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I welcome the Minister of State, Department of Health and Social Care, my hon. Friend Caroline Dinenage, who will respond to tonight’s debate. It is, I think, her first time in action as a Health Minister. Although this subject is not directly part of her departmental portfolio, we are grateful to her for coming to respond to the debate.
I obtained the debate to draw attention to the appalling standard of the patient transport services that Thames Ambulance Service Ltd has been providing to my constituents in north Lincolnshire. That concern is shared by other local Members of Parliament—indeed, all of us, not just across north Lincolnshire but through to the City of Hull, where Thames Ambulance Service also provides patient transport services. A common theme that constituents have raised with me and my team is that they themselves raised these concerns with Thames Ambulance Service but received no satisfactory response from the company. Having loved ones stranded when at their most vulnerable, following chemotherapy, or learning that elderly relatives with severe dementia or Alzheimer’s have been stranded or forgotten in very low temperatures, is of course very emotive for family members. Their questions to Thames Ambulance Service often go unanswered, in a thoroughly unacceptable way.
The hon. Gentleman is making a very good speech. The service is also a problem in the rural parts of my constituency. Old people are now refusing to go to hospital appointments because they are worried about whether they can get there and get back, because the transport is so bad. Does he agree that this is fundamentally a health issue?
I am sorry to learn that the experiences extend also to County Durham, because going to hospital is stressful enough in and of itself, particularly if one is very elderly or very vulnerable, as many people who use these services are, but especially so if one is not sure whether one will get home at the end of one’s treatment or after an appointment.
This is not, of course, a reflection on the frontline staff of Thames Ambulance Service, who are doing their very best in very difficult circumstances. I will come on to what some of the whistleblowers who have contacted us from that service have told us.
I congratulate the hon. Gentleman on securing this debate. I have regularly had messages commenting about patient transport arriving late to pick people up, sometimes too late to get to appointments in time; patient transport sending unsuitable vehicles, so that disabled patients cannot access the transport; transport arriving late to a pick-up from hospital. That is a consistent theme. I have met with Thames. They held their hands up and said they had got problems. They said they were going to sort them out, but sadly, a month later, the problem is not getting any better.
I thank my hon. Friend and neighbour for that intervention. This is the problem. In many ways, it is nice that Thames Ambulance Service have met him. The correspondence that I have repeatedly sent them, chased by their official complaints procedure, by their chief executive, has not been responded to. So constituents have come to me who have not had a response, and I have then gone to Thames Ambulance Service, and they have not responded to me. The service has not got any better. I will cite a few of the examples that my constituents have given, which are similar to my hon. Friend’s experience.
These experiences are being wrought on very vulnerable people. I want to go through a number of examples from my constituency. I will not name patients.
I congratulate the hon. Gentleman on securing this evening’s debate. In Hull, we were also covered by Thames Ambulance Service. They are already under a contract performance notice because of their failure to do what their contract says they should. A constituent—a cancer patient—contacted me just today to tell me about being left, being forgotten, not being able to get to chemotherapy sessions, not being able to get to radiotherapy sessions. That constituent had seen people who had had to wait up to four hours for a journey back to Scarborough or Lincolnshire, in a waiting area with only upright chairs, when all one would want to do at that stage is sleep. It is totally unacceptable and the service does not seem to have improved, despite that contract performance notice.
It is saddening that the same experiences are happening just across the river in the city of Hull as well. This appears to be a consistent theme wherever this company provides ambulance transport services. Unfortunately, the hon. Lady describes an experience that many of my constituents have shared.
In fairness to the north Lincolnshire clinical commissioning group, it has, through the scrutiny processes at North Lincolnshire Council, effectively put the company on notice and informed it that the service is not good enough. Despite that, the improvements have not happened.
I thank the hon. Gentleman for giving way. It is fair to say that all our constituents have suffered for reasons that Thames Ambulance Service Ltd has brought on itself to some extent. It has decided not to pay volunteer drivers, who have been the backbone of the service for some time, to travel to and from where patients must be collected. That means that it has lost 40 of those volunteer drivers. Should it not be rewarding the people who have been the backbone of the service rather than treating them that shoddily?
I could not disagree with a word the hon. Lady said. She has stolen my thunder—[Interruption.] No, it is good! I was going to come on to the company’s treatment of volunteer drivers. Not only has it said that it will not pay them for mileage unless a patient is in the vehicle, but at three months’ notice it told them that if their vehicles were more than five years old, they could no longer be volunteer drivers. Despite that having been its policy for a considerable time, a company cannot give volunteers three months’ notice like that—say, effectively, “Change your vehicle or give up on the service.” Through its own actions, the company has made an already struggling service much worse. It has absolutely brought the situation on itself.
