East of England Ambulance Service: 25th June 2013

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
It is a pleasure to serve under your chairmanship, Mr Howarth. I begin by paying tribute to my hon. Friend the Member for Witham (Priti Patel) for bringing this matter, quite properly, to Westminster Hall this morning, for giving an excellent speech, and for her outstanding campaign on behalf of her constituents. In simple terms, she seeks to hold the ambulance trust, which clearly has performance figures that are simply unacceptable—they are the lowest in the country—to account. There is a clear feeling of anger—that is no criticism at all; it is based on frustration. I know that my hon. Friend the Member for Suffolk Coastal (Dr Coffey) has joined her in this admirable work, and despite raising the issue and notwithstanding all their efforts, they are frustrated and angry because they feel that it has taken many months for the trust to even begin to make some sort of attempt to address the inherent problems that it clearly faces.​

Another thing that clearly emerges from the many interventions and excellent speeches by hon. Members this morning is that there is wholesale support, and many tributes, for the staff—the front-line workers. Nobody is for one moment saying that there is any failing on their part. The failing is clear: it is failing at a leadership level and at board level. There is a failing of leadership, which must be addressed as a matter of some urgency.

I only have about 12 minutes to address the many points that have been made, so the usual rules apply: anybody who has asked a question that I am not able to answer in my short speech will, of course, get a written answer. I just want to deal quickly with the important point made by my hon. Friend the Member for North West Norfolk (Mr Bellingham), who asked whether the usual rules that apply to non-executives on public limited companies, or on companies that are listed on the stock exchange and so on, apply to non-executives who are appointed to NHS trusts. I must tell him that the rules are not the same; their responsibilities and duties are different. I will provide more detail in a letter to my hon. Friend, but it is not as simple as it is when people are non-executive directors on other bodies, where it could be said there is much more accountability and much more of a duty on them to resign when there have been the sorts of failings that we have heard about today—if that was applied to a business, for example.

Robert Halfon
Will the Minister give way?

Anna Soubry
May I just make one other point? Then I shall be more than happy to give way, although the clock is against me, as my hon. Friend will appreciate.

Here we have another issue that should concern, as I know it does, all hon. Members, on both sides of the House. It is the culture that is now becoming clear. I take the view that it is not a new culture. I suspect that it has been there for many years. It is just that it is now being exposed, often through the admirable work of Members of Parliament and because of the work of my right hon. Friend the Secretary of State for Health. That is a mates culture, where people’s priority is to protect their mates, systems and procedures, as opposed to what should be the absolute priority for somebody in the NHS, which is to protect the patient—not their friends and the structures, but the patient—and also, of course, the hard-earned money of the taxpayer.
 
Robert Halfon
My hon. Friend will have heard me set out the treatment of Harlow residents. Does she agree with me and with our hon. Friend the Member for South Norfolk (Mr Bacon) that the East of England ambulance trust is too big and should be broken up, and that we should restore the Essex ambulance service trust?
 
Anna Soubry
That is a good point, but it is not for me to say whether it has any merit that should be taken forward. But clearly it is an important point, which must now be considered.

May I quickly pay tribute to all the very helpful interventions from hon. Friends? My hon. Friend the Member for Broadland (Mr Simpson) talked about ​the buck passing in the NHS and the recycling. We also heard from my hon. Friends the Members for Maldon (Mr Whittingdale) and for Huntingdon (Mr Djanogly). My hon. Friend the Member for Waveney (Peter Aldous) made an excellent speech. My hon. Friend the Member for Suffolk Coastal also made an excellent and important speech. There were interventions from my hon. Friends the Members for Clacton (Mr Carswell) and for Cambridge (Dr Huppert) and from my right hon. Friend the Member for Saffron Walden (Sir Alan Haselhurst). There were speeches by my hon. Friends the Members for Harlow, for North West Norfolk and for South Norfolk (Mr Bacon). They all made important and good points.

We know that overall in England in 2012-13 the number of emergency calls to ambulance services was 9.08 million—a 6.9% increase. That is an important figure, I would suggest. We know that overall, in England, the performance figures are stable. That does not really assist in this debate, of course, because we also know that the East of England ambulance trust and, I have to say, my own, the East Midlands ambulance trust, have serious failings and the performance figures are simply not good enough.

The best that I can say of the performance of the East of England ambulance trust is that it has not been good. It is clearly recognised as the lowest-performing ambulance trust in England. As with the national picture, its overall poor performance figures hide huge discrepancies between the services and response times in the urban and rural areas that it covers. There are too many stories—we have heard many today—of patients in distress having to wait hours for ambulances, or solo paramedics being sent when an ambulance is needed. Solo paramedics cannot transport patients and might not, for instance, be able to lift or move a patient unaided. It is simply not good enough.

It is clear to me that some hon. Members and many patients might be forgiven for thinking that the trust seems to have forgotten that it is there to serve all patients and not only tick the performance boxes as far as it can. Concentrating resources in towns and effectively abandoning people in the countryside is simply unacceptable.

Mr Bacon
Will the Minister give way?

