that she is passionate and informed about the importance of bus journeys to everyone.”
“Where responsibility for highways or individual assets sits elsewhere, close and effective working between the relevant authorities is essential. We expect local plans to join up services, infrastructure and passenger information, rather than treating them as separate issues. That will no doubt be music to the ears of my hon.”
“Our guidance encourages authorities to take a strategic approach to stops and interchanges, including keeping an inventory of infrastructure, identifying priorities for investment and setting locally appropriate standards for facilities and maintenance.”
“She is absolutely right that the quality of a bus stop is about more than accessibility, although of course accessibility is vital. Passengers notice whether a stop is easy to find and use, whether it offers shelter or seating where appropriate, whether it is clean, whether the surroundings feel safe and well maintained and, as we have di…”
“That approach reflects a simple principle: local transport authorities know their areas and are best placed to plan improvements across the whole local bus network. That is why the Department’s vision for buses, within an integrated transport system, puts local transport authorities at the centre of delivery.”
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“I am sick of my area missing out on funding for improvements to the community, bus services and other local infrastructure. If we have ambition for the country, it should be for the whole country. We need real ambition; we do not need any more empty promises. We want a real say in the way services are run. We do not want to keep putting in bids for pots of money and then being left at the whim of commercial operators. We want control of our bus services and we want resources to be able to deliver them properly for the benefit of our communities. Labour leaders in power in cities and towns across the country have the ambition to reverse the decline we have seen over the last decade. We want a London-style system that is run in the public interest, to make buses quicker, cheaper and more reliable for our communities.”
“Since 2010, more than 3,000 bus routes and more than 350,000 passenger journeys have been lost, leaving people cut off from friends, family, work and education opportunities, and other public services. It seems to me that the Prime Minister has no intention of keeping his promise of “great bus services to everyone, everywhere”, because, as my hon. Friend said, hidden away in the levelling-up plan is a massive cut to bus funding of £1.8 billion. Figures show that the cost of funding bids submitted by 53 out of 79 local authorities totals more than £7 billion, so it is clear that many areas will miss out. With this Government’s record of picking and choosing winners and losers, I have little confidence that my constituency will benefit from that funding at all.”
“Arriva received the contract on a temporary basis and, when there was a further reprocurement, it got an alternative timetable as part of the bid. Some of the routes were retained, but many roads previously served no longer are. Unfortunately, again, constituents lose out. Those are examples of not only a lack of resources, but a lack of joined-up thinking and strategy on what bus services are for. They are for serving our communities and, clearly, this constant chopping and changing, reducing routes and leaving areas out altogether does not benefit our constituents at all. As my hon. Friend the Member for Warrington North said, 10 years of cuts have left bus coverage at its lowest level in decades.”
“It is hard for people to argue to retain a service when they are not aware that it is threatened. Greater transparency is needed from service providers when they enter such consultations. The last local change to mention was that, last year, the route of the No. 5, which is an hourly service between Mold and Ellesmere Port calling at Cheshire Oaks—a major employer in the area—was altered, leaving the Stanney Grange estate with reduced access. One constituent who contacted me was distressed about the impact that that would have on her learning-disabled son, who relied on the bus service to get out and about. When we made inquiries, we were advised that Stagecoach had served notice and it intended to reprocure the route and consider costs.”
“Yes, I agree. At the heart of this, clearly, is a bus service that has been under-resourced for many years. There are two problems: lack of support for operators and lack of strategy, so we keep facing chopping and changing decisions based on commercial considerations that do not necessarily serve the communities. The example of the bus service I have just mentioned means that someone who wants to get to the hospital, even though if it is only a mile from their home, must now take two buses. It is too far for them to walk. What was also clear from the process was that the consultations were not adequate. Numerous comments were lodged by constituents, but they seemed to make no difference to the results. As I set out, the 22 bus service was not even mentioned as under threat during the consultation.”
“I was struck that the Minister recognised the surprise that I felt, when I first arrived in the capital, at the ease and affordability of bus services. My constituents want to know when they will no longer be paying twice the fare to get half the distance on their local buses.”
“On freezing the fuel duty, if the Minister has been to forecourts recently, he will know that the cost of petrol and diesel has gone up tremendously in the last few weeks. What has been the impact on the Treasury’s coffers from VAT receipts as a result?”
