Patients in rural areas are dying while they wait for an ambulance because of a postcode lottery in NHS emergency care, a damning report by MPs has found.
The public accounts committee said “how quickly an ambulance arrives depends too much on where a patient lives”, with huge disparities between cities and the countryside.
The average ambulance response time for the most serious, life-threatening incidents, such as cardiac arrests, was six minutes 51 seconds for the London ambulance service in 2021-22, the fastest in England. But for the South Western service, patients waited more than three minutes longer on average, with response times of ten minutes 20 seconds.
• Ambulance waiting times by postcode: how does your area compare?
Coroners have warned that long ambulance delays have contributed to a series of deaths in recent years, including three in Cornwall in 2021 and last year.
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The parliamentary report said the long delays for emergency care were driven by record rates of delayed discharges, when hospital beds are taken up by elderly patients who need social care. It said the worst-performing regions took twice as long to discharge patients from hospital as the top performers.
MPs on the committee said A&E and ambulance waiting times had been “deteriorating for many years”, despite the NHS having “more money and staff than ever before”. The health service’s £152 billion budget in 2022-23 is £28 billion more than its budget in 2016-17, while there are twice as many doctors in A&E departments compared with 2009.
The report criticised the government for failing to hold NHS England accountable for missing performance targets, noting that targets for ambulance handovers had not been met since November 2017 and not since July 2015 for A&E waits.
• Ambulance response times missed as patient waits more than two days
Dame Meg Hillier, the Labour MP who is chairwoman of the committee, said: “Anyone who has had recent contact with the NHS knows it is in crisis. Patients suffering long waits and hard-pressed staff working in a system which is not delivering deserve better.
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“Excluding demand-led spending such as welfare payments, health takes up approximately 40 per cent of day-to-day budgeted spending by Whitehall departments. It is vital this is delivering benefits for patients. The government and health system need to be alert to the serious doubts our report lays out around the workforce crisis, both the approach to tackling it now and the additional costs funding it in the future.”
Concerns were also raised about the long-term workforce plan unveiled by Rishi Sunak this summer to train tens of thousands of extra doctors and nurses. The report said the plans were “unfunded and uncosted” and could lead to unsustainable financial pressures.
Only £2.4 billion has been committed to cover training costs for the first five years of the 15-year plan. The MPs warned that other workforce costs, including the salaries for an extra 260,000 to 360,000 staff, had not been accounted for.
Responding to the document, Professor Julian Redhead, NHS England’s national clinical director for urgent and emergency care, said the situation was improving. “It is testament to the hard work of staff and results of our NHS winter plan — rolling out 800 new ambulances, 10,000 virtual ward beds and work towards 5,000 extra core beds — that waiting times for ambulances, 999 calls and in A&E have improved across the country during this financial year,” he said.
Saffron Cordery, deputy chief executive of NHS Providers, said: “The committee has highlighted accurately the huge pressures being faced in urgent and emergency care. Last winter, one of the toughest the NHS has ever seen, saw huge demand across the whole health and care system. This winter threatens to be even tougher.
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“Trusts are working flat-out in the face of relentless pressure, compounded by severe workforce shortages and insufficient capacity. But still, many patients are having to wait too long for care. Last month was the busiest September on record for A&E departments, with attendances up by almost 8 per cent compared to the same time last year.
“Delayed discharges, where thousands of patients well enough to recover at or closer to home are in hospital beds largely due to a lack of social care capacity, are a major concern. The NHS needs more staff, beds and equipment and significant investment in social care.
“And with 125,000 unfilled jobs across the NHS today, MPs are right to highlight that we still don’t know exactly how all of the ambitions in the long-term workforce plan ... will be funded.”
