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Patients in need of urgent medical attention are still subject to a postcode lottery where the quality of care depends on where they live, MPs have warned.

There are still wide variations in ambulance response times depending on region, MPs on the Public Accounts Committee (PAC) said, as they found performances in key services had fallen “far below the standard the NHS says patients should expect and receive”.

It said that despite the NHS having “more money and staff than ever before”, it had made “poor use” of its resources to improve access for patients.

The committee said that although the NHS budget in 2023-23 came to £152bn – £28bn more than in 2016-17 – the performance of urgent and emergency care services “has been deteriorating for many years”.

Productivity, which had been improving before the COVID-19 pandemic, subsequently fell 23% over the two years from 2019-20 and 2020-21, the MPs noted.

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The PAC report comes after the NHS waiting list in England hit a record high, with an estimated 7.75 million people waiting to start treatment at the end of August – up from 7.68 million in July.

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The committee’s inquiry also examined delays in hospital discharges, which increased to an average of 13,623 patients in the fourth quarter of 2022-23 from 12,118 people during the same period the previous year.

Dame Meg Hillier MP, chair 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. The PAC’s role is to analyse the underlying numbers, and attempt to provide a ‘get well soon’ plan for the NHS.

“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 of funding it in the future.”

The PAC report found that people in some parts of the country are having to wait, on average, more than three minutes longer for an ambulance to arrive when they are facing a life-threatening emergency.

In 2021/22, average ambulance response times for the most serious incidents, including cardiac arrests, varied from six minutes 51 seconds for the London Ambulance Service to 10 minutes 20 seconds for the South Western Ambulance Service.

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‘I’ve lost control of my birth’

Ambulances aim to respond to the most serious life-threatening injuries and illnesses in an average time of seven minutes.

Along with variations in ambulance response times, the report also highlighted issues with sending patients home when they no longer need hospital care.

The length of stay in the worst-performing areas for discharging medically fit patients is more than double that of the best-performing areas, according to the report.

“Not enough [is] being done to address the systemic issues with discharges that lie within the gift of the NHS and its hospitals, and which cannot be blamed on external factors,” the MPs said.

“The NHS has not met targets for ambulance handovers since November 2017 and for A&E waits since July 2015, with wider declines in performance across the board.”

Meanwhile, they said the NHS’s long-term workforce plan includes only a commitment of an additional £2.4bn to cover training costs for the first five years of the 15-year plan.

The MPs said they were “unconvinced” by NHS England’s approach to address workforce shortfall, saying its desire to retain 130,000 staff who would otherwise leave over the next 15 years was an “aspiration which seems highly doubtful”.

Professor Julian Redhead, NHS England’s national clinical director for urgent and emergency care, said: “While this report includes data which is more than two years old and coincided with a once-in-a-generation pandemic, it is right to note the NHS has been under increasing pressure with staff experiencing record A&E attendances, hospitals fuller than at any point in their history and with thousands of beds taken up each day, in part, due to pressures in social care.

“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.

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“This progress has come as the NHS has committed to delivering £12 billion of annualised savings by 2024/25 – all while dealing with more than 100,000 staff posts being vacant.”

Royal College of Nursing Director for England, Patricia Marquis added: “Another day, and yet another report into failing NHS services that cannot keep patients safe.

“Nursing staff have been sounding the siren on staff shortages for years, but the government remains more focused on soundbites than solutions.

“We need the government to take urgent action, to stop our nursing staff leaving the profession. Patient care demands it. We are crying out for funding and detail on the workforce plan – there is still very limited progress on closing the gap in nursing vacancies.”

The Department of Health and Social Care has been approached for comment.

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No 10 backs Chancellor Rachel Reeves and says she ‘is going nowhere’ after tearful appearance in Commons

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No 10 backs Chancellor Rachel Reeves and says she 'is going nowhere' after tearful appearance in Commons

Rachel Reeves has not offered her resignation and is “going nowhere”, Downing Street has said, following her tearful appearance in the House of Commons.

A Number 10 spokesperson said the chancellor had the “full backing” of Sir Keir Starmer, despite Ms Reeves looking visibly upset during Prime Minister’s Questions.

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A spokesperson for the chancellor later clarified that Ms Reeves had been affected by a “personal matter” and would be working out of Downing Street this afternoon.

