Debate contribution: Ambulance Handovers

Debate contribution by Mr Mark Durkan on 24 March 2025.

MLA

Mr Mark Durkan

Party at the time

Social Democratic and Labour Party

Date

24 March 2025

Type

Debate contribution

Business

Opposition Business

Heading

Ambulance Handovers

Assembly identifier

Official Report component 4864602

Read the official Assembly record

Text

I beg to move

I note and welcome the amendments that have been tabled. We do not disagree with the sentiments expressed in either of the amendments, as they recognise the interlinked issues that have aligned to leave our health service in such disarray, but the wide-ranging calls in both amendments, worthy as they are, threaten to deflect attention from and prevent action on the focus of our motion.

The whole system needs fixed. We support transformation, but we cannot continue to wait for everything to be fixed before we fix anything. Our focus today is on improving the Ambulance Service and ensuring that people can access emergency care when they need it. While transformation will require tough decisions, as we keep saying and keep hearing, there will be concerns in some areas at the prospect of losing services from the local community. However, the one thing that fills all of us with dread, wherever we are, is the fear that, in the event of an emergency, be it one of our elderly parents falling down the stairs or a young child badly injuring themselves jumping down them, it will take hours for an ambulance to show up, while someone we love lies suffering or maybe even dying before our eyes. What we propose today is something that the SDLP is passionate about. Something that we all agree on is that our health service is in a precarious position. We are passionate about that too. Throughout a patient's pathway, we hear stories of a service that is falling apart at the seams. Whether it is the emergency departments (EDs), the extensive waiting lists or the struggle to allocate care packages, we can all agree that, if we are to improve patient outcomes and deliver a fit-for-purpose healthcare system for the future, we must act now. Quite simply, we must transform our healthcare system if it is to survive. The SDLP does not believe that it is right to lay all of that at the feet of the Health Minister. One Minister cannot do it all on their own; rather, as our motion proposes, while the Minister has primary responsibility around the details, the buck stops not with him but with the Executive as a whole. I will say again that transformation requires difficult decisions and buy-in from all Executive Ministers, and it should compel all Ministers to consider the way in which they operate. Our health service, rather like our Executive and, indeed, the Assembly, is highly interdependent. What impacts one part will directly or indirectly impact all others. It is in that spirit that we have genuinely and sincerely tabled the motion for today. The SDLP policy paper 'Help Can’t Wait' makes a number of recommendations, which are not easy. We are well aware that the recommendations that we have made will not sit easily with everyone. However, we ask everyone to consider at the outset that the recommendations are a result of best practices and facts and should be seen through the lens of wanting to improve patient flow in our hospitals and, therefore, improve patient outcomes. In essence, we propose a solid example of transformation in health. It begins with ambulance handovers. There is a target time across the NHS for ambulance staff to hand over a patient when they arrive at the emergency department. It is 15 minutes. That is 15 minutes to get the patient in and get the ambulance back on the road to do it all again. While that is an aspiration, we know that, despite the best efforts of our heroic paramedic staff, one can only imagine the horrors that they have to face in a day or night at work. They are worthy not just of our gratitude but of better pay, conditions and support. It is great to see that workforce being bolstered now by the first cohort of graduates from the paramedic course at Magee College. We need to improve our system to maximise the benefit of that brilliant workforce. Paramedics do not want to sit all day at hospitals when there are lives out there to be saved. Every minute and every hour that a patient waits outside an emergency department is a minute or an hour that another patient must wait for an ambulance. The W45 policy is relatively new and relatively straightforward. In essence, if a patient has been waiting for 45 minutes outside an emergency department and is yet to be handed over, the ambulance crew will safely bring them into the emergency department, at which point, staff can begin their assessments and triage.

Certainly.

I thank the Member for his intervention. I know that, at the outset, it appears shocking that we would propose putting more pressure on our already overworked emergency department staff. I get that, and I will get to it. That is why the SDLP undertook a fact-finding visit to the London Ambulance Service and to Guy's Hospital and St Thomas' Hospital in London to see the model in practice, and it was startling.

When the model was proposed, the London Ambulance Service heard similar concerns and, indeed, criticism, including rather toxic press coverage. The result, however, has been that category 2 response times have been reduced by 50% right across the London network. At Guy's and St Thomas' NHS Foundation Trust, we saw the model in action, from a patient being brought into the ED and triaged to then starting on their pathway within minutes. What makes it work? Two things: process and culture. The process involves not only the W45 policy, because also enshrined in NHS England policy is clear guidance that, as soon as an ambulance arrives at a hospital — once it goes through the gate — the patient becomes the hospital's responsibility. The culture is one of wanting to make things work. Staff explained that, when the policy was introduced, they consciously decided that they would make it work. There was no other option, and it does work. What is the process here? What is the culture here? The process here requires some work. The permanent secretary wrote to all trusts in 2020, stating that, from the moment that an ambulance arrives at the emergency department, patient care is the hospital's responsibility. That guidance could be tightened to reflect the fact that, from the moment an ambulance arrives at the hospital, the patient is the hospital's responsibility. In addition, staff capacity needs to be enhanced, hence the reason that we propose a minimum investment of £4·3 million to provide 24-hour band 5 nursing support at our emergency departments and to provide band 7 nursing practitioners to help enhance patient flow. Those processes seem to be relatively easy and cost-effective ones, and they can be introduced and implemented quickly. Our biggest challenge is the culture here. Right across the North, people are afraid and exhausted. They are afraid of needing to be brought to a hospital or of needing to phone an ambulance. They are exhausted from hearing the endless stories of healthcare falling apart, of political fallouts and of staff having to take highly risky decisions. The public have been conditioned to think that this is the best that it is ever going to be. That is on all of us: on every MLA, every Minister and every media outlet. The truth is that it should not be this way and that it does not need to be this way. We can do better. We can deliver a healthcare system that works for staff and patients. We know that the entire system needs to be changed, but we must start somewhere, Health Minister.

1,277 words. Text as published by the Northern Ireland Assembly.

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