“I fear that until more home truths are spoken about what it will take to break the cycle, we will continue to see prices rise and the war continue. I recognise that addressing the issue is not solely within the Government’s gift. Grasping the nettle will be a continent-wide effort, but we must look at what the Government can control. There is an opportunity today to act on the national insurance increases. It beggars belief that we are looking at tax rises at the same time as prices are rising and bills are skyrocketing at levels not seen for a generation. This is the wrong tax at the wrong time.”
“That resulted from comments from the US Secretary of State, Antony Blinken, that conversations about a boycott were taking place—one can only imagine what would happen if people moved beyond conversations and a boycott actually took place. It is not clear to what extent the price spikes are being exacerbated by speculators who are seeking to take advantage of the situation. Nor do we know whether a real effort by OPEC countries to increase production would mitigate it, or what impact the conflict will have on food prices over the medium term. The reality is that western Europe, trapped by its reliance on Russian energy, is forced to buy fuel that pays for the war that pushes up the price of energy further still.”
“Everywhere we turn, prices are going up far faster than anyone can keep up with—at the supermarket checkout, at the petrol pump, in gas and electricity bills. Adding in mortgage rises, rent rises and council tax rises, we face a perfect storm of inflationary pressures that we have not seen for an entire generation. I do not think that anyone has really levelled with the public about what the implications of a protracted war in Ukraine will be for prices. Things are going to get a lot more difficult before the pressure eases off. Just look at how the mere suggestion of a boycott of Russian gas and oil has pushed trading prices sky-high.”
“I place on record my dismay that the Government have chosen to hit working people and businesses with a national insurance rise at the worst possible time—when one in six working households cannot make ends meet, according to the Institute for Public Policy Research; when the number of jobs that pay below the national minimum wage and the living wage is still more than two and a half times higher than at pre-pandemic levels; when inflation is forecast to reach 7.25% next month, the highest level since August 1991. We already have the highest level of inflation for three decades, but I am afraid that everything we know about the implications of Ukraine tells us that it will only get higher in the next few months.”
“This will be an ongoing crisis, and there is no solution from the Government. Everywhere we turn, from housing to heating to eating, prices are going up. People face some really tough times ahead unless something is done now. Let us not add to that impossible burden. Let us scrap this national insurance increase right now.”
“Housing is a basic right, but with affordable and council housing in short supply, reliance upon the private rented sector has increased. However, a recent search of properties available in Ellesmere Port showed that of the 13 properties available—a minuscule number to start with—only two came within a rental liability level that would be covered by the local housing allowance, while the rest ranged from £30 to £225 over the rates. In Neston, the results of a search are even worse: all the properties were well over the LHA. In fact, it is now incredibly rare to see any properties offered at a rental value equivalent to the LHA. How on earth can we expect people to put a roof over their head in that situation, let alone pay for energy bills, food or council tax bills?”
“There is nothing to give families the security that they would get from the fully funded measures that the Opposition have proposed to keep energy bills down, which would be paid for by a windfall tax on North sea oil and gas producer profits. In my constituency alone, 12,500 families would be £400 better off as a result of the tax, and our plan would mean almost all households making savings on their bills. Nor would an extra £40 charge be hidden away and come out of people’s bills in a few years’ time, regardless of whether they had benefited from the scheme in the first place. We see the effects of the current crisis playing out every day. One example in my constituency relates to housing affordability.”
“The same report also said that nearly a fifth of businesses would consider employing fewer staff as a result of these rises. Almost three quarters of companies in manufacturing say that they are also very likely to pass on the costs to customers, so it is no surprise that Make UK has said that the proposal is “illogical” and “ill-timed”. We know that some areas will be worse hit than others. Analysis shows that the north-east and the midlands—areas that rely on wages rather than income from investment and properties—will be hardest hit. That is not levelling up, is it? Trapping the country in a low-growth, high-tax cycle and hitting working people with tax rise after tax rise is the opposite of levelling up. Within four years, the average household will be paying £3,000 a year more in tax than when the Prime Minister first came to power.”