Anna Soubry
May I make some progress? Then I will take an intervention. The latest figures, as we have heard, show that the East of England ambulance trust failed to deliver two of the three response time standards. The exception was the performance against Category A Red 1—immediately life threatening—calls, where the 75% standard was achieved, with 75.8% of calls responded to within eight minutes.

Mr Bacon
The phenomenon of people forgetting what they are there for, which my hon. Friend alluded to, is of course what would happen in a mates culture. I have had the feeling for a long time that there has been the growth of what we might call a self-serving nomenclatura that looks after its own interests first. Then I heard my hon. Friend the Member for Bristol North West (Charlotte Leslie) on the radio the other day referring to a mafia within the top of the NHS, looking out for their own interests. What I want to ​know is, as this is a recognised phenomenon—I do not think we are going mad—what is the Department going to do about it?
 
Anna Soubry
In short, what I will say is that the Secretary of State has made it clear that it is a culture that he will not accept, and that no member of his ministerial team will accept. He is now becoming undoubtedly the champion of the patient. We are seeing that. We saw it last week with the CQC and then of course we saw the change: the names of people who had been put forward in the report were made public and people are now being held to account. We are beginning to see at least a tackling of this culture; we now need to see some results.
 
Mr Keith Simpson
My hon. Friend has alluded, as have other hon. Friends, to leadership. Is the NHS thinking of positively recruiting from senior retired people from the armed forces, who display leadership and the ability to get people to work together? A brigadier had to sort out BSE over 10 years ago, because nobody in the Department for Environment, Food and Rural Affairs could.

Anna Soubry
That is an excellent point, extremely well made. I shall certainly take it away and speak to the Secretary of State, because this really is important, but to be fair to the NHS, it does have its own leadership academy, where it seeks to bring on people. That is within the NHS. But I think that we should involve far more people from other fields, who could come into the NHS—people with huge skill sets, who have proved those in other walks of life. I am thinking of, for example, retired judges, who would have an invaluable role to play—people who have shown real leadership and not been afraid to make tough decisions in the right circumstances. All these people should now be being looked at actively to play a role.

Priti Patel
Will the Minister give way?

Anna Soubry
I will take one quick intervention with four minutes to go.

Priti Patel
I thank my hon. Friend for giving way; she has been very generous. There is a specific issue not just about leadership but about accountability with this trust. Is the Minister able to tell us what is preventing the current non-exec directors from resigning their posts immediately?
 
Anna Soubry
I know of no reason why they should not. Of course, it is a matter for their own consciences. I am not one who normally shies away from giving an opinion, as my hon. Friend, I hope, would agree, but I think that in this instance it is very important that Ministers do not give an opinion and do not get involved. I think that would be quite improper. It is for those people, or anybody who has come under criticism, to examine their own role and their own conscience and act accordingly.​

We might well ask why some ambulance services with comparable funding to the East of England trust—this is not about funding, cuts or money; it is about leadership and poor management—and the same mix of urban and rural areas can provide a good level of service and others cannot. I believe that the ambulance staff will generally be the same in their dedication to caring for patients, so as I said, it is all about effective—or in this case, ineffective—management.

The trust has recently had the benefit of an excellent governance review prepared by Dr Anthony Marsh. I pay public tribute to him and thank him for that. I have referred to it already, as have other hon. Members. It is a clear and professional account, and I will arrange for a copy of it to be placed in the Library. Dr Marsh is, as we know, the chief executive of the West Midlands ambulance service and he chairs the Association of Ambulance Chief Executives, so he knows what he is talking about. His report, as we have heard, reveals how poorly the trust has been managed and how the valiant efforts of front-line staff have been undermined. My hon. Friend the Member for Harlow described them as “lions led by donkeys”.

Results from the 2012 staff survey for the trust underline that. Only one key finding improved; nine key findings became worse. The East of England ambulance service trust had by far the worst staff survey results of all ambulance trusts in England, with 13 of the lowest scores. Its sickness levels—I think this is a very important statistic; it says it all—are nearly twice the average of those in other trusts. However, I am pleased to say that Dr Marsh will be working closely with the trust over the coming months to ensure that the necessary action is taken, and taken quickly.

The NHS Trust Development Authority—it is called the TDA—provides the line of accountability from local NHS trusts to the Secretary of State for the performance of the organisation. Steps have already been taken to address poor performance. As we know, a new interim chair, Dr Geoff Harris, has been appointed; he took up his post at the end of May. His first task is to review the trust board and ensure that the right people are on it. He needs, if I may say so, to be quick and decisive. To make the necessary changes, the board needs to be fully capable of radically improving its performance. I am fully aware that many hon. Members hold strong views about the role that board members play, and I have made my comments accordingly. The duty of the trust board is to add value to the organisation, enabling it to deliver health care and health improvement within the law and without causing harm. It should do that by providing a framework of good governance.

Earl Howe, as we have heard, is the Minister responsible. He has taken a close interest in the matter and visited the trust at the end of May. He has met hon. Members. He is committed to convening a second meeting towards the end of this year, when we all expect to see real evidence of changes for the better. We will of course continue to monitor the situation closely.