To: Gillian Keegan MP
Minister of State DHSC
Urgent - South East Coast Ambulance Service (SECAmb)
Last Friday, I received a very worrying call from the ambulance service that serves my constituents, SECAmb, warning that they are currently at REAP (Resource Escalation Action Plan) 4.
As you will know, this is the highest level of escalation across the service. The causes of the problems are:
- shortages of staff
- the type of call outs being received
- increased demand, partly due to people not seeking help earlier because of Covid-19
SECAmb explained that there are 4 categories to rank call outs (CAT 1,2,3,4), with CAT 1&2 calls being emergencies where urgent care is needed (heart attacks, strokes etc).
The usual CAT split in terms of % of calls is:
- 60% 1 & 2
- 40% 3 & 4
At present though, CAT 1&2 call outs are at an unprecedented 74% of the overall total. These calls also require more resources, so s taff are frequently assigning ambulances to CAT 3 & 4 calls, then having to divert them to CAT 1 & 2 call outs. There are not enough staff to respond, leading to long queues or "stacks" of CAT 3 & 4 cases.
To demonstrate the severity of the problem, the usual stack of CAT 3 & 4 calls outs at any given time is around 100 but recently there have been as many as 250 and even 350 in the stack. With approximately 250 ambulances in service, SECAmb regularly have 250 patients live in ambulances and a further 250 calls outs waiting in the stack. That’s a worrying number of patients waiting and the reality is that some simply won't be reached.
This situation is unacceptable and is putting staff, who have coped with all that Covid-19 has demanded of the NHS, under further enormous pressure, in addition to that caused by the ongoing demands of the pandemic. There are serious concerns about the number of ambulance crew staff who are unable to work because they are suffering from significant stress and anxiety problems.
Urgent Ministerial action required
I am acutely aware that the real solutions to this are long-term and relate to workforce planning and proper social care reform. In the meantime, I am writing to ask what immediate plans you have in place to relieve some of this intolerable pressure. I understand that some fire services are being trained to drive ambulances in case of further staff sickness or another wave of Covid-19. What resources and support is central Government putting in place to facilitate this, and to ensure that fire services have the resources required for their own work?
Urgent Government action could also make a real difference in relation to wellbeing of ambulance staff, more fall prevention work, care staff retention bonuses and more call handling.
On the first point, are Ministers taking steps to get urgent additional mental health and well-being support to ambulance staff who need it, to try to get and keep as many staff in work as possible? I know that there is some support available, but more is urgently needed and could make a difference to staffing levels.
Turning to fall prevention training, SECAmb have flagged the urgency of this ahead of the winter. They report that lots of calls are because an older person has fallen. An urgent programme of fall prevention including training, exercises, drug reviews etc could make an important difference. Is this something you are looking at facilitating, both in Brighton and Hove and nationally?
Thirdly, I should be grateful for your response to the warning from NHS leaders, as reported in the FT today, that the NHS in England is facing the most difficult winter in its history and the call for Government to introduce “retention bonuses” for social care staff or risk them being leaving to work instead for retailers such as Amazon in the run-up to Christmas.
Finally, on call handling, I understand that capacity to answer phones as quickly as usual is currently affected by the volume of incoming calls. I understand some central Government money has been made available to recruit extra call staff, but with calls numbers much higher than they were pre pandemic, and reports that 111 is very busy, what assessment are Ministers making of whether the funds allocated to date are sufficient?
I appreciate that this is a national crisis and hope that the above is helpful in setting out what it means for my constituents and others served by SECAmb. I should be grateful for your urgent response.