“I am sorry, but the hon. Member has just spoken. If he did not get his point in then, he has missed his opportunity. The tax rise was wrong back in September when it was first proposed, and even more wrong now. That is not just the view of Opposition Members; the cross-party Treasury Committee has highlighted that the increase in national insurance contributions for employers will lead to higher costs being passed on to consumers. If we speak to anyone in social care, they tell us that that is pushing them into unviability. Data from the Institute of Directors in January demonstrated that more than a third of businesses would respond to the increase by raising prices and passing on the burden to customers, yet again increasing inflationary pressures.”
“Does the Minister agree that the police and crime commissioner for Cheshire needs to reconsider his priorities when he is talking about closing down Ellesmere Port police station to the public and getting rid of 40 police community support officers while, at the same time, giving his deputy a 33% pay rise despite their having been in the post for five months?”
“I am pleased to hear that the Foreign Secretary will not be cowed by letters from oligarchs’ lawyers. She will know that, no matter how distasteful we might find it and how damaging it might be to those law firms’ reputations, even oligarchs are entitled to legal representation because that is part of what makes us a free and democratic society. Does she agree that the best way to deal with these issues is to ensure that the laws are watertight in the first place? Will she assure us that she has got the best, most expert lawyers available to ensure that no loopholes can be exploited?”
“According to the Asbestos Victims Support Group Forum, figures from 2019-20 showed that a 77-year-old with mesothelioma would receive £14,334 if they claimed themselves, but if they died before claiming —as we know can happen with such aggressive and difficult to diagnose cancers—their surviving partner or dependant would receive just £7,949, which is just over half. That issue has been raised by Members year after year in these debates.”
“Members will be aware from experiences with their constituents that the process is not necessarily adapted to individuals’ needs, and the one size fits all approach can sometimes ignore irrefutable medical evidence. The Minister has set out some of the changes that have been made, but security for individuals from having their payments automatically uprated would be an important step forward, and the least that they deserve. The hon. Member for Glasgow South West raised the issue of equalisation of lump sum payments to victims’ dependants.”
“I hope that the Government will address the issue of automatic uprating, because it would not reduce Members’ ability to raise specific issues. It would also send a powerful message that, while no amount of money will compensate for the suffering and loss caused by the diseases, the Government are committed as a matter of course to ensuring that support is provided to those entitled to it. It would also provide security to those affected if they knew that the uprating would apply each year without fail. That is especially important when those in receipt of payments may already have experienced a long and stressful wait for their assessment and gone through what can sometimes be a challenging and distressing assessment process.”
“As we have noted, the Government are not under any obligation to uprate the payments, but it is clear that Members have asked on many occasions whether future increases could be made automatically rather than at the discretion of Parliament. One of the Minister’s predecessors agreed to consider that proposal, and I wonder the Minister can update us on that point. We have been told previously that automatic uprating would not be sensible because it would prevent debate, but when the yearly debate consists of very much the same issues being raised again and again, that argument appears a little artificial. Members are more than capable of raising issues in several ways through debates and in other forums.”
“It was clearly very commonly used and we are still reaping the consequences today, but it was not banned until the Asbestos (Prohibitions) (Amendment) Regulations 1999. That means that buildings constructed up until the turn of the century might still have asbestos in them. Many colleagues will be aware that unfortunately those who worked in industries such as building and construction from the 1970s to the 1990s may still experience the consequences of exposure to asbestos, but those consequences are not limited to people who worked in those industries. For example, the National Education Union found that at least 319 teachers have died from mesothelioma since 1980, 205 of whom died after 2001. That is a staggering statistic and highlights the pervasiveness of asbestos in many of our buildings.”
“As with mesothelioma, there is a long delay between exposure and the onset of the disease. The Health and Safety Executive estimates that overall 12,000 deaths each year are linked to occupational lung disease. I pay tribute to organisations such as Mesothelioma UK, the British Lung Foundation and Macmillan Cancer Support, which raise awareness and provide ongoing support for individuals and their families who are affected by these terrible diseases. We know that before the dangers of asbestos were known it was frequently used for insulation, roofing and flooring in commercial buildings and homes. Indeed, it has been used in this very building and I recall my grandfather telling me how they used to use it as a snowball when he was at work.”