Politics latest: Reeves looks visibly upset in Commons

UK government bond prices fell by the most since October 2022, and the pound tumbled after Ms Reeves’s Commons appearance, while the yield on the 10-year government bond, or gilt, rose as much as 22 basis points at one point to around 4.68%.

Downing Street’s insistence came despite Sir Keir refusing to guarantee that Ms Reeves would stay as chancellor until the next election following the fallout from the government’s recent welfare U-turn.

Tory leader Kemi Badenoch branded the chancellor the “human shield” for the prime minister’s “incompetence” just hours after he was forced to perform a humiliating U-turn over his controversial welfare bill.

Emotional Reeves a painful watch – and reminder of tough decisions ahead

It is hard to think of a PMQs like it – it was a painful watch.

The prime minister battled on, his tone assured, even if his actual words were not always convincing.

But it was the chancellor next to him that attracted the most attention.

Rachel Reeves looked visibly upset.

It is hard to know for sure right now what was going on behind the scenes, the reasons – predictable or otherwise – why she appeared to be emotional, but it was noticeable and it was difficult to watch.

To read more of Ali Fortescue’s analysis, click here

Speaking at Prime Minister’s Questions, Ms Badenoch said: “This man has forgotten that his welfare bill was there to plug a black hole created by the chancellor. Instead they’re creating new ones.”

Turning to the chancellor, the Tory leader added: “[She] is pointing at me – she looks absolutely miserable.

“Labour MPs are going on the record saying that the chancellor is toast, and the reality is that she is a human shield for his incompetence. In January, he said that she would be in post until the next election. Will she really?”

Not fully answering the question, the prime minister replied: “[Ms Badenoch] certainly won’t.

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Welfare vote ‘a blow to the prime minister’

“I have to say, I’m always cheered up when she asks me questions or responds to a statement because she always makes a complete mess of it and shows just how unserious and irrelevant they are.”

Mrs Badenoch interjected: “How awful for the chancellor that he couldn’t confirm that she would stay in place.”

The prime minister’s watered-down Universal Credit and Personal Independent Payment Bill, aimed at saving £5bn, was backed by a majority of 75 in a tense vote on Tuesday evening.

A total of 49 Labour MPs voted against the bill – the largest rebellion in a prime minister’s first year in office since 47 MPs voted against Tony Blair’s Lone Parent benefit in 1997, according to Professor Phil Cowley from Queen Mary University.

After multiple concessions made due to threats of a Labour rebellion, many MPs questioned what they were voting for as the bill had been severely stripped down.

They ended up voting for only one part of the plan: a cut to Universal Credit (UC) sickness benefits for new claimants from £97 a week to £50 from 2026/7.

Ms Badenoch said the climbdown was proof that Sir Keir was “too weak to get anything done”.

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Ms Reeves has also borne a lot of the criticism over the handling of the vote, with some MPs believing that her strict approach to fiscal rules has meant she has approached the ballooning welfare bill from the standpoint of trying to make savings, rather than getting people into work.

Experts have now warned that the welfare U-turn, on top of reversing the cut to winter fuel, means that tax rises in the autumn are more likely – with Ms Reeves now needing to find £5bn to make up for the policy U-turns.

Asked by Ms Badenoch whether he could rule out further tax rises – something Labour promised it would not do on working people in its manifesto – Sir Keir said: “She knows that no prime minister or chancellor ever stands at the despatch box and writes budgets in the future.

“But she talks about growth, for 14 years we had stagnation, and that is what caused the problem.”

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Prosecutors consider more charges against Lucy Letby

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Prosecutors consider more charges against Lucy Letby

Prosecutors are considering whether to bring further criminal charges against Lucy Letby over the deaths of babies at two hospitals where she worked

The Crown Prosecution Service said it had received “a full file of evidence from Cheshire Constabulary asking us to consider further allegations in relation to deaths and non-fatal collapses of babies at the Countess of Chester Hospital and Liverpool Women’s Hospital”.

“We will now carefully consider the evidence to determine whether any further criminal charges should be brought,” it added.

“As always, we will make that decision independently, based on the evidence and in line with our legal test.”