I have dealt with the issue of volunteer drivers, and I thank Melanie Onn for raising it. I want to give a couple of examples from my constituency to demonstrate how poor the service has been. One of my constituents in Brigg was given short notice that their transport was to be cancelled because there were no ambulances. That meant that this person, who suffers from mobility issues, had to cancel an important scan. It is impossible for them to get in or out of vehicles unless they have been specially arranged.
The mother of another constituent from Crowle on the Isle of Axholme is 87 years old; she suffers from dementia, is partially sighted and has been repeatedly left stranded following appointments arranged way in advance. My constituent has completely lost trust in the service and family members have had to take time off work to ensure that the lady gets to hospital. The service is there to ensure that that does not have to happen. The situation is completely unacceptable.
Another constituent from the Isle of Axholme has repeatedly been left stranded and unable to book an ambulance. They have been forced to use expensive taxis, which meant that the trip doubled in length. On one occasion the service failed to fulfil a pick-up arranged in advance, and that again required them to use a taxi. The service is totally unacceptable.
Like the Opposition Members and my hon. Friend, I have a long list of complaints from constituents, but I want to highlight a particularly bad case. On two occasions—once at Scunthorpe Hospital and once at Grimsby Hospital—a 91-year-old gentleman in Barton-upon-Humber had to wait for four hours before transport was provided to get him home. On one occasion, he did not get home until past midnight. The situation is extremely serious.
Absolutely. As my hon. Friend has highlighted again in this debate, we are not talking about one or two cases: Members of Parliament across our area have multiple cases. I want to highlight another one. Another constituent of mine, this time from Burton-upon-Stather, has to attend Castle Hill Hospital for chemotherapy every single day. His experience is of ambulances frequently being late, of other patients missing their appointments and of late collection for following treatment. As he has pointed out, receiving chemotherapy means that he is already very ill and weakened, but not just once but regularly he has had to wait up to three hours for an ambulance to collect him. He has also had issues with the booking system and trying to get a place at all.
My final example is of another constituent living just outside Burton-upon-Stather: 82 years old, suffering from Alzheimer’s, in a wheelchair and with very poor mobility, he is totally dependent on the assistance of others to get to and from hospital. Again, his experience is of frequently waiting for the service to collect him from Scunthorpe Hospital. Not so long ago, during snowy, freezing weather, he was left for over three hours in a hospital doorway, waiting for a lift. In the end, hospital staff intervened and brought him inside to warm up, but yet again the experience of the complaints process was that Thames Ambulance Service was wholly unresponsive in dealing with complaints.
I congratulate the hon. Gentleman on securing this debate. The consensus in the Chamber is clear. The current format has people waiting at home for transport to hospital—for a scan or other procedure—and then having it cancelled. Does he agree that it is not just about cancelled operations and appointments or wasted slots, but about the financial impact on the service and on the patients, who then have to go to the back of the queue, and about the trauma they go through as a result?
It has a whole knock-on effect, whether it be individuals having to find their own transport, missed appointments or rescheduled appointments—it is all incredibly expensive—and it is not just patients who have these terrible experiences, of course; it is also the drivers. I have had whistleblowers from the service contact my office. One said they come on duty at 12 o’clock and are expected at the same time to be at Castle Hill Hospital in Hull with patients. They have described themselves as being at their wits’ end and thoroughly stressed. One contacted me recently about a 100-year-old lady who had to wait three and a half hours to get home.
It is interesting to reflect that back before Thames took over the contract we did not have these problems. When we, as northern Lincolnshire MPs, met the hospital trust, it confirmed that these problems were related to how Thames was operating the contract and that it was adding to their problems trying to deliver high-quality care.
That is absolutely right. There is an argument for saying that those who provide the emergency services—East Midlands Ambulance Service in the case of Scunthorpe—are better able to provide the patient transport services, just as in Goole we would want Yorkshire Ambulance Service to provide the patient transport. There seems to be some sense in that, unless it is a very strong local community transport organisation that we know we can trust. Yes, there are always examples of failure, but we did not have this recurrent theme of failure under the previous system.
I thank the hon. Gentleman for giving way; he is being very generous this evening. Following on from the point made by my hon. Friend the Member for Scunthorpe (Nic Dakin), our local hospital trust is already in special measures—it has gone into special measures for the second time—and senior board members are raising Thames as a potential difficulty and challenge in their efforts to meet their key performance indicators and get out of special measures. This is something the Government need to take really seriously.
It is incredible that what is judged to be a failing trust has a failing transport patient service that is making it even more difficult for it to get out of special measures. That is another reason I brought this matter to the House today.