“The Health and Safety Executive reports that the UK has the highest rate of mesothelioma in the world and mortality rates have more than quadrupled in the past 30 years, with the disease being more common in certain parts of the country, reflecting the location of industries such as shipbuilding where asbestos was frequently used. Sadly, it is estimated that about 2,500 people die of the disease every year. Over the next 30 years, some 60,000 people will die of mesothelioma in the UK unless new treatments are found. Pneumoconiosis refers to a group of lung diseases caused by inhaling dust. Common types include asbestosis; coal workers’ pneumoconiosis, caused by breathing in coal mine dust; and silicosis, caused by breathing in respirable silica and typically affecting industries such as quarrying, foundries and potteries.”
“As we have heard this afternoon, mesothelioma is an invasive type of cancer caused by prior exposure to asbestos and for which there is currently no cure. It grows in the pleural membrane that lines the outside of the lung and the inside of the chest. Less commonly, it can also affect a similar lining around the abdomen or heart. It can take a long time to develop, as we have heard, with the first symptoms sometimes appearing 30 to 40 years after exposure. Patients experience complex debilitating symptoms and often have a short life expectancy. Of course, that presents real difficulties for those who develop the disease in being able to pursue a legal remedy.”
“Friend the Member for Leicester South (Jonathan Ashworth) has already stated, uprating in line with inflation last September does not really reflect the true position that we are now in, given that inflation is likely to be around 6% for much of the course of the year according to the Bank of England. The uprating therefore reflects a real-terms cut. The cost of living crisis has been debated in this place many times already this year and will no doubt be discussed again. As the regulations are not amendable, we cannot substitute the figure of 3.1% for something more akin to reality, but I believe it shows how once again the Government have struggled to recognise the very real financial pressures people face.”
“As we have heard, today’s regulations uprate the amount of compensation paid to disease sufferers or their dependants by 3.1%. I note that the Government have reviewed the rates to maintain their value in line with inflation, as measured by the September 2021 consumer prices index, and in line with disability benefits. Although we recognise that the Government are under no obligation to do any uprating under either Act, we believe that it is vital to continue to support people affected by these awful diseases and their families and that annual uprating is necessary. Having said that, it is worth noting that, as my right hon.”
“I believe that this is the first time I have appeared before you in the Chair, Dr Huq, so I will do my best to make sure that it is a memorable occasion for us both. I thank the Minister for introducing the regulations. As she set out, the mesothelioma regulations amend the Child Maintenance and Other Payments Act 2008 and the pneumoconiosis regulations amend the Pneumoconiosis etc. (Workers’ Compensation) Act 1979. As we heard, both Acts make provision for lump compensation payments to be made to people suffering from specific dust-related diseases or their dependants, provided that they meet the conditions of entitlement. I note that as of 1.30 pm today both statutory instruments had still not been assigned numbers and the explanatory memorandums appeared in draft form on the Government website. I hope that that can be addressed.”
“Members have raised and to address them, so that we do not have to come back next year and debate them all over again.”
“He was told: “It is right that available funding is prioritised where it is needed most, that is to people living with these diseases.” Will the Minister explain whether she agrees with that assessment; when she will be able to give us a timetable for when any change in the Government’s position on the matter can be expected; and what recent estimates have been made of the cost of providing equal payments to sufferers and their dependants? I feel that that may well be what is behind the inertia on the Government Benches. Furthermore, given that the difference in payments often affects women whose husbands were directly exposed to asbestos, will the Minister tell us whether there has been any equality impact assessments in respect of the lack of parity in payments? I conclude by urging the Minister to reflect on the issues that hon.”
“I thank the hon. Gentleman for his intervention, which highlights the point that we have these debates every year and the same issues continue to be raised. The Government are sympathetic, as indicated by previous commitments, but action is missing. The Minister has said that she will write to the hon. Gentleman after the debate, and I hope that she will share that correspondence with the rest of the Committee, because this is an important issue that needs addressing. It will not go away; we will continue to raise it on an annual basis. When the Minister responds to this debate, will she comment on a response given to a written question tabled by my hon. Friend the Member for Manchester, Gorton (Afzal Khan) on this matter?”
“I wonder if the Minister has done any stakeholder engagement with the new Minister for Brexit Opportunities and Government Efficiency, the right hon. Member for North East Somerset (Mr Rees-Mogg). I ask that question because in The Times at the weekend the new Minister said: “Sometimes the employer would think they need more protection from the employee.” That view is wrong. Too many people are in precarious employment and do not have strong workplace rights, and the Employment Bill is a chance to begin to address that. Does the Minister agree with us that it is employees who need more protection, or does he agree with his colleague that it is the employers who need more help?”