Letby, 35, was found guilty of murdering seven children and attempting to murder seven more between June 2015 and June 2016 while working in the neonatal unit of the Countess of Chester Hospital and is currently serving 15 whole-life orders.

lucy letby
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Letby worked at the Countess of Chester Hospital and Liverpool Women’s Hospital

She is understood to have carried out two work placements at Liverpool Women’s Hospital, where she trained as a student, between October and December 2012, and January and February 2015.

Police said in December that Letby was interviewed in prison as part of an investigation into more baby deaths and non-fatal collapses.

A Cheshire Constabulary spokesperson said: “We can confirm that Cheshire Constabulary has submitted a full file of evidence to the CPS for charging advice regarding the ongoing investigation into deaths and non-fatal collapses of babies at the neo-natal units of both the Countess of Chester Hospital and the Liverpool Women’s Hospital as part of Operation Hummingbird.”

Detectives previously said the investigation was looking into the full period of time that Letby worked as a nurse, covering the period from 2012 to 2016 and including a review of 4,000 admissions of babies.

Letby’s lawyer Mark McDonald said: “The evidence of the innocence of Lucy Letby is overwhelming,” adding: “We will cross every bridge when we get to it but if Lucy is charged I know we have a whole army of internationally renowned medical experts who will totally undermine the prosecution’s unfounded allegations.”

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Three managers at the hospital where Lucy Letby worked have been arrested on suspicion of gross negligence manslaughter.

On Tuesday, it was confirmed that three managers at the Countess of Chester hospital had been arrested on suspicion of gross negligence manslaughter in a separate investigation.

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Police said the suspects, who occupied senior positions at the hospital between 2015 and 2016, have all been bailed pending further inquiries.

There is also an investigation into corporate manslaughter at the hospital, which began in October 2023.

A public inquiry has also been examining the hospital’s response to concerns raised about Letby before her arrest.

In May, it was announced the inquiry’s final report into how the former nurse was able to commit her crimes will now be published early next year.

Earlier this year, Letby’s lawyers called for the suspension of the inquiry, claiming there was “overwhelming and compelling evidence” that her convictions were unsafe.

In February, an international panel of neonatologists and paediatric specialists told reporters that poor medical care and natural causes were the reasons for the collapses and deaths.

Their evidence has been passed to the Criminal Cases Review Commission (CCRC), which investigates potential miscarriages of justice, and Letby’s legal team hopes her case will be referred back to the Court of Appeal.

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More criminal charges being considered over baby deaths at Lucy Letby hospitals

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More criminal charges being considered over baby deaths at Lucy Letby hospitals

The Crown Prosecution Service has said it is considering whether to bring further criminal charges over the deaths of babies at hospitals where Lucy Letby worked.

The CPS said it had received “a full file of evidence from Cheshire Constabulary asking us to consider further allegations in relation to deaths and non-fatal collapses of babies at the Countess of Chester Hospital and Liverpool Women’s Hospital”.

“We will now carefully consider the evidence to determine whether any further criminal charges should be brought,” it added.

“As always, we will make that decision independently, based on the evidence and in line with our legal test.”

Letby, 35, was found guilty of murdering seven children and attempting to murder seven more between June 2015 and June 2016 while working in the neonatal unit of the Countess of Chester Hospital and is currently serving 15 whole-life orders.

She is understood to have carried out two work placements at Liverpool Women’s Hospital, where she trained as a student, between October and December 2012, and January and February 2015.

On Tuesday, it was confirmed that three managers at the Countess of Chester hospital had been arrested on suspicion of gross negligence manslaughter.

Police said the suspects, who occupied senior positions at the hospital between 2015 and 2016, have all been bailed pending further inquiries.

There is also an investigation into corporate manslaughter at the hospital, which began in October 2023.

A public inquiry has also been examining the hospital’s response to concerns raised about Letby before her arrest.

In May, it was announced the inquiry’s final report into how the former nurse was able to commit her crimes will now be published early next year.

Earlier this year, Letby’s lawyers called for the suspension of the inquiry, claiming there was “overwhelming and compelling evidence” that her convictions were unsafe.

In February, an international panel of neonatologists and paediatric specialists told reporters that poor medical care and natural causes were the reasons for the collapses and deaths.

Their evidence has been passed to the Criminal Cases Review Commission (CCRC), which investigates potential miscarriages of justice, and Letby’s legal team hopes her case will be referred back to the Court of Appeal.

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