Debate contribution: Ambulance Waiting Times

Debate contribution by Mr Danny Donnelly on 13 January 2025.

MLA

Mr Danny Donnelly

Party at the time

Alliance Party

Date

13 January 2025

Type

Debate contribution

Business

Private Members' Business

Heading

Ambulance Waiting Times

Assembly identifier

Official Report component 4738626

Read the official Assembly record

Text

Thank you, Mr Deputy Speaker. I will begin by thanking all Members for their contributions. It is an important debate. I welcome the fact that this is the first Assembly motion of 2025. I encourage all Members to vote in favour of it. As the final Member to speak in the debate, I want to discuss some of the points that were raised by other Members, particularly the Minister, but I want to make a few specific points first. As I mentioned, this is the first opportunity for debate in this new year, and it is absolutely appropriate that we begin with such an important issue: the pressures facing the Northern Ireland Ambulance Service and the implications of those pressures across the wider Health and Social Care service. As we all know, the pressures on health services are significantly worse in the winter months. I was pleased that, last week, we discussed that with the Minister in the Health Committee. The pressures were simply too urgent to wait until we returned today. To his credit, the Minister provided a written statement to the Assembly on his plans for winter preparedness on 6 November, but, while welcome, it did not provide the details or the planning needed to fully tackle the yearly crisis that we faced this winter. That will require a long-term approach, including multi-year budgets, political support for reform and greater efforts to protect the welfare of hard-working HSC staff, who go above and beyond all year round to deliver the best possible service. As has been said many times, we cannot deliver in the long term until we have proper political stability in this place. The need for institutional reform cannot be ignored or forgotten. The statistics that indicate the pressures on the Ambulance Service are truly shocking. As the motion states:

"response time targets for categories one, two and three calls to the Ambulance Service were missed in every month of last year".