“I am not sure that the Prime Minister understands that supporting people to self-isolate is not a restriction on their freedom; it is actually what a responsible Government do. He will know that millions of people do not qualify for SSP at the moment and that without financial support they cannot self-isolate. Does he understand the invidious position that he is putting some people in?”
““The only way to save NHS dentistry in England is to listen to dentists. It’s currently financially unviable for dentists in high need areas with large UDA contracts...this is only going to widen the oral health inequalities further.” I urge the Minister to do just that: listen to dentists and act accordingly.”
“One constituent, whose son was in pain after cracking his tooth, was told to keep ringing back each month to see if there was any capacity to reregister, another resorted to carrying out a temporary filling repair themselves at home and one lady, who had been shielding, was removed from the register due to inactivity. Many were shocked to find out how few rights or guarantees they have to remain registered at a practice. Healthwatch has suggested that clear information is needed so that patients are fully aware of the risk following inactivity or missed appointments. I agree that there needs to be greater information. However, there also need to be greater guarantees of access for individuals. I will conclude by sharing the words of Cherie, a dentist who operates in my constituency.”
“I have heard of price increases as high as 100% on previous NHS fees for those going private. Together with the cost of living, that is simply pricing people out. Healthwatch Cheshire West confirmed that deregistration from dental practices is the primary cause of people needing to contact other NHS dentists and being unable to find one locally. The reality is that waiting lists locally sit in their thousands. One practice quoted a total waiting list of more than 3,000 people, demonstrating the significant challenge to be addressed. In the last six months of 2021, I was contacted by 25 different constituents who faced that challenge. Many were writing on behalf of their whole families as well as themselves.”
“However, the practices I am in contact with already do that and are proactive in trying to fill the slots. It seems, once again, that there is a disjuncture between what the Department says and what is happening on the ground. Given that infection rates and community spread of covid-19 have been at their highest level in recent months, setting the target at 85% at this time seems questionable. There is little surprise that we are hearing of more dental practices leaving the NHS and operating on a purely private basis when there seems little financial incentive or, indeed, financial feasibility in continuing to deliver NHS services. We face the very real prospect of growing privatisation of dental services and people being priced out of receiving dental care.”
“Between January and March 2022, it is expected that 85% of the UDA should be met. Last year, a practice in my constituency had to refund £45,000 because of activity that simply could not be delivered. I understand there is nervousness across the sector about the levels that will need to be refunded given that practices are expected to meet the 20% UDA increase at a time when we still have omicron-related staff sickness and appointment cancellations. I recently asked whether any assessment had been made of the impact of short-notice cancellations on the ability of dental practices to meet their UDA target. The answer I received simply stated that that was considered within the 85% target and suggested that dental practices keep a short-notice cancellation list.”
“One patient advised my local Healthwatch that they had contacted 45 practices in one day, and was told by all of them that there was no capacity as “they only have a small NHS contract and are therefore not taking on patients at present” but would be happy to take that person on as a private patient. The system actually encourages greater privatisation. One constituent, who contacted me because of the pain she was experiencing from a hole in her tooth, described her attempts to register at a practice as a fight, which sums the situation up perfectly. We would not accept people having to ring around A&E departments to see if there was any space for NHS patients, so I do not see why we should accept it for dentists. Since January 2021, there have been several increases in the UDA targets placed on dental practices.”
“To my mind, that means that we start from a position of knowing that many people will be denied access to dental care. We need a functioning NHS dental system, and that will be possible only through contract reform recognising the realities of the difficulties that the sector faces, and if services are commissioned for a much higher proportion of the population. I am told that the local commissioning figure sits at around 55% of the population, but of course that was pre-pandemic, so the number of people who have been able to access services is actually lower. Unless more of the population is covered, constituents will continue to struggle to access dentistry.”
“I pay tribute to all dentists and dental staff in my constituency, who have worked in a high-risk environment throughout the pandemic. I know that they are doing all they can to deliver those services. The correspondence I have had with them shows how passionate they are about ensuring good access to NHS dentistry. As the Father of the House, the hon. Member for Worthing West (Sir Peter Bottomley), explained, a lot of the issues relate to the UDA system, which does not encourage dentists to take on new patients, especially those who require a lot of treatment. That scenario is increasingly common in the light of the difficulties that we have had over the past two years. The UDA system accommodates only 50% of the population.”