Following on from the intervention of Nic Dakin, one of my requests is to the Department for Transport—so not directly in the gift of the Minister in the Department of Health and Social Care—which is currently undertaking a transport accessibility consultation. It might be sensible if the issue of patient transport were to be wound up as part of that. That is one of my asks. I know that the Minister cannot respond, as it is not her Department, but it would be useful if she could pursue it interdepartmentally.
I want to give the Minister enough time to respond, so I will not say much more, but the concerns that I have described are shared by the clinical commissioning group, which has raised these issues with North Lincolnshire Council’s health scrutiny panel on a number of occasions and has told the panel that there will be further sanctions if the service does not improve. Sadly, that was said at the end of October, and, as other Members’ interventions have made clear, there has been no turnaround since then.
I think that that is absolutely true. The chairman of the scrutiny panel, Holly Mumby-Croft, who is a councillor for the Broughton and Appleby ward in my constituency, has said that the “volume of people” who have contacted the panel directly is “very unusual”. It is for people to go directly to a scrutiny panel; not many are aware of the position of the council. That alone suggests that the problem cannot be solved through the usual channels. After the most recent appearance of Thames Ambulance Service before the panel, the chairman said:
“I have seen actually no improvement. None at all. It is worse.”
There is something seriously failing here, and it is putting the performance of our local hospitals at risk. More important, it is having a huge impact on our constituents.
I realise that the Government did not commission the service, and that it was commissioned by the CCG, which is responsible for the performance of the contract. However, I have some asks of the Minister.
Could the whole issue of patient transport be considered as part of the consultation that is currently being undertaken by the Department for Transport? Will the Minister and the Department look at the performance of Thames Ambulance Service in north Lincolnshire, and perhaps also in Hull, to see whether anything can be done directly by the Department to improve its performance? Will they, if necessary, look into what powers are available to establish whether or not this is a business that should be operating within the health service at all? If it is routinely leaving people with three and a half to four hours to get home, surely we need to ask, whether through NHS England or locally, whether this organisation should be allowed to provide transport services.
I accept that responsibility lies directly with the commissioners. I therefore urge the Minister to engage with the north Lincolnshire CCG and put maximum pressure on it to ensure that the powers made available in the contract tender to impose fines or even terminate the contract are used if there are not serious improvements very quickly. I have no confidence that the service will improve. I think it is time that the contract was terminated, and that either the local authority or the local ambulance service has another opportunity to tender. All of us in our area want the same thing. We want a patient transport service that does what it is meant to do: take people to hospital and get them home in a timely manner.
I look forward to the Minister’s response.
I congratulate my hon. Friend Andrew Percy on securing the debate. As he has so elegantly articulated, the provision of patient transport services is important to many people throughout the country.
Let me take this opportunity to give heartfelt thanks to all the staff in the health and care system. They work tirelessly in often difficult circumstances, routinely going above and beyond the call of duty to keep patients safe. Those dedicated people make our NHS truly great. No one knows that better than my hon. Friend, who spends weekends volunteering as a first responder with the Yorkshire Ambulance Service. He deserves massive thanks for everything that he does in that role, as do all first responders up and down the country.
We recognise that effective patient transport services are vitally important, not only to ensure the provision of high-quality, safe services for patients, but to ensure that patient flow through hospitals is not slowed by missed medical appointments or delayed patient discharges. We are clear that local NHS CCGs must ensure that reliable, safe and comfortable patient transport services are delivered and maintained.
Patient transport services, like almost all other health services, are locally commissioned and provided to ensure that they are well adapted to local conditions. It is for local CCGs to set appropriate expectations of service with their providers and to take swift action where they fall short. However, that is not to say that the Government have no expectations of how these services should be delivered and should function. There is well-established national guidance on who is eligible to use patient transport services which makes it very clear that patients should reach appointments in reasonable time and comfort without detriment to their medical condition. NHS England has also communicated with the CCGs about their responsibilities when commissioning patient transport services via its CCG bulletin.
I congratulate the Minister on taking up her new post, which I am sure she will do very well. She said that CCGs should take swift action when things are not working. What does swift action look like? This has been going on for some time now; how quickly should the people of northern Lincolnshire expect to have the patient transport service they deserve?
Of course, we have devolved this matter locally and it is up to the local CCG to take action. I know that a recovery plan is in place and the delivery of the plan is now being monitored weekly, but the hon. Gentleman is right, and, like my hon. Friend the Member for Brigg and Goole, he has kept on articulating this issue and asking these questions on behalf of his constituents, to try to find out when they will see a visible difference to the service, because it is currently not good enough.
Patient transport providers are also required to be registered and inspected by the Care Quality Commission, the independent regulator of health services. This Government have given the CQC more powers, and it is now able to rate independent healthcare transport providers in the same way as NHS ambulance services. We fully support the CQC in its work to ensure that users of patient transport services are protected, and where services are not good enough and the necessary improvements have not been made, it can take further action, including issuing fines, service restrictions, and ultimately the cancellation of a provider’s registration.
Additionally, we are very supportive of the Department for Transport-led total transport initiative, which I think was what my hon. Friend the Member for Brigg and Goole was referring to, and which is currently piloting the joint commissioning of public sector-funded transport in order to reduce the risk of services overlapping, improve efficiency, and provide a better overall service to passengers.
From the local work carried out so far, it has become clear there are a range of potential benefits for the NHS, including helping to avoid bed blocking—where patients sometimes cannot go home because non-emergency patient transport is not available—and improving access to NHS services by reducing missed appointments due to late or unavailable transport. We have asked NHS England to ensure that CCGs are all engaging in this important work.
I welcome the Minister to her new role and wish her the best of luck, but from what she is saying I am not entirely clear how the Government will follow up and pressure will be brought to bear on the CCGs in the delivery of the contract. I had a 97-year-old lady, whom the new chief executive of the Diana, Princess of Wales Hospital and the Northern Lincolnshire and Goole NHS Foundation Trust met. She had had to wait for eight hours in the emergency care centre for transport to go home. There needs to be a little more urgency in the Minister’s response.
I completely understand why the hon. Lady is articulating that; every one of these incidents is absolutely unacceptable and in many cases very distressing. The issue with devolving such clinical decisions to local areas, however, is that we have to allow the CCG to take the necessary steps to ensure the service is put back on to a better footing.
The hon. Lady is absolutely right to raise that point. I am aware that similar problems have been identified with the same provider in other parts of Yorkshire and the east midlands. Improvements must of course be made, which is why commissioners are working to oversee and manage the necessary improvements and trying to achieve the level of performance that is required.
Turning to the particular issues affecting northern Lincolnshire, my hon. Friend the Member for Brigg and Goole and other hon. Members across the House are absolutely right to point out the problems with the services commissioned in and around their constituencies. I have read some of the cases today, including some distressing cases involving patients with conditions such as dementia and cancer experiencing long delays with their transport. Such delays are clearly a source of incredible distress for people who are already facing a very difficult time in their lives. Many of them may be very vulnerable, and we are absolutely clear that this needs to change.
North Lincolnshire CCG awarded a patient transport contract to Thames Ambulance Service in October 2016 following an open procurement process. Issues around the quality of service are acknowledged, and we are aware that people have experienced delays. That is clearly unacceptable. I assure my hon. Friend and other Members that a range of actions is being undertaken to ensure the delivery of an appropriately high-quality service. The CCG is working closely to support Thames Ambulance Service to achieve the required level of performance. It has served a contract notice to the provider based on delivery against key performance indicators, the number of patient complaints, and issues associated with data reporting.
A robust recovery plan has been put in place, and delivery against this is carefully monitored on an ongoing basis. Key actions include the recruitment of six additional staff in north Lincolnshire and the mobilisation of additional vehicles. I understand these staff have recently been trained and deployed. A patient transport co-ordinator has also been employed, working with the hospital to improve the process for patients being discharged. The CCG has also worked with the provider to improve its complaints process, and I am advised that its backlog of complaints has now been cleared.
I hope that my hon. Friend is also reassured by the level of Care Quality Commission engagement with Thames Ambulance Service. In its inspection report of April 2017, the CQC uncovered a number of areas for improvement, ultimately issuing enforcement action against the provider in respect of regulation 17, which covers good governance; regulation 13, covering safeguarding; and regulation 5, which deals with requirements relating to registered managers. The CQC continues to monitor closely the provider to ensure that the required improvements are being made. It is currently undertaking a fresh review of the service and will issue a further report when its latest inspection is complete. We expect this to be published and available online before the end of March. That will be exactly the same for the provider in the constituency of Diana Johnson.
Finally, I am also advised that the CCG has reviewed the application of the eligibility criteria for patient transport services across the area to ensure that they are being applied evenly. Through this process, it has determined that some patients who have historically accessed these services may no longer be considered eligible. We obviously have to take steps to ensure that the service is more consistent and that the CCG is working with the provider to ensure that affected patients are informed as soon as possible and given helpful advice on how to access alternative services if they are required. I would like to thank my hon. Friend again for bringing these matters to our attention, and I very much hope he is reassured that all appropriate actions are beginning to be taken to restore the delivery of effective patient transport services to his constituents.
Question put and agreed to.