The number of people who have died while waiting for an ambulance has also trebled in the past five years. From 2020 to 2024, sadly, 149 people have lost their lives while waiting at home for emergency response help; specifically, 50 in the year 2023-24. Of course, it cannot be said that a delayed ambulance response is a contributory factor, and we must remember that every death is a tragedy for the individual, their family and friends and the wider community. The Department of Health must do what it can to assist the Northern Ireland Ambulance Service to release ambulances to respond to those calls. The motion raises some of the issues facing the Ambulance Service that, to date, the Department of Health has failed to address adequately. One such issue relates to the lack of workforce capacity. The Minister has indicated that more staff have been recruited in the past year. Certainly, members of the Health Committee visited ambulance HQ and met some of our new trainee paramedics. That is fantastic to see. That recruitment is always welcome, and we should encourage people to consider a career as a paramedic or ambulance staff, but we have not heard the corresponding number of people who are retiring or leaving the service. There is also the threat of abuse, harassment and even violence towards ambulance staff. Last week, it was reported that around 55 members of ambulance staff are abused or attacked every day across the UK. That is absolutely unacceptable abuse that can have a lasting impact on the well-being of staff and has led to many people leaving the Ambulance Service. There is no excuse for such violence. No one should ever have to face that while they are at work, especially not those who are working under severe pressure to save lives, as our hard-working and resilient Ambulance Service staff do every day. Another problem that faces the Ambulance Service is the difficulty in admitting patients into hospital. We have talked again and again today about the issues with flow. One example of that was reported by the BBC news during the Christmas holidays, when a patient was waiting in an ambulance outside a hospital for 19 hours. Nineteen hours covers a series of paramedics' shifts. I think that it was Mr McGrath who said that paramedics were handing patients over to each other in the back of an ambulance. No patient should have to wait that long. However, the most concerning aspect of that is that it is not an isolated incident. Long waits outside hospitals have become increasingly common. Again, we heard that when we met paramedic and ambulance staff at the headquarters. While it is an all-year problem, it is exacerbated by winter pressures. The key problem here is the flow of patients throughout hospitals, particularly the bottleneck at the back door: the failure to discharge patients when appropriate, leading to a lack of available beds for those who need to be admitted. I saw that for myself while working over the holidays in a busy hospital ward. It is clear that little has changed since the publication of the Department of Health's winter preparedness plan in early November. That did not adequately address the issues, which led to overcrowding in hospital wards and delay in people being safely discharged. It should be noted that overcrowding in A&E departments is associated with longer hospital stays and even increased mortality. Dr Russell McLaughlin from the Royal College of Emergency Medicine did a study last year that looked at 2022. The evidence that he presented suggested that 1,400 people died in that year in Northern Ireland — excess deaths — because of overcrowding in our A&E departments. I can only imagine what the figure will be for this winter. While it is understandable that the Minister has called on people to consider, when appropriate, alternatives to hospital such as visiting pharmacies or general practice first, that needs to be accompanied by more decisive decisions by the Department to support people who are in vulnerable positions. Community staff are working as hard as possible to deliver those essential services. We also need further progress on and support for care homes and domiciliary care, recognising that those services can provide an alternative to hospital visits. However, the Department is not providing adequate support in those areas. The Minister's statement in November on winter preparedness mentioned the possibility of people accepting a temporary community placement in a care home or a nursing home after being discharged from hospital. That would be a positive step for those who can avail themselves of it, but what further support can the Minister and the Department provide not only to care and nursing homes but to organisations such as our community pharmacies, which also face pressures? We have all heard over the past couple of weeks from constituents who, sadly, have needed A&E or the Ambulance Service for medical emergencies. We have heard their experience, and it is very real for anyone who has been in those circumstances and for their family. One case that particularly struck me was that of a 98-year-old lady who required an ambulance. She was in the back of the ambulance for 11 hours and then on a trolley in A&E for five days. That is absolutely unacceptable. It must have been incredibly traumatic for her and her family, who were hoping to see her get better as soon as possible. I will address a few of the comments that people have made. My colleague Stewart Dickson opened the debate and gave examples from his constituency of the long stays in ambulances and A&E that people had come to him about. He suggested that GPs should have better access so that they can refer people more quickly for diagnostic tests, and he emphasised the need for transformation towards the Bengoa reforms. The Chair of the Health Committee, Liz Kimmins, highlighted the fact that the pressures are not new but are the result of a perfect storm of increased need. We have certainly seen that with the increased flu numbers over the past couple of weeks. Liz highlighted the Hospital at Home service that is active in the Southern Trust and suggested that its expansion across Northern Ireland could help to divert people from A&E. She also suggested that direct admissions to hospital from GPs could also help people to avoid our A&E departments. Diane Dodds noted that the pressures are not new and that we are just chugging along, that the number of staffed ambulances has not risen along with the increasing pressure on our staff and that workforce planning is needed to improve patient flow and address issues in social care. Alan Chambers said that this is not just a Northern Ireland problem and pointed to critical incidents across the UK. He queried whether the debate is the best use of everyone's time. I say that it is and that this is a very important debate. People need us to talk about the matter and to highlight solutions and raise the urgent issues that patients have faced over the past couple of weeks. It is important that those issues are raised in this place at this time. Colin McGrath highlighted the fact that, at the end of their shift, paramedics are handing patients over to the next paramedic in the back of an ambulance, which, again, must be unbearable for them and for the patient in the ambulance. He said that there had been closures of units that could have provided beds for recuperation and eased a bit of the pressure. I will go on to the Minister's speech. The Minister said that he had visited six A&E departments since Christmas, which is laudable. I welcome that, because I know that he has talked to front-line staff about what they see as solutions. He said:

"the health of our people is the ... most important issue that we face".

He is absolutely right about that and about how all areas of healthcare are interdependent. It is about the flow, and we need to address the problems in social care in order to widen the bottleneck. I was glad to hear the Minister mention the £500 million investment to increase the real living wage for domiciliary care workers —.

Sorry: £50 million. I was glad to hear about the £50 million to increase the real living wage for domiciliary care workers this year; that 50 paramedics are being trained every year in Northern Ireland; the announcement of the 10-year workforce plan for the Northern Ireland Ambulance Service; and about the success of the integrated care hubs — again, the Health Committee saw that on its visit to headquarters — which has resulted in a 40% reduction in mental health calls.

Thank you very much, Mr Deputy Speaker. I hope that the House will support our motion.

1,813 words. Text as published by the Northern Ireland Assembly.

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