“It is a pleasure to see you in the Chair, Mr Efford. Access to NHS dentistry has been raised with me throughout the pandemic, and judging by turnout for the debate, it is something that a lot of Members are keen to get their teeth into— [ Interruption. ] I promise to make no more dental puns. I have met dentists and made representations to Ministers numerous times. The overwhelming feeling that I have had from such discussions is of a disjuncture between the two. Dentists and patients do not feel listened to, and Ministers are not offering the solutions needed to ensure that NHS dentistry is accessible for much of the population. While that is not being addressed, waiting times build, preventive dental action is not taken and health inequalities rise.”
“They are 14% higher than the previous highest total for the number of patients forced to wait during the same period, with the previous high being in the winter of 2019-20. As awful as those headline figures sound, the figures for the number of ambulances waiting more than 60 minutes are even worse: they are up 82% compared with the last two winters. These are exceptional and concerning statistics.”
“The blame for that does not lie with the staff—the paramedics, the first responders and the call handlers—all of whom do a magnificent job in very demanding circumstances. We say thank you for their service, not just in the last couple of years but throughout their time in the NHS. Despite their efforts, we are in a crisis. Last week ambulance waiting figures outside hospitals reached their highest level in five years. The latest NHS figures show that record numbers of patients in England—over 150,000 of them—have waited in the back of an ambulance for at least half an hour so far this winter, because emergency departments are too busy to admit them. That is the equivalent of one in every five patients—that is the scale of the challenge that we are facing. Those figures sound extraordinary because they are.”
“I am pleased to see the Minister for Health, the hon. Member for Charnwood (Edward Argar), in his place. He and I have debated many issues on health and social care over the last couple of years, and ambulance services have perhaps not had the attention that we would have liked. I know the Minister has had an extremely busy week, possibly because of the new trend for Ministers having multiple jobs, so I am grateful that he is here to deal with the points that will be raised. It is an important and timely debate. We are regularly seeing images of long delays, with ambulances stacking up outside hospitals for long periods of time. Those images demonstrate wider difficulties throughout the whole system, but on an individual level they mean that patients are not getting the care they need as quickly as they should.”
“I appreciate there is quite a lot of ground to cover here, but when the Minister responds I would be interested to hear his analysis of the situation, whether he believes the examples I have given are part of a wider pattern of concern or isolated incidents, and what he believes must be done to put the ambulance service on a sustainable, safe footing for the long term. Are those images that we have seen of ambulances queuing up outside hospitals a temporary feature of a very difficult winter, problems with the ambulance service in particular, or symptoms of a wider health and social care system that is under incredible pressure?”
“I do not know whether the Government have given any thought to whether those 10 million missing referrals will lead to increased pressure on emergency services and A&E attendances. What about those people whose care was not managed to target? The British Heart Foundation estimates that up to 1,865,000 people with high blood pressure were not managed to target last year, which could mean more than 11,000 additional heart attacks and more than 16,000 additional strokes across England over the next three years if those patients do not get support. Of course, that will again increase pressure on urgent and emergency care services in the longer term.”
“That is completely wrong and certainly not the message we should be giving people who are clearly in urgent need of treatment. A recovery plan has been announced this week, which, if we are honest, does not really address the issues of the wider NHS and social care pressures. It does not have any real plan for this particular area. The recovery plan, such as it is, is one part of the much wider system overhaul that is needed. The Secretary of State said this week that approximately 10 million people represent missing referrals who did not come forward for treatment during the pandemic. I am afraid they may well end up becoming urgent referrals because they have not been through treatment and been spotted and helped at an earlier stage.”
“The British Heart Foundation told me that it recently reviewed two calls to its heart helpline that highlighted instances where patients with suspected heart attacks called 999 and paramedics did attend, but then asked both to have their family drive them to hospital for further tests because the ambulance services in their area were under so much pressure. Neither person actually went to A&E, which is most unfortunate: one did not want to bother their family and the other thought that, if the ambulance was not taking them, their situation must not be urgent enough, which of course was not the case. In short, those two patients did not access the care they needed because of the message being sent out about the burden they were placing on